WorldWideScience

Sample records for providing practical guidance

  1. Guidance for health and social care providers, principles of good practice in medication reconciliation

    LENUS (Irish Health Repository)

    Ward, Marie

    2017-07-17

    Healthcare organisations have a responsibility for ensuring that the governance of workplace settings creates a culture that supports good professional practice. Encouraging such a culture needs to start from an understanding of the factors that make it difficult for health professionals to raise issues of concern in relation to patient safety. The focus of this study is to determine whether a customised education intervention, developed as part of the study, with interns and senior house officers (SHOs) can imbue a culture of medical professionalism in relation to patient safety and support junior doctors to raise issues of concern, while shaping a culture of responsiveness and learning.

  2. Anticipatory guidance for children and adolescents with Fetal Alcohol Spectrum Disorder (FASD): practice points for primary health care providers.

    Science.gov (United States)

    Hanlon-Dearman, Ana; Green, Courtney R; Andrew, Gail; LeBlanc, Nicole; Cook, Jocelynn L

    2015-01-01

    Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term that describes the range of effects that can occur in an individual who was prenatally exposed to alcohol and includes an array of complex neurodevelopmental and physical findings. To give primary healthcare providers (PHCP) evidence-based recommendations for supporting and managing the symptoms of FASD after patients have received a diagnosis. MethodsPrimary health recommendations for the management of children and adolescents with FASD were developed based on expert clinical judgment and supported by evidence-based research, where appropriate. The format was adapted from other health supervision practice guidelines as developed by the American Academy of Pediatrics. Clinical practice "Points" for the PHCP are highlighted. A reference table of anticipatory recommendations by age is presented. In most cases, the initial screening and referral for diagnosis will be made by the PHCP, and they will be responsible for ongoing management. It is anticipated that these recommendations will provide the PHCP with evidence to support the longitudinal health care of children and adolescents with FASD and their families as they transition throughout all developmental stages. There is a pressing need for the involvement of PHCP in the active care of children and adolescents with FASD and their families over the lifespan. PHCP are trained in screening, prevention, and management of health needs, and are in the position to coordinate sub-specialty referrals as needed. Engaging PHCP will provide a truly integrated care system for individuals with FASD and their families.

  3. Spiritual care competence for contemporary nursing practice: A quantitative exploration of the guidance provided by fundamental nursing textbooks.

    Science.gov (United States)

    Timmins, Fiona; Neill, Freda; Murphy, Maryanne; Begley, Thelma; Sheaf, Greg

    2015-11-01

    Spirituality is receiving unprecedented attention in the nursing literature. Both the volume and scope of literature on the topic is expanding, and it is clear that this topic is of interest to nurses. There is consensus that the spiritual required by clients receiving health ought to be an integrated effort across the health care team. Although undergraduate nurses receive some education on the topic, this is ad hoc and inconsistent across universities. Textbooks are clearly a key resource in this area however the extent to which they form a comprehensive guide for nursing students and nurses is unclear. This study provides a hitherto unperformed analysis of core nursing textbooks to ascertain spirituality related content. 543 books were examined and this provides a range of useful information about inclusions and omissions in this field. Findings revealed that spirituality is not strongly portrayed as a component of holistic care and specific direction for the provision of spiritual care is lacking. Fundamental textbooks used by nurses and nursing students ought to inform and guide integrated spiritual care and reflect a more holistic approach to nursing care. The religious and/or spiritual needs of an increasingly diverse community need to be taken seriously within scholarly texts so that this commitment to individual clients' needs can be mirrored in practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Anticipatory guidance in pediatric practice.

    Science.gov (United States)

    Reisinger, K S; Bires, J A

    1980-12-01

    Physicians, by their collective positions in society and their individual interaction with patients, can be facilitators in helping families adopt more healthful ways of living. This study addresses the issue of the amount of time pediatricians in private practice spend with patients during well-child visits and the proportion of that time they devote to discussing potential health problems. The study population consisted of a random sample of pediatricians in the metropolitan Pittsburgh area. Observation of physician-patient interactions were made during one day in each of 23 pediatricians' offices. During the days of observation there were 305 well-child visits. The time spent with each patient averaged 10.3 minutes. Anticipatory guidance constituted 8.4% of total visit time. Pediatricians in group practice or partnerships and those recently trained spent more time with patients and a greater part of their time in anticipatory guidance. The amount of time during the well-child visit spent in anticipatory guidance varied with the age of the patient. The most time discussing potential future problems was spent with parents of infants less than 5 months of age (1 minute 37 seconds), with only an average of seven seconds being spent with adolescents. Of particular note was the lack of time spent discussing issues of safety, sex, behavior and growth. Because pediatricians spend more than 60% of their in-office time seeing patients for well-child care, they have an excellent opportunity to motivate parents and patients to change to more healthful ways of living. This opportunity will be lost however unless pediatricians reorient their priorities by addressing currently unmet health problems.

  5. Research Circles - a method for developing guidance practices

    DEFF Research Database (Denmark)

    2012-01-01

    This video reports on our work with using research circles to improve our understanding of how to provide guidance and counseling to help young people in danger of dropping out of school. The video is based on the paper: Research Circles -- a method for developing guidance practices...

  6. Marriage guidance counselling in a group practice.

    Science.gov (United States)

    Marsh, G N; Barr, J

    1975-01-01

    This paper describes the work of a marriage guidance cousellor in a group-practice centre. The considerable advantages to patient, doctor, and counsellor of her close association with the primary medical care team are discussed.

  7. 14 CFR 1263.110 - Intention to provide guidance.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Intention to provide guidance. 1263.110 Section 1263.110 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION DEMAND FOR INFORMATION OR TESTIMONY SERVED ON AGENCY EMPLOYEES; PROCEDURES § 1263.110 Intention to provide guidance. This...

  8. Series: Practical guidance to qualitative research : part 1: introduction

    NARCIS (Netherlands)

    Albine Moser; Irene Korstjens

    2017-01-01

    In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called Frequently Asked Questions. This journal series of four articles intends to provide novice researchers with practical guidance for

  9. Practical research-based guidance for motor imagery practice in neurorehabilitation.

    Science.gov (United States)

    Bovend'eerdt, Thamar J H; Dawes, Helen; Sackley, Catherine; Wade, Derick T

    2012-01-01

    The purpose of this appraisal is to offer guidance to clinicians on applying motor imagery in neurorehabilitation and provide guidance to support this process. We used evidence from a variety of fields as well as clinical experience with motor imagery to develop guidance for employing motor imagery during neurorehabilitation. Motor imagery is a relatively new intervention for neurorehabilitation supported by evidence from areas such as cognitive neuroscience and sports psychology. Motor imagery has become a very popular intervention modality for clinicians but there is insufficient information available on how to administer it in clinical practice and make deliberate decisions during its application. We provide evidence-based guidance for employing motor imagery in neurorehabilitation and use the principles of motor learning as the framework for clinical application.

  10. Algorithm of trajectory guidance of a planning unmanned flight vehicle to a ground target providing the guidance in case the final conditions of guidance are given

    Directory of Open Access Journals (Sweden)

    О.Г. Водчиць

    2004-01-01

    Full Text Available  In the article are obtained the mathematical relations which allow to implement algorithm of trajectory guidance of a unmanned flight vehicle to a ground target providing the guidance in case the final conditions of guidance are given.

  11. Series: Practical guidance to qualitative research. Part 1: Introduction.

    Science.gov (United States)

    Moser, Albine; Korstjens, Irene

    2017-12-01

    In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called Frequently Asked Questions. This journal series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By 'novice' we mean Master's students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of papers reporting on qualitative research. This first article describes the key features of qualitative research, provides publications for further learning and reading, and gives an outline of the series.

  12. Guidance Provided by Teacher and Simulation for Inquiry-Based Learning: a Case Study

    Science.gov (United States)

    Lehtinen, Antti; Viiri, Jouni

    2017-04-01

    Current research indicates that inquiry-based learning should be guided in order to achieve optimal learning outcomes. The need for guidance is even greater when simulations are used because of their high information content and the difficulty of extracting information from them. Previous research on guidance for learning with simulations has concentrated on guidance provided by the simulation. Little research has been done on the role of the teacher in guiding learners with inquiry-based activities using simulations. This descriptive study focuses on guidance provided during small group investigations; pre-service teachers ( n = 8) guided third and fifth graders using a particular simulation. Data was collected using screen capture videos. The data was analyzed using a combination of theory- and data-driven analysis. Forms of guidance provided by the simulation and by the teachers were divided into the same categories. The distribution of the guidance between the teacher and the simulation was also analyzed. The categories for forms of guidance provided by simulations proved to be applicable to guidance provided by the teachers as well. Teachers offered more various forms of guidance than the simulation. The teachers adapted their guidance and used different patterns to complement the guidance provided by the simulation. The results of the study show that guidance provided by teachers and simulations have different affordances, and both should be present in the classroom for optimal support of learning. This has implications for both teaching with simulations and development of new simulations.

  13. The effectiveness of baby books for providing pediatric anticipatory guidance to new mothers.

    Science.gov (United States)

    Reich, Stephanie M; Bickman, Leonard; Saville, Benjamin R; Alvarez, Joann

    2010-05-01

    To assess whether embedding pediatric anticipatory guidance into books read to infants is an effective way to educate low-income, first-time mothers about injury-prevention and health-promotion practices. Primiparous women (N = 168) were randomly assigned to 1 of 3 groups: an educational-book group; a noneducational-book group; or a no-book group. Knowledge of anticipatory-guidance topics regarding children from birth to 12 months of age (eg, injury prevention, parenting, nutrition) was assessed during the third trimester of pregnancy and again when infants were approximately 2, 4, 6, 9, 12, and 18 months of age. Women in the educational-book group scored consistently higher on knowledge than did those in the other 2 groups. Those in the educational-book group were found to have significantly higher knowledge scores than those in both the noneducational-book group (effect size [ES]: 0.3, P book group (ES: 0.3, P Books read by mothers to infants seem to be an effective way to provide anticipatory guidance to new mothers. However, future work is needed to determine if increased knowledge translates into safer and more developmentally appropriate parenting practices.

  14. 76 FR 82308 - Guidance for Industry: Current Good Tissue Practice and Additional Requirements for Manufacturers...

    Science.gov (United States)

    2011-12-30

    ... HUMAN SERVICES Food and Drug Administration Guidance for Industry: Current Good Tissue Practice and... document entitled ``Guidance for Industry: Current Good Tissue Practice (CGTP) and Additional Requirements... consistent with FDA's good guidance practices regulation (21 CFR 10.115). The guidance represents FDA's...

  15. Guidance on current good radiopharmacy practice (cGRPP) for the small-scale preparation of radiopharmaceuticals

    OpenAIRE

    Todde, Sergio; Stopar, Tanja; Mikolajczak, Renata; Farstad, Brit; Elsinga, Philip; Westera, Gerrit; Faivre-Chauvet, Alan; Meyer, Geerd; Penuelas, Ivan; Decristoforo, Clemens

    2010-01-01

    This guidance is meant as a guidance to Part B of the EANM ?Guidelines on Good Radiopharmacy Practice (GRPP)? issued by the Radiopharmacy Committee of the EANM (see www.eanm.org), covering the small-scale ?in house? preparation of radiopharmaceuticals which are not kit procedures. The aim is to provide more detailed and practice-oriented guidance to those who are involved in the small-scale preparation of, for example, PET, therapeutic or other radiopharmaceuticals which are not intended for ...

  16. Determinants of nutrition guidance practices of primary-care physicians

    NARCIS (Netherlands)

    Hiddink, G.J.

    1996-01-01


    The aim of the studies described in this thesis was to analyze nutrition guidance practices of primary-care physicians (PCPs), their nutritional attitudes and knowledge and their interest in the role of nutrition in health and disease. A second objective was to identify the determinants

  17. Expanded Guidance for NASA Systems Engineering. Volume 1: Systems Engineering Practices

    Science.gov (United States)

    Hirshorn, Steven R.

    2016-01-01

    This document is intended to provide general guidance and information on systems engineering that will be useful to the NASA community. It provides a generic description of Systems Engineering (SE) as it should be applied throughout NASA. A goal of the expanded guidance is to increase awareness and consistency across the Agency and advance the practice of SE. This guidance provides perspectives relevant to NASA and data particular to NASA. This expanded guidance should be used as a companion for implementing NPR 7123.1, Systems Engineering Processes and Requirements, the Rev 2 version of SP-6105, and the Center-specific handbooks and directives developed for implementing systems engineering at NASA. It provides a companion reference book for the various systems engineering-related training being offered under NASA's auspices.

  18. 78 FR 11654 - Draft Guidance for Industry and Food and Drug Administration Staff; Providing Information About...

    Science.gov (United States)

    2013-02-19

    ... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry and Food and Drug Administration... Food, Drug, and Cosmetic Act; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice... entitled ``Draft Guidance for Industry and Food and Drug Administration Staff: Providing Information About...

  19. Guidance Manual: Asbestos Operations & Maintenance Work Practices. Second Edition.

    Science.gov (United States)

    National Inst. of Building Sciences, Washington, DC.

    This technical manual provides detailed guidance to building owners, asbestos program managers, and operations and maintenance (O&M) workers for managing asbestos-containing materials (ACM) in buildings. The manual addresses four different types of ACM found in buildings and three different levels of precaution which may be warranted by…

  20. Announcement: Guidance for U.S. Laboratory Testing for Zika Virus Infection: Implications for Health Care Providers.

    Science.gov (United States)

    2016-11-25

    CDC has released updated guidance online for U.S. laboratory testing for Zika virus infection. The guidance is available at https://www.cdc.gov/zika/laboratories/lab-guidance.html. Frequently asked questions are addressed at https://www.cdc.gov/zika/laboratories/lab-guidance-faq.html. This guidance updates recommendations for testing of specimens by U.S. laboratories for possible Zika virus infection. Major updates to the guidance with clinical implications for health care providers include the following.

  1. Guidance for Organisational Strategy on Knowledge to Action from Conceptual Frameworks and Practice

    Science.gov (United States)

    Willis, Cameron; Riley, Barbara; Lewis, Mary; Stockton, Lisa; Yessis, Jennifer

    2017-01-01

    This paper aims to provide public health organisations involved in chronic disease prevention with conceptual and practical guidance for developing contextually sensitive knowledge-to-action (KTA) strategies. Methods involve an analysis of 13 relevant conceptual KTA frameworks, and a review of three case examples of organisations with active KTA…

  2. Lone-Actor Terrorism. Toolkit Paper 1 : Practical Guidance for Mental Health Practitioners and Social Workers

    NARCIS (Netherlands)

    Bakker, E.; Roy, de van Zuijdewijn J.

    2016-01-01

    The aim of this paper is to draw out practical implications for mental health practitioners and social workers in dealing with Lone-Actor Terrorism. It is not intended to provide a profile of lone-actor terrorists, but rather to offer guidance that may be of use to practitioners in Europe (and

  3. Series: Practical guidance to qualitative research : part 4: trustworthiness and publishing

    NARCIS (Netherlands)

    Irene Korstjens; Albine Moser

    2017-01-01

    In the course of our supervisory work over the years we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting

  4. Series: Practical guidance to qualitative research. : part 2: context, research questions and designs

    NARCIS (Netherlands)

    Albine Moser; Irene Korstjens

    2017-01-01

    In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting

  5. Practical guidance for defining a smart grid modernization strategy the case of distribution

    CERN Document Server

    Madrigal, Marcelino

    2015-01-01

    This document provides some practical guidance on how utilities can define their own smart grid vision, identify priorities, and structure investment plans. While most of these strategic aspects apply to any area of the electricity grid, the document focuses on the segment of distribution. The guidance includes key building blocks that are needed to modernize the distribution grid and provides examples of grid modernization projects. Potential benefits that can be achieved (in monetary terms) for a given investment range are also discussed.The concept of the smart grid is relevant to any grid

  6. Best clinical practice guidance for management of early caries lesions in children and young adults

    DEFF Research Database (Denmark)

    Kühnisch, J; Ekstrand, K R; Pretty, I

    2016-01-01

    BACKGROUND: The European Academy of Paediatric Dentistry (EAPD) encourages prevention and arrest of active dental caries. Therefore, the present guidance provides evidence- and clinically-based recommendations for detecting and diagnosing early/non-cavitated caries lesions, risk assessment...... is an essential aspect of preventive dentistry. Therefore, the EAPD encourages oral health care providers and caregivers to implement preventive practices that can arrest early caries and improve individual and public dental health....

  7. Practical guidance: the use of social media in oncology practice.

    Science.gov (United States)

    Dizon, Don S; Graham, David; Thompson, Michael A; Johnson, Lisa J; Johnston, Claire; Fisch, Michael J; Miller, Robert

    2012-09-01

    The penetration of social media into modern society has become a worldwide cultural phenomenon. Social media use widely accessible Web-based and mobile technologies to facilitate the creation and sharing of user-generated content in a collaborative and social manner. The uptake of social media in medicine provides new opportunities for health care professionals and institutions to interact with patients and other professionals. Oncologists may use social media as a platform for patient education and authoritative health messaging, for professional development and knowledge sharing, and for direct patient interaction, although this may be fraught with important legal and privacy concerns. In this article, a working group of the ASCO Integrated Media and Technology Committee explores how oncologists might responsibly use social media in their professional lives. Existing social media policies from hospitals, health systems, and pharmaceutical industries are examined to identify common concepts informing the development of future guidelines. Key principles identified include establishing institutional ownership of social media activities and safeguarding protected health information. Furthermore, oncologists must not confuse the roles of provider of information and provider of care, must understand regulations related to state licensure and medical records, and must recognize the importance of transparency and disclosure of potential conflicts of interest. social media may be particularly useful for raising the awareness of and recruitment to clinical trials, but compliance with federal and state regulations and areas under the purview of a local institutional review board must also be ensured. Examples of constructive use of social media in oncology with Facebook, Twitter, and YouTube are provided.

  8. Guidance on current good radiopharmacy practice (cGRPP) for the small-scale preparation of radiopharmaceuticals.

    Science.gov (United States)

    Elsinga, Philip; Todde, Sergio; Penuelas, Ivan; Meyer, Geerd; Farstad, Brit; Faivre-Chauvet, Alain; Mikolajczak, Renata; Westera, Gerrit; Gmeiner-Stopar, Tanja; Decristoforo, Clemens

    2010-05-01

    This guidance is meant as a guidance to Part B of the EANM "Guidelines on Good Radiopharmacy Practice (GRPP)" issued by the Radiopharmacy Committee of the EANM (see www.eanm.org ), covering the small-scale "in house" preparation of radiopharmaceuticals which are not kit procedures. The aim is to provide more detailed and practice-oriented guidance to those who are involved in the small-scale preparation of, for example, PET, therapeutic or other radiopharmaceuticals which are not intended for commercial purposes or distribution.

  9. Provider practice characteristics that promote interpersonal continuity.

    Science.gov (United States)

    Mittelstaedt, Tyler S; Mori, Motomi; Lambert, William E; Saultz, John W

    2013-01-01

    Becoming certified as a patient-centered medical home now requires practices to measure how effectively they provide continuity of care. To understand how continuity can be improved, we studied the association between provider practice characteristics and interpersonal continuity using the Usual Provider Continuity Index (UPC). We conducted a mixed-methods study of the relationship between provider practice characteristics and UPC in 4 university-based family medicine clinics. For the quantitative part of the study, we analyzed data extracted from monthly provider performance reports for 63 primary care providers (PCPs) between July 2009 and June 2010. We tested the association of 5 practice parameters on UPC: (1) clinic frequency; (2) panel size; (3) patient load (ratio of panel size to clinic frequency); (4) attendance ratio; and (5) duration in practice (number of years working in the current practice). Clinic, care team, provider sex, and provider type (physicians versus nonphysician providers) were analyzed as covariates. Simple and multiple linear regressions were used for statistical modeling. Findings from the quantitative part of the study were validated using qualitative data from provider focus groups that were analyzed using sequential thematic coding. There were strong linear associations between UPC and both clinic frequency (β = 0.94; 95% CI, 0.62-1.27) and patient load (β = -0.37; 95% CI, -0.48 to -0.26). A multiple linear regression including clinic frequency, patient load, duration in practice, and provider type explained more than 60% of the variation in UPC (adjusted R(2) = 0.629). UPC for nurse practitioners and physician assistants was more strongly dependent on clinic frequency and was at least as high as it was for physicians. Focus groups identified 6 themes as other potential sources of variability in UPC. Variability in UPC between providers is strongly correlated with variables that can be modified by practice managers. Our study

  10. Moral guidance, moral philosophy, and moral issues in practice.

    Science.gov (United States)

    Holt, J; Long, T

    1999-04-01

    Approaches to teaching ethics to nurses have been debated in literature for some years. Three issues in particular are commonly addressed: the intentions of such teaching; the value of examples and case studies; and the compatibility of philosophical approaches with the clinical reality experienced by students. It is argued here that moral guidance as a strategy is unacceptable, and that a basic introduction to philosophical methods is the key to effective learning of the skills required for autonomous analysis and decision making. A means for including the use of personal experiences and case study material is presented which relies upon the provision of a framework of analysis to facilitate structured thinking and the pursuit of justifiable arguments. The approach suggested is compatible with students' existing experiences and work-context, and enhances the integration of ethical reasoning into the multi-faceted totality of clinical practice.

  11. Passive sampling methods for contaminated sediments: Practical guidance for selection, calibration, and implementation

    OpenAIRE

    Ghosh, Upal; Driscoll, Susan Kane; Burgess, Robert M.; Jonker, Michiel To; Reible, Danny; Gobas, Frank; Choi, Yongju; Apitz, Sabine E; Maruya, Keith A; Gala, William R; Mortimer, Munro; Beegan, Chris

    2014-01-01

    This article provides practical guidance on the use of passive sampling methods (PSMs) that target the freely dissolved concentration (C free) for improved exposure assessment of hydrophobic organic chemicals in sediments. Primary considerations for selecting a PSM for a specific application include clear delineation of measurement goals for C free, whether laboratory-based “ex situ” and/or field-based “in situ” application is desired, and ultimately which PSM is best-suited to fulfill the me...

  12. 78 FR 310 - Draft Revision of Guidance for Industry on Providing Regulatory Submissions in Electronic Format...

    Science.gov (United States)

    2013-01-03

    ... Doc No: 2012-31577] DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-1256] Draft Revision of Guidance for Industry on Providing Regulatory Submissions in... Electronic Common Technical Document Specifications; Availability AGENCY: Food and Drug Administration, HHS...

  13. The Use of ICT in School Guidance: Attitudes and Practices of Guidance Counselors in Metro Manila, the Philippines

    Science.gov (United States)

    Vinluan, Lorelei R.

    2011-01-01

    A survey was conducted among a sample of school guidance counselors in Metro Manila, the Philippines, to determine their level of awareness, attitudes, and extent of practice of ICT in the conduct of their work. The respondents showed a higher level of awareness of communication technologies than of information technologies. They spent an average…

  14. Make Change Happen at the Program or Institutional Scale: Converting Community Expertise into Practical Guidance

    Science.gov (United States)

    McDaris, J. R.; Manduca, C. A.; Orr, C. H.

    2016-12-01

    As geoscience and STEM programs address common challenges like increasing the diversity of graduates or implementing active learning pedagogies, it is important to learn from the experiences of others in the community. Individual faculty members embody a wealth of experience on these topics but distilling that experience into practical guidance that has value for a broad audience is not as simple as knowing exactly what one person did. Context is important, not only because activities used in similar contexts are easier to adapt, but also because activities that work across multiple contexts are more robust. The development of any best practices guidance benefits from the engagement of a community. Synthesizing across multiple viewpoints leads to a consensus that builds on the diversity of individual experiences. The Science Education Resource Center (SERC) at Carleton College has had success generating such resources in geoscience and STEM education. Working with different groups of educators, we have helped develop content around making change happen at the program or institutional levels, increasing the diversity of students graduating in geoscience and STEM, fostering interdisciplinary learning, translating the results of education research into practice, and several others. These resources draw out common practices, situate them in the education research base, and highlight examples of their use in the real world but also communicate the different ways individuals or institutions have adapted these practices for their particular situation. These resources were developed through a group synthesis process involving the contribution of individual or group expertise, a face-to-face meeting of teams working on themes drawn from the contributed work, and asynchronous group revision and review following the meeting. The materials developed via this process provide reliable and adaptable guidance firmly rooted in the community's experience. This presentation will

  15. 78 FR 44573 - Guidance for Industry on Providing Submissions in Electronic Format-Postmarket Non-Expedited...

    Science.gov (United States)

    2013-07-24

    ... HUMAN SERVICES Food and Drug Administration Guidance for Industry on Providing Submissions in Electronic...; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing the availability of a guidance to industry entitled ``Providing Submissions in...

  16. Mobile phone-based clinical guidance for rural health providers in India.

    Science.gov (United States)

    Gautham, Meenakshi; Iyengar, M Sriram; Johnson, Craig W

    2015-12-01

    There are few tried and tested mobile technology applications to enhance and standardize the quality of health care by frontline rural health providers in low-resource settings. We developed a media-rich, mobile phone-based clinical guidance system for management of fevers, diarrhoeas and respiratory problems by rural health providers. Using a randomized control design, we field tested this application with 16 rural health providers and 128 patients at two rural/tribal sites in Tamil Nadu, Southern India. Protocol compliance for both groups, phone usability, acceptability and patient feedback for the experimental group were evaluated. Linear mixed-model analyses showed statistically significant improvements in protocol compliance in the experimental group. Usability and acceptability among patients and rural health providers were very high. Our results indicate that mobile phone-based, media-rich procedural guidance applications have significant potential for achieving consistently standardized quality of care by diverse frontline rural health providers, with patient acceptance. © The Author(s) 2014.

  17. Prevention and management of foot problems in diabetes: A Summary Guidance for Daily Practice 2015, based on the IWGDF guidance documents.

    Science.gov (United States)

    Schaper, N C; Van Netten, J J; Apelqvist, J; Lipsky, B A; Bakker, K

    2017-02-01

    Foot problems complicating diabetes are a source of major patient suffering and societal costs. To prevent, or at least reduce, the adverse effects of foot problems in diabetes, the International Working Group on the Diabetic Foot (IWGDF; www.iwgdf.org) was founded in 1996, consisting of experts from almost all the disciplines involved in the care of patients with diabetes and foot problems. An important output of the IWGDF is the international consensus guidance, continuously updated since 1999. To date, the publications have been translated into 26 languages, and more than 100,000 copies have been distributed globally. The "Summary Guidance for Daily Practice" summarises the essentials of prevention and management of foot problems in persons with diabetes for clinicians who work with these patients on a daily basis. This guidance is the result of a long and careful process that started with the empaneling in 2013 of five working groups consisting of 49 international experts. These experts performed seven targeted systematic reviews to provide the evidence supporting the five chapters of the IWGDF Guidance on prevention; footwear and offloading; diagnosis, prognosis and management of peripheral artery disease; diagnosis and management of foot infections; interventions to enhance healing. In total almost 80,000 studies were detected by our literature review. After review of the title and abstract the reviewers of the different working groups selected only studies that fulfilled a minimal set of quality criteria and ended up with 429 articles for complete quality analysis. The GRADE system was used to translate the evidence from the studies into recommendations for daily clinical practice. The rating of each recommendation takes into account both the strength and the quality of the evidence. The IWGDF Guidance 2015 makes a total of 77 recommendations on prevention and management of foot problems in diabetes. These recommendations were condensed by the editorial

  18. Practical Maintenance of Digital Systems: Guidance to Maximize the Benefits of Digital Technology for the Maintenance of Digital Systems and Plant Equipment

    Energy Technology Data Exchange (ETDEWEB)

    Hill, D; Scarola, K

    2004-10-30

    This report presents detailed guidance for the maintenance and testing of modern digital systems. The guidance provides practical means for plants to take advantage of the increased diagnostic and self-test capabilities of these systems. It helps plants avoid mistakes in design and installation that could lead to increased maintenance burden and decreased system reliability and availability.

  19. 76 FR 4360 - Guidance for Industry on Process Validation: General Principles and Practices; Availability

    Science.gov (United States)

    2011-01-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Guidance for Industry on Process Validation: General Principles and Practices; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY...

  20. College Counselors' Perceptions and Practices regarding Anticipatory Guidance on Firearms

    Science.gov (United States)

    Price, James; Mrdjenovich, Adam J.; Thompson, Amy; Dake, Joseph A.

    2009-01-01

    Objectives: This study assessed college counselors' anticipatory guidance on firearms for student clients. Participants: The membership of the Association for University and College Counseling Center Directors was used to identify a national random sample of counseling centers (n = 361). One counselor from each center was selected to survey.…

  1. 21 CFR 10.115 - Good guidance practices.

    Science.gov (United States)

    2010-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL..., documents that relate to: The design, production, labeling, promotion, manufacturing, and testing of... guidance documents do not legally bind FDA, they represent the agency's current thinking. Therefore, FDA...

  2. 76 FR 47593 - Guidance for Small Business Entities on Current Good Manufacturing Practice for Positron Emission...

    Science.gov (United States)

    2011-08-05

    ... a guidance for small business entities entitled ``PET Drugs--Current Good Manufacturing Practice... entitled ``PET Drugs--Current Good Manufacturing Practice (CGMP); Small Entity Compliance Guide.'' This... Manufacturing Practice for Positron Emission Tomography Drugs; Availability AGENCY: Food and Drug Administration...

  3. Practical guidance for statistical analysis of operational event data

    Energy Technology Data Exchange (ETDEWEB)

    Atwood, C.L.

    1995-10-01

    This report presents ways to avoid mistakes that are sometimes made in analysis of operational event data. It then gives guidance on what to do when a model is rejected, a list of standard types of models to consider, and principles for choosing one model over another. For estimating reliability, it gives advice on which failure modes to model, and moment formulas for combinations of failure modes. The issues are illustrated with many examples and case studies.

  4. Low-Income Women's Feeding Practices and Perceptions of Dietary Guidance: A Qualitative Study.

    Science.gov (United States)

    Savage, Jennifer S; Neshteruk, Cody D; Balantekin, Katherine N; Birch, Leann L

    2016-12-01

    Objectives Describe themes characterizing feeding behaviors of low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and identify the attitudes, beliefs, and sources of information that inform these practices. Methods Formative research was conducted including focus groups and semi-structured individual phone interviews with a total of 68 low-income women participating in WIC. Qualitative data were recorded, transcribed, imported into NVivo 8.0, and analyzed for common themes. Results Mothers reported feeding behaviors inconsistent with guidance from WIC and the American Academy of Pediatrics. Three main themes were identified. First, mothers reported receiving conflicting messaging/advice from medical professionals, WIC nutritionists, and family members, which was confusing. Mothers also reported dissatisfaction with the "one size fits most" approach. Lastly, mothers reported relying on their "instincts" and that "all babies are different" when deciding and rationalizing what feeding guidance to follow. Conclusions Future interventions targeting this high-risk population should consider developing personalized (individualized) messaging, tailored to the needs of each mother-child dyad. Focused efforts are needed to build partnerships between WIC providers and other health care providers to provide more consistent messages about responsive feeding to prevent early obesity.

  5. Practical guidance for using rivaroxaban in patients with atrial fibrillation: balancing benefit and risk

    Directory of Open Access Journals (Sweden)

    Haas S

    2014-03-01

    Full Text Available Sylvia Haas,1 Christoph Bode,2 Bo Norrving,3 Alexander GG Turpie4 1Technical University Munich, Munich, Germany; 2Department of Cardiology and Angiology, University of Freiburg, Freiburg, Germany; 3Department of Clinical Neuroscience, Lund University Hospital, Lund, Sweden; 4Department of Medicine, McMaster University, Hamilton, Ontario, Canada Abstract: Rivaroxaban is a direct factor Xa inhibitor that is widely available to reduce the risk of stroke or systemic embolism in patients with nonvalvular atrial fibrillation and one or more risk factors for stroke. Rivaroxaban provides practical advantages compared with warfarin and other vitamin K antagonists, including a rapid onset of action, few drug interactions, no dietary interactions, a predictable anticoagulant effect, and no requirement for routine coagulation monitoring. However, questions have emerged relating to the responsible use of rivaroxaban in day-to-day clinical practice, including patient selection, dosing, treatment of patients with renal impairment, conversion from use of vitamin K antagonists to rivaroxaban and vice versa, coagulation tests, and management of patients requiring invasive procedures or experiencing bleeding or an ischemic event. This article provides practical recommendations relating to the use of rivaroxaban in patients with nonvalvular atrial fibrillation, based on clinical trial evidence, relevant guidelines, prescribing information, and the authors' clinical experience. Keywords: novel oral anticoagulants, direct factor Xa inhibitor, peri-interventional management, practical guidance, rivaroxaban, stroke prevention

  6. Guidance Provided by Teacher and Simulation for Inquiry-Based Learning: A Case Study

    Science.gov (United States)

    Lehtinen, Antti; Viiri, Jouni

    2017-01-01

    Current research indicates that inquiry-based learning should be guided in order to achieve optimal learning outcomes. The need for guidance is even greater when simulations are used because of their high information content and the difficulty of extracting information from them. Previous research on guidance for learning with simulations has…

  7. Practical Intersubjectivity and Normative Guidance: Bratman on Shared Agency

    Directory of Open Access Journals (Sweden)

    Roth Abraham Sesshu

    2015-01-01

    Full Text Available In an important new book on shared agency, Michael Bratman develops an account of the normative demand for the coordination of intentions amongst participants in shared agency. Bratman seeks to understand this form of normative guidance in terms of that associated with individual planning intentions. I give reasons to resist his form of reductionism. In addition, I note how Bratman’s discussion raises the interesting issue of the function or purpose of shared intention and of shared agency more generally. According to Bratman, the function of shared intention is to promote interpersonal coordination of intention and action. I suggest that power sharing amongst participants must also be included as a function of shared intention.

  8. No Ifs, No Butts: Compliance with Smoking Cessation in Secondary Care Guidance (NICE PH48) by Providers of Cancer Therapies (Radiotherapy and Chemotherapy) in the UK

    Science.gov (United States)

    Hutton, Daniel; Gee, Ivan; McGee, Ciara E.; Mellor, Rebecca

    2016-01-01

    Background: Legislation preventing smoking in public places was introduced in England in July 2007. Since then, smoke-free policies have been extended to the majority of hospitals including those providing cancer therapies. Whilst studies have been conducted on the impact and effectiveness of hospital smoke-free policy in the UK and other countries, there have not been any studies with a focus on cancer care providers. Cancer patients are a priority group for smoking cessation and support and this study aimed to examine implementation of the National Institute Clinical Excellence (NICE) guidance (PH48) in acute cancer care trusts in the UK. Methods: Participants were recruited from UK radiotherapy and chemotherapy departments (total 80 sites, 65 organisations) and asked to complete a 15 min online questionnaire exploring the implementation of NICE guidance at their hospital site. Results: Considerable variability in implementation of the NICE guidance was observed. A total of 79.1% trusts were smoke-free in theory; however, only 18.6% were described as smoke-free in practice. Areas of improvement were identified in information and support for patients and staff including in Nicotine Replacement Therapy (NRT) provision, staff training and clarity on e-cigarette policies. Conclusions: While some trusts have effective smoke-free policies and provide valuable cessation support services for patients, improvements are required to ensure that all sites fully adopt the NICE guidance. PMID:27983709

  9. No Ifs, No Butts: Compliance with Smoking Cessation in Secondary Care Guidance (NICE PH48 by Providers of Cancer Therapies (Radiotherapy and Chemotherapy in the UK

    Directory of Open Access Journals (Sweden)

    Daniel Hutton

    2016-12-01

    Full Text Available Background: Legislation preventing smoking in public places was introduced in England in July 2007. Since then, smoke-free policies have been extended to the majority of hospitals including those providing cancer therapies. Whilst studies have been conducted on the impact and effectiveness of hospital smoke-free policy in the UK and other countries, there have not been any studies with a focus on cancer care providers. Cancer patients are a priority group for smoking cessation and support and this study aimed to examine implementation of the National Institute Clinical Excellence (NICE guidance (PH48 in acute cancer care trusts in the UK. Methods: Participants were recruited from UK radiotherapy and chemotherapy departments (total 80 sites, 65 organisations and asked to complete a 15 min online questionnaire exploring the implementation of NICE guidance at their hospital site. Results: Considerable variability in implementation of the NICE guidance was observed. A total of 79.1% trusts were smoke-free in theory; however, only 18.6% were described as smoke-free in practice. Areas of improvement were identified in information and support for patients and staff including in Nicotine Replacement Therapy (NRT provision, staff training and clarity on e-cigarette policies. Conclusions: While some trusts have effective smoke-free policies and provide valuable cessation support services for patients, improvements are required to ensure that all sites fully adopt the NICE guidance.

  10. Providing Feedback: Practical Skills and Strategies.

    Science.gov (United States)

    Sarkany, David; Deitte, Lori

    2017-06-01

    Feedback is an essential component of education. It is designed to influence, reinforce, and change behaviors, concepts, and attitudes in learners. Although providing constructive feedback can be challenging, it is a learnable skill. The negative consequences of destructive feedback or lack of feedback all together are far-reaching. This article summarizes the components of constructive feedback and provides readers with tangible skills to enhance their ability to give effective feedback to learners and peers. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  11. Statistics provide guidance for indigenous organic carbon detection on Mars missions.

    Science.gov (United States)

    Sephton, Mark A; Carter, Jonathan N

    2014-08-01

    Data from the Viking and Mars Science Laboratory missions indicate the presence of organic compounds that are not definitively martian in origin. Both contamination and confounding mineralogies have been suggested as alternatives to indigenous organic carbon. Intuitive thought suggests that we are repeatedly obtaining data that confirms the same level of uncertainty. Bayesian statistics may suggest otherwise. If an organic detection method has a true positive to false positive ratio greater than one, then repeated organic matter detection progressively increases the probability of indigeneity. Bayesian statistics also reveal that methods with higher ratios of true positives to false positives give higher overall probabilities and that detection of organic matter in a sample with a higher prior probability of indigenous organic carbon produces greater confidence. Bayesian statistics, therefore, provide guidance for the planning and operation of organic carbon detection activities on Mars. Suggestions for future organic carbon detection missions and instruments are as follows: (i) On Earth, instruments should be tested with analog samples of known organic content to determine their true positive to false positive ratios. (ii) On the mission, for an instrument with a true positive to false positive ratio above one, it should be recognized that each positive detection of organic carbon will result in a progressive increase in the probability of indigenous organic carbon being present; repeated measurements, therefore, can overcome some of the deficiencies of a less-than-definitive test. (iii) For a fixed number of analyses, the highest true positive to false positive ratio method or instrument will provide the greatest probability that indigenous organic carbon is present. (iv) On Mars, analyses should concentrate on samples with highest prior probability of indigenous organic carbon; intuitive desires to contrast samples of high prior probability and low prior

  12. Sexual Harassment in the Workplace: An Ethical Dilemma for Career Guidance Practice?

    Science.gov (United States)

    Bimrose, Jenny

    2004-01-01

    Sexual harassment in the workplace poses something of an ethical dilemma for career guidance practice. This is because it is now known that about half of all working women in the UK are likely to be victims at some stage of their employment and that the effects on individuals are invariably negative and can be positively harmful. What, therefore,…

  13. Upholding Equality and Social Justice: A Social Constructivist Perspective on Emancipatory Career Guidance Practice

    Science.gov (United States)

    Bassot, Barbara

    2012-01-01

    After several years of political agendas focused on social inclusion, career guidance practice needs to return to its roots of promoting equality and social justice. This conceptual article argues that for many years there has been an overreliance on theories focused on the individual, and examines the relationship between social structures and…

  14. Sampling in forests for radionuclide analysis. General and practical guidance

    Energy Technology Data Exchange (ETDEWEB)

    Aro, Lasse (Finnish Forest Research Inst. (METLA) (Finland)); Plamboeck, Agneta H. (Swedish Defence Research Agency (FOI) (Sweden)); Rantavaara, Aino; Vetikko, Virve (Radiation and Nuclear Safety Authority (STUK) (Finland)); Straalberg, Elisabeth (Inst. Energy Technology (IFE) (Norway))

    2009-01-15

    The NKS project FOREST was established to prepare a guide for sampling in forest ecosystems for radionuclide analysis. The aim of this guide is to improve the reliability of datasets generated in future studies by promoting the use of consistent, recommended practices, thorough documentation of field sampling regimes and robust preparation of samples from the forest ecosystem. The guide covers general aims of sampling, the description of major compartments of the forest ecosystem and outlines key factors to consider when planning sampling campaigns for radioecological field studies in forests. Recommended and known sampling methods for various sample types are also compiled and presented. The guide focuses on sampling practices that are applicable in various types of boreal forests, robust descriptions of sampling sites, and documentation of the origin and details of individual samples. The guide is intended for scientists, students, forestry experts and technicians who appreciate the need to use sound sampling procedures in forest radioecological projects. The guide will hopefully encourage readers to participate in field studies and sampling campaigns, using robust techniques, thereby fostering competence in sampling. (au)

  15. Resources for Guidance Program Improvement. Volume I.

    Science.gov (United States)

    Walz, Garry R., Comp.; And Others

    Designed for use by counselors, guidance directors, school administrators, school board members, and anyone interested in the improvement of school guidance programs, this resource book provides a collection of over 100 guidance program models and individual guidance practices. The format consists of references (bibliographic information with…

  16. Guidance on current good radiopharmacy practice for the small-scale preparation of radiopharmaceuticals using automated modules: a European perspective.

    Science.gov (United States)

    Aerts, Joel; Ballinger, James R; Behe, Martin; Decristoforo, Clemens; Elsinga, Philip H; Faivre-Chauvet, Alain; Mindt, Thomas L; Kolenc Peitl, Petra; Todde, Sergio C; Koziorowski, Jacek

    2014-08-01

    This document is meant to complement Part B of the EANM 'Guidelines on current good radiopharmacy practice (cGRPP) in the preparation of radiopharmaceuticals' issued by the Radiopharmacy Committee of the European Association of Nuclear Medicine, covering small-scale in-house preparation of radiopharmaceuticals with automated modules. The aim is to provide more detailed and practice-oriented guidance to those who are involved in the small-scale preparation of radiopharmaceuticals, which are not intended for commercial purposes or distribution. Copyright © 2014 John Wiley & Sons, Ltd.

  17. Exploring the Nature and Practice of Career Guidance in Secondary ...

    African Journals Online (AJOL)

    The ministry of Public Service, Labour and Social welfare in conjunction with the ministry of Education Sport and Culture organized career day sessions annually. Different service providers ... Students' career choices had gender biases reflecting traditional beliefs in careers for men and woman. The spectrum of facilitators ...

  18. 75 FR 69449 - Draft Guidance for Industry and Food and Drug Administration Staff on Dear Health Care Provider...

    Science.gov (United States)

    2010-11-12

    ... Staff on Dear Health Care Provider Letters: Improving Communication of Important Safety Information... Administration (FDA) is announcing the availability of a draft guidance for industry and FDA staff entitled... include in a DHCP letter, how to organize that information, and formatting techniques to make the...

  19. Vertebroplasty and kyphoplasty in the United States: provider distribution and guidance method, 2001-2010.

    Science.gov (United States)

    Long, Suzanne S; Morrison, William B; Parker, Laurence

    2012-12-01

    The purpose of this study was to determine the utilization by specialty and guidance method for vertebral augmentation (including vertebroplasty and kyphoplasty) in the United States from 2001 to 2010. Using the 2001 through 2010 United States part B Medicare claims database, we studied the CPT-4 (Current Procedural Terminology, 4th ed.) codes used for thoracic (22520) and lumbar (22521) vertebroplasty, thoracic (22523) and lumbar (22524) kyphoplasty, and the method of radiologic guidance (76012 for fluoroscopy and 76013 for CT). For each of these codes, volume and physician specialty were tabulated. Radiologists performed 73% of Medicare-reimbursed vertebroplasty procedures in the United States in 2001-2010 and 30% of kyphoplasty procedures from 2006 to 2010. The majority were performed by nonradiologists, most notably orthopedic surgeons, who accounted for 40%. Although there was a decrease in utilization of vertebroplasty and kyphoplasty from 2009 to 2010, the number of vertebroplasties increased by 72.9% from 2001 to 2010, and the number of kyphoplasties increased by 12.0% from 2006 to 2010. Fluoroscopy is nearly universal as a guidance method for both vertebroplasty and kyphoplasty. This study shows that despite controversy regarding the long-term efficacy of vertebral augmentation, including vertebroplasty and kyphoplasty, utilization has risen since these procedures have been instituted and fluoroscopy is nearly universal as a guidance method. For vertebroplasty, the decrease in utilization from 2007 to 2009 may be explained in part by a combination of the initiation of kyphoplasty codes in 2006 and the August 2009 Kallmes et al. and Buchbinder et al. publications. Decreased utilization of both vertebroplasty and kyphoplasty from 2009 to 2010 may also be partly due to these publications.

  20. Blending Research and Practice: A 10-Year Evaluation of a Community-Based Child Guidance Clinic.

    Science.gov (United States)

    Mueller, Daniel P.; Hosley, Cheryl A.; Heiserman, Mary S.

    This document discusses a project designed to assess trends in service data and the effectiveness of the services provided over a 10-year period. It begins by describing the services provided by the Wilder Foundation Child Guidance Clinic, an outpatient mental health center serving children and families in the Saint Paul, Minnesota area. A number…

  1. Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis.

    Science.gov (United States)

    Moser, Albine; Korstjens, Irene

    2017-12-04

    In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By 'novice' we mean Master's students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of qualitative research papers. The second article focused on context, research questions and designs, and referred to publications for further reading. This third article addresses FAQs about sampling, data collection and analysis. The data collection plan needs to be broadly defined and open at first, and become flexible during data collection. Sampling strategies should be chosen in such a way that they yield rich information and are consistent with the methodological approach used. Data saturation determines sample size and will be different for each study. The most commonly used data collection methods are participant observation, face-to-face in-depth interviews and focus group discussions. Analyses in ethnographic, phenomenological, grounded theory, and content analysis studies yield different narrative findings: a detailed description of a culture, the essence of the lived experience, a theory, and a descriptive summary, respectively. The fourth and final article will focus on trustworthiness and publishing qualitative research.

  2. Passive sampling methods for contaminated sediments: Practical guidance for selection, calibration, and implementation

    Science.gov (United States)

    Ghosh, Upal; Driscoll, Susan Kane; Burgess, Robert M; Jonker, Michiel To; Reible, Danny; Gobas, Frank; Choi, Yongju; Apitz, Sabine E; Maruya, Keith A; Gala, William R; Mortimer, Munro; Beegan, Chris

    2014-01-01

    This article provides practical guidance on the use of passive sampling methods (PSMs) that target the freely dissolved concentration (Cfree) for improved exposure assessment of hydrophobic organic chemicals in sediments. Primary considerations for selecting a PSM for a specific application include clear delineation of measurement goals for Cfree, whether laboratory-based “ex situ” and/or field-based “in situ” application is desired, and ultimately which PSM is best-suited to fulfill the measurement objectives. Guidelines for proper calibration and validation of PSMs, including use of provisional values for polymer–water partition coefficients, determination of equilibrium status, and confirmation of nondepletive measurement conditions are defined. A hypothetical example is described to illustrate how the measurement of Cfree afforded by PSMs reduces uncertainty in assessing narcotic toxicity for sediments contaminated with polycyclic aromatic hydrocarbons. The article concludes with a discussion of future research that will improve the quality and robustness of Cfree measurements using PSMs, providing a sound scientific basis to support risk assessment and contaminated sediment management decisions. Integr Environ Assess Manag 2014;10:210–223. © 2014 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of SETAC. PMID:24288273

  3. Integrity of Evidence-Based Practice: Are Providers Modifying Practice Content or Practice Sequencing?

    OpenAIRE

    Park, Alayna L.; Chorpita, Bruce F.; Regan, Jennifer; Weisz, John R

    2014-01-01

    This study examined patterns of evidence-based treatment (EBT) implementation within community settings by evaluating integrity along separate dimensions of practice content (PC; a session included the prescribed procedure) and practice sequencing (a session occurred in the prescribed sequence) within a recent randomized effectiveness trial. We measured whether sessions showed integrity to PC and to flexible or linear practice sequences. Findings revealed that providers tended to incorporate ...

  4. Metaboli-Net: online groupware system providing counseling guidance for patients with metabolic syndrome.

    Science.gov (United States)

    Kuwata, Shigeki; Taniguchi, Shin-ichi; Kato, Atsuko; Inoue, Kazuoki; Yamamoto, Naoya; Ohkura, Tsuyoshi; Teramoto, Kei; Shigemasa, Chiaki; Kondoh, Hiroshi

    2010-01-01

    This study presented a newly developed online groupware system, Metaboli-Net, to yield counseling guidance on diet and exercise to patients with metabolic syndrome. A distinctive feature adopted in the system to maintain the retention rate of patients was the social network service (SNS) that enables the patients to share their dietary and relevant health information with other participants in the same group on the network. A pilot study was conducted to prove the effectiveness of the system in improving the patient's lifestyle and dietary health awareness. SNS also contributed to the participant's adherence to intervention programs.

  5. Strategic Environmental Assessment as catalyst of healthier spatial planning: The Danish guidance and practice

    DEFF Research Database (Denmark)

    Kørnøv, Lone

    2009-01-01

    A wide range of factors within spatial planning can affect health. There is therefore an important scope for Strategic Environmental Assessment (SEA) of spatial plans to protect and improve human health. Due to the EU Directive 2001/42/EC on SEA, health has been made explicit in Danish legislation...... and guidance. This paper examines the inclusion of health as a formal component in impact assessment of spatial plans. Based upon a documentary study of 100 environmental reports, the paper analyses and discusses how health impact considerations are incorporated in SEA practice. It is found that health impacts...... are included in SEA practice and are being interpreted in a broader sense than what the national guidance exemplifies. The frequent included health aspects are noise, drinking water, air pollution, recreation/outdoor life and traffic safety. The primary determinant for health is transport...

  6. The evolution of behavior guidance: a history of professional, practice, corporate and societal influences.

    Science.gov (United States)

    Strange, David M

    2014-01-01

    Behavior guidance in pediatric dentistry is a composite of influences including expert opinion, historical precedent, scientific studies, and social factors including the law and the media. The early icons of pediatric dentistry injected their personal views on child management, and those often reflected the child-rearing norms of the times. The business of pediatric dentistry with its efficiency and quality orientations also shaped approaches to behavior management. Scientific studies contributed minimally. A major influence on behavior guidelines in recent years has been external scrutiny of techniques prompted by media and other exposure of both private practice and corporate management of children. Changing parenting and reaction of society to authority have also had significant impact on behavior. This paper describes in more detail the evolution of behavior guidance and the subsequent codification of practices into professionally derived guidelines.

  7. Series: Practical guidance to qualitative research. Part 2: Context, research questions and designs.

    Science.gov (United States)

    Korstjens, Irene; Moser, Albine

    2017-12-01

    In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By 'novice' we mean Master's students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of qualitative research papers. This second article addresses FAQs about context, research questions and designs. Qualitative research takes into account the natural contexts in which individuals or groups function to provide an in-depth understanding of real-world problems. The research questions are generally broad and open to unexpected findings. The choice of a qualitative design primarily depends on the nature of the research problem, the research question(s) and the scientific knowledge one seeks. Ethnography, phenomenology and grounded theory are considered to represent the 'big three' qualitative approaches. Theory guides the researcher through the research process by providing a 'lens' to look at the phenomenon under study. Since qualitative researchers and the participants of their studies interact in a social process, researchers influence the research process. The first article described the key features of qualitative research, the third article will focus on sampling, data collection and analysis, while the last article focuses on trustworthiness and publishing.

  8. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing.

    Science.gov (United States)

    Korstjens, Irene; Moser, Albine

    2017-12-05

    In the course of our supervisory work over the years we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By 'novice' we mean Master's students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of qualitative research papers. The first article provides an introduction to this series. The second article focused on context, research questions and designs. The third article focused on sampling, data collection and analysis. This fourth article addresses FAQs about trustworthiness and publishing. Quality criteria for all qualitative research are credibility, transferability, dependability, and confirmability. Reflexivity is an integral part of ensuring the transparency and quality of qualitative research. Writing a qualitative research article reflects the iterative nature of the qualitative research process: data analysis continues while writing. A qualitative research article is mostly narrative and tends to be longer than a quantitative paper, and sometimes requires a different structure. Editors essentially use the criteria: is it new, is it true, is it relevant? An effective cover letter enhances confidence in the newness, trueness and relevance, and explains why your study required a qualitative design. It provides information about the way you applied quality criteria or a checklist, and you can attach the checklist to the manuscript.

  9. Guidance on current good radiopharmacy practice (cGRPP) for the small-scale preparation of radiopharmaceuticals

    NARCIS (Netherlands)

    Elsinga, Philip; Todde, Sergio; Penuelas, Ivan; Meyer, Geerd; Farstad, Brit; Faivre-Chauvet, Alain; Mikolajczak, Renata; Westera, Gerrit; Gmeiner-Stopar, Tanja; Decristoforo, Clemens

    This guidance is meant as a guidance to Part B of the EANM "Guidelines on Good Radiopharmacy Practice (GRPP)" issued by the Radiopharmacy Committee of the EANM (see www.eanm.org), covering the small-scale "in house" preparation of radiopharmaceuticals which are not kit procedures. The aim is to

  10. Practical guidance for conducting mediation analysis with multiple mediators using inverse odds ratio weighting.

    Science.gov (United States)

    Nguyen, Quynh C; Osypuk, Theresa L; Schmidt, Nicole M; Glymour, M Maria; Tchetgen Tchetgen, Eric J

    2015-03-01

    Despite the recent flourishing of mediation analysis techniques, many modern approaches are difficult to implement or applicable to only a restricted range of regression models. This report provides practical guidance for implementing a new technique utilizing inverse odds ratio weighting (IORW) to estimate natural direct and indirect effects for mediation analyses. IORW takes advantage of the odds ratio's invariance property and condenses information on the odds ratio for the relationship between the exposure (treatment) and multiple mediators, conditional on covariates, by regressing exposure on mediators and covariates. The inverse of the covariate-adjusted exposure-mediator odds ratio association is used to weight the primary analytical regression of the outcome on treatment. The treatment coefficient in such a weighted regression estimates the natural direct effect of treatment on the outcome, and indirect effects are identified by subtracting direct effects from total effects. Weighting renders treatment and mediators independent, thereby deactivating indirect pathways of the mediators. This new mediation technique accommodates multiple discrete or continuous mediators. IORW is easily implemented and is appropriate for any standard regression model, including quantile regression and survival analysis. An empirical example is given using data from the Moving to Opportunity (1994-2002) experiment, testing whether neighborhood context mediated the effects of a housing voucher program on obesity. Relevant Stata code (StataCorp LP, College Station, Texas) is provided. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Respiratory Protection Toolkit: Providing Guidance Without Changing Requirements-Can We Make an Impact?

    Science.gov (United States)

    Bien, Elizabeth Ann; Gillespie, Gordon Lee; Betcher, Cynthia Ann; Thrasher, Terri L; Mingerink, Donna R

    2016-12-01

    International travel and infectious respiratory illnesses worldwide place health care workers (HCWs) at increasing risk of respiratory exposures. To ensure the highest quality safety initiatives, one health care system used a quality improvement model of Plan-Do-Study-Act and guidance from Occupational Safety and Health Administration's (OSHA) May 2015 Hospital Respiratory Protection Program (RPP) Toolkit to assess a current program. The toolkit aided in identification of opportunities for improvement within their well-designed RPP. One opportunity was requiring respirator use during aerosol-generating procedures for specific infectious illnesses. Observation data demonstrated opportunities to mitigate controllable risks including strap placement, user seal check, and reuse of disposable N95 filtering facepiece respirators. Subsequent interdisciplinary collaboration resulted in other ideas to decrease risks and increase protection from potentially infectious respiratory illnesses. The toolkit's comprehensive document to evaluate the program showed that while the OSHA standards have not changed, the addition of the toolkit can better protect HCWs. © 2016 The Author(s).

  12. Steve Jobs provides lessons for any medical practice.

    Science.gov (United States)

    Ornstein, Hal; Baum, Neil

    2013-01-01

    Steve Jobs is inarguably the greatest inventor and creative genius since Thomas Edison. He provided technology that enhances communication on a global level. Jobs also provided ideas and suggestions that could work in any medical practice regardless of the size of the practice, the location of the practice, or the employment model. His advice can be transferred from a high-tech business that employs thousands to a high-touch medical practice that has only a few employees. This article will list a few of Jobs leadership characteristics and how they might apply to physicians, their teams, and their practices. Wouldn't you like to be the Steve Jobs of healthcare? If so, read on!

  13. Nutrition: Intervention Guidance for Service Providers and Families. Connecticut Birth to Three System, Service Guideline 6.

    Science.gov (United States)

    Connecticut Birth to Three System, Hartford.

    This guide was developed to assist families and service providers in Connecticut with nutrition services for infants and toddlers with disabilities. Individual sections provide information about the following topics: laws and regulations related to nutrition services; eligibility for the Connecticut Birth to Three System and nutrition; nutrition…

  14. Knowledge and Practices of PMTCT among Health Care Providers ...

    African Journals Online (AJOL)

    Adequate knowledge by health care providers of antiretroviral use and other PMTCT strategies will be required to ensure control of vertical transmission of the virus. Objective: To assess the knowledge and practice of PMTCT among health care providers in private health facilities in Ilorin, Nigeria. Method: This is a review of ...

  15. Providing services to trafficking survivors: Understanding practices across the globe.

    Science.gov (United States)

    Steiner, Jordan J; Kynn, Jamie; Stylianou, Amanda M; Postmus, Judy L

    2018-01-01

    Human trafficking is a global issue, with survivors representing all genders, ages, races, ethnicities, religions, and countries. However, little research exists that identifies effective practices in supporting survivors of human trafficking. The research that does exist is Western-centric. To fill this gap in the literature, the goal of this research was to understand practices used throughout the globe with adult human trafficking survivors. A qualitative approach was utilized. Providers from 26 countries, across six different continents, were interviewed to allow for a comprehensive and multi-faceted understanding of practices in working with survivors. Participants identified utilizing an empowerment-based, survivor, and human life-centered approach to working with survivors, emphasized the importance of engaging in community level interventions, and highlighted the importance of government recognition of human trafficking. Findings provide information from the perspective of advocates on best practices in the field that can be used by agencies to enhance human trafficking programming.

  16. Silica dust control in small-scale building/structure demolition operations using good work practice guidance

    Energy Technology Data Exchange (ETDEWEB)

    Muianga, C V; Rice, C H; Succop, P, E-mail: muiangcv@email.uc.ed [Department of Environmental Health, College of Medicine University of Cincinnati. 3223 Eden Ave., Kettering Laboratory, Cincinnati, OH 45267-0056 (United States)

    2009-02-01

    Work practices can influence exposure, especially in small-scale operations conducted by mobile work crews. This study evaluated the use of information on good work practice in control guidance sheets adapted from UK Silica Essentials guidance sheets by trained workers and supervisors employed in small-scale concrete and masonry demolition operations. A one-page employee silica task-based control guidance sheet for each of four demolition tasks and multiple-page silica control guidance for supervisors were developed. Interactive, hands-on worker training on these task-based good work practice controls was developed. Training was presented to 26 participants from two demolition crews. Feedback on the training and task-based good work practice control guidance sheets was elicited. Observations of work practices were made before and after training. Participants indicated gains in knowledge and checklists were used to document skill attainment. The quality of the training and usefulness of the material/skills was rated high by trainees. Increased use of water to suppress dust and wet cleaning methods on the job were documented following the training. Additional follow-up after training is required to determine long-term impact on sustained changes in work practices, and to evaluate the need for refresher training.

  17. A Surgical Robot Teleoperation Framework for Providing Haptic Feedback Incorporating Virtual Environment-Based Guidance

    OpenAIRE

    Munawar, Adnan; Fischer, Gregory

    2016-01-01

    In robot-assisted teleoperated laparoscopic surgeries, the patient side manipulators are controlled via the master manipulators, operated by the surgeon. The current generation of robots approved for laparoscopic surgery lack haptic feedback. In theory, haptic feedback could enhance the surgical procedures by providing a palpable sense of the environment as a function of surgeon’s hands movements. This research presents an overall control framework for haptic feedback on existing robot platfo...

  18. Guidance for researchers developing and conducting clinical trials in practice-based research networks (PBRNs).

    Science.gov (United States)

    Dolor, Rowena J; Schmit, Kristine M; Graham, Deborah G; Fox, Chester H; Baldwin, Laura Mae

    2014-01-01

    There is increased interest nationally in multicenter clinical trials to answer questions about clinical effectiveness, comparative effectiveness, and safety in real-world community settings. Primary care practice-based research networks (PBRNs), comprising community- and/or academically affiliated practices committed to improving medical care for a range of health problems, offer ideal settings for these trials, especially pragmatic clinical trials. However, many researchers are not familiar with working with PBRNs. Experts in practice-based research identified solutions to challenges that researchers and PBRN personnel experience when collaborating on clinical trials in PBRNs. These were organized as frequently asked questions in a draft document presented at a 2013 Agency for Health care Research and Quality PBRN conference workshop, revised based on participant feedback, then shared with additional experts from the DARTNet Institute, Clinical Translational Science Award PBRN, and North American Primary Care Research Group PBRN workgroups for further input and modification. The "Toolkit for Developing and Conducting Multi-site Clinical Trials in Practice-Based Research Networks" offers guidance in the areas of recruiting and engaging practices, budgeting, project management, and communication, as well as templates and examples of tools important in developing and conducting clinical trials. Ensuring the successful development and conduct of clinical trials in PBRNs requires a highly collaborative approach between academic research and PBRN teams. © Copyright 2014 by the American Board of Family Medicine.

  19. Buprenorphine prescribing practice trends and attitudes among New York providers.

    Science.gov (United States)

    Kermack, Andrea; Flannery, Mara; Tofighi, Babak; McNeely, Jennifer; Lee, Joshua D

    2017-03-01

    Buprenorphine office-based opioid maintenance is an increasingly common form of treatment for opioid use disorders. However, total prescribing has not kept pace with the current opioid and overdose epidemic and access remains scarce among the underserved. This study sought to assess current provider attitudes and clinical practices among a targeted sample of primarily New York City public sector buprenorphine prescribers. A cross-sectional online survey purposefully sampled buprenorphine prescribers in NYC with a focus on those serving Medicaid and uninsured patient populations. Expert review of local provider networks, snowball referrals, and in-person networking generated an email list, which received a survey link. A brief 25-question instrument queried provider and practice demographics, prescribing practices including induction approaches and attitudes regarding common hot topics (e.g., buprenorphine diversion, prescriber patient limits, insurance issues, ancillary treatments). Of 132 email invitations, N=72 respondents completed (n=64) or partially completed (n=8) the survey between January and April 2016. Most (79%) were Medicaid providers in non-psychiatric specialties (72%), working in a hospital-based or community general practice (51%), and board-certified in addiction medicine or psychiatry (58%). Practice sizes were generally 100 patients or fewer (71%); many providers (64%) individually prescribed buprenorphine Buprenorphine diversion was not rated as an important practice barrier. In conclusion, this targeted survey of buprenorphine prescribers in NYC treating primarily underserved populations showed a consistent pattern of part-time prescribing to modest volumes of patients, routine use of unobserved buprenorphine induction, and primarily elective referrals to psychosocial counseling. Barriers to prescribing included prior authorization requirements, lack of clinical resources (space, staff) and psychiatric services. Federal and local efforts to

  20. A simulation study provided sample size guidance for differential item functioning (DIF) studies using short scales.

    Science.gov (United States)

    Scott, Neil W; Fayers, Peter M; Aaronson, Neil K; Bottomley, Andrew; de Graeff, Alexander; Groenvold, Mogens; Gundy, Chad; Koller, Michael; Petersen, Morten A; Sprangers, Mirjam A G

    2009-03-01

    Differential item functioning (DIF) analyses are increasingly used to evaluate health-related quality of life (HRQoL) instruments, which often include relatively short subscales. Computer simulations were used to explore how various factors including scale length affect analysis of DIF by ordinal logistic regression. Simulated data, representative of HRQoL scales with four-category items, were generated. The power and type I error rates of the DIF method were then investigated when, respectively, DIF was deliberately introduced and when no DIF was added. The sample size, scale length, floor effects (FEs) and significance level were varied. When there was no DIF, type I error rates were close to 5%. Detecting moderate uniform DIF in a two-item scale required a sample size of 300 per group for adequate (>80%) power. For longer scales, a sample size of 200 was adequate. Considerably larger sample sizes were required to detect nonuniform DIF, when there were extreme FEs or when a reduced type I error rate was required. The impact of the number of items in the scale was relatively small. Ordinal logistic regression successfully detects DIF for HRQoL instruments with short scales. Sample size guidelines are provided.

  1. Organization of primary care practice for providing energy balance care.

    Science.gov (United States)

    Klabunde, Carrie N; Clauser, Steven B; Liu, Benmei; Pronk, Nicolaas P; Ballard-Barbash, Rachel; Huang, Terry T-K; Smith, Ashley Wilder

    2014-01-01

    Primary care physicians (PCPs) may not adequately counsel or monitor patients regarding diet, physical activity, and weight control (i.e., provide energy balance care). We assessed the organization of PCPs' practices for providing this care. The study design was a nationally representative survey conducted in 2008. The study setting was U.S. primary care practices. A total of 1740 PCPs completed two sequential questionnaires (response rate, 55.5%). The study measured PCPs' reports of practice resources, and the frequency of body mass index assessment, counseling, referral for further evaluation/management, and monitoring of patients for energy balance care. Descriptive statistics and logistic regression modeling were used. More than 80% of PCPs reported having information resources on diet, physical activity, or weight control available in waiting/exam rooms, but fewer billed (45%), used reminder systems (energy balance care. A total of 26% reported regularly assessing body mass index and always/often providing counseling as well as tracking patients for progress related to energy balance. In multivariate analyses, PCPs in practices with full electronic health records or those that bill for energy balance care provided this care more often and more comprehensively. There were strong specialty differences, with pediatricians more likely (odds ratio, 1.78; 95% confidence interval, 1.26-2.51) and obstetrician/gynecologists less likely (odds ratio, 0.28; 95% confidence interval, 0.17-0.44) than others to provide energy balance care. PCPs' practices are not well organized for providing energy balance care. Further research is needed to understand PCP care-related specialty differences.

  2. Theory in Practice: Helping Providers Address Depression in Diabetes Care

    Science.gov (United States)

    Osborn, Chandra Y.; Kozak, Cindy; Wagner, Julie

    2010-01-01

    Introduction: A continuing education (CE) program based on the theory of planned behavior was designed to understand and improve health care providers' practice patterns in screening, assessing, and treating and/or referring patients with diabetes for depression treatment. Methods: Participants completed assessments of attitudes, confidence,…

  3. VET Providers Planning to Deliver Degrees: Good Practice Guide

    Science.gov (United States)

    National Centre for Vocational Education Research (NCVER), 2015

    2015-01-01

    This good practice guide is intended to assist public and private registered training organisations (RTOs) planning to commence higher education (HE) delivery. The guide is based on research undertaken by Victor Callan and Kaye Bowman, who completed case studies with six providers currently delivering higher education qualifications in addition to…

  4. Health care providers' knowledge and practice of focused antenatal ...

    African Journals Online (AJOL)

    The potential of antenatal care for reducing maternal morbidity and mortality and improving newborn survival and health is widely acknowledged. The study sought to investigate Health Care Providers knowledge and practice of focused antenatal care in a cottage Hospital Okpatu. Qualitative ethnographical research design ...

  5. Practical guidance for the management of aromatase inhibitor-associated bone loss.

    Science.gov (United States)

    Hadji, P; Body, J-J; Aapro, M S; Brufsky, A; Coleman, R E; Guise, T; Lipton, A; Tubiana-Hulin, M

    2008-08-01

    Recent studies indicate that women with breast cancer are at increased risk of fracture compared with their age-matched peers. Current treatment guidelines are inadequate for averting fractures in osteopenic women, especially those receiving aromatase inhibitor (AI) therapy. Therefore, we sought to identify clinically relevant risk factors for fracture that can be used to assess overall fracture risk and to provide practical guidance for preventing and treating bone loss in women with breast cancer receiving AI therapy. Systematic review of pertinent information from published literature and meeting abstracts through December 2007 was carried out to identify factors contributing to fracture risk in women with breast cancer. An evidence-based medicine approach was used to select risk factors that can be used to determine when to initiate bisphosphonate treatment of aromatase inhibitor-associated bone loss (AIBL). Fracture risk factors were chosen from large, well-designed, controlled, population-based trials in postmenopausal women. Evidence from multiple prospective clinical trials in women with breast cancer was used to validate AI therapy as a fracture risk factor. Overall, eight fracture risk factors were validated in women with breast cancer: AI therapy, T-score 65 years, low body mass index (BMI 6 months, and smoking. Treatment recommendations were derived from randomized clinical trials. The authors recommend the following for preventing and treating AIBL in women with breast cancer. All patients initiating AI therapy should receive calcium and vitamin D supplements. Any patient initiating or receiving AI therapy with a T-score >/=-2.0 and no additional risk factors should be monitored every 1-2 years for change in risk status and bone mineral density (BMD). Any patient initiating or receiving AI therapy with a T-score 65 years, low BMI (6 months, and smoking-should receive bisphosphonate therapy. BMD should be monitored every 2 years, and treatment should

  6. Normalization in EDIP97 and EDIP2003: updated European inventory for 2004 and guidance towards a consistent use in practice

    DEFF Research Database (Denmark)

    Laurent, Alexis; Olsen, Stig Irving; Hauschild, Michael Zwicky

    2011-01-01

    regular updates. The study presents updated sets of normalization inventories, normalization references for the EDIP97/EDIP2003 methodology and guidance on their consistent use in practice. Materials and methods: The base year of the inventory is 2004; the geographical scope for the non-global impacts...... is limited to Europe. The emission inventory was collected from different publicly available databases and monitoring bodies. Where necessary, gaps were filled using extrapolations. A new approach for inventorizing specific groups of substances—non-methane volatile organic compounds and pesticides—was also...... developed. The resulting inventory was combined with the most updated sets of characterization factors for each impact category in the EDIP methodologies. Results and discussion: Normalization references are provided for global and non-global impact categories for the year 2004, and causes of variations...

  7. Reporting Guidelines for Survey Research: An Analysis of Published Guidance and Reporting Practices

    Science.gov (United States)

    Bennett, Carol; Khangura, Sara; Brehaut, Jamie C.; Graham, Ian D.; Moher, David; Potter, Beth K.; M. Grimshaw, Jeremy

    2011-01-01

    Background Research needs to be reported transparently so readers can critically assess the strengths and weaknesses of the design, conduct, and analysis of studies. Reporting guidelines have been developed to inform reporting for a variety of study designs. The objective of this study was to identify whether there is a need to develop a reporting guideline for survey research. Methods and Findings We conducted a three-part project: (1) a systematic review of the literature (including “Instructions to Authors” from the top five journals of 33 medical specialties and top 15 general and internal medicine journals) to identify guidance for reporting survey research; (2) a systematic review of evidence on the quality of reporting of surveys; and (3) a review of reporting of key quality criteria for survey research in 117 recently published reports of self-administered surveys. Fewer than 7% of medical journals (n = 165) provided guidance to authors on survey research despite a majority having published survey-based studies in recent years. We identified four published checklists for conducting or reporting survey research, none of which were validated. We identified eight previous reviews of survey reporting quality, which focused on issues of non-response and accessibility of questionnaires. Our own review of 117 published survey studies revealed that many items were poorly reported: few studies provided the survey or core questions (35%), reported the validity or reliability of the instrument (19%), defined the response rate (25%), discussed the representativeness of the sample (11%), or identified how missing data were handled (11%). Conclusions There is limited guidance and no consensus regarding the optimal reporting of survey research. The majority of key reporting criteria are poorly reported in peer-reviewed survey research articles. Our findings highlight the need for clear and consistent reporting guidelines specific to survey research. Please see

  8. Brief Mindfulness Practices for Healthcare Providers - A Systematic Literature Review.

    Science.gov (United States)

    Gilmartin, Heather; Goyal, Anupama; Hamati, Mary C; Mann, Jason; Saint, Sanjay; Chopra, Vineet

    2017-10-01

    Mindfulness practice, where an individual maintains openness, patience, and acceptance while focusing attention on a situation in a nonjudgmental way, can improve symptoms of anxiety, burnout, and depression. The practice is relevant for health care providers; however, the time commitment is a barrier to practice. For this reason, brief mindfulness interventions (eg, ≤ 4 hours) are being introduced. We systematically reviewed the literature from inception to January 2017 about the effects of brief mindfulness interventions on provider well-being and behavior. Studies that tested a brief mindfulness intervention with hospital providers and measured change in well-being (eg, stress) or behavior (eg, tasks of attention or reduction of clinical or diagnostic errors) were selected for narrative synthesis. Fourteen studies met inclusion criteria; 7 were randomized controlled trials. Nine of 14 studies reported positive changes in levels of stress, anxiety, mindfulness, resiliency, and burnout symptoms. No studies found an effect on provider behavior. Brief mindfulness interventions may be effective in improving provider well-being; however, larger studies are needed to assess an impact on clinical care. Published by Elsevier Inc.

  9. Nutrition and physical activity guidance practices in general practice: A critical review

    NARCIS (Netherlands)

    Dillen, van S.M.E.; Binsbergen, van J.J.; Koelen, M.A.; Hiddink, G.J.

    2013-01-01

    Objective - The aim of this critical review is to provide insight into the main outcomes of research on communication about nutrition and/or physical activity between GPs and patients for prevention or treatment of overweight and obesity. Methods - Relevant studies were identified by a computerized

  10. Nutrition and physical activity guidance practices in general practice: a critical review

    NARCIS (Netherlands)

    Dillen, S.M. van; Binsbergen, J.J. van; Koelen, M.A.; Hiddink, G.J.

    2013-01-01

    OBJECTIVE: The aim of this critical review is to provide insight into the main outcomes of research on communication about nutrition and/or physical activity between GPs and patients for prevention or treatment of overweight and obesity. METHODS: Relevant studies were identified by a computerized

  11. Abortion practice in Mexico: a survey of health care providers.

    Science.gov (United States)

    Dayananda, Ila; Walker, Dilys; Atienzo, Erika E; Haider, Sadia

    2012-03-01

    Little is known about abortion practice in Mexico postlegalization of abortion in Mexico City in 2007. In 2009, we anonymously surveyed 418 Mexican health care providers at the Colegio Mexicano de Especialistas en Ginecologia y Obstetricia meeting using audio computer-assisted self-interview technology. The majority of respondents were obstetrician gynecologists (376, 90%), Catholic (341, 82%), 35-60 years old (332, 79%) and male (222, 53%) and worked with trainees (307, 74%). Prior to 2007, 11% (46) and 17% (71) provided medical and surgical abortions; now, 15% (62) and 21% (86) provide these services, respectively. Practitioners from Mexico City were more likely to provide services than those from other areas. Most medical abortion providers (50, 81%) used ineffective protocols. Surgical abortion providers mainly used either manual vacuum aspiration (39, 45%) or sharp curettage (27, 32%). Most abortion providers were trained in residency and wanted more training in medical (54, 87%) and surgical (59, 69%) abortion. Among nonproviders, 49% (175) and 27% (89) expressed interest in learning to perform medical and surgical abortion, respectively. Given the interest in learning to provide safe abortion services and the prevalent use of ineffective medical abortion regimens and sharp curettage, abortion training in Mexico should be strengthened. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Hand Washing Practices Among Emergency Medical Services Providers.

    Science.gov (United States)

    Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

    2015-09-01

    Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing.

  13. Obesity management in gynecologic cancer survivors: provider practices and attitudes.

    Science.gov (United States)

    Jernigan, Amelia M; Tergas, Ana I; Satin, Andrew J; Fader, Amanda N

    2013-05-01

    Obesity is associated with the development and risk of death from several women's cancers. The study objective was to describe and compare oncologic providers' attitudes and practices as they relate to obesity counseling and management in cancer survivors. Society of Gynecologic Oncology members (n = 924) were surveyed with the use of a web-based, electronic questionnaire. χ(2) and Fisher exact tests were used to analyze responses. Of the 240 respondents (30%), 92.9% were practicing gynecologic oncologists or fellows, and 5.1% were allied health professionals. Median age was 42 years; 50.8% of the respondents were female. Of the respondents, 42.7% reported that they themselves were overweight/obese and that ≥50% of their survivor patients were overweight/obese. Additionaly, 82% of the respondents believed that discussing weight would not harm the doctor-patient relationship. Most of the respondents (95%) agreed that addressing lifestyle modifications with survivors is important. Respondents believed that gynecologic oncologists (85.1%) and primary care providers (84.5%) were responsible for addressing obesity. More providers who were ≤42 years old reported undergoing obesity management training (P 42 years old (P = .017). After initial counseling, 81.5% of the respondents referred survivors to other providers for obesity interventions. Oncology provider respondents believe that addressing obesity with cancer survivors is important. Providers believed themselves to be responsible for initial counseling but believed that obesity interventions should be directed by other specialists. Further research is needed to identify barriers to care for obese cancer survivors and to improve physician engagement with obesity counseling in the "teachable moment" that is provided by a new cancer diagnosis. Copyright © 2013 Mosby, Inc. All rights reserved.

  14. Adaptation Guidance for Evidence-Based Teen Pregnancy and STI/HIV Prevention Curricula: From Development to Practice

    Science.gov (United States)

    Rolleri, Lori A.; Fuller, Taleria R.; Firpo-Triplett, Regina; Lesesne, Catherine A.; Moore, Claire; Leeks, Kimberly D.

    2014-01-01

    Evidence-based interventions (EBIs) are effective in preventing adolescent pregnancy and sexually transmitted infections; however, prevention practitioners are challenged when selecting and adapting the most appropriate programs. While there are existing adaptation frameworks, there is little practical guidance in applying research in the field.…

  15. 78 FR 28228 - Guidance for Industry and Food and Drug Administration Staff on Best Practices for Conducting and...

    Science.gov (United States)

    2013-05-14

    ... HUMAN SERVICES Food and Drug Administration Guidance for Industry and Food and Drug Administration Staff on Best Practices for Conducting and Reporting Pharmacoepidemiologic Safety Studies Using Electronic Healthcare Data; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food...

  16. Does social marketing provide a framework for changing healthcare practice?

    Science.gov (United States)

    Morris, Zoë Slote; Clarkson, Peter John

    2009-07-01

    We argue that social marketing can be used as a generic framework for analysing barriers to the take-up of clinical guidelines, and planning interventions which seek to enable this change. We reviewed the literature on take-up of clinical guidelines, in particular barriers and enablers to change; social marketing principles and social marketing applied to healthcare. We then applied the social marketing framework to analyse the literature and to consider implications for future guideline policy to assess its feasibility and accessibility. There is sizeable extant literature on healthcare practitioners' non-compliance with clinical guidelines. This is an international problem common to a number of settings. The reasons for poor levels of take up appear to be well understood, but not addressed adequately in practice. Applying a social marketing framework brings new insights to the problem." We show that a social marketing framework provides a useful solution-focused framework for systematically understanding barriers to individual behaviour change and designing interventions accordingly. Whether the social marketing framework provides an effective means of bringing about behaviour change remains an empirical question which has still to be tested in practice. The analysis presented here provides strong motivation to begin such testing.

  17. Applying the intention-to-treat principle in practice: Guidance on handling randomisation errors.

    Science.gov (United States)

    Yelland, Lisa N; Sullivan, Thomas R; Voysey, Merryn; Lee, Katherine J; Cook, Jonathan A; Forbes, Andrew B

    2015-08-01

    The intention-to-treat principle states that all randomised participants should be analysed in their randomised group. The implications of this principle are widely discussed in relation to the analysis, but have received limited attention in the context of handling errors that occur during the randomisation process. The aims of this article are to (1) demonstrate the potential pitfalls of attempting to correct randomisation errors and (2) provide guidance on handling common randomisation errors when they are discovered that maintains the goals of the intention-to-treat principle. The potential pitfalls of attempting to correct randomisation errors are demonstrated and guidance on handling common errors is provided, using examples from our own experiences. We illustrate the problems that can occur when attempts are made to correct randomisation errors and argue that documenting, rather than correcting these errors, is most consistent with the intention-to-treat principle. When a participant is randomised using incorrect baseline information, we recommend accepting the randomisation but recording the correct baseline data. If ineligible participants are inadvertently randomised, we advocate keeping them in the trial and collecting all relevant data but seeking clinical input to determine their appropriate course of management, unless they can be excluded in an objective and unbiased manner. When multiple randomisations are performed in error for the same participant, we suggest retaining the initial randomisation and either disregarding the second randomisation if only one set of data will be obtained for the participant, or retaining the second randomisation otherwise. When participants are issued the incorrect treatment at the time of randomisation, we propose documenting the treatment received and seeking clinical input regarding the ongoing treatment of the participant. Randomisation errors are almost inevitable and should be reported in trial publications. The

  18. Review of LCA studies of solid waste management systems – Part II: Methodological guidance for a better practice

    Energy Technology Data Exchange (ETDEWEB)

    Laurent, Alexis, E-mail: alau@dtu.dk [Division for Quantitative Sustainability Assessment, Department of Management Engineering, Technical University of Denmark, 2800 Kgs. Lyngby (Denmark); Clavreul, Julie [Residual Resources Engineering, Department of Environmental Engineering, Technical University of Denmark, 2800 Kgs. Lyngby (Denmark); Bernstad, Anna [Water and Environmental Engineering, Department of Chemical Engineering, Lund University, 221 00 Lund (Sweden); Bakas, Ioannis [Division for Quantitative Sustainability Assessment, Department of Management Engineering, Technical University of Denmark, 2800 Kgs. Lyngby (Denmark); Niero, Monia [Division for Quantitative Sustainability Assessment, Department of Management Engineering, Technical University of Denmark, 2800 Kgs. Lyngby (Denmark); ECO – Ecosystems and Environmental Sustainability, Department of Chemical and Biochemical Engineering, Technical University of Denmark, 4000 Roskilde (Denmark); Gentil, Emmanuel [Copenhagen Resource Institute, 1215 Copenhagen K (Denmark); Christensen, Thomas H. [Residual Resources Engineering, Department of Environmental Engineering, Technical University of Denmark, 2800 Kgs. Lyngby (Denmark); Hauschild, Michael Z. [Division for Quantitative Sustainability Assessment, Department of Management Engineering, Technical University of Denmark, 2800 Kgs. Lyngby (Denmark)

    2014-03-01

    Highlights: • We perform a critical review of 222 LCA studies of solid waste management systems. • We analyse the past LCA practice against the ISO standard and ILCD Handbook guidance. • Malpractices exist in many methodological aspects with large variations among studies. • Many of these aspects are important for the reliability of the results. • We provide detailed recommendations to practitioners of waste management LCAs. - Abstract: Life cycle assessment (LCA) is increasingly used in waste management to identify strategies that prevent or minimise negative impacts on ecosystems, human health or natural resources. However, the quality of the provided support to decision- and policy-makers is strongly dependent on a proper conduct of the LCA. How has LCA been applied until now? Are there any inconsistencies in the past practice? To answer these questions, we draw on a critical review of 222 published LCA studies of solid waste management systems. We analyse the past practice against the ISO standard requirements and the ILCD Handbook guidelines for each major step within the goal definition, scope definition, inventory analysis, impact assessment, and interpretation phases of the methodology. Results show that malpractices exist in several aspects of the LCA with large differences across studies. Examples are a frequent neglect of the goal definition, a frequent lack of transparency and precision in the definition of the scope of the study, e.g. an unclear delimitation of the system boundaries, a truncated impact coverage, difficulties in capturing influential local specificities such as representative waste compositions into the inventory, and a frequent lack of essential sensitivity and uncertainty analyses. Many of these aspects are important for the reliability of the results. For each of them, we therefore provide detailed recommendations to practitioners of waste management LCAs.

  19. Best clinical practice guidance for local analgesia in paediatric dentistry: an EAPD policy document.

    Science.gov (United States)

    Kühnisch, J; Daubländer, M; Klingberg, G; Dougall, A; Spyridonos Loizides, M; Stratigaki, E; Amar, J L; Anttonen, V; Duggal, M; Gizani, S

    2017-10-01

    The European Academy of Paediatric Dentistry (EAPD) proposes this best-practice guidance to help practitioners to decide when and how to use local analgesia to control pain in children, adolescents, and medically compromised individuals during the delivery of oral health care. A search of different databases was conducted using all terms relevant to the subject. Relevant papers were identified after a review of their titles, abstracts or full papers. Three workshops were held during the corresponding EAPD interim seminar in Torino (Italy) in 2017. Several statements were agreed upon and, furthermore, knowledge gaps were identified. An important outcome was that when local analgesia administered appropriately-correct choice of agent(s) and dosage, proper route of administration-it is, firstly, clinically effective for pain-control in treating children and, secondly, it carries a very low risk of morbidity including adverse or side-effects. Furthermore, several gaps in knowledge were identified during the workshop which indicates future research needs. Most importantly it remains unsatisfactory that in several European countries the most frequently used injectable local analgesic agent, articaine, is not approved for usage in children below the age of 4 years. When considering the dental demand to treat vulnerable (medically compromised) children and adolescents in a safe, painless, less-invasive and effective way, there seems to be an urgent need to close these gaps in knowledge.

  20. Providing guidance for genomics-based cancer treatment decisions: insights from stakeholder engagement for post-prostatectomy radiation therapy.

    Science.gov (United States)

    Abe, James; Lobo, Jennifer M; Trifiletti, Daniel M; Showalter, Timothy N

    2017-08-24

    aid program, based upon Markov modeling with individualized model inputs, to provide a patient-centered framework to support for genomic-based treatment decisions for cancer patients. The guidance provided by our stakeholders may be broadly applicable to the communication of genomic test results to patients in a patient-centered fashion that supports effective shared decision-making that represents a spectrum of personal factors such as age, medical comorbidities, and individual priorities and values.

  1. Provider attitudes and practice patterns of obesity management with pharmacotherapy.

    Science.gov (United States)

    Granara, Brittany; Laurent, Jennifer

    2017-09-01

    More than one third of American adults are obese. Extreme obesity is rapidly rising. Nine medications are approved for weight loss yet they remain underutilized with the focus primarily on lifestyle modifications. The objective was to determine current prescribing patterns and attitudes of weight loss medications in the management of obesity among primary care providers (PCPs). PCPs were surveyed to determine practice patterns, attitudes, barriers, and facilitators for prescribing weight loss medications. Ninety-four surveys were analyzed. Seventy-six percent of all PCPs did not prescribe weight loss medications for long-term weight loss and 58% of PCPs had negative perceptions of pharmacotherapy. Differences existed between prescribing patterns and attitudes of advanced practice clinicians and physicians. Safety concerns were the greatest barrier. Having 2+ comorbidities and severe obesity were facilitators for prescribing weight loss medications. Underutilization of pharmacotherapy suggests that PCPs may not have sufficient knowledge about medication safety profiles and efficacy. Delaying treatment until patients have reached a high level of morbidity may be less efficacious than earlier treatment. Education regarding effectiveness and risks of weight loss medications for obesity management is needed and earlier interventions with pharmacotherapy may prevent significant morbidity and mortality. ©2017 American Association of Nurse Practitioners.

  2. Guidance on a better integration of aquaculture, fisheries, and other activities in the coastal zone: from tools to practical examples

    NARCIS (Netherlands)

    Stelzenmüller, V.; Schulze, T.; Gimpel, A.; Bartelings, H.; Bello, E.; Bergh, O.; Bolman, B.; Caetano, M.; Davaasuren, N.; Fabi, G.; Ferreira, J.G.; Gault, J.; Gramolini, R.; Grati, F.; Hamon, K.G.; Jak, R.G.; Kopke, K.; Laurans, M.; Mäkinen, T.; O’Donnell, V.; O’Hagan, A.M.; O’Mahony, C.; Oostenbrugge, van H.; Ramos, J.; Saurel, C.; Sell, A.L.; Silvo, K.; Sinschek, K.; Soma, K.; Stenberg, C.; Taylor, N.; Vale, C.; Vasquez, F.; Verner-Jeffreys, D.W.

    2013-01-01

    This guidance document provides a comprehensive assessment of the conflicts and synergies between fisheries, aquaculture and other activities in the coastal zone in six COEXIST case study areas. It forms deliverable D5.2 of the COEXIST project and synthesises deliverable D5.1, which provides a more

  3. The nursing implications of routine provider-initiated HIV testing and counselling in sub-Saharan Africa: a critical review of new policy guidance from WHO/UNAIDS.

    Science.gov (United States)

    Evans, Catrin; Ndirangu, Eunice

    2009-05-01

    In 2007 WHO/UNAIDS issued new HIV testing guidelines recommending 'provider-initiated HIV testing and counselling' (PITC). In contrast to existing 'voluntary counselling and testing' guidelines (whereby individuals self refer for testing), the PITC guidance recommends that, in countries with generalised epidemics, all patients are routinely offered an HIV test during clinical encounters. In sub-Saharan Africa, PITC aims to dramatically increase HIV testing rates so that PITC becomes a vehicle to increase access to HIV prevention and care. Nurses in this region work on the frontlines of HIV testing but have been neglected in related policy development. To provide an overview of the PITC policy guidance and to critically consider its implications for the nursing profession in sub-Saharan Africa. Policy documents and published and unpublished research were identified from organisational websites, electronic databases and conference proceedings. PITC has generated widespread debate about whether it is the right approach in a context of HIV-related stigma and lack of human/material resources. Key concerns are whether/how informed consent, privacy and confidentiality will be upheld in overstretched health care settings, and whether appropriate post-test counselling, treatment and support can be provided. Limited available evidence suggests that health systems factors and organisational/professional culture may create obstacles to effective PITC implementation. Specific findings are that: PITC greatly increases nurses' workload and work-related stress. Nurses are generally positive about PITC, but express the need for more training and managerial support. Health system constraints (lack of staff, lack of space) mean that nurses do not always have time to provide adequate counselling. A hierarchical and didactic nursing culture affects counselling quality and the boundaries between voluntary informed consent and coercion can become rather blurred. Nurses are particularly

  4. Impact of quality assurance program: providing practice assessment.

    Science.gov (United States)

    Saporito, R A; Feldman, C A; Stewart, D C; Echoldt, H; Buchanan, R N

    1994-05-01

    Participation in a self-administered quality assessment (SAQA) program led to changes in New Jersey dentists' perceptions of practice quality. Ninety-four percent indicated they discovered practice deficiencies. This study suggests that using a self-administered quality assessment program, such as the SAQA program, can lead to a better understanding of a practice's strengths and weaknesses.

  5. 77 FR 9945 - Draft Guidance for Industry on Providing Submissions in Electronic Format-Standardized Study Data...

    Science.gov (United States)

    2012-02-21

    ... current thinking on the submission of study data in a standard electronic format. The draft guidance... current thinking on submitting standardized study data in electronic format. It does not create or confer... Electronic Format--Standardized Study Data; Availability AGENCY: Food and Drug Administration, HHS. ACTION...

  6. Good Clinical Practice Guidance and Pragmatic Clinical Trials: Balancing the Best of Both Worlds

    OpenAIRE

    Mentz, Robert J.; Hernandez, Adrian F.; Berdan, Lisa G.; Rorick, Tyrus; O?Brien, Emily C.; Ibarra, Jenny C.; Curtis, Lesley H.; Peterson, Eric D.

    2016-01-01

    Randomized clinical trials are commonly regarded as the highest level of evidence to support clinical decisions. Good Clinical Practice (GCP) guidelines have been constructed to provide an ethical and scientific quality standard for trials that involve human subjects in a manner aligned with the Declaration of Helsinki. Originally designed to provide a unified standard of trial data to support submission to regulatory authorities, the principles may also be applied to other studies of human s...

  7. Practical guidance on characterizing availability in resource selection functions under a use-availability design.

    Science.gov (United States)

    Northrup, Joseph M; Hooten, Mevin B; Anderson, Charles R; Wittemyer, George

    2013-07-01

    Habitat selection is a fundamental aspect of animal ecology, the understanding of which is critical to management and conservation. Global positioning system data from animals allow fine-scale assessments of habitat selection and typically are analyzed in a use availability framework, whereby animal locations are contrasted with random locations (the availability sample). Although most use-availability methods are in fact spatial point process models, they often are fit using logistic regression. This framework offers numerous methodological challenges, for which the literature provides little guidance. Specifically, the size and spatial extent of the availability sample influences coefficient estimates potentially causing interpretational bias. We examined the influence of availability on statistical inference through simulations and analysis of serially correlated mule deer GPS data. Bias in estimates arose from incorrectly assessing and sampling the spatial extent of availability. Spatial autocorrelation in covariates, which is common for landscape characteristics, exacerbated the error in availability sampling leading to increased bias. These results have strong implications for habitat selection analyses using GPS data, which are increasingly prevalent in the literature. We recommend that researchers assess the sensitivity of their results to their availability sample and, where bias is likely, take care with interpretations and use cross validation to assess robustness.

  8. Climate Risk Informed Decision Analysis (CRIDA): A novel practical guidance for Climate Resilient Investments and Planning

    Science.gov (United States)

    Jeuken, Ad; Mendoza, Guillermo; Matthews, John; Ray, Patrick; Haasnoot, Marjolijn; Gilroy, Kristin; Olsen, Rolf; Kucharski, John; Stakhiv, Gene; Cushing, Janet; Brown, Casey

    2016-04-01

    over time. They are part of the Dutch adaptive planning approach Adaptive Delta Management, executed and develop by the Dutch Delta program. Both decision scaling and adaptation pathways have been piloted in studies worldwide. The objective of CRIDA is to mainstream effective climate adaptation for professional water managers. The CRIDA publication, due in april 2016, follows the generic water design planning design cycle. At each step, CRIDA describes stepwise guidance for incorporating climate robustness: problem definition, stress test, alternatives formulation and recommendation, evaluation and selection. In the presentation the origin, goal, steps and practical tools available at each step of CRIDA will be explained. In two other abstracts ("Climate Risk Informed Decision Analysis: A Hypothetical Application to the Waas Region" by Gilroy et al., "The Application of Climate Risk Informed Decision Analysis to the Ioland Water Treatment Plant in Lusaka, Zambia, by Kucharski et al.), the application of CRIDA to cases is explained

  9. Conversion between noise exposure indicators Leq24h, LDay, LEvening, LNight, Ldn and Lden: Principles and practical guidance.

    Science.gov (United States)

    Brink, Mark; Schäffer, Beat; Pieren, Reto; Wunderli, Jean Marc

    2017-10-09

    This article presents empirically derived conversion rules between the environmental noise exposure metrics Leq24h, LDay, LEvening, LNight, Ldn, and Lden for the noise sources road, rail and air traffic. It caters to researchers that need to estimate the value of one (unknown) noise metric from the value of another (known) metric, e.g. in the scope of epidemiological meta-analyses or systematic reviews, when results from different studies are pooled and need to be related to one common exposure metric. Conversion terms are derived using two empirical methods a) based on analyzing the diurnal variation of traffic, and b) by analyzing differences between calculated noise exposure metrics. For a) we collected and analyzed diurnal traffic share data from European and US airports as well as data on the diurnal variation of traffic from roads in several European countries and from railway lines in Switzerland which were derived from counting stations and official records. For b) we calculated differences between noise metrics in over 50'000 stratified randomly sampled dwellings in Switzerland. As a result of this exercise, conversion terms, including uncertainty estimates, are systematically tabulated for all variants of the target metrics. Guidance as to the practical applicability of the proposed conversions in different contexts is provided, and limitations of their use are discussed. Copyright © 2017 Elsevier GmbH. All rights reserved.

  10. The Indian consensus guidance on stroke prevention in atrial fibrillation: An emphasis on practical use of nonvitamin K oral anticoagulants

    Directory of Open Access Journals (Sweden)

    Jamshed Dalal

    2015-12-01

    Full Text Available The last ten years have seen rapid strides in the evolution of nonvitamin K oral anticoagulants (NOACs for stroke prevention in patients with atrial fibrillation (AF. For the preparation of this consensus, a comprehensive literature search was performed and data on available trials, subpopulation analyses, and case reports were analyzed. This Indian consensus document intends to provide guidance on selecting the right NOAC for the right patients by formulating expert opinions based on the available trials and Asian/Indian subpopulation analyses of these trials. A section has been dedicated to the current evidence of NOACs in the Asian population. Practical suggestions have been formulated in the following clinical situations: (i Dose recommendations of the NOACs in different clinical scenarios; (ii NOACs in patients with rheumatic heart disease (RHD; (iii Monitoring anticoagulant effect of the NOACs; (iv Overdose of NOACs; (v Antidotes to NOACs; (vi Treatment of hypertrophic cardiomyopathy (HCM with AF using NOACs; (vii NOACs dose in elderly, (viii Switching between NOACs and vitamin K antagonists (VKA; (ix Cardioversion or ablation in NOAC-treated patients; (x Planned/emergency surgical interventions in patients currently on NOACs; (xi Management of bleeding complications of NOACs; (xii Management of acute coronary syndrome (ACS in AF with NOACs; (xiii Management of acute ischemic stroke while on NOACs.

  11. What is a good health check? An interview study of health check providers' views and practices.

    Science.gov (United States)

    Stol, Yrrah H; Asscher, Eva C A; Schermer, Maartje H N

    2017-10-02

    Health checks identify (risk factors for) disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as 'personal health checks'. Health check providers' perspective of 'good' health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks. In 2015, we interviewed twenty Dutch health check providers on criteria for 'good' health checks, and the role these criteria play in their practices. Providers unanimously formulate a number of minimal criteria: Checks must focus on (risk factors for) treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of (potential) users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any (risk factor for) disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources. Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the (Dutch) organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice. According to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health

  12. Good Clinical Practice Guidance and Pragmatic Clinical Trials: Balancing the Best of Both Worlds.

    Science.gov (United States)

    Mentz, Robert J; Hernandez, Adrian F; Berdan, Lisa G; Rorick, Tyrus; O'Brien, Emily C; Ibarra, Jenny C; Curtis, Lesley H; Peterson, Eric D

    2016-03-01

    Randomized, clinical trials are commonly regarded as the highest level of evidence to support clinical decisions. Good Clinical Practice guidelines have been constructed to provide an ethical and scientific quality standard for trials that involve human subjects in a manner aligned with the Declaration of Helsinki. Originally designed to provide a unified standard of trial data to support submission to regulatory authorities, the principles may also be applied to other studies of human subjects. Although the application of Good Clinical Practice principles generally led to improvements in the quality and consistency of trial operations, these principles have also contributed to increasing trial complexity and costs. Alternatively, the growing availability of electronic health record data has facilitated the possibility for streamlined pragmatic clinical trials. The central tenets of Good Clinical Practice and pragmatic clinical trials represent potential tensions in trial design (stringent quality and highly efficient operations). In the present article, we highlight potential areas of discordance between Good Clinical Practice guidelines and the principles of pragmatic clinical trials and suggest strategies to streamline study conduct in an ethical manner to optimally perform clinical trials in the electronic age. © 2016 American Heart Association, Inc.

  13. Nursing students' practice in providing oral hygiene for patients.

    Science.gov (United States)

    McAuliffe, Ann

    To explore and identify precedent factors that may influence nursing students' oral hygiene practice in hospitalised patients, by using an adaptation of the Precede Model. A quantitative approach with a descriptive design was adopted in this pilot study. A questionnaire was designed and implemented as a self-report method of data collection. A convenience sample of 37 second-year diploma nursing students in an Irish teaching hospital participated in the study. The clinical area and the practices within it are influential factors in the provision of oral hygiene. Students are exposed to and influenced by outdated and non-research-based practices. Role modelling is an effective means of motivating and reinforcing student practices. However, qualified nurses' practices need to be critically reviewed before assuming that they can act as role models in assisting students to implement research-based oral hygiene. Formal education, current practices, socialisation and role modelling may influence students' behaviour in relation to oral hygiene. The results should be tentatively reviewed by clinical staff as an indication of current practices.

  14. The use of theory in research on nutrition guidance practices by primary care physicians from 1995 to Oct 2008: A review

    NARCIS (Netherlands)

    Hooft Van Huysduynen, E.J.C.; Hiddink, G.J.; Woerkum, van C.M.J.

    2012-01-01

    Background - Theory-based interventions on nutrition guidance practices of primary care physicians (PCPs) are thought to be more effective than those that do not use theory. Objective - To assess how often and which theoretical models of behaviour change are used in research on nutrition guidance

  15. Evidence, Policy and Guidance for Practice: A Critical Reflection on the Case of Social Housing Landlords and Antisocial Behaviour in Scotland

    Science.gov (United States)

    Anderson, Isobel

    2011-01-01

    This paper examines the role of guidance for practitioners in the evidence-policy-practice relationship through a critical reflection of the process of developing evidence-informed guidance for housing practitioners working in the area of antisocial behaviour in Scotland. The paper applies theoretical models for the use of evidence in policy and…

  16. Practical guidance and considerations for transitioning patients from oxcarbazepine or carbamazepine to eslicarbazepine acetate--Expert opinion.

    Science.gov (United States)

    Peltola, Jukka; Holtkamp, Martin; Rocamora, Rodrigo; Ryvlin, Philippe; Sieradzan, Kasia; Villanueva, Vicente

    2015-09-01

    There is currently a lack of guidance on methodology and special considerations for transitioning patients from oxcarbazepine (OXC) or carbamazepine (CBZ) to eslicarbazepine acetate (ESL), if deemed clinically necessary. An advisory panel of epilepsy experts was convened to share their experience on the use of adjunctive ESL in clinical practice and to provide practical recommendations to help address this gap. When changing over from OXC to ESL, an OXC:ESL dose ratio of 1:1 should be employed to calculate the ESL target dose, and the changeover can take place overnight. No changes to comedication are required. Since CBZ has a different mechanism of action to ESL and is a stronger inducer of cytochrome P450 (CYP) enzymes, the transitioning of patients from CBZ to ESL requires careful consideration on a patient-by-patient basis. In general, a CBZ:ESL dose ratio of 1:1.3 should be employed to calculate the ESL target dose, and patients should be transitioned over a minimum period of 1-2weeks. Special considerations include adjustment of titration schedule and target dose in elderly patients and those with hepatic or renal impairment and potential adjustment of comedications metabolized by CYP enzymes. In summary, due to structural distinctions between ESL, OXC, and CBZ, which affect mechanism of action and tolerability, there are clinical situations in which it may be appropriate to consider transitioning patients from OXC or CBZ to ESL. Changing patients over from OXC to ESL is generally more straightforward than transitioning patients from CBZ to ESL, which requires careful consideration. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Best Practices in Physics Program Assessment: Should APS Provide Accreditation Standards for Physics?

    Science.gov (United States)

    Hodapp, Theodore

    The Phys21 report, ``Preparing Physics Students for 21st Century Careers,'' provides guidance for physics programs to improve their degree programs to make them more relevant for student career choices. Undertaking such changes and assessing impact varies widely by institution, with many departments inventing assessments with each periodic departmental or programmatic review. American Physical Society has embarked on a process to integrate information from Phys21, the results of other national studies, and educational research outcomes to generate a best-practices guide to help physics departments conduct program review, assessment, and improvement. It is anticipated that departments will be able to use this document to help with their role in university-level accreditation, and in making the case for improvements to departmental programs. Accreditation of physics programs could stem from such a document, and I will discuss some of the thinking of the APS Committee on Education in creating this guide, and how they are advising APS to move forward in the higher education landscape that is increasingly subject to standards-based evaluations. I will describe plans for the design, review, and dissemination of this guide, and how faculty can provide input into its development. This material is based upon work supported by the National Science Foundation under Grant No. 1540570. Opinions expressed do not necessarily reflect those of the NSF.

  18. Utilization of nondentist providers and attitudes toward new provider models: findings from the National Dental Practice-Based Research Network.

    Science.gov (United States)

    Blue, Christine M; Funkhouser, D Ellen; Riggs, Sheila; Rindal, D Brad; Worley, Donald; Pihlstrom, Daniel J; Benjamin, Paul; Gilbert, Gregg H

    2013-01-01

    The purpose of this study was to quantify, within the National Dental Practice-Based Research Network, current utilization of dental hygienists and assistants with expanded functions and quantify network dentists' attitudes toward a new nondentist provider model - the dental therapist. National Dental Practice-Based Research Network practitioner-investigators participated in a single, cross-sectional administration of a questionnaire. Current nondentist providers are not being utilized by network practitioner-investigators to the fullest extent allowed by law. Minnesota practitioners, practitioners in large group practices, and those with prior experience with expanded-function nondentist providers delegate at a higher rate and had more-positive perceptions of the new dental therapist model. Expanding scopes of practice for dental hygienists and assistants has not translated to the maximal delegation allowed by law among network practices. This finding may provide insight into dentists' acceptance of newer nondentist provider models. © 2013 American Association of Public Health Dentistry.

  19. Engagement and guidance: The effects of maternal parenting practices on children's development

    NARCIS (Netherlands)

    Tramonte, L.; Gauthier, A.H.; Willms, D.

    2015-01-01

    Problems with inattention, physical aggression, and poor cognitive skills when children enter school can have long-term negative effects on their development. In this study, we address the issues of whether and how parental engagement and guidance are related to children’s behavioral and cognitive

  20. Environmental Compliance and Best Management Practices: Guidance Manual for K-12 Schools

    Science.gov (United States)

    US Environmental Protection Agency, 2006

    2006-01-01

    This user-friendly guidance manual is organized by the "target audience" or "end user." First, the manual introduces a "Typical School," which is a school organized in such a way that it represents how many schools in the real world are organized. This Typical School is subdivided into "Organizational Units"…

  1. Determinants of Dutch general practitioners’ nutrition and physical activity guidance practices

    NARCIS (Netherlands)

    Hiddink, G.J.; Woerkum, van C.M.J.; Dillen, van S.M.E.

    2013-01-01

    Objective General practitioners (GP) are uniquely placed to guide their patients on nutrition and physical activity. The aims of the present study were to assess: (i) the extent to which GP guide on nutrition and physical activity; (ii) the determinants that cause GP to give guidance on nutrition

  2. Best clinical practice guidance for management of early caries lesions in children and young adults: an EAPD policy document.

    Science.gov (United States)

    Kühnisch, J; Ekstrand, K R; Pretty, I; Twetman, S; van Loveren, C; Gizani, S; Spyridonos Loizidou, M

    2016-02-01

    The European Academy of Paediatric Dentistry (EAPD) encourages prevention and arrest of active dental caries. Therefore, the present guidance provides evidence- and clinically-based recommendations for detecting and diagnosing early/non-cavitated caries lesions, risk assessment and disease management. A search of different databases was conducted using all terms related to the subject. Relevant papers were identified after a review of their titles, abstracts or full texts. Three workshops were held during the corresponding EAPD interim seminar in Brussels in 2015. Several statements were agreed upon and, furthermore, gaps in our knowledge were identified. Following the systematic reviews and outcomes of the seminars, it was concluded that visual and radiographic caries detection should be utilised as a basic diagnostic approach to locate, assess and monitor non-cavitated caries lesions in primary and permanent teeth. As another important evaluation step, a caries risk assessment should be performed at a child's first dental visit, and reassessments should be performed on a regular basis. It is widely accepted that non-cavitated caries lesions can be managed non-invasively in the majority of cases. The spectrum of measures includes a low cariogenicity tooth-friendly diet, daily and appropriate management of the biofilm, home and within the dental office/surgery usage of fluorides as well as sealing techniques. The detection and management of non-cavitated caries is an essential aspect of preventive dentistry. Therefore, the EAPD encourages oral health care providers and caregivers to implement preventive practices that can arrest early caries and improve individual and public dental health.

  3. Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure--United States, 2016.

    Science.gov (United States)

    Petersen, Emily E; Polen, Kara N D; Meaney-Delman, Dana; Ellington, Sascha R; Oduyebo, Titilope; Cohn, Amanda; Oster, Alexandra M; Russell, Kate; Kawwass, Jennifer F; Karwowski, Mateusz P; Powers, Ann M; Bertolli, Jeanne; Brooks, John T; Kissin, Dmitry; Villanueva, Julie; Muñoz-Jordan, Jorge; Kuehnert, Matthew; Olson, Christine K; Honein, Margaret A; Rivera, Maria; Jamieson, Denise J; Rasmussen, Sonja A

    2016-04-01

    CDC has updated its interim guidance for U.S. health care providers caring for women of reproductive age with possible Zika virus exposure to include recommendations on counseling women and men with possible Zika virus exposure who are interested in conceiving. This guidance is based on limited available data on persistence of Zika virus RNA in blood and semen. Women who have Zika virus disease should wait at least 8 weeks after symptom onset to attempt conception, and men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to Zika virus but without clinical illness consistent with Zika virus disease should wait at least 8 weeks after exposure to attempt conception. Possible exposure to Zika virus is defined as travel to or residence in an area of active Zika virus transmission ( http://www.cdc.gov/zika/geo/active-countries.html), or sex (vaginal intercourse, anal intercourse, or fellatio) without a condom with a man who traveled to or resided in an area of active transmission. Women and men who reside in areas of active Zika virus transmission should talk with their health care provider about attempting conception. This guidance also provides updated recommendations on testing of pregnant women with possible Zika virus exposure. These recommendations will be updated when additional data become available.

  4. Interprofessional Oral Health Education Improves Knowledge, Confidence, and Practice for Pediatric Healthcare Providers.

    Science.gov (United States)

    Cooper, Devon; Kim, JungSoo; Duderstadt, Karen; Stewart, Ray; Lin, Brent; Alkon, Abbey

    2017-01-01

    Dental caries is the most prevalent chronic childhood disease in the United States. Dental caries affects the health of 60-90% of school-aged children worldwide. The prevalence of untreated early childhood dental caries is 19% for children 2-5 years of age in the U.S. Some factors that contribute to the progression of dental caries include socioeconomic status, access to dental care, and lack of anticipatory guidance. The prevalence of dental caries remains highest for children from specific ethnic or racial groups, especially those living in underserved areas where there may be limited access to a dentist. Although researchers have acknowledged the various links between oral health and overall systemic health, oral health care is not usually a component of pediatric primary health care. To address this public health crisis and oral health disparity in children, new collaborative efforts among health professionals is critical for dental disease prevention and optimal oral health. This evaluation study focused on a 10-week interprofessional practice and education (IPE) course on children's oral health involving dental, osteopathic medical, and nurse practitioner students at the University of California, San Francisco. This study's objective was to evaluate changes in knowledge, confidence, attitude, and clinical practice in children's oral health of the students completed the course. Thirty-one students participated in the IPE and completed demographic questionnaires and four questionnaires before and after the IPE course: (1) course content knowledge, (2) confidence, (3) attitudes, and (4) clinical practice. Results showed a statistically significant improvement in the overall knowledge of children's oral health topics, confidence in their ability to provide oral health services, and clinical practice. There was no statistically significant difference in attitude, but there was an upward trend toward positivity. To conclude, this IPE evaluation showed that

  5. Interprofessional Oral Health Education Improves Knowledge, Confidence, and Practice for Pediatric Healthcare Providers

    Directory of Open Access Journals (Sweden)

    Devon Cooper

    2017-08-01

    Full Text Available Dental caries is the most prevalent chronic childhood disease in the United States. Dental caries affects the health of 60–90% of school-aged children worldwide. The prevalence of untreated early childhood dental caries is 19% for children 2–5 years of age in the U.S. Some factors that contribute to the progression of dental caries include socioeconomic status, access to dental care, and lack of anticipatory guidance. The prevalence of dental caries remains highest for children from specific ethnic or racial groups, especially those living in underserved areas where there may be limited access to a dentist. Although researchers have acknowledged the various links between oral health and overall systemic health, oral health care is not usually a component of pediatric primary health care. To address this public health crisis and oral health disparity in children, new collaborative efforts among health professionals is critical for dental disease prevention and optimal oral health. This evaluation study focused on a 10-week interprofessional practice and education (IPE course on children’s oral health involving dental, osteopathic medical, and nurse practitioner students at the University of California, San Francisco. This study’s objective was to evaluate changes in knowledge, confidence, attitude, and clinical practice in children’s oral health of the students completed the course. Thirty-one students participated in the IPE and completed demographic questionnaires and four questionnaires before and after the IPE course: (1 course content knowledge, (2 confidence, (3 attitudes, and (4 clinical practice. Results showed a statistically significant improvement in the overall knowledge of children’s oral health topics, confidence in their ability to provide oral health services, and clinical practice. There was no statistically significant difference in attitude, but there was an upward trend toward positivity. To conclude, this IPE

  6. Career guidance in communities

    DEFF Research Database (Denmark)

    Thomsen, Rie

    from a critical psychological standpoint the paper introduces a social practice theory of career guidance. The social practice theory of career guidance argues that career guidance can be seen as a collective practice in which people can join forces with career guidance practitioners to analyse...... their situation and based on these insights create new opportunities in relation to their future educational or vocational participation in society (Thomsen 2012). From this idea, the second part of the paper the paper moves on to consider the practical implications of taking the collective as the starting point...

  7. Educating advanced practice nurses for collaborative practice in the multidisciplinary provider team.

    Science.gov (United States)

    Spain, Margaret P; DeCristofaro, Claire; Smith, Carol A

    2004-12-01

    To describe the use of a clinical decision-making work sheet as a tool to teach communication skills to advanced practice nurse (APN) students. Achievement of competencies in communication and documentation that utilize language and communication strategies that are shared with other health professionals promotes effective collaborative practice among members of the multidisciplinary provider team. Review of the recent Institute of Medicine report on health professions education and other health professional literature. The Clinical Decision-Making Work Sheet helps APN students effectively communicate in real-world clinical settings. The clinical work sheet allows nurse practitioner students to communicate more effectively and efficiently, using a vocabulary that is shared with other members of the multidisciplinary health care provider team. Use of the tool in students' clinical-rotation settings facilitates effective application and refinement of the clinical decision-making skills that students learned in the advanced health assessment course. Faculty have the responsibility to assist nurses as they transition from traditional nursing to APN roles. The work sheet facilitates learning the common language for data collection, clinical decision making, documentation, and reporting that is shared with other health professionals. Using the tool, students learn to efficiently organize information that supports communication and documentation that enhances their clinical problem-solving skills. Case presentation and documentation using the work sheet provide a basis for preceptor and student interaction and for student evaluation.

  8. Primary care providers' knowledge, practices, and perceived barriers to the treatment and prevention of childhood obesity.

    Science.gov (United States)

    Spivack, Jordan G; Swietlik, Maggie; Alessandrini, Evaline; Faith, Myles S

    2010-07-01

    This study evaluated primary care providers' (PCPs, pediatricians, and nurse practitioners) knowledge, current practices, and perceived barriers to childhood obesity prevention and treatment, with an emphasis on first-year well-child care visits. A questionnaire was distributed to 192 PCPs in the primary care network at The Children's Hospital of Philadelphia (CHOP) addressing (i) knowledge of obesity and American Academy of Pediatrics (AAP) guidelines, (ii) anticipatory guidance practices at well visits regarding nutrition and exercise, and (iii) perceived barriers to childhood obesity treatment and prevention. Eighty pediatricians and seven nurse practitioners responded, and a minority correctly identified the definition (26%) and prevalence (9%) of childhood overweight and AAP guidelines for exercise (39%) and juice consumption (44%). Most PCPs (81%) spent 11-20 min per well visit during the first 2 years, and 79% discussed diet, nutrition, and exercise for > or =3 min. Although >95% of PCPs discussed juice, fruits and vegetables, sippy cups, and finger foods during the first year, over 35% never discussed fast food, TV, or candy, and 55% never discussed exercise. Few rated current resources as adequate to treat or prevent childhood obesity. Over 90% rated the following barriers for obesity prevention and treatment as important or very important: parent is not motivated, child is not motivated, parents are overweight, families often have fast food, watch too much TV, and do not get enough exercise. In conclusion, there is much room to improve PCPs' knowledge of obesity and AAP guidelines. Although PCPs rate fast-food consumption, TV viewing, and lack of exercise as important treatment barriers, many never discussed these topics during the first year.

  9. An investigation into e-learning practices: Implications for providers ...

    African Journals Online (AJOL)

    The last decade has seen a considerable growth in the application of e-learning courses in most higher education institutions and in companies that provide inhouse training for employees. Hereby recognition is given that modern information and telecommunication technologies can help educators to meet the dual

  10. 75 FR 18514 - Developing Guidance on Naming, Labeling, and Packaging Practices to Reduce Medication Errors...

    Science.gov (United States)

    2010-04-12

    ... Practices to Reduce Medication Errors; Public Workshop; Request for Comments AGENCY: Food and Drug... Packaging Practices to Reduce Medication Errors.'' The purpose of the public workshop is to initiate... practices to develop proprietary names to reduce medication errors. The input from this workshop will be...

  11. 75 FR 33629 - Developing Guidance on Naming, Labeling, and Packaging Practices to Reduce Medication Errors...

    Science.gov (United States)

    2010-06-14

    ... Practices to Reduce Medication Errors; Public Workshop; Change of Meeting Location AGENCY: Food and Drug... Practices to Reduce Medication Errors.'' A new address is given for those attending the workshop. DATES: The... on describing practices for naming, labeling, and packaging drugs and biologics to reduce medication...

  12. Career guidance on the move

    DEFF Research Database (Denmark)

    Thomsen, Rie

    2013-01-01

    This article is about how the notion of place can be used in an analysis of career guidance practices and their development. It is about how a focus on the context of career guidance can develop an awareness of the place where guidance is practiced and support the development of career guidance...... in new places. In this article I introduce an analytical perspective on place; I give the example of the guidance café a practice development that took place into serious consideration because it was an attempt to develop career guidance practice through relocating it....

  13. Federal Guidance for Radiation Protection

    Science.gov (United States)

    EPA produces federal guidance technical reports, which standardize dose and risk assessment and issues radiation protection guidance to federal agencies. This page provides links to federal guidance policy recommendations and technical reports.

  14. Hardware Implementation of a Spline-Based Genetic Algorithm for Embedded Stereo Vision Sensor Providing Real-Time Visual Guidance to the Visually Impaired

    Directory of Open Access Journals (Sweden)

    James K. Archibald

    2008-04-01

    Full Text Available Many image and signal processing techniques have been applied to medical and health care applications in recent years. In this paper, we present a robust signal processing approach that can be used to solve the correspondence problem for an embedded stereo vision sensor to provide real-time visual guidance to the visually impaired. This approach is based on our new one-dimensional (1D spline-based genetic algorithm to match signals. The algorithm processes image data lines as 1D signals to generate a dense disparity map, from which 3D information can be extracted. With recent advances in electronics technology, this 1D signal matching technique can be implemented and executed in parallel in hardware such as field-programmable gate arrays (FPGAs to provide real-time feedback about the environment to the user. In order to complement (not replace traditional aids for the visually impaired such as canes and Seeing Eyes dogs, vision systems that provide guidance to the visually impaired must be affordable, easy to use, compact, and free from attributes that are awkward or embarrassing to the user. “Seeing Eye Glasses,” an embedded stereo vision system utilizing our new algorithm, meets all these requirements.

  15. Hardware Implementation of a Spline-Based Genetic Algorithm for Embedded Stereo Vision Sensor Providing Real-Time Visual Guidance to the Visually Impaired

    Science.gov (United States)

    Lee, Dah-Jye; Anderson, Jonathan D.; Archibald, James K.

    2008-12-01

    Many image and signal processing techniques have been applied to medical and health care applications in recent years. In this paper, we present a robust signal processing approach that can be used to solve the correspondence problem for an embedded stereo vision sensor to provide real-time visual guidance to the visually impaired. This approach is based on our new one-dimensional (1D) spline-based genetic algorithm to match signals. The algorithm processes image data lines as 1D signals to generate a dense disparity map, from which 3D information can be extracted. With recent advances in electronics technology, this 1D signal matching technique can be implemented and executed in parallel in hardware such as field-programmable gate arrays (FPGAs) to provide real-time feedback about the environment to the user. In order to complement (not replace) traditional aids for the visually impaired such as canes and Seeing Eyes dogs, vision systems that provide guidance to the visually impaired must be affordable, easy to use, compact, and free from attributes that are awkward or embarrassing to the user. "Seeing Eye Glasses," an embedded stereo vision system utilizing our new algorithm, meets all these requirements.

  16. Internet guidance in oncology practice: determinants of health professionals' Internet referral behavior.

    Science.gov (United States)

    Emond, Yvette; de Groot, Jos; Wetzels, Wendy; van Osch, Liesbeth

    2013-01-01

    Many cancer patients turn to the Internet to obtain information on their disease. This digital quest is often motivated by a perceived discrepancy between the information received from health professionals and patients' actual informational needs. This discrepancy may be reduced by supplementing standard patient education with reliable online information sources. This study investigates health professionals' opinions, cognitions, and behavior regarding referring cancer patients to Internet-based information. Online and written questionnaires were distributed among Dutch oncology nurses and medical specialists, measuring perception of patients' informational needs, prompted and unprompted Internet referral, and socio-cognitive factors regarding referral behavior. Health professionals (N = 130) positively appraised Internet use among cancer patients. Despite recognizing patients' needs for additional information (84%) and need for referral to reliable websites (67%), only 20% frequently referred patients to Internet-based information. Prompted Internet referral was higher (64%). Motives for nonreferral included unfamiliarity with websites and uncertainty about information quality. Intentions towards future referral were moderate to high. To translate intentions into referral, health professionals need reminder tools and information on reliability and content of websites. Cognitive determinants of referral behavior included professionals' attitude, self-efficacy, and intentions regarding referral. Recognition of patients' information needs does not culminate in Internet referral among health professionals in cancer care. High intentions to change, however, indicate good prospects for future referral. This study yields valuable insights into behavioral determinants of health professionals' Internet referral behavior. Targeting determinants and barriers in future interventions will provide opportunities for optimization of educational practices. Copyright © 2011 John

  17. Information architecture. Volume 3: Guidance

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-04-01

    The purpose of this document, as presented in Volume 1, The Foundations, is to assist the Department of Energy (DOE) in developing and promulgating information architecture guidance. This guidance is aimed at increasing the development of information architecture as a Departmentwide management best practice. This document describes departmental information architecture principles and minimum design characteristics for systems and infrastructures within the DOE Information Architecture Conceptual Model, and establishes a Departmentwide standards-based architecture program. The publication of this document fulfills the commitment to address guiding principles, promote standard architectural practices, and provide technical guidance. This document guides the transition from the baseline or defacto Departmental architecture through approved information management program plans and budgets to the future vision architecture. This document also represents another major step toward establishing a well-organized, logical foundation for the DOE information architecture.

  18. Geospatial resources for supporting data standards, guidance and best practice in health informatics

    Directory of Open Access Journals (Sweden)

    Kamel Boulos Maged N

    2011-01-01

    Full Text Available Abstract Background The 1980s marked the occasion when Geographical Information System (GIS technology was broadly introduced into the geo-spatial community through the establishment of a strong GIS industry. This technology quickly disseminated across many countries, and has now become established as an important research, planning and commercial tool for a wider community that includes organisations in the public and private health sectors. The broad acceptance of GIS technology and the nature of its functionality have meant that numerous datasets have been created over the past three decades. Most of these datasets have been created independently, and without any structured documentation systems in place. However, search and retrieval systems can only work if there is a mechanism for datasets existence to be discovered and this is where proper metadata creation and management can greatly help. This situation must be addressed through support mechanisms such as Web-based portal technologies, metadata editor tools, automation, metadata standards and guidelines and collaborative efforts with relevant individuals and organisations. Engagement with data developers or administrators should also include a strategy of identifying the benefits associated with metadata creation and publication. Findings The establishment of numerous Spatial Data Infrastructures (SDIs, and other Internet resources, is a testament to the recognition of the importance of supporting good data management and sharing practices across the geographic information community. These resources extend to health informatics in support of research, public services and teaching and learning. This paper identifies many of these resources available to the UK academic health informatics community. It also reveals the reluctance of many spatial data creators across the wider UK academic community to use these resources to create and publish metadata, or deposit their data in repositories

  19. Geospatial resources for supporting data standards, guidance and best practice in health informatics.

    Science.gov (United States)

    Mathys, Tony; Kamel Boulos, Maged N

    2011-01-26

    The 1980s marked the occasion when Geographical Information System (GIS) technology was broadly introduced into the geo-spatial community through the establishment of a strong GIS industry. This technology quickly disseminated across many countries, and has now become established as an important research, planning and commercial tool for a wider community that includes organisations in the public and private health sectors.The broad acceptance of GIS technology and the nature of its functionality have meant that numerous datasets have been created over the past three decades. Most of these datasets have been created independently, and without any structured documentation systems in place. However, search and retrieval systems can only work if there is a mechanism for datasets existence to be discovered and this is where proper metadata creation and management can greatly help.This situation must be addressed through support mechanisms such as Web-based portal technologies, metadata editor tools, automation, metadata standards and guidelines and collaborative efforts with relevant individuals and organisations. Engagement with data developers or administrators should also include a strategy of identifying the benefits associated with metadata creation and publication. The establishment of numerous Spatial Data Infrastructures (SDIs), and other Internet resources, is a testament to the recognition of the importance of supporting good data management and sharing practices across the geographic information community. These resources extend to health informatics in support of research, public services and teaching and learning.This paper identifies many of these resources available to the UK academic health informatics community. It also reveals the reluctance of many spatial data creators across the wider UK academic community to use these resources to create and publish metadata, or deposit their data in repositories for sharing.The Go-Geo! service is introduced as an

  20. Prepared to practice? Perception of career preparation and guidance of recent medical graduates at two campuses of a transnational medical school: a cross-sectional study.

    OpenAIRE

    Kassim, Sameer S; McGowan, Yvonne; McGee, Hannah; Whitford, David L

    2016-01-01

    BACKGROUND: Graduating medical students enter the workforce with substantial medical knowledge and experience, yet little is known about how well they are prepared for the transition to medical practice in diverse settings. We set out to compare perceptions of medical school graduates' career guidance with their perceptions of preparedness to practice as interns. We also set out to compare perceptions of preparedness for hospital practice between graduates from two transnational medical schoo...

  1. Best Practices for Young Children's Music Education: Guidance from Brain Research

    Science.gov (United States)

    Flohr, John W.

    2010-01-01

    This article reviews best practices for young children's music experiences in light of developments in brain research. The first section reviews research music and brain topics including neuromyths, effect of music on structural brain changes and general intelligence, plasticity, critical and optimal periods, and at-risk student populations. The…

  2. 77 FR 56851 - Draft and Revised Draft Guidances for Industry Describing Product-Specific Bioequivalence...

    Science.gov (United States)

    2012-09-14

    ... HUMAN SERVICES Food and Drug Administration Draft and Revised Draft Guidances for Industry Describing... provide product-specific guidance on the design of BE studies to support abbreviated new drug applications... practices regulation (21 CFR 10.115). These guidances represent the Agency's current thinking on product...

  3. Practical guidance for the use of a pattern-matching technique in case-study research: a case presentation.

    Science.gov (United States)

    Almutairi, Adel F; Gardner, Glenn E; McCarthy, Alexandra

    2014-06-01

    This paper reports on a study that demonstrates how to apply pattern matching as an analytical method in case-study research. Case-study design is appropriate for the investigation of highly-contextualized phenomena that occur within the social world. Case-study design is considered a pragmatic approach that permits employment of multiple methods and data sources in order to attain a rich understanding of the phenomenon under investigation. The findings from such multiple methods can be reconciled in case-study analysis, specifically through a pattern-matching technique. Although this technique is theoretically explained in the literature, there is scant guidance on how to apply the method practically when analyzing data. This paper demonstrates the steps taken during pattern matching in a completed case-study project that investigated the influence of cultural diversity in a multicultural nursing workforce on the quality and safety of patient care. The example highlighted in this paper contributes to the practical understanding of the pattern-matching process, and can also make a substantial contribution to case-study methods. © 2013 Wiley Publishing Asia Pty Ltd.

  4. Guidance towards Best Practice in Psychophysical Procedures Used when Measuring Relative Spatial Brightness

    DEFF Research Database (Denmark)

    Fotios, Steve; Chan, A; Engelke, U

    This report reviews evidence for the procedures and other factors of experiments carried out to investigate relative spatial brightness, making recommendations of those aspects that ought to be considered as essential, or at least desirable, for best practice. These factors include the size......: unfortunately such awareness is not widespread. This report hence serves as a guide for those planning experiments to investigate spatial brightness. The proposals are presented as recommendations and not as compulsory. The report identifies those issues for which further research is desirable. The publication...

  5. Understanding U.S. healthcare providers' practices and experiences with molluscum contagiosum.

    Directory of Open Access Journals (Sweden)

    Christine M Hughes

    Full Text Available INTRODUCTION: Molluscum contagiosum is a common superficial skin infection caused by the poxvirus, Molluscum Contagiosum virus. The study objective is to obtain a better understanding of physician practices and experiences with molluscum contagiosum in order to focus informational and guidance material. METHODS: A cross-sectional survey to assess medical practitioners' knowledge and practices with molluscum contagiosum was conducted using the 2009 DocStyles survey. Questions regarding category and number of molluscum contagiosum patients seen, treatments used and advice given to patients were included in the survey. RESULTS: Dermatologists saw the most cases, with the majority seeing 51-100 molluscum contagiosum cases/year. The most common cases seen were children with multiple lesions and adults with genital lesions. Respondents were most likely to recommend treatment to immunocompromised individuals, HIV patients, adults with genital lesions and children with multiple lesions. Cryotherapy was the top choice for all specialties with the exception of OB/GYNs, whose top choice was curettage. "Avoid intimate contact until lesions resolve", "Avoid touching lesions to reduce further spread", and "Don't be concerned, this will go away" were the top advice choices. DISCUSSION: Most survey respondents have dealt with molluscum contagiosum in their practice during the previous year. Overall, respondents picked appropriate choices for treatment and advice given; however some ineffective or unnecessary treatments were chosen and recommendations to prevent spread were chosen infrequently. Knowledge gaps for appropriate transmission precaution advice might cause unnecessary spread or autoinoculation. This survey has demonstrated that molluscum contagiosum is a common infection seen by many types of practitioners and therefore guidance on treatment considerations and infection control is valuable.

  6. Guidance and Research Centers (GRC) Managers' Perceptions of Problems Encountered in the Identification, Placement-Follow up, Individualized Education Program (IEP) Development and Integration Practice

    Science.gov (United States)

    Avcioglu, Hasan

    2012-01-01

    The aim of the study is to determine of the Guidance and Research Center (GRC) managers' opinions about unexpected problems of identification, placement-follow up, IEP development, and integration practicing. Being a descriptive study, the research data are collected from 116 managers of GRC. The inquiry form, which is developed by the researcher,…

  7. Dentist-Perceived Barriers and Attractors to Cognitive-Behavioral Treatment Provided by Mental Health Providers in Dental Practices.

    Science.gov (United States)

    Heyman, R E; Wojda, A K; Eddy, J M; Haydt, N C; Geiger, J F; Slep, A M Smith

    2018-02-01

    Over 1 in 5 dental patients report moderate to severe dental fear. Although the efficacy of cognitive-behavioral treatment (CBT) for dental fear has been examined in over 20 randomized controlled trials-with 2 meta-analyses finding strong average effect sizes ( d > 1)-CBT has received almost no dissemination beyond the specialty clinics that tested it. The challenge, then, is not how to treat dental fear but how to disseminate and implement such an evidence-based treatment in a way that recognizes the rewards and barriers in the US health care system. This mixed-method study investigated the potential of disseminating CBT through care from a mental health provider from within the dental home, a practice known as evidence-based collaborative care (EBCC). Two preadoption studies were conducted with practicing dentists drawn from a self-organized Practice-Based Research Network in the New York City metropolitan area. The first comprised 3 focus groups ( N = 17), and the second involved the administration of a survey ( N = 46). Focus group participants agreed that CBT for dental fear is worthy of consideration but identified several concerns regarding its appeal, feasibility, and application in community dental practices. Survey participants indicated endorsement of factors promoting the use of EBCC as a mechanism for CBT dissemination, with no factors receiving less than 50% support. Taken together, these findings indicate that EBCC may be a useful framework through which an evidence-based treatment for dental fear treatment can be delivered.

  8. Being relevant: Practical guidance for early career researchers interested in solving conservation problems

    Directory of Open Access Journals (Sweden)

    J.M. Chapman

    2015-07-01

    Full Text Available In a human-altered world where biodiversity is in decline and conservation problems abound, there is a dire need to ensure that the next generation of conservation scientists have the knowledge, skills, and training to address these problems. So called “early career researchers” (ECRs in conservation science have many challenges before them and it is clear that the status quo must change to bridge the knowledge–action divide. Here we identify thirteen practical strategies that ECRs can employ to become more relevant. In this context, “relevance” refers to the ability to contribute to solving conservation problems through engagement with practitioners, policy makers, and stakeholders. Conservation and career strategies outlined in this article include the following: thinking ‘big picture’ during conservation projects; embracing various forms of knowledge; maintaining positive relationships with locals familiar with the conservation issue; accepting failure as a viable (and potentially valuable outcome; daring to be creative; embracing citizen science; incorporating interdisciplinarity; promoting and practicing pro-environmental behaviours; understanding financial aspects of conservation; forming collaboration from the onset of a project; accepting the limits of technology; ongoing and effective networking; and finally, maintaining a positive outlook by focusing on and sharing conservation success stories. These strategies move beyond the generic and highlight the importance of continuing to have an open mind throughout the entire conservation process, from establishing one’s self as an asset to embracing collaboration and interdisciplinary work, and striving to push for professional and personal connections that strengthen personal career objectives.

  9. Practical guidance for prescribing ziprasidone in acute manic or mixed episodes of bipolar I disorder.

    Science.gov (United States)

    Cañas, Fernando; Correll, Christoph U; Fagiolini, Andrea; Larmo, Ilkka; Levy, Pedro; Papageorgiou, Georgios; Rossi, Alessandro; Zink, Marhias; Montes, José Manuel

    2011-10-01

    Limited information is available on the clinical issues and strategies for optimal clinical usage of ziprasidone in the treatment of adult patients with acute manic or mixed episodes of bipolar disorder. To address those issues, information from clinical trials addressing the efficacy and tolerability of ziprasidone in acute bipolar mania was reviewed and supplemented with the input from an expert faculty of European psychiatrists with extensive experience in treating patients with bipolar mania, both in clinical trials and in everyday clinical practice. Effective use of oral ziprasidone in the treatment of acute bipolar mania requires rapid titration to doses in the range 120 - 160 mg/day and administration with meals of ≥ 500 kcal. As in the clinical trials, temporary short-term use of benzodiazepines (in particular lorazepam for agitation or temazepam for insomnia) could be advisable. Available evidence from randomized clinical trials in combination with clinical experience supports the use of ziprasidone as one of the first-line effective and safe treatments for acute manic or mixed episodes associated with bipolar I disorder.

  10. Maximizing students' retention via spaced review: practical guidance from computational models of memory.

    Science.gov (United States)

    Khajah, Mohammad M; Lindsey, Robert V; Mozer, Michael C

    2014-01-01

    During each school semester, students face an onslaught of material to be learned. Students work hard to achieve initial mastery of the material, but when they move on, the newly learned facts, concepts, and skills degrade in memory. Although both students and educators appreciate that review can help stabilize learning, time constraints result in a trade-off between acquiring new knowledge and preserving old knowledge. To use time efficiently, when should review take place? Experimental studies have shown benefits to long-term retention with spaced study, but little practical advice is available to students and educators about the optimal spacing of study. The dearth of advice is due to the challenge of conducting experimental studies of learning in educational settings, especially where material is introduced in blocks over the time frame of a semester. In this study, we turn to two established models of memory-ACT-R and MCM-to conduct simulation studies exploring the impact of study schedule on long-term retention. Based on the premise of a fixed time each week to review, converging evidence from the two models suggests that an optimal review schedule obtains significant benefits over haphazard (suboptimal) review schedules. Furthermore, we identify two scheduling heuristics that obtain near optimal review performance: (a) review the material from μ-weeks back, and (b) review material whose predicted memory strength is closest to a particular threshold. The former has implications for classroom instruction and the latter for the design of digital tutors. Copyright © 2013 Cognitive Science Society, Inc.

  11. 76 FR 9027 - Draft Guidance for Industry and Food and Drug Administration Staff on Best Practices for...

    Science.gov (United States)

    2011-02-16

    ... Electronic Healthcare Data Sets; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing the availability of a draft guidance for... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry and Food and Drug Administration...

  12. The European Society of Therapeutic Radiology and Oncology-European Institute of Radiotherapy (ESTRO-EIR) report on 3D CT-based in-room image guidance systems: a practical and technical review and guide

    DEFF Research Database (Denmark)

    Korreman, Stine; Rasch, Coen; McNair, Helen

    2010-01-01

    The past decade has provided many technological advances in radiotherapy. The European Institute of Radiotherapy (EIR) was established by the European Society of Therapeutic Radiology and Oncology (ESTRO) to provide current consensus statement with evidence-based and pragmatic guidelines on topics...... of practical relevance for radiation oncology. This report focuses primarily on 3D CT-based in-room image guidance (3DCT-IGRT) systems. It will provide an overview and current standing of 3DCT-IGRT systems addressing the rationale, objectives, principles, applications, and process pathways, both clinical...... demonstrates a wide variability based on local practices. This report whilst comprehensive is not exhaustive as this area of development remains a very active field for research and development. However, it should serve as a practical guide and framework for all professional groups within the field, focussed...

  13. Development of recommended practices and guidance documents for upstream oil and gas flow measurement

    Energy Technology Data Exchange (ETDEWEB)

    Dahl, Eivind; Scheers, Lex; Ting, Frank; Letton, Chip

    2005-07-01

    As first stated in the Introduction, improvements in multiphase flow meters during the last 15 years have resulted in their increased usage in upstream oil and gas applications, especially in difficult offshore locations both topside and deep subsea. To address user needs for information and standardization in the area, documentation has recently been created under the auspices of the NFOGM, API, and ISO. Our intent here was to familiarize potential users with the three new documents, which should be helpful in a number of respects, e.g., (a) distribution of best knowledge and operational practices on the subject, (b) provision of a common language for discussing multiphase flow, and (c) accounting for the requirements of governing regulatory authorities. At this stage of completion of NFOGM, API, and ISO reports, a natural question arises as to what the future holds for another round of flow measurement documentation. Candidate areas include: 1) In Situ Verification of Multiphase Flow Meters. 2) Wet Gas Flow Measurement. 3) Flare Gas Meters. 4) Virtual Metering. 5) Composition and Phase Behavior Issues In Measurement. 6) Flow Measurement Uncertainty. Addressing certain of these is already being proposed in several possible venues, among which are (1) the DeepStar Consortium, (2) a JIP for investigating total system (meter + flowline + separator) uncertainty organized by a group at Tulsa University, and (3) a program for development of drilling and production capabilities in ultradeep water to be sponsored by the US Department of Energy. The creation of the three documents discussed in this paper demonstrates the benefits that strong international cooperation can achieve in producing standardization documents, ensuring their true global input and acceptance. On the other hand, it should also be questioned why two or more documents are required, which are the result of much duplication of effort. For example, although there are differences between API RP86 and the

  14. A Systematic Review of End-of-Life Care Communication Skills Training for Generalist Palliative Care Providers: Research Quality and Reporting Guidance.

    Science.gov (United States)

    Brighton, Lisa Jane; Koffman, Jonathan; Hawkins, Amy; McDonald, Christine; O'Brien, Suzanne; Robinson, Vicky; Khan, Shaheen A; George, Rob; Higginson, Irene J; Selman, Lucy Ellen

    2017-09-01

    End-of-life care (EoLC) communication skills training for generalist palliative care providers is recommended in policy guidance globally. Although many training programs now exist, there has been no comprehensive evidence synthesis to inform future training delivery and evaluation. To identify and appraise how EoLC communication skills training interventions for generalist palliative care providers are developed, delivered, evaluated, and reported. Systematic review. Ten electronic databases (inception to December 2015) and five relevant journals (January 2004 to December 2015) were searched. Studies testing the effectiveness of EoLC communication skills training for generalists were included. Two independent authors assessed study quality. Descriptive statistics and narrative synthesis are used to summarize the findings. From 11,441 unique records, 170 reports were identified (157 published, 13 unpublished), representing 160 evaluation studies of 153 training interventions. Of published papers, eight were of low quality, 108 medium, and 41 high. Few interventions were developed with service user involvement (n = 7), and most were taught using a mixture of didactics (n = 123), reflection and discussion (n = 105), and role play (n = 86). Evaluation designs were weak: skills training interventions in the literature, evidence is limited by poor reporting and weak methodology. Based on our findings, we present a CONSORT statement supplement to improve future reporting and encourage more rigorous testing. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  15. Procurement risk management practices and supply chain performance among mobile phone service providers in Kenya

    Directory of Open Access Journals (Sweden)

    Emily Adhiambo Okonjo

    2016-02-01

    Full Text Available The aim of this study was to establish the relationship between procurement risk management practices and supply chain performance among mobile phone service providers in Kenya. The study specifically set out to establish the extent to which mobile phone service providers have implemented procurement risk management practices and to determine the relationship between procurement risk management practices and supply chain performance. The study adopted a descriptive study design by collecting data from the four (4 mobile telecommunication companies in Kenya using a self-administered questionnaire. Means, standard deviation, and regression analysis were used to analyze the data collected. The study established that most of the mobile phone service providers in Kenya had implemented procurement risk management practices. It was also clear that there was a very significant relationship between procurement risk management practices and supply chain performance.

  16. Best Practices for Dual-Energy X-ray Absorptiometry Measurement and Reporting: International Society for Clinical Densitometry Guidance.

    Science.gov (United States)

    Lewiecki, E Michael; Binkley, Neil; Morgan, Sarah L; Shuhart, Christopher R; Camargos, Bruno Muzzi; Carey, John J; Gordon, Catherine M; Jankowski, Lawrence G; Lee, Joon-Kiong; Leslie, William D

    2016-01-01

    Dual-energy X-ray absorptiometry (DXA) is a technology that is widely used to diagnose osteoporosis, assess fracture risk, and monitor changes in bone mineral density (BMD). The clinical utility of DXA is highly dependent on the quality of the scan acquisition, analysis, and interpretation. Clinicians are best equipped to manage patients when BMD measurements are correct and interpretation follows well-established standards. Poor-quality acquisition, analysis, or interpretation of DXA data may mislead referring clinicians, resulting in unnecessary diagnostic evaluations, failure to evaluate when needed, inappropriate treatment, or failure to provide medical treatment, with potentially ineffective, harmful, or costly consequences. Misallocation of limited healthcare resources and poor treatment decisions can be minimized, and patient care optimized, through meticulous attention to DXA instrument calibration, data acquisition and analysis, interpretation, and reporting. This document from the International Society for Clinical Densitometry describes quality standards for BMD testing at DXA facilities worldwide to provide guidance for DXA supervisors, technologists, interpreters, and clinicians. High-quality DXA testing is necessary for correct diagnostic classification and optimal fracture risk assessment, and is essential for BMD monitoring. Copyright © 2016 International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  17. Best practice guidance for the use of strategies to improve retention in randomized trials developed from two consensus workshops.

    Science.gov (United States)

    Brueton, Valerie; Stenning, Sally P; Stevenson, Fiona; Tierney, Jayne; Rait, Greta

    2017-08-01

    To develop best practice guidance for the use of retention strategies in randomized clinical trials (RCTs). Consensus development workshops conducted at two UK Clinical Trials Units. Sixty-six statisticians, clinicians, RCT coordinators, research scientists, research assistants, and data managers associated with RCTs participated. The consensus development workshops were based on the consensus development conference method used to develop best practice for treatment of medical conditions. Workshops commenced with a presentation of the evidence for incentives, communication, questionnaire format, behavioral, case management, and methodological retention strategies identified by a Cochrane review and associated qualitative study. Three simultaneous group discussions followed focused on (1) how convinced the workshop participants were by the evidence for retention strategies, (2) barriers to the use of effective retention strategies, (3) types of RCT follow-up that retention strategies could be used for, and (4) strategies for future research. Summaries of each group discussion were fed back to the workshop. Coded content for both workshops was compared for agreement and disagreement. Agreed consensus on best practice guidance for retention was identified. Workshop participants agreed best practice guidance for the use of small financial incentives to improve response to postal questionnaires in RCTs. Use of second-class post was thought to be adequate for postal communication with RCT participants. The most relevant validated questionnaire was considered best practice for collecting RCT data. Barriers identified for the use of effective retention strategies were: the small improvements seen in questionnaire response for the addition of monetary incentives, and perceptions among trialists that some communication strategies are outdated. Furthermore, there was resistance to change existing retention practices thought to be effective. Face-to-face and electronic follow

  18. Hurricane Season Public Health Preparedness, Response, and Recovery Guidance for Health Care Providers, Response and Recovery Workers, and Affected Communities - CDC, 2017.

    Science.gov (United States)

    2017-09-22

    CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) have guidance and technical materials available in both English and Spanish to help communities prepare for hurricanes and floods (Table 1). To help protect the health and safety of the public, responders, and clean-up workers during response and recovery operations from hurricanes and floods, CDC and ATSDR have developed public health guidance and other resources; many are available in both English and Spanish (Table 2).

  19. Analysis of the astray/robo2 zebrafish mutant reveals that degenerating tracts do not provide strong guidance cues for regenerating optic axons

    Science.gov (United States)

    Wyatt, Cameron; Ebert, Anselm; Reimer, Michell M.; Rasband, Kendall; Hardy, Melissa; Chien, Chi-Bin; Becker, Thomas; Becker, Catherina G.

    2010-01-01

    During formation of the optic projection in astray/robo2 mutant zebrafish, optic axons exhibit rostro-caudal pathfinding errors, ectopic midline crossing and increased terminal arbor size. Here we show that these errors persist into adulthood, even when robo2 function is conditionally reduced only during initial formation of the optic projection. Adult errors include massive ectopic optic tracts in the telencephalon. During optic nerve regeneration in astray/robo2 animals, these tracts are not re-populated and ectopic midline crossing is reduced compared to unlesioned mutants. This is despite a comparable macrophage/microglial response and upregulation of contactin1a in oligodendrocytes of entopic and ectopic tracts. However, other errors, such as expanded termination areas and ectopic growth into the tectum, were frequently re-committed by regenerating optic axons. Retinal ganglion cells with regenerating axons re-express robo2 and expression of slit ligands is maintained in some areas of the adult optic pathway. However, slit expression is reduced rostral and caudal to the chiasm, compared to development and ubiquitous overexpression of Slit2 did not elicit major pathfinding phenotypes. This shows that (1) there is not an efficient correction mechanism for large-scale pathfinding errors of optic axons during development; (2) degenerating tracts do not provide a strong guidance cue for regenerating optic axons in the adult CNS, unlike the PNS; and (3) robo2 is less important for pathfinding of optic axons during regeneration than during development. PMID:20943924

  20. PERCEPTIONS OF INDONESIAN PRACTICAL NURSES TOWARDS UPDATING CAPABILITY TO PROVIDE CARE: A QUALITATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Fitri Arofiati

    2017-02-01

    Full Text Available Background: Capability to provide care can be recognized as the combination of nursing knowledge, skills, and attitude of care which is dynamic. Objective: This study aims to explore the perceptions of practical nurses towards updating capability to provide care. Methods: A descriptive qualitative study was conducted to explore the deep understanding of practical nurses towards updating capability to provide care. Data were gathered using in-depth interview with 25 practical nurses from different areas of practices, three times focus group discussion (FGD and participant-observation. Qualitative content analysis model was applied to anaylze the data. Result: There were two themes emerged from data: 1 Internal perceptions of updating capacity to provide care, with three subthemes: Having great expectation, Being confidence as a professional nurse, and Developing Self-Initiation, 2 External contexts driving perception of practicing nurses, with two subthemes: Giving best care and Acquiring requirement. Conclusions: The findings indicated that updating capacity to provide care supports practical nurses to provide better nursing services to patients and meet the regulation of nursing professionalism.

  1. The role of Advanced Practice Providers in interdisciplinary oncology care in the United States.

    Science.gov (United States)

    Reynolds, Rae Brana; McCoy, Kimberly

    2016-06-01

    Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs), generally referred to as Advanced Practice Providers (APPs), are fundamental to interdisciplinary oncology care. As the projected demand for oncology services is anticipated to outpace the supply of oncologists, APPs will become increasingly vital in the delivery of oncology care and services. The training, education, and scope of practice for APPs gives the interdisciplinary care team professionals that deliver high-quality clinical services and provide valuable contributions and leadership to health care quality improvement initiatives. Optimizing the integration of APPs in oncology care offers immense advantages towards improvement of clinical outcomes.

  2. The impact of nonphysician providers on diagnostic and interventional radiology practices: regulatory, billing, and compliance perspectives.

    Science.gov (United States)

    Hawkins, C Matthew; Bowen, Michael A; Gilliland, Charles A; Walls, D Gail; Duszak, Richard

    2015-08-01

    The numbers of nurse practitioners and physician assistants are increasing throughout the entire health care enterprise, and a similar expansion continues within radiology. Some practices have instead embraced radiologist assistants. The increased volume of services rendered by this growing nonphysician provider subset of the health care workforce within and outside of radiology departments warrants closer review. The authors evaluate the recent literature and offer recommendations to radiology practices regarding both regulatory and scope-of-practice issues related to these professionals. Additionally, billing and compliance issues for care provided by nurse practitioners, physician assistants, and radiologist assistants are detailed. An analysis of the integration of these professionals into interventional and diagnostic radiology practices, as well as potential implications for medical education, is provided in the second part of this series. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  3. Scope of practice review: providers for triage and assessment of spine-related disorders.

    Science.gov (United States)

    Boakye, Omenaa; Birney, Arden; Suter, Esther; Phillips, Leah Adeline; Suen, Victoria Ym

    2016-01-01

    This study explored which health care providers could be involved in centralized intake for patients with nonspecific low back pain to enhance access, continuity, and appropriateness of care. We reviewed the scope of practice regulations for a range of health care providers. We also conducted telephone interviews with 17 individuals representing ten provincial colleges and regulatory bodies to further understand providers' legislated scopes of practice. Activities relevant to triaging and assessing patients with low back pain were mapped against professionals' scope of practice. Family physicians and nurse practitioners have the most comprehensive scopes and can complete all restricted activities for spine assessment and triage, while the scope of registered nurses and licensed practical nurses are progressively narrower. Chiropractors, occupational therapists, physiotherapists, and athletic therapists are considered experts in musculoskeletal assessments and appear best suited for musculoskeletal specific assessment and triage. Other providers may play a complementary role depending on the individual patient needs. These findings indicate that an interprofessional assessment and triage team that includes allied health professionals would be a feasible option to create a centralized intake model. Implementation of such teams would require removing barriers that currently prevent providers from delivering on their full scope of practice.

  4. Neurology advanced practice providers: A position paper of the American Academy of Neurology.

    Science.gov (United States)

    Schwarz, Heidi B; Fritz, Joseph V; Govindarajan, Raghav; Penfold Murray, Rebecca; Boyle, Kathryn B; Getchius, Thomas S D; Freimer, Miriam

    2015-08-01

    There are many factors driving health care reform, including unsustainable costs, poor outcomes, an aging populace, and physician shortages. These issues are particularly relevant to neurology. New reimbursement models are based on value and facilitated by the use of multidisciplinary teams. Integration of advanced practice providers (APPs) into neurology practice offers many advantages with new models of care. Conversely, there are many and varied challenges financially and logistically with these practice models. The American Academy of Neurology has formed a Work Group to address the needs of both neurologists and neurologic APPs and monitor the effect of APPs on quality and cost of neurologic care.

  5. Scope of practice review: providers for triage and assessment of spine-related disorders

    Directory of Open Access Journals (Sweden)

    Boakye O

    2016-05-01

    Full Text Available Omenaa Boakye,1 Arden Birney,1 Esther Suter,1 Leah Adeline Phillips,2 Victoria YM Suen3 1Workforce Research and Evaluation, Alberta Health Services, Calgary, 2College of Licensed Practical Nurses of Alberta, Edmonton, 3Addiction and Mental Health SCN, Alberta Health Services, Edmonton, AB, Canada Purpose: This study explored which health care providers could be involved in centralized intake for patients with nonspecific low back pain to enhance access, continuity, and appropriateness of care. Methods: We reviewed the scope of practice regulations for a range of health care providers. We also conducted telephone interviews with 17 individuals representing ten provincial colleges and regulatory bodies to further understand providers' legislated scopes of practice. Activities relevant to triaging and assessing patients with low back pain were mapped against professionals' scope of practice. Results: Family physicians and nurse practitioners have the most comprehensive scopes and can complete all restricted activities for spine assessment and triage, while the scope of registered nurses and licensed practical nurses are progressively narrower. Chiropractors, occupational therapists, physiotherapists, and athletic therapists are considered experts in musculoskeletal assessments and appear best suited for musculoskeletal specific assessment and triage. Other providers may play a complementary role depending on the individual patient needs. Conclusion: These findings indicate that an interprofessional assessment and triage team that includes allied health professionals would be a feasible option to create a centralized intake model. Implementation of such teams would require removing barriers that currently prevent providers from delivering on their full scope of practice. Keywords: scope of practice review, low back pain, integrated service model, centralized intake, interprofessional team

  6. Knowledge, attitudes, and practices of private sector immunization service providers in Gujarat, India.

    Science.gov (United States)

    Hagan, José E; Gaonkar, Narayan; Doshi, Vikas; Patni, Anas; Vyas, Shailee; Mazumdar, Vihang; Kosambiya, J K; Gupta, Satish; Watkins, Margaret

    2018-01-02

    India is responsible for 30% of the annual global cohort of unvaccinated children worldwide. Private practitioners provide an estimated 21% of vaccinations in urban centers of India, and are important partners in achieving high vaccination coverage. We used an in-person questionnaire and on-site observation to assess knowledge, attitudes, and practices of private immunization service providers regarding delivery of immunization services in the urban settings of Surat and Baroda, in Gujarat, India. We constructed a comprehensive sampling frame of all private physician providers of immunization services in Surat and Baroda cities, by consulting vaccine distributors, local branches of physician associations, and published lists of private medical practitioners. All providers were contacted and asked to participate in the study if they provided immunization services. Data were collected using an in-person structured questionnaire and directly observing practices; one provider in each practice setting was interviewed. The response rate was 82% (121/147) in Surat, and 91% (137/151) in Baroda. Of 258 participants 195 (76%) were pediatricians, and 63 (24%) were general practitioners. Practices that were potential missed opportunities for vaccination (MOV) included not strictly following vaccination schedules if there were concerns about ability to pay (45% of practitioners), and not administering more than two injections in the same visit (60%). Only 22% of respondents used a vaccination register to record vaccine doses, and 31% reported vaccine doses administered to the government. Of 237 randomly selected vaccine vials, 18% had expired vaccine vial monitors. Quality of immunization services in Gujarat can be strengthened by providing training and support to private immunization service providers to reduce MOVs and improve quality and safety; other more context specific strategies that should be evaluated may involve giving feedback to providers on quality of services

  7. Knowledge, attitudes, and practices regarding Rocky Mountain spotted fever among healthcare providers, Tennessee, 2009.

    Science.gov (United States)

    Mosites, Emily; Carpenter, L Rand; McElroy, Kristina; Lancaster, Mary J; Ngo, Tue H; McQuiston, Jennifer; Wiedeman, Caleb; Dunn, John R

    2013-01-01

    Tennessee has a high incidence of Rocky Mountain spotted fever (RMSF), the most severe tick-borne rickettsial illness in the United States. Some regions in Tennessee have reported increased illness severity and death. Healthcare providers in all regions of Tennessee were surveyed to assess knowledge, attitudes, and perceptions regarding RMSF. Providers were sent a questionnaire regarding knowledge of treatment, diagnosis, and public health reporting awareness. Responses were compared by region of practice within the state, specialty, and degree. A high proportion of respondents were unaware that doxycycline is the treatment of choice in children ≤ 8 years of age. Physicians practicing in emergency medicine, internal medicine, and family medicine; and nurse practitioners, physician assistants, and providers practicing for < 20 years demonstrated less knowledge regarding RMSF. The gaps in knowledge identified between specialties, designations, and years of experience can help target education regarding RMSF.

  8. Barriers and facilitators that influence the delivery of prevention guidance in health service dental practice: a questionnaire study of practising dentists in Southwest England.

    Science.gov (United States)

    Witton, R V; Moles, D R

    2013-06-01

    Objective: To investigate the barriers and facilitators influencing the delivery of prevention in accordance with a national guideline (Delivering Better Oral Health, Department of Health England) in health service dental practice. Self-completion questionnaire. Health service general dental practices. Questionnaires were sent via two mailings to all 508 dentists registered to work in health service general dental practice in Devon, South West England. In total 266 questionnaires were returned (52% response rate). Examples of barriers and facilitators were evident at various organisational levels of dentistry. These were principally the healthcare system, practice (dental office) arrangements and professional factors. Respondents gave positive responses to questions concerning the flexibility (53%) and benefit of the guideline (63%) and they tended to indicate that they didn't perceive problems in changing their old routines (58%). Opinion was divided among respondents on whether they felt patients followed their advice (49%). There was overall agreement that delivering prevention in practice is problematic if there are insufficient staff (68%), facilities (53%) and time (60%). Encouragingly most respondents felt adequately trained to deliver the evidence based prevention guidance (59%). This study has identified some barriers and facilitators to the delivery of prevention guidance in this group of health service dentists with no single factor viewed consistently as more important than any others. A further qualitative study is planned to investigate in more depth the reasons underpinning the responses given in this study.

  9. The use of nutritional guidance within chiropractic patient management: a survey of 333 chiropractors from the ACORN practice-based research network.

    Science.gov (United States)

    Lee, Mi Kyung; Amorin-Woods, Lyndon; Cascioli, Vincenzo; Adams, Jon

    2018-01-01

    Food consumption and nutritional status affect an individual's health throughout their life-course and an unhealthy diet is a major risk factor for the current global burden of chronic disease. The promotion of health and good nutrition through healthy eating requires the active involvement of all health professionals including chiropractors. This paper reports findings from the first nationally representative examination of the use of nutritional guidance within chiropractic patient management in Australia. A sample of 1000 practising chiropractors was randomly selected from the Australian Chiropractic Research Network (ACORN) practice-based research network database for a cross-sectional study and 33% participated in the online survey in November 2016. The questionnaire, based on previous designs used in similar surveys and nutrition resources developed by the National Health and Medical Research Council, was pretested prior to the survey. Pearson's Chi square and bivariate logistic regression were undertaken to explore relationships with variables of interest. The demographic details of the respondents are similar to those of the chiropractic workforce registered in Australia. Most chiropractors provided nutritional advice as part of their patient care and around a quarter provided specific dietary advice to their patients, including the use of nutrition supplements. Nutrition-related conditions most commonly encountered by the chiropractors were musculoskeletal, usually inflammatory in origin. Common nutritional assessment methods used included questioning patients to assess their nutritional and health status and physical appearance. Most of the participants provided nutritional resources to their patients in their clinics. However, the Australian Dietary Guidelines and the accompanying Australian Guide to Healthy Eating were not well utilised by the respondents. Australian chiropractors often referred patients with nutrition issues to qualified dietitians and

  10. Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians.

    Science.gov (United States)

    Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J

    2015-12-01

    Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may

  11. Provider Attitudes and Practices toward Sexual and Reproductive Health Care for Young Women with Cystic Fibrosis.

    Science.gov (United States)

    Kazmerski, Traci M; Borrero, Sonya; Sawicki, Gregory S; Abebe, Kaleab Z; Jones, Kelley A; Tuchman, Lisa K; Weiner, Daniel J; Pilewski, Joseph M; Orenstein, David M; Miller, Elizabeth

    2017-10-01

    To investigate the attitudes and practices of cystic fibrosis (CF) providers toward sexual and reproductive health (SRH) care in young women with CF. Adult and pediatric US CF providers were sent an online survey exploring their attitudes toward SRH importance, SRH care practices, and barriers/facilitators to SRH care in adolescent and/or young adult women. Descriptive statistics and logistic regression were used to analyze results. Attitudes toward the importance of SRH care in patients with CF and self-report of practice patterns of SRH discussion. Respondents (n = 196) were 57% pediatric (111/196) and 24% adult physicians (48/196) and 19% nurse practitioners (NPs)/physician assistants (PAs) (37/196). Ninety-four percent of respondents believed SRH was important for female patients with CF (184/196). More than 75% believed SRH care should be standardized within the CF care model (147/196) and 41% believed the CF team should have the primary role in SRH discussion and care (80/196). For many CF-specific SRH topics, discrepancies emerged between how important respondents believed these were to address and how often they reported discussing these topics in practice. Significant differences in SRH attitudes and practices were present between adult and pediatric physicians. The most significant barriers to SRH care identified were lack of time (70%, 137/196) and the presence of family in clinic room (54%, 106/196). Potential facilitators included training materials for providers (68%, 133/196) and written (71%, 139/196) or online (76%, 149/196) educational resources for patients. CF providers perceive SRH topics as important to discuss, but identify barriers to routine discussion in current practice. Providers endorsed provider training and patient educational resources as means to improve SRH delivery. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  12. Providers perspectives on self-regulation impact their use of responsive feeding practices in child care.

    Science.gov (United States)

    Dev, Dipti A; Speirs, Katherine E; Williams, Natalie A; Ramsay, Samantha; McBride, Brent A; Hatton-Bowers, Holly

    2017-11-01

    Supporting children's self-regulation in eating through caregivers' practice of responsive feeding is paramount to obesity prevention, and while much attention has been given to supporting children's self-regulation in eating through parents' responsive feeding practices in the home setting, little attention has been given to this issue in childcare settings. This qualitative study examines childcare providers' perspectives on using responsive feeding practices with young children (2-5years). Individual semi-structured interviews were conducted with providers until saturation was reached. Data was analyzed using thematic analysis. The final sample included 18 providers who were employed full-time in Head Start or state-licensed center-based childcare programs, cared for children (2-5y), and were directly responsible for serving meals and snacks. Providers were primarily (67%) employed in childcare programs that served children from low-income families and received reimbursement for meals and snacks from the US Department of Agriculture's Child and Adult Care Food Program. Three factors emerged that shaped childcare providers' experiences using responsive feeding practices: the providers' perspectives about whether or not young children can self-regulate food intake, their understanding of Child and Adult Care Food Program (CACFP) portion size regulations, and the availability of food at the center where they worked. Future research should examine how childcare providers' understanding of children's ability to self-regulate their food intake, the appropriate use of the CACFP regulations in relationship to serving sizes, and having food available to offer seconds promotes providers' use of responsive feeding practices in center-based childcare programs and children's dietary behaviors. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Vertical integration of teaching in Australian general practice--a survey of regional training providers.

    Science.gov (United States)

    Stocks, Nigel P; Frank, Oliver; Linn, Andrew M; Anderson, Katrina; Meertens, Sarah

    2011-06-06

    To examine vertical integration of teaching and clinical training in general practice and describe practical examples being undertaken by Australian general practice regional training providers (RTPs). A qualitative study of all RTPs in Australia, mid 2010. All 17 RTPs in Australia responded. Eleven had developed some vertical integration initiatives. Several encouraged registrars to teach junior doctors and medical students, others encouraged general practitioner supervisors to run multilevel educational sessions, a few coordinated placements, linkages and support across their region. Three RTPs provided case studies of vertical integration. Many RTPs in Australia use vertical integration of teaching in their training programs. RTPs with close associations with universities and rural clinical schools seem to be leading these initiatives.

  14. Palliative Care Providers' Practices Surrounding Psychological Distress Screening and Treatment: A National Survey.

    Science.gov (United States)

    Kozlov, Elissa; Eghan, Claude; Moran, Sheila; Herr, Keela; Reid, M Carrington

    2017-01-01

    To investigate how inpatient palliative care teams nationwide currently screen for and treat psychological distress. A web-based survey was sent to inpatient palliative care providers of all disciplines nationwide asking about their practice patterns regarding psychological assessment and treatment. Descriptive statistics were used to characterize the sample and responses, and analysis of variance was conducted to determine whether certain disciplines were more likely to utilize specific treatment modalities. A total of N = 236 respondents were included in the final analyses. Providers reported that they encounter psychological distress regularly in their practice and that they screen for distress using multiple methods. When psychological distress is detected, providers reported referring patients to an average of 3 different providers (standard deviation = 1.46), most frequently a social worker (69.6%) or chaplain (65.3%) on the palliative care team. A total of 84.6% of physicians and 54.5% of nurse practitioners reported that they prescribe anxiolytics or selective serotonin reuptake inhibitors to patients experiencing psychological distress. This study revealed significant variability and redundancy in how palliative care teams currently manage psychological distress. The lack of consistency potentially stems from the variability in the composition of palliative care teams across care settings and the lack of scientific evidence for best practices in psychological care in palliative care. Future research is needed to establish best practices in the screening and treatment of psychological distress for patients receiving palliative care.

  15. Student-selected components in surgery: providing practical experience and increasing student confidence.

    LENUS (Irish Health Repository)

    Falk, G A

    2009-09-01

    Reviews of the medical school curriculum in the UK and Ireland have recommended the introduction of student-selected components (SSCs). The Department of Surgery in The Royal College of Surgeons in Ireland (RCSI) has introduced a 6-week surgical SSC, which aims to develop practical clinical skills, provide mentorship and prepare students for internship.

  16. Provider Strategies and the Greening of Consumption Practices: Exploring the Role of Companies in Sustainable Consumption

    NARCIS (Netherlands)

    Spaargaren, G.; Koppen, van C.S.A.

    2009-01-01

    Making consumption practices more sustainable means incorporating new ideas, information and products into existing consumption routines of citizen-consumers. For a successful incorporation process it is crucial that companies, as main providers of new products and services, develop an active

  17. United States Air Force Health Care Provider Practices: Skin Testing for Mycobacterium Tuberculosis

    Science.gov (United States)

    1997-04-03

    Infection Control Manager Nurse Manager, Family Practice Clinic Infection Control Assistant Manager Clinical Nurse, Obstetrical Ward Clinical...172 Air Force health care providers at a mid- level medical treatment facility including: medical doctors (MD), doctors of osteopathy (DO...of osteopathy , physician assistants, nurse practitioners and independent duty medical technicians. Knowledge of tuberculosis skin testing: shall be

  18. The Relationship between Practices and Child Care Providers' Beliefs Related to Child Feeding and Obesity Prevention

    Science.gov (United States)

    Lanigan, Jane D.

    2012-01-01

    Objective: To examine the association between child care practices and child care provider knowledge and beliefs about their role in supporting children's healthful eating. Design: Longitudinal design using survey and observation data from baseline and year 1 of the Encouraging Healthy Activity and Eating in Childcare Environments (ENHANCE) pilot…

  19. In-Center Nutrition Practices of Clinics within a Large Hemodialysis Provider in the United States.

    Science.gov (United States)

    Benner, Debbie; Burgess, Mary; Stasios, Maria; Brosch, Becky; Wilund, Ken; Shen, Sa; Kistler, Brandon

    2016-05-06

    Eating during hemodialysis treatment remains a controversial topic. It is perceived that more restrictive practices in the United States contribute to poorer nutritional status and elevated mortality compared with some other parts of the world. However, in-center food practices in the United States have not been previously described. In 2011, we conducted a survey of clinic practices and clinician (dietitian, facility administrator, and medical director) opinions related to in-center food consumption within a large dialysis organization. After the initial survey, we provided clinicians with educational materials about eating during treatment. In 2014, we performed a follow-up survey. Differences in practices and opinions were analyzed using chi-squared tests and logistic regression. In 2011, 343 of 1199 clinics (28.6%) did not allow eating during treatment, 222 clinics (18.2%) did not allow drinking during treatment, and 19 clinics (1.6%) did not allow eating at the facility before or after treatment. In 2014, the proportion of clinics that did not allow eating during treatment had declined to 22.6% (321 of 1422 clinics), a significant shift in practice (Pnutritional status. Among clinicians, a higher percentage encouraged eating during treatment (53.1% versus 37.4%; P<0.05), and facility administrators and medical directors were less concerned about the seven reasons commonly cited for restricting eating during treatment in 2014 compared with 2011 (P<0.05 for all). We found that 28.6% and 22.6% of hemodialysis clinics within the United States restricted eating during treatment in 2011 and 2014, respectively, a rate more than double that found in an international cohort on which we previously published. However, practices and clinician opinions are shifting toward allowing patients to eat. Additional research is warranted to understand the effect that these practices have on patient outcomes and outline best practices. Copyright © 2016 by the American Society of

  20. Laser Guidance Analysis Facility

    Data.gov (United States)

    Federal Laboratory Consortium — This facility, which provides for real time, closed loop evaluation of semi-active laser guidance hardware, has and continues to be instrumental in the development...

  1. Review of LCA studies of solid waste management systems--part II: methodological guidance for a better practice.

    Science.gov (United States)

    Laurent, Alexis; Clavreul, Julie; Bernstad, Anna; Bakas, Ioannis; Niero, Monia; Gentil, Emmanuel; Christensen, Thomas H; Hauschild, Michael Z

    2014-03-01

    Life cycle assessment (LCA) is increasingly used in waste management to identify strategies that prevent or minimise negative impacts on ecosystems, human health or natural resources. However, the quality of the provided support to decision- and policy-makers is strongly dependent on a proper conduct of the LCA. How has LCA been applied until now? Are there any inconsistencies in the past practice? To answer these questions, we draw on a critical review of 222 published LCA studies of solid waste management systems. We analyse the past practice against the ISO standard requirements and the ILCD Handbook guidelines for each major step within the goal definition, scope definition, inventory analysis, impact assessment, and interpretation phases of the methodology. Results show that malpractices exist in several aspects of the LCA with large differences across studies. Examples are a frequent neglect of the goal definition, a frequent lack of transparency and precision in the definition of the scope of the study, e.g. an unclear delimitation of the system boundaries, a truncated impact coverage, difficulties in capturing influential local specificities such as representative waste compositions into the inventory, and a frequent lack of essential sensitivity and uncertainty analyses. Many of these aspects are important for the reliability of the results. For each of them, we therefore provide detailed recommendations to practitioners of waste management LCAs. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Discharge communication practices and healthcare provider and patient preferences, satisfaction and comprehension: A systematic review.

    Science.gov (United States)

    Newnham, Harvey; Barker, Anna; Ritchie, Edward; Hitchcock, Karen; Gibbs, Harry; Holton, Sara

    2017-09-07

    To systematically review the available evidence about hospital discharge communication practices and identify which practices were preferred by patients and healthcare providers, improved patient and provider satisfaction, and increased patients' understanding of their medical condition. OVID Medline, Web of Science, ProQuest, PubMed and CINAHL plus. Databases were searched for peer-reviewed, English-language papers, published to August 2016, of empirical research using quantitative or qualitative methods. Reference lists in the papers meeting inclusion criteria were searched to identify further papers. Of the 3489 articles identified, 30 met inclusion criteria and were reviewed. Much research to date has focused on the use of printed material and person-based discharge communication methods including verbal instructions (either in person or via telephone calls). Several studies have examined the use of information technology (IT) such as computer-generated and video-based discharge communication practices. Utilizing technology to deliver discharge information is preferred by healthcare providers and patients, and improves patients' understanding of their medical condition and discharge instructions. Well-designed IT solutions may improve communication, coordination and retention of information, and lead to improved outcomes for patients, their families, caregivers and primary healthcare providers as well as expediting the task for hospital staff.

  3. Guidance for patients considering direct-to-consumer genetic testing and health professionals involved in their care: development of a practical decision tool.

    Science.gov (United States)

    Jackson, Leigh; Goldsmith, Lesley; Skirton, Heather

    2014-06-01

    Direct-to-consumer (DTC) genetic tests are available online, but there is little practical guidance for health professionals and consumers concerning their use. Work to produce such guidance was initially informed by three systematic reviews assessing the evidence on views and experiences of users and health professionals and policies of professional and bioethics organizations. The evidence suggested that consumers' motivations include general curiosity, improving their general health, ascertaining the risk of a particular condition or planning for future children. However, health professionals and bioethics organizations expressed concerns about potential harms resulting from these tests. Using this evidence, we constructed a list of topics to be included in proposed guidelines. Using an expert group technique, we aimed to develop guidance for (i) potential consumers and (ii) health professionals approached by patients considering or having undertaken such tests. We considered it important to involve a wide range of participants with relevant experience. Accordingly, researchers and clinicians based in four countries were invited to a 2-day workshop in August 2012. Following an iterative process, we decided to produce clinically relevant and pragmatic guidance in the form of a decision support tool for use in primary care. By utilizing both the relevant literature and the experience of the expert group, we identified seven key underlying reasons that might prompt individuals to consider DTC testing. We considered primary care physicians as the most likely health professionals from whom individuals would seek advice. Based on the outcomes of the workshop, we developed a decision support tool encompassing varied clinical scenarios. Health professionals and patients are guided through a pathway that includes relevant actions and information on the appropriateness of the test. This tool will be freely accessible to health professionals and patients online. © The

  4. EMS providers' perceptions of safety climate and adherence to safe work practices.

    Science.gov (United States)

    Eliseo, Laura J; Murray, Kate A; White, Laura F; Dyer, Sophia; Mitchell, Patricia A; Fernandez, William G

    2012-01-01

    Occupational injuries are an important source of morbidity for emergency medical services (EMS) providers. Previous work has shown that employee perceptions of an organization's commitment to safety (i.e., safety climate) correlate with adherence to safe practices. To assess the association between perceived safety climate and compliance with safety procedures in an urban EMS system with >100,000 calls/year. EMS providers were issued a self-administered survey that included questions on demographics, years of experience, perceived safety climate, and adherence to safety procedures. Safety climate was assessed with a 20-item validated instrument. Adherence to safety procedures was assessed with a nine-item list of safety behaviors. Strict adherence to safety procedures was defined as endorsing "agree" or "strongly agree" on 80% of items. The effect of safety climate on compliance with safe practices was estimated using multiple logistic regression. One hundred ninety-six of 221 providers (89%) completed surveys; 74% were male; the median age was 36-40 years; and the median amount of experience was 8 years. One hundred twenty-seven of 196 respondents (65%) reported strict adherence to safe work practice. Factor analysis confirmed the original six-factor grouping of questions; frequent safety-related feedback/training was significantly associated with safe practices (odds ratio [OR] = 2.14, 95% confidence interval [CI] = 1.01-4.51). EMS workers perceiving a high degree of perceived safety climate was associated with twofold greater odds of self-reported level of strict adherence to safe work practices. Frequent safety-related feedback/training was the one dimension of safety climate that had the strongest association with adherence to safe workplace behaviors.

  5. Current Knowledge and Practice of Pediatric Providers in Umbilical Cord Blood Banking.

    Science.gov (United States)

    Armstrong, Amy E; Fonstad, Rachel; Spellman, Stephen; Tullius, Zoe; Chaudhury, Sonali

    2018-02-01

    More than 35 000 umbilical cord blood (UCB) transplants have been performed worldwide, prompting the development of private and public banks to collect and store UCB cells. We hypothesized that pediatricians, who are uniquely poised to discuss UCB banking (UCBB) during prenatal or sibling visits, rarely do so. Through distribution of a 26-question electronic survey to general and subspecialty pediatric providers, we assessed baseline knowledge and conversations about UCBB. A total of 473 providers completed the survey; only 22% of physicians ever discussed UCBB with expectant parents. The majority responded that autologous UCB transplants were indicated in malignant (73%) and nonmalignant (61%) conditions; however, these are rare indications. Providers practicing >10 years were more likely to address UCBB ( P ≤ .001), whereas younger and female general pediatric providers were significantly less likely ( P < .001). Overall, pediatric providers rarely speak to families about UCBB, and we believe that they can be better informed to its current clinical utility.

  6. Ways of Doing: Restorative Practices, Governmentality, and Provider Conduct in Post-Apartheid Health Care.

    Science.gov (United States)

    Harris, Bronwyn; Eyles, John; Goudge, Jane

    2016-01-01

    In this article, we consider the conduct of post-apartheid health care in a policy context directed toward entrenching democracy, ensuring treatment-adherent patients, and creating a healthy populace actively responsible for their own health. We ask how tuberculosis treatment, antiretroviral therapy, and maternal services are delivered within South Africa's health system, an institutional site of colonial and apartheid injustice, and democratic reform. Using Foucauldian and post-Foucauldian notions of governmentality, we explore provider ways of doing to, for, and with patients in three health subdistricts. Although restorative provider engagements are expected in policy, older authoritarian and paternalistic norms persist in practice. These challenge and reshape, even 'undo' democratic assertions of citizenship, while producing compliant, self-responsible patients. Alongside the need to address pervasive structural barriers to health care, a restorative approach requires community participation, provider accountability, and a health system that does with providers as much as providers who do with patients.

  7. Oncology healthcare providers' knowledge, attitudes, and practice behaviors regarding LGBT health.

    Science.gov (United States)

    Shetty, Gina; Sanchez, Julian A; Lancaster, Johnathan M; Wilson, Lauren E; Quinn, Gwendolyn P; Schabath, Matthew B

    2016-10-01

    There are limited data on lesbian, gay, bisexual, and transgender (LGBT) healthcare experiences and interactions with the providers. This study assessed knowledge, attitudes, and practice behaviors of oncology providers regarding LGBT health. A 32-item web-based survey was emailed to 388 oncology providers at a single institution. The survey assessed: demographics, knowledge, attitudes, and practice behaviors. 108 providers participated in the survey (28% response rate). LGBT cultural competency at the institution. Results from the open comments section identified multiple misconceptions. This study revealed knowledge gaps about LGBT health risks. Cultural competency training may aid oncology providers to understand the need to inquire about patients' gender identity and sexual orientation. Health care providers who incorporate the routine collection of gender identity and sexual orientation (SOGI) in their patient history taking may improve patient care by offering tailored education and referrals. While identifying as LGBT does not in itself increase risk for adverse health outcomes, this population tends to have increased risk behaviors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Opioid-prescribing practices and provider confidence recognizing opioid analgesic abuse in HIV primary care settings.

    Science.gov (United States)

    Lum, Paula J; Little, Sherri; Botsko, Michael; Hersh, David; Thawley, Robert E; Egan, James E; Mitty, Jennifer; Boverman, Joshua; Fiellin, David A

    2011-03-01

    Pain syndromes are common in HIV-infected patients, who also are commonly affected by opioid-use disorders. Although opioids can treat pain, prescribers must consider the consequences of iatrogenic or missed addiction diagnoses. In an anonymous online survey, we asked a national sample of HIV providers about their demographics, experience, and patients, and their practices and attitudes about chronic opioid therapy, addiction, and confidence recognizing opioid analgesic abuse. One hundred six providers reported 28% of their patients had chronic pain; 21% received opioid analgesics; 37% were HIV infected by injecting drug use; and 12% were addicted to prescription opioids. Few providers followed recommended guidelines for chronic opioid therapy in nonmalignant pain. Mean provider confidence was 6.3 on a scale of 10. Higher confidence was associated with provider sex (P opioids (P = 0.005), and prescribing buprenorphine (P = 0.009). HIV providers seldom follow recommended guidelines for opioid prescribing and have limited confidence in their ability to recognize opioid analgesic abuse. Clinical practices developed to reduce misuse and increase early detection and treatment of opioid dependence are associated with higher confidence. The implementation of guidelines to improve the quality of opioid prescribing in HIV clinics may aid in the diagnosis of addictive disorders and prevent their adverse outcomes.

  9. Provider practices impact adequate diagnosis of sleep disorders in children with epilepsy.

    Science.gov (United States)

    Jain, Sejal V; Simakajornboon, Narong; Glauser, Tracy A

    2013-05-01

    Sleep disorders significantly affect the lives of children with epilepsy. Limited data exist about provider practices concerning detection and correct diagnosis of sleep problems in epilepsy. The authors conducted this study to identify and correlate sleep screening methods, referral practices, referral reasons and final sleep diagnoses. They identified that 94% of the providers who had referred patients to the sleep center of a major children's hospital used routine screening and 70% of them used 2 to 3 screening questions. This method, however, underidentified the patients at risk for sleep disorders. Moreover, in 40% of the children, sleep disorder was incorrectly anticipated, based on the initial symptoms. Of these children, 10% had no sleep disorder and 30% had unexpected sleep disorder. The authors conclude that better screening methods should be used for sleep disorders. Once identified, these patients should have formal sleep evaluation and management. Further studies are needed to develop screening questionnaires.

  10. Informal allopathic provider knowledge and practice regarding control and prevention of TB in rural Bangladesh.

    Science.gov (United States)

    Islam, Qazi S; Ahmed, Syed M; Islam, Mohammad A; Chowdhury, Anita S; Siddiquea, Bodrun N; Husain, Mohammad A

    2014-09-01

    BRAC (formerly Bangladesh Rural Advancement Committee), in collaboration with the National Tuberculosis Control Programme, provides one full-day training on TB to make informal allopathic providers knowledgeable for managing TB in rural Bangladesh. This study explored the knowledge and practices of the providers receiving the above training in the control and prevention of TB. The study was conducted in 30 subdistricts, with 30 trained and 30 untrained providers randomly selected from each subdistrict. Approximately 3% (49/1800) did not provide complete information. Pre-tested structured and semi-structured questionnaires were used. TB was commonly perceived as a disease of only males (66.1%, 1157/1751). Only one-quarter knew about the bacterial cause of TB. Very few providers (2.1%, 36) had adequate knowledge regarding prevention of TB. They also lacked knowledge about TB treatment duration (71.6%, 1253), the meaning of DOTS (directly observed treatment, short course) (26.0%, 455) and multidrug resistance (20.6%, 360). Antibiotics (79.7%, 1396) and cough syrup (75.0%, 1313) were commonly prescribed by providers despite symptoms suggestive of TB. However, 70.2% (613) and 74.5% (650) of trained providers' knowledge and practice scores were equal to or more than the mean scores (≥6.97 and ≥6.6, respectively), whereas they were only 49.5% (435) and 64.2% (563), respectively, among untrained providers (ppreventing TB efficiently. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Image Guidance

    Science.gov (United States)

    Guidance that explains the process for getting images approved in One EPA Web microsites and resource directories. includes an appendix that shows examples of what makes some images better than others, how some images convey meaning more than others

  12. Healthcare Provider Views on Transitioning From Task Shifting to Advanced Practice Nursing in Tanzania.

    Science.gov (United States)

    Mboineki, Joanes Faustine; Zhang, Weihong

    The Tanzanian health sector suffers from shortages of healthcare workers as well as uneven distribution of healthcare workers in urban and rural areas. Task shifting-delegation of tasks from professionals to other healthcare team members with less training, such as medical attendants-is practiced, compromising quality of care. Advanced practice nursing is underutilized. The purpose of this study was to explore the views of nurses and physicians on current responses to shortages of healthcare workers and the potential for utilization of advanced practice nurses. A descriptive, qualitative design was used. Purposeful sampling was used to select 20 participants. An in-depth interview guide was used to obtain information. Interviews were conducted in Swahili or English. Content analysis was used to identify themes. Shortage of human resources in rural primary healthcare facilities was identified as a major rationale for implementation of the advanced practice nurse practitioner role because the current health providers in rural health facilities are less trained and doctors are not ready to work in these settings. Opposition from physicians is expected during the course of implementing the nurse practitioner role. Professional bodies and government should reach consensus before the implementation of this role in such a way that they should agree on scope and standards of practice of nurse practitioners in Tanzania. Shortage of human resources for health is greater in rural primary healthcare facilities. Task shifting in Tanzania is neither effective nor legally recognized. Transition to advanced practice nursing roles-particularly the nurse practitioner role-can facilitate provision of optimal care. Nurse practitioners should be prepared to work in rural primary healthcare facilities.

  13. Knowledge, attitudes and practices of private sector providers of tuberculosis care: a scoping review.

    Science.gov (United States)

    Bell, C A; Duncan, G; Saini, B

    2011-08-01

    The past decade has seen a significant increase in private sector provision of tuberculosis (TB)care. While patients often seek and select treatment from private providers at significant out-of-pocket expense,treatment outcomes remain largely unknown. To investigate the knowledge, attitudes and practices of private sector TB care providers in high burden countries. Medline, PubMed, Embase, International Pharmaceutical Abstracts and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched using Medical Subject Headings terms,Emtree terms and key words. Searches were limited to the English language and published between 1998 and week 2 of November 2009. Studies were included if they reported the knowledge, attitudes or practice behaviours of private health care providers working in one of 22 high-TB-burden countries. Each included study was critically assessed using a structured data extraction tool. Data extracted included the study setting, objective, design, sample, response rate, outcomes and limitations. The 34 studies that met review inclusion criteriaen compassed diverse study methods and designs.All categories of TB care providers lacked comprehensive knowledge of national treatment guidelines. Procedures for referral, treatment monitoring, record keeping and case holding were not systematically implemented.However, there was a high degree of willingness to collaborate with national TB programmes. Research using standardised data collection methods may assist in identifying gaps in knowledge and practice among all providers of TB care. Further studies in developing and evaluating needs-based interventions should be undertaken; systematic reviews of such studies may then assist in strategic decision making in public-private mix DOTS expansion.

  14. 78 FR 22887 - Guidance for Industry on Non-Penicillin Beta-Lactam Drugs: A Current Good Manufacturing Practices...

    Science.gov (United States)

    2013-04-17

    ... Current Good Manufacturing Practices Framework for Preventing Cross- Contamination; Availability AGENCY... health risks associated with cross-reactivity. Although the existing current good manufacturing practices (CGMP) regulations require separation of manufacturing facilities to avoid cross-contamination, the only...

  15. Primary Care Providers' Knowledge and Practices of Diabetes Management During Ramadan.

    Science.gov (United States)

    Ali, Mujtaba; Adams, Alexandra; Hossain, Md Anwar; Sutin, David; Han, Benjamin Hyun

    2016-01-01

    There are an estimated 3.5 million Muslims in North America. During the holy month of Ramadan, healthy adult Muslims are to fast from predawn to after sunset. While there are exemptions for older and sick adults, many adults with diabetes fast during Ramadan. However, there are risks associated with fasting and specific management considerations for patients with diabetes. We evaluated provider practices and knowledge regarding the management of patients with diabetes who fast during Ramadan. A 15-question quality improvement survey based on a literature review and the American Diabetes Association guidelines was developed and offered to providers at the outpatient primary care and geriatric clinics at an inner-city hospital in New York City. Forty-five providers completed the survey. Most respondents did not ask their Muslim patients with diabetes if they were fasting during the previous Ramadan. Knowledge of fasting practices during Ramadan was variable, and most felt uncomfortable managing patients with diabetes during Ramadan. There is room for improvement in educating providers about specific cultural and medical issues regarding fasting for patients with diabetes during Ramadan. © The Author(s) 2015.

  16. [Elements of comprehensiveness in the professional health practices provided to rural women victims of violence].

    Science.gov (United States)

    da Costa, Marta Cocco; Lopes, Marta Julia Marques

    2012-10-01

    The present article refers to a qualitative study that was performed with the objective to identify and analyze the practice of healthcare professionals regarding rural women victims of violence, under the perspective of comprehensive care, in cities located in southern Rio Grande do Sul state. Participants were healthcare professionals and workers from health services who work in rural areas. The information was generated through interviews and analyzed using the thematic mode. In regards to care elements provided to rural women who are victims of violence, the study pointed out not only the relational strategies - welcoming, attachment and dialogue - but also the construction of collective actions through group activities, recognized as supporting health promotion, as well as individual and collective empowerment in the dimension of violent events. It was found that the professionals' care practices are aimed at focusing care on the rural women, establishing a relationship between the worker and client to produce comprehensiveness of care.

  17. lmbali Guidance Project: Facilitating Development among Guidance ...

    African Journals Online (AJOL)

    A project to assist guidance educators in developing their skills, resources and confidence in providing a mental health service to the learners in their schools, was set up as part of a wider school-based reform initiative. The project was structured according to the principles of community psychology: community collaboration ...

  18. Safeguards Guidance Document for Designers of Commercial Nuclear Facilities: International Nuclear Safeguards Requirements and Practices For Uranium Enrichment Plants

    Energy Technology Data Exchange (ETDEWEB)

    Robert Bean; Casey Durst

    2009-10-01

    This report is the second in a series of guidelines on international safeguards requirements and practices, prepared expressly for the designers of nuclear facilities. The first document in this series is the description of generic international nuclear safeguards requirements pertaining to all types of facilities. These requirements should be understood and considered at the earliest stages of facility design as part of a new process called “Safeguards-by-Design.” This will help eliminate the costly retrofit of facilities that has occurred in the past to accommodate nuclear safeguards verification activities. The following summarizes the requirements for international nuclear safeguards implementation at enrichment plants, prepared under the Safeguards by Design project, and funded by the U.S. Department of Energy (DOE) National Nuclear Security Administration (NNSA), Office of NA-243. The purpose of this is to provide designers of nuclear facilities around the world with a simplified set of design requirements and the most common practices for meeting them. The foundation for these requirements is the international safeguards agreement between the country and the International Atomic Energy Agency (IAEA), pursuant to the Treaty on the Non-proliferation of Nuclear Weapons (NPT). Relevant safeguards requirements are also cited from the Safeguards Criteria for inspecting enrichment plants, found in the IAEA Safeguards Manual, Part SMC-8. IAEA definitions and terms are based on the IAEA Safeguards Glossary, published in 2002. The most current specification for safeguards measurement accuracy is found in the IAEA document STR-327, “International Target Values 2000 for Measurement Uncertainties in Safeguarding Nuclear Materials,” published in 2001. For this guide to be easier for the designer to use, the requirements have been restated in plainer language per expert interpretation using the source documents noted. The safeguards agreement is fundamentally a

  19. Frequent attenders in general practice: problem solving treatment provided by nurses [ISRCTN51021015

    Directory of Open Access Journals (Sweden)

    van Oppen P

    2005-10-01

    Full Text Available Abstract Background There is a need for assistance from primary care mental health workers in general practice in the Netherlands. General practitioners (GPs experience an overload of frequent attenders suffering from psychological problems. Problem Solving Treatment (PST is a brief psychological treatment tailored for use in a primary care setting. PST is provided by nurses, and earlier research has shown that it is a treatment at least as effective as usual care. However, research outcomes are not totally satisfying. This protocol describes a randomized clinical trial on the effectiveness of PST provided by nurses for patients in general practice. The results of this study, which currently being carried out, will be presented as soon as they are available. Methods/design This study protocol describes the design of a randomized controlled trial to investigate the effectiveness and cost-effectiveness of PST and usual care compared to usual care only. Patients, 18 years and older, who present psychological problems and are frequent attenders in general practice are recruited by the research assistant. The participants receive questionnaires at baseline, after the intervention, and again after 3 months and 9 months. Primary outcome is the reduction of symptoms, and other outcomes measured are improvement in problem solving skills, psychological and physical well being, daily functioning, social support, coping styles, problem evaluation and health care utilization. Discussion Our results may either confirm that PST in primary care is an effective way of dealing with emotional disorders and a promising addition to the primary care in the UK and USA, or may question this assumption. This trial will allow an evaluation of the effects of PST in practical circumstances and in a rather heterogeneous group of primary care patients. This study delivers scientific support for this use and therefore indications for optimal treatment and referral.

  20. Bedside resource stewardship in disasters: a provider's dilemma practicing in an ethical gap.

    Science.gov (United States)

    Daniel, Michelle

    2012-01-01

    During disasters, clinicians may be forced to play dual roles, as both a provider and an allocator of scarce resources. At present, a clear framework to govern resource stewardship at the bedside is lacking. Clinicians who find themselves practicing in this ethical gap between clinical and public health ethics can experience significant moral distress. One provider describes her experience allocating an oxygen tank in the intensive care unit at a hospital in Port-au-Prince, Haiti, immediately following the 2010 earthquake. Using a clinical vignette and reflective narrative she attempts to identify the factors that influenced her allocation decision, opening up the factors for commentary and debate by an ethicist. A better paradigm for the ethical care of patients during disasters is needed to better guide provider choices in the future.

  1. Exploring mental health providers' interest in using web and mobile-based tools in their practices

    Directory of Open Access Journals (Sweden)

    Stephen M. Schueller

    2016-05-01

    Full Text Available A growing number of Internet sites and mobile applications are being developed intended for use in clinical practice. However, during the development process (e.g., creating features and determining use cases, the needs and interests of providers are often overlooked. We explored providers' interests using a mixed-methods approach incorporating both qualitative and quantitative research methods. A first study used an interview approach to identify the challenges providers faced, tools they used, and any use of computers and apps specifically. Fifteen providers from both the United States and Canada completed the interview and recordings were transcribed and analyzed using a constructivist grounded theory approach. Four primary themes were identified including challenges, potential tools, access and usability. A second study used a brief survey completed by 132 providers at a large healthcare system to explore current use of and potential interest in Internet and mobile technologies. Although many providers (80.9% reported recommending some form of technology to patients, these were mostly Internet websites that were predominantly informational/psychoeducational in nature. Overall, these studies combine to suggest a strong interest in websites and apps for use in clinical settings while highlighting potential areas (ease of use, patient security and privacy that should be considered in the design and deployment of these tools.

  2. Dentist preferences for patients: dimensions and associations with provider, practice, and service characteristics.

    Science.gov (United States)

    Brennan, David S; Spencer, A John

    2006-01-01

    Provider-patient relations may influence the nature of care provided. The aim of this study was to examine dentist preferences for patients, relate these to characteristics of dentists and practices, and to services provided. A random sample of Australian dentists completed mailed questionnaires (response = 60.3%). Four factor-based subscales and an overall scale (Selectivity) were derived from a 37-item battery. The 4 subscales comprised treatment adherence (behavior relevant to the treatment situation), personal adaptability (willingness to cooperate when expected to do so), social interactiveness (positive affect, communicativeness, and appreciativeness), and enabling characteristics (willing and able to pay, and good dental knowledge). Reliability was adequate (Cronbach's alpha = 0.71-0.90). Treatment adherence was associated with higher orthodontic rates, but a lower extraction rate; social interactiveness was associated with higher extraction and denture rates; personal adaptability was associated with higher orthodontic rates, but lower general/miscellaneous service rates; enabling characteristics was associated with higher endodontic and crown and bridge rates; selectivity was associated with higher rates of diagnostic, preventive, and total services per visit. The associations with service rates indicated that provider preferences were related to treatment behavior that could affect the mix of services, indicating that the nature of care provided may be influenced by the provider-patient relation.

  3. Googling Concussion Care: A Critical Appraisal of Online Concussion Healthcare Providers and Practices in Canada.

    Science.gov (United States)

    Ellis, Michael J; Ritchie, Lesley; Selci, Erin; Chu, Stephanie; McDonald, Patrick; Russell, Kelly

    2017-03-01

    Concussion is an emerging public health concern, but care of patients with a concussion is presently unregulated in Canada. Independent, blinded Google Internet searches were conducted for the terms "concussion" and "concussion clinic" and each of the Canadian provinces and territories. The first 10 to 15 concussion healthcare providers per province were identified. A critical appraisal of healthcare personnel and services offered on the provider's Web site was conducted. Fifty-eight concussion healthcare providers were identified using this search methodology. Only 40% listed the presence of an on-site medical doctor (M.D.) as a member of the clinical team. Forty-seven percent of concussion healthcare providers advertised access to a concussion clinic, program, or center on their Web site. Professionals designated as team leaders, directors, or presidents among concussion clinics, programs, and centers included a neuropsychologist (15%), sports medicine physician (7%), neurologist (4%), and neurosurgeon (4%). Services offered by providers included baseline testing (67%), physiotherapy (50%), and hyperbaric oxygen therapy (2%). This study indicates that there are numerous concussion healthcare providers in Canada offering diverse services with clinics operated by professionals with varying levels of training in traumatic brain injury. In some cases, the practices of these concussion clinics do not conform to current expert consensus guidelines.

  4. Contraception Initiation in the Emergency Department: A Pilot Study on Providers' Knowledge, Attitudes, and Practices.

    Science.gov (United States)

    Liles, Iyanna; Haddad, Lisa B; Lathrop, Eva; Hankin, Abigail

    2016-05-01

    Almost half of all pregnancies in the United States are unintended; these pregnancies are associated with adverse outcomes. Many reproductive-age females seek care in the emergency department (ED), are at risk of pregnancy, and are amenable to contraceptive services in this setting. Through a pilot study, we sought to assess ED providers' current practices; attitudes; and knowledge of emergency contraception (EC) and nonemergency contraception (non-EC), as well as barriers with respect to contraception initiation. ED physicians and associate providers in Georgia were e-mailed a link to an anonymous Internet questionnaire using state professional databases and contacts. The questionnaire included Likert scales with multiple-choice questions to assess study objectives. Descriptive statistics were generated as well as univariate analyses using χ(2) and Fisher exact tests. A total of 1232 providers were e-mailed, with 119 questionnaires completed. Participants were predominantly physicians (80%), men (59%), and individuals younger than 45 years (59%). Common practices were referrals (96%), EC prescriptions (77%), and non-EC prescriptions (40%). Common barriers were perceived as low likelihood for follow-up (63%), risk of complications (58%), and adverse effects (51%). More than 70% of participants correctly identified the highly effective contraceptive methods, 3% identified the correct maximum EC initiation time, and 42% correctly recognized pregnancy as a higher risk than hormonal contraception use for pulmonary embolism. Most ED providers in this pilot study referred patients for contraception; however, there was no universal contraceptive counseling and management. Many ED providers in this study had an incorrect understanding of the efficacy, risks, and eligibility associated with contraceptive methods. This lack of understanding may affect patient access and be a barrier to patient care.

  5. The Consequences of Fading Instructional Guidance on Delayed Performance: The Case of Financial Services Training

    Science.gov (United States)

    Kissane, Mark; Kalyuga, Slava; Chandler, Paul; Sweller, John

    2008-01-01

    Empirical studies within a cognitive load framework have determined that for novice learners, worked examples provide appropriate levels of instructional guidance. As learners advance in specific subject domains, worked examples should be gradually replaced by practice problems with limited guidance. This study compared performance, both…

  6. Supporting Emergency Medical Care Teams with an Integrated Status Display Providing Real-Time Access to Medical Best Practices, Workflow Tracking, and Patient Data.

    Science.gov (United States)

    Wu, PoLiang; Nam, Min-Young; Choi, Jeonghwan; Kirlik, Alex; Sha, Lui; Berlin, Richard B

    2017-10-17

    The work of a hospital's medical staff is safety critical and often occurs under severe time constraints. To provide timely and effective cognitive support to medical teams working in such contexts, guidelines in the form of best practice workflows for healthcare have been developed by medical organizations. However, the high cognitive load imposed in such stressful and rapidly changing environments poses significant challenges to the medical staff or team in adhering to these workflows. In collaboration with physicians and nurses from Carle Foundation Hospital, we first studied and modeled medical team's individual responsibilities and interactions in cardiac arrest resuscitation and decomposed their overall task into a set of distinct cognitive tasks that must be specifically supported to achieve successful human-centered system design. We then developed a medical Best Practice Guidance (BPG) system for reducing medical teams' cognitive load, thus fostering real-time adherence to best practices. We evaluated the resulting system with physicians and nurses using a professional patient simulator used for medical training and certification. The evaluation results point to a reduction of cognitive load and enhanced adherence to medical best practices.

  7. Engineering practice variation through provider agreement: a cluster-randomized feasibility trial

    Directory of Open Access Journals (Sweden)

    McCarren M

    2014-10-01

    Full Text Available Madeline McCarren,1 Elaine L Twedt,1 Faizmohamed M Mansuri,2 Philip R Nelson,3 Brian T Peek3 1Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, IL, 2Wilkes-Barre VA Medical Center, Wilkes-Barre, PA, 3Charles George VA Medical Center, Asheville, NC, USA Purpose: Minimal-risk randomized trials that can be embedded in practice could facilitate learning health-care systems. A cluster-randomized design was proposed to compare treatment strategies by assigning clusters (eg, providers to “favor” a particular drug, with providers retaining autonomy for specific patients. Patient informed consent might be waived, broadening inclusion. However, it is not known if providers will adhere to the assignment or whether institutional review boards will waive consent. We evaluated the feasibility of this trial design.Subjects and methods: Agreeable providers were randomized to “favor” either hydrochlorothiazide or chlorthalidone when starting patients on thiazide-type therapy for hypertension. The assignment applied when the provider had already decided to start a thiazide, and providers could deviate from the strategy as needed. Prescriptions were aggregated to produce a provider strategy-adherence rate.Results: All four institutional review boards waived documentation of patient consent. Providers (n=18 followed their assigned strategy for most of their new thiazide prescriptions (n=138 patients. In the “favor hydrochlorothiazide” group, there was 99% adherence to that strategy. In the “favor chlorthalidone” group, chlorthalidone comprised 77% of new thiazide starts, up from 1% in the pre-study period. When the assigned strategy was followed, dosing in the recommended range was 48% for hydrochlorothiazide (25–50 mg/day and 100% for chlorthalidone (12.5–25.0 mg/day. Providers were motivated to participate by a desire to contribute to a comparative effectiveness study. A study promotional mug, provider information

  8. Perception and Practice Among Emergency Medicine Health Care Providers Regarding Discharging Patients After Opioid Administration.

    Science.gov (United States)

    Surmaitis, Ryan M; Amaducci, Alexandra; Henry, Kathryn; Jong, Michael; Kiernan, Emily A; Kincaid, Hope; Houck, Lindsay J; Sabbatini, Sandra J; Greenberg, Marna Rayl; Katz, Kenneth D

    2018-01-19

    This study aimed to determine the current attitudes, perceptions, and practices of emergency medicine providers and nurses (RNs) regarding the discharge of adult patients from the emergency department (ED) after administration of opioid analgesics. A cross-sectional survey was administered at 3 hospital sites with a combined annual ED census of >180,000 visits per year. All 59 attending emergency physicians (EPs), 233 RNs, and 23 advanced practice clinicians (APCs) who worked at these sites were eligible to participate. Thirty-five EPs (59.3%), 88 RNs (37.8%), and 14 APCs (60.9%) completed the survey for an overall response rate of 51.75%. Most respondents were female (95 [69.9%]). The factor ranked most important to consider when discharging a patient from the ED after administration of opioids was the patient's functional status and vital signs (median, 2.00; interquartile range, 2.00-3.50). More RNs (84 [96.6%]) than EPs (29 [82.9%]) reported that developing an ED policy or guideline for safe discharge after administration of opioids is important to clinical practice (P = 0.02). Only 8 physicians (23.5%) reported that they did not prescribe intramuscular morphine, and 15 (42.9%) reported that they did not prescribe intramuscular hydromorphone. EPs (7 [20.0%]) and RNs (3 [3.4%]) differed in regard to whether they were aware if any patients to whom they administered an opioid had experienced an adverse drug-related event (P = 0.01). Most EPs (24 [68.6%]) and RNs (54 [61.4%]) believed that the decision for patient discharge should be left to both the emergency medicine provider and the RN. Most study participants believed that developing a policy or guideline for safe discharge after administration opioids in the ED is important to clinical practice. Only a few physicians reported that they did not prescribe intramuscular hydromorphone or morphine. Most participants believed the discharge decision after administration of opioids in the ED should be primarily

  9. Taking stock: provider prescribing practices in the presence and absence of ACT stock

    Directory of Open Access Journals (Sweden)

    Jones Caroline

    2011-08-01

    Full Text Available Abstract Background Globally, the monitoring of prompt and effective treatment for malaria with artemisinin combination therapy (ACT is conducted largely through household surveys. This measure; however, provides no information on case management processes at the health facility level. The aim of this review was to assess evidence from health facility surveys on malaria prescribing practices using ACT, in the presence and absence of ACT stock, at time and place where treatment was sought. Methods A systematic search of published literature was conducted. Findings were collated and data extracted on proportion of patients prescribed ACT and alternative anti-malarials in the presence and absence of ACT stock. Results Of the 14 studies identified in which ACT prescription for uncomplicated malaria in the public sector was evaluated, just six, from three countries (Kenya, Uganda and Zambia, reported this in the context of ACT stock. Comparing facilities with ACT stock to facilities without stock (i ACT prescribing was significantly higher in all six studies, increasing by a range of 21.3% in children Conclusions Prescriber practices vary based on ACT availability. Although ACT prescriptions increased and alternative anti-malarials prescriptions decreased in the presence of ACT stock, ACT was prescribed in the absence, and alternative anti-malarials were prescribed in the presence of, ACT. Presence of stock alone does not ensure that treatment guidelines are followed. More health facility surveys, together with qualitative research, are needed to understand the role of ACT stock-outs on provider prescribing behaviours and preferences.

  10. Narrative in interprofessional education and practice: implications for professional identity, provider-patient communication and teamwork.

    Science.gov (United States)

    Clark, Phillip G

    2014-01-01

    Health and social care professionals increasingly use narrative approaches to focus on the patient and to communicate with each other. Both effective interprofessional education (IPE) and practice (IPP) require recognizing the various values and voices of different professions, how they relate to the patient's life story, and how they interact with each other at the level of the healthcare team. This article analyzes and integrates the literature on narrative to explore: self-narrative as an expression of one's professional identity; the co-creation of the patient's narrative by the professional and the patient; and the interprofessional multi-vocal narrative discourse as co-constructed by members of the healthcare team. Using a narrative approach to thinking about professional identity, provider-patient communication, and interprofessional teamwork expands our thinking about both IPE and IPP by providing new insights into the nature of professional practice based on relationships to oneself, the patient, and others on the team. How professionals define themselves, gather and present information from the patient, and communicate as members of a clinical team all have important dimensions that can be revealed by a narrative approach. Implications and conclusions for the further development of the narrative approach in IPE and IPP are offered.

  11. Surgery and trauma care providers' perception of the impact of dual-practice employment on quality of care provided in an Andean country.

    Science.gov (United States)

    LaGrone, L N; Isquith-Dicker, L N; Huaman Egoavil, E; Herrera-Matta, J J; Fuhs, A K; Ortega Checa, D; Revoredo, F; Rodriguez Castro, M J A; Mock, C N

    2017-05-01

    Dual-practice, simultaneous employment by healthcare workers in the public and private sectors is pervasive worldwide. Although an estimated 30 per cent of the global burden of disease is surgical, the implications of dual practice on surgical care are not well understood. Anonymous in-depth individual interviews on trauma quality improvement practices were conducted with healthcare providers who participate in the care of the injured at ten large hospitals in Peru's capital city, Lima. A grounded theory approach to qualitative data analysis was employed to identify salient themes. Fifty interviews were conducted. A group of themes that emerged related to the perceived negative and positive impacts of dual practice on the quality of surgical care. Participants asserted that the majority of physicians in Lima working in the public sector also worked in the private sector. Dual practice has negative impacts on physicians' time, quality of care in the public sector, and surgical education. Dual practice positively affects patient care by allowing physicians to acquire management and quality improvement skills, and providing incentives for research and academic productivity. In addition, dual practice provides opportunities for clinical innovations and raises the economic status of the physician. Surgeons in Peru report that dual practice influences patient care negatively by creating time and human resource conflicts. Participants assert that these conflicts widen the gap in quality of care between rich and poor. This practice warrants redirection through national-level regulation of physician schedules and reorganization of public investment in health via physician remuneration. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  12. Increasing Patient / Provider Communications about Colorectal Cancer Screening In Rural Primary Care Practices

    Science.gov (United States)

    Geller, Berta M.; Skelly, Joan M.; Dorwaldt, Anne L.; Howe, Kathleen D.; Dana, Greg S.; Flynn, Brian S.

    2009-01-01

    Background Rural populations as well as less educated people in the U.S. are less likely to receive colorectal cancer (CRC) screening than people living in urban areas and more educated people. Methods We tested a computer tablet, Patient/Provider Communication Assistant (PPCA), which collected data, educated patients, and printed personalized notes to patients and providers encouraging conversation about CRC screening. Mixed model analyses using a pre-post quasi-experimental design compared patient results during the comparison and intervention periods in 5 rural primary care practices on provider discussion about CRC screening, provider recommendation, and patient intention to be screened. Models including age, education and literacy measures as covariates were examined. Results Providers talked with patients about CRC screening in general, and colonoscopy specifically more frequently after the PPCA than with the comparison group (p values =.04 and .01, respectively). Providers recommended CRC screening more often to patients in the intervention group than to the comparison group (p=.02). Patients planned to be screened and specifically with colonoscopy more frequently following the intervention than in the comparison group (p=.003). There were no interactions between group and any of the covariates. Ninety-five percent of the patients regardless of age or education found the PPCA easy to use. Conclusion Results indicated increased provider discussion and recommendation, and patients' intentions to obtain CRC screening, and in particular colonoscopy, for patients exposed to the intervention, regardless of the patients' age or literacy levels. The PPCA is a promising intervention method that is acceptable to rural patients. PMID:18725831

  13. Providing Students with Foundational Field Instruction within a 50 Minute Class Period: A Practical Example

    Science.gov (United States)

    Percy, M.

    2014-12-01

    There is a growing recognition among secondary educators and administrators that students need to have a science education that provides connections between familiar classes like biology, chemistry, and physics. Because of this waxing interest in an integrative approach to the sciences, there is a broader push for school districts to offer classes geared towards the earth sciences, a field that incorporates knowledge and skills gleaned from the three core science subjects. Within the contexts of a regular secondary school day on a traditional schedule (45- to 50-minute long classes), it is challenging to engage students in rigorous field-based learning, critical for students to develop a deeper understanding of geosciences content, without requiring extra time outside of the regular schedule. We suggest instruction using common, manmade features like drainage retention ponds to model good field practices and provide students with the opportunity to calculate basic hydrologic budgets, take pH readings, and, if in an area with seasonal rainfall, make observations regarding soils by way of trenching, and near-surface processes, including mass wasting and the effects of vegetation on geomorphology. Gains in student understanding are discussed by analyzing the difference in test scores between exams provided to the students after they had received only in-class instruction, and after they had received field instruction in addition to the in-class lectures. In an advanced setting, students made measurements regarding ion contents and pollution that allowed the classes to practice lab skills while developing a data set that was analyzed after field work was completed. It is posited that similar fieldwork could be an effective approach at an introductory level in post-secondary institutions.

  14. The knowledge, efficacy, and practices instrument for oral health providers: a validity study with dental students.

    Science.gov (United States)

    Behar-Horenstein, Linda S; Garvan, Cyndi W; Moore, Thomas E; Catalanotto, Frank A

    2013-08-01

    Valid and reliable instruments to measure and assess cultural competence for oral health care providers are scarce in the literature, and most published scales have been contested due to a lack of item analysis and internal estimates of reliability. The purposes of this study were, first, to develop a standardized instrument to measure dental students' knowledge of diversity, skills in culturally competent patient-centered communication, and use of culture-centered practices in patient care and, second, to provide preliminary validity support for this instrument. The initial instrument used in this study was a thirty-six-item Likert-scale survey entitled the Knowledge, Efficacy, and Practices Instrument for Oral Health Providers (KEPI-OHP). This instrument is an adaption of an initially thirty-three-item version of the Multicultural Awareness, Knowledge, and Skills Scale-Counselor Edition (MAKSS-CE), a scale that assesses factors related to social justice, cultural differences among clients, and cross-cultural client management. After the authors conducted cognitive and expert interviews, focus groups, pilot testing, and item analysis, their initial instrument was reduced to twenty-eight items. The KEPI-OHP was then distributed to 916 dental students (response rate=48.6 percent) across the United States to measure its reliability and assess its validity. Both exploratory and confirmatory factor analyses were conducted to test the scale's validity. The modification of the survey into a sensible instrument with a relatively clear factor structure using factor analysis resulted in twenty items. A scree test suggested three expressive factors, which were retained for rotation. Bentler's comparative fit and Bentler and Bonnett's non-normed indices were 0.95 and 0.92, respectively. A three-factor solution, including efficacy of assessment, knowledge of diversity, and culture-centered practice subscales, comprised of twenty-items was identified. The KEPI-OHP was found to

  15. A Formal Investigation of the Organization of Guidance Behavior: Implications for Humans and Autonomous Guidance

    Science.gov (United States)

    Kong, Zhaodan

    Guidance behavior generated either by artificial agents or humans has been actively studied in the fields of both robotics and cognitive science. The goals of these two fields are different. The former is the automatic generation of appropriate or even optimal behavior, while the latter is the understanding of the underlying mechanism. Their challenges, though, are closely related, the most important one being the lack of a unified, formal and grounded framework where the guidance behavior can be modeled and studied. This dissertation presents such a framework. In this framework, guidance behavior is analyzed as the closed-loop dynamics of the whole agent-environment system. The resulting dynamics give rise to interaction patterns. The central points of this dissertation are that: first of all, these patterns, which can be explained in terms of symmetries that are inherent to the guidance behavior, provide building blocks for the organization of behavior; second, the existence of these patterns and humans' organization of their guidance behavior based on these patterns are the reasons that humans can generate successful behavior in spite of all the complexities involved in the planning and control. This dissertation first gives an overview of the challenges existing in both scientific endeavors, such as human and animal spatial behavior study, and engineering endeavors, such as autonomous guidance system design. It then lays out the foundation for our formal framework, which states that guidance behavior should be interpreted as the collection of the closed-loop dynamics resulting from the agent's interaction with the environment. The following, illustrated by examples of three different UAVs, shows that the study of the closed-loop dynamics should not be done without the consideration of vehicle dynamics, as is the common practice in some of the studies in both autonomous guidance and human behavior analysis. The framework, the core concepts of which are

  16. Ethical and practical challenges in providing noninvasive prenatal testing for chromosome abnormalities: an update.

    Science.gov (United States)

    Benn, Peter; Chapman, Audrey R

    2016-04-01

    Noninvasive prenatal testing (NIPT) through the analysis of cell-free DNA in maternal plasma has rapidly changed screening for fetal chromosome abnormalities. We review practical and ethical challenges associated with the transition, progress in their resolution, and identify new emerging difficulties. NIPT is an advanced screening test for trisomies 21, 18, and 13 that was initially limited to women at high risk for an affected pregnancy. It is now recognized as suitable for all women. The testing has been expanded to include sex chromosome abnormalities and some microdeletion syndromes. Some ethicists are concerned about inclusion of disorders that have less severe phenotypes. Clinical providers have experienced difficulty in maintaining an up-to-date knowledge about the scope of NIPT, differences between tests, who should be offered the testing, performance of tests, reasons for false-positive results, and optimal patient management following positive results. Some of the practical difficulties associated with the introduction can be attributed to this knowledge gap. There remain some important ethical issues associated with NIPT. We believe that the same ethical and legal principles that were considered in the justification of conventional prenatal screening can be used to assess the appropriateness of additional NIPT applications.

  17. Identifying attitudes, beliefs and reported practices of nurses and doctors as immunization providers.

    Science.gov (United States)

    Pielak, Karen L; McIntyre, Cheryl C; Tu, Andrew W; Remple, Valencia P; Halperin, Beth; Buxton, Jane A

    2010-07-01

    This paper is a report of a study conducted to examine the attitudes, beliefs, behavioural intentions and self-reported behaviour of nurses and physicians relating to key immunization behaviours and compare the findings for nurses and physicians. Immunization is an important and effective public health intervention. Understanding immunization providers' attitudes and beliefs toward immunization has the potential to improve educational efforts and lead to behavioural change. A postal survey was conducted with all immunization providers in British Columbia, Canada, in 2005. The survey elicited data on demographics, practice characteristics, attitudes, perceived social norms and perceived behavioural control related to key immunization behaviours. Responses were received from 344 nurses and 349 physicians. The response rate was 67% for nurses and 22% for physicians. More nurses than physicians thought that administering all recommended vaccines at one visit was important (89.2% vs. 63.2%P vaccines (82.4% vs. 48.7%P vaccines at one visit (98.8% vs. 73.8%P vaccine each year was important (88.9%, 87.1% respectively P = 0.65). The foundational work done to develop the survey tool can be used to modify it so that survey findings can be validated according to the Theory of Planned Behaviour. The results could inform the development of behavioural change interventions targeting the identified determinants of immunization provider behaviour.

  18. Collaboration of midwives in primary care midwifery practices with other maternity care providers.

    Science.gov (United States)

    Warmelink, J Catja; Wiegers, Therese A; de Cock, T Paul; Klomp, Trudy; Hutton, Eileen K

    2017-12-01

    interactions with physicians (GPs, obstetricians and paediatricians). Midwives with more work experience were more satisfied with their collaboration with GPs. Midwives from the southern region of the Netherlands were more satisfied with collaboration with GPs and obstetricians. Compared to the urban areas, in the rural or mixed areas the midwives were more satisfied regarding their collaboration with MCA(O)s and clinical midwives. Midwives from non-Dutch origin were less satisfied with the collaboration with paediatricians. No relations were found between the overall mean satisfaction of collaboration and work-related and personal characteristics and attitude towards work. Inter-professionals relations in maternity care in the Netherlands can be enhanced, especially the primary care midwives' interactions with physicians and with maternity care providers in the northern and central part of the Netherlands, and in urban areas. Future exploratory or deductive research may provide additional insight in the collaborative practice in everyday work setting. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Australian practice nurses' perceptions of their role and competency to provide nutrition care to patients living with chronic disease.

    Science.gov (United States)

    Cass, Sarah; Ball, Lauren; Leveritt, Michael

    2014-01-01

    Nutrition is important in the management of chronic disease, and practice nurses in the Australian primary care setting are increasingly providing nutrition care to patients living with chronic disease. The aim of the present study was to investigate practice nurses' perceptions of their role and competency to provide nutrition care to patients living with chronic disease in Australia. Twenty practice nurses currently employed in general practice participated in an individual semi-structured telephone interview. Interviews were transcribed verbatim and thematically analysed. Practice nurses perceived themselves to be in a prime position to provide opportunistic nutrition care to patients. Participants perceived that the ideal role of a practice nurse is to advocate for nutrition and provide a basic level of nutrition care to patients; however, the interpretation of the term 'basic' varied between participants. Participants perceived that practice nurses are highly trusted and approachable, which they valued as important characteristics for the provision of nutrition care. Barriers to providing nutrition care included time constraints, lack of nutrition knowledge and lack of confidence. Participants were concerned about the availability and accessibility of nutrition education opportunities for practice nurses. The present study has demonstrated that practice nurses perceive themselves as having a significant role in the provision of nutrition care to patients with chronic disease in the Australian primary care setting. Further investigation of strategies to enhance the effectiveness of nutrition care provision by practice nurses is warranted.

  20. USDA food and nutrient databases provide the infrastructure for food and nutrition research, policy, and practice.

    Science.gov (United States)

    Ahuja, Jaspreet K C; Moshfegh, Alanna J; Holden, Joanne M; Harris, Ellen

    2013-02-01

    The USDA food and nutrient databases provide the basic infrastructure for food and nutrition research, nutrition monitoring, policy, and dietary practice. They have had a long history that goes back to 1892 and are unique, as they are the only databases available in the public domain that perform these functions. There are 4 major food and nutrient databases released by the Beltsville Human Nutrition Research Center (BHNRC), part of the USDA's Agricultural Research Service. These include the USDA National Nutrient Database for Standard Reference, the Dietary Supplement Ingredient Database, the Food and Nutrient Database for Dietary Studies, and the USDA Food Patterns Equivalents Database. The users of the databases are diverse and include federal agencies, the food industry, health professionals, restaurants, software application developers, academia and research organizations, international organizations, and foreign governments, among others. Many of these users have partnered with BHNRC to leverage funds and/or scientific expertise to work toward common goals. The use of the databases has increased tremendously in the past few years, especially the breadth of uses. These new uses of the data are bound to increase with the increased availability of technology and public health emphasis on diet-related measures such as sodium and energy reduction. Hence, continued improvement of the databases is important, so that they can better address these challenges and provide reliable and accurate data.

  1. Stage-matched nutrition guidance for patients at elevated risk for cardiovascular disease: A randomized intervention study in family practice

    NARCIS (Netherlands)

    Veen, van der J.E.; Bakx, J.C.; Hoogen, van den H.; Verheijden, M.W.; Bosch, van den W.; Weel, van C.; Staveren, van W.A.

    2002-01-01

    OBJECTIVE To examine stage-matched nutrition counseling by family physicians and its effect on dietary intake, anthropometry, and serum lipid levels in patients at elevated risk for cardiovascular disease. METHODS In this controlled trial, patients randomized to intervention practices received

  2. Guidance on current good radiopharmacy practice for the small-scale preparation of radiopharmaceuticals using automated modules : a European perspective

    NARCIS (Netherlands)

    Aerts, Joel; Ballinger, James R.; Behe, Martin; Decristoforo, Clemens; Elsinga, Philip H.; Faivre-Chauvet, Alain; Mindt, Thomas L.; Peitl, Petra Kolenc; Todde, Sergio C.; Koziorowski, Jacek

    This document is meant to complement Part B of the EANM Guidelines on current good radiopharmacy practice (cGRPP) in the preparation of radiopharmaceuticals' issued by the Radiopharmacy Committee of the European Association of Nuclear Medicine, covering small-scale in-house preparation of

  3. Continuous Care Provided Through Comprehensive Medication Management in an Acute Care Practice Model.

    Science.gov (United States)

    Marr, T David; Pinelli, Nicole R; Jarmul, Jamie A; Waldron, Kayla M; Eckel, Stephen F; Cicci, Jonathan D; Bates, Jill S; Amerine, Lindsey B

    2017-10-01

    Pharmacy practice models that foster pharmacists' accountability for medication-related outcomes are imperative for the profession. Comprehensive medication management (CMM) is an opportunity to advance patient care. The objective of this study was to evaluate the impact of a CMM practice model in the acute care setting on organizational, patient, and financial outcomes. Three adult service lines focused on at-risk patients identified using internal risk stratification methodology were implemented. Core CMM elements included medication reconciliation, differentiated clinical pharmacy services, inpatient MTM consultations, discharge services, and documentation. Mixed methods compared the effect of the CMM model before and after implementation. Historical patients served as comparative controls in an observational design. Pharmacists completed a 60-minute interview regarding their experiences. Qualitative data were analyzed using thematic coding to characterize perception of the model. Three pharmacists implemented the model on cardiology, hematology/oncology, and surgery transplant services and provided services to 75 patients during the study. A total of 145 medication-related problems were identified and resolved. CMM was associated with a nonsignificant reduction of 8.8% in 30-day hospital readmission rates ( P = 0.64) and a 24.9% reduction in 30-day hospital utilization ( P = 0.41) as well as a significant reduction of 86.5% in emergency department visits ( P = 0.02). Patients receiving discharge prescriptions from our outpatient pharmacies increased by 21.4%, resulting in an 11.3% increase in discharge prescription capture and additional revenue of $5780. Themes identified from qualitative interviews included CMM structure, challenges, value, and resources. This study demonstrated successful implementation of a CMM model that positively affected organizational, patient, and financial outcomes.

  4. [Practical chemistry education provided by team-based learning (TBL) and peer evaluation].

    Science.gov (United States)

    Yasuhara, Tomohisa; Konishi, Motomi; Nishida, Takahiro; Kushihata, Taro; Sone, Tomomichi; Kurio, Wasako; Yamamoto, Yumi; Nishikawa, Tomoe; Yanada, Kazuo; Nakamura, Mitsutaka

    2014-01-01

    Learning chemistry is cumulative: basic knowledge and chemical calculation skills are required to gain understanding of higher content. However, we often suffer from students' lack of learning skills to acquire these concepts. One of the reasons is the lack of adequate training in the knowledge and skills of chemistry, and one of the reasons for this lack is the lack of adequate evaluation of training procedures and content. Team-based learning (TBL) is a strong method for providing training in the knowledge and skills of chemistry and reaffirms the knowledge and skills of students of various levels. In our faculty, TBL exercises are provided for first-year students concurrently with lectures in physical chemistry and analytical chemistry. In this study, we researched the adoption of a peer evaluation process for this participatory learning model. Questionnaires taken after TBL exercises in the previous year showed a positive response to TBL. Further, a questionnaire taken after TBL exercises in the spring semester of the current year also yielded a positive response not only to TBL but also to peer evaluation. In addition, a significant correlation was observed between the improvement of students' grades in chemistry classes and the feeling the percentage (20%) of peer evaluation in overall evaluation low (logistic regression analysis, p=0.022). On the basis of the findings, we argue that TBL provides a generic, practical learning environment including an effective focus on learning strategy and evaluation of knowledge, skills, and attitudes, and studies on the educational effects of TBL and peer evaluation.

  5. Supporting Aboriginal Women to Quit Smoking: Antenatal and Postnatal Care Providers' Confidence, Attitudes, and Practices.

    Science.gov (United States)

    Tzelepis, Flora; Daly, Justine; Dowe, Sarah; Bourke, Alex; Gillham, Karen; Freund, Megan

    2017-05-01

    Tobacco use during pregnancy is substantially higher among Aboriginal women compared to non-Aboriginal women in Australia. However, no studies have investigated the amount or type of smoking cessation care that staff from Aboriginal antenatal and postnatal services provide to clients who smoke or staff confidence to do so. This study examined Aboriginal antenatal and postnatal staff confidence, perceived role and delivery of smoking cessation care to Aboriginal women and characteristics associated with provision of such care. Staff from 11 Aboriginal Maternal and Infant Health Services and eight Aboriginal Child and Family Health services in the Hunter New England Local Health District in Australia completed a cross-sectional self-reported survey (n = 67, response rate = 97.1%). Most staff reported they assessed clients' smoking status most or all of the time (92.2%). However, only a minority reported they offered a quitline referral (42.2%), provided follow-up support (28.6%) or provided nicotine replacement therapy (4.7%) to most or all clients who smoked. Few staff felt confident in motivating clients to quit smoking (19.7%) and advising clients about using nicotine replacement therapy (15.6%). Staff confident with talking to clients about how smoking affected their health had significantly higher odds of offering a quitline referral [OR = 4.9 (1.7-14.5)] and quitting assistance [OR = 3.9 (1.3-11.6)] to clients who smoke. Antenatal and postnatal staff delivery of smoking cessation care to pregnant Aboriginal women or mothers with young Aboriginal children could be improved. Programs that support Aboriginal antenatal and postnatal providers to deliver smoking cessation care to clients are needed. Aboriginal antenatal and postnatal service staff have multiple opportunities to assist Aboriginal women to quit smoking during pregnancy and postpartum. However, staff confidence and practices of offering various forms of smoking cessation support to pregnant Aboriginal

  6. Characterizing providers' immunization communication practices during health supervision visits with vaccine-hesitant parents: a pilot study.

    Science.gov (United States)

    Opel, Douglas J; Robinson, Jeffrey D; Heritage, John; Korfiatis, Carolyn; Taylor, James A; Mangione-Smith, Rita

    2012-02-08

    To determine the feasibility of using direct observation of provider-parent immunization discussions and to characterize provider communication practices with vaccine-hesitant parents. Over a 6 month period in 2010, we videotaped immunization discussions between pediatric providers and vaccine-hesitant parents during health supervision visits involving children 2-15 months old (N=24) in the Seattle area, Washington, USA. Videotapes were analyzed using the qualitative method of conversation analysis. We approached 96 parents seen by 9 different providers. Of those who were eligible (N=56), we enrolled 43% (N=24). Four videotaped visits were excluded from analysis for failure to obtain parental HIPAA authorization. Of the remaining 20 visits, there were ≥2 visits each that involved children aged 2, 4, 6, 9, 12, and 15 months, and all videotaped visits contained at least a brief immunization discussion. We identified 6 communication practices and several behavior types within each practice relevant to immunization: Practice 1, providers' initiations of the topic of vaccination; Types: participatory or presumptive format; Practice 2, parents' responses to providers' topic initiations; Types: strong or weak acceptance or resistance; Practice 3, providers' follow-ups to parent's responses; Types: no, immediate, or delayed pursuit; Practice 4, parents' vaccine-related questions or statements; Types: fact- or concern-based; Practice 5, providers' explicit solicitations of parent's questions/concerns; Types: designed to discourage or encourage discussion; and Practice 6, parents' responses to providers' solicitations of questions/concerns; Types: no question or fact- or concern-based inquiry. Direct observation of immunization discussions in the primary care pediatric setting is feasible and yields insight into several provider-parent immunization communication practices that are worthy of further study to determine which are effective at improving parental acceptance of

  7. Translating sickle cell guidelines into practice for primary care providers with Project ECHO

    Directory of Open Access Journals (Sweden)

    Lisa M. Shook

    2016-11-01

    Full Text Available Background: Approximately 100,000 persons with sickle cell disease (SCD live in the United States, including 15,000 in the Midwest. Unfortunately, many patients experience poor health outcomes due to limited access to primary care providers (PCPs who are prepared to deliver evidence-based SCD care. Sickle Treatment and Outcomes Research in the Midwest (STORM is a regional network established to improve care and outcomes for individuals with SCD living in Indiana, Illinois, Michigan, Minnesota, Ohio, and Wisconsin. Methods: STORM investigators hypothesized that Project ECHO® methodology could be replicated to create a low-cost, high-impact intervention to train PCPs in evidence-based care for pediatric and young adult patients with SCD in the Midwest, called STORM TeleECHO. This approach utilizes video technology for monthly telementoring clinics consisting of didactic and case-based presentations focused on the National Heart, Lung and Blood Institute (NHLBI evidence-based guidelines for SCD. Results: Network leads in each of the STORM states assisted with developing the curriculum and are recruiting providers for monthly clinics. To assess STORM TeleECHO feasibility and acceptability, monthly attendance and satisfaction data are collected. Changes in self-reported knowledge, comfort, and practice patterns will be compared with pre-participation, and 6 and 12 months after participation. Conclusions: STORM TeleECHO has the potential to increase implementation of the NHLBI evidence-based guidelines, especially increased use of hydroxyurea, resulting in improvements in the quality of care and outcomes for children and young adults with SCD. This model could be replicated in other pediatric chronic illness conditions to improve PCP knowledge and confidence in delivering evidence-based care.

  8. Technology for dementia: attitudes and practices of occupational therapists in providing assistive technology for way finding.

    Science.gov (United States)

    Jarvis, Fiona; Clemson, Lindy Maxted; Mackenzie, Lynette

    2017-05-01

    One of the many difficulties a person with dementia can experience is difficulty with way finding and subsequently getting lost in the community. Prescriptions of assistive technology are a key role for occupational therapists. This study aimed to describe the attitudes and practices of occupational therapists in recommending and using assistive technology for persons with dementia who have difficulties with way finding in the community. An online survey was distributed to members of Occupational Therapy Australia NSW and included 25 items on demographics, frequency of use of assistive technology and assessment. A total of 85 occupational therapists responded to the survey. Significant differences were identified in the approaches used, the types of assistive technology used and the evaluation of outcomes, between community-based and hospital-based occupational therapists. Over half of the participants had never prescribed any of the assistive devices listed in the survey for people with dementia. The most frequently prescribed assistive devices were low-tech items that were already freely available to carers and other professions. Therapists used a conservative approach to problem solving with their clients with dementia. There is a limited understanding from occupational therapists about available interventions for people with dementia. Implications for Rehabilitation There is limited awareness on how assistive technology might be used to support occupational performance for persons with dementia. This survey suggests that occupational therapists experience barriers in identifying and providing appropriate assistive technology for this group. Access to targeted education and online resources for occupational therapists is recommended to provide better awareness of the types of assistive technology available to assist persons with dementia and their caregivers.

  9. Assessment of Barriers to Providing Introductory Pharmacy Practice Experiences (IPPEs in the Hospital Setting

    Directory of Open Access Journals (Sweden)

    Matthew J Gibson

    2016-07-01

    Full Text Available Objectives: The primary objective of the study is to identify the barriers to providing Introductory Pharmacy Practice Experiences (IPPEs in the hospital setting. Methods: Potential barriers to IPPEs were identified via literature review and interviews with current IPPE preceptors from various institutions. Based on this information, an electronic survey was developed and distributed to IPPE preceptors in order to assess student, preceptor, logistical and college or school of pharmacy related barriers that potentially exist for providing IPPE in the hospital setting. Results: Sixty-eight of the 287 eligible survey respondents (24% completed the electronic survey. Seventy-six percent of respondents agreed or strongly agreed that available time was a barrier to precepting IPPE students even though a majority of respondents reported spending a third or more of their day with an IPPE student when on rotation. Seventy-three percent of respondents disagreed or strongly disagreed that all preceptors have consistent performance expectations for students, while just 46% agreed or strongly agreed that they had adequate training to precept IPPEs. Sixty-five percent of respondents agreed that IPPE students have the ability to be a participant in patient care and 70% of preceptors believe that IPPE students should be involved in patient care. Conclusions: Conducting IPPEs in the institutional setting comes with challenges. Based on the results of this study, experiential directors and colleges/schools of pharmacy could make a positive impact on the quality and consistency of IPPEs by setting student expectations and training preceptors on appropriate and consistent expectations for students.   Type: Original Research

  10. Health care provider confidence and exercise prescription practices of Exercise is Medicine Canada workshop attendees.

    Science.gov (United States)

    O'Brien, Myles W; Shields, Christopher A; Oh, Paul I; Fowles, Jonathon R

    2017-04-01

    The Exercise is Medicine Canada (EIMC) initiative promotes physical activity counselling and exercise prescription within health care. The purpose of this study was to evaluate perceptions and practices around physical activity counselling and exercise prescription in health care professionals before and after EIMC training. Prior to and directly following EIMC workshops, 209 participants (physicians (n = 113); allied health professionals (AHPs) (n = 54), including primarily nurses (n = 36) and others; and exercise professionals (EPs) (n = 23), including kinesiologists (n = 16), physiotherapists (n = 5), and personal trainers (n = 2)) from 7 provinces completed self-reflection questionnaires. Compared with AHPs, physicians saw more patients (78% > 15 patients/day vs 93% exercise counselling during routine client encounters (48% vs 72% in most sessions; p exercise counselling into sessions (2.74 ± 0.71, out of 5) compared with AHPs (2.17 ± 0.94; p = 0.001) and EPs (1.43 ± 0.66; p exercise prescription as lack of patient interest (2.77 ± 0.85 out of 4), resources (2.65 ± 0.82 out of 4), and time (2.62 ± 0.71 out of 4). The majority of physicians (85%) provided a written prescription for exercise in exercise routinely, and 33% planned on increasing physical activity and exercise counselling, measured through open-ended responses.

  11. GUIDANCE DOCUMENT ON IMPLEMENTATION OF THE ...

    Science.gov (United States)

    The Agreement in Principle for the Stage 2 M-DBP Federal Advisory Committee contains a list of treatment processes and management practices for water systems to use in meeting additional Cryptosporidium treatment requirements under the LT2ESWTR. This list, termed the microbial toolbox, includes watershed control programs, alternative intake locations, pretreatment processes, additional filtration barriers, inactivation technologies, and enhanced plant performance. The intent of the microbial toolbox is to provide water systems with broad flexibility in selecting cost-effective LT2ESWTR compliance strategies. Moreover, the toolbox allows systems that currently provide additional pathogen barriers or that can demonstrate enhanced performance to receive additional Cryptosporidium treatment credit. Provide guidance to utilities with surface water supplies and to state drinking water programs on the use of different treatment technologies to reduce the level of Cryptosporidium in drinking water. Technologies included in the guidance manual may be used to achieve compliance with the requirements of the LT2ESWTR.

  12. Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group.

    Science.gov (United States)

    Neuberger, James M; Bechstein, Wolf O; Kuypers, Dirk R J; Burra, Patrizia; Citterio, Franco; De Geest, Sabina; Duvoux, Christophe; Jardine, Alan G; Kamar, Nassim; Krämer, Bernhard K; Metselaar, Herold J; Nevens, Frederik; Pirenne, Jacques; Rodríguez-Perálvarez, Manuel L; Samuel, Didier; Schneeberger, Stefan; Serón, Daniel; Trunečka, Pavel; Tisone, Giuseppe; van Gelder, Teun

    2017-04-01

    Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes.COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant.The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting.

  13. Regulatory Advocacy Update: ASPS Comments in Response to the FDA Draft Guidance Documents on Human Cell and Tissue Products.

    Science.gov (United States)

    Rubin, J Peter; D'Amico, Richard A; Rodriguez, Ricardo; Coleman, Sydney R; Cederna, Paul; Glasberg, Scot; Neumeister, Michael; Song, David H; Butler, Charles; Hume, Keith M

    2017-02-09

    The Food and Drug Administration (FDA) released draft guidance documents on Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/P) Regulations. These proposed guidance documents can impact the practice of plastic surgery in the area of tissue grafting procedures. This article describes the relevant issues in these draft guidance documents, and presents the comments provided to the FDA by the American Society of Plastic Surgeons (ASPS).

  14. Utilisation of Evidence-Based Practices by ASD Early Intervention Service Providers

    Science.gov (United States)

    Paynter, Jessica M.; Ferguson, Sarah; Fordyce, Kathryn; Joosten, Annette; Paku, Sofia; Stephens, Miranda; Trembath, David; Keen, Deb

    2017-01-01

    A number of autism intervention practices have been demonstrated to be effective. However, the use of unsupported practices persists in community early intervention settings. Recent research has suggested that personal, professional and workplace factors may influence intervention choices. The aim of this research was to investigate knowledge and…

  15. Current attitudes and practices of obesity counselling by health care providers.

    Science.gov (United States)

    Petrin, Christine; Kahan, Scott; Turner, Monique; Gallagher, Christine; Dietz, William H

    Relatively few patients receive obesity counselling consistent with the USPSTF guidelines, and many health care professionals (HCPs) are biased in their attitudes towards obesity management. A national sample of family physicians, internists, OB/GYN physicians, and nurse practitioners (NPs) completed a web-based survey of beliefs, practice, and knowledge regarding obesity management. A majority of HCPs believe that it is both the patient's and the provider's responsibility to ensure that the patient is counselled about obesity. Obesity (77%), obesity-related diseases (79%), or obesity-related risk factors (71%) prompt HCPs to offer obesity counselling; 59% of HCPs wait for the patient to broach the subject of their weight. Increased blood pressure (89%) and heart disease risks (90%) are the most common themes in counselling. Across all HCPs except NPs "exercise" is discussed more frequently than "physical activity" (85% vs 81%), "diet" more frequently than "eating habits" (77% vs 75%), and "obesity" more frequently than "unhealthy weight" (60% vs 45%). NPs are more likely to discuss physical activity, eating habits, and unhealthy weight instead. To improve counselling for obesity, HCPs reported needing more time (70%), training in obesity management (53%), improved reimbursement (53%), and better tools to help patients recognise obesity risks (50%). Obesity-related diseases, risk factors, or obesity alone predict obesity counselling amongst HCPs. Better training in weight management and tools to help patients recognise risks appear to be key elements in helping patients compare the risks of what they may consider invasive therapy against the risks of continued obesity. Copyright © 2016 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

  16. Impact of advanced practice providers (nurse practitioners and physician assistants) on surgical residents' critical care experience.

    Science.gov (United States)

    Kahn, Steven A; Davis, Sarah A; Banes, Caroline T; Dennis, Bradley M; May, Addison K; Gunter, Oliver D

    2015-11-01

    Teaching hospitals often employ advanced practice providers (nurse practitioners and physician assistants or APPs) to counteract residents' work-hour restrictions. With increased utilization of APPs in labor-intense areas, such as intensive care units (ICUs), APPs may have an impact on resident education and experience. No studies have investigated the direct role an APP plays on the training experience of a surgical resident in the ICU. An institutional review board-approved survey was emailed to residents in Accreditation Council for Graduate Medical Education-accredited general surgery programs. Surveys asked about demographics, residency and/or ICU characteristics, and the effects of APPs on patient care, workflow, and educational experience. Regression analysis determined predictors of resident perception. A total of 354 of 1178 residents responded to the survey (30%). Some residents felt that nurses calling APPs preferentially for patient-care issues interfered with education (17%) and residents' ability to follow patients (12%) and was associated with overall detrimental effects to ICU experience on regression (odds ratio, 3.7; confidence interval, 1.5-9.1). Most residents reported positive effects of APPs, such as reduced resident workload (79.8%), teaching protocols and/or guidelines (60.3%), enhanced patient care (60.3%), and enhanced communication (50.5%). When asked how APPs affected their overall ICU experience, 48.4% reported positive effects, 20.6% reported "no effect," and 31% reported detrimental effects. Only a minority of residents perceived that APPs detract from training, particularly those who felt excluded when nurses preferentially contact APPs with patient-care issues. APPs have the potential to enhance training and ICU experience, as reflected in many of the responses. Strategies to maintain direct nurse and resident communication might preserve residents' perception of the educational value of APPs. Copyright © 2015 Elsevier Inc. All

  17. Teachers' Accounts of Their Perceptions and Practices of Providing Written Feedback to Nursing Students on Their Assignments

    Science.gov (United States)

    Iqbal, Sajid; Gul, Raisa; Lakhani, Arusa; Rizvi, Nusrat Fatima

    2014-01-01

    Written feedback can facilitate students' learning in several ways. However, the teachers' practices of written feedback may be affected by various factors. This study aimed to explore the nurse teachers' accounts of their perceptions and practices of providing written feedback. A descriptive exploratory design was employed in the study. A…

  18. Laboratory Biosafety and Biosecurity Risk Assessment Technical Guidance Document

    Energy Technology Data Exchange (ETDEWEB)

    Astuto-Gribble, Lisa M; Caskey, Susan Adele

    2014-07-01

    The purpose of this document is threefold: 1) to describe the laboratory bio safety and biosecurity risk assessment process and its conceptual framework; 2) provide detailed guidance and suggested methodologies on how to conduct a risk assessment; and 3) present some practical risk assessment process strategies using realistic laboratory scenarios.

  19. Management and Control | Ajaiya | Nigerian Journal of Guidance ...

    African Journals Online (AJOL)

    This article provides a practical guide on how tp use positive reinforcement through behaviour modification technique for classroom management and control. Its concept and process as well as its relevance to learning are presented as a more acceptable alternative to the use of punishment. Nigerian Journal of Guidance ...

  20. Avoiding plagiarism: guidance for nursing students.

    Science.gov (United States)

    Price, Bob

    The pressures of study, diversity of source materials, past assumptions relating to good writing practice, ambiguous writing guidance on best practice and students' insecurity about their reasoning ability, can lead to plagiarism. With the use of source checking software, there is an increased chance that plagiarised work will be identified and investigated, and penalties given. In extreme cases, plagiarised work may be reported to the Nursing and Midwifery Council and professional as well as academic penalties may apply. This article provides information on how students can avoid plagiarism when preparing their coursework for submission.

  1. Frequent attenders in general practice: problem solving treatment (PST) provided by nurses

    NARCIS (Netherlands)

    Schreuder, B.; van Oppen, P.C.; van Marwijk, H.W.J.; Smit, J.H.; Stalman, W.A.B.

    2005-01-01

    Background: There is a need for assistance from primary care mental health workers in general practice in the Netherlands. General practitioners (GPs) experience an overload of frequent attenders suffering from psychological problems. Problem Solving Treatment (PST) is a brief psychological

  2. Frequent attenders in general practice: problem solving treatment provided by nurses [ISRCTN51021015

    NARCIS (Netherlands)

    Schreuders, B.; van Oppen, P.C.; van Marwijk, H.W.J.; Smit, J.H.; Stalman, W.A.B.

    2005-01-01

    Background: There is a need for assistance from primary care mental health workers in general practice in the Netherlands. General practitioners (GPs) experience an overload of frequent attenders suffering from psychological problems. Problem Solving Treatment (PST) is a brief psychological

  3. Frequent attenders in general practice: problem solving treatment provided by nurses [ISRCTN51021015

    NARCIS (Netherlands)

    Schreuders, B.; Oppen, van P.C.; Marwijk, van H.W.J.; Smit, J.H.; Stalman, W.A.B.

    2005-01-01

    BACKGROUND: There is a need for assistance from primary care mental health workers in general practice in the Netherlands. General practitioners (GPs) experience an overload of frequent attenders suffering from psychological problems. Problem Solving Treatment (PST) is a brief psychological

  4. A study of the cost-effectiveness of providing psychomotor practice in teaching intravenous infusion techniques.

    Science.gov (United States)

    Hegstad, L N; Zsohar, H

    1986-01-01

    Does psychomotor practice affect the student's ability to perform venipuncture? This was the primary question in a study conducted to compare two versions of an instructional program--a no-practice version and a costly version that involved practice on the simulated arm. The initial study was composed of 40 (20 each group) Junior nursing students enrolled in a baccalaureate program. The instructional program for both groups included a handout of the task-by-task description of the procedure; a performance check list, a 10-minute color videotape demonstrating the entire process, and a live demonstration on a simulated arm. Each group took a post test which covered the cognitive aspects of the task. The practice group was able to practice on the simulated arm prior to evaluation on a live subject. The cognitive scores for both groups were near 90% and the performance scores above 80%. Since there was no significant difference between the groups the study was repeated with another group of students from the same school. This group differed slightly from the original group in that they had no experience with venipuncture. The second study contained 34 students and the cognitive scores were 91% for both groups and above 80% for the performance scores. The results indicated that the least costly version was equally effective and presents nursing education with an opportunity to evaluate skills teaching to determine the most effective, efficient and/or economical method to teach skills.

  5. Practical Tips for Increasing Listening Practice Time

    Science.gov (United States)

    McCaughey, Kevin

    2015-01-01

    Learning a language--like learning to dance ballet, weaving carpets, or playing the saxophone--takes time and practice. In general, it is safe to say that the more practice one gets, the better one will become. This article will help teachers of English reconsider how to think about listening tasks. It will provide guidance for increasing…

  6. Safe, timely, convenient, and cost-effective: a single-center experience with bedside placement of enteral feeding tubes by midlevel providers using fluoroscopic guidance.

    Science.gov (United States)

    Hauschild, Tricia B; Fu, Katy Y; Hipwell, Randall C; Baraghoshi, Gabriele; Mone, Mary C; Nirula, Raminder; Kimball, Edward J; Barton, Richard G

    2012-12-01

    Enteral feeding tube placement has been performed by nurses, gastroenterologists using endoscopy, and interventional radiologists. We hypothesized that midlevel providers placed feeding tubes at bedside using fluoroscopy safely, rapidly, and cost-effectively. We retrospectively analyzed bedside feeding tube placement under fluoroscopy by trained nurse practitioners. We compared charges for this method with charges for placement by other practitioners. Nurse practitioners placed 632 feeding tubes in 462 patients. Three hundred seventy-nine placements took place in mechanically ventilated placements. Ninety-seven percent of tubes were positioned past the pylorus. The mean fluoroscopy time was 0.7 ± 1.2 minutes. The mean procedure time was 7.0 ± 5.1 minutes. All tubes were placed within 24 hours of the request. There were no complications. Institutional charges for tube placement were $149 for nurse practitioners, $226 for gastroenterologists, and $328 for interventional radiologists. The placement of feeding tubes under fluoroscopy by nurse practitioners is safe, timely, and cost-effective. Published by Elsevier Inc.

  7. Costing the distribution of insecticide-treated nets: a review of cost and cost-effectiveness studies to provide guidance on standardization of costing methodology.

    Science.gov (United States)

    Kolaczinski, Jan; Hanson, Kara

    2006-05-08

    Insecticide-treated nets (ITNs) are an effective and cost-effective means of malaria control. Scaling-up coverage of ITNs is challenging. It requires substantial resources and there are a number of strategies to choose from. Information on the cost of different strategies is still scarce. To guide the choice of a delivery strategy (or combination of strategies), reliable and standardized cost information for the different options is required. The electronic online database PubMed was used for a systematic search of the published English literature on costing and economic evaluations of ITN distribution programmes. The keywords used were: net, bednet, insecticide, treated, ITN, cost, effectiveness, economic and evaluation. Identified papers were analysed to determine and evaluate the costing methods used. Methods were judged against existing standards of cost analysis to arrive at proposed standards for undertaking and presenting cost analyses. Cost estimates were often not readily comparable or could not be adjusted to a different context. This resulted from the wide range of methods applied and measures of output chosen. Most common shortcomings were the omission of certain costs and failure to adjust financial costs to generate economic costs. Generalisability was hampered by authors not reporting quantities and prices of resources separately and not examining the sensitivity of their results to variations in underlying assumptions. The observed shortcomings have arisen despite the abundance of literature and guidelines on costing of health care interventions. This paper provides ITN specific recommendations in the hope that these will help to standardize future cost estimates.

  8. Performance assessment in health care providers: a critical review of evidence and current practice.

    Science.gov (United States)

    Hamilton, Karen E Stc; Coates, Vivien; Kelly, Billy; Boore, Jennifer R P; Cundell, Jill H; Gracey, Jacquie; McFetridge, Brian; McGonigle, Mary; Sinclair, Marlene

    2007-11-01

    To evaluate methods of performance assessment through an international literature review and a survey of current practice. Over the past two decades health care organizations have focussed on promoting high quality care in conjunction with retaining motivated staff. Cognisant of such initiatives, we sought to evaluate assessment methods for qualified staff according to their utility in the working environment. A systematic literature search was completed and each paper independently reviewed. All health care organizations in Northern Ireland submitted details of their performance assessments. Each was critically appraised using a utility index. Performance was not universally defined. A broad range of assessments were identified, each method had advantages and disadvantages. Although many lacked rigorous testing, areas of good practice were also noted. No single method is appropriate for assessing clinical performance. Rather, this study endorses proposals for a multi-method strategy to ensure that performance assessment demonstrates all attributes required for effective nursing and midwifery practice.

  9. Costing the distribution of insecticide-treated nets: a review of cost and cost-effectiveness studies to provide guidance on standardization of costing methodology

    Directory of Open Access Journals (Sweden)

    Hanson Kara

    2006-05-01

    Full Text Available Abstract Background Insecticide-treated nets (ITNs are an effective and cost-effective means of malaria control. Scaling-up coverage of ITNs is challenging. It requires substantial resources and there are a number of strategies to choose from. Information on the cost of different strategies is still scarce. To guide the choice of a delivery strategy (or combination of strategies, reliable and standardized cost information for the different options is required. Methods The electronic online database PubMed was used for a systematic search of the published English literature on costing and economic evaluations of ITN distribution programmes. The keywords used were: net, bednet, insecticide, treated, ITN, cost, effectiveness, economic and evaluation. Identified papers were analysed to determine and evaluate the costing methods used. Methods were judged against existing standards of cost analysis to arrive at proposed standards for undertaking and presenting cost analyses. Results Cost estimates were often not readily comparable or could not be adjusted to a different context. This resulted from the wide range of methods applied and measures of output chosen. Most common shortcomings were the omission of certain costs and failure to adjust financial costs to generate economic costs. Generalisability was hampered by authors not reporting quantities and prices of resources separately and not examining the sensitivity of their results to variations in underlying assumptions. Conclusion The observed shortcomings have arisen despite the abundance of literature and guidelines on costing of health care interventions. This paper provides ITN specific recommendations in the hope that these will help to standardize future cost estimates.

  10. Review of LCA studies of solid waste management systems – Part II: Methodological guidance for a better practice

    DEFF Research Database (Denmark)

    Laurent, Alexis; Clavreul, Julie; Bernstad, Anna

    2014-01-01

    Life cycle assessment (LCA) is increasingly used in waste management to identify strategies that prevent or minimise negative impacts on ecosystems, human health or natural resources. However, the quality of the provided support to decision- and policy-makers is strongly dependent on a proper...... and the ILCD Handbook guidelines for each major step within the goal definition, scope definition, inventory analysis, impact assessment, and interpretation phases of the methodology. Results show that malpractices exist in several aspects of the LCA with large differences across studies. Examples...... are a frequent neglect of the goal definition, a frequent lack of transparency and precision in the definition of the scope of the study, e.g. an unclear delimitation of the system boundaries, a truncated impact coverage, difficulties in capturing influential local specificities such as representative waste...

  11. Using Health Provider Insights to Inform Pediatric HIV Disclosure: A Qualitative Study and Practice Framework from Kenya

    Science.gov (United States)

    John-Stewart, Grace; Shah, Brandi; Wamalwa, Dalton; Maleche-Obimbo, Elizabeth; Kelley, Maureen

    2014-01-01

    Abstract Optimal pediatric HIV disclosure impacts illness and developmental experiences while improving access to timely treatment. However, disclosure rates in high HIV prevalence countries remain low and there are limited data on best practices. We conducted a qualitative study of disclosure practices and interviewed healthcare providers from five pediatric HIV clinics in Kenya. We identified themes central to disclosure practices, rationale for approaches, barriers to implementing disclosure, and creative strategies to overcome challenges. We used these insights to develop a practice-based framework for disclosure that is sensitive to practical challenges. Overall, providers had limited training but extensive experience in disclosure, endorsed individualized disclosure practices, invested substantial time on disclosure despite clinical burden, and noted adverse outcomes associated with unplanned or abrupt disclosure. Providers advocated for an approach to disclosure that is child-centered but respects caregiver fears and values. Caregiver support was provided to enable caregivers to be the person who ultimately disclosed HIV status to children. Unplanned or abrupt disclosure to children was reported to have severe and persistent adverse impact and was a stimulus to accelerate disclosure in scenarios when providers believed children may be suspecting their diagnosis. Based on these expert insights, the framework we developed incorporates concurrent evaluation of child and caregiver readiness, identifies cues to prompt disclosure discussions, includes caregiver education and support, and utilizes a gradual approach of unveiling HIV diagnosis to the child. PMID:25216105

  12. Association of provider opioid prescribing practices and the Centers for Medicare and Medicaid Services hierarchical condition category score: A retrospective examination of correlation between the volume of provider-prescribed opioid medications and provider panel complexity

    Directory of Open Access Journals (Sweden)

    Frederick North

    2017-03-01

    Full Text Available Objective: Opioids are being prescribed at increasing rates in primary care practices, and among individual providers there is significant variability in opioid prescribing. Primary care practices also vary significantly in complexity of their patients, ranging from healthy patients to those with multiple comorbidities. Our objective was to examine individual primary care providers for an association between their opioid prescribing and the complexity/risk of their panel of patients (a panel of patients is a group of patients whose medical care is the responsibility of a specific healthcare provider or care team. Methods: We retrospectively examined 12 months of opioid prescription data from a primary care practice. We obtained counts of opioids prescribed by providers in the Mayo Clinic, Rochester, Minnesota primary care practice. For patients paneled (assigned to family medicine and internal medicine, we used the Centers for Medicare and Medicaid Services hierarchical condition category patient risk score as a measure of patient complexity. After adjusting the opioid counts for panel patient count (to get opioid counts per patient, we used linear regression analysis to determine the correlation between the hierarchical condition category risk and the amount of opioid prescribed by individual providers. Results: Among our combined 103 primary care providers, opioid unit counts prescribed per patient were highly correlated with the providers’ hierarchical condition category panel risk score (r2 = 0.54. After excluding three outliers, r2 was 0.74. With and without the outliers, the correlation was very significant (p  0.45 showed significant correlation with hierarchical condition category (r2 = 0.26; p = 0.001. Conclusion: When examining differences in primary care providers’ opioid prescribing practices, the Centers for Medicare and Medicaid Services endorsed risk score (the hierarchical condition category score can help

  13. Practice nurses mental health provide space to patients to discuss unpleasant emotions

    NARCIS (Netherlands)

    Griep, E.C.; Noordman, J.; Dulmen, S. van

    2016-01-01

    WHAT IS KNOWN ON THE SUBJECT?: A core skill of practice nurses' mental health is to recognize and explore patients' unpleasant emotions. Patients rarely express their unpleasant emotions directly and spontaneously, but instead give indirect signs that something is worrying them. WHAT THIS PAPER ADDS

  14. Practice nurses mental health provide space to patients to discuss unpleasant emotions.

    NARCIS (Netherlands)

    Griep, E.C.M.; Noordman, J.; Dulmen, A.M. van

    2016-01-01

    WHAT IS KNOWN ON THE SUBJECT? A core skill of practice nurses' mental health is to recognize and explore patients' unpleasant emotions. Patients rarely express their unpleasant emotions directly and spontaneously, but instead give indirect signs that something is worrying them.

  15. Adoption of Evidence-Based Practices among Substance Abuse Treatment Providers

    Science.gov (United States)

    Haug, Nancy A.; Shopshire, Michael; Tajima, Barbara; Gruber, Valerie; Guydish, Joseph

    2008-01-01

    This research was conducted at a Substance Abuse Forum designed to address local community needs by focusing on Evidence-Based Practices (EBPs) in addiction treatment. The purpose of the study was to assess substance abuse treatment professionals' readiness to adopt EBPs, experience with EBPs, and attitudes toward EBPs, as well as agency support…

  16. Knowledge of Child Abuse and Reporting Practices among Early Care and Education Providers

    Science.gov (United States)

    Dinehart, Laura; Kenny, Maureen C.

    2015-01-01

    This study sought to assess child abuse knowledge and reporting practices of a diverse sample of early care and education (ECE) practitioners. One hundred and thirty-seven practitioners in the state of Florida completed the "Early Childhood Educators Child Abuse Questionnaire." Results revealed that only a minority of participants have…

  17. Practical considerations in the pharmacological treatment of postherpetic neuralgia for the primary care provider

    Directory of Open Access Journals (Sweden)

    Massengill JS

    2014-03-01

    Full Text Available Jamie S Massengill,1 John L Kittredge2 1JSM Medical, Edmond, OK, USA; 2Michiana Spine, Sports and Occupational Rehab, PC, Mishawaka, IN, USA Abstract: An estimated one million individuals in the US are diagnosed with herpes zoster (HZ; shingles each year. Approximately 20% of these patients will develop postherpetic neuralgia (PHN, a complex HZ complication characterized by neuropathic pain isolated to the dermatome that was affected by the HZ virus. PHN is debilitating, altering physical function and quality of life, and commonly affects vulnerable populations, including the elderly and the immunocompromised. Despite the availability of an immunization for HZ prevention and several approved HZ treatments, the incidence of PHN is increasing. Furthermore, management of the neuropathic pain associated with PHN is often suboptimal, and the use of available therapeutics may be complicated by adverse effects and complex, burdensome treatment regimens, as well as by patients' comorbidities and polypharmacy, which may lead to drug–drug interactions. Informed and comprehensive assessments of currently available pharmacological treatment options to achieve effective pain control in the primary care setting are needed. In this article, we discuss the situation in clinical practice, review currently recommended prevention and treatment options for PHN, and outline practical considerations for the management of this neuropathic pain syndrome, with a focus on optimal, individual-based treatment plans for use in the primary care setting. Keywords: herpes zoster, postherpetic neuralgia, primary care, clinical practice, pharmacological treatment, practical guidelines

  18. Providing Assistance to the Victims of Adolescent Dating Violence: A National Assessment of School Nurses' Practices

    Science.gov (United States)

    Khubchandani, Jagdish; Telljohann, Susan K.; Price, James H.; Dake, Joseph A.; Hendershot, Candace

    2013-01-01

    Background: This study assessed the perceptions and practices of school nurses regarding adolescent dating violence (ADV). Methods: The membership list of the National Association of School Nurses was used to identify a national random cross-sectional sample of high school nurses in the United States (N?=?750). A valid and reliable survey…

  19. Relationship of Evidence-Based Practice and Treatments: A Survey of Community Mental Health Providers

    Science.gov (United States)

    DiMeo, Michelle A.; Moore, G. Kurt; Lichtenstein, Carolyn

    2012-01-01

    Evidence-based treatments (EBTs) are "interventions" that have been proven effective through rigorous research methodologies. Evidence-based practice (EBP), however, refers to a "decision-making process" that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service…

  20. Do immunisation procedures match provider perception? A study from the South Carolina Pediatric Practice Research Network (SCPPRN).

    Science.gov (United States)

    Roberts, James R; Freeland, Katherine D; Kolasa, Maureen S; McElligott, James T; Darden, Paul M

    2011-01-01

    Immunisation coverage of children by 19 months of age in US primary care practices is below the desired goal of 80%. In order to improve this rate, primary care providers must first understand the specific processes of immunisation delivery within their office settings. This paper aims to identify key components in identifying strategies for quality improvement (QI) of immunisation delivery. We surveyed a South Carolina Pediatric Practice Research Network (SCPPRN) representative for each of six paediatric practices. The surveys included questions regarding immunisation assessment, medical record keeping, opportunities for immunisation administration and prompting. Subsequently, research staff visited the participating practices to directly observe their immunisation delivery process and review patient charts in order to validate survey responses and identify areas for QI. Most survey responses were verified using direct observation of actual practice or chart review. However, observation of actual practice and chart review identified key areas for improvement of immunisation delivery. Although four practices responded that they prompted for needed immunisations at sick visits, only one did so. We also noted considerable variation among and within practices in terms of immunising with all indicated vaccines during sick visits. In addition, most practices had multiple immunisation forms and all administered immunisations were not always recorded on all forms, making it difficult to determine a child's immunisation status. For any QI procedure, including immunisation delivery, providers must first understand how the process within their practice actually occurs. Direct observation of immunisation processes and medical record review enhances survey responses in identifying areas for improvement. This study identified several opportunities that practices can use to improve immunisation delivery, particularly maintaining accurate and easy-to-locate immunisation records

  1. CDM Convective Forecast Planning guidance

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The CDM Convective Forecast Planning (CCFP) guidance product provides a foreast of en-route aviation convective hazards. The forecasts are updated every 2 hours and...

  2. Pharmacist services provided in general practice clinics: a systematic review and meta-analysis.

    Science.gov (United States)

    Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

    2014-01-01

    Integration of pharmacists into primary care general practice clinics has the potential to improve interdisciplinary teamwork and patient care; however this practice is not widespread. The aim of this study was to review the effectiveness of clinical pharmacist services delivered in primary care general practice clinics. A systematic review of English language randomized controlled trials cited in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and International Pharmaceutical Abstracts was conducted. Studies were included if pharmacists had a regular and ongoing relationship with the clinic; delivered an intervention aimed at optimizing prescribing for, and/or medication use by, clinic patients; and were physically present within the clinic for all or part of the intervention, or for communication with staff. The search generated 1484 articles. After removal of duplicates and screening of titles and abstracts against inclusion criteria, 131 articles remained. A total of 38 studies were included in the review and assessed for quality. Seventeen studies had common endpoints (blood pressure, glycosylated hemoglobin, cholesterol and/or Framingham risk score) and were included in meta-analyses. Twenty-nine of the 38 studies recruited patients with specific medical conditions, most commonly cardiovascular disease (15 studies) and/or diabetes (9 studies). The remaining 9 studies recruited patients at general risk of medication misadventure. Pharmacist interventions usually involved medication review (86.8%), with or without other activities delivered collaboratively with the general practitioner (family physician). Positive effects on primary outcomes related to medication use or clinical outcomes were reported in 19 studies, mixed effects in six studies, and no effect in 13 studies. The results of meta-analyses favored the pharmacist intervention, with significant improvements in blood pressure, glycosylated hemoglobin, cholesterol and Framingham

  3. Practice development: providing benefits for both managers and older patients with delerium and dementia.

    Science.gov (United States)

    Bezzant, Kim

    2008-03-01

    This article describes the ways in which practice development can aid Nurse Managers to enhance both efficiency and effectiveness, focussing particularly on the care of older people with delerium and dementia. Practitioners caring for this group of patients in acute general hospitals need specialist skills, particularly skills in working with the unusual ('challenging') behaviours that these patients often exhibit. These skills are rarely present at the point of registration but practice development techniques can facilitate the acquisition of appropriate skills with resultant benefits for both patients and organization. The study contains an outline of the ways in which a practice development approach can be delivered and appraised: the theories are outlined, strategies for delivery of the techniques are described and methods of evaluation are suggested. These theories and techniques are being applied in a project in Portsmouth called 'Rise to the Challenge', which has the specific aim of improving the care of people with delerium and dementia in an acute hospital setting. This project is currently running and will be evaluated in the summer of 2008.

  4. Oncology nursing: educating advanced practice nurses to provide culturally competent care.

    Science.gov (United States)

    Yeo, Theresa Pluth; Phillips, Janice; Delengowski, Anne; Griffiths, Margaret; Purnell, Larry

    2011-01-01

    More than 37 million persons or 12.4% of the U.S. population are older than 65 years. These numbers are expected to reach 71.5 million (20% of the population) by 2030. This older population is becoming more racially and ethnically diverse as the overall minority and culturally diverse populations increase. Although the incidence and mortality rates from several major cancers have declined due to advances in cancer care, these advances have lagged among the underserved and more vulnerable racially and culturally diverse populations. Moreover, the disparity between the gender and the racial mix of nurses and the overall population continues to widen. Thus, a growing need for professional nurses and advanced practice nurses with formal educational preparation in all areas of oncology nursing exists. This article (a) highlights significant cancer disparities among diverse populations, (b) describes how cultural belief systems influence cancer care and decision making, and (c) explicates the need to prepare advanced practice nurses for careers that include cancer care of diverse and vulnerable populations through formal oncology educational programs. The "Top 10" reasons for becoming an advanced practice nurse specializing in the oncologic care of patients from diverse and underserved populations are presented. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Home Care Pharmacy Practice in Canada: A Cross-Sectional Survey of Services Provided, Remuneration, Barriers, and Facilitators.

    Science.gov (United States)

    Houle, Sherilyn; MacKeigan, Linda

    2017-01-01

    As the population ages, and individuals desire to remain in their homes as long as possible, the need for in-home care is expected to increase. However, pharmacists have rarely been included in studies of in-home care, and little is known about the prevalence or effectiveness of pharmacists' home-based services in Canada. To identify pharmacy practices in Canada that regularly provide in-home patient care and to identify specific services provided, remuneration obtained, and barriers and facilitators influencing the provision of home-based care. A link to a web-based survey was posted in e-newsletters of provincial, territorial, and national pharmacy associations in Canada. In addition, pharmacists known to the researchers as providing in-home clinical services were contacted directly. The survey was open from October to December 2015. Practices or organizations that performed at least one home visit per week for clinical purposes, with documentation of the services provided, were eligible to participate. One response per practice or organization was allowed. Seventeen practices meeting the inclusion criteria were identified, representing community, hospital, and clinic settings. Home visits were most commonly performed for individuals with complex medication regimens or nonadherence to medication therapy. The most common services were conducting medication reconciliation and reviews and counselling patients about medication adherence. No practices or organizations billed patients for these services, yet lack of remuneration was an important barrier identified by many respondents. Although 12 (71%) of the respondents collected data for evaluative purposes, collection of clinical or health system outcome data was rare. Few Canadian pharmacy practices that provide in-home patient care at least once a week could be identified. Data collection suitable to establish an evidence base for this service was infrequently performed by practices and organizations providing

  6. Influenza Vaccination among Pregnant Women: Patient Beliefs and Medical Provider Practices

    National Research Council Canada - National Science Library

    Stark, Lauren M; Power, Michael L; Turrentine, Mark; Samelson, Renee; Siddiqui, Maryam M; Paglia, Michael J; Strassberg, Emmie R; Kelly, Elizabeth; Murtough, Katie L; Schulkin, Jay

    2016-01-01

    ...% of patients reported receiving a recommendation. Age, education, a medical provider's recommendation, and educational materials were found to positively influence patient beliefs about the influenza...

  7. E-Mail Communication Practices and Preferences Among Patients and Providers in a Large Comprehensive Cancer Center.

    Science.gov (United States)

    Cook, Natalie; Maganti, Manjula; Dobriyal, Aditi; Sheinis, Michal; Wei, Alice C; Ringash, Jolie; Krzyzanowska, Monika K

    2016-07-01

    Little is known about how electronic mail (e-mail) is currently used in oncology practice to facilitate patient care. The objective of our study was to understand the current e-mail practices and preferences of patients and physicians in a large comprehensive cancer center. Separate cross-sectional surveys were administered to patients and physicians (staff physicians and clinical fellows) at the Princess Margaret Cancer Centre. Logistic regression was used to identify factors associated with current e-mail use. Record review was performed to assess the impact of e-mail communication on care. The survey was completed by 833 patients. E-mail contact with a member of the health care team was reported by 41% of respondents. The team members contacted included administrative assistants (52%), nurses (45%), specialist physicians (36%), and family physicians (18%). Patient factors associated with a higher likelihood of e-mail contact with the health care team included younger age, higher education, higher income, enrollment in a clinical trial, and receipt of multiple treatments. Eighty percent of physicians (n = 63 of 79) reported previous contact with a patient via e-mail. Physician factors associated with a greater likelihood of e-mail contact with patients included older age, more senior clinical position, and higher patient volume. Nine hundred sixty-two patient records were reviewed, with e-mail correspondence documented in only 9% of cases. E-mail is commonly used for patient care but is poorly documented. The use of e-mail in this setting can be developed with appropriate guidance; however, there may be concerns about widening the gap between certain groups of patients. Copyright © 2016 by American Society of Clinical Oncology.

  8. Health-care providers' perceptions, attitudes towards and recommendation practice of cervical cancer screening.

    Science.gov (United States)

    Hweissa, N Ab; Lim, J N W; Su, T T

    2016-09-01

    In Libya, cervical cancer is ranked third as the most frequent cancer among women with early diagnosis being shown to reduce morbidity and mortality. Health-care providers can influence women's screening behaviours, and their lack of recommendations for screening can be one of the barriers that affect women's participation in screening programmes. This study aims to assess the health-care provider's perception around cervical cancer screening. In-depth, face-to-face interviews were conducted with 16 health-care providers, from both public and private sectors in Az-Zawiya city, Libya, between February and July of 2014. The interviews were recorded and transcribed, then analysed using thematic analysis. Our findings suggest that health-care providers did not provide sufficient information regarding cervical cancer screening for women who attend health-care facilities. The results highlight the role played by health-care professionals in motivating women to attend cervical cancer screening programs, and the need for health education of health-care providers to offer a precious advice regarding the screening. On the other hand, health-care providers highlighted that implementation of reminding system of cervical cancer screening will support them to improve screening attendance. In addition, health-care providers stressed the necessity for educational and awareness campaigns of cervical cancer screening among Libyan women. © 2016 John Wiley & Sons Ltd.

  9. Post-abortion family planning counselling practice among abortion service providers in China

    DEFF Research Database (Denmark)

    Tang, Longmei; Wu, Shangchun; Li, Jiong

    2017-01-01

    /doctor' [1.99 (1.01,3.92), 2.32 (1.22,4.40) and 2.34 (1.06,5.17), respectively]. Conclusions: The majority of providers could provide PAFP counselling to women undergone an abortion, but some of them had insufficient time to make it available. Education, knowledge about fertility and reproductive health...

  10. Engineering practice variation through provider agreement: a cluster-randomized feasibility trial

    OpenAIRE

    McCarren M; Twedt EL; Mansuri FM; Nelson PR; Peek BT

    2014-01-01

    Madeline McCarren,1 Elaine L Twedt,1 Faizmohamed M Mansuri,2 Philip R Nelson,3 Brian T Peek3 1Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, IL, 2Wilkes-Barre VA Medical Center, Wilkes-Barre, PA, 3Charles George VA Medical Center, Asheville, NC, USA Purpose: Minimal-risk randomized trials that can be embedded in practice could facilitate learning health-care systems. A cluster-randomized design was proposed to compare treatment strategies by assigning clusters...

  11. Knowledge, attitude & practice on human papillomavirus vaccination: A cross-sectional study among healthcare providers

    Directory of Open Access Journals (Sweden)

    P Cheena Chawla

    2016-01-01

    Interpretation & conclusions: The findings reinforce continued medical education of healthcare providers, particularly those from the government sector on HPV vaccination for cervical cancer prevention. Public education is also pertinent for a successful HPV vaccination programme in the country.

  12. Knowledge, attitudes, and practices regarding dengue infection among public sector healthcare providers in Machala, Ecuador

    OpenAIRE

    Handel, Andrew S.; Ayala, Efra?n Beltr?n; Borbor-Cordova, Mercy J.; Fessler, Abigail G.; Finkelstein, Julia L.; Espinoza, Roberto Xavier Robalino; Ryan, Sadie J.; Stewart-Ibarra, Anna M.

    2016-01-01

    Background Dengue fever is a rapidly emerging infection throughout the tropics and subtropics with extensive public health burden. Adequate training of healthcare providers is crucial to reducing infection incidence through patient education and collaboration with public health authorities. We examined how public sector healthcare providers in a dengue-endemic region of Ecuador view and manage dengue infections, with a focus on the 2009 World Health Organization (WHO) Dengue Guidelines. Metho...

  13. Practicing provider-initiated HIV testing in high prevalence settings: consent concerns and missed preventive opportunities

    OpenAIRE

    Shayo Elizabeth H; Blystad Astrid; Njeru Mercy K; Nyamongo Isaac K; Fylkesnes Knut

    2011-01-01

    Abstract Background Counselling is considered a prerequisite for the proper handling of testing and for ensuring effective HIV preventive efforts. HIV testing services have recently been scaled up substantially with a particular focus on provider-initiated models. Increasing HIV test rates have been attributed to the rapid scale-up of the provider-initiated testing model, but there is limited documentation of experiences with this new service model. The aim of this study was to determine the ...

  14. Clinical pharmacy consultations provided by American and Kenyan pharmacy students during an acute care advanced pharmacy practice experience.

    Science.gov (United States)

    Pastakia, Sonak D; Vincent, William R; Manji, Imran; Kamau, Evelyn; Schellhase, Ellen M

    2011-04-11

    To compare the clinical consultations provided by American and Kenyan pharmacy students in an acute care setting in a developing country. The documented pharmacy consultation recommendations made by American and Kenyan pharmacy students during patient care rounds on an advanced pharmacy practice experience at a referral hospital in Kenya were reviewed and classified according to type of intervention and therapeutic area. The Kenyan students documented more interventions than American students (16.7 vs. 12.0 interventions/day) and provided significantly more consultations regarding human immunodeficiency virus (HIV) and antibiotics. The top area of consultations provided by American students was cardiovascular diseases. American and Kenyan pharmacy students successfully providing clinical pharmacy consultations in a resource-constrained, acute-care practice setting suggests an important role for pharmacy students in the reconciliation of prescriber orders with medication administration records and in providing drug information.

  15. Fluid resuscitation practices in cardiac surgery patients in the USA: a survey of health care providers

    Directory of Open Access Journals (Sweden)

    Solomon Aronson

    2017-10-01

    Full Text Available Abstract Background Fluid resuscitation during cardiac surgery is common with significant variability in clinical practice. Our goal was to investigate current practice patterns of fluid volume expansion in patients undergoing cardiac surgeries in the USA. Methods We conducted a cross-sectional online survey of 124 cardiothoracic surgeons, cardiovascular anesthesiologists, and perfusionists. Survey questions were designed to assess clinical decision-making patterns of intravenous (IV fluid utilization in cardiovascular surgery for five types of patients who need volume expansion: (1 patients undergoing cardiopulmonary bypass (CPB without bleeding, (2 patients undergoing CPB with bleeding, (3 patients undergoing acute normovolemic hemodilution (ANH, (4 patients requiring extracorporeal membrane oxygenation (ECMO or use of a ventricular assist device (VAD, and (5 patients undergoing either off-pump coronary artery bypass graft (OPCABG surgery or transcatheter aortic valve replacement (TAVR. First-choice fluid used in fluid boluses for these five patient types was requested. Descriptive statistics were performed using Kruskal-Wallis test and follow-up tests, including t tests, to evaluate differences among respondent groups. Results The most commonly preferred indicators of volume status were blood pressure, urine output, cardiac output, central venous pressure, and heart rate. The first choice of fluid for patients needing volume expansion during CPB without bleeding was crystalloids, whereas 5% albumin was the most preferred first choice of fluid for bleeding patients. For volume expansion during ECMO or VAD, the respondents were equally likely to prefer 5% albumin or crystalloids as a first choice of IV fluid, with 5% albumin being the most frequently used adjunct fluid to crystalloids. Surgeons, as a group, more often chose starches as an adjunct fluid to crystalloids for patients needing volume expansion during CPB without bleeding. Surgeons

  16. "I think we've got too many tests!": Prenatal providers' reflections on ethical and clinical challenges in the practice integration of cell-free DNA screening.

    Science.gov (United States)

    Gammon, B L; Kraft, S A; Michie, M; Allyse, M

    2016-01-01

    on prenatal practice, and potential future of cfDNA screening in clinical practice. Given the likelihood that the scope and uptake of cfDNA screening will continue to increase, it is essential to consider how these changes will affect frontline prenatal care providers and, in turn, patients. Providers' requests for additional guidance and data as well as their concerns with the lack of time available to explain screening and testing options indicate significant potential issues with patient care. It is important to ensure that the clinical integration of cfDNA screening is managed responsibly and ethically before it expands further, exacerbating pre-existing issues. As prenatal screening evolves, so should informed consent and the resources available to women making decisions. The field must take steps to maximize the advantages of cfDNA screening and responsibly manage its ethical issues.

  17. Factors influencing practice variation in the management of nephrotic syndrome: a qualitative study of pediatric nephrology care providers.

    Science.gov (United States)

    Samuel, Susan M; Flynn, Rachel; Zappitelli, Michael; Dart, Allison; Parekh, Rulan; Pinsk, Maury; Mammen, Cherry; Wade, Andrew; Scott, Shannon D

    2017-06-07

    Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome. Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis. Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome. Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes. Copyright 2017, Joule Inc. or its licensors.

  18. Birth Care Providers' Experiences and Practices in a Brazilian Alongside Midwifery Unit: An Ethnographic Study.

    Science.gov (United States)

    Nunes, Michelly Christiny M; Reberte Gouveia, Luciana M; Reis-Queiroz, Jessica; Hoga, Luiza A K

    2016-01-01

    The implementation of a new birthing facility in a country such as Brazil requires an extensive in-depth analysis of the challenges faced. The aim of this study was to explore beliefs, values, experiences, and practices related to the provision of birthing and neonatal care with the implementation of a new birth care facility structure called alongside midwifery units in Brazil. The study utilizes an ethnographic method to evaluate members of a Brazilian public hospital's midwifery unit. The ethnographic study focuses on the cultural theme of "between the proposed and the possible": the following birthing care guidelines require overcoming numerous obstacles, and four other cultural subthemes toward revealing the analyzed birth care team's perspectives. The study found that prior training and preparation of all members of the care team, as well as the provision of adequate institutional infrastructure are essential for the implementation of a new and innovative birthing care center.

  19. Social Media and the Practicing Hematologist: Twitter 101 for the Busy Healthcare Provider.

    Science.gov (United States)

    Thompson, Michael A; Majhail, Navneet S; Wood, William A; Perales, Miguel-Angel; Chaboissier, Mélanie

    2015-12-01

    Social media is a relatively new form of media that includes social networks for communication dissemination and interaction. Patients, physicians, and other users are active on social media including the microblogging platform Twitter. Many online resources are available to facilitate joining and adding to online conversations. Social media can be used for professional uses, therefore, we include anecdotes of physicians starting on and implementing social media successfully despite the limits of time in busy practices. Various applications demonstrating the utility of social media are explored. These include case discussions, patient groups, research collaborations, medical education, and crowdsourcing/crowdfunding. Social media is integrating into the professional workflow for some individuals and hematology/oncology societies. The potential for improving hematology care and research is just starting to be explored.

  20. Strategic Planning: A Practical Primer for the Healthcare Provider: Part I.

    Science.gov (United States)

    Baum, Neil; Brockmann, Erich N; Lacho, Kenneth J

    2016-01-01

    Entrepreneurs are known for opportunity recognition--that is, "How can I start a business to make money from this opportunity?" However, once a commercial entity is formed to take advantage of an opportunity, the leadership priority shifts from entrepreneurial to strategic. A strategic perspective leverages limited resources to position a business for future success relative to rivals in a competitive environment. Often, the talents needed for one priority are not the same as those needed for the other. This article, the first part of a two-part article, intends to simplify the transition from an entrepreneurial to a strategic focus. It walks an entrepreneur through the strategic management planning process using a fictional business. The various tasks in the process (i.e., mission, vision, internal analysis, external analysis) are illustrated with examples from a typical primary physician's private practice. The examples show how the strategic management tasks are interrelated and ultimately lead to a philosophical approach to managing a business.

  1. Lipid management in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry.

    Science.gov (United States)

    Navar, Ann Marie; Wang, Tracy Y; Li, Shuang; Robinson, Jennifer G; Goldberg, Anne C; Virani, Salim; Roger, Veronique L; Wilson, Peter W F; Elassal, Joseph; Lee, L Veronica; Peterson, Eric D

    2017-11-01

    The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDL-C) targets toward statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk. Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary prevention patients from 138 PALM Registry practices. Overall, 74.7% of eligible adults were on statins; only 42.4% were on guideline-recommended intensity. Relative to primary prevention patients, ASCVD patients were more likely to be on a statin (83.6% vs 63.4%, Pobesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients (OR 1.71, 95% CI 1.41-2.09), as were those seen by cardiologists (OR 1.43, 95% CI 1.12-1.83). Median LDL-C levels were highest among patients not on statins (124.0 mg/dL) and slightly higher among those on lower-than-recommended intensity compared with recommended-therapy recipients (88.0 and 84.0 mg/dL, respectively; P≤.0001). In routine contemporary practice, 1 in 4 guideline-eligible patients was not on a statin; less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Guidance in Business Process Modelling

    Science.gov (United States)

    Bartho, Andreas; Gröner, Gerd; Rahmani, Tirdad; Zhao, Yuting; Zivkovic, Srdjan

    This chapter shows how process modellers can be supported by guidance. If a telecommunication provider introduces a value-added service, this might involve the establishment of new business processes, whose specification is not trivial. A guidance engine can help a process engineer develop a new business process by stepwise refining, i.e. creating a more concrete version of the process from an abstract version. The guidance engine identifies inconsistencies and proposes possible refinement steps. The topics covered in this chapter range from theoretical foundations of business process refinement over the formalisation of refinement problems in ontologies to implementation issues. The presented solutions were developed in the MOST project.

  3. Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators.

    Science.gov (United States)

    Nadler, Michelle; Bainbridge, Daryl; Tomasone, Jennifer; Cheifetz, Oren; Juergens, Rosalyn A; Sussman, Jonathan

    2017-07-01

    Despite the reported benefits of physical activity in alleviating the impact of cancer and its treatments, oncology care providers (OCPs) are not routinely discussing exercise with their patients, suggesting a knowledge to action gap. We sought to determine OCP's knowledge, beliefs, barriers, and facilitators to exercise discussion. A survey was administered to OCPs at the cancer center in Hamilton, Ontario. Questions comprised of demographics, knowledge and beliefs regarding exercise guidelines, and barriers and facilitators to exercise discussion. Analysis of survey responses was descriptive. Pearson's chi-squared test was used to examine select associations. There were 120 respondents (61% response rate) representing a diversity of professions. Approximately, 80% of OCPs were not aware of any exercise guidelines in cancer and self-reported poor knowledge on when, how, and which patients to refer to exercise programs. OCPs who reported meeting Canada's Physical Activity guidelines were significantly more likely to identify correct guidelines (p = 0.023) and to report good knowledge on how to provide exercise counseling (p = 0.014). Across OCP groups, barriers to exercise discussion included poor knowledge, lack of time, and safety concerns. Most felt that educational sessions and having an exercise specialist on the clinical team would be beneficial. OCPs have low knowledge regarding exercise counseling, but believe that discussing exercise is a multidisciplinary task and expressed a desire for further training. Interventions will require a multi-pronged approach including education for OCPs and guidance on assessment for exercise safety.

  4. Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices.

    Science.gov (United States)

    Steele, Joseph R; Schomer, Don F

    2009-07-01

    Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.

  5. Health care provider education as a tool to enhance antibiotic stewardship practices.

    Science.gov (United States)

    Ohl, Christopher A; Luther, Vera P

    2014-06-01

    Antibiotic stewardship education for health care providers provides a foundation of knowledge and an environment that facilitates and supports optimal antibiotic prescribing. There is a need to extend this education to medical students and health care trainees. Education using passive techniques is modestly effective for increasing prescriber knowledge, whereas education using active techniques is more effective for changing prescribing behavior. Such education has been shown to enhance other antibiotic stewardship interventions. In this review, the need and suggested audience for antibiotic stewardship education are highlighted, and effective education techniques are recommended for increasing knowledge of antibiotics and improving their use. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Childcare Providers' Use of Practices to Promote Young Children's Social-Emotional Competence

    Science.gov (United States)

    Steed, Elizabeth A.; Roach, Andrew T.

    2017-01-01

    Findings are presented regarding childcare providers' use of evidence-based strategies to promote preschoolers' social-emotional competence in 38 urban childcare classrooms. Descriptive results from classroom observations and childcare teachers' interviews indicated that in the absence of training, childcare teaching staff implemented few of these…

  7. Continuity and Change: Employers' Training Practices and Partnerships with Training Providers. Research Report

    Science.gov (United States)

    Smith, Erica; Smith, Andy; Tuck, Jacqueline; Callan, Victor

    2017-01-01

    A number of factors influence the motivations of employers to train their workforce and the ways in which they engage with the training system. This study combines a national survey and interviews with Australian employers and registered training organisations (RTOs) to provide a comprehensive picture of the way in which employers navigate the…

  8. Considerations of Administrative Licensure, Provider Type, and Leadership Quality: Recommendations for Research, Policy, and Practice

    Science.gov (United States)

    Hackmann, Donald G.

    2016-01-01

    This article reviews U.S. administrative licensure regulations, focusing on type of school leader licensure, provider types, and leadership quality. Licensure obtained through university-based and alternative routes is examined. Due to limited research on alternative school administrative licensure, regulations in medicine, psychology,…

  9. Maintaining Long-Distance Friendships: Communication Practices for Seeking and Providing Social Support across Geographic Divides

    Science.gov (United States)

    Lobburi, Patipan

    2012-01-01

    People seek and provide support through their personal social network, especially when they must cope with stress, deal with an emergency, or need help. Coping with a new culture or new environment is a stressful situation that sojourner students must face. Support through friendship plays an important role in facing such new situations. Focusing…

  10. Establishing best practices to improve usability of web interfaces providing atmospheric data

    Science.gov (United States)

    Oakley, N.; Daudert, B.

    2014-12-01

    Accessing scientific data through an online portal can be a frustrating task. The concept of making web interfaces easy to use known as "usability" has been thoroughly researched in the field of e-commerce but has not been explicitly addressed in the atmospheric sciences. As more observation stations are installed, satellite missions flown, models run, and field campaigns performed, large amounts of data are produced. Portals on the Internet have become the favored mechanisms to share this information and are ever increasing in number. Portals are often created without being tested for usability with the target audience though the expenses of testing are low and the returns high. To remain competitive and relevant in the provision of atmospheric data, it is imperative that developers understand design elements of a successful portal to make their product stand out among others. This presentation informs the audience of the benefits and basic principles of usability for web pages presenting atmospheric data. We will also share some of the best practices and recommendations we have formulated from the results of usability testing performed on two data provision web sites hosted by the Western Regional Climate Center.

  11. Providing Nutritional Care in the Office Practice: Teams, Tools, and Techniques.

    Science.gov (United States)

    Kushner, Robert F

    2016-11-01

    Provision of dietary counseling in the office setting is enhanced by using team-based care and electronic tools. Effective provider-patient communication is essential for fostering behavior change: the key component of lifestyle medicine. The principles of communication and behavior change are skill-based and grounded in scientific theories and models. Motivational interviewing and shared decision making, a collaboration process between patients and their providers to reach agreement about a health decision, is an important process in counseling. The stages of change, self-determination, health belief model, social cognitive model, theory of planned behavior, and cognitive behavioral therapy are used in the counseling process. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Does Risk-Adjusted Payment Influence Primary Care Providers' Decision on Where to Set Up Practices?

    DEFF Research Database (Denmark)

    Dietrichson, Jens; Anell, Anders; Dackehag, Margareta

    Providing equal access to health care is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where providers are free to establish themselves in any part of the country. To improve equity in access to care, 15 out 21 county...... capitation on the supply of private primary care centers. We use a dataset that combines information on all primary care centers in Sweden during 2005-2013, the payment system and other conditions for establishing new primary care centers used in the county councils, and demographic, geographic......-adjusted capitation significantly increase the number of private primary care centers in areas with relatively high Care Need Index values. The adjustment results in a changed distribution of private centers within county councils; the total number of private centers does not increase in county councils using care...

  13. Switching basal insulins in type 2 diabetes: practical recommendations for health care providers.

    Science.gov (United States)

    Anderson, Sarah L; Trujillo, Jennifer M; Anderson, John E; Tanenberg, Robert J

    2017-12-27

    Basal insulin remains the mainstay of treatment of type 2 diabetes when diet changes and exercise in combination with oral drugs and other injectable agents are not sufficient to control hyperglycemia. Insulin therapy should be individualized, and several factors influence the choice of basal insulin; these include pharmacological properties, patient preferences, and lifestyle, as well as health insurance plan formularies. The recent availability of basal insulin formulations with longer durations of action has provided further dosing flexibility; however, patients may need to switch agents throughout therapy for a variety of personal, clinical, or economic reasons. Although a unit-to-unit switching approach is usually recommended, this conversion strategy may not be appropriate for all patients and types of insulin. Glycemic control and risk of hypoglycemia must be closely monitored by health care providers during the switching process. In addition, individual changes in care and formulary coverage need to be adequately addressed in order to enable a smooth transition with optimal outcomes.

  14. Current practice and knowledge of oral care for cancer patients: a survey of supportive health care providers

    NARCIS (Netherlands)

    Barker, Gerry J.; Epstein, Joel B.; Williams, Karen B.; Gorsky, Meir; Raber-Durlacher, Judith E.

    2005-01-01

    The Oral Care Study Section of the Multinational Association of Supportive Care in Cancer (MASCC) and the International Society for Oral Oncology (ISOO) conducted a survey on clinical practices of oral/dental management of cancer patients among supportive health care providers. The main purpose was

  15. Social support in the practices of informal providers: The case of patent and proprietary medicine vendors in Nigeria.

    Science.gov (United States)

    Sieverding, Maia; Liu, Jenny; Beyeler, Naomi

    2015-10-01

    The social and institutional environments in which informal healthcare providers operate shape their health and business practices, particularly in contexts where regulatory enforcement is weak. In this study, we adopt a social capital perspective to understanding the social networks on which proprietary and patent medicine vendors (PPMVs) in Nigeria rely for support in the operation of their shops. Data are drawn from 70 in-depth interviews with PPMVs in three states, including interviews with local leaders of the PPMV professional association. We find that PPMVs primarily relied on more senior colleagues and formal healthcare professionals for informational support, including information about new medicines and advice on how to treat specific cases of illness. For instrumental support, including finance, start-up assistance, and intervention with regulatory agencies, PPMVs relied on extended family, the PPMVs with whom they apprenticed, and the leaders of their professional association. PPMVs' networks also provided continual reinforcement of what constitutes good PPMV practice through admonishments to follow scope of practice limitations. These informal reminders, as well as monitoring activities conducted by the professional association, served to reinforce PPMVs' concern with avoiding negative customer health outcomes, which were perceived to be detrimental to their business reputations. That PPMVs' networks both encouraged practices to reduce the likelihood of poor health outcomes, and provided advice regarding customers' health conditions, highlights the potential impact of informal providers' access to different forms of social capital on their delivery of health services, as well as their success as microenterprises. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Nurses' attitude and practice in providing tobacco cessation care to patients.

    Science.gov (United States)

    Sreedharan, J; Muttappallymyalil, J; Venkatramana, M

    2010-06-01

    Patients respond very positively with nurses when they talk to them about their health related problems. This cross sectional study was carried out among nurses working in Gulf Medical College hospital and Research centre, Ajman, UAE to assess the their attitude in providing tobacco cessation counselling or advise to their patients and potential barriers they face in providing tobacco cessation care. 108 nurses participated in the study. Among the nurses 87% were females, the majority were aged between 25 and 34 years, and 46.3% had a work experience of less than 5 years. Among the nurses who participated in the survey, 99.1% felt that the hospital stay was a suitable time for nurses to create awareness on tobacco and health to the patients and had a positive attitude towards creating awareness on tobacco and health to the patients. Only 0.9% had a negative attitude towards creating awareness on tobacco and health and they felt that patients might not listen to them. All nurses, irrespective of their socio-demographic characteristics had a positive attitude to motivating patients to quit tobacco use. Currently, 70.4% regularly advise their patients to avoid tobacco products. Potential barriers pointed out by nurses were: lack of time (6.3%) patients may not appreciate it (90.6%) and not part of their job (3.1%). The study concludes that nurses have a positive attitude in providing tobacco cessation care to their patients and they can utilize their unique knowledge and know-how to promote tobacco cessation and prevent the spread of this public health crisis. Providing advice and support for tobacco cessation by nurses would increase the chance of patients stopping tobacco use. This will create an enabling environment and greater potential for public health persons to fight the epidemic with greater vigour

  17. Best Practices for Cloud Provider Connectivity for R&E Users

    CERN Document Server

    Bos, Erik-Jan; Kleist, Josva; Foster, David; CERN. Geneva. IT Department

    2016-01-01

    R&E Networks have been in the business of serving the needs of research and education for decades. A recent development is that more and more R&E Networks are required to support the overall business of research and education for their customers. As R&E institutes have felt the pressure from governments to become more efficient and cost-effective, their interest has turned to cloud solutions for scientific applications as well as back-end office systems. The use of clouds, both commercial and private, is increasing rapidly. Large scale connectivity with cloud providers is a rather new but important area, in which R&E Networks are trying to find their way to add value. Connectivity with commercial cloud providers nowadays is an important topic, and it is becoming crucial that advice to policy makers, decision makers and procurers is given so that over time it will lead to a coherent, scalable and increasingly cost-effective solution for connecting to cloud service providers.

  18. Is there a difference between center and home care providers' training, perceptions, and practices related to obesity prevention?

    Science.gov (United States)

    Kim, Juhee; Shim, Jae Eun; Wiley, Angela R; Kim, Keunsei; McBride, Brent A

    2012-11-01

    To compare the obesity related training, practices, and perceptions of home child care providers and center care providers. A self-administered survey was collected from child care providers who attended local child care training workshops in east central Illinois from March 2009 to August 2010. Study results were based on responses from 88 home care providers and 94 center providers. The survey questions addressed child care providers' training in the prior year, their obesity prevention practices including written policies, their perceptions of influences on children's health, and factors determining food menu selection. Paired t tests and Chi-square tests were used to compare the difference by child care type. 81.9% of home care providers and 58.6% of center care providers received nutrition training, while 66.7 and 43.0% of these providers received physical activity training, respectively. Nutrition content, guidelines or state regulations, and food availability were the most important factors that influenced both types of care providers' food service menus. Both care provider types perceived they have less influence on children's food preferences, eating habits, and weight status compared to the home environment. However, home care providers perceived a smaller discrepancy between the influences of child care and home environments compared to center care providers. Compared to center providers, home care providers were more likely to have had training, be involved with health promotion activities, and rate their influence higher on children's health behaviors. Findings underscore the need for obesity prevention efforts in both types of child care settings.

  19. Provider-agency fit in substance abuse treatment organizations: implications for learning climate, morale, and evidence-based practice implementation.

    Science.gov (United States)

    Ramsey, Alex T; van den Berk-Clark, Carissa

    2015-05-12

    Substance abuse agencies have been slow to adopt and implement evidence-based practices (EBPs), due in part to poor provider morale and organizational climates that are not conducive to successful learning and integration of these practices. Person-organization fit theory suggests that alignment, or fit, between provider- and agency-level characteristics regarding the implementation of EBPs may influence provider morale and organizational learning climate and, thus, implementation success. The current study hypothesized that discrepancies, or lack of fit, between provider- and agency-level contextual factors would negatively predict provider morale and organizational learning climate, outcomes shown to be associated with successful EBP implementation. Direct service providers (n = 120) from four substance abuse treatment agencies responded to a survey involving provider morale, organizational learning climate, agency expectations for EBP use, agency resources for EBP use, and provider attitudes towards EBP use. Difference scores between combinations of provider- and agency-level factors were computed to model provider-agency fit. Quadratic regression analyses were conducted to more adequately and comprehensively model the level of the dependent variables across the entire "fit continuum". Discrepancies, or misfit, between agency expectations and provider attitudes and between agency resources and provider attitudes were associated with poorer provider morale and weaker organizational learning climate. For all hypotheses, the curvilinear model of provider-agency discrepancies significantly predicted provider morale and organizational learning climate, indicating that both directions of misfit (provider factors more favorable than agency factors, and vice-versa) were detrimental to morale and climate. However, outcomes were most negative when providers viewed EBPs favorably, but perceived that agency expectations and resources were less supportive of EBP use. The

  20. Neuraminidase activity provides a practical read-out for a high throughput influenza antiviral screening assay

    Directory of Open Access Journals (Sweden)

    Wu Meng

    2008-09-01

    Full Text Available Abstract Background The emergence of influenza strains that are resistant to commonly used antivirals has highlighted the need to develop new compounds that target viral gene products or host mechanisms that are essential for effective virus replication. Existing assays to identify potential antiviral compounds often use high throughput screening assays that target specific viral replication steps. To broaden the search for antivirals, cell-based replication assays can be performed, but these are often labor intensive and have limited throughput. Results We have adapted a traditional virus neutralization assay to develop a practical, cell-based, high throughput screening assay. This assay uses viral neuraminidase (NA as a read-out to quantify influenza replication, thereby offering an assay that is both rapid and sensitive. In addition to identification of inhibitors that target either viral or host factors, the assay allows simultaneous evaluation of drug toxicity. Antiviral activity was demonstrated for a number of known influenza inhibitors including amantadine that targets the M2 ion channel, zanamivir that targets NA, ribavirin that targets IMP dehydrogenase, and bis-indolyl maleimide that targets protein kinase A/C. Amantadine-resistant strains were identified by comparing IC50 with that of the wild-type virus. Conclusion Antivirals with specificity for a broad range of targets are easily identified in an accelerated viral inhibition assay that uses NA as a read-out of replication. This assay is suitable for high throughput screening to identify potential antivirals or can be used to identify drug-resistant influenza strains.

  1. Attitudes and beliefs toward the use of a dental diagnostic terminology A survey of dental providers in a dental practice

    Science.gov (United States)

    Ramoni, Rachel B.; Walji, Muhammad F.; Kim, Soyun; Tokede, Oluwabunmi; McClellan, Lyle; Simmons, Kristen; Skourtes, Eugene; Yansane, Alfa; White, Joel M.; Kalenderian, Elsbeth

    2015-01-01

    Background Attitudes and views are critical to the adoption of innovation. While there have been broadening calls for a standardized dental diagnostic terminology, little is known about the views of private practice dental team members towards the adoption of such a terminology. Methods A survey was developed using validated questions identified through literature review. Domain experts’ input allowed for further modifications. The final survey was administered electronically to 814 team members at a multi-office practice based in the Pacific Northwest. Results Response proportion was 92%. The survey had excellent reliability (Cronbach alpha coefficient = 0.87). Results suggested that participants showed, in general, positive attitudes and beliefs towards using a standardized diagnostic terminology in their practices. Additional written comments by participants highlighted the potential for improved communication with use of the terminology. Conclusions Dental providers and staff in one multi-office practice showed positive attitudes towards the use of a diagnostic terminology, specifically they believed it would improve communication between the dentist and patient as well as among providers, while expressing some concerns if using standardized dental diagnostic terms helps clinicians to deliver better dental care. Practical Implications As the dental profession is advancing towards the use of standardized diagnostic terminologies, successful implementation will require that dental team leaders prepare their dental teams by gauging their attitude toward the use of such a terminology. PMID:26025826

  2. Agile practice guide (English)

    CERN Document Server

    2017-01-01

    This practice guide provides guidance on when, where, and how to apply agile approaches and provides practical tools for practitioners and organizations wanting to increase agility. This practice guide is aligned with other PMI standards, including A Guide to the Project Management Body of Knowledge (PMBOK® Guide) - Sixth Edition, and was developed as the result of collaboration between the Project Management Institute and the Agile Alliance.

  3. Understanding teen dating violence: practical screening and intervention strategies for pediatric and adolescent healthcare providers.

    Science.gov (United States)

    Cutter-Wilson, Elizabeth; Richmond, Tracy

    2011-08-01

    Teen dating violence (TDV) is a serious and potentially lethal form of relationship violence in adolescence. TDV is highly correlated with several outcomes related to poor physical and mental health. Although incidence and prevalence data indicate high rates of exposure to TDV among adolescents throughout the United States, significant confusion remains in healthcare communities concerning the definition and implications of TDV. Additionally, healthcare providers are uncertain about effective screening and intervention methods. The article will review the definition and epidemiology of TDV and discuss possible screening and intervention strategies. TDV research is a relatively new addition to the field of relationship violence. Although some confusion remains, the definition and epidemiology of TDV are better understood, which has greatly led to effective ways in which to screen and intervene when such violence is detected. Universal screening with a focus on high-risk subgroups combined with referrals to local and national support services are key steps in reducing both primary and secondary exposure. TDV is a widespread public health crisis with serious short-term and long-term implications. It is necessary for pediatric and adolescent healthcare providers to be aware of TDV and its potential repercussions, as well as possible methods for screening and intervention. More research is needed to better understand TDV as well as to further define effective screening and intervention protocol for the clinical environment.

  4. Knowledge, attitude, and practice towards blood donation among health care providers in hospitals at Bahir Dar City, Ethiopia.

    Science.gov (United States)

    Abera, Bayeh; Mohammed, Beyan; Betela, Wendmagegn; Yimam, Reshid; Oljira, Adam; Ahmed, Merhab; Tsega, Wubet; Mulu, Wondemagegn; Yizengaw, Endalew

    2017-06-01

    Like other sub-Saharan Africa, in Ethiopia there is a shortage of adequate and safe blood supplies. Health care providers are potential resource and promoter of voluntary blood donation. This study was conducted to determine the knowledge, attitude and practice towards blood donation among health care providers in Bahir Dar City, Ethiopia. Paper based questionnaire was distributed to 276 health care providers from May 01 to June 30, 2016. Overall, 42.8% had donated blood at least once. Of these, males accounted for 60%. The median age of blood donors was 26 years. Voluntary-unpaid donation was 21.2%. Overall, 75.5% health care providers were knowledgeable. The levels of knowledge were significantly different among different disciplines (One-way ANOVA; F=69.7; P=0.004). Males were more knowledgeable than females (Pattitude was 78.6%. Previous practice of blood donation determined the odds of favorable attitude to be a future regular voluntary-unpaid blood donor (OR: 5.7, 95% CI: 3.2-10.4). Majority of health care providers had adequate knowledge and favorable attitude. However, voluntary-unpaid donation practice (21.1%) was lower compared to 100% target of voluntary-unpaid donation. There should be motivation packages to enhance voluntary-unpaid blood donation among health care professionals. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Impact of office-based intravenous deep sedation providers upon traditional sedation practices employed in pediatric dentistry.

    Science.gov (United States)

    Tarver, Michael; Guelmann, Marcio; Primosch, Robert

    2012-01-01

    This survey intended to determine how the implementation of office-based IV deep sedation by a third party provider (OIVSED) impacted the traditional sedation practices employed in pediatric dentistry private practice settings. A digital survey was e-mailed to 924 members of the American Academy of Pediatric Dentistry practicing in California, Florida, and New York, chosen because these states had large samples of practicing pediatric dentists in geographically disparate locations. 151 pediatric dentists using OIVSED responded to the survey. Improved efficiency, safety and quality of care provided, and increased parental acceptance were reported advantages of this service. Although less costly than hospital-based general anesthesia, the average fee for this service was a deterrent to some parents considering this option. Sixty-four percent of respondents continued to provide traditional sedation modalities, mostly oral sedation, in their offices, as parenteral routes taught in their training programs were less often selected. OIVSED users reported both a reduction in the use of traditional sedation modalities in their offices and use of hospital-based GA services in exchange for perceived improvements in efficiency, safety and quality of care delivered. Patient costs, in the absence of available health insurance coverage, inhibited accessing this service by some parents.

  6. Cancer and the LGBTQ Population: Quantitative and Qualitative Results from an Oncology Providers' Survey on Knowledge, Attitudes, and Practice Behaviors.

    Science.gov (United States)

    Tamargo, Christina L; Quinn, Gwendolyn P; Sanchez, Julian A; Schabath, Matthew B

    2017-10-07

    Despite growing social acceptance, the LGBTQ population continues to face barriers to healthcare including fear of stigmatization by healthcare providers, and providers' lack of knowledge about LGBTQ-specific health issues. This analysis focuses on the assessment of quantitative and qualitative responses from a subset of providers who identified as specialists that treat one or more of the seven cancers that may be disproportionate in LGBTQ patients. A 32-item web-based survey was emailed to 388 oncology providers at a single institution. The survey assessed: demographics, knowledge, attitudes, and practice behaviors. Oncology providers specializing in seven cancer types had poor knowledge of LGBTQ-specific health needs, with fewer than half of the surveyed providers (49.5%) correctly answering knowledge questions. Most providers had overall positive attitudes toward LGBTQ patients, with 91.7% agreeing they would be comfortable treating this population, and would support education and/or training on LGBTQ-related cancer health issues. Results suggest that despite generally positive attitudes toward the LGBTQ population, oncology providers who treat cancer types most prevalent among the population, lack knowledge of their unique health issues. Knowledge and practice behaviors may improve with enhanced education and training on this population's specific needs.

  7. Women's access and provider practices for the case management of malaria during pregnancy: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Jenny Hill

    2014-08-01

    Full Text Available BACKGROUND: WHO recommends prompt diagnosis and quinine plus clindamycin for treatment of uncomplicated malaria in the first trimester and artemisinin-based combination therapies in subsequent trimesters. We undertook a systematic review of women's access to and healthcare provider adherence to WHO case management policy for malaria in pregnant women. METHODS AND FINDINGS: We searched the Malaria in Pregnancy Library, the Global Health Database, and the International Network for the Rational Use of Drugs Bibliography from 1 January 2006 to 3 April 2014, without language restriction. Data were appraised for quality and content. Frequencies of women's and healthcare providers' practices were explored using narrative synthesis and random effect meta-analysis. Barriers to women's access and providers' adherence to policy were explored by content analysis using NVivo. Determinants of women's access and providers' case management practices were extracted and compared across studies. We did not perform a meta-ethnography. Thirty-seven studies were included, conducted in Africa (30, Asia (4, Yemen (1, and Brazil (2. One- to three-quarters of women reported malaria episodes during pregnancy, of whom treatment was sought by >85%. Barriers to access among women included poor knowledge of drug safety, prohibitive costs, and self-treatment practices, used by 5%-40% of women. Determinants of women's treatment-seeking behaviour were education and previous experience of miscarriage and antenatal care. Healthcare provider reliance on clinical diagnosis and poor adherence to treatment policy, especially in first versus other trimesters (28%, 95% CI 14%-47%, versus 72%, 95% CI 39%-91%, p = 0.02, was consistently reported. Prescribing practices were driven by concerns over side effects and drug safety, patient preference, drug availability, and cost. Determinants of provider practices were access to training and facility type (public versus private. Findings were

  8. Evidence-based practice implementation: The impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice

    Directory of Open Access Journals (Sweden)

    Sommerfeld David H

    2009-12-01

    Full Text Available Abstract Background The goal of this study is to extend research on evidence-based practice (EBP implementation by examining the impact of organizational type (public versus private and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use. We also expected attitudes toward EBPs to mediate the association of organizational support and EBP use. Methods Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170. Path analyses were conducted to compare three theoretical models of the impact of organization type on organizational support for EBP and of organizational support on provider attitudes toward EBP and EBP use. Results Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice. Conclusion This study offers further support for the importance of organizational context as an influence on organizational support for EBP and provider attitudes toward adopting EBP. The study demonstrates the role organizational support in provider use of EBP in practice. This study also suggests that organizational support for innovation is a malleable factor in supporting use of EBP. Greater attention should be paid to organizational influences that can facilitate the dissemination and implementation of EBPs in

  9. 77 FR 71803 - Guidance on Food and Drug Administration Oversight of Positron Emission Tomography Drug Products...

    Science.gov (United States)

    2012-12-04

    ... surveillance processes, including application submission, review, compliance with good manufacturing practices... Act directed FDA to establish appropriate approval procedures and current good manufacturing practices..., 65, 66, 88, and 89). This guidance is being issued consistent with FDA's good guidance practices...

  10. 76 FR 14943 - Antidisruptive Practices Authority

    Science.gov (United States)

    2011-03-18

    ...--Massachusetts Institute of Technology. Appendix IV Parties Submitting Comment Letters in Response to Disruptive... this interpretive order to provide interpretive guidance regarding the three statutory disruptive.... SUPPLEMENTARY INFORMATION: Prohibition of Disruptive Practices I. Statutory and Regulatory Authorities On July...

  11. Post-abortion family planning counselling practice among abortion service providers in China: a nationwide cross-sectional study.

    Science.gov (United States)

    Tang, Longmei; Wu, Shangchun; Li, Jiong; Wang, Kun; Xu, Jialin; Temmerman, Marleen; Zhang, Wei-Hong

    2017-02-01

    To assess the practice of post-abortion family planning (PAFP) counselling among Chinese abortion service providers, and identify the influencing factors. A cross-sectional questionnaire survey was conducted between July and September 2013 among abortion services providers in 30 provinces in China. Univariate and multivariable logistic regression analyses were used to identify the factors that influenced PAFP counselling. 94% of the 579 service providers responded to the questionnaire in the survey. The median age was 39 years (range 20-72), and 95% were females. 92% providers showed a positive attitude and had promoted the PAFP counselling services; however, only 57% spent more than 10 min for it. The overall knowledge on PAFP was limited to the participants. After adjusting for potential confounding factors: providers from the middle region (compared with 'east region', ORadj = 3.33, 95% CI: 2.12-5.21) conducted more PAFP counseling; providers with more knowledge (ORadj = 2.08, 95% CI: 1.38-3.15) provided more counseling; and compared with 'middle school and below', providers with higher education gave more counseling [ORadj(95% CI)] for 'college', 'university' and 'master/doctor' [1.99 (1.01,3.92), 2.32 (1.22,4.40) and 2.34 (1.06,5.17), respectively]. The majority of providers could provide PAFP counselling to women undergone an abortion, but some of them had insufficient time to make it available. Education, knowledge about fertility and reproductive health and residence region were the main factors influencing the practice. Training of health providers and integrating family planning as a part of abortion services are essential to provide adequate PAFP to abortion seekers, thereby reducing the risk of unintended pregnancy.

  12. Primary care providers' physical activity counseling and referral practices and barriers for cardiovascular disease prevention.

    Science.gov (United States)

    Omura, John D; Bellissimo, Moriah P; Watson, Kathleen B; Loustalot, Fleetwood; Fulton, Janet E; Carlson, Susan A

    2017-12-27

    The US Preventive Services Task Force (USPSTF) recommends offering or referring adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. This study determined the proportion of primary care providers (PCPs) who discussed physical activity with most of their at-risk patients and referred them to intensive behavioral counseling, and reported barriers to counseling. Our analyses used data from DocStyles 2015, a Web-based panel survey of 1251 PCPs. Overall, 58.6% of PCPs discussed physical activity with most of their at-risk patients. Among these PCPs, the prevalence of components offered ranged from 98.5% encouraging increased physical activity to 13.9% referring to intensive behavioral counseling. Overall, only 8.1% both discussed physical activity with most at-risk patients and referred to intensive behavioral counseling. Barriers related to PCPs' attitudes and beliefs about counseling (e.g., counseling is not effective) were significantly associated with both discussing physical activity with most at-risk patients and referring them to intensive behavioral counseling (adjusted odds ratio, 1.92; 95% confidence interval, 1.15-3.20). System-level barriers (e.g., referral services not available) were not. Just over half of PCPs discussed physical activity with most of their at-risk patients, and few both discussed physical activity and referred patients to intensive behavioral counseling. Overcoming barriers related to attitudes and beliefs about physical activity counseling could help improve low levels of counseling and referrals to intensive behavioral counseling for CVD prevention. Published by Elsevier Inc.

  13. State of Data Guidance in Journal Policies: A Case Study in Oncology

    Directory of Open Access Journals (Sweden)

    Deborah H. Charbonneau

    2015-06-01

    Full Text Available This article reports the results of a study examining the state of data guidance provided to authors by 50 oncology journals. The purpose of the study was the identification of data practices addressed in the journals’ policies. While a number of studies have examined data sharing practices among researchers, little is known about how journals address data sharing. Thus, what was discovered through this study has practical implications for journal publishers, editors, and researchers. The findings indicate that journal publishers should provide more meaningful and comprehensive data guidance to prospective authors. More specifically, journal policies requiring data sharing, should direct researchers to relevant data repositories, and offer better metadata consultation to strengthen existing journal policies. By providing adequate guidance for authors, and helping investigators to meet data sharing mandates, scholarly journal publishers can play a vital role in advancing access to research data.

  14. CAREER GUIDANCE EXPERIENCE ABROAD

    Directory of Open Access Journals (Sweden)

    Sergey N. Tolstoguzov

    2015-01-01

    Full Text Available The aim of this paper is to describe the experience of careeroriented activities carried out with students of schools in developed and developing countries. Career Guidance in Russia, despite the vast experience of its implementation, is experiencing serious difficulties. In this regard, it is important to take into account the international experience career-oriented activities, such as in the developed countries of North America and the European Union as well as in several Asian countries with rapidly growing economies and a large demographic potential, taking into account the best variants for the Russian education system. Methods. The experience of career-oriented work undertaken with pupils of the USA, Canada, Israel, France, UK, Germany, Denmark, Sweden, Japan, Singapore, China and India is shown on the basis of the comparative analysis of different publications and information sources. The author has made an attempt to generalize the principles of psycho-pedagogical and administrative assistance in professional self-determination of senior pupils abroad. Scientific novelty. The approaches to career-oriented activities in countries with different levels of economic development are compared for the first time. Some principles are revealed. Firstly, the higher the income level per capita in the country, the greater attention is given to vocational guidance. The politics in the developed countries is based on interests of the individual: children’s acquaintance with the world of professions begins already at younger school and the moment of definitive selfdetermination is postponed till the end of their senior stage of education; the possibility of direction change of professional preparation in case of detection of discrepancy of qualities of the pupil to originally selected profile is provided. Career-oriented activity in developing countries, on the contrary, is rigidly coordinated to requirements of economy and a labour market

  15. Knowledge, attitudes, and practice patterns among healthcare providers in the prevention of recurrent kidney stones in Northern Ontario

    Science.gov (United States)

    Bos, Derek; Abara, Emmanuel; Parmar, Malvinder S.

    2014-01-01

    Introducton: Kidney stone recurrence is common. Preventive measures can lead to improved quality of life and costs savings to the individual and healthcare system. Guidelines to prevent recurrent kidney stones are published by various urological societies. Adherence to guidelines amongst healthcare professionals in general is poor, while adherence to preventive management guidelines regarding stone disease is unknown. To understand this issue, we conducted an online study to assess the knowledge, attitudes, and practice patterns of healthcare practitioners in Northern Ontario. Methods: We used the database of healthcare providers affiliated with the Northern Ontario School of Medicine, in Sudbury (East Campus) and Thunder Bay (West Campus), Ontario. We designed the survey based on current best practice guidelines for the management of recurrent kidney stones. Questions covered 3 domains: knowledge, attitudes, and practice patterns. Demographic data were also collected. The survey was distributed electronically to all participants. Results: A total of 68 healthcare providers completed the survey. Of these, most were primary care physicians (72%). To keep uniformity, we analyzed the data of this homogenous group. A total of 70% of the respondents were aware of the current guidelines; however, only 43% applied their knowledge in clinical practice. Most participants lacked confidence while answering most items in the attitude domain. Conclusions: Most primary care physician respondents were aware of the appropriate preventive measures for recurrent kidney stones; however, they do not appear to apply this knowledge effectively in clinical practice. A low response rate is a limitation of our study. Further studies involving a larger sample size may lead to information sharing and collaborative care among healthcare providers. PMID:25485006

  16. Knowledge, attitudes, and practice patterns among healthcare providers in the prevention of recurrent kidney stones in Northern Ontario.

    Science.gov (United States)

    Bos, Derek; Abara, Emmanuel; Parmar, Malvinder S

    2014-11-01

    Kidney stone recurrence is common. Preventive measures can lead to improved quality of life and costs savings to the individual and healthcare system. Guidelines to prevent recurrent kidney stones are published by various urological societies. Adherence to guidelines amongst healthcare professionals in general is poor, while adherence to preventive management guidelines regarding stone disease is unknown. To understand this issue, we conducted an online study to assess the knowledge, attitudes, and practice patterns of healthcare practitioners in Northern Ontario. We used the database of healthcare providers affiliated with the Northern Ontario School of Medicine, in Sudbury (East Campus) and Thunder Bay (West Campus), Ontario. We designed the survey based on current best practice guidelines for the management of recurrent kidney stones. Questions covered 3 domains: knowledge, attitudes, and practice patterns. Demographic data were also collected. The survey was distributed electronically to all participants. A total of 68 healthcare providers completed the survey. Of these, most were primary care physicians (72%). To keep uniformity, we analyzed the data of this homogenous group. A total of 70% of the respondents were aware of the current guidelines; however, only 43% applied their knowledge in clinical practice. Most participants lacked confidence while answering most items in the attitude domain. Most primary care physician respondents were aware of the appropriate preventive measures for recurrent kidney stones; however, they do not appear to apply this knowledge effectively in clinical practice. A low response rate is a limitation of our study. Further studies involving a larger sample size may lead to information sharing and collaborative care among healthcare providers.

  17. Attitudes, practices, and barriers to adolescent suicide and mental health screening: a survey of pennsylvania primary care providers.

    Science.gov (United States)

    Diamond, Guy S; O'Malley, Alana; Wintersteen, Matthew B; Peters, Sherry; Yunghans, Suzanne; Biddle, Virginia; O'Brien, Connell; Schrand, Susan

    2012-01-01

    To determine primary care providers' rates of screening for suicide and mental health problems in adolescents and the factors that promote or discourage this practice. Overall, 671 medical professionals (ie, pediatricians, family physicians, nurse practitioners, physician assistants) completed an electronic survey. The 53 items focused on (1) attitudes, knowledge, and comfort with general psychosocial and suicide screening and (2) current practices and barriers regarding screening and referrals to behavioral health services. Forty percent had a patient attempt suicide in the past year, and 7.7% had 6 or more patients attempt suicide. At a well visit, 67% screened for mental health, and 35.2% screened for suicide risk. Most (61.1%) primary care providers rarely screened for suicide or only when it was indicated. Only 14.2% of primary care providers often used a standardized suicide screening tool. Factors associated with screening were being knowledgeable about suicide risk, being female, working in an urban setting, and having had a suicidal patient. Only 3.0% reported adequate compensation for these practices, and 44% agreed that primary care providers frequently use physical health billing codes for behavioral health services. Nearly 90% said parent involvement was needed if adolescents were to follow through with referrals to mental health services. Only 21% frequently heard back from the behavioral health providers after a referral was made. Policy that promotes mental health education for primary care providers, provides reimbursement for mental health screening, and encourages better service integration could increase suicide screening and save healthcare costs and patients' lives.

  18. Urban-rural differences in attitudes and practices toward long-acting reversible contraceptives among family planning providers in Texas.

    Science.gov (United States)

    Vaaler, Margaret L; Kalanges, Lauri K; Fonseca, Vincent P; Castrucci, Brian C

    2012-03-01

    Despite the elevated rates of teen and unplanned pregnancies across the United States, long-acting reversible contraceptives (LARCs) remain a less utilized birth control method. The present study investigated family planning providers' attitudes and considerations when recommending family planning methods and LARCs to clients. Additionally, this study explored whether urban-rural differences exist in providers' attitudes toward LARCs and in clients' use of LARCs. Data were collected using an online survey of family planning providers at Title X clinics in Texas. Survey data was linked to family planning client data from the Family Planning Annual Report (2008). Findings indicated that, although providers were aware of the advantages of LARCs, clients' LARC use remains infrequent. Providers reported that the benefits of hormone implants include their effectiveness for 3 years and that they are an option for women who cannot take estrogen-based birth control. Providers acknowledged the benefits of several types of LARCs; however, urban providers were more likely to acknowledge the benefits of hormone implants compared with their rural counterparts. Results also indicated barriers to recommending LARCs, such as providers' misinformation about LARCs and their caution in recommending LARCs to adolescents. However, findings also indicated providers lack training in LARC insertion, specifically among those practicing in rural areas. In light of the effectiveness and longevity of LARCs, teenagers and clients living in rural areas are ideal LARC candidates. Increased training among family planning providers, especially for those practicing in rural areas, may increase their recommendations of LARCs to clients. Copyright © 2012 Jacobs Institute of Women

  19. Influence of Family History of Diabetes on Health Care Provider Practice and Patient Behavior Among Nondiabetic Oregonians

    OpenAIRE

    Zlot, Amy I.; Bland, Mary Pat; Silvey, Kerry; Epstein, Beth; Leman, Richard F.; Mielke, Beverly

    2008-01-01

    Introduction People with a family history of diabetes are at increased risk of developing diabetes; however, the effect of family history of diabetes on health care provider practice and patient behavior has not been well defined. Methods We analyzed data from the 2005 Oregon Behavioral Risk Factor Surveillance System, a state-based, random-digit?dialed telephone survey, to evaluate, among people with diabetes, associations between family history of diabetes and 1) patients' reports of health...

  20. Providing for energy efficiency in homes and small buildings. Part III. Determining which practices are most effective and installing materials

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-06-01

    The training program is designed to educate students and individuals in the importance of conserving energy and to provide for developing skills needed in the application of energy-saving techniques that result in energy-efficient buildings. A teacher guide and student workbook are available to supplement the basic manual. Subjects covered in Part III are: determining which practices are most efficient and economical; installing energy-saving materials; and improving efficiency of equipment.

  1. Defining High-Quality Palliative Care in Oncology Practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement.

    Science.gov (United States)

    Bickel, Kathleen E; McNiff, Kristen; Buss, Mary K; Kamal, Arif; Lupu, Dale; Abernethy, Amy P; Broder, Michael S; Shapiro, Charles L; Acheson, Anupama Kurup; Malin, Jennifer; Evans, Tracey; Krzyzanowska, Monika K

    2016-09-01

    Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden. Using modified Delphi methodology, 31 multidisciplinary panelists rated each service item on three constructs: importance, feasibility, and scope within medical oncology practice. Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision Making (79%); and Advance Care Planning (78%). The lowest proportions were in Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level, with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain. Within the Appropriate Palliative Care and Hospice Referral domain, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients appropriately. This statement describes the elements comprising high-quality primary palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find this information useful to inform operational changes and quality improvement efforts. Copyright © 2016 by American Society of Clinical Oncology.

  2. ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS CONSANGUINEOUS MARRIAGES AMONG A COHORT OF MULTIETHNIC HEALTH CARE PROVIDERS IN SAUDI ARABIA.

    Science.gov (United States)

    Alnaqeb, Dhekra; Hamamy, Hanan; Youssef, Amira M; Al-Rubeaan, Khalid

    2016-12-29

    This study aimed to assess knowledge, attitude and practice related to consanguinity among multiethnic health care providers in the Kingdom of Saudi Arabia. Using a cross-sectional study design, a validated, self-administered close-ended questionnaire was randomly distributed to health care providers in different health institutions in the country between 1st August 2012 and 31st July 2013. A total of 1235 health care providers completed the study questionnaire. Of the 892 married participants (72.23% of total), 11.43% were married to a first cousin, and were predominantly Arabs, younger than 40 years and male. Only 17.80% of the patients seen by the health care providers requested consanguinity related counselling. A knowledge barrier was expressed by 27.49% of the participants, and 85.67% indicated their willingness to have more training in basic genetic counselling. A language barrier was expressed as a limiting factor to counselling for consanguinity among non-Arabs. The health care providers had a major dearth of knowledge that was reflected in their attitude and practice towards consanguinity counselling. This finding indicates the need for more undergraduate and postgraduate medical and nursing education and training in the counselling of consanguineous couples. It is recommended that consanguinity counselling is included in the current premarital screening and counselling programmes in the Kingdom.

  3. Evaluation of the impact of restructuring wound management practices in a community care provider in Niagara, Canada.

    Science.gov (United States)

    Hurd, Theresa; Zuiliani, Nancy; Posnett, John

    2008-06-01

    The burden of chronic wounds is substantial, and this burden is set to increase as the population ages. The challenge for community health services is significant. Wound care is labour intensive, and demand for services is set to increase at a time when the availability of nursing resources is likely to be severely limited. In March 2005, the Niagara community health care provider implemented a radical reorganisation of wound management practices designed to ensure that available resources, particularly nurse time, were being used in the most efficient way. An evaluation of the impact of the reorganisation has shown improvements in clinical practice and better patient outcomes. The use of traditional wound care products reduced from 75% in 2005 to 20% in 2007 in line with best practice recommendations, and frequency of daily dressing changes reduced from 48% in 2005 to 15% in 2007. In a comparison of patients treated in 2005 and 2006, average time to healing was 51.5 weeks in 2005 compared with 20.9 weeks in 2006. Total treatment cost was lower in 2006 by $10,700 (75%) per patient. Overall, improvements in wound management practice led to a net saving of $3.8 million in the Niagara wound care budget.

  4. 76 FR 55927 - Draft Guidance for Industry and Food and Drug Administration Staff; Demonstrating the Substantial...

    Science.gov (United States)

    2011-09-09

    ... draft guidance provides responses to questions FDA has received on the Family Smoking Prevention [email protected] . SUPPLEMENTARY INFORMATION: I. Background This draft guidance provides responses to...

  5. Understanding the drivers of interprofessional collaborative practice among HIV primary care providers and case managers in HIV care programmes.

    Science.gov (United States)

    Mavronicolas, Heather A; Laraque, Fabienne; Shankar, Arti; Campbell, Claudia

    2017-05-01

    Care coordination programmes are an important aspect of HIV management whose success depends largely on HIV primary care provider (PCP) and case manager collaboration. Factors influencing collaboration among HIV PCPs and case managers remain to be studied. The study objective was to test an existing theoretical model of interprofessional collaborative practice and determine which factors play the most important role in facilitating collaboration. A self-administered, anonymous mail survey was sent to HIV PCPs and case managers in New York City. An adapted survey instrument elicited information on demographic, contextual, and perceived social exchange (trustworthiness, role specification, and relationship initiation) characteristics. The dependent variable, perceived interprofessional practice, was constructed from a validated scale. A sequential block wise regression model specifying variable entry order examined the relative importance of each group of factors and of individual variables. The analysis showed that social exchange factors were the dominant drivers of collaboration. Relationship initiation was the most important predictor of interprofessional collaboration. Additional influential factors included organisational leadership support of collaboration, practice settings, and frequency of interprofessional meetings. Addressing factors influencing collaboration among providers will help public health programmes optimally design their structural, hiring, and training strategies to foster effective social exchanges and promote collaborative working relationships.

  6. Diagnostic work-up of neurological syndromes in a rural African setting: knowledge, attitudes and practices of health care providers.

    Directory of Open Access Journals (Sweden)

    Alain Mpanya

    Full Text Available BACKGROUND: Neurological disorders of infectious origin are common in rural sub-Saharan Africa and usually have serious consequences. Unfortunately, these syndromes are often poorly documented for lack of diagnostic tools. Clinical management of these diseases is a major challenge in under-equipped rural health centers and hospitals. We documented health care provider knowledge, attitudes and practices related to this syndrome in two rural health zones in Bandundu Province, Democratic Republic of Congo. METHODS: We used a qualitative research approach combining observation, in-depth interviews and focus group discussions. We observed 20 patient-provider contacts related to a neurological syndrome, conducted 12 individual interviews and 4 focus group discussions with care providers. All interviews were audiotaped and the transcripts were analyzed with the software ATLAS.ti. RESULTS: Care providers in this region usually limit their diagnostic work-up to clinical examination primarily because of the financial hurdles in this entirely out-of-pocket payment system. The patients prefer to purchase drugs rather than diagnostic tests. Moreover the general lack of diagnostic tools and the representation of the clinician as a "diviner" do not enhance any use of laboratory or other diagnostic methods. CONCLUSION: Innovation in diagnostic technology for neurological disorders is badly needed in Central-Africa, but its uptake in clinical practice will only be a success if tools are simple, affordable and embedded in a patient-centered approach.

  7. Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs

    Directory of Open Access Journals (Sweden)

    Moyer Cheryl A

    2012-06-01

    Full Text Available Abstract Background Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness. Methods In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0. Results 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1 Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2 Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3 Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or “red earth sand.” Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill. Conclusions This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of

  8. attitude of secondary school students towards guidance and ...

    African Journals Online (AJOL)

    Elizabeth Egbochuku

    counsellors should be posted to practice and create awareness of guidance and counselling services. Introduction. Guidance and counselling as the third force in education along with instruction, is an integral part of educational system. Guidance programmes for secondary school students are designed to address the.

  9. Beliefs, Knowledge, Implementation, and Integration of Evidence-Based Practice Among Primary Health Care Providers: Protocol for a Scoping Review.

    Science.gov (United States)

    Pereira, Filipa; Salvi, Mireille; Verloo, Henk

    2017-08-01

    The adoption of evidence-based practice (EBP) is promoted because it is widely recognized for improving the quality and safety of health care for patients, and reducing avoidable costs. Providers of primary care face numerous challenges to ensuring the effectiveness of their daily practices. Primary health care is defined as: the entry level into a health care services system, providing a first point of contact for all new needs and problems; patient-focused (not disease-oriented) care over time; care for all but the most uncommon or unusual conditions; and coordination or integration of care, regardless of where or by whom that care is delivered. Primary health care is the principal means by which to approach the main goal of any health care services system: optimization of health status. This review aims to scope publications examining beliefs, knowledge, implementation, and integration of EBPs among primary health care providers (HCPs). We will conduct a systematic scoping review of published articles in the following electronic databases, from their start dates until March 31, 2017: Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed (from 1946), Embase (from 1947), Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1937), the Cochrane Central Register of Controlled Trials (CENTRAL; from 1992), PsycINFO (from 1806), Web of Science (from 1900), Joanna Briggs Institute (JBI) database (from 1998), Database of Abstracts of Reviews of Effects (DARE; from 1996), Trip medical database (from 1997), and relevant professional scientific journals (from their start dates). We will use the predefined search terms of, "evidence-based practice" and, "primary health care" combined with other terms, such as, "beliefs", "knowledge", "implementation", and "integration". We will also conduct a hand search of the bibliographies of all relevant articles and a search for unpublished studies using Google Scholar, ProQuest, Mednar, and World

  10. Knowledge, attitudes, and practices among health care providers regarding complementary and alternative medicine in Trinidad and Tobago.

    Science.gov (United States)

    Bahall, Mandreker; Legall, George

    2017-03-08

    Health care providers are often ill prepared to interact about or make acceptable conclusions on complementary and alternative medicine (CAM) despite its widespread use. We explored the knowledge, attitudes, and practices of health care providers regarding CAM. This cross-sectional study was conducted between March 1 and July 31, 2015 among health care providers working mainly in the public sector in Trinidad and Tobago. A 34-item questionnaire was distributed and used for data collection. Questionnaire data were analysed using inferential and binary logistic regression models. Response rate was 60.3% (362/600). Responders were 172 nurses, 77 doctors, 30 pharmacists, and 83 other health care providers of unnamed categories (mainly nursing assistants). Responders were predominantly female (69.1%), Indo-Trinidadian (55.8%), Christian (47.5%), self-claimed "very religious" (48.3%), and had alternative, and physical types of CAM, but had no knowledge of energy therapy and therapeutic methods. Sex, ethnicity, and type of health care provider were associated with both personal use and recommendation for the use of CAM. Predictors of CAM use were sex, religion, and type of health care provider; predictors of recommendation for the use of CAM were sex and type of health care provider. About half of health care providers (51.4%) and doctors (52%) were likely to ask their patients about CAM and medicine alone. Less than 10% said conventional medicine should be used alone. Knowledge about CAM is low among health care providers. The majority engages in using CAM but is reluctant to recommend it. Predictors of CAM use were sex, religion, and profession; predictors of recommendation for the use of CAM were sex and profession. Health care providers feel the future lies in integrative medicine.

  11. Impact of educational intervention on knowledge, attitude and awareness of good clinical practice among health care providers.

    Science.gov (United States)

    Goel, Divya; Walia, Rani; Sharma, Poonam; Kaur, Harmanjeet; Agnihotri, Pallak

    2017-01-01

    Clinical trials play an important role in the generation of evidence-based data in health care practices. To ensure the credibility of data and the safety and well-being of the patients Good clinical practice (GCP) guidelines play an important role. At present, we have little knowledge about awareness of GCP guidelines among health care providers in India. To assess the level of awareness, and perception of the health care providers toward GCP and subsequent change in these after a dayer training session on GCP guidelines. A cross-sectional descriptive questionnaire-based study was conducted amongst health care providers, that is, doctors, dentists, nurses of a Tertiary Health Care and Teaching Institute. Participants were given descriptive questionnaire; they completed the questionnaire before and after undergoing a day training program in GCP guidelines. The impact of the effectiveness of educational intervention among healthcare professionals was evaluated by two-tailed Z-test. Out of 120 participants, 80 were medical doctors, 20 dental doctors, and 20 nurses. A dayse training program on GCP guidelines was found to increase positive attitudes toward various aspects of clinical trials. A day's training program on GCP guidelines may help to increase the knowledge as well as awareness about principles and techniques of clinical research, which will increase the credibility of clinical research in the country.

  12. Influences of attribution and stigma on working relationships with providers practicing Western psychiatry in the Taiwanese context.

    Science.gov (United States)

    Chen, Fang-Pei; Wu, Hui-Ching; Huang, Chun-Jen

    2014-12-01

    This study examined influences of causal attributions of schizophrenia and perceived and internalized mental illness stigma on perceived working alliance with, and informational support received from doctors practicing Western psychiatry in the Taiwanese social-cultural context. This cross-sectional quantitative study used a non-probability, purposive sampling technique to recruit 212 Taiwanese diagnosed with schizophrenia from Taiwanese Alliance of the Mentally Ill, 4 community mental health rehabilitation centres and 2 psychiatric hospitals between July 2012 and March 2013. Linear regression models were used for analysis. The results showed that environmental attributions were positively associated with both perceived working alliance and perceived informational support, while supernatural attributions were negatively associated with perceived working alliance and perceived informational support. Perceived stigma had a negative association with perceived working alliance. The discrimination domain of internalized stigma specifically had a positive association with perceived working alliance, while the withdraw domain had a negative association with perceived informational support. Findings inform the importance of culturally sensitive practices in developing an effective working relationship. Western psychiatric care providers need to explore consumers' casual attributions of mental illness and understand the impact of stigma so that providers may successfully engage consumers in care and provide tailored illness education and information.

  13. OVERVIEW OF SCHOOL GUIDANCE AND COUNSELLING SERVICES

    OpenAIRE

    Donald A. Odeleye

    2017-01-01

    Education in the broadest sense is aimed at helping individuals become more productive members of the society. At the heart of the whole pedagogy is Guidance and Counselling, which has been positively correlated with effective learning outcomes. Primarily, School Guidance and Counselling services are geared towards helping students know themselves, the world around them and make optimal decisions for enhanced future for all. This paper presents guidance and counselling services provided in th...

  14. Launch flexibility using NLP guidance and remote wind sensing

    Science.gov (United States)

    Cramer, Evin J.; Bradt, Jerre E.; Hardtla, John W.

    1990-01-01

    This paper examines the use of lidar wind measurements in the implementation of a guidance strategy for a nonlinear programming (NLP) launch guidance algorithm. The NLP algorithm uses B-spline command function representation for flexibility in the design of the guidance steering commands. Using this algorithm, the guidance system solves a two-point boundary value problem at each guidance update. The specification of different boundary value problems at each guidance update provides flexibility that can be used in the design of the guidance strategy. The algorithm can use lidar wind measurements for on pad guidance retargeting and for load limiting guidance steering commands. Examples presented in the paper use simulated wind updates to correct wind induced final orbit errors and to adjust the guidance steering commands to limit the product of the dynamic pressure and angle-of-attack for launch vehicle load alleviation.

  15. Adolescent health care in a large multispecialty prepaid group practice. Who provides it and how well are they doing?

    Science.gov (United States)

    Klitsner, I. N.; Borok, G. M.; Neinstein, L.; MacKenzie, R.

    1992-01-01

    Adolescents are at risk for pregnancy, sexually transmitted diseases, suicide, homicide, accidents, and substance abuse. Adolescent medicine involves an overlap of many skills needed to provide routine medical care, as well as care for those conditions that require psychosocial assessment. We report the results of a mail survey covering care of this age group by practitioners of pediatrics, internal medicine, obstetrics and gynecology, family practice, and adolescent medicine in a large, multispecialty, prepaid group practice. The mail survey covered 10 areas of adolescent care. Adolescent medicine physicians expressed the highest level of perceived knowledge and competence in these areas, with family practitioners ranked second. More than 50% of internists and pediatricians felt only fair to poor competence for a variety of adolescent conditions, whereas a third of internists and pediatricians reported that they liked to care for adolescents. Physicians in all 4 of the primary care specialties reported a need for a teen health center for both consultation and education. These results are similar to those reported for pediatricians and primary care physicians in private practice and for residents in internal medicine. PMID:1615655

  16. Endorsing good quality assurance practices in molecular pathology: risks and recommendations for diagnostic laboratories and external quality assessment providers.

    Science.gov (United States)

    Tembuyser, Lien; Dequeker, Elisabeth M C

    2016-01-01

    Quality assurance is an indispensable element in a molecular diagnostic laboratory. The ultimate goal is to warrant patient safety. Several risks that can compromise high quality procedures are at stake, from sample collection to the test performed by the laboratory, the reporting of test results to clinicians, and the organization of effective external quality assessment schemes. Quality assurance should therefore be safeguarded at each level and should imply a holistic multidisciplinary approach. This review aims to provide an overview of good quality assurance practices and discusses certain risks and recommendations to promote and improve quality assurance for both diagnostic laboratories and for external quality assessment providers. The number of molecular targets is continuously rising, and new technologies are evolving. As this poses challenges for clinical implementation and increases the demand for external quality assessment, the formation of an international association for improving quality assurance in molecular pathology is called for.

  17. Contrasting views of animal healthcare providers on worm control practices for sheep and goats in an arid environment.

    Science.gov (United States)

    Saddiqi, H A; Jabbar, A; Babar, W; Sarwar, M; Iqbal, Z; Cabaret, J

    2012-02-01

    A questionnaire survey was conducted to determine the worm control practices and anthelmintic usage of 150 key respondents involved in sheep and goat production in the arid Thal area of Pakistan. The information was collected by visiting farms, and interviewing the key respondents which included veterinary officers (n = 15), veterinary assistants (n = 51), traditional practitioners (n = 24), and small and large scale sheep/goat farm herders and owners (n = 60). Among all interviewed animal healthcare providers, the veterinary officers had the highest level of awareness of parasitic infection and advocated the use of modern available anthelmintics according to the predefined schedule. The farmers on the other hand, had the lowest level of knowledge about parasitic infections. They used modern anthelmintics at low frequencies (every six months) following an unusual practice of diluting the medicine. Veterinary assistants had a medium level of awareness about the parasitic infections using anthelmintic treatments when they deemed necessary rather than following a predefined treatment schedule. Traditional practitioners were also aware of parasitic infections and used traditional anthelmintics or a combination of the traditional and modern anthelmintics. The animal health providers had a different awareness and knowledge of parasitic infections which resulted in contrasting proposals for its' control. The farmers used worm control measures in accordance with their own views and those of animal healthcare advisors, combining modern and traditional treatments. This study provides the first insight into the differing views of those animal healthcare providers who form the basis for effective parasitic control within the sheep and goat industry of an arid region.

  18. Contrasting views of animal healthcare providers on worm control practices for sheep and goats in an arid environment

    Directory of Open Access Journals (Sweden)

    Saddiqi H.A.

    2012-02-01

    Full Text Available A questionnaire survey was conducted to determine the worm control practices and anthelmintic usage of 150 key respondents involved in sheep and goat production in the arid Thal area of Pakistan. The information was collected by visiting farms, and interviewing the key respondents which included veterinary officers (n = 15, veterinary assistants (n = 51, traditional practitioners (n = 24, and small and large scale sheep/goat farm herders and owners (n = 60. Among all interviewed animal healthcare providers, the veterinary officers had the highest level of awareness of parasitic infection and advocated the use of modern available anthelmintics according to the predefined schedule. The farmers on the other hand, had the lowest level of knowledge about parasitic infections. They used modern anthelmintics at low frequencies (every six months following an unusual practice of diluting the medicine. Veterinary assistants had a medium level of awareness about the parasitic infections using anthelmintic treatments when they deemed necessary rather than following a predefined treatment schedule. Traditional practitioners were also aware of parasitic infections and used traditional anthelmintics or a combination of the traditional and modern anthelmintics. The animal health providers had a different awareness and knowledge of parasitic infections which resulted in contrasting proposals for its control. The farmers used worm control measures in accordance with their own views and those of animal healthcare advisors, combining modern and traditional treatments. This study provides the first insight into the differing views of those animal healthcare providers who form the basis for effective parasitic control within the sheep and goat industry of an arid region.

  19. Practical digital preservation a how-to guide for organizations of any size

    CERN Document Server

    Brown, Adrian

    2014-01-01

    A practical guide to the development and operation of digital preservation services for organizations of any size. This offers an overview of best practice and provides guidance as to how to implement strategies with minimal time and resources. It is intended at the non-specialist, assuming only a basic understanding of IT and offering guidance.

  20. Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures.

    Science.gov (United States)

    Alter, Katharine E; Karp, Barbara I

    2017-12-28

    Injections of botulinum neurotoxins (BoNTs) are prescribed by clinicians for a variety of disorders that cause over-activity of muscles; glands; pain and other structures. Accurately targeting the structure for injection is one of the principle goals when performing BoNTs procedures. Traditionally; injections have been guided by anatomic landmarks; palpation; range of motion; electromyography or electrical stimulation. Ultrasound (US) based imaging based guidance overcomes some of the limitations of traditional techniques. US and/or US combined with traditional guidance techniques is utilized and or recommended by many expert clinicians; authors and in practice guidelines by professional academies. This article reviews the advantages and disadvantages of available guidance techniques including US as well as technical aspects of US guidance and a focused literature review related to US guidance for chemodenervation procedures including BoNTs injection.

  1. Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures

    Directory of Open Access Journals (Sweden)

    Katharine E. Alter

    2017-12-01

    Full Text Available Injections of botulinum neurotoxins (BoNTs are prescribed by clinicians for a variety of disorders that cause over-activity of muscles; glands; pain and other structures. Accurately targeting the structure for injection is one of the principle goals when performing BoNTs procedures. Traditionally; injections have been guided by anatomic landmarks; palpation; range of motion; electromyography or electrical stimulation. Ultrasound (US based imaging based guidance overcomes some of the limitations of traditional techniques. US and/or US combined with traditional guidance techniques is utilized and or recommended by many expert clinicians; authors and in practice guidelines by professional academies. This article reviews the advantages and disadvantages of available guidance techniques including US as well as technical aspects of US guidance and a focused literature review related to US guidance for chemodenervation procedures including BoNTs injection.

  2. Abstinence and teenagers: prevention counseling practices of health care providers serving high-risk patients in the United States.

    Science.gov (United States)

    Harper, Cynthia C; Henderson, Jillian T; Schalet, Amy; Becker, Davida; Stratton, Laura; Raine, Tina R

    2010-06-01

    Abstinence-only education has had little demonstrable impact on teenagers' sexual behaviors, despite significant policy and funding efforts. Given the struggle over resources to improve teenagers' reproductive health outcomes, the views of clinicians serving teenagers at high risk for unintended pregnancy and STDs merit particular attention. In 2005, a qualitative study with 31 clinicians serving low-income, at-risk patients was conducted. A semistructured interview guide was used to ask clinicians about adolescent pregnancy, HIV and STD prevention counseling, and when they include abstinence. Thematic content analysis was used to examine the content of the counseling and the techniques used in different situations. Providers reported offering comprehensive counseling, presenting abstinence as a choice for teenagers, along with information about contraceptives and condoms. Several providers mentioned that with young, sexually inexperienced teenagers, they discuss delaying sexual activity and suggest other ways to be affectionate, while giving information on condoms. Providers explained how they assess whether teenagers feel ready to be sexually active and try to impart skills for healthy relationships. Some described abstinence as giving teenagers a way to opt out of unwanted sexual activity. Many support abstinence if that is the patient's desire, but routinely dispense condoms and contraceptives. Overall, providers did not give abstinence counseling as a rigid categorical concept in their preventive practices, but as a health tool to give agency to teenagers within a harm reduction framework. Their approach may be informative for adolescent policies and programs in the future.

  3. Malaria treatment perceptions, practices and influences on provider behaviour: comparing hospitals and non-hospitals in south-east Nigeria

    Directory of Open Access Journals (Sweden)

    Dike Nkem

    2009-10-01

    Full Text Available Abstract Background People seek treatment for malaria from a wide range of providers ranging from itinerant drug sellers to hospitals. However, there are lots of problems with treatment provision. Hence, factors influencing treatment provision in hospitals and non-hospitals require further investigation in order to remedy the situation. Objectives To examine the knowledge, pattern of treatment provision and factors influencing the behaviour of hospitals and non-hospitals in the treatment of malaria, so as to identify loci for interventions to improve treatment of the disease. Methods A pre-tested structured questionnaire was used to collect data from 225 providers from hospitals and non-hospitals about their malaria treatment practices and factors that influence their provision of malaria treatment services in south-east Nigeria. The data from hospitals and other providers were compared for systematic differences. Results 73.5% of hospitals used microscopy to diagnose malaria and only 34.5.1% of non-hospitals did (p Conclusion There are many challenges to appropriate provision of malaria treatment services, although challenges are less in hospitals compared to other types of non-hospitals. Improving proper diagnosis of malaria and improving the knowledge of providers about malaria are interventions that could be used to improve malaria treatment provision.

  4. Academic Libraries and Learning Support in Collaboration. Library Based Guidance for Peer Assisted Learning Leaders at Bournemouth University: Theory and Practice.

    OpenAIRE

    Parton, Steve; Fleming, Hugh

    2008-01-01

    This article begins with an overview of the University’s pioneering Peer Assisted Learning Scheme (PAL) and describes how in 2005/6, the Library became involved, collaborating with the PAL Coordinator to develop materials for use by PAL Leaders. PAL is intended to foster cross-year support between students on the same course. It encourages students to support each other and learn co-operatively under the guidance of trained students from the year above - called PAL Leaders. Two documents were...

  5. Current Practices in Home Management of Nasogastric Tube Placement in Pediatric Patients: A Survey of Parents and Homecare Providers.

    Science.gov (United States)

    Northington, LaDonna; Lyman, Beth; Guenter, Peggi; Irving, Sharon Y; Duesing, Lori

    Enteral feeding tubes are used in pediatric patients to deliver nutrition, fluids or medications. The literature related to short-term feeding tube (nasogastric [NG], hereafter known as NGT, or orogastric [OGT],) use in pediatric homecare patients is sparse. This descriptive study sought to gather baseline information about these children and how their feeding tubes are managed at home. Specifically, we sought to better understand how the tubes are placed and the method(s) used for tube placement verification. Two surveys were distributed: one to parents and one to homecare providers who have direct patient contact. Responses were obtained from 144 parents and 66 homecare providers. Over half of the children were 12months of age or younger and had a 6 Fr feeding tube. Over 75% (108) had an NGT for 1year or less. Predominantly parents replaced the NGT but a few children self-inserted their tubes. Feeding tube placement was verified by auscultation (44%) or measurement of gastric pH (25%) in the parent's survey. Twenty-six percent of parents indicated they had misplaced an NGT at least once and 35 parents described symptoms of pulmonary misplacement. The homecare provider data indicated auscultation (39%) and pH measurement of gastric contents (28%) to verify NG tube placement location. Study results confirms a need for consistency of practice among health care professionals and in parent education for those children who require NGTs at home. It is troubling that auscultation is still widely used for NGT location confirmation despite practice alerts that warn against its use. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Variation in hepatitis B immunization coverage rates associated with provider practices after the temporary suspension of the birth dose

    Directory of Open Access Journals (Sweden)

    Mullooly John P

    2006-11-01

    Full Text Available Abstract Background In 1999, the American Academy of Pediatrics and U.S. Public Health Service recommended suspending the birth dose of hepatitis B vaccine due to concerns about potential mercury exposure. A previous report found that overall national hepatitis B vaccination coverage rates decreased in association with the suspension. It is unknown whether this underimmunization occurred uniformly or was associated with how providers changed their practices for the timing of hepatitis B vaccine doses. We evaluate the impact of the birth dose suspension on underimmunization for the hepatitis B vaccine series among 24-month-olds in five large provider groups and describe provider practices potentially associated with underimmunization following the suspension. Methods Retrospective cohort study of children enrolled in five large provider groups in the United States (A-E. Logistic regression was used to evaluate the association between the birth dose suspension and a child's probability of being underimmunized at 24 months for the hepatitis B vaccine series. Results Prior to July 1999, the percent of children who received a hepatitis B vaccination at birth varied widely (3% to 90% across the five provider groups. After the national recommendation to suspend the hepatitis B birth dose, the percent of children who received a hepatitis B vaccination at birth decreased in all provider groups, and this trend persisted after the policy was reversed. The most substantial decreases were observed in the two provider groups that shifted the first hepatitis B dose from birth to 5–6 months of age. Accounting for temporal trend, children in these two provider groups were significantly more likely to be underimmunized for the hepatitis B series at 24 months of age if they were in the birth dose suspension cohort compared with baseline (Group D OR 2.7, 95% CI 1.7 – 4.4; Group E OR 3.1, 95% CI 2.3 – 4.2. This represented 6% more children in Group D and 9

  7. Mothers’ Use of Social Media to Inform Their Practices for Pumping and Providing Pumped Human Milk to Their Infants

    Directory of Open Access Journals (Sweden)

    Rei Yamada

    2016-10-01

    Full Text Available Despite U.S. mothers’ wide adoption of pumps and bottles to provide human milk (HM to their infants, mothers lack comprehensive, evidence-based guidelines for these practices. Thus, some women use online sources to seek information from each other. We aimed to characterize the information women sought online about pumping. We used data provided by ~25,000 women in an open cohort within a discussion forum about parenting. We examined 543 posts containing questions about providing pumped HM cross-sectionally and longitudinally in three time intervals: prenatal, 0 through 1.5 months postpartum, and 1.5 to 4.5 months postpartum. We used thematic analysis with Atlas.ti to analyze the content of posts. During pregnancy, women commonly asked questions about how and where to obtain pumps, both out-of-pocket and through insurance policies. Between 0–1.5 months postpartum, many mothers asked about how to handle pumped HM to ensure its safety as fed. Between 1.5–4.5 months postpartum, mothers sought strategies to overcome constraints to pumping both at home and at work and also asked about stopping pumping and providing their milk. Women’s questions related to ensuring the safety of pumped HM represent information women need from health professionals, while their questions related to obtaining pumps suggest that women may benefit from clearer guidelines from their insurance providers. The difficulties women face at home and at work identify avenues through which families and employers can support women to meet their goals for providing HM.

  8. Knowledge, Attitudes, and Practices Regarding Epidemiology and Management of Travelers' Diarrhea: A Survey of Front-Line Providers in Iraq and Afghanistan

    National Research Council Canada - National Science Library

    Sanders, John W

    2005-01-01

    To evaluate the relationship between medical knowledge and clinical practice, a survey on travelers' diarrhea was administered to military health care providers attending a professional development...

  9. Regulatory Advocacy Update: American Society of Plastic Surgeons Comments in Response to the U.S. Food and Drug Administration Draft Guidance Documents on Human Cell and Tissue Products.

    Science.gov (United States)

    Rubin, J Peter; D'Amico, Richard A; Rodriguez, Ricardo; Coleman, Sydney R; Cederna, Paul; Glasberg, Scot; Neumeister, Michael; Song, David H; Butler, Charles; Hume, Keith M

    2017-05-01

    The U.S. Food and Drug Administration released draft guidance documents on human cells, tissues, and cellular and tissue-based products regulations. These proposed guidance documents can impact the practice of plastic surgery in the area of tissue grafting procedures. This article describes the relevant issues in these draft guidance documents, and presents the comments provided to the U.S. Food and Drug Administration by the American Society of Plastic Surgeons.

  10. Preventing HIV transmission among Iranian prisoners: Initial support for providing education on the benefits of harm reduction practices

    Science.gov (United States)

    Eshrati, Babak; Asl, Rahim Taghizadeh; Dell, Colleen Anne; Afshar, Parviz; Millson, Peggy Margaret E; Kamali, Mohammad; Weekes, John

    2008-01-01

    Background Harm reduction is a health-centred approach that seeks to reduce the health and social harms associated with high-risk behaviors, such as illicit drug use. The objective of this study is to determine the association between the beliefs of a group of adult, male prisoners in Iran about the transmission of HIV and their high-risk practices while in prison. Methods A cross-sectional study was conducted in 2004. The study population was a random selection of 100 men incarcerated at Rajaei-Shahr prison. The data were collected through a self-administered questionnaire. Focus group discussions were held at the prison to guide the design of the questionnaire. The relationship between components of the Health Belief Model (HBM) and prisoners' risky HIV-related behaviors was examined. Results Calculating Pearson's correlation coefficient, a significant, positive association was found between the benefit component of the HBM and prisoners not engaging in HIV high-risk behaviors. Conclusion Educational harm reduction initiatives that promote the effectiveness of strategies designed to reduce the risk of HIV transmission may decrease prisoners' high-risk behaviors. This finding provides initial support for the Iran prison system's current offering of HIV/AIDS harm reduction programming and suggests the need to offer increased education about the effectiveness of HIV prevention practices. PMID:18541032

  11. Preventing HIV transmission among Iranian prisoners: Initial support for providing education on the benefits of harm reduction practices

    Directory of Open Access Journals (Sweden)

    Millson Peggy

    2008-06-01

    Full Text Available Abstract Background Harm reduction is a health-centred approach that seeks to reduce the health and social harms associated with high-risk behaviors, such as illicit drug use. The objective of this study is to determine the association between the beliefs of a group of adult, male prisoners in Iran about the transmission of HIV and their high-risk practices while in prison. Methods A cross-sectional study was conducted in 2004. The study population was a random selection of 100 men incarcerated at Rajaei-Shahr prison. The data were collected through a self-administered questionnaire. Focus group discussions were held at the prison to guide the design of the questionnaire. The relationship between components of the Health Belief Model (HBM and prisoners' risky HIV-related behaviors was examined. Results Calculating Pearson's correlation coefficient, a significant, positive association was found between the benefit component of the HBM and prisoners not engaging in HIV high-risk behaviors. Conclusion Educational harm reduction initiatives that promote the effectiveness of strategies designed to reduce the risk of HIV transmission may decrease prisoners' high-risk behaviors. This finding provides initial support for the Iran prison system's current offering of HIV/AIDS harm reduction programming and suggests the need to offer increased education about the effectiveness of HIV prevention practices.

  12. Managing Student Behavior during Large Group Guidance: What Works Best?

    Science.gov (United States)

    Quarto, Christopher J.

    2007-01-01

    Participants provided information pertaining to managing non-task-related behavior of students during large group guidance lessons. In particular, school counselors were asked often how often they provide large group guidance, the frequency of which students exhibit off-task and/or disruptive behavior during guidance lessons, and techniques they…

  13. Evaluation of the Metered-Dose Inhaler Technique among Health Care Providers Practicing in Hamadan University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    E. Nadi

    2004-07-01

    Full Text Available Poor inhaler technique is a common problem both in asthma patients and health care providers , which contributes to poor asthma control. The aim of this study was to evaluate the correctness of metered-dose inhaler (MDI technique in a sample of physicians , pharmacists and nurses practicing in Hamadan University hospitals. A total of 176 healthcare providers (35 internists and general physicians , 138 nurses and 3 pharmacists were participated voluntary in this study. After the participants answered a questionnaire aimed at identifying their involvement in MDI prescribing and counseling , a trained observer assessed their MDI technique using a checklist of ten steps.Of the 176 participants , 35(20% were physician , and 3 subjects (2% were pharmacists , and 138 (78% were nurses. However only 6 participants (3.4% performed all steps correctly. Physicians performed significantly better than non-physicians (8.6% vs. 2.13%.The majority of healthcare providers responsible for instructing patients on the correct MDI technique were unable to perform this technique correctly ‘indicating the need for regular formal training programmes on inhaler techniques.

  14. POSSIBILITY OF CAREER GUIDANCE ORGANIZATION IN TODAY UNIVERSITY

    Directory of Open Access Journals (Sweden)

    Irina Serafimovna Begantsova

    2014-11-01

    Full Text Available The article presents the authors’ experience with students as a part of career guidance in terms of modern university. In the context of the stated problems, the authors examine such concepts as "career guidance", "readiness to professional choice", "socio-psychological characteristics of applicants".In the article presented, the authors emphasize that targeted career guidance work allows not only to assist students in choosing a career, but also provides a man with psychological readiness to the choice of a profession, the very awareness of this choice.The diagnostic tools used are especially noteworthy, it provided with initial understanding about potential consumers of educational services.The developed socio-psychological characteristics of potential applicants has a significant role for theory and practice, it allowed to formulate the strategy and tactics of interaction with students, parents, teachers, and other potential consumers of educational services, and it also allowed to outline a strategy for career guidance in higher educational institutions.The article is of interest to specialists in the field of applied psychology and social work.

  15. Women's knowledge of taking oral contraceptive pills correctly and of emergency contraception: effect of providing information leaflets in general practice.

    Science.gov (United States)

    Smith, L F; Whitfield, M J

    1995-01-01

    BACKGROUND. About one third of all pregnancies are unplanned and 20% of all pregnancies end in abortion. More than 170,000 legal abortions are performed in the United Kingdom annually. Nearly all general practitioners provide contraceptive advice; the most commonly used form of reversible contraception is the oral contraceptive pill. AIM. The aim of this study was to determine factors associated with women's knowledge of taking the contraceptive pill correctly and of emergency contraception, and to investigate if their knowledge could be improved in general practice by providing women with Family Planning Association information leaflets. METHOD. An uncontrolled intervention study was performed in one rural and one urban English general practice, using a self-completion questionnaire that was initially administered to women attending their general practitioner for oral contraception over six months from 1 October 1992. The questionnaire asked for: sociodemographic information; knowledge of how late women can be taking an oral contraceptive pill and still be protected against unplanned pregnancy; for how many days after being late with a pill they need to use other precautions; sources and methods of emergency contraception; and for how long the methods are effective after the primary contraceptive failure. After completing the questionnaire women were given two leaflets: one about how to take their prescribed contraceptive pill correctly and one about emergency contraception. Three to 12 months later the same questionnaire was administered in the same manner. RESULTS. Of 449 women completing the first questionnaire, 233 (52%) completed the second questionnaire. Initially 71% of 406 women taking an oestrogen/progestogen combined pill knew about the '12-hour rule' and 17% knew about the 'seven-day rule'; giving women information about the pill they were taking increased the extent of knowledge about these rules among 212 respondents to 82% (P emergency contraception

  16. Guide to good practices for developing learning objectives. DOE guideline

    Energy Technology Data Exchange (ETDEWEB)

    1992-07-01

    This guide to good practices provides information and guidance on the types of, and the development of learning objectives in performance-based training system at reactor and nonreactor nuclear facilities. Contractors are encouraged to consider this guidance as a reference when developing new learning objectives or refining existing ones. Training managers, designers, developers, and instructors are the intended audiences.

  17. Combining QOF data with the care bundle approach may provide a more meaningful measure of quality in general practice

    Directory of Open Access Journals (Sweden)

    de Wet Carl

    2012-10-01

    Full Text Available Abstract Background A significant minority of patients do not receive all the evidence-based care recommended for their conditions. Health care quality may be improved by reducing this observed variation. Composite measures offer a different patient-centred perspective on quality and are utilized in acute hospitals via the ‘care bundle’ concept as indicators of the reliability of specific (evidence-based care delivery tasks and improved outcomes. A care bundle consists of a number of time-specific interventions that should be delivered to every patient every time. We aimed to apply the care bundle concept to selected QOF data to measure the quality of evidence-based care provision. Methods Care bundles and components were selected from QOF indicators according to defined criteria. Five clinical conditions were suitable for care bundles: Secondary Prevention of Coronary Heart Disease (CHD, Stroke & Transient Ischaemic Attack (TIA, Chronic Kidney Disease (CKD, Chronic Obstructive Pulmonary Disease (COPD and Diabetes Mellitus (DM. Each bundle has 3-8 components. A retrospective audit was undertaken in a convenience sample of nine general medical practices in the West of Scotland. Collected data included delivery (or not of individual bundle components to all patients included on specific disease registers. Practice level and overall compliance with bundles and components were calculated in SPSS and expressed as a percentage. Results Nine practices (64.3% with a combined patient population of 56,948 were able to provide data in the format requested. Overall compliance with developed QOF-based care bundles (composite measures was as follows: CHD 64.0%, range 35.0-71.9%; Stroke/TIA 74.1%, range 51.6-82.8%; CKD 69.0%, range 64.0-81.4%; and COPD 82.0%, range 47.9-95.8%; and DM 58.4%, range 50.3-65.2%. Conclusions In this small study compliance with individual QOF-based care bundle components was high, but overall (‘all or nothing’ compliance was

  18. Social Impact Assessment : Guidance for assessing and managing the social impacts of projects

    NARCIS (Netherlands)

    Vanclay, Francis; Esteves, Ana Maria; Aucamp, Ilse; Franks, Daniel

    2015-01-01

    The purpose of this Guidance Note is to provide advice to various stakeholders about what is expected in good practice social impact assessment (SIA) and social impact management processes, especially in relation to project development. Project development refers to dams, mines, oil and gas

  19. Guidance for Schools Selecting Antibullying Approaches: Translating Evidence-Based Strategies to Contemporary Implementation Realities

    Science.gov (United States)

    Ansary, Nadia S.; Elias, Maurice J.; Greene, Michael B.; Green, Stuart

    2015-01-01

    This article synthesizes the current research on bullying prevention and intervention in order to provide guidance to schools seeking to select and implement antibullying strategies. Evidence-based best practices that are shared across generally effective antibullying approaches are elucidated, and these strategies are grounded in examples…

  20. Best design practices for walking and bicycling in Michigan.

    Science.gov (United States)

    2012-01-01

    The Michigan Department of Transportation (MDOT) has undertaken : a research initiative to determine how to optimize pedestrian and : bicycle safety while minimizing impacts to vehicular mobility. The : best practices in this document provide guidanc...

  1. Guidance for performing preliminary assessments under CERCLA

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1991-09-01

    EPA headquarters and a national site assessment workgroup produced this guidance for Regional, State, and contractor staff who manage or perform preliminary assessments (PAs). EPA has focused this guidance on the types of sites and site conditions most commonly encountered. The PA approach described in this guidance is generally applicable to a wide variety of sites. However, because of the variability among sites, the amount of information available, and the level of investigative effort required, it is not possible to provide guidance that is equally applicable to all sites. PA investigators should recognize this and be aware that variation from this guidance may be necessary for some sites, particularly for PAs performed at Federal facilities, PAs conducted under EPA`s Environmental Priorities Initiative (EPI), and PAs at sites that have previously been extensively investigated by EPA or others. The purpose of this guidance is to provide instructions for conducting a PA and reporting results. This guidance discusses the information required to evaluate a site and how to obtain it, how to score a site, and reporting requirements. This document also provides guidelines and instruction on PA evaluation, scoring, and the use of standard PA scoresheets. The overall goal of this guidance is to assist PA investigators in conducting high-quality assessments that result in correct site screening or further action recommendations on a nationally consistent basis.

  2. 78 FR 73200 - Draft Guidance for Industry on Bioequivalence Recommendations for Paliperidone Palmitate Extended...

    Science.gov (United States)

    2013-12-05

    ...). The draft guidance, when finalized, will represent the Agency's current thinking on the design of BE... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry on Bioequivalence... for Paliperidone Palmitate.'' The guidance provides specific recommendations on the design of...

  3. 78 FR 55263 - Draft Guidance for Industry on Bioequivalence Recommendations for Fluticasone Propionate...

    Science.gov (United States)

    2013-09-10

    ....115). The draft guidance, when finalized, will represent the Agency's current thinking on the design... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry on Bioequivalence... Propionate; Salmeterol Xinafoate.'' The recommendations provide specific guidance on the design of...

  4. Knowledge, Attitudes, Practices and Beliefs about Medical Male Circumcision (MMC) among a Sample of Health Care Providers in Haiti.

    Science.gov (United States)

    Dévieux, Jessy G; Saxena, Anshul; Rosenberg, Rhonda; Klausner, Jeffrey D; Jean-Gilles, Michèle; Madhivanan, Purnima; Gaston, Stéphanie; Rubens, Muni; Theodore, Harry; Deschamps, Marie-Marcelle; Koenig, Serena P; Pape, Jean William

    2015-01-01

    Haiti has the highest number of people living with HIV infection in the Caribbean/Latin America region. Medical male circumcision (MMC) has been recommended to help prevent the spread of HIV. We sought to assess knowledge, attitudes, practices and beliefs about MMC among a sample of health care providers in Haiti. A convenience sample of 153 health care providers at the GHESKIO Centers in Haiti responded to an exploratory survey that collected information on several topics relevant to health providers about MMC. Descriptive statistics were calculated for the responses and multivariable logistic regression was conducted to determine opinions of health care providers about the best age to perform MMC on males. Bayesian network analysis and sensitivity analysis were done to identify the minimum level of change required to increase the acceptability of performing MMC at age less than 1 year. The sample consisted of medical doctors (31.0%), nurses (49.0%), and other health care professionals (20.0%). Approximately 76% showed willingness to offer MMC services if they received training. Seventy-six percent believed that their male patients would accept circumcision, and 59% believed infancy was the best age for MMC. More than 90% of participants said that MMC would reduce STIs. Physicians and nurses who were willing to offer MMC if provided with adequate training were 2.5 (1.15-5.71) times as likely to choose the best age to perform MMC as less than one year. Finally, if the joint probability of choosing "the best age to perform MMC" as one year or older and having the mistaken belief that "MMC prevents HIV entirely" is reduced by 63% then the probability of finding that performing MMC at less than one year acceptable to health care providers is increased by 35%. Participants demonstrated high levels of knowledge and positive attitudes towards MMC. Although this study suggests that circumcision is acceptable among certain health providers in Haiti, studies with larger and

  5. The practice of commissioning healthcare from a private provider: learning from an in-depth case study.

    Science.gov (United States)

    Chambers, Naomi; Sheaff, Rod; Mahon, Ann; Byng, Richard; Mannion, Russell; Charles, Nigel; Exworthy, Mark; Llewellyn, Sue

    2013-01-01

    The direction of health service policy in England is for more diversification in the design, commissioning and provision of health care services. The case study which is the subject of this paper was selected specifically because of the partnering with a private sector organisation to manage whole system redesign of primary care and to support the commissioning of services for people with long term conditions at risk of unplanned hospital admissions and associated service provision activities. The case study forms part of a larger Department of Health funded project on the practice of commissioning which aims to find the best means of achieving a balance between monitoring and control on the one hand, and flexibility and innovation on the other, and to find out what modes of commissioning are most effective in different circumstances and for different services. A single case study method was adopted to explore multiple perspectives of the complexities and uniqueness of a public-private partnership referred to as the "Livewell project". 10 single depth interviews were carried out with key informants across the GP practices, the PCT and the private provider involved in the initiative. The main themes arising from single depth interviews with the case study participants include a particular understanding about the concept of commissioning in the context of primary care, ambitions for primary care redesign, the importance of key roles and strong relationships, issues around the adoption and spread of innovation, and the impact of the current changes to commissioning arrangements. The findings identified a close and high trust relationship between GPs (the commissioners) and the private commissioning support and provider firm. The antecedents to the contract for the project being signed indicated the importance of leveraging external contacts and influence (resource dependency theory). The study has surfaced issues around innovation adoption in the healthcare context

  6. Agile practice guide

    CERN Document Server

    2017-01-01

    Agile Practice Guide – First Edition has been developed as a resource to understand, evaluate, and use agile and hybrid agile approaches. This practice guide provides guidance on when, where, and how to apply agile approaches and provides practical tools for practitioners and organizations wanting to increase agility. This practice guide is aligned with other PMI standards, including A Guide to the Project Management Body of Knowledge (PMBOK® Guide) – Sixth Edition, and was developed as the result of collaboration between the Project Management Institute and the Agile Alliance.

  7. Anticipatory guidance and early child development: pediatrician advice, parent behaviors, and unmet needs as reported by parents from different backgrounds.

    Science.gov (United States)

    Combs-Orme, Terri; Holden Nixon, Barbara; Herrod, Henry G

    2011-08-01

    Anticipatory guidance is acknowledged as an important aspect of pediatric practice, and research shows that parents expect and value the information and advice they receive from their pediatric health care providers. This study surveyed 373 parents (88% mothers) of infants in waiting rooms of diverse pediatric practices in Memphis,Tennessee, about their recall of anticipatory guidance received, unmet needs for anticipatory guidance, preferences for sources of information, and activities to promote healthy development. Most parents recalled specific guidance received (diet, communication, and discipline being the most common), and unmet needs (discipline and development being among the most common). Disadvantaged parents reported the fewest unmet needs. Most parents readily named specific activities they engage in to promote development, including reading, educational toys, and nurturing.

  8. Image Guidance Technologies for Interventional Pain Procedures: Ultrasound, Fluoroscopy, and CT.

    Science.gov (United States)

    Wang, Dajie

    2018-01-26

    to fluoroscopy. However, further studies are required to prove the efficacy of ultrasound-guided transforaminal epidural injections. SI joint is unique due to its multiplanar orientation, irregular joint gap, partial ankylosis, and thick dorsal and interosseous ligament. Therefore, it can be difficult to access the joint space with fluoroscopic guidance and ultrasound guidance. CT scan, with its cross-sectional images, can identify posterior joint gap, is most likely the best guidance technology for this intervention. Intercostal nerves lie in the subcostal grove close to the plural space. Significant risk of pneumothorax is associated with intercostal blocks. Ultrasound can provide visualization of ribs and pleura. Therefore, it may improve the accuracy of the injection and reduce the risk of pneumothorax. At present time, most pain specialists are familiar with fluoroscopic guidance techniques, and fluoroscopic machines are readily available in the pain clinics. In the contrast, CT guidance can only be performed in specially equipped facilities. Ultrasound machine is generally portable and inexpensive in comparison to CT scanner and fluoroscopic machine. As pain specialists continue to improve their patient care, ultrasound and CT guidance will undoubtedly be incorporated more into the pain management practice. This review is based on a paucity of clinical evidence to compare these guidance technologies; clearly, more clinical studies is needed to further elucidate the pro and cons of each guidance method for various pain management interventions.

  9. European practices of providing of efficiency of self-organizations institutions of population in the context of public services

    Directory of Open Access Journals (Sweden)

    T. V. Serohina

    2017-06-01

    level of financing carried out by persons with appropriate competence and qualifications. The example of Portugal discloses the status of self-organization institutions as public benefit organizations, which provides them of advantages, particularly in competition with private sector organizations. However, in the light of practical implementation of the principle of subsidiarity and other elements of decentralization is appropriate to introduce European experience in the domestic soil in the context of attracting self-organization institutions in the scope of public services delivery. The results of the study formulated the main components of a mechanism to ensure effectiveness of the self-organizations institutions in the provision of public services: subsidies of statutory activities; delegation of services; regulatory support; recognition of the status of self-organization institutions as public benefit organizations; limitation of agreements terms.

  10. Providing reviews of evidence to COPD patients: qualitative study of barriers and facilitating factors to patient-mediated practice change.

    Science.gov (United States)

    Harris, Melanie; Wildgoose, Deborah; Veale, Antony J; Smith, Brian J

    2010-01-01

    This study aimed to identify barriers and facilitating factors to people with COPD performing the following actions: (a) reading a manual that contained summaries of evidence on treatments used in chronic obstructive pulmonary disease (COPD) and (b) at a medical consultation, asking questions that were provided in the manual and were designed to prompt doctors to review current treatments in the light of evidence. The manual was developed using current best practice and was designed to facilitate reading and discussion with doctors. In-depth interviews were held with patients who had received the manual. Of 125 intervention participants from a controlled clinical trial of the manual, 16 were interviewed in their homes in and around Adelaide, South Australia. Plain language writing and a simple layout facilitated reading of the manual by participants. Where the content matched the interests of participants this also facilitated reading. On the other hand, some participants showed limited interest in the evidence summaries. Participant comments indicated that they did not see it as possible or acceptable for patients to master research evidence or initiate discussions of evidence with doctors. These appeared to be the main barriers to effectiveness of the manual. If evidence summaries for patients are to be used in disease management, they should be understandable and relevant to patients and provide a basis for discussion between patients and doctors. Work is now needed so that we can both present evidence summaries in a way that is relevant to patients and reduce the barriers to patient-initiated discussions of evidence.

  11. Enhancing pediatric workforce diversity and providing culturally effective pediatric care: implications for practice, education, and policy making.

    Science.gov (United States)

    2013-10-01

    This policy statement serves to combine and update 2 previously independent but overlapping statements from the American Academy of Pediatrics (AAP) on culturally effective health care (CEHC) and workforce diversity. The AAP has long recognized that with the ever-increasing diversity of the pediatric population in the United States, the health of all children depends on the ability of all pediatricians to practice culturally effective care. CEHC can be defined as the delivery of care within the context of appropriate physician knowledge, understanding, and appreciation of all cultural distinctions, leading to optimal health outcomes. The AAP believes that CEHC is a critical social value and that the knowledge and skills necessary for providing CEHC can be taught and acquired through focused curricula across the spectrum of lifelong learning. This statement also addresses workforce diversity, health disparities, and affirmative action. The discussion of diversity is broadened to include not only race, ethnicity, and language but also cultural attributes such as gender, religious beliefs, sexual orientation, and disability, which may affect the quality of health care. The AAP believes that efforts must be supported through health policy and advocacy initiatives to promote the delivery of CEHC and to overcome educational, organizational, and other barriers to improving workforce diversity.

  12. Adherence to NICE guidance on glucagon-like peptide-1 receptor agonists among patients with type 2 diabetes mellitus: an evaluation using the Clinical Practice Research Datalink.

    Science.gov (United States)

    Jameson, Kevin; D'Oca, Kalpana; Leigh, Paul; Murray-Thomas, Tarita

    2016-01-01

    To assess adherence to the UK's National Institute for Health and Care Excellence (NICE) guidelines for initiating and continuing glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes (T2DM). A retrospective cohort study of 7133 primary care patients ≥40 years with a first prescription for a GLP-1 receptor agonist following publication of NICE guideline/guidance. Patient characteristics and levels of clinical monitoring were assessed using descriptive analyses. Main outcomes were the proportion of patients initiating GLP-1 receptor agonists as part of NICE-recommended dual- or triple-therapy regimens; the proportions meeting NICE triple therapy initiation criteria (glycosylated hemoglobin [HbA1c] ≥7.5% and body mass index [BMI] ≥35 kg/m(2)) and the proportions continuing GLP-1 receptor agonist at 6 months according to NICE recommendations. Mean age at initiating GLP-1 receptor agonists was 58.2 years (SD 9.4), BMI 38.4 kg/m(2) (SD 6.8) and HbA1c 9.2% (SD 3.2%). Overall, only 25% of patients initiated GLP-1 receptor agonists as part of a NICE-recommended regimen. Of patients initiated on a recommended triple-therapy regimen, 50% (646/1284) fulfilled both NICE HbA1c and BMI initiation criteria. Approximately 18% (32/174) of patients continuing NICE-recommended dual therapy at 6 months achieved a 1% reduction in HbA1c and 6.4% (33/515) continuing with NICE-recommended triple therapy achieved NICE's target reductions for both HbA1c and body weight. About 8% of patients continuing exenatide as triple therapy (N = 243) achieved both targets. Adherence to NICE guidance for initiating and continuing GLP-1 receptor agonists is low. However, lack of data on ethnicity (for assessing NICE's BMI criteria) and on contraindications and/or hypersensitivity to other diabetes medication in the treatment pathway have limited our ability to fully assess adherence to GLP-1 prescribing. Further research is warranted to better understand general

  13. 77 FR 10415 - Standards for Business Practices for Interstate Natural Gas Pipelines

    Science.gov (United States)

    2012-02-22

    ... Energy Regulatory Commission 18 CFR Part 284 Standards for Business Practices for Interstate Natural Gas... natural gas pipelines.\\1\\ The Commission also proposes to provide guidance on the standards the Commission...) applicable to natural gas pipelines. The Commission also proposes to provide guidance on the standards the...

  14. GUIDANCE ON SELECTING AGE GROUPS FOR ...

    Science.gov (United States)

    This guidance document provides a set of early-lifestage age groups for Environmental Protection Agency scientists to consider when assessing children’s exposure to environmental contaminants and the resultant potential dose. These recommended age groups are based on current understanding of differences in behavior and physiology which may impact exposures in children. A consistent set of early-life age groups, supported by an underlying scientific rationale, is expected to improve Agency exposure and risk assessments for children by increasing the consistency and comparability of risk assessments across the Agency; by improving accuracy and transparency in assessments for those cases where current practice might too broadly combine behaviorally and physiologically disparate age groups; and by fostering a consistent approach to future exposure surveys and monitoring efforts to generate improved exposure factors for children. see description

  15. Health care provider management of patients with type 2 diabetes mellitus: analysis of trends in attitudes and practices.

    Science.gov (United States)

    Williamson, Chad; Glauser, Terry Ann; Burton, B Stephen; Schneider, Doron; Dubois, Anne Marie; Patel, Daxa

    2014-05-01

    To identify attitudes and practices of endocrinologists (ENDOs), family practitioners (FPs), internists (IMs), primary care nurse practitioners (NPs), physician assistants (PAs), certified diabetes educators (CDEs), retail pharmacists (R-PHs), and hospital pharmacists (H-PHs) with respect to type 2 diabetes mellitus (T2DM) management; to compare current study data with results from a similar 2011 study. A nominal group technique focus group identified barriers to optimal management of patients with T2DM. Five case-vignette surveys were created, 1 for each group of health care professionals (HCPs): ENDOs; FPs and IMs; NPs and PAs; CDEs; and R-PHs and H-PHs. Surveys were tailored to each group. Versions were as similar as possible to each other and to the 2011 surveys to facilitate comparisons. Questions assessed guideline familiarity; knowledge of insulin formulations, glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors; patterns of referral to ENDOs and CDEs; as well as cultural barriers and communication barriers. Surveys were distributed by e-mail/fax to a nationally representative, random sample of US HCPs during January and February 2013. Notable shifts from 2011 included NPs' increased familiarity with American Diabetes Association (ADA) guidelines; FPs, IMs, NPs, and PAs continued comfort with prescribing long-acting basal insulin but less with basal-bolus, Neutral Protamine Hagedorn insulin alone, or human premixed insulin; increased pharmacists' comfort in discussing long-acting basal insulin; increased likelihood that FPs will refer patients with recurrent hypoglycemia unable to achieve target glycated hemoglobin level to an ENDO; and continued incorporation of insulin and incretins into treatment regimens. The trends suggest gaps in perception, knowledge, and management practices to be addressed by education. Most HCPs lack confidence in using insulin regimens more complex than long-acting insulin alone. All

  16. Guidance notes for the protection of persons against ionising radiations arising from veterinary use

    Energy Technology Data Exchange (ETDEWEB)

    1988-01-01

    These notes are not intended to provide detailed guidance on all the conditions that apply to veterinary practice but rather to indicate the types of arrangements which should be employed in order to comply with the main requirements of the Regulations. They also aim to establish a pattern by which good radiological practice can be achieved and radiation doses to veterinary surgeons, radiographic staff, and anyone else involved, minimised.

  17. Surface Water Treatment Rules State Implementation Guidance

    Science.gov (United States)

    These documents provide guidance to states, tribes and U.S. EPA Regions exercising primary enforcement responsibility under the Safe Drinking Water Act. The documents contain EPA’s recommendations for implementation of the Surface Water Treatment Rules.

  18. The Industrial User Permitting Guidance Manual

    Science.gov (United States)

    Provides guidance for control authorities to effectively develop and issue control mechanisms to IUs discharging to the POTW and covers developing and implementing control mechanisms for both SIUs and non-SIUs.

  19. Preparing MSW Students to Provide Integrated Behavioral Health Services in Rural Communities: The Importance of Relationships in Knowledge Building and Practice

    National Research Council Canada - National Science Library

    Carrie W Rishel; Helen P Hartnett; Brandi L Davis

    2016-01-01

    .... This shift prompts the need for providers who understand the interrelationship among physical and behavioral health and who are prepared to practice in an interprofessional and team-based approach...

  20. Agent Based Individual Traffic guidance

    DEFF Research Database (Denmark)

    Wanscher, Jørgen Bundgaard

    2004-01-01

    When working with traffic planning or guidance it is common practice to view the vehicles as a combined mass. >From this models are employed to specify the vehicle supply and demand for each region. As the models are complex and the calculations are equally demanding the regions and the detail...... of the road network is aggregated. As a result the calculations reveal only what the mass of vehicles are doing and not what a single vehicle is doing. This is the crucial difference to ABIT (Agent Based Individual Trafficguidance). ABIT is based on the fact that information on the destination of each vehicle...

  1. BENCHMARK DOSE TECHNICAL GUIDANCE DOCUMENT ...

    Science.gov (United States)

    The U.S. EPA conducts risk assessments for an array of health effects that may result from exposure to environmental agents, and that require an analysis of the relationship between exposure and health-related outcomes. The dose-response assessment is essentially a two-step process, the first being the definition of a point of departure (POD), and the second extrapolation from the POD to low environmentally-relevant exposure levels. The benchmark dose (BMD) approach provides a more quantitative alternative to the first step in the dose-response assessment than the current NOAEL/LOAEL process for noncancer health effects, and is similar to that for determining the POD proposed for cancer endpoints. As the Agency moves toward harmonization of approaches for human health risk assessment, the dichotomy between cancer and noncancer health effects is being replaced by consideration of mode of action and whether the effects of concern are likely to be linear or nonlinear at low doses. Thus, the purpose of this project is to provide guidance for the Agency and the outside community on the application of the BMD approach in determining the POD for all types of health effects data, whether a linear or nonlinear low dose extrapolation is used. A guidance document is being developed under the auspices of EPA's Risk Assessment Forum. The purpose of this project is to provide guidance for the Agency and the outside community on the application of the benchmark dose (BMD) appr

  2. Coral Reef Guidance

    Science.gov (United States)

    Guidance prepared by EPA and Army Corps of Engineers concerning coral reef protection under the Clean Water Act, Marine Protection, Research, and Sanctuaries Act, Rivers and Harbors Act, and Federal Project Authorities.

  3. Pollinator Risk Assessment Guidance

    Science.gov (United States)

    This Guidance is part of a long-term strategy to advance the science of assessing the risks posed by pesticides to honey bees, giving risk managers the means to further improve pollinator protection in our regulatory decisions.

  4. An evaluation of two guidance programmes to promote breast-feeding

    Directory of Open Access Journals (Sweden)

    M. Steyn

    1989-09-01

    Full Text Available During the past ten years a comprehensive research project has been undertaken to develop a guidance programme in three adjacent communities in the South- Western Cape with the aim o f lowering the high incidence o f coronary heart disease. The purpose o f this substudy was to determine whether the guidance provided in the different communities had any influence on the knowledge o f and attitudes towards the nutrition o f pregnant women, babies and infants as well as breast-feeding practices o f the women who gave birth during the period 1980 to 1986. In the first community guidance was provided by means o f small mass media and interpersonal communication whereas only the small mass media were employed in the second. The third served as the control community. The findings suggest that the combined interpersonal and mass media programme was more successful than the mass media programme alone.

  5. Scientific and Regulatory Policy Committee Review: Review of the Organisation for Economic Co-operation and Development (OECD) Guidance on the GLP Requirements for Peer Review of Histopathology.

    Science.gov (United States)

    Fikes, James D; Patrick, Daniel J; Francke, Sabine; Frazier, Kendall S; Reindel, James F; Romeike, Annette; Spaet, Robert H; Tomlinson, Lindsay; Schafer, Kenneth A

    2015-10-01

    In 2014, the Organisation for Economic Co-operation and Development (OECD) issued guidance no. 16, Guidance on the GLP Requirements for Peer Review of Histopathology. The stated purpose of the guidance document is "to provide guidance to pathologists, test facility management, study directors and quality assurance personnel on how the peer review of histopathology should be planned, managed, documented, and reported in order to meet Good Laboratory Practice (GLP) expectations and requirements." On behalf of and in collaboration with the global societies of toxicologic pathology, the Society of Toxicologic Pathology initiated a review of OECD guidance no. 16. The objectives of this review are to provide a unified interpretation of the guidance, to recommend compliant processes for organizations to implement, and to avoid inconsistent process adaptations across the industry. This review of the guidance document is the product of a global collaboration with other societies of toxicologic pathology and provides a section-by-section international consensus view and interpretation of the OECD guidance on peer review. © 2015 by The Author(s).

  6. Impact of current good manufacturing practices and emission regulations and guidances on the discharge of pharmaceutical chemicals into the environment from manufacturing, use, and disposal.

    OpenAIRE

    Velagaleti, Ranga; Burns, Philip K; Gill, Michael; Prothro, James

    2002-01-01

    The current Good Manufacturing Practice (cGMP) and effluent emission (use and disposal) regulations of the U.S. Food and Drug Administration (FDA) and manufacturing effluent discharge and emission regulations of the U.S. Environmental Protection Agency (U.S. EPA) require contained manufacture, use, and disposal of pharmaceuticals with the goal of minimizing the release of pharmaceutical chemicals into the environment. However, debate has recently arisen in several scientific forums over wheth...

  7. RH Packaging Program Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Washington TRU Solutions LLC

    2008-01-12

    The purpose of this program guidance document is to provide the technical requirements for use, operation, inspection, and maintenance of the RH-TRU 72-B Waste Shipping Package (also known as the "RH-TRU 72-B cask") and directly related components. This document complies with the requirements as specified in the RH-TRU 72-B Safety Analysis Report for Packaging (SARP), and Nuclear Regulatory Commission (NRC) Certificate of Compliance (C of C) 9212. If there is a conflict between this document and the SARP and/or C of C, the C of C shall govern. The C of C states: "...each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, Operating Procedures, of the application." It further states: "...each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, Acceptance Tests and Maintenance Program of the Application." Chapter 9.0 of the SARP tasks the Waste Isolation Pilot Plant (WIPP) Management and Operating (M&O) Contractor with assuring the packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC-approved, users need to be familiar with Title 10 Code of Federal Regulations (CFR) §71.8, "Deliberate Misconduct." Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the U.S. Department of Energy (DOE) Carlsbad Field Office (CBFO) shall be notified immediately. The CBFO will evaluate the issue and notify the NRC if required.In accordance with 10 CFR Part 71, "Packaging and Transportation of Radioactive Material," certificate holders, packaging users, and contractors or subcontractors who use, design, fabricate, test, maintain, or modify the packaging shall post copies of (1) 10 CFR Part 21, "Reporting of Defects and Noncompliance," regulations, (2) Section 206 of the Energy Reorganization Act of 1974, and (3) NRC Form 3, Notice to Employees. These documents must be posted in a

  8. RH Packaging Program Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Washington TRU Solutions LLC

    2006-11-07

    The purpose of this program guidance document is to provide the technical requirements for use, operation, inspection, and maintenance of the RH-TRU 72-B Waste Shipping Package and directly related components. This document complies with the requirements as specified in the RH-TRU 72-B Safety Analysis Report for Packaging (SARP), and Nuclear Regulatory Commission (NRC) Certificate of Compliance (C of C) 9212. If there is a conflict between this document and the SARP and/or C of C, the C of C shall govern. The C of C states: "...each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, Operating Procedures, of the application." It further states: "...each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, Acceptance Tests and Maintenance Program of the Application." Chapter 9.0 of the SARP tasks the Waste Isolation Pilot Plant (WIPP) Management and Operating (M&O) Contractor with assuring the packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC-approved, users need to be familiar with 10 Code of Federal Regulations (CFR) §71.8, "Deliberate Misconduct." Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the U.S. Department of Energy (DOE) Carlsbad Field Office (CBFO) shall be notified immediately. CBFO will evaluate the issue and notify the NRC if required. In accordance with 10 CFR Part 71, "Packaging and Transportation of Radioactive Material," certificate holders, packaging users, and contractors or subcontractors who use, design, fabricate, test, maintain, or modify the packaging shall post copies of (1) 10 CFR Part 21, "Reporting of Defects and Noncompliance," regulations, (2) Section 206 of the Energy Reorganization Act of 1974, and (3) NRC Form 3, Notice to Employees. These documents must be posted in a conspicuous location where the activities subject to

  9. Continuous Renal Replacement Therapy: Reviewing Current Best Practice to Provide High-Quality Extracorporeal Therapy to Critically Ill Patients.

    Science.gov (United States)

    Connor, Michael J; Karakala, Nithin

    2017-07-01

    Continuous renal replacement therapy (CRRT) use continues to expand globally. Despite improving technology, CRRT remains a complex intervention. Delivery of high-quality CRRT requires close collaboration of a multidisciplinary team including members of the critical care medicine, nephrology, nursing, pharmacy, and nutrition support teams. While significant gaps in medical evidence regarding CRRT persist, the growing evidence base supports evolving best practice and consensus to define high-quality CRRT. Unfortunately, there is wide variability in CRRT operating characteristics and limited uptake of these best practices. This article will briefly review the current best practice on important aspects of CRRT delivery including CRRT dose, anticoagulation, dialysis vascular access, fluid management, and drug dosing in CRRT. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  10. Treatment Options for Back Pain Provided Online in Canadian Magazines: Comparison against Evidence from a Clinical Practice Guideline

    Science.gov (United States)

    Sniderman, Jhase A.; Roffey, Darren M.; Lee, Richard; Papineau, Gabrielle D.; Miles, Isabelle H.; Wai, Eugene K.; Kingwell, Stephen P.

    2017-01-01

    Background: Evidence-based treatments for adult back pain have long been confirmed, with research continuing to narrow down the scope of recommended practices. However, a tension exists between research-driven treatments and unsubstantiated modalities and techniques promoted to the public. This disparity in knowledge translation, which results in…

  11. Treatment of mental health problems in general practice: a survey of psychotropics prescribed and other treatments provided.

    NARCIS (Netherlands)

    Rijswijk, E. van; Borghuis, M.; Lisdonk, E.H. van de; Zitman, F.G.; Weel, C. van

    2007-01-01

    OBJECTIVE: Real-life data on the treatment of patients with mental health problems are important as a reference to evaluate care and benchmarking. This study describes the treatment of mental health problems in general practice as diagnosed by general practitioners (GP). MATERIAL AND METHODS: Data

  12. Smart Energy Management for Households - A practical guide for designers, HEMS developers, energy providers, and the building industry

    NARCIS (Netherlands)

    Van Dam, S.S.

    2013-01-01

    This publication is an extended version of the summary and conclusions of the doctoral thesis ‘Smart Energy Management for Households’. It is specifically intended to give practitioners dealing with HEMS in their day to day profession practical tools to strive to improve the use and effectiveness of

  13. Providing education on evidence-based practice improved knowledge but did not change behaviour: a before and after study

    Directory of Open Access Journals (Sweden)

    Lovarini Meryl

    2005-12-01

    Full Text Available Abstract Background Many health professionals lack the skills to find and appraise published research. This lack of skills and associated knowledge needs to be addressed, and practice habits need to change, for evidence-based practice to occur. The aim of this before and after study was to evaluate the effect of a multifaceted intervention on the knowledge, skills, attitudes and behaviour of allied health professionals. Methods 114 self-selected occupational therapists were recruited. The intervention included a 2-day workshop combined with outreach support for eight months. Support involved email and telephone contact and a workplace visit. Measures were collected at baseline, post-workshop, and eight months later. The primary outcome was knowledge, measured using the Adapted Fresno Test of Evidence-Based Practice (total score 0 to 156. Secondary outcomes were attitude to evidence-based practice (% reporting improved skills and confidence; % reporting barriers, and behaviour measured using an activity diary (% engaging/not engaging in search and appraisal activities, and assignment completion. Results Post-workshop, there were significant gains in knowledge which were maintained at follow-up. The mean difference in the Adapted Fresno Test total score was 20.6 points (95% CI, 15.6 to 25.5. The change from post-workshop to follow-up was small and non-significant (mean difference 1.2 points, 95% CI, -6.0 to 8.5. Fewer participants reported lack of searching and appraisal skills as barriers to evidence-based practice over time (searching = 61%, 53%, 24%; appraisal 60%, 65%, 41%. These differences were statistically significant (p = 0.0001 and 0.010 respectively. Behaviour changed little. Pre-workshop, 6% engaged in critical appraisal increasing to 18% post-workshop and 18% at follow-up. Nearly two thirds (60% were not reading any research literature at follow-up. Twenty-three participants (20.2% completed their assignment. Conclusion Evidence

  14. Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: A practical review for clinical researchers-Part I. general guidance and tips

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Won; Choi, Sang Hyun; Huh, Jimi; Park, Seong Ho [Dept. of Radiology, and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Lee, June Young [Dept. of Biostatistics, Korea University College of Medicine, Seoul (Korea, Republic of)

    2015-12-15

    In the field of diagnostic test accuracy (DTA), the use of systematic review and meta-analyses is steadily increasing. By means of objective evaluation of all available primary studies, these two processes generate an evidence-based systematic summary regarding a specific research topic. The methodology for systematic review and meta-analysis in DTA studies differs from that in therapeutic/interventional studies, and its content is still evolving. Here we review the overall process from a practical standpoint, which may serve as a reference for those who implement these methods.

  15. Relationship of Provider and Practice Volume to Performance Measure Adherence for Coronary Artery Disease, Heart Failure, and Atrial Fibrillation: Results From the National Cardiovascular Data Registry.

    Science.gov (United States)

    Fleming, Lisa M; Jones, Philip; Chan, Paul S; Andrei, Adin-Christian; Maddox, Thomas M; Farmer, Steven A

    2016-01-01

    There is a reported association between high clinical volume and improved outcomes. Whether this relationship is true for outpatients with coronary artery disease (CAD), heart failure (HF), and atrial fibrillation (AF) remains unknown. Using the PINNACLE Registry (2009-2012), average monthly provider and practice volumes were calculated for CAD, HF, and AF. Adherence with 4 American Heart Association CAD, 2 HF, and 1 AF performance measure were assessed at the most recent encounter for each patient. Hierarchical logistic regression models were used to assess the relationship between provider and practice volume and performance on eligible quality measures. Data incorporated patients from 1094 providers at 71 practices (practice level analyses n=654 535; provider level analyses n=529 938). Median monthly provider volumes were 79 (interquartile range [IQR], 51-117) for CAD, 27 (16-45) for HF, and 37 (24-54) for AF. Median monthly practice volumes were 923 (IQR, 476-1455) for CAD, 311 (145-657) for HF, and 459 (185-720) for AF. Overall, 55% of patients met all CAD measures, 72% met all HF measures, and 58% met the AF measure. There was no definite relationship between practice volume and concordance for CAD, AF, or HF (P=0.56, 0.52, and 0.79, respectively). In contrast, higher provider volume was associated with increased concordance for CAD and AF performance measures (Pperformance was modest and variable. Higher provider volume was positively associated with quality, whereas practice volume was not. © 2015 American Heart Association, Inc.

  16. Practice and Perceived Importance of Advance Care Planning and Difficulties in Providing Palliative Care in Geriatric Health Service Facilities in Japan: A Nationwide Survey.

    Science.gov (United States)

    Yokoya, Shoji; Kizawa, Yoshiyuki; Maeno, Takami

    2018-03-01

    The provision of end-of-life (EOL) care by geriatric health service facilities (GHSFs) in Japan is increasing. Advance care planning (ACP) is one of the most important issues to provide quality EOL care. This study aimed to clarify the practice and perceived importance of ACP and the difficulties in providing palliative care in GHSFs. A self-report questionnaire was mailed to head nurses at 3437 GHSFs nationwide. We asked participants about their practices regarding ACP, their recognition of its importance, and their difficulties in providing palliative care. We also analyzed the relationship between these factors and EOL care education. Among 844 respondents (24.5% response rate), approximately 69% to 81% of head nurses confirmed that GHSF residents and their families understood disease conditions and goals of care. There was a large discrepancy between the actual practice of ACP components and the recognition of their importance (eg, asking residents about existing advance directive [AD; 27.5% practiced it, while 79.6% considered it important]; recommending completion of an AD [18.1% vs 68.4%], and asking for designation of a health-care proxy [30.4% vs 76.8%]). The EOL care education was provided at 517 facilities (61.3%). Head nurses working at EOL care education-providing GHSFs practiced ACP significantly more frequently and had significantly fewer difficulties in providing palliative care. A large discrepancy was found between GHSF nurses' practice of ACP and their recognition of its importance. Providing EOL care education in GHSFs may increase ACP practices and enhance respect for resident's preferences concerning EOL care.

  17. Safer fluid prescribing at North Bristol Trust: Bringing practice in line with NICE Guidance with a redesign of the fluid prescription chart.

    Science.gov (United States)

    Andersson, Johanna; Bull, Thomas; Paul, Daniel; Reynolds, Emily; Nishimura, Aimi; Lloyd, Jessica; Jetley, Amanda; Davies, Mari; Eisenhauer, Helen; Maggs, Daniel; Clapham, Sorcha; Trivedi, Kaushali; Hair, Robert; Plumb, Benjamin; Plumb, Benjamin

    2015-01-01

    The National Institute of Clinical Excellence (NICE) released new fluid guidelines following data suggesting 20% of patients receiving fluids suffer adversely (2013). This quality improvement group assessed fluid prescribing in a tertiary teaching centre and introduced a new fluid- prescribing chart to align practice with NICE recommendations. Notes and corresponding fluid prescription charts were reviewed for evidence of (1) indication, (2) co-morbidities, and (3) further management as surrogate markers of safe prescribing in accordance with NICE. Overall, the data showed practice fell short and prompted a redesign of the Trust fluid prescription chart. Three different variations of the chart were issued consecutively using a PDSA method (plan, do, study, act) over a 6-month period. They all included indication, co-morbidities and further management plans as constant design features. Suggestions from interested parties were incorporated and an educational programme was implemented to promote awareness. Prior to our intervention, an indication for fluids was documented in 26% of notes, it took an average of 4.6 minutes to find co-morbidities, and further management plans were rarely documented. Following the new prescription chart, an indication was recorded in 72% of cases, co-morbidities noted on 63% of charts with 93.1% accuracy, and further management documented in 100% of cases. The new fluid prescription chart encourages prescribers to incorporate NICE recommendations when prescribing fluids. The new fluid prescription design has since been rolled out Trust wide.

  18. To Be One's Own Confessor: Educational Guidance and Governmentality

    Science.gov (United States)

    Fejes, Andreas

    2008-01-01

    Educational guidance is often seen as something good and empowering for the individual. In the present article, such taken-for-granted ideas will be destabilised by analysing educational guidance as a practice in which confession operates as a technology that fosters and governs specific subjectivities. White papers produced by the Swedish…

  19. Challenges faced by genetics service providers' practicing in a culturally and linguistically diverse population: an Australian experience.

    Science.gov (United States)

    Saleh, Mona; Barlow-Stewart, Kristine; Meiser, Bettina; Muchamore, Ian

    2009-10-01

    This paper explores the perceived challenges facing clinical genetics practitioners in multicultural Australia. Focus groups conducted with 53 practitioners explored: 1) participants' experiences and definitions of cultural diversity; 2) their use of educational resources with clients; 3) their experiences with culturally diverse groups/individuals in practice; 4) their experiences working with interpreters; and 5) the impact culturally specific educational training and/or experiential learning had on their confidence or practice when dealing with culturally diverse clients. Participants viewed culture as extending beyond traditional definitions such as ethnicity, language and religion. Most respondents had experienced positive results working with health care interpreters, although at times, this was a challenge for the family as they preferred privacy and the use of family members as interpreters. Another commonly reported challenge was the limited availability of reliable, culturally appropriate translated resources. Some participants expressed concern that learning theories about specific cultures may lead to stereotypes and that opportunities for formal cultural competence training were limited. Recommendations for practice include the targeting of educational resources to meet the needs of a diverse community and placing cultural competence on the agenda for ongoing training and maintenance of professional standards for clinical genetics practitioners to avoid the current ad hoc approach.

  20. Research based empathic knowledge for nursing: a translational strategy for disseminating phenomenological research findings to provide evidence for caring practice.

    Science.gov (United States)

    Galvin, Kathleen T; Todres, Les

    2011-04-01

    We are interested in the kind of knowledge that is particularly relevant to caring practice and the way in which qualitative research findings can serve such knowledge. As phenomenological researchers we have been engaged with the question of how findings from such research can be re-presented and expressed more aesthetically. Such a movement towards a more aesthetic phenomenology may serve the communicative concern to express phenomena relevant to caring practice in ways that appeal to the 'head, hand and heart'. The paper first offers some thoughts about the complex kind of knowledge relevant to caring that is not only technical or propositional, but actionable and aesthetically moving as well. We call this kind of knowledge 'embodied relational understanding'. Further, the paper outlines the development of one way of serving a more aesthetic phenomenology whereby research findings can be faithfully and evocatively translated into more empathically impactful expressions. We call this process 'embodied interpretation'. It is guided by an epistemological framework grounded in the philosophies of Gadamer and Gendlin. We finally illustrate the process with reference to the experience of living after Stroke, and consider the value of this translational process for nursing education and practice. Copyright © 2010 Elsevier Ltd. All rights reserved.

  1. Untangling the web of European regulations for the preparation of unlicensed radiopharmaceuticals: a concise overview and practical guidance for a risk-based approach.

    Science.gov (United States)

    Lange, Rogier; ter Heine, Rob; Decristoforo, Clemens; Peñuelas, Iván; Elsinga, Philip H; van der Westerlaken, Monique M L; Hendrikse, N Harry

    2015-05-01

    Radiopharmaceuticals are highly regulated, because they are controlled both as regular medicinal products and as radioactive substances. This can pose a hurdle for their development and clinical use. Radiopharmaceuticals are fundamentally different from other medicinal products and these regulations are not always adequate for their production. Strict compliance may have a huge resource impact, without further improving product quality. In this paper we give an overview of the applicable legislation and guidelines and propose a risk-based approach for their implementation. We focus on a few controversial Good Manufacturing Practice topics: cleanroom classification, air pressure regime, cleanroom qualification and microbiological monitoring. We have developed an algorithm to assess the combined risk of microbiological contamination of a radiopharmaceutical preparation process and propose corresponding Good Manufacturing Practice classification levels. In our opinion, the risk of carry-over of radiopharmaceuticals by individuals cannot be contained by pressure differences, and complicated regimes with underpressured rooms are not necessary in most situations. We propose a sterility assurance level of 10 for radiopharmaceuticals that are administered within a working day, irrespective of their use. We suggest the adoption of limits for environmental monitoring of microbial contamination, as proposed by Bruel and colleagues, on behalf of the French Society of Radiopharmacy. Recently launched regulatory documents seem to breathe a more liberal spirit than current legislation and recognize the need for the use of risk assessment. We argue that future legislation be further harmonized and state risk assessment as the gold standard for implementation of drug quality regulations for the preparation of unlicensed radiopharmaceuticals.

  2. Primary Care Provider Utilization: A Descriptive Analysis of Family Practice Referral Rates Before and After the Family Practice Service Reorganization at Reynolds Army Community Hospital, Fort Sill, OK

    Science.gov (United States)

    1997-05-01

    focuses on the referrals originating from the family practice clinics and directed to the four largest specialty departments at RACH: Obstetrics ...patterns in HMOs found that the four most frequently referred to specialties were general surgery, otolaryngology, orthopedics, and obstetrics ...n=19) and doctors of osteopathy (DO) (n=5). The experience of these physicians ranges from residency graduates with six months of post-residency

  3. What Can Academic Writers Learn from Creative Writers? Developing Guidance and Support for Lecturers in Higher Education

    Science.gov (United States)

    Antoniou, Maria; Moriarty, Jessica

    2008-01-01

    Writing and publishing are crucial to the development of a successful academic career. However, lecturers typically receive little guidance on this strand of their job. Any support that does exist tends to focus on the technical and practical aspects of scholarly writing. Advice is rarely provided on managing creative and emotional facets--factors…

  4. Instructional and Career Guidance in STEM: An Improvement Initiative to Create Opportunities for Female High School Students

    Science.gov (United States)

    Belcher, Aaron Heath

    2017-01-01

    The purpose of this disquisition is to disseminate an improvement initiative in a public high school that addressed female Science, Technology, Engineering and Math (STEM) disparity in STEM classes. In this high school current instructional and career guidance practices were inadequate in providing female STEM students opportunities to experience…

  5. Starting learning in medical practice: an evaluation of a new Introductory Clerkship.

    NARCIS (Netherlands)

    Jacobs, J.C.G.; Bolhuis, S.M.; Bulten, J.; Laan, R. van der; Holdrinet, R.S.G.

    2005-01-01

    The transition from undergraduate medical education to learning in clinical clerkships can be difficult for students. Learning in clinical practice requires awareness of learning opportunities and goals, active elaboration and reflection. Staff should provide students with guidance to learn from

  6. Development of Offshore Wind Recommended Practice for U.S. Waters: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Musial, W. D.; Sheppard, R. E.; Dolan, D.; Naughton, B.

    2013-04-01

    This paper discusses how the American Petroleum Institute oil and gas standards were interfaced with International Electrotechnical Commission and other wind turbine and offshore industry standards to provide guidance for reliable engineering design practices for offshore wind energy systems.

  7. Green IT in Practice How One Company is Approaching the Greening of Its IT

    CERN Document Server

    Hird, Gary

    2010-01-01

    Green IT in Practice, Second edition provides guidance on how to implement a Green IT programme. It will help you to formulate a Green IT policy, curb demand for data storage capacity, and lower the electricity consumption of the datacentre.

  8. Impact of Symptoms and Care Practices on Nursing Home Residents at the End of Life: A Rating by Front-line Care Providers.

    Science.gov (United States)

    Hoben, Matthias; Chamberlain, Stephanie A; Knopp-Sihota, Jennifer A; Poss, Jeffrey W; Thompson, Genevieve N; Estabrooks, Carole A

    2016-02-01

    Burdensome symptoms and potentially inappropriate care practices are common at the end of life for nursing home residents. Appropriately managing symptoms and limiting aggressive care practices is key to high-quality end-of-life care. Little research is available, however, on the opinions of nursing home care providers about the impact of symptoms and practices for both residents and care facilities. Our objectives were to (1) identify common burdensome symptoms and potentially inappropriate practices at the end of life for nursing home residents, (2) develop and assess the feasibility of a procedure to have various groups of nursing home care providers rate impact of symptoms and practices, and (3) generate recommendations for action and further research, with key policy and decision makers. Proof-of-concept study. Partnered research by researchers, health professionals, and decision makers to identify and explore the impact of burdensome symptoms and potentially inappropriate care practices for nursing home residents at the end of life. Thirty-six nursing homes from Alberta, Manitoba, and Saskatchewan. A total of 6007 residents (prevalence rating); 4 medical directors, 5 directors of care, 4 nurse practitioners, 4 registered nurses, 5 licensed practical nurses, 5 care aides (impact rating); and 13 key policy or decision makers from Alberta, British Columbia, and Manitoba (expert panel). Based on a literature search and data in the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0, we generated lists of burdensome symptoms and potentially inappropriate care practices for nursing home residents at the end of life. We rated prevalence of those symptoms and practices in the last quarter before death as high, medium, or low. Care providers rated the burden of symptoms and inappropriateness of practices as high, medium, or low. Directors of care rated the unnecessary cost of those symptoms and practices to a nursing home as high, medium, or low. We ranked

  9. A cost-effectiveness analysis of provider interventions to improve health worker practice in providing treatment for uncomplicated malaria in Cameroon: a study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Wiseman Virginia

    2012-01-01

    Full Text Available Abstract Background Governments and donors all over Africa are searching for sustainable, affordable and cost-effective ways to improve the quality of malaria case management. Widespread deficiencies have been reported in the prescribing and counselling practices of health care providers treating febrile patients in both public and private health facilities. Cameroon is no exception with low levels of adherence to national guidelines, the frequent selection of non-recommended antimalarials and the use of incorrect dosages. This study evaluates the effectiveness and cost-effectiveness of introducing two different provider training packages, alongside rapid diagnostic tests (RDTs, designed to equip providers with the knowledge and practical skills needed to effectively diagnose and treat febrile patients. The overall aim is to target antimalarial treatment better and to facilitate optimal use of malaria treatment guidelines. Methods/Design A 3-arm stratified, cluster randomized trial will be conducted to assess whether introducing RDTs with provider training (basic or enhanced is more cost-effective than current practice without RDTs, and whether there is a difference in the cost effectiveness of the provider training interventions. The primary outcome is the proportion of patients attending facilities that report a fever or suspected malaria and receive treatment according to malaria guidelines. This will be measured by surveying patients (or caregivers as they exit public and mission health facilities. Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes, including changes in provider knowledge. Costs will be estimated from a societal and provider perspective using standard economic evaluation methodologies. Trial Registration ClinicalTrials.gov: NCT00981877

  10. Vocational Guidance and the Labour Market: Guidance to Transform or Guidance to Domesticate?

    Science.gov (United States)

    Kann, Ulla

    1988-01-01

    Explores the conflict in guidance arising from the desire to consider the needs of society while guaranteeing individual freedom of choice. Discusses the theoretical basis of vocational guidance. Gives examples of "domestication" and "transformation" approaches to guidance and discusses the consequences of viewing guidance as a…

  11. Space guidance evolution - A personal narrative

    Science.gov (United States)

    Battin, R. H.

    1982-04-01

    The history of space guidance and navigation begins in the early 1950s when the MIT Instrumentation Laboratory was chosen to provide a self-contained guidance system backup for the new Atlas intercontinental ballistic missile. Computing developments during the 1950s are considered, taking into account the construction of the all-electronic digital computer at MIT in the early 1950s, the first algebraic compiler, and the design of an algebraic programming language. Attention is given to the Delta guidance method, the Q-system which was first implemented on the Thor IRBM, and the symmetry of the Q matrix. The effect of the launch of Sputnik on computational developments related to space guidance applications is discussed. A NASA study contract made it possible to continue work which had begun under Air Force auspices. Work related to Mars probe navigation is considered along with developments related to the race to the moon.

  12. Practical Guidance on Science and Engineering Ethics Education for Instructors and Administrators: Papers and Summary from a Workshop, December 12, 2012

    Science.gov (United States)

    Benya, Frazier F., Ed.; Fletcher, Cameron H.,Ed.; Hollander, Rachelle D.,Ed.

    2013-01-01

    Over the last two decades, colleges and universities in the United States have significantly increased the formal ethics instruction they provide in science and engineering. Today, science and engineering programs socialize students into the values of scientists and engineers as well as their obligations in the conduct of scientific research and…

  13. General practitioner management of genetic aspects of a cardiac disease: a scenario-based study to anticipate providers' practices.

    NARCIS (Netherlands)

    Challen, K.; Harris, H.; Kristoffersson, U.; Nippert, I.; Schmidtke, J.; Kate, L.P. ten; Benjamin, C.; Anionwu, E.; Plass, A.M.; Julian-Reynier, C.; Harris, R.

    2010-01-01

    It is increasingly recognised that genetics will have to be integrated into all parts of primary health care. Previous research has demonstrated that involvement and confidence in genetics varies amongst primary care providers. We aimed to analyse perceptions of primary care providers regarding

  14. General practitioner management of genetic aspects of a cardiac disease: a scenario-based study to anticipate providers' practices

    NARCIS (Netherlands)

    Challen, K.; Harris, H.; Kristoffersson, U.; Nippert, I.; Schmidtke, J.; ten Kate, L.P.; Benjamin, C.; Anionwu, E.; Plass, A.M.C.; Julian-Reynier, C.; Harris, R

    2010-01-01

    It is increasingly recognised that genetics will have to be integrated into all parts of primary health care. Previous research has demonstrated that involvement and confidence in genetics varies amongst primary care providers. We aimed to analyse perceptions of primary care providers regarding

  15. Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania

    Directory of Open Access Journals (Sweden)

    Hoffman Steven J

    2011-12-01

    Full Text Available Abstract Background Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization of insecticide-treated nets (ITNs. Methods This study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to 497 healthcare providers in Ghana (140, Laos (136, Senegal (100 and Tanzania (121. Ten questions tested participants' knowledge and clinical practice related to malaria prevention. Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics. Results The survey achieved a 75% response rate (372/497 across Ghana (107/140, Laos (136/136, Senegal (51/100 and Tanzania (78/121. Few participating healthcare providers correctly answered all five knowledge questions about ITNs (13% or self-reported performing all five clinical practices according to established evidence (2%. Statistically significant factors associated with higher knowledge within each country included: 1 training in acquiring systematic reviews through the Cochrane Library (OR 2.48, 95% CI 1.30-4.73; and 2 ability to read and write English well or very well (OR 1.69, 95% CI 1.05-2.70. Statistically significant factors associated with better clinical practices within each country include: 1 reading scientific journals from their own country (OR

  16. 78 FR 38683 - Availability of Guidance: Establishments Guidance for the Selection of a Commercial or Private...

    Science.gov (United States)

    2013-06-27

    ... required, accreditation provides increased confidence in the accuracy of the test results. Using either an... instructions in the guidance should change the definition of ``routine PT'' to reflect the reality that PT is...

  17. To feed or not to feed? Case presentation and best practice guidance for human milk feeding and group B streptococcus in developed countries.

    Science.gov (United States)

    Davanzo, Riccardo; De Cunto, Angela; Travan, Laura; Bacolla, Gianfranco; Creti, Roberta; Demarini, Sergio

    2013-11-01

    Group B Streptococcus (GBS) is the most frequent cause of neonatal invasive disease. Two forms of GBS are recognized: early-onset and late-onset disease. The average incidence of late-onset disease is 0.24 per 1000, a figure that has remained substantially unchanged over time. Exposure to breast milk represents a potential source of infection, especially in late-onset and/or recurrent GBS disease. As a result, both breastfeeding and the use of breast milk have been questioned. We report for the first time the case of both simultaneous and recurrent infection in newborn preterm twins, born 3 weeks apart, resulting from ingestion of GBS positive breast milk. A genetically identical strain was found in both breast milk and her newborn infants. Transmission of GBS through breast milk should be considered in late-onset GBS sepsis. An eradicating antibiotic treatment of GBS positive mothers with ampicillin plus rifampin and temporary discontinuation of breastfeeding and/or the use of heat processed breast milk may represent preventive measures, although outcomes are inconsistent, for recurrent GBS disease. Guidelines on breastfeeding and prevention of recurrent neonatal GBS disease are needed. It is unfortunate that existing scientific literature is scarce and there is no general consensus. As a consequence, we propose a best practice approach on the topic.

  18. Hippocampal Sclerosis in Older Patients: Practical Examples and Guidance With a Focus on Cerebral Age-Related TDP-43 With Sclerosis.

    Science.gov (United States)

    Cykowski, Matthew D; Powell, Suzanne Z; Schulz, Paul E; Takei, Hidehiro; Rivera, Andreana L; Jackson, Robert E; Roman, Gustavo; Jicha, Gregory A; Nelson, Peter T

    2017-08-01

    - Autopsy studies of the older population (≥65 years of age), and particularly of the "oldest-old" (≥85 years of age), have identified a significant proportion (∼20%) of cognitively impaired patients in which hippocampal sclerosis is the major substrate of an amnestic syndrome. Hippocampal sclerosis may also be comorbid with frontotemporal lobar degeneration, Alzheimer disease, and Lewy body disease. Until recently, the terms hippocampal sclerosis of aging or hippocampal sclerosis dementia were applied in this context. Recent discoveries have prompted a conceptual expansion of hippocampal sclerosis of aging because (1) cellular inclusions of TAR DNA-binding protein 43 kDa (TDP-43) are frequent; (2) TDP-43 pathology may be found outside hippocampus; and (3) brain arteriolosclerosis is a common, possibly pathogenic, component. - To aid pathologists with recent recommendations for diagnoses of common neuropathologies in older persons, particularly hippocampal sclerosis, and highlight the recent shift in diagnostic terminology from HS-aging to cerebral age-related TDP-43 with sclerosis (CARTS). - Peer-reviewed literature and 5 autopsy examples that illustrate common age-related neuropathologies, including CARTS, and emphasize the importance of distinguishing CARTS from late-onset frontotemporal lobar degeneration with TDP-43 pathology and from advanced Alzheimer disease with TDP-43 pathology. - In advanced old age, the substrates of cognitive impairment are often multifactorial. This article demonstrates common and frequently comorbid neuropathologic substrates of cognitive impairment in the older population, including CARTS, to aid those practicing in this area of pathology.

  19. Passing the baton: a grounded practical theory of handoff communication between multidisciplinary providers in two Department of Veterans Affairs outpatient settings.

    Science.gov (United States)

    Koenig, Christopher J; Maguen, Shira; Daley, Aaron; Cohen, Greg; Seal, Karen H

    2013-01-01

    Handoffs are communication processes that enact the transfer of responsibility between providers across clinical settings. Prior research on handoff communication has focused on inpatient settings between provider teams and has emphasized patient safety. This study examines handoff communication within multidisciplinary provider teams in two outpatient settings. To conduct an exploratory study that describes handoff communication among multidisciplinary providers, to develop a theory-driven descriptive framework for outpatient handoffs, and to evaluate the strengths and weaknesses of different handoff types. Qualitative, in-depth, semi-structured interviews with 31 primary care, mental health, and social work providers in two Department of Veterans Affairs (VA) Medical Center outpatient clinics. Audio-recorded interviews were transcribed and analyzed using Grounded Practical Theory to develop a theoretical model of and a descriptive framework for handoff communication among multidisciplinary providers. Multidisciplinary providers reported that handoff decisions across settings were made spontaneously and without clear guidelines. Two situated values, clinic efficiency and patient-centeredness, shaped multidisciplinary providers' handoff decisions. Providers reported three handoff techniques along a continuum: the electronic handoff, which was the most clinically efficient; the provider-to-provider handoff, which balanced clinic efficiency and patient-centeredness; and the collaborative handoff, which was the most patient-centered. Providers described handoff choice as a practical response to manage constituent features of clinic efficiency (time, space, medium of communication) and patient-centeredness (information continuity, management continuity, relational continuity, and social interaction). We present a theoretical and descriptive framework to help providers evaluate differential handoff use, reflect on situated values guiding clinic communication, and guide

  20. Adaptation and validation of the Evidence-Based Practice Belief and Implementation scales for French-speaking Swiss nurses and allied healthcare providers.

    Science.gov (United States)

    Verloo, Henk; Desmedt, Mario; Morin, Diane

    2017-09-01

    To evaluate two psychometric properties of the French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales, namely their internal consistency and construct validity. The Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales developed by Melnyk et al. are recognised as valid, reliable instruments in English. However, no psychometric validation for their French versions existed. Secondary analysis of a cross sectional survey. Source data came from a cross-sectional descriptive study sample of 382 nurses and other allied healthcare providers. Cronbach's alpha was used to evaluate internal consistency, and principal axis factor analysis and varimax rotation were computed to determine construct validity. The French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales showed excellent reliability, with Cronbach's alphas close to the scores established by Melnyk et al.'s original versions. Principal axis factor analysis showed medium-to-high factor loading scores without obtaining collinearity. Principal axis factor analysis with varimax rotation of the 16-item Evidence-Based Practice Beliefs scale resulted in a four-factor loading structure. Principal axis factor analysis with varimax rotation of the 17-item Evidence-Based Practice Implementation scale revealed a two-factor loading structure. Further research should attempt to understand why the French Evidence-Based Practice Implementation scale showed a two-factor loading structure but Melnyk et al.'s original has only one. The French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales can both be considered valid and reliable instruments for measuring Evidence-Based Practice beliefs and implementation. The results suggest that the French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales are valid and reliable and can therefore be used to

  1. Adaptive internal model guidance law for weaving maneuvering target.

    Science.gov (United States)

    Deng, Xiangfei; Liu, Xiangbin

    2017-09-01

    For the terminal phase guidance problem of the missile intercepting weaving maneuvering target, an adaptive internal model guidance laws in the three-dimensional (3-D) engagement space is proposed in this paper. The guidance law adopts the disturbance rejection theory by treating the target weaving maneuvering accelerations as external disturbance, which comprises of nominal part and adaptive part. The nominal part based on feedback linearization method ensures the whole guidance system stable and the adaptive part based on internal model principle is used to recover the disturbance signals on-line to reject the target maneuver asymptotically. The algorithm guarantees the whole guidance system with satisfying performance both in transient and steady state on the effect of target maneuver on guidance system. The stability analyses and theory proof are provided in this paper. At last, numerical simulations are carried out to illustrate the effectiveness of the proposed guidance law. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

  2. A review of Grey and academic literature of evaluation guidance relevant to public health interventions.

    Science.gov (United States)

    Denford, Sarah; Abraham, Charles; Callaghan, Margaret; Aighton, Peter; De Vocht, Frank; Arris, Steven

    2017-09-12

    Public Health evaluation is essential to understanding what does and does not work, and robust demonstration of effectiveness may be crucial to securing future funding. Despite this, programs are often implemented with poor, incomplete or no evaluation. Public health practitioners are frequently required to provide evidence for the effectiveness of their services; thus, there is a growing need for evaluation guidance on how to evaluate public health programs. The aim of this study is to identify accessible high-quality, evaluation guidance, available to researchers and practitioners and to catalogue, summarise and categorise the content of a subset of accessible, quality guides to evaluation. We systematically reviewed grey and academic literature for documents providing support for evaluation of complex health interventions. Searches were conducted January to March 2015, and included academic databases, internet search engines, and consultations with academic and practicing public health experts. Data were extracted by two authors and sent to the authors of the guidance documents for comments. Our initial search identified 402 unique documents that were screened to identify those that were (1) developed by or for a national or international organization (2) freely available to all (3) published during or after 2000 (4) specific to public health. This yielded 98 documents from 43 organisations. Of these, 48 were reviewed in detail. This generated a detailed catalogue of quality evaluation guidance. The content included in documents covers 37 facets of evaluation. A wide range of guidance on evaluation of public health initiatives is available. Time and knowledge constraints may mean that busy practitioners find it challenging to access the most, up-to-date, relevant and useful guidance. This review presents links to and reviews of 48 quality guides to evaluation as well as categorising their content. This facilitates quick and each access to multiple selected

  3. Trajectory reshaping based guidance with impact time and angle constraints

    Directory of Open Access Journals (Sweden)

    Zhao Yao

    2016-08-01

    Full Text Available This study presents a novel impact time and angle constrained guidance law for homing missiles. The guidance law is first developed with the prior-assumption of a stationary target, which is followed by the practical extension to a maneuvering target scenario. To derive the closed-form guidance law, the trajectory reshaping technique is utilized and it results in defining a specific polynomial function with two unknown coefficients. These coefficients are determined to satisfy the impact time and angle constraints as well as the zero miss distance. Furthermore, the proposed guidance law has three additional guidance gains as design parameters which make it possible to adjust the guided trajectory according to the operational conditions and missile’s capability. Numerical simulations are presented to validate the effectiveness of the proposed guidance law.

  4. Impact of current good manufacturing practices and emission regulations and guidances on the discharge of pharmaceutical chemicals into the environment from manufacturing, use, and disposal.

    Science.gov (United States)

    Velagaleti, Ranga; Burns, Philip K; Gill, Michael; Prothro, James

    2002-03-01

    The current Good Manufacturing Practice (cGMP) and effluent emission (use and disposal) regulations of the U.S. Food and Drug Administration (FDA) and manufacturing effluent discharge and emission regulations of the U.S. Environmental Protection Agency (U.S. EPA) require contained manufacture, use, and disposal of pharmaceuticals with the goal of minimizing the release of pharmaceutical chemicals into the environment. However, debate has recently arisen in several scientific forums over whether these regulations adequately protect human and environmental health from the new pharmaceutical drugs introduced each year into the marketplace and the multitude of existing products, each with many distinct biochemical modes of actions. To address this issue, it is important to understand the relevance of current cGMP regulations and emission regulations that have a direct bearing on the releases of pharmaceutical chemicals into the environment during the manufacture, use, and disposal of active pharmaceutical ingredients (drug substances) and drug products. This knowledge may help us assess the quantity of residues that may be released into the environment. Additionally, the information on physical, chemical, and degradation and sorption properties of the pharmaceutical chemicals may help determine the net residue levels that could persist in the environment to evaluate if such residues have any bearing on human and environmental health. The scientific and regulatory aspects of issues related to the manufacture, use, and disposal of pharmaceutical chemicals are discussed in this article, with special emphasis on potential environmental exposure pathways during the life cycle of an active pharmaceutical ingredient or drug product. The mechanisms of degradation (transformation or depletion) and dilution of pharmaceutical residues that may be released into aquatic or terrestrial environmental compartments are described. Such degradation and dilution of pharmaceutical

  5. Health Care Providers’ Attitudes and Practices Regarding the use of Advance Directives in a Military Health Care Setting

    Science.gov (United States)

    1998-10-02

    providers’ erroneous beliefs that these documents are mainly for the terminally ill and elderly . Additionally, inadequate health care provider training...expected to die when injured due to lack of HCPs on the battlefield, lack of treatment options available, and death by secondary infection or malnourishment ...Doukas and McCullough (1995) all supported the counseling of healthy patients. Layson et al. (1994) stated that 70 to 92 % of elderly outpatients

  6. The International Safety Framework for nuclear power source applications in outer space-Useful and substantial guidance

    Science.gov (United States)

    Summerer, L.; Wilcox, R. E.; Bechtel, R.; Harbison, S.

    2015-06-01

    In 2009, the International Safety Framework for Nuclear Power Source Applications in Outer Space was adopted, following a multi-year process that involved all major space faring nations under the auspices of a partnership between the UN Committee on the Peaceful Uses of Outer Space and the International Atomic Energy Agency. The Safety Framework reflects an international consensus on best practices to achieve safety. Following the 1992 UN Principles Relevant to the Use of Nuclear Power Sources in Outer Space, it is the second attempt by the international community to draft guidance promoting the safety of applications of nuclear power sources in space missions. NPS applications in space have unique safety considerations compared with terrestrial applications. Mission launch and outer space operational requirements impose size, mass and other space environment limitations not present for many terrestrial nuclear facilities. Potential accident conditions could expose nuclear power sources to extreme physical conditions. The Safety Framework is structured to provide guidance for both the programmatic and technical aspects of safety. In addition to sections containing specific guidance for governments and for management, it contains technical guidance pertinent to the design, development and all mission phases of space NPS applications. All sections of the Safety Framework contain elements directly relevant to engineers and space mission designers for missions involving space nuclear power sources. The challenge for organisations and engineers involved in the design and development processes of space nuclear power sources and applications is to implement the guidance provided in the Safety Framework by integrating it into the existing standard space mission infrastructure of design, development and operational requirements, practices and processes. This adds complexity to the standard space mission and launch approval processes. The Safety Framework is deliberately

  7. Providing health information to the general public: a survey of current practices in academic health sciences libraries*

    Science.gov (United States)

    Hollander, Sue M.

    2000-01-01

    A questionnaire was mailed to 148 publicly and privately supported academic health sciences libraries affiliated with Association of American Medical Colleges (AAMC)–accredited medical schools in the United States and Canada to determine level of access and services provided to the general public. For purposes of this study, “general public” was defined as nonaffiliated students or health care professionals, attorneys and other nonhealth-related professionals, patients from affiliated or other hospitals or clinics, and general consumers. One hundred five (71%) libraries responded. Results showed 98% of publicly supported libraries and 88% of privately supported libraries provided access to some or all of the general public. Publicly supported libraries saw greater numbers of public patrons, often provided more services, and were more likely to circulate materials from their collections than were privately supported libraries. A significant number of academic health sciences libraries housed a collection of consumer-oriented materials and many provided some level of document delivery service, usually for a fee. Most allowed the public to use some or all library computers. Results of this study indicated that academic health sciences libraries played a significant role in serving the information-seeking public and suggested a need to develop written policies or guidelines covering the services that will be provided to minimize the impact of this service on primary clientele. PMID:10658965

  8. RH Packaging Program Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Washington TRU Solutions, LLC

    2003-08-25

    The purpose of this program guidance document is to provide technical requirements for use, operation, inspection, and maintenance of the RH-TRU 72-B Waste Shipping Package and directly related components. This document complies with the requirements as specified in the RH-TRU 72-B Safety Analysis Report for Packaging (SARP), and Nuclear Regulatory Commission (NRC) Certificate of Compliance (C of C) 9212. If there is a conflict between this document and the SARP and/or C of C, the SARP and/or C of C shall govern. The C of C states: ''...each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, ''Operating Procedures,'' of the application.'' It further states: ''...each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, ''Acceptance Tests and Maintenance Program of the Application.'' Chapter 9.0 of the SARP tasks the Waste Isolation Pilot Plant (WIPP) Management and Operating (M&O) contractor with assuring the packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC approved, users need to be familiar with 10 CFR {section} 71.11, ''Deliberate Misconduct.'' Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the Carlsbad Field Office (CBFO) shall be notified immediately. CBFO will evaluate the issue and notify the NRC if required. This document details the instructions to be followed to operate, maintain, and test the RH-TRU 72-B packaging. This Program Guidance standardizes instructions for all users. Users shall follow these instructions. Following these instructions assures that operations are safe and meet the requirements of the SARP. This document is available on the Internet at: ttp://www.ws/library/t2omi/t2omi.htm. Users are responsible for ensuring they are using the current

  9. Understanding infant feeding beliefs, practices and preferred nutrition education and health provider approaches: an exploratory study with Somali mothers in the USA

    Science.gov (United States)

    Steinman, Lesley; Doescher, Mark; Keppel, Gina A.; Pak-Gorstein, Suzinne; Graham, Elinor; Haq, Aliya; Johnson, Donna B.; Spicer, Paul

    2011-01-01

    The objective of this study was to explore Somali mothers’ beliefs and practices around infant feeding and education, towards developing a culturally informed infant nutrition curriculum for health providers. Four focus groups were conducted to explore: (1) beliefs about infant feeding, hunger and ideal weight; (2) feeding practices; (3) nutrition education approaches; and (4) provider/mother interactions. Thirty-seven Somali mother participants identified the following themes within these topics: (1) strategies for assessing hunger, satiety and when to feed; shared beliefs that plump babies are healthy, leading to worry about infant weight; (2) context of breast milk adequacy, difficulties breastfeeding and environmental and cultural barriers to breastfeeding, leading to nearly universal early supplementation with formula; (3) preferred education approaches include provider visits with interpreters, Somali language educational materials and advice from older, experienced family members; and (4) desired health provider skills include: listening, explaining, empathy, addressing specific concerns, repeating important information, offering preventive advice and sufficient visit time. This study presents knowledge about Somali beliefs and practices that can directly guide discussions with these families. Given that these infants appear on a trajectory towards obesity, influencing infant feeding practices in the Somali community is a good upstream approach to preventing obesity. These findings will underpin a new infant nutrition curriculum for health providers. PMID:20055931

  10. Multimodality and video observation in “Collective Academic Supervision” in the Master Program in Guidance, Aarhus University, Denmark

    DEFF Research Database (Denmark)

    Nordentoft, Helle; Buhl, Mie

    2012-01-01

    How come that the practice of guidance appears to be so simple and yet so vastly complicated. What could be simpler than being and interested interviewer and listener? Still, the complexity of what is involved in professional interaction practices can be difficult to pinpoint. In this presentation...... we argue that an analytical approach to the professional’s own practice provides valuable knowledge of how to practice guidance and counseling. Furthermore, we argue that this must be addressed as an active part of the master programme’s pedagogy. We propose an introduction of video observation...... as a tool to bridge the practical experience and analytical distance where collective academic supervision process is brought in to enhance the transformation processes. In our discussion we draw on findings from a recent developmental project and video observations of group supervision sessions...

  11. Content-Focused Coaching: Five Key Practices

    Science.gov (United States)

    Gibbons, Lynsey K.; Cobb, Paul

    2016-01-01

    Many districts are using content-focused coaching as a strategy to provide job-embedded support to teachers. However, the current coaching literature provides little guidance on what coaches need to know and be able to do to engage teachers in activities that will support their development of ambitious instructional practices. Furthermore, little…

  12. Vocational Development and Guidance.

    Science.gov (United States)

    Tennyson, W. Wesley; And Others

    The vocational education volume considers questions of career development, the role of guidance in the school, vocational training, the relation of self-concept to vocational choice, and occupational information. Twenty-six papers deal with theories of vocational behavior, the success of vocational education programs, and testing information.…

  13. Guidance on lobbying restrictions

    Science.gov (United States)

    The purpose of this guidance is to remind nonprofit organizations, universities, and other non-government recipients of EPA grants that, with very limited exceptions, you may not use Federal grant funds or cost-sharing funds to conduct lobbying activities.

  14. PIV Logon Configuration Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Glen Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-03-04

    This document details the configurations and enhancements implemented to support the usage of federal Personal Identity Verification (PIV) Card for logon on unclassified networks. The guidance is a reference implementation of the configurations and enhancements deployed at the Los Alamos National Laboratory (LANL) by Network and Infrastructure Engineering – Core Services (NIE-CS).

  15. Latino family childcare providers' beliefs, attitudes, and practices related to promotion of healthy behaviors among preschool children: a qualitative study.

    Science.gov (United States)

    Lindsay, Ana C; Salkeld, Judith A; Greaney, Mary L; Sands, Faith D

    2015-01-01

    The continuing rise of obesity among Latinos is a public health concern with an immediate need for early prevention. Changes in family structures have increased demand and reliance for child care for young children. Latino children are the fastest-growing segment of the child population in the United States, and research shows that Latino families use preschools and day care centers much less than those of other ethnic groups, apparently because of cultural preferences for family-like care. Given that many low income Latino children attend family child care homes (FCCHs), there is a need to explore the role that FCCH providers may play in establishing and reinforcing children's early healthful eating and physical activity behaviors and consequently in the prevention of childhood obesity. Using purposive sampling, six focus groups were conducted in Spanish with licensed Latino FCCH providers (n = 44). Data was analyzed to identify recurrent themes. Latino FCCH providers described how they play an influential role in promoting healthful eating and physical activity behaviors of preschool children in their care. They also identified many barriers and challenges in establishing and maintaining healthful nutrition and physical activity behaviors, including high cost of healthy foods, cold weather, and physical environment of FCCH. Latino FCCH providers can have a strong impact in promoting healthful behaviors in low-income, Latino communities. They may be able to effectively deliver interventions targeting low-income, minority families to promote healthful eating and physical activity behaviors and prevent child obesity.

  16. Providers caring for adolescents with perinatally-acquired HIV: Current practices and barriers to communication about sexual and reproductive health.

    Science.gov (United States)

    Albright, Jamie N; Fair, Cynthia D

    2014-11-01

    The population of adolescents and young adults (AYA) with perinatally-acquired HIV (PHIV) present challenges to HIV healthcare providers (HHCPs). Originally not expected to survive childhood, they are now living well into young adulthood. Little is known about the type of sexual and reproductive (SRH) information/services offered to AYA with PHIV by HHCPs. HHCPs (n=67) were recruited using snowball sampling, and completed an online survey. Providers' most frequently endorsed SRH topics discussed with both male and female patients included condom use (77.3%), STD prevention (73.1%), and screening (62.1%). Providers' reports indicated that females received significantly more education about SRH topics overall. The most frequently noted barriers to SRH communication included more pressing health concerns (53.0%), parent/guardian not receptive (43.9%), and lack of time during appointment (43.9%). Provider-reported SRH conversations with HHCPs were highly focused on horizontal transmission and pregnancy prevention. Salient social aspects of SRH promotion for AYAs with PHIV (e.g., managing disclosure and romantic relationships) were less commonly discussed, though such conversations may serve to reduce secondary transmission and enhance the overall well-being of AYA with PHIV. Findings indicated that further work must be done to identify strategies to address unmet SRH needs of the aging population of AYA with PHIV.

  17. Providing Recreation Services for all Individuals: The Connection of Inclusive Practices to Commercial, Community, and Outdoor Recreation Students

    Science.gov (United States)

    Piatt, Jennifer A.; Jorgensen, Lisa J.

    2012-01-01

    Individuals with disabilities currently represent the largest minority group in the United States, yet recreation undergraduate students often perceive this as a population they may or may not provide services to in their future careers. The activities presented in this paper, Inclusion Knowledge Audits (IKA), are developed to make the connection…

  18. Mind the gap: knowledge and practice of providers treating uncomplicated malaria at public and mission health facilities, pharmacies and drug stores in Cameroon and Nigeria.

    Science.gov (United States)

    Mangham-Jefferies, Lindsay; Hanson, Kara; Mbacham, Wilfred; Onwujekwe, Obinna; Wiseman, Virginia

    2015-11-01

    Artemisinin combination therapy (ACT) has been the first-line treatment for uncomplicated malaria in Cameroon since 2004 and Nigeria since 2005, though many febrile patients receive less effective antimalarials. Patients often rely on providers to select treatment, and interventions are needed to improve providers' practice and encourage them to adhere to clinical guidelines. Providers' adherence to malaria treatment guidelines was examined using data collected in Cameroon and Nigeria at public and mission facilities, pharmacies and drug stores. Providers' choice of antimalarial was investigated separately for each country. Multilevel logistic regression was used to determine whether providers were more likely to choose ACT if they knew it was the first-line antimalarial. Multiple imputation was used to impute missing data that arose when linking exit survey responses to details of the provider responsible for selecting treatment. There was a gap between providers' knowledge and their practice in both countries, as providers' decision to supply ACT was not significantly associated with knowledge of the first-line antimalarial. Providers were, however, more likely to supply ACT if it was the type of antimalarial they prefer. Other factors were country-specific, and indicated providers can be influenced by what they perceived their patients prefer or could afford, as well as information about their symptoms, previous treatment, the type of outlet and availability of ACT. Public health interventions to improve the treatment of uncomplicated malaria should strive to change what providers prefer, rather than focus on what they know. Interventions to improve adherence to malaria treatment guidelines should emphasize that ACT is the recommended antimalarial, and it should be used for all patients with uncomplicated malaria. Interventions should also be tailored to the local setting, as there were differences between the two countries in providers' choice of antimalarial

  19. The Connection Between Forms of Guidance for Inquiry-Based Learning and the Communicative Approaches Applied—a Case Study in the Context of Pre-service Teachers

    Science.gov (United States)

    Lehtinen, Antti; Lehesvuori, Sami; Viiri, Jouni

    2017-09-01

    Recent research has argued that inquiry-based science learning should be guided by providing the learners with support. The research on guidance for inquiry-based learning has concentrated on how providing guidance affects learning through inquiry. How guidance for inquiry-based learning could promote learning about inquiry (e.g. epistemic practices) is in need of exploration. A dialogic approach to classroom communication and pedagogical link-making offers possibilities for learners to acquire these practices. The focus of this paper is to analyse the role of different forms of guidance for inquiry-based learning on building the communicative approach applied in classrooms. The data for the study comes from an inquiry-based physics lesson implemented by a group of five pre-service primary science teachers to a class of sixth graders. The lesson was video recorded and the discussions were transcribed. The data was analysed by applying two existing frameworks—one for the forms of guidance provided and another for the communicative approaches applied. The findings illustrate that providing non-specific forms of guidance, such as prompts, caused the communicative approach to be dialogic. On the other hand, providing the learners with specific forms of guidance, such as explanations, shifted the communication to be more authoritative. These results imply that different forms of guidance provided by pre-service teachers can affect the communicative approach applied in inquiry-based science lessons, which affects the possibilities learners are given to connect their existing ideas to the scientific view. Future research should focus on validating these results by also analysing inservice teachers' lessons.

  20. Review of guidance on recurrence risk management for general practitioners in breast cancer, colorectal cancer and melanoma guidelines.

    Science.gov (United States)

    Spronk, Inge; Korevaar, Joke C; Burgers, Jako S; Albreht, Tit; Schellevis, François G

    2017-04-01

    General practitioners (GPs) will face cancer recurrences more frequently due to the rising number of cancer survivors and greater involvement of GPs in the follow-up care. Currently, GPs are uncertain about managing recurrence risks and may need more guidance. To explore what guidance is available for GPs on managing recurrence risks for breast cancer, colorectal cancer and melanoma, and to examine whether recurrence risk management differs between these tumour types. Breast cancer, colorectal cancer and melanoma clinical practice guidelines were identified via searches on internet and the literature, and experts were approached to identify guidelines. Guidance on recurrence risk management that was (potentially) relevant for GPs was extracted and summarized into topics. We included 24 breast cancer, 21 colorectal cancer and 15 melanoma guidelines. Identified topics on recurrence risk management were rather similar among the three tumour types. The main issue in the guidelines was recurrence detection through consecutive diagnostic testing. Guidelines agree on both routine and nonroutine tests, but, recommended frequencies for follow-up are inconsistent, except for mammography screening for breast cancer. Only six guidelines provided targeted guidance for GPs. This inventory shows that recurrence risk management has overlapping areas between tumour types, making it more feasible for GPs to provide this care. However, few guidance on recurrence risk management is specific for GPs. Recommendations on time intervals of consecutive diagnostic tests are inconsistent, making it difficult for GPs to manage recurrence risks and illustrating the need for more guidance targeted for GPs.

  1. Supporting adherence to oral anticancer agents: clinical practice and clues to improve care provided by physicians, nurse practitioners, nurses and pharmacists

    NARCIS (Netherlands)

    Timmers, L.; Boons, C.C.; Verbrugghe, M.; Bemt, B.J.F van den; Hecke, A. Van; Hugtenburg, J.G.

    2017-01-01

    BACKGROUND: Healthcare provider (HCP) activities and attitudes towards patients strongly influence medication adherence. The aim of this study was to assess current clinical practices to support patients in adhering to treatment with oral anticancer agents (OACA) and to explore clues to improve the

  2. Investigating the Practice of Providing Written Corrective Feedback Types by ESL Teachers at the Upper Secondary Level in High Performance Schools

    Science.gov (United States)

    Mahmud, Norasyikin

    2016-01-01

    The past few decades has seen the rapid development of WCF (written corrective feedback) study. The present study examined the practice of providing WCF by teachers. The aim of this study was to determine the types of WCF used by English teachers. The study is an explanatory sequential mixed-methods design using open-ended and close-ended survey…

  3. Women's knowledge of taking oral contraceptive pills correctly and of emergency contraception: effect of providing information leaflets in general practice.

    OpenAIRE

    Smith, L F; Whitfield, M J

    1995-01-01

    BACKGROUND. About one third of all pregnancies are unplanned and 20% of all pregnancies end in abortion. More than 170,000 legal abortions are performed in the United Kingdom annually. Nearly all general practitioners provide contraceptive advice; the most commonly used form of reversible contraception is the oral contraceptive pill. AIM. The aim of this study was to determine factors associated with women's knowledge of taking the contraceptive pill correctly and of emergency contraception, ...

  4. Mixed methods survey of zoonotic disease awareness and practice among animal and human healthcare providers in Moshi, Tanzania

    OpenAIRE

    Zhang, Helen L.; Mnzava, Kunda W; Mitchell, Sara T.; Melubo, Matayo L.; Kibona, Tito J.; Cleaveland, Sarah; Kazwala, Rudovick R.; Crump, John A; Sharp, Joanne P.; Halliday, J.E.B.

    2016-01-01

    Background: Zoonoses are common causes of human and livestock illness in\\ud Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever\\ud account for a large proportion of human febrile illness in northern Tanzania, yet they\\ud are infrequently diagnosed. We conducted this study to assess awareness and\\ud knowledge regarding selected zoonoses among healthcare providers in Moshi,\\ud Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain\\...

  5. Recommendations and administration of the HPV vaccine to 11- to 12-year-old girls and boys: a statewide survey of Georgia vaccines for children provider practices.

    Science.gov (United States)

    Luque, John S; Tarasenko, Yelena N; Dixon, Betty T; Vogel, Robert L; Tedders, Stuart H

    2014-10-01

    This study explores the prevalence and provider- and practice-related correlates of physician recommendation and administration of the quadrivalent human papillomavirus (HPV) vaccine, Gardasil, to 11- to 12-year-old girls and the intention to recommend the HPV vaccine to 11- to 12-year-old boys in Georgia. The study also describes physician knowledge about and barriers to HPV vaccination. This cross-sectional study was conducted from December 2010 to February 2011. The study sample was drawn using the Georgia Vaccines for Children (VFC) provider list as a sampling frame and probability 1-stage cluster sampling with counties as clusters. The final analytic sample was restricted to 206 provider locations. Weighted percentages and corresponding statistics were calculated accounting for selection probabilities, nonresponse, and the cluster sample design. Among Georgia VFC providers attending to 11- to 12-year-old girls, 46% had always recommended that their patients get the HPV vaccination and 41% had vaccinated their female patients. Among Georgia VFC providers attending to 11- to 12-year-old boys, 20% would always recommend that their male patients get vaccinated.Physicians most frequently endorsed costs of stocking the vaccine (73%), upfront costs (69%), vaccination (68%), and insurance reimbursements (63%) as barriers to their HPV vaccination practices. Despite the Advisory Committee on Immunization Practices' recommendations on HPV vaccination, the prevalence of recommending and administering the HPV vaccine to female and male patients, aged 11 to 12 years, by VFC providers is an ongoing challenge in Georgia.

  6. 77 FR 9947 - Guidance for Industry: Early Clinical Trials With Live Biotherapeutic Products: Chemistry...

    Science.gov (United States)

    2012-02-21

    ... Biotherapeutic Products: Chemistry, Manufacturing, and Control Information; Availability AGENCY: Food and Drug... Products: Chemistry, Manufacturing, and Control Information '' dated February 2012. The guidance provides... Products: Chemistry, Manufacturing, and Control Information'' dated February 2012. The guidance provides...

  7. Analysing Interplanetary Probe Guidance Accuracy

    Directory of Open Access Journals (Sweden)

    S. V. Sukhova

    2016-01-01

    Full Text Available The paper presents a guidance accuracy analysis and estimates delta-v budget required to provide the trajectory correction maneuvers for direct interplanetary flights (without midcourse gravity assists. The analysis takes into consideration the orbital hyperbolic injection errors (depend on a selected launch vehicle and ascent trajectory and the uncertainties of midcourse correction maneuvers.The calculation algorithm is based on Monte Carlo simulation and Danby’s matrix methods (the matrizant of keplerian motion. Danby’s method establishes a link between the errors of the spacecraft state vectors at different flight times using the reference keplerian orbit matrizant. Utilizing the nominal trajectory parameters and the covariance matrix of launch vehicle injection errors the random perturbed orbits are generated and required velocity corrections are calculated. The next step is to simulate midcourse maneuver performance uncertainty using the midcourse maneuver covariance matrix. The obtained trajectory correction impulses and spacecraft position errors are statistically processed to compute required delta-v budget and dispersions ellipse parameters for different prediction intervals.As an example, a guidance accuracy analysis has been conducted for a 2022 mission to Mars and a Venus mission in 2026. The paper considers one and two midcourse correction options, as well as utilization of two different launch vehicles.The presented algorithm based on Monte Carlo simulation and Danby’s methods provides preliminary evaluation for midcourse corrections delta-v budget and spacecraft position error. The only data required for this guidance accuracy analysis are a reference keplerian trajectory and a covariance matrix of the injection errors. Danby’s matrix method allows us to take into account also the other factors affecting the trajectory thereby increasing the accuracy of analysis.

  8. Remedial Investigation/Feasibility Study (RI/FS) process, elements and techniques guidance

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-01

    This manual provides detailed guidance on Remedial Investigation/Feasibility Studies (RI/FSs) conducted pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) at Department of Energy (DOE) facilities. The purpose of the RI/FS, to assess the risk posed by a hazardous waste site and to determine the best way to reduce that risk, and its structure (site characterization, risk assessment, screening and detailed analysis of alternatives, etc.) is defined in the National Oil and Hazardous Substances Pollution Contingency Plan (NCP) and further explained in the Environmental Protection Agency`s (EPA`s) Guidance for Conducting Remedial Investigations and Feasibility Studies Under CERCLA (Interim Final) 540/G-89/004, OSWER Directive 9355.3-01, October 1988. Though issued in 1988, the EPA guidance remains an excellent source of information on the conduct and structure of an RI/FS. This document makes use of supplemental RI/FS-related guidance that EPA has developed since its initial document was issued in 1988, incorporates practical lessons learned in more than 12 years of experience in CERCLA hazardous site remediation, and drawing on those lessons, introduces the Streamlined Approach For Environmental Restoration (SAFER), developed by DOE as a way to proceed quickly and efficiently through the RI/FS process at DOE facilities. Thus as its title implies, this guidance is intended to describe in detail the process and component elements of an RI/FS, as well as techniques to manage the RI/FS effectively.

  9. Identifying dentists' attitudes towards prevention guidance using Q-sort methodology.

    Science.gov (United States)

    Witton, R V; Moles, D R

    2015-06-01

    To gain insight into the attitudes and motivating factors of dentists working in the English National Health Service (NHS) towards prevention guidance. Q-methodology: an established hybrid quantitative/qualitative technique used in the social sciences to categorise subjects based on their views by considering factors as part of their overall decision-making profile. General Dental Practices offering care under an NHS contract. NHS dentists (n = 26) placed 36 statements about prevention guidance derived from an earlier study into a distribution grid that ranked the statements from "most agree" to "most disagree". Principal components factor analysis was applied to determine the principal patterns in the rankings of statements. Analysis indicated a total of six distinct profiles within the responses, of which three profiles had at least six dentists loading onto them. The first profile was strongly characterised by dentists who appear motivated to provide prevention but financial and time constraints prevent them from doing so. The second was characterised by dentists using prevention guidance but restricting its use to only certain patients. The third was characterised by dentists who appeared "health-focused". They placed importance on working to prevention guidance, but were keen to have greater patient and professional support in achieving this. In this group of dentists Q-methodology identified three main profiles to the delivery of prevention guidance.

  10. Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania.

    Directory of Open Access Journals (Sweden)

    Helen L Zhang

    2016-03-01

    Full Text Available Zoonoses are common causes of human and livestock illness in Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever account for a large proportion of human febrile illness in northern Tanzania, yet they are infrequently diagnosed. We conducted this study to assess awareness and knowledge regarding selected zoonoses among healthcare providers in Moshi, Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain insights into contextual factors contributing to the apparent under-diagnosis of zoonoses.We conducted a questionnaire about zoonoses knowledge, case reporting, and testing with 52 human health practitioners and 10 livestock health providers. Immediately following questionnaire administration, we conducted semi-structured interviews with 60 of these respondents, using the findings of a previous fever etiology study to prompt conversation. Sixty respondents (97% had heard of brucellosis, 26 (42% leptospirosis, and 20 (32% Q fever. Animal sector respondents reported seeing cases of animal brucellosis (4, rabies (4, and anthrax (3 in the previous 12 months. Human sector respondents reported cases of human brucellosis (15, 29%, rabies (9, 18% and anthrax (6, 12%. None reported leptospirosis or Q fever cases. Nineteen respondents were aware of a local diagnostic test for human brucellosis. Reports of tests for human leptospirosis or Q fever, or for any of the study pathogens in animals, were rare. Many respondents expressed awareness of malaria over-diagnosis and zoonoses under-diagnosis, and many identified low knowledge and testing capacity as reasons for zoonoses under-diagnosis.This study revealed differences in knowledge of different zoonoses and low case report frequencies of brucellosis, leptospirosis, and Q fever. There was a lack of known diagnostic services for leptospirosis and Q fever. These findings emphasize a need for improved diagnostic capacity alongside healthcare

  11. An court action for payment from the National Health Fund for health benefits provided in emergency – selected practical issues

    Directory of Open Access Journals (Sweden)

    Damian Wąsik

    2015-09-01

    Full Text Available The publication describes the problems of payment seeking by healthcare institutions from the National Health Fund for the so-called “life-saving health benefits”. Issues, which are discussed, include the possibility of health benefits financing in the context of the contract’s limits, the burden of proof to provide the health benefits in emergencies, and the necessary of consult experts on these issues in the context of the conditions of Article 248 § 1 Polish Civil Procedure Code.

  12. Providing for energy efficiency in homes and small buildings. Part I. Understanding and practicing energy conservation in buildings

    Energy Technology Data Exchange (ETDEWEB)

    Parady, W. Harold; Turner, J. Howard

    1980-06-01

    This is a training program to educate students and individuals in the importance of conserving energy and to provide for developing skills needed in the application of energy-saving techniques that result in energy-efficient buildings. A teacher guide and student workbook are available to supplement the basic guide, which contains three parts. Part I considers the following: understanding the importance of energy; developing a concern for conserving energy; understanding the use of energy in buildings; care and maintenance of energy-efficient buildings; and developing energy-saving habits. A bibliography is presented.

  13. Guidance and counselling services in federal government colleges ...

    African Journals Online (AJOL)

    The effective organization of guidance and counselling services in Nigeria would be a reality, if the federal and state Ministries of Education are able to provide professionally trained guidance counsellors, recognize their services in schools and provide them with necessary incentives and facilities. Since the Federal ...

  14. Guidance on spatial wildland fire analysis: models, tools, and techniques

    Science.gov (United States)

    Richard D. Stratton

    2006-01-01

    There is an increasing need for spatial wildland fire analysis in support of incident management, fuel treatment planning, wildland-urban assessment, and land management plan development. However, little guidance has been provided to the field in the form of training, support, or research examples. This paper provides guidance to fire managers, planners, specialists,...

  15. Environmental Guidance Program Reference Book: American Indian Religious Freedom Act

    Energy Technology Data Exchange (ETDEWEB)

    1987-11-01

    This Reference Book contains a copy of the American Indian Religious Freedom Act and guidance for DOE compliance with the statute. The document is provided to DOE and contractor staff for informational purposes only and should not be interpreted as legal guidance. Updates that include important new requirements will be provided periodically.

  16. 77 FR 69632 - Draft Guidance for Industry on Electronic Source Data in Clinical Investigations; Availability

    Science.gov (United States)

    2012-11-20

    ... 10.115(g)(5)), to ensure that FDA considers your comment on the revised draft guidance before it... source data: Identifying and specifying authorized source data originators; Creating data element... issued consistent with FDA's good guidance practices regulation (21 CDR 10.115). The draft guidance, when...

  17. The Role of the Regular Teacher in a Whole School Approach to Guidance Counselling in Ireland

    Science.gov (United States)

    Hearne, Lucy; Galvin, James

    2015-01-01

    A whole school approach to guidance counselling has been promulgated by Irish policy-makers as a model of good practice in the delivery of guidance counselling in the post-primary sector since the 1998 Education Act (DES, 2005a, 2009, 2012). This approach to guidance counselling provision is viewed as a whole school responsibility where schools…

  18. 77 FR 72868 - Compliance Guidance for Small Business Entities on Labeling and Effectiveness Testing; Sunscreen...

    Science.gov (United States)

    2012-12-06

    ... regulations: Requires that OTC sunscreen drug products follow Drug Facts labeling content and format... level 2 guidance consistent with FDA's good guidance practices regulation (21 CFR 10.115). The guidance.... Electronic Access Persons with access to the Internet may obtain the document at either http://www.fda.gov...

  19. General practice out-of-hours service in Ireland provides a new source of syndromic surveillance data on influenza.

    LENUS (Irish Health Repository)

    Brabazon, E D

    2010-01-01

    The use of routinely available electronic sources of healthcare data on the spread of influenza has the potential to enhance current surveillance activities. This study aimed to develop a method for identifying influenza-related records from general practitioner(GP) out-of-hours (OOH) services in Ireland. Data from one such service were interrogated for keywords relating to influenza-like illness (ILI) and a proxy measure of influenza activity in the community setting was developed. Comparison of this syndromic surveillance measure with national data on ILI consultation rates demonstrated a statistically significant temporal correlation.In five out of six influenza seasons investigated,peaks in the GP OOH influenza-related calls appeared at least one week ahead of peaks in the national ILI consultation rates. The method described in this paper has been extended to nine OOH services in Ireland (covering 70% of the Irish population) to provide weekly figures on self-reported illness for influenza in the community and its data have been incorporated into the national weekly influenza reports produced by the Health Protection Surveillance Centre. These data should provide early warnings of both seasonal and pandemic influenza in Ireland.

  20. Evidence-based training in the era of evidence-based practice: Challenges and opportunities for training of PTSD providers.

    Science.gov (United States)

    Rosen, Raymond C; Ruzek, Josef I; Karlin, Bradley E

    2017-01-01

    There is a pressing global need for trained and competent mental health clinicians to deliver evidence-based psychological therapies to millions of trauma survivors in need of care. Three model, large-scale training programs were initiated a decade ago, one in the United Kingdom (U.K.), and two in the United States (U.S.), to disseminate high-quality, evidence-based psychological care to traumatized children and adults in need of assistance. Milestone contributions to implementation science have been made by each of these training programs, although limitations and challenges remain to be considered. In contrast, culturally adapted and simplified PTSD interventions and therapy training programs have also been developed and tested during the past decade, three of which show particular promise for broader implementation. These simplified but evidence-based interventions have been developed for use by lay counsellors or health technicians with minimal or no prior mental health training. Finally, a growing range of technology-based and technology-assisted training models for PTSD providers have also been developed and disseminated in the past decade. This trend is expected to accelerate as more providers become accustomed to acquiring clinical training in this modality or format, although significant barriers to technology-based training will need to be overcome. Copyright © 2016. Published by Elsevier Ltd.

  1. Changing current practice in urological cancer care: Providing better information, advice and related support on work engagement.

    Science.gov (United States)

    MacLennan, S J; Murdoch, S E; Cox, T

    2017-09-01

    There is a growing body of evidence on the importance of work following a diagnosis of cancer and the need to provide better information, advice and related support to patients on work engagement. The aim of this study was to better understand the nature of those needs and to identify better ways to meet these for those with a urological cancer. The focus was on the issues that were common to three key stakeholder groups. Semi-structured interviews were conducted with stakeholders in North East Scotland: 12 individuals with kidney, bladder or prostate cancer, 10 healthcare providers and 10 managers from large organisations. Five key themes emerged from the Framework Analysis: perceived importance of work engagement; decision-making: treatment, work and cancer; roles and responsibilities; education and training; information, advice and support resources. The data confirmed that work engagement is important to those with urological cancer. It also made clear that the current provision of information and advice could be improved. Any such interventions should involve all three key stakeholder groups with greater clarity on their respective roles and responsibilities. Finally, any new system would be best integrated with existing care provision and supported by adequate education and training of those involved. © 2017 John Wiley & Sons Ltd.

  2. Nurses' attitudes toward aging and older adults--examining attitudes and practices among health services providers in Australia.

    Science.gov (United States)

    Wells, Yvonne; Foreman, Peter; Gething, Lindsay; Petralia, Walter

    2004-09-01

    Data from an applied research project on ageism among health professionals were used to examine nurses' attitudes toward aging and working with older adults. Nurses were compared with groups of other health professionals, and sources of variation within the nurses (e.g., employer, work setting, gerontology education) were examined. Nurses had less accurate knowledge of aging than other health professionals. Nurses expressed higher anxiety about aging and were more likely to believe working with older adults was associated with low esteem in the profession. Nurses were more likely to hold positive attitudes if they worked for a service provider rather than an employment agency, had gerontology education, and worked outside the residential care sector. Improving education in gerontology is an important strategy in improving the attitudes of the profession toward older adults and could help to address nursing shortages in this sector.

  3. Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice.

    Science.gov (United States)

    Klein, J; Boyle, J A; Kirkham, R; Connors, C; Whitbread, C; Oats, J; Barzi, F; McIntyre, D; Lee, I; Luey, M; Shaw, J; Brown, A D H; Maple-Brown, L J

    2017-07-01

    Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Islamic Guidance for Drug Addiction

    Directory of Open Access Journals (Sweden)

    Agus Supriyanto

    2016-10-01

    Full Text Available Islamic Guidance is social rehabilitation program for Drug Addiction (resident. The goal of this research to know the Islamic guidance for resident at the Center for Rehabilitation of the National Narcotics Agency Lido Bogor. The methodology in this research is qualitative descriptive, with a sample two religious counselor. Can be concluded that Islamic guidance is implemented with the classical format, group format, and individual formats. The goal of the Islamic Guidance to develop religious mentally.

  5. Transdisciplinary collaboration and endorsement of pharmacological and psychosocial evidence-based practices by medical and psychosocial substance abuse treatment providers in the United States.

    Science.gov (United States)

    Pinto, Rogério M; Spector, Anya Y; Yu, Gary; Campbell, Aimee N C

    To examine the relative contribution of providers' professional affiliation (medical vs. non-medical), involvement in research, and training needs for associations with endorsement of the following evidence-based practices (EBPs): (1) pharmacological - buprenorphine treatment and (2) psychosocial - Cognitive Behavioural Therapy (CBT). Secondary analysis from a 2008 survey of a national sample (n = 571) of substance abuse treatment providers (medical, social workers, psychologists and counsellors) affiliated with the United States National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network. Multivariate linear regression models to analyze cross-sectional survey data. Results demonstrated that medical providers and providers with previous research involvement more strongly endorsed the effectiveness of buprenorphine over CBT. Compared to medical providers, psychosocial providers more strongly endorsed CBT. There was a positive association between needing training in rapport with patients and endorsement of buprenorphine and a negative association with CBT. There was a positive association between needing training in behavioural management and needs assessment and endorsement of CBT. Results underscore the importance of providers' involvement in research and the need for training medical and non-medical providers in practice areas that can purposely enhance their use of pharmacological and psychosocial EBPs.

  6. Association of State-Level Restrictions in Nurse Practitioner Scope of Practice With the Quality of Primary Care Provided to Medicare Beneficiaries.

    Science.gov (United States)

    Perloff, Jennifer; Clarke, Sean; DesRoches, Catherine M; O'Reilly-Jacob, Monica; Buerhaus, Peter

    2017-09-01

    State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality of primary care is very limited. This study uses six different classifications of state regulations and bivariate and multivariate analyses to compare beneficiaries attributed to primary care nurse practitioners and primary care physicians in 2013 testing two hypotheses: (1) chronic disease management, cancer screening, preventable hospitalizations, and adverse outcomes of care provided by primary care nurse practitioners are better in reduced and restricted practice states compared to states without restrictions and (2) by decreasing access to care, SoP restrictions negatively affect the quality of primary care. Results show a lack of consistent association between quality of primary care provided by NPs and state SoP restrictions. State regulations restricting NP SoP do not improve the quality of care.

  7. Are We Prepped for Preexposure Prophylaxis (PrEP)? Provider Opinions on the Real-World Use of PrEP in the United States and Canada

    OpenAIRE

    Karris, Maile Y.; Beekmann, Susan E.; Mehta, Sanjay R.; Anderson, Christy M.; Philip M Polgreen

    2013-01-01

    We present the results of a nationwide survey regarding HIV preexposure prophylaxis (PrEP) opinions and practices of infectious diseases physicians. Providers supported PrEP, but very few had provided it. Despite CDC guidance, real-world PrEP practices were highly variable.

  8. Arbovirus models to provide practical management tools for mosquito control and disease prevention in the Northern Territory, Australia.

    Science.gov (United States)

    Jacups, Susan P; Whelan, Peter I; Harley, David

    2011-03-01

    Ross River virus (RRV) causes the most common human arbovirus disease in Australia. Although the disease is nonfatal, the associated arthritis and postinfection fatigue can be debilitating for many months, impacting on workforce participation. We sought to create an early-warning system to notify of approaching RRV disease outbreak conditions for major townships in the Northern Territory. By applying a logistic regression model to meteorologic factors, including rainfall, a postestimation analysis of sensitivity and specificity can create rainfall cut-points. These rainfall cut-points indicate the rainfall level above which previous epidemic conditions have occurred. Furthermore, rainfall cut-points indirectly adjust for vertebrate host data from the agile wallaby (Macropus agilis) as the life cycle of the agile wallaby is intricately meshed with the wet season. Once generated, cut-points can thus be used prospectively to allow timely implementation of larval survey and control measures and public health warnings to preemptively reduce RRV disease incidence. Cut-points are location specific and have the capacity to replace previously used models, which require data management and input, and rarely provide timely notification for vector control requirements and public health warnings. These methods can be adapted for use elsewhere.

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

    Directory of Open Access Journals (Sweden)

    Elikana Lekei

    2017-02-01

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

  10. [Survey on patients' satisfaction with opioid rescue guidance by pharmacists].

    Science.gov (United States)

    Takase, Hisamitsu; Kawade, Yoshihiro; Iwata, Hiromi; Endo, Rika; Itoh, Toshimasa; Shiokawa, Mitsuru; Shibasaki, Yumiko; Nakamura, Masumi; Hisada, Atsuo; Sano, Motohiko; Kokubun, Hideya; Kagaya, Hajime; Suzuki, Tsutomu

    2008-05-01

    To examine the influence of drug therapy guidance by pharmacists on the use of a rescue dose (RD) for opioid analgesics (opioids) and pain as well as drug therapy guidance in cancer pain treatment, we conducted a patient satisfaction survey. The subjects were 56 cancer patients undergoing opioid therapy in hospitals belonging to the Symptom Control Research Group (SCORE-G). The survey period was 2 months (from November 1 until December 31, 2006). Drug therapy guidance regarding the use of RD was performed twice in each patient to evaluate the patients' satisfaction. RD was prescribed in 87.8% of the patients in the first guidance and in 80.5% in the second guidance periods. The proportion of patients who used RD significantly increased from 63.8% to 87.5%. Five items significantly improved in the second guidance period: "marked analgesic effects," "satisfaction with current treatment," "correct understanding of RD usage," "relief through RD," and "appropriate use of RD." On comprehensive evaluation following the second round of guidance, 81% of the patients reported overall satisfaction, and 78% reported the usefulness of guidance in pain treatment. These results suggest that positive guidance by pharmacists increases patients' satisfaction. In providing guidance, it was important to confirm the characteristics and side effects of opioids as well as the necessity of RD to patients accurately and repeatedly.

  11. Provider performance in treating poor patients - factors influencing prescribing practices in lao PDR: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Petzold Max

    2011-01-01

    Full Text Available Abstract Background Out-of-pocket payments make up about 80% of medical care spending at hospitals in Laos, thereby putting poor households at risk of catastrophic health expenditure. Social security schemes in the form of community-based health insurance and health equity funds have been introduced in some parts of the country. Drug and Therapeutics Committees (DTCs have been established to ensure rational use of drugs and improve quality of care. The objective was to assess the appropriateness and expenditure for treatment for poor patients by health care providers at hospitals in three selected provinces of Laos and to explore associated factors. Methods Cross-sectional study using four tracer conditions. Structured interviews with 828 in-patients at twelve provincial and district hospitals on the subject of insurance protection, income and expenditures for treatment, including informal payment. Evaluation of each patient's medical record for appropriateness of drug use using a checklist of treatment guidelines (maximum score = 10. Results No significant difference in appropriateness of care for patients at different income levels, but higher expenditures for patients with the highest income level. The score for appropriate drug use in insured patients was significantly higher than uninsured patients (5.9 vs. 4.9, and the length of stay in days significantly shorter (2.7 vs. 3.7. Insured patients paid significantly less than uninsured patients, both for medicines (USD 14.8 vs. 43.9 and diagnostic tests (USD 5.9 vs. 9.2. On the contrary the score for appropriateness of drug use in patients making informal payments was significantly lower than patients not making informal payments (3.5 vs. 5.1, and the length of stay significantly longer (6.8 vs. 3.2, while expenditures were significantly higher both for medicines (USD 124.5 vs. 28.8 and diagnostic tests (USD 14.1 vs. 7.7. Conclusions The lower expenditure for insured patients can help reduce

  12. Evidence-based obstetrics in four hospitals in China: An observational study to explore clinical practice, women's preferences and provider's views

    Directory of Open Access Journals (Sweden)

    Liang Ji

    2001-05-01

    Full Text Available Abstract Background Evidence-based obstetric care is widely promoted in developing countries, but the success of implementation is not known. Using selected childbirth care procedures in four hospitals in Shanghai, we compared practice against evidence-based information, and explored user and provider views about each procedure. Methods Observational study. Using the Cochrane Library, we identified six procedures that should be avoided as routine and two that should be encouraged. Procedure rate determined by exit interviews with women, verified using hospital notes. Views of women and providers explored with in depth interviews. The study sites were three hospitals in Shanghai and one in neighbouring province of Jiangsu. 150 women at each centre for procedure rate, and 48 in-depth interviews with women and providers. Results Vaginal births were 50% (303/599 of the total. Of the six practices where evidence suggests they should be avoided as routine, three were performed with rates above 70%: pubic shaving (3 hospitals, rectal examination (3 hospitals, and episiotomy (3 hospitals. Most women delivered lying down, pain relief was rarely given, and only in the urban district hospital did women routinely have a companion. Most women wanted support or companionship during labour and to be given pain relief; but current practice is insufficient to meet women's needs. Conclusion Obstetric practice is not following best available evidence in the hospitals studied. There is a need to adjust hospital policy to support the use of interventions proven to be of benefit to women during childbirth, and develop approaches that ensure clinical practice changes.

  13. Calcium and Vitamin D Supplement Prescribing Practices among Providers Caring for Children with Autism Spectrum Disorders: Are We Addressing Bone Health?

    Directory of Open Access Journals (Sweden)

    Shylaja Srinivasan

    2016-01-01

    Full Text Available Children with autism spectrum disorders (ASD have several risk factors for low bone mineral density. The gluten-free, casein-free (GFCF diet is a complementary therapy sometimes used in ASD that raises concerns for the adequacy of calcium and vitamin D intake. This study evaluated the prescribing practices of calcium and vitamin D supplements and the practice of checking 25-hydroxy vitamin D (25(OHD levels by providers in 100 children with ASD, 50 of whom were on the GFCF diet. Fifty-two percent and 46% of children on the GFCF diet were on some form of vitamin D and calcium supplements, respectively, compared to 18% and 14% of those not on this diet. Twenty-four percent of children in the GFCF group had a documented 25(OHD level compared to none in the non-GFCF group. The data highlight a gap in calcium and vitamin D supplement prescribing practices among providers caring for children with ASD as well as a gap in the practice of checking 25(OHD levels.

  14. Automatic guidance and control laws for helicopter obstacle avoidance

    Science.gov (United States)

    Cheng, Victor H. L.; Lam, T.

    1992-01-01

    The authors describe the implementation of a full-function guidance and control system for automatic obstacle avoidance in helicopter nap-of-the-earth (NOE) flight. The guidance function assumes that the helicopter is sufficiently responsive so that the flight path can be readily adjusted at NOE speeds. The controller, basically an autopilot for following the derived flight path, was implemented with parameter values to control a generic helicopter model used in the simulation. Evaluation of the guidance and control system with a 3-dimensional graphical helicopter simulation suggests that the guidance has the potential for providing good and meaningful flight trajectories.

  15. Citizens' views on the practices of zero-grazing and cow-calf separation in the dairy industry: Does providing information increase acceptability?

    Science.gov (United States)

    Hötzel, Maria J; Cardoso, Clarissa S; Roslindo, Angélica; von Keyserlingk, Marina A G

    2017-05-01

    The primary aim of this study was to assess the influence of provision of information on lay citizens' opinions regarding 2 common management practices, zero-grazing and cow-calf separation. To aid in the interpretation of the findings, our secondary aim was to explore the awareness and opinions of Brazilian citizens about these practices. We surveyed a convenience sample of Brazilian citizens (192 men and 208 women), recruited in a public place, with the majority stating that they were largely unfamiliar with animal production and lived in urban environments. Participants were presented short scenarios with information on the primary production factors and welfare concerns for and against zero-grazing (n = 200) or cow-calf separation (n = 200). Participants were then asked to state their position (reject, indifferent, or support), and to provide the reason(s) justifying their position. Immediately following, participants were provided a short statement describing either zero-grazing or cow-calf separation, depending on what question they responded to in the first part. Two closed questions (Q) followed each of these statements: (Q1) "Are you aware of this practice?" with choices yes, somewhat, or no, and (Q2) "What is your position regarding this practice?" with choices reject, indifferent, or support. Only 31 and 33% of the respondents were aware of zero-grazing and cow-calf separation, respectively. Previous awareness of existence of practice did not influence levels of support. Provision of information resulted in more people rejecting the practices of zero-grazing and cow-calf separation. Participants' main justifications to reject zero-grazing and cow-calf separation focused on perceived negative effects of practices on farm animal welfare and product quality, and loss of naturalness. Survey participants, Brazilians living in urban environments, with little or no association with dairy production, were generally unaware that many cows do not have access to

  16. Communication Services and Supports for Individuals With Severe Disabilities: Guidance for Assessment and Intervention.

    Science.gov (United States)

    Brady, Nancy C; Bruce, Susan; Goldman, Amy; Erickson, Karen; Mineo, Beth; Ogletree, Bill T; Paul, Diane; Romski, Mary Ann; Sevcik, Rose; Siegel, Ellin; Schoonover, Judith; Snell, Marti; Sylvester, Lorraine; Wilkinson, Krista

    2016-03-01

    The National Joint Committee for the Communication Needs of People With Severe Disabilities (NJC) reviewed literature regarding practices for people with severe disabilities in order to update guidance provided in documents originally published in 1992. Changes in laws, definitions, and policies that affect communication attainments by persons with severe disabilities are presented, along with guidance regarding assessment and intervention practices. A revised version of the Communication Bill of Rights, a powerful document that describes the communication rights of all individuals, including those with severe disabilities is included in this article. The information contained within this article is intended to be used by professionals, family members, and individuals with severe disabilities to inform and advocate for effective communication services and opportunities.

  17. Best Practices in Relational Skills Training for Medical Trainees and Providers: An Essential Element of Addressing Adverse Childhood Experiences and Promoting Resilience.

    Science.gov (United States)

    Magen, Eran; DeLisser, Horace M

    Medical providers' ability to form strong therapeutic alliances with patients is an essential clinical skill that is associated with a higher quality of care and improved provider well-being. However, comparatively few medical providers exhibit adequate relational skills, which serve to convey respect, communicate caring, and build trust between the medical provider and the patient. A growing number of medical training programs and continuing medical education programs have begun to incorporate relational skills training, but the results have been highly variable in terms of training methods and effect. To support administrators who are considering the implementation (or improvement) of relational skills training in their organization, we provide a set of best practices for relational skills training, in the basis of a review of the literature and on our experience as clinical educators, and show the application of these best practices through a case study. We conclude with a discussion of challenges for implementing a high-quality relational skills training program, policy-level solutions for these challenges, and recommendations for future research. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  18. Safety of magnetic fusion facilities: Guidance

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

    This document provides guidance for the implementation of the requirements identified in DOE-STD-6002-96, Safety of Magnetic Fusion Facilities: Requirements. This guidance is intended for the managers, designers, operators, and other personnel with safety responsibilities for facilities designated as magnetic fusion facilities. While the requirements in DOE-STD-6002-96 are generally applicable to a wide range of fusion facilities, this Standard, DOE-STD-6003-96, is concerned mainly with the implementation of those requirements in large facilities such as the International Thermonuclear Experimental Reactor (ITER). Using a risk-based prioritization, the concepts presented here may also be applied to other magnetic fusion facilities. This Standard is oriented toward regulation in the Department of Energy (DOE) environment as opposed to regulation by other regulatory agencies. As the need for guidance involving other types of fusion facilities or other regulatory environments emerges, additional guidance volumes should be prepared. The concepts, processes, and recommendations set forth here are for guidance only. They will contribute to safety at magnetic fusion facilities.

  19. The evolution: Handwashing to hand hygiene guidance.

    Science.gov (United States)

    Bjerke, Nancy B

    2004-01-01

    Handwashing is a fundamental principle and practice in the prevention, control, and reduction of healthcare-acquired infection. Advocated by Semmelweiss (Nursing, The Finest Art: An Illustrated History. St Louis: Mosby; 1985:204) from the 1800s to resolve an obstetric morbidity and mortality occurrence, the simple act of hand cleansing portrays the intuitive benefits to basic hygiene, health continuum, and, most important, disease prevention. According to recently published guidance (MMWR Morb Mortal Wkly Rep. October 25, 2002;51:32-34), the term handwashing is replaced by the new term hand hygiene, which includes hand cleansing, hand disinfecting, and surgical hand scrub. This article focuses on the published guidance, blending the salient aspects of hand hygiene practices from noted champions, reinforcing the aesthetics of meticulous cleansing, to guidance on its practice in healthcare settings. In healthcare, the principle of "clean hands are healing hands" bears value and demands compliance in order to prevent and control infectious processes while protecting the person from acquiring infectious diseases.

  20. The history and future of dietary guidance in America

    Science.gov (United States)

    LAY ABSTRACT The United States has a 100-year history of providing dietary guidance to Americans. This review describes the development and significance of dietary guidance in the US, including the Dietary Guidelines for Americans, and emphasizes the foundations upon which they were developed, the ...

  1. Meta-Narrative on Guidance and Counselling in Schools

    Science.gov (United States)

    Thamarasseri, Ismail

    2014-01-01

    The purposes of guidance and counselling provide emphasis and strength to the educational program. The major goals of counselling are to promote personal growth and to prepare students to become motivated workers and responsible citizens. The chief aim of an educational guidance is to develop the ability of co-ordinating with the school…

  2. An Evaluation of Guidance and Counselling Services Offered to ...

    African Journals Online (AJOL)

    This paper sought to evaluate the guidance and counselling services offered to students in Gwanda urban and peri-urban secondary schools. Guidance and counselling is regarded as a programme and service in the education system, providing advice with regards to students' education, career planning, social issues or ...

  3. Factors affecting guidance and counseling programme in primary ...

    African Journals Online (AJOL)

    Too, it was found that teachers' attitudes, training in counselling, availability of time and facilities have a negative impact on the guidance and counselling programme. The Government and the schools' management do not provide the needed infrastructure for guidance and counseling. It was recommended that training of ...

  4. PSD Increment Consumption Guidance

    Science.gov (United States)

    This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  5. Can a sustainability and health scenario provide a realistic challenge to student nurses and provoke changes in practice? An evaluation of a training intervention.

    Science.gov (United States)

    Grose, J; Richardson, J

    2016-06-01

    Climate change and limited natural resources will impact on the sustainable supply and disposal of materials used in health care. Healthcare students need opportunities to reflect on the ecological footprint of health services to mitigate against negative effects on service delivery. In order to raise awareness of these issues, there is a need for evidence-based teaching tools which are relevant and meaningful to nursing practice. An evidence-based sustainability skills teaching session was delivered to 293 nursing students from child and adult health disciplines. Following the sessions, evaluation sheets were distributed to the participants, of which 290 responded. The majority of nurses valued both the delivery and the content of the training and some were motivated to complete further study. The evaluation provided valuable information on how to deliver sustainability education and important insights into where more information and support was needed in order to change practice. Embedding sustainability teaching in skill sessions appears to be a realistic way of informing and motivating learners to consider current and best practice. Following training, further evaluation of practice-based behaviour is needed. © 2015 Wiley Publishing Asia Pty Ltd.

  6. Supporting students' scientific explanations: A case study investigating the synergy focusing on a teacher's practices when providing instruction and using mobile devices

    Science.gov (United States)

    Delen, Ibrahim

    Engage students in constructing scientific practices is a critical component of science instruction. Therefore a number of researchers have developed software programs to help students and teachers in this hard task. The Zydeco group, designed a mobile application called Zydeco, which enables students to collect data inside and outside the classroom, and then use the data to create scientific explanations by using claim-evidence-reasoning framework. Previous technologies designed to support scientific explanations focused on how these programs improve students' scientific explanations, but these programs ignored how scientific explanation technologies can support teacher practices. Thus, to increase our knowledge how different scaffolds can work together, this study aimed to portray the synergy between a teacher's instructional practices (part 1) and using supports within a mobile devices (part 2) to support students in constructing explanations. Synergy can be thought of as generic and content-specific scaffolds working together to enable students to accomplish challenging tasks, such as creating explanations that they would not normally be able to do without the scaffolds working together. Providing instruction (part 1) focused on understanding how the teacher scaffolds students' initial understanding of the claim-evidence-reasoning (CER) framework. The second component of examining synergy (part 2: using mobile devices) investigated how this teacher used mobile devices to provide feedback when students created explanations. The synergy between providing instruction and using mobile devices was investigated by analyzing a middle school teacher's practices in two different units (plants and water quality). Next, this study focused on describing how the level of synergy influenced the quality of students' scientific explanations. Finally, I investigated the role of focused teaching intervention sessions to inform teacher in relation to students' performance. In

  7. Augmented reality image guidance during off-pump mitral valve replacement through the guiraudon universal cardiac introducer.

    Science.gov (United States)

    Guiraudon, Gerard M; Jones, Douglas L; Bainbridge, Daniel; Linte, Cristian; Pace, Danielle; Moore, John; Wedlake, Christopher; Lang, Pencilla; Peters, Terry M

    2010-11-01

    : We report our experience with ultrasound augmented reality (US-AR) guidance for mitral valve prosthesis (MVP) implantation in the pig using off-pump, closed, beating intracardiac access through the Guiraudon Universal Cardiac Introducer attached to the left atrial appendage. : Before testing US-AR guidance, a feasibility pilot study on nine pigs was performed using US alone. US-AR guidance, tested on a heart phantom, was subsequently used in three pigs (∼65 kg) using a tracked transesophageal echocardiography probe, augmented with registration of a 3D computed tomography scan, and virtual representation of the MVP and clip-delivering tool (Clipper); three pigs were used to test feature-based registration. : Navigation of the MVP was facilitated by the 3D anatomic display. AR displayed the MVP and the Clipper within the Atamai Viewer, with excellent accuracy for tool placement. Positioning the Clipper was hampered by the design of the MVP holder and Clipper. These limitations were well displayed by AR, which provided guidance for improved design of tools. : US-AR provided informative image guidance. It documented the flaws of the current implantation technology. This information could not be obtained by any other method of evaluation. These evaluations provided guidance for designing an integrated tool: combining an unobtrusive valve holder that allows the MVP to function properly as soon as positioned, and an anchoring system, with clips that can be released one at a time, and retracted if necessary, for optimal results. The portability of Real-time US-AR may prove to be the ideal practical image guidance system for all closed intracardiac interventions.

  8. Putting PrEP into Practice: Lessons Learned from Early-Adopting U.S. Providers’ Firsthand Experiences Providing HIV Pre-Exposure Prophylaxis and Associated Care

    Science.gov (United States)

    Calabrese, Sarah K.; Magnus, Manya; Mayer, Kenneth H.; Krakower, Douglas S.; Eldahan, Adam I.; Gaston Hawkins, Lauren A.; Hansen, Nathan B.; Kershaw, Trace S.; Underhill, Kristen; Betancourt, Joseph R.; Dovidio, John F.

    2016-01-01

    Optimizing access to HIV pre-exposure prophylaxis (PrEP), an evidence-based HIV prevention resource, requires expanding healthcare providers’ adoption of PrEP into clinical practice. This qualitative study explored PrEP providers’ firsthand experiences relative to six commonly-cited barriers to prescription—financial coverage, implementation logistics, eligibility determination, adherence concerns, side effects, and anticipated behavior change (risk compensation)—as well as their recommendations for training PrEP-inexperienced providers. U.S.-based PrEP providers were recruited via direct outreach and referral from colleagues and other participants (2014–2015). One-on-one interviews were conducted in person or by phone, transcribed, and analyzed. The sample (n = 18) primarily practiced in the Northeastern (67%) or Southern (22%) U.S. Nearly all (94%) were medical doctors (MDs), most of whom self-identified as infectious disease specialists. Prior experience prescribing PrEP ranged from 2 to 325 patients. Overall, providers reported favorable experiences with PrEP implementation and indicated that commonly anticipated problems were minimal or manageable. PrEP was covered via insurance or other programs for most patients; however, pre-authorization requirements, laboratory/service provision costs, and high deductibles sometimes presented challenges. Various models of PrEP care and coordination with other providers were utilized, with several providers highlighting the value of clinical staff support. Eligibility was determined through joint decision-making with patients; CDC guidelines were commonly referenced but not considered absolute. Patient adherence was variable, with particularly strong adherence noted among patients who had actively sought PrEP (self-referred). Providers observed minimal adverse effects or increases in risk behavior. However, they identified several barriers with respect to accessing and engaging PrEP candidates. Providers offered

  9. Global guidance on environmental life cycle impact assessment indicators: Progress and case study

    DEFF Research Database (Denmark)

    Frischknecht, Rolf; Fantke, Peter; Tschümperlin, Laura

    2016-01-01

    Purpose The life cycle impact assessment (LCIA) guidance flagship project of the United Nations Environment Programme (UNEP)/Society of Environmental Toxicology and Chemistry (SETAC) Life Cycle Initiative aims at providing global guidance and building scientific consensus on environmental LCIA...

  10. NAFTA Guidance on Data Requirements for Pesticide Import Tolerances: Questions & Answers

    Science.gov (United States)

    These Qs&As provide details of implementation related to a guidance document describing the data requirements for establishing pesticide import tolerances in Canada and the United States: NAFTA Guidance on Data Requirements for Pesticide Import Tolerances.

  11. What do healthcare providers know about nutrition support? A survey of the knowledge, attitudes, and practice of pharmacists and doctors toward nutrition support in Malaysia.

    Science.gov (United States)

    Karim, Sarah A; Ibrahim, Baharudin; Tangiisuran, Balamurugan; Davies, J Graham

    2015-05-01

    Malnutrition is one of the health problems that can be prevented by appropriate nutrition care provided by healthcare providers. However, this practice is still lacking possibly because of the providers' inadequate knowledge. The aim of this study was to evaluate the self-reported knowledge, attitudes, and practices of pharmacists and doctors toward nutrition support in a tertiary care hospital setting. A validated questionnaire was distributed to all the doctors and pharmacists working in a tertiary hospital in Penang, Malaysia. Seven individuals including academics, general surgeons, and pharmacists performed the face and content validity. The questionnaire was piloted using 24 healthcare providers at a different hospital. Of 400 surveyed, 158 doctors and 72 pharmacists from various grades completed the questionnaire. More doctors (31.6%) than pharmacists (15.3%) reported adequate knowledge to perform patients' nutrition screening. However, in the knowledge assessment, pharmacists had a higher mean score (6.07 ± 1.77) than the doctors did (4.59 ± 1.87; P doctors have ambivalent attitudes toward nutrition support. Only 31.3% stated that they perform nutrition screening on admission, and half of them performed nutrition assessment during hospitalization. Inappropriate nutrition care might be due to the lack of guidelines and insufficient knowledge among doctors and pharmacists. Special nutrition training and education for both pharmacists and doctors should be established. © 2014 American Society for Parenteral and Enteral Nutrition.

  12. Online Training in Specific Meditation Practices Improves Gratitude, Well-Being, Self-Compassion, and Confidence in Providing Compassionate Care Among Health Professionals.

    Science.gov (United States)

    Rao, Nisha; Kemper, Kathi J

    2016-04-06

    Mind-body practices that intentionally generate positive emotion could improve health professionals' well-being and compassion. However, the feasibility and impact of clinician training in these practices is unknown. Data were analyzed from 3 online modules offered to health professionals: (a) Gratitude, (b) Positive Word, and (c) Loving-kindness/Compassion meditation. Pairedttests were used to assess pre- to posttraining changes in gratitude (Gratitude Questionnaire), well-being (World Health Organization Well-Being Index), self-compassion (Neff's Self-Compassion Scale), and confidence in providing compassionate care (Confidence in Providing Calm, Compassionate Care Scale). The 177 enrollees included diverse practitioners (nurses, physicians, social workers, and others). Training was associated with statistically significant improvements in gratitude (38.3 ± 4.6 to 39.5 ± 3.3), well-being (16.4 ± 4.0 to 17.9 ± 4.2), self-compassion (39.5 ± 8.1 to 43.1 ± 7.6), and confidence in providing compassionate care (73.3 ± 16.4 to 80.9 ± 13.8;Pgratitude, well-being, self-compassion, and confidence in providing compassionate care. © The Author(s) 2016.

  13. NSRD-10: Leak Path Factor Guidance Using MELCOR

    Energy Technology Data Exchange (ETDEWEB)

    Louie, David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Humphries, Larry L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-03-01

    Estimates of the source term from a U.S. Department of Energy (DOE) nuclear facility requires that the analysts know how to apply the simulation tools used, such as the MELCOR code, particularly for a complicated facility that may include an air ventilation system and other active systems that can influence the environmental pathway of the materials released. DOE has designated MELCOR 1.8.5, an unsupported version, as a DOE ToolBox code in its Central Registry, which includes a leak-path-factor guidance report written in 2004 that did not include experimental validation data. To continue to use this MELCOR version requires additional verification and validations, which may not be feasible from a project cost standpoint. Instead, the recent MELCOR should be used. Without any developer support and lack of experimental data validation, it is difficult to convince regulators that the calculated source term from the DOE facility is accurate and defensible. This research replaces the obsolete version in the 2004 DOE leak path factor guidance report by using MELCOR 2.1 (the latest version of MELCOR with continuing modeling development and user support) and by including applicable experimental data from the reactor safety arena and from applicable experimental data used in the DOE-HDBK-3010. This research provides best practice values used in MELCOR 2.1 specifically for the leak path determination. With these enhancements, the revised leak-path-guidance report should provide confidence to the DOE safety analyst who would be using MELCOR as a source-term determination tool for mitigated accident evaluations.

  14. Development and validation of scales for attitudes, self-reported practices, difficulties and knowledge among home care nurses providing palliative care.

    Science.gov (United States)

    Shimizu, Megumi; Nishimura, Misako; Ishii, Yoko; Kuramochi, Masayo; Kakuta, Naoe; Miyashita, Mitsunori

    2016-06-01

    Although educational programs for nurses are required to ensure high-quality home care, there is currently no scale to appropriately evaluate such programs for home care nurses providing palliative care. We developed and validated four scales to evaluate home care nurses' attitude, self-reported practices, difficulties, and knowledge regarding home palliative cancer care, and identified factors associated with home care nurses' attitude, self-reported practices, and difficulties. The scale items were generated based on literature review and a cross-sectional questionnaire survey was conducted. Experienced home care nurses from visiting nurse stations who enrolled in a home palliative care educational program were recruited for this survey. Of the 125 questionnaires delivered to home care nurses, 122 were returned (response rate, 98%). After factor analysis, the scale for attitude comprised four domains with 12 items, the scale for self-reported practices comprised six domains with 26 items, and the scale for difficulties comprised five domains with 18 items. Cronbach's alphas for these scales were 0.61-0.70. After using the Item Response Theory model, the scale for knowledge was found to comprise 26 items. The multiple logistic regression model showed that experience in caring for terminal patients at home or in hospitals were associated with having more positive attitude, higher self-reported practices and lower difficulties. We developed valid and reliable scales to evaluate home care nurses' attitude, self-reported practices, difficulties, and knowledge regarding home palliative cancer care. These scales potentially useful for evaluating a home palliative cancer care education program for nurses. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Geometry can provide long-range mechanical guidance for embryogenesis.

    Directory of Open Access Journals (Sweden)

    Mahamar Dicko

    2017-03-01

    Full Text Available Downstream of gene expression, effectors such as the actomyosin contractile machinery drive embryo morphogenesis. During Drosophila embryonic axis extension, actomyosin has a specific planar-polarised organisation, which is responsible for oriented cell intercalation. In addition to these cell rearrangements, cell shape changes also contribute to tissue deformation. While cell-autonomous dynamics are well described, understanding the tissue-scale behaviour challenges us to solve the corresponding mechanical problem at the scale of the whole embryo, since mechanical resistance of all neighbouring epithelia will feedback on individual cells. Here we propose a novel numerical approach to compute the whole-embryo dynamics of the actomyosin-rich apical epithelial surface. We input in the model specific patterns of actomyosin contractility, such as the planar-polarisation of actomyosin in defined ventro-lateral regions of the embryo. Tissue strain rates and displacements are then predicted over the whole embryo surface according to the global balance of stresses and the material behaviour of the epithelium. Epithelia are modelled using a rheological law that relates the rate of deformation to the local stresses and actomyosin anisotropic contractility. Predicted flow patterns are consistent with the cell flows observed when imaging Drosophila axis extension in toto, using light sheet microscopy. The agreement between model and experimental data indicates that the anisotropic contractility of planar-polarised actomyosin in the ventro-lateral germband tissue can directly cause the tissue-scale deformations of the whole embryo. The three-dimensional mechanical balance is dependent on the geometry of the embryo, whose curved surface is taken into account in the simulations. Importantly, we find that to reproduce experimental flows, the model requires the presence of the cephalic furrow, a fold located anteriorly of the extending tissues. The presence of this geometric feature, through the global mechanical balance, guides the flow and orients extension towards the posterior end.

  16. Providing varying degrees of guidance for Work-Integrated Learning

    NARCIS (Netherlands)

    Lindstaedt, S.N.; Kump, B.; Beham, G.; Pammer, V.; Ley, T.; Dotan, A.; de Hoog, Robert; Wolpers, M.; Kirschner, P.A.; Scheffel, M.; Lindstaedt, S.; Dimitrova, V.

    2010-01-01

    We present a work-integrated learning (WIL) concept which aims at empowering employees to learn while performing their work tasks. Within three usage scenarios we introduce the APOSDLE environment which embodies the WIL concept and helps knowledge workers move fluidly along the whole spectrum of WIL

  17. Strategic Communication During Whole-System Change: Advice and Guidance for School District Leaders and PR Specialists. Leading Systemic School Improvement #9

    Science.gov (United States)

    Duffy, Francis M.; Chance, Patti L.

    2006-01-01

    Times of great change in school districts require strategic communication with internal and external stakeholders including the use of school public relations tools and techniques. This book provides theoretical and practical advice and guidance to district-based change leaders and school public relations specialists on how they can support their…

  18. Improving opioid safety practices in primary care: protocol for the development and evaluation of a multifaceted, theory-informed pilot intervention for healthcare providers

    Science.gov (United States)

    Leece, Pamela; Buchman, Daniel Z; Hamilton, Michael; Timmings, Caitlyn; Shantharam, Yalnee; Moore, Julia; Furlan, Andrea D

    2017-01-01

    Introduction In North America, drug overdose deaths are reaching unprecedented levels, largely driven by increasing prescription opioid-related deaths. Despite the development of several opioid guidelines, prescribing behaviours still contribute to poor patient outcomes and societal harm. Factors at the provider and system level may hinder or facilitate the application of evidence-based guidelines; interventions designed to address such factors are needed. Methods and analysis Using implementation science and behaviour change theory, we have planned the development and evaluation of a comprehensive Opioid Self-Assessment Package, designed to increase adherence to the Canadian Opioid Guideline among family physicians. The intervention uses practical educational and self-assessment tools to provide prescribers with feedback on their current knowledge and practices, and resources to improve their practice. The evaluation approach uses a pretest and post-test design and includes both quantitative and qualitative methods at baseline and 6 months. We will recruit a purposive sample of approximately 10 family physicians in Ontario from diverse practice settings, who currently treat patients with long-term opioid therapy for chronic pain. Quantitative data will be analysed using basic descriptive statistics, and qualitative data will be analysed using the Framework Method. Ethics and dissemination The University Health Network Research Ethics Board approved this study. Dissemination plan includes publications, conference presentations and brief stakeholder reports. This evidence-informed, theory-driven intervention has implications for national application of opioid quality improvement tools in primary care settings. We are engaging experts and end users in advisory and stakeholder roles throughout our project to increase its national relevance, application and sustainability. The performance measures could be used as the basis for health system quality improvement

  19. Deep Energy Retrofit Guidance for the Building America Solutions Center

    Energy Technology Data Exchange (ETDEWEB)

    Less, Brennan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Walker, Iain [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-01-01

    The U.S. DOE Building America program has established a research agenda targeting market-relevant strategies to achieve 40% reductions in existing home energy use by 2030. Deep Energy Retrofits (DERs) are part of the strategy to meet and exceed this goal. DERs are projects that create new, valuable assets from existing residences, by bringing homes into alignment with the expectations of the 21st century. Ideally, high energy using, dated homes that are failing to provide adequate modern services to their owners and occupants (e.g., comfortable temperatures, acceptable humidity, clean, healthy), are transformed through comprehensive upgrades to the building envelope, services and miscellaneous loads into next generation high performance homes. These guidance documents provide information to aid in the broader market adoption of DERs. They are intended for inclusion in the online resource the Building America Solutions Center (BASC). This document is an assemblage of multiple entries in the BASC, each of which addresses a specific aspect of Deep Energy Retrofit best practices for projects targeting at least 50% energy reductions. The contents are based upon a review of actual DERs in the U.S., as well as a mixture of engineering judgment, published guidance from DOE research in technologies and DERs, simulations of cost-optimal DERs, Energy Star and Consortium for Energy Efficiency (CEE) product criteria, and energy codes.

  20. Recommended practice for accepting new concrete pavement surfaces for tire/pavement noise : designation CPSCP PP 1-11 (rev 3/1/2011).

    Science.gov (United States)

    2011-03-01

    This practice provides guidance and example specification language intended for use by Owner- : Agencies in development of specific contract language when requiring the evaluation of : tire/pavement noise for new concrete pavement surfaces. The overa...