WorldWideScience

Sample records for rapidly escalating healthcare

  1. Controlling cost escalation of healthcare: making universal health coverage sustainable in China.

    Science.gov (United States)

    Tang, Shenglan; Tao, Jingjing; Bekedam, Henk

    2012-01-01

    An increasingly number of low- and middle-income countries have developed and implemented a national policy towards universal coverage of healthcare for their citizens over the past decade. Among them is China which has expanded its population coverage by health insurance from around 29.7% in 2003 to over 90% at the end of 2010. While both central and local governments in China have significantly increased financial inputs into the two newly established health insurance schemes: new cooperative medical scheme (NCMS) for the rural population, and urban resident basic health insurance (URBMI), the cost of healthcare in China has also been rising rapidly at the annual rate of 17.0%% over the period of the past two decades years. The total health expenditure increased from 74.7 billion Chinese yuan in 1990 to 1998 billion Chinese yuan in 2010, while average health expenditure per capital reached the level of 1490.1 Chinese yuan per person in 2010, rising from 65.4 Chinese yuan per person in 1990. The repaid increased population coverage by government supported health insurance schemes has stimulated a rising use of healthcare, and thus given rise to more pressure on cost control in China.There are many effective measures of supply-side and demand-side cost control in healthcare available. Over the past three decades China had introduced many measures to control demand for health care, via a series of co-payment mechanisms. The paper introduces and discusses new initiatives and measures employed to control cost escalation of healthcare in China, including alternative provider payment methods, reforming drug procurement systems, and strengthening the application of standard clinical paths in treating patients at hospitals, and analyses the impacts of these initiatives and measures. The paper finally proposes ways forward to make universal health coverage in China more sustainable.

  2. Cost escalation in health-care technology - possible solutions

    African Journals Online (AJOL)

    Systems analysis, technology assessment and planning. If the challenges of health maintenance are to be met, emerging technologies will have to be considered in the context of the total health-care system.' In the best tra- ditions of .... density of 100 000 functions per chip has been achieved at a cost of a fraction of a cent ...

  3. Dose Escalation and Healthcare Resource Use among Ulcerative Colitis Patients Treated with Adalimumab in English Hospitals: An Analysis of Real-World Data.

    Directory of Open Access Journals (Sweden)

    Christopher M Black

    Full Text Available To describe the real-world use of adalimumab for maintenance treatment of ulcerative colitis (UC and associated healthcare costs in English hospitals.Retrospective cohort study.Analysis of NHS Hospital Episode Statistics linked with pharmacy dispensing data in English hospitals.Adult UC patients receiving ≥240mg during adalimumab treatment induction, subsequently maintained on adalimumab.Frequency and pattern of adalimumab use and dose escalation during maintenance treatment and associated healthcare costs (prescriptions and hospital visits.191 UC patients completed adalimumab treatment induction. 83 (43.46% dose escalated during maintenance treatment by ≥100% (equivalent to weekly dosing (median time to dose escalation: 139 days. 56 patients (67.47% subsequently de-escalated by ≥50% (median time to dose de-escalation: 21 days. Mean all-cause healthcare costs for all patients ≤12 months of index were £13,892. Dose escalators incurred greater mean healthcare costs than non-escalators ≤12 months of index (£14,596 vs. £13,351. Prescriptions accounted for 96.49% of UC-related healthcare costs (£11,090 of £11,494 in all patients.Within the cohort, 43.46% of UC patients escalated their adalimumab dose by ≥100% and incurred greater costs than non-escalators. The apparent underestimation of adalimumab dose escalation in previous studies may have resulted in underestimated costs in healthcare systems.

  4. Increase in healthcare facilities and rapid environmental ...

    African Journals Online (AJOL)

    The scenario of waste management in many Nigerian cities has been complicated by the non segregation of healthcare wastes from domestic wastes in many healthcare facilities (HCFs). Incidentally, the healthcare facilities have soared in numbers over a 50 - year period in all the six geopolitical zones of Nigeria.

  5. Managing in the context of healthcare's escalating technology and evolving culture.

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    Bowden, Dawn E; Smits, Stanley J

    2012-01-01

    As healthcare has become more scientifically based and far more sophisticated in terms of technology, it has become more fragmented in terms of care-giving, and less personal. The purpose of this paper is to discuss the challenging task of leading and managing in the gap between the existing and emerging cultures of healthcare. This paper considers the literature on culture, how it exists at many levels and in multiple forms, and the impacts it has on the US healthcare system. Further, the paper explores foundations of the current healthcare culture and attempts to forecast features of the emerging culture, incorporating examples of advances in scientific knowledge and technology. System change will continue to be problematic until leaders and change agents find ways to operate effectively in the gap between the existing cultural tenets and those emerging as the result of scientific and technological advancements. Punctuated equilibrium theory serves as a main tenet for describing how changes will continue to push the USA towards a cultural tipping point. This paper contends that leaders and managers can succeed only by understanding and respecting both cultures and calls for improved theory development and research to help find creative ways to advance the new culture without trampling the old.

  6. Efficacy and safety of rapid escalation of cabergoline in comparison to conventional regimen for macroprolactinoma: A prospective, randomized trial

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    Ashu Rastogi

    2012-01-01

    Full Text Available Introduction: Cabergoline (CAB is conventionally started at a dose of 0.25-0.5 mg once a week with dose escalation at 1to 3months intervals. Previously, we and others have shown that rapid escalation and high doses of CAB can lead to normalization of serum PRL as early as 8.2 weeks in 93% of the patients. We hypothesize that rapid escalation of CAB doses, may help in both the earlier normalization of PRL and also significant shrinkage of tumor mass. Study Design: Randomized, prospective, interventional trial. Subjects and Methods: Forty two patients (male or female with macroprolactinoma were randomized to conventional (group A or rapid escalation (group B of CAB dosing. In group B, CAB was started at a dose of 0.5 mg twice a week followed by a weekly hike of 1 mg/week, based on serum PRL and then monthly. The end point of the present study was a composite of normoprolactinemia and tumor shrinkage ≥50% from baseline. PRL and visual field analysis (weekly, other hormonal work up periodically and magnetic resonance imaging (sella was performed monthly. Results: A total of 19 patients in each group completed a minimum follow-up of 6 months. There was a reduction of 72.7 ± 26.2% in group A and 84.1 ± 15.0 in group B (P = 0.24 within a week of CAB therapy. The duration of CAB treatment to normalize PRL was 10.2 ± 9.2 week(2-36 in group A and 7.2 ± 6.2 weeks(1-24 in group B (P = 0.28. There was no difference in the tumor shrinkage in either of the groups (92.3% [46.7-100%] in group A and 90.5% [66.6-100%] reduction in group B. The composite end point was achieved in 14 patients in group A (73.6% and 16 patients in group B (84.2% (P = 0.69. The composite end point was achieved in 13.1 ± 9.5 weeks (group A versus 16.5 ± 14.1 weeks (group B (P = 0.61. Discussion: This is first head to head comparative trial showing that a rapid hike of CAB dose is not associated with earlier normalization of PRL or reduction in tumor volume as compared to

  7. Avoiding analgesic escalation and excessive healthcare utilization in severe irritable bowel syndrome: a role for intramuscular anticholinergics?

    Science.gov (United States)

    Pearson, James S; Pollard, Christine; Whorwell, Peter J

    2014-11-01

    In patients with severe irritable bowel syndrome (IBS), abdominal pain can be the predominant symptom impacting on all aspects of their lives and resulting in excessive healthcare utilization. Furthermore, the use of analgesics can become excessive in this group of patients, sometimes leading to opiate dependency. Typically, the pain is often described as spastic in nature and we have speculated that parenteral anticholinergics might provide effective relief when all other measures have failed. For several years, we have therefore been asking general practitioners to consider teaching such patients to administer intramuscular hyoscine butylbromide for pain episodes and this study is an audit of this approach. Patients in whom the use of intramuscular hyoscine butylbromide had been recommended to their general practitioner in the last three years were interviewed over the telephone in order to document the efficacy of this approach as well as any potential disadvantages. A total of 122 general practitioners were advised to try this approach, with 58 agreeing to teach the technique and prescribe the medication. Of the 58 patients who used the medication, 50 (86%) found it gave them pain relief, which was complete in six (10%), substantial in 36 (62%) and mild in eight (14%), with 15 (26%) decreasing the use of analgesics and 13 (32%) of the 41 taking opiates able to reduce or stop them completely. Side effects were few and largely consisted of those associated with anticholinergics. Only four patients stopped medication because of side effects and no major skin reactions were reported. The use of intramuscular hyoscine butylbromide shows promise in the management of IBS when severe unmanageable abdominal pain is a major problem. This approach appears to be safe and has the potential to reduce analgesic escalation, opiate dependency and attendances at accident and emergency departments.

  8. Preliminary feasibility studies in times of rapid cost escalation. [Oil shale and tar sand industries

    Energy Technology Data Exchange (ETDEWEB)

    Oliver, E.D.; Moll, A.J.

    1976-01-01

    Not the least of the problems delaying the development and commercialization of synthetic fuel processes has been the extraordinary escalation of cost estimates by factors of up to ten in the past eight years. This study identifies and analyzes some of the most important contributing factors that have converged in the last few years. These factors include overoptimism and ill-defined project scope in the early stages, tightening environmental controls, difficulties in obtaining raw materials and fuels, general inflationary trends, ''hyperinflation'' of the costs of critical equipment, local labor shortages, and increased times required for procurement and construction. Cost increases have been particularly dramatic for ''offsites,'' liberally defined as nonprocess related parts of projects. Case histories of oil shale and tar sand developments are analyzed. Learning curves of costs during development and commercial use are studied. The analysis suggests that the worst of the extraordinary increases (above general inflationary trends) are probably over. Criteria to judge the state of development of processes are given, and some procedures to avoid future pitfalls are suggested.

  9. Increase in healthcare facilities and rapid environmental degradation

    African Journals Online (AJOL)

    user

    Increase in healthcare facilities and rapid environmental degradation: A technological paradox in. Nigeria's urban centres. Akinwale Coker1* and Mynepalli K. C. Sridhar2. 1Department of Civil Engineering, Faculty of Technology, University of Ibadan, Oyo State, Nigeria. 2Division of Environmental Health, Department of ...

  10. Management of benzodiazepine-resistant alcohol withdrawal across a healthcare system: Benzodiazepine dose-escalation with or without propofol.

    Science.gov (United States)

    Wong, Adrian; Benedict, Neal J; Lohr, Brian R; Pizon, Anthony F; Kane-Gill, Sandra L

    2015-09-01

    Severe cases of alcohol withdrawal syndrome (AWS) may not resolve despite escalating doses of benzodiazepines (BZDs). Benzodiazepine-resistant alcohol withdrawal (RAW) is a subset of severe alcohol withdrawal defined by the requirement of ≥40mg of diazepam administered within one hour. Use of adjunct agents, such as propofol, may be beneficial to minimize BZD adverse effects and improve symptom control. While limited evidence suggests propofol as an effective adjunct in AWS through improved sedation, evidence is currently lacking for the addition of only propofol to BZDs for management of RAW. Retrospective review of adult patients from January, 2009 to March, 2012 with RAW. Patients were categorized into BZD dose-escalation only or BZD plus propofol. The primary endpoint was time to resolution of AWS. Secondary endpoints included safety outcomes associated with medication use. Of 1083 patients with severe AWS, 66 RAW patients (n=33 BZD only, n=33 BZD plus propofol) met inclusion. Median time to AWS resolution was 5.0 and 7.0 days for BZD only vs. BZD plus propofol (p=0.025). Duration of mechanical ventilation, ICU and hospital length of stay were significantly higher with propofol (p=0.017, <0.001 and <0.001, respectively). Ten patients required intervention for management of propofol-induced adverse reactions. The addition of propofol for RAW treatment is associated with significant increases in clinical care. While randomized, prospective evaluations are necessary to determine the cause of this association, our data suggests use of adjunctive propofol therapy in RAW is associated with longer and more complicated hospital admissions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Escalation of Commitment in the Surgical ICU.

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    Braxton, Carla C; Robinson, Celia N; Awad, Samir S

    2017-04-01

    Escalation of commitment is a business term that describes the continued investment of resources into a project even after there is objective evidence of the project's impending failure. Escalation of commitment may be a contributor to high healthcare costs associated with critically ill patients as it has been shown that, despite almost certain futility, most ICU costs are incurred in the last week of life. Our objective was to determine if escalation of commitment occurs in healthcare settings, specifically in the surgical ICU. We hypothesize that factors previously identified in business and organizational psychology literature including self-justification, accountability, sunk costs, and cognitive dissonance result in escalation of commitment behavior in the surgical ICU setting resulting in increased utilization of resources and cost. A descriptive case study that illustrates common ICU narratives in which escalation of commitment can occur. In addition, we describe factors that are thought to contribute to escalation of commitment behaviors. Escalation of commitment behavior was observed with self-justification, accountability, and cognitive dissonance accounting for the majority of the behavior. Unlike in business decisions, sunk costs was not as evident. In addition, modulating factors such as personality, individual experience, culture, and gender were identified as contributors to escalation of commitment. Escalation of commitment occurs in the surgical ICU, resulting in significant expenditure of resources despite a predicted and often known poor outcome. Recognition of this phenomenon may lead to actions aimed at more rational decision making and may contribute to lowering healthcare costs. Investigation of objective measures that can help aid decision making in the surgical ICU is warranted.

  12. Rapid Deterioration of Basic Life Support Skills in Dentists With Basic Life Support Healthcare Provider.

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    Nogami, Kentaro; Taniguchi, Shogo; Ichiyama, Tomoko

    2016-01-01

    The aim of this study was to investigate the correlation between basic life support skills in dentists who had completed the American Heart Association's Basic Life Support (BLS) Healthcare Provider qualification and time since course completion. Thirty-six dentists who had completed the 2005 BLS Healthcare Provider course participated in the study. We asked participants to perform 2 cycles of cardiopulmonary resuscitation on a mannequin and evaluated basic life support skills. Dentists who had previously completed the BLS Healthcare Provider course displayed both prolonged reaction times, and the quality of their basic life support skills deteriorated rapidly. There were no correlations between basic life support skills and time since course completion. Our results suggest that basic life support skills deteriorate rapidly for dentists who have completed the BLS Healthcare Provider. Newer guidelines stressing chest compressions over ventilation may help improve performance over time, allowing better cardiopulmonary resuscitation in dental office emergencies. Moreover, it may be effective to provide a more specialized version of the life support course to train the dentists, stressing issues that may be more likely to occur in the dental office.

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

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    Daniel O Erim

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

  14. Healthcare

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

  15. Expediting evidence synthesis for healthcare decision-making: exploring attitudes and perceptions towards rapid reviews using Q methodology

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    Shannon E. Kelly

    2016-10-01

    Full Text Available Background Rapid reviews expedite the knowledge synthesis process with the goal of providing timely information to healthcare decision-makers who want to use evidence-informed policy and practice approaches. A range of opinions and viewpoints on rapid reviews is thought to exist; however, no research to date has formally captured these views. This paper aims to explore evidence producer and knowledge user attitudes and perceptions towards rapid reviews. Methods A Q methodology study was conducted to identify central viewpoints about rapid reviews based on a broad topic discourse. Participants rank-ordered 50 text statements and explained their Q-sort in free-text comments. Individual Q-sorts were analysed using Q-Assessor (statistical method: factor analysis with varimax rotation. Factors, or salient viewpoints on rapid reviews, were identified, interpreted and described. Results Analysis of the 11 individual Q sorts identified three prominent viewpoints: Factor A cautions against the use of study design labels to make judgements. Factor B maintains that rapid reviews should be the exception and not the rule. Factor C focuses on the practical needs of the end-user over the review process. Conclusion Results show that there are opposing viewpoints on rapid reviews, yet some unity exists. The three factors described offer insight into how and why various stakeholders act as they do and what issues may need to be resolved before increase uptake of the evidence from rapid reviews can be realized in healthcare decision-making environments.

  16. Integrating Low-Cost Rapid Usability Testing into Agile System Development of Healthcare IT: A Methodological Perspective.

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    Kushniruk, Andre W; Borycki, Elizabeth M

    2015-01-01

    The development of more usable and effective healthcare information systems has become a critical issue. In the software industry methodologies such as agile and iterative development processes have emerged to lead to more effective and usable systems. These approaches highlight focusing on user needs and promoting iterative and flexible development practices. Evaluation and testing of iterative agile development cycles is considered an important part of the agile methodology and iterative processes for system design and re-design. However, the issue of how to effectively integrate usability testing methods into rapid and flexible agile design cycles has remained to be fully explored. In this paper we describe our application of an approach known as low-cost rapid usability testing as it has been applied within agile system development in healthcare. The advantages of the integrative approach are described, along with current methodological considerations.

  17. A Rapid Review of the Factors Affecting Healthcare Students' Satisfaction with Small-Group, Active Learning Methods.

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    Kilgour, James M; Grundy, Lisa; Monrouxe, Lynn V

    2016-01-01

    PHENOMENON: Problem-based learning (PBL) and other small-group, active learning methodologies have been widely adopted into undergraduate and postgraduate healthcare curricula across the world. Although much research has examined student perceptions of these innovative teaching pedagogies, there are still questions over which factors influence these views. This article aims to identify these key elements that affect healthcare student satisfaction with PBL and other small-group learning methods, including case-based and team-based learning. A systematic rapid review method was used to identify high-quality original research papers from the healthcare education literature from between 2009 and 2014. All papers were critically appraised before inclusion in line with published guidelines. Narrative synthesis was achieved using an inductively developed, thematic framework approach. Fifty-four papers were included in the narrative synthesis. The evidence suggests that, despite an initial period of negative emotion and anxiety, the perspectives of healthcare students toward small-group, active learning methods are generally positive. The key factors influencing this satisfaction level include (a) the facilitator role, (b) tutorial structure, (c) individual student factors, (d) case authenticity, (e) increased feedback, (f) group harmony, and (g) resource availability. Insights: Student satisfaction is an important determinant of healthcare education quality, and the findings of this review may be of value in future curriculum design. The evidence described here suggests that an ideal curriculum may be based on an expert-led, hybrid PBL model.

  18. Assessment of Universal Healthcare Coverage in a District of North India: A Rapid Cross-Sectional Survey Using Tablet Computers.

    Science.gov (United States)

    Singh, Tarundeep; Roy, Pritam; Jamir, Limalemla; Gupta, Saurav; Kaur, Navpreet; Jain, D K; Kumar, Rajesh

    2016-01-01

    A rapid survey was carried out in Shaheed Bhagat Singh Nagar District of Punjab state in India to ascertain health seeking behavior and out-of-pocket health expenditures. Using multistage cluster sampling design, 1,008 households (28 clusters x 36 households in each cluster) were selected proportionately from urban and rural areas. Households were selected through a house-to-house survey during April and May 2014 whose members had (a) experienced illness in the past 30 days, (b) had illness lasting longer than 30 days, (c) were hospitalized in the past 365 days, or (d) had women who were currently pregnant or experienced childbirth in the past two years. In these selected households, trained investigators, using a tablet computer-based structured questionnaire, enquired about the socio-demographics, nature of illness, source of healthcare, and healthcare and household expenditure. The data was transmitted daily to a central server using wireless communication network. Mean healthcare expenditures were computed for various health conditions. Catastrophic healthcare expenditure was defined as more than 10% of the total annual household expenditure on healthcare. Chi square test for trend was used to compare catastrophic expenditures on hospitalization between households classified into expenditure quartiles. The mean monthly household expenditure was 15,029 Indian Rupees (USD 188.2). Nearly 14.2% of the household expenditure was on healthcare. Fever, respiratory tract diseases, gastrointestinal diseases were the common acute illnesses, while heart disease, diabetes mellitus, and respiratory diseases were the more common chronic diseases. Hospitalizations were mainly due to cardiovascular diseases, gastrointestinal problems, and accidents. Only 17%, 18%, 20% and 31% of the healthcare for acute illnesses, chronic illnesses, hospitalizations and childbirth was sought in the government health facilities. Average expenditure in government health facilities was 16.6% less

  19. Assessment of Universal Healthcare Coverage in a District of North India: A Rapid Cross-Sectional Survey Using Tablet Computers.

    Directory of Open Access Journals (Sweden)

    Tarundeep Singh

    Full Text Available A rapid survey was carried out in Shaheed Bhagat Singh Nagar District of Punjab state in India to ascertain health seeking behavior and out-of-pocket health expenditures.Using multistage cluster sampling design, 1,008 households (28 clusters x 36 households in each cluster were selected proportionately from urban and rural areas. Households were selected through a house-to-house survey during April and May 2014 whose members had (a experienced illness in the past 30 days, (b had illness lasting longer than 30 days, (c were hospitalized in the past 365 days, or (d had women who were currently pregnant or experienced childbirth in the past two years. In these selected households, trained investigators, using a tablet computer-based structured questionnaire, enquired about the socio-demographics, nature of illness, source of healthcare, and healthcare and household expenditure. The data was transmitted daily to a central server using wireless communication network. Mean healthcare expenditures were computed for various health conditions. Catastrophic healthcare expenditure was defined as more than 10% of the total annual household expenditure on healthcare. Chi square test for trend was used to compare catastrophic expenditures on hospitalization between households classified into expenditure quartiles.The mean monthly household expenditure was 15,029 Indian Rupees (USD 188.2. Nearly 14.2% of the household expenditure was on healthcare. Fever, respiratory tract diseases, gastrointestinal diseases were the common acute illnesses, while heart disease, diabetes mellitus, and respiratory diseases were the more common chronic diseases. Hospitalizations were mainly due to cardiovascular diseases, gastrointestinal problems, and accidents. Only 17%, 18%, 20% and 31% of the healthcare for acute illnesses, chronic illnesses, hospitalizations and childbirth was sought in the government health facilities. Average expenditure in government health facilities was

  20. Role of teleconsultation in moving the healthcare system forward.

    Science.gov (United States)

    Yusof, Khairuddin; Neoh, Karen Hong Beng; bin Hashim, Muhammad Arif; Ibrahim, Ishak

    2002-01-01

    The equitable access to quality healthcare by Malaysians has consistently been the primary objective of the Ministry of Health (MOH). The epidemiological transition to chronic illnesses, advances in medical technology, escalating healthcare costs and rising patient expectations has necessitated the strategic use of information systems in healthcare delivery. Malaysia has broken new ground by implementing a nationwide network to address inadequate access to healthcare, as well as to lower costs and achieve better health outcomes. Teleconsultation refers to the electronic transmission of medical information and services from one site to another using telecommunication technologies. This technology transforms the healthcare system by rapidly matching patient needs with the appropriate level of care however geographically remote they may be. Our findings suggest that even in these early stages of implementation, teleconsultation has led to cost savings, a more efficient allocation of resources, enhanced diagnostic options and better health outcomes.

  1. Rapid cross platform healthcare gaming design and implementation: The cost effective methodology.

    Science.gov (United States)

    Zhang, Melvyn W B; Ho, Roger C M

    2016-11-14

    There have been massive advances in E-Health and M-Health technology, with recent interest in the utility of games for healthcare and the promotion of well-being and recovery as well as patient empowerment. There has been various review demonstrating the clinical effectiveness and efficacy of games for healthcare. It is the aim of this technical note to illustrate how appropriate gaming engines could be used by non-expert clinicians to program games that could run across various platforms, as well as games that could integrate well with existing mechanical sensors. This would address the limitations with regards to the evidence base of games, as well as the limitations in the deployment of games to various participants. More importantly, games designed are also more likely to be cost-effective and lower in cost. The ability of integration with existing mechanical sensors would value-add existing games and enable recovery and remediation in various domains of health. This would further expand the potential of games as an adjunctive treatment for patients, or at least, to maintain the gains that they have made in their recovery process.

  2. What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings? A rapid evidence synthesis.

    Science.gov (United States)

    Clarke, David; Jones, Fiona; Harris, Ruth; Robert, Glenn

    2017-07-11

    Co-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings. To identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings. Rapid evidence synthesis. Medline, Cinahl, Web of Science, Embase, HMIC, Cochrane Database of Systematic Reviews, SCIE, Proquest Dissertation and Theses, EThOS, OpenGrey; CoDesign; The Design Journal; Design Issues. Studies reporting patient, staff or organisational outcomes associated with using co-production in an acute healthcare setting. 712 titles and abstracts were screened; 24 papers underwent full-text review, and 11 papers were included in the evidence synthesis. One study was a feasibility randomised controlled trial, three were process evaluations and seven used descriptive qualitative approaches. Reported outcomes related to (a) the value of patient and staff involvement in co-production processes; (b) the generation of ideas for changes to processes, practices and clinical environments; and (c) tangible service changes and impacts on patient experiences. Only one study included cost analysis; none reported an economic evaluation. No studies assessed the sustainability of any changes made. Despite increasing interest in and advocacy for co-production, there is a lack of rigorous evaluation in acute healthcare settings. Future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Potentially broader

  3. Rapid, low cost prototyping of transdermal devices for personal healthcare monitoring.

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    Sharma, Sanjiv; Saeed, Anwer; Johnson, Christopher; Gadegaard, Nikolaj; Cass, Anthony Eg

    2017-04-01

    The next generation of devices for personal healthcare monitoring will comprise molecular sensors to monitor analytes of interest in the skin compartment. Transdermal devices based on microneedles offer an excellent opportunity to explore the dynamics of molecular markers in the interstitial fluid, however good acceptability of these next generation devices will require several technical problems associated with current commercially available wearable sensors to be overcome. These particularly include reliability, comfort and cost. An essential pre-requisite for transdermal molecular sensing devices is that they can be fabricated using scalable technologies which are cost effective. We present here a minimally invasive microneedle array as a continuous monitoring platform technology. Method for scalable fabrication of these structures is presented. The microneedle arrays were characterised mechanically and were shown to penetrate human skin under moderate thumb pressure. They were then functionalised and evaluated as glucose, lactate and theophylline biosensors. The results suggest that this technology can be employed in the measurement of metabolites, therapeutic drugs and biomarkers and could have an important role to play in the management of chronic diseases.

  4. Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS: literature review and case series report

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    Langan Julie

    2012-11-01

    Full Text Available Abstract Background “Neuroleptic malignant syndrome” (NMS is a potentially fatal idiosyncratic reaction to any medication which affects the central dopaminergic system. Between 0.5% and 1% of patients exposed to antipsychotics develop the condition. Mortality rates may be as high as 55% and many risk factors have been reported. Although rapid escalation of antipsychotic dose is thought to be an important risk factor, to date it has not been the focus of a published case series or scientifically defined. Description We aimed to identify cases of NMS and review risk factors for its development with a particular focus on rapid dose escalation in the 30 days prior to onset. A review of the literature on rapid dose escalation was undertaken and a pragmatic definition of “rapid dose escalation” was made. NMS cases were defined using DSM-IV criteria and systematically identified within a secondary care mental health service. A ratio of titration rate was calculated for each NMS patient and “rapid escalators” and “non rapid escalators” were compared. 13 cases of NMS were identified. A progressive mean dose increase 15 days prior to the confirmed episode of NMS was observed (241.7 mg/day during days 1–15 to 346.9 mg/day during days 16–30 and the mean ratio of dose escalation for NMS patients was 1.4. Rapid dose escalation was seen in 5/13 cases and non rapid escalators had markedly higher daily cumulative antipsychotic dose compared to rapid escalators. Conclusions Rapid dose escalation occurred in less than half of this case series (n = 5, 38.5%, although there is currently no consensus on the precise definition of rapid dose escalation. Cumulative antipsychotic dose – alongside other known risk factors - may also be important in the development of NMS.

  5. An electronic trigger based on care escalation to identify preventable adverse events in hospitalised patients.

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    Bhise, Viraj; Sittig, Dean F; Vaghani, Viralkumar; Wei, Li; Baldwin, Jessica; Singh, Hardeep

    2017-09-21

    Methods to identify preventable adverse events typically have low yield and efficiency. We refined the methods of Institute of Healthcare Improvement's Global Trigger Tool (GTT) application and leveraged electronic health record (EHR) data to improve detection of preventable adverse events, including diagnostic errors. We queried the EHR data repository of a large health system to identify an 'index hospitalization' associated with care escalation (defined as transfer to the intensive care unit (ICU) or initiation of rapid response team (RRT) within 15 days of admission) between March 2010 and August 2015. To enrich the record review sample with unexpected events, we used EHR clinical data to modify the GTT algorithm and limited eligible patients to those at lower risk for care escalation based on younger age and presence of minimal comorbid conditions. We modified the GTT review methodology; two physicians independently reviewed eligible 'e-trigger' positive records to identify preventable diagnostic and care management events. Of 88 428 hospitalisations, 887 were associated with care escalation (712 ICU transfers and 175 RRTs), of which 92 were flagged as trigger-positive and reviewed. Preventable adverse events were detected in 41 cases, yielding a trigger positive predictive value of 44.6% (reviewer agreement 79.35%; Cohen's kappa 0.573). We identified 7 (7.6%) diagnostic errors and 34 (37.0%) care management-related events: 24 (26.1%) adverse drug events, 4 (4.3%) patient falls, 4 (4.3%) procedure-related complications and 2 (2.2%) hospital-associated infections. In most events (73.1%), there was potential for temporary harm. We developed an approach using an EHR data-based trigger and modified review process to efficiently identify hospitalised patients with preventable adverse events, including diagnostic errors. Such e-triggers can help overcome limitations of currently available methods to detect preventable harm in hospitalised patients. © Article

  6. Escalate shamefully, de-escalate angrily or gratefully: the influence of discrete emotions on escalation of commitment.

    Science.gov (United States)

    Dang, Junhua; Xiao, Shanshan; Liljedahl, Sophie

    2014-08-01

    Decision makers often tend to escalate their commitment when faced with a dilemma of whether to continue a losing course of action. Researchers recently began to investigate the influence of discrete emotions on this decision tendency. However, this work has mainly focused on negative emotions and rarely considered positive emotions, to say nothing of comparing the effects of both of them simultaneously. The current study addresses this need by presenting the results of three experiments that examined the effects of four emotions of both positive and negative valences in escalation situations. Experiment 1 investigated the relationships of three trait emotions (hope, shame, and anger) and escalation of commitment. Experiments 2 and 3 examined the effects of three induced emotions (anger, shame, and gratitude) on escalation of commitment in a student sample and an employee sample, respectively. The results revealed that the effects of discrete emotions in escalation situations are mainly due to their associated differences on the appraisal dimension of responsibility that is related to escalation situations rather than their valence. The theoretical and practical implications are discussed. © 2014 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

  7. Family initiated escalation of care for the deteriorating patient in hospital: Family centred care or just "box ticking".

    Science.gov (United States)

    Gill, Fenella J; Leslie, Gavin D; Marshall, Andrea P

    2016-11-01

    Family centred care is a shared belief that a child's emotional and developmental needs are best met when the health system involves the family in planning, delivery and evaluation of care. The important role that families contribute to health care outcomes is emphasised throughout the National Safety and Quality Healthcare Service (NSQHS) Standards. An emerging component is the family's contribution to Rapid Response Systems (RRS) through the early detection of patient clinical deterioration. This initiative has been driven, in part, by a number of high profile paediatric cases where it was identified that healthcare providers did not appropriately respond to families' concerns, resulting in patient deaths. This paper draws together the synergies between family centred care concepts, the NSQHS Standards, and the progress made to date in developing a family initiated process for escalating care with specific reference to paediatric acute care. A number of programs have been developed to guide implementation of family escalation of care. Measures of effectiveness of implementation have mainly focused on policy and process without first understanding barriers or facilitators through engagement with stakeholders and environmental assessment. Two recent reviews have not identified any rigorous attempts to evaluate implementation and only 11 reports are cited across these reviews to date. Evaluation of effectiveness of this complex intervention should take into account process measures of fidelity, dose and reach. There is also a need to assess the impact on families, particularly within a diverse cultural mix. An agreed definition for a paediatric RRS patient outcome measure is essential in evaluating the impact on patient safety and quality. Without this systematic evidence informed knowledge translation approach, then it would appear that progress in implementing family initiated deterioration of condition processes is more about meeting the NSQHS Standards - ticking

  8. Sensitivity of five rapid HIV tests on oral fluid or finger-stick whole blood: a real-time comparison in a healthcare setting.

    Directory of Open Access Journals (Sweden)

    Juliette Pavie

    Full Text Available BACKGROUND: Health authorities in several countries recently recommended the expansion of human immunodeficiency virus (HIV antibody testing, including the use of rapid tests. Several HIV rapid tests are now licensed in Europe but their sensitivity on total blood and/or oral fluid in routine healthcare settings is not known. METHODS AND FINDINGS: 200 adults with documented HIV-1 (n=194 or HIV-2 infection (n=6 were prospectively screened with five HIV rapid tests using either oral fluid (OF or finger-stick whole blood (FSB. The OraQuick Advance rapid HIV1/2 was first applied to OF and then to FSB, while the other tests were applied to FSB, in the following order: Vikia HIV 1/2, Determine HIV 1-2, Determine HIV-1/2 Ag/Ab Combo and INSTI HIV-1/HIV-2. Tests negative on FSB were repeated on paired serum samples. Twenty randomly selected HIV-seronegative subjects served as controls, and the results were read blindly. Most patients had HIV-1 subtype B infection (63.3% and most were on antiretroviral therapy (68.5%. Sensitivity was 86.5%, 94.5%, 98.5%, 94.9%, 95.8% and 99% respectively, with OraQuick OF, OraQuick FSB, Vikia, Determine, Determine Ag/Ab Combo and INSTI (p<0.0001. OraQuick was less sensitive on OF than on FSB (p=0.008. Among the six patients with three or more negative tests, two had recent HIV infection and four patients on antiretroviral therapy had undetectable plasma viral load. When patients positive in all the tests were compared with patients who had at least one negative test, only a plasma HIV RNA level<200 cp/ml was significantly associated with a false-negative result (p=0.009. When the 33 rapid tests negative on FSB were repeated on serum, all but six (5 negative with OraQuick, 1 with INSTI were positive. The sensitivity of OraQuick, Determine and Determine Ag/Ab Combo was significantly better on serum than on FSB (97.5%, p=0.04; 100%, p=0.004; and 100%, p=0.02, respectively. CONCLUSION: When evaluated in a healthcare setting

  9. Migration, Occupational Mobility, and Regional Escalators in Scotland

    Directory of Open Access Journals (Sweden)

    Maarten van Ham

    2012-01-01

    Full Text Available This paper seeks to unpick the complex relationship between an individual’s migration behaviour, their place of residence, and their occupational performance in the Scottish labour market between 1991 and 2001. We investigate whether Edinburgh has emerged as an occupational escalator region and whether individuals moving there experience more rapid upward occupational mobility than those living and moving elsewhere. Using country of birth, we also control for an individual’s propensity to make long distance moves during earlier periods of their life course. Using data from the Scottish Longitudinal Study, linking 1991 and 2001 individual census records, and logistic regressions, we show that those who migrate over long distances within or to Scotland are most likely to achieve upward occupational mobility. We also found that Edinburgh is by far the most important regional escalator in Scotland; those moving to Edinburgh are the most likely to experience upward occupational mobility from low to high occupational status jobs. This is an important finding as most of the literature on escalator regions focuses on international mega cities.

  10. Escalation Bias: Does It Extend to Marketing?

    OpenAIRE

    JS Armstrong; Nicole Coviello; Barbara Safranek

    2005-01-01

    Escalation bias implies that managers favor reinvestments in projects that are doing poorly over those doing well. We tested this implication in a marketing context by conducting experiments on advertising and product-design decisions. Each situation was varied to reflect either a long-term or a short-term decision. Besides these four conditions, we conducted three replications. We found little evidence of escalation bias by 365 subjects in the seven experimental comparisons.

  11. Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review

    Directory of Open Access Journals (Sweden)

    Sergio Garbarino

    2016-08-01

    Full Text Available Sleep disorders are frequent (18%–23% and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.

  12. Pressure applied by the healthcare staff on a cricoids cartilage simulator during Sellick's maneuver in rapid sequence intubation

    NARCIS (Netherlands)

    J.A. Calvache (Jose Andrés); L.C.B. Sandoval (Luz); W.A. Vargas (William Andres)

    2013-01-01

    textabstractBackground: Sellick's maneuver or cricoid pressure is a strategy used to prevent bronchoaspiration during the rapid intubation sequence. Several studies have described that the force required for an adequate maneuver is of 2.5-3.5 kg. The purpose of this paper was to determine the force

  13. Application of a Healthcare Failure Modes and Effects Analysis to Identify and Mitigate Potential Risks in the Implementation of a National Prehospital Pediatric Rapid Sequence Intubation Program.

    Science.gov (United States)

    Howard, Ian; Castle, Nicholas; Al Shaikh, Loua Asad

    2017-12-15

    Rapid sequence intubation (RSI) has become the de facto airway method of choice in the emergency airway management of adult and pediatric patients. There is significant controversy regarding pediatric RSI in the prehospital setting, given not only the complexities inherent in both the procedure and patient population, but in variations in emergency medical service models, prehospital qualifications, scope of practice, and patient exposure too. A Healthcare Failure Mode and Effects Analysis was conducted to identify and mitigate potential hazards in the national implementation of a prehospital pediatric RSI program. A process map and potential failure points were developed and identified. Probabilities, severity, and hazards scores were calculated for each failure point, and actions items developed to address these. One hundred four potential failure points were identified among 44 subprocesses, divided between nine major processes. In terms of severity, most were classified as either major (n = 39 [37.5%]) or catastrophic (n = 35 [33.7%]) with just more than half falling within the uncommon category (n = 56 [53.9%]) in terms of probability. Five strategic actions items were identified to mitigate against the failure points meeting criteria for action. To monitor the success of these, 11 quality and performance indicators were developed for concurrent implementation. The Healthcare Failure Mode and Effects Analysis represents a simple yet comprehensive first step toward risk analysis of complex procedures within the prehospital emergency care setting. Application of the methodology provided guidance for the consensus identification of hazards associated with prehospital pediatric RSI and appropriate actions to mitigate them.

  14. Cross-cultural adaptation of an environmental health measurement instrument: Brazilian version of the health-care waste management • rapid assessment tool.

    Science.gov (United States)

    Cozendey-Silva, Eliana Napoleão; da Silva, Cintia Ribeiro; Larentis, Ariane Leites; Wasserman, Julio Cesar; Rozemberg, Brani; Teixeira, Liliane Reis

    2016-09-05

    Periodic assessment is one of the recommendations for improving health-care waste management worldwide. This study aimed at translating and adapting the Health-Care Waste Management - Rapid Assessment Tool (HCWM-RAT), proposed by the World Health Organization, to a Brazilian Portuguese version, and resolving its cultural and legal issues. The work focused on the evaluation of the concepts, items and semantic equivalence between the original tool and the Brazilian Portuguese version. A cross-cultural adaptation methodology was used, including: initial translation to Brazilian Portuguese; back translation to English; syntheses of these translation versions; formation of an expert committee to achieve consensus about the preliminary version; and evaluation of the target audience's comprehension. Both the translated and the original versions' concepts, items and semantic equivalence are presented. The constructs in the original instrument were considered relevant and applicable to the Brazilian context. The Brazilian version of the tool has the potential to generate indicators, develop official database, feedback and subsidize political decisions at many geographical and organizational levels strengthening the Monitoring and evaluation (M&E) mechanism. Moreover, the cross-cultural translation expands the usefulness of the instrument to Portuguese-speaking countries in developing regions. The translated and original versions presented concept, item and semantic equivalence and can be applied to Brazil.

  15. Cross-cultural adaptation of an environmental health measurement instrument: Brazilian version of the health-care waste management • rapid assessment tool

    Directory of Open Access Journals (Sweden)

    Eliana Napoleão Cozendey-Silva

    2016-09-01

    Full Text Available Abstract Background Periodic assessment is one of the recommendations for improving health-care waste management worldwide. This study aimed at translating and adapting the Health-Care Waste Management - Rapid Assessment Tool (HCWM-RAT, proposed by the World Health Organization, to a Brazilian Portuguese version, and resolving its cultural and legal issues. The work focused on the evaluation of the concepts, items and semantic equivalence between the original tool and the Brazilian Portuguese version. Methods A cross-cultural adaptation methodology was used, including: initial translation to Brazilian Portuguese; back translation to English; syntheses of these translation versions; formation of an expert committee to achieve consensus about the preliminary version; and evaluation of the target audience’s comprehension. Results Both the translated and the original versions’ concepts, items and semantic equivalence are presented. The constructs in the original instrument were considered relevant and applicable to the Brazilian context. The Brazilian version of the tool has the potential to generate indicators, develop official database, feedback and subsidize political decisions at many geographical and organizational levels strengthening the Monitoring and evaluation (M&E mechanism. Moreover, the cross-cultural translation expands the usefulness of the instrument to Portuguese-speaking countries in developing regions. Conclusion The translated and original versions presented concept, item and semantic equivalence and can be applied to Brazil

  16. Acceptability Among Community Healthcare Nurses of Intelligent Wireless Sensor-system Technology for the Rapid Detection of Health Issues in Home-dwelling Older Adults.

    Science.gov (United States)

    Cohen, Christine; Kampel, Thomas; Verloo, Henk

    2017-01-01

    The effective care and support of community healthcare nurses (CHNs) contribute greatly to the healthy aging of older adults living at home. Integrating innovative technologies into CHNs' daily practice offers new opportunities and perspectives for early detection of health issues and interventions among home-dwelling older adults. To explore the perception of acceptability among CHNs of an intelligent wireless sensor system (IWSS) for use in daily practice for the detection of health issues in home-dwelling older adults receiving home healthcare. Descriptive and qualitative data were sourced from a pilot randomized controlled trial involving 17 CHNs using an IWSS in their daily practice to rapidly detect falls and other health issues in patients' homes. IWSS alerts indicating behavior changes were sent to CHNs. Their perceived usefulness (PU) and perceived ease of use (PEOU) were assessed. The acceptability of IWSS technology was explored using a questionnaire and focus group discussions. The PU and PEOU of the IWSS technology were low to moderate. A majority of the CHNs were dissatisfied with its performance and intrusiveness; they reported multiple obstacles in the usefulness and ease of use of the IWSS technology in daily practice. To improve the IWSS technology's low to moderate acceptability among CHNs, we recommend a more user-centered implementation strategy and an embedded model of nursing care.

  17. Early warning scores: unravelling detection and escalation.

    Science.gov (United States)

    Smith, Gary B; Prytherch, David R; Meredith, Paul; Schmidt, Paul E

    2015-01-01

    The purpose of this paper is to increase understanding of how patient deterioration is detected and how clinical care escalates when early warning score (EWS) systems are used. The authors critically review a recent National Early Warning Score paper published in IJHCQA using personal experience and EWS-related publications, and debate the difference between detection and escalation. Incorrect EWS choice or poorly understood EWS escalation may result in unnecessary workloads forward and responding staff. EWS system implementers may need to revisit their guidance materials; medical and nurse educators may need to expand the curriculum to improve EWS system understanding and use. The paper raises the EWS debate and alerts EWS users that scrutiny is required.

  18. Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review

    Science.gov (United States)

    Quach, Pauline; Hamel, Candyce; Thavorn, Kednapa; Garritty, Chantelle; Skidmore, Becky; Vallenas, Constanza; Norris, Susan L.; Egger, Matthias; Eremin, Sergey; Ferri, Mauricio; Shindo, Nahoko; Moher, David

    2015-01-01

    Background A rapid review, guided by a protocol, was conducted to inform development of the World Health Organization’s guideline on personal protective equipment in the context of the ongoing (2013–present) Western African filovirus disease outbreak, with a focus on health care workers directly caring for patients with Ebola or Marburg virus diseases. Methods Electronic databases and grey literature sources were searched. Eligibility criteria initially included comparative studies on Ebola and Marburg virus diseases reported in English or French, but criteria were expanded to studies on other viral hemorrhagic fevers and non-comparative designs due to the paucity of studies. After title and abstract screening (two people to exclude), full-text reports of potentially relevant articles were assessed in duplicate. Fifty-seven percent of extraction information was verified. The Grading of Recommendations Assessment, Development and Evaluation framework was used to inform the quality of evidence assessments. Results Thirty non-comparative studies (8 related to Ebola virus disease) were located, and 27 provided data on viral transmission. Reporting of personal protective equipment components and infection prevention and control protocols was generally poor. Conclusions Insufficient evidence exists to draw conclusions regarding the comparative effectiveness of various types of personal protective equipment. Additional research is urgently needed to determine optimal PPE for health care workers caring for patients with filovirus. PMID:26451847

  19. Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review.

    Directory of Open Access Journals (Sweden)

    Mona Hersi

    Full Text Available A rapid review, guided by a protocol, was conducted to inform development of the World Health Organization's guideline on personal protective equipment in the context of the ongoing (2013-present Western African filovirus disease outbreak, with a focus on health care workers directly caring for patients with Ebola or Marburg virus diseases.Electronic databases and grey literature sources were searched. Eligibility criteria initially included comparative studies on Ebola and Marburg virus diseases reported in English or French, but criteria were expanded to studies on other viral hemorrhagic fevers and non-comparative designs due to the paucity of studies. After title and abstract screening (two people to exclude, full-text reports of potentially relevant articles were assessed in duplicate. Fifty-seven percent of extraction information was verified. The Grading of Recommendations Assessment, Development and Evaluation framework was used to inform the quality of evidence assessments.Thirty non-comparative studies (8 related to Ebola virus disease were located, and 27 provided data on viral transmission. Reporting of personal protective equipment components and infection prevention and control protocols was generally poor.Insufficient evidence exists to draw conclusions regarding the comparative effectiveness of various types of personal protective equipment. Additional research is urgently needed to determine optimal PPE for health care workers caring for patients with filovirus.

  20. Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings

    Science.gov (United States)

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

    2017-01-01

    Objectives To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia. Design Analysisof nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study). Setting Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda. Participants 522 480 children and adults with acute febrile illness. Interventions Rapid diagnostic tests for malaria. Main outcome measures Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings. Results Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole. Conclusions Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials—a beneficial public health outcome—could drive up

  1. Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings.

    Science.gov (United States)

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

    2017-03-29

    Objectives  To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia. Design  Analysisof nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study). Setting  Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda. Participants  522 480 children and adults with acute febrile illness. Interventions  Rapid diagnostic tests for malaria. Main outcome measures  Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings. Results  Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole. Conclusions  Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials-a beneficial public health outcome-could drive

  2. Neurobiology of escalated aggression and violence

    NARCIS (Netherlands)

    Miczek, Klaus A.; de Almeida, Rosa M. M.; Kravitz, Edward A.; Rissman, Emilie F.; de Boer, Sietse F.; Raine, Adrian

    2007-01-01

    Psychopathological violence in criminals and intense aggression in fruit flies and rodents are studied with novel behavioral, neurobiological, and genetic approaches that characterize the escalation from adaptive aggression to violence. One goal is to delineate the type of aggressive behavior and

  3. Elephant invasion and escalated depletion of environmental ...

    African Journals Online (AJOL)

    For decades, elephants' invasion is known to be associated with severe environmental consequences leading to escalated depletion o environmental resources (plants, water, wildlife and soil). This paper examined the effects of elephants' activity on the environmental resources inHong and Gombi Local Government areas ...

  4. Flunking Kindergarten: Escalating Curriculum Leaves Many Behind.

    Science.gov (United States)

    Shepard, Lorrie A.; Smith, Mary Lee

    1988-01-01

    Study of kindergarten retention in Colorado reveals the following: (1) kindergarten retention does nothing to boost subsequent academic achievement; (2) regardless of what it is called, kindergarten retention creates a social stigma; and (3) kindergarten retention feeds the escalation of inappropriate academic demand in first grade. Policy…

  5. Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Jaya, Ziningi; Drain, Paul K; Mashamba-Thompson, Tivani P

    2017-01-01

    Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa. We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic's compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor). A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05. Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2%) of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics' average rating score for compliance to the WHO guidelines ranged between 64.4% (CI

  6. Neurobiology of Escalated Aggression and Violence

    Science.gov (United States)

    Miczek, Klaus A.; de Almeida, Rosa M. M.; Kravitz, Edward A.; Rissman, Emilie F.; de Boer, Sietse F.; Raine, Adrian

    2009-01-01

    Psychopathological violence in criminals and intense aggression in fruit flies and rodents are studied with novel behavioral, neurobiological, and genetic approaches that characterize the escalation from adaptive aggression to violence. One goal is to delineate the type of aggressive behavior and its escalation with greater precision; second, the prefrontal cortex (PFC) and brainstem structures emerge as pivotal nodes in the limbic circuitry mediating escalated aggressive behavior. The neurochemical and molecular work focuses on the genes that enable invertebrate aggression in males and females and genes that are expressed or suppressed as a result of aggressive experiences in mammals. The fruitless gene, immediate early genes in discrete serotonin neurons, or sex chromosome genes identify sexually differentiated mechanisms for escalated aggression. Male, but not female, fruit flies establish hierarchical relationships in fights and learn from previous fighting experiences. By manipulating either the fruitless or transformer genes in the brains of male or female flies, patterns of aggression can be switched with males using female patterns and vice versa. Work with Sts or Sry genes suggests so far that other genes on the X chromosomes may have a more critical role in female mouse aggression. New data from feral rats point to the regulatory influences on mesocortical serotonin circuits in highly aggressive animals via feedback to autoreceptors and via GABAergic and glutamatergic inputs. Imaging data lead to the hypothesis that antisocial, violent, and psychopathic behavior may in part be attributable to impairments in some of the brain structures (dorsal and ventral PFC, amygdala, and angular gyrus) subserving moral cognition and emotion. PMID:17978016

  7. De-Escalating the IT-Projects

    Directory of Open Access Journals (Sweden)

    Ghulam Muhammad Kundi

    2007-12-01

    Full Text Available Escalation stickins with an ailing project beyond rational justifications. This happens because in the face of negative feedback, decision makers are strangled between whether to stick with or quit the dying project. Environmental uncertainty has been identified as the root cause of the escalatory behavior. This uncertainty emanates from several sources relating to individual, group, organization and broader environmental factors. This paper argues the premise that effective communication can help create an environment whereby workforce can develop an organized action thereby distributing the responsibility across the whole workforce and not the individuals – leading to the possible reduction of escalatory behavior in IT projects.

  8. De-escalating and escalating treatments for early-stage breast cancer

    DEFF Research Database (Denmark)

    Curigliano, G; Burstein, H J; P Winer, E

    2017-01-01

    The 15th St. Gallen International Breast Cancer Conference 2017 in Vienna, Austria reviewed substantial new evidence on loco-regional and systemic therapies for early breast cancer. Treatments were assessed in light of their intensity, duration and side-effects, seeking where appropriate to escal...

  9. Dose escalation of a curcuminoid formulation

    Directory of Open Access Journals (Sweden)

    Crowell James

    2006-03-01

    Full Text Available Abstract Background Curcumin is the major yellow pigment extracted from turmeric, a commonly-used spice in India and Southeast Asia that has broad anticarcinogenic and cancer chemopreventive potential. However, few systematic studies of curcumin's pharmacology and toxicology in humans have been performed. Methods A dose escalation study was conducted to determine the maximum tolerated dose and safety of a single dose of standardized powder extract, uniformly milled curcumin (C3 Complex™, Sabinsa Corporation. Healthy volunteers were administered escalating doses from 500 to 12,000 mg. Results Seven of twenty-four subjects (30% experienced only minimal toxicity that did not appear to be dose-related. No curcumin was detected in the serum of subjects administered 500, 1,000, 2,000, 4,000, 6,000 or 8,000 mg. Low levels of curcumin were detected in two subjects administered 10,000 or 12,000 mg. Conclusion The tolerance of curcumin in high single oral doses appears to be excellent. Given that achieving systemic bioavailability of curcumin or its metabolites may not be essential for colorectal cancer chemoprevention, these findings warrant further investigation for its utility as a long-term chemopreventive agent.

  10. Tobacco and the Escalating Global Cancer Burden

    Directory of Open Access Journals (Sweden)

    Richard F. Oppeltz

    2011-01-01

    Full Text Available The global burden of cancer is escalating as a result of dramatic increases in the use of tobacco in the developing world. The use of tobacco is linked to the development of a broad variety of cancers, mainly lung cancer, the single most common cancer in the world. Tobacco smoking-attributable deaths extends beyond cancer and include stroke, heart attack and COPD. Widening disparities in cancer-related mortality have shifted towards a more dramatic burden in the developing world. Appropriate interventions must be implemented to reduce tobacco use and prevent global mortality that has escalated to epidemic levels. Tobacco control policies, including public health advertisement campaigns, warning labels, adoption of smoke-free laws, comprehensive bans and tax policies are highly effective measures to control tobacco use. Clinicians and academic institutions have to be actively committed to support tobacco control initiatives. The reduction in cancer related morbidity and mortality should be viewed as a global crisis and definitive results will depend on a multilevel effort to effectively reduce the burden of cancer, particularly in underprivileged regions of the world.

  11. MARKETING PLANNING IN HEALTHCARE INDUSTRY

    Directory of Open Access Journals (Sweden)

    Bobeica Ana Amaria

    2013-04-01

    Full Text Available The purpose of this paper is to develop a perspective on what is important or critical to the discipline of healthcare marketing by analyzing the marketing plan from the institutional (or organizational perspective. This “salience issue” is complicated by the structural problems in healthcare such as new advertising programs, advances in medical technology, and the escalating costs of care in the recent economic situation of world economic crisis. Reviewing a case study, the paper examines how marketing managers face increasingly difficult management and it emphasizes one more time the importance of marketing in the internal organizational structure. Also it shows the direct connection between the marketing strategy, the Quality of Healthcare and marketing planning in the internal organization of Private Healthcare Practice in Romania. Also it concludes that marketing planning in healthcare has to be very precised in order to achieve some major objectives: customer care, financial stability, equilibrium between stakeholders and shareholders and future improvement in communication to customers. The marketing strategies and programs discussed in this paper follow the analysis of the 4Ps of Healthcare Marketing Services and propose call to action plans and possibilities that might result in a more particular case study analysis of the Romanian Healthcare Market.

  12. Apps for hearing healthcare.

    Science.gov (United States)

    Paglialonga, Alessia; Tognola, Gabriella; Pinciroli, Francesco

    2015-01-01

    The hearing healthcare scenario is rapidly evolving due to the pervasive use of m-Health solutions, in particular mobile apps. This brings along significant advantages and opportunities (e.g., accessibility, affordability, personalized healthcare, patient empowerment) as well as significant potential risks and threats (e.g., safety, misuse, quality issues, privacy). Our research aims at the identification and assessment of apps in the hearing healthcare domain. In this article we present an overview of the current availability, variety, and penetration of hearing-related apps.

  13. Causal loop diagrams as a de-escalation technique

    NARCIS (Netherlands)

    Pala, O.; Vriens, D.J.; Vennix, J.A.M.

    2015-01-01

    Escalation of commitment, the tendency of decision makers to keep on investing in losing courses of action, has been shown to be a costly decision bias that affects many areas of decision making. Even though escalation is a widely studied phenomenon, there has been comparatively little research on

  14. Strategy Escalation: An emerging paradigm for safe clinical development of T cell gene therapies

    Directory of Open Access Journals (Sweden)

    Junghans Richard

    2010-06-01

    Full Text Available Abstract Gene therapy techniques are being applied to modify T cells with chimeric antigen receptors (CARs for therapeutic ends. The versatility of this platform has spawned multiple options for their application with new permutations in strategies continually being invented, a testimony to the creative energies of many investigators. The field is rapidly expanding with immense potential for impact against diverse cancers. But this rapid expansion, like the Big Bang, comes with a somewhat chaotic evolution of its therapeutic universe that can also be dangerous, as seen by recently publicized deaths. Time-honored methods for new drug testing embodied in Dose Escalation that were suitable for traditional inert agents are now inadequate for these novel "living drugs". In the following, I propose an approach to escalating risk for patient exposures with these new immuno-gene therapy agents, termed Strategy Escalation, that accounts for the molecular and biological features of the modified cells and the methods of their administration. This proposal is offered not as a prescriptive but as a discussion framework that investigators may wish to consider in configuring their intended clinical applications.

  15. A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol.

    Science.gov (United States)

    Cohen, Deborah J; Balasubramanian, Bijal A; Gordon, Leah; Marino, Miguel; Ono, Sarah; Solberg, Leif I; Crabtree, Benjamin F; Stange, Kurt C; Davis, Melinda; Miller, William L; Damschroder, Laura J; McConnell, K John; Creswell, John

    2016-06-29

    The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to those with fewer than ten physicians per clinic). Examples of external support include practice facilitation, expert consultation, performance feedback, and educational materials and activities. This paper describes the study protocol for the EvidenceNOW national evaluation, which is called Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES). This prospective observational study will examine the portfolio of EvidenceNOW Cooperatives using both qualitative and quantitative data. Qualitative data include: online implementation diaries, observation and interviews at Cooperatives and practices, and systematic assessment of context from the perspective of Cooperative team members. Quantitative data include: practice-level performance on clinical quality measures (aspirin prescribing, blood pressure and cholesterol control, and smoking cessation; ABCS) collected by Cooperatives from electronic health records (EHRs); practice and practice member surveys to assess practice capacity and other organizational and structural characteristics; and systematic tracking of intervention delivery. Quantitative, qualitative, and mixed methods analyses will be conducted to examine how Cooperatives organize to provide external support to practices, to compare effectiveness of the dissemination and implementation approaches they implement, and to examine how regional variations and other organization and contextual factors influence implementation and effectiveness. ESCALATES is

  16. Efficient healthcare logistics with a human touch

    NARCIS (Netherlands)

    van de Vrugt, Noëlle Maria

    2016-01-01

    Despite the long experienced urgency of rapidly increasing healthcare expenditures, there is still a large potential to improve hospitals' logistical efficiency. Operations Research (OR) methodologies may support healthcare professionals in making better decisions concerning planning and capacity

  17. Escalator-related injuries in 30 dogs (2007-2014).

    Science.gov (United States)

    Pearson, Emma-Leigh; Whelan, Megan; Bracker, Kiko

    2017-07-01

    To describe a population of dogs affected by escalator-related injuries, and to characterize the types of injuries sustained and describe treatment administered. Retrospective study from March 2007 to November 2014. Large urban referral and emergency facility. Thirty client-owned dogs presenting with injuries acquired while riding an escalator. None. All injuries in this study occurred secondary to entrapment of 1 or more paws in the moving parts of an escalator; 39 paws were injured in total. The median body weight of the patients in this study was 4.25 kg, with 73.3% of the patients weighing less than 10 kg. Fifteen patients (50.0%) were treated surgically, the remainder were managed conservatively. Eight patients (26.7%) underwent digit or partial-digit amputation. Of the conservatively managed patients, 10 were treated with bandaging of the wounds. Antimicrobials, opiate analgesics, and nonsteroidal anti-inflammatory drugs were administered in both surgically and conservatively managed patients. While uncommon, escalator accidents can result in significant injury to dogs. Measures can be taken to prevent these injuries from occurring, whether through client education, dog training, structural modifications in the escalators themselves, or avoidance of escalators. In the present study, the survival rate of dogs injured on escalators was 100%. © Veterinary Emergency and Critical Care Society 2017.

  18. Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study.

    Science.gov (United States)

    Kaplovitch, Eric; Gomes, Tara; Camacho, Ximena; Dhalla, Irfan A; Mamdani, Muhammad M; Juurlink, David N

    2015-01-01

    The use of opioids for noncancer pain is widespread, and more than 16,000 die of opioid-related causes in the United States annually. The patients at greatest risk of death are those receiving high doses of opioids. Whether sex influences the risk of dose escalation or opioid-related mortality is unknown. We conducted a cohort study using healthcare records of 32,499 individuals aged 15 to 64 who commenced chronic opioid therapy for noncancer pain between April 1, 1997 and December 31, 2010 in Ontario, Canada. Patients were followed from their first opioid prescription until discontinuation of therapy, death from any cause or the end of the study period. Among patients receiving chronic opioid therapy, 589 (1.8%) escalated to high dose therapy and n = 59 (0.2%) died of opioid-related causes while on treatment. After multivariable adjustment, men were more likely than women to escalate to high-dose opioid therapy (adjusted hazard ratio 1.44; 95% confidence interval 1.21 to 1.70) and twice as likely to die of opioid-related causes (adjusted hazard ratio 2.04; 95% confidence interval 1.18 to 3.53). These associations were maintained in a secondary analysis of 285,520 individuals receiving any opioid regardless of the duration of therapy. Men are at higher risk than women for escalation to high-dose opioid therapy and death from opioid-related causes. Both outcomes were more common than anticipated.

  19. Agricultural intensification escalates future conservation costs

    Science.gov (United States)

    Phelps, Jacob; Carrasco, Luis Roman; Webb, Edward L.; Koh, Lian Pin; Pascual, Unai

    2013-01-01

    The supposition that agricultural intensification results in land sparing for conservation has become central to policy formulations across the tropics. However, underlying assumptions remain uncertain and have been little explored in the context of conservation incentive schemes such as policies for Reducing Emissions from Deforestation and forest Degradation, conservation, sustainable management, and enhancement of carbon stocks (REDD+). Incipient REDD+ forest carbon policies in a number of countries propose agricultural intensification measures to replace extensive “slash-and-burn” farming systems. These may result in conservation in some contexts, but will also increase future agricultural land rents as productivity increases, creating new incentives for agricultural expansion and deforestation. While robust governance can help to ensure land sparing, we propose that conservation incentives will also have to increase over time, tracking future agricultural land rents, which might lead to runaway conservation costs. We present a conceptual framework that depicts these relationships, supported by an illustrative model of the intensification of key crops in the Democratic Republic of Congo, a leading REDD+ country. A von Thünen land rent model is combined with geographic information systems mapping to demonstrate how agricultural intensification could influence future conservation costs. Once postintensification agricultural land rents are considered, the cost of reducing forest sector emissions could significantly exceed current and projected carbon credit prices. Our analysis highlights the importance of considering escalating conservation costs from agricultural intensification when designing conservation initiatives. PMID:23589860

  20. E-commerce in healthcare: changing the traditional landscape.

    Science.gov (United States)

    Aggarwal, A K; Travers, S

    2001-01-01

    The healthcare industry, with more than one trillion dollars in revenue, accounts for about one-seventh of the U.S. economy. A significant portion of this revenue is lost to escalating healthcare system costs. This article examines the shortcomings of the traditional healthcare delivery system in terms of information flow, communication standards, case collections, and IT spending. It makes the case that e-commerce has the ability to transact some healthcare business more efficiently and cost-effectively. With the Internet as a delivery platform, several models offer improvement over the status quo.

  1. Metaniche session 2016: Tailor-made sensors for rapid Therapeutic Drug Monitoring?Interactions between Biomaterial Physicists, Chemical Engineers and Clinicians for successful translation of technologies in Healthcare

    OpenAIRE

    Yoshimi Y; Pushkala S; Vijaykumar H; Dedeepiya VD; Ignacy A; Swaminathan J; Rajmohan M; Karthick R; Abraham SJ

    2016-01-01

    The Metaniche session is an academic session conducted as a part of Nichi-In Centre for Regenerative Medicine (NCRM)’s novel Initiatives' Conclave in Healthcare Every year (NICHE), the ‘NCRM NICHE’ organized every year in the month of October by Nichi-In Centre for Regenerative Medicine (NCRM), an Indo-Japan academic Institute based at Chennai, India. The Metaniche session aims to bring together the realms of Physics, Chemistry and Biology by portraying inventions or discoveries in physical a...

  2. Mobile healthcare.

    Science.gov (United States)

    Morgan, Stephen A; Agee, Nancy Howell

    2012-01-01

    Mobile technology's presence in healthcare has exploded over the past five years. The increased use of mobile devices by all segments of the US population has driven healthcare systems, providers, and payers to accept this new form of communication and to develop strategies to implement and leverage the use of mobile healthcare (mHealth) within their organizations and practices. As healthcare systems move toward a more value-driven model of care, patient centeredness and engagement are the keys to success. Mobile healthcare will provide the medium to allow patients to participate more in their care. Financially, mHealth brings to providers the ability to improve efficiency and deliver savings to both them and the healthcare consumer. However, mHealth is not without challenges. Healthcare IT departments have been reluctant to embrace this shift in technology without fully addressing security and privacy concerns. Providers have been hesitant to adopt mHealth as a form of communication with patients because it breaks with traditional models. Our healthcare system has just started the journey toward the development of mHealth. We offer an overview of the mobile healthcare environment and our approach to solving the challenges it brings to healthcare organizations.

  3. De-escalation techniques for psychosis-induced aggression or agitation.

    Science.gov (United States)

    Du, Maolin; Wang, Xuemei; Yin, Shaohua; Shu, Wei; Hao, Ruiqi; Zhao, Sai; Rao, Harish; Yeung, Wan-Ley; Jayaram, Mahesh B; Xia, Jun

    2017-04-03

    Aggression is a disposition, a willingness to inflict harm, regardless of whether this is behaviourally or verbally expressed and regardless of whether physical harm is sustained.De-escalation is a psychosocial intervention for managing people with disturbed or aggressive behaviour. Secondary management strategies such as rapid tranquillisation, physical intervention and seclusion should only be considered once de-escalation and other strategies have failed to calm the service user. To investigate the effects of de-escalation techniques in the short-term management of aggression or agitation thought or likely to be due to psychosis. We searched Cochrane Schizophrenia Group's Study-Based Register of Trials (latest search 7 April, 2016). Randomised controlled trials using de-escalation techniques for the short-term management of aggressive or agitated behaviour. We planned to include trials involving adults (at least 18 years) with a potential for aggressive behaviour due to psychosis, from those in a psychiatric setting to those possibly under the influence of alcohol or drugs and/or as part of an acute setting as well. We planned to include trials meeting our inclusion criteria that provided useful data. We used the standard methodological procedures expected by Cochrane. Two review authors inspected all abstracts of studies identified by the search process. As we were unable to include any studies, we could not perform data extraction and analysis. Of the 345 citations that were identified using the search strategies, we found only one reference to be potentially suitable for further inspection. However, after viewing the full text, it was excluded as it was not a randomised controlled trial. Using de-escalation techniques for people with psychosis induced aggression or agitation appears to be accepted as good clinical practice but is not supported by evidence from randomised trials. It is unclear why it has remained such an under-researched area. Conducting

  4. School District Health Care Expense: Moderating the Escalation Rate.

    Science.gov (United States)

    Abel, Gene P.

    1991-01-01

    The cafeteria plan for health insurance benefits employers by reducing the overall escalation of health costs. Employees benefit by tailoring their benefit packages to their needs to including the option to decline coverage because of spouse employment. (MLF)

  5. Effective ingredients of verbal de-escalation: validating an English modified version of the 'De-Escalating Aggressive Behaviour Scale'.

    Science.gov (United States)

    Mavandadi, V; Bieling, P J; Madsen, V

    2016-08-01

    WHAT IS KNOWN ON THE SUBJECT?: Verbal de-escalation is an intervention aimed at calmly managing an agitated client to prevent violence. Effective de-escalation can help reduce the use of seclusion and restraint in psychiatric settings. Despite its importance in practice, there is little agreement on the necessary techniques of de-escalation and most of the research on the topic is based on expert opinion. To our knowledge, only one attempt at quantifying de-escalation skill has been pursued through the German-language De-Escalating Aggressive Behaviour Scale (DABS). While the DABS identified seven qualities necessary for de-escalation, it has not been validated in English and may lack important descriptors. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The present study enhanced the original DABS with best, acceptable and least desirable staff de-escalation practice descriptions for each of the seven items. This enhancement of the DABS lead to the creation of the English modified DABS (EMDABS). The EMDABS was psychometrically validated for use in research and practice: raters could use the EMDABS with a high level of agreement and consistency. Also, the scale appeared to measure a single cohesive construct - de-escalation. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: With further validation, the EMDABS has potential to be the first English quantitative measure of de-escalation. The EMDABS offers seven items, with associated best practice descriptions, that may be used to inform de-escalation practice. The EMDABS can be used to evaluate training and education programmes and inform how these programmes and independent de-escalation practice may be improved. Introduction Verbal de-escalation is crucial to a non-coercive psychiatric environment. Despite its importance, the literature on de-escalation is sparse and mostly qualitative. To address this, Nau et al. (2009) quantified de-escalation by creating the German-language De-Escalating Aggressive Behaviour Scale (DABS

  6. De-escalating Antibiotic Use in the Inpatient Setting: Strategies, Controversies, and Challenges.

    Science.gov (United States)

    Daniel Markley, J; Bernard, Shaina; Bearman, Gonzalo; Stevens, Michael P

    2017-04-01

    Antibiotic de-escalation (ADE) is widely accepted as an integral strategy to curtail the global antibiotic resistance crisis. However, there is significant uncertainty regarding the ideal ADE strategy and its true impact on antibiotic resistance. Rapid diagnostic testing has the potential to enhance ADE strategies. Herein, we aim to discuss the current strategies, controversies, and challenges of ADE in the inpatient setting. A consensus definition of ADE remains elusive at this time. Preliminary studies utilizing rapid diagnostic tests including matrix-assisted laser desorption/ionization time of flight (MALDI-TOF), procalcitonin, and other molecular techniques have demonstrated the potential to support ADE strategies. In the absence of evidence-based, highly specific ADE protocols, the likelihood that individual providers will make consistent, often challenging, decisions to de-escalate antibiotic therapy is low. Antimicrobial stewardship programs should support local physicians with ADE and develop innovative ways to integrate ADE into the broader construct of antimicrobial stewardship programs. The evolving field of rapid diagnostics has significant potential to improve ADE strategies, but more research is needed to fully realize this goal.

  7. Rapid Gene Turnover as a Significant Source of Genetic Variation in a Recently Seeded Population of a Healthcare-Associated Pathogen

    Directory of Open Access Journals (Sweden)

    Lucía Graña-Miraglia

    2017-09-01

    Full Text Available Genome sequencing has been useful to gain an understanding of bacterial evolution. It has been used for studying the phylogeography and/or the impact of mutation and recombination on bacterial populations. However, it has rarely been used to study gene turnover at microevolutionary scales. Here, we sequenced Mexican strains of the human pathogen Acinetobacter baumannii sampled from the same locale over a 3 year period to obtain insights into the microevolutionary dynamics of gene content variability. We found that the Mexican A. baumannii population was recently founded and has been emerging due to a rapid clonal expansion. Furthermore, we noticed that on average the Mexican strains differed from each other by over 300 genes and, notably, this gene content variation has accrued more frequently and faster than the accumulation of mutations. Moreover, due to its rapid pace, gene content variation reflects the phylogeny only at very short periods of time. Additionally, we found that the external branches of the phylogeny had almost 100 more genes than the internal branches. All in all, these results show that rapid gene turnover has been of paramount importance in producing genetic variation within this population and demonstrate the utility of genome sequencing to study alternative forms of genetic variation.

  8. Rapid Gene Turnover as a Significant Source of Genetic Variation in a Recently Seeded Population of a Healthcare-Associated Pathogen.

    Science.gov (United States)

    Graña-Miraglia, Lucía; Lozano, Luis F; Velázquez, Consuelo; Volkow-Fernández, Patricia; Pérez-Oseguera, Ángeles; Cevallos, Miguel A; Castillo-Ramírez, Santiago

    2017-01-01

    Genome sequencing has been useful to gain an understanding of bacterial evolution. It has been used for studying the phylogeography and/or the impact of mutation and recombination on bacterial populations. However, it has rarely been used to study gene turnover at microevolutionary scales. Here, we sequenced Mexican strains of the human pathogen Acinetobacter baumannii sampled from the same locale over a 3 year period to obtain insights into the microevolutionary dynamics of gene content variability. We found that the Mexican A. baumannii population was recently founded and has been emerging due to a rapid clonal expansion. Furthermore, we noticed that on average the Mexican strains differed from each other by over 300 genes and, notably, this gene content variation has accrued more frequently and faster than the accumulation of mutations. Moreover, due to its rapid pace, gene content variation reflects the phylogeny only at very short periods of time. Additionally, we found that the external branches of the phylogeny had almost 100 more genes than the internal branches. All in all, these results show that rapid gene turnover has been of paramount importance in producing genetic variation within this population and demonstrate the utility of genome sequencing to study alternative forms of genetic variation.

  9. Security leadership in a changing healthcare world.

    Science.gov (United States)

    Smith, Thomas A

    2014-01-01

    In the next few years, the healthcare industry will experience rapid change, the author says. In this article, he describes how this changing healthcare landscape will provide many opportunities for the healthcare security leader willing to think about and provide security on a different scale by focusing on six key areas--mission and culture, goal alignment, value and metrics, relationships, technology, and professionalism.

  10. Mobile healthcare informatics.

    Science.gov (United States)

    Siau, Keng; Shen, Zixing

    2006-06-01

    Advances in wireless technology give pace to the rapid development of mobile applications. The coming mobile revolution will bring dramatic and fundamental changes to our daily life. It will influence the way we live, the way we do things, and the way we take care of our health. For the healthcare industry, mobile applications provide a new frontier in offering better care and services to patients, and a more flexible and mobile way of communicating with suppliers and patients. Mobile applications will provide important real time data for patients, physicians, insurers, and suppliers. In addition, it will revolutionalize the way information is managed in the healthcare industry and redefine the doctor - patient communication. This paper discusses different aspects of mobile healthcare. Specifically, it presents mobile applications in healthcare, and discusses possible challenges facing the development of mobile applications. Obstacles in developing mobile healthcare applications include mobile device limitations, wireless networking problems, infrastructure constraints, security concerns, and user distrust. Research issues in resolving or alleviating these problems are also discussed in the paper.

  11. Healthcare is primary.

    Science.gov (United States)

    Kumar, Raman

    2015-01-01

    India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2(nd) National Conference on Family Medicine and Primary Care 2015 (FMPC) brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care), the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

  12. Healthcare is primary

    Directory of Open Access Journals (Sweden)

    Raman Kumar

    2015-01-01

    Full Text Available India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care, the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

  13. An analysis of the role of media in conflict escalation:

    OpenAIRE

    Boğa, Gözde; Boga, Gozde

    2006-01-01

    In 25-27 May 2005, a conference entitled “Ottoman Armenians During the Decline of the Empire: Issues of Scientific Responsibility and Democracy,” referred to as the “Armenian conference” in this thesis, was scheduled to be held at Bogaziçi University, Istanbul, Turkey. There were two conflict escalation periods, in May and September 2005 about the conference. Such conflict escalation periods strengthen the parties’ own understanding of the issue and context of conflict; thus, further demarcat...

  14. Evidence-based decision-making in Asia-Pacific with rapidly changing health-care systems: Thailand, South Korea, and Taiwan.

    Science.gov (United States)

    Jirawattanapisal, Thidaporn; Kingkaew, Pritaporn; Lee, Tae-Jin; Yang, Ming-Chin

    2009-01-01

    To review the use of evidence in the market approval process, reimbursement, and price control mechanisms for medicines and medical devices in Thailand, South Korea, and Taiwan. Documentary reviews supplemented by interviews with senior policymakers of relevant public health authorities. Drug regulatory authorities play a vital role in the market authorization process by considering evidence on safety, efficacy and quality for new medicines, and bio-equivalence for new generic products of previously patented medicines. For the formulation of the reimbursement list, all three cases applied evidence on cost-effectiveness, to various degrees, with clear institutional structure, capacity, and functions. Only Thailand has specified an explicit benchmark on cost-effectiveness for inclusion in the reimbursement list. For price control, all have established mechanisms and processes for price negotiation. These mechanisms apply evidence on cost structure and relative prices in other countries to ensure affordable prices, especially with the patented drug industry. Thailand's universal insurance schemes use a capitation payment model which proves effective in implicit price control. To increase access to essential medicines that have patents on and high price, Thailand applied Trade-Related Aspects of Intellectual Property flexibilities; "government use of patent," for public noncommercial purposes to seven essential drugs in 2006 to 2008. Rapidly increasing health expenditure and universal health insurance systems have created greater requirement for proof of "value for money" in the approval and funding of new medical technologies. All settings have established clear mechanisms to apply appropriate evidence in the processes of market approval, reimbursement, and pricing control.

  15. Improving uptake and use of malaria rapid diagnostic tests in the context of artemisinin drug resistance containment in eastern Myanmar: an evaluation of incentive schemes among informal private healthcare providers.

    Science.gov (United States)

    Aung, Tin; White, Christopher; Montagu, Dominic; McFarland, Willi; Hlaing, Thaung; Khin, Hnin Su Su; San, Aung Kyaw; Briegleb, Christina; Chen, Ingrid; Sudhinaraset, May

    2015-03-06

    As efforts to contain artemisinin resistance and eliminate Plasmodium falciparum intensify, the accurate diagnosis and prompt effective treatment of malaria are increasingly needed in Myanmar and the Greater Mekong Sub-region (GMS). Rapid diagnostic tests (RDTs) have been shown to be safe, feasible, and effective at promoting appropriate treatment for suspected malaria, which are of particular importance to drug resistance containment. The informal private sector is often the first point of care for fever cases in malaria endemic areas across Myanmar and the GMS, but there is little published information about informal private provider practices, quality of service provision, or potential to contribute to malaria control and elimination efforts. This study tested different incentives to increase RDT use and improve the quality of care among informal private healthcare providers in Myanmar. The study randomized six townships in the Mon and Shan states of rural Myanmar into three intervention arms: 1) RDT price subsidies, 2) price subsidies with product-related financial incentives, and 3) price subsidies with intensified information, education and counselling (IEC). The study assessed the uptake of RDT use in the communities by cross-sectional surveys of 3,150 households at baseline and six months post-intervention (6,400 households total, 832 fever cases). The study also used mystery clients among 171 providers to assess quality of service provision across intervention arms. The pilot intervention trained over 600 informal private healthcare providers. The study found a price subsidy with intensified IEC, resulted in the highest uptake of RDTs in the community, as compared to subsidies alone or merchandise-related financial incentives. Moreover, intensified IEC led to improvements in the quality of care, with mystery client surveys showing almost double the number of correct treatment following diagnostic test results as compared to a simple subsidy. Results show

  16. Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study.

    Directory of Open Access Journals (Sweden)

    Eric Kaplovitch

    Full Text Available The use of opioids for noncancer pain is widespread, and more than 16,000 die of opioid-related causes in the United States annually. The patients at greatest risk of death are those receiving high doses of opioids. Whether sex influences the risk of dose escalation or opioid-related mortality is unknown.We conducted a cohort study using healthcare records of 32,499 individuals aged 15 to 64 who commenced chronic opioid therapy for noncancer pain between April 1, 1997 and December 31, 2010 in Ontario, Canada. Patients were followed from their first opioid prescription until discontinuation of therapy, death from any cause or the end of the study period. Among patients receiving chronic opioid therapy, 589 (1.8% escalated to high dose therapy and n = 59 (0.2% died of opioid-related causes while on treatment. After multivariable adjustment, men were more likely than women to escalate to high-dose opioid therapy (adjusted hazard ratio 1.44; 95% confidence interval 1.21 to 1.70 and twice as likely to die of opioid-related causes (adjusted hazard ratio 2.04; 95% confidence interval 1.18 to 3.53. These associations were maintained in a secondary analysis of 285,520 individuals receiving any opioid regardless of the duration of therapy.Men are at higher risk than women for escalation to high-dose opioid therapy and death from opioid-related causes. Both outcomes were more common than anticipated.

  17. An Intelligent System for Aggression De-escalation Training

    NARCIS (Netherlands)

    Bosse, T.; Gerritsen, C.; de Man, J.

    2016-01-01

    Artificial Intelligence techniques are increasingly being used to develop smart training applications for professionals in various domains. This paper presents an intelligent training system that enables professionals in the public domain to practice their aggression de-escalation skills. The system

  18. Les escales de Likert poden augmentar en sensibilitat?

    Directory of Open Access Journals (Sweden)

    Rafel Bisquerra Alzina

    2015-07-01

    Full Text Available En les investigacions que utilitzen escales tipus Likert s’apliquen principalment escales de 5 punts, sense una fonamentació metodològica que ho justifiqui. La revisió de 3 conegudes revistes permet arribar a aquesta conclusió. Sembla que es fa així per tradició i perquè és difícil posar nom a més de cinc opcions de resposta. En aquest article es posa en qüestió aquesta tradició i s’aporten arguments per proposar altres alternatives. S’analitza la importància de millorar la sensibilitat de les escales augmentant les opcions de resposta; es recomana evitar l’ús de denominacions categòriques, que strictu sensu impedeix el seu ús com a escala d’interval ja que la converteix en nominal (categòrica; s’analitza el rebuig a valors extrems, etc. Com a conseqüència, es recomana la proposta en favor d’escales d’onze punts (de 0 a 10.

  19. Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs.

    Science.gov (United States)

    Sapp, John L; Wells, George A; Parkash, Ratika; Stevenson, William G; Blier, Louis; Sarrazin, Jean-Francois; Thibault, Bernard; Rivard, Lena; Gula, Lorne; Leong-Sit, Peter; Essebag, Vidal; Nery, Pablo B; Tung, Stanley K; Raymond, Jean-Marc; Sterns, Laurence D; Veenhuyzen, George D; Healey, Jeff S; Redfearn, Damian; Roux, Jean-Francois; Tang, Anthony S L

    2016-07-14

    Recurrent ventricular tachycardia among survivors of myocardial infarction with an implantable cardioverter-defibrillator (ICD) is frequent despite antiarrhythmic drug therapy. The most effective approach to management of this problem is uncertain. We conducted a multicenter, randomized, controlled trial involving patients with ischemic cardiomyopathy and an ICD who had ventricular tachycardia despite the use of antiarrhythmic drugs. Patients were randomly assigned to receive either catheter ablation (ablation group) with continuation of baseline antiarrhythmic medications or escalated antiarrhythmic drug therapy (escalated-therapy group). In the escalated-therapy group, amiodarone was initiated if another agent had been used previously. The dose of amiodarone was increased if it had been less than 300 mg per day or mexiletine was added if the dose was already at least 300 mg per day. The primary outcome was a composite of death, three or more documented episodes of ventricular tachycardia within 24 hours (ventricular tachycardia storm), or appropriate ICD shock. Of the 259 patients who were enrolled, 132 were assigned to the ablation group and 127 to the escalated-therapy group. During a mean (±SD) of 27.9±17.1 months of follow-up, the primary outcome occurred in 59.1% of patients in the ablation group and 68.5% of those in the escalated-therapy group (hazard ratio in the ablation group, 0.72; 95% confidence interval, 0.53 to 0.98; P=0.04). There was no significant between-group difference in mortality. There were two cardiac perforations and three cases of major bleeding in the ablation group and two deaths from pulmonary toxic effects and one from hepatic dysfunction in the escalated-therapy group. In patients with ischemic cardiomyopathy and an ICD who had ventricular tachycardia despite antiarrhythmic drug therapy, there was a significantly lower rate of the composite primary outcome of death, ventricular tachycardia storm, or appropriate ICD shock among

  20. Lean Six Sigma in Healthcare: Combating the Military’s Escalating Pharmacy Costs

    Science.gov (United States)

    2009-04-30

    SYSTEM CMOP CONSOLIDATED MAIL ORDER PHARMACY CTQ CRITICAL TO QUALITY DLA DEFENSE LOGISTICS AGENCY DLI DEFENSE LANGUAGE INSTITUTE DMAIC DEFINE...standard improvement procedure in Six Sigma is DMAIC (Define, Measure, Analyze, Improve and Control). DMAIC is a structured, disciplined, rigorous...and techniques prescribed in the DMAIC methodology (Define, Measure, Analyze, Improve and Control) of Lean Six Sigma. To better understand the

  1. ESCALATING AIR FORCE HEALTHCARE COSTS: REFORMING THE AIR FORCE MEDICAL SERVICE THROUGH PERFORMANCE BASED INCENTIVES

    Science.gov (United States)

    2011-10-01

    example, non-monetary rewards such as major education and training opportunities or leadership visibility at national conferences can build reputations...identified factors such as leadership priorities and staff satisfaction could also be contributing factors for the positive effect. The study recommended...not about the future – it is about the future of decisions we make today. Peter Drucker As quoted in the Summer 2008 Military Health System

  2. 7 CFR 1726.251 - Prior approved contract modification related to price escalation on transmission equipment...

    Science.gov (United States)

    2010-01-01

    ... escalation on transmission equipment, generation equipment, and generation construction contracts. 1726.251 Section 1726.251 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES... escalation on transmission equipment, generation equipment, and generation construction contracts. (a...

  3. E4 - Energy efficient elevators and escalators. Barriers to and strategies for promoting energy-efficient lift and escalator technologies

    Energy Technology Data Exchange (ETDEWEB)

    Duetschke, Elisabeth; Hirzel, Simon

    2010-02-25

    According to prior findings of the E4 project, considerable savings potential exists both for lifts and escalators that could be realized if appropriate technology is implemented. However, energy-efficient technology is slowly diffusing the market - a phenomenon that could be explained by barriers present in the market. A barrier is defined as a mechanism that inhibits a decision or behavior that appears to be both energy-efficient and economically efficient and thereby prevents investment in energy-efficient technologies. This document has two aims. First, it will identify influential barriers in the European lift and escalator market. This analysis is based on the literature as well as a study including interviews as well as group discussions with relevant stakeholders. Second, strategies and measures to overcome the barriers identified in the first step are outlined. Major barriers to the penetration of energy-efficient technologies identified in this paper include a lack of monitoring energy consumption of installations and a lack of awareness of as well as knowledge about energy-efficient technology. Thus, installations and components are usually chosen without a (comprehensive) assessment of their energy consumption and without considering life-cycle approaches. On top of this, split incentives are a regularly occurring barrier. Various stakeholders are influential in the decisionmaking process about an installation or its components. However, those who will later pay for the energy consumption often are not involved in this process. Moreover, it is important to keep in mind that the number of new lifts and escalators installed each year is relatively low compared to the existing stock. Thus, it is very important to discuss enhancement of energy efficiency also for the existing stock. Based on our analyses, several recommendations are developed in this paper that could contribute to a market transformation in the lift and escalator market. First of all, a

  4. What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service.

    Science.gov (United States)

    Shearer, Bill; Marshall, Stuart; Buist, Michael David; Finnigan, Monica; Kitto, Simon; Hore, Tonina; Sturgess, Tamica; Wilson, Stuart; Ramsay, Wayne

    2012-07-01

    To explore the causes of failure to activate the rapid response system (RRS). The organisation has a recognised incidence of staff failing to act when confronted with a deteriorating patient and leading to adverse outcomes. A multi-method study using the following: a point prevalence survey to determine the incidence of abnormal simple bedside observations and activation of the rapid response team by clinical staff; a prospective audit of all patients experiencing a cardiac arrest, unplanned intensive care unit admission or death over an 8-week period; structured interviews of staff to explore cognitive and sociocultural barriers to activating the RRS. Southern Health is a comprehensive healthcare network with 570 adult in-patient beds across four metropolitan teaching hospitals in the south-eastern sector of Melbourne. Frequency of physiological instability and outcomes within the in-patient hospital population. Qualitative data from staff interviews were thematically coded. The incidence of physiological instability in the acute adult population was 4.04%. Nearly half of these patients (42%) did not receive an appropriate clinical response from the staff, despite most (69.2%) recognising their patient met physiological criteria for activating the RRS, and being 'quite', or 'very' concerned about their patient (75.8%). Structured interviews with 91 staff members identified predominantly sociocultural reasons for failure to activate the RRS. Despite an organisational commitment to the RRS, clinical staff act on local cultural rules within the clinical environment that are usually not explicit. Better understanding of these informal rules may lead to more appropriate activation of the RRS.

  5. De-escalation in mental health care settings: patient and staff member perspectives

    DEFF Research Database (Denmark)

    Lauge Berring, Lene; Pedersen, Liselotte; Buus, Niels

    2016-01-01

    This multiple case study explored de-escalation processes in threatening and violent situations based on patients and staff members perspectives. Our post hoc analysis indicated that de-escalation included responsive interactions influenced by the perspectives of both patients and staff members. ......-escalation can foster shared problem solving in violent and threatening situations....

  6. Building a rapid response team.

    Science.gov (United States)

    Halvorsen, Lisa; Garolis, Salomeja; Wallace-Scroggs, Allyson; Stenstrom, Judy; Maunder, Richard

    2007-01-01

    The use of rapid response teams is a relatively new approach for decreasing or eliminating codes in acute care hospitals. Based on the principles of a code team for cardiac and/or respiratory arrest in non-critical care units, the rapid response teams have specially trained nursing, respiratory, and medical personnel to respond to calls from general care units to assess and manage decompensating or rapidly changing patients before their conditions escalate to a full code situation. This article describes the processes used to develop a rapid response team, clinical indicators for triggering a rapid response team call, topics addressed in an educational program for the rapid response team members, and methods for evaluating effectiveness of the rapid response team.

  7. Factor Analysis 01- Healthcare Service Quality In Medan Government Hospital

    OpenAIRE

    Lubis, Arlina Nurbaity; Lumbanraja, Prihatin; Lubis, Rahmawaty; Hasibuan, Beby Kendida

    2016-01-01

    Service sector increases rapidly especially in Indonesia. This can be seen from the distribution of the percentage of Product Domestic Bruto (PDB) based on job vacancy showing that the service sector contribution approaches 50%. One of the service/care industries with rapid growth is healthcare service. It can be seen from the government plan year 2015-2016 to do healthcare reinforcement. Generally, healthcare is identically related to hospital. A hospital is a professional healthcare institu...

  8. Deterrence Adrift Mapping Conflict and Escalation in South Asia

    Science.gov (United States)

    2016-06-21

    selective list of conflict flashpoints articulated in the document—namely, “ the unresolved issue of Kashmir , the violation of treaty arrangements on...between India and Pakistan spiked from 2014 through late 2015, meriting an analysis of how an armed conflict might un- fold between the two nuclear... The doctrine is premised on the assump- tion that India will be able to assert escalation control and prevent the ensuing conflict from spiraling out

  9. Macroscopic broadband optical escalator with force-loaded transformation optics.

    Science.gov (United States)

    Gao, Dongliang; Qiu, Cheng-Wei; Gao, Lei; Cui, Tiejun; Zhang, Shuang

    2013-01-14

    Transformation optics enables one to guide and control light at will using metamaterials. However the designed device is deterministic and not flexible for different objects. Based on force-loaded transformation optics we propose a force-induced transformational device, which can realize dynamic escalator metamorphosing continuously between optical elevator and invisibility cloak. This escalator can visually lift up and down the perceived height of a plane fixed in space by controlling the forces loaded in different directions. Or conversely, the escalator can physically lift up and down a plane while visually maintaining the same height to an outside observer. One can quickly adjust this device to the required demand without changing the background index, while the usual transformation cloak will be detectable due to the lateral shift from mismatched background. The schematic is self-adaptive, multi-functional, and free of metamaterial or nanofabrication. Our work opens a new perspective in controlling light dynamically and continuously, empowering unprecedented applications in military cloak, optic communication, holographic imaging, and phase-involved microtechnique.

  10. Learning to make collective decisions: the impact of confidence escalation.

    Science.gov (United States)

    Mahmoodi, Ali; Bang, Dan; Ahmadabadi, Majid Nili; Bahrami, Bahador

    2013-01-01

    Little is known about how people learn to take into account others' opinions in joint decisions. To address this question, we combined computational and empirical approaches. Human dyads made individual and joint visual perceptual decision and rated their confidence in those decisions (data previously published). We trained a reinforcement (temporal difference) learning agent to get the participants' confidence level and learn to arrive at a dyadic decision by finding the policy that either maximized the accuracy of the model decisions or maximally conformed to the empirical dyadic decisions. When confidences were shared visually without verbal interaction, RL agents successfully captured social learning. When participants exchanged confidences visually and interacted verbally, no collective benefit was achieved and the model failed to predict the dyadic behaviour. Behaviourally, dyad members' confidence increased progressively and verbal interaction accelerated this escalation. The success of the model in drawing collective benefit from dyad members was inversely related to confidence escalation rate. The findings show an automated learning agent can, in principle, combine individual opinions and achieve collective benefit but the same agent cannot discount the escalation suggesting that one cognitive component of collective decision making in human may involve discounting of overconfidence arising from interactions.

  11. Learning to make collective decisions: the impact of confidence escalation.

    Directory of Open Access Journals (Sweden)

    Ali Mahmoodi

    Full Text Available Little is known about how people learn to take into account others' opinions in joint decisions. To address this question, we combined computational and empirical approaches. Human dyads made individual and joint visual perceptual decision and rated their confidence in those decisions (data previously published. We trained a reinforcement (temporal difference learning agent to get the participants' confidence level and learn to arrive at a dyadic decision by finding the policy that either maximized the accuracy of the model decisions or maximally conformed to the empirical dyadic decisions. When confidences were shared visually without verbal interaction, RL agents successfully captured social learning. When participants exchanged confidences visually and interacted verbally, no collective benefit was achieved and the model failed to predict the dyadic behaviour. Behaviourally, dyad members' confidence increased progressively and verbal interaction accelerated this escalation. The success of the model in drawing collective benefit from dyad members was inversely related to confidence escalation rate. The findings show an automated learning agent can, in principle, combine individual opinions and achieve collective benefit but the same agent cannot discount the escalation suggesting that one cognitive component of collective decision making in human may involve discounting of overconfidence arising from interactions.

  12. The effects of mortality salience on escalation of commitment.

    Science.gov (United States)

    Yen, Chih-Long; Lin, Chun-Yu

    2012-01-01

    Based on propositions derived from terror management theory (TMT), the current study proposes that people who are reminded of their mortality exhibit a higher degree of self-justification behavior to maintain their self-esteem. For this reason, they could be expected to stick with their previous decisions and invest an increasing amount of resources in those decisions, despite the fact that negative feedback has clearly indicated that they might be on a course toward failure (i.e., "escalation of commitment"). Our experiment showed that people who were reminded of their mortality were more likely to escalate their level of commitment by maintaining their current course of action. Two imaginary scenarios were tested. One of the scenarios involved deciding whether to send additional troops into the battlefield when previous attempts had failed; the other involved deciding whether to continue developing an anti-radar fighter plane when the enemy had already developed a device to detect it. The results supported our hypothesis that mortality salience increases the tendency to escalate one's level of commitment.

  13. Social media disruptive change in healthcare : responses of healthcare providers

    NARCIS (Netherlands)

    Smailhodzic, Edin; Boonstra, Albert; Langley, David

    Social media represent specific types of technologies that are end-user driven and end-users are able to drive disruptive change giving little time to organizations to react. With rapid and powerful emergence of social media communities in healthcare, this sector is faced with new and alternative

  14. Social media disruptive change in healthcare : Responses of healthcare providers?

    NARCIS (Netherlands)

    Smailhodzic, E.; Boonstra, A.; Langley, D.J.

    2016-01-01

    Social media represent specific types of technologies that are end-user driven and end-users are able to drive disruptive change giving little time to organizations to react. With rapid and powerful emergence of social media communities in healthcare, this sector is faced with new and alternative

  15. Innovations in healthcare finance lessons from the 401(k) model.

    Science.gov (United States)

    Myers, Chris; Lineen, Jason

    2008-10-01

    *Escalating health benefit expenses are leading employers to shift more of the costs to their employees. *Global financial services companies and startup entrepreneurs are competing to develop private-sector solutions to capitalize on the ailing and mis-aligned healthcare financing system. *Emerging innovations are targeting insured individuals who are facing increasing responsibility for first-dollar coverage. *Healthcare providers should view patients as individual "price-sensitive payers" as new tools enable them to shop around for services based on cost and quality.

  16. Maternal risk taking on the balloon analogue risk task as a prospective predictor of youth alcohol use escalation.

    Science.gov (United States)

    Banducci, Anne N; Felton, Julia W; Dahne, Jennifer; Ninnemann, Andrew; Lejuez, C W

    2015-10-01

    The transition from late childhood through middle adolescence represents a critical developmental period during which there is a rapid increase in the initiation and escalation of alcohol use. Alcohol use is part of a constellation of risk taking behaviors that increase during this developmental transition, which can be explained by environmental and genetic factors. Social learning theory (SLT) implicates observations of parental drinking in the development of alcohol use in youth. Parental risk taking more broadly has not previously been examined as a factor predictive of alcohol use escalation in youth across adolescence. The current study examined the relative contributions of maternal risk taking on the Balloon Analogue Risk Task (BART) and maternal alcohol use in the prediction of alcohol escalation among youth over three years. Participants were a sample of 245 youth (55.0% male, 49.6% Caucasian) who participated annually between grades 8 and 10, drawn from a larger study of adolescent risk taking. Within our sample, maternal risk taking, as measured by the BART, predicted increases in alcohol use. Interestingly, maternal alcohol use and other youth factors were not predictive of escalations in youth alcohol use. Our findings suggest the importance of considering maternal riskiness more broadly, rather than solely focusing on maternal alcohol use when attempting to understand youth alcohol use across adolescence. These findings emphasize the relevance of maternal risk taking as measured by a behavioral task and suggest a general level of riskiness displayed by mothers might encourage youth to behave in a riskier manner themselves. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. [Smart Medicine and Healthcare].

    Science.gov (United States)

    Lu, Yen-Chiao Angel; Chen, Li-Chin

    2017-08-01

    Innovation and rapid technological development in Smart Medicine or Smart Healthcare impact profoundly on many aspects of healthcare. It is believed that Health Information Technology (HIT) has the potential to improve integration between care providers, reduce administrative costs and burdens, reduce medical errors, and improve care quality and patient outcomes. However, issues such as interoperability, compatibility, and integration are critical to effectively integrating hardware and software in order to fully realize the benefits of HIT. High-end medical devices and equipment, including medical carts / mobile computer carts and wireless physiological and biomedical monitoring devices, should also be integrated into the hospital information system. Furthermore, the Data, Information, Knowledge, and Wisdom Hierarchy (DIKW) has been gaining popularity in the development of Nursing Information Systems (NIS) since 2013. To create a DIKW-based information system, data must first be defined and analyzed and then transformed into meaningful information. Eventually, this information is transformed into an intelligent system. For example, if evidence-based nursing research results / findings are integrated into the NIS to guide clinical practice, patient outcomes, patient safety, and healthcare quality will be greatly enhanced.

  18. Predictors of effective de-escalation in acute inpatient psychiatric settings.

    Science.gov (United States)

    Lavelle, Mary; Stewart, Duncan; James, Karen; Richardson, Michelle; Renwick, Laoise; Brennan, Geoffrey; Bowers, Len

    2016-08-01

    To explore the factors that influence the use of de-escalation and its success in halting conflict in acute psychiatric inpatient setting. De-escalation is the use of verbal and nonverbal communication to reduce or eliminate aggression and violence during the escalation phase of a patient's behaviour. Although de-escalation is a first-line intervention in aggression management in acute psychiatric settings, little is known about the use or effectiveness of this technique. A retrospective case note analysis. For each patient (n = 522), their involvement in conflict (e.g. aggression) or containment (e.g. coerced medication) during the first two weeks of their admission was recorded. The frequency and order of the conflict and containment events were identified during each shift. The sequences of events occurring in shifts involving de-escalation were analysed. Sequences where de-escalation ended the pattern of conflict or containment were categorised as 'successful', and all others were categorised as 'unsuccessful'. Over half of patients (53%) experienced de-escalation during the first two weeks of admission, with the majority of these (37%) experiencing multiple episodes. De-escalation was successful in approximately 60% of cases. Successful de-escalations were preceded by fewer, and less aggressive, conflict events, compared with unsuccessful de-escalations, which were most frequently followed by administration of pro re nata medication. Patients with a history of violence were more likely to experience de-escalation, and it was more likely to be unsuccessful. De-escalation is frequently effective in halting a sequence of conflict in acute inpatient settings, but patients with a history of violence may be specifically challenging. These findings provide support for de-escalation in practice but suggest that nurses may lack confidence in using the technique when the risk of violence is greater. Providing evidence-based staff training may improve staff confidence

  19. Predicting Responses to Bids for Sexual and Romantic Escalation in Cross-Sex Friendships.

    Science.gov (United States)

    Akbulut, Valerie; Weger, Harry

    2016-01-01

    The transition from a platonic cross-sex friendship to a more intimate sexual and/or romantic relationship is an interesting, yet somewhat understudied, phenomenon. In this study, we introduce and test relationship adaptation theory to predict cross-sex friends' predispositions for reciprocating a bid for escalation to an exclusive dating or friends with benefits (FWB) relationship. Analyses of data collected from 288 participants found participants' dating status, anticipated rewards from escalating the relationship, expected social disapproval, friendship quality, and their friend's attractiveness predicted disposition to reciprocating a cross-sex friend's hypothetical bid for escalation to an exclusive romantic escalation. In addition, participants' biological sex, anticipated rewards from escalating the relationship, expected social disapproval, sexual permissiveness, and their friend's attractiveness emerged as predictors of disposition toward a friend's hypothetical bid to escalate a platonic friendship to a FWB relationship.

  20. Nuclear Weapons and Coercive Escalation in Regional Conflicts: Lessons from North Korea and Pakistan

    Science.gov (United States)

    2014-11-01

    Daniel S. Geller . “Nuclear Weapons, Deterrence and Crisis Escalation.” Journal of Conflict Resolution 34 (1990). 17 “Nuclear Weapons, Deterrence... Geller , “Nuclear Weapons, Deterrence and Crisis Escalation,” 1990. 21 Beardsley and Asal, “Winning with the Bomb,” 2009. 22 Utgoff and Wheeler...After Proliferation: Deterrence Theory and Emerging Nuclear Powers,” 2012, 18. 25 Geller , “Nuclear Weapons, Deterrence and Crisis Escalation,” 1990

  1. Big Data and Analytics in Healthcare.

    Science.gov (United States)

    Tan, S S-L; Gao, G; Koch, S

    2015-01-01

    This editorial is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare". The amount of data being generated in the healthcare industry is growing at a rapid rate. This has generated immense interest in leveraging the availability of healthcare data (and "big data") to improve health outcomes and reduce costs. However, the nature of healthcare data, and especially big data, presents unique challenges in processing and analyzing big data in healthcare. This Focus Theme aims to disseminate some novel approaches to address these challenges. More specifically, approaches ranging from efficient methods of processing large clinical data to predictive models that could generate better predictions from healthcare data are presented.

  2. Electronic healthcare information security

    CERN Document Server

    Dube, Kudakwashe; Shoniregun, Charles A

    2010-01-01

    The ever-increasing healthcare expenditure and pressing demand for improved quality and efficiency of patient care services are driving innovation in healthcare information management. The domain of healthcare has become a challenging testing ground for information security due to the complex nature of healthcare information and individual privacy. ""Electronic Healthcare Information Security"" explores the challenges of e-healthcare information and security policy technologies. It evaluates the effectiveness of security and privacy implementation systems for anonymization methods and techniqu

  3. Licensed Healthcare Facilities

    Data.gov (United States)

    California Department of Resources — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

  4. Big Data Analytics in Healthcare.

    Science.gov (United States)

    Belle, Ashwin; Thiagarajan, Raghuram; Soroushmehr, S M Reza; Navidi, Fatemeh; Beard, Daniel A; Najarian, Kayvan

    2015-01-01

    The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined.

  5. Increasing Use of Dose-Escalated External Beam Radiation Therapy for Men With Nonmetastatic Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Swisher-McClure, Samuel, E-mail: Swisher-Mcclure@uphs.upenn.edu [Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (United States); Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (United States); Mitra, Nandita; Woo, Kaitlin [Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (United States); Smaldone, Marc; Uzzo, Robert [Division of Urologic Oncology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA (United States); Bekelman, Justin E. [Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (United States); Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (United States); Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (United States); Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2014-05-01

    Purpose: To examine recent practice patterns, using a large national cancer registry, to understand the extent to which dose-escalated external beam radiation therapy (EBRT) has been incorporated into routine clinical practice for men with prostate cancer. Methods and Materials: We conducted a retrospective observational cohort study using the National Cancer Data Base, a nationwide oncology outcomes database in the United States. We identified 98,755 men diagnosed with nonmetastatic prostate cancer between 2006 and 2011 who received definitive EBRT and classified patients into National Comprehensive Cancer Network (NCCN) risk groups. We defined dose-escalated EBRT as total prescribed dose of ≥75.6 Gy. Using multivariable logistic regression, we examined the association of patient, clinical, and demographic characteristics with the use of dose-escalated EBRT. Results: Overall, 81.6% of men received dose-escalated EBRT during the study period. The use of dose-escalated EBRT did not vary substantially by NCCN risk group. Use of dose-escalated EBRT increased from 70.7% of patients receiving treatment in 2006 to 89.8% of patients receiving treatment in 2011. On multivariable analysis, year of diagnosis and use of intensity modulated radiation therapy were significantly associated with receipt of dose-escalated EBRT. Conclusions: Our study results indicate that dose-escalated EBRT has been widely adopted by radiation oncologists treating prostate cancer in the United States. The proportion of patients receiving dose-escalated EBRT increased nearly 20% between 2006 and 2011. We observed high utilization rates of dose-escalated EBRT within all disease risk groups. Adoption of intensity modulated radiation therapy was strongly associated with use of dose-escalated treatment.

  6. Do Sell-Side Stock Analysts Exhibit Escalation of Commitment?

    Science.gov (United States)

    Beshears, John; Milkman, Katherine L

    2011-03-01

    This paper presents evidence that when an analyst makes an out-of-consensus forecast of a company's quarterly earnings that turns out to be incorrect, she escalates her commitment to maintaining an out-of-consensus view on the company. Relative to an analyst who was close to the consensus, the out-of-consensus analyst adjusts her forecasts for the current fiscal year's earnings less in the direction of the quarterly earnings surprise. On average, this type of updating behavior reduces forecasting accuracy, so it does not seem to reflect superior private information. Further empirical results suggest that analysts do not have financial incentives to stand by extreme stock calls in the face of contradictory evidence. Managerial and financial market implications are discussed.

  7. Healthcare Fraud Investigations

    Directory of Open Access Journals (Sweden)

    Adrian Victor Vevera

    2015-12-01

    Full Text Available Tax healthcare fraud and tax evasion affects us all. It occurs within a country and across countries both within the EU,USA and globally. That is why a single country cannot solve the problem on its own. The EU and Member States need to work more together and internationally to combat the problem at home and abroad. Open dialogue involving the European Commission, stakeholders and interested parties helps ensure that existing rules and proposals for new rules are designed to keep pace with the reality of rapid change. This dialogue helps to achieve the regulatory efficiency we need to foster best administrative and legislative practice tailored to meet the needs of business in the European Union in the third millennium

  8. How organizational escalation prevention potential affects success of implementation of innovations: Electronic medical records in hospitals

    NARCIS (Netherlands)

    M.S. Lambooij (Mattijs); F. Koster (Ferry)

    2016-01-01

    textabstractBackground: Escalation of commitment is the tendency that (innovation) projects continue, even if it is clear that they will not be successful and/or become extremely costly. Escalation prevention potential (EPP), the capability of an organization to stop or steer implementation

  9. Water and Wastewater Annual Price Escalation Rates for Selected Cities across the United States

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2017-10-27

    Pacific Northwest National Laboratory conducted this study for the Federal Energy Management Program to identify trends in annual water and wastewater price escalation rates across the United States. This study can be used to inform the selection of an appropriate escalation rates for inclusion in LCCA.

  10. Dose Escalation of Tamoxifen in Patients with Low Endoxifen Level: Evidence for Therapeutic Drug Monitoring-The TADE Study.

    Science.gov (United States)

    Fox, Peter; Balleine, Rosemary L; Lee, Clara; Gao, Bo; Balakrishnar, Bavanthi; Menzies, Alexander M; Yeap, Shang Heng; Ali, Sayed Sahanawaz; Gebski, Val; Provan, Pamela; Coulter, Sally; Liddle, Christopher; Hui, Rina; Kefford, Richard; Lynch, Jodi; Wong, Mark; Wilcken, Nicholas; Gurney, Howard

    2016-07-01

    Endoxifen is the major mediator of tamoxifen effect and endoxifen levels <15 nmol/L may be associated with increased risk of breast cancer recurrence. We increased tamoxifen dose in breast cancer patients with low endoxifen levels and assessed the influence of various parameters on reaching 15 nmol/L and 30 nmol/L endoxifen levels. Tamoxifen dose was increased in those with endoxifen levels below 30 nmol/L. Toxicity, including hot flash score, was measured. CYP2D6 metabolizer status was classified as ultra-rapid (UM), extensive (EM), intermediate (IM), or poor (PM) based genotype of somatic DNA. Dosage was escalated in 68 of 122 participants. On 20 mg tamoxifen, 24% had endoxifen levels below 15 nmol/L and this reduced to 6% following dose escalation. In over 50% of cases, there was no identified cause for low endoxifen. Low baseline endoxifen level, and not CYP2D6 metabolizer status, independently predicted reaching threshold targets for both the 15 nmol/L and 30 nmol/L targets (P = 0.04 and 0.003 respectively). The 15 nmol/L target was reached in all UM/EM and IM patients, 63% of PM patients, and 58% of those with baseline endoxifen of <10 nmol/L. There was no correlation between hot flash score and genotype or any tamoxifen metabolite level including endoxifen (R = 0.07). Low endoxifen on standard dose tamoxifen was the only independent predictor of failure to achieve potentially therapeutic levels. Trials examining tamoxifen dose escalation and breast cancer outcome should be guided by endoxifen levels alone, without reference to CYP2D6 genotype or presence of hot flashes. Clin Cancer Res; 22(13); 3164-71. ©2016 AACRSee related commentary by Hertz and Rae, p. 3121. ©2016 American Association for Cancer Research.

  11. Android权限提升漏洞攻击的检测%Android Privilege Escalation Vulnerability Attacks Detection

    Institute of Scientific and Technical Information of China (English)

    沈才樑; 唐科萍; 俞立峰; 樊甫伟

    2012-01-01

    近年来,Android发展迅速,已成为当前全球智能手机操作系统市场的领导者.有关Android系统安全机制的研究具有非常明显的意义.首先,简要介绍了Android系统的安全机制,接着重点分析了Android权限提升漏洞攻击原理,并提出了通过应用安装前的漏洞检测与运行时IPC监测两种方式提升Android应用防范权限提升攻击的能力.%In recent years, the Android system developed rapidly. It has become the leader of the smart phone operating system. Hie research of Android security mechanisms is significant. This article briefly describes the security mechanisms of the Androidsystem, and then introduces the principle of Android privilege escalation attacks, then give two methods------vulnerabilitydetection before the application installed and IPC monitoring on runtime, to improve the capacity of preventing Android privilege escalation attacks.

  12. Image guided dose escalated prostate radiotherapy: still room to improve

    Directory of Open Access Journals (Sweden)

    Milosevic Michael

    2009-11-01

    Full Text Available Abstract Background Prostate radiotherapy (RT dose escalation has been reported to result in improved biochemical control at the cost of greater late toxicity. We report on the application of 79.8 Gy in 42 fractions of prostate image guided RT (IGRT. The primary objective was to assess 5-year biochemical control and potential prognostic factors by the Phoenix definition. Secondary endpoints included acute and late toxicity by the Radiotherapy Oncology Group (RTOG scoring scales. Methods From October/2001 and June/2003, 259 men were treated with at least 2-years follow-up. 59 patients had low, 163 intermediate and 37 high risk disease. 43 had adjuvant hormonal therapy (HT, mostly for high- or multiple risk factor intermediate-risk disease (n = 25. They received either 3-dimensional conformal RT (3DCRT, n = 226 or intensity modulated RT (IMRT including daily on-line IGRT with intraprostatic fiducial markers. Results Median follow-up was 67.8 months (range 24.4-84.7. There was no severe (grade 3-4 acute toxicity, and grade 2 acute gastrointestinal (GI toxicity was unusual (10.1%. The 5-year incidence of grade 2-3 late GI and genitourinary (GU toxicity was 13.7% and 12.1%, with corresponding grade 3 figures of 3.5% and 2.0% respectively. HT had an association with an increased risk of grade 2-3 late GI toxicity (11% v 21%, p = 0.018. Using the Phoenix definition for biochemical failure, the 5 year-bNED is 88.4%, 76.5% and 77.9% for low, intermediate and high risk patients respectively. On univariate analysis, T-category and Gleason grade correlated with Phoenix bNED (p = 0.006 and 0.039 respectively. Hormonal therapy was not a significant prognostic factor on uni- or multi-variate analysis. Men with positive prostate biopsies following RT had a lower chance of bNED at 5 years (34.4% v 64.3%; p = 0.147. Conclusion IGRT to 79.8 Gy results in favourable rates of late toxicity compared with published non-IGRT treated cohorts. Future avenues of

  13. Pharmacokinetics of Escalating Doses of Oral Psilocybin in Healthy Adults.

    Science.gov (United States)

    Brown, Randall T; Nicholas, Christopher R; Cozzi, Nicholas V; Gassman, Michele C; Cooper, Karen M; Muller, Daniel; Thomas, Chantelle D; Hetzel, Scott J; Henriquez, Kelsey M; Ribaudo, Alexandra S; Hutson, Paul R

    2017-03-28

    Psilocybin is a psychedelic tryptamine that has shown promise in recent clinical trials for the treatment of depression and substance use disorders. This open-label study of the pharmacokinetics of psilocybin was performed to describe the pharmacokinetics and safety profile of psilocybin in sequential, escalating oral doses of 0.3, 0.45, and 0.6 mg/kg in 12 healthy adults. Eligible healthy adults received 6-8 h of preparatory counseling in anticipation of the first dose of psilocybin. The escalating oral psilocybin doses were administered at approximately monthly intervals in a controlled setting and subjects were monitored for 24 h. Blood and urine samples were collected over 24 h and assayed by a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay for psilocybin and psilocin, the active metabolite. The pharmacokinetics of psilocin were determined using both compartmental (NONMEM) and noncompartmental (WinNonlin) methods. No psilocybin was found in plasma or urine, and renal clearance of intact psilocin accounted for less than 2% of the total clearance. The pharmacokinetics of psilocin were linear within the twofold range of doses, and the elimination half-life of psilocin was 3 h (standard deviation 1.1). An extended elimination phase in some subjects suggests hydrolysis of the psilocin glucuronide metabolite. Variation in psilocin clearance was not predicted by body weight, and no serious adverse events occurred in the subjects studied. The small amount of psilocin renally excreted suggests that no dose reduction is needed for subjects with mild-moderate renal impairment. Simulation of fixed doses using the pharmacokinetic parameters suggest that an oral dose of 25 mg should approximate the drug exposure of a 0.3 mg/kg oral dose of psilocybin. Although doses of 0.6 mg/kg are in excess of likely therapeutic doses, no serious physical or psychological events occurred during or within 30 days of any dose. NCT02163707.

  14. Destined to die but not to wage war: how existential threat can contribute to escalation or de-escalation of violent intergroup conflict.

    Science.gov (United States)

    Jonas, Eva; Fritsche, Immo

    2013-10-01

    War means threat to people's lives. Research derived from terror management theory (TMT) illustrates that the awareness of death leads people to defend cultural ingroups and their worldviews to attain a sense of symbolic immortality and thereby buffer existential anxiety. This can result in hostile effects of mortality salience (MS), such as derogation of outgroup members, prejudice, stereotyping, aggression, and racism, which, in turn, can lead to the escalation of violent intergroup conflict and, thus, the escalation of war. Yet, escalation of destructive conflict following MS is not automatic. Instead, research on TMT suggests that MS does not necessarily result in conflict and intolerance but can also foster positive tendencies, such as intergroup fairness or approval of pacifism, depending on how existential threat is perceived, whether the need for symbolic self-transcendence is satisfied, which social norms are salient, and how social situations are interpreted. In the present article, we review current TMT research with the aim of reconciling the seemingly contradictory findings of hostile and peaceful reactions to reminders of death. We present a terror management model of escalation and de-escalation of violent intergroup conflicts, which takes into account the interaction between threat salience and features of the social situation. We also discuss possible intervention strategies to override detrimental consequences of existential threat and argue that war is not the inevitable consequence of threat. PsycINFO Database Record (c) 2013 APA, all rights reserved

  15. Fossil evidence for Cretaceous escalation in angiosperm leaf vein evolution.

    Science.gov (United States)

    Feild, Taylor S; Brodribb, Timothy J; Iglesias, Ari; Chatelet, David S; Baresch, Andres; Upchurch, Garland R; Gomez, Bernard; Mohr, Barbara A R; Coiffard, Clement; Kvacek, Jiri; Jaramillo, Carlos

    2011-05-17

    The flowering plants that dominate modern vegetation possess leaf gas exchange potentials that far exceed those of all other living or extinct plants. The great divide in maximal ability to exchange CO(2) for water between leaves of nonangiosperms and angiosperms forms the mechanistic foundation for speculation about how angiosperms drove sweeping ecological and biogeochemical change during the Cretaceous. However, there is no empirical evidence that angiosperms evolved highly photosynthetically active leaves during the Cretaceous. Using vein density (D(V)) measurements of fossil angiosperm leaves, we show that the leaf hydraulic capacities of angiosperms escalated several-fold during the Cretaceous. During the first 30 million years of angiosperm leaf evolution, angiosperm leaves exhibited uniformly low vein D(V) that overlapped the D(V) range of dominant Early Cretaceous ferns and gymnosperms. Fossil angiosperm vein densities reveal a subsequent biphasic increase in D(V). During the first mid-Cretaceous surge, angiosperm D(V) first surpassed the upper bound of D(V) limits for nonangiosperms. However, the upper limits of D(V) typical of modern megathermal rainforest trees first appear during a second wave of increased D(V) during the Cretaceous-Tertiary transition. Thus, our findings provide fossil evidence for the hypothesis that significant ecosystem change brought about by angiosperms lagged behind the Early Cretaceous taxonomic diversification of angiosperms.

  16. Attention modulates adaptive motor learning in the 'broken escalator' paradigm.

    Science.gov (United States)

    Patel, Mitesh; Kaski, Diego; Bronstein, Adolfo M

    2014-07-01

    The physical stumble caused by stepping onto a stationary (broken) escalator represents a locomotor aftereffect (LAE) that attests to a process of adaptive motor learning. Whether such learning is primarily explicit (requiring attention resources) or implicit (independent of attention) is unknown. To address this question, we diverted attention in the adaptation (MOVING) and aftereffect (AFTER) phases of the LAE by loading these phases with a secondary cognitive task (sequential naming of a vegetable, fruit and a colour). Thirty-six healthy adults were randomly assigned to 3 equally sized groups. They performed 5 trials stepping onto a stationary sled (BEFORE), 5 with the sled moving (MOVING) and 5 with the sled stationary again (AFTER). A 'Dual-Task-MOVING (DTM)' group performed the dual-task in the MOVING phase and the 'Dual-Task-AFTEREFFECT (DTAE)' group in the AFTER phase. The 'control' group performed no dual task. We recorded trunk displacement, gait velocity and gastrocnemius muscle EMG of the left (leading) leg. The DTM, but not the DTAE group, had larger trunk displacement during the MOVING phase, and a smaller trunk displacement aftereffect compared with controls. Gait velocity was unaffected by the secondary cognitive task in either group. Thus, adaptive locomotor learning involves explicit learning, whereas the expression of the aftereffect is automatic (implicit). During rehabilitation, patients should be actively encouraged to maintain maximal attention when learning new or challenging locomotor tasks.

  17. PET-guided dose escalation tomotherapy in malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Fodor, Andrei; Dell' Oca, Italo; Pasetti, Marcella; Di Muzio, Nadia Gisella [San Raffaele Scientific Institute, Milan (Italy). Dept. of Radiotherapy; Fiorino, Claudio; Broggi, Sara; Cattaneo, Giovanni Mauro; Calandrino, Riccardo [San Raffaele Scientific Institute, Milan (Italy). Medical Physics; Gianolli, Luigi [San Raffaele Scientific Institute, Milan (Italy). Dept. of Nuclear Medicine

    2011-11-15

    To test the feasibility of salvage radiotherapy using PET-guided helical tomotherapy in patients with progressive malignant pleural mesothelioma (MPM). A group of 12 consecutive MPM patients was treated with 56 Gy/25 fractions to the planning target volume (PTV); FDG-PET/CT simulation was always performed to include all positive lymph nodes and MPM infiltrations. Subsequently, a second group of 12 consecutive patients was treated with the same dose to the whole pleura adding a simultaneous integrated boost of 62.5 Gy to the FDG-PET/CT positive areas (BTV). Good dosimetric results were obtained in both groups. No grade 3 (RTOG/EORTC) acute or late toxicities were reported in the first group, while 3 cases of grade 3 late pneumonitis were registered in the second group: the duration of symptoms was 2-10 weeks. Median overall survival was 8 months (1.2-50.5 months) and 20 months (4.3-33.8 months) from the beginning of radiotherapy, for groups I and II, respectively (p = 0.19). A significant impact on local relapse from radiotherapy was seen (median time to local relapse: 8 vs 17 months; 1-year local relapse-free rate: 16% vs 81%, p = 0.003). The results of this pilot study support the planning of a phase III study of combined sequential chemoradiotherapy with dose escalation to BTV in patients not able to undergo resection. (orig.)

  18. Escalation scenarios initiated by gas explosions on offshore installations. Probabilistic cause and consequence modelling

    Energy Technology Data Exchange (ETDEWEB)

    Eknes, Monika Loeland

    1996-12-31

    This Dr. ing. thesis deals with escalation scenarios initiated by gas explosions on offshore installations. Gas explosions is one of the major hazards to such installations. The objectives were to estimate the probability of ignition and frequency of gas explosions for gas leaks on top sides of offshore installations, and to estimate the response and resistance of components that could result in escalation if they failed. Main fields considered cover risk analysis methodology, gas explosions, simplified escalation models, evaluation of structural consequences, case studies, and guidelines. 107 refs., 33 figs., 33 tabs.

  19. Cost of dose escalation in people with rheumatoid arthritis treated with tumour necrosis factor inhibitors across Europe.

    Science.gov (United States)

    Holden, Sarah E; Currie, Craig J; Lennon, Martin; Reynolds, Alan V; Moots, Robert J

    2016-01-01

    The aim of this study was to calculate the marginal cost of dose escalation in people with rheumatoid arthritis treated with tumour necrosis factor (TNF) inhibitors across Europe. The proportion of people who escalate their dose of TNF inhibitor and the average percentage increase in TNF inhibitor cost associated with escalators versus non-escalators was calculated from previously published estimates, weighted by the sample size for each study. The number of people with rheumatoid arthritis treated with TNF inhibitors and the corresponding total drug sales were obtained for five European countries from Decision Resources' Pharmacor Market Forecast. Method 1 assumed that total sales of a TNF inhibitor represented the cost of an escalator multiplied by the number of escalators plus the cost of a non-escalator multiplied by the number of non-escalators. Method 2 assumed that the drug cost per day used to forecast total sales was calculated using the dose of TNF inhibitor used by non-escalators. The marginal cost of TNF inhibitor dose escalation was estimated by multiplying the difference in cost between escalators and non-escalators by the number of escalators. The estimated increase in TNF inhibitor costs associated with dose escalation in people with rheumatoid arthritis across five European countries (Germany, France, UK, Spain and Italy) was €51.5-54.4 million for adalimumab, €44.8-52.8 million for infliximab and €5.8-5.9 million for etanercept. Dose escalation of the TNF inhibitors adalimumab, etanercept and infliximab in people with rheumatoid arthritis has resulted in an increase in TNF inhibitor costs across five European countries.

  20. Healthcare. Executive Summary

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This executive summary highlights several findings about healthcare. These are: (1) Healthcare is 18 percent of the U.S. economy, twice as high as in other countries; (2) There are two labor markets in healthcare: high-skill, high-wage professional and technical jobs and low-skill, low-wage support jobs; (3) Demand for postsecondary education in…

  1. The quality of healthcare

    African Journals Online (AJOL)

    The quality of healthcare provided by a healthcare system is not always easily assessed. How can one assess the smile of reassurance from a nursing sister or the feeling of satisfaction of a patient when visiting a doctor in a resource-limited setting? There are, however, some objective measures of healthcare activity.

  2. PtmxGuard: An Improved Method for Android Kernel to Prevent Privilege Escalation Attack

    Directory of Open Access Journals (Sweden)

    Kong Bin

    2017-01-01

    Full Text Available Vulnerabilities in Android kernel give opportunity for attacker to damage the system. Privilege escalation is one of the most dangerous attacks, as it helps attacker to gain root privilege by exploiting kernel vulnerabilities. Mitigation technologies, static detection methods and dynamic defense methods have been suggested to prevent privilege escalation attack, but they still have some disadvantages. In this paper, we propose an improved method named PtmxGuard to enhance Android kernel and defeat privilege escalation attack. We focus on a typical attack pattern that attacker hijacks the control flow of Android kernel to modify process credentials by corrupting critical global function pointers. PtmxGuard enforces Code Pointer Integrity to Android kernel, checks the accuracy and reliability of those pointers when they’re triggered by related system calls, and intercepts the system calls when attack activities are detected. Experiment result demonstrates that PtmxGuard can defense privilege escalation attack effectively.

  3. Studying the efficacy of escalated dose conformal radiation therapy in prostate carcinoma – Pakistan experience

    Directory of Open Access Journals (Sweden)

    Asad Zamir

    2017-11-01

    Conclusion: Our data were comparable to international studies of dose escalation using 3D and beneficial as compared to conventional radiation therapy delivered by 2D in terms of biochemical failure rate and treatment related toxicity.

  4. Factors Predicting an Escalation of Restrictive Eating During Adolescence.

    Science.gov (United States)

    Haynos, Ann F; Watts, Allison W; Loth, Katie A; Pearson, Carolyn M; Neumark-Stzainer, Dianne

    2016-10-01

    To examine longitudinal risk factors and short-term risk correlates for the development of extreme forms of restrictive eating among adolescent dieters. Data from Project Eating and Activity in Teens and Young Adults, a population-based study of 2,516 students aged 12-18 years, were collected in 1998-1999 (Time 1) and 5 years later (Time 2). Within this sample, 243 adolescents who reported dieting but not engaging in disordered forms of restrictive eating (e.g., fasting, skipping meals) at Time 1 were followed to determine the self-reported psychological, familial, and social variables predicting initiation of disordered restrictive eating at Time 2. To investigate short-term risk correlates of initiating disordered restrictive eating, the same risk factors were also compared cross-sectionally at Time 2 between the dieters who had and had not initiated disordered restrictive eating. Poisson regression models with robust standard errors were fit for each predictor adjusted for covariates. Depressive symptoms and low self-esteem were significantly associated with the initiation of disordered restrictive eating in both longitudinal and cross-sectional analyses. Poor family communication/caring and maternal dieting significantly predicted long-term risk for escalating restrictive eating severity; whereas, individual body image issues (i.e., weight concerns, body dissatisfaction) and social concerns (i.e., weight-related teasing, peer dieting) were significant short-term correlates of initiating disordered restrictive eating. Depressive symptoms and low self-esteem may be especially important targets for risk identification and prevention for disordered restrictive eating. Intervening on family influences may decrease long-term risk, whereas intervening on body image and responses to social influences may decrease short-term risk for disordered restrictive eating. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights

  5. Critical success factors for implementing healthcare e-Learning.

    Science.gov (United States)

    Lee, Te-Shu; Kuo, Mu-Hsing; Borycki, Elizabeth M; Yunyong, David

    2011-01-01

    The use of e-Learning in educational institutes has rapidly increased along with the development of information and communication technology (ICT). In healthcare, more medical educators are using e-Learning to support their curriculum design, delivery and evaluation. However, no systematic work exists on characterizing a collective set of Critical Success Factors (CSFs) for implementing e-Learning in the healthcare education institutions. The aim of this paper is to study the CSFs of implementing healthcare e-Learning.

  6. Device Data Protection in Mobile Healthcare Applications

    Science.gov (United States)

    Weerasinghe, Dasun; Rajarajan, Muttukrishnan; Rakocevic, Veselin

    The rapid growth in mobile technology makes the delivery of healthcare data and services on mobile phones a reality. However, the healthcare data is very sensitive and has to be protected against unauthorized access. While most of the development work on security of mobile healthcare today focuses on the data encryption and secure authentication in remote servers, protection of data on the mobile device itself has gained very little attention. This paper analyses the requirements and the architecture for a secure mobile capsule, specially designed to protect the data that is already on the device. The capsule is a downloadable software agent with additional functionalities to enable secure external communication with healthcare service providers, network operators and other relevant communication parties.

  7. The effects of oral and intramuscular administration and dose escalation of enrofloxacin on the selection of quinolone resistance among Salmonella and coliforms in pigs

    DEFF Research Database (Denmark)

    Wiuff, C.; Lykkesfeldt, J.; Svendsen, O.

    2003-01-01

    the resistant and total number of coliforms and Salmonella in faeces of the pigs. High frequencies of fluoroquinolone resistance developed rapidly among the coliform flora independent of route of administration, dose or time of initiation of the treatment. Selection for resistance among the artificially...... introduced Salmonella was reduced by using the intramuscular route and by escalating the dose 3 or 6 times the recommended dose of 2.5 mg/kg bwt, which also resulted in shortening of the period, in which the pigs were shedding Salmonella. The resistance among the coliform flora persisted for at least 2 weeks...

  8. Finding What Works: Leadership Competencies for the Changing Healthcare Environment

    Science.gov (United States)

    Herd, Ann M.; Adams-Pope, Brittany L.; Bowers, Amanda; Sims, Brittany

    2016-01-01

    As the world of healthcare changes rapidly, healthcare leaders and managers must hone their leadership competencies in order to remain effective in their organizations. With changes such as the Affordable Care Act, increasing medical school costs, decreased graduation rates, and increased needs for care, how are current and future healthcare…

  9. Crime and punishment. Instead of a slap on the wrist, crooked healthcare executives now are being sentenced to prison thanks to a crackdown on white-collar crime.

    Science.gov (United States)

    Taylor, Mark

    2002-03-18

    Lawmakers wondering how to handle white-collar crime might look to the healthcare industry, where crooked executives are being held criminally accountable for shady business dealings and corrupt practices that previously may have resulted in quiet dismissals. A confluence of factors has driven the crackdown, from escalating whistleblower lawsuits to a decade-long effort to halt Medicare and Medicaid fraud.

  10. Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience.

    Science.gov (United States)

    Back, Jonathan; Ross, Alastair J; Duncan, Myanna D; Jaye, Peter; Henderson, Katherine; Anderson, Janet E

    2017-11-01

    Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes. The study objective is to examine escalation policies in theory and practice. This was a mixed-method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16-month period in a large UK ED (n=30 observations). The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need ("work as done") was found to be incompletely specified in policies ("work as imagined"). Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  11. Modelling the implications of reducing smoking prevalence: the benefits of increasing the UK tobacco duty escalator to public health and economic outcomes.

    Science.gov (United States)

    Knuchel-Takano, Andre; Hunt, Daniel; Jaccard, Abbygail; Bhimjiyani, Arti; Brown, Martin; Retat, Lise; Brown, Katrina; Hinde, Sebastian; Selvarajah, Chit; Bauld, Linda; Webber, Laura

    2017-12-06

    Taxing tobacco is one of the most effective ways to reduce smoking prevalence, mitigate its devastating consequential health harms and progress towards a tobacco-free society. This study modelled the health and economic impacts of increasing the existing cigarette tobacco duty escalator (TDE) in the UK from the current 2% above consumer price inflation to 5%. A two-stage modelling process was used. First, a non-linear multivariate regression model was fitted to cross-sectional smoking data, creating longitudinal projections from 2015 to 2035. Second, these projections were used to predict the future incidence, prevalence and cost of 17 smoking-related diseases using a Monte Carlo microsimulation approach. A sustained increase in the duty escalator was evaluated against a baseline of continuing historical smoking trends and the existing duty escalator. A sustained increase in the TDE is projected to reduce adult smoking prevalence to 6% in 2035, from 10% in a baseline scenario. After increasing the TDE, only 65% of female and 60% of male would-be smokers would actually be smoking in 2035. The intervention is projected to avoid around 75 200 new cases of smoking-related diseases between 2015 and 2035. In 2035 alone, £49 m in National Health Service and social care costs and £192 m in societal premature mortality and morbidity costs are projected to be avoided. Increasing the UK TDE to 5% above inflation could effectively reduce smoking prevalence, prevent diseases and avoid healthcare costs. It would deliver substantial progress towards a tobacco-free society and should be implemented by the UK Government with urgency. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Improving Healthcare Logistics Processes

    DEFF Research Database (Denmark)

    Feibert, Diana Cordes

    provision whilst providing high quality care. Logistics activities in hospitals provide a significant opportunity for cost containment in healthcare through the implementation of best practices. Literature provides little guidance on how to improve healthcare logistics processes. This study investigates...... at hospitals in Denmark and the US investigating three different types of processes: bed logistics, hospital cleaning, and pharmaceutical distribution. Based on an analysis and comparison of the case studies, a set of factors were identified influencing the decision on how to improve healthcare logistics......Healthcare costs are increasing due to an ageing population and more sophisticated technologies and treatments. At the same time, patients expect high quality care at an affordable cost. The healthcare industry has therefore experienced increasing pressures to reduce the cost of healthcare...

  13. Healthcare financing in Malaysia.

    Science.gov (United States)

    Kananatu, K

    2002-01-01

    This paper presents an overview of the Malaysian healthcare system and its method of financing. The development of the healthcare delivery system in Malaysia is commendable. However, the strength and weaknesses of the public healthcare system and the financing problems encountered are also discussed. Cost of healthcare and funding of both the public and private sectors were also revealed. One must optimise the advantages of operating a health financing scheme which is affordable and controllable which contribute towards cost-containment and quality assurance. Thus, there is a need for the establishment of a National Healthcare Financing, a mechanism to sustain the healthcare delivery network and operate it as a viable option. A model of the National Health Financing Scheme (NHFS) was proposed.

  14. Younger age of escalation of cardiovascular risk factors in Asian Indian subjects

    Directory of Open Access Journals (Sweden)

    Gupta Shaon

    2009-07-01

    Full Text Available Abstract Background Cardiovascular risk factors start early, track through the young age and manifest in middle age in most societies. We conducted epidemiological studies to determine prevalence and age-specific trends in cardiovascular risk factors among adolescent and young urban Asian Indians. Methods Population based epidemiological studies to identify cardiovascular risk factors were performed in North India in 1999–2002. We evaluated major risk factors-smoking or tobacco use, obesity, truncal obesity, hypertension, dysglycemia and dyslipidemia using pre-specified definitions in 2051 subjects (male 1009, female 1042 aged 15–39 years of age. Age-stratified analyses were performed and significance of trends determined using regression analyses for numerical variables and Χ2 test for trend for categorical variables. Logistic regression was used to identify univariate and multivariate odds ratios (OR for correlation of age and risk factors. Results In males and females respectively, smoking or tobacco use was observed in 200 (11.8% and 18 (1.4%, overweight or obesity (body mass index, BMI ≥ 25 kg/m2 in 12.4% and 14.3%, high waist-hip ratio, WHR (males > 0.9, females > 0.8 in 15% and 32.3%, hypertension in 5.6% and 3.1%, high LDL cholesterol (≥ 130 mg/dl in 9.4% and 8.9%, low HDL cholesterol ( Conclusion Low prevalence of multiple cardiovascular risk factors (smoking, hypertension, dyslipidemias, diabetes and metabolic syndrome in adolescents and rapid escalation of these risk factors by age of 30–39 years is noted in urban Asian Indians. Interventions should focus on these individuals.

  15. Marketing in Healthcare Unit

    OpenAIRE

    Mariana BIRSA

    2011-01-01

    Healthcare marketing is a part of public services marketing. In developed countries, healthcare marketing can be applied to a microeconomic as well as to a macroeconomic level. The main feature of healthcare marketing is that there are products, markets, but there is no cash equivalent. For both traditional marketing and public healthcare marketing, the user of a product or service is called “consumer” and a group of consumers is mentioned as a “market”. Acceptance of marketing by USA heath s...

  16. Healthcare financing in Croatia

    Directory of Open Access Journals (Sweden)

    Nevenka Kovač

    2013-12-01

    Full Text Available Healthcare financing system is of crucial importance for the functioning of any healthcare system, especially because there is no country in the world that is able to provide all its residents with access to all the benefits afforded by modern medicine. Lack of resources in general and rising healthcare expenditures are considered a difficult issue to solve in Croatia as well. Since Croatia gained its independence, its healthcare system has undergone a number of reforms, the primary objective of which was to optimize healthcare services to the actual monetary capacity of the Croatian economy. The objectives of the mentioned re - forms were partially achieved. The solutions that have been offered until now, i.e. consolidation measures undertaken in the last 10 years were necessary; however, they have not improved the operating conditions. There is still the issue of the deficit from the previous years, i.e. outstanding payments, the largest in the last decade. Analysis of the performance of healthcare institutions in 2011 shows that the decision makers will have to take up a major challenge of finding a solution to the difficulties the Croatian healthcare system has been struggling with for decades, causing a debt of 7 billion kuna. At the same time, they will need to uphold the basic principles of the Healthcare Act, i.e. to provide access to healthcare and ensure its continuity, comprehensiveness and solidarity, keeping in mind that the National Budget Act and Fiscal Responsibility Act have been adopted.

  17. Board Governance: Transformational Approaches Under Healthcare Reform.

    Science.gov (United States)

    Zastocki, Deborah K

    2015-01-01

    Previous successes of healthcare organizations and effective governance practices in the pre-reform environment are not predictive of future success. Healthcare has been through numerous phases of growth and development using tried-and-true strategies. The challenge is that our toolbox does not contain what is needed to build the future healthcare delivery systems required in the post-reform world. Healthcare has had a parochial focus at the local level, with some broadening of horizons at the state and national levels. But healthcare delivery is now a global issue that requires a totally different perspective, and many countries are confronting similar issues. US healthcare reform initiatives have far-reaching implications. Compounding the reform dynamics are the simultaneously occurring, gamechanging accelerants such as enabling information technologies and mobile health, new providers of healthcare, increased consumer demands, and limited healthcare dollars, to name a few. Operating in this turbulent environment requires transformational board, executive, and physician leadership because traditional ways of planning for incremental change and attempting to time those adjustments can prove disastrous. Creating the legacy healthcare system for tomorrow requires governing boards and executive leadership to act today as they would in the desired future system. Boards need to create a culture that fosters.innovation with a tolerance for risk and some failure. To provide effective governance, boards must essentially develop new skills, expertise, and ways of thinking. The rapid rate of change requires board members to possess certain capabilities, including the ability to deal with ambiguity and uncertainty while demonstrating flexibility and adaptability, all with a driving commitment to metrics and results. This requires development plans for both individual members and the overall board. In short, the board needs to function differently, particularly regarding the

  18. A phase I, dose-escalation trial evaluating the safety and efficacy of emulsified isoflurane in healthy human volunteers.

    Science.gov (United States)

    Huang, Han; Li, Rui; Liu, Jin; Zhang, Wensheng; Liao, Tianzhi; Yi, Xiaoqian

    2014-03-01

    This first-in-human volunteer phase I clinical trial aimed to evaluate the safety, tolerability, and anesthesia efficacy of emulsified isoflurane (EI), an intravenously injectable formulation of isoflurane. Seventy-eight healthy volunteers were recruited in this open-label, single-bolus, dose-escalation, phase I trial and were allocated into 16 cohorts. Each volunteer received a single bolus injection of EI. The dose started with 0.3 mg/kg (for isoflurane) and was planned to end with 64.6 mg/kg. Postdose vital signs, physical examination, laboratory tests, chest radiograph, 12-lead electrocardiogram, and development of any adverse event were closely monitored as safety measurements. Effectiveness in producing sedation/anesthesia was assessed by Modified Observer's Assessment of Alertness/Sedation and Bispectral Index. The dose escalation ended as planned. The most common adverse events associated with EI were injection pain (77 of 78, 98.7%) and transient tachycardia (22 of 78, 25.6%). Only at high doses (≥38.3 mg/kg) did EI cause transient hypotension (5 of 78, 6.4%) or apnea (11 of 78, 14.1%), but all the affected volunteers recovered uneventfully. Fast onset of unconsciousness (typically 40 s after injection) was developed in all volunteers receiving doses of 22.6 mg/kg or greater. Waking-up time and depression in Modified Observer's Assessment of Alertness/Sedation correlated well with EI dose. None of the postdose tests revealed any abnormal result. EI is safe for intravenous injection in human volunteers in the dose range of 0.3 to 64.6 mg/kg. At doses of 22.6 mg/kg or higher, EI produced rapid onset of unconsciousness in all volunteers followed by fast, predictable, and complete recovery.

  19. Subthreshold depressive disorder in adolescents: predictors of escalation to full-syndrome depressive disorders.

    Science.gov (United States)

    Klein, Daniel N; Shankman, Stewart A; Lewinsohn, Peter M; Seeley, John R

    2009-07-01

    Subthreshold depressive disorder is one of the best established risk factors for the onset of full-syndrome depressive disorders. However, many youths with subthreshold depressive disorder do not develop full-syndrome depression. We examined predictors of escalation to full-syndrome depressive disorders in a community sample of 225 adolescents with subthreshold depressive disorder. Criteria for subthreshold depressive disorder were an episode of depressed mood or loss of interest or pleasure lasting at least 1 week and at least two of the seven other DSM-IV-associated symptoms for major depression. Participants were assessed four times from mid-adolescence to age 30 years using semistructured diagnostic interviews. The estimated risk for escalation to full-syndrome depressive disorders was 67%. Five variables accounted for unique variance in predicting escalation: severity of depressive symptoms, medical conditions/symptoms, history of suicidal ideation, history of anxiety disorder, and familial loading for depression. Adolescents with three or more risk factors had an estimated 90% chance of escalating to full-syndrome depressive disorder, compared with 47% of adolescents with fewer than three risk factors. These data may be useful in identifying a subgroup of youths with subthreshold depressive disorder who are at especially high risk for escalating to full-syndrome depressive disorders.

  20. Benefits and unintended consequences of antimicrobial de-escalation: Implications for stewardship programs.

    Directory of Open Access Journals (Sweden)

    Josie Hughes

    Full Text Available Sequential antimicrobial de-escalation aims to minimize resistance to high-value broad-spectrum empiric antimicrobials by switching to alternative drugs when testing confirms susceptibility. Though widely practiced, the effects de-escalation are not well understood. Definitions of interventions and outcomes differ among studies. We use mathematical models of the transmission and evolution of Pseudomonas aeruginosa in an intensive care unit to assess the effect of de-escalation on a broad range of outcomes, and clarify expectations. In these models, de-escalation reduces the use of high-value drugs and preserves the effectiveness of empiric therapy, while also selecting for multidrug-resistant strains and leaving patients vulnerable to colonization and superinfection. The net effect of de-escalation in our models is to increase infection prevalence while also increasing the probability of effective treatment. Changes in mortality are small, and can be either positive or negative. The clinical significance of small changes in outcomes such as infection prevalence and death may exceed more easily detectable changes in drug use and resistance. Integrating harms and benefits into ranked outcomes for each patient may provide a way forward in the analysis of these tradeoffs. Our models provide a conceptual framework for the collection and interpretation of evidence needed to inform antimicrobial stewardship.

  1. Infliximab Dose Escalation as an Effective Strategy for Managing Secondary Loss of Response in Ulcerative Colitis.

    Science.gov (United States)

    Taxonera, Carlos; Barreiro-de Acosta, Manuel; Calvo, Marta; Saro, Cristina; Bastida, Guillermo; Martín-Arranz, María D; Gisbert, Javier P; García-Sánchez, Valle; Marín-Jiménez, Ignacio; Bermejo, Fernando; Chaparro, María; Ponferrada, Ángel; Martínez-Montiel, María P; Pajares, Ramón; de Gracia, Celia; Olivares, David; Alba, Cristina; Mendoza, Juan L; Fernández-Blanco, Ignacio

    2015-10-01

    The outcomes of infliximab dose escalation in ulcerative colitis (UC) have not been well evaluated. To assess the short- and long-term outcomes of infliximab dose escalation in a cohort of patients with UC. This was a multicenter, retrospective, cohort study. All consecutive UC patients who had lost response to infliximab maintenance infusions and who underwent infliximab dose escalation were included. Post-escalation short-term clinical response and remission were evaluated. In the long term, the cumulative probabilities of infliximab failure-free survival and colectomy-free survival were calculated. Predictors of short-term response and event-free survival were estimated using logistic regression analysis and Cox proportional hazard regression analysis. Seventy-nine patients were included. Fifty-four patients (68.4%) achieved short-term clinical response and 41 patients (51.9%) entered in clinical remission. After a median follow-up of 15 months [interquartile range (IQR) 8-26], 33 patients (41.8%) had infliximab failure. Patients with short-term response had a significantly lower adjusted rate of infliximab failure [hazard ratio (HR) 0.24, 95% confidence interval (CI) 0.12-0.49; p infliximab during maintenance, infliximab dose escalation enabled recovery of short-term response in nearly 70% of patients. In the long term, 58% of patients maintained sustained clinical benefit, and 9 of 10 avoided colectomy. Short-term response was associated with an 86% reduction in the relative risk of colectomy.

  2. Enzyme replacement therapy with alglucosidase alfa in Pompe disease: Clinical experience with rate escalation.

    Science.gov (United States)

    Desai, Ankit K; Walters, Crista K; Cope, Heidi L; Kazi, Zoheb B; DeArmey, Stephanie M; Kishnani, Priya S

    2017-12-23

    Patients with Pompe disease have realized significant medical benefits due to enzyme replacement therapy (ERT) infusions with alglucosidase alfa. However, regular infusions are time-consuming. Utilizing recommended infusion rates, infusion duration is 3h 45min for a patient receiving the standard dose of 20mg/kg, not including additional time needed for preparation of ERT, assessment of vital signs, intravenous access, and post-infusion monitoring. Recent studies have demonstrated increased effectiveness of higher dose of ERT (40mg/kg) in infantile-onset Pompe disease (IOPD), which increases the infusion duration to 6h 36min. Increased infusion durations compound the psychosocial burden on patients and families and potentially further disrupt family activities and obligations. We developed a stepwise infusion rate escalation protocol to administer higher dose ERT safely while decreasing infusion duration, which has been implemented in 15 patients to date. Reported here in detail are five patients with IOPD on 40mg/kg/weekly ERT in whom infusion duration was decreased with individualized, stepwise rate escalation. All patients tolerated rate escalations above the recommended rates without experiencing any infusion associated reactions and experienced a reduction in infusion duration by 1h and 24min with a corresponding increase in reported satisfaction. Our experience with ERT rate escalation is presented. A careful stepwise method of enzyme replacement therapy (ERT) rate escalation can safely reduce infusion duration in patients with Pompe disease. Copyright © 2017. Published by Elsevier Inc.

  3. Radiobiological evaluation of simultaneously dose-escalated versus non-escalated intensity-modulated radiation therapy for patients with upper thoracic esophageal cancer

    Directory of Open Access Journals (Sweden)

    Huang BT

    2017-04-01

    Full Text Available Bao-Tian Huang,1,* Li-Li Wu,1,* Long-Jia Guo,1,* Liang-Yu Xu,1,* Rui-Hong Huang,1 Pei-Xian Lin,2 Jian-Zhou Chen,1,3 De-Rui Li,1 Chuang-Zhen Chen1 1Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, 2Department of Nosocomial Infection Management, The Second Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China; 3CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom *These authors contributed equally to this work Objective: To compare the radiobiological response between simultaneously dose-escalated and non-escalated intensity-modulated radiation therapy (DE-IMRT and NE-IMRT for patients with upper thoracic esophageal cancer (UTEC using radiobiological evaluation. Methods: Computed tomography simulation data sets for 25 patients pathologically diagnosed with primary UTEC were used in this study. DE-IMRT plan with an escalated dose of 64.8 Gy/28 fractions to the gross tumor volume (GTV and involved lymph nodes from 25 patients pathologically diagnosed with primary UTEC, was compared to an NE-IMRT plan of 50.4 Gy/28 fractions. Dose-volume metrics, tumor control probability (TCP, and normal tissue complication probability for the lung and spinal cord were compared. In addition, the risk of acute esophageal toxicity (AET and late esophageal toxicity (LET were also analyzed. Results: Compared with NE-IMRT plan, we found the DE-IMRT plan resulted in a 14.6 Gy dose escalation to the GTV. The tumor control was predicted to increase by 31.8%, 39.1%, and 40.9% for three independent TCP models. The predicted incidence of radiation pneumonitis was similar (3.9% versus 3.6%, and the estimated risk of radiation-induced spinal cord injury was extremely low (<0.13% in both groups. Regarding the esophageal toxicities, the estimated grade ≥2 and grade ≥3 AET predicted by the Kwint model were increased by 2.5% and 3.8%. Grade ≥2

  4. A design thinking framework for healthcare management and innovation.

    Science.gov (United States)

    Roberts, Jess P; Fisher, Thomas R; Trowbridge, Matthew J; Bent, Christine

    2016-03-01

    The business community has learned the value of design thinking as a way to innovate in addressing people's needs--and health systems could benefit enormously from doing the same. This paper lays out how design thinking applies to healthcare challenges and how systems might utilize this proven and accessible problem-solving process. We show how design thinking can foster new approaches to complex and persistent healthcare problems through human-centered research, collective and diverse teamwork and rapid prototyping. We introduce the core elements of design thinking for a healthcare audience and show how it can supplement current healthcare management, innovation and practice. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Healthcare. State Report

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report projects education requirements linked to forecasted job growth in healthcare by state and the District of Columbia from 2010 through 2020. It complements a larger national report which projects educational demand for healthcare for the same time period. The national report shows that with or without Obamacare, the United States will…

  6. Audience reactions to peace journalism: How supporters and critics of the Israeli policy process escalation and de-escalation oriented media frames

    Directory of Open Access Journals (Sweden)

    Stephanie Thiel

    2014-04-01

    Full Text Available This paper reports on an experiment that uses the Israeli-Palestinian conflict as a natural laboratory for studying how recipients make sense of escalation vs. de-escalation oriented news articles. The results of the study indicate that media frames and individual frames have both a direct effect and complex interaction effects on participants’ text understanding. Particularly the effect of media war frames diminishes if they are incongruent with participants’ individual frames, and the propaganda function of reports about violence and human casualties can be neutralized if framed according to a peace frame. If participants had a priori positioned themselves in favor of the perpetrator, they may produce reactance, however.

  7. The escalating health care cost of AIDS: who will pay?

    Science.gov (United States)

    Kerley, L J

    1990-01-01

    AIDS is a crisis that has been imposed on an imperfect healthcare system. The flaws are easy to recognize but difficult to treat. Difficult choices about who pays for the medical care for AIDS patients will be made by upper-class and upper middle-class policymakers who are influenced by their own sense of vulnerability and by an aroused public. Social prejudice and moral judgment must be set aside. While the public ethic speaks the language of social justice, public activity often speaks the language of market justice. Beauchamp (1984) cites the philosophy of Anthony Downs when he states that solving social problems "requires painful losses, the restructuring of society and the acceptance of new burdens by the most powerful and the most numerous on behalf of the least powerful or the least numerous" (p. 306). It is characteristic of the public to attend to social problems until "it becomes clear that solving these problems requires painful costs that the dominant interests in society are unwilling to pay" (p. 306). The problem of AIDS care will require painful costs; but unlike many social problems, it will refuse to be hidden, refuse to be contained, refuse to be silenced, and refuse to be equitable in the marketplace and in the social system.

  8. Changing the game; some thoughts on future healthcare demands, technology, nursing and interprofessional education.

    Science.gov (United States)

    Garrett, Bernard M

    2012-07-01

    This editorial discusses the conclusions of a number of high-profile reports on the future of healthcare provision, and healthcare professional education. The need for the realignment of service provision, regulation, interdisciplinary healthcare and supporting education is discussed in the context of rapid technological and social change. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. The role of technology and engineering models in transforming healthcare.

    Science.gov (United States)

    Pavel, Misha; Jimison, Holly Brugge; Wactlar, Howard D; Hayes, Tamara L; Barkis, Will; Skapik, Julia; Kaye, Jeffrey

    2013-01-01

    The healthcare system is in crisis due to challenges including escalating costs, the inconsistent provision of care, an aging population, and high burden of chronic disease related to health behaviors. Mitigating this crisis will require a major transformation of healthcare to be proactive, preventive, patient-centered, and evidence-based with a focus on improving quality-of-life. Information technology, networking, and biomedical engineering are likely to be essential in making this transformation possible with the help of advances, such as sensor technology, mobile computing, machine learning, etc. This paper has three themes: 1) motivation for a transformation of healthcare; 2) description of how information technology and engineering can support this transformation with the help of computational models; and 3) a technical overview of several research areas that illustrate the need for mathematical modeling approaches, ranging from sparse sampling to behavioral phenotyping and early detection. A key tenet of this paper concerns complementing prior work on patient-specific modeling and simulation by modeling neuropsychological, behavioral, and social phenomena. The resulting models, in combination with frequent or continuous measurements, are likely to be key components of health interventions to enhance health and wellbeing and the provision of healthcare.

  10. Choosing between stairs and escalators in China: The impact of location, height and pedestrian volume.

    Science.gov (United States)

    Zacharias, John; Tang, Boshen

    2015-01-01

    This research examines whether Beijing residents are more or less likely than Montréal residents to avoid stair climbing, by replicating a study in Montréal, Canada that measured the impacts of distance between stairs and escalator, height between floors and pedestrian volume on stair climbing rate. 15 stairways, 14 up-escalators and 13 down-escalators were selected in 13 publicly accessible settings in Beijing. Distance between the bottom or top of nearest stair and escalator combinations varied from 2.1 m to 114.1 m with height between floors varying from 3.3 m to 21.7 m. Simultaneous counts were conducted on stair and escalator pairs, for a total of 37,081 counted individuals. In the ascent model, pedestrian volume accounted for 16.3% of variance in stair climbing, 16.4% when height was added and 45.1% when distance was added. In the descent model, 40.9% of variance was explained by pedestrian volume, 41.5% when height was added and 45.5% when distance was added. Separating stairs and escalator is effective in increasing stair climbing in Beijing, accounting for 29% of the variance in stair climbing, compared with 43% in Montreal. As in the Montreal case, distance has less effect on stair use rate when descending. Overall, 25.4% of Beijingers opted for stairs when ascending compared with 20.3% of Montrealers, and for descending 32.8% and 31.1% respectively.

  11. Revisiting the cost escalation curse of nuclear power: New lessons from the French experience

    OpenAIRE

    Escobar Rangel, Lina; Lévêque, François

    2012-01-01

    Since the first wave of nuclear reactors in 1970 to the construction of Generation III+ reactors in Finland and France in 2005 and 2007 respectively, nuclear power seems to be doomed to a cost escalation curse. In this paper we reexamine this issue for the French nuclear power fleet. Using the construction costs from the Cour des Comptes report, that was publicly available in 2012, we found that previous studies overestimated the cost escalation. Although, it is undeniable that the scale-up e...

  12. Factors influencing healthcare service quality

    OpenAIRE

    Ali Mohammad Mosadeghrad

    2014-01-01

    Background The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results Quality in healthcare is a production o...

  13. Stormy weather in healthcare

    DEFF Research Database (Denmark)

    Clemensen, Jane; Jakobsen, Pernille; Myhre Jensen, Charlotte

    2017-01-01

    This paper discusses how the roles of patients and health professionals have changed over the years. It also explores how accelerated courses of treatment and busy staff have turned healthcare services and hospitals into “factories”, where care and relationships now exist in very cramped conditions...... and healthcare professionals, by a dominant paradigm. We suggest a shift in focus from valuing the neo-liberal approach, to focus on care by linking an Ecology of Care (EoC) approach to the healthcare context, as EoC can be used as a complementary philosophy to help change the paradigm and thereby secure...

  14. Healthcare Associated Infections - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infection (HAI) measures - provider data. These measures are developed by Centers for Disease Control and Prevention (CDC) and...

  15. Healthcare Associated Infections - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infections (HAI) measures - national data. These measures are developed by Centers for Disease Control and Prevention (CDC) and...

  16. Healthcare Associated Infections - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infections (HAI) measures - state data. These measures are developed by Centers for Disease Control and Prevention (CDC) and collected...

  17. Climate-induced forest dieback: An escalating global phenomenon?

    Science.gov (United States)

    Allen, Craig D.

    2009-01-01

    Forests, which today cover 30 percent of the world’s land surface (FAO, 2006), are being rapidly and directly transformed in many areas by the impacts of expanding human populations and economies. Less evident are the pervasive effects of ongoing climatic changes on the condition and status of forests around the world. Recent examples of drought and heat-related forest stress and dieback (defined here as tree mortality noticeably above usual mortality levels) are being documented from all forested continents, making it possible to begin to see global patterns. This article introduces these patterns and considers the possibility that many forests and woodlands today are at increasing risk of climate-induced dieback. A more comprehensive article (Allen et al., 2009) addresses this topic in considerably greater detail. While climate events can damage forests in many ways ranging from ice storms to tornadoes and hurricanes, the emphasis here is on climatic water stress, driven by drought and warm temperatures.

  18. Information Technology for Healthcare

    OpenAIRE

    Abbas Yazdanpanah

    2016-01-01

    The article produced below hopes to focus on the use of information technology solutions for improving healthcare delivery systems. It explains evolution of IT-Enhanced healthcare from Telemedicine to e-health, including definition and requirements of telemedical systems. It also traces the evolution of contemporary telemedical systems and the challenges faced by future technologies including legal and formal aspects of telemedicine as well as its acceptance among users. It overvi...

  19. A Co-operative Inquiry Into Generating, Describing, and Transforming Knowledge About De-escalation Practices in Mental Health Settings

    DEFF Research Database (Denmark)

    Berring, Lene Lauge; Hummelvoll, Jan Kåre; Pedersen, Liselotte

    2016-01-01

    De-escalation is concerned with managing violent behaviour without resorting to coercive measures. Co-operative Inquiry provided the conceptual basis for generating knowledge regarding de-escalation practices in acute mental health care settings. The research included service users and staff memb...

  20. SYSTEMS-2: A randomised phase II study of radiotherapy dose escalation for pain control in malignant pleural mesothelioma

    Directory of Open Access Journals (Sweden)

    M. Ashton

    2018-01-01

    Full Text Available SYSTEMS-2 is a randomised study of radiotherapy dose escalation for pain control in 112 patients with malignant pleural mesothelioma (MPM. Standard palliative (20 Gy/5# or dose escalated treatment (36 Gy/6# will be delivered using advanced radiotherapy techniques and pain responses will be compared at week 5. Data will guide optimal palliative radiotherapy in MPM.

  1. Temporal Aspects of Moral Disengagement in School Bullying: Crystallization or Escalation?

    Science.gov (United States)

    Obermann, Marie-Louise

    2013-01-01

    This study investigated the stability and change in bullying behavior and their relation to increases and decreases in moral disengagement, specifically exploring whether crystallization and escalation of disengagement occur. Within a 1-year span, two sets of data were collected. A total of 567 sixth to eighth graders participated in both data…

  2. Siding and other reactions to a conflict: A theory of escalation toward outsiders

    NARCIS (Netherlands)

    Van de Vliert, E

    1981-01-01

    Siding in a dyadic conflict is important because it precipitates escalation. Nevertheless, little is known about how and why a nonprofessional outsider (P) reacts when a conflict party puts him under pressure to take sides. Coalition and role conflict theories suggest four behavior alternatives

  3. Journal Price Escalation and the Market for Information: The Librarians' Solution.

    Science.gov (United States)

    Kingma, Bruce R.; Eppard, Philip B.

    1992-01-01

    Analyzes the problem of journal price escalation as one of equilibrium between two market segments--the library market and the market for individual subscriptions. Argues that high quality photocopying has encouraged individuals to rely on library subscriptions and proposes that the socially responsible solution is to increase photocopy costs and…

  4. Vaginal dose de-escalation in image guided adaptive brachytherapy for locally advanced cervical cancer

    DEFF Research Database (Denmark)

    Mohamed, Sandy; Lindegaard, Jacob Christian; de Leeuw, Astrid A C

    2016-01-01

    Purpose Vaginal stenosis is a major problem following radiotherapy in cervical cancer. We investigated a new dose planning strategy for vaginal dose de-escalation (VDD). Materials and methods Fifty consecutive locally advanced cervical cancer patients without lower or middle vaginal involvement...

  5. Evaluation methodology for tariff design under escalating penetrations of distributed energy resources

    NARCIS (Netherlands)

    Abdelmotteleb, I.I.A.; Gómez, Tomás; Reneses, Javier

    2017-01-01

    As the penetration of distributed energy resources (DERs) escalates in distribution networks, new network tariffs are needed to cope with this new situation. These tariffs should allocate network costs to users, promoting an efficient use of the distribution network. This paper proposes a

  6. Silent Escalation: Salaries of Senior University Administrators in Ontario, 1996-2006

    Science.gov (United States)

    Essaji, Azim; Horton, Sue

    2010-01-01

    The real compensation of senior university administrators in Ontario has increased by over 43% in the last decade. The escalation is especially pronounced for presidents and provosts: their pay has risen by 63% in real terms between 1996 and 2006. These trends have been evident in universities of all types, for both genders and for professional as…

  7. Lateral and escalation therapy in relapsing-remitting multiple sclerosis: a comparative study.

    Science.gov (United States)

    D'Amico, Emanuele; Leone, Carmela; Zanghì, Aurora; Fermo, Salvatore Lo; Patti, Francesco

    2016-09-01

    Performing a therapeutic switch in MS is still a matter of debate. Objective of our study is to compare switching to another first-line therapy with switching to a second-line therapy in persons with relapsing-remitting multiple sclerosis (pwRRMS). A retrospective analysis of data prospectively collected was performed. PwRRMS experiencing on-treatment disease activity were included. No clinical relapse, no sustained disability progression by the Expanded Disability Status Scale (EDSS), and no radiological activity (new T2 and/or gadolinium-enhanced brain lesions) were used as indicators of no disease activity (NEDA 3). Time to reach the first relapse after switch and time to reach an EDSS of 4.0 were also evaluated. Ninety-one pwRRMS were enrolled. Forty-eight (52.7 %) were on lateral switch, and 43 (47.3 %) on escalation switch. At baseline, the two groups differed for T2 and T1 brain lesions number (higher in the escalation group, p < 0.005). The proportion of pwRRMS who were NEDA 3 after 24 months from the switch was similar in the two groups (20.8 % in lateral group and 18.6 % in escalation group). No difference in timing to reach the first relapse after switch and an EDSS of 4.0 were found. Therefore, in selected pwRRMS, lateral and escalation strategies showed similar efficacy in delaying MS progression.

  8. The social process of escalation: a promising focus for crisis management research.

    Science.gov (United States)

    Bergström, Johan; Dekker, Sidney; Nyce, James M; Amer-Wåhlin, Isis

    2012-06-15

    This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis. Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction) tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved). However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.

  9. Escalation of drug self-administration as a hallmark of persistent addiction liability.

    Science.gov (United States)

    Edwards, Scott; Koob, George F

    2013-09-01

    Drug addiction is a progressive, relapsing disease comprised of interlocking stages of disordered motivation. Numerous animal models describing various stages of the addiction process have been developed over the past few decades, providing considerable advantages for the modeling of drug addiction compared with other complex psychiatric disease states. Escalation of drug self-administration has emerged as a widely accepted operant conditioning model of excessive drug intake. We further argue here that drug-escalated animals represent a comprehensive model of addiction according to the manifestations of behavioral neuroadaptations resulting directly or indirectly from excessive drug consumption. In particular, drug-escalated animals exhibit a host of symptoms in line with multiple Diagnostic and Statistical Manual of Mental Disorders criteria for substance dependence, which can be summarized as an emergence of uncontrollable drug-taking and drug-seeking behaviors as a consequence of within-circuit and between-circuit neuroadaptations. Such a transition from impulsive drug sampling to compulsive intake represents a highly valid conceptualization of the addiction timeline in humans, and further investigation of persistent or near-permanent (e.g. epigenetic) neuroadaptations generated by operant drug intake escalation models will continue to provide mechanisms and therapeutic interventions for reversing the aberrant neuroplasticity underlying addiction.

  10. From Crisis to De-escalation: An Examination of Politics in a U.S. High School Steroid Testing Program.

    Science.gov (United States)

    Berg, Brennan K; Winsley, Kathryn; Fuller, Rhema D; Hutchinson, Michael

    2017-01-01

    Preventing the use of performance enhancing drugs in sport has long been a concern for policymakers. In the United States, amidst national attention the state of Texas constructed the country's largest steroid testing program for high school athletes. However, resource allocation steadily declined until the program was defunded in 2015. Using escalation of commitment theory as a framework, this conceptual paper examines the critical, but less studied, role of politics and de-escalation behavior that directed this distinct sport situation. By combining policy and media documents with the academic literature, this paper allows for a greater understanding of how the steroid testing program was formulated and implemented, which may influence how policymakers address steroids among amateur athletes in the future. This paper also offers new opportunities for future research by highlighting a new sport context in which escalation of commitment theory applies and specifically noting the significant role politics can play in escalation or de-escalation decision making.

  11. De-escalation techniques used, and reasons for seclusion and restraint, in a forensic psychiatric hospital.

    Science.gov (United States)

    Kuivalainen, Satu; Vehviläinen-Julkunen, Katri; Louheranta, Olavi; Putkonen, Anu; Repo-Tiihonen, Eila; Tiihonen, Jari

    2017-10-01

    In Finland, the Mental Health Act determines the legal basis for seclusion and restraint. Restrictive measures are implemented to manage challenging situations and should be used as a last resort in psychiatric inpatient care. In the present study, we examined the reasons for seclusion and restraint, as well as whether any de-escalation techniques were used to help patients calm down. Seclusion and restraint files from a 4-year period (1 June 2009-31 May 2013) were retrospectively investigated and analysed by content analysis. Descriptive statistics were calculated. A total of 144 episodes of seclusion and restraint were included to analyse the reasons for seclusion and restraint, and 113 episodes were analysed to examine unsuccessful de-escalation techniques. The most commonly-used techniques were one-to-one interaction with a patient (n = 74, 65.5% of n = 113) and administration of extra medication (n = 37, 32.7% of n = 113). The reasons for seclusion and restraint were threatening harmful behaviour (n = 51, 35.4% of n = 144), direct harmful behaviour (n = 43, 29.9%), indirect harmful behaviour (n = 42, 29.1%), and other behaviours (n = 8, 5.6%). In general, the same de-escalation techniques were used with most patients. Most episodes of seclusion or restraint were due to threats of violence or direct violence. Individual means of self-regulation and patient guidance on these techniques are needed. Additionally, staff should be educated on a diverse range of de-escalation techniques. Future studies should focus on examining de-escalation techniques for the prevention of seclusion. © 2017 Australian College of Mental Health Nurses Inc.

  12. Student nurses' de-escalation of patient aggression: a pretest-posttest intervention study.

    Science.gov (United States)

    Nau, Johannes; Halfens, Ruud; Needham, Ian; Dassen, Theo

    2010-06-01

    Experts recommend staff training to prevent and manage aggressive situations involving patients or their relatives. However, in many countries this subject is not covered in pre-registration nursing education. In addition, the evidence regarding its impact on practical placements remains weak. This study examines the influence of an aggression management training programme for nursing students on their performance in de-escalating aggressive patients. Pretest-posttest within-and-between-groups design. A School of Nursing in Germany. Convenience sample out of six classes of nursing students at differing educational levels (10th to 28th month of nursing education, n=78, mean age=22). In a cross-sectional and longitudinal two groups before and after design nursing students encountered two scenarios (A or B) with simulation patients. After completing the training, each student was confronted with the unknown other scenario. De-escalation experts from three German-speaking countries evaluated 156 video scenes using the De-escalating Aggressive Behaviour Scale (DABS), not knowing whether the videos had been recorded before or after the training. Mean values and statistical significance tests were computed to compare the results. The performance levels of students who had been trained rose significantly from 2.74 to 3.65 as measured by the DABS on a 5-point Likert scale (Wilcoxon test pstudents managed scenario A significantly better than the untrained students (untrained 2.50, trained 3.70; Mann-Whitney-U-test pstudents' age or duration of previous nursing education. Aggression management training is able to improve nursing students' performance in de-escalating aggressive behaviour. A maturation-effect on the de-escalating performance due to general nursing education or age is unlikely. (c) 2009 Elsevier Ltd. All rights reserved.

  13. Impact of antibiotic de-escalation on clinical outcomes in community-acquired pneumococcal pneumonia.

    Science.gov (United States)

    Viasus, Diego; Simonetti, Antonella F; Garcia-Vidal, Carolina; Niubó, Jordi; Dorca, Jordi; Carratalà, Jordi

    2017-02-01

    Although antibiotic de-escalation is regarded as a measure that reduces selection pressure, adverse drug effects and costs, evidence supporting this practice in community-acquired pneumococcal pneumonia (CAPP) is lacking. We carried out a retrospective analysis of prospectively collected data of a cohort of hospitalized adults with CAPP. Pneumococcal aetiology was established in patients with one or more positive cultures for Streptococcus pneumoniae obtained from blood, sterile fluids or sputum, and/or a positive urinary antigen test. De-escalation therapy was considered when the initial antibiotic therapy was narrowed to penicillin, amoxicillin or amoxicillin/clavulanate within the first 72 h after admission. The primary outcomes were 30 day mortality and length of hospital stay (LOS). Adjustment for confounders was performed with multivariate and propensity score analyses. Of 1410 episodes of CAPP, antibiotic de-escalation within the first 72 h after admission was performed in 166 cases. After adjustment, antibiotic de-escalation was not associated with a higher risk of mortality (OR = 0.83, 95% CI = 0.24-2.81), but it was found to be a protective factor for prolonged LOS (above the median) (OR = 0.46, 95% CI = 0.30-0.70). Similar results were found in patients classified into high-risk pneumonia severity index classes (IV-V), those with clinical instability and those with bacteraemia. No significant differences were documented in adverse drug reactions or readmission (Antibiotic de-escalation seems to be safe and effective in reducing the duration of LOS, and did not adversely affect outcomes of patients with CAPP, even those with bacteraemia and severe disease, and those who were clinically unstable. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  14. Amygdala 14-3-3ζ as a novel modulator of escalating alcohol intake in mice.

    Directory of Open Access Journals (Sweden)

    Heidi M B Lesscher

    Full Text Available Alcoholism is a devastating brain disorder that affects millions of people worldwide. The development of alcoholism is caused by alcohol-induced maladaptive changes in neural circuits involved in emotions, motivation, and decision-making. Because of its involvement in these processes, the amygdala is thought to be a key neural structure involved in alcohol addiction. However, the molecular mechanisms that govern the development of alcoholism are incompletely understood. We have previously shown that in a limited access choice paradigm, C57BL/6J mice progressively escalate their alcohol intake and display important behavioral characteristic of alcohol addiction, in that they become insensitive to quinine-induced adulteration of alcohol. This study used the limited access choice paradigm to study gene expression changes in the amygdala during the escalation to high alcohol consumption in C57BL/6J mice. Microarray analysis revealed that changes in gene expression occurred predominantly after one week, i.e. during the initial escalation of alcohol intake. One gene that stood out from our analysis was the adapter protein 14-3-3ζ, which was up-regulated during the transition from low to high alcohol intake. Independent qPCR analysis confirmed the up-regulation of amygdala 14-3-3ζ during the escalation of alcohol intake. Subsequently, we found that local knockdown of 14-3-3ζ in the amygdala, using RNA interference, dramatically augmented alcohol intake. In addition, knockdown of amygdala 14-3-3ζ promoted the development of inflexible alcohol drinking, as apparent from insensitivity to quinine adulteration of alcohol. This study identifies amygdala 14-3-3ζ as a novel key modulator that is engaged during escalation of alcohol use.

  15. Suicide Attempts in a Longitudinal Sample of Adolescents Followed Through Adulthood: Evidence of Escalation

    Science.gov (United States)

    Goldston, David B.; Daniel, Stephanie S.; Erkanli, Alaattin; Heilbron, Nicole; Doyle, Otima; Weller, Bridget; Sapyta, Jeffrey

    2015-01-01

    Objectives This study was designed to examine escalation in repeat suicide attempts from adolescence through adulthood, as predicted by sensitization models (and reflected in increasing intent and lethality with repeat attempts, decreasing amount of time between attempts, and decreasing stress to trigger attempts) Method In a prospective study of 180 adolescents followed through adulthood after a psychiatric hospitalization, suicide attempts and antecedent life events were repeatedly assessed (M = 12.6 assessments, SD = 5.1) over an average of 13 years, 6 months (SD = 4 years, 5 months). Multivariate logistic, multiple linear, and negative binomial regression models were used to examine patterns over time. Results After age 17-18, the majority of suicide attempts were repeat attempts (i.e., made by individuals with prior suicidal behavior). Intent increased both with increasing age, and with number of prior attempts. Medical lethality increased as a function of age but not recurrent attempts. The time between successive suicide attempts decreased as a function of number of attempts. The amount of precipitating life stress was not related to attempts. Conclusions Adolescents and young adults show evidence of escalation of recurrent suicidal behavior, with increasing suicidal intent and decreasing time between successive attempts. However, evidence that sensitization processes account for this escalation was inconclusive. Effective prevention programs that reduce the likelihood of individuals attempting suicide for the first time (and entering this cycle of escalation), and relapse prevention interventions that interrupt the cycle of escalating suicidal behavior among individuals who already have made attempts are critically needed. PMID:25622200

  16. Long-term outcome of magnetic resonance spectroscopic image–directed dose escalation for prostate brachytherapy

    Science.gov (United States)

    King, Martin T.; Nasser, Nicola J.; Mathur, Nitin; Cohen, Gil’ad N.; Kollmeier, Marisa A.; Yuen, Jasper; Vargas, Hebert A.; Pei, Xin; Yamada, Yoshiya; Zakian, Kristen L.; Zaider, Marco; Zelefsky, Michael J.

    2017-01-01

    PURPOSE To report the long-term control and toxicity outcomes of patients with clinically localized prostate cancer, who underwent low-dose-rate prostate brachytherapy with magnetic resonance spectroscopic image (MRSI)–directed dose escalation to intraprostatic regions. METHODS AND MATERIALS Forty-seven consecutive patients between May 2000 and December 2003 were analyzed retrospectively. Each patient underwent a preprocedural MRSI, and MRS-positive voxels suspicious for malignancy were identified. Intraoperative planning was used to determine the optimal seed distribution to deliver a standard prescription dose to the entire prostate, while escalating the dose to MRS-positive voxels to 150% of prescription. Each patient underwent transperineal implantation of radioactive seeds followed by same-day CT for postimplant dosimetry. RESULTS The median prostate D90 (minimum dose received by 90% of the prostate) was 125.7% (interquartile range [IQR], 110.3–136.5%) of prescription. The median value for the MRS-positive mean dose was 229.9% (IQR, 200.0–251.9%). Median urethra D30 and rectal D30 values were 142.2% (137.5–168.2%) and 56.1% (40.1–63.4%), respectively. Median followup was 86.4 months (IQR, 49.8–117.6). The 10-year actuarial prostate-specific antigen relapse–free survival was 98% (95% confidence interval, 93–100%). Five patients (11%) experienced late Grade 3 urinary toxicity (e.g., urethral stricture), which improved after operative intervention. Four of these patients had dose-escalated voxels less than 1.0 cm from the urethra. CONCLUSIONS Low-dose-rate brachytherapy with MRSI-directed dose escalation to suspicious intraprostatic regions exhibits excellent long-term biochemical control. Patients with dose-escalated voxels close to the urethra were at higher risk of late urinary stricture. PMID:27009848

  17. Suicide attempts in a longitudinal sample of adolescents followed through adulthood: Evidence of escalation.

    Science.gov (United States)

    Goldston, David B; Daniel, Stephanie S; Erkanli, Alaattin; Heilbron, Nicole; Doyle, Otima; Weller, Bridget; Sapyta, Jeffrey; Mayfield, Andrew; Faulkner, Madelaine

    2015-04-01

    This study was designed to examine escalation in repeat suicide attempts from adolescence through adulthood, as predicted by sensitization models (and reflected in increasing intent and lethality with repeat attempts, decreasing amount of time between attempts, and decreasing stress to trigger attempts). In a prospective study of 180 adolescents followed through adulthood after a psychiatric hospitalization, suicide attempts, and antecedent life events were repeatedly assessed (M = 12.6 assessments, SD = 5.1) over an average of 13 years 6 months (SD = 4 years 5 months). Multivariate logistic, multiple linear, and negative binomial regression models were used to examine patterns over time. After age 17-18, the majority of suicide attempts were repeat attempts (i.e., made by individuals with prior suicidal behavior). Intent increased both with increasing age, and with number of prior attempts. Medical lethality increased as a function of age but not recurrent attempts. The time between successive suicide attempts decreased as a function of number of attempts. The amount of precipitating life stress was not related to attempts. Adolescents and young adults show evidence of escalation of recurrent suicidal behavior, with increasing suicidal intent and decreasing time between successive attempts. However, evidence that sensitization processes account for this escalation was inconclusive. Effective prevention programs that reduce the likelihood of individuals attempting suicide for the first time (and entering this cycle of escalation), and relapse prevention interventions that interrupt the cycle of escalating suicidal behavior among individuals who already have made attempts are critically needed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  18. Climate-induced forest dieback: An escalating global phenomenon?

    Science.gov (United States)

    Allen, C.D.

    2009-01-01

    The impacts of growing human populations and economies are both rapidly and directly transforming forests in many areas. However, little known are the pervasive effects of the ongoing climatic changes on the condition and status of forests around the world. Global patterns are now evident with the global tree mortality that is now above its usual mortality levels as it is affected by drought and heat-related forest stress and dieback. Thus, the possibility of an increased risk of climate-induced dieback is now being considered within many of the forests and woodlands of today. A focus will be given on the climatic water stress that is driven by both drought and warm temperatures. However, studying the trends in forest mortality and predictions has its limitations with such a number of information gaps and scientific uncertainties. First is the absence of an adequate global data on forest health status, followed by the fact that only a few tree species have the researchers an adequate quantitative knowledge with regards to its physiological thresholds of individual tree mortality from chronic or acute water stress. Lastly, the adequate knowledge of the feedback and non-linear interactions between climate-induced forest stress and other climate-related disturbance processes are lacking among the current scientists.

  19. Applications of 3D printing in healthcare

    Science.gov (United States)

    2016-01-01

    3D printing is a relatively new, rapidly expanding method of manufacturing that found numerous applications in healthcare, automotive, aerospace and defense industries and in many other areas. In this review, applications in medicine that are revolutionizing the way surgeries are carried out, disrupting prosthesis and implant markets as well as dentistry will be presented. The relatively new field of bioprinting, that is printing with cells, will also be briefly discussed. PMID:27785150

  20. Healthcare and healthcare systems: inspiring progress and future prospects.

    Science.gov (United States)

    Durrani, Hammad

    2016-01-01

    growth will occur in the urban areas of poor countries. The rapid, unplanned and unsustainable style of urban development will make developing countries cities the key focal points for emerging environmental and health hazards. Changes will be seen in design, culture and practices of hospitals to better meet the needs of patients, families and providers. Top driving factors of global healthcare system for next 30 years will be leading causes of mortalities, non-health factors (impact of nutrition, sanitation and women's empowerment), investment in health workforce and growth of medical tourism in future healthcare scenario. Evaluating the patterns of previous 30 years and predicting the progress and challenges of future health system are no rocket science. Medical care will be more self-directed in a more tech-savvy population as information will be more accessible and user friendly with higher quality. Health driving factors such as clean water, sanitation and food will take the center stage in humanities struggle and even increase population size.

  1. How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

    Science.gov (United States)

    Bronkhorst, Babette

    2017-08-01

    Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

  2. Two experiments focusing on de-escalation oriented coverage of post-war conflicts

    Directory of Open Access Journals (Sweden)

    Wilhelm Kempf

    2005-10-01

    Full Text Available War coverage has a strong bias towards the promotion of conflict escalation and - though less pronounced - this bias often survives in post-war coverage as well. Even after the end of war, only a minority of journalists frame conflict in a firmly de-escalation oriented way. Do they have a chance to reach the public? Will their reports be respected by the audience as more balanced and unbiased? Will they have an impact on the audience's mental models of the conflict? Or will the audience continue to cling to its prejudices and reject news articles which do not affirm the enemy images that emerged during wartime? The present paper investigates these questions by means of two experimental studies. In the first experiment, news articles on three events in former Yugoslavia after the fall of Milosevic were presented to a total of n = 128 subjects, representative of the readership of the German quality press: (1 violent conflicts in Southern Serbia (December 2000, (2 the extradition of Milosevic to The Hague (June, 2001 and (3 the treaty between Serbia and Montenegro (March 2003. For each of the events, four different types of articles were used: moderately escalation oriented articles from prestigious German newspapers (Die Welt, Frankfurter Allgemeine Zeitung, Süddeutsche Zeitung and three variants of these articles, (a with increased escalation-oriented framing, (b with moderate de-escalation oriented framing and (c with more strongly de-escalation oriented framing of the events. Each subject was asked to read one article on each of the three events in chronological order and after each article (a to narrate the reported events in their own words and (b to fill out a questionnaire designed to measure the acceptance of the articles as unbiased, well-balanced, interesting, etc. The subjects' mental models of the reported events were inferred from their narratives by means of quantitative content analysis. The second experiment measured the

  3. The Cuban National Healthcare System: Characterization of primary healthcare services.

    Directory of Open Access Journals (Sweden)

    Keli Regina DAL PRÁ

    2015-10-01

    Full Text Available This article presents a report on the experience of healthcare professionals in Florianópolis, who took the course La Atención Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS Cuba’s SNS Family Healthcare (SF service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

  4. Leadership strategies in healthcare.

    Science.gov (United States)

    Menaker, Ronald

    2009-01-01

    Healthcare is one of the largest and most important industries in the United States because it affects every individual in the nation. Numerous parties are stakeholders in healthcare, which contributes to the complexity of change efforts. Physicians and administrators play a significant role by providing direct care and influencing other decisions that impact the delivery of patient care. Success in the healthcare industry is influenced by numerous factors, some of which are controllable and others that are not. Understanding leadership and change management will be increasingly important to overcome resistance to change and to improve relationships, the core of leadership in an environment that will become more challenging. In what follows, different approaches to understanding leadership and change management are presented along with other leadership strategies to enhance the effectiveness of leaders. Raising leader awareness regarding transformational leadership behaviors and developing strategies to increase the use of these behaviors may be helpful to enhance organizational performance.

  5. Conization and healthcare use

    DEFF Research Database (Denmark)

    Frederiksen, Maria E; Vázquez-Prada Baillet, Miguel; Jensen, Pernille T

    2017-01-01

    The aim of this study was to assess whether negative psychological consequences of conization reported in questionnaire studies translated into increased use of the healthcare services that could relieve such symptoms. This was a population-based register study comparing women undergoing conization......, healthcare use increased significantly from the 'before' to the 'after' period. For contacts with GPs and hospitals, the increase was significantly larger for the conization group than for the control group, but this could be attributed to the standard postconization follow-up process. In the 'before' period......, women who later had a conization used fewer drugs than the control-group women, but their drug use increased similarly over time. The conization event did not result in an increased use of the healthcare services that could relieve potential negative side effects. However, women who underwent...

  6. Can consumers cure healthcare?

    Science.gov (United States)

    Gruber, David

    2009-01-01

    The U.S. healthcare delivery system is in crises. Costs are too high and increasingly becoming unaffordable to federal and state governments, employers and consumers. Americans are dissatisfied with the current system and believe it should be fundamentally altered or rebuilt. A solution needs to be found, and it is not the single-payer system espoused by many in Washington and elsewhere. We believe consumers can cure healthcare if (a) professionals, providers and policy experts shift their mindset from treating diseases and conditions to taking a holistic approach to the caring of people, particularly Baby Boomers and their parents; (b) technology becomes widely available to increase engagement, personalize healthcare, share experiences, make better choices and embrace convenience and (c) a cost-effective and reimbursed primary care navigator (coordinator and/or health manager), consistent with the medical home concept espoused by the American Association of Family Practitioners (AAFP) becomes a central component of public policy.

  7. Role of the pharmacist in reducing healthcare costs: current insights

    Directory of Open Access Journals (Sweden)

    Dalton K

    2017-01-01

    Full Text Available Kieran Dalton, Stephen Byrne Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland Abstract: Global healthcare expenditure is escalating at an unsustainable rate. Money spent on medicines and managing medication-related problems continues to grow. The high prevalence of medication errors and inappropriate prescribing is a major issue within healthcare systems, and can often contribute to adverse drug events, many of which are preventable. As a result, there is a huge opportunity for pharmacists to have a significant impact on reducing healthcare costs, as they have the expertise to detect, resolve, and prevent medication errors and medication-related problems. The development of clinical pharmacy practice in recent decades has resulted in an increased number of pharmacists working in clinically advanced roles worldwide. Pharmacist-provided services and clinical interventions have been shown to reduce the risk of potential adverse drug events and improve patient outcomes, and the majority of published studies show that these pharmacist activities are cost-effective or have a good cost:benefit ratio. This review demonstrates that pharmacists can contribute to substantial healthcare savings across a variety of settings. However, there is a paucity of evidence in the literature highlighting the specific aspects of pharmacists’ work which are the most effective and cost-effective. Future high-quality economic evaluations with robust methodologies and study design are required to investigate what pharmacist services have significant clinical benefits to patients and substantiate the greatest cost savings for healthcare budgets. Keywords: pharmacoeconomics, pharmaceutical care, clinical pharmacy, cost-effectiveness, economic evaluation

  8. Advanced healthcare materials

    CERN Document Server

    Tiwari, Ashutosh

    2014-01-01

    Advanced materials are attracting strong interest in the fundamental as well as applied sciences and are being extensively explored for their potential usage in a range of healthcare technological and biological applications. Advanced Healthcare Nanomaterials summarises the current status of knowledge in the fields of advanced materials for functional therapeutics, point-of-care diagnostics, translational materials, up and coming bio-engineering devices. The book highlights the key features which enable engineers to design stimuli-responsive smart nanoparticles, novel biomaterials, nan

  9. Costing Practices in Healthcare

    DEFF Research Database (Denmark)

    Chapman, Christopher; Kern, Anja; Laguecir, Aziza

    2014-01-01

    The rising cost of healthcare is a globally pressing concern. This makes detailed attention to the way in which costing is carried out of central importance. This article offers a framework for considering the interdependencies between a dominant element of the contemporary healthcare context, i.......e., Diagnosis Related Group (DRG) systems, and costing practices. DRG-based payment systems strongly influence costing practices in multiple ways. In particular, setting DRG tariffs requires highly standardized costing practices linked with specific skill sets from management accountants and brings other...... jurisdictions (e.g., clinical coding) to bear on costing practice. These factors contribute to the fragmentation of the jurisdiction of management accounting....

  10. Rapidly Escalating Hepcidin and Associated Serum Iron Starvation Are Features of the Acute Response to Typhoid Infection in Humans.

    Directory of Open Access Journals (Sweden)

    Thomas C Darton

    2015-09-01

    Full Text Available Iron is a key pathogenic determinant of many infectious diseases. Hepcidin, the hormone responsible for governing systemic iron homeostasis, is widely hypothesized to represent a key component of nutritional immunity through regulating the accessibility of iron to invading microorganisms during infection. However, the deployment of hepcidin in human bacterial infections remains poorly characterized. Typhoid fever is a globally significant, human-restricted bacterial infection, but understanding of its pathogenesis, especially during the critical early phases, likewise is poorly understood. Here, we investigate alterations in hepcidin and iron/inflammatory indices following experimental human typhoid challenge.Fifty study participants were challenged with Salmonella enterica serovar Typhi and monitored for evidence of typhoid fever. Serum hepcidin, ferritin, serum iron parameters, C-reactive protein (CRP, and plasma IL-6 and TNF-alpha concentrations were measured during the 14 days following challenge. We found that hepcidin concentrations were markedly higher during acute typhoid infection than at baseline. Hepcidin elevations mirrored the kinetics of fever, and were accompanied by profound hypoferremia, increased CRP and ferritin, despite only modest elevations in IL-6 and TNF-alpha in some individuals. During inflammation, the extent of hepcidin upregulation associated with the degree of hypoferremia.We demonstrate that strong hepcidin upregulation and hypoferremia, coincident with fever and systemic inflammation, are hallmarks of the early innate response to acute typhoid infection. We hypothesize that hepcidin-mediated iron redistribution into macrophages may contribute to S. Typhi pathogenesis by increasing iron availability for macrophage-tropic bacteria, and that targeting macrophage iron retention may represent a strategy for limiting infections with macrophage-tropic pathogens such as S. Typhi.

  11. Rapidly Escalating Hepcidin and Associated Serum Iron Starvation Are Features of the Acute Response to Typhoid Infection in Humans.

    Science.gov (United States)

    Darton, Thomas C; Blohmke, Christoph J; Giannoulatou, Eleni; Waddington, Claire S; Jones, Claire; Sturges, Pamela; Webster, Craig; Drakesmith, Hal; Pollard, Andrew J; Armitage, Andrew E

    2015-09-01

    Iron is a key pathogenic determinant of many infectious diseases. Hepcidin, the hormone responsible for governing systemic iron homeostasis, is widely hypothesized to represent a key component of nutritional immunity through regulating the accessibility of iron to invading microorganisms during infection. However, the deployment of hepcidin in human bacterial infections remains poorly characterized. Typhoid fever is a globally significant, human-restricted bacterial infection, but understanding of its pathogenesis, especially during the critical early phases, likewise is poorly understood. Here, we investigate alterations in hepcidin and iron/inflammatory indices following experimental human typhoid challenge. Fifty study participants were challenged with Salmonella enterica serovar Typhi and monitored for evidence of typhoid fever. Serum hepcidin, ferritin, serum iron parameters, C-reactive protein (CRP), and plasma IL-6 and TNF-alpha concentrations were measured during the 14 days following challenge. We found that hepcidin concentrations were markedly higher during acute typhoid infection than at baseline. Hepcidin elevations mirrored the kinetics of fever, and were accompanied by profound hypoferremia, increased CRP and ferritin, despite only modest elevations in IL-6 and TNF-alpha in some individuals. During inflammation, the extent of hepcidin upregulation associated with the degree of hypoferremia. We demonstrate that strong hepcidin upregulation and hypoferremia, coincident with fever and systemic inflammation, are hallmarks of the early innate response to acute typhoid infection. We hypothesize that hepcidin-mediated iron redistribution into macrophages may contribute to S. Typhi pathogenesis by increasing iron availability for macrophage-tropic bacteria, and that targeting macrophage iron retention may represent a strategy for limiting infections with macrophage-tropic pathogens such as S. Typhi.

  12. Greening healthcare at Muskoka Algonquin Healthcare.

    Science.gov (United States)

    Stone, Debra

    2017-03-01

    Waste diversion is fundamental to reducing the ecological footprint. Until 2012, waste generated by Muskoka Algonquin Healthcare (MAHC) was not incorporated into any formal waste diversion efforts. In 2012, the Reduce, Recycle, Waste Diversion Program was initiated. Support for the program was endorsed by the senior leadership team, staff, and the community, and incorporated into the strategic plan, which was instrumental in the program's success. The goal of the waste diversion program was to help MAHC work towards a sustainable future and make MAHC a leading hospital in making responsible environmental choices. By increasing the number of recycle stations at MAHC's two hospital sites and providing education and promotion on the importance of waste diversion, MAHC has been successful in reducing the amount of waste going to the landfill to a 48% level between 2012 and 2015. The following case study illustrates and discusses MAHC's successful waste diversion efforts.

  13. Social marketing in healthcare

    Directory of Open Access Journals (Sweden)

    Radha Aras

    2011-08-01

    Full Text Available BackgroundSocial marketing is an important tool in the delivery ofhealthcare services. For any healthcare programme orproject to be successful, community/consumer participationis required. The four principles of social marketing can guidepolicymakers and healthcare providers to successfully planand implement health programmes.AimTo review the existing literature in order to project thebenefits of social marketing in healthcare.MethodA search of periodical literature by the author involvingsocial marketing and marketing concepts in health wascarried out. Items were identified initially through healthorientedindexing services such as Medline, Health STARand Cinahl, using the identifiers “social marketing“ and“marketing in health”. An extensive search was also carriedout on educational database ERIC.ResultsA literature review of various studies on social marketingindicated that the selection of the right product (accordingto the community need at the right place, with the rightstrategy for promotion and at the right price yields goodresults. However, along with technical sustainability(product, price, promotion and place, financialsustainability, institutional sustainability and marketsustainability are conducive factors for the success of socialmarketing.ConclusionThe purpose of this literature review was to ascertain thelikely effectiveness of social marketing principles andapproaches and behaviour change communication towardshealth promotion.It is important for all healthcare workers to understand andrespond to the public’s desires and needs and routinely useconsumer research to determine how best to help thepublic to solve problems and realise aspirations. Socialmarketing can optimise public health by facilitatingrelationship-building with consumers and making their liveshealthier.

  14. Coproduction of healthcare service.

    Science.gov (United States)

    Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

    2016-07-01

    Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. Personal and Contextual Factors in the Escalation of Driving after Drinking Across the College Years

    OpenAIRE

    Quinn, Patrick D.; Fromme, Kim

    2012-01-01

    College students continue to drive after drinking at alarmingly high rates. Age trends suggest that driving after drinking increases from late adolescence across the college years, largely mirroring trends in binge drinking. Relatively little research, however, has examined change over time in driving after drinking among college students or tested whether some students might be at greater risk of escalations in driving after drinking. Using a sample of 1,833 non-abstaining students who compl...

  16. The social process of escalation: a promising focus for crisis management research

    Directory of Open Access Journals (Sweden)

    Bergström Johan

    2012-06-01

    Full Text Available Abstract Background This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis. Discussion Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved. However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. Implications The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.

  17. Avoidance orientation and the escalation of negative communication in intimate relationships

    OpenAIRE

    Kuster Monika; Bernecker Katharina; Backes Sabine; Brandstätter Veronika; Nussbeck Fridtjof W; Bradbury Thomas N.; Martin Mike; Sutter-Stickel Dorothee; Bodenmann Guy

    2015-01-01

    © 2015 American Psychological Association. Avoidance goals heighten the salience of negative social experiences and in intimate relationships such an orientation may contribute to communication difficulties and the perpetuation of avoidance. We therefore hypothesized that individuals with stronger avoidance goals would be particularly prone to engage in escalating levels of negative communication with their intimate partner and we tested this prediction by conducting sequential analyses on vi...

  18. Avoidance orientation and the escalation of negative communication in intimate relationships

    OpenAIRE

    Kuster, Monika; Bernecker, Katharina; Backes, Sabine; Brandstätter, Veronika; Nussbeck, Fridtjof W; Bradbury, Thomas N; Martin, Mike; Sutter-Stickel, Dorothee; Bodenmann, Guy

    2015-01-01

    Avoidance goals heighten the salience of negative social experiences, and in intimate relationships such an orientation may contribute to communication difficulties and the perpetuation of avoidance. We therefore hypothesized that individuals with stronger avoidance goals would be particularly prone to engage in escalating levels of negative communication with their intimate partner, and we tested this prediction by conducting sequential analyses on videotaped observational data (28,470 obser...

  19. Social marketing in healthcare.

    Science.gov (United States)

    Aras, Radha

    2011-01-01

    Social marketing is an important tool in the delivery of healthcare services. For any healthcare programme or project to be successful, community/consumer participation is required. The four principles of social marketing can guide policymakers and healthcare providers to successfully plan and implement health programmes. To review the existing literature in order to project the benefits of social marketing in healthcare. A search of periodical literature by the author involving social marketing and marketing concepts in health was carried out. Items were identified initially through health-oriented indexing services such as Medline, Health STAR and Cinahl, using the identifiers "social marketing" and "marketing in health". An extensive search was also carried out on educational database ERIC. A literature review of various studies on social marketing indicated that the selection of the right product (according to the community need) at the right place, with the right strategy for promotion and at the right price yields good results. However, along with technical sustainability (product, price, promotion and place), financial sustainability, institutional sustainability and market sustainability are conducive factors for the success of social marketing. The purpose of this literature review was to ascertain the likely effectiveness of social marketing principles and approaches and behaviour change communication towards health promotion. It is important for all healthcare workers to understand and respond to the public's desires and needs and routinely use consumer research to determine how best to help the public to solve problems and realise aspirations. Social marketing can optimise public health by facilitating relationship-building with consumers and making their lives healthier.

  20. A product of independent beta probabilities dose escalation design for dual-agent phase I trials.

    Science.gov (United States)

    Mander, Adrian P; Sweeting, Michael J

    2015-04-15

    Dual-agent trials are now increasingly common in oncology research, and many proposed dose-escalation designs are available in the statistical literature. Despite this, the translation from statistical design to practical application is slow, as has been highlighted in single-agent phase I trials, where a 3 + 3 rule-based design is often still used. To expedite this process, new dose-escalation designs need to be not only scientifically beneficial but also easy to understand and implement by clinicians. In this paper, we propose a curve-free (nonparametric) design for a dual-agent trial in which the model parameters are the probabilities of toxicity at each of the dose combinations. We show that it is relatively trivial for a clinician's prior beliefs or historical information to be incorporated in the model and updating is fast and computationally simple through the use of conjugate Bayesian inference. Monotonicity is ensured by considering only a set of monotonic contours for the distribution of the maximum tolerated contour, which defines the dose-escalation decision process. Varied experimentation around the contour is achievable, and multiple dose combinations can be recommended to take forward to phase II. Code for R, Stata and Excel are available for implementation. © 2015 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

  1. Mucosal healing in inflammatory bowel disease: Maintain or de-escalate therapy.

    Science.gov (United States)

    Cintolo, Marcello; Costantino, Giuseppe; Pallio, Socrate; Fries, Walter

    2016-02-15

    In the past decade, thanks to the introduction of biologic therapies, a new therapeutic goal, mucosal healing (MH), has been introduced. MH is the expression of an arrest of disease progression, resulting in minor hospitalizations, surgeries, and prolonged clinical remission. MH may be achieved with several therapeutic strategies reaching success rates up to 80% for both, ulcerative colitis (UC) and Crohn's disease (CD). Various scoring systems for UC and for the transmural CD, have been proposed to standardize the definition of MH. Several attempts have been undertaken to de-escalate therapy once MH is achieved, thus, reducing the risk of adverse events. In this review, we analysed the available studies regarding the achievement of MH and the subsequent treatment de-escalation according to disease type and administered therapy, together with non-invasive markers proposed as predictors for relapse. The available data are not encouraging since de-escalation after the achievement of MH is followed by a high number of clinical relapses reaching up to 50% within one year. Unclear is also another question, in case of combination therapies, which drug is more appropriate to stop, in order to guarantee a durable remission. Predictors of unfavourable outcome such as disease extension, perianal disease, or early onset disease appear to be inadequate to foresee behaviour of disease. Further studies are warranted to investigate the role of histologic healing for the further course of disease.

  2. Evolution of pyrrolizidine alkaloid biosynthesis in Apocynaceae: revisiting the defence de-escalation hypothesis.

    Science.gov (United States)

    Livshultz, Tatyana; Kaltenegger, Elisabeth; Straub, Shannon C K; Weitemier, Kevin; Hirsch, Elliot; Koval, Khrystyna; Mema, Lumi; Liston, Aaron

    2018-02-26

    Plants produce specialized metabolites for their defence. However, specialist herbivores adapt to these compounds and use them for their own benefit. Plants attacked predominantly by specialists may be under selection to reduce or eliminate production of co-opted chemicals: the defence de-escalation hypothesis. We studied the evolution of pyrrolizidine alkaloids (PAs) in Apocynaceae, larval host plants for PA-adapted butterflies (Danainae, milkweed and clearwing butterflies), to test if the evolutionary pattern is consistent with de-escalation. We used the first PA biosynthesis specific enzyme (homospermidine synthase, HSS) as tool for reconstructing PA evolution. We found hss orthologues in diverse Apocynaceae species, not all of them known to produce PAs. The phylogenetic analysis showed a monophyletic origin of the putative hss sequences early in the evolution of one Apocynaceae lineage (the APSA clade). We found an hss pseudogene in Asclepias syriaca, a species known to produce cardiac glycosides but no PAs, and four losses of an HSS amino acid motif. APSA clade species are significantly more likely to be Danainae larval host plants than expected if all Apocynaceae species were equally likely to be exploited. Our findings are consistent with PA de-escalation as an adaptive response to specialist attack. © 2018 The Authors New Phytologist © 2018 New Phytologist Trust.

  3. Factors Influencing Healthcare Service Quality

    Directory of Open Access Journals (Sweden)

    Ali Mohammad Mosadeghrad

    2014-07-01

    Full Text Available Background The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality.

  4. Lean in healthcare: the unfilled promise?

    Science.gov (United States)

    Radnor, Zoe J; Holweg, Matthias; Waring, Justin

    2012-02-01

    In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean 'tools', such as 'kaizen blitz' and 'rapid improvement events', which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the 'tool level'. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining 'customer value' that drives process improvement activities. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily 'professional' in origin but actually more 'organisational' and 'managerial' and, if not addressed could severely constrain Lean's impact on healthcare productivity at the systems level. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Migrants' access to healthcare.

    Science.gov (United States)

    Norredam, Marie

    2011-10-01

    There are strong pragmatic and moral reasons for receiving societies to address access to healthcare for migrants. Receiving societies have a pragmatic interest in sustaining migrants' health to facilitate integration; they also have a moral obligation to ensure migrants' access to healthcare according to international human rights principles. The intention of this thesis is to increase the understanding of migrants' access to healthcare by exploring two study aims: 1) Are there differences in migrants' access to healthcare compared to that of non-migrants? (substudy I and II); and 2) Why are there possible differences in migrants' access to healthcare compared to that of non-migrants? (substudy III and IV). The thesis builds on different methodological approaches using both register-based retrospective cohort design, cross-sectional design and survey methods. Two different measures of access were used to explore differences: 1) cancer stage at diagnosis as a clinical outcome and 2) emergency room (ER) contacts as a utilisation measure. Both informal and formal barriers to access were studied to explore why possible differences existed including: 1) motivation for using ER; and 2) asylum seekers' healthcare entitlements. Different definitions of migration and ethnicity were investigated including: country of birth and residence status. Substudy I showed a tendency towards more advanced stage at diagnosis or unknown stage among most subgroups of migrant women with a history of cancer compared to non-migrant women. Sub-study II found that some migrants (those born in Somalia, Turkey and Ex-Yugoslavia) use ER services more frequently than do non-migrants whereas others have the same or lower utilisation levels. As a consequence, substudy III was undertaken, which documented that more migrant within all subgroups had considered contacting a primary caregiver before visiting the ER compared to non-migrants, but that migrants experienced communication problems herein

  6. Healthcare technology in the home

    DEFF Research Database (Denmark)

    Ballegaard, Stinne Aaløkke

    2011-01-01

    The dissertation explores through ethnographic field studies ways in which negotiations and transformations take place when healthcare technology is introduced to the home. With the increased focus on tele-medical solutions and on supporting patient self-care through new healthcare technologies i...... of healthcare technology extends beyond making treatment available outside the hospital. Healthcare technology is not neutral, but transforms practice and entails both challenges and possibilities.......The dissertation explores through ethnographic field studies ways in which negotiations and transformations take place when healthcare technology is introduced to the home. With the increased focus on tele-medical solutions and on supporting patient self-care through new healthcare technologies...... it is relevant to examine the changes induced by this development: How is healthcare technology appropriated and domesticated by users, how does the development affect the role of the patient, and how is the relationship between home patients, family caregivers and healthcare professionals transformed? The role...

  7. Youth in the midst of escalated political violence: sense of coherence and hope among Jewish and Bedouin Arab adolescents

    National Research Council Canada - National Science Library

    Sarah Abu-Kaf; Orna Braun-Lewensohn; Tehila Kalagy

    2017-01-01

    .... This study aimed to compare coping resources and stress reactions among adolescents from two ethnic groups in southern Israel-Jews and Bedouin Arabs-during a period of escalated political violence (November 2012...

  8. Radiation dose escalation for loco-regional recurrence of breast cancer after mastectomy

    Directory of Open Access Journals (Sweden)

    Skinner Heath D

    2013-01-01

    Full Text Available Abstract Background Radiation is a standard component of treatment for patients with locoregional recurrence (LRR of breast cancer following mastectomy. The current study reports the results of a 10% radiation dose escalation in these patients. Methods 159 patients treated at MD Anderson Cancer Center between 1994-2006 with isolated LRR after mastectomy alone were reviewed. Patients in the standard treatment group (65 pts, 40.9% were treated to 50 Gy comprehensively plus a boost of 10 Gy. The dose escalated group (94 pts, 59.1% was treated to 54 Gy comprehensively and a minimum 12 Gy boost. Median dose in the standard dose and dose escalated group was 60 Gy (±1 Gy, 95% CI and 66 Gy (±0.5 Gy, 95% CI respectively. Median follow up for living patients was 94 months from time of recurrence. Results The actuarial five year locoregional control (LRC rate was 77% for the entire study population. The five year overall survival and disease-free survival was 55% and 41%, respectively. On multivariate analysis, initial tumor size (p = 0.03, time to initial LRR (p = 0.03, absence of gross tumor at the time of radiation (p = 0.001 and Her2 status (p = 0.03 were associated with improved LRC. Five year LRC rates were similar in patients with a complete response to chemotherapy without surgery and patients with a complete surgical excision (77% vs 83%, p = NS, compared to a 63% LRC rate in patients with gross disease at the time of radiation (p = 0.024. LRC rates were 80% in the standard dose group and 75% in the dose escalated group (p = NS. Conclusions While LRR following mastectomy is potentially curable, distant metastasis and local control rates remain suboptimal. Radiation dose escalation did not appear to improve LRC. Given significant local failure rates, these patients are good candidates for additional strategies to improve their outcomes.

  9. STRESS MANAGEMENT FOR HEALTHCARE PROFESSIONALS

    OpenAIRE

    Odigie, Anita

    2016-01-01

    Healthcare professionals are exposed to several job stressors that can adversely affect both their mental and physical health, decrease their efficiency at work, for a successful intervention, the causes and management of stress in any healthcare unit or among healthcare professionals must be diligently documented. The aim of this study is to explore issues on specific occupational stress related to job performance, the role of healthcare in stress management and the effects of job resourc...

  10. Impact of de-escalation of beta-lactam antibiotics on the emergence of antibiotic resistance in ICU patients: a retrospective observational study.

    Science.gov (United States)

    De Bus, Liesbet; Denys, Wouter; Catteeuw, Julie; Gadeyne, Bram; Vermeulen, Karel; Boelens, Jerina; Claeys, Geert; De Waele, Jan J; Decruyenaere, Johan; Depuydt, Pieter O

    2016-06-01

    Antibiotic de-escalation is promoted to limit prolonged exposure to broad-spectrum antibiotics, but proof that it prevents the emergence of resistance is lacking. We evaluated determinants of antibiotic de-escalation in an attempt to assess whether the latter is associated with a lower emergence of antimicrobial resistance. Antibiotic treatments, starting with empirical beta-lactam prescriptions, were prospectively documented during 2013 and 2014 in a tertiary intensive care unit (ICU) and categorized as continuation, de-escalation or escalation of the empirical antimicrobial treatment. Determinants of the de-escalation or escalation treatments were identified by multivariate logistic regression; the continuation category was used as the reference group. Using systematically collected diagnostic and surveillance cultures, we estimated the cumulative incidence of antimicrobial resistance following de-escalation or continuation of therapy, with adjustment for ICU discharge and death as competing risks. Of 478 anti-pseudomonal antibiotic prescriptions, 42 (9 %) were classified as escalation of the antimicrobial treatment and 121 (25 %) were classified as de-escalation, mainly through replacement of the originally prescribed antibiotics with those having a narrower spectrum. In multivariate analysis, de-escalation was associated with the identification of etiologic pathogens (p antibiotic course in the ICU in de-escalated versus continued prescriptions was 8 (range 6-10) versus 5 (range 4-7) days, respectively (p resistance to the initial beta-lactam antibiotic on day 14 were 30.6 and 23.5 % for de-escalation and continuation, respectively (p = 0.22). For the selection of multi-drug resistant pathogens, these values were 23.5 (de-escalation) and 18.6 % (continuation) respectively (p = 0.35). The emergence of antibiotic-resistant bacteria after exposure to anti-pseudomonal beta-lactam antibiotics was not lower following de-escalation.

  11. Innovation Concepts in Healthcare

    CERN Multimedia

    CERN. Geneva

    2010-01-01

    AbstractDemographic change and advances in medical science pose increased challenges to healthcare systems globally: The economic basis is aging and thus health is becoming more and more a productivity factor. At the same time, with today’s new communication possibilities the demand and expectations of effective medical treatment have been increased. This presentation will illustrate the need for the “industrialization” of healthcare in order to achieve highest results at limited budgets. Thereby, industrialization is not meaning the medical treatment based on the assembly line approach. Rather it is to recognize the cost of medical care as an investment with respective expectations on the return of the investment. Innovations in imaging and pharmaceutical products as well as in processes - that lead to similar medical results, but with lower efforts - are keys in such scenarios.BiographyProf. Dr. Hermann Requardt, 54, is a member of the Managing Board of Siemens AG and Chief Executive Officer of the He...

  12. Quality management in healthcare

    OpenAIRE

    Subhash S Dodwad

    2013-01-01

    Clinical governance and better human resource management practices are important planks in the current health policies emphasizing quality of patient care. There are numerous reasons why it is important to improve quality of healthcare, including enhancing the accountability of health practitioners and managers, resource efficiency, identifying, and minimizing medical errors while maximizing the use of effective care and improving outcomes, and aligning care to what users/patients want in add...

  13. Sociotechnical changing in healthcare.

    Science.gov (United States)

    Petrakaki, Dimitra; Cornford, Tony; Klecun, Ela

    2010-01-01

    This paper discusses a conceptual approach to the study of the implementation of ICTs in healthcare organizations. The paper uses some fundamental concepts from sociotechnical studies to address the complex process of change--the changing--that accompanies ICT innovations. The paper argues for the importance of the perspective of changing as a way to account for the dynamics as technology and people, organizations and institutions co-constitutively work-out their future together.

  14. Regional Healthcare Effectiveness

    Directory of Open Access Journals (Sweden)

    Olga Vladimirovna Kudelina

    2016-03-01

    Full Text Available An evaluation of healthcare systems effectiveness of the regions of the Russian Federation (federal districts was conducted using the Minmax method based on the data available at the United Interdepartmental Statistical Information System. Four groups of components (i.e. availability of resources; use of resources; access to resources and medical effectiveness decomposed into 17 items were analyzed. The resource availability was measured by four indicators, including the provision of doctors, nurses, hospital beds; agencies providing health care to the population. Use of resources was measured by seven indicators: the average hospital stay, days; the average bed occupancy, days; the number of operations per 1 physician surgical; the cost per unit volume of medical care: in outpatient clinics, day hospitals, inpatient and emergency care. Access to the resources was measured by three indicators: the satisfaction of the population by medical care; the capacity of outpatient clinics; the average number of visits to health facility. The medical effectiveness was also measured by three indicators: incidence with the "first-ever diagnosis of malignancy"; life expectancy at birth, years; the number of days of temporary disability. The study of the dynamics of the components and indexes for 2008–2012 allows to indicate a multidirectional influence on the regional healthcare system. In some federal districts (e.g. North Caucasian, the effectiveness decreases due to resource availability, in others (South, North Caucasian — due to the use of resources, in others (Far Eastern, Ural — due to access to resources. It is found that the effectiveness of the healthcare systems of the federal districts differs significantly. In addition, the built matrix proves the variability the of effectiveness (comparison of expenditures and results of healthcare systems of the federal districts of the Russian Federation: the high results can be obtained at high costs

  15. Tuberculosis in healthcare workers, Scotland.

    Science.gov (United States)

    Pollock, Kevin G; McDonald, Eisin; Smith-Palmer, Alison; Johnston, Fiona; Ahmed, Syed

    2017-08-01

    In an attempt to explore healthcare worker acquisition of tuberculosis infection, we conducted population-based surveillance of all cases recorded as healthcare workers reported to Enhanced Surveillance of Mycobacterial Infection from 2000 to 2015. Over the study period, the mean incidence rate of tuberculosis among all healthcare workers was 15.4 per 100,000 healthcare workers. However, the incidence rate of tuberculosis amongst those healthcare workers born outside the UK was 164.8 per 100,000 compared with 5.0 per 100,000 UK-born healthcare workers. Fifty-seven per cent of all non-UK-born healthcare workers were diagnosed within five years of their arrival in the UK and would have been new entrants to the NHS. An effective new entrant occupational health screening programme for latent tuberculosis infection may have prevented some of these active cases of infection.

  16. Improving Healthcare through Lean Management

    DEFF Research Database (Denmark)

    Nielsen, Anders Paarup; Edwards, Kasper

    2011-01-01

    The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis...... of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare...... still is in its infancy and it is just a matter of letting sufficient time pass in order have a successful implementation of lean in all areas of healthcare. The second hypothesis states that a major barrier to lean management in healthcare simply is lacking understanding of the lean concepts leading...

  17. Validation of treatment escalation as a definition of atopic eczema flares.

    Directory of Open Access Journals (Sweden)

    Kim S Thomas

    Full Text Available Atopic eczema (AE is a chronic disease with flares and remissions. Long-term control of AE flares has been identified as a core outcome domain for AE trials. However, it is unclear how flares should be defined and measured.To validate two concepts of AE flares based on daily reports of topical medication use: (i escalation of treatment and (ii days of topical anti-inflammatory medication use (topical corticosteroids and/or calcineurin inhibitors.Data from two published AE studies (studies A (n=336 and B (n=60 were analysed separately. Validity and feasibility of flare definitions were assessed using daily global bother (scale 0 to 10 as the reference standard. Intra-class correlations were reported for continuous variables, and odds ratios and area under the receiver operator characteristic (ROC curve for binary outcome measures.Good agreement was found between both AE flare definitions and change in global bother: area under the ROC curve for treatment escalation of 0.70 and 0.73 in studies A and B respectively, and area under the ROC curve of 0.69 for topical anti-inflammatory medication use (Study A only. Significant positive relationships were found between validated severity scales (POEM, SASSAD, TIS and the duration of AE flares occurring in the previous week - POEM and SASSAD rose by half a point for each unit increase in number of days in flare. Smaller increases were observed on the TIS scale. Completeness of daily diaries was 95% for Study A and 60% for Study B over 16 weeks.Both definitions were good proxy indicators of AE flares. We found no evidence that 'escalation of treatment' was a better measure of AE flares than 'use of topical anti-inflammatory medications'. Capturing disease flares in AE trials through daily recording of medication use is feasible and appears to be a good indicator of long-term control.Current Controlled Trials ISRCTN71423189 (Study A.

  18. Rapid Prototyping

    Science.gov (United States)

    1999-01-01

    Javelin, a Lone Peak Engineering Inc. Company has introduced the SteamRoller(TM) System as a commercial product. The system was designed by Javelin during a Phase II NASA funded small commercial product. The purpose of the invention was to allow automated-feed of flexible ceramic tapes to the Laminated Object Manufacturing rapid prototyping equipment. The ceramic material that Javelin was working with during the Phase II project is silicon nitride. This engineered ceramic material is of interest for space-based component.

  19. Impact of dose escalation and adaptive radiotherapy for cervical cancers on tumour shrinkage—a modelling study

    Science.gov (United States)

    Røthe Arnesen, Marius; Paulsen Hellebust, Taran; Malinen, Eirik

    2017-03-01

    Tumour shrinkage occurs during fractionated radiotherapy and is regulated by radiation induced cellular damage, repopulation of viable cells and clearance of dead cells. In some cases additional tumour shrinkage during external beam therapy may be beneficial, particularly for locally advanced cervical cancer where a small tumour volume may simplify and improve brachytherapy. In the current work, a mathematical tumour model is utilized to investigate how local dose escalation affects tumour shrinkage, focusing on implications for brachytherapy. The iterative two-compartment model is based upon linear-quadratic radiation response, a doubling time for viable cells and a half-time for clearance of dead cells. The model was individually fitted to clinical tumour volume data from fractionated radiotherapy of 25 cervical cancer patients. Three different fractionation patterns for dose escalation, all with an additional dose of 12.2 Gy, were simulated and compared to standard fractionation in terms of tumour shrinkage. An adaptive strategy where dose escalation was initiated after one week of treatment was also considered. For 22 out of 25 patients, a good model fit was achieved to the observed tumour shrinkage. A large degree of inter-patient variation was seen in predicted volume reduction following dose escalation. For the 10 best responding patients, a mean tumour volume reduction of 34  ±  3% (relative to standard treatment) was estimated at the time of brachytherapy. Timing of initiating dose escalation had a larger impact than the number of fractions applied. In conclusion, the model was found useful in evaluating the impact from dose escalation on tumour shrinkage. The results indicate that dose escalation could be conducted from the start of external beam radiotherapy in order to obtain additional tumour shrinkage before brachytherapy.

  20. Clinical Outcomes With Dose-Escalated Adaptive Radiation Therapy for Urinary Bladder Cancer: A Prospective Study

    Energy Technology Data Exchange (ETDEWEB)

    Murthy, Vedang, E-mail: vmurthy@actrec.gov.in [Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai (India); Masodkar, Renuka; Kalyani, Nikhil; Mahantshetty, Umesh [Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai (India); Bakshi, Ganesh; Prakash, Gagan [Department of Surgical Oncology, Tata Memorial Centre, Parel, Mumbai (India); Joshi, Amit; Prabhash, Kumar [Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai (India); Ghonge, Sujata; Shrivastava, Shyamkishore [Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai (India)

    2016-01-01

    Purpose: The purpose of this study was to assess feasibility, clinical outcomes, and toxicity in patients with bladder cancer treated with adaptive, image guided radiation therapy (IGRT) for bladder preservation as a part of trimodality treatment. The role of dose escalation was also studied. Methods and Materials: Forty-four patients with localized bladder cancer were enrolled in a prospective study. They underwent maximal safe resection of bladder tumor and concurrent platinum-based chemotherapy. Patients with large tumors were offered induction chemotherapy. Radiation therapy planning was done using either 3 (n=34) or 6 (n=10) concentrically grown planning target volumes (PTV). Patients received 64 Gy in 32 fractions to the whole bladder and 55 Gy to the pelvic nodes and, if appropriate, a simultaneous integrated boost to the tumor bed to 68 Gy (equivalent dose for 2-Gy fractions assuming α/β of 10 [EQD2]{sub 10} = 68.7 Gy). Daily megavoltage (MV) imaging helped to choose the most appropriate PTV encompassing bladder for the particular day (using plan-of-the-day approach). Results: Most patients (88%) had T2 disease. Sixteen patients (36%) received neoadjuvant chemotherapy. A majority of the patients (73%) received prophylactic nodal irradiation, whereas 55% of the patients received escalated dose to the tumor bed. With a median follow-up of 30 months, the 3-year locoregional control (LRC), disease-free survival, and overall survival (OS) were 78%, 66%, and 67%, respectively. The bladder preservation rate was 83%. LRC (87% vs 68%, respectively, P=.748) and OS (74% vs 60%, respectively, P=.36) rates were better in patients receiving dose escalation. Instances of acute and late Radiation Therapy Oncology Group (RTOG) grade 3 genitourinary toxicity was seen in 5 (11%) and 2 (4%) patients, respectively. There was no acute or late RTOG grade 3 or higher gastrointestinal toxicity. Conclusions: Adaptive IGRT using plan-of-the-day approach for bladder

  1. The DNA damage checkpoint precedes activation of ARF in response to escalating oncogenic stress during tumorigenesis

    DEFF Research Database (Denmark)

    Evangelou, K.; Bartkova, J.; Kotsinas, A.

    2013-01-01

    Oncogenic stimuli trigger the DNA damage response (DDR) and induction of the alternative reading frame (ARF) tumor suppressor, both of which can activate the p53 pathway and provide intrinsic barriers to tumor progression. However, the respective timeframes and signal thresholds for ARF induction...... oncogenes showed that the delayed upregulation of ARF reflected a requirement for a higher, transcriptionally based threshold of oncogenic stress, elicited by at least two oncogenic 'hits', compared with lower activation threshold for DDR. We propose that relative to DDR activation, ARF provides...... a complementary and delayed barrier to tumor development, responding to more robust stimuli of escalating oncogenic overload....

  2. Successful pregnancy outcome in paroxysmal nocturnal hemoglobinuria (PNH following escalated eculizumab dosing to control breakthrough hemolysis

    Directory of Open Access Journals (Sweden)

    Ruby Sharma

    2015-01-01

    Full Text Available Pregnancy in women with paroxysmal nocturnal hemoglobinuria (PNH is associated with increased maternal and fetal morbidity and mortality. There is limited published experience regarding therapy of PNH during pregnancy. We describe a case of a 30 year old female with hypoplastic myelodysplastic syndrome and PNH. After two years of treatment with eculizumab, she became pregnant. She developed breakthrough hemolysis at 20 weeks gestation. Pharmacokinetic and pharmacodynamic studies demonstrated a subtherapeutic eculizumab level with absence of complement blockade. Escalation of her eculizumab dose successfully controlled hemolysis and restored therapeutic eculizumab level and activity. She delivered a healthy baby at 36 weeks.

  3. Stormy Weather in Healthcare

    DEFF Research Database (Denmark)

    Clemensen, Jane; Jakobsen, Pernille Ravn; Myhre Jensen, Charlotte

    2017-01-01

    This paper discusses how the roles of patients and health professionals have changed over the years. It also explores how accelerated courses of treatment and busy staff have turned healthcare services and hospitals into “factories”, where care and relationships now exist in very cramped conditions....... The paper discusses the gap between patients’ need for care and the care received. The analysis and discussion focus on how health professionals can be empowered to re-find care in their daily practice. We reveal how different health paradigms can affect care, and the relationship between patients...

  4. Building National Healthcare Infrastructure

    DEFF Research Database (Denmark)

    Jensen, Tina Blegind; Thorseng, Anne

    2017-01-01

    This case chapter is about the evolution of the Danish national e-health portal, sundhed.dk, which provides patient-oriented digital services. We present how the organization behind sundhed.dk succeeded in establishing a national healthcare infrastructure by (1) collating and assembling existing...... data resources, (2) repurposing and enhancing current data sources in the health sector, and (3) engaging a multiplicity of stakeholders. We argue that these activities represent three ways of capitalizing on the installed base that has led to the evolution and current situation of the e-health portal...

  5. Measuring healthcare quality: the challenges.

    Science.gov (United States)

    van den Heuvel, Jaap; Niemeijer, Gerard C; Does, Ronald J M M

    2013-01-01

    Current health care quality performance indicators appear to be inadequate to inform the public to make the right choices. The aim of this paper is to define a framework and an organizational setting in which valid and reliable healthcare information can be produced to inform the general public about healthcare quality. To improve health care quality information, the paper explores the analogy between financial accounting, which aims to produce valid and reliable information to support companies informing their shareholders and stakeholders, and healthcare aiming to inform future patients about healthcare quality. Based on this analogy, the authors suggest a measurement framework and an organizational setting to produce healthcare information. The authors suggest a five-quality element framework to structure quality reporting. The authors also indicate the best way to report each type of quality, comparing performance indicators with certification/accreditation. Health gain is the most relevant quality indicator to inform the public, but this information is the most difficult to obtain. Finally, the organizational setting, comparable to financial accounting, required to provide valid, reliable and objective information on healthcare quality is described. Framework elements should be tested in quantitative studies or case studies, such as a performance indicator's relative value compared to accreditation/certification. There are, however, elements that can be implemented right away such as third party validation of healthcare information produced by healthcare institutions. Given the money spent on healthcare worldwide, valid and reliable healthcare quality information's value can never be overestimated. It can justify delivering "expensive healthcare, but also points the way to savings by stopping useless healthcare. Valid and reliable information puts the patient in the driver's seat and enables him or her to make the right decision when choosing their healthcare

  6. Social media in the healthcare context: Ethical challenges and ...

    African Journals Online (AJOL)

    The popularity of social media has grown rapidly and healthcare practitioners and students commonly use sites such as Facebook. The ethical and professional implications and their benefits and hazards must be considered. Concerns include blurring of boundaries between an individual's public and professional lives, ...

  7. Cultural Competence Training for Healthcare Professionals Working with LGBT Older Adults

    Science.gov (United States)

    Gendron, Tracey; Maddux, Stu; Krinsky, Lisa; White, Jay; Lockeman, Kelly; Metcalfe, Yohvane; Aggarwal, Sadashiv

    2013-01-01

    The population of the aging lesbian, gay, bisexual and transgender (LGBT) community is significant and growing rapidly. As LGBT individuals age and begin to move into healthcare communities, they are fearful of apathy, discrimination, and abuse by healthcare providers and other residents. Person-centered cultural competence and sensitivity among…

  8. Pharmacovigilance: Empowering healthcare professionals

    Directory of Open Access Journals (Sweden)

    Mugoša Snežana S.

    2015-01-01

    Full Text Available Introduction: Spontaneous reporting of adverse reactions is of greatest importance for obtaining information about adverse drug reactions (ADRs after granting the marketing authorization. The most important role and also the greatest responsibility belong to healthcare professionals. Their active participation is a prerequisite for the existence of an effective national drug safety monitoring. Methods: This paper examines the legislative framework concerning the pharmacovigilance system in Montenegro. The information was collected from scientific articles and the website of the Agency for Medicines and Medical Devices of Montenegro. Topic: Key segments of pharmacovigilance system are presented, with a special reference to the importance of spontaneous reporting of ADRs, results of spontaneous reporting of ADRs according to the latest Agency's Annual report on the results of spontaneous reporting of adverse reactions to medicines, possible reasons for underreporting ADRs, as well as the new EU regulation on pharmacovigilance. Conclusions: Spontaneous reporting of ADRs remains the cornerstone of pharmacovigilance systems. Hence, continuous education of healthcare professionals is needed, with the aim of improving their awareness of the importance of ADRs and risk factors that lead to them, in order to reduce the incidence of ADRs and to increase the number of reported suspected ADRs.

  9. Healthcare costs, buyer alert.

    Science.gov (United States)

    Brown, Melissa M; Brown, Gary C; Leiske, Heidi B; Lieske, P Alexander

    2011-05-01

    To assess the direct medical cost perspective versus the societal cost perspective associated with a vitreoretinal intervention. Most insurers, physicians, hospital administrators, legislators and the general public refer to direct medical costs when assessing the costs associated with healthcare interventions. The direct medical cost perspective, which is the same as the third-party insurer cost perspective, includes the costs an insurer might be expected to pay, including those for physicians, hospitals, drugs, durable goods, skilled nursing facilities and others. The societal cost perspective includes direct medical costs; direct nonmedical costs (caregiver, transportation, residence); and indirect medical costs (employment and salary). When assessing the costs associated with a healthcare intervention, the societal cost perspective generally yields a greater financial return-on-investment (ROI) to society and to the gross domestic product than does the utilization of direct medical costs alone. Consequently, the use of societal costs in cost-utility analysis typically results in more cost-effective interventions than when direct medical costs alone are employed. A societal cost perspective is more likely than the third-party insurer cost perspective to demonstrate a greater financial ROI to society.

  10. Why healthcare workers are sick of TB

    Directory of Open Access Journals (Sweden)

    Arne von Delft

    2015-03-01

    Full Text Available Dr Thato Mosidi never expected to be diagnosed with tuberculosis (TB, despite widely prevalent exposure and very limited infection control measures. The life-threatening diagnosis of primary extensively drug-resistant TB (XDR-TB came as an even greater shock. The inconvenient truth is that, rather than being protected, Dr Mosidi and thousands of her healthcare colleagues are at an increased risk of TB and especially drug-resistant TB. In this viewpoint paper we debunk the widely held false belief that healthcare workers are somehow immune to TB disease (TB-proof and explore some of the key factors contributing to the pervasive stigmatization and subsequent non-disclosure of occupational TB. Our front-line workers are some of the first to suffer the consequences of a progressively more resistant and fatal TB epidemic, and urgent interventions are needed to ensure the safety and continued availability of these precious healthcare resources. These include the rapid development and scale-up of improved diagnostic and treatment options, strengthened infection control measures, and focused interventions to tackle stigma and discrimination in all its forms. We call our colleagues to action to protect themselves and those they care for.

  11. An Hourly Dose-Escalation Desensitization Protocol for Aspirin-Exacerbated Respiratory Disease.

    Science.gov (United States)

    Chen, Justin R; Buchmiller, Brett L; Khan, David A

    2015-01-01

    Aspirin desensitization followed by maintenance therapy effectively improves symptom control in patients with aspirin exacerbated respiratory disease (AERD). The majority of current desensitization protocols use 3-hour dosing intervals and often require 2 to 3 days to complete. We evaluated hourly dose escalations in a subset of patients with chronic rhinosinusitis, nasal polyps, and asthma who historically reacted to aspirin within 1 hour or were avoiding aspirin with the goal of developing a safe and efficient desensitization protocol. Fifty-seven aspirin desensitizations were performed under the hourly protocol. All patients had refractory nasal polyposis as an indication for aspirin desensitization. The clinical characteristics of each subject were analyzed in relation to aspects of his or her reactions during the procedure. Ninety-eight percent of study patients were successfully treated under the hourly protocol, including those with a history of severe reactions and intubation. None required further medication than is available in an outpatient allergy clinic. A total of 96% of reactors recorded a bronchial or naso-ocular reaction within 1 hour of the preceding dose. Of the total patients on this protocol, 40% were able to complete the procedure in a single day, and 60% within 2 days. Patients with AERD who have a history of symptoms less than 1 hour after aspirin exposure can be safely desensitized with a 1-hour dose-escalation protocol that can often be completed in a single day. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  12. Escalation of Intake Under Intermittent Ethanol Access in Diverse Mouse Genotypes

    Science.gov (United States)

    Rosenwasser, Alan M.; Fixaris, Michael C.; Crabbe, John C.; Brooks, Peter C.; Ascheid, Sonja

    2012-01-01

    Experimental animals offered continuous 24-hour free choice access to ethanol rarely display voluntary ethanol consumption at levels sufficient to induce intoxication or to engender dependence. One of the simplest ways to increase voluntary ethanol intake is to impose temporal limitations on ethanol availability. Escalation of ethanol intake has been observed in both rats and mice under a variety of different schedules of alternating ethanol access and deprivation. While such effects have been observed in a variety of rat and mouse genotypes, little is known concerning possible genetic correlations between responses to intermittent ethanol access and other ethanol-related phenotypes. In the present study, we examined the effects of intermittent ethanol access in mouse genotypes characterized by divergent responses to ethanol in other domains, including ethanol preference (C57BL/6J and C3H/HeJ mice), binge-like ethanol drinking (HDID-1 and HS/Npt mice), and ethanol withdrawal severity (WSP-2 and WSR-2 mice). While intermittent ethanol access resulted in escalated ethanol intake in all tested genotypes, the robustness of the effect varied across genotypes. On the other hand, we saw no evidence that the effects of intermittent access are correlated with either binge-like drinking or withdrawal severity, and only weak evidence for a genetic correlation with baseline ethanol preference. Thus, these different ethanol-related traits appear to depend on largely unique sets of genetic mediators. PMID:22862671

  13. Investor’s Commitment Bias and Escalation of Firm’s Investment Decision

    Directory of Open Access Journals (Sweden)

    Anis JARBOUI

    2012-12-01

    Full Text Available This study examines the reasons of perseverance in firm’s investment decision. It shows the possible influence of three closely related features which are: firm’s financial indicators, investor’s risk profile, and investor’s commitment bias, on a firm’s investment decisions escalation. This study aims to provide evidence as to whether investor considers the financial and risk’s perception features (financial strength and risk profile to persevere his initial investment decision while he notes a high level of commitment bias. The proposed model of this paper uses GLM univariate data analyses to examine this relationship. Investor’s risk profile and his commitment bias have been measured by means of a questionnaire comprising several items. As for the selected sample, it has been composed of some 360 Tunisian individual investors. Our results have revealed that investors pay more attention to keep their psychology comfort than their financial comfort. It exposed the importance of the investor’s commitment bias and its risk perception in explaining investment decision escalation. Moreover results shows that there is strong and significant empirical relationship linking the escalatory behavior in investment decision and the interaction effects between the three independent variables. This means that, in practice, investors consider the three factors simultaneously.

  14. Physical discipline, escalation, and child abuse potential: psychometric evidence for the Analog Parenting Task.

    Science.gov (United States)

    Russa, Mary Bower; Rodriguez, Christina M

    2010-01-01

    Data from three studies provide new evidence to support the validity of the Analog Parenting Task (APT) as an instrument to assess risk for harsh, physically aggressive parenting. In this series of studies, there was a strong association between APT scores of expected use and escalation of discipline strategies and self-reported disciplinary attitudes. APT scores were also associated with physical abuse potential as assessed by both a well-established measure of child abuse potential (Child Abuse Potential Inventory) and another instrument designed specifically for use in pre-parent populations (e.g., Adult-Adolescent Parenting Inventory-2). This study provides new psychometric evidence to support the use of the APT to assess harsh parenting. Additionally, these data highlight the connection between acceptance and use of physical disciplinary strategies, propensity for disciplinary escalation, and risk for abuse perpetration. The findings are discussed in the context of Milner's Social Information Processing model [Milner, 2003] of abuse, which suggests that parental selection of disciplinary responding and the monitoring of disciplinary responding are key events in the disciplinary process. The APT may prove a useful adjunct to more commonly used self-report measures to allow for multimethod assessment of risk for punitive parenting.

  15. EFFECT OF TARIFF ESCALATION ON GHANAIAN COCOA EXPORTS: AN EMPIRICAL PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Ahmed Abdul Aziz

    2017-01-01

    Full Text Available This study analyses the effects of tariff escalation on Ghanaian cocoa exports in four importing markets: USA, EU, Japan and Malaysia. The study estimates nominal and effective protection coefficients in these markets based on ad-valorem equivalent of applied and bound specific tariffs. Results revealed that, effective protection exists in the Japanese and Malaysian cocoa industries at different stages of processing on both bound and applied tariffs. In contrast, the USA and the EU do not effectively protect their cocoa industries, thus, no tariff escalation on applied tariffs against cocoa imports from Ghana. This study concludes that from a static effect, higher tariffs do have a negative consequence on Ghanaian cocoa exports in these importing countries. From a dynamic perspective however, the relationship between tariff structures in these importing countries and Ghanaian cocoa exports is somewhat ambiguous and each situation has to be viewed on their own merit. A complete elimination of tariffs as a form of trade barrier on Ghanaian cocoa exports does not necessarily imply that Ghana could easily increase its exports of value added cocoa.

  16. Ion Elevators and Escalators in Multilevel Structures for Lossless Ion Manipulations

    Energy Technology Data Exchange (ETDEWEB)

    Ibrahim, Yehia M.; Hamid, Ahmed M.; Cox, Jonathan T.; Garimella, Venkata BS; Smith, Richard D.

    2017-01-19

    We describe two approaches based upon ion ‘elevator’ and ‘escalator’ components that allow moving ions to different levels in structures for lossless ion manipulations (SLIM). Guided by ion motion simulations we designed elevator and escalator components providing essentially lossless transmission in multi-level designs based upon ion current measurements. The ion elevator design allowed ions to efficiently bridge a 4 mm gap between levels. The component was integrated in a SLIM and coupled to a QTOF mass spectrometer using an ion funnel interface to evaluate the m/z range transmitted as compared to transmission within a level (e.g. in a linear section). Mass spectra for singly-charged ions of m/z 600-2700 produced similar mass spectra for both elevator and straight (linear motion) components. In the ion escalator design, traveling waves (TW) were utilized to transport ions efficiently between two SLIM levels. Ion current measurements and ion mobility (IM) spectrometry analysis illustrated that ions can be transported between TW-SLIM levels with no significant loss of either ions or IM resolution. These developments provide a path for the development of multilevel designs providing e.g. much longer IM path lengths, more compact designs, and the implementation of much more complex SLIM devices in which e.g. different levels may operate at different temperatures or with different gases.

  17. Stairs or escalator? Using theories of persuasion and motivation to facilitate healthy decision making.

    Science.gov (United States)

    Suri, Gaurav; Sheppes, Gal; Leslie, Sara; Gross, James J

    2014-12-01

    To encourage an increase in daily activity, researchers have tried a variety of health-related communications, but with mixed results. In the present research-using the stair escalator choice context-we examined predictions derived from the Heuristic Systematic Model (HSM), Self Determination Theory (SDT), and related theories. Specifically, we tested whether (as predicted by HSM) signs that encourage heuristic processing ("Take the Stairs") would have greatest impact when placed at the stair/escalator point of choice (when processing time is limited), whereas signs that encourage systematic processing ("Will You Take the Stairs?") would have greatest impact when placed at some distance from the point of choice (when processing time is less limited). We also tested whether (as predicted by SDT) messages promoting autonomy would be more likely to result in sustained motivated behavior (i.e., stair taking at subsequent uncued choice points) than messages that use commands. A series of studies involving more than 9,000 pedestrians provided support for these predictions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  18. Patient perspectives on barriers and enablers to the use and effectiveness of de-escalation techniques for the management of violence and aggression in mental health settings.

    Science.gov (United States)

    Price, Owen; Baker, John; Bee, Penny; Grundy, Andrew; Scott, Anne; Butler, Debbie; Cree, Lindsey; Lovell, Karina

    2017-10-30

    Investigate patient perspectives on barriers and enablers to the use and effectiveness of de-escalation techniques for aggression in mental health settings. De-escalation techniques are the recommended first-line intervention for the management of aggression in mental health settings internationally, yet use of higher risk restrictive practices persists. This indicates de-escalation techniques are not used at optimum frequency and/or there are important factors limiting their use and effect. Descriptive qualitative research using semi-structured interviews and Framework Analysis. Inpatient interviews (N = 26) exploring staff, patient and environmental factors influencing the use and effectiveness of staff de-escalation were conducted mid-2014. Three service user researchers led analysis. Data were synthesized in three deductive themes relating to staff, patient and environmental influences on the use and effectiveness of de-escalation techniques. The dominant view was that restrictive practices, rather than de-escalation techniques, are used in response to escalating patient behaviour. Under-use of de-escalation techniques was attributed to: lack of staff reflection on culture and practice and a need to retain control/dominance over patients. Ward rules, patient factors and a lack of staff respect for patients diluted their effectiveness. Participants identified a systematic process of de-escalation, rule subversion, reduced social distance and staff authenticity as enablers of effective de-escalation. This study investigated patient perspectives on staff, patient and environmental influences on the use and effectiveness of de-escalation techniques. Our framework of barriers and enablers provides indicators of organizational/behaviour change targets for interventions seeking to reduce violence and restrictive practices through enhanced de-escalation techniques. © 2017 John Wiley & Sons Ltd.

  19. Healthcare regulatory concepts in Brazil.

    Science.gov (United States)

    Oliveira, Robson Rocha de; Elias, Paulo Eduardo Mangeon

    2012-06-01

    The healthcare regulatory concepts used in Brazilian scientific publications on healthcare management were reviewed. A typo-logical classification for regulatory concepts was developed from the most current ideas in five disciplines: life sciences, law, economics, sociology and political science. Four ideas stood out: control, balance, adaptation and direction, with greatest emphasis on the technical nature of regulation. The political nature of regulation was secondary. It was considered that dis-cussion of healthcare regulatory concepts was connected with comprehension of the role that the state plays in this sector. De-finition of the forms of state intervention is the key convergence point between the different ways of conceptualizing healthcare regulation.

  20. Recommended Vaccines for Healthcare Workers

    Science.gov (United States)

    ... Professionals in Infection Control and Epidemiology (APIC). Increasing Flu Vaccination Rates among Healthcare Workers Position statements from professional organizations, mandatory influenza vaccination policies, and many helpful ...

  1. Healthcare plans and consumer perceptions of healthcare institutions.

    Science.gov (United States)

    Arboleda-Arango, Ana M

    2015-01-01

    This study evaluates the effect of healthcare insurance plans on consumer perception of trust in a healthcare institution, and the mediating effect of trust on consumer loyalty towards an institution. The study was conducted at a healthcare institution in Colombia where a total of 841 patients responded to a questionnaire. A structural equation model shows that individuals who have a pre-paid healthcare plan have a stronger evaluation of trust compared to those who hold a regulated healthcare plan (i.e., subsidized and contributory plans). In turn, trust positively predicts consumers' loyalty towards an institution. The relationship between the patients' healthcare plans and their degree of loyalty towards healthcare institutions is completely mediated by their perception of trust towards the institution. A greater perception of trust is explained by having a medical plan that provides consumers with more flexibility, allowing them to select their health provider at a premium price. Although health institutions do not control healthcare regimes, these affect consumers' trust in their service. Institutions cannot modify characteristics of the regime, but they can promote a trustworthy environment to strengthen consumers' loyalty to the institution.

  2. Constructing Healthcare Spaces

    DEFF Research Database (Denmark)

    Harty, Chris; Holm Jacobsen, Peter; Tryggestad, Kjell

    2015-01-01

    The aim of this paper is to inquire into the role of project visualisations in shaping healthcare spaces and practices. The study draws upon an ethnographic field study from a large on-going hospital construction project in Denmark, and focuses on the early phases of on-boarding the design team...... into the project organisation. The theoretical contribution concerns the ways in which project visualisations plays an active role in developing novel conceptions of space and how these are mobilized in the process of on-boarding, in terms of 1. Design space (especially the engagement of users in the design...... process), 2.Organisational space (work processes and their spatial-temporal dimension) and; 3. Economic space (cost estimations and budgets). In practice, our findings show that the visualisations of different yet connected project spaces and the development of future clinical practices is related...

  3. Escalation to Major Depressive Disorder among adolescents with subthreshold depressive symptoms: evidence of distinct subgroups at risk.

    Science.gov (United States)

    Hill, Ryan M; Pettit, Jeremy W; Lewinsohn, Peter M; Seeley, John R; Klein, Daniel N

    2014-04-01

    The presence of subthreshold depressive symptoms (SubD) in adolescence is associated with high prospective risk of developing Major Depressive Disorder (MDD). Little is known about variables that predict escalation from SubD to MDD. This study used a longitudinal prospective design in a community sample of adolescents to identify combinations of risk factors that predicted escalation from SubD to MDD. Classification tree analysis was used to identify combinations of risk factors that improved the sensitivity and specificity of prediction of MDD onset among 424 adolescents with a lifetime history of SubD. Of the 424, 144 developed MDD during the follow-up period. Evidence for multiple subgroups was found: among adolescents with poor friend support, the highest risk of escalation was among participants with lifetime histories of an anxiety or substance use disorder. Among adolescents with high friend support, those reporting multiple major life events in the past year or with a history of an anxiety disorder were at highest risk of escalation. Study findings may not inform prevention efforts for individuals who first develop SubD during adulthood. This study did not examine the temporal ordering of predictors involved in escalation from SubD to MDD. Adolescents with a history of SubD were at highest risk of escalation to MDD in the presence of poor friend support and an anxiety or substance use disorder, or in the presence of better friend support, multiple major life events, and an anxiety disorder. Findings may inform case identification approaches for adolescent depression prevention programs. Copyright © 2014 Elsevier B.V. All rights reserved.

  4. [Knowledge management and healthcare organizations].

    Science.gov (United States)

    Favaretti, Carlo

    2013-10-01

    The present scenario is characterized by a high "environmental turbulence". Healthcare professionals and organizations must increase their knowledge, skills and attitudes for choosing wisely. Healthcare organizations are complex adaptive systems which should use integrated governance systems: knowledge management should be a strategic goal. These organizations should become learning organizations: they should build and renovate their knowledge in a systematic, explicit and definite way.

  5. Developing healthcare in South Sudan

    African Journals Online (AJOL)

    The Need. The provision of healthcare in South Sudan is offered by a 'mixed economy' of public hospitals and clinics, private hospitals and clinics, international aid organisations, and traditional community practice. Yet for most of the 11.7 million population [1], the provision of both primary and secondary healthcare is ...

  6. Governance mechanisms for healthcare apps

    DEFF Research Database (Denmark)

    Manikas, Konstantinos; Hansen, Klaus Marius; Kyng, Morten

    2014-01-01

    policies for apps that are medical devices.In this paper, we approach the problem of how to govern healthcare and medical apps by addressing the risks the use of these apps pose, while at the same time inviting for development of new apps. To do so we (i) analyze four cases of healthcare app governance/regulation...

  7. Freeform electronics for advanced healthcare

    KAUST Repository

    Hussain, Muhammad Mustafa

    2017-02-16

    Freeform (physically flexible, stretchable and reconfigurable) electronics can be critical enabler for advanced personalized healthcare. With increased global population and extended average lifetime of mankind, it is more important than ever to integrate advanced electronics into our daily life for advanced personalized healthcare. In this paper, we discuss some critical criteria to design such electronics with enabling applications.

  8. Healthcare Systems and Other Applications

    NARCIS (Netherlands)

    van Kasteren, T.L.M.; Kröse, B.J.A.

    2007-01-01

    This Works in Progress department discusses eight projects related to healthcare. The first project aims to aid people with mild dementia. The second project plans to simplify the delivery of healthcare services to the elderly and cognitively disabled, while the third project is developing models

  9. Cardiac misconceptions in healthcare workers.

    Science.gov (United States)

    Angus, Neil; Patience, Fiona; Maclean, Elizabeth; Corrigall, Helen; Bradbury, Ian; Thompson, David R; Atherton, Iain; Leslie, Stephen J

    2012-12-01

    Cardiac misconceptions are common and may have a detrimental effect on patients. Such misconceptions may be introduced or reinforced by vague and inconsistent advice from healthcare staff and can adversely affect health outcomes. To assess whether level of cardiac misconceptions significantly differs between groups of healthcare staff based on occupation. The 22-item York cardiac beliefs questionnaire (YCBQ) was administered to a convenience sample of healthcare staff (n = 263) in direct contact with cardiac patients. Data was also collected on the occupation of healthcare staff and years worked. Medical staff had the lowest mean score (17.5, CI 15.6-19.4), indicating fewest misconceptions, and unqualified healthcare workers had the highest mean score (32.1, CI 28.4-35.7). Analysis by ANOVA indicated differences between staff groups to be statistically significant (F = 17.66, p misconception score (Pearson's r = - 0.243, p misconceptions in different groups of healthcare staff. Education to correct cardiac misconceptions should be particularly targeted at unqualified healthcare staff. The importance of maintaining appropriate ratios of qualified to unqualified healthcare staff in the care of cardiac patients is supported by this study.

  10. households' choices of healthcare services in the north west region ...

    African Journals Online (AJOL)

    Efficient healthcare systems in developing economies are significant indicators of development. ... access to quality healthcare can be improved with efficient healthcare support programs and deferred payment options. ... Healthcare Services; Healthcare Providers; Multinomial Logistic Model; Healthcare Systems; Primary.

  11. Can naturopathy provide answers to the escalating health care costs in India?

    Science.gov (United States)

    Tripathy, Jaya Prasad

    2015-01-01

    There are substantial areas of overlap between naturopathy and public health, which include a focus on health rather than disease, a preventive approach, and an emphasis on health promotion and health education. Public health can look to naturopathy for answers to the emergence of chronic disease through natural therapies, many of which can take the role of primordial and primary prevention of several diseases. Some selected naturopathic therapies include nutrition, hydrotherapy, fasting therapy, yoga, behavioral therapy, and health promotion. We must reorient our focus on prevention and wellness to make a true impact on escalating health care costs. With the National Health Policy in India emphasizing the need for integrating the Indian Systems of Medicines with modern medicine, now is the right time for naturopathy and public health to come together to provide a holistic health care system. PMID:26151012

  12. Le port d’Acapulco, escale sur le chemin de l’Asie

    OpenAIRE

    Tempère, Delphine

    2016-01-01

    Acapulco joue à l’époque coloniale un rôle déterminant entre l’Asie, l’Amérique et l’Espagne ; c’est une escale obligatoire sur le chemin de l’Asie, c’est le port asiatique de l’Amérique. De Séville à Veracruz, des côtes mexicaines à Mexico, de la capitale de la Nouvelle Espagne à Acapulco, les informations, les marchandises et les hommes circulent afin de rejoindre les Philippines. Acapulco est en effet le seul port autorisé en Amérique afin de se rendre à Manille grâce à la liaison maritime...

  13. Macroevolutionary chemical escalation in an ancient plant–herbivore arms race

    Science.gov (United States)

    Becerra, Judith X.; Noge, Koji; Venable, D. Lawrence

    2009-01-01

    A central paradigm in the field of plant–herbivore interactions is that the diversity and complexity of secondary compounds in plants have intensified over evolutionary time, resulting in the great variety of secondary products that currently exists. Unfortunately, testing of this proposal has been very limited. We analyzed the volatile chemistry of 70 species of the tropical plant genus Bursera and used a molecular phylogeny to test whether the species' chemical diversity or complexity have escalated. The results confirm that as new species diverged over time they tended to be armed not only with more compounds/species, but also with compounds that could potentially be more difficult for herbivores to adapt to because they belong to an increasing variety of chemical pathways. Overall chemical diversity in the genus also increased, but not as fast as species diversity, possibly because of allopatric species gaining improved defense with compounds that are new locally, but already in existence elsewhere. PMID:19706441

  14. Macroevolutionary chemical escalation in an ancient plant-herbivore arms race.

    Science.gov (United States)

    Becerra, Judith X; Noge, Koji; Venable, D Lawrence

    2009-10-27

    A central paradigm in the field of plant-herbivore interactions is that the diversity and complexity of secondary compounds in plants have intensified over evolutionary time, resulting in the great variety of secondary products that currently exists. Unfortunately, testing of this proposal has been very limited. We analyzed the volatile chemistry of 70 species of the tropical plant genus Bursera and used a molecular phylogeny to test whether the species' chemical diversity or complexity have escalated. The results confirm that as new species diverged over time they tended to be armed not only with more compounds/species, but also with compounds that could potentially be more difficult for herbivores to adapt to because they belong to an increasing variety of chemical pathways. Overall chemical diversity in the genus also increased, but not as fast as species diversity, possibly because of allopatric species gaining improved defense with compounds that are new locally, but already in existence elsewhere.

  15. Does selective pleural irradiation of malignant pleural mesothelioma allow radiation dose escalation. A planning study

    Energy Technology Data Exchange (ETDEWEB)

    Botticella, A.; Defraene, G. [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); Nackaerts, K. [KU Leuven - University of Leuven, University Hospitals Leuven, Department of Respiratory Medicine, Leuven (Belgium); Deroose, C. [KU Leuven - University of Leuven, University Hospitals Leuven, Nuclear Medicine, Leuven (Belgium); Coolen, J. [KU Leuven - University of Leuven, University Hospitals Leuven, Radiology Department, Leuven (Belgium); Nafteux, P. [University Hospitals Leuven, Department of Thoracic Surgery, Leuven (Belgium); Vanstraelen, B. [University Hospitals Leuven, Department of Radiation Oncology, Leuven (Belgium); Joosten, S.; Michiels, L.A.W. [Fontys University of Applied Science, Institute Paramedical Studies, Medical Imaging and Radiotherapeutic Techniques, Eindhoven (Netherlands); Peeters, S. [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); University Hospitals Leuven, Department of Radiation Oncology, Leuven (Belgium); Ruysscher, D. de [KU Leuven - University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven (Belgium); Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO Clinic), Maastricht (Netherlands)

    2017-04-15

    After lung-sparing radiotherapy for malignant pleural mesothelioma (MPM), local failure at sites of previous gross disease represents the dominant form of failure. Our aim is to investigate if selective irradiation of the gross pleural disease only can allow dose escalation. In all, 12 consecutive stage I-IV MPM patients (6 left-sided and 6 right-sided) were retrospectively identified and included. A magnetic resonance imaging-based pleural gross tumor volume (GTV) was contoured. Two sets of planning target volumes (PTV) were generated for each patient: (1) a ''selective'' PTV (S-PTV), originating from a 5-mm isotropic expansion from the GTV and (2) an ''elective'' PTV (E-PTV), originating from a 5-mm isotropic expansion from the whole ipsilateral pleural space. Two sets of volumetric modulated arc therapy (VMAT) treatment plans were generated: a ''selective'' pleural irradiation plan (SPI plan) and an ''elective'' pleural irradiation plan (EPI plan, planned with a simultaneous integrated boost technique [SIB]). In the SPI plans, the average median dose to the S-PTV was 53.6 Gy (range 41-63.6 Gy). In 4 of 12 patients, it was possible to escalate the dose to the S-PTV to >58 Gy. In the EPI plans, the average median doses to the E-PTV and to the S-PTV were 48.6 Gy (range 38.5-58.7) and 49 Gy (range 38.6-59.5 Gy), respectively. No significant dose escalation was achievable. The omission of the elective irradiation of the whole ipsilateral pleural space allowed dose escalation from 49 Gy to more than 58 Gy in 4 of 12 chemonaive MPM patients. This strategy may form the basis for nonsurgical radical combined modality treatment of MPM. (orig.) [German] Beim malignen Pleuramesotheliom (MPM) ist nach lungenschonender Radiotherapie das lokale Scheitern an Stellen eines frueheren, sichtbaren Tumors die dominierende Form des Scheiterns. Unser Ziel ist es, zu untersuchen, ob die selektive

  16. Escalation with Overdose Control Using Ordinal Toxicity Grades for Cancer Phase I Clinical Trials

    Directory of Open Access Journals (Sweden)

    Mourad Tighiouart

    2012-01-01

    Full Text Available We extend a Bayesian adaptive phase I clinical trial design known as escalation with overdose control (EWOC by introducing an intermediate grade 2 toxicity when assessing dose-limiting toxicity (DLT. Under the proportional odds model assumption of dose-toxicity relationship, we prove that in the absence of DLT, the dose allocated to the next patient given that the previously treated patient had a maximum of grade 2 toxicity is lower than the dose given to the next patient had the previously treated patient exhibited a grade 0 or 1 toxicity at the most. Further, we prove that the coherence properties of EWOC are preserved. Simulation results show that the safety of the trial is not compromised and the efficiency of the estimate of the maximum tolerated dose (MTD is maintained relative to EWOC treating DLT as a binary outcome and that fewer patients are overdosed using this design when the true MTD is close to the minimum dose.

  17. Can naturopathy provide answers to the escalating health care costs in India?

    Directory of Open Access Journals (Sweden)

    Jaya Prasad Tripathy

    2015-04-01

    Full Text Available There are substantial areas of overlap between naturopathy and public health, which include a focus on health rather than disease, a preventive approach, and an emphasis on health promotion and health education. Public health can look to naturopathy for answers to the emergence of chronic disease through natural therapies, many of which can take the role of primordial and primary prevention of several diseases. Some selected naturopathic therapies include nutrition, hydrotherapy, fasting therapy, yoga, behavioral therapy, and health promotion. We must reorient our focus on prevention and wellness to make a true impact on escalating health care costs. With the National Health Policy in India emphasizing the need for integrating the Indian Systems of Medicines with modern medicine, now is the right time for naturopathy and public health to come together to provide a holistic health care system.

  18. The snowball effect: friendship moderates escalations in depressed affect among avoidant and excluded children.

    Science.gov (United States)

    Bukowski, William M; Laursen, Brett; Hoza, Betsy

    2010-11-01

    A three-wave longitudinal study conducted with preadolescent boys and girls (N = 231 at Time 1 [T1]) was used to assess the hypotheses that aspects of social withdrawal would be predictors of a "snowball" cascade of depressed affect, and that friendship experiences would moderate these effects. Consistent with these hypotheses, multilevel modeling showed that measures of avoidance and exclusion at T1 were associated with concurrent levels of depressed affect and were antecedent to escalating trajectories of depressed affect over time. These accelerating growth curves fit a snowball cascade model. The analyses also showed the protective effects of friendship. Specifically, the snowball effect was limited to avoidant and excluded children who were friendless. Depressed affect did not increase among avoidant and excluded children who were friended.

  19. Phase I dose escalation safety study of nanoparticulate paclitaxel (CTI 52010) in normal dogs.

    Science.gov (United States)

    Axiak, Sandra M; Selting, Kim A; Decedue, Charles J; Henry, Carolyn J; Tate, Deborah; Howell, Jahna; Bilof, K James; Kim, Dae Y

    2011-01-01

    Paclitaxel is highly effective in the treatment of many cancers in humans, but cannot be routinely used in dogs as currently formulated due to the exquisite sensitivity of this species to surfactant-solubilizing agents. CTI 52010 is a formulation of nanoparticulate paclitaxel consisting of drug and normal saline. Our objectives were to determine the maximally tolerated dose, dose-limiting toxicities, and pharmacokinetics of CTI 52010 administered intravenously to normal dogs. Three normal adult hound dogs were evaluated by physical examination, complete blood count, chemistry profile, and urinalysis. Dogs were treated with staggered escalating dosages of CTI 52010 with a 28-day washout. All dogs were treated with a starting dosage of 40 mg/m(2), and subsequent dosages were escalated at 50% (dog 1), 100% (dog 2), or 200% (dog 3) with each cycle, to a maximum of 240 mg/m(2). Dogs were monitored by daily physical assessment and weekly laboratory evaluation. Standard criteria were used to grade adverse events. Plasma was collected at regular intervals to determine pharmacokinetics. Dogs were euthanized humanely, and necropsy was performed one week after the last treatment. The dose-limiting toxicity was grade 4 neutropenia and the maximum tolerated dosage was 120 mg/m(2). Grade 1-2 gastrointestinal toxicity was noted at higher dosages. Upon post mortem evaluation, no evidence of organ (liver, kidney, spleen) toxicity was noted. CTI 52010 was well tolerated when administered intravenously to normal dogs. A starting dosage for a Phase I/II trial in tumor-bearing dogs is 80 mg/m(2).

  20. Radiation Therapy Dose Escalation for Glioblastoma Multiforme in the Era of Temozolomide

    Energy Technology Data Exchange (ETDEWEB)

    Badiyan, Shahed N.; Markovina, Stephanie; Simpson, Joseph R.; Robinson, Clifford G.; DeWees, Todd [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Tran, David D.; Linette, Gerry [Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri (United States); Jalalizadeh, Rohan [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Dacey, Ralph; Rich, Keith M.; Chicoine, Michael R.; Dowling, Joshua L.; Leuthardt, Eric C.; Zipfel, Gregory J.; Kim, Albert H. [Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri (United States); Huang, Jiayi, E-mail: jhuang@radonc.wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States)

    2014-11-15

    Purpose: To review clinical outcomes of moderate dose escalation using high-dose radiation therapy (HDRT) in the setting of concurrent temozolomide (TMZ) in patients with newly diagnosed glioblastoma multiforme (GBM), compared with standard-dose radiation therapy (SDRT). Methods and Materials: Adult patients aged <70 years with biopsy-proven GBM were treated with SDRT (60 Gy at 2 Gy per fraction) or with HDRT (>60 Gy) and TMZ from 2000 to 2012. Biological equivalent dose at 2-Gy fractions was calculated for the HDRT assuming an α/β ratio of 5.6 for GBM. Results: Eighty-one patients received SDRT, and 128 patients received HDRT with a median (range) biological equivalent dose at 2-Gy fractions of 64 Gy (61-76 Gy). Overall median follow-up time was 1.10 years, and for living patients it was 2.97 years. Actuarial 5-year overall survival (OS) and progression-free survival (PFS) rates for patients that received HDRT versus SDRT were 12.4% versus 13.2% (P=.71), and 5.6% versus 4.1% (P=.54), respectively. Age (P=.001) and gross total/near-total resection (GTR/NTR) (P=.001) were significantly associated with PFS on multivariate analysis. Younger age (P<.0001), GTR/NTR (P<.0001), and Karnofsky performance status ≥80 (P=.001) were associated with improved OS. On subset analyses, HDRT failed to improve PFS or OS for those aged <50 years or those who had GTR/NTR. Conclusion: Moderate radiation therapy dose escalation above 60 Gy with concurrent TMZ does not seem to improve clinical outcomes for patients with GBM.

  1. Disposition, behavioural and physiological effects of escalating doses of intravenously administered fentanyl to young foals.

    Science.gov (United States)

    Knych, H K; Steffey, E P; Casbeer, H C; Mitchell, M M

    2015-09-01

    Foal responses to a broader range of plasma fentanyl concentrations than currently reported are desirable to support (or not) clinical use. To describe fentanyl plasma concentrations following an escalating i.v. fentanyl dosing schedule in foals aged 5-13 days and describe selected, associated dose- and time-related behavioural and physiological responses to plasma fentanyl concentration. Experimental. Fentanyl was administered i.v. in an escalating fashion (2, 4, 8, 16 and 32 μg/kg bwt) at 10-min intervals. Blood samples were collected before and at selected times until 24 h post administration. Blood samples were analysed for fentanyl and metabolite concentrations and correlated with behavioural and physiological observations and selected blood analytes. Foals mostly appeared to be unaffected following 2 μg/kg bwt (1.09 ± 0.41 μg/l; average maximal plasma concentration) of fentanyl, but 6 of the 8 foals appeared to be sedated following 4 μg/kg bwt (3.07 ± 1.11 μg/l). Ataxia with increased locomotor activity, muscle rigidity and head pressing posture was observed in many foals at 8 (7.24 ± 3.22 μg/l) and 16 μg/kg bwt (17.4 ± 5.67 μg/l). All foals were heavily sedated after 32 μg/kg bwt (34.5 ± 10.3 μg/l); 3 of the 8 foals became recumbent. The average (± s.d.) terminal half-life following administration of the final dose was 44.2 ± 9.85 min. Behavioural and physiological responses to i.v. fentanyl in young foals are dose related. As with mature horses, the window of fentanyl plasma concentrations related to possible clinically desirable actions appears relatively narrow. © 2014 EVJ Ltd.

  2. Where is the pleasure in that? Low hedonic capacity predicts smoking onset and escalation.

    Science.gov (United States)

    Audrain-McGovern, Janet; Rodriguez, Daniel; Leventhal, Adam M; Cuevas, Jocelyn; Rodgers, Kelli; Sass, Joseph

    2012-10-01

    Hedonic capacity is a dispositional ability to experience pleasure in response to stimuli that are typically rewarding. The ability to derive pleasure from natural reinforcers has been relatively overlooked as a risk factor for adolescent smoking. The present study sought to provide initial evidence for a relationship between hedonic capacity and adolescent smoking onset and escalation. The sample was composed of 1,106 adolescents participating in a prospective longitudinal survey study of adolescent health behaviors. Variables were measured via self-report every 6 months for 4 waves of data spanning 18 months. We hypothesized that adolescents with lower hedonic capacity may be less responsive to natural reinforcers and therefore be prone to take up and rely on smoking as a reinforcer. A two-part latent growth curve model indicated that adolescents low in hedonic capacity were over two and a half times more likely to have smoked a cigarette in the past month at age 15.5 years (odds ratio = 2.64, 95% CI = 1.08-6.45) and to show a 90% increase (β = 0.9, z = 2.28, p = .02) in the rate of smoking escalation every 6 months across the following 18 months compared with adolescents with high hedonic capacity. This study provides the first evidence implicating hedonic capacity as a risk factor for adolescent smoking initiation and progression. Adolescents low in hedonic capacity may be an important population to target for smoking prevention and smoking cessation efforts possibly through behavioral skills to enhance pleasure derived through natural reinforcers.

  3. Brain Serotonin Receptors and Transporters: Initiation vs. Termination of Escalated Aggression

    Science.gov (United States)

    Takahashi, Aki; Quadros, Isabel M.; de Almeida, Rosa M. M.; Miczek, Klaus A.

    2013-01-01

    Rationale Recent findings have shown a complexly regulated 5-HT system as it is linked to different kinds of aggression. Objective We focus on (1) phasic and tonic changes of 5-HT and (2) state and trait of aggression, and emphasize the different receptor subtypes, their role in specific brain regions, feed-back regulation and modulation by other amines, acids and peptides. Results New pharmacological tools differentiate the first three 5-HT receptor families and their modulation by GABA, glutamate and CRF. Activation of 5-HT1A, 5-HT1B and 5-HT2A/2C receptors in mesocorticolimbic areas, reduce species-typical and other aggressive behaviors. In contrast, agonists at 5-HT1A and 5-HT1B receptors in the medial prefrontal cortex or septal area can increase aggressive behavior under specific conditions. Activation of serotonin transporters reduce mainly pathological aggression. Genetic analyses of aggressive individuals have identified several molecules that affect the 5-HT system directly (e.g., Tph2, 5-HT1B, 5-HT transporter, Pet1, MAOA) or indirectly (e.g., Neuropeptide Y, αCaMKII, NOS, BDNF). Dysfunction in genes for MAOA escalates pathological aggression in rodents and humans, particularly in interaction with specific experiences. Conclusions Feedback to autoreceptors of the 5-HT1 family and modulation via heteroreceptors are important in the expression of aggressive behavior. Tonic increase of the 5-HT2 family expression may cause escalated aggression, whereas the phasic increase of 5-HT2 receptors inhibits aggressive behaviors. Polymorphisms in the genes of 5-HT transporters or rate-limiting synthetic and metabolic enzymes of 5-HT modulate aggression, often requiring interaction with the rearing environment. PMID:20938650

  4. Social stress and escalated drug self-administration in mice I. Alcohol and corticosterone.

    Science.gov (United States)

    Norman, Kevin J; Seiden, Jacob A; Klickstein, Jacob A; Han, Xiao; Hwa, Lara S; DeBold, Joseph F; Miczek, Klaus A

    2015-03-01

    Stress experiences have been shown to be a risk factor for alcohol abuse in humans; however, a reliable mouse model using episodic social stress has yet to be developed. The current studies investigated the effects of mild and moderate social defeat protocols on plasma corticosterone, voluntary alcohol drinking, and motivation to drink alcohol. Outbred Carworth Farms Webster (CFW) mice were socially defeated for 10 days during which the intruder mouse underwent mild (15 bites: mean = 1.5 min) or moderate (30 bites: mean = 3.8 min) stress. Plasma corticosterone was measured on days 1 and 10 of the defeat. Ethanol drinking during continuous access to alcohol was measured 10 days following the defeat or 10 days prior to, during, and 20 days after the defeat. Motivation to drink was determined using a progressive ratio (PR) operant conditioning schedule during intermittent access to alcohol. Plasma corticosterone was elevated in both stress groups on days 1 and 10. Ethanol consumption and preference following moderate stress were higher (13.3 g/kg/day intake) than both the mild stress group (8.0 g/kg/day) and controls (7.4 g/kg/day). Mice with previously acquired ethanol drinking showed decreased alcohol consumption during the moderate stress followed by an increase 20 days post-defeat. Moderately stressed mice also showed escalated ethanol intake and self-administration during a schedule of intermittent access to alcohol. Social defeat experiences of moderate intensity and duration led to increased ethanol drinking and preference in CFW mice. Ongoing work investigates the interaction between glucocorticoids and dopaminergic systems as neural mechanisms for stress-escalated alcohol consumption.

  5. Fake news in healthcare

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-10-01

    Full Text Available No abstract available. Article truncated at 150 words. An article in the National Review by Pascal-Emmanuel Gobry points out that there is considerable waste in healthcare spending (1. He blames much of this on two entitlements-Medicare and employer-sponsored health insurance. He also lays much of the blame on doctors. “Doctors are the biggest villains in American health care. ... As with public-school teachers, we should be able to recognize that a profession as a whole can be pathological even as many individual members are perfectly good actors, and even if many of them are heroes. And just like public-school teachers, the medical profession as a whole puts its own interests ahead of those of the citizens it claims to be dedicated to serve.” Who is Pascal-Emmanuel Gobry and how could he say something so nasty about teachers and my profession? A quick internet search revealed that Mr. Gobry is a fellow at the Ethics & Public Policy Center …

  6. [Healthcare patient loyalty].

    Science.gov (United States)

    Ameri, Cinzia; Fiorini, Fulvio

    2016-01-01

    If the "old economy" preached standardization of products/services in order to reduce costs, the "new economy" is based on the recognition of the needs and the management of information. It is aimed at providing better and more usable services. One scenario is a national health service with regional management but based on competition between hospitals/companies.This led to a different handling of the user/patient, which has become the center of the health system: marketing seeks to retain the patient, trying to push a client-patient to not change their healthcare service provider. In costs terms, it is more economical to retain a customer rather than acquire a new one: a satisfied customer is also the best sounding board for each company. Customer equity is the management of relations with patients which can result in a greater customer value: it is possible to recognize an equity of the value, of the brand and of the report. Loyalty uses various marketing activities (basic, responsive, responsible, proactive and collaborative): each hospital/company chooses different actions depending on how many resources it plans to invest in loyalty.

  7. Healthcare financing in Yemen.

    Science.gov (United States)

    Holst, Jens; Gericke, Christian A

    2012-01-01

    Yemen is a low-middle-income country where more than half of the population live in rural areas and lack access to the most basic health care. At US$40 per capita, Yemen's annual total health expenditure (THE) is among the lowest worldwide. This study analyses the preconditions and options for implementing basic social health protection in Yemen. It reveals a four-tiered healthcare system characterised by high geographic and financial access barriers mainly for the poor. Out-of-pocket payments constitute 55% of THE, and cost-sharing exemption schemes are not well organised. Resource-allocation practices are inequitable because about 30% of THE gets spent on treatment abroad for a small number of patients, mainly from better-off families. Against the background of a lack of social health protection, a series of small-scale and often informal solidarity schemes have developed, and a number of public and private companies have set up health benefit schemes for their employees. Employment-based schemes usually provide reasonable health care at an average annual cost of YR44 000 (US$200) per employee. In contrast, civil servants contribute to a mandatory health-insurance scheme without receiving any additional health benefits in return. A number of options for initiating a pathway towards a universal health-insurance system are discussed. Copyright © 2012 John Wiley & Sons, Ltd.

  8. A Framework for Healthcare Planning and Control

    NARCIS (Netherlands)

    Hans, Elias W.; van Houdenhoven, Mark; Hulshof, P.J.H.; Hall, Randolph

    2012-01-01

    Rising expenditures spur healthcare organizations to organize their processes more efficiently and effectively. Unfortunately, healthcare planning and control lags behind manufacturing planning and control. We analyze existing planning and control concepts or frameworks for healthcare operations

  9. Leveraging Digital Innovation in Healthcare

    DEFF Research Database (Denmark)

    Brown, Carol V.; Jensen, Tina Blegind; Aanestad, Margun

    2014-01-01

    investments in digital infrastructures. New technologies are leveraged to achieve widespread 24x7 disease management, patients’ wellbeing, home-based healthcare and other patient-centric service innovations. Yet, digital innovations in healthcare face barriers in terms of standardization, data privacy...... and security concerns, fragmented markets, and misaligned incentives across stakeholders. The panel will focus on this apparent paradox and highlight the potential of big data, cloud and mobile computing for achieving better health. The panel co-chairs will introduce differences in healthcare delivery...

  10. Complexity leadership: a healthcare imperative.

    Science.gov (United States)

    Weberg, Dan

    2012-01-01

    The healthcare system is plagued with increasing cost and poor quality outcomes. A major contributing factor for these issues is that outdated leadership practices, such as leader-centricity, linear thinking, and poor readiness for innovation, are being used in healthcare organizations. Complexity leadership theory provides a new framework with which healthcare leaders may practice leadership. Complexity leadership theory conceptualizes leadership as a continual process that stems from collaboration, complex systems thinking, and innovation mindsets. Compared to transactional and transformational leadership concepts, complexity leadership practices hold promise to improve cost and quality in health care. © 2012 Wiley Periodicals, Inc.

  11. Home-based Healthcare Technology

    DEFF Research Database (Denmark)

    Verdezoto, Nervo

    of these systems target a specific treatment or condition and might not be sufficient to support the care management work at home. Based on a case study approach, my research investigates home-based healthcare practices and how they can inform future design of home-based healthcare technology that better account......Sustaining daily, unsupervised healthcare activities in non-clinical settings such as the private home can challenge, among others, older adults. To support such unsupervised care activities, an increasingly number of reminders and monitoring systems are being designed. However, most...... for the home setting and people’s everyday activities....

  12. The effect of elective sham dose escalation on the placebo response during an antimuscarinic trial for overactive bladder symptoms

    NARCIS (Netherlands)

    Staskin, David R.; Michel, Martin C.; Sun, Franklin; Guan, Zhonghong; Morrow, Jon D.

    2012-01-01

    We analyzed the effects of baseline symptom severity and placebo response magnitude on the decision to dose escalate in a 12-week, randomized, double-blind, flexible dose antimuscarinic trial of subjects with overactive bladder symptoms. Data from the placebo arm of the trial were used for this post

  13. Words of Violence: “Fear Speech,” or How Violent Conflict Escalation Relates to the Freedom of Expression

    NARCIS (Netherlands)

    Buyse, Antoine

    2014-01-01

    The limits of the freedom of expression are a perennial discussion in human rights discourse. This article focuses on identifying yardsticks to establish the boundaries of freedom of expression in cases where violence is a risk. It does so by using insights from the social sciences on the escalation

  14. 20 CFR 1002.194 - Can the application of the escalator principle result in adverse consequences when the employee...

    Science.gov (United States)

    2010-04-01

    ... or lower position, laid off, or even terminated. For example, if an employee's seniority or job... Reemployment Rights and Benefits Reemployment Position § 1002.194 Can the application of the escalator... lawful adverse job consequences that result from the employee's restoration on the seniority ladder...

  15. De-escalation: A methodology to reduce coercive measures in clinical psychiatry. A project based on Action Research Principles

    DEFF Research Database (Denmark)

    Lauge Berring, Lene

    The study investigates whether coercive measures and violence can be reduced in psychiatric wards when staff uses a deescalating approach, as the patient's behaviour is escalating. The study is based on action research principles and the objective is to identify, characterize and test deescalating...

  16. The utility of fecal calprotectin in predicting the need for escalation of therapy in inflammatory bowel disease.

    Science.gov (United States)

    Kwapisz, Lukasz; Gregor, Jamie; Chande, Nilesh; Yan, Brian; Ponich, Terry; Mosli, Mahmoud

    2017-08-01

    Fecal calprotectin is an important biomarker used in the evaluation of inflammatory bowel disease. It has proven to be an effective tool in initial screening as well monitoring response to therapy. The aim of this study is to examine the utility of fecal calprotectin both as a predictor for the escalation of therapy in established inflammatory bowel disease and as a predictor of de novo diagnosis. Patients with signs and symptoms concerning for inflammatory bowel disease presenting to outpatient clinics were recruited to provide fecal calprotectin stool samples prior to endoscopic evaluation. Patients were followed up for at least one year and monitored clinically for any change in symptomatology, escalation of therapy or development of IBD, confirmed endoscopically. A total of 126 patients, of whom 72 were known to have underlying inflammatory bowel disease, were included in the final analysis. Among the patients with elevated fecal calprotectin levels and known inflammatory bowel disease, 66% (33/50) went on to have escalation of therapy within 12 months compared to 18% (4/22) if the fecal calprotectin levels were in the normal range (p inflammatory bowel disease and a normal endoscopic evaluation, elevated fecal calprotectin resulted in no cases (0/17) of a new diagnosis in the next 12 months. Fecal calprotectin is a useful test for predicting escalation of therapy in established inflammatory bowel disease.

  17. Class solution in inverse planned HDR prostate brachytherapy for dose escalation of DIL defined by combined MRI/MRSI

    Science.gov (United States)

    Kim, Yongbok; Hsu, I-Chow J.; Lessard, Etienne; Kurhanewicz, John; Noworolski, Susan Moyher; Pouliot, Jean

    2015-01-01

    Purpose To establish an inverse planning set of parameters (class solution) to boost dominant intra-prostatic lesion (DIL) defined by MRI/MRSI. Methods For 15 patients, DIL were contoured on CT or MR images and a class solution was developed to boost the DIL under the dosimetric requirements of the RTOG-0321 protocol. To determine the maximum attainable level of boost for each patient, 5 different levels were considered, at least 110%, 120%, 130%, 140% and 150% of the prescribed dose. The maximum attainable level was compared to the plan without boost using cumulative dose volume histogram (DVH). Results DIL dose escalation was feasible for 11/15 patients under the requirements. The planning target volume (PTV) dose was slightly increased, while the DIL dose was significantly increased without any violation of requirements. With slight adjustments of the dose constraint parameters, the dose escalation was feasible for 13/15 patients under requirements. Conclusion Using a class solution, a dose escalation of the MRI/MRSI defined DIL up to 150% while complying with RTOG dosimetric requirements is feasible. This HDR brachytherapy approach to dose escalation allows a significant dose increase to the tumor while maintaining an acceptable risk of complications. PMID:18083260

  18. A phase I/II dose-escalation trial of vitamin D3 and calcium in multiple sclerosis.

    Science.gov (United States)

    Burton, J M; Kimball, S; Vieth, R; Bar-Or, A; Dosch, H-M; Cheung, R; Gagne, D; D'Souza, C; Ursell, M; O'Connor, P

    2010-06-08

    Low vitamin D status has been associated with multiple sclerosis (MS) prevalence and risk, but the therapeutic potential of vitamin D in established MS has not been explored. Our aim was to assess the tolerability of high-dose oral vitamin D and its impact on biochemical, immunologic, and clinical outcomes in patients with MS prospectively. An open-label randomized prospective controlled 52-week trial matched patients with MS for demographic and disease characteristics, with randomization to treatment or control groups. Treatment patients received escalating vitamin D doses up to 40,000 IU/day over 28 weeks to raise serum 25-hydroxyvitamin D [25(OH)D] rapidly and assess tolerability, followed by 10,000 IU/day (12 weeks), and further downtitrated to 0 IU/day. Calcium (1,200 mg/day) was given throughout the trial. Primary endpoints were mean change in serum calcium at each vitamin D dose and a comparison of serum calcium between groups. Secondary endpoints included 25(OH)D and other biochemical measures, immunologic biomarkers, relapse events, and Expanded Disability Status Scale (EDSS) score. Forty-nine patients (25 treatment, 24 control) were enrolled [mean age 40.5 years, EDSS 1.34, and 25(OH)D 78 nmol/L]. All calcium-related measures within and between groups were normal. Despite a mean peak 25(OH)D of 413 nmol/L, no significant adverse events occurred. Although there may have been confounding variables in clinical outcomes, treatment group patients appeared to have fewer relapse events and a persistent reduction in T-cell proliferation compared to controls. High-dose vitamin D (approximately 10,000 IU/day) in multiple sclerosis is safe, with evidence of immunomodulatory effects. This trial provides Class II evidence that high-dose vitamin D use for 52 weeks in patients with multiple sclerosis does not significantly increase serum calcium levels when compared to patients not on high-dose supplementation. The trial, however, lacked statistical precision and the

  19. Sensor technologies: healthcare, wellness, and environmental applications

    National Research Council Canada - National Science Library

    McGrath, Michael J., Ph.D; Ní Scanaill, Cliodhna

    Sensor Technologies: Healthcare, Wellness and Environmental Applications explores the key aspects of sensor technologies, covering wired, wireless, and discrete sensors for the specific application domains of healthcare...

  20. SU-C-BRB-02: Automatic Planning as a Potential Strategy for Dose Escalation for Pancreas SBRT?

    Energy Technology Data Exchange (ETDEWEB)

    Wang, S; Zheng, D; Ma, R; Lin, C; Zhu, X; Lei, Y; Enke, C; Zhou, S [University of Nebraska Medical Center, Omaha, NE (United States)

    2016-06-15

    Purpose: Stereotactic body radiation therapy (SBRT) has been suggested to provide high rates of local control for locally advanced pancreatic cancer. However, the close proximity of highly radiosensitive normal tissues usually causes the labor-intensive planning process, and may impede further escalation of the prescription dose. The present study evaluates the potential of an automatic planning system as a dose escalation strategy. Methods: Ten pancreatic cancer patients treated with SBRT were studied retrospectively. SBRT was delivered over 5 consecutive fractions with 6 ∼ 8Gy/fraction. Two plans were generated by Pinnacle Auto-Planning with the original prescription and escalated prescription, respectively. Escalated prescription adds 1 Gy/fraction to the original prescription. Manually-created planning volumes were excluded in the optimization goals in order to assess the planning efficiency and quality simultaneously. Critical organs with closest proximity were used to determine the plan normalization to ensure the OAR sparing. Dosimetric parameters including D100, and conformity index (CI) were assessed. Results: Auto-plans directly generate acceptable plans for 70% of the cases without necessity of further improvement, and two more iterations at most are necessary for the rest of the cases. For the pancreas SBRT plans with the original prescription, autoplans resulted in favorable target coverage and PTV conformity (D100 = 96.3% ± 1.48%; CI = 0.88 ± 0.06). For the plans with the escalated prescriptions, no significant target under-dosage was observed, and PTV conformity remains reasonable (D100 = 93.3% ± 3.8%, and CI = 0.84 ± 0.05). Conclusion: Automatic planning, without substantial human-intervention process, results in reasonable PTV coverage and PTV conformity on the premise of adequate OAR sparing for the pancreas SBRT plans with escalated prescription. The results highlight the potential of autoplanning as a dose escalation strategy for pancreas

  1. Choice of healthcare provider following reform in Vietnam

    Directory of Open Access Journals (Sweden)

    Lindholm Lars

    2008-07-01

    Full Text Available Abstract Background In Vietnam, the health-sector reforms since 1989 have lead to a rapid increase in out-of-pocket expenses. This paper examines the choice of medical provider and household healthcare expenditure for different providers in a rural district of Vietnam following healthcare reform. Methods The study consisted of twelve monthly follow-up interviews of 621 randomly selected households. The households are part of the FilaBavi project sample – Health System Research Project. The heads of household were interviewed at monthly intervals from July 2001 to June 2002. Results The use of private health providers and self-treatment are quite common for both episodes (60% and 23% of all illness episodes and expenditure (60% and 12.8% of healthcare expenditure The poor tend to use self-treatment more frequently than wealthier members of the community (31% vs. 14.5% of illness episodes respectively. All patients in this study often use private services before public ones. The poor use less public care and less care at higher levels than the rich do (8% vs.13% of total illness episodes, which decomposes into 3% vs. 7% at district level, and 1% vs. 3% at the provincial or central level, respectively. The education of the patients significantly affects healthcare decisions. Those with higher education tend to choose healthcare providers rather than self-treatment. Women tend to use drugs or healthcare services more often than men do. Patients in two highest quintiles use health services more than in the lowest quintile. Moreover, seriously ill patients frequently use more drugs, healthcare services, public care than those with less severe illness. Conclusion The results are useful for policy makers and healthcare professionals to (i formulate healthcare policies-of foremost importance are methods used to reduce self-treatment and no treatment; (ii the management of private practices and maintaining public healthcare providers at all levels

  2. Quality management in healthcare.

    Science.gov (United States)

    Dodwad, Subhash S

    2013-01-01

    Clinical governance and better human resource management practices are important planks in the current health policies emphasizing quality of patient care. There are numerous reasons why it is important to improve quality of healthcare, including enhancing the accountability of health practitioners and managers, resource efficiency, identifying, and minimizing medical errors while maximizing the use of effective care and improving outcomes, and aligning care to what users/patients want in addition to what they need. "Quality in health is doing the right things for the right people at the right time, and doing them right first time and every time." Quality can also refer to the technical quality of care, to nontechnical aspects of service delivery such as clients' waiting time and staff's attitudes, and to programmatic elements such as policies, infrastructure, access, and management. In this oration/article quality initiatives like Reproductive and Child Health (RCH) and National Rural Health Mission (NRHM) of Government of India (GOI), which concentrate on improving the quality of infrastructure of vast rural health facilities including sub-center, primary health center, and community health center has been taken into account with focus on improving quality of health services also. United Nation Population Fund (UNFPA) in collaboration with the GOI has proposed introducing quality assurance program for accessing and improving the quality of services at public sector health facilities. It is felt that improving the quality of health services in public sector will attract the client belonging to low economic strata, and surely will help in achieving the goal of the NRHM, that is, "Reaching the enriched with quality of health services."

  3. Healthcare Managers' Perceptions of Patient Perpetrated Aggression and Prevention Strategies: A Cross Sectional Survey.

    Science.gov (United States)

    Baby, Maria; Swain, Nicola; Gale, Christopher

    2016-07-01

    Patient or client aggression towards staff is a risk in healthcare. Healthcare takes place in a variety of settings, including hospitals, community, and Aged Care facilities. A minimal amount is known regarding the existence of safety and training measures available throughout the broad range of hospital and community healthcare services. A web-based survey of the type and frequency of violence experienced by healthcare staff was sent to unit managers working in mental health and older peoples' services of District Health Boards, Non-Governmental Organisations, and Aged Care facilities across New Zealand. One hundred and forty-one managers responded to the survey with a response rate of 79.21%. Managers reported high rates of verbal aggression and assaults against staff within their services. A total of 60% of respondents stated that an increase in assaults against staff was due to an increase in violent events and 43.1% related this to increased staff awareness and reporting of violent events to management. Communication skills and de-escalation training were provided across approximately 95% of organisations. The availability of safety measures including panic buttons, personal alarms, use of security personnel, and police assistance were more widely available and accessible within hospital settings and the community sector was found to mostly rely on police for assistance when violence occurs. The perception of violence is high in healthcare. Prevention and management training is provided in public hospital and aged care setting but not so much in NGOs. All areas of healthcare provision could benefit from increased evidence based aggression prevention programmes.

  4. Healthcare Finance in the Kingdom of Saudi Arabia: A Qualitative Study of Householders' Attitudes.

    Science.gov (United States)

    Al-Hanawi, Mohammed Khaled; Alsharqi, Omar; Almazrou, Saja; Vaidya, Kirit

    2018-02-01

    The public sector healthcare system in Saudi Arabia, essentially financed by oil revenues and 'free at the point of delivery', is coming under increasing strain due to escalating expenditure and an increasingly volatile oil market and is likely to be unsustainable in the medium to long term. This study examines how satisfied the Saudi people are with their public sector healthcare services and assesses their willingness to contribute to financing the system through a national health insurance scheme. The study also examines public preferences and expectations of a future national health insurance system. A total of 36 heads of households participated in face-to-face audio-recorded semi-structured interviews. The participants were purposefully selected based on different socio-economic and socio-demographic factors from urban and rural areas to represent the geographical diversity that would presumably influence individual views, expectations, preferences and healthcare experiences. The evidence showed some dissatisfaction with the provision and quality of current public sector healthcare services, including the availability of appointments, waiting times and the availability of drugs. The households indicated a willingness to contribute to a national insurance scheme, conditional upon improvements in the quality of public sector healthcare services. The results also revealed a variety of preferences and expectations regarding the proposed national health insurance scheme. Quality improvement is a key factor that could motivate the Saudi people to contribute to financing the healthcare system. A new authority, consisting of a partnership between the public and private sectors under government supervision, could represent an acceptable option for addressing the variation in public preferences.

  5. Pseudomonas aeruginosa in Healthcare Settings

    Science.gov (United States)

    ... Sepsis Sharps Safety - CDC Transplant Safety Vaccine Safety Pseudomonas aeruginosa in Healthcare Settings Recommend on Facebook Tweet Share ... aeruginosa . Pseudomonas aeruginosa What types of infections does Pseudomonas aeruginosa cause? Serious Pseudomonas infections usually occur in people ...

  6. Business process modeling in healthcare.

    Science.gov (United States)

    Ruiz, Francisco; Garcia, Felix; Calahorra, Luis; Llorente, César; Gonçalves, Luis; Daniel, Christel; Blobel, Bernd

    2012-01-01

    The importance of the process point of view is not restricted to a specific enterprise sector. In the field of health, as a result of the nature of the service offered, health institutions' processes are also the basis for decision making which is focused on achieving their objective of providing quality medical assistance. In this chapter the application of business process modelling - using the Business Process Modelling Notation (BPMN) standard is described. Main challenges of business process modelling in healthcare are the definition of healthcare processes, the multi-disciplinary nature of healthcare, the flexibility and variability of the activities involved in health care processes, the need of interoperability between multiple information systems, and the continuous updating of scientific knowledge in healthcare.

  7. Applying lean principles in healthcare.

    Science.gov (United States)

    Rinehart, Brenda

    2013-01-01

    Healthcare is charged to do more with less and improve patient satisfaction at the same time in order to balance the bottom line. Lean is a proven and effective way to remove waste, identify issues, and successfully implement change. The principle of Lean is based on the reality that there are value added and non-value added processes in every workflow. To improve quality and reduce loss, the non-value added processes need to be eliminated. In healthcare, value is determined from the perspective of the patient. While not exhaustive of the Lean processes that a healthcare system can employ, this article provides a general outline of Lean, definitions, and its benefits to any healthcare organization.

  8. Securing Information Technology in Healthcare.

    Science.gov (United States)

    Anthony, Denise; Campbell, Andrew T; Candon, Thomas; Gettinger, Andrew; Kotz, David; Marsch, Lisa A; Molina-Markham, Andrés; Page, Karen; Smith, Sean W; Gunter, Carl A; Johnson, M Eric

    2013-08-08

    Dartmouth College's Institute for Security, Technology, and Society conducted three workshops on securing information technology in healthcare, attended by a diverse range of experts in the field. This article summarizes the three workshops.

  9. Securing Information Technology in Healthcare

    OpenAIRE

    Anthony, Denise; Andrew T. Campbell; Candon, Thomas; Gettinger, Andrew; Kotz, David; Marsch, Lisa A.; Molina-Markham, Andrés; Page, Karen; Smith, Sean W.; Gunter, Carl A.; Johnson, M. Eric

    2013-01-01

    Dartmouth College’s Institute for Security, Technology, and Society conducted three workshops on securing information technology in healthcare, attended by a diverse range of experts in the field. This article summarizes the three workshops.

  10. Healthcare information technology and economics.

    Science.gov (United States)

    Payne, Thomas H; Bates, David W; Berner, Eta S; Bernstam, Elmer V; Covvey, H Dominic; Frisse, Mark E; Graf, Thomas; Greenes, Robert A; Hoffer, Edward P; Kuperman, Gil; Lehmann, Harold P; Liang, Louise; Middleton, Blackford; Omenn, Gilbert S; Ozbolt, Judy

    2013-01-01

    At the 2011 American College of Medical Informatics (ACMI) Winter Symposium we studied the overlap between health IT and economics and what leading healthcare delivery organizations are achieving today using IT that might offer paths for the nation to follow for using health IT in healthcare reform. We recognized that health IT by itself can improve health value, but its main contribution to health value may be that it can make possible new care delivery models to achieve much larger value. Health IT is a critically important enabler to fundamental healthcare system changes that may be a way out of our current, severe problem of rising costs and national deficit. We review the current state of healthcare costs, federal health IT stimulus programs, and experiences of several leading organizations, and offer a model for how health IT fits into our health economic future.

  11. Narrative medicine and healthcare reform.

    Science.gov (United States)

    Lewis, Bradley E

    2011-03-01

    Narrative medicine is one of medicine's most important internal reforms, and it should be a critical dimension of healthcare debate. Healthcare reform must eventually ask not only how do we pay for healthcare and how do we distribute it, but more fundamentally, what kind of healthcare do we want? It must ask, in short, what are the goals of medicine? Yet, even though narrative medicine is crucial to answering these pivotal and inescapable questions, it is not easy to describe. Many of its core claims go against the grain of common sense thinking about medicine. This article argues that the best way to understand narrative medicine is to tell a story that puts its emergence in historical context.

  12. Control of corruption in healthcare.

    Science.gov (United States)

    Ahmed, Armin; Azim, Afzal

    2015-01-01

    A recently published article on corruption in Indian healthcare in the BMJ has triggered a hot debate and numerous responses (1, 2, 3, 4). We do agree that corruption in Indian healthcare is a colossal issue and needs to be tackled urgently (5). However, we want to highlight that corruption in healthcare is not a local phenomenon confined to the Indian subcontinent, though India does serve as a good case study and intervention area due to the magnitude of the problem and the country's large population (6). Good governance, strict rules, transparency and zero tolerance are some of the strategies prescribed everywhere to tackle corruption. However, those entrusted with implementing good governance and strict rules in India need to go through a process of introspection to carry out their duties in a responsible fashion. At present, it looks like a no-win situation. In this article, we recommend education in medical ethics as the major intervention for dealing with corruption in healthcare.

  13. The healthcare system and the provision of oral healthcare in European Union member states. Part 8: Italy.

    Science.gov (United States)

    Bindi, M; Paganelli, C; Eaton, K A; Widström, E

    2017-05-26

    In Italy healthcare is provided for all Italian citizens and residents and it is delivered mainly by public providers, with some private or private-public entities. Italy's public healthcare system - the Servizio Sanitario Nazionale (SSN) - is organised by the Ministry of Health and administered on a devolved regional basis. It is financed by general taxation that provides universal coverage, largely free of charge at the point of service. The central government establishes the basic national health benefits package, which must be uniformly provided throughout the country, through services guaranteed under the NHS provision called LEA - (Livelli Essenziali di Assistenza [Essential Level of Assistance]) and allocates national funds to the regions. The regions, through their regional health departments, are responsible for organising, administering and delivering primary, secondary and tertiary healthcare services as well as preventive and health promotion services. Regions are allowed a large degree of autonomy in how they perform this role and regarding decisions about the local structure of the system. Complementary and supplementary private health insurance is also available. However, as in most other Mediterranean European countries, in Italy oral healthcare is mainly provided under private arrangements. The public healthcare system provides only 5-8% of oral healthcare services and this percentage varies from region to region. Oral healthcare is included in the Legislation on Essential levels of care (LEAs) for specific populations such as children, vulnerable people (medically compromised and those on low income) and individuals who need oral healthcare in some urgent/emergency cases. For other people, oral healthcare is generally not covered. Apart from the national benefits package, regions may also carry out their own initiatives autonomously, but must finance these themselves. The number of dentists working in Italy has grown rapidly in the last few years

  14. "Cloud" health-care workers.

    OpenAIRE

    Sherertz, R J; Bassetti, S.; Bassetti-Wyss, B.

    2001-01-01

    Certain bacteria dispersed by health-care workers can cause hospital infections. Asymptomatic health-care workers colonized rectally, vaginally, or on the skin with group A streptococci have caused outbreaks of surgical site infection by airborne dispersal. Outbreaks have been associated with skin colonization or viral upper respiratory tract infection in a phenomenon of airborne dispersal of Staphylococcus aureus called the "cloud" phenomenon. This review summarizes the data supporting the e...

  15. Healthcare IT and Patient Empowerment

    DEFF Research Database (Denmark)

    Danholt, Peter; Bødker, Keld; Hertzum, Morten

    2004-01-01

    Technology Studies (STS), we address the question of designing IT support for communication and coordination among the heterogeneous network of actors involved in contemporary healthcare work. The paper reports work in progress from a diabetes outpatient clinic at a large Danish hospital. The treatment......This short paper outlines a recently initiated research project that concerns healthcare information systems and patient empowerment. Drawing on various theoretical backgrounds, Participatory Design (PD), Computer Supported Cooperative Work (CSCW), Computer Mediated Communication (CMC), and Science...

  16. Machine learning in healthcare informatics

    CERN Document Server

    Acharya, U; Dua, Prerna

    2014-01-01

    The book is a unique effort to represent a variety of techniques designed to represent, enhance, and empower multi-disciplinary and multi-institutional machine learning research in healthcare informatics. The book provides a unique compendium of current and emerging machine learning paradigms for healthcare informatics and reflects the diversity, complexity and the depth and breath of this multi-disciplinary area. The integrated, panoramic view of data and machine learning techniques can provide an opportunity for novel clinical insights and discoveries.

  17. Securities backed by healthcare receivables.

    Science.gov (United States)

    Pallarito, K

    1992-09-14

    Prudential Securities has placed $40 million in medium-term, taxable notes believed to be the first AAA-rated securities backed by healthcare receivables. Standard & Poor's Corp. rated the three-year notes, which were issued by NPF III, an Ohio company created to buy receivables from cash-strapped providers, and are backed by the Medicare, Medicaid and insurance receivables of 21 hospitals and healthcare providers nationwide.

  18. A prescription for Lean healthcare.

    Science.gov (United States)

    Wood, David

    2014-01-01

    The adoption of Lean in the healthcare industry has been an important advancement, and not just for healthcare management. Evidence suggests that Lean can improve labour and capital efficiencies, reduce the throughput time for patients and enhance the quality of care. However, the adoption of Lean has generated large variations in results and even wider-ranging suggestions on how to implement Lean in a healthcare setting. In this article, the author examines three very similar hospitals that implemented Lean in the emergency department during the same time. Through an examination of longitudinal data and a collection of unstructured interviews, the author found that implementation does make a substantial difference to long-term results. Although the presence of strong and persistent leadership can have favourable results on performance in the short term, these performance improvements are not sustainable. To have a long-term impact, healthcare providers need to engage all of the stakeholders in the healthcare system and create a culture that is continuously focused on the improvement of the patient healthcare experience. Copyright © 2014 Longwoods Publishing.

  19. Healthcare Quality: A Concept Analysis.

    Science.gov (United States)

    Allen-Duck, Angela; Robinson, Jennifer C; Stewart, Mary W

    2017-10-01

    Worsening quality indicators of health care shake public trust. Although safety and quality of care in hospitals can be improved, healthcare quality remains conceptually and operationally vague. Therefore, the aim of this analysis is to clarify the concept of healthcare quality. Walker and Avant's method of concept analysis, the most commonly used in nursing literature, provided the framework. We searched general and medical dictionaries, public domain websites, and 5 academic literature databases. Search terms included health care and quality, as well as healthcare and quality. Peer-reviewed articles and government publications published in English from 2004 to 2016 were included. Exclusion criteria were related concepts, discussions about the need for quality care, gray literature, and conference proceedings. Similar attributes were grouped into themes during analysis. Forty-two relevant articles were analyzed after excluding duplicates and those that did not meet eligibility. Following thematic analysis, 4 defining attributes were identified: (1) effective, (2) safe, (3) culture of excellence, and (4) desired outcomes. Based on these attributes, the definition of healthcare quality is the assessment and provision of effective and safe care, reflected in a culture of excellence, resulting in the attainment of optimal or desired health. This analysis proposes a conceptualization of healthcare quality that defines its implied foundational components and has potential to improve the provision of quality care. Theoretical and practice implications presented promote a fuller, more consistent understanding of the components that are necessary to improve the provision of healthcare and steady public trust. © 2017 Wiley Periodicals, Inc.

  20. Six Sigma in healthcare delivery.

    Science.gov (United States)

    Liberatore, Matthew J

    2013-01-01

    The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

  1. Serial murder by healthcare professionals.

    Science.gov (United States)

    Yorker, Beatrice Crofts; Kizer, Kenneth W; Lampe, Paula; Forrest, A R W; Lannan, Jacquetta M; Russell, Donna A

    2008-01-01

    The prosecution of Charles Cullen, a nurse who killed at least 40 patients over a 16-year period, highlights the need to better understand the phenomenon of serial murder by healthcare professionals. The authors conducted a LexisNexis search which yielded 90 criminal prosecutions of healthcare providers that met inclusion criteria for serial murder of patients. In addition we reviewed epidemiologic studies, toxicology evidence, and court transcripts, to provide data on healthcare professionals who have been prosecuted between 1970 and 2006. Fifty-four of the 90 have been convicted; 45 for serial murder, four for attempted murder, and five pled guilty to lesser charges. Twenty-four more have been indicted and are either awaiting trial or the outcome has not been published. The other 12 prosecutions had a variety of legal outcomes. Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment. Prosecutions were reported from 20 countries with 40% taking place in the United States. Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals. The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113. These numbers are disturbing and demand that systemic changes in tracking adverse patient incidents associated with presence of a specific healthcare provider be implemented. Hiring practices must shift away from preventing wrongful discharge or denial of employment lawsuits to protecting patients from employees who kill.

  2. LEAN thinking in Finnish healthcare.

    Science.gov (United States)

    Jorma, Tapani; Tiirinki, Hanna; Bloigu, Risto; Turkki, Leena

    2016-01-01

    Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

  3. Do It Yourself solution of Internet of Things Healthcare System: Measuring body parameters and environmental parameters affecting health.

    OpenAIRE

    Mirjana Maksimović; Vladimir Vujović; Branko Perišić

    2016-01-01

    The rapid advancements in information and communications technologies (ICT) and the increasing number of smart things shift an old-fashioned healthcare system to a model better suited for a population of the 21st century. New healthcare approaches based on Internet of Things (IoT)/Internet of Medical Things (IoMT) powered systems make health monitoring, diagnostics and treatment more personalized, timely and convenient, enabling a global approach to the healthcare system infrastructure develo...

  4. Telepathology for effective healthcare in Developing Nations

    Directory of Open Access Journals (Sweden)

    Smita Sankaye

    2011-11-01

    Full Text Available Telepathology has grown immensely due to rapid advances in information and technology. It has a wide variety of applications especially in the developing world, namely for remote primary diagnosis, specialist referrals, secondary opinions, remote teachings and in research. Basic infrastructure and skilled and experienced staff are the prerequisites for its successful implementation.Socio-economic differences in developing nations result in a chaotic scenario so that, the advanced areas have expertise, while rural and remote areas remain deprived. Telepathology has the potential to bridge this gap.This article discusses how successful use of the internet for telepathology is bridging this gap in developing nations and thereby contributing positively to effective healthcare. Possible constraints to telepathology and some solutions to overcome them are also discussed.

  5. A Systematic Review of Healthcare Applications for Smartphones

    Science.gov (United States)

    2012-01-01

    Background Advanced mobile communications and portable computation are now combined in handheld devices called “smartphones”, which are also capable of running third-party software. The number of smartphone users is growing rapidly, including among healthcare professionals. The purpose of this study was to classify smartphone-based healthcare technologies as discussed in academic literature according to their functionalities, and summarize articles in each category. Methods In April 2011, MEDLINE was searched to identify articles that discussed the design, development, evaluation, or use of smartphone-based software for healthcare professionals, medical or nursing students, or patients. A total of 55 articles discussing 83 applications were selected for this study from 2,894 articles initially obtained from the MEDLINE searches. Results A total of 83 applications were documented: 57 applications for healthcare professionals focusing on disease diagnosis (21), drug reference (6), medical calculators (8), literature search (6), clinical communication (3), Hospital Information System (HIS) client applications (4), medical training (2) and general healthcare applications (7); 11 applications for medical or nursing students focusing on medical education; and 15 applications for patients focusing on disease management with chronic illness (6), ENT-related (4), fall-related (3), and two other conditions (2). The disease diagnosis, drug reference, and medical calculator applications were reported as most useful by healthcare professionals and medical or nursing students. Conclusions Many medical applications for smartphones have been developed and widely used by health professionals and patients. The use of smartphones is getting more attention in healthcare day by day. Medical applications make smartphones useful tools in the practice of evidence-based medicine at the point of care, in addition to their use in mobile clinical communication. Also, smartphones can play

  6. A Systematic Review of Healthcare Applications for Smartphones

    Directory of Open Access Journals (Sweden)

    Mosa Abu Saleh

    2012-07-01

    Full Text Available Abstract Background Advanced mobile communications and portable computation are now combined in handheld devices called “smartphones”, which are also capable of running third-party software. The number of smartphone users is growing rapidly, including among healthcare professionals. The purpose of this study was to classify smartphone-based healthcare technologies as discussed in academic literature according to their functionalities, and summarize articles in each category. Methods In April 2011, MEDLINE was searched to identify articles that discussed the design, development, evaluation, or use of smartphone-based software for healthcare professionals, medical or nursing students, or patients. A total of 55 articles discussing 83 applications were selected for this study from 2,894 articles initially obtained from the MEDLINE searches. Results A total of 83 applications were documented: 57 applications for healthcare professionals focusing on disease diagnosis (21, drug reference (6, medical calculators (8, literature search (6, clinical communication (3, Hospital Information System (HIS client applications (4, medical training (2 and general healthcare applications (7; 11 applications for medical or nursing students focusing on medical education; and 15 applications for patients focusing on disease management with chronic illness (6, ENT-related (4, fall-related (3, and two other conditions (2. The disease diagnosis, drug reference, and medical calculator applications were reported as most useful by healthcare professionals and medical or nursing students. Conclusions Many medical applications for smartphones have been developed and widely used by health professionals and patients. The use of smartphones is getting more attention in healthcare day by day. Medical applications make smartphones useful tools in the practice of evidence-based medicine at the point of care, in addition to their use in mobile clinical communication. Also

  7. Phase I study of continuous MKC-1 in patients with advanced or metastatic solid malignancies using the modified Time-to-Event Continual Reassessment Method (TITE-CRM) dose escalation design.

    Science.gov (United States)

    Tevaarwerk, Amye; Wilding, George; Eickhoff, Jens; Chappell, Rick; Sidor, Carolyn; Arnott, Jamie; Bailey, Howard; Schelman, William; Liu, Glenn

    2012-06-01

    MKC-1 is an oral cell-cycle inhibitor with broad antitumor activity in preclinical models. Clinical studies demonstrated modest antitumor activity using intermittent dosing schedule, however additional preclinical data suggested continuous dosing could be efficacious with additional effects against the mTor/AKT pathway. The primary objectives were to determine the maximum tolerated dose (MTD) and response of continuous MKC-1. Secondary objectives included characterizing the dose limiting toxicities (DLTs) and pharmacokinetics (PK). Patients with solid malignancies were eligible, if they had measurable disease, ECOG PS ≤1, and adequate organ function. Exclusions included brain metastases and inability to receive oral drug. MKC-1 was dosed twice daily, continuously in 28-day cycles. Other medications were eliminated if there were possible drug interactions. Doses were assigned using a TITE-CRM algorithm following enrollment of the first 3 pts. Disease response was assessed every 8 weeks. Between 5/08-9/09, 24 patients enrolled (15 M/9 F, median 58 years, range 44-77). Patients 1-3 received 120 mg/d of MKC-1; patients 4-24 were dosed per the TITE-CRM algorithm: 150 mg [n = 1], 180 [2], 200 [1], 230 [1], 260 [5], 290 [6], 320 [5]. The median time on drug was 8 weeks (range 4-28). The only DLT occurred at 320 mg (grade 3 fatigue). Stable disease occurred at 150 mg/d (28 weeks; RCC) and 320 mg/d (16 weeks; breast, parotid). Escalation halted at 320 mg/d. Day 28 pharmacokinetics indicated absorption and active metabolites. Continuous MKC-1 was well-tolerated; there were no RECIST responses, although clinical benefit occurred in 3/24 pts. Dose escalation stopped at 320 mg/d, and this is the MTD as defined by the CRM dose escalation algorithm; this cumulative dose/cycle exceeds that determined from intermittent dosing studies. A TITE-CRM allowed for rapid dose escalation and was able to account for late toxicities with continuous dosing via a modified algorithm.

  8. Dilemma of healthcare reform and invention of new discipline of health fiscalogy.

    Science.gov (United States)

    Liu, Jitong; Miao, Jianchun; Zhang, Dongqi

    2016-01-01

    China's Reform and Open up Policy in 1980s has brought rapid economic development to Chinese society. With the deepening of economic reform, the withdrawal of the state in China has had visible and worrisome consequences for health and for the functioning of health services. The new round of healthcare reform after 2009 has made significant achievements on improving fundamental health and bringing back the nature of welfare of health. However, the financing mechanism of health system has not been established, and the underlying reason behind the healthcare reform dilemma and the theoretical solution need to be found. This study used the methods of literature review, theoretical research and comparative research to summarize and analyze the reasons and solutions of current dilemma in healthcare reform, and created the new discipline of health fiscalogy through theoretical analysis and vertical and horizontal comparison of healthcare system, especially health financing. Dilemma in healthcare system emerged from the circumstances of rapid process of industrialization, urbanization and population aging, including the profit-driven phenomena, tendency of excessive marketization in public hospitals, strained doctor-patient relationship, high disease burden on individuals and families, and so on. It can be concluded that the theoretical basis of healthcare system and the nature of health resources are crucial in solving the dilemma of healthcare reform. The theoretical basis of healthcare reform should be health fiscalogy focusing on government as the main body of health care responsibility rather than health economics focusing on anti-monopoly. There are two key differences between health economics and health fiscalogy: responsible person/department of disease and health welfare, and nature of resource. The new discipline of health fiscalogy has universal and important implications on both China's healthcare reform and the healthcare reform in the world. China

  9. Soft-leadership competencies for today's healthcare finance executives.

    Science.gov (United States)

    Madden, Mark

    2015-05-01

    With the healthcare industry changing rapidly, organizations seek finance leaders who have skills that go beyond traditional expertise in revenue and expenses. These additional competencies fall under the heading of soft-leadership skills and include the ability to be strategy-oriented, agile, passionate, inspirational, influential, communicative, dependable, driven, integrative, and engaged. Networking, participation in a mentoring program, and continuing education provide avenues for finance leaders to develop these sorts of skills.

  10. Radiation Dose Escalation in Esophageal Cancer Revisited: A Contemporary Analysis of the National Cancer Data Base, 2004 to 2012

    Energy Technology Data Exchange (ETDEWEB)

    Brower, Jeffrey V. [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin (United States); Chen, Shuai [Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin (United States); Bassetti, Michael F. [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin (United States); Yu, Menggang [Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin (United States); Harari, Paul M.; Ritter, Mark A. [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin (United States); Baschnagel, Andrew M., E-mail: baschnagel@humonc.wisc.edu [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin (United States)

    2016-12-01

    Purpose: To evaluate the effect of radiation dose escalation on overall survival (OS) for patients with nonmetastatic esophageal cancer treated with concurrent radiation and chemotherapy. Methods and Materials: Patients diagnosed with stage I to III esophageal cancer treated from 2004 to 2012 were identified from the National Cancer Data Base. Patients who received concurrent radiation and chemotherapy with radiation doses of ≥50 Gy and did not undergo surgery were included. OS was compared using Cox proportional hazards regression and propensity score matching. Results: A total of 6854 patients were included; 3821 (55.7%) received 50 to 50.4 Gy and 3033 (44.3%) received doses >50.4 Gy. Univariate analysis revealed no significant difference in OS between patients receiving 50 to 50.4 Gy and those receiving >50.4 Gy (P=.53). The dose analysis, binned as 50 to 50.4, 51 to 54, 55 to 60, and >60 Gy, revealed no appreciable difference in OS within any group compared with 50 to 50.4 Gy. Subgroup analyses investigating the effect of dose escalation by histologic type and in the setting of intensity modulated radiation therapy also failed to reveal a benefit. Propensity score matching confirmed the absence of a statistically significant difference in OS among the dose levels. The factors associated with improved OS on multivariable analysis included female sex, lower Charlson-Deyo comorbidity score, private insurance, cervical/upper esophagus location, squamous cell histologic type, lower T stage, and node-negative status (P<.01 for all analyses). Conclusions: In this large national cohort, dose escalation >50.4 Gy did not result in improved OS among patients with stage I to III esophageal cancer treated with definitive concurrent radiation and chemotherapy. These data suggest that despite advanced contemporary treatment techniques, OS for patients with esophageal cancer remains unaltered by escalation of radiation dose >50.4 Gy, consistent with the results of

  11. Clinical review criteria and medical emergency teams: evaluating a two-tier rapid response system.

    Science.gov (United States)

    Bingham, Gordon; Fossum, Mariann; Barratt, Macey; Bucknall, Tracey

    2015-09-01

    To assess the prevalence of patients fulfilling clinical review criteria (CRC), to determine activation rates for CRC assessments, to compare baseline characteristics and outcomes of patients who fulfilled CRC with patients who did not, and to identify the documented nursing actions in response to CRC values. A cross-sectional study using a retrospective medical record audit, in a universityaffiliated, tertiary referral hospital with a two-tier rapid response system in Melbourne, Australia. We used a convenience sample of hospital inpatients on general medical, surgical and specialist service wards admitted during a 24-hour period in 2013. Medical emergency team (MET) or code blue activation, unplanned intensive care unit admissions, hospital length of stay and inhospital mortality. For patients who fulfilled CRC or MET criteria during the 24- hour period, the specific criteria fulfilled, escalation treatments and outcomes were collected. Of the sample (N = 422), 81 patients (19%) fulfilled CRC on 109 occasions. From 109 CRC events, 66 patients (81%) had at least one observation fulfilling CRC, and 15 patients (18%) met CRC on multiple occasions. The documented escalation rate was 58 of 109 events (53%). The number of patients who fulfilled CRC and subsequent MET call activation criteria within 24 hours was significantly greater than the number who did not meet CRC (P CRC during the study period; these patients were about four times more likely to also fulfil MET call criteria. Contrary to hospital policy, escalation was not documented for about half the patients meeting CRC values. Despite the clarity of escalation procedures on the graphic observation chart, escalation remains an ongoing problem. Further research is needed on the impact on patient outcomes over time and to understand factors influencing staff response.

  12. Development of an antibiotic spectrum score based on veterans affairs culture and susceptibility data for the purpose of measuring antibiotic de-escalation: a modified Delphi approach.

    Science.gov (United States)

    Madaras-Kelly, Karl; Jones, Makoto; Remington, Richard; Hill, Nicole; Huttner, Benedikt; Samore, Matthew

    2014-09-01

    Development of a numerical score to measure the microbial spectrum of antibiotic regimens (spectrum score) and method to identify antibiotic de-escalation events based on application of the score. Web-based modified Delphi method. Physician and pharmacist antimicrobial stewards practicing in the United States recruited through infectious diseases-focused listservs. Three Delphi rounds investigated: organisms and antibiotics to include in the spectrum score, operationalization of rules for the score, and de-escalation measurement. A 4-point ordinal scale was used to score antibiotic susceptibility for organism-antibiotic domain pairs. Antibiotic regimen scores, which represented combined activity of antibiotics in a regimen across all organism domains, were used to compare antibiotic spectrum administered early (day 2) and later (day 4) in therapy. Changes in spectrum score were calculated and compared with Delphi participants' judgments on de-escalation with 20 antibiotic regimen vignettes and with non-Delphi steward judgments on de-escalation of 300 pneumonia regimen vignettes. Method sensitivity and specificity to predict expert de-escalation status were calculated. Twenty-four participants completed all Delphi rounds. Expert support for concepts utilized in metric development was identified. For vignettes presented in the Delphi, the sign of change in score correctly classified de-escalation in all vignettes except those involving substitution of oral antibiotics. The sensitivity and specificity of the method to identify de-escalation events as judged by non-Delphi stewards were 86.3% and 96.0%, respectively. Identification of de-escalation events based on an algorithm that measures microbial spectrum of antibiotic regimens generally agreed with steward judgments of de-escalation status.

  13. Dose-Escalated Robotic SBRT for Stage I-II Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Robert eMeier

    2015-04-01

    Full Text Available Abstract: Stereotactic body radiotherapy (SBRT is the precise external delivery of very high-dose radiotherapy to targets in the body, with treatment completed in one to five fractions. SBRT should be an ideal approach for organ-confined prostate cancer because (I dose escalation should yield improved rates of cancer control; (II the unique radiobiology of prostate cancer favors hypofractionation and (III the conformal nature of SBRT minimizes high-dose radiation delivery to immediately adjacent organs, potentially reducing complications. This approach is also more convenient for patients, and is cheaper than intensity modulated radiotherapy (IMRT. Several external beam platforms are capable of delivering SBRT for early-stage prostate cancer, although most of the mature reported series have employed a robotic non-coplanar platform (i.e., CyberKnife. Several large studies report 5-year biochemical relapse rates which compare favorably to IMRT. Rates of late GU toxicity are similar to those seen with IMRT, and rates of late rectal toxicity may be less than with IMRT and low dose rate (LDR brachytherapy. Patient-reported quality of life (QOL outcomes appear similar to IMRT in the urinary domain. Bowel QOL may be less adversely affected by SBRT than with other radiation modalities. After five years of follow-up, SBRT delivered on a robotic platform is yielding outcomes at least as favorable as IMRT, and may be considered appropriate therapy for stage I-II prostate cancer.

  14. Managing and sharing the escalating number of sponge "unknowns": the SpongeMaps project.

    Science.gov (United States)

    Hooper, J N A; Hall, K A; Ekins, M; Erpenbeck, D; Wörheide, G; Jolley-Rogers, G

    2013-09-01

    Contemporary collections of sponges in the Indo-west Pacific have escalated substantially due to pharmaceutical discovery, national bioregional planning, and compliance with international conventions on the seabed and its marine genetic resources beyond national jurisdictions. These partially processed operational taxonomic unit (OTU) collections now vastly outweigh the expertise available to make them better "known" via complete taxonomy, yet for many bioregions they represent the most significant body of currently available knowledge. Increasing numbers of cryptic species, previously undetected morphologically, are now being discovered by molecular and chemical analyses. The uncoordinated and fragmented nature of many previous collections, however, means that knowledge and expertise gained from a particular project are often lost to future projects without a biodiversity informatics legacy. Integrating these diverse data (GIS; OTUs; images; molecular, chemical, and other datasets) required a two-way iterative process so far unavailable for sponges with existing biodiversity informatics tools. SpongeMaps arose from the initial need for online collaboration to integrate morphometric data with molecular barcodes, including the Porifera Tree of Life (PorTol) project. It provides interrogation of existing data to better process new collections; capacity to create new OTUs; publication of online pages for individual species, so as to interpret GIS and other data for online biodiversity databases and services; and automatic links to external datasets for taxonomic hierarchy, specimen GIS and mapping, DNA sequence data, chemical structures, and images.

  15. Escalating placenta invasiveness: repeated placenta accreta at the limit of viability

    Directory of Open Access Journals (Sweden)

    Greenbaum S

    2016-04-01

    Full Text Available Shirley Greenbaum,1 Alla Khashper,2 Elad Leron,1 Eric Ohana,1 Mihai Meirovitz,1 Reli Hershkovitz,1 Offer Erez1 1Department of Obstetrics and Gynecology, 2Department of Radiology, Soroka University Medical Center, School of Medicine, Ben-Gurion University of the Negev, Be’er Sheva, Israel Abstract: Placenta percreta is an obstetric condition in which the placenta invades through the myometrium. This is the most severe form of placenta accreta and may result in spontaneous uterine rupture, a rare complication that threatens the life of both mother and fetus. In this case report, we describe a 32-year-old woman in her fourth pregnancy, diagnosed with repeated placenta accreta, which was eventually complicated by spontaneous uterine rupture at 24 weeks’ gestation. This patient had a history of abnormal placentation in prior pregnancies and previous uterine injuries. This case demonstrates a pattern of escalating placental invasiveness, and raises questions regarding the process of abnormal placentation and the manifestation of uterine rupture in scarred uteri. Keywords: placenta percreta, uterine injury, laparoscopy, dilatation and curettage, residua, cesarean section scar, spontaneous uterine rupture

  16. Avoidance orientation and the escalation of negative communication in intimate relationships.

    Science.gov (United States)

    Kuster, Monika; Bernecker, Katharina; Backes, Sabine; Brandstätter, Veronika; Nussbeck, Fridtjof W; Bradbury, Thomas N; Martin, Mike; Sutter-Stickel, Dorothee; Bodenmann, Guy

    2015-08-01

    Avoidance goals heighten the salience of negative social experiences, and in intimate relationships such an orientation may contribute to communication difficulties and the perpetuation of avoidance. We therefore hypothesized that individuals with stronger avoidance goals would be particularly prone to engage in escalating levels of negative communication with their intimate partner, and we tested this prediction by conducting sequential analyses on videotaped observational data (28,470 observations) collected from 365 heterosexual couples engaging in a relationship-related conflict. While less avoidance-oriented spouses showed a decline in their likelihood of negative communication over the course of the 8-min conflict discussion, the likelihood that more avoidance-oriented spouses would display negative communication behaviors remained at a high level. The likelihood of negative communication even increased when avoidance-oriented spouses were confronted with negative communication behavior of their partners. The effects of avoidance orientation were independent of relationship satisfaction and neuroticism. These findings demonstrate that avoidance goals underlie individuals' heightened reactivity to the partner's negative behavior, while also clarifying 1 possible reason why some individuals engage in communication behaviors that may prove maladaptive to their relationship. (c) 2015 APA, all rights reserved.

  17. Vaginal dose de-escalation in image guided adaptive brachytherapy for locally advanced cervical cancer.

    Science.gov (United States)

    Mohamed, Sandy; Lindegaard, Jacob Christian; de Leeuw, Astrid A C; Jürgenliemk-Schulz, Ina; Kirchheiner, Kathrin; Kirisits, Christian; Pötter, Richard; Tanderup, Kari

    2016-09-01

    Vaginal stenosis is a major problem following radiotherapy in cervical cancer. We investigated a new dose planning strategy for vaginal dose de-escalation (VDD). Fifty consecutive locally advanced cervical cancer patients without lower or middle vaginal involvement at diagnosis from 3 institutions were analysed. External beam radiotherapy was combined with MRI-guided brachytherapy. VDD was obtained by decreasing dwell times in ovoid/ring and increasing dwell times in tandem/needles. The aim was to maintain the target dose (D90 of HR-CTV⩾85Gy EQD2) while reducing the dose to the surface of the vagina to <140% of the physical fractional brachytherapy dose corresponding to a total EQD2 of 85Gy. The mean vaginal loading (ovoid/ring) was reduced from 51% to 33% of the total loading with VDD, which significantly reduced the dose to the vaginal dose points (p<0.001) without compromising the target dose. The dose to the ICRU recto-vaginal point was reduced by a mean of 4±4Gy EQD2 (p<0.001), while doses to bladder and rectum (D 2cm 3 ) were reduced by 2±2Gy and 3±2Gy, respectively (p<0.001). VDD significantly reduces dose to the upper vagina which is expected to result in reduction of vaginal stenosis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. The influence of toxicity constraints in models of chemotherapeutic protocol escalation

    KAUST Repository

    Boston, E. A. J.

    2011-04-06

    The prospect of exploiting mathematical and computational models to gain insight into the influence of scheduling on cancer chemotherapeutic effectiveness is increasingly being considered. However, the question of whether such models are robust to the inclusion of additional tumour biology is relatively unexplored. In this paper, we consider a common strategy for improving protocol scheduling that has foundations in mathematical modelling, namely the concept of dose densification, whereby rest phases between drug administrations are reduced. To maintain a manageable scope in our studies, we focus on a single cell cycle phase-specific agent with uncomplicated pharmacokinetics, as motivated by 5-Fluorouracil-based adjuvant treatments of liver micrometastases. In particular, we explore predictions of the effectiveness of dose densification and other escalations of the protocol scheduling when the influence of toxicity constraints, cell cycle phase specificity and the evolution of drug resistance are all represented within the modelling. For our specific focus, we observe that the cell cycle and toxicity should not simply be neglected in modelling studies. Our explorations also reveal the prediction that dose densification is often, but not universally, effective. Furthermore, adjustments in the duration of drug administrations are predicted to be important, especially when dose densification in isolation does not yield improvements in protocol outcomes. © The author 2011. Published by Oxford University Press on behalf of the Institute of Mathematics and its Applications. All rights reserved.

  19. Anticipatory 50 kHz ultrasonic vocalizations are associated with escalated alcohol intake in dependent rats.

    Science.gov (United States)

    Buck, Cara L; Malavar, Jordan C; George, Olivier; Koob, George F; Vendruscolo, Leandro F

    2014-09-01

    Rats emit 50kHz ultrasonic vocalizations (USVs) in situations of increased motivation, such as during the anticipation of palatable food or drugs of abuse. Whether the same holds true for the anticipation of alcohol intake remains unknown. Alcohol drinking in a nondependent state is thought to be mediated by its rewarding effects (positive reinforcement), whereas drinking in the dependent state is motivated by alcohol's stress-relieving effects (negative reinforcement). Here, we measured context-elicited 50kHz USVs in alcohol-dependent (alcohol vapor-exposed) and nondependent rats immediately before operant alcohol self-administration sessions. Dependent rats showed escalated levels of alcohol intake compared with nondependent rats. Overall, dependent and nondependent rats showed similar levels of anticipatory 50kHz USVs. However, the number of anticipatory USVs was positively correlated with alcohol intake in dependent rats but not nondependent rats. Additionally, dependent rats with higher alcohol intake displayed increased anticipatory 50kHz USVs compared with rats that had lower alcohol intake, whereas no difference was observed between rats with high and low alcohol intake in the nondependent group. Increased 50kHz USVs were specific for the anticipation of alcohol self-administration and did not generalize to a novel environment. These findings suggest that anticipatory 50kHz USVs may be an indicator of context-elicited negative reinforcement learning. Copyright © 2014. Published by Elsevier B.V.

  20. Effect of Height on Pedestrian Route Choice between Stairs and Escalator

    Directory of Open Access Journals (Sweden)

    Qian Li

    2014-01-01

    Full Text Available In order to overcome the subjectivity of existing pedestrian route choice models, an alternative choice model is presented based on the utility equation. It is composed of several indirectly objective characteristic variables, including the height, length, and width of interlayer facilities; speed of automated facilities; and carry-on luggage. Considering the scene that pedestrians choose between the stairs or escalators, an extended binary logit model is developed. Calibration and validation of the model are accomplished by using the data collected in four typical passenger transfer stations in Beijing, China. The results show that the proposed model has an average accuracy of 86.56% in bidirection for predicting pedestrians’ behavior. An interesting phenomenon can be found that the length of facility has poorer impact than height on pedestrians’ route choice behavior. Some quantitative and irradiative conclusions have been illustrated on the relationship between the selection probability and the variables, which is expected to be valuable for extracting the implicit theoretical mechanism of passenger choice behavior.

  1. Energy drinks and escalation in drug use severity: An emergent hazard to adolescent health.

    Science.gov (United States)

    Leal, Wanda E; Jackson, Dylan B

    2017-11-29

    The aim of the current study is to determine whether energy drink consumption contributes to drug use and, more specifically, an escalation in the severity of drug use. We first examine the association between energy drink use and hard drug use, and subsequently investigate whether soft drug use mediates this relationship. Potential moderating influences are also investigated by testing whether the degree of mediation varies by age, gender, and race. The current study uses a nationally representative sample of 8th (ages 13-14), 10th (ages 15-16), and 12th (ages 17-18) grade adolescents from the 2015 Monitoring the Future survey. Negative binomial regression is employed to examine associations between energy drink consumption and soft and hard drug use. Mediation results indicate that energy drink consumption is significantly associated with increased soft drug use, which is, in turn, associated with significant increases in hard drug use. This cascading effect of energy drink consumption on drug use appears to be stronger among younger females and older males. Results for the moderating effect of race are mixed. Energy drinks appear to pose an important threat to adolescent health in the form of soft and hard drug use. The United States may want to consider adopting energy drink policies similar to European countries and Canada, which require warning labels on beverages with high caffeine content. Copyright © 2017. Published by Elsevier Inc.

  2. Caffeine in Parkinson's disease: a pilot open-label, dose-escalation study.

    Science.gov (United States)

    Altman, Robert D; Lang, Anthony E; Postuma, Ronald B

    2011-11-01

    Epidemiologic studies consistently find an inverse association between caffeine use and PD. Numerous explanations exist, but are difficult to evaluate as caffeine's symptomatic effect and tolerability in PD are unknown. We designed an open-label, 6-week dose-escalation study of caffeine to establish dose tolerability and evaluate potential motor/nonmotor benefits. Caffeine was started at 200 mg daily and was increased to a maximum of 1,000 mg. Of 25 subjects, 20 tolerated 200 mg, 17 tolerated 400 mg, 7 tolerated 800 mg, and 3 tolerated 1,000 mg. The most common adverse events were gastrointestinal discomfort, anxiety, and worsening/emerging tremor. At 400 mg daily, we found potential improvements in motor manifestations and somnolence (UPDRS III: -4.5 ± 4.6, P = 0.003; Epworth: -2.0 ± 3.0, P = 0.015). Maximum dose tolerability for caffeine in PD appears to be 100 to 200 mg BID. We found pilot preliminary evidence that caffeine may improve some motor and nonmotor aspects of PD, which must be confirmed in longer term, placebo-controlled, clinical trials. Copyright © 2011 Movement Disorder Society.

  3. Tomotherapy PET-guided dose escalation. A dosimetric feasibility study for patients with malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Maggio, Angelo; Cutaia, Claudia; Di Dia, Amalia; Bresciani, Sara; Miranti, Anna; Poli, Matteo; Stasi, Michele [Candiolo Cancer Institute - FPO, IRCCS, Medical Physics, Turin (Italy); Del Mastro, Elena; Garibaldi, Elisabetta; Gabriele, Pietro [Candiolo Cancer Institute - FPO, IRCCS, Radiotherapy Department, Turin (Italy)

    2016-02-15

    The aim of this study was to investigate whether a safe escalation of the dose to the pleural cavity and PET/CT-positive areas in patients with unresectable malignant pleural mesothelioma (MPM) is possible using helical tomotherapy (HT). We selected 12 patients with MPM. Three planning strategies were investigated. In the first strategy (standard treatment), treated comprised a prescribed median dose to the planning target volume (PTV) boost (PTV{sub 1}) of 64.5 Gy (range: 56 Gy/28 fractions to 66 Gy/30 fractions) and 51 Gy (range: 50.4 Gy/28 fractions to 54 Gy/30 fractions) to the pleura PTV (PTV{sub 2}). Thereafter, for each patient, two dose escalation plans were generated prescribing 62.5 and 70 Gy (2.5 and 2.8 Gy/fraction, respectively) to the PTV{sub 1} and 56 Gy (2.24 Gy/fraction) to the PTV{sub 2}, in 25 fractions. Dose-volume histogram (DVH) constraints and normal tissue complication probability (NTCP) calculations were used to evaluate the differences between the plans. For all plans, the 95 % PTVs received at least 95 % of the prescribed dose. For all patients, it was possible to perform the dose escalation in accordance with the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) constraints for organs at risk (OARs). The average contralateral lung dose was < 8 Gy. NTCP values for OARs did not increase significantly compared with the standard treatment (p > 0.05), except for the ipsilateral lung. For all plans, the lung volume ratio was strongly correlated with the V{sub 20}, V{sub 30}, and V{sub 40} DVHs of the lung (p < 0.0003) and with the lung mean dose (p < 0.0001). The results of this study suggest that by using HT it is possible to safely escalate the dose delivery to at least 62.5 Gy in PET-positive areas while treating the pleural cavity to 56 Gy in 25 fractions without significantly increasing the dose to the surrounding normal organs. (orig.) [German] Ziel war es, zu untersuchen, ob mit der helikalen Tomotherapie (HT) eine

  4. SU-E-T-69: A Radiobiological Investigation of Dose Escalation in Lower Oesophageal Tumours with a Focus On Gastric Toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Carrington, R [Cardiff University, Cardiff, Wales (United Kingdom); Staffurth, J; Spezi, E; Crosby, T [Velindre Cancer Centre, Cardiff, Wales (United Kingdom); Warren, S; Partridge, M; Hawkins, M [CRUK/MRC Oxford Institute for Radiation Oncology, Oxford (United Kingdom); Gwynne, S [Singleton Hospital, Swansea, Wales (United Kingdom)

    2015-06-15

    The incidence of lower third oesophageal tumours is increasing in most Western populations. With the role of radiotherapy dose escalation being identified as a research priority in improving outcomes, it is important to quantify the increased toxicity that this may pose to sites such as the lower oesophagus. This study therefore aims to investigate the feasibility of lower oesophageal dose escalation with a focus on stomach tissue toxicity.The original 3D-conformal plans (50Gy3D) from 10 patients in the SCOPE1 trial were reviewed and compared to two RapidArc plans created retrospectively to represent the treatment arms of the forthcoming SCOPE2 trial: 50GyRA and 60GyRA (50Gy to PTV1 with a simultaneously integrated boost of 60Gy to PTV2). The stomach was contoured as stomach wall and dose constraints set according to QUANTEC. Normal tissue complication probability (NTCP) was estimated for the stomach wall for an endpoint of gastric bleeding. There was a mean increase of 5.93% in NTCP from 50Gy3D to 60GyRA and a mean increase of 8.15% in NTCP from the 50GyRA to 60GyRA. With NTCP modelling restricted to volumes outside PTV2, there was a mean decrease of 0.92% in NTCP from the 50Gy3D to 60GyRA, and a mean increase of 2.25% from 50GyRA to 60GyRA. There was a strong correlation between the NTCP and Stomach Wall/PTV1 overlap volume for all plans (R=0.80, 0.77 and 0.77 for 60GyRA, 50GyRA and 50Gy3D respectively). There was also a strong correlation between NTCP and the Stomach Wall/PTV2 overlap volume for 60GyRA (R= 0.82).Radiobiological modelling suggests that increasing the prescribed dose to 60Gy may be associated with a significantly increased risk of toxicity to the stomach within the boost volume. It is recommended that stomach toxicity be closely monitored prospectively when treating patients with lower oesophageal tumours in the forthcoming SCOPE 2 trial. Rhys Carrington received a PhD studentship grant from Cancer Research Wales. Grant number: 2445; Dr Warren and

  5. The Microbiome and Sustainable Healthcare

    Science.gov (United States)

    Dietert, Rodney R.; Dietert, Janice M.

    2015-01-01

    Increasing prevalences, morbidity, premature mortality and medical needs associated with non-communicable diseases and conditions (NCDs) have reached epidemic proportions and placed a major drain on healthcare systems and global economies. Added to this are the challenges presented by overuse of antibiotics and increased antibiotic resistance. Solutions are needed that can address the challenges of NCDs and increasing antibiotic resistance, maximize preventative measures, and balance healthcare needs with available services and economic realities. Microbiome management including microbiota seeding, feeding, and rebiosis appears likely to be a core component of a path toward sustainable healthcare. Recent findings indicate that: (1) humans are mostly microbial (in terms of numbers of cells and genes); (2) immune dysfunction and misregulated inflammation are pivotal in the majority of NCDs; (3) microbiome status affects early immune education and risk of NCDs, and (4) microbiome status affects the risk of certain infections. Management of the microbiome to reduce later-life health risk and/or to treat emerging NCDs, to spare antibiotic use and to reduce the risk of recurrent infections may provide a more effective healthcare strategy across the life course particularly when a personalized medicine approach is considered. This review will examine the potential for microbiome management to contribute to sustainable healthcare. PMID:27417751

  6. Healthcare waste management in Asia.

    Science.gov (United States)

    Ananth, A Prem; Prashanthini, V; Visvanathan, C

    2010-01-01

    The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.

  7. Clinical engagement: improving healthcare together.

    Science.gov (United States)

    Riches, E; Robson, B

    2014-02-01

    Clinical engagement can achieve lasting change in the delivery of healthcare. In October 2011, Healthcare Improvement Scotland formulated a clinical engagement strategy to ensure that a progressive and sustainable approach to engaging healthcare professionals is firmly embedded in its health improvement and public assurance activities. The strategy was developed using a 90-day process, combining an evidence base of best practice and feedback from semi-structured interviews and focus groups. The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities. The strategy works towards developing a respectful partnership between Healthcare Improvement Scotland, the clinical community and key stakeholders whereby clinicians' contributions are recognised in a non-financial reward system. To do this, the organisation needs a sustainable infrastructure and an efficient, cost-effective approach to clinical engagement. There are a number of obstacles to achieving successful clinical engagement and these must be addressed as key drivers in its implementation. The implementation of the strategy is supported by an action and resource plan, and its impact will be monitored by a measurement plan to ensure the organisation reviews its approaches towards clinical engagement.

  8. Healthcare experiences of the homeless.

    Science.gov (United States)

    Nickasch, Bonnie; Marnocha, Suzanne K

    2009-01-01

    To explore the healthcare experiences of homeless individuals and inform providers of the barriers created by the situation of homelessness. This was a qualitative research study using a grounded theory approach. The sample included homeless individuals older than 18 years living in northeastern Wisconsin. This research provided rich insight into the healthcare experiences of the homeless. Five key conclusions were made: (a) the great majority of homeless people have an external locus of control; (b) most homeless individuals lack the necessary resources to meet their physical needs of shelter, air, water, and food; (c) most homeless individuals lack the financial resources to seek adequate health care; (d) access to resources is limited because of poor transportation, telephones, and mail; and (e) all those interviewed felt that healthcare providers lack compassion for the homeless. Healthcare providers can use the concepts discovered in this study to help improve their skills and comfort level when working with homeless individuals. A decrease in acute illnesses and an increase in the effective management of chronic disease resulting in fewer long-term complications and medical costs because of these unnecessary complications could be seen. Healthcare professionals may also volunteer to become more involved with the care of the homeless if they are confident in their skills. Improving the health of the homeless in the community will result in improvements in the overall health of the community.

  9. Healthcare innovation – The Epital

    DEFF Research Database (Denmark)

    Hesseldal, Louise; Kayser, Lars

    2016-01-01

    There is an ongoing debate about how best to organize healthcare innovation. This article introduces and illustrates an alternative way of doing so by studying an emerging informal and inter-organizational network (IION) in practice. Taking an ethnographic research approach, the authors propose...... the concept of a potluck feast to describethe nature of an IION and the dynamics within it. The relationship between the project andthe actors is explored by introducing Steven Brown’s reading of Michel Serres’ concept of the parasite. The unique way of organizing healthcare innovation studied in the article...... the emergence and dynamics of IIONs. In this way, this article contributes to the field of healthcare innovation and how to organize it, and may inspire those who are already in or intend to study this field....

  10. Systems design for remote healthcare

    CERN Document Server

    Bonfiglio, Silvio

    2014-01-01

    This book provides a multidisciplinary overview of the design and implementation of systems for remote patient monitoring and healthcare. Readers are guided step-by-step through the components of such a system and shown how they could be integrated in a coherent framework for deployment in practice. The authors explain planning from subsystem design to complete integration and deployment, given particular application constraints. Readers will benefit from descriptions of the clinical requirements underpinning the entire application scenario, physiological parameter sensing techniques, information processing approaches and overall, application dependent system integration. Each chapter ends with a discussion of practical design challenges and two case studies are included to provide practical examples and design methods for two remote healthcare systems with different needs. ·         Provides a multi-disciplinary overview of next-generation mobile healthcare system design; ·         Includes...

  11. Developing a diabetes prevention education programme for community health-care workers in Thailand: formative findings.

    Science.gov (United States)

    Sranacharoenpong, Kitti; Hanning, Rhona M

    2011-10-01

    The aim of this study was to investigate barriers to and supports for implementing a diabetes prevention education programme for community health-care workers (CHCWs) in Chiang Mai province, Thailand. The study also aimed to get preliminary input into the design of a tailored diabetes prevention education programme for CHCWs. Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. As access to diabetes prevention programme is limited in Thailand, especially in rural and semi-urban areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective, and sustainable. Health-care professionals (n = 12) selected from health centres within one district participated in in-depth interviews. In addition, screened people at risk for diabetes participated in interviews (n = 8) and focus groups (n = 4 groups, 23 participants). Coded transcripts from audio-taped interviews or focus groups were analysed by hand and using NVivo software. Concept mapping illustrated the findings. Health-care professionals identified potential barriers to programme success as a motivation for regular participation, and lack of health policy support for programme sustainability. Health-care professionals identified opportunities to integrate health promotion and disease prevention into CHCWs' duties. Health-care professionals recommended small-group workshops, hands-on learning activities, case studies, and video presentations that bring knowledge to practice within their cultural context. CHCWs should receive a credit for continuing study. People at risk for diabetes lacked knowledge of nutrition, diabetes risk factors, and resources to access health information. They desired two-way communication with CHCWs. Formative research supports the need for an effective, sustainable programme to support knowledge translation to CHCWs and at-risk populations in the

  12. The Role of Inflation and Price Escalation Adjustments in Properly Estimating Program Costs: F-35 Case Study

    Science.gov (United States)

    2016-04-30

    of price indexes presents a substantial challenge in estimating the costs of new defense systems . The problem is twofold. First, the analyst must...qÜáêíÉÉåíÜ=^ååì~ä= ^Åèìáëáíáçå=oÉëÉ~êÅÜ= póãéçëáìã= qÜìêëÇ~ó=pÉëëáçåë= sçäìãÉ=ff= = The Role of Inflation and Price Escalation Adjustments in Properly...The Role of Inflation and Price Escalation Adjustments in Properly Estimating Program Costs: F-35 Case Study Stanley Horowitz, Assistant Division

  13. Cross-layer fault tolerant data aggregation for improved network delay in healthcare management applications.

    Science.gov (United States)

    Yuan, Xiaojing; Liu, Haoying

    2009-01-01

    The escalation of American health care costs compels a new approach to manage chronic diseases. Wireless sensor networks (WSN) have been applied successfully in remote monitoring in military, aerospace, civil structure, and healthcare. However, existing wireless network framework cannot provide required quality of service (QoS) due to communication device failure, message loss caused by link error, collision, and hidden terminal for personalized disease management applications. In this paper, we present scalable network architecture and an operating mechanism that tolerates network structure changes caused by failure, with the application level data aggregation algorithm able to heal from the failure. We provide close form solutions that can achieve optimized network delay. Performance analysis was done to evaluate the significance of different nodes' failure in both homogeneous and heterogeneous sensor network and the effects of sensing and communication speed on failure impact in heterogeneous sensor networks.

  14. Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis.

    Science.gov (United States)

    Johnston, Maximilian J; King, Dominic; Arora, Sonal; Cooper, Kerri; Panda, Neha Aparajita; Gosling, Rebecca; Singh, Kaushiki; Sanders, Bradley; Cox, Benita; Darzi, Ara

    2014-08-01

    In order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user-informed guide for the development of an application-based communication system (ABCS), tailored for use in patient handover and escalation of care. Current methods of inter-professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis. Seventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group-messaging functions. Despite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety. © 2014 John Wiley & Sons, Ltd.

  15. Integrated boost IMRT with FET-PET-adapted local dose escalation in glioblastomas. Results of a prospective phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Piroth, M.D.; Pinkawa, M.; Holy, R. [RWTH Aachen University Hospital (Germany). Dept. of Radiation Oncology; Forschungszentrum Juelich GmbH (DE). Juelich-Aachen Research Alliance (JARA) - Section JARA-Brain] (and others)

    2012-04-15

    Dose escalations above 60 Gy based on MRI have not led to prognostic benefits in glioblastoma patients yet. With positron emission tomography (PET) using [{sup 18}F]fluorethyl-L-tyrosine (FET), tumor coverage can be optimized with the option of regional dose escalation in the area of viable tumor tissue. In a prospective phase II study (January 2008 to December 2009), 22 patients (median age 55 years) received radiochemotherapy after surgery. The radiotherapy was performed as an MRI and FET-PET-based integrated-boost intensity-modulated radiotherapy (IMRT). The prescribed dose was 72 and 60 Gy (single dose 2.4 and 2.0 Gy, respectively) for the FET-PET- and MR-based PTV-FET{sub (72 Gy)} and PTV-MR{sub (60 Gy)}. FET-PET and MRI were performed routinely for follow-up. Quality of life and cognitive aspects were recorded by the EORTC-QLQ-C30/QLQ Brain20 and Mini-Mental Status Examination (MMSE), while the therapy-related toxicity was recorded using the CTC3.0 and RTOG scores. Median overall survival (OS) and disease-free survival (DFS) were 14.8 and 7.8 months, respectively. All local relapses were detected at least partly within the 95% dose volume of PTV-MR{sub (60 Gy)}. No relevant radiotherapy-related side effects were observed (excepted alopecia). In 2 patients, a pseudoprogression was observed in the MRI. Tumor progression could be excluded by FET-PET and was confirmed in further MRI and FET-PET imaging. No significant changes were observed in MMSE scores and in the EORTC QLQ-C30/QLQ-Brain20 questionnaires. Our dose escalation concept with a total dose of 72 Gy, based on FET-PET, did not lead to a survival benefit. Acute and late toxicity were not increased, compared with historical controls and published dose-escalation studies. (orig.)

  16. Words of Violence: “Fear Speech,” or How Violent Conflict Escalation Relates to the Freedom of Expression

    OpenAIRE

    Buyse, Antoine

    2014-01-01

    The limits of the freedom of expression are a perennial discussion in human rights discourse. This article focuses on identifying yardsticks to establish the boundaries of freedom of expression in cases where violence is a risk. It does so by using insights from the social sciences on the escalation of violent conflict. By emphasizing the interaction between violence and discourse, and its effect on antagonisms between groups, it offers an interdisciplinary perspective on an ongoing legal deb...

  17. Applying predictive analytics to develop an intelligent risk detection application for healthcare contexts.

    Science.gov (United States)

    Moghimi, Fatemeh Hoda; Cheung, Michael; Wickramasinghe, Nilmini

    2013-01-01

    Healthcare is an information rich industry where successful outcomes require the processing of multi-spectral data and sound decision making. The exponential growth of data and big data issues coupled with a rapid increase of service demands in healthcare contexts today, requires a robust framework enabled by IT (information technology) solutions as well as real-time service handling in order to ensure superior decision making and successful healthcare outcomes. Such a context is appropriate for the application of real time intelligent risk detection decision support systems using predictive analytic techniques such as data mining. To illustrate the power and potential of data science technologies in healthcare decision making scenarios, the use of an intelligent risk detection (IRD) model is proffered for the context of Congenital Heart Disease (CHD) in children, an area which requires complex high risk decisions that need to be made expeditiously and accurately in order to ensure successful healthcare outcomes.

  18. Visioning future emergency healthcare collaboration

    DEFF Research Database (Denmark)

    Söderholm, Hanna M.; Sonnenwald, Diane H.

    2010-01-01

    physicians, nurses, administrators, and information technology (IT) professionals working at large and small medical centers, and asked them to share their perspectives regarding 3DMC's potential benefits and disadvantages in emergency healthcare and its compatibility and/or lack thereof...... care in real time. Today only an early prototype of 3DMC exists. To better understand 3DMC's potential for adoption and use in emergency healthcare before large amounts of development resources are invested we conducted a visioning study. That is, we shared our vision of 3DMC with emergency room...

  19. 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...

  20. Direct-to-Consumer Genetic and Genomic Testing: Preparing Nurse Practitioners for Genomic Healthcare

    OpenAIRE

    Loud, Jennifer T.

    2010-01-01

    Rapidly emerging technologies make it possible for consumers to acquire information that is intended to explain their inherited susceptibility to disease and facilitate tailored healthcare services through direct-to-consumer (DTC) marketing of personal genetic (PG) and personal genomic (PGM) testing. However, the health benefits and risks associated with these technologies are largely unknown. Consumers will turn to their healthcare providers, including nurse practitioners, to interpret test ...

  1. Energy efficient routing in mobile ad-hoc networks for Healthcare Environments

    OpenAIRE

    Sohail Abid; Imran Shafi; Shahid Abid

    2013-01-01

    The modern and innovative medical applications based on wireless network are being developed in the commercial sectors as well as in research. The emerging wireless networks are rapidly becoming a fundamental part of medical solutions due to increasing accessibility for healthcare professionals/patients reducing healthcare costs. Discovering the routes among hosts that are energy efficient without compromise on smooth communication is desirable. This work investigates energy efficiency of som...

  2. Strategies of dose escalation in the treatment of locally advanced non-small cell lung cancer: image guidance and beyond

    Directory of Open Access Journals (Sweden)

    Alexander eChi

    2014-06-01

    Full Text Available Radiation dose in the setting of chemo-radiation for locally advanced non-small cell lung cancer (NSCLC has been historically limited by the risk of normal tissue toxicity and this has been hypothesized to correlate with the poor results in regard to local tumor recurrences. Dose escalation, as a means to improve local control, with concurrent chemotherapy has been shown to be feasible with three-dimensional conformal radiotherapy in early phase studies with good clinical outcome. However, the potential superiority of moderate dose escalation to 74 Gy has not been shown in phase III randomized studies. In this review, the limitations in target volume definition in previous studies; and the factors that may be critical to safe dose escalation in the treatment of locally advanced NSCLC, such as respiratory motion management, image guidance, intensity modulation, FDG-PET incorporation in the treatment planning process, and adaptive radiotherapy, are discussed. These factors, along with novel treatment approaches that have emerged in recent years, are proposed to warrant further investigation in future trials in a more comprehensive and integrated fashion.

  3. How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews.

    NARCIS (Netherlands)

    Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.; Groenewegen, P.

    2009-01-01

    Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

  4. How do healthcare consumers process and evaluate comparative healthcare information? A qualitive study using cognitive interviews

    NARCIS (Netherlands)

    Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.M.J.; Groenewegen, P.P.

    2009-01-01

    Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

  5. Population Aging and Healthcare Expenditure in Korea.

    Science.gov (United States)

    Hyun, Kyung-Rae; Kang, Sungwook; Lee, Sunmi

    2016-10-01

    Korea's rapid population aging has been considered as a major factor in increase of healthcare expenditure (HCE). However, there were no clear empirical evidences in Korea that show if population aging has a significant impact on HCE. To examine the 'red herring' argument, this study used Heckman, two-part, and augmented model with Korean National Health Insurance claim data for the deceased and survivors of aged 20 years and over verified by Korean National Health Insurance Service between January 1 and December 31, 2010. Our results suggest that when time to death is controlled for as explanatory variable, HCE decreases as a function of age, and HCE during the terminal year increases as a function of time to death, and HCE in the last quarter of life decreases with age. Therefore, this study affirms that there is no age effect in Korea experiencing the most rapid population aging among Asian countries. An increase in the number of elderly, due to the aging of baby boomers, may not increase a share of HCE out of gross domestic product (GDP) in Korea. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  6. Strategic Stability Reconsidered: Prospects for Escalation and Nuclear War in the Middle East

    Energy Technology Data Exchange (ETDEWEB)

    Russell, J.A.

    2009-07-01

    for survival'. The paper first draws upon Thomas Schelling's ideas to assess the regional strategic framework, and finds systemic uncertainties which suggest that escalation by various parties - state and non-state actors - is a possible outcome. Both near-term and long-term scenarios are considered. The near-term nuclear use scenarios are all predicated on the assumption that nuclear use will occur within the context of escalation to or within war. As dangerous as these circumstances are, longer-term scenarios for nuclear use will also be proposed, which, like the alarming near-term scenarios, flow from the same unstable regional dynamics. The Middle East's unstable dynamics occur within a global environment characterized by a general sense of insecurity about various nuclear issues. Reflecting this situation, the Bulletin of Atomic Scientists recently moved its 'Doomsday Clock' from seven- to five minutes to midnight - the most advanced setting since 1981. Citing Iran's nuclear ambitions, North Korea's test of a nuclear weapon, the failure to secure nuclear materials, a controversial U.S. nuclear doctrine that some argue suggests an expanded role for nuclear weapons, and the continued presence of 26,000 nuclear weapons in the United States and Russia, the Bulletin expressed new concerns about global strategic stability. These developments occurred against a backdrop of the collapse of the 2005 Nonproliferation Treaty Review conference due, among other things, to disinterest in the global community in supporting the spread of nonproliferation norms. (author)

  7. A randomised controlled trial of the efficacy and safety of allopurinol dose escalation to achieve target serum urate in people with gout.

    Science.gov (United States)

    Stamp, Lisa K; Chapman, Peter T; Barclay, Murray L; Horne, Anne; Frampton, Christopher; Tan, Paul; Drake, Jill; Dalbeth, Nicola

    2017-09-01

    To determine the efficacy and safety of allopurinol dose escalation using a treat-to-target serum urate (SU) approach. A randomised, controlled, parallel-group, comparative clinical trial was undertaken. People with gout receiving at least creatinine clearance (CrCL)-based allopurinol dose for ≥1 month and SU ≥6 mg/dL were recruited. Participants were randomised to continue current dose (control) or allopurinol dose escalation for 12 months. In the dose escalation group, allopurinol was increased monthly until SU was gout. Allopurinol dose escalation is well tolerated. ANZCTR12611000845932; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Heterogeneous FDG-guided dose-escalation for locally advanced NSCLC (the NARLAL2 trial): Design and early dosimetric results of a randomized, multi-centre phase-III study

    DEFF Research Database (Denmark)

    Møller, Ditte Sloth; Nielsen, Tine Bjørn; Brink, Carsten

    2017-01-01

    -escalation driven by FDG-avid volumes, while respecting normal tissue constraints and requiring no increase in mean lung dose. Dose-escalation driven by FDG-avid volumes, delivering mean doses of 95 Gy (tumour) and 74 Gy (lymph nodes), was pursued and compared to standard 66 Gy/33 F plans. Material and methods......: Dose plans for the first thirty patients enroled were analysed. Standard and escalated plans were created for all patients, blinded to randomization, and compared for each patient in terms of the ability to escalate while protecting normal tissue. Results: The median dose-escalation in FDG-avid areas...... received doses between 66 and 74 Gy due to escalation. Conclusions: FDG-driven inhomogeneous dose-escalation achieves large increment in tumour and lymph node dose, while delivering similar doses to normal tissue as homogenous standard plans....

  9. NMDA receptor antagonism: escalation of aggressive behavior in alcohol-drinking mice.

    Science.gov (United States)

    Newman, Emily L; Chu, Adam; Bahamón, Brittany; Takahashi, Aki; Debold, Joseph F; Miczek, Klaus A

    2012-11-01

    Memantine is a potential treatment for alcoholic patients, yet few studies investigate the effect of concurrent treatment with memantine and ethanol on aggression. We evaluated aggressive behavior following ethanol consumption and treatment with glutamatergic drugs to characterize interactions between these compounds. This study aimed to use rodent models of aggression to examine interactions between glutamatergic compounds and ethanol. Once male CFW mice reliably self-administered 1 g/kg ethanol or water, they were assessed for aggression in resident-intruder confrontations. Alternatively, aggression was evaluated following a social-instigation procedure. Animals were then injected with memantine, ketamine, neramexane, MTEP, or LY379268 before aggressive confrontations. Effects of the pharmacological manipulations on salient aggressive and non-aggressive behaviors were analyzed. Moderate doses of memantine, neramexane, and MTEP interacted with ethanol to increase the frequency of attack bites while ketamine did not. The highest dose of LY379268, an mGluR(2/3) agonist, reduced both aggressive and non-aggressive behaviors after water and ethanol self-administration. Attack bites increased with social instigation and decreased with administration of high doses of MTEP and LY379268. Memantine and MTEP both reduced attack bite frequency in the instigation condition without reducing locomotor behavior. Memantine and neramexane interacted with ethanol to heighten aggression. The binding characteristics of these compounds allow for 'partial trapping' by which some NMDARs are unblocked between depolarizations. We propose that this feature may contribute to the differential aggression-heightening interactions between these compounds and ethanol. MTEP also interacted with ethanol to escalate aggression, possibly through inhibition of mGluR(5) modulation of NMDARs.

  10. Decision Regret in Men Undergoing Dose-Escalated Radiation Therapy for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Steer, Anna N. [Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour (Australia); Aherne, Noel J., E-mail: noel.aherne@ncahs.health.nsw.gov.au [Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour (Australia); Rural Clinical School Faculty of Medicine, University of New South Wales, Coffs Harbour (Australia); Gorzynska, Karen; Hoffman, Matthew; Last, Andrew; Hill, Jacques [Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour (Australia); Shakespeare, Thomas P. [Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour (Australia); Rural Clinical School Faculty of Medicine, University of New South Wales, Coffs Harbour (Australia)

    2013-07-15

    Purpose: Decision regret (DR) is a negative emotion associated with medical treatment decisions, and it is an important patient-centered outcome after therapy for localized prostate cancer. DR has been found to occur in up to 53% of patients treated for localized prostate cancer, and it may vary depending on treatment modality. DR after modern dose-escalated radiation therapy (DE-RT) has not been investigated previously, to our knowledge. Our primary aim was to evaluate DR in a cohort of patients treated with DE-RT. Methods and Materials: We surveyed 257 consecutive patients with localized prostate cancer who had previously received DE-RT, by means of a validated questionnaire. Results: There were 220 responses (85.6% response rate). Image-guided intensity modulated radiation therapy was given in 85.0% of patients and 3-dimensional conformal radiation therapy in 15.0%. Doses received included 73.8 Gy (34.5% patients), 74 Gy (53.6%), and 76 Gy (10.9%). Neoadjuvant androgen deprivation (AD) was given in 51.8% of patients and both neoadjuvant and adjuvant AD in 34.5%. The median follow-up time was 23 months (range, 12-67 months). In all, 3.8% of patients expressed DR for their choice of treatment. When asked whether they would choose DE-RT or AD again, only 0.5% probably or definitely would not choose DE-RT again, compared with 8.4% for AD (P<.01). Conclusion: Few patients treated with modern DE-RT express DR, with regret appearing to be lower than in previously published reports of patients treated with radical prostatectomy or older radiation therapy techniques. Patients experienced more regret with the AD component of treatment than with the radiation therapy component, with implications for informed consent. Further research should investigate regret associated with individual components of modern therapy, including AD, radiation therapy and surgery.

  11. Dose-escalated simultaneous integrated-boost treatment of prostate cancer patients via helical tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Geier, M.; Astner, S.T.; Duma, M.N.; Putzhammer, J.; Winkler, C.; Molls, M.; Geinitz, H. [Technische Univ. Muenchen (Germany). Klinik und Poliklinik fuer Strahlentherapie und Radiologische Onkologie; Jacob, V. [Universitaetsklinikum Freiburg (Germany). Klinik fuer Strahlenheilkunde; Nieder, C. [Nordland Hospital, Bodoe (Norway). Dept. of Oncology and Palliative Care; Tromsoe Univ. (Norway). Inst. of Clinical Medicine

    2012-05-15

    The goal of this work was to assess the feasibility of moderately hypofractionated simultaneous integrated-boost intensity-modulated radiotherapy (SIB-IMRT) with helical tomotherapy in patients with localized prostate cancer regarding acute side effects and dose-volume histogram data (DVH data). Acute side effects and DVH data were evaluated of the first 40 intermediate risk prostate cancer patients treated with a definitive daily image-guided SIB-IMRT protocol via helical tomotherapy in our department. The planning target volume including the prostate and the base of the seminal vesicles with safety margins was treated with 70 Gy in 35 fractions. The boost volume containing the prostate and 3 mm safety margins (5 mm craniocaudal) was treated as SIB to a total dose of 76 Gy (2.17 Gy per fraction). Planning constraints for the anterior rectal wall were set in order not to exceed the dose of 76 Gy prescribed to the boost volume. Acute toxicity was evaluated prospectively using a modified CTCAE (Common Terminology Criteria for Adverse Events) score. SIB-IMRT allowed good rectal sparing, although the full boost dose was permitted to the anterior rectal wall. Median rectum dose was 38 Gy in all patients and the median volumes receiving at least 65 Gy (V65), 70 Gy (V70), and 75 Gy (V75) were 13.5%, 9%, and 3%, respectively. No grade 4 toxicity was observed. Acute grade 3 toxicity was observed in 20% of patients involving nocturia only. Grade 2 acute intestinal and urological side effects occurred in 25% and 57.5%, respectively. No correlation was found between acute toxicity and the DVH data. This institutional SIB-IMRT protocol using daily image guidance as a precondition for smaller safety margins allows dose escalation to the prostate without increasing acute toxicity. (orig.)

  12. Conformational targeting of fibrillar polyglutamine proteins in live cells escalates aggregation and cytotoxicity.

    Directory of Open Access Journals (Sweden)

    Erik Kvam

    2009-05-01

    Full Text Available Misfolding- and aggregation-prone proteins underlying Parkinson's, Huntington's and Machado-Joseph diseases, namely alpha-synuclein, huntingtin, and ataxin-3 respectively, adopt numerous intracellular conformations during pathogenesis, including globular intermediates and insoluble amyloid-like fibrils. Such conformational diversity has complicated research into amyloid-associated intracellular dysfunction and neurodegeneration. To this end, recombinant single-chain Fv antibodies (scFvs are compelling molecular tools that can be selected against specific protein conformations, and expressed inside cells as intrabodies, for investigative and therapeutic purposes.Using atomic force microscopy (AFM and live-cell fluorescence microscopy, we report that a human scFv selected against the fibrillar form of alpha-synuclein targets isomorphic conformations of misfolded polyglutamine proteins. When expressed in the cytoplasm of striatal cells, this conformation-specific intrabody co-localizes with intracellular aggregates of misfolded ataxin-3 and a pathological fragment of huntingtin, and enhances the aggregation propensity of both disease-linked polyglutamine proteins. Using this intrabody as a tool for modulating the kinetics of amyloidogenesis, we show that escalating aggregate formation of a pathologic huntingtin fragment is not cytoprotective in striatal cells, but rather heightens oxidative stress and cell death as detected by flow cytometry. Instead, cellular protection is achieved by suppressing aggregation using a previously described intrabody that binds to the amyloidogenic N-terminus of huntingtin. Analogous cytotoxic results are observed following conformational targeting of normal or polyglutamine-expanded human ataxin-3, which partially aggregate through non-polyglutamine domains.These findings validate that the rate of aggregation modulates polyglutamine-mediated intracellular dysfunction, and caution that molecules designed to

  13. Gemcitabine plus dose-escalated epirubicin in advanced breast cancer: results of a phase I study.

    Science.gov (United States)

    Lüftner, D; Flath, B; Akrivakis, C; Mergenthaler, H G; Ohnmacht, U; Arning, M; Possinger, K

    1998-01-01

    Gemcitabine has shown single-agent activity in metastatic breast cancer. Epirubicin is also widely used for the adjuvant and treatment of metastatic breast cancer. The toxicity profiles and modes of action are different which provides a good rationale for studying both drugs in combination. In a phase I study gemcitabine at a fixed dose of 1000 mg/m2 on days 1, 8, 15 of a 28 day cycle was combined with escalated weekly doses of epirubicin starting with an initial dose of 10 mg/m2. Patients had stage IV metastatic disease without previous chemotherapy except as adjuvant treatment. Nineteen patients were included in the study which defined the maximum tolerated dose (MTD) of epirubicin at 20 mg/m2. Myelosuppression was the dose limiting toxicity with leucopenia WHO grade 3 and 4 in 40.0% and 20.0%, neutropenia WHO grade 3 and 4 without neutropenic fever in 20.0% and 40.0% and thrombocytopenia WHO grade 4 in 20.0%. At the epirubicin 15 mg/m2 dose level, leucopenia (11.1% WHO grade 3) and neutropenia (12.5 and 37.5% WHO grade 3 and 4) were reported. Symptomatic toxicity was generally mild: nausea/vomiting in about 20% of patients (WHO grade 3 or 4) on both 15 and 20 mg/m2 epirubicin dose levels. Alopecia WHO grade 3 and 4 was seen in 2 patients at MTD. Four of 19 evaluable patients had a partial response. We conclude that the combination of gemcitabine and epirubicin is well tolerated and has promising activity. A phase II study is underway with gemcitabine 1000 mg/m2 and epirubicin 15 mg/m2 on days 1, 8 and 15 of a 28 day cycle.

  14. Dose-Escalation Study for Cardiac Radiosurgery in a Porcine Model

    Energy Technology Data Exchange (ETDEWEB)

    Blanck, Oliver, E-mail: oliver.blanck@uksh.de [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); CyberKnife Center Northern Germany, Guestrow (Germany); Bode, Frank [Medical Department II, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Gebhard, Maximilian [Institute of Pathology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Hunold, Peter [Department of Radiology and Nuclear Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Brandt, Sebastian [Department of Anaesthesiology and Intensive Care Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Bruder, Ralf [Institute for Robotics and Cognitive Systems, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Grossherr, Martin [Department of Anaesthesiology and Intensive Care Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Vonthein, Reinhard [Institute of Medical Biometry and Statistics, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Rades, Dirk [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Dunst, Juergen [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); University Copenhagen (Denmark)

    2014-07-01

    Purpose: To perform a proof-of-principle dose-escalation study to radiosurgically induce scarring in cardiac muscle tissue to block veno-atrial electrical connections at the pulmonary vein antrum, similar to catheter ablation. Methods and Materials: Nine mini-pigs underwent pretreatment magnetic resonance imaging (MRI) evaluation of heart function and electrophysiology assessment by catheter measurements in the right superior pulmonary vein (RSPV). Immediately after examination, radiosurgery with randomized single-fraction doses of 0 and 17.5-35 Gy in 2.5-Gy steps were delivered to the RSPV antrum (target volume 5-8 cm{sup 3}). MRI and electrophysiology were repeated 6 months after therapy, followed by histopathologic examination. Results: Transmural scarring of cardiac muscle tissue was noted with doses ≥32.5 Gy. However, complete circumferential scarring of the RSPV was not achieved. Logistic regressions showed that extent and intensity of fibrosis significantly increased with dose. The 50% effective dose for intense fibrosis was 31.3 Gy (odds ratio 2.47/Gy, P<.01). Heart function was not affected, as verified by MRI and electrocardiogram evaluation. Adjacent critical structures were not damaged, as verified by pathology, demonstrating the short-term safety of small-volume cardiac radiosurgery with doses up to 35 Gy. Conclusions: Radiosurgery with doses >32.5 Gy in the healthy pig heart can induce circumscribed scars at the RSPV antrum noninvasively, mimicking the effect of catheter ablation. In our study we established a significant dose-response relationship for cardiac radiosurgery. The long-term effects and toxicity of such high radiation doses need further investigation in the pursuit of cardiac radiosurgery for noninvasive treatment of atrial fibrillation.

  15. Healthcare Engineering Defined: A White Paper

    Directory of Open Access Journals (Sweden)

    Ming-Chien Chyu

    2015-01-01

    Full Text Available Engineering has been playing an important role in serving and advancing healthcare. The term “Healthcare Engineering” has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of “Healthcare Engineering” remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects.

  16. Healthcare Engineering Defined: A White Paper.

    Science.gov (United States)

    Chyu, Ming-Chien; Austin, Tony; Calisir, Fethi; Chanjaplammootil, Samuel; Davis, Mark J; Favela, Jesus; Gan, Heng; Gefen, Amit; Haddas, Ram; Hahn-Goldberg, Shoshana; Hornero, Roberto; Huang, Yu-Li; Jensen, Øystein; Jiang, Zhongwei; Katsanis, J S; Lee, Jeong-A; Lewis, Gladius; Lovell, Nigel H; Luebbers, Heinz-Theo; Morales, George G; Matis, Timothy; Matthews, Judith T; Mazur, Lukasz; Ng, Eddie Yin-Kwee; Oommen, K J; Ormand, Kevin; Rohde, Tarald; Sánchez-Morillo, Daniel; Sanz-Calcedo, Justo García; Sawan, Mohamad; Shen, Chwan-Li; Shieh, Jiann-Shing; Su, Chao-Ton; Sun, Lilly; Sun, Mingui; Sun, Yi; Tewolde, Senay N; Williams, Eric A; Yan, Chongjun; Zhang, Jiajie; Zhang, Yuan-Ting

    2015-01-01

    Engineering has been playing an important role in serving and advancing healthcare. The term "Healthcare Engineering" has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of "Healthcare Engineering" remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects.

  17. mHealth transforming healthcare

    CERN Document Server

    Malvey, Donna

    2014-01-01

    Examines regulatory trends and their impact on mHealth innovations and applications Offers solutions for those in the health care industry that are attempting to engage consumers in reducing healthcare costs and in improving their health care encounters and personal health Explains what is necessary for long-term viability of mHealth as a health care delivery medium.

  18. Healthcare priority setting in Kenya

    DEFF Research Database (Denmark)

    Bukachi, Salome A.; Onyango-Ouma, Washington; Siso, Jared Maaka

    2014-01-01

    improves the priority setting decisions. This paper describes the healthcare priority setting processes in Malindi district, Kenya, prior to the implementation of A4R in 2008 and evaluates the process for its conformance with the conditions for A4R. In-depth interviews and focus group discussions with key...

  19. Measuring healthcare quality: the challenges

    NARCIS (Netherlands)

    van den Heuvel, J.; Niemeijer, G.C.; Does, R.J.M.M.

    2013-01-01

    Purpose - Current health care quality performance indicators appear to be inadequate to inform the public to make the right choices. The aim of this paper is to define a framework and an organizational setting in which valid and reliable healthcare information can be produced to inform the general

  20. Making Franchising in Healthcare Work

    NARCIS (Netherlands)

    K.J. Nijmeijer (Karlijn J.)

    2014-01-01

    markdownabstract__Abstract__ Business format franchising is a form of interorganizational cooperation that originates from the business sector. It is increasingly used in a variety of healthcare services to reach positive results. In a franchise system contractual arrangements are made between

  1. [Healthcare aspects of domestic abuse].

    Science.gov (United States)

    Kórász, Krisztián

    2015-03-08

    The paper reviews the forms of domestic abuse, its causes, prevalence and possible consequences. British and Hungarian Law, guidelines and the roles and responsibilities of healthcare professionals in relation to dealing with domestic abuse in their practice is also addressed within the paper.

  2. Your Heart Failure Healthcare Team

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Your Heart Failure Healthcare Team Updated:May 9,2017 Patients with ... to the Terms and Conditions and Privacy Policy Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  3. Business intelligence in healthcare organizations

    NARCIS (Netherlands)

    Spil, Antonius A.M.; Stegwee, R.A.; Teitink, Christian J.A.

    2002-01-01

    The management of healthcare organizations is starting to recognize the relevance of the definition of care products in relation to management information. In the turmoil between costs, care results and patient satisfaction, the right balance is needed, and it can be found in upcoming information

  4. Bill Gates eyes healthcare market.

    Science.gov (United States)

    Dunbar, C

    1995-02-01

    The entrepreneurial spirit is still top in Bill Gates' mind as he look toward healthcare and other growth industries. Microsoft's CEO has not intention of going the way of other large technology companies that became obsolete before they could compete today.

  5. Big Data for personalized healthcare

    NARCIS (Netherlands)

    Siemons, Liseth; Sieverink, Floor; Vollenbroek, Wouter; van de Wijngaert, Lidwien; Braakman-Jansen, Annemarie; van Gemert-Pijnen, Lisette

    2016-01-01

    Big Data, often defined according to the 5V model (volume, velocity, variety, veracity and value), is seen as the key towards personalized healthcare. However, it also confronts us with new technological and ethical challenges that require more sophisticated data management tools and data analysis

  6. Sensing behaviour in healthcare design

    DEFF Research Database (Denmark)

    Thorpe, Julia Rosemary; Hysse Forchhammer, Birgitte; Maier, Anja

    2017-01-01

    specifically on activity and location data that can easily be obtained from smartphones or wearables. We further demonstrate how these are applied in healthcare design using an example from dementia care. Comparing a current and proposed scenario exemplifies how integrating sensor-derived information about...

  7. Where families and healthcare meet

    NARCIS (Netherlands)

    Verkerk, M. A.; Lindemann, Hilde; McLaughlin, Janice; Scully, Jackie Leach; Kihlbom, Ulrik; Nelson, Jamie; Chin, Jacqueline

    Recent developments in professional healthcare pose moral problems that standard bioethics cannot even identify as problems, but that are fully visible when redefined as problems in the ethics of families. Here, we add to the growing body of work that began in the 1990s by demonstrating the need for

  8. Changes in clinical disease activity are weakly linked to changes in MRI inflammation on treat-to-target escalation of therapy in rheumatoid arthritis

    OpenAIRE

    McQueen, Fiona M; Chapman, Peter; Pollock, Terina; D’Souza, Dena; Lee, Arier C; Dalbeth, Nicola; Stamp, Lisa; Lindsay, Karen; Doyle, Anthony

    2017-01-01

    Background Rheumatoid arthritis (RA) treat-to-target (T2T) regimens often use the disease activity score (28 joints) incorporating C-reactive protein (DAS28CRP) as an outcome measure. We compared changes in the DAS28CRP with changes in magnetic resonance imaging (MRI) inflammation on treatment escalation. Methods Eighty seropositive RA patients with active disease were enrolled. Group A (N = 57) escalated to another conventional disease-modifying therapy (cDMARD) combination, and Group B (N =...

  9. Work motivation among healthcare professionals.

    Science.gov (United States)

    Kjellström, Sofia; Avby, Gunilla; Areskoug-Josefsson, Kristina; Andersson Gäre, Boel; Andersson Bäck, Monica

    2017-06-19

    Purpose The purpose of this paper is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives. Design/methodology/approach Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. In total, 43 interviews were completed with different medical professions and qualitative deductive content analysis was conducted. Findings Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers' positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematic quality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. Practical implications Leaders need to consistently translate and integrate reforms with the professionals' drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work. Social implications The design of the reforms and leadership are essential preconditions for work motivation. Originality/value The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.

  10. The Hazards of Data Mining in Healthcare.

    Science.gov (United States)

    Househ, Mowafa; Aldosari, Bakheet

    2017-01-01

    From the mid-1990s, data mining methods have been used to explore and find patterns and relationships in healthcare data. During the 1990s and early 2000's, data mining was a topic of great interest to healthcare researchers, as data mining showed some promise in the use of its predictive techniques to help model the healthcare system and improve the delivery of healthcare services. However, it was soon discovered that mining healthcare data had many challenges relating to the veracity of healthcare data and limitations around predictive modelling leading to failures of data mining projects. As the Big Data movement has gained momentum over the past few years, there has been a reemergence of interest in the use of data mining techniques and methods to analyze healthcare generated Big Data. Much has been written on the positive impacts of data mining on healthcare practice relating to issues of best practice, fraud detection, chronic disease management, and general healthcare decision making. Little has been written about the limitations and challenges of data mining use in healthcare. In this review paper, we explore some of the limitations and challenges in the use of data mining techniques in healthcare. Our results show that the limitations of data mining in healthcare include reliability of medical data, data sharing between healthcare organizations, inappropriate modelling leading to inaccurate predictions. We conclude that there are many pitfalls in the use of data mining in healthcare and more work is needed to show evidence of its utility in facilitating healthcare decision-making for healthcare providers, managers, and policy makers and more evidence is needed on data mining's overall impact on healthcare services and patient care.

  11. Big Data, Big Problems: A Healthcare Perspective.

    Science.gov (United States)

    Househ, Mowafa S; Aldosari, Bakheet; Alanazi, Abdullah; Kushniruk, Andre W; Borycki, Elizabeth M

    2017-01-01

    Much has been written on the benefits of big data for healthcare such as improving patient outcomes, public health surveillance, and healthcare policy decisions. Over the past five years, Big Data, and the data sciences field in general, has been hyped as the "Holy Grail" for the healthcare industry promising a more efficient healthcare system with the promise of improved healthcare outcomes. However, more recently, healthcare researchers are exposing the potential and harmful effects Big Data can have on patient care associating it with increased medical costs, patient mortality, and misguided decision making by clinicians and healthcare policy makers. In this paper, we review the current Big Data trends with a specific focus on the inadvertent negative impacts that Big Data could have on healthcare, in general, and specifically, as it relates to patient and clinical care. Our study results show that although Big Data is built up to be as a the "Holy Grail" for healthcare, small data techniques using traditional statistical methods are, in many cases, more accurate and can lead to more improved healthcare outcomes than Big Data methods. In sum, Big Data for healthcare may cause more problems for the healthcare industry than solutions, and in short, when it comes to the use of data in healthcare, "size isn't everything."

  12. Healthcare service quality: towards a broad definition.

    Science.gov (United States)

    Mosadeghrad, Ali Mohammad

    2013-01-01

    The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying definitions for clients, professionals, managers, policy makers and payers. This study represents an exploratory effort to understand healthcare quality in an Iranian context. In-depth individual and focus group interviews were conducted with key healthcare stakeholders. Quality healthcare is defined as "consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient's needs and satisfies providers". Healthcare quality definitions common to all stakeholders involve offering effective care that contributes to the patient well-being and satisfaction. This study helps us to understand quality healthcare, highlighting its complex nature, which has direct implications for healthcare providers who are encouraged to regularly monitor healthcare quality using the attributes identified in this study. Accordingly, they can initiate continuous quality improvement programmes to maintain high patient-satisfaction levels. This is the first time a comprehensive healthcare quality definition has been developed using various healthcare stakeholder perceptions and expectations.

  13. Healthcare's Future: Strategic Investment in Technology.

    Science.gov (United States)

    Franklin, Michael A

    2018-01-01

    Recent and rapid advances in the implementation of technology have greatly affected the quality and efficiency of healthcare delivery in the United States. Simultaneously, diverse generational pressures-including the consumerism of millennials and unsustainable growth in the costs of care for baby boomers-have accelerated a revolution in healthcare delivery that was marked in 2010 by the passage of the Affordable Care Act.Against this backdrop, Maryland and the Centers for Medicare & Medicaid Services entered into a partnership in 2014 to modernize the Maryland All-Payer Model. Under this architecture, each Maryland hospital negotiates a global budget revenue agreement with the state's rate-setting agency, limiting the hospital's annual revenue to the budgetary cap established by the state.At Atlantic General Hospital (AGH), leaders had established a disciplined strategic planning process in which the board of trustees, medical staff, and administration annually agree on goals and initiatives to achieve the objectives set forth in its five-year strategic plans. This article describes two initiatives to improve care using technology. In 2006, AGH introduced a service guarantee in the emergency room (ER); the ER 30-Minute Promise assures patients that they will be placed in a bed or receive care within 30 minutes of arrival in the ER. In 2007, several independent hospitals in the state formed Maryland eCare to jointly contract for intensive care unit (ICU) physician coverage via telemedicine. This technology allows clinical staff to continuously monitor ICU patients remotely. The positive results of the ER 30-Minute Promise and Maryland eCare program show that technological advances in an independent, small, rural hospital can make a significant impact on its ability to maintain independence. AGH's strategic investments prepared the organization well for the transition in 2014 to a value-based payment system.

  14. [Fostering LGBT-friendly healthcare services].

    Science.gov (United States)

    Wei, Han-Ting; Chen, Mu-Hong; Ku, Wen-Wei

    2015-02-01

    LGBT (lesbian, gay, bisexual, transgender) patients suffer from stigma and discrimination when seeking healthcare. A large LGBT healthcare survey revealed that 56% of gay patients and 70% of transgender patients suffered some type of discrimination while seeking healthcare in 2014. The fostering of LGBT-friendly healthcare services is not just an advanced step of gender mainstreaming but also a fulfillment of health equality and equity. Additionally, LGBT-friendly healthcare services are expected to provide new opportunities for healthcare workers. Therefore, proactive government policies, education, research, and clinical practice should all encourage the development of these healthcare services. We look forward to a well-developed LGBT-friendly healthcare system in Taiwan.

  15. Healthcare providers' attitudes and perceptions in infection ...

    African Journals Online (AJOL)

    Conclusions: Healthcare providers demonstrated attitudes and perceptions in antibiotic prescribing or use of laboratory derived information in infection diagnosis that could have negative impacts on antibiotic prescribing. Key words: Healthcare providers, Lesotho, antibiotic prescribing, laboratory derived information ...

  16. Innovation in medicine and healthcare 2015

    CERN Document Server

    Torro, Carlos; Tanaka, Satoshi; Howlett, Robert; Jain, Lakhmi

    2016-01-01

    Innovation in medicine and healthcare is an interdisciplinary research area, which combines the advanced technologies and problem solving skills with medical and biological science. A central theme of this proceedings is Smart Medical and Healthcare Systems (modern intelligent systems for medicine and healthcare), which can provide efficient and accurate solution to problems faced by healthcare and medical practitioners today by using advanced information communication techniques, computational intelligence, mathematics, robotics and other advanced technologies. The techniques developed in this area will have a significant effect on future medicine and healthcare.    The volume includes 53 papers, which present the recent trend and innovations in medicine and healthcare including Medical Informatics; Biomedical Engineering; Management for Healthcare; Advanced ICT for Medical and Healthcare; Simulation and Visualization/VR for Medicine; Statistical Signal Processing and Artificial Intelligence; Smart Medic...

  17. Discussing Diabetes with Your Healthcare Provider

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Diabetes Discussing Diabetes with Your Healthcare Provider Past Issues / Fall 2009 Table of Contents Diabetes Medicines—Always Discuss Them with Your Healthcare Provider ...

  18. A Way Forward for Healthcare in Madagascar?

    Science.gov (United States)

    Marks, Florian; Rabehanta, Nathalie; Baker, Stephen; Panzner, Ursula; Park, Se Eun; Fobil, Julius N; Meyer, Christian G; Rakotozandrindrainy, Raphaël

    2016-03-15

    A healthcare utilization survey was conducted as a component of the Typhoid Fever Surveillance in Africa Program (TSAP). The findings of this survey in Madagascar contrasted with those in other sites of the program; namely, only 30% of the population sought healthcare at the government-provided healthcare facilities for fever. These findings promoted us to determine the drivers and barriers in accessing and utilizing healthcare in Madagascar. Here we review the results of the TSAP healthcare utilization initiative and place them in the context of the current organization of the Madagascan healthcare system. Our work highlights the demands of the population for access to appropriate healthcare and the need for novel solutions that can quickly provide an affordable and sustainable basic healthcare infrastructure until a government-funded scheme is in place. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  19. Healthcare professionals' perceptions of alcoholintoxicated trauma ...

    African Journals Online (AJOL)

    Healthcare professionals' perceptions of alcoholintoxicated trauma patients: Implications for healthcare delivery at South Rand Hospital Emergency Department. ... Conclusion: HCPs experience negative emotions and develop negative attitudes in response to alcohol-intoxicated patients who have been assaulted.

  20. Public Healthcare Organizations: Leadership or Management?

    National Research Council Canada - National Science Library

    Maite Martínez-Gonzalez; Pilar Monreal-Bosch; Santiago Perera; Clara Selva Olid

    2016-01-01

    ...) was sent to 120 people occupying management positions in healthcare centers and hospitals as well as 14 others who also hold such positions in these healthcare centers and hospitals, were interviewed...

  1. Innovation with information technologies in healthcare

    CERN Document Server

    Berkowitz, Lyle

    2012-01-01

    This book offers healthcare executives, consultants and vendors a truly helpful and practical resource for planning and implementing healthcare IT, one which provides real life examples as well as advice on how to utilize HIT in a truly innovative manner.

  2. Healthcare Cost and Utilization Project (HCUP)

    Science.gov (United States)

    The Healthcare Cost and Utilization Project is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality.

  3. Sustainable healthcare: how to assess and improve healthcare structures' sustainability.

    Science.gov (United States)

    Buffoli, M; Capolongo, S; Bottero, M; Cavagliato, E; Speranza, S; Volpatti, L

    2013-01-01

    Sustainability is a broad and debated subject, often difficult to be defined and applied into real projects, especially when dealing with a complex scenario as the one of healthcare. Many research studies and evaluation systems have handled this topic from different perspectives, but many limits and criticalities still have to be overcome to properly cope with actual needs. The Sustainable Healthcare project has been developed through three main phases: a deep study of the state of the art, unraveling pros and cons of available sustainability scoring systems; an accurate analysis of the stakeholders network and their needs; the realization of an objective evaluation framework, through scientific methods, as the ANP. The newly developed evaluation system takes into consideration all the three pillars of sustainability, analyzing social, environmental and economic sustainability through a set of criteria, specified by measurable indicators. So the system identifies both global sustainability and specific critical areas, pointing out possible strategic solutions to improve sustainability. The evaluation is achieved through technical analyses and qualitative surveys, which eventually allow to quantitatively assess sustainability, through a sound scoring method. This study proposes an innovative evaluation method to determine the sustainability of a hospital, already existing or in the design phase, within the European context. The Sustainable Healthcare system overcomes some of the current evaluation systems' limits by establishing a multidisciplinary approach and being an easy-to-use tool. This protocol is intended to be of support in the identification of the main hospital's weaknesses and in setting priorities for implementation of the solutions.

  4. Transnational Healthcare Practices of Retired Circular Migrants

    OpenAIRE

    Bilecen, Başak; Tezcan-Güntekin, Hürrem

    2014-01-01

    Studies on healthcare of migrants usually focus on their problems including mental health, psychosomatic complaints, assuming that they mainly use the healthcare services of the host country. As migrants may also use healthcare services in their home countries, we examine empirically the influence of being subject to different healthcare systems and services particulary focusing on the migrants’ consumption of medicine. This paper contributes to the literature by specifically exploring the tr...

  5. Mobile Healthcare System using NFC Technology

    OpenAIRE

    A Devendran; T. Bhuvaneswari; Arun Kumar Krishnan

    2012-01-01

    Although primary care physicians are increasingly interested in adopting electronic medical record (EMR) systems, few use such systems in practice. Mobile devices offer new ways for users to access health care data and services in a secure and user-friendly environment. Mobile healthcare (m-healthcare) systems are regarded as a solution to healthcare costs without reducing the quality of patient care. We are developing a basic architecture for m-healthcare services using Near Field Communicat...

  6. Healthcare Industry Improvement with Business Intelligence

    Directory of Open Access Journals (Sweden)

    Mihaela-Laura IVAN

    2015-01-01

    Full Text Available The current paper highlights the advantages of big data analytics and business intelligence in the healthcare industry. In the paper are reviewed the Real-Time Healthcare Analytics Solutions for Preventative Medicine provided by SAP and the different ideas realized by possible customers for new applications in Healthcare industry in order to demonstrate that the healthcare system can and should benefit from the new opportunities provided by ITC in general and big data analytics in particular.

  7. Data mining applications in healthcare | Ogwueleka | International ...

    African Journals Online (AJOL)

    Data mining applications have benefited the healthcare industry in terms of fraud and abuse detection by insurers, use in customer relationship management decisions by healthcare organizations and identification of effective treatments and best practices by physicians. The enormous data generated by healthcare ...

  8. Organization development in the healthcare setting.

    Science.gov (United States)

    McClure, L

    1985-01-01

    Organization development (OD) is useful in the corporate setting, and it can successfully be applied to the healthcare environment if it undergoes certain changes. OD processes must became more prescriptive, develop management-oriented methods, use structure-oriented interventions, and generally adapt to the healthcare setting. This article illustrates how healthcare organizations can benefit from new versions of OD.

  9. Coherence in the Danish Healthcare System

    DEFF Research Database (Denmark)

    Frederiksen, Jesper; Olivares Bøgeskov, Benjamin Miguel

    2017-01-01

    of this tradition are used to generate data from discourse as representations of institutional logics. The aim is to uncover how coherence in healthcare emerges as different strategies in healthcare governance in relation to different institutions seen as positions. Hence, our findings suggest that, although...... to the strategy of coherence, is a part of greater efforts to the endeavour of governing healthcare....

  10. Hazardous Waste Management by healthcare Institutions, Addis ...

    African Journals Online (AJOL)

    A study regarding healthcare institution waste management and practical implementation of laws and regulation was conducted in selected hospitals of Addis Ababa during the period of 2012/13. The entire healthcare system generates non-hazardous and hazardous wastes during healthcare processes. Therefore, this ...

  11. HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response

    Science.gov (United States)

    Abdool Karim, Salim S.; Churchyard, Gavin J.; Abdool Karim, Quarraisha; Lawn, Stephen D.

    2009-01-01

    One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0·7% of the world’s population, had 17% of the global burden of HIV infection, and one of the world’s worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government’s response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches. PMID:19709731

  12. HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response.

    Science.gov (United States)

    Abdool Karim, Salim S; Churchyard, Gavin J; Karim, Quarraisha Abdool; Lawn, Stephen D

    2009-09-12

    One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0.7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government's response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.

  13. A phase I, dose-escalation study of volasertib combined with nintedanib in advanced solid tumors.

    Science.gov (United States)

    de Braud, F; Cascinu, S; Spitaleri, G; Pilz, K; Clementi, L; Liu, D; Sikken, P; De Pas, T

    2015-11-01

    Volasertib is a potent and selective cell-cycle kinase inhibitor that induces mitotic arrest and apoptosis by targeting Polo-like kinases. This study determined the maximum tolerated dose (MTD) and pharmacokinetics of volasertib combined with nintedanib, a potent and orally bioavailable triple angiokinase inhibitor, in patients with advanced solid tumors. This open-label, dose-escalation trial recruited patients with advanced metastatic solid tumors following failure of conventional treatment (NCT01022853; Study 1230.7). Volasertib was administered by intravenous infusion over 2 h, starting at 100 mg in the first dose cohort. Nintedanib was administered orally at a dose of 200 mg twice daily. The first treatment cycle comprised 28 days (days 1-7 and days 9-28: nintedanib; day 8: volasertib). From cycle 2 onwards, volasertib was administered on day 1 of a 21-day cycle and nintedanib was administered days 2-21. The primary objective was the MTD of volasertib in combination with nintedanib. Thirty patients were treated. The MTD of volasertib plus fixed-dose nintedanib was 300 mg once every 3 weeks, the same as the recommended single-agent dose of volasertib in solid tumors. Two of 12 assessable patients treated with the MTD experienced dose-limiting toxicities [grade 3 increased alanine aminotransferase (ALT); grade 3 ALT increase and grade 3 increased aspartate aminotransferase]. Disease control [stable disease (SD)/partial response (PR)/complete response (CR)] was achieved in 18 patients (60%): 1 CR (breast cancer), 1 PR (nonsmall-cell lung cancer), and 16 patients with SD. Volasertib showed that multiexponential pharmacokinetic behavior and co-administration of nintedanib had no significant effects on its exposure. Volasertib could be combined with fixed-dose nintedanib at the recommended single-agent dose. At this dose, the combination had a manageable safety profile without unexpected or overlapping adverse events, and showed antitumor activity. © The Author

  14. Healthcare responsibilities and conscientious objection.

    Science.gov (United States)

    Cook, Rebecca J; Olaya, Mónica Arango; Dickens, Bernard M

    2009-03-01

    The Constitutional Court of Colombia has issued a decision of international significance clarifying legal duties of providers, hospitals, and healthcare systems when conscientious objection is made to conducting lawful abortion. The decision establishes objecting providers' duties to refer patients to non-objecting providers, and that hospitals, clinics, and other institutions have no rights of conscientious objection. Their professional and legal duties are to ensure that patients receive timely services. Hospitals and other administrators cannot object, because they do not participate in the procedures they are obliged to arrange. Objecting providers, and hospitals, must maintain knowledge of non-objecting providers to whom their patients must be referred. Accordingly, medical schools must adequately train, and licensing authorities approve, non-objecting providers. Where they are unavailable, midwives and perhaps nurse practitioners may be trained, equipped, and approved for appropriate service delivery. The Court's decision has widespread implications for how healthcare systems must accommodate conscientious objection and patients' legal rights.

  15. Personalized healthcare through intelligent gadgets.

    Science.gov (United States)

    Jang, Hyeju; Kim, Sanghyun; Bae, Changseok

    2008-01-01

    An intelligent gadget is a wearable platform which is reconfigurable, scalable, and component-based and which can be equipped, carried as a personal accessory, or in a certain case, implanted internally into a body. Various kinds of personal information can be gathered with intelligent gadgets, and that information is used to provide specially personalized services to people in the ubiquitous computing environment. In this paper, we show a personalized healthcare service through intelligent gadgets. A service based on intelligent gadgets can be built intuitively and easily with a context representation language, called the intelligent gadget markup language (IGML) based on the event-condition-action (ECA) rule. The inherent nature of extensibility, not only environmental information but also physiological information can be specified as a context in IGML and can be dealt with an intelligent gadget with ease. It enables intelligent gadgets to be adopted to many different kinds of personalized healthcare services.

  16. The Cadmio XML healthcare record.

    Science.gov (United States)

    Barbera, Francesco; Ferri, Fernando; Ricci, Fabrizio L; Sottile, Pier Angelo

    2002-01-01

    The management of clinical data is a complex task. Patient related information reported in patient folders is a set of heterogeneous and structured data accessed by different users having different goals (in local or geographical networks). XML language provides a mechanism for describing, manipulating, and visualising structured data in web-based applications. XML ensures that the structured data is managed in a uniform and transparent manner independently from the applications and their providers guaranteeing some interoperability. Extracting data from the healthcare record and structuring them according to XML makes the data available through browsers. The MIC/MIE model (Medical Information Category/Medical Information Elements), which allows the definition and management of healthcare records and used in CADMIO, a HISA based project, is described in this paper, using XML for allowing the data to be visualised through web browsers.

  17. Strategic planning in healthcare organizations.

    Science.gov (United States)

    Rodríguez Perera, Francisco de Paula; Peiró, Manel

    2012-08-01

    Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. The organizational level at which the strategic planning process is relevant depends on the unit's size, its complexity, and the differentiation of the service provided. A cardiology department, a hemodynamic unit, or an electrophysiology unit can be an appropriate level, as long as their plans align with other plans at higher levels. The leader of each unit is the person responsible for promoting the planning process, a core and essential part of his or her role. The process of strategic planning is programmable, systematic, rational, and holistic and integrates the short, medium, and long term, allowing the healthcare organization to focus on relevant and lasting transformations for the future. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  18. Redefining the Core Competencies of Future Healthcare Executives under Healthcare Reform

    Science.gov (United States)

    Love, Dianne B.; Ayadi, M. Femi

    2015-01-01

    As the healthcare industry has evolved over the years, so too has the administration of healthcare organizations. The signing into law of the Patient Protection and Affordable Care Act (ACA) has brought additional changes to the healthcare industry that will require changes to the healthcare administration curriculum. The movement toward a…

  19. Organizational change strategies within healthcare.

    Science.gov (United States)

    Steinke, Claudia; Dastmalchian, Ali; Blyton, Paul; Hasselback, Paul

    2013-01-01

    This study explores ways in which healthcare organizations can improve their organizational fitness for change using Beer and Nohria's framework of Theory E (concentrating on the economic value of change) and Theory O (concentrating on the organization's long-term capabilities for change). Data were collected from senior leaders/medical directors from health regions in Alberta. The results show that even though there is a tendency for reliance on Theory E change strategies, the respondents demonstrated other preferred approaches to change.

  20. Multicultural healthcare: a transatlantic project.

    Science.gov (United States)

    Koskinen, Liisa; Jokinen, Pirkko

    2007-01-01

    Healthcare is increasingly multicultural, posing a challenge for nurse educators in both Europe and the United States. Nursing education faculties are responding to the challenge of internationalization, for instance, by participating in international student exchange projects to foster students' intercultural competence. The authors describe an educational model constructed during a transatlantic project between European and American universities. The benefits of the project from the Finnish partner's perspective are also reported.

  1. Healthcare Energy Metering Guidance (Brochure)

    Energy Technology Data Exchange (ETDEWEB)

    2011-07-01

    This brochure is intended to help facility and energy managers plan and prioritize investments in energy metering. It offers healthcare-specific examples of metering applications, benefits, and steps that other health systems can reproduce. It reflects collaborative input from the U.S. Department of Energy national laboratories and the health system members of the DOE Hospital Energy Alliance's Benchmarking and Measurement Project Team.

  2. Legitimate Allocation of Public Healthcare

    DEFF Research Database (Denmark)

    Lippert-Rasmussen, Kasper; Lauridsen, Sigurd

    2009-01-01

    governing priorities among groups of patients. The Accountability for Reasonableness (A4R) framework suggests an ingenious solution to this problem of moral disagreement. Rather than advocating any substantive distributive principle, its advocates propose a feasible set of conditions, which, if met......Citizens' consent to political decisions is often regarded as a necessary condition of political legitimacy. Consequently, legitimate allocation of healthcare has seemed almost unattainable in contemporary pluralistic societies. The problem is that citizens do not agree on any single principle...

  3. Will biomedical innovation change the future of healthcare?

    Science.gov (United States)

    Schmid, Esther F; Ashkenazy, Rebecca; Merson, James; Smith, Dennis A

    2009-11-01

    Healthcare costs in all industrial nations have increased and payors are starting to look at new ways to contain costs and at new funding models. The business model of pharmaceutical companies is also undergoing rapid changes - potentially disruptive new modalities, such as RNAi, therapeutic vaccines, and cell therapy are emerging, R&D costs have increased year on year, pressures on drug pricing and the efficacy and safety of medicines are mounting. Change is therefore inevitable and already ongoing in healthcare systems and pharmaceutical companies alike. This paper presents several major forces which could drive different future scenarios including: R&D costs, the source of payments for medicines and the emergence of new modalities.

  4. Organizing Healthcare For Changing Markets: The Case of Ascension Health

    Directory of Open Access Journals (Sweden)

    Eric S. Engler

    2013-12-01

    Full Text Available This case describes a Ministry Positioning process that will enable the management of Ascension Health to enact designs suitable for the rapidly changing healthcare industry. Ascension Health is the largest not-for-profit healthcare system in the United States with $21 billion in annual revenues and a presence in 24 states and the District of Columbia. Because the design of a large organization for a fast-moving environment is too complex and ambiguous to be fully planned in advance, the focus of the case is on the processes of learning while designing—that is, learning how to learn from designing organizations. The main lessons drawn from the Ministry Positioning process are discussed.

  5. Workplace bullying among healthcare workers.

    Science.gov (United States)

    Ariza-Montes, Antonio; Muniz, Noel M; Montero-Simó, María José; Araque-Padilla, Rafael Angel

    2013-07-24

    This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European Working Conditions Survey, conducted in 2010 by the European Foundation for the Improvement of Living and Working Conditions. In light of these objectives, we collected a subsample of 284 health professionals, some of them from the International Standard Classification of Occupations--subgroup 22--(ISCO-08). The results indicated that the chance of a healthcare worker referring to him/herself as bullied increases among those who work on a shift schedule, perform monotonous and rotating tasks, suffer from work stress, enjoy little satisfaction from their working conditions, and do not perceive opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes within the usual course of events that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist human resource managers in facilitating, to some extent, good social relationships among healthcare workers.

  6. Workplace Bullying among Healthcare Workers

    Science.gov (United States)

    Ariza-Montes, Antonio; Muniz, Noel M.; Montero-Simó, María José; Araque-Padilla, Rafael Angel

    2013-01-01

    This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European Working Conditions Survey, conducted in 2010 by the European Foundation for the Improvement of Living and Working Conditions. In light of these objectives, we collected a subsample of 284 health professionals, some of them from the International Standard Classification of Occupations—subgroup 22—(ISCO-08). The results indicated that the chance of a healthcare worker referring to him/herself as bullied increases among those who work on a shift schedule, perform monotonous and rotating tasks, suffer from work stress, enjoy little satisfaction from their working conditions, and do not perceive opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes within the usual course of events that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist human resource managers in facilitating, to some extent, good social relationships among healthcare workers. PMID:23887621

  7. Workplace Bullying among Healthcare Workers

    Directory of Open Access Journals (Sweden)

    María José Montero-Simó

    2013-07-01

    Full Text Available This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European Working Conditions Survey, conducted in 2010 by the European Foundation for the Improvement of Living and Working Conditions. In light of these objectives, we collected a subsample of 284 health professionals, some of them from the International Standard Classification of Occupations—subgroup 22—(ISCO-08. The results indicated that the chance of a healthcare worker referring to him/herself as bullied increases among those who work on a shift schedule, perform monotonous and rotating tasks, suffer from work stress, enjoy little satisfaction from their working conditions, and do not perceive opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes within the usual course of events that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist human resource managers in facilitating, to some extent, good social relationships among healthcare workers.

  8. The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system.

    Science.gov (United States)

    Lee, Bruce Y; Wong, Kim F; Bartsch, Sarah M; Yilmaz, S Levent; Avery, Taliser R; Brown, Shawn T; Song, Yeohan; Singh, Ashima; Kim, Diane S; Huang, Susan S

    2013-06-01

    As healthcare systems continue to expand and interconnect with each other through patient sharing, administrators, policy makers, infection control specialists, and other decision makers may have to take account of the entire healthcare 'ecosystem' in infection control. We developed a software tool, the Regional Healthcare Ecosystem Analyst (RHEA), that can accept user-inputted data to rapidly create a detailed agent-based simulation model (ABM) of the healthcare ecosystem (ie, all healthcare facilities, their adjoining community, and patient flow among the facilities) of any region to better understand the spread and control of infectious diseases. To demonstrate RHEA's capabilities, we fed extensive data from Orange County, California, USA, into RHEA to create an ABM of a healthcare ecosystem and simulate the spread and control of methicillin-resistant Staphylococcus aureus. Various experiments explored the effects of changing different parameters (eg, degree of transmission, length of stay, and bed capacity). Our model emphasizes how individual healthcare facilities are components of integrated and dynamic networks connected via patient movement and how occurrences in one healthcare facility may affect many other healthcare facilities. A decision maker can utilize RHEA to generate a detailed ABM of any healthcare system of interest, which in turn can serve as a virtual laboratory to test different policies and interventions.

  9. The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system

    Science.gov (United States)

    Lee, Bruce Y; Wong, Kim F; Bartsch, Sarah M; Yilmaz, S Levent; Avery, Taliser R; Brown, Shawn T; Song, Yeohan; Singh, Ashima; Kim, Diane S; Huang, Susan S

    2013-01-01

    Objective As healthcare systems continue to expand and interconnect with each other through patient sharing, administrators, policy makers, infection control specialists, and other decision makers may have to take account of the entire healthcare ‘ecosystem’ in infection control. Materials and methods We developed a software tool, the Regional Healthcare Ecosystem Analyst (RHEA), that can accept user-inputted data to rapidly create a detailed agent-based simulation model (ABM) of the healthcare ecosystem (ie, all healthcare facilities, their adjoining community, and patient flow among the facilities) of any region to better understand the spread and control of infectious diseases. Results To demonstrate RHEA's capabilities, we fed extensive data from Orange County, California, USA, into RHEA to create an ABM of a healthcare ecosystem and simulate the spread and control of methicillin-resistant Staphylococcus aureus. Various experiments explored the effects of changing different parameters (eg, degree of transmission, length of stay, and bed capacity). Discussion Our model emphasizes how individual healthcare facilities are components of integrated and dynamic networks connected via patient movement and how occurrences in one healthcare facility may affect many other healthcare facilities. Conclusions A decision maker can utilize RHEA to generate a detailed ABM of any healthcare system of interest, which in turn can serve as a virtual laboratory to test different policies and interventions. PMID:23571848

  10. GABAA receptors in the dorsal raphé nucleus of mice: escalation of aggression after alcohol consumption

    Science.gov (United States)

    Takahashi, Aki; Kwa, Carolyn; DeBold, Joseph F.

    2010-01-01

    Rationale The dorsal raphé nucleus (DRN), the origin for serotonin (5-HT) in forebrain areas, has been implicated in the neural control of escalated aggression. Gamma aminobutyric acid type-A (GABAA) and type-B (GABAB) receptors are expressed in the DRN and modulate 5-HT neuronal activity, and both play a role in the behavioral effect of alcohol. Objective The purpose of this study is to examine the interaction between drugs acting on GABA receptors in the DRN and alcohol in their effects on aggressive behaviors. Method Male CFW mice, housed with a female, were trained to self-administer ethanol (1.0 g/kg) or water via an operant conditioning panel in their home cage. Immediately after they drank either ethanol or water, the animals were microinfused with a GABAergic drug into the DRN, and their aggressive behaviors were assessed 10 min later. Muscimol (0.006 nmol), a GABAA receptor agonist, escalated alcohol-heightened aggression but had no effect in the absence of ethanol. This effect of muscimol was prominent in the animals that showed alcohol-heightened aggression, but not the animals that reduced or did not change aggressive behavior after ethanol infusion compared to water. On the other hand, the GABAB agonist baclofen (0.06 nmol) increased aggressive behavior similarly in both water and ethanol conditions. Antagonists of the GABAA and GABAB receptors, bicuculline (0.006 nmol) and phaclofen (0.3 nmol) respectively, did not suppress heightened-aggressive behavior induced by ethanol self-administration. Conclusion GABAA receptors in the DRN are one of the neurobiological targets of alcohol-heightened aggression. Activation of the GABAB receptors in the DRN also produced escalated aggression, but that is independent of the effect of alcohol. PMID:20589493

  11. GABA(A) receptors in the dorsal raphé nucleus of mice: escalation of aggression after alcohol consumption.

    Science.gov (United States)

    Takahashi, Aki; Kwa, Carolyn; Debold, Joseph F; Miczek, Klaus A

    2010-09-01

    The dorsal raphé nucleus (DRN), the origin for serotonin (5-HT) in forebrain areas, has been implicated in the neural control of escalated aggression. Gamma aminobutyric acid type-A (GABA(A)) and type-B (GABA(B)) receptors are expressed in the DRN and modulate 5-HT neuronal activity, and both play a role in the behavioral effect of alcohol. The purpose of this study is to examine the interaction between drugs acting on GABA receptors in the DRN and alcohol in their effects on aggressive behaviors. Male CFW mice, housed with a female, were trained to self-administer ethanol (1.0 g/kg) or water via an operant conditioning panel in their home cage. Immediately after they drank either ethanol or water, the animals were microinfused with a GABAergic drug into the DRN, and their aggressive behaviors were assessed 10 min later. Muscimol (0.006 nmol), a GABA(A) receptor agonist, escalated alcohol-heightened aggression but had no effect in the absence of ethanol. This effect of muscimol was prominent in the animals that showed alcohol-heightened aggression, but not the animals that reduced or did not change aggressive behavior after ethanol infusion compared to water. On the other hand, the GABA(B) agonist baclofen (0.06 nmol) increased aggressive behavior similarly in both water and ethanol conditions. Antagonists of the GABA(A) and GABA(B) receptors, bicuculline (0.006 nmol) and phaclofen (0.3 nmol) respectively, did not suppress heightened-aggressive behavior induced by ethanol self-administration. GABA(A) receptors in the DRN are one of the neurobiological targets of alcohol-heightened aggression. Activation of the GABA(B) receptors in the DRN also produced escalated aggression, but that is independent of the effect of alcohol.

  12. A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens.

    Science.gov (United States)

    Gold, Jeffrey A; Rimal, Binaya; Nolan, Anna; Nelson, Lewis S

    2007-03-01

    Patients with severe alcohol withdrawal and delirium tremens are frequently resistant to standard doses of benzodiazepines. Case reports suggest that these patients have a high incidence of requiring intensive care and many require mechanical ventilation. However, few data exist on treatment strategies and outcomes for these subjects in the medical intensive care unit (ICU). Our goal was a) to describe the outcomes of patients admitted to the medical ICU solely for treatment of severe alcohol withdrawal and b) to determine whether a strategy of escalating doses of benzodiazepines in combination with phenobarbital would improve outcomes. Retrospective cohort study. Inner-city municipal hospital. Subjects admitted to the medical ICU solely for the treatment of severe alcohol withdrawal. Institution of guidelines emphasizing escalating doses of diazepam in combination with phenobarbital. Preguideline (n = 54) all subjects were treated with intermittent boluses of diazepam with an average total and maximal individual dose of 248 mg and 32 mg, respectively; 17% were treated with phenobarbital. Forty-seven percent required intubation due to inability to achieve adequate sedation and need for constant infusion of sedative-hypnotics. Intubated subjects had longer length of stay (5.6 vs. 3.4 days; p = .09) and higher incidence of nosocomial pneumonia (42 vs. 21% p = .08). Postguideline (n = 41) there were increases in maximum individual dose of diazepam (32 vs. 86 mg; p = .001), total amount of diazepam (248 vs. 562 mg; p = .001), and phenobarbital use (17 vs. 58%; p = .01). This was associated with a reduction in the need for mechanical ventilation (47 vs. 22%; p = .008), with trends toward reductions in ICU length of stay and nosocomial pneumonia. Patients admitted to a medical ICU solely for treatment of severe alcohol withdrawal have a high incidence of requiring mechanical ventilation. Guidelines emphasizing escalating bolus doses of diazepam, and barbiturates if

  13. Focal Radiation Therapy Dose Escalation Improves Overall Survival in Locally Advanced Pancreatic Cancer Patients Receiving Induction Chemotherapy and Consolidative Chemoradiation

    Energy Technology Data Exchange (ETDEWEB)

    Krishnan, Sunil, E-mail: skrishnan@mdanderson.org [Department of Radiation Oncology, The University of Texas, Houston, Texas (United States); Chadha, Awalpreet S. [Department of Radiation Oncology, The University of Texas, Houston, Texas (United States); Suh, Yelin [Department of Radiation Physics, The University of Texas, Houston, Texas (United States); Chen, Hsiang-Chun [Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas (United States); Rao, Arvind [Department of Bioinformatics and Computational Biology, MD Anderson Cancer Center, Houston, Texas (United States); Das, Prajnan; Minsky, Bruce D.; Mahmood, Usama; Delclos, Marc E. [Department of Radiation Oncology, The University of Texas, Houston, Texas (United States); Sawakuchi, Gabriel O. [Department of Radiation Physics, The University of Texas, Houston, Texas (United States); Graduate School of Biomedical Sciences, The University of Texas, Houston, Texas (United States); Beddar, Sam [Department of Radiation Physics, The University of Texas, Houston, Texas (United States); Katz, Matthew H.; Fleming, Jason B. [Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Javle, Milind M.; Varadhachary, Gauri R.; Wolff, Robert A. [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Crane, Christopher H. [Department of Radiation Oncology, The University of Texas, Houston, Texas (United States)

    2016-03-15

    Purpose: To review outcomes of locally advanced pancreatic cancer (LAPC) patients treated with dose-escalated intensity modulated radiation therapy (IMRT) with curative intent. Methods and Materials: A total of 200 patients with LAPC were treated with induction chemotherapy followed by chemoradiation between 2006 and 2014. Of these, 47 (24%) having tumors >1 cm from the luminal organs were selected for dose-escalated IMRT (biologically effective dose [BED] >70 Gy) using a simultaneous integrated boost technique, inspiration breath hold, and computed tomographic image guidance. Fractionation was optimized for coverage of gross tumor and luminal organ sparing. A 2- to 5-mm margin around the gross tumor volume was treated using a simultaneous integrated boost with a microscopic dose. Overall survival (OS), recurrence-free survival (RFS), local-regional and distant RFS, and time to local-regional and distant recurrence, calculated from start of chemoradiation, were the outcomes of interest. Results: Median radiation dose was 50.4 Gy (BED = 59.47 Gy) with a concurrent capecitabine-based (86%) regimen. Patients who received BED >70 Gy had a superior OS (17.8 vs 15.0 months, P=.03), which was preserved throughout the follow-up period, with estimated OS rates at 2 years of 36% versus 19% and at 3 years of 31% versus 9% along with improved local-regional RFS (10.2 vs 6.2 months, P=.05) as compared with those receiving BED ≤70 Gy. Degree of gross tumor volume coverage did not seem to affect outcomes. No additional toxicity was observed in the high-dose group. Higher dose (BED) was the only predictor of improved OS on multivariate analysis. Conclusion: Radiation dose escalation during consolidative chemoradiation therapy after induction chemotherapy for LAPC patients improves OS and local-regional RFS.

  14. The status of TQM in healthcare.

    Science.gov (United States)

    Yasin, M M; Meacham, K A; Alavi, J

    1998-01-01

    The face of the healthcare industry has changed dramatically over the last few years. This study examines the literature related to Total Quality Management (TQM) and Benchmarking (BM) applications in healthcare. Recommendations for healthcare managers and administrators, as they chart operational and strategic directions for their organization, are provided. In this context, a conceptual framework which stresses the significance of viewing the healthcare organization as an open system is provided. The framework underscores the fact that TQM and BM efforts should not be viewed in isolation. Rather, these efforts should be viewed as an integral part of the operational and strategic facets of the healthcare organization.

  15. Communication and general concern criterion prior to activation of the rapid response team: a grounded theory.

    Science.gov (United States)

    Martland, Jarrad; Chamberlain, Diane; Hutton, Alison; Smigielski, Michael

    2016-11-01

    Objective Patients commonly show signs and symptoms of deterioration for hours or days before cardiorespiratory arrest. Rapid response teams (RRT) were created to improve recognition and response to patient deterioration in these situations. Activation criteria include vital signs or 'general concern' by a clinician or family member. The general concern criterion for RRT activation accounts for nearly one-third of all RRT activity, and although it is well established that communication deficits between staff can contribute to poorer outcomes for patients, there is little evidence pertaining to communication and its effects on the general concern RRT activation. Thus, the aim of the present study was to develop a substantive grounded theory related to the communication process between clinicians that preceded the activation of an RRT when general concern criterion was used. Methods Qualitative grounded theory involved collection of three types of data details namely personal notes from participants in focus groups with white board notes from discussions and audio recordings of the focus groups sessions. Focus groups were conducted with participants exploring issues associated with clinician communication and how it related to the activation of an RRT using the general concern criterion. Results The three main phases of coding (i.e. open, axial and selective coding) analysis identified 322 separate open codes. The strongest theme contributed to a theory of ineffective communication and decreased psychological safety, namely that 'In the absence of effective communication there is a subsequent increase in anxiety, fear or concern that can be directly attributed to the activation of an RRT using the 'general concern' criterion'. The RRT filled cultural and process deficiencies in the compliance with an escalation protocol. Issues such as 'not for resuscitation documentation' and 'inability to establish communication with and between medical or nursing personnel' rated

  16. Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

    OpenAIRE

    Claassens, Mareli M.; Cari van Schalkwyk; Elizabeth du Toit; Eline Roest; Lombard, Carl J; Enarson, Donald A.; Nulda Beyers; Borgdorff, Martien W.

    2013-01-01

    BACKGROUND: Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures a...

  17. Healthcare

    Science.gov (United States)

    ... Emphasis Programs Directives Severe Violators TOPICS By Sector Construction Health Care Agriculture Maritime Oil and Gas Federal ... include formaldehyde, used for preservation of specimens for pathology; ethylene oxide, glutaraldehyde, and paracetic acid used for ...

  18. Is Androgen Deprivation Therapy Necessary in All Intermediate-Risk Prostate Cancer Patients Treated in the Dose Escalation Era?

    Energy Technology Data Exchange (ETDEWEB)

    Castle, Katherine O., E-mail: kocastle@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hoffman, Karen E.; Levy, Lawrence B.; Lee, Andrew K.; Choi, Seungtaek; Nguyen, Quynh N.; Frank, Steven J.; Pugh, Thomas J.; McGuire, Sean E.; Kuban, Deborah A. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-03-01

    Purpose: The benefit of adding androgen deprivation therapy (ADT) to dose-escalated radiation therapy (RT) for men with intermediate-risk prostate cancer is unclear; therefore, we assessed the impact of adding ADT to dose-escalated RT on freedom from failure (FFF). Methods: Three groups of men treated with intensity modulated RT or 3-dimensional conformal RT (75.6-78 Gy) from 1993-2008 for prostate cancer were categorized as (1) 326 intermediate-risk patients treated with RT alone, (2) 218 intermediate-risk patients treated with RT and ≤6 months of ADT, and (3) 274 low-risk patients treated with definitive RT. Median follow-up was 58 months. Recursive partitioning analysis based on FFF using Gleason score (GS), T stage, and pretreatment PSA concentration was applied to the intermediate-risk patients treated with RT alone. The Kaplan-Meier method was used to estimate 5-year FFF. Results: Based on recursive partitioning analysis, intermediate-risk patients treated with RT alone were divided into 3 prognostic groups: (1) 188 favorable patients: GS 6, ≤T2b or GS 3+4, ≤T1c; (2) 71 marginal patients: GS 3+4, T2a-b; and (3) 68 unfavorable patients: GS 4+3 or T2c disease. Hazard ratios (HR) for recurrence in each group were 1.0, 2.1, and 4.6, respectively. When intermediate-risk patients treated with RT alone were compared to intermediate-risk patients treated with RT and ADT, the greatest benefit from ADT was seen for the unfavorable intermediate-risk patients (FFF, 74% vs 94%, respectively; P=.005). Favorable intermediate-risk patients had no significant benefit from the addition of ADT to RT (FFF, 94% vs 95%, respectively; P=.85), and FFF for favorable intermediate-risk patients treated with RT alone approached that of low-risk patients treated with RT alone (98%). Conclusions: Patients with favorable intermediate-risk prostate cancer did not benefit from the addition of ADT to dose-escalated RT, and their FFF was nearly as good as patients with low-risk disease

  19. [Role of Visiting Nursing Care in Japanese Home Healthcare].

    Science.gov (United States)

    Yu, Sang-Ju

    2018-02-01

    Taiwan's rapidly aging society is expected to make it a super-aged society in 2026. By 2060, people aged 65 or older will account for 40% of the population, a ratio that will approximate that in Japan. In Japan, the elderly population was 27.3% in 2016. By 2025, when the baby-boomers become 75 years old in Japan, issues of long-term care and end-of-life care will be more important and challenging. Since 1976, more Japanese have died in hospital settings than in home settings. Although the percentage of people dying at home increased slightly to 12.7% in 2016, after the recent introduction and promotion of home healthcare, Japan will face a significant challenge to deal with the healthcare 'tsunami' of high natural death rates, which is expected to impose a heavy death burdened on society by 2040, when the death rate is expected to reach 1,670,000/year. Therefore, the Japanese authorities have begun to promote the Community-based Integrated Care System, in which home healthcare and visiting nursing play crucial roles. This article summarizes the historical trend and current situation of visiting nursing in Japan. Japan uses a hybrid payment system for visiting nursing that is financially supported both through private medical insurance policies and Kaigo insurance (Japanese long-term care insurance). The total of 8613 visiting nursing stations that were active in community settings in 2016 cooperated with 14,000 support clinics for home healthcare and cared for 570,000 patients in home settings. We believe that visiting nursing will play an important role in home healthcare in Taiwan in the future.

  20. Public healthcare interests require strict competition enforcement.

    Science.gov (United States)

    Loozen, Edith M H

    2015-07-01

    Several countries have introduced competition in their health systems in order to maintain the supply of high quality health care in a cost-effective manner. The introduction of competition triggers competition enforcement. Since healthcare is characterized by specific market failures, many favor healthcare-specific competition enforcement in order not only to account for the competition interest, but also for the healthcare interests. The question is whether healthcare systems based on competition can succeed when competition enforcement deviates from standard practice. This paper analyzes whether healthcare-specific competition enforcement is theoretically sound and practically effective. This is exemplified by the Dutch system that is based on regulated competition and thus crucially depends on getting competition enforcement right. Governments are responsible for correcting market failures. Markets are responsible for maximizing the public healthcare interests. By securing sufficient competitive pressure, competition enforcement makes sure they do. When interpreted according to welfare-economics, competition law takes into account both costs and benefits specific market behavior may have for healthcare. Competition agencies and judiciary are not legitimized to deviate from standard evidentiary requirements. Dutch case law shows that healthcare-specific enforcement favors the healthcare undertakings concerned, but to the detriment of public health care. Healthcare-specific competition enforcement is conceptually flawed and counterproductive. In order for healthcare systems based on competition to succeed, competition enforcement should be strict. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Bluetooth: Opening a Blue Sky for Healthcare

    Directory of Open Access Journals (Sweden)

    X. H. Wang

    2006-01-01

    Full Text Available Over the last few years, there has been a blossoming of developing mobile healthcare programs. Bluetooth technology, which has the advantages of being low-power and inexpensive, whilst being able to transfer moderate amounts of data over a versatile, robust and secure radio link, has been widely applied in mobile healthcare as a replacement for cables. This paper discussed the applications of Bluetooth technology in healthcare. It started with the brief description of the history of Bluetooth technology, its technical characteristics, and the latest developments. Then the applications of Bluetooth technology in healthcare sector were reviewed. The applications are based on two basic types of links of Bluetooth technology: point-to-point link and point-to-multipoint link. The special requirements from healthcare and the challenges of successful application of Bluetooth in healthcare will be discussed. At last the future development of Bluetooth technology and its impacts on healthcare were envisioned.

  2. Improving Healthcare Using Big Data Analytics

    Directory of Open Access Journals (Sweden)

    Revanth Sonnati

    2017-03-01

    Full Text Available In daily terms we call the current era as Modern Era which can also be named as the era of Big Data in the field of Information Technology. Our daily lives in todays world are rapidly advancing never quenching ones thirst. The fields of science engineering and technology are producing data at an exponential rate leading to Exabytes of data every day. Big data helps us to explore and re-invent many areas not limited to education health and law. The primary purpose of this paper is to provide an in-depth analysis in the area of Healthcare using the big data and analytics. The main purpose is to emphasize on the usage of the big data which is being stored all the time helping to look back in the history but this is the time to emphasize on the analyzation to improve the medication and services. Although many big data implementations happen to be in-house development this proposed implementation aims to propose a broader extent using Hadoop which just happen to be the tip of the iceberg. The focus of this paper is not limited to the improvement and analysis of the data it also focusses on the strengths and drawbacks compared to the conventional techniques available.

  3. Safety of a dose-escalated pre-workout supplement in recreationally active females.

    Science.gov (United States)

    Vogel, Roxanne M; Joy, Jordan M; Falcone, Paul H; Mosman, Matt M; Kim, Michael P; Moon, Jordan R

    2015-01-01

    Pre-workout supplements (PWS) have increased in popularity among athletic populations for their purported ergogenic benefits. Most PWS contain a "proprietary blend" of several ingredients, such as caffeine, beta-alanine, and nitrate in undisclosed dosages. Currently, little research exists on the safety and potential side effects of chronic consumption of PWS, and even less so involving female populations. Therefore, the purpose of the present study was to examine the safety of consuming a dose-escalated PWS over a 28-day period among active adult females. 34 recreationally active, adult females (27.1 ± 5.4 years, 165.2 ± 5.7 cm, 68.2 ± 16.0 kg) participated in this study. Participants were randomly assigned to consume either 1 (G1) or 2 (G2) servings of a PWS daily or remain unsupplemented (CRL) for a period of 28 days. All were instructed to maintain their habitual dietary and exercise routines for the duration of the study. Fasting blood samples, as well as resting blood pressure and heart rate, were taken prior to and following the supplementation period. Samples were analyzed for hematological and clinical chemistry panels, including lipids. Significant (p < 0.05) group by time interactions were present for absolute monocytes (CRL -0.10 ± 0.10; G1 + 0.03 ± 0.13; G2 + 0.01 ± 0.12×10E3/uL), MCH (CRL -0.13 ± 0.46; G1 + 0.36 ± 0.52; G2 -0.19 ± 0.39 pg), creatinine (CRL 0.00 ± 0.05; G1 -0.06 ± 0.13; G2 -0.14 ± 0.08 mg/dL), eGFR (CRL -0.69 ± 5.97; G1 + 6.10 ± 15.89; G2 + 14.63 ± 7.11 mL/min/1.73), and total cholesterol (CRL -2.44 ± 13.63; G1 + 14.40 ± 27.32; G2 -10.38 ± 15.39 mg/dL). Each of these variables remained within the accepted physiological range. No other variables had significant interactions. The present study confirms the hypothesis that a PWS containing caffeine, beta-alanine, and nitrate will not cause abnormal changes in

  4. Physician leadership: a health-care system's investment in the future of quality care.

    Science.gov (United States)

    Orlando, Rocco; Haytaian, Marcia

    2012-08-01

    The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

  5. Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression.

    Science.gov (United States)

    Price, Owen; Baker, John; Bee, Penny; Lovell, Karina

    2015-06-01

    De-escalation techniques are a recommended non-physical intervention for the management of violence and aggression in mental health. Although taught as part of mandatory training for all National Health Service (NHS) mental health staff, there remains a lack of clarity around training effectiveness. To conduct a systematic review of the learning, performance and clinical safety outcomes of de-escalation techniques training. The review process involved a systematic literature search of 20 electronic databases, eligibility screening of results, data extraction, quality appraisal and data synthesis. A total of 38 relevant studies were identified. The strongest impact of training appears to be on de-escalation-related knowledge, confidence to manage aggression and deescalation performance (although limited to artificial training scenarios). No strong conclusions could be drawn about the impact of training on assaults, injuries, containment and organisational outcomes owing to the low quality of evidence and conflicting results. It is assumed that de-escalation techniques training will improve staff's ability to de-escalate violent and aggressive behaviour and improve safety in practice. There is currently limited evidence that this training has these effects. © The Royal College of Psychiatrists 2015.

  6. Prospective evaluation of a hydrogel spacer for rectal separation in dose-escalated intensity-modulated radiotherapy for clinically localized prostate cancer

    Directory of Open Access Journals (Sweden)

    Eckert Franziska

    2013-01-01

    Full Text Available Abstract Background As dose-escalation in prostate cancer radiotherapy improves cure rates, a major concern is rectal toxicity. We prospectively assessed an innovative approach of hydrogel injection between prostate and rectum to reduce the radiation dose to the rectum and thus side effects in dose-escalated prostate radiotherapy. Methods Acute toxicity and planning parameters were prospectively evaluated in patients with T1-2 N0 M0 prostate cancer receiving dose-escalated radiotherapy after injection of a hydrogel spacer. Before and after hydrogel injection, we performed MRI scans for anatomical assessment of rectal separation. Radiotherapy was planned and administered to 78 Gy in 39 fractions. Results From eleven patients scheduled for spacer injection the procedure could be performed in ten. In one patient hydrodissection of the Denonvillier space was not possible. Radiation treatment planning showed low rectal doses despite dose-escalation to the target. In accordance with this, acute rectal toxicity was mild without grade 2 events and there was complete resolution within four to twelve weeks. Conclusions This prospective study suggests that hydrogel injection is feasible and may prevent rectal toxicity in dose-escalated radiotherapy of prostate cancer. Further evaluation is necessary including the definition of patients who might benefit from this approach. Trial registration: German Clinical Trials Register DRKS00003273.

  7. Missed opportunities in child healthcare

    Directory of Open Access Journals (Sweden)

    Linda Jonker

    2014-01-01

    Full Text Available Background: Various policies in health, such as Integrated Management of Childhood Illnesses, were introduced to enhance integrated service delivery in child healthcare. During clinical practice the researcher observed that integrated services may not be rendered.Objectives: This article describes the experiences of mothers that utilised comprehensive child health services in the Cape Metropolitan area of South Africa. Services included treatment for diseases; preventative interventions such as immunisation; and promotive interventions, such as improvement in nutrition and promotion of breastfeeding.Method: A qualitative, descriptive phenomenological approach was applied to explore the experiences and perceptions of mothers and/or carers utilising child healthcare services. Thirty percent of the clinics were selected purposively from the total population. A convenience purposive non-probability sampling method was applied to select 17 mothers who met the criteria and gave written consent. Interviews were conducted and recorded digitally using an interview guide. The data analysis was done using Tesch’s eight step model.Results: Findings of the study indicated varied experiences. Not all mothers received information about the Road to Health book or card. According to the mothers, integrated child healthcare services were not practised. The consequences were missed opportunities in immunisation, provision of vitamin A, absence of growth monitoring, feeding assessment and provision of nutritional advice.Conclusion: There is a need for simple interventions such as oral rehydration, early recognition and treatment of diseases, immunisation, growth monitoring and appropriate nutrition advice. These services were not offered diligently. Such interventions could contribute to reducing the incidence of child morbidity and mortality.

  8. Healthcare Applications of Smart Watches

    Science.gov (United States)

    Lu, Tsung-Chien; Fu, Chia-Ming; Ma, Matthew Huei-Ming; Fang, Cheng-Chung

    2016-01-01

    Summary Objective The aim of this systematic review is to synthesize research studies involving the use of smart watch devices for healthcare. Materials and Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was chosen as the systematic review methodology. We searched PubMed, CINAHL Plus, EMBASE, ACM, and IEEE Xplore. In order to include ongoing clinical trials, we also searched ClinicalTrials.gov. Two investigators evaluated the retrieved articles for inclusion. Discrepancies between investigators regarding article inclusion and extracted data were resolved through team discussion. Results 356 articles were screened and 24 were selected for review. The most common publication venue was in conference proceedings (13, 54%). The majority of studies were published or presented in 2015 (19, 79%). We identified two registered clinical trials underway. A large proportion of the identified studies focused on applications involving health monitoring for the elderly (6, 25%). Five studies focused on patients with Parkinson’s disease and one on cardiac arrest. There were no studies which reported use of usability testing before implementation. Discussion Most of the reviewed studies focused on the chronically ill elderly. There was a lack of detailed description of user-centered design or usability testing before implementation. Based on our review, the most commonly used platform in healthcare research was that of the Android Wear. The clinical application of smart watches as assistive devices deserves further attention. Conclusion Smart watches are unobtrusive and easy to wear. While smart watch technology supplied with biosensors has potential to be useful in a variety of healthcare applications, rigorous research with their use in clinical settings is needed. PMID:27623763

  9. Agent based simulations in healthcare.

    Science.gov (United States)

    Bilge, Ugur; Saka, Osman

    2006-01-01

    Agent Based Simulations (ABS) is a relatively recent computer paradigm. As opposed to "top down" conventional computer simulations, the ABS approach is a "bottom-up" modelling technique where a medium to high number of independent agents is modelled. These agents' interactions sometimes cause unexpected "emergent" system behaviour. ABS is particularly suitable in the social context such as healthcare where a large number of human agents interact and co-operate for common goals. Today ABS in the social context is often used together with the recently introduced network analysis techniques and network visualization tools for modelling and simulating social agents within organisations. At Akdeniz University we are starting a number of projects for applying ABS technology in healthcare. In this paper we present two of the ongoing projects in this field. Firstly we have developed a prototype simulator for the long term monitoring of Chronic Obstructive Pulmonary Disease (COPD) as a major public health problem. We present the COPD simulator, its agents, parameters and working principles. Secondly we want to apply ABS and the network analysis techniques to visualise and explore informal social networks amongst staff at the Akdeniz University Hospital to assess and evaluate properties of the organisation in terms of its ability to innovate and share knowledge. In our applications, we primarily aim to use ABS in a web-based platform to create a virtual environment for discussion, visualising and running what-if scenarios to test out various options for managing healthcare, as well as sharing information and creating a virtual community.

  10. Decline in the Quality of Family Relationships Predicts Escalation in Children's Internalizing Symptoms from Middle to Late Childhood.

    Science.gov (United States)

    Brock, Rebecca L; Kochanska, Grazyna

    2015-10-01

    An integration of family systems perspectives with developmental psychopathology provides a framework for examining the complex interplay between family processes and developmental trajectories of child psychopathology over time. In a community sample of 98 families, we investigated the evolution of family relationships, across multiple subsystems of the family (i.e., interparental, mother-child, father-child), and the impact of these changing family dynamics on developmental trajectories of child internalizing symptoms over 6 years, from preschool age to pre-adolescence. Parent-child relationship quality was observed during lengthy sessions, consisting of multiple naturalistic, carefully scripted contexts. Each parent completed reports about interparental relationship satisfaction and child internalizing symptoms. To the extent that mothers experienced a steeper decline in interparental relationship satisfaction over time, children developed internalizing symptoms at a faster rate. Further, symptoms escalated at a faster rate to the extent that negative mother-child relationship quality increased (more negative affect expressed by both mother and child, greater maternal power assertion) and positive mother-child relationship quality decreased (less positive affect expressed by both mother and child, less warmth and positive reciprocity). Time-lagged growth curve analyses established temporal precedence such that decline in family relationships preceded escalation in child internalizing symptoms. Results suggest that family dysfunction, across multiple subsystems, represents a driving force in the progression of child internalizing symptoms.

  11. Decline in the Quality of Family Relationships Predicts Escalation in Children’s Internalizing Symptoms from Middle to Late Childhood

    Science.gov (United States)

    Kochanska, Grazyna

    2015-01-01

    An integration of family systems perspectives with developmental psychopathology provides a framework for examining the complex interplay between family processes and developmental trajectories of child psychopathology over time. In a community sample of 98 families, we investigated the evolution of family relationships, across multiple subsystems of the family (i.e., interparental, mother-child, father-child), and the impact of these changing family dynamics on developmental trajectories of child internalizing symptoms over 6 years, from preschool age to pre-adolescence. Parent–child relationship quality was observed during lengthy sessions, consisting of multiple naturalistic, carefully scripted contexts. Each parent completed reports about interparental relationship satisfaction and child internalizing symptoms. To the extent that mothers experienced a steeper decline in interparental relationship satisfaction over time, children developed internalizing symptoms at a faster rate. Further, symptoms escalated at a faster rate to the extent that negative mother-child relationship quality increased (more negative affect expressed by both mother and child, greater maternal power assertion) and positive mother-child relationship quality decreased (less positive affect expressed by both mother and child, less warmth and positive reciprocity). Time-lagged growth curve analyses established temporal precedence such that decline in family relationships preceded escalation in child internalizing symptoms. Results suggest that family dysfunction, across multiple subsystems, represents a driving force in the progression of child internalizing symptoms. PMID:25790794

  12. Stair descending exercise using a novel automatic escalator: effects on muscle performance and health-related parameters.

    Science.gov (United States)

    Paschalis, Vassilis; Theodorou, Anastasios A; Panayiotou, George; Kyparos, Antonios; Patikas, Dimitrios; Grivas, Gerasimos V; Nikolaidis, Michalis G; Vrabas, Ioannis S

    2013-01-01

    A novel automatic escalator was designed, constructed and used in the present investigation. The aim of the present investigation was to compare the effect of two repeated sessions of stair descending versus stair ascending exercise on muscle performance and health-related parameters in young healthy men. Twenty males participated and were randomly divided into two equal-sized groups: a stair descending group (muscle-damaging group) and a stair ascending group (non-muscle-damaging group). Each group performed two sessions of stair descending or stair ascending exercise on the automatic escalator while a three week period was elapsed between the two exercise sessions. Indices of muscle function, insulin sensitivity, blood lipid profile and redox status were assessed before and immediately after, as well as at day 2 and day 4 after both exercise sessions. It was found that the first bout of stair descending exercise caused muscle damage, induced insulin resistance and oxidative stress as well as affected positively blood lipid profile. However, after the second bout of stair descending exercise the alterations in all parameters were diminished or abolished. On the other hand, the stair ascending exercise induced only minor effects on muscle function and health-related parameters after both exercise bouts. The results of the present investigation indicate that stair descending exercise seems to be a promising way of exercise that can provoke positive effects on blood lipid profile and antioxidant status.

  13. O conhecimento tático declarativo e processual em jogadores de futebol de diferentes escalões

    Directory of Open Access Journals (Sweden)

    Diogo Schüler Giacomini

    2011-03-01

    Full Text Available A qualidade na prestação esportiva, nos jogos esportivos coletivos, relaciona-se com as capacidades cognitivas, especificamente com o conhecimento. Esse estudo verificou a associação entre o conhecimento tático processual convergente e divergente, assim como as associações entre o conhecimento tático processual e declarativo. Participaram do estudo 221 jogadores de futebol de campo, do sexo masculino, do escalão sub-14, sub-15 e sub-17. O conhecimento tático processual foi avaliado através da aplicação do teste KORA-OO no parâmetro “oferecer-se” e “orientar-se”. O conhecimento tático declarativo foi avaliado através de cenas-situação do futebol. Os resultados indicaram uma alta associação entre o conhecimento tático processual, convergente e divergente, geral e especifico por escalão, além de uma baixa associação entre o conhecimento tático declarativo e processual (convergente e divergente. Esses dados suportam a idéia de que os conhecimentos progridem serialmente do declarativo ao processual.

  14. Evaluating in a Healthcare Setting

    DEFF Research Database (Denmark)

    Jensen, Janne Jul

    2007-01-01

    The think-aloud protocol, also known as concurrent verbalisation protocol, is widely used in the field of HCI today, but as the technology and applications have evolved the protocol has had to cope with this. Therefore new variations of the protocol have seen the light of day. One example...... is retrospective verbalisation. To compare concurrent and retrospective verbalisation an experiment was conducted. A home healthcare application was evaluated with 15 participants using both protocols. The results of the experiment show that the two protocols have each their strengths and weaknesses...

  15. Romanian healthcare system at a glance

    Directory of Open Access Journals (Sweden)

    Christiana Balan

    2013-04-01

    Full Text Available The Romanian healthcare system is facing constant challenges to produce high quality care with low costs. Objectives The paper aims to analyze the efficiency of the Romanian healthcare system in terms of resources allocation. The evaluation and the dimension of healthcare system efficiency are important for identifying a balance between the resources required and the health outcomes. Prior Work Previous studies describe the Romanian healthcare system as a system in transition. This study focuses on the relationship between the inputs and outputs of the system. Approach In order to assess the efficiency of the Romanian healthcare system we use Data Envelopment Analysis approach. Both input and output healthcare indicators are observed for the period 1999-2010 and the years when healthcare inputs have been used efficiently are identified. Results The results show that human, financial, and technological resources have been used at maximum capacity in 1999, 2003, 2004, 2007 and 2010. Implications Though efficiency is defined differently by diverse stakeholders, healthcare policies should focus on rising the responsibility of communities and individuals for better treatments and services and better access to information on healthcare providers. Value The paper is an empirically based study of the healthcare resources allocation in Romania.

  16. Public perceptions of healthcare in Singapore.

    Science.gov (United States)

    Lim, Jeremy Fy; Joshi, Veena Dhanajay

    2008-02-01

    Understanding public perceptions of healthcare delivery is important to guide policy formulation and practice as well as to identify areas where public health communication needs to be strengthened to overcome misconceptions and allay unfounded concerns. We conducted a survey of Singapore residents to determine perceptions of the affordability and quality of healthcare in Singapore. A sampling frame was drawn from the 2005/2006 edition of the telephone directory. One thousand seven hundred and eighty-three respondents were interviewed via telephone and asked to rank their agreement with statements pertaining to healthcare cost and quality on a 5-point Likert scale. Respondents were representative of the general population in ethnicity and housing type but lower income households were over-represented. 79.6% of respondents agreed that Singapore had a good healthcare system and 57.5% agreed that the government provided good and affordable healthcare to Singaporeans. The majority agreed that healthcare was generally affordable, especially at polyclinics (78%) and restructured hospitals (50%) and that the quality of healthcare in Singapore was high. Comparing primary and tertiary care, there was uniformity in the perception of quality at both levels but respondents assessed tertiary healthcare to be less affordable (P Singapore healthcare is generally regarded to be high although there are growing concerns regarding the affordability of healthcare.

  17. Healthcare access: A sequence-sensitive approach

    Directory of Open Access Journals (Sweden)

    Marco J. Haenssgen

    2017-12-01

    Full Text Available It is widely accepted that healthcare-seeking behaviour is neither limited to nor terminated by access to one single healthcare provider. Yet the sequential conceptualisation of healthcare-seeking processes has not diffused into quantitative research, which continues to analyse healthcare access as a “one-off” event. The ensuing lack of understanding healthcare behaviour is problematic in light of the immense burden of premature death especially in low- and middle-income countries. This paper presents an alternative approach. Based on a novel survey instrument, we analyse original survey data from rural India and China that contain 119 unique healthcare pathways among 637 respondents. We offer three applications of how such sequential data can be analysed to enhance our understanding of people's health behaviour. First, descriptive analysis of sequential data enables more a comprehensive representation of people's health behaviours, for example the time spent in various healthcare activities, common healthcare pathways across different groups, or shifts in healthcare provider access during a typical illness. Second, by analysing the effect of mobile technology on healthcare-seeking process characteristics, we demonstrate that conventional, sequence-insensitive indicators are potentially inconsistent and misleading approximations when compared to a more precise, sequence-sensitive measure. Third, we describe how sequential data enable transparent and flexible evaluations of people's healthcare behaviour. The example of a sequence-insensitive evaluation suggests that household wealth has no statistical link to an illustrative “ideal” form of public healthcare utilisation. In contrast, sequence-sensitive evaluations demonstrate that household wealth is associated with an increased likelihood of bypassing referral processes and approaching unregulated and costly informal and private practitioners before accessing a public clinic. Sequential

  18. Future applications of electronic-nose technologies in healthcare and biomedicine

    Science.gov (United States)

    Alphus D. Wilson

    2011-01-01

    The development and utilization of many new electronic-nose (e-nose) applications in the healthcare and biomedical fields have continued to rapidly accelerate over the past 20 years. Innovative e-nose technologies are providing unique solutions to a diversity of complex problems in biomedicine that are now coming to fruition. A wide range of electronic-nose instrument...

  19. Simulation, Mastery Learning and Healthcare.

    Science.gov (United States)

    Dunn, William; Dong, Yue; Zendejas, Benjamin; Ruparel, Raaj; Farley, David

    2017-02-01

    Healthcare organizations, becoming increasingly complex, need to use simulation techniques as a tool to provide consistently safe care. Mastery learning techniques minimize variation in learner outcome, thus improving the consistency and cost-effectiveness of care. Today׳s organizations (and their teams of decision makers) exist within varying states of transformation. These transformational times afford opportunities to use mastery learning concepts at an organizational level and to affect necessary change(s). Evolving technologies, including simulation, have provided mechanisms to enhance system performance, reducing reliance on custom-built "problem-solving" solutions for individual system needs. As such, simulation has emerged as an increasingly necessary organizational tool in improving value-driven, consistent processes of care. Both computer-based and non-computer-based algorithms of healthcare simulations offer distinct advantages in improving system performance over traditional methods of quality improvement. Simulation as a process engineering tool, integrated with mastery learning techniques, provides powerful platforms for improving value-based care. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  20. Cuba: healthcare and the revolution.

    Science.gov (United States)

    Binns, L A

    2013-03-01

    This paper depicts Cuba as a relic of the Cold War Its coverage of healthcare demonstrates steadfastness and success in surmounting hurdles of complacency and disregard to socialized medicine - an extension of Soviet patronage and third world alliances. The literature relays a mission of inclusivity underpinned by political ideology and a conviction to humanity. With the aid ofendorsements, it speaks to contrasts and critiques in service and results by reflecting on the delivery offree healthcare for all Cuban citizens and its impression on the eradication of numerous diseases, reduced mortality rate and increased life expectancy. Punished by the longest trade embargo in modern history, the regime is in possession of limited resources to expedite remedy to its subjects. Such, much to the dislike of the authorities, elevates elements of distinction in association with the dispensation of service and drugs demonstrated by an evolving two-tier system for the disenfranchised and privileged clientele while simultaneously impacting the maintenance of facilities and equipment. Consequently, it recognizes harsh ramifications attributed to compliance with ideology and subtle adjustments to withstand external exertion. The Cuban replica is currently a tale of sorts awaiting a comprehensible definition for future generations.

  1. [Plan for stroke healthcare delivery].

    Science.gov (United States)

    Alvarez Sabín, J; Alonso de Leciñana, M; Gállego, J; Gil-Peralta, A; Casado, I; Castillo, J; Díez Tejedor, E; Gil, A; Jiménez, C; Lago, A; Martínez-Vila, E; Ortega, A; Rebollo, M; Rubio, F

    2006-12-01

    All stroke patients should receive the same degree of specialized healthcare attention according to the stage of their disease, independently of where they live, their age, gender or ethnicity. To create an organized healthcare system able to offer the needed care for each patient, optimizing the use of the existing resource. A committee of 14 neurologists specialized in neurovascular diseases representing different regions of Spain evaluated the available scientific evidence according to the published literature. During the acute phase, all stroke patients must be evaluated in hospitals that offer access to specialized physicians (neurologists) and the indicated diagnostic and therapeutic procedures. Hospitals that deliver care to acute stroke patients must be prepared to attend these patients and need to arrange a predefined transferring circuit coordinated with the extrahospitalary emergency service. Since resources are limited, they should be structured into different care levels according to the target population. Thus, three types of hospitals will be defined for stroke care: reference stroke hospital, hospital with stroke unit, hospital with stroke team.

  2. Trump proposes initial healthcare agenda

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-11-01

    Full Text Available No abstract available. Article truncated at 150 words. On Friday, November 11, President-elect Trump proposed a healthcare agenda on his website greatagain.gov (1. Yesterday, November 12, he gave an interview on 60 Minutes clarifying his positions (2. Trump said that he wanted to focus on healthcare and has proposed to: •Repeal all of the Affordable Care Act; •Allow the sale of health insurance across state lines; •Make the purchase of health insurance fully tax deductible; •Expand access to the health savings accounts;•Increase price transparency; •Block grant Medicaid; •Lower entrance barriers to new producers of drugs. In his 60 Minutes interview Trump reiterated that two provisions of the ACA – prohibition of pre-existing conditions exclusion and ability for adult children to stay on parents insurance plans until age 26 – have his support (2. Other aspects of the ACA that might receive his support were not discussed. On the Department of Veterans’ Affairs ...

  3. Contact Allergy in Danish Healthcare Workers

    DEFF Research Database (Denmark)

    Schwensen, Jakob F; Menné, Torkil; Sommerlund, Mette

    2015-01-01

    Contact dermatitis in healthcare workers is a pan-European problem. We conducted a retrospective observational study of the patch-test results of 1402 healthcare workers and 1402 matched controls with contact dermatitis who were treated at 3 hospitals departments in Denmark between 2007 and 2014....... The primary objective was to determine whether healthcare work was associated with contact allergy to thiuram mix. Unadjusted univariate analyses revealed that healthcare work was significantly associated with occupational contact dermatitis and hand dermatitis. Contact allergy to thiuram mix was more common...... in healthcare workers was significantly associated with having occupational contact dermatitis, hand dermatitis and older age. In conclusion, we report here a potential problem of contact allergy to thiurams in healthcare workers with contact dermatitis. Legislative authorities may in the future focus...

  4. Requirements for Interoperability in Healthcare Information Systems

    Directory of Open Access Journals (Sweden)

    Rita Noumeir

    2012-01-01

    Full Text Available Interoperability is a requirement for the successful deployment of Electronic Health Records (EHR. EHR improves the quality of healthcare by enabling access to all relevant information at the diagnostic decision moment, regardless of location. It is a system that results from the cooperation of several heterogeneous distributed subsystems that need to successfully exchange information relative to a specific healthcare process. This paper analyzes interoperability impediments in healthcare by first defining them and providing concrete healthcare examples, followed by discussion of how specifications can be defined and how verification can be conducted to eliminate those impediments and ensure interoperability in healthcare. This paper also analyzes how Integrating the Healthcare Enterprise (IHE has been successful in enabling interoperability, and identifies some neglected aspects that need attention.

  5. The making of a European healthcare union

    DEFF Research Database (Denmark)

    Vollaard, Hans; van de Bovenkamp, Hester M.; Martinsen, Dorte Sindbjerg

    2016-01-01

    that federalism offers the most fruitful way to do so because of its sensitivity to the EU’s institutional settings and to the territorial dimension of politics. The division of competences and national diversity of healthcare systems have been major obstacles for the formation of a healthcare union. However......, the EU obtained a role in healthcare through the impact of non-healthcare legislation, voluntary co-operation, court rulings, governments’ joint-decision traps, and fiscal stress of member states. The emerging European healthcare union is a system of cooperative federalism without much cost......-sharing. The healthcare union’s robustness is limited, also because it does not generate much loyalty towards the EU....

  6. Occupational Hazards in the Thai Healthcare Sector.

    Science.gov (United States)

    Tipayamongkholgul, Mathuros; Luksamijarulkul, Pipat; Mawn, Barbara; Kongtip, Pornpimol; Woskie, Susan

    2016-05-01

    Healthcare personnel work in vulnerable conditions that can adversely impact physical and/or mental health. This paper aims to synthesize the state of knowledge on work-related illnesses, injuries, and risks experienced by Thai healthcare workers. We found that Thai healthcare personnel, like others worldwide, are at risk for injury related to needle sticks and sharp instruments; infectious diseases due to biological hazards exposure such as airborne pathogens and patient secretions; muscle pain due to workload and long duration of work; and psychological disorders related to stressful working conditions. Because detailed surveillance data are limited for the Thai healthcare workforce, we recommend that additional surveillance data on Thai healthcare workers' health outcomes be collected. Future research efforts should also focus on evidence-based interventions in order to develop methods to prevent and treat occupational health injuries and illnesses acquired in the workplace for Thai healthcare sector workers. © The Author(s) 2016.

  7. Methods of responding to healthcare security incidents.

    Science.gov (United States)

    Furnell, S; Gritzalis, D; Katsikas, S; Mavroudakis, K; Sanders, P; Warren, M

    1998-01-01

    This paper considers the increasing requirement for security in healthcare IT systems and, in particular, identifies the need for appropriate means by which healthcare establishments (HCEs) may respond to incidents. The main discussion focuses upon two significant initiatives that have been established in order to improve understanding and awareness of healthcare security issues. The first is the establishment of a dedicated Incident Reporting Scheme (IRS) for HCEs, enabling the level and types of security incidents faced within the healthcare community to be monitored and advice appropriately targeted. The second aspect presents a description of healthcare security World Wide Web service, which provides a comprehensive source of advice and guidance for establishments when trying to address and prevent IT security breaches. The discussion is based upon work that is currently being undertaken with the ISHTAR (Implementing Secure Healthcare Telematics Applications in Europe) project, as part of the Telematics Applications for Health programme of the European Commission.

  8. Healthcare service delivery: a literature review

    CSIR Research Space (South Africa)

    Arhete, LE

    2016-05-01

    Full Text Available . These features can be traced back to the days in South African history where healthcare facilities were racially segregated and both curative and preventive healthcare services were separated by the Public Health Amendment act of 1897 (Coovadia et al. 2009... was greeted with enormous reform measures to redress the discrimination, disempowerment, underdevelopment and ill-health service delivery that had greatly weakened the healthcare system. Although the government has implemented bold initiatives to strengthen...

  9. Macroergonomics in Healthcare Quality and Patient Safety

    OpenAIRE

    Carayon, Pascale; Karsh, Ben-Tzion; Gurses, Ayse P; Holden, Richard; Hoonakker, Peter; Hundt, Ann Schoofs; Montague, Enid; Rodriguez, Joy; Wetterneck, Tosha B.

    2013-01-01

    The US Institute of Medicine and healthcare experts have called for new approaches to manage healthcare quality problems. In this chapter, we focus on macroergonomics, a branch of human factors and ergonomics that is based on the systems approach and considers the organizational and sociotechnical context of work activities and processes. Selected macroergonomic approaches to healthcare quality and patient safety are described such as the SEIPS model of work system and patient safety and the ...

  10. Mobile healthcare in the home environment.

    Science.gov (United States)

    Price, Sheila; Summers, Ron

    2006-01-01

    Mobile healthcare provision in the home environment presents many challenges. Patients are becoming more informed about the management of chronic conditions and the use of technology to support the process is rising. Issues such as system interoperability, cost, security and training all have to be addressed to ensure effective use of mobile devices within the home healthcare arena. An aging population will impact upon traditional healthcare delivery methods.

  11. Complexity science and leadership in healthcare.

    Science.gov (United States)

    Burns, J P

    2001-10-01

    The emerging field of complexity science offers an alternative leadership strategy for the chaotic, complex healthcare environment. A survey revealed that healthcare leaders intuitively support principles of complexity science. Leadership that uses complexity principles offers opportunities in the chaotic healthcare environment to focus less on prediction and control and more on fostering relationships and creating conditions in which complex adaptive systems can evolve to produce creative outcomes.

  12. Healthcare mergers and acquisitions: strategies for consolidation.

    Science.gov (United States)

    Zuckerman, Alan M

    2011-01-01

    The passage of federal healthcare reform legislation, in combination with other factors, makes it likely that the next few years will be a major period of consolidation for healthcare organizations. This article examines the seven key forces reshaping healthcare delivery--from insurance industry consolidation to cost inflation to the increasing gap between financially strong and struggling providers--and provides advice for organizations on both sides of an acquisition.

  13. Digital health is a cultural transformation of traditional healthcare.

    Science.gov (United States)

    Meskó, Bertalan; Drobni, Zsófia; Bényei, Éva; Gergely, Bence; Győrffy, Zsuzsanna

    2017-01-01

    Under the term "digital health", advanced medical technologies, disruptive innovations and digital communication have gradually become inseparable from providing best practice healthcare. While the cost of treating chronic conditions is increasing and doctor shortages are imminent worldwide, the needed transformation in the structure of healthcare and medicine fails to catch up with the rapid progress of the medical technology industry. This transition is slowed down by strict regulations; the reluctance of stakeholders in healthcare to change; and ignoring the importance of cultural changes and the human factor in an increasingly technological world. With access and adoption of technology getting higher, the risk of patients primarily turning to an accessible, but unregulated technological solution for their health problem is likely to increase. In this paper, we discuss how the old paradigm of the paternalistic model of medicine is transforming into an equal level partnership between patients and professionals and how it is aided and augmented by disruptive technologies. We attempt to define what digital health means and how it affects the status quo of care and also the study design in implementing technological innovations into the practice of medicine.

  14. Information overload in healthcare: too much of a good thing?

    Science.gov (United States)

    Klerings, Irma; Weinhandl, Alexandra S; Thaler, Kylie J

    2015-01-01

    The rapidly growing production of healthcare information - both scientific and popular - increasingly leads to a situation of information overload affecting all actors of the healthcare system and threatening to impede the adoption of evidence-based practice. In preparation for the 2015 Cochrane Colloquium in Vienna, we discuss the issues faced by three major actors of this system: patients, healthcare practitioners, and systematic reviewers. We analyze their situation through the concept of "filter failure", positing that the main problem is not that there is "too much information", but that the traditional means of managing and evaluating information are ill-suited to the realities of the digital age. Some of the major instances of filter failure are inadequate information retrieval systems for point-of-care settings, the problem of identifying all relevant evidence in an exceedingly diverse landscape of information resources, and the very basic lack of health information literacy, concerning not only the general public. Finally, we give an overview of proposed solutions to the problem of information overload. These new or adapted filtering systems include adapting review literature to the specific needs of practitioners or patients, technological improvements to information systems, strengthening the roles of intermediaries, as well as improving health literacy. Copyright © 2015. Published by Elsevier GmbH.

  15. A clear case for conscience in healthcare practice.

    Science.gov (United States)

    Birchley, Giles

    2012-01-01

    The value of conscience in healthcare ethics is widely debated. While some sources present it as an unquestionably positive attribute, others question both the veracity of its decisions and the effect of conscientious objection on patient access to health care. This paper argues that the right to object conscientiously should be broadened, subject to certain previsos, as there are many benefits to healthcare practice in the development of the consciences of practitioners. While effects such as the preservation of moral integrity are widely considered to benefit practitioners, this paper draws on the work of Hannah Arendt to offer several original arguments in defence of conscience that may more directly benefit patients, namely that a pang of conscience may be useful in rapidly unfolding situations in which there is no time to reflect satisfactorily upon activities and that, given the hierarchical nature of healthcare institutions, a right to defy authority on the basis of conscience may benefit junior staff who lack the institutional power to challenge the orders of superiors.

  16. Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes.

    Science.gov (United States)

    Cillino, S; Raimondi, G; Guépratte, N; Damiani, S; Cillino, M; Di Pace, F; Casuccio, A

    2010-04-01

    To investigate the long-term effectiveness and safety of botulinum neurotoxin A (BoNT-A) treatment in patients with blepharospasm (BEB), hemifacial spasm (HFS), and entropion (EN) and to use for the first time two modified indexes, 'botulin toxin escalation index-U' (BEI-U) and 'botulin toxin escalation index percentage' (BEI-%), in the dose-escalation evaluation. All patients in this multicentre study were followed for at least 10 years and main outcomes were clinical efficacy, duration of relief, BEI-U and BEI-%, and frequency of adverse events. BEB, HFS, and EN patients received a mean BoNT-A dose with a significant inter-group difference (P<0.0005, respectively). The mean (+/-SD) effect duration was statistically different (P=0.009) among three patient groups. Regarding the BoNT-A escalation indexes, the mean (+/-SD) values of BEI-U and BEI-% were statistically different (P=0.035 and 0.047, respectively) among the three groups. In BEB patients, the BEI-% was significantly increased in younger compared with older patients (P=0.008). The most frequent adverse events were upper lid ptosis, diplopia, ecchymosis, and localized bruising. This long-term multicentre study supports a high efficacy and good safety profile of BoNT-A for treatment of BEB, HFS, and EN. The BEI indexes indicate a significantly greater BoNT-A-dose escalation for BEB patients compared with HFS or EN patients and a significantly greater BEI-% in younger vsolder BEB patients. These results confirm a greater efficacy in the elderly and provide a framework for long-term studies with a more flexible and reliable evaluation of drug-dose escalation.

  17. Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal.

    Science.gov (United States)

    Ruiz-Casares, Mónica; Cleveland, Janet; Oulhote, Youssef; Dunkley-Hickin, Catherine; Rousseau, Cécile

    2016-01-01

    Following changes to the Interim Federal Health (IFH) program in Canada in 2012, this study investigates health service providers' knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40-49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues.

  18. Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal.

    Directory of Open Access Journals (Sweden)

    Mónica Ruiz-Casares

    Full Text Available Following changes to the Interim Federal Health (IFH program in Canada in 2012, this study investigates health service providers' knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40-49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues.

  19. Healthcare operations management through use of simulation

    CERN Document Server

    Mustafee, Navonil; Williams, Michael D

    2012-01-01

    Over the past decades healthcare organisations have grown in size and complexity and healthcare costs have outpaced economic growth. In countries where healthcare is publicly-funded, increasing costs have traditionally meant a rise in the healthcare budgets in real terms; however, the ongoing global financial and economic crisis (2007-present) has had spending implications on governmental budgets for public resources in several countries. This apparent contradiction - "provide better service at a lesser cost" - which may last for years to come therefore necessitates the careful use of the allo

  20. Group profile management in ubiquitous healthcare environment.

    Science.gov (United States)

    Fengou, Maria-Anna; Mantas, Georgios; Lymberopoulos, Dimitrios

    2012-01-01

    Nowadays, ubiquitous healthcare is of utmost importance in the patient-centric model. Furthermore, the personalization of ubiquitous healthcare services plays a very important role to make the patient-centric model a reality. The personalization of the ubiquitous healthcare services is based on the profiles of the entities participating in these services. In this paper, we propose a group profile management system in a ubiquitous healthcare environment. The proposed system is responsible for the dynamic creation of a group profile and its management.

  1. Steering healthcare service delivery: a regulatory perspective.

    Science.gov (United States)

    Prakash, Gyan

    2015-01-01

    The purpose of this paper is to explore regulation in India's healthcare sector and makes recommendations needed for enhancing the healthcare service. The literature was reviewed to understand healthcare's regulatory context. To understand the current healthcare system, qualitative data were collected from state-level officials, public and private hospital staff. A patient survey was performed to assess service quality (QoS). Regulation plays a central role in driving healthcare QoS. India needs to strengthen market and institutional co-production based approaches for steering its healthcare in which delivery processes are complex and pose different challenges. This study assesses current healthcare regulation in an Indian state and presents a framework for studying and strengthening regulation. Agile regulation should be based on service delivery issues (pull approach) rather than monitoring and sanctions based regulatory environment (push approach). Healthcare pitfalls across the world seem to follow similar follies. India's complexity and experience is useful for emerging and developed economies. The author reviewed around 70 publications and synthesised them in healthcare regulatory contexts. Patient's perception of private providers could be a key input towards steering regulation. Identifying gaps across QoS dimensions would be useful in taking corrective measures.

  2. Incentives and intrinsic motivation in healthcare

    Directory of Open Access Journals (Sweden)

    Mikel Berdud

    2016-11-01

    Conclusions: The conclusions could act as a guide to support the optimal design of incentive policies and schemes within health organisations when healthcare professionals are intrinsically motivated.

  3. Rapid Prototyping Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — The ARDEC Rapid Prototyping (RP) Laboratory was established in December 1992 to provide low cost RP capabilities to the ARDEC engineering community. The Stratasys,...

  4. Implementación de un módulo de adaptación de contenidos multimedia escalable para entornos centralizados y distribuidos

    OpenAIRE

    Díaz Ribalaiga, Pedro

    2007-01-01

    Implementación de un módulo de adaptación de contenidos multimedia escalable para entornos centralizados y distribuidos La existencia de un sistema escalable que gestione los recursos de la forma más eficiente posible es un punto importante que se ha de tener siempre en cuenta en el desarrollo de cualquier servicio, de él depende, en parte, su éxito. En este documento se dará una solución a la problemática de escalabilidad del módulo de gestión y adaptación de contenidos del Pr...

  5. Uncertainty "escalation" and use of machine learning to forecast residual and data model uncertainties

    Science.gov (United States)

    Solomatine, Dimitri

    2016-04-01

    some variant of the Monte Carlo simulation when values of parameters or inputs are sampled from the assumed distributions and the model is run multiple times to generate multiple outputs. This is the most widely used approach. The data generated by Monte Carlo analysis can be used to build a machine learning model which will be able to make predictions of model uncertainty for the future his method is named MLUE (Machine Learning for Uncertainty Estimation) and is covered in [4,5] With this in mind, one may consider the following framework based on the stepwise "building up" (or "escalation") of the model uncertainty: • first consider the residual uncertainty of an optimal model M (X, p*) • then add and consider the model uncertainty due the parameters uncertainty (p) • then add and consider the model uncertainty due the data (mainly, input) uncertainty (X) • then add and consider the structural uncertainty of the model M (X, p). The paper presents the details of this framework and examples if its application in hydrological forecasting. This study is partly supported by the FP7 European Project WeSenseIt Citizen Water Observatory (www.http://wesenseit.eu/). References [1] Koenker, R., and G. Bassett (1978). Regression quantiles. Econometrica, 46(1), 33- 50, doi:10.2307/1913643. [2] D.L. Shrestha, D.P. Solomatine (2006). Machine learning approaches for estimation of prediction interval for the model output. Neural Networks J., 19(2), 225-235. [3] D.P. Solomatine, D.L. Shrestha (2009). A novel method to estimate model uncertainty using machine learning techniques. Water Resources Res. 45, W00B11. [4] D. L. Shrestha, N. Kayastha, and D. P. Solomatine. A novel approach to parameter uncertainty analysis of hydrological models using neural networks. Hydrol. Earth Syst. Sci., 13, 1235-1248, 2009. [5] F. Pianosi and L. Raso (2012). Dynamic modeling of predictive uncertainty by regression on absolute errors. WRR, 48, W03516. [6] Shrestha, D.L., Kayastha, N., Solomatine

  6. Urgent Need to Orient Public Health Response to Rapid Nutrition Transition

    Directory of Open Access Journals (Sweden)

    Umesh Kapil

    2012-01-01

    Full Text Available India is currently undergoing a rapid transition on economic, demographic, epidemiologic, nutrition, and sociological fronts. There is evidence of a decline in undernutrition with a simultaneous escalation in overnutrition and associated non-communicable diseases (NCDs. However, the current concern and national policy response for tackling malnutrition in India is still primarily restricted to undernutrition diagnosed on the basis of body size (anthropometry. A complex range of interacting factors have been linked to the rising trend of overnutrition and associated NCDs from a global perspective. The burden of overnutrition and associated morbidities is rapidly escalating to alarming proportions, particularly in urban areas and high socio-economic status groups. The poor are not spared from this transition. It is predicted that a more rapid transition may occur amongst poor populations in future with higher economic development. The need of the hour is to launch an integrated public health response to the dual burden beginning from pregnancy and early life. This will obviously require careful deliberation of the strategy and interventions, and a multi-sectoral approach, especially involving the health, women and child development, nutrition, education, agriculture, food processing, trade, architecture, water supply and sanitation, community and non-governmental organizations.

  7. Innovations in primary mental healthcare.

    Science.gov (United States)

    Reifels, Lennart; Bassilios, Bridget; King, Kylie E; Fletcher, Justine R; Blashki, Grant; Pirkis, Jane E

    2013-06-01

    We review the evidence on innovations in Tier 2 of the Access to Allied Psychological Services (ATAPS) program, which is designed to facilitate the provision of primary mental healthcare to hard-to-reach and at-risk population groups (including women with perinatal depression, people at risk of self-harm or suicide, people experiencing or at risk of homelessness, people affected by the 2009 Victorian bushfires, people in remote locations, Aboriginal and Torres Strait Islanders and children with mental disorders) and the trialling of new modalities of service delivery (e.g. telephone-based or web-based CBT). The primary focus is on the uptake, outcomes and issues associated with the provision of ATAPS Tier 2. Drawing on data from an ongoing national ATAPS evaluation, including a national minimum dataset, key informant interviews and surveys, the impact of ATAPS innovations is analysed and illustrated through program examples. ATAPS Tier 2 facilitates access to, uptake of and positive clinical outcomes from primary mental healthcare for population groups with particular needs, although it requires periods of time to implement locally. Relatively simple innovations in mental health program design can have important practical ramifications for service provision, extending program reach and improving mental health outcomes for target populations. What is known about the topic? It is recognised that innovative approaches are required to tailor mental health programs for hard-to-reach and at-risk population groups. Divisions of General Practice have implemented innovations in the Access to Allied Psychological Services (ATAPS) program for several years. What does this paper add? Drawing on data from an ongoing national ATAPS evaluation, this paper presents a systematic analysis of the uptake, outcomes and issues associated with provision of the innovative ATAPS program. What are the implications for practitioners? The findings highlight the benefits of introducing

  8. Traceability in healthcare: crossing boundaries.

    Science.gov (United States)

    Lovis, C

    2008-01-01

    This paper is a survey on the problem of traceability in healthcare. Traceability covers many different aspects and its understanding varies among different players. In supply chains and retails, traceability usually covers aspects pertaining to logistics. The challenge is to keep trace of objects manufactured, to track their locations in a production and distribution processes. In food industry, traceability has received a lot of attention because of public health problems related to infectious diseases. For instance, in Europe, the challenge of traceability has been to build the tracking of meat, from the living animal to the shell. In the health sector, traceability has mostly been involved in patient safety around human products such as blood derivates contaminants or implanted devices and prosthesis such as mammary implants. There are growing interests involving traceability in health related to drug safety, including the problem of counterfeited drugs, and to privacy. Traceability is also increasingly seen as a mean to improve efficiency of the logistics of care and a way to better understand costs and usage of resources. This survey is reviewing the literature and proposes a discussion based on the real use and needs of traceability in a large teaching hospital. Traceability in healthcare is at the crossroads of numerous needs. It is therefore of particular complexity and raises many new challenges. Identification management and entity tracking, from serialization of consumers' good production in the supply chains, to the identification of actors, patients, care providers, locations and processes is a huge effort, tackling economical, political, ethical and technical challenges. New requirements are needed, not usually met in the supply chain, such as serialization and persistence in time. New problems arise, such as privacy and legal frameworks. There are growing needs to increase traceability for drug products, related to drug safety, counterfeited drugs

  9. Do It Yourself solution of Internet of Things Healthcare System: Measuring body parameters and environmental parameters affecting health.

    Directory of Open Access Journals (Sweden)

    Mirjana Maksimović

    2016-03-01

    Full Text Available The rapid advancements in information and communications technologies (ICT and the increasing number of smart things shift an old-fashioned healthcare system to a model better suited for a population of the 21st century. New healthcare approaches based on Internet of Things (IoT/Internet of Medical Things (IoMT powered systems make health monitoring, diagnostics and treatment more personalized, timely and convenient, enabling a global approach to the healthcare system infrastructure development. Commercial systems in this area exist in various forms but usually do not fit the general patient needs, and those that do are usually economically unacceptable due to the high operational and development costs. Do It Yourself (DIY healthcare, including mobile applications and consumer medical devices, nowadays is the top healthcare trend. Therefore, this paper, based on well-known low-cost technologies, presents a DIY IoMT solution for observing human vital parameter as well as environmental factors affecting health.

  10. Dose Escalation of Total Marrow Irradiation With Concurrent Chemotherapy in Patients With Advanced Acute Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Jeffrey Y.C., E-mail: jwong@coh.org [Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California (United States); Forman, Stephen; Somlo, George [Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California (United States); Rosenthal, Joseph [Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California (United States); Department of Pediatrics, City of Hope National Medical Center, Duarte, California (United States); Liu An; Schultheiss, Timothy; Radany, Eric [Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California (United States); Palmer, Joycelynne [Department of Biostatistics, City of Hope National Medical Center, Duarte, California (United States); Stein, Anthony [Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California (United States)

    2013-01-01

    Purpose: We have demonstrated that toxicities are acceptable with total marrow irradiation (TMI) at 16 Gy without chemotherapy or TMI at 12 Gy and the reduced intensity regimen of fludarabine/melphalan in patients undergoing hematopoietic cell transplantation (HCT). This article reports results of a study of TMI combined with higher intensity chemotherapy regimens in 2 phase I trials in patients with advanced acute myelogenous leukemia or acute lymphoblastic leukemia (AML/ALL) who would do poorly on standard intent-to-cure HCT regimens. Methods and Materials: Trial 1 consisted of TMI on Days -10 to -6, etoposide (VP16) on Day -5 (60 mg/kg), and cyclophosphamide (CY) on Day -3 (100 mg/kg). TMI dose was 12 (n=3 patients), 13.5 (n=3 patients), and 15 (n=6 patients) Gy at 1.5 Gy twice daily. Trial 2 consisted of busulfan (BU) on Days -12 to -8 (800 {mu}M min), TMI on Days -8 to -4, and VP16 on Day -3 (30 mg/kg). TMI dose was 12 (n=18) and 13.5 (n=2) Gy at 1.5 Gy twice daily. Results: Trial 1 had 12 patients with a median age of 33 years. Six patients had induction failures (IF), and 6 had first relapses (1RL), 9 with leukemia blast involvement of bone marrow ranging from 10%-98%, 5 with circulating blasts (24%-85%), and 2 with chloromas. No dose-limiting toxicities were observed. Eleven patients achieved complete remission at Day 30. With a median follow-up of 14.75 months, 5 patients remained in complete remission from 13.5-37.7 months. Trial 2 had 20 patients with a median age of 41 years. Thirteen patients had IF, and 5 had 1RL, 2 in second relapse, 19 with marrow blasts (3%-100%) and 13 with peripheral blasts (6%-63%). Grade 4 dose-limiting toxicities were seen at 13.5 Gy (stomatitis and hepatotoxicity). Stomatitis was the most frequent toxicity in both trials. Conclusions: TMI dose escalation to 15 Gy is possible when combined with CY/VP16 and is associated with acceptable toxicities and encouraging outcomes. TMI dose escalation is not possible with BU/VP16 due to

  11. SU-E-T-183: Feasibility of Extreme Dose Escalation for Glioblastoma Multiforme Using 4π Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, D; Rwigema, J; Yu, V; Kaprealian, T; Kupelian, P; Selch, M; Low, D; Sheng, K [Department of Radiation Oncology, UCLA, Los Angeles, CA (United States)

    2014-06-01

    Purpose: GBM recurrence primarily occurs inside or near the high-dose radiation field of original tumor site requiring greater than 100 Gy to significantly improve local control. We utilize 4π non-coplanar radiotherapy to test the feasibility of planning target volume (PTV) margin expansions or extreme dose escalations without incurring additional radiation toxicities. Methods: 11 GBM patients treated with VMAT to a prescription dose of 59.4 Gy or 60 Gy were replanned with 4π. Original VMAT plans were created with 2 to 4 coplanar or non-coplanar arcs using 3 mm hi-res MLC. The 4π optimization, using 5 mm MLC, selected and inverse optimized 30 beams from a candidate pool of 1162 beams evenly distributed through 4π steradians. 4π plans were first compared to clinical plans using the same prescription dose. Two more studies were then performed to respectively escalate the GTV and PTV doses to 100 Gy, followed by a fourth plan expanding the PTV by 5 mm and maintaining the prescription dose. Results: The standard 4π plan significantly reduced (p<0.01) max and mean doses to critical structures by a range of 47.0–98.4% and 61.0–99.2%, respectively. The high dose PTV/high dose GTV/expanded PTV studies showed a reduction (p<0.05) or unchanged* (p>0.05) maximum dose of 72.1%/86.7%/77.1% (chiasm), 7.2%*/27.7%*/30.7% (brainstem), 39.8%*/84.2%/51.9%* (spinal cord), 69.0%/87.0%/66.9% (L eye), 76.2%/88.1%/84.1% (R eye), 95.0%/98.6%/97.5% (L lens), 93.9%/98.8%/97.6% (R lens), 74.3%/88.5%/72.4% (L optical nerve), 80.4%/91.3%/75.7% (R optical nerve), 64.8%/84.2%/44.9%* (L cochlea), and 85.2%/93.0%/78.0% (R cochlea), respectively. V30 and V36 for both brain and (brain - PTV) were reduced for all cases except the high dose PTV plan. PTV dose coverage increased for all 4π plans. Conclusion: Extreme dose escalation or further margin expansion is achievable using 4π, maintaining or reducing OAR doses. This study indicates that clinical trials employing 4π delivery using

  12. Understanding bullying in healthcare organisations.

    Science.gov (United States)

    Allen, Belinda

    2015-12-02

    Bullying is a pervasive problem in healthcare organisations. Inquiries and reports on patient care and poor practice in the NHS have emphasised the substantial negative effects this behaviour may have on patient care. If bullying is to be addressed, it is crucial we develop clarity about what behaviours constitute bullying and how these behaviours differ from other negative behaviours in the workplace. It is important that we recognise the extent of the problem; statistics on the prevalence of bullying are likely to be an underestimate because of under-reporting of bullying. Effective interventions may only be designed and implemented if there is knowledge about what precipitates bullying and the magnitude of the changes required in organisations to tackle bullying. Individuals should also be aware of the options that are available to them should they be the target of bullying behaviour and what they should do if they witness bullying in their workplace.

  13. Spirituality in the Healthcare Workplace

    Directory of Open Access Journals (Sweden)

    Donia Baldacchino

    2017-11-01

    Full Text Available Spirituality involves a sense of connectedness, meaning making and transcendence. There is abundant published research that focuses on the importance of spirituality to patients and their families during times of illness and distress. However over the last decade there has also been a growing awareness about the importance of considering the need to address peoples’ spiritual needs in the workplace. Engaging in ones own personal spirituality involves connecting with the inner self, becoming more self aware of ones humanity and limitations. Engaging with ones personal spirituality can also mean that people begin to greater find meaning and purpose in life and at work. This may be demonstrated in the workplace by collegial relationships and teamwork. Those who engage with their own spirituality also engage more easily with others through a connectedness with other staff and by aligning their values with the respective organization if they fit well with ones personal values. Workplace spirituality is oriented towards self-awareness of an inner life which gives meaning, purpose and nourishment to the employees’ dynamic relationships at the workplace and is eventually also nourished by meaningful work. Exercising ones personal spirituality contributes towards generating workplace spirituality. Essentially acting from ones own personal spirituality framework by being in doing can contribute towards a person becoming a healing and therapeutic presence for others, that is nourishing in many workplaces. Personal spirituality in healthcare can be enhanced by: reflection in and on action; role-modeling; taking initiative for active presence in care; committing oneself to the spiritual dimension of care; and, integrating spirituality in health caregivers’ education. As spirituality is recognized as becoming increasingly important for patients in healthcare, increasing educational opportunities are now becoming available for nurses internationally that

  14. Mindful Application of Aviation Practices in Healthcare.

    Science.gov (United States)

    Powell-Dunford, Nicole; Brennan, Peter A; Peerally, Mohammad Farhad; Kapur, Narinder; Hynes, Jonny M; Hodkinson, Peter D

    2017-12-01

    Evidence supports the efficacy of incorporating select recognized aviation practices and procedures into healthcare. Incident analysis, debrief, safety brief, and crew resource management (CRM) have all been assessed for implementation within the UK healthcare system, a world leader in aviation-based patient safety initiatives. Mindful application, in which aviation practices are specifically tailored to the unique healthcare setting, show promise in terms of acceptance and long-term sustainment. In order to establish British healthcare applications of aviation practices, a PubMed search of UK authored manuscripts published between 2005-2016 was undertaken using search terms 'aviation,' 'healthcare,' 'checklist,' and 'CRM.' A convenience sample of UK-authored aviation medical conference presentations and UK-authored patient safety manuscripts were also reviewed. A total of 11 of 94 papers with UK academic affiliations published between 2005-2016 and relevant to aviation modeled healthcare delivery were found. The debrief process, incident analysis, and CRM are the primary practices incorporated into UK healthcare, with success dependent on cultural acceptance and mindful application. CRM training has gained significant acceptance in UK healthcare environments. Aviation modeled incident analysis, debrief, safety brief, and CRM training are increasingly undertaken within the UK healthcare system. Nuanced application, in which the unique aspects of the healthcare setting are addressed as part of a comprehensive safety approach, shows promise for long-term success. The patient safety brief and aviation modeled incident analysis are in earlier phases of implementation, and warrant further analysis.Powell-Dunford N, Brennan PA, Peerally MF, Kapur N, Hynes JM, Hodkinson PD. Mindful application of aviation practices in healthcare. Aerosp Med Hum Perform. 2017; 88(12):1107-1116.

  15. Healthcare professionals' perspectives on environmental sustainability.

    Science.gov (United States)

    Dunphy, Jillian L

    2014-06-01

    Human health is dependent upon environmental sustainability. Many have argued that environmental sustainability advocacy and environmentally responsible healthcare practice are imperative healthcare actions. What are the key obstacles to healthcare professionals supporting environmental sustainability? How may these obstacles be overcome? Data-driven thematic qualitative analysis of semi-structured interviews identified common and pertinent themes, and differences between specific healthcare disciplines. A total of 64 healthcare professionals and academics from all states and territories of Australia, and multiple healthcare disciplines were recruited. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were de-identified to protect participant anonymity. Qualitative analysis indicated that Australian healthcare professionals often take more action in their personal than professional lives to protect the environment, particularly those with strong professional identities. The healthcare sector's focus on economic rationalism was a substantial barrier to environmentally responsible behaviour. Professionals also feared conflict and professional ostracism, and often did not feel qualified to take action. This led to healthcare professionals making inconsistent moral judgements, and feeling silenced and powerless. Constraints on non-clinical employees within and beyond the sector exacerbated these difficulties. The findings are consistent with the literature reporting that organisational constraints, and strong social identification, can inhibit actions that align with personal values. This disparity can cause moral distress and residue, leading to feelings of powerlessness, resulting in less ethical behaviour. The data highlight a disparity between personal and professional actions to address environmental sustainability. Given the constraints Australian healthcare professionals encounter, they are unlikely to

  16. Healthcare Firms and the ERP Systems

    Directory of Open Access Journals (Sweden)

    A. Garefalakis

    2016-04-01

    Full Text Available With the continuous and drastic changes due to the economic crisis, along with the increasing market demands, major reforms are initiated in the healthcare sector in order to improve the quality of healthcare and operational efficiency, while reducing costs and optimizing back-end operations. ERP systems have been the basic technological infrastructure to many sectors as well as healthcare. The main objective of this study is to discuss how the adoption of ERP systems in healthcare organizations improves their functionality, simplifies their business processes, assure the quality of care services and helps their management accounting and controlling. This study presents also the stages required for the implementation of ERP system in healthcare organizations. This study utilizes a literature review in order to reach the research conclusions. Specifically, through related case studies and research, it examines how ERP systems are used to evaluate the better functionality of the healthcare organizations, addressing in parallel important problems, and possible malfunctions. The implementation of ERP systems in healthcare organizations promises to evolve and align strictly to the organizations’ corporate objectives and high-levels of healthcare quality. In order to accomplish this goal, the right decisions should be made by the managers of the healthcare organization regarding the choice of the appropriate ERP system following its installation and its application. Limited research exists on the significance ERP systems implementation in healthcare organizations, while possible dysfunctions and challenges during its installation and implementation are recorded. Therefore, new evidence in the significance of ERP systems in healthcare organization is provided.

  17. Improving Healthcare through Lean Management: Experiences from the Danish healthcare system

    DEFF Research Database (Denmark)

    Edwards, Kasper; Nielsen, Anders Paarup

    of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare...

  18. Inequalities in healthcare provision for individuals with substance use disorders : Perspectives from healthcare professionals and clients

    NARCIS (Netherlands)

    van Boekel, L.C.; Brouwers, E.P.M.; van Weeghel, J.; Garretsen, H.F.L.

    2016-01-01

    Background: Little is known about inequalities in healthcare provision for individuals with substance use disorders. The main objective of this study was to assess expectations and perceptions of inequalities in healthcare provision among healthcare professionals (HCPs) and clients in treatment for

  19. Telemedicine and its transformation of emergency care: a case study of one of the largest US integrated healthcare delivery systems.

    Science.gov (United States)

    Sharma, Rahul; Fleischut, Peter; Barchi, Daniel

    2017-12-01

    Innovative methods for delivering healthcare via the use of technology are rapidly growing. Despite the passage of the Affordable Care Act, emergency department visits have continued to rise nationally. Healthcare systems must devise solutions to face these increasing volumes and also deliver high quality care. In response to the changing healthcare landscape, New York Presbyterian Hospital has implemented a comprehensive enterprise wide digital health portfolio which includes the first mobile stroke treatment unit on the east coast and the first emergency department-based digital emergency care program in New York City.

  20. CRF neurons in the ventral tegmental area control the aversive effects of nicotine withdrawal and promote escalation of nicotine intake

    Science.gov (United States)

    Grieder, Taryn E.; Herman, Melissa A.; Contet, Candice; Tan, Laura A.; Vargas-Perez, Hector; Cohen, Ami; Chwalek, Michal; Maal-Bared, Geith; Freiling, John; Schlosburg, Joel E; Clarke, Laura; Crawford, Elena; Koebel, Pascale; Canonigo, Vez; Sanna, Pietro; Tapper, Andrew; Roberto, Marisa; Kieffer, Brigitte L.; Sawchenko, Paul E.; Koob, George F.; van der Kooy, Derek; George, Olivier

    2014-01-01

    SUMMARY Dopaminergic neurons in the ventral tegmental area (VTA) are well known for their role in mediating the positive reinforcing effects of drugs of abuse. Here, we identify in rodents and humans a population of VTA dopamine neurons co-expressing corticotropin releasing factor (CRF). We provide further evidence in rodents that chronic nicotine exposure upregulates CRF mRNA in dopaminergic neurons of the posterior VTA, activates local CRF1 receptors, and blocks nicotine-induced activation of transient GABAergic input to dopaminergic neurons. Local downregulation of CRF mRNA and specific pharmacological blockade of CRF1 receptors in the VTA reversed the effect of nicotine on GABAergic input to dopaminergic neurons, prevented the aversive effects of nicotine withdrawal, and limited the escalation of nicotine intake. These results link the brain reward and stress systems within the same brain region in signaling the negative motivational effects of nicotine withdrawal. PMID:25402857

  1. A Phase I dose-escalation study of afatinib combined with nintedanib in patients with advanced solid tumors.

    Science.gov (United States)

    Gordon, Michael S; Springett, Gregory M; Su, Yungpo Bernard; Ould-Kaci, Mahmoud; Wind, Sven; Zhao, Yihua; LoRusso, Patricia M

    2015-01-01

    To evaluate the safety and maximum tolerated dose (MTD) of afatinib combined with nintedanib. Patients received afatinib 10-20 mg daily plus nintedanib 150-200 mg twice daily (28-day cycle). Dose escalation followed a 3+3 design. Patients received afatinib/nintedanib: 10/150 mg (n = 11); 10/200 mg (n = 13; MTD); 20/200 mg (n = 4). Four patients had dose-limiting toxicities (all grade 3): increased alanine aminotransferase (afatinib/nintedanib: 10/150 mg), diarrhea (10/200 mg), dehydration (20/200 mg), diarrhea with elevated liver enzymes (20/200 mg). Frequent treatment-related adverse events were diarrhea, nausea, anorexia, fatigue and vomiting. In total, 14 patients (46.2%) had objective responses at the MTD. The MTD, afatinib 10 mg daily plus nintedanib 200 mg twice daily, had a manageable safety profile, but was considered subtherapeutic for Phase II evaluation.

  2. The role of motivation, responsibility, and integrative complexity in crisis escalation: comparative studies of war and peace crises.

    Science.gov (United States)

    Winter, David G

    2007-05-01

    Drawing on D. G. Winter's (1993) comparison of 1914 and the Cuban Missile Crisis, the author identified 8 paired crises (1 escalating to war, 1 peacefully resolved). Documents (diplomatic messages, speeches, official media commentary) from each crisis were scored for power, affiliation, and achievement motivation; text measures of responsibility and activity inhibition; and integrative complexity. Aggregated effect-size results show that war crises had significantly higher levels of power motivation and responsibility, whereas peace crises showed trends toward higher integrative complexity and achievement motivation. Follow-up analyses suggested that these results are robust with respect to both sides in a crisis, type of material scored, and historical time. The power motive results extend previous findings, but the responsibility results suggest that responsibility plays a paradoxical role in war. Future research directions are sketched, and the role of psychological content analysis in monitoring the danger of war is discussed. ((c) 2007 APA, all rights reserved).

  3. Harmful Algal Blooms in Asia: an insidious and escalating water pollution phenomenon with effects on ecological and human health

    Directory of Open Access Journals (Sweden)

    Patricia M Glibert

    2014-02-01

    Full Text Available Harmful Algal Blooms (HABs, those proliferations of algae that causeenvironmental, economic, or human health problems, are increasing in frequency,duration, and geographic extent due to nutrient pollution. The scale of the HABproblem in Asia has escalated in recent decades in parallel with the increase in useof agricultural fertilizer, the development of aquaculture, and a growing population.Three examples, all from China but illustrative of the diversity of events and theirecological, economic, and human health effects throughout Asia, are highlightedhere. These examples include inland (Lake Tai or Taihu as well as offshore (EastChina Sea and Yellow Sea waters. The future outlook for controlling these bloomsis bleak. The effects of advancing industrialized agriculture and a continually growingpopulation will continue to result in more nutrient pollution and more HABs—-and more effects - in the foreseeable future.

  4. A randomized, pilot trial comparing full versus escalating dose regimens for the desensitization of AIDS patients allergic to sulfonamides

    Directory of Open Access Journals (Sweden)

    Straatmann Andrea

    2002-01-01

    Full Text Available Sulfonamides are drugs extensively used in the management of AIDS patients. However, the use of sulfonamides is often associated with the development of allergic reactions, provoking the substitution of the drug (by another that may be less effective; alternatively attempts are made to desensitize the patient. OBJECTIVE: Compare two drug regimens (full vs. escalating doses for the oral desensitization of AIDS patients allergic to sulfonamides. MATERIAL AND METHODS: AIDS patients with previous allergic reactions to sulfonamides and requiring prophylaxis against Pneumocistis carinii, central nervous system toxoplasmosis and diarrhea caused by Isospora belli were randomly assigned to a group receiving a routine dose of cothrimoxazole, or another that received escalating doses of an oral suspension of the same drug, initiating with 75mg/day of sulfamethoxazole that was doubled every 48 hours till the full dose was reached, if no allergic reaction occurred. Patients were monitored for at least 6 months after enrollment in the trial. The major end-point was the ability to maintain prophylactic treatment after that period of time. Plasma viral load (PVL and CD4/CD8 counts were measured at baseline. Liver enzymes and hematological parameters were measured at baseline and after 1, 3 and 6 months. RESULTS: Eighteen patients were enrolled in the study (15 men and 3 women, with ages ranging from 30 to 57 years (mean 39.9. The mean CD4 counts were slightly higher for patients receiving a full dose; there was also a trend towards higher baseline CD8 counts among patients developing new reactions. The mean PVL was similar among the patients in both desensitization groups. The incidence of new allergic reactions was identical (40% in the two groups. All adverse reactions were mild and no significant increase in liver enzymes were observed. CONCLUSON: Dose regimen is not a predictor of the development of new allergic reactions amongst patients challenged with

  5. Phase I dose escalation trial of docetaxel plus curcumin in patients with advanced and metastatic breast cancer.

    Science.gov (United States)

    Bayet-Robert, Mathilde; Kwiatkowski, Fabrice; Leheurteur, Marianne; Gachon, Françoise; Planchat, Eloïse; Abrial, Catherine; Mouret-Reynier, Marie-Ange; Durando, Xavier; Barthomeuf, Chantal; Chollet, Philippe

    2010-01-01

    Since the improvement of chemotherapy with safe molecules is needed for a better efficacy without supplementary toxicity, we investigated the feasibility and tolerability of the combination of docetaxel and curcumin, a polyphenolic derivative extracted from Curcuma longa root. Fourteen patients were accrued in this open-label phase I trial. At the last dose level of curcumin, three dose-limiting toxicities were observed and two out of three patients at this dose level refused to continue treatment, leading us to define the maximal tolerated dose of curcumin at 8,000 mg/d. Eight patients out of 14 had measurable lesions according to RECIST criteria, with five PR and three SD. Some improvements as biological and clinical responses were observed in most patients. Patients with advanced or metastatic breast cancer were eligible. Docetaxel (100 mg/m(2)) was administered as a 1 h i.v. infusion every 3 w on d 1 for six cycles. Curcumin was orally given from 500 mg/d for seven consecutive d by cycle (from d-4 to d+2) and escalated until a dose-limiting toxicity should occur. The primary endpoint of this study was to determine the maximal tolerated dose of the combination of dose-escalating curcumin and standard dose of docetaxel chemotherapy in advanced and metastatic breast cancer patients. Secondary objectives included toxicity, safety, vascular endothelial growth factor and tumor markers measurements and assessment of objective and clinical responses to the combination therapy. The recommended dose of curcumin is 6,000 mg/d for seven consecutive d every 3 w in combination with a standard dose of docetaxel. From the encouraging efficacy results, a comparative phase II trial of this regimen plus docetaxel versus docetaxel alone is ongoing in advanced and metastatic breast cancer patients.

  6. A randomized, pilot trial comparing full versus escalating dose regimens for the desensitization of AIDS patients allergic to sulfonamides

    Directory of Open Access Journals (Sweden)

    Andrea Straatmann

    Full Text Available Sulfonamides are drugs extensively used in the management of AIDS patients. However, the use of sulfonamides is often associated with the development of allergic reactions, provoking the substitution of the drug (by another that may be less effective; alternatively attempts are made to desensitize the patient. OBJECTIVE: Compare two drug regimens (full vs. escalating doses for the oral desensitization of AIDS patients allergic to sulfonamides. MATERIAL AND METHODS: AIDS patients with previous allergic reactions to sulfonamides and requiring prophylaxis against Pneumocistis carinii, central nervous system toxoplasmosis and diarrhea caused by Isospora belli were randomly assigned to a group receiving a routine dose of cothrimoxazole, or another that received escalating doses of an oral suspension of the same drug, initiating with 75mg/day of sulfamethoxazole that was doubled every 48 hours till the full dose was reached, if no allergic reaction occurred. Patients were monitored for at least 6 months after enrollment in the trial. The major end-point was the ability to maintain prophylactic treatment after that period of time. Plasma viral load (PVL and CD4/CD8 counts were measured at baseline. Liver enzymes and hematological parameters were measured at baseline and after 1, 3 and 6 months. RESULTS: Eighteen patients were enrolled in the study (15 men and 3 women, with ages ranging from 30 to 57 years (mean 39.9. The mean CD4 counts were slightly higher for patients receiving a full dose; there was also a trend towards higher baseline CD8 counts among patients developing new reactions. The mean PVL was similar among the patients in both desensitization groups. The incidence of new allergic reactions was identical (40% in the two groups. All adverse reactions were mild and no significant increase in liver enzymes were observed. CONCLUSON: Dose regimen is not a predictor of the development of new allergic reactions amongst patients challenged with

  7. Genetic mapping of escalated aggression in wild-derived mouse strain MSM/Ms: association with serotonin-related genes

    Directory of Open Access Journals (Sweden)

    Aki eTakahashi

    2014-06-01

    Full Text Available The Japanese wild-derived mouse strain MSM/Ms (MSM retains a wide range of traits related to behavioral wildness, including high levels of emotionality and avoidance of humans. In this study, we observed that MSM showed a markedly higher level of aggression than the standard laboratory strain C57BL/6J. Whereas almost all MSM males showed high frequencies of attack bites and pursuit in the resident-intruder test, only a few C57BL/6J males showed aggressive behaviors, with these behaviors observed at only a low frequency. Sexually mature MSM males in their home cages killed their littermates, or sometimes female pair-mates. To study the genetic and neurobiological mechanisms that underlie the escalated aggression observed in MSM mice, we analyzed reciprocal F1 crosses and five consomic strains of MSM (Chr 4, 13, 15, X and Y against the background of C57BL/6J. We identified two chromosomes, Chr 4 and Chr 15, which were involved in the heightened aggression observed in MSM. These chromosomes had different effects on aggression: whereas MSM Chr 15 increased agitation and initiation of aggressive events, MSM Chr 4 induced a maladaptive level of aggressive behavior. Expression analysis of mRNAs of serotonin receptors, serotonin transporter and Tph2, an enzyme involved in serotonin synthesis in seven brain areas, indicated several differences among MSM, C57BL/6J, and their consomic strains. We found that Tph2 expression in the midbrain was increased in the Chr 4 consomic strain, as well as in MSM, and that there was a strong positive genetic correlation between aggressive behavior and Tph2 expression at the mRNA level. Therefore, it is possible that increased expression of the Tph2 gene is related to escalated aggression observed in MSM.

  8. Multicenter, Phase 1, Dose Escalation Study of Hypofractionated Stereotactic Radiation Therapy With Bevacizumab for Recurrent Glioblastoma and Anaplastic Astrocytoma.

    Science.gov (United States)

    Clarke, Jennifer; Neil, Elizabeth; Terziev, Robert; Gutin, Philip; Barani, Igor; Kaley, Thomas; Lassman, Andrew B; Chan, Timothy A; Yamada, Josh; DeAngelis, Lisa; Ballangrud, Ase; Young, Robert; Panageas, Katherine S; Beal, Kathryn; Omuro, Antonio

    2017-11-15

    To establish the maximum tolerated dose of a 3-fraction hypofractionated stereotactic reirradiation schedule when delivered with concomitant bevacizumab to treat recurrent high-grade gliomas. Patients with recurrent high-grade glioma with Karnofsky performance status ≥60, history of standard fractionated initial radiation, tumor volume at recurrence ≤40 cm3, and absence of brainstem or corpus callosum involvement were eligible. A standard 3+3 phase 1 dose escalation trial design was utilized, with dose-limiting toxicities defined as any grade 3 to 5 toxicities possibly, probably, or definitely related to radiation. Bevacizumab was given at a dose of 10 mg/kg every 2 weeks. Hypofractionated stereotactic reirradiation was initiated after 2 bevacizumab doses, delivered in 3 fractions every other day, starting at 9 Gy per fraction. A total of 3 patients were enrolled at the 9 Gy × 3 dose level cohort, 5 in the 10 Gy × 3 cohort, and 7 in the 11 Gy × 3 cohort. One dose-limiting toxicity of grade 3 fatigue and cognitive deterioration possibly related to hypofractionated stereotactic reirradiation was observed in the 11 Gy × 3 cohort, and this dose was declared the maximum tolerated dose in combination with bevacizumab. Although no symptomatic radionecrosis was observed, substantial treatment-related effects and necrosis were observed in resected specimens. The intent-to-treat median overall survival was 13 months. Reirradiation using a 3-fraction schedule with bevacizumab support is feasible and reasonably well tolerated. Dose-escalation was possible up to 11 Gy × 3, which achieves a near doubling in the delivered biological equivalent dose to normal brain, in comparison with our previous 6 Gy × 5 schedule. Promising overall survival warrants further investigation. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Phase 1 Dose Escalation Study of Accelerated Radiation Therapy With Concurrent Chemotherapy for Locally Advanced Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kelsey, Chris R., E-mail: christopher.kelsey@duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Das, Shiva [Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina (United States); Gu, Lin [Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (United States); Dunphy, Frank R.; Ready, Neal E. [Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina (United States); Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina (United States)

    2015-12-01

    Purpose: To determine the maximum tolerated dose of radiation therapy (RT) given in an accelerated fashion with concurrent chemotherapy using intensity modulated RT. Methods and Materials: Patients with locally advanced lung cancer (non-small cell and small cell) with good performance status and minimal weight loss received concurrent cisplatin and etoposide with RT. Intensity modulated RT with daily image guidance was used to facilitate esophageal avoidance and delivered using 6 fractions per week (twice daily on Fridays with a 6-hour interval). The dose was escalated from 58 Gy to a planned maximum dose of 74 Gy in 4 Gy increments in a standard 3 + 3 trial design. Dose-limiting toxicity (DLT) was defined as acute grade 3-5 nonhematologic toxicity attributed to RT. Results: A total of 24 patients were enrolled, filling all dose cohorts, all completing RT and chemotherapy as prescribed. Dose-limiting toxicity occurred in 1 patient at 58 Gy (grade 3 esophagitis) and 1 patient at 70 Gy (grade 3 esophageal fistula). Both patients with DLTs had large tumors (12 cm and 10 cm, respectively) adjacent to the esophagus. Three additional patients were enrolled at both dose cohorts without further DLT. In the final 74-Gy cohort, no DLTs were observed (0 of 6). Conclusions: Dose escalation and acceleration to 74 Gy with intensity modulated RT and concurrent chemotherapy was tolerable, with a low rate of grade ≥3 acute esophageal reactions.

  10. A Phase I Dose Escalation Study of Hypofractionated IMRT Field-in-Field Boost for Newly Diagnosed Glioblastoma Multiforme

    Energy Technology Data Exchange (ETDEWEB)

    Monjazeb, Arta M., E-mail: arta.monjazeb@ucdmc.ucdavis.edu [U.C. Davis School of Medicine, Department of Radiation Oncology, Sacramento, CA (United States); Ayala, Deandra; Jensen, Courtney [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Case, L. Douglas [Biostatistical Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Bourland, J. Daniel; Ellis, Thomas L. [Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, NC (United States); McMullen, Kevin P.; Chan, Michael D. [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Tatter, Stephen B. [Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Lesser, Glen J. [Hematology Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Shaw, Edward G. [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States)

    2012-02-01

    Objectives: To describe the results of a Phase I dose escalation trial for newly diagnosed glioblastoma multiforme (GBM) using a hypofractionated concurrent intensity-modulated radiotherapy (IMRT) boost. Methods: Twenty-one patients were enrolled between April 1999 and August 2003. Radiotherapy consisted of daily fractions of 1.8 Gy with a concurrent boost of 0.7 Gy (total 2.5 Gy daily) to a total dose of 70, 75, or 80 Gy. Concurrent chemotherapy was not permitted. Seven patients were enrolled at each dose and dose limiting toxicities were defined as irreversible Grade 3 or any Grade 4-5 acute neurotoxicity attributable to radiotherapy. Results: All patients experienced Grade 1 or 2 acute toxicities. Acutely, 8 patients experienced Grade 3 and 1 patient experienced Grade 3 and 4 toxicities. Of these, only two reversible cases of otitis media were attributable to radiotherapy. No dose-limiting toxicities were encountered. Only 2 patients experienced Grade 3 delayed toxicity and there was no delayed Grade 4 toxicity. Eleven patients requiring repeat resection or biopsy were found to have viable tumor and radiation changes with no cases of radionecrosis alone. Median overall and progression-free survival for this cohort were 13.6 and 6.5 months, respectively. One- and 2-year survival rates were 57% and 19%. At recurrence, 15 patients received chemotherapy, 9 underwent resection, and 5 received radiotherapy. Conclusions: Using a hypofractionated concurrent IMRT boost, we were able to safely treat patients to 80 Gy without any dose-limiting toxicity. Given that local failure still remains the predominant pattern for GBM patients, a trial of dose escalation with IMRT and temozolomide is warranted.

  11. A phase I dose-escalation and bioequivalence study of a trastuzumab biosimilar in healthy male volunteers.

    Science.gov (United States)

    Wisman, Liselijn A B; De Cock, Eduard P M; Reijers, Joannes A A; Kamerling, Ingrid M C; Van Os, Sandra H G; de Kam, Marieke L; Burggraaf, Jacobus; Voortman, Gerrit

    2014-12-01

    Trastuzumab (Herceptin(®)) is a humanized monoclonal antibody targeting the human epidermal growth factor receptor 2 (HER2) and is used in the treatment of HER2-overexpressing breast and gastric cancer. FTMB is being developed as a biosimilar of trastuzumab. In this combined dose-escalation and bioequivalence study of parallel design, the pharmacokinetic profile of FTMB was compared with Herceptin(®). Healthy male volunteers received single doses of 0.5, 1.5, 3.0 or 6.0 mg/kg FTMB, or placebo, in consecutive dose-escalation cohorts to assess the safety profile. Thereafter, the 6 mg/kg cohort was expanded to establish bioequivalence between FTMB (Test) and Herceptin(®) (Reference) based on an acceptance interval of 80.0-125.0 %. In total, 118 subjects were enrolled in the study. The mean area under the concentration-time curve from time zero to infinity (AUC∞) was 1,609 µg·day/mL (Test) and 1,330 µg·day/mL (Reference). The log-transformed geometric mean Test/Reference (T/R) ratio for AUC∞ was 89.6 % (90 % confidence interval [CI] 85.1-94.4), demonstrating bioequivalence. For the secondary endpoint, the maximum concentration observed (Cmax), the geometric mean T/R ratio was 89.4 % (90 % CI 83.4-95.9). Non-linear, target-mediated pharmacokinetics were also observed. Adverse events other than the documented side effects of Herceptin(®) (fever, influenza-like illness, and fatigue) did not occur. No signs of cardiotoxicity were observed. This bioequivalence study with a trastuzumab biosimilar in healthy male volunteers demonstrated bioequivalence of FTMB with Herceptin(®). FTMB was well tolerated in doses up to 6 mg/kg. Non-linear target elimination was also observed in the pharmacokinetic profile of trastuzumab.

  12. Effects of donepezil dose escalation in Parkinson's patients with dementia receiving long-term donepezil treatment: an exploratory study.

    Science.gov (United States)

    Ishikawa, Kei-Ichi; Motoi, Yumiko; Mizuno, Yoshikuni; Kubo, Shin-Ichiro; Hattori, Nobutaka

    2014-06-01

    The benefits of escalating the dose of donepezil in patients who are already receiving long-term treatment with it have not been well evaluated. Therefore, an exploratory study to assess the effects of donepezil dose escalation in patients with Parkinson's disease with dementia, and specifically on patients receiving long-term treatment with donepezil, was performed. Patients treated with 5-mg/day donepezil for at least 3 months and having a Mini-Mental State Examination (MMSE) score between 10 and 26 were included in this study. Donepezil dosage was then increased to 10 mg/day for 12 weeks. The outcome measures were a modified form of the Neuropsychiatric Inventory (NPI) with an extra domain for additional evaluation of fluctuation in cognitive functions (NPI-11) and the MMSE. Of the nine patients enrolled, two withdrew because of nausea and inability to be assessed on the predetermined date; this left seven participants (four men and three women) with a mean age of 74.6 ± 6.9 years, a mean period of Parkinson's disease of 11.7 ± 7.5 years, and median donepezil use of 7 months (range: 3-56 months). At baseline, the mean total NPI-11 and mean MMSE scores were 18.3 ± 5.6 points and 21.3 ± 5.3 points, respectively. At week 12, they improved by 8.3 points (P donepezil from 5 mg/day to 10 mg/day may be therapeutically useful for patients with Parkinson's disease with dementia who have taken donepezil 5 mg/day in the long term. © 2014 The Authors. Psychogeriatrics © 2014 Japanese Psychogeriatric Society.

  13. Social defeat stress in rats: Escalation of cocaine and “speedball” binge self-administration, but not heroin

    Science.gov (United States)

    Cruz, Fabio C.; Quadros, Isabel M.; Hogenelst, Koen; Planeta, Cleopatra S.; Miczek, Klaus A.

    2013-01-01

    Rationale Exposure to intermittent episodes of social defeat stress can increase drug seeking and leads to intense drug taking in rats. Objectives This study investigated the consequences of repeated, intermittent social defeat stress on patterns of drug self-administration in rats with access to heroin, cocaine, or a heroin-cocaine combination (“speedball”). Methods Male Long-Evans rats were either handled (controls) or subjected to 25 min social defeat stress episodes on days 1, 4, 7 and 10 during confrontations with an aggressive resident. Ten days following the last defeat, rats were assessed for locomotor cross-sensitization in response to heroin or cocaine. Animals were then prepared with intrajugular catheters for drug self-administration. Separate groups of controls and defeated rats were examined for self-administration of heroin (Experiment 1), a heroin-cocaine combination (Experiment 2), or cocaine (Experiment 3). Drug self-administration patterns were evaluated using fixed or progressive ratio schedules (FR, PR respectively) of reinforcement during limited access sessions or a 24-h unlimited access binge. Results Rats with a history of intermittent social defeat stress showed sensitized locomotor behavior when challenged with heroin or cocaine relative to controls. During the 24-h binge session, defeated rats escalated cocaine taking behavior (ca. 110 mg/kg vs. 66 mg/kg in controls), persisted in self-administering cocaine or the heroin-cocaine mixture for more hours, and showed a tendency for increased heroin-cocaine intake, but no effects on heroin taking. Conclusions A history of social defeat stress seems to preferentially promote escalated intake of cocaine but not heroin, unless a heroin-cocaine combination is available. PMID:21197616

  14. Social defeat stress in rats: escalation of cocaine and "speedball" binge self-administration, but not heroin.

    Science.gov (United States)

    Cruz, Fabio C; Quadros, Isabel M; Hogenelst, Koen; Planeta, Cleopatra S; Miczek, Klaus A

    2011-05-01

    Exposure to intermittent episodes of social defeat stress can increase drug seeking and leads to intense drug taking in rats. This study investigated the consequences of repeated, intermittent social defeat stress on patterns of drug self-administration in rats with access to heroin, cocaine, or a heroin-cocaine combination ("speedball"). Male Long-Evans rats were either handled (controls) or subjected to 25-min social defeat stress episodes on days 1, 4, 7, and 10 during confrontations with an aggressive resident. Ten days following the last defeat, rats were assessed for locomotor cross-sensitization in response to heroin or cocaine. Animals were then prepared with intrajugular catheters for drug self-administration. Separate groups of controls and defeated rats were examined for self-administration of heroin (experiment 1), a heroin-cocaine combination (experiment 2), or cocaine (experiment 3). Drug self-administration patterns were evaluated using fixed or progressive ratio schedules of reinforcement during limited access sessions or a 24-h unlimited access binge. Rats with a history of intermittent social defeat stress showed sensitized locomotor behavior when challenged with heroin or cocaine relative to controls. During the 24-h binge session, defeated rats escalated cocaine-taking behavior (ca. 110 mg/kg vs. 66 mg/kg in controls), persisted in self-administering cocaine or the heroin-cocaine mixture for more hours, and showed a tendency for increased heroin-cocaine intake, but no effects on heroin taking. A history of social defeat stress seems to preferentially promote escalated intake of cocaine but not heroin, unless a heroin-cocaine combination is available.

  15. Dose escalation of radiotherapy for metastatic spinal cord compression (MSCC) in patients with relatively favorable survival prognosis

    Energy Technology Data Exchange (ETDEWEB)

    Rades, Dirk [Luebeck Univ. (Germany). Dept. of Radiation Oncology; Hamburg Univ. (Germany). Dept. of Radiation Oncology; Panzner, Annika [Luebeck Univ. (Germany). Dept. of Radiation Oncology; Rudat, Volker [Saad Specialist Hospital, Al-Khobar (Saudi Arabia). Dept. of Radiation Oncology; Hamburg Univ. (Germany). Dept. of Radiation Oncology; Karstens, Johann H. [Medical School Hannover (Germany). Dept. of Radiation Oncology; Schild, Steven E. [Mayo Clinic, Scottsdale, AZ (United States). Dept. of Radiation Oncology

    2011-11-15

    Local control of metastatic spinal cord compression (MSCC) is particularly important for long-term survivors. Radiotherapy alone is the most common treatment for MSCC. The most frequently used schedule world wide is 30 Gy/10 fractions. This study investigated whether patients with favorable survival prognoses benefit from a dose escalation beyond 30 Gy. Data from 191 patients treated with 30 Gy/10 fractions were matched to 191 patients (1:1) receiving higher doses (37.5 Gy/15 fractions or 40 Gy/20 fractions). All patients had favorable survival prognoses based on a validated scoring system and were matched for age, gender, tumor type, performance status, number of involved vertebrae, visceral or other bone metastases, interval from tumor diagnosis to radiotherapy, ambulatory status, and time developing motor deficits. Both groups were compared for local control, progression-free survival, overall survival, and functional outcome. Local control rates at 2 years were 71 % after 30 Gy and 92 % after higher doses (p = 0.012). Two-year progression-free survival rates were 68 % and 90 %, respectively (p = 0.013). Two-year overall survival rates were 53 % and 68 %, respectively (p = 0.032). Results maintained significance in the multivariate analyses (Cox proportional hazards model; stratified model) with respect to local control (p = 0.011; p = 0.012), progression-free survival (p = 0.010; p = 0.018), and overall survival (p = 0.014; p = 0.015). Functional outcome was similar in both groups. Motor function improved in 40 % of patients after 30 Gy and 41 % after higher doses (p = 0.98). Escalation of the radiation dose beyond 30 Gy resulted in significantly better local control, progression-free survival, and overall survival in patients with favorable survival prognoses. (orig.)

  16. Phase 1 Study of Dose Escalation in Hypofractionated Proton Beam Therapy for Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gomez, Daniel R., E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gillin, Michael [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liao, Zhongxing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, Caimiao [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H.; Swanick, Cameron; Alvarado, Tina; Komaki, Ritsuko; Cox, James D.; Chang, Joe Y. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-07-15

    Background: Many patients with locally advanced non-small cell lung cancer (NSCLC) cannot undergo concurrent chemotherapy because of comorbidities or poor performance status. Hypofractionated radiation regimens, if tolerable, may provide an option to these patients for effective local control. Methods and Materials: Twenty-five patients were enrolled in a phase 1 dose-escalation trial of proton beam therapy (PBT) from September 2010 through July 2012. Eligible patients had histologically documented lung cancer, thymic tumors, carcinoid tumors, or metastatic thyroid tumors. Concurrent chemotherapy was not allowed, but concurrent treatment with biologic agents was. The dose-escalation schema comprised 15 fractions of 3 Gy(relative biological effectiveness [RBE])/fraction, 3.5 Gy(RBE)/fraction, or 4 Gy(RBE)/fraction. Dose constraints were derived from biologically equivalent doses of standard fractionated treatment. Results: The median follow-up time for patients alive at the time of analysis was 13 months (range, 8-28 months). Fifteen patients received treatment to hilar or mediastinal lymph nodes. Two patients experienced dose-limiting toxicity possibly related to treatment; 1 received 3.5-Gy(RBE) fractions and experienced an in-field tracheoesophageal fistula 9 months after PBT and 1 month after bevacizumab. The other patient received 4-Gy(RBE) fractions and was hospitalized for bacterial pneumonia/radiation pneumonitis 4 months after PBT. Conclusion: Hypofractionated PBT to the thorax delivered over 3 weeks was well tolerated even with significant doses to the lungs and mediastinal structures. Phase 2/3 trials are needed to compare the efficacy of this technique with standard treatment for locally advanced NSCLC.

  17. Knowledge and perception of microbicides among healthcare ...

    African Journals Online (AJOL)

    2014-06-02

    Jun 2, 2014 ... products and services depend, to a large extent, on healthcare providers' knowledge, perception and attitude regarding them. Objectives: To determine the knowledge and perception of healthcare providers regarding microbicides. Methods: A ... creams, suppositories, films, sponge or ring that releases.

  18. Developing Ethical Competence in Healthcare Management

    Science.gov (United States)

    Falkenström, Erica; Ohlsson, Jon; Höglund, Anna T

    2016-01-01

    Purpose: The purpose of this paper was to explore what kind of ethical competence healthcare managers need in handling conflicts of interest (COI). The aim is also to highlight essential learning processes to develop healthcare managers' ethical competence. Design/methodology/approach: A qualitative study was performed. Semi-structured interviews…

  19. Discourse Analysis of Encouragement in Healthcare Manga

    Science.gov (United States)

    Matsuoka, Rieko; Smith, Ian; Uchimura, Mari

    2011-01-01

    This article examines how healthcare professionals use encouragement. Focusing on GAMBARU ["to try hard"], forty-one scenes were collected from healthcare manga. Each scene of encouragement was analyzed from three perspectives; the contextual background of the communication, the relationship with the patients and the patients' response…

  20. Quality-driven Efficiency in Healthcare

    NARCIS (Netherlands)

    Kortbeek, Nikky

    2012-01-01

    During the upcoming decades, healthcare organizations face the challenge to deliver more patient care, of higher quality, and with less financial and human resources. The goal of this thesis is to help and guide healthcare professionals making their organizations future-proof. Building on techniques