WorldWideScience

Sample records for reported medical home

  1. Evaluating the Impact of Parent-Reported Medical Home Status on Children's Health Care Utilization, Expenditures, and Quality: A Difference-in-Differences Analysis with Causal Inference Methods.

    Science.gov (United States)

    Han, Bing; Yu, Hao; Friedberg, Mark W

    2017-04-01

    To evaluate the effects of the parent-reported medical home status on health care utilization, expenditures, and quality for children. Medical Expenditure Panel Survey (MEPS) during 2004-2012, including a total of 9,153 children who were followed up for 2 years in the survey. We took a causal difference-in-differences approach using inverse probability weighting and doubly robust estimators to study how changes in medical home status over a 2-year period affected children's health care outcomes. Our analysis adjusted for children's sociodemographic, health, and insurance statuses. We conducted sensitivity analyses using alternative statistical methods, different approaches to outliers and missing data, and accounting for possible common-method biases. Compared with children whose parents reported having medical homes in both years 1 and 2, those who had medical homes in year 1 but lost them in year 2 had significantly lower parent-reported ratings of health care quality and higher utilization of emergency care. Compared with children whose parents reported having no medical homes in both years, those who did not have medical homes in year 1 but gained them in year 2 had significantly higher ratings of health care quality, but no significant differences in health care expenditures and utilization. Having a medical home may help improve health care quality for children; losing a medical home may lead to higher utilization of emergency care. © Health Research and Educational Trust.

  2. Home Health PPS - Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Abt Associates July 21, 2010 Analysis of 2000-2008 Home Health Case-mix Change Report estimates the extent to which the observed increases in average case-mix were...

  3. Are patients reliable when self-reporting medication use? Validation of structured drug interviews and home visits by drug analysis and prescription data in acutely hospitalized patients

    DEFF Research Database (Denmark)

    Glintborg, Bente; Hillestrøm, Peter René; Olsen, Lenette Holm

    2007-01-01

    The medication history among hospitalized patients often relies on patients' self-reports due to insufficient communication between health care professionals. The aim of the present study was to estimate the reliability of patients' self-reported medication use. Five hundred patients admitted...... to an acute medical department at a Danish university hospital were interviewed on the day of admission about their recent medication use. Blood samples drawn immediately after admission were screened for contents of 5 drugs (digoxin, bendroflumethiazide, amlodipine, simvastatin, glimepiride), and the results...... were compared to the patients' self-reported medication history. Information on prescribed drugs dispensed from any Danish pharmacy was collected from nationwide real-time pharmacy records. The authors performed home visits in a subgroup of 115 patients 4 weeks after their discharge. Stored drugs were...

  4. Active physiology learning in a diverse class: an analysis of medical student responses in terms of sex, home language, and self-reported test performance.

    Science.gov (United States)

    Higgins-Opitz, Susan B; Tufts, Mark

    2012-06-01

    The student body at the Nelson R. Mandela School of Medicine (NRMSM) is very diverse, representing many cultures, religions, and languages. Research has shown that weakness in English can impact student performance. Recent studies have also highlighted sex-based differences in students' learning and listening styles. These factors pose both challenges and opportunities for teachers of physiology. Student presentations were incorporated for a number of years into the traditional didactic second-year medical physiology curriculum at the NRMSM. Feedback obtained about the perceived benefits of these presentations for the learning of gastrointestinal and endocrine physiology included demographic data pertaining to students' sex, home language, and self-reported performance in tests. Analysis of the 50-item questionnaire responses, obtained over a 2-yr period, provided some interesting insights. Student responses to the items differed significantly in 27 of the 50 items in the questionnaire, based on sex alone (22%), sex and home language (7%), home language alone (37%), performance alone (26%), and performance and home language (7%). Our analyses of student perceptions support the findings of other studies and show that factors such as sex, home language, and student performance can play an important role in the way students are motivated to learn. In designing active learning strategies, academics need to take into account the potential influences that might affect student learning in diverse, multicultural, and multilingual classes.

  5. Library links on medical school home pages.

    Science.gov (United States)

    Thomas, Sheila L

    2011-01-01

    The purpose of this study was to assess the websites of American Association of Medical Colleges (AAMC)-member medical schools for the presence of library links. Sixty-one percent (n = 92) of home pages of the 150 member schools of the AAMC contain library links. For the 58 home pages not offering such links, 50 provided a pathway of two or three clicks to a library link. The absence of library links on 39% of AAMC medical school home pages indicates that the designers of those pages did not consider the library to be a primary destination for their visitors.

  6. Fires and Burns Involving Home Medical Oxygen

    Science.gov (United States)

    ... nfpa.org Fires and Burns Involving Home Medical Oxygen The air is normally 21% oxygen. Oxygen is not flammable, but fire needs it to burn. ¾ When more oxygen is present, any fire that starts will burn ...

  7. The medical home: locus of physician formation.

    Science.gov (United States)

    Daaleman, Timothy P

    2008-01-01

    Family medicine is currently undergoing a transformation and, amid such change, the medical home has emerged as the new polestar. This article examines the medical home through the lens of philosopher Alasdair MacIntyre and offers a perspective, informed by Hubert Dreyfus and Peter Senge, about medical homes as practical sites of formation for family physicians. The intellectual past of family medicine points to contextually sensitive patient care as a practice that is particular to the discipline, with the virtue of "placing patients within contexts over time" as a commonly held virtue. Dreyfus provides a model of knowledge and skill acquisition that is relevant to the training of family physicians in practical wisdom. In this model, there is a continuum from novice to more advanced stages of professional formation that is aided by rules that not only must be learned, but must be applied in greater contextually informed situations. Senge's emphasis on learning organizations-organizations where people are continually learning how to learn together-presents a framework for evaluating the extent to which future medical homes facilitate or retard the formation of family physicians.

  8. Analgesic medication errors in North Carolina nursing homes.

    Science.gov (United States)

    Desai, Rishi J; Williams, Charrlotte E; Greene, Sandra B; Pierson, Stephanie; Caprio, Anthony J; Hansen, Richard A

    2013-06-01

    The objective of this study was to characterize analgesic medication errors and to evaluate their association with patient harm. The authors conducted a cross-sectional analysis of individual medication error incidents reported by North Carolina nursing homes to the Medication Error Quality Initiative (MEQI) during fiscal years 2010-2011. Bivariate associations between analgesic medication errors with patient factors, error-related factors, and impact on patients were tested with chi-square tests. A multivariate logistic regression model explored the relationship between type of analgesic medication errors and patient harm, controlling for patient- and error-related factors. A total of 32,176 individual medication error incidents were reported over a 2-year period in North Carolina nursing homes, 12.3% (n = 3949) of which were analgesic medication errors. Of these analgesic medication errors, opioid and nonopioid analgesics were involved in 3105 and 844 errors, respectively. Opioid errors were more likely to be wrong drug errors, wrong dose errors, and administration errors compared with nonopioid errors (P errors were found to have higher odds of patient harm compared with nonopioid errors (odds ratio [OR] = 3, 95% confodence interval [CI]: 1.1-7.8). The authors conclude that opioid analgesics represent the majority of analgesic error reports, and these error reports reflect an increased likelihood of patient harm compared with nonopioid analgesics.

  9. HOME Participating Jurisdictions Vacant Units Reports

    Data.gov (United States)

    Department of Housing and Urban Development — This report is an MS Excel spreadsheet broken up by state, similar to the HOME Participating Jurisdiction's Open Activities Reports. The purpose of the HOME...

  10. The Roles and Functions of Medical Directors in Nursing Homes.

    Science.gov (United States)

    Nanda, Aman

    2015-03-03

    The medical director is an important member of the healthcare team in a nursing home, and is responsible for overall coordination of care and for implementation of policies related to care of the residents in a nursing home. The residents in nursing homes are frail, medically complex, and have multiple disabilities. The medical director has an important leadership role in assisting nursing home administration in providing quality care that is consistent with current standards of care. This article provides an overview of roles and functions of the medical director, and suggests ways the medical director can be instrumental in achieving excellent care in today's nursing facilities.

  11. STS-3 medical report

    Science.gov (United States)

    Pool, S. L. (Editor); Johnson, P. C., Jr. (Editor); Mason, J. A. (Editor)

    1982-01-01

    The medical operations report for STS-3, which includes a review of the health of the crew before, during, and immediately after the third Shuttle orbital flight is presented. Areas reviewed include: health evaluation, medical debriefing of crewmembers, health stabilization program, medical training, medical 'kit' carried in flight, tests and countermeasures for space motion sickness, cardiovascular profile, biochemistry and endocrinology results, hematology and immunology analyses, medical microbiology, food and nutrition, potable water, shuttle toxicology, radiological health, and cabin acoustic noise. Environmental effects of shuttle launch and landing medical information management, and management, planning, and implementation of the medical program are also dicussed.

  12. Low use of medication in home deliveries in the Netherlands

    NARCIS (Netherlands)

    Schirm, E; Tobi, H; de Jong-van den Berg, LTW

    2002-01-01

    Objectives: In view of the growing concern for de-medicalizing childbirth, the aim of this study is to give detailed figures on the use of medication during home deliveries in the Netherlands. Methods: A prospective study of medication use by 68 community midwives during 716 home births in the Nethe

  13. Nursing Home Medical Staff Organization and 30-Day Rehospitalizations

    Science.gov (United States)

    Lima, Julie C.; Intrator, Orna; Karuza, Jurgis; Wetle, Terrie; Mor, Vincent; Katz, Paul

    2013-01-01

    Objectives To examine the relationship between features of nursing home (NH) medical staff organization and residents’ 30-day rehospitalizations. Design Cross-sectional study combining primary data collected from a survey of medical directors, NH resident assessment data (minimum data set), Medicare claims, and the Online Survey Certification and Reporting (OSCAR) database. Setting A total of 202 freestanding US nursing homes. Participants Medicare fee-for-service beneficiaries who were hospitalized and subsequently admitted to a study nursing home. Measurements Medical staff organization dimensions derived from the survey, NH residents’ characteristics derived from minimum data set data, hospitalizations obtained from Part A Medicare claims, and NH characteristics from the OSCAR database and from www.ltcfocus.org. Study outcome defined within a 30-day window following an index hospitalization: rehospitalized, otherwise died, otherwise survived and not rehospitalized. Results Thirty-day rehospitalizations occurred for 3788 (20.3%) of the 18,680 initial hospitalizations. Death was observed for 884 (4.7%) of residents who were not rehospitalized. Adjusted by hospitalization, resident, and NH characteristics, nursing homes having a more formal appointment process for physicians were less likely to have 30-day rehospitalization (b = −0.43, SE = 0.17), whereas NHs in which a higher proportion of residents were cared for by a single physician were more likely to have rehospitalizations (b = 0.18, SE = 0.08). Conclusion This is the first study to show a direct relationship between features of NH medical staff organization and resident-level process of care. The relationship of a more strict appointment process and rehospitalizations might be a consequence of more formalized and dedicated medical practice with a sense of ownership and accountability. A higher volume of patients per physician does not appear to improve quality of care. PMID:22682694

  14. Electronic business in the home medical equipment industry.

    Science.gov (United States)

    Wei, June; Graham, Michael J; Liu, Lai C

    2011-01-01

    This paper aims at developing electronic business solutions to increase value for the home medical equipment industry. First, an electronic strategic value chain model was developed for the home medical equipment industry. Second, electronic business solutions were mapped from this model. Third, the top 20 dominant companies in the home medical equipment industry were investigated to see the current adoption patterns of these electronic business solutions. The solutions will be beneficial to decision-makers in the information technology adoptions in the home medical equipment industry to increase the business values.

  15. STS-1 medical report

    Science.gov (United States)

    Pool, S. L. (Editor); Johnson, P. C., Jr. (Editor); Mason, J. A. (Editor)

    1981-01-01

    The report includes a review of the health of the crew before, during and immediately after the first Shuttle orbital flight (April 12-14, 1981). Areas reviewed include: health evaluation, medical debriefing of crewmembers, health stabilization program, medical training, medical kit carried inflight; tests and countermeasures for space motion sickness, cardiovascular profile, biochemistry and endocrinology results; hematology and immunology analyses; medical microbiology; food and nutrition; potable water; shuttle toxicology; radiological health; cabin acoustical noise. Also included is information on: environmental effects of Shuttle launch and landing, medical information management; and management, planning and implementation of the medical program.

  16. Are patients reliable when self-reporting medication use? Validation of structured drug interviews and home visits by drug analysis and prescription data in acutely hospitalized patients

    DEFF Research Database (Denmark)

    Glintborg, Bente; Hillestrøm, Peter René; Olsen, Lenette Holm;

    2007-01-01

    to an acute medical department at a Danish university hospital were interviewed on the day of admission about their recent medication use. Blood samples drawn immediately after admission were screened for contents of 5 drugs (digoxin, bendroflumethiazide, amlodipine, simvastatin, glimepiride), and the results......The medication history among hospitalized patients often relies on patients' self-reports due to insufficient communication between health care professionals. The aim of the present study was to estimate the reliability of patients' self-reported medication use. Five hundred patients admitted...

  17. The Patient-Centered Medical Home: How Is It Related to Quality and Equity Among the General Adult Population?

    Science.gov (United States)

    Reibling, Nadine

    2016-10-01

    This study investigates whether patient-reported characteristics of the medical home are associated with improved quality and equity of preventive care, advice on health habits, and emergency department use. We used adjusted risk ratios to examine the association between medical home characteristics and care measures based on the 2010 Medical Expenditure Panel Survey. Medical home characteristics are associated with 6 of the 11 outcome measures, including flu shots, smoking advice, exercise advice, nutrition advice, all advice, and emergency department visits. Educational and income groups benefit relatively equally from medical home characteristics. However, compared with insurance and access to a provider, medical home characteristics have little influence on overall disparities in care. In sum, our findings support that medical home characteristics can improve quality and reduce emergency visits but we find no evidence that medical home characteristics alleviate disparities in care.

  18. Medication administration to the diabetic clients of the Helsinki Deaconess's institute nursing homes : Medication administration

    OpenAIRE

    2014-01-01

    Diabetic clients in nursing care homes are among the most vulnerable members of the society, as they depend on their care home staff for almost all of their entire needs. A combination of complex medical conditions may result in the need to take multiple medications with some taking up to eight medications on average. Medication system in nursing home passes through many steps before it actually reaches the client. This may result in an increase in medication error. The purpose of this st...

  19. Expanded Medical Home Model Works for Children in Foster Care

    Science.gov (United States)

    Jaudes, Paula Kienberger; Champagne, Vince; Harden, Allen; Masterson, James; Bilaver, Lucy A.

    2012-01-01

    The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates. These…

  20. Expanded Medical Home Model Works for Children in Foster Care

    Science.gov (United States)

    Jaudes, Paula Kienberger; Champagne, Vince; Harden, Allen; Masterson, James; Bilaver, Lucy A.

    2012-01-01

    The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates. These…

  1. Implementing best practice in medication management in a nursing home

    OpenAIRE

    2012-01-01

    Medication management is one of the major roles of a nurse leader in any health care setting particularly in the nursing homes. Evidence suggests that errors do occur at any stage of the medication use process (prescribing, documenting/transcribing, dispensing, administering and monitoring) and these might pose significant risks to older people in nursing homes. Thus, this change project was carried out to reduce the incidence of medication errors, ensure resident’s safety and promote complia...

  2. Anticoagulant medication errors in nursing homes: characteristics, causes, outcomes, and association with patient harm.

    Science.gov (United States)

    Desai, Rishi J; Williams, Charlotte E; Greene, Sandra B; Pierson, Stephanie; Hansen, Richard A

    2013-01-01

    Appropriate and safe use of medications is an important aspect of quality of care in nursing home patients. Because of their complex medication use process, anticoagulants are prone to medication errors in the frail elderly. Therefore, we designed this study to characterize anticoagulant medication errors and to evaluate their association with patient harm using individual medication error incidents reported by all North Carolina nursing homes to the Medication Error Quality Initiative (MEQI) during fiscal years 2010-2011. Characteristics, causes, and specific outcomes of harmful anticoagulant medication errors were reported as frequencies and proportions and compared between anticoagulant errors and other medication errors using chi-square tests. A multivariate logistic regression model explored the relationship between anticoagulant medication errors and patient harm, controlling for patient- and error-related factors.

  3. Association Between Patient-Centered Medical Homes and Adherence to Chronic Disease Medications: A Cohort Study.

    Science.gov (United States)

    Lauffenburger, Julie C; Shrank, William H; Bitton, Asaf; Franklin, Jessica M; Glynn, Robert J; Krumme, Alexis A; Matlin, Olga S; Pezalla, Edmund J; Spettell, Claire M; Brill, Gregory; Choudhry, Niteesh K

    2017-01-17

    Despite the widespread adoption of patient-centered medical homes into primary care practice, the evidence supporting their effect on health care outcomes has come primarily from geographically localized and well-integrated health systems. To assess the association between medication adherence and medical homes in a national patient and provider population, given the strong ties between adherence to chronic disease medications and health care quality and spending. Retrospective cohort study. Claims from a large national health insurer. Patients initiating therapy with common medications for chronic diseases (diabetes, hypertension, and hyperlipidemia) between 2011 and 2013. Medication adherence in the 12 months after treatment initiation was compared among patients cared for by providers practicing in National Committee for Quality Assurance-recognized patient-centered medical homes and propensity score-matched control practices in the same Primary Care Service Areas. Linear mixed models were used to examine the association between medical homes and adherence. Of 313 765 patients meeting study criteria, 18 611 (5.9%) received care in patient-centered medical homes. Mean rates of adherence were 64% among medical home patients and 59% among control patients. Among 4660 matched control and medical home practices, medication adherence was significantly higher in medical homes (2.2% [95% CI, 1.5% to 2.9%]). The association between medical homes and better adherence did not differ significantly by disease state (diabetes, 3.0% [CI, 1.5% to 4.6%]; hypertension, 3.2% [CI, 2.2% to 4.2%]; hyperlipidemia, 1.5% [CI, 0.6% to 2.5%]). Clinical outcomes related to medication adherence were not assessed. Receipt of care in a patient-centered medical home is associated with better adherence, a vital measure of health care quality, among patients initiating treatment with medications for common high-cost chronic diseases. CVS Health.

  4. General practitioners' experiences as nursing home medical consultants

    OpenAIRE

    Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro

    2017-01-01

    OBJECTIVE: To describe general practitioners' experiences of being the principal physician responsible for a nursing home. METHOD: Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. RESULT: Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-li...

  5. Community Oncology Medical Homes: Physician-Driven Change to Improve Patient Care and Reduce Costs.

    Science.gov (United States)

    Waters, Teresa M; Webster, Jennifer A; Stevens, Laura A; Li, Tao; Kaplan, Cameron M; Graetz, Ilana; McAneny, Barbara L

    2015-11-01

    Although the patient-centered medical home is a well-established model of care for primary care providers, adoption by specialty providers has been relatively limited. Recently, there has been particular interest in developing specialty medical homes in medical oncology because of practice variation, care fragmentation, and high overall costs of care. In 2012, the Center for Medicare and Medicaid Innovation awarded Innovative Oncology Business Solutions a 3-year grant for their Community Oncology Medical Home (COME HOME) program to implement specialty medical homes in seven oncology practices across the country. We report our early experience and lessons learned.Through September 30, 2014, COME HOME has touched 16,353 unique patients through triage encounters, patient education visits, or application of clinical pathways. We describe the COME HOME model and implementation timeline, profile use of key services, and report patient satisfaction. Using feedback from practice sites, we highlight patient-centered innovations and overall lessons learned.COME HOME incorporates best practices care driven by triage and clinical pathways, team-based care, active disease management, enhanced access and care, as well as financial support for the medical home infrastructure. Information technology plays a central role, supporting both delivery of care and performance monitoring. Volume of service use has grown steadily over time, leveling out in second quarter 2014. The program currently averages 1,265 triage encounters, 440 extended hours visits, and 655 patient education encounters per month.COME HOME offers a patient-centered model of care to improve quality and continuity of care. Copyright © 2015 by American Society of Clinical Oncology.

  6. Medical Equipment at Home After the NICU

    Science.gov (United States)

    ... they go home, some babies need to continue gavage feeding. Gavage feeding is when a baby is fed breastmilk ... nose or mouth into the stomach or intestines. Gavage feeding helps babies get enough food when they ...

  7. Standardised electronic information exchange between nurses in home care and GPs - the medication information processes.

    Science.gov (United States)

    Lyngstad, Merete; Melby, Line; Hellesø, Ragnhild

    2012-01-01

    Improving the transfer of medication information between home care nurses and patient's general practitioners (GP) is assessed as essential for ensuring safe care. In this paper, we report on a Norwegian study in which we investigated how home care nurses experienced using standardised electronic messages in their communication with the GPs. Standardised electronic solutions were developed and implemented to resolve gaps in the medication information processes when patients received nursing care in their homes. Data was collected combining focus group interviews and individual interviews with nurses from home care in two municipalities in Norway. The data was analysed using systematic text condensation. We found that the nurses reported mostly advantages, but also some disadvantages regarding accuracy, consistency, availability and efficiency in the medication information process when they used standardised electronic messages. Efforts to refine the electronic messages to achieve better work processes and patient safety should be addressed.

  8. Medication administration in nursing homes: pharmacists' contribution to error prevention.

    Science.gov (United States)

    Verrue, Charlotte L; Mehuys, Els; Somers, Annemie; Van Maele, Georges; Remon, Jean Paul; Petrovic, Mirko

    2010-05-01

    The elderly use a large number of medications, which exposes them to an increased risk for medication-related errors, especially in nursing homes. The aim of this study was to investigate the impact of an educational session addressing good medication administration practices on the medication administration error rate in 2 nursing homes. A before-after study was performed, comparing outcome measurements 1 month before and 1 month after implementation of a formal training session on "good medication administration principles." Medication administration errors were detected using a direct observation method. Two experts (a geriatrician and a clinical pharmacist) scored the clinical relevance of these errors. The study was carried out between March 2007 and June 2007. In both nursing homes, the overall error rate (preparation errors and administration errors) decreased after the intervention. This decrease was significant both in nursing home 1 (P errors was rated highly likely to cause harm according to the experts. An educational session about good medication administration practices provided by a pharmacist is a very simple way to decrease medication administration error rates and to raise awareness on the possible clinical significance of the errors. Copyright (c) 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

  9. 77 FR 5186 - Medical Foster Homes

    Science.gov (United States)

    2012-02-02

    ... and recordkeeping requirements, Scholarships and fellowships, Travel and transportation expenses... appropriate recreational and leisure activities. (d) Residents' bedrooms. Each veteran resident must have a... exterior of the home that does not require travel through any other portion of the residence, and access...

  10. Unintentional Discontinuation of Chronic Medications for Seniors in Nursing Homes

    Science.gov (United States)

    Stall, Nathan M.; Fischer, Hadas D.; Wu, C. Fangyun; Bierman, Arlene S.; Brener, Stacey; Bronskill, Susan; Etchells, Edward; Fernandes, Olavo; Lau, Davina; Mamdani, Muhammad M.; Rochon, Paula; Urbach, David R.; Bell, Chaim M.

    2015-01-01

    Abstract Transitions of care leave patients vulnerable to the unintentional discontinuation of medications with proven efficacy for treating chronic diseases. Older adults residing in nursing homes may be especially susceptible to this preventable adverse event. The effect of large-scale policy changes on improving this practice is unknown. The objective of this study was to analyze the effect of a national medication reconciliation accreditation requirement for nursing homes on rates of unintentional medication discontinuation after hospital discharge. It was a population-based retrospective cohort study that used linked administrative records between 2003 and 2012 of all hospitalizations in Ontario, Canada. We identified nursing home residents aged ≥66 years who had continuous use of ≥1 of the 3 selected medications for chronic disease: levothyroxine, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs). In 2008 medication reconciliation became a required practice for accreditation of Canadian nursing homes. The main outcome measures included the proportion of patients who restarted the medication of interest after hospital discharge at 7 days. We also performed a time series analysis to examine the impact of the accreditation requirement on rates of unintentional medication discontinuation. The study included 113,088 adults aged ≥66 years who were nursing home residents, had an acute hospitalization, and were discharged alive to the same nursing home. Overall rates of discontinuation at 7-days after hospital discharge were highest in 2003–2004 for all nursing homes: 23.9% for thyroxine, 26.4% for statins, and 23.9% for PPIs. In most of the cases, these overall rates decreased annually and were lowest in 2011–2012: 4.0% for thyroxine, 10.6% for statins, and 8.3% for PPIs. The time series analysis found that nursing home accreditation did not significantly lower medication discontinuation rates for any of the 3 drug groups. From 2003

  11. The contribution of work characteristics, home characteristics and gender to burnout in medical residents.

    Science.gov (United States)

    Verweij, Hanne; van der Heijden, Frank M M A; van Hooff, Madelon L M; Prins, Jelle T; Lagro-Janssen, Antoine L M; van Ravesteijn, Hiske; Speckens, Anne E M

    2016-09-20

    Burnout is highly prevalent in medical residents. In order to prevent or reduce burnout in medical residents, we should gain a better understanding of contributing and protective factors of burnout. Therefore we examined the associations of job demands and resources, home demands and resources, and work-home interferences with burnout in male and female medical residents. This study was conducted on a nation-wide sample of medical residents. In 2005, all Dutch medical residents (n = 5245) received a self-report questionnaire on burnout, job and home demands and resources and work-home interference. Path analysis was used to examine the associations between job and home characteristics and work-home interference and burnout in both males and females. In total, 2115 (41.1 %) residents completed the questionnaire. In both sexes emotional demands at work and the interference between work and home were important contributors to burnout, especially when work interferes with home life. Opportunities for job development appeared to be an important protective factor. Other contributing and protective factors were different for male and female residents. In females, social support from family or partner seemed protective against burnout. In males, social support from colleagues and participation in decision-making at work seemed important. Effectively handling emotional demands at work, dealing with the interference between work and home, and having opportunities for job development are the most essential factors which should be addressed. However it is important to take gender differences into consideration when implementing preventive or therapeutic interventions for burnout in medical residents.

  12. Nursing Home Medication Reconciliation: A Quality Improvement Initiative.

    Science.gov (United States)

    Tong, Monica; Oh, Hye Young; Thomas, Jennifer; Patel, Sheila; Hardesty, Jennifer L; Brandt, Nicole J

    2017-04-01

    The current quality improvement initiative evaluated the medication reconciliation process within select nursing homes in Washington, DC. The identification of common types of medication discrepancies through monthly retrospective chart reviews of newly admitted patients in two different nursing homes were described. The use of high-risk medications, namely antidiabetic, anticoagulant, and opioid agents, was also recorded. A standardized spreadsheet tool based on multiple medication reconciliation implementation tool kits was created to record the information. The five most common medication discrepancies were incorrect indication (21%), no monitoring parameters (17%), medication name omitted (11%), incorrect dose (10%), and incorrect frequency (8%). Antidiabetic agents in both sites were the most used high-risk medication. This initiative highlights that medication discrepancies on admission are common in nursing homes and may be clinically impactful. More attention needs to be given to work flow processes to improve medication reconciliation considering the increased risk for adverse drug events and hospitalizations. [Journal of Gerontological Nursing and Mental Health Services, 43(4), 9-14.].

  13. [Attitude survey of medical staff on the participation of community pharmacists in palliative home care].

    Science.gov (United States)

    Akai, Namika; Fujita-Hamabe, Wakako; Tokuyama, Shogo

    2009-11-01

    The treatment of cancer pain requires an individually-targeted multidimensional team approach. Further, the basic act for the Anti-Cancer Measures describes that medical staff including pharmacists should participate in the palliative care. Thus it is obvious that community pharmacists should also participate in palliative home care. In addition, a misunderstanding about opioids remains strong in Japan, which could be one of the barriers to palliative home care. In our previous report, we clarified for local residents the importance of educational activity using opioids as a new role for community pharmacists, and it was recognized of great significance by these pharmacists. In this study, we conducted a questionnaire survey among medical doctors, nurses, care managers and home helpers about the need and meaning of the educational activity performed by pharmacists in palliative home care. 86.4% of respondents felt pharmacists' participation in home care was required. Furthermore, most respondents thought that misunderstanding remained about opioids in palliative home care, and believed that pharmacists could play an important role in educational activity about opioids as experts in medicine. This study clarified that other medical team members need the participation of community pharmacists in palliative home care. Therefore, it seems important for these pharmacists to be proactive in participating in such care in the future.

  14. General practitioners' experiences as nursing home medical consultants.

    Science.gov (United States)

    Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro

    2017-03-01

    To describe general practitioners' experiences of being the principal physician responsible for a nursing home. Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems. © 2016 Nordic College of Caring Science.

  15. ECO-Report - Halfway home

    Science.gov (United States)

    Jane Kapler Smith; Janet Sullivan; Clinton E. Carlson; L. Jack Lyon; J. Tewksbury; S. Hejl; T. Martin; Stephen F. Arno; Ward McCaughey; Cathy Stewart; Colin Hardy; J. Greg Jones; Madelyn Kempf; Leslie Weldon

    1996-01-01

    ECO-Report is an annual Rocky Mountain Research Station (RMRS) publication which contains a set of articles showcasing the Bitterroot Ecosystem Management Research Project (BEMRP) research projects and activities. The articles are concise, user-friendly, and designed to inform a broad range of audiences interested in ecosystem management. Articles featured in...

  16. Organizational factors and change strategies associated with medical home transformation.

    Science.gov (United States)

    Solberg, Leif I; Stuck, Logan H; Crain, A Lauren; Tillema, Juliana O; Flottemesch, Thom J; Whitebird, Robin R; Fontaine, Patricia L

    2015-01-01

    There is limited information about how to transform primary care practices into medical homes. The research team surveyed leaders of the first 132 primary care practices in Minnesota to achieve medical home certification. These surveys measured priority for transformation, the presence of medical home practice systems, and the presence of various organizational factors and change strategies. Survey response rates were 98% for the Change Process Capability Questionnaire survey and 92% for the Physician Practice Connections survey. They showed that 80% to 100% of these certified clinics had 15 of the 18 organizational factors important for improving care processes and that 60% to 90% had successfully used 16 improvement strategies. Higher priority for this change (P = .001) and use of more strategies (P = .05) were predictive of greater change in systems. Clinics contemplating medical home transformation should consider the factors and strategies identified here and should be sure that such a change is indeed a high priority for them. © The Author(s) 2014.

  17. Integrating the Medical Home into the EHDI Process

    Science.gov (United States)

    Munoz, Karen F.; Nelson, Lauri; Bradham, Tamala S.; Hoffman, Jeff; Houston, K. Todd

    2011-01-01

    State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that examined 12 areas within state EHDI programs. Related to how the medical home is integrated into the EHDI process, 273 items were listed by 48 coordinators, and themes were identified…

  18. Integrating the Medical Home into the EHDI Process

    Science.gov (United States)

    Munoz, Karen F.; Nelson, Lauri; Bradham, Tamala S.; Hoffman, Jeff; Houston, K. Todd

    2011-01-01

    State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that examined 12 areas within state EHDI programs. Related to how the medical home is integrated into the EHDI process, 273 items were listed by 48 coordinators, and themes were identified…

  19. Visiting nurses' posthospital medication management in home health care

    DEFF Research Database (Denmark)

    Kollerup, Mette Geil; Curtis, Tine; Schantz Laursen, Birgitte

    2017-01-01

    BACKGROUND: Medication management is the most challenging component of a successful transition from hospital to home, a challenge of growing complexity as the number of older persons living with chronic conditions grows, along with increasingly specialised and accelerated hospital treatment plans...

  20. A prospective, non-randomized study of home use of mifepristone for medical abortion in the U.S.

    Science.gov (United States)

    Chong, Erica; Frye, Laura J; Castle, Jen; Dean, Gillian; Kuehl, Laurel; Winikoff, Beverly

    2015-09-01

    To determine the acceptability of taking mifepristone at home for early medical abortion in the United States. This prospective, non-randomized, open-label study at six Planned Parenthood centers gave women with pregnancies up to 63 days' gestation seeking medical abortion the choice of taking mifepristone in the center or at home. Participants were interviewed at a follow-up visit 1-2 weeks after mifepristone administration to assess their experience with the option they selected. Four-hundred women were enrolled between April 2013 and June 2014 of which 32% (n=128) chose to take mifepristone at home. Abortion success rates did not differ between home and center users (96% and 97%). Among home users, 82% reported taking the mifepristone at the time they planned with their provider and no participant took it after 63 days' gestation. The most common reason cited for selecting home use was scheduling flexibility and significantly more home users took misoprostol on the weekend (50% vs. 36%, p=.02). Home users were more likely than center users to report missing no days of work due to the abortion (47% vs. 28%, p=.08). Ninety-nine percent of home users reported that they would take mifepristone at home again and 96% would recommend home use to a friend. Offering this option did not increase the service delivery burden on study providers, who would recommend home use in the future for most participants. Home use of mifepristone is a highly acceptable practice for which there is current demand, and it should be offered as part of routine medical abortion services. Offering the option of home use of mifepristone to medical abortion patients can provide women and clinics with more flexibility while maintaining a safe, effective and acceptable service. These results provide support for telemedicine or pharmacy distribution. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Embedding care management in the medical home: a case study.

    Science.gov (United States)

    Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D

    2014-04-01

    Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.

  2. Antecedents and consequences of work-home interference among medical residents

    NARCIS (Netherlands)

    Geurts, S.A.E.; Rutte, C.G.; Peeters, M.C.W.

    1999-01-01

    A cross-sectional field study is reported in which a comprehensive model of work–home interference (WHI) was developed and tested among 166 medical residents of an academic hospital in the Netherlands. It was hypothesized that WHI functions as a critical mediating pathway in the relationship between

  3. A medical home: value and implications of knowledge management.

    Science.gov (United States)

    Orzano, A John; McInerney, Claire R; McDaniel, Reuben R; Meese, Abigail; Alajmi, Bibi; Mohr, Stewart M; Tallia, Alfred F

    2009-01-01

    Central to the "medical home" concept is the premise that the delivery of effective primary care requires a fundamental shift in relationships among practice members and between practice members and patients. Primary care practices can potentially increase their capacity to deliver effective care through knowledge management (KM), a process of sharing and making existing knowledge available or by developing new knowledge among practice members and patients. KM affects performance by influencing work relationships to enhance learning, decision making, and task execution. We extend our previous work to further characterize, describe, and contrast how primary care practices exhibit KM and explain why KM deserves attention in medical home redesign initiatives. Case studies were conducted, drawn from two higher and lower performing practices, which were purposely selected based on disease management, prevention, and productivity measures from an improvement trial. Observations of operations, clinical encounters, meetings, and interviews with office members and patients were transcribed and coded independently using a KM template developed from a previous secondary analysis. Face-to-face discussions resolved coding differences among research team members. Confirmation of findings was sought from practice participants. Practices manifested varying degrees of KM effectiveness through six interdependent processes and multiple overlapping tools. Social tools, such as face-to-face-communication for sharing and developing knowledge, were often more effective than were expensive technical tools such as an electronic medical record. Tool use was tailored for specific outcomes, interacted with each other, and leveraged by other organizational capacities. Practices with effective KM were more open to adopting and sustaining new ways of functioning, ways reflecting attributes of a medical home. Knowledge management differences occur within and between practices and can explain

  4. Marketing home health care medical services: the physician's view.

    Science.gov (United States)

    Ryan, E J; Phelps, R A

    1993-01-01

    The authors surveyed physicians serving the Jackson, Mississippi home health care market. They identified problems and studied physician perceptions regarding services provided by home health care agencies, private duty nursing agencies, and durable medical equipment suppliers. Respondents perceived home health care as providing: (1) increased patient satisfaction, (2) greater patient convenience, (3) earlier discharge, and (4) lowered patient costs. They least liked: (1) lack of control and involvement in the patient caring process, (2) paperwork, (3) quality control potential, and the possibility that patient costs could increase. Two sets of implications for health care marketers are presented that involve both national and regional levels. Overall results indicate that a growing and profitable market segment exists and is being served in an effective and socially responsible manner.

  5. Home medical monitoring network based on embedded technology

    Science.gov (United States)

    Liu, Guozhong; Deng, Wenyi; Yan, Bixi; Lv, Naiguang

    2006-11-01

    Remote medical monitoring network for long-term monitoring of physiological variables would be helpful for recovery of patients as people are monitored at more comfortable conditions. Furthermore, long-term monitoring would be beneficial to investigate slowly developing deterioration in wellness status of a subject and provide medical treatment as soon as possible. The home monitor runs on an embedded microcomputer Rabbit3000 and interfaces with different medical monitoring module through serial ports. The network based on asymmetric digital subscriber line (ADSL) or local area network (LAN) is established and a client - server model, each embedded home medical monitor is client and the monitoring center is the server, is applied to the system design. The client is able to provide its information to the server when client's request of connection to the server is permitted. The monitoring center focuses on the management of the communications, the acquisition of medical data, and the visualization and analysis of the data, etc. Diagnosing model of sleep apnea syndrome is built basing on ECG, heart rate, respiration wave, blood pressure, oxygen saturation, air temperature of mouth cavity or nasal cavity, so sleep status can be analyzed by physiological data acquired as people in sleep. Remote medical monitoring network based on embedded micro Internetworking technology have advantages of lower price, convenience and feasibility, which have been tested by the prototype.

  6. Towards automated assistance for operating home medical devices.

    Science.gov (United States)

    Gao, Zan; Detyniecki, Marcin; Chen, Ming-Yu; Wu, Wen; Hauptmann, Alexander G; Wactlar, Howard D

    2010-01-01

    To detect errors when subjects operate a home medical device, we observe them with multiple cameras. We then perform action recognition with a robust approach to recognize action information based on explicitly encoding motion information. This algorithm detects interest points and encodes not only their local appearance but also explicitly models local motion. Our goal is to recognize individual human actions in the operations of a home medical device to see if the patient has correctly performed the required actions in the prescribed sequence. Using a specific infusion pump as a test case, requiring 22 operation steps from 6 action classes, our best classifier selects high likelihood action estimates from 4 available cameras, to obtain an average class recognition rate of 69%.

  7. Sedative load of medications prescribed for older people with dementia in care homes

    Directory of Open Access Journals (Sweden)

    Stevenson Elizabeth

    2011-09-01

    Full Text Available Abstract Background The objective of this study was to determine the sedative load and use of sedative and psychotropic medications among older people with dementia living in (residential care homes. Methods Medication data were collected at baseline and at two further time-points for eligible residents of six care homes participating in the EVIDEM-End Of Life (EOL study for whom medication administration records were available. Regular medications were classified using the Anatomical Therapeutic Chemical classification system and individual sedative loads were calculated using a previously published model. Results At baseline, medication administration records were reviewed for 115 residents; medication records were reviewed for 112 and 105 residents at time-points 2 and 3 respectively. Approximately one-third of residents were not taking any medications with sedative properties at each time-point, while a significant proportion of residents had a low sedative load score of 1 or 2 (54.8%, 59.0% and 57.1% at baseline and time-points 2 and 3 respectively. More than 10% of residents had a high sedative load score (≥ 3 at baseline (12.2%, and this increased to 14.3% at time-points 2 and 3. Approximately two-thirds of residents (66.9% regularly used one or more psychotropic medication(s. Antidepressants, predominantly selective serotonin re-uptake inhibitors (SSRIs, were most frequently used, while antipsychotics, hypnotics and anxiolytics were less routinely administered. The prevalence of antipsychotic use among residents was 19.0%, lower than has been previously reported for nursing home residents. Throughout the duration of the study, administration of medications recognised as having prominent sedative adverse effects and/or containing sedative components outweighed the regular use of primary sedatives. Conclusions Sedative load scores were similar throughout the study period for residents with dementia in each of the care homes. Scores were

  8. Making Room for Mental Health in the Medical Home

    OpenAIRE

    Hogan, Michael F.; Sederer, Lloyd I.; Smith, Thomas E.; Nossel, Ilana R.

    2010-01-01

    Discussions of health care reform emphasize the need for coordinated care, and evidence supports the effectiveness of medical home and integrated delivery system models. However, mental health often is left out of the discussion. Early intervention approaches for children and adolescents in primary care are important given the increased rates of detection of mental illness in youth. Most adults also receive treatment for mental illness from nonspecialists, underscoring the role for mental hea...

  9. MDR (Medical Device Reporting)

    Data.gov (United States)

    U.S. Department of Health & Human Services — This database allows you to search the CDRH's database information on medical devices which may have malfunctioned or caused a death or serious injury during the...

  10. Self-medication and storage of drugs at home among the clients of drugstores in Tabriz.

    Science.gov (United States)

    Sahebi, Leyla; Vahidi, Reza Gholi

    2009-05-01

    This study was conducted with four objectives in mind, including: (1) characteristics of self-medication; (2) storage of drugs at home; (3) factors associated with storage of drugs at home; and (4) comparison of the level and sources of knowledge between over-the-counter (OTC) and prescription-only (POM) medication consumers. A cross-sectional survey was conducted in 2007 using a semi-structured questionnaire on 300 clients of 21 drugstores (from a total of 214 drugstores in the city of Tabriz, Iran). The highest demand for drugs was for analgesics (from OTC drugs) and antibiotics (from POM drugs). Of 325 requests for medications by 300 customers of drugstores in Tabriz, aged 15 years or higher, 50.8% (165 requests) were for OTC drugs and 49.2% (160 requests) were for POM drugs, twenty-five cases requested both OTC and POM medications. There were 246 customers (82%) who reported that they stored drugs at home. Physicians were reportedly the most common source of information about medications, while the highest-quality information was obtained from pharmacists. The frequency of home storing of medications was very high in this study. Customers, especially the lower education groups, had very little information about the side effects of drugs and differentiation of OTC and POM medications. Wayward use of antibiotics was very high among the drugstore clients. It seems that the information provided by the pharmacists can be one of the most effective ways for advancing the level of knowledge among the consumers of medications.

  11. Guidelines for Reporting Medical Research

    DEFF Research Database (Denmark)

    Johansen, Mathilde; Thomsen, Simon Francis

    2016-01-01

    As a response to a low quality of reporting of medical research, guidelines for several different types of study design have been developed to secure accurate reporting and transparency for reviewers and readers from the scientific community. Herein, we review and discuss the six most widely...... accepted and used guidelines: PRISMA, CONSORT, STROBE, MOOSE, STARD, and SPIRIT. It is concluded that the implementation of these guidelines has led to only a moderate improvement in the quality of the reporting of medical research. There is still much work to be done to achieve accurate and transparent...... reporting of medical research findings....

  12. An exploratory study on medications in Qatar homes

    Directory of Open Access Journals (Sweden)

    Yousif A

    2011-12-01

    Full Text Available N Kheir1, MS El Hajj1, K Wilbur1, RML Kaissi1, A Yousif21College of Pharmacy, 2College of Arts and Sciences, Qatar University, Doha, QatarBackground: Drug therapy is the most often used intervention for treatment and prevention of disease. However, if used inappropriately, drugs can cause more harm than good. Improper drug storage and disposal can have a direct impact on public safety, the environment, and the health care services. The purpose of this study was to characterize medications stored in Qatar homes and to explore their methods of storage and disposal, and to identify the public's source of information related to medicines.Methods: For the purpose of this cross-sectional exploratory study, a list of telephone numbers was generated from Qatar's telephone directory using a systematic sampling method. Individuals consenting to participate were interviewed using a multipart pretested survey instrument.Results: Data were collected from a total of 49 homes. Most respondents did not have a designated compartment or box specifically for storing medications. The majority of drugs (48% were kept in bedrooms and a number of respondents were keeping their drugs in the fridge and in the kitchen. The most often stored classes of medicines were analgesics, antihistamines, nutritional supplements, and medications used for the respiratory system. Most respondents disposed of unwanted medicines by throwing them in the trash. In about 15% of cases, the dosage of drug taken was different from the instructions on the label. Sharing of prescription medicines was not uncommon. The majority of respondents sought information related to drugs from doctors.Conclusion: These findings raise concerns about how medications are stored and disposed of in the community. The fact that no household routinely returned unwanted medications to a pharmacy for proper disposal places the environment at risk. There is a need for more societal awareness about the safe handling

  13. Creating an interdisciplinary medical home for survivors of human trafficking.

    Science.gov (United States)

    McNiel, Melinda; Held, Theodore; Busch-Armendariz, Noël

    2014-09-01

    Health care providers play an important role in identifying victims of human trafficking and addressing their unique medical needs. In response to a recently published call to action in Obstetrics & Gynecology, an interdisciplinary medical home has been created in central Texas to serve as a model for delivery of care to survivors of human trafficking that is sensitive to their history of trauma, or "trauma-informed." An overview of the topic is provided along with a description of the stakeholders involved and the steps that were taken to create the clinic. This information is presented with the intention of educating health care providers on the long-term medical needs of survivors and on how they can establish a similar clinic in other parts of the country.

  14. Barriers to medical error reporting

    Directory of Open Access Journals (Sweden)

    Jalal Poorolajal

    2015-01-01

    Full Text Available Background: This study was conducted to explore the prevalence of medical error underreporting and associated barriers. Methods: This cross-sectional study was performed from September to December 2012. Five hospitals, affiliated with Hamadan University of Medical Sciences, in Hamedan,Iran were investigated. A self-administered questionnaire was used for data collection. Participants consisted of physicians, nurses, midwives, residents, interns, and staffs of radiology and laboratory departments. Results: Overall, 50.26% of subjects had committed but not reported medical errors. The main reasons mentioned for underreporting were lack of effective medical error reporting system (60.0%, lack of proper reporting form (51.8%, lack of peer supporting a person who has committed an error (56.0%, and lack of personal attention to the importance of medical errors (62.9%. The rate of committing medical errors was higher in men (71.4%, age of 50-40 years (67.6%, less-experienced personnel (58.7%, educational level of MSc (87.5%, and staff of radiology department (88.9%. Conclusions: This study outlined the main barriers to reporting medical errors and associated factors that may be helpful for healthcare organizations in improving medical error reporting as an essential component for patient safety enhancement.

  15. The medical home, preventive care screenings, and counseling for children: evidence from the Medical Expenditure Panel Survey.

    Science.gov (United States)

    Romaire, Melissa A; Bell, Janice F

    2010-01-01

    Little is known about the role of the medical home in promoting essential preventive health care services in the general pediatric population. This study examined associations between having a medical home and receipt of health screenings and anticipatory guidance. We conducted a cross-sectional analysis of the 2004-2006 Medical Expenditure Panel Survey (MEPS). Our sample included 21 055 children aged 0 to 17 years who visited a health care provider in the year prior to the survey. A binary indicator of the medical home was developed from 22 questions in MEPS, reflecting 4 of the 7 American Academy of Pediatrics' recommended components of the medical home: accessible, family-centered, comprehensive, and compassionate care. Multivariable logistic regression was used to examine the association between the medical home and receipt of specific health screenings and anticipatory guidance, controlling for confounding variables. Approximately 49% of our study sample has a medical home. The medical home, defined when the usual source of care is a person or facility, is significantly associated with 3 health screenings (ie, weight, height, and blood pressure) and several anticipatory guidance topics (ie, advice about dental checkups, diet, exercise, car and bike safety), with odds ratios ranging from 1.26 to 1.54. The medical home is associated with increased odds of children receiving some health screenings and anticipatory guidance. The medical home may provide an opportunity to improve the delivery of these services for children. Copyright 2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  16. Analyzing voluntary medical incident reports.

    Science.gov (United States)

    Gong, Yang; Richardson, James; Zhijian, Luan; Alafaireet, Patricia; Yoo, Illhoi

    2008-11-06

    Voluntary medical incident reports lacking consistency and accuracy impede the ultimate use of the reports for patient safety research. To improve this, two coders examined harm score usage in a voluntary medical incident reporting system where the harm scores were selected from a predefined list by different reporters. The two coders inter-rater agreement percent was 82%. The major categories and reviewed harm score jointly demonstrate that this process is critical and necessary in preparing the voluntary reports for further content and semantics analysis.

  17. 'Redefining health care': medical homes or archipelagos to navigate?

    Science.gov (United States)

    Enthoven, Alain C; Crosson, Francis J; Shortell, Stephen M

    2007-01-01

    This paper provides an analysis of the structure of the health care delivery system, emphasizing physician group practices. The authors argue for comprehensive integrated delivery systems (IDSs). The jumping-off point for their analysis is the recently published Redefining Health Care: Creating Value-Based Competition on Results, by Michael Porter and Elizabeth Teisberg. The authors focus on the book's core idea that competitors should be freestanding integrated practice units (or "islands in archipelagos") versus IDSs (or "medical homes"). In any case, the authors contend that this issue should be resolved by competition to attract and serve informed, cost-conscious, responsible consumers on a level playing field.

  18. Young adults with spina bifida transitioned to a medical home: a survey of medical care in Jacksonville, Florida.

    Science.gov (United States)

    Aguilera, Antonio M; Wood, David L; Keeley, Cortney; James, Hector E; Aldana, Philipp R

    2015-10-23

    OBJECT The transition of the young adult with spina bifida (YASB) from pediatric to adult health care is considered a priority by organized pediatrics. There is a paucity of transition programs and related studies. Jacksonville Health and Transition Services (JaxHATS) is one such transition program in Jacksonville, Florida. This study's purpose was to evaluate the health care access, utilization, and quality of life (QOL) of a group of YASBs who have transitioned from pediatric care. METHODS A survey tool addressing access to health care and quality of health and life was developed based on an established survey. Records of the Spinal Defects Clinic held at Wolfson Children's Hospital and JaxHATS Clinic were reviewed and YASBs (> 18 and spina bifida (SB) specialists; none reported difficulty or delays in obtaining health care. Only 2 patients required emergent care in the last year for an SB-related medical problem. Seven respondents reported very good to excellent QOL. Family, lifestyle, and environmental factors were also examined. CONCLUSIONS In this small group of YASBs with a medical home, easy access to care for medical conditions was the norm, with few individuals having recent emergency visits and almost all reporting at least a good overall QOL. Larger studies of YASBs are needed to evaluate the positive effects of medical homes on health and QOL in this population.

  19. Medication administration errors in nursing homes using an automated medication dispensing system.

    Science.gov (United States)

    van den Bemt, Patricia M L A; Idzinga, Jetske C; Robertz, Hans; Kormelink, Dennis Groot; Pels, Neske

    2009-01-01

    OBJECTIVE To identify the frequency of medication administration errors as well as their potential risk factors in nursing homes using a distribution robot. DESIGN The study was a prospective, observational study conducted within three nursing homes in the Netherlands caring for 180 individuals. MEASUREMENTS Medication errors were measured using the disguised observation technique. Types of medication errors were described. The correlation between several potential risk factors and the occurrence of medication errors was studied to identify potential causes for the errors. RESULTS In total 2,025 medication administrations to 127 clients were observed. In these administrations 428 errors were observed (21.2%). The most frequently occurring types of errors were use of wrong administration techniques (especially incorrect crushing of medication and not supervising the intake of medication) and wrong time errors (administering the medication at least 1 h early or late).The potential risk factors female gender (odds ratio (OR) 1.39; 95% confidence interval (CI) 1.05-1.83), ATC medication class antibiotics (OR 11.11; 95% CI 2.66-46.50), medication crushed (OR 7.83; 95% CI 5.40-11.36), number of dosages/day/client (OR 1.03; 95% CI 1.01-1.05), nursing home 2 (OR 3.97; 95% CI 2.86-5.50), medication not supplied by distribution robot (OR 2.92; 95% CI 2.04-4.18), time classes "7-10 am" (OR 2.28; 95% CI 1.50-3.47) and "10 am-2 pm" (OR 1.96; 1.18-3.27) and day of the week "Wednesday" (OR 1.46; 95% CI 1.03-2.07) are associated with a higher risk of administration errors. CONCLUSIONS Medication administration in nursing homes is prone to many errors. This study indicates that the handling of the medication after removing it from the robot packaging may contribute to this high error frequency, which may be reduced by training of nurse attendants, by automated clinical decision support and by measures to reduce workload.

  20. Medical Surveillance Monthly Report

    Science.gov (United States)

    2016-12-01

    albopictus); however, sexual transmis- sion and transmission through other bodily fluids have been confirmed. Approximately one out of five individuals...to the U.S. Centers for Disease Control and Prevention (CDC), research suggests a strong association between Zika and GBS, but the link continues...all countries and territories traveled to with ongoing ZIKV transmis- sion or possible endemic transmission that were reported by the infected person

  1. Patient-Centered Medical Home in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ortiz G

    2011-10-01

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

  2. Medical Foster Homes: Can the Adult Foster Care Model Substitute for Nursing Home Care?

    Science.gov (United States)

    Levy, Cari; Whitfield, Emily A

    2016-12-01

    To compare characteristics, healthcare use, and costs of care of veterans in the rapidly expanding Veterans Health Administration (VHA) medical foster home (MFH) with those of three other VHA long-term care (LTC) programs. Descriptive, unmatched study. VHA MFHs, home-based primary care (HBPC), community living centers (CLCs), and community nursing homes (CNHs). Veterans newly enrolled in one of the four LTC settings in calendar years 2010 or 2011. Using VA and Medicare data from fiscal years 2010 and 2011, demographic characteristics, healthcare use, and costs of 388 veterans in MFHs were compared with 26,037 of those in HBPC, 5,355 in CLCs, and 5,517 in CNHs in the year before and the year after enrollment. Veterans enrolled in the MFH program were more likely to be unmarried than those in other LTC programs and had higher levels of comorbidity and frailty than veterans receiving HBPC but had similar levels of comorbidity, frailty, and healthcare use as those in CLCs and CNHs. MFH veterans incurred lower costs than those in CNHs and CLCs. MFHs served a distinct subset of veterans with levels of comorbidity and frailty similar to those of veterans cared for in CLCs and CNHs at costs that were comparable to or lower than those of the VHA. Propensity-matched comparisons will be necessary to confirm these findings. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  3. Home uterine activity monitoring: the role of medical evidence.

    Science.gov (United States)

    Reichmann, James P

    2008-08-01

    The current paradigm in obstetrics has shifted toward evidence-based medicine, and yet in clinical practice physicians continue to use interventions for which there exists no credible evidence. This article examines the U.S. Food and Drug Administration (FDA) status of home uterine activity monitoring (HUAM) and the published clinical trials examining HUAM for the management of current preterm labor. The use of HUAM was introduced into clinical practice and heavily marketed without benefit of scientific rigor. Gradually, HUAM use migrated primarily for patients diagnosed (or misdiagnosed) with preterm labor in the current pregnancy who are stabilized and sent home with or without a tocolytic. This clinical intervention has not been cleared by the FDA, has virtually no scientific support, and constitutes a gross deviation from evidence-based medicine. As obstetricians accept the role of medical evidence steering clinical practice, HUAM clearly has no clinical value and therefore should not be used to manage patients outside of a randomized controlled clinical trial.

  4. Variation in use of antipsychotic medications in nursing homes in the United States: A systematic review.

    Science.gov (United States)

    Cioltan, Hannah; Alshehri, Samah; Howe, Carol; Lee, Jeannie; Fain, Mindy; Eng, Howard; Schachter, Kenneth; Mohler, Jane

    2017-01-26

    The use of antipsychotic medications (APMs) in nursing home residents in the U.S. is an increasingly prominent issue and has been associated with increased risk of hospitalization, cardiovascular events, hip fractures, and mortality, among other adverse health events. The Food and Drug Administration has placed a black box warning on these drugs, specifying that they are not meant for residents with dementia, and has asked providers to review their treatment plans. The purpose of this systematic PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)-based review was to summarize original research studies on facility level characteristics contributing to the use of antipsychotics in nursing homes across the United States, in order to investigate the variation of use. We searched Ovid Medline, Embase, Cochrane Library, Web of Science, CINAHL, PsycInfo, and Sociological Abstracts. Articles were selected according to the following criteria: (1) Population of interest: older adults (≥60 years of age) residing in nursing homes (not home-based or inpatient hospital settings) in the U.S. (2) Receiving APMs, typical and/or atypical. Specifically excluded were studies of psychotropic medications such as antidepressants, benzodiazepines, anxiolytics, hypnotics, mood stabilizers, and stimulants. All study designs were considered, though reviews, editorials, letters to the editor and opinion pieces were excluded. An expert consultant panel was consulted to categorize facility characteristics into domains and determine possible etiologies of APM use based upon each characteristic. Nineteen observational studies, both quantitative and qualitative, published from 2000 to 2015, met full inclusion criteria and were included in this review. APM use varied based on multiple facility characteristics across several domains: 1) physical, 2) staffing, 3) occupancy, 4) market, and 5) quality. Variation in use of APMs in U.S. nursing homes based upon facility

  5. Guidelines for Reporting Medical Research

    DEFF Research Database (Denmark)

    Johansen, Mathilde; Thomsen, Simon Francis

    2016-01-01

    accepted and used guidelines: PRISMA, CONSORT, STROBE, MOOSE, STARD, and SPIRIT. It is concluded that the implementation of these guidelines has led to only a moderate improvement in the quality of the reporting of medical research. There is still much work to be done to achieve accurate and transparent...

  6. Medicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

    Science.gov (United States)

    2016-11-03

    This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).

  7. On search guide phrase compilation for recommending home medical products.

    Science.gov (United States)

    Luo, Gang

    2010-01-01

    To help people find desired home medical products (HMPs), we developed an intelligent personal health record (iPHR) system that can automatically recommend HMPs based on users' health issues. Using nursing knowledge, we pre-compile a set of "search guide" phrases that provides semantic translation from words describing health issues to their underlying medical meanings. Then iPHR automatically generates queries from those phrases and uses them and a search engine to retrieve HMPs. To avoid missing relevant HMPs during retrieval, the compiled search guide phrases need to be comprehensive. Such compilation is a challenging task because nursing knowledge updates frequently and contains numerous details scattered in many sources. This paper presents a semi-automatic tool facilitating such compilation. Our idea is to formulate the phrase compilation task as a multi-label classification problem. For each newly obtained search guide phrase, we first use nursing knowledge and information retrieval techniques to identify a small set of potentially relevant classes with corresponding hints. Then a nurse makes the final decision on assigning this phrase to proper classes based on those hints. We demonstrate the effectiveness of our techniques by compiling search guide phrases from an occupational therapy textbook.

  8. Lessons Learned from Implementing the Patient-Centered Medical Home

    Directory of Open Access Journals (Sweden)

    Ellen P. Green

    2012-01-01

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

  9. The Contribution of Work Characteristics, Home Characteristics and Gender to Burnout in Medical Residents

    Science.gov (United States)

    Verweij, Hanne; van der Heijden, Frank M. M. A.; van Hooff, Madelon L. M.; Prins, Jelle T.; Lagro-Janssen, Antoine L. M.; van Ravesteijn, Hiske; Speckens, Anne E. M.

    2017-01-01

    Burnout is highly prevalent in medical residents. In order to prevent or reduce burnout in medical residents, we should gain a better understanding of contributing and protective factors of burnout. Therefore we examined the associations of job demands and resources, home demands and resources, and work-home interferences with burnout in male and…

  10. Medical homes: "where you stand on definitions depends on where you sit".

    Science.gov (United States)

    Vest, Joshua R; Bolin, Jane N; Miller, Thomas R; Gamm, Larry D; Siegrist, Thomas E; Martinez, Luis E

    2010-08-01

    The medical home is a potentially transformative strategy to address issues of access, quality, and efficiency in the delivery of health care in the United States. While numerous organizations support a physician-driven definition, it is by no means the universally accepted definition. Several professional groups, payers, and researchers have offered differing, or nuanced, definitions of medical homes. This lack of consensus has contributed to uncertainty among providers about the medical home. We conducted a systematic review of the literature on the medical home and identified 29 professional, government, and academic sources offering definitions. While consensus appears to exist around a core of selected features, the medical home means different things to different people. The variation in definitions can be partly explained by the obligation of organizations to their members and whether the focus is on the patient or provider. Differences in definitions have implications at both the policy and practice levels.

  11. Impact of intimate partner violence on children's well-child care and medical home.

    Science.gov (United States)

    Bair-Merritt, Megan H; Crowne, Sarah Shea; Burrell, Lori; Caldera, Debra; Cheng, Tina L; Duggan, Anne K

    2008-03-01

    Intimate partner violence has been linked to poor child health. A continuous relationship with a primary care pediatric provider can help to detect intimate partner violence and connect families with needed services. The objectives of this study were to determine the relationship between intimate partner violence and (1) maternal report of a regular site for well-child care, (2) maternal report of a primary pediatric provider, (3) well-child visits in the first year of life, (4) up-to-date immunizations at 2 years of age, (5) maternal report of medical neglect, and (6) maternal report of the pediatric provider-caregiver relationship. This retrospective cohort study evaluated data from 209 at-risk families participating in the evaluation of the Healthy Families Alaska program. Research staff interviewed mothers near the time of an index child's birth and again at the child's second birthday. Medical charts were abstracted for information on well-child visits and immunizations. Mothers who disclosed intimate partner violence at the initial interview (n = 62) were significantly less likely to report a regular site for well-child care or a primary pediatric provider. In multivariable models, children of mothers who disclosed intimate partner violence tended to be less likely to have the recommended 5 well-child visits within the first year of life and were significantly less likely to be fully immunized at 2 years of age. Differences in medical neglect were not statistically significant. Of mothers who reported a specific primary pediatric provider, those with intimate partner violence histories trusted this provider less and tended to rate less favorably pediatric provider-caregiver communication and the overall quality of the pediatric provider-caregiver relationship. Future research should explore effective ways to link intimate partner violence-exposed children with a medical home and a primary pediatric provider and to improve relationships between pediatric

  12. Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

    Science.gov (United States)

    Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

    2016-01-01

    The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

  13. Administration of over-the-counter medication to children at home--a survey of parents from community health centers.

    Science.gov (United States)

    Anderson, Colleen; Rolfe, Paula; Brennan-Hunter, Andrea

    2013-01-01

    Parents (n = 135) were surveyed in relation to administering antipyretic/analgesic medications to their children (2 months-6 years) at home. Parents usually chose acetaminophen, calculated dosages based on weight but did not always know the child's weight, administered medications with a dropper, and reported having a sick child was moderately stressful. Many children were medicated for pain and/or fever during the week prior to immunization and many weighed more than the age/weight recommended dosages on the label. Community health nurses can facilitate safe administration of medications by integrating knowledge of parents' pain and fever management practices into discussions and anticipatory planning during clinic visits.

  14. Patient-centered medical home cyberinfrastructure current and future landscape.

    Science.gov (United States)

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

    2011-05-01

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

  15. Mental Health Recovery in the Patient-Centered Medical Home.

    Science.gov (United States)

    Sklar, Marisa; Aarons, Gregory A; O'Connell, Maria; Davidson, Larry; Groessl, Erik J

    2015-09-01

    We examined the impact of transitioning clients from a mental health clinic to a patient-centered medical home (PCMH) on mental health recovery. We drew data from a large US County Behavioral Health Services administrative data set. We used propensity score analysis and multilevel modeling to assess the impact of the PCMH on mental health recovery by comparing PCMH participants (n = 215) to clients receiving service as usual (SAU; n = 22,394) from 2011 to 2013 in San Diego County, California. We repeatedly assessed mental health recovery over time (days since baseline assessment range = 0-1639; mean = 186) with the Illness Management and Recovery (IMR) scale and Recovery Markers Questionnaire. For total IMR (log-likelihood ratio χ(2)[1] = 4696.97; P recovery over time were greater for PCMH than SAU participants. Increases on all other measures over time were similar for PCMH and SAU participants. Greater increases in mental health recovery over time can be expected when patients with severe mental illness are provided treatment through the PCMH. Evaluative efforts should be taken to inform more widespread adoption of the PCMH.

  16. Shortening a Patient Experiences Survey for Medical Homes

    Directory of Open Access Journals (Sweden)

    Judy H. Ng

    2015-12-01

    Full Text Available The Consumer Assessment of Healthcare Providers and Systems—Patient-Centered Medical Home (CAHPS PCMH Survey assesses patient experiences reflecting domains of care related to general patient experience (access to care, communication with providers, office staff interaction, provider rating and PCMH-specific aspects of patient care (comprehensiveness of care, self-management support, shared decision making. The current work compares psychometric properties of the current survey and a proposed shortened version of the survey (from 52 to 26 adult survey items, from 66 to 31 child survey items. The revisions were based on initial psychometric analysis and stakeholder input regarding survey length concerns. A total of 268 practices voluntarily submitted adult surveys and 58 submitted child survey data to the National Committee for Quality Assurance in 2013. Mean unadjusted scores, practice-level item and composite reliability, and item-to-scale correlations were calculated. Results show that the shorter adult survey has lower reliability, but still it still meets general definitions of a sound survey for the adult version, and resulted in few changes to mean scores. The impact was more problematic for the pediatric version. Further testing is needed to investigate approaches to improving survey response and the relevance of survey items in informing quality improvement.

  17. Identifying risk factors for healthcare-associated infections from electronic medical record home address data

    Directory of Open Access Journals (Sweden)

    Rosenman Marc B

    2010-09-01

    Full Text Available Abstract Background Residential address is a common element in patient electronic medical records. Guidelines from the U.S. Centers for Disease Control and Prevention specify that residence in a nursing home, skilled nursing facility, or hospice within a year prior to a positive culture date is among the criteria for differentiating healthcare-acquired from community-acquired methicillin-resistant Staphylococcus aureus (MRSA infections. Residential addresses may be useful for identifying patients residing in healthcare-associated settings, but methods for categorizing residence type based on electronic medical records have not been widely documented. The aim of this study was to develop a process to assist in differentiating healthcare-associated from community-associated MRSA infections by analyzing patient addresses to determine if residence reported at the time of positive culture was associated with a healthcare facility or other institutional location. Results We identified 1,232 of the patients (8.24% of the sample with positive cultures as probable cases of healthcare-associated MRSA based on residential addresses contained in electronic medical records. Combining manual review with linking to institutional address databases improved geocoding rates from 11,870 records (79.37% to 12,549 records (83.91%. Standardization of patient home address through geocoding increased the number of matches to institutional facilities from 545 (3.64% to 1,379 (9.22%. Conclusions Linking patient home address data from electronic medical records to institutional residential databases provides useful information for epidemiologic researchers, infection control practitioners, and clinicians. This information, coupled with other clinical and laboratory data, can be used to inform differentiation of healthcare-acquired from community-acquired infections. The process presented should be extensible with little or no added data costs.

  18. Caregivers Create a Veteran-Centric Community in VHA Medical Foster Homes.

    Science.gov (United States)

    Haverhals, Leah M; Manheim, Chelsea E; Gilman, Carrie V; Jones, Jacqueline; Levy, Cari

    2016-01-01

    The Veteran's Health Administration's Medical Foster Home program offers a unique long-term care option for veterans who require nursing-home- or assisted-living-level care. Veterans in a medical foster home reside with community-based caregivers who provide 24-hr-a-day care and monitoring. The veterans often remain in the medical foster home until end of life. Support and oversight is provided to the caregiver from the Veteran's Health Administration's community-based medical team. This qualitative descriptive study is based on secondary analysis of interviews with 20 medical foster home caregivers from 7 programs across the United States. The study's research aims are to describe and explain (a) the type of care backgrounds and skills these caregivers possess, (b) caregivers' primary motivations to open their homes to veterans who often have complex medical and social needs, and (c) how caregivers function in their role as primary caregiver for veterans. Findings indicated that caregivers interviewed had worked in long-term care settings and/or cared for family members. A strong desire to serve veterans was a primary motivation for caregivers, rather than financial gain. The caregivers' long-term care skills aided them in building and sustaining the unique medical foster home family-like community.

  19. Medical and Para-Medical Personnel’ Perspectives on Home Health Care Technology

    Directory of Open Access Journals (Sweden)

    Vera Stara

    2017-06-01

    Full Text Available User-based research is strongly recommended in design for older adults. The aim of this paper is to focus the attention on the poorly explored role of medical and para-medical personnel’s perspective on home health care technologies using data that have been gained during the “Active Ageing At Home” (AA@H project. A focus group was organized at the National Institute of Health & Science on Ageing (INRCA in Italy. Results demonstrate that several challenges deserve a stronger effort by the whole research sector on ageing and technology: (1 a leading role of the participatory design process; (2 the assessment of the added value of health technologies through robust methods; (3 the definition of an unique identity and well established practices among disciplines; (4 the creation of favorable prerequisites and conditions to the technology uptake.

  20. Cost, staffing and quality impact of bedside electronic medical record (EMR) in nursing homes.

    Science.gov (United States)

    Rantz, Marilyn J; Hicks, Lanis; Petroski, Gregory F; Madsen, Richard W; Alexander, Greg; Galambos, Colleen; Conn, Vicki; Scott-Cawiezell, Jill; Zwygart-Stauffacher, Mary; Greenwald, Leslie

    2010-09-01

    There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions of EMR at the bedside and on-site clinical consultation by gerontological expert nurses on cost, staffing, and quality of care in nursing homes. Eighteen nursing facilities in 3 states participated in a 4-group 24-month comparison: Group 1 implemented bedside EMR, used nurse consultation; Group 2 implemented bedside EMR only; Group 3 used nurse consultation only; Group 4 neither. Intervention sites (Groups 1 and 2) received substantial, partial financial support from CMS to implement EMR. Costs and staffing were measured from Medicaid cost reports, and staff retention from primary data collection; resident outcomes were measured by MDS-based quality indicators and quality measures. Total costs increased in both intervention groups that implemented technology; staffing and staff retention remained constant. Improvement trends were detected in resident outcomes of ADLs, range of motion, and high-risk pressure sores for both intervention groups but not in comparison groups. Implementation of bedside EMR is not cost neutral. There were increased total costs for all intervention facilities. These costs were not a result of increased direct care staffing or increased staff turnover. Nursing home leaders and policy makers need to be aware of on-going hardware and software costs as well as costs of continual technical support for the EMR and constant staff orientation to use the system. EMR can contribute to the quality of nursing home care and can be enhanced by on-site consultation by nurses with graduate education in nursing and expertise in gerontology. Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

  1. Personalized Medication Management: Towards a Design of Individualized Support for Elderly Citizens at Home

    DEFF Research Database (Denmark)

    Verdezoto, Nervo; Olsen, Jesper Wolff

    2012-01-01

    purpose to help them to manage their medications and recall challenges. We confirm that a considerable number of older adults integrate their medication treatments into their daily life routines, and that the lack of knowledge, caregiver's support, medicine outside the home, forgetting medication intake......Several technologies have been developed to support people's medication management, including pillboxes, specialized software applications, reminders and paper-based medication lists. Several of these technologies were discovered in older adults' homes during user studies carried out with the main...

  2. Medical Home Features of VHA Primary Care Clinics and Avoidable Hospitalizations.

    Science.gov (United States)

    Yoon, Jean; Rose, Danielle E; Canelo, Ismelda; Upadhyay, Anjali S; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Yano, Elizabeth M

    2013-09-01

    As the Veterans Health Administration (VHA) reorganizes providers into the patient-centered medical home, questions remain whether this model of care can demonstrate improved patient outcomes and cost savings. We measured adoption of medical home features by VHA primary care clinics prior to widespread implementation of the patient-centered medical home and examined if they were associated with lower risk and costs of potentially avoidable hospitalizations. Secondary patient data was linked to clinic administrative and survey data. Patient and clinic factors in the baseline year (FY2009) were used to predict patient outcomes in the follow-up year. 2,853,030 patients from 814 VHA primary care clinics Patient outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC) and their costs and identified through diagnosis and procedure codes from inpatient records. Clinic adoption of medical home features was obtained from the American College of Physicians Medical Home Builder®. The overall mean home builder score in the study clinics was 88 (SD = 13) or 69%. In adjusted analyses an increase of 10 points in the medical home adoption score in a clinic decreased the odds of an ACSC hospitalization for patients by 3% (P = 0.032). By component, higher access and scheduling (P = 0.004) and care coordination and transitions (P = 0.020) component scores were related to lower risk of an ACSC hospitalization, and higher population management was related to higher risk (P = 0.023). Total medical home features was not related to ACSC hospitalization costs among patients with at least one (P = 0.074). Greater adoption of medical home features by VHA primary care clinics was found to be significantly associated with lower risk of avoidable hospitalizations with access and scheduling and care coordination/transitions in care as key factors.

  3. Knowledge and perspectives of Dutch home heathcare nurses regarding medication frequently used by older people

    NARCIS (Netherlands)

    Sino, Carolien; Munnik, Aukje; Schuurmans, Marieke

    2013-01-01

    Home healthcare nurses in their roles as caregivers, educators and administrators of medications are particularly well positioned to act on a preventive way to be alert of adverse drug reactions. However, knowledge about medication and a professional attitude is required. To describe medication-rela

  4. Safety in home care: A research protocol for studying medication management

    Directory of Open Access Journals (Sweden)

    Easty Anthony

    2010-06-01

    Full Text Available Abstract Background Patient safety is an ongoing global priority, with medication safety considered a prevalent, high-risk area of concern. Yet, we have little understanding of the supports and barriers to safe medication management in the Canadian home care environment. There is a clear need to engage the providers and recipients of care in studying and improving medication safety with collaborative approaches to exploring the nature and safety of medication management in home care. Methods A socio-ecological perspective on health and health systems drives our iterative qualitative study on medication safety with elderly home care clients, family members and other informal caregivers, and home care providers. As we purposively sample across four Canadian provinces: Alberta (AB, Ontario (ON, Quebec (QC and Nova Scotia (NS, we will collect textual and visual data through home-based interviews, participant-led photo walkabouts of the home, and photo elicitation sessions at clients' kitchen tables. Using successive rounds of interpretive description and human factors engineering analyses, we will generate robust descriptions of managing medication at home within each provincial sample and across the four-province group. We will validate our initial interpretations through photo elicitation focus groups with home care providers in each province to develop a refined description of the phenomenon that can inform future decision-making, quality improvement efforts, and research. Discussion The application of interpretive and human factors lenses to the visual and textual data is expected to yield findings that advance our understanding of the issues, challenges, and risk-mitigating strategies related to medication safety in home care. The images are powerful knowledge translation tools for sharing what we learn with participants, decision makers, other healthcare audiences, and the public. In addition, participants engage in knowledge exchange

  5. Home Healthcare Medical Devices: Infusion Therapy - Getting the Most Out of Your Pump

    Science.gov (United States)

    ... Home Healthcare Medical Devices: Infusion Therapy - Getting the Most Out of Your Pump Share Tweet Linkedin Pin ... and accessories schedule routine maintenance What are the most common problems with an infusion pump and how ...

  6. The effect of organizational climate on patient-centered medical home implementation.

    Science.gov (United States)

    Reddy, Ashok; Shea, Judy A; Canamucio, Anne; Werner, Rachel M

    2015-01-01

    Organizational climate is a key determinant of successful adoption of innovations; however, its relation to medical home implementation is unknown. This study examined the association between primary care providers' (PCPs') perception of organization climate and medical home implementation in the Veterans Health Administration. Multivariate regression was used to test the hypothesis that organizational climate predicts medical home implementation. This analysis of 191 PCPs found that higher scores in 2 domains of organizational climate (communication and cooperation, and orientation to quality improvement) were associated with a statistically significantly higher percentage (from 7 to 10 percentage points) of PCPs implementing structural changes to support the medical home model. In addition, some aspects of a better organizational climate were associated with improved organizational processes of care, including a higher percentage of patients contacted within 2 days of hospital discharge (by 2 to 3 percentage points) and appointments made within 3 days of a patient request (by 2 percentage points).

  7. Importance of patient education on home medical care waste disposal in Japan

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Yukihiro, E-mail: yuyu@med.kindai.ac.jp

    2014-07-15

    Highlights: • Attached office nurses more recovered medical waste from patients’ homes. • Most nurses educated their patients on how to store home medical care waste in their homes and on how to separate them. • Around half of nurses educated their patients on where to dispose of their home medical care waste. - Abstract: To determine current practices in the disposal and handling of home medical care (HMC) waste, a questionnaire was mailed to 1965 offices nationwide. Of the office that responded, 1283 offices were analyzed. Offices were classified by management configuration: those attached to hospitals were classified as ”attached offices” and others as “independent offices”. More nurses from attached offices recovered medical waste from patients’ homes than those from independent offices. Most nurses educated their patients on how to store HMC waste in their homes (79.3% of total) and on how to separate HMC waste (76.5% of total). On the other hand, only around half of nurses (47.3% from attached offices and 53.2% from independent offices) educated their patients on where to dispose of their HMC waste. 66.0% of offices replied that patients had separated their waste appropriately. The need for patient education has emerged in recent years, with education for nurses under the diverse conditions of HMC being a key factor in patient education.

  8. Is There Evidence of Cream Skimming among Nursing Homes following the Publication of the Nursing Home Compare Report Card?

    Science.gov (United States)

    Mukamel, Dana B.; Ladd, Heather; Weimer, David L.; Spector, William D.; Zinn, Jacqueline S.

    2009-01-01

    Purpose: A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream…

  9. Type of oral solid medication packaging and medication preparation time in nursing homes: A direct observation study.

    Science.gov (United States)

    Cready, C M; Hudson, C; Dreyer, K

    2017-06-05

    Medication administration is a substantial portion of the workday in nursing homes, with the medication preparation step being the most time-consuming. However, little is known about how medication preparation time is affected by the type of packaging used for oral solid medications (ie, tablets/capsules). We examined the effects of two types of packaging. As fewer steps are associated with strip packaging compared to bingo card packaging, we hypothesized that the increase in medication preparation seconds per resident with each additional oral solid medication would be smaller when strip packaging was used. A total of 430 medication preparations conducted by eight nurses during the regularly scheduled morning medication administration period in two nursing homes-using strip packaging and bingo card packaging, respectively-were observed. Each medication preparation observation was matched to its corresponding medication administration record and observations averaged across resident. Using the resident sample (N=149), we estimated three regression models (adjusting the standard errors for the clustering of resident by nurse). The first model regressed medication preparation seconds on the number of oral solid medications. The second model added the type of packaging used and the control variables (type of unit [long-term care, post-acute care], the number of one-half pills and the dosage form diversity in the preparation). To test our hypothesis, the third model added an interaction term between the number of oral solid medications and the type of packaging used. As hypothesized, all else equal, the number of oral solid medications tended to increase medication preparation time per resident in both nursing homes, but the increase was smaller in the strip packaging nursing home (Phome increased medication preparation by an average of 13 seconds (b=13.077), whereas each oral solid medication administered in the strip packaging nursing home increased medication

  10. Nurse and Medical Provider Perspectives on Antibiotic Stewardship in Nursing Homes.

    Science.gov (United States)

    Scales, Kezia; Zimmerman, Sheryl; Reed, David; Beeber, Anna Song; Kistler, Christine E; Preisser, John S; Weiner, Bryan J; Ward, Kimberly; Fann, Amy; Sloane, Philip D

    2017-01-01

    To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes (NHs). Cross-sectional survey. NHs in North Carolina (N = 31). Nursing staff (n = 182) and medical providers (n = 50). Respondents completed a self-administered questionnaire about their perspectives on antibiotic use in their NH, the influence of residents and families on antibiotic prescribing decisions, and readiness to improve antibiotic stewardship. Open-ended questions on barriers to antibiotic stewardship were also asked. Linear mixed modeling was used to analyze differences between respondent groups and to test for associations with individual and organizational characteristics. All respondents supported reducing antibiotic use, although medical providers' support was significantly stronger (P = .005). When asked about their perception of residents' and family members' preference for antibiotic use in the case of suspected infection and the influence of that preference on antibiotic-prescribing decisions, respondents indicated that residents and families favor antibiotic use and influence prescribing decisions. Nurses reported a stronger perception than medical providers that families prefer antibiotics (P = .04) and influence prescribing decisions (P = .02). All respondents reported commitment and efficacy to change practices (mean 4.0-4.1 for nurses and 3.6-3.9 for medical providers on a 5-point scale). Four significant associations related to organizational and individual characteristics were found: directors of nursing and specialist nurses reported greater self-efficacy for changing practice than other nurses (P = .003), medical providers with a subspecialty (e.g., geriatrics) reported greater self-efficacy (P = .007) and commitment to change (P = .001) than those without a subspecialty, and medical providers specializing in hospice and palliative care rated family influence (P = .006) higher than those with other subspecialties

  11. [Mapping of risks related to medication care in nursing homes: An overview in Alsace - France].

    Science.gov (United States)

    Weber, K; Beck, M; Rybarczyk-Vigouret, M C; Michel, B

    2015-06-01

    Medication care of patients in nursing homes involves a complex circuit whose related risks need to be identified. The aim of this study was first to map risks related to medication care in a representative panel of nursing homes under contract with community pharmacies in Alsace, then to propose improvement action plans to remedy the weaknesses identified. This study was conducted on a representative sample of 23 nursing homes in Alsace in 2014. A self-assessment questionnaire (Interdiag EHPAD), divided into 7 fields and made up of 198 questions, was completed by each of the 23 nursing homes during multidisciplinary meetings that were organized by the OMEDIT (observatoire du médicament, des dispositifs médicaux et de l'innovation thérapeutique of Alsace). The percentages of controlled risks were calculated for each of the 7 fields of the medication circuit, both at nursing home and regional levels. Similarly, the percentages of non-controlled risks were calculated for each of the 198 items. Considering the 7 fields, regional percentages of controlled risks varied from 63% to 85%. The field relative to drug supply was the best controlled, while that relative to prevention was the least controlled. Considering the 198 items, 30 important vulnerability points were identified, among which stand out: failure to report and to analyze adverse drug events, lack of involvement of general practitioner in nursing homes through collaborative approaches and transcription by nurse staff of oral or handwritten prescriptions in medical software. The analysis of those items led to the proposal of 13 improvement actions. The study pointed out mainly difficulties linked to the absence of suitable risk management policies and the lack of adjustment between nursing home staffs and general practitioners. In contrast, it revealed that the collaboration between nursing homes and community pharmacies was successful overall. Finally, we hope that this multi-center study, that led to

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

    Science.gov (United States)

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

    2011-06-01

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

  13. A qualitative study describing nursing home nurses sensemaking to detect medication order discrepancies.

    Science.gov (United States)

    Vogelsmeier, Amy; Anderson, Ruth A; Anbari, Allison; Ganong, Lawrence; Farag, Amany; Niemeyer, MaryAnn

    2017-08-04

    Medication reconciliation is a safety practice to identify medication order discrepancies when patients' transitions between settings. In nursing homes, registered nurses (RNs) and licensed practical nurses (LPNs), each group with different education preparation and scope of practice responsibilities, perform medication reconciliation. However, little is known about how they differ in practice when making sense of medication orders to detect discrepancies. Therefore, the purpose of this study was to describe differences in RN and LPN sensemaking when detecting discrepancies. We used a qualitative methodology in a study of 13 RNs and 13 LPNs working in 12 Midwestern United States nursing homes. We used both conventional content analysis and directed content analysis methods to analyze semi-structured interviews. Four resident transfer vignettes embedded with medication order discrepancies guided the interviews. Participants were asked to describe their roles with medication reconciliation and their rationale for identifying medication order discrepancies within the vignettes as well as to share their experiences of performing medication reconciliation. The analysis approach was guided by Weick's Sensemaking theory. RNs provided explicit stories of identifying medication order discrepancies as well as examples of clinical reasoning to assure medication order appropriateness whereas LPNs described comparing medication lists. RNs and LPNs both acknowledged competing demands, but when performing medication reconciliation, RNs were more concerned about accuracy and safety, whereas LPNs were more concerned about time. Nursing home nurses, particularly RNs, are in an important position to identify discrepancies that could cause resident harm. Both RNs and LPNs are valuable assets to nursing home care and keeping residents safe, yet RNs offer a unique contribution to complex processes such as medication reconciliation. Nursing home leaders must acknowledge the differences

  14. Understanding safety-critical interactions with a home medical device through Distributed Cognition.

    Science.gov (United States)

    Rajkomar, Atish; Mayer, Astrid; Blandford, Ann

    2015-08-01

    As healthcare shifts from the hospital to the home, it is becoming increasingly important to understand how patients interact with home medical devices, to inform the safe and patient-friendly design of these devices. Distributed Cognition (DCog) has been a useful theoretical framework for understanding situated interactions in the healthcare domain. However, it has not previously been applied to study interactions with home medical devices. In this study, DCog was applied to understand renal patients' interactions with Home Hemodialysis Technology (HHT), as an example of a home medical device. Data was gathered through ethnographic observations and interviews with 19 renal patients and interviews with seven professionals. Data was analyzed through the principles summarized in the Distributed Cognition for Teamwork methodology. In this paper we focus on the analysis of system activities, information flows, social structures, physical layouts, and artefacts. By explicitly considering different ways in which cognitive processes are distributed, the DCog approach helped to understand patients' interaction strategies, and pointed to design opportunities that could improve patients' experiences of using HHT. The findings highlight the need to design HHT taking into consideration likely scenarios of use in the home and of the broader home context. A setting such as home hemodialysis has the characteristics of a complex and safety-critical socio-technical system, and a DCog approach effectively helps to understand how safety is achieved or compromised in such a system.

  15. HOME Participating Jurisdictions Open Activities Reports

    Data.gov (United States)

    Department of Housing and Urban Development — This report is an MS Excel spreadsheet broken up by state. Participating Jurisdictions can use this report to view open activities in IDIS including activities with...

  16. Report of VA Medical Training Programs

    Data.gov (United States)

    Department of Veterans Affairs — The Report of VA Medical Training Programs Database is used to track medical center health services trainees and VA physicians serving as faculty. The database also...

  17. Letters Home as an Alternative to Lab Reports

    Science.gov (United States)

    Lane, W. Brian

    2014-01-01

    The traditional lab report is known to create several pedagogical shortcomings in the introductory physics course, particularly with regard to promoting student engagement and encouraging quality writing. This paper discusses the use of a "letter home" written to a non-physicist as an alternative to lab reports that creates a more…

  18. Home Use Devices: How to Prepare for and Handle Power Outages for Medical Devices That Require Electricity

    Science.gov (United States)

    ... Handle Power Outages for Medical Devices that Require Electricity Center for De CDRH vices and Rad lth ... Handle Power Outages for Medical Devices that Require Electricity As a home medical device user, it is ...

  19. Learning by Living: Life-Altering Medical Education through Nursing Home-Based Experiential Learning

    Science.gov (United States)

    Gugliucci, Marilyn R.; Weiner, Audrey

    2013-01-01

    The University of New England College of Osteopathic Medicine Learning by Living Project (referred to as Learning by Living) was piloted in 2006 as an experiential medical education learning model. Since its inception, medical and other health professions students have been "admitted" into nursing homes to live the life of an older adult nursing…

  20. Learning by Living: Life-Altering Medical Education through Nursing Home-Based Experiential Learning

    Science.gov (United States)

    Gugliucci, Marilyn R.; Weiner, Audrey

    2013-01-01

    The University of New England College of Osteopathic Medicine Learning by Living Project (referred to as Learning by Living) was piloted in 2006 as an experiential medical education learning model. Since its inception, medical and other health professions students have been "admitted" into nursing homes to live the life of an older adult nursing…

  1. Cost of Transformation among Primary Care Practices Participating in a Medical Home Pilot.

    Science.gov (United States)

    Martsolf, Grant R; Kandrack, Ryan; Gabbay, Robert A; Friedberg, Mark W

    2016-07-01

    Medical home initiatives encourage primary care practices to invest in new structural capabilities such as patient registries and information technology, but little is known about the costs of these investments. To estimate costs of transformation incurred by primary care practices participating in a medical home pilot. We interviewed practice leaders in order to identify changes practices had undertaken due to medical home transformation. Based on the principles of activity-based costing, we estimated the costs of additional personnel and other investments associated with these changes. The Pennsylvania Chronic Care Initiative (PACCI), a statewide multi-payer medical home pilot. Twelve practices that participated in the PACCI. One-time and ongoing yearly costs attributed to medical home transformation. Practices incurred median one-time transformation-associated costs of $30,991 per practice (range, $7694 to $117,810), equivalent to $9814 per clinician ($1497 to $57,476) and $8 per patient ($1 to $30). Median ongoing yearly costs associated with transformation were $147,573 per practice (range, $83,829 to $346,603), equivalent to $64,768 per clinician ($18,585 to $93,856) and $30 per patient ($8 to $136). Care management activities accounted for over 60% of practices' transformation-associated costs. Per-clinician and per-patient transformation costs were greater for small and independent practices than for large and system-affiliated practices. Error in interviewee recall could affect estimates. Transformation costs in other medical home interventions may be different. The costs of medical home transformation vary widely, creating potential financial challenges for primary care practices-especially those that are small and independent. Tailored subsidies from payers may help practices make these investments. Agency for Healthcare Research and Quality.

  2. Medical home implementation: a sensemaking taxonomy of hard and soft best practices.

    Science.gov (United States)

    Hoff, Timothy

    2013-12-01

    The patient-centered medical home (PCMH) model of care is currently a central focus of U.S. health system reform, but less is known about the model's implementation in the practice of everyday primary care. Understanding its implementation is key to ensuring the approach's continued support and success nationally. This article addresses this gap through a qualitative examination of the best practices associated with PCMH implementation for older adult patients in primary care. I used a multicase, comparative study design that relied on a sensemaking approach and fifty-one in-depth interviews with physicians, nurses, and clinic support staff working in six accredited medical homes located in various geographic areas. My emphasis was on gaining descriptive insights into the staff's experiences delivering medical home care to older adult patients in particular and then analyzing how these experiences shaped the staff's thinking, learning, and future actions in implementing medical home care. I found two distinct taxonomies of implementation best practices, which I labeled "hard" and "soft" because of their differing emphasis and content. Hard implementation practices are normative activities and structural interventions that align well with existing national standards for medical home care. Soft best practices are more relational in nature and derive from the existing practice social structure and everyday interactions between staff and patients. Currently, external stakeholders are less apt to recognize, encourage, or incentivize soft best practices. The results suggest that there may be no standardized, one-size-fits-all approach to making medical home implementation work, particularly for special patient populations such as the elderly. My study also raises the issue of broadening current PCMH assessments and reward systems to include implementation practices that contain heavy social and relational components of care, in addition to the emphasis now placed on

  3. Medical Home Finds Real Estate in a Children’s Hospital

    Directory of Open Access Journals (Sweden)

    Renee M. Turchi

    2015-08-01

    Full Text Available The Center for children and youth with special health care needs (CYSHCN at St. Christopher’s Hospital for Children in Philadelphia is one such model and has grown steadily over the last 10 years. The medical home model embraced by the Center for CYSHCN focuses on care coordination, patient- and family-centered care, and integrated communication tools (such as care plans and medical summaries. The vast majority of CYSHCN treated at the Center during this study ranged in age from 6 to 12 years. Of those children, 82% had public insurance, 17% required home-nursing services, 24% required mobility aids, and 16% required enteral nutritional/feeding tubes. The most common diagnoses included developmental delay, intellectual disability, and cerebral palsy. When compared with CYSHCN enrolled in a statewide medical home program, the severity of the medical conditions of CYSHCN cared for at the Center was statistically significantly higher/more complex.

  4. Seniors managing multiple medications: using mixed methods to view the home care safety lens.

    Science.gov (United States)

    Lang, Ariella; Macdonald, Marilyn; Marck, Patricia; Toon, Lynn; Griffin, Melissa; Easty, Tony; Fraser, Kimberly; MacKinnon, Neil; Mitchell, Jonathan; Lang, Eddy; Goodwin, Sharon

    2015-12-12

    Patient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS). Informed by a socio-ecological perspective, this study utilized Interpretive Description (ID) methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and/or rural households in each province. A total of 94 participants (i.e., seniors receiving home care services, their family/caregivers, and paid providers) were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns. Six patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home

  5. Medicare program; Home Health Prospective Payment System rate update for calendar year 2013, hospice quality reporting requirements, and survey and enforcement requirements for home health agencies. Final rule.

    Science.gov (United States)

    2012-11-08

    This final rule updates the Home Health Prospective Payment System (HH PPS) rates, including the national standardized 60-day episode rates, the national per-visit rates, the low-utilization payment amount (LUPA), the non-routine medical supplies (NRS) conversion factor, and outlier payments under the Medicare prospective payment system for home health agencies effective January 1, 2013. This rule also establishes requirements for the Home Health and Hospice quality reporting programs. This final rule will also establish requirements for unannounced, standard and extended surveys of home health agencies (HHAs) and sets forth alternative sanctions that could be imposed instead of, or in addition to, termination of the HHA's participation in the Medicare program, which could remain in effect up to a maximum of 6 months, until an HHA achieves compliance with the HHA Conditions of Participation (CoPs) or until the HHA's provider agreement is terminated.

  6. Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

    Science.gov (United States)

    2015-11-01

    This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.

  7. The Relationship Between the Use of a Worksite Medical Home and ED Visits or Hospitalizations

    Directory of Open Access Journals (Sweden)

    Marissa Stroo BS

    2015-10-01

    Full Text Available Worksite medical homes may be a good model for improving employee health. The aim of this study was to compare the likelihood of being seen in the emergency department (ED or being hospitalized by level of use (no use, occasional use, or primary care of a worksite medical home, overall and by type of user (employee, adult dependent, or pediatric dependent. This was a retrospective analysis of claims data, using covariate-adjusted logistic regression models for ED visits and inpatient hospitalizations. Secondary data for the years 2006 to 2008 from a company that offers an on-site health care center (HCC were used. Analyses were based on a data set that combines health plan claims and human resources demographic data. Overall, people who did not use the HCC were more likely to be seen in the ED (adjusted odds ratio [OR] = 1.20, 95% confidence interval or CI [1.06, 1.37], P = .005 or to be hospitalized (adjusted OR = 1.58; 95% CI [1.34, 1.86]; P < .0001 compared with those who used the HCC for primary care. Both ED visits and hospitalizations for employees and dependents in this study were lower among those who used the worksite medical home for primary care. Worksite medical homes can improve chronic disease management and thus reduce ED visits and hospitalizations. These findings contribute to growing evidence that worksite medical homes are potentially cost-effective.

  8. Technology for Improving Medication Monitoring in Nursing Homes

    Science.gov (United States)

    2005-01-01

    Education Foundation. The Geriatric Risk Assessment MedGuide™ (GRAM™) software19 specifically alerts prescribers and nursing facility staff to...developed and delivered inservice programs for nursing staff of the 13 facilities that received the intervention as part of the AHRQ-funded study. The in...Research and Education Foundation who have encouraged innovations in the delivery of quality pharmaceutical care to nursing home residents. Author

  9. Medication in nursing homes in Alsace: a preferential list of drugs obtained by consensus

    OpenAIRE

    Hannou, Sophia; Rousseau, Amélie; Rybarczyk-Vigouret, Marie-Christine; Michel,Bruno

    2014-01-01

    Abstract In order to improve patient care, OMEDIT (Observatory of drugs, medical devices and therapeutic innovation) Alsace, conducted a study to develop a Preferential list of Drugs adapted to the Elderly (PDE list) in nursing homes. The study conducted from December 2011 to June 2012 was organized in 4 phases: 1) creation of a preliminary list of drugs from those currently used in nursing homes in Alsace, 2) application of a two-round Delphi process to evaluate the preliminary list involvin...

  10. Medication Errors in the Home: A Multisite Study of Children With Cancer

    Science.gov (United States)

    Roblin, Douglas W.; Weingart, Saul N.; Houlahan, Kathleen E.; Degar, Barbara; Billett, Amy; Keuker, Christopher; Biggins, Colleen; Li, Justin; Wasilewski, Karen; Mazor, Kathleen M.

    2013-01-01

    OBJECTIVE: As home medication use increases, medications previously managed by nurses are now managed by patients and their families. Our objective was to describe the types of errors occurring in the home medication management of children with cancer. METHODS: In a prospective observational study at 3 pediatric oncology clinics in the northeastern and southeastern United States, patients undergoing chemotherapy and their parents were recruited from November 2007 through April 2011. We reviewed medical records and checked prescription doses. A trained nurse visited the home, reviewed medication bottles, and observed administration. Two physicians independently made judgments regarding whether an error occurred and its severity. Overall rates of errors were weighted to account for clustering within sites. RESULTS: We reviewed 963 medications and observed 242 medication administrations in the homes of 92 patients. We found 72 medication errors. Four errors led to significant patient injury. An additional 40 errors had potential for injury: 2 were life-threatening, 13 were serious, and 25 were significant. Error rates varied between study sites (40–121 errors per 100 patients); the weighted overall rate was 70.2 errors per 100 patients (95% confidence interval [CI]: 58.9–81.6). The weighted rate of errors with injury was 3.6 (95% CI: 1.7–5.5) per 100 patients and with potential to injure the patient was 36.3 (95% CI: 29.3–43.3) per 100 patients. Nonchemotherapy medications were more often involved in an error than chemotherapy. CONCLUSIONS: Medication errors were common in this multisite study of outpatient pediatric cancer care. Rates of preventable medication-related injuries in this outpatient population were comparable or higher than those found in studies of hospitalized patients. PMID:23629608

  11. Polypharmacy and potentially inappropriate medications: a cross-sectional analysis among 451 nursing homes in France.

    Science.gov (United States)

    Herr, Marie; Grondin, Helene; Sanchez, Stéphane; Armaingaud, Didier; Blochet, Caroline; Vial, Antoine; Denormandie, Philippe; Ankri, Joël

    2017-05-01

    The quality of drug therapy is an important issue for nursing homes. This study aimed to assess the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a large sample of nursing home residents by using the data recorded during the preparation of pill dispensers. This is a cross-sectional study that included 451 nursing homes across France. Information about the medications received by the 30,702 residents (73.8% women) living in these nursing homes was extracted from the system that assists in the preparation of pill dispensers in pharmacies. The anonymized database included age, sex, and medications prescribed to residents, as well as nursing home characteristics (capacity, legal status). Factors associated with excessive polypharmacy (≥10 different drugs) and PIMs according to the Laroche list were studied using multilevel regression models. The average number of drugs prescribed was 6.9 ± 3.3, and excessive polypharmacy concerned 21.1% of the residents (n = 6468). According to the Laroche list, 47.4% of residents (n = 14,547) received at least one PIM. Benzodiazepines (excessive doses, long-acting benzodiazepines, and combination of benzodiazepines) and anticholinergic medications (hydroxyzine, cyamemazine, alimemazine) accounted for a large part of PIMs. Individual characteristics (age, gender) influenced the risk of receiving PIMs whereas nursing home characteristics (capacity, legal status) influenced the risk of excessive polypharmacy. This study shows that polypharmacy and PIMs remain highly prevalent among nursing home residents. Main PIMs concerned psychotropic and anticholinergic medications.

  12. Making multipayer reform work: what can be learned from medical home initiatives.

    Science.gov (United States)

    Takach, Mary; Townley, Charles; Yalowich, Rachel; Kinsler, Sarah

    2015-04-01

    Multipayer collaboratives of all types will encounter legal, logistical, and often political obstacles that multipayer medical home initiatives have already overcome. The seventeen multipayer medical home initiatives launched between 2008 and 2014 all navigated four critical decision-making points: convening stakeholders; establishing provider participation criteria; determining payment; and measuring performance. Although we observed trends toward voluntary payer participation and more flexible participation criteria for both payers and providers, initiatives continue to vary widely, each shaped largely by its insurance market and policy environment. Medical home initiatives across the United States are demonstrating that multipayer reform, although complex and difficult to implement, is feasible when committed stakeholders negotiate strategies that are responsive to the local context. Their experiences can inform, and perhaps expedite, negotiations in current and future multipayer collaborations.

  13. Indoor fire in a nursing home : evaluation of the medical response to a mass casualty incident based on a standardized protocol

    NARCIS (Netherlands)

    Koning, S. W.; Ellerbroek, P. M.; Leenen, L. P. H.

    This retrospective study reports the outcome of a mass casualty incident (MCI) caused by a fire in a nursing home. Data from the medical charts and registration system of the Major Incident Hospital (MIH) and ambulance service were analyzed. The evaluation reports from the MIH and an independent

  14. Indoor fire in a nursing home : evaluation of the medical response to a mass casualty incident based on a standardized protocol

    NARCIS (Netherlands)

    Koning, S. W.; Ellerbroek, P. M.; Leenen, L. P. H.

    2015-01-01

    This retrospective study reports the outcome of a mass casualty incident (MCI) caused by a fire in a nursing home. Data from the medical charts and registration system of the Major Incident Hospital (MIH) and ambulance service were analyzed. The evaluation reports from the MIH and an independent res

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

    Science.gov (United States)

    Quinn, Kevin

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

  16. Potentially inappropriate home medications among older patients with cardiovascular disease admitted to a cardiology service in USA.

    Science.gov (United States)

    Sheikh-Taha, Marwan; Dimassi, Hani

    2017-07-17

    The use of potentially inappropriate medications (PIMs) may pose more risks than benefits to patients and is a major factor contributing to the likelihood of serious adverse drug reactions and negative health outcomes among older patients. A retrospective chart review was conducted in a tertiary care center in USA where home medications of the older patients were reviewed and analyzed upon hospital admission over three months, from March till May 2016. Inclusion criteria were age of 65 years and above, history of cardiovascular disease, and admission to the cardiology service. The aim of our study was to determine the frequency and factors associated with PIMs, by applying the updated Beers 2015 criteria. A total of 404 patients were included in the study and were taking a total of 4669 medications at home, an average of 11.6 ± 4.5 medications per patient. The proportion of PIMS was 20% of all medications reported, with an average of 2.4 PIM per patient, and 87.4% of patients were receiving at least one PIM. Significant association was found between use of PIMs and number of home medications, female gender, and number and types of comorbidities. Comorbidities associated with more PIMs were heart failure, atrial fibrillation/flutter, history of falls/fractures, cerebrovascular accident, and depression. The most commonly prescribed PIMs were: drugs that may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia (29.7%), scheduled use of proton pump inhibitors (PPIs) > 8 weeks in non-high-risk patients (11.3%), and benzodiazepines (8.1%). A high prevalence of PIMs in older patients with cardiovascular disease was observed. Provider education and detailed assessment of medication lists upon hospital admission by multidisciplinary teams can help in preventing the use of PIMs.

  17. Medical confidentiality and patient safety: reporting procedures.

    Science.gov (United States)

    Abbing, Henriette Roscam

    2014-06-01

    Medical confidentiality is of individual and of general interest. Medical confidentiality is not absolute. European countries differ in their legislative approaches of consent for data-sharing and lawful breaches of medical confidentiality. An increase of interference by the legislator with medical confidentiality is noticeable. In The Netherlands for instance this takes the form of new mandatory duties to report resp. of legislation providing for a release of medical confidentiality in specific situations, often under the condition that reporting takes place on the basis of a professional code that includes elements imposed by the legislator (e.g. (suspicion of) child abuse, domestic violence). Legislative interference must not result in the patient loosing trust in healthcare. To avoid erosion of medical confidentiality, (comparative) effectiveness studies and privacy impact assessments are necessary (European and national level). Medical confidentiality should be a subject of permanent education of health personnel.

  18. Challenges facing primary care practices aiming to implement patient-centered medical homes.

    Science.gov (United States)

    Farmer, Melissa M; Rose, Danielle E; Rubenstein, Lisa V; Canelo, Ismelda A; Schectman, Gordon; Stark, Richard; Yano, Elizabeth M

    2014-07-01

    While the potential of patient-centered medical homes (PCMH) is promising, little is known empirically about the frontline challenges that primary care (PC) leaders face before making the decision to implement PCMH, let alone in making it a reality. Prior to the design and implementation of the Veterans Health Administration's (VA) national PCMH model--Patient Aligned Care Teams (PACT)--we identified the top challenges faced by PC directors and examined the organizational and area level factors that influenced those challenges. A national cross-sectional key informant organizational survey was fielded to the census of PC directors at VA medical centers and large community-based outpatient clinics (final sample n = 229 sites). PC directors were asked to rate the degree to which they faced 48 management challenges in eight PCMH-related domains (access, preventive care, chronic diseases requiring care in PC, challenging medical conditions, mental health/substance abuse, special populations, PC coordination of care, and clinical informatics). Responses were dichotomized as moderately-to-extremely challenging versus somewhat-slightly-not at all challenging. Items were rank ordered; chi square or regression techniques were used to examine variations in facility size, type, urban/rural location, and region. On average, VA PC directors reported 16 moderate-to-extreme challenges, and the top 20 challenges spanned all eight PCMH domains. Four of the top 20 challenges, including the top two challenges, were from the clinical informatics domain. Management of chronic non-malignant pain requiring opiate therapy was the third most reported challenge nationwide. Significant organizational and area level variations in reported challenges were found especially for care coordination. Better understanding of PC challenges ahead of PCMH implementation provides important context for strategic planning and redesign efforts. As a national healthcare system, the VA provides a unique

  19. Psychotropic medication in a randomly selected group of citizens receiving residential or home care

    DEFF Research Database (Denmark)

    Futtrup, Tina Bergmann; Helnæs, Ann Kathrine; Schultz, Hanne

    2014-01-01

    INTRODUCTION: Treatment with one or more psychotropic medications (PMs), especially in the elderly, is associated with risk, and the effects of treatment are poorly validated. The aim of this article was to describe the use of PM in a population of citizens receiving either residential care or home...... care with focus on the prevalence of drug use, the combination of different PMs and doses in relation to current recommendations. METHODS: The medication lists of 214 citizens receiving residential care (122) and home care (92) were collected together with information on age, gender and residential...... number 2007-58-0015....

  20. Home delivery of medication - the role of a patient information leaflet on maximising service uptake.

    Science.gov (United States)

    Watson, L; Ahmed, N; Mccall, H; Minton, J; Benn, P; Edwards, S; Waters, L

    2014-12-01

    There are currently over 30,000 HIV-positive individuals in London and over 25,000 on anti-retroviral therapy. In 2009/2010, this equated to £170m spent by London's NHS on anti-retroviral drugs. Ways employed to reduce this cost include standardising the drugs patients are on and delivering medication to patients at home. Home delivery (HD) medication is exempt from value-added tax. The savings made from 10 patients using the home delivery service would free up resources to provide anti-retroviral therapy to one further patient. Studies have shown that concerns surrounding potential breaches of confidentiality are a potential barrier to some people using the home delivery service. In order to challenge these concerns, a leaflet was devised highlighting the major benefits to both the patient and the NHS of home delivery and addressing concerns over confidentiality. The leaflet was handed out to patients at the Mortimer Market Centre who were currently on anti-retroviral medication but not on home delivery. They were asked to complete a survey on their views of the service before and after reading the leaflet, whether they had been previously aware of the service and whether their concerns had been addressed. Some 79% felt that the patient information leaflet addressed all of their concerns, and it helped 11% decide whether to consider using home delivery. However, as more patients were opposed to the service after reading the patient information leaflet than those considering it, more work needs to be done to explore patients' concerns and other factors influencing home delivery service uptake.

  1. Model medication management process in Australian nursing homes using business process modeling.

    Science.gov (United States)

    Qian, Siyu; Yu, Ping

    2013-01-01

    One of the reasons for end user avoidance or rejection to use health information systems is poor alignment of the system with healthcare workflow, likely causing by system designers' lack of thorough understanding about healthcare process. Therefore, understanding the healthcare workflow is the essential first step for the design of optimal technologies that will enable care staff to complete the intended tasks faster and better. The often use of multiple or "high risk" medicines by older people in nursing homes has the potential to increase medication error rate. To facilitate the design of information systems with most potential to improve patient safety, this study aims to understand medication management process in nursing homes using business process modeling method. The paper presents study design and preliminary findings from interviewing two registered nurses, who were team leaders in two nursing homes. Although there were subtle differences in medication management between the two homes, major medication management activities were similar. Further field observation will be conducted. Based on the data collected from observations, an as-is process model for medication management will be developed.

  2. Nursing Home Stakeholder Views of Resident Involvement in Medical Care Decisions

    Science.gov (United States)

    Garcia, Theresa J.; Harrison, Tracie C.; Goodwin, James S.

    2017-01-01

    Demand by nursing home residents for involvement in their medical care, or, patient-centered care, is expected to increase as baby boomers begin seeking long-term care for their chronic illnesses. To explore the needs in meeting this proposed demand, we used a qualitative descriptive method with content analysis to obtain the joint perspective of key stakeholders on the current state of person-centered medical care in the nursing home. We interviewed 31 nursing home stakeholders: 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Our findings revealed constraints placed by the long-term care system limited medical involvement opportunities and created conflicting goals for patient-centered medical care. Resident participation in medical care was perceived as low, but important. The creation of supportive educational programs for all stakeholders to facilitate a common goal for nursing home admission and to provide assistance through the long-term care system was encouraged. PMID:25721717

  3. Medication incidents reported to an online incident reporting system.

    LENUS (Irish Health Repository)

    Alrwisan, Adel

    2011-01-15

    AIMS: Approximately 20% of deaths from adverse events are related to medication incidents, costing the NHS an additional £500 million annually. Less than 5% of adverse events are reported. This study aims to assess the reporting rate of medication incidents in NHS facilities in the north east of Scotland, and to describe the types and outcomes of reported incidents among different services. Furthermore, we wished to quantify the proportion of reported incidents according to the reporters\\' profession. METHODS: A retrospective description was made of medication incidents reported to an online reporting system (DATIX) over a 46-month-period (July 2005 to April 2009). Reports originated from acute and community hospitals, mental health, and primary care facilities. RESULTS: Over the study period there were 2,666 incidents reported with a mean monthly reporting rate of 78.2\\/month (SD±16.9). 6.1% of all incidents resulted in harm, with insulin being the most commonly implicated medication. Nearly three-quarters (74.2%, n=1,978) of total incidents originated from acute hospitals. Administration incidents were implicated in the majority of the reported medication incidents (59%), followed by prescribing (10.8%) and dispensing (9.9%), while the nondescript "other medication incidents" accounted for 20.3% of total incidents. The majority of reports were made by nursing and midwifery staff (80%), with medical and dental professionals reporting the lowest number of incidents (n=56, 2%). CONCLUSIONS: The majority of medication incidents in this study were reported by nursing and midwifery staff, and were due to administration incidents. There is a clear need to elucidate the reasons for the limited contribution of the medical and dental professionals to reporting medication incidents.

  4. 75 FR 20854 - Medical Device Use in the Home Environment: Implications for the Safe and Effective Use of...

    Science.gov (United States)

    2010-04-21

    ..., including infusion pumps, ventilators, and wound care therapies, are now being used in the home. Home healthcare can provide significant benefits to patients, in terms of both quality of life and cost of care... safety. Home medical care is often provided by lay caregivers, who may not have received proper...

  5. The impact of medical technology on sense of security in the palliative home care setting.

    Science.gov (United States)

    Munck, Berit; Sandgren, Anna

    2017-03-02

    The increase in the use of medical devices in palliative home care requires that patients and next-of-kin feel secure. Therefore, the aim was to describe medical technology's impact on the sense of security for patients, next-of-kin and district nurses. Deductive content analysis was conducted on data from three previous studies, using the theoretical framework 'palliative home care as a secure base'. The use of medical technology was shown to have an impact on the sense of security for all involved. A sense of control was promoted by trust in staff and their competence in managing the technology, which was linked to continuity. Inner peace and being in comfort implied effective symptom relief facilitated by pain pumps and being relieved of responsibility. Health care professionals need to have practical knowledge about medical technology, but at the same time have an awareness of how to create and maintain a sense of security.

  6. Living with an adult family member using advanced medical technology at home.

    Science.gov (United States)

    Fex, Angelika; Flensner, Gullvi; Ek, Anna-Christina; Söderhamn, Olle

    2011-12-01

    Living with an adult family member using advanced medical technology at home An increased number of chronically ill adults perform self-care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self-care at home, either using long-term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent-care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent-care and transition, which may have an influence on the self-care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context.

  7. The Food and Drug Administration's initiative for safe design and effective use of home medical equipment.

    Science.gov (United States)

    Weick-Brady, Mary; Singh, Simran

    2014-06-01

    Although home-use medical devices provide significant benefits, including improved quality of life and cost savings, they are associated with unique risks. These risks result from interactions among the user, the use environment, and the device, and they can greatly impact user and patient safety. This article describes measures being taken by the Food and Drug Administration to address safe use of medical equipment by trained and untrained people outside of clinical facilities.

  8. Free child passenger restraints for patients in an urban pediatric medical home: effects on caregiver behavior.

    Science.gov (United States)

    Brixey, Suzanne; Guse, Clare E; Ngui, Emmanuel

    2009-10-01

    Motor vehicle crashes are a leading cause of death in children despite the availability of effective child passenger restraints that reduce morbidity and mortality. Inappropriate restraint is more common in minority and low-income populations. Removing barriers by distributing child passenger restraint systems (CPRS) and providing education has been 1 approach to improve child safety. The objective of this study was to evaluate the efficacy of providing no-cost CPRS in combination with targeted education to improve restraint use for low-income, minority, and urban children in a medical home. This prospective, non-randomized, community-based cohort study used a certified car seat technician to provide CPRS and training to the caregivers of 101 children when those caregivers reported not owning the appropriate type of restraint system during the index clinic visit. In the first 3 months of follow-up, caregivers were 2.4 times more likely to report appropriate use of CPRS: relative risk 2.4 (95% confidence interval [CI] 1.7 to 3.5). Reported improvement declined slightly between months 4 and 9. Appropriate restraint significantly improved, yet rates remained suboptimal. Multifactoral approaches are needed to understand why the set of patients studied and other at-risk populations may not use child restraints properly even when given access and information.

  9. Assessing the skills of home care workers in helping older people take their prescribed medications.

    Science.gov (United States)

    Smyth, Elizabeth E J

    2015-08-01

    The Southern Health and Social Care Trust in Northern Ireland applied a modified version of the Objective Structured Clinical Examination (OSCE) to assess the skills of home care workers in assisting older people taking prescribed medications. In Northern Ireland, home care workers are care workers employed by health and social care trusts or private agencies. The application of the model has developed the skills of this staff group, improved the relationship between the commissioner and provider, significantly reduced the time spent by community nurses in individual training and assessment, and enhanced the patient experience for those taking medication. Overall, the application of this model has provided assurances to the Trust board, the executive director of nursing, and operational directors that home care workers are competent in assisting older people in this high-risk activity.

  10. Maintaining compliance at home: Helping the elderly with their medications

    Directory of Open Access Journals (Sweden)

    E Mokgele

    2000-09-01

    Full Text Available The elderly population consumes more drugs for their chronic conditions compared to any age group. In this study it was indicated that the average elderly takes two to four drugs per day. The high quantity and wide range of drugs used by the elderly can lead to significant risks. Adding to the risks is the problem of compliance. Areas of concern regarding safety in administering medications to the elderly are the need for increased awareness of the effects of drugs in their systems.

  11. Evaluation of a statewide medical home program on children and young adults with asthma.

    Science.gov (United States)

    Hamburger, Robert; Berhane, Zekarias; Gatto, Molly; Yunghans, Suzanne; Davis, Renee K; Turchi, Renee M

    2015-01-01

    Asthma, the most common chronic condition among children, accounts for significant healthcare utilization and impact on quality of life. Care coordination in a medical home is considered standard practice, but has not been rigorously evaluated. We initiated this pilot study of children/young adults with asthma (n = 967), ages: birth to 24 years, receiving care from a subset of pediatric practices (n = 20) participating in the Pennsylvania Medical Home Initiative, Educating Practices in Community-Integrated Care (92 practices statewide). We hypothesized children and youth with asthma receiving care coordination in the context of a formal medical home program would experience favorable associations with healthcare utilization and quality of life measures. A total of 9240 care coordination encounters for this cohort of children/youth occurred over 100 days. The average length of care coordination encounter was 20.7 minutes. The most common care coordination activity was referral management (21%) and the care coordinator in the practice most often contacted parent/family and specialists (75%). Children with more severe asthma had more hospitalizations and emergency department (ED) visits than children with less severe asthma. There was a significant decrease in school absences, ED visits and acute care visits for children/youth with asthma with increasing length of time in a medical home program (p children/youth with asthma is feasible and may yield improvements in healthcare utilization, expenditures and quality of life. Larger-scale implementation of care coordination and medical home models for children/youth with asthma and other diagnoses are warranted.

  12. Physical Restraint and Antipsychotic Medication Use Among Nursing Home Residents With Dementia.

    Science.gov (United States)

    Foebel, Andrea D; Onder, Graziano; Finne-Soveri, Harriet; Lukas, Albert; Denkinger, Michael D; Carfi, Angelo; Vetrano, Davide L; Brandi, Vincenzo; Bernabei, Roberto; Liperoti, Rosa

    2016-02-01

    To explore antipsychotic (AP) medications and physical restraint use and their effects on physical function and cognition in older nursing home residents. This retrospective cohort studied involved 532 residents with dementia from 57 nursing homes participating in the Services and Health for Elderly in Long-Term Care study. Poisson log regression models explored the effect of physical restraint and/or AP medication use on cognitive or functional decline at 6 months. Physical restraint use was associated with a higher risk of both functional and cognitive decline compared with AP medication use alone. These risks were highest among residents receiving both AP medications and physical restraints, suggesting additive effects. Physical restraint use, and even more strongly, concurrent physical restraint and AP medication use, is related to function and cognitive decline in nursing home residents with dementia. Antipsychotic use is cautioned, but these results suggest physical restraint use is potentially more risky. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  13. Beyond the medical home: Special Care Family Academy for children and youth.

    Science.gov (United States)

    Thrall, Roger S; Blumberg, Jody H; Beck, Stephanie; Bourgoin, Magdalena D; Votto, John J; Barton, Randall W

    2012-01-01

    Children and youth with special health care needs require more health care and related services and consequently incur more costs than other individuals. Implementation of the "medical home" concept has benefitted children with special needs, resulting in fewer unmet medical needs and more consistent health care delivery. As advances in health care have enabled an increasingly higher percentage of children with special needs to live far into adulthood, the transition from adolescence to adulthood poses new challenges in obtaining medical care, education, job training, and employment opportunities. A more comprehensive medical home paradigm for children with special needs is composed of three fundamental components: 1) home/community, 2) education, and 3) medical/dental care. These components should be developed equally and in parallel, emphasizing consumer advocacy, care coordination, education, life skills, and career development, to attain independent or minimally dependent living. This new model has been initiated at Hospital for Special Care in New Britain, Connecticut, in its Special Care Family Academy.

  14. A randomized trial of hospital vs home self administration of vaginal misoprostol for medical abortion.

    Science.gov (United States)

    Shrestha, A; Sedhai, L B

    2014-01-01

    A combination of mifepristone followed after 24 hrs by misoprostol has proved a safe and effective abortifacient for termination of early pregnancy. Home use of misoprostol for medical abortion is still controversial in many countries including ours where women's literacy rate is low. Particularly in developing countries, this method markedly decreased the hospital visit which would be beneficial to patients and hospital staff. To see whether the home self administration of vaginal misoprostol was equally effective as administered by trained staff in terms of successful termination of early pregnancy. Secondary outcomes were bleeding and pain duration during medical abortion, side effects, reason for termination of pregnancy and women's acceptability of the procedure. One hundred and eighty eight women requesting medical abortion with pregnancy less than 63 days gestation were randomized into two groups either self administration of vaginal misoprostol (800 mcg) at home or hospital administration 24 hours after oral 200 mg mifepristone. Ultrasound was performed after 14 days to confirm complete abortion. The overall success rate was similar in two groups: 89.13% on home group Vs 86.9% in hospital group. Eleven out of 18 women (61.1%) having incomplete abortion had successful termination after 2nd dose misoprostol( 400 mcg). None of the women had continued pregnancy. Multigravida had slightly higher risk of failure (R.R: 1.04). Home self administration of vaginal misoprostol was safe and effective for early termination of medical abortion and was acceptable. Use of extra dose of misoprostol has advantage of higher completion rate of abortion.

  15. Effects of health insurance on non-working married women’s medical care use and bed days at home

    Science.gov (United States)

    2013-01-01

    Background This study examines whether bed days are alternative methods to medical care use for treating a particular illness. If bed days at home are considered as an alternative to medical treatment, then medical care use and bed days at home should be influenced by an individual’s health insurance status. Method This study uses data from the 2003 Medical Expenditure Panel Survey (MEPS) on medical care use and bed days at home for each contracted illness of non-working married women. Results The results suggest that the health insurance status of non-working married women has considerable influence on their choice between medical care use and bed days at home. In addition, those with health insurance are more likely to use medical care and less likely to use bed days at home, but they tend to avoid the simultaneous use of medical care and bed days at home. Conclusions In contrast to previous studies’ findings indicating that absences from work and medical care use among working males may be complements, this study’s results for non-working married women without health insurance suggest that they use rest and medical treatment as substitutes, not complements. PMID:23816313

  16. Campbell Creek Research Homes FY 2012 Annual Performance Report

    Energy Technology Data Exchange (ETDEWEB)

    Gehl, Anthony C [ORNL; Munk, Jeffrey D [ORNL; Jackson, Roderick K [ORNL; Boudreaux, Philip R [ORNL; Khowailed, Gannate A [ORNL

    2013-01-01

    The Campbell Creek project is funded and managed by the Tennessee Valley Authority (TVA) Technology Innovation, Energy Efficiency, Power Delivery & and Utilization Office. Technical support is provided under contract by the Oak Ridge National Laboratory (ORNL) and the Electric Power Research Institute.The project was designed to determine the relative energy efficiency of typical new home construction, energy efficiency retrofitting of existing homes, and high -performance new homes built from the ground up for energy efficiency. This project will compare three houses that represented the current construction practice as a base case (Builder House CC1); a modified house that could represent a major energy- efficient retrofit (Retrofit House CC2); and a house constructed from the ground up to be a high- performance home (High Performance House CC3). In order tTo enablehave a valid comparison, it was necessary to simulate occupancy in all three houses and heavily monitor the structural components and the energy usage by component. All three houses are two story, slab on grade, framed construction. CC1 and CC2 are approximately 2,400 square feet2. CC3 has a pantry option, that is primarily used as a mechanical equipment room, that adds approximately 100 square feet2. All three houses are all-electric (with the exception of a gas log fireplace that is not used during the testing), and use air-source heat pumps for heating and cooling. The three homes are located in Knoxville in the Campbell Creek Subdivision. CC1 and CC2 are next door to each other and CC3 is across the street and a couple of houses down. The energy data collected will be used to determine the benefits of retrofit packages and high -performance new home packages. There are over 300 channels of continuous energy performance and thermal comfort data collection in the houses (100 for each house). The data will also be used to evaluate the impact of energy -efficient upgrades ton the envelope, mechanical

  17. Effect of humour therapy on psychotropic medication use in nursing homes.

    Science.gov (United States)

    Leow, Jerome By; Pont, Lisa; Low, Lee-Fay

    2016-12-01

    The aim of this study was to assess the effect of Play Up humour therapy on antipsychotic, benzodiazepine and antidepressant use in Australian nursing homes. Play Up is a humour therapy program that has been implemented in Australian nursing homes. This study was an uncontrolled retrospective review of psychotropic medication charts of 406 residents in thirty-three nursing homes before and after 12 weeks of participation in Play Up. Prevalence and mean daily equivalent doses of psychotropic medication use were analysed. There were significant reductions from before to after the Play Up program in the prevalence of any psychotropic medication use, antipsychotic use and benzodiazepine use (P = 0.001, 0.02, 0.007, respectively). Mean daily dose equivalents of pro re nata (PRN) antipsychotics and PRN benzodiazepines significantly reduced over time (P = 0.007; P = 0.001). Play Up was associated with an overall decline in the use of psychotropic medications. Further trials are required to confirm and better define this association. © 2016 AJA Inc.

  18. Psychotropic medication use among nursing home residents in Austria: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Pitkälä Kaisu

    2009-05-01

    Full Text Available Abstract Background The use of psychotropic medications and their adverse effects in frail elderly has been debated extensively. However, recent data from European studies show that these drugs are still frequently prescribed in nursing home residents. In Austria, prevalence data are lacking. We aimed to determine the prevalence of psychotropic medication prescription in Austrian nursing homes and to explore characteristics associated with their prescription. Methods Cross-sectional study and association analysis in forty-eight out of 50 nursing homes with 1844 out of a total of 2005 residents in a defined urban-rural region in Austria. Prescribed medication was retrieved from residents' charts. Psychotropic medications were coded according to the Anatomical Therapeutic Chemical Classification 2005. Cluster-adjusted multiple logistic regression analysis was performed to investigate institutional and residents' characteristics associated with prescription. Results Residents' mean age was 81; 73% of residents were female. Mean cluster-adjusted prevalence of residents with at least one psychotropic medication was 74.6% (95% confidence interval, CI, 72.0–77.2. A total of 45.9% (95% CI 42.7–49.1 had at least one prescription of an antipsychotic medication. Two third of all antipsychotic medications were prescribed for bedtime use only. Anxiolytics were prescribed in 22.2% (95% CI 20.0–24.5, hypnotics in 13.3% (95% CI 11.3–15.4, and antidepressants in 36.8% (95% CI 34.1–39.6 of residents. None of the institutional characteristics and only few residents' characteristics were significantly associated with psychotropic medication prescription. Permanent restlessness was positively associated with psychotropic medication prescription (AOR 1.54, 95% CI 1.32–1.79 whereas cognitive impairment was inversely associated (AOR 0.70, 95% CI 0.56–0.88. Conclusion Frequency of psychotropic medication prescription is high in Austrian nursing homes

  19. Fiscal 2000 achievement report on the research and development of medical and welfare apparatus/technology. Home rehabilitation system for aphasia patients; 2000 nendo iryo fukushi kiki gijutsu kenkyu kaihatsu seika hokokusho. Shitsugosho zaitaku rehabilitation shien system

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-05-01

    In the effort to develop an authoring system for assistance programs, a self-training system to enhance home rehabilitation, a remote rehabilitation evaluation/diagnosis supporting system, and a communication assisting system, the systems developed in the preceding fiscal years were customized and, together with their operation manuals, introduced to seven hospitals and subjected to evaluation. The results were analyzed, and improvement centering on the ease of operation was carried out. Various development efforts were exerted to improve on what were strongly demanded. As for the aphasiac/caregiver interface, it was distributed to every hospital concerned. There was a demand for immediate introduction, and then the interface was developed into a practical tool to satisfy the demand. This enabled aphasiac patients to receive training stimuli effectively through various sense organs. (NEDO)

  20. 76 FR 79050 - Federal Home Loan Bank Housing Goals: Mortgage Reporting Amendments

    Science.gov (United States)

    2011-12-21

    ... AGENCY 12 CFR Part 1281 RIN 2590-AA48 Federal Home Loan Bank Housing Goals: Mortgage Reporting Amendments... Federal Home Loan Banks (Banks) to make those requirements consistent with other data reporting... Economic Recovery Act of 2008 (HERA) amended the Federal Home Loan Bank Act (Bank Act) by adding a...

  1. Evaluating sociodemographic and medical conditions of patients under home care service

    Directory of Open Access Journals (Sweden)

    Tolga Önder

    2015-09-01

    Full Text Available Objective: In our study, we aimed to reveal medical conditions and the sociodemographic conditions of patients under home care service. Methods: Our study is planned on 52 patients who are under home care service at Sarıkamış State Hospital between June 2013 and May 2014. Patients' sex, education, social security status, comorbid diseases and general health status were recorded. Results: Fifty-two patients enrolled. 21 of them (40.4% were men, 31 of them (59.6 % were women. It is revealed that In 36 patients (69.2% did not receive formal education throughout their lives, while16 (30.8% of them had only primary education. All female patients were housewives. The most frequent diseases in home care patients were cerebrovascular disease in 18 (34.6% subjects, Alzheimer's disease in 9 (17.3%, and chronic obstructive pulmonary disease in 4 (7.7% d. 38 patients (73.1% needed routine follow-up. Most of the patients (61.5% had green card health insurance. Only 6 patients (11.5% were in need of narcotic analgesics. Thirteen patients had pressure ulcers due to immobilization. Evaluating the exercise capacity of the patients; 43 (82.7% could not dressed themselves, 38 (73.1% could not use phone. Thirty-two patients had urinary incontinence and 31 had fecal incontinence. Conclusion: Today, population of patients who need home care service is increasing due to ease access to home care service and increase in survival. For a better care of patients, home care providers should be well educated and differences on features of patients and medical conditions it should be taken into consideration.

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

    Science.gov (United States)

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

    2016-02-25

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

  3. The Impact of Patient-Centered Medical Homes on Quality of Care and Medication Adherence in Patients with Diabetes Mellitus.

    Science.gov (United States)

    An, JaeJin

    2016-11-01

    Current evidence suggests that patient-centered medical homes (PCMHs) potentially increase overall quality of disease management, including preventive care. However, there are mixed findings regarding quality of diabetes care, and little evidence exists with respect to the effect of PCMHs on medication adherence in patients with diabetes. To investigate associations between PCMHs and process measures of diabetes care, as well as adherence to oral hypoglycemic agents (OHAs) in patients with diabetes in a nationally representative U.S. Using the 2009-2013 longitudinal data files from the Medical Expenditure Panel Survey, adult diabetes patients were identified. Patients whose usual sources of care have all PCMH features at baseline (i.e., enhanced access after hours and online, shared decision making, and enhanced patient engagement) were categorized as the PCMH group, which was compared with patients without PCMH features. Process measures of diabetes care included ≥ 2 hemoglobin A1c tests and ≥ 1 cholesterol test, foot examination, dilated eye examination, and flu vaccination during 1 year of follow-up. Medication possession ratio (MPR) during follow-up was calculated for patients with OHAs without any insulin use, with MPR ≥ 80% considered to be adherent to OHAs. Univariate and multivariate regression models considering sampling strata and weights were used to examine the association between the PCMH and study outcomes. A total of 3,334 patients with diabetes was identified, representing 61 million U.S. lives. The mean (SE) age was 61.6 (0.3) years, and 52.4% of patients were female. The mean (SE) years of having diabetes was 12.0 (0.2) years. Approximately 11.4% of the patients were categorized as the PCMH group at baseline, and only 3.6% of those patients remained in the PCMH group for 2 years. Of the diabetic patients identified, only 26.9% met all of the diabetes care process measure criteria defined in this study. A higher proportion of patients met

  4. Potentially inappropriate prescribing of primarily renally cleared medications for older veterans affairs nursing home patients.

    Science.gov (United States)

    Hanlon, Joseph T; Wang, Xiaoqiang; Handler, Steven M; Weisbord, Steven; Pugh, Mary Jo; Semla, Todd; Stone, Roslyn A; Aspinall, Sherrie L

    2011-06-01

    Inappropriate prescribing of primarily renally cleared medications in older patients with kidney disease can lead to adverse outcomes. To estimate the prevalence of potentially inappropriate prescribing of 21 primarily renally cleared medications based on 2 separate estimates of renal function and to identify factors associated with this form of suboptimal prescribing in older VA nursing home (NH) patients. Longitudinal study Participants were 1304 patients, aged 65 years or older, admitted between January 1, 2004, and June 30, 2005, for 90 days or more to 1 of 133 VA NHs. Potentially inappropriate prescribing of primarily renally cleared medications determined by estimating creatinine clearance using the Cockcroft Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations and applying explicit guidelines for contraindicated medications and dosing. The median estimated creatinine clearance via CG was 67 mL/min, whereas it was 80 mL/min/1.73m(2) with the MDRD. Overall, 11.89% patients via CG and only 5.98% via MDRD had evidence of potentially inappropriate prescribing of at least 1 renally cleared medication. The most commonly involved medications were ranitidine, glyburide, gabapentin, and nitrofurantoin. Factors associated with potentially inappropriate prescribing as per the CG were age older than 85 (adjusted odds ratio [AOR] 4.24, 95% confidence interval [CI] 2.42-7.43), obesity (AOR 0.26, 95% CI 0.14-0.50) and having multiple comorbidities (AOR 1.09 for each unit increase in the Charlson comorbidity index, 95% CI 1.01-1.19). Potentially inappropriate prescribing of renally cleared medications is common in older VA NH patients. Intervention studies to improve the prescribing of primarily renally cleared medications in nursing homes are needed. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

  5. Caregiver reports of serious injuries in children who remain at home after a child protective services investigation.

    Science.gov (United States)

    Schneiderman, Janet U; Leslie, Laurel K; Hurlburt, Michael S; Zhang, Jinjin; Horwitz, Sarah McCue

    2012-02-01

    The study objectives were to examine serious injuries requiring medical attention among children who remain at home after a child welfare/child protective services (CPS) maltreatment investigation in the US and to determine whether child/caregiver characteristics and ongoing CPS involvement are related to injuries requiring medical attention. Using the National Survey of Child and Adolescent Well-being, we analyzed data on the subsample of children who remained at home (N = 3,440). A multivariate logistic regression model included child characteristics, chronic illness and disability in the child, level of CPS involvement, subsequent foster care placement, caregiver characteristics, and caregiver/family psychological variables. Injuries requiring medical attention were identified in 10.6% of the in-home population over a 15-month period, with no differences in rates by age. Children with a chronic medical condition (OR = 2.07; 95% CI, 1.20-3.58) and children with depressed caregivers (OR = 2.28; 95% CI, 1.45-3.58) were more likely to have an injury that required medical care. Older caregivers (>54 years) were less likely (OR = 0.15; 95% CI, 0.03-0.69) to have a child with an injury requiring care. Injuries were not related to further involvement with CPS after the initial maltreatment investigation. Children with chronic medical conditions who remained in their biological homes or whose caregivers were depressed were likely to experience an injury requiring medical attention. Older caregivers were less likely to report a child injury. Extending existing health policies for foster children to children who remain at home following referral to CPS may encourage more comprehensive injury prevention for this population.

  6. New journals for publishing medical case reports.

    Science.gov (United States)

    Akers, Katherine G

    2016-04-01

    Because they do not rank highly in the hierarchy of evidence and are not frequently cited, case reports describing the clinical circumstances of single patients are seldom published by medical journals. However, many clinicians argue that case reports have significant educational value, advance medical knowledge, and complement evidence-based medicine. Over the last several years, a vast number (∼160) of new peer-reviewed journals have emerged that focus on publishing case reports. These journals are typically open access and have relatively high acceptance rates. However, approximately half of the publishers of case reports journals engage in questionable or "predatory" publishing practices. Authors of case reports may benefit from greater awareness of these new publication venues as well as an ability to discriminate between reputable and non-reputable journal publishers.

  7. The Path to Quality in Outpatient Practice: Meaningful Use, Patient-Centered Medical Homes, Financial Incentives, and Technical Assistance.

    Science.gov (United States)

    Meehan, Thomas P; Meehan, Thomas P; Kelvey-Albert, Michele; Van Hoof, Thomas J; Ruth, Steve; Petrillo, Marcia K

    2014-01-01

    Adoption and meaningful use of electronic health records is considered an essential step to improve the quality of health care. The authors assessed whether a series of Connecticut primary care providers who achieved Stage I Meaningful Use of electronic health records used quality improvement strategies that are associated with improvements in care. Practice structural characteristics, quality improvement-related electronic health record processes, outcomes, and barriers were assessed in 14 primary care practices. Implementation of quality improvement-related electronic health record processes was variable and barriers were common. Only 4 practices used data consistently to assess their performance, and only 3 reported improvements in care. Practices that were patient-centered medical homes scored higher on all quality improvement domains and received financial rewards more commonly. These findings suggest that primary care quality may be improved by formal alignment of Meaningful Use and Patient-Centered Medical Home criteria and by ongoing technical assistance to practices. © 2013 by the American College of Medical Quality.

  8. Music therapy for reducing agitation and psychotropic medication in nursing home residents with dementia

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner

    2015-01-01

    Dementia is a neurocognitive disease with a high risk of social isolation and agitation due to loss of cognitive functions. In nursing home residents with dementia, agitation is the most significant symptom causing patient distress and care- giver burden. Agitation is described as abuse or aggres...... without first trying the efficacy of psychosocial interventions. The aim of this paper is to provide an overview of research on the effectiveness of music therapy on agitation and psychotropic medication....

  9. A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home

    Science.gov (United States)

    Gabbay, Robert A.; Friedberg, Mark W.; Miller-Day, Michelle; Cronholm, Peter F.; Adelman, Alan; Schneider, Eric C.

    2013-01-01

    PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving the care models of practices showing the greatest and least improvement in diabetes care in a sample of 25 primary care practices in southeast Pennsylvania. METHODS We ranked practices into improvement quintiles on the basis of the average absolute percentage point improvement from baseline to 18 months in 3 registry-based measures of performance related to diabetes care: glycated hemoglobin concentration, blood pressure, and low-density lipoprotein cholesterol level. We then conducted surveys and key informant interviews with leaders and staff in the 5 most and least improved practices, and compared their responses. RESULTS The most improved/higher-performing practices tended to have greater structural capabilities (eg, electronic health records) than the least improved/lower-performing practices at baseline. Interviews revealed striking differences between the groups in terms of leadership styles and shared vision; sense, use, and development of teams; processes for monitoring progress and obtaining feedback; and presence of technologic and financial distractions. CONCLUSIONS Positive deviance analysis suggests that primary care practices’ baseline structural capabilities and abilities to buffer the stresses of change may be key facilitators of performance improvement in medical home transformations. Attention to the practices’ structural capabilities and factors shaping successful change, especially early in the process, will be necessary to improve the likelihood of successful medical home transformation and better care. PMID:23690393

  10. Achievement report for fiscal 1999 on research and development of technologies for medical welfare equipment. Home rehabilitation system for aphasia patients; 1999 nendo iryo fukushi kiki gijutsu kenkyu kaihatsu seika hokokusho. Shitsugosho zaitaku rehabilitation shien system

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-05-01

    Element technologies under development involve (1) an authoring system for assistance program processing, (2) self-training system for supporting home rehabilitation, (3) human interface for aphasia patients and caregivers, (4) remote rehabilitation evaluation and diagnosis supporting system, and (5) a communication assisting system. Under item (1), a material incorporating interface, training contents layout and combination function, and general-purpose interface specifications are determined, and a one-piece system is designed and developed. Under item (2), a self-training player that behaves in compliance with the authoring specifications is designed and developed. Under item (3), a secondary unit is fabricated on the assumption of its use at an actual treatment scene. Under item (4), remotely controlled two-way face-to-face communication, camera control, shared operation of a training player, training scenario transfer component, etc., are developed and, furthermore, a one-piece system is designed and developed to support the therapist's rehabilitation assessment and diagnosis in coordination with the above-mentioned remotely controlled functions. Under item (5), a network communication component and an auxiliary function using voice synthesis are added for designing and developing a one-piece system that enables long-distance communication between the therapist and patients. (NEDO)

  11. Interdisciplinary approach to the management of medical supplies in the nursing home setting

    Directory of Open Access Journals (Sweden)

    Juan Francisco Peris Martí

    2017-07-01

    Full Text Available Introduction: Given the impact of pressure ulcers in institutionalized elderly people, an interdisciplinary approach to the care of ulcers and the management of medical supplies is essential. The aim of this study is to describe and evaluate the management of medical supplies by an interdisciplinary team in order to promote their rational use in the nursing home setting. Methods: An interdisciplinary team was set up, coordinated by a Pharmacy Unit including representatives of 18 elderly nursing homes (1,599 beds. Team interventions were assessed in terms of improvements in the management of wound care supplies. In addition, a retrospective descriptive study was carried out on those patients with pressure ulcers, in order to consider future interventions. Results: The team interventions led to a selection of 15% of the 180 wound care supplies from the public tender process. The monthly savings in wound dressing material purchases was at least 17%. Furthermore, a reduction in consumption greater than 50% was found in 7 centres. The prevalence of ulcers was 5.59%. A fourth of these ulcers were originated outside nursing homes. Conclusions: The creation of an interdisciplinary team, in which the pharmacist gets closer to patient needs, and where nurses share responsibility for the selection and management of medical supplies, leads to positive results and represents an opportunity for improvement in elderly care.

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

    Science.gov (United States)

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

    2015-01-01

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

  13. A prospective study of symptoms, function, and medication use during acute illness in nursing home residents: design, rationale and cohort description

    Directory of Open Access Journals (Sweden)

    Liu Sophia

    2010-07-01

    incidence of 1.5 (SD 2.0 episodes per resident per year; 74% were managed in the nursing home and 26% managed in the acute care setting. Conclusion In this report, we describe the conceptual model and methods of designing a longitudinal cohort to measure acute illness patterns and symptoms among nursing home residents, and describe the characteristics of our cohort at baseline. In our planned analysis, we will further estimate the effect of the use and interruption of medications on withdrawal and relapse symptoms and illness outcomes.

  14. Nursing home social services directors who report thriving at work.

    Science.gov (United States)

    Liu, Jinyu; Bern-Klug, Mercedes

    2013-01-01

    Nationally representative data from a sample (n = 928) of full-time nursing home social services directors were used to investigate whether knowing characteristics of the social environment at work can help to explain which directors report job thriving. Two-thirds of directors reported they were thriving in their jobs. Multiple regression results show that thriving is increased by job autonomy, being treated like an important part of the team, having enough time to identify and meet resident psychosocial needs, not having to do things that others could do, and being clear what the social services role is. Findings suggest that addressing these aspects of the social environment and social services role will likely contribute to increasing a sense of thriving at work among social services staff members.

  15. The political economy of a public health case management program's transition into medical homes.

    Science.gov (United States)

    Wells, Rebecca; Cilenti, Dorothy; Issel, L Michele

    2015-11-01

    Throughout the United States, public health leaders are experimenting with how best to integrate services for individuals with complex needs. To that end, North Carolina implemented a policy incorporating both local public health departments and other providers into medical homes for low income pregnant women and young children at risk of developmental delays. To understand how this transition occurred within local communities, a pre-post comparative case study was conducted. A total of 42 people in four local health departments across the state were interviewed immediately before the 2011 policy change and six months later: 32 professionals (24 twice) and 10 pregnant women receiving case management at the time of the policy implementation. We used constant comparative analysis of interview and supplemental data to identify three key consequences of the policy implementation. One, having medical homes increased the centrality of other providers relative to local health departments. Two, a shift from focusing on personal relationships toward medical efficiency diverged in some respects from both case managers' and mothers' goals. Three, health department staff re-interpreted state policies to fit their public health values. Using a political economy perspective, these changes are interpreted as reflecting shifts in public health's broader ideological environment. To a large extent, the state successfully induced more connection between health department-based case managers and external providers. However, limited provider engagement may constrain the implementation of the envisioned medical homes. The increased focus on medical risk may also undermine health departments' role in supporting health over time by attenuating staff relationships with mothers. This study helps clarify how state public health policy innovations unfold at local levels, and why front line practice may in some respects diverge from policy intent.

  16. A study of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting

    NARCIS (Netherlands)

    Finkers, F.; Maring, J. G.; Boersma, F.; Taxis, K.

    2007-01-01

    Background: Little is known about the extent of drug-related problems of polypharmacy patients in Dutch nursing homes. Objectives: We investigated the feasibility of teams of hospital pharmacists and nursing home physicians carrying out medication reviews. We aimed to identify the number and nature

  17. 42 CFR 410.170 - Payment for home health services, for medical and other health services furnished by a provider...

    Science.gov (United States)

    2010-10-01

    ... SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Payment of SMI Benefits § 410.170 Payment for home health... furnished in accordance with a written plan prepared and periodically reviewed by a team that includes...

  18. Wildfire ignition resistant home design(WIRHD) program: Full-scale testing and demonstration final report.

    Energy Technology Data Exchange (ETDEWEB)

    Quarles, Stephen, L.; Sindelar, Melissa

    2011-12-13

    The primary goal of the Wildfire ignition resistant home design(WIRHD) program was to develop a home evaluation tool that could assess the ignition potential of a structure subjected to wildfire exposures. This report describes the tests that were conducted, summarizes the results, and discusses the implications of these results with regard to the vulnerabilities to homes and buildings.

  19. Learning by living: life-altering medical education through nursing home-based experiential learning.

    Science.gov (United States)

    Gugliucci, Marilyn R; Weiner, Audrey

    2013-01-01

    The University of New England College of Osteopathic Medicine Learning by Living Project (referred to as Learning by Living) was piloted in 2006 as an experiential medical education learning model. Since its inception, medical and other health professions students have been "admitted" into nursing homes to live the life of an older adult nursing home resident for approximately 2 weeks-24 hours a day/7 days a week-complete with a medical diagnosis and "standard" procedures of care. The Learning by Living Project applies qualitative ethnographic/autobiographic research methods to collect students' perspectives and experiences about life lived as an older adult with functional challenges in a residential setting. To date, all students have completed their extended stay successfully and felt that this experiential learning project provided life-altering medical education. Longitudinal data reveals that students' maintain patient-centered attitudes and skills such as the use of eye contact, touch, body position, and voice cadence. Barriers to working with older adults are decreased; understanding is gained by "wheeling a mile in an older person's wheelchair."

  20. Home

    Directory of Open Access Journals (Sweden)

    Rokeya Sakhawat Hossain

    2012-11-01

    Full Text Available A fiery feminist piece that argues that Indian women are all homeless; animals have homes but Indian women have none, because they have to depend on the mercy of their "keepers"; therefore, Indian women live a life worse than animals.

  1. Importance of patient education on home medical care waste disposal in Japan.

    Science.gov (United States)

    Ikeda, Yukihiro

    2014-07-01

    To determine current practices in the disposal and handling of home medical care (HMC) waste, a questionnaire was mailed to 1965 offices nationwide. Of the office that responded, 1283 offices were analyzed. Offices were classified by management configuration: those attached to hospitals were classified as "attached offices" and others as "independent offices". More nurses from attached offices recovered medical waste from patients' homes than those from independent offices. Most nurses educated their patients on how to store HMC waste in their homes (79.3% of total) and on how to separate HMC waste (76.5% of total). On the other hand, only around half of nurses (47.3% from attached offices and 53.2% from independent offices) educated their patients on where to dispose of their HMC waste. 66.0% of offices replied that patients had separated their waste appropriately. The need for patient education has emerged in recent years, with education for nurses under the diverse conditions of HMC being a key factor in patient education.

  2. A cloud-based home health care information sharing system to connect patients with home healthcare staff -A case report of a study in a mountainous region.

    Science.gov (United States)

    Nomoto, Shinichi; Utsumi, Momoe; Sasayama, Satoshi; Dekigai, Hiroshi

    2017-01-01

    We have developed a cloud system, the e-Renraku Notebook (e-RN) for sharing of home care information based on the concept of "patient-centricity". In order to assess the likelihood that our system will enhance the communication and sharing of information between home healthcare staff members and home-care patients, we selected patients who were residing in mountainous regions for inclusion in our study. We herein report the findings.Eighteen staff members from 7 medical facilities and 9 patients participated in the present study.The e-RN was developed for two reasons: to allow patients to independently report their health status and to have staff members view and respond to the information received. The patients and staff members were given iPads with the pre-installed applications and the information being exchanged was reviewed over a 54-day period.Information was mainly input by the patients (61.6%), followed by the nurses who performed home visits (19.9%). The amount of information input by patients requiring high-level nursing care and their corresponding staff member was significantly greater than that input by patients who required low-level of nursing care.This patient-centric system in which patients can independently report and share information with a member of the healthcare staff provides a sense of security. It also allows staff members to understand the patient's health status before making a home visit, thereby giving them a sense of security and confidence. It was also noteworthy that elderly patients requiring high-level nursing care and their staff counterpart input information in the system significantly more frequently than patients who required low-level care.

  3. mHealth tools for the pediatric patient-centered medical home.

    Science.gov (United States)

    Slaper, Michael R; Conkol, Kimberly

    2014-02-01

    The concept of the pediatric patient-centered medical home (PCMH) as a theory has been evolving since it was initially conceived more than 40 years ago. When the American Academy of Pediatrics' (AAP) Council on Pediatric Practice first wrote about this model, "medical home" was defined solely as the central location of a pediatric patient's medical records. Approximately two decades later, the AAP published its inaugural policy statement on this topic. Through this policy statement, the medical home was defined as a place where care for pediatric patients would be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. Although the lack of access to providers, especially in rural communities, may inhibit the adoption of the PCMH or chronic care models, technology has evolved to the point where many of the gaps in care can be bridged. mHealth, defined by the National Institutes of Health (NIH) as the use of mobile and wireless devices to improve health outcomes, health care services, and health research, can be one specific example of how technology can address these issues. One early study has shown that patients who use mHealth tools are more likely to adhere to self-monitoring requirements and, in turn, have significantly improved outcomes. A rapidly evolving and scalable mHealth technology that has the ability to address these issues are self-management mobile applications, or apps. It has been estimated that there are currently more than 40,000 health care-related apps available. Furthermore, use of these apps is growing, as more than 50% of smartphone users surveyed responded that they have used their device to gather health information, and almost 20% of this population has at least one health care app on their device.

  4. A Web site-based reporting system for monitoring home treatment during oral immunotherapy for food allergy.

    Science.gov (United States)

    Nachshon, Liat; Goldberg, Michael R; Elizur, Arnon; Levy, Michael B; Schwartz, Naama; Katz, Yitzhak

    2015-06-01

    Reactions during the home treatment phase of oral immunotherapy (OIT) are not uncommon. An ongoing accurate reporting of home treatment outcomes is crucial for the safety and success of OIT. Previous reports have shown that as few as 20% of patients are truly compliant with paper-based diaries. To develop a Web site-based electronic reporting system (web-RS) for monitoring home treatment during OIT for food allergy. A web-RS was developed and incorporated a thorough questionnaire querying for pertinent data including the dose(s) consumed, occurrence and details of adverse reactions, treatment(s), and relevant potential exacerbating factors. All patients enrolled in milk, peanut, or egg OIT programs for at least 4 weeks from November 2012 through January 2014 were introduced to web-RS (n = 157). Successful reporting through web-RS was defined by consecutive reporting during the first home treatment phase (24 days) after its introduction. Comparisons were made with a previous group of OIT-treated patients (n = 100) who reported by E-mail. Successful reporting was achieved by 142 of 157 patients (90.44%) in contrast to a 75% success rate with E-mail (P = .0009). The odds for successful reporting using web-RS were 3.1 (95% confidence interval 1.6-6.3) times higher compared with using E-mail. Mild reactions were reported more frequently with web-RS (P = .0032). Patient reports were constantly available in real time for medical staff review. No complaints regarding web-RS feasibility were reported. One risk factor for failure to use web-RS was a patient's prior successful OIT experience without using web-RS (P = .012). A web-RS can be a powerful tool for improving OIT safety by achieving a high level of patient cooperation in reporting home treatment results. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  5. LOW SULFUR HOME HEATING OIL DEMONSTRATION PROJECT SUMMARY REPORT.

    Energy Technology Data Exchange (ETDEWEB)

    BATEY, J.E.; MCDONALD, R.J.

    2005-06-01

    This project was funded by NYSERDA and has clearly demonstrated many advantages of using low sulfur content heating oil to provide thermal comfort in homes. Prior laboratory research in the United States and Canada had indicated a number of potential benefits of using lower sulfur (0.05%) heating oil. However, this prior research has not resulted in the widespread use of low sulfur fuel oil in the marketplace. The research project described in this report was conducted with the assistance of a well-established fuel oil marketer in New York State (NYS) and has provided clear proof of the many real-world advantages of marketing and using low sulfur content No. 2 fuel oil. The very positive experience of the participating marketer over the past three years has already helped to establish low sulfur heating oil as a viable option for many other fuel marketers. In large part, based on the initial findings of this project and the experience of the participating NYS oilheat marketer, the National Oilheat Research Alliance (NORA) has already fully supported a resolution calling for the voluntary use of low sulfur (0.05 percent) home heating oil nationwide. The NORA resolution has the goal of converting eighty percent of all oil-heated homes to the lower sulfur fuel (0.05 percent by weight) by the year 2007. The Oilheat Manufacturers Association (OMA) has also passed a resolution fully supporting the use of lower sulfur home heating oil in the equipment they manufacture. These are important endorsements by prominent national oil heat associations. Using lower sulfur heating oil substantially lowers boiler and furnace fouling rates. Laboratory studies had indicated an almost linear relationship between sulfur content in the oil and fouling rates. The completed NYSERDA project has verified past laboratory studies in over 1,000 occupied residential homes over the course of three heating seasons. In fact, the reduction in fouling rates so clearly demonstrated by this project is

  6. Medical specialist attendance in nursing homes [Beschreibung und Bewertung der fachärztlichen Versorgung von Pflegeheimbewohnern in Deutschland

    Directory of Open Access Journals (Sweden)

    Balzer, Katrin

    2013-04-01

    Full Text Available [english] The care in nursing homes was examined based on scientific studies. The analysis focuses on dementia and type II diabetes. There is evidence for deficits in the supply of medical specialist attendance to nursing home residents with these diseases in Germany. Compared with corresponding guidelines the medical care for nursing home residents may be too low or inadequate.[german] Es wird die Versorgung in Pflegeheimen auf Basis wissenschaftlicher Studien untersucht. Schwerpunkte der Analyse sind Demenz und Diabetes. Es gibt Hinweise auf fachärztliche Versorgungsmängel bei Pflegeheimbewohnern mit diesen Krankheiten in Deutschland. Verglichen mit entsprechenden Leitlinien bestehen mögliche Unter- bzw. Fehlversorgungen.

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

    Directory of Open Access Journals (Sweden)

    Riddle MC

    2014-09-01

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

  8. Adverse events in diabetic foot infections: a case control study comparing early versus delayed medical treatment after home remedies

    Directory of Open Access Journals (Sweden)

    Cawich SO

    2014-11-01

    Full Text Available Shamir O Cawich, Patrick Harnarayan, Shariful Islam, Steve Budhooram, Shivaa Ramsewak, Vijay Naraynsingh Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies Background: The aim of conventional medical therapy in diabetic foot infections is to control infection, thereby reducing amputation rates, infectious morbidity, and death. Any delay incurred during a trial of home remedies could allow an infection to progress unchecked, increasing the risk of these adverse outcomes. This study sought to determine the effects of delayed operative interventions and amputations in these patients. Methods: A questionnaire study targeting all consecutive patients admitted with diabetic foot infection was carried out over 1 year. Two groups were defined, ie, a medical therapy group comprising patients who sought medical attention after detecting their infection and a home remedy group comprising those who voluntarily chose to delay medical therapy in favor of home remedies. The patients were followed throughout their hospital admissions. We recorded the duration of hospitalization and number of operative debridements and amputations performed. Results: There were 695 patients with diabetic foot infections, comprising 382 in the medical therapy group and 313 in the home remedy group. Many were previously hospitalized for foot infections in the medical therapy (78% and home remedy (74.8% groups. The trial of home remedies lasted for a mean duration of 8.9 days. The home remedy group had a longer duration of hospitalization (16.3 versus 8.5 days; P<0.001, more operative debridements (99.7% versus 94.5%; P<0.001, and more debridements per patient (2.85 versus 2.45; P<0.001. Additionally, in the home remedy group, there was an estimated increase in expenditure of US $10,821.72 US per patient and a trend toward more major amputations (9.3% versus 5.2%; P=0.073. Conclusion: There are negative

  9. Medical Sciences Division report for 1993

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-31

    This year`s Medical Sciences Division (MSD) Report is organized to show how programs in our division contribute to the core competencies of Oak Ridge Institute for Science and Education (ORISE). ORISE`s core competencies in education and training, environmental and safety evaluation and analysis, occupational and environmental health, and enabling research support the overall mission of the US Department of Energy (DOE).

  10. Adaptation of oral medication in people institutionalized in nursing homes for whom medication is crushed: The ADECUA Study

    Directory of Open Access Journals (Sweden)

    Francisco Apolo Carvajal

    2016-12-01

    Full Text Available Purpose: To evaluate the effect of pharmacist interventions in the adaptation of pharmaceutical forms in elders institutionalized in nursing homes whose medicines are crushed, which may have a clinical relevance. Methods: Quasi-experimental, multicenter, transversal and prospective study carried out in 10 nursing homes. Subjects for whom drugs were being crushed were identified. Their treatments were reviewed in order to identify drugs that should not be crushed. In these cases, we proposed an alternative to the physician and we evaluated the degree of acceptance, its association to other variables and the pre-post adaptation index (tablets that can be crushed and capsules that can be opened/ total number of tablets and capsules before and after the intervention. Moreover, health professionals received a training course. Results: Medication was being crushed for 33% (618/1875 of residents (mean: 5 drugs susceptible of crushing. 220 pharmaceutical interventions were performed, mostly in extended release or gastro-resistant drugs (48% were accepted. Switch was the type of intervention more frequent (79%, mainly to Purpose: To evaluate the effect of pharmacist interventions in the adaptation of pharmaceutical forms in elders institutionalized in nursing homes whose medicines are crushed, which may have a clinical relevance. Methods: Quasi-experimental, multicenter, transversal and prospective study carried out in 10 nursing homes. Subjects for whom drugs were being crushed were identified. Their treatments were reviewed in order to identify drugs that should not be crushed. In these cases, we proposed an alternative to the physician and we evaluated the degree of acceptance, its association to other variables and the pre-post adaptation index (tablets that can be crushed and capsules that can be opened/ total number of tablets and capsules before and after the intervention. Moreover, health professionals received a training course. Results

  11. A comparison of medication administration errors from original medication packaging and multi-compartment compliance aids in care homes: A prospective observational study.

    Science.gov (United States)

    Gilmartin-Thomas, Julia Fiona-Maree; Smith, Felicity; Wolfe, Rory; Jani, Yogini

    2017-07-01

    No published study has been specifically designed to compare medication administration errors between original medication packaging and multi-compartment compliance aids in care homes, using direct observation. Compare the effect of original medication packaging and multi-compartment compliance aids on medication administration accuracy. Prospective observational. Ten Greater London care homes. Nurses and carers administering medications. Between October 2014 and June 2015, a pharmacist researcher directly observed solid, orally administered medications in tablet or capsule form at ten purposively sampled care homes (five only used original medication packaging and five used both multi-compartment compliance aids and original medication packaging). The medication administration error rate was calculated as the number of observed doses administered (or omitted) in error according to medication administration records, compared to the opportunities for error (total number of observed doses plus omitted doses). Over 108.4h, 41 different staff (35 nurses, 6 carers) were observed to administer medications to 823 residents during 90 medication administration rounds. A total of 2452 medication doses were observed (1385 from original medication packaging, 1067 from multi-compartment compliance aids). One hundred and seventy eight medication administration errors were identified from 2493 opportunities for error (7.1% overall medication administration error rate). A greater medication administration error rate was seen for original medication packaging than multi-compartment compliance aids (9.3% and 3.1% respectively, risk ratio (RR)=3.9, 95% confidence interval (CI) 2.4 to 6.1, phomes) and multi-compartment compliance aids (RR=2.3, 95%CI 1.1 to 4.9, p=0.03), and between original medication packaging and multi-compartment compliance aids within care homes that used a combination of both medication administration systems (RR=4.3, 95%CI 2.7 to 6.8, phomes, as well as local

  12. Experiences and characteristics of women seeking and completing at-home medical termination of pregnancy through online telemedicine in Ireland and Northern Ireland: a population-based analysis.

    Science.gov (United States)

    Aiken, Ara; Gomperts, R; Trussell, J

    2017-07-01

    To examine the characteristics and experiences of women in Ireland and Northern Ireland seeking at-home medical termination of pregnancy (TOP) using online telemedicine. Population-based study. Ireland and Northern Ireland. Between 1 January 2010 and 31 December 2015, 5650 women requested at-home medical TOP through online telemedicine initiative Women on Web. We examined the demographics and circumstances of women requesting medical TOP and examined the experiences of the 1023 women who completed TOP between January 2010 and December 2012. We conducted a content analysis of women's evaluations and used logistic regression to examine factors associated with lack of emotional support during and after TOP MAIN OUTCOME MEASURES: Satisfaction with TOP; feelings before and after TOP; emotional support during TOP. Women requesting TOP were diverse with respect to age, pregnancy circumstances and reasons for seeking TOP. Among those completing TOP, 97% felt they made the right choice and 98% would recommend it to others in a similar situation. Women commonly reported serious mental stress caused by their pregnancies and their inability to afford travel abroad to access TOP. The feelings women most commonly reported after completing TOP were 'relieved' (70%) and 'satisfied' (36%). Women with financial hardship had twice the risk of lacking emotional support (odds ratio = 2.0, P < 0.001). The vast majority of women who completed at-home medical TOP through Women on Web had a positive experience. These demonstrated benefits to health and wellbeing contribute new evidence to the debate surrounding abortion laws in Ireland and Northern Ireland. Irish and Northern Irish women completing at-home medical TOP report benefits for health, wellbeing and autonomy. © 2016 Royal College of Obstetricians and Gynaecologists.

  13. Effects of Hospital Systems on Medical Home Transformation in Primary Care Residency Training Practices.

    Science.gov (United States)

    Knierim, Kyle; Hall, Tristen; Fernald, Douglas; Staff, Thomas J; Buscaj, Emilie; Allen, Jessica Cornett; Onysko, Mary; Dickinson, W Perry

    2016-11-23

    Most primary care residency training practices have close financial and administrative relationships with teaching hospitals and health systems. Many residency practices have begun integrating the core principles of the patient-centered medical home (PCMH) into clinical workflows and educational experiences. Little is known about how the relationships with hospitals and health systems affect these transformation efforts. Data from the Colorado Residency PCMH Project were analyzed. Results show that teaching hospitals and health systems have significant opportunities to influence residency practices' transformation, particularly in the areas of supporting team-based care, value-based payment reforms, and health information technology.

  14. Learning from Alma Ata: the medical home and comprehensive primary health care.

    Science.gov (United States)

    Gottlieb, Laura M

    2009-01-01

    The patient-centered medical home (PCMH) recently has received much attention in health systems literature. The PCMH holds considerable promise for improving health outcomes and re-establishing a role for family medicine in a fragmented health care system. Despite its philosophical approach to comprehensive health care reform, the PCMH fails to offer concrete recommendations to address the social determinants of health, which include health and social policy. Political engagement to promote health is part of both primary health care and specifically family medicine's history; the absence of practical, adaptable ways to implement this engagement may undermine the PCMH's ultimate goals of improving individual and population health.

  15. Spreading a patient-centered medical home redesign: a case study.

    Science.gov (United States)

    Hsu, Clarissa; Coleman, Katie; Ross, Tyler R; Johnson, Eric; Fishman, Paul A; Larson, Eric B; Liss, David; Trescott, Claire; Reid, Robert J

    2012-01-01

    Health care leaders and policymakers are turning to the patient-centered medical home (PCMH) model to contain costs, improve the quality of care, and create a more positive primary care work environment. We describe how Group Health, an integrated delivery system, developed and implemented a PCMH intervention that included standardized structural and practice level changes. This intervention was spread to a diverse set of 26 primary care practices in 14 months using Lean Management principles. Group Health's experience provides valuable insights that can be used to improve the design and implementation of future PCMH models.

  16. Disparities in the Medical Examination of Children in the Home of a Child with Suspected Physical Abuse

    Science.gov (United States)

    Campbell, Kristine A.; Squires, Janet; Cook, Lawrence J.; Berger, Rachel P.

    2009-01-01

    Objective: To identify factors predicting the medical examination of children living in a home with a child referred to child protection services (CPS) for suspected physical abuse. Methods: Medical providers at Children's Hospital of Pittsburgh referred 189 children for suspected physical abuse to CPS between November 1, 2004 and May 1, 2006…

  17. Pharmaceutical care and home delivery of medication to patients with chronic myeloid leukemia

    Directory of Open Access Journals (Sweden)

    Begoña San José Ruiz

    2015-01-01

    Full Text Available Objectives: To describe the implementation of a new model face to face and remote pharmaceutical care with home delivery of tyronsine kinase inhibitors medicines for patients with chronic myeloid leukemia. Methods: Patients with chronic myeloid leukemia were selected to start this new model of care. Four characteristics were taken into account for the choice: chronicity of the disease, frequency of doctor visits, pharmaceutical care value and conservation of tyronsine kinase inhibitors medicines at room temperature. Results: Out of 68 patients with chronic myeloid leukemia and treated with tyronsine kinase inhibitors, 42 were selected due to the frequency of their hematologist visits. An introductory letter and a questionnaire about their preferences were sent to these patients.Sixteen of them expressed their desire to participate. The legal department designed a confidentiality contract, as well as a model of informed consent. A logistic distribution model based on defined routes and timetables was established. Prior to inclusion, pharmaceutical care was performed in a face to face consultation and the communication way was established for the followings remote consultations. Home delivery had a monthly cost of 13.2 € (including VAT per patient. All the patients who started this program continue in it. To date, 5 deliveries per patient have been conducted Conclusions: It is possible to establish an alternative model of pharmaceutical care with home delivery of medication, keeping the pharmacist-patient relationship, avoiding travel, ensuring the confidentiality and rationalizing the stocks

  18. The facilitators and barriers associated with implementation of a patient-centered medical home in VHA.

    Science.gov (United States)

    Helfrich, Christian D; Sylling, Philip W; Gale, Randall C; Mohr, David C; Stockdale, Susan E; Joos, Sandra; Brown, Elizabeth J; Grembowski, David; Asch, Steven M; Fihn, Stephan D; Nelson, Karin M; Meredith, Lisa S

    2016-02-24

    The patient-centered medical home (PCMH) is a team-based, comprehensive model of primary care. When effectively implemented, PCMH is associated with higher patient satisfaction, lower staff burnout, and lower hospitalization for ambulatory care-sensitive conditions. However, less is known about what factors contribute to (or hinder) PCMH implementation. We explored the associations of specific facilitators and barriers reported by primary care employees with a previously validated, clinic-level measure of PCMH implementation, the Patient Aligned Care Team Implementation Progress Index (Pi(2)). We used a 2012 survey of primary care employees in the Veterans Health Administration to perform cross-sectional, respondent-level multinomial regressions. The dependent variable was the Pi(2) categorized as high implementation (top decile, 54 clinics, 235 respondents), medium implementation (middle eight deciles, 547 clinics, 4537 respondents), and low implementation (lowest decile, 42 clinics, 297 respondents) among primary care clinics. The independent variables were ordinal survey items rating 19 barriers to patient-centered care and 10 facilitators of PCMH implementation. For facilitators, we explored clinic Pi(2) score decile both as a function of respondent-reported availability of facilitators and of rating of facilitator helpfulness. The availability of five facilitators was associated with higher odds of a respondent's clinic's Pi(2) scores being in the highest versus lowest decile: teamlet huddles (OR = 3.91), measurement tools (OR = 3.47), regular team meetings (OR = 2.88), information systems (OR = 2.42), and disease registries (OR = 2.01). The helpfulness of four facilitators was associated with higher odds of a respondent's clinic's Pi(2) scores being in the highest versus lowest decile. Six barriers were associated with significantly higher odds of a respondent's clinic's Pi(2) scores being in the lowest versus highest decile, with the

  19. Neonates and Infants Discharged Home Dependent on Medical Technology: Characteristics and Outcomes.

    Science.gov (United States)

    Toly, Valerie Boebel; Musil, Carol M; Bieda, Amy; Barnett, Kimberly; Dowling, Donna A; Sattar, Abdus

    2016-10-01

    Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization. To determine incidence, characteristics, and healthcare utilization outcomes (emergency room visits, rehospitalizations) of technology-dependent neonates and infants following initial discharge from the hospital. This descriptive, correlational study used retrospective medical record review to examine technology-dependent neonates (N = 71) upon discharge home. Study variables included demographic characteristics, hospital length of stay, and type of medical technology used. Analysis of neonates (n = 22) with 1-year postdischarge data was conducted to identify relationships with healthcare utilization. Descriptive and regression analyses were performed. Approximately 40% of the technology-dependent neonates were between 23 and 26 weeks' gestation, with birth weight of less than 1000 g. Technologies used most frequently were supplemental oxygen (66%) and feeding tubes (46.5%). The mean total hospital length of stay for technology-dependent versus nontechnology-dependent neonates was 108.6 and 25.7 days, respectively. Technology-dependent neonates who were female, with a gastrostomy tube, or with longer initial hospital length of stay were at greater risk for rehospitalization. Assessment and support of families, particularly mothers of technology-dependent neonates following initial hospital discharge, are vital. Longitudinal studies to determine factors affecting long-term outcomes of technology-dependent infants are needed.

  20. Use of a geriatric home visit experience to teach medical students the functional status assessment.

    Science.gov (United States)

    Tung, Ericka E; Thomas, Matthew R

    2009-02-01

    Functional status measures strongly predict hospital outcomes and mortality, yet teaching of these measures is often missing from medical schools' curricula. To address this deficiency, we developed a Geriatric Home-based Assessment (GHA) module for third-year medical students. The module was composed of a workshop and two to three home visits. To determine whether the GHA module would improve students' knowledge and proficiency in the functional status assessment. Students completed a validated questionnaire and evaluated a standardized patient in an Observed Structured Clinical Examination (OSCE). Scores from students completing the GHA were compared to the scores of students without this experience. Thirty-one students participated in the GHA module, and 19 students were in the control group. The mean score on the written assessment was 87% among GHA students vs. 46% in the control group (p students' knowledge and proficiency in the functional status assessment. "Hands on" experiences like the GHA allow students to develop a solid foundation for assessing functional status and mobility.

  1. Adaptation and Validation of the HOME-SF as a Caregiver-Report Home Environment Measure for Use in the Taiwan Birth Cohort Study (TBCS)

    Science.gov (United States)

    Wu, Jennifer Chun-Li; Chiang, Tung-liang; Bradley, Robert H.

    2011-01-01

    This study aimed to develop a brief caregiver-report instrument for measuring the home environment of children aged three and under, as part of the Taiwan Birth Cohort Study (TBCS). Instrument development was conducted by translating and adapting the Home Observation for the Measurement of Environment Inventory-Short Form (HOME-SF) which comprises…

  2. Patient-centered medical home intervention at an internal medicine resident safety-net clinic.

    Science.gov (United States)

    Hochman, Michael E; Asch, Steven; Jibilian, Arek; Chaudry, Bharat; Ben-Ari, Ron; Hsieh, Eric; Berumen, Margaret; Mokhtari, Shahrod; Raad, Mohamad; Hicks, Elisabeth; Sanford, Crystal; Aguirre, Norma; Tseng, Chi-hong; Vangala, Sitaram; Mangione, Carol M; Goldstein, David A

    2013-10-14

    The patient-centered medical home (PCMH) model holds promise for improving primary care delivery, but it has not been adequately tested in teaching settings. We implemented an intervention guided by PCMH principles at a safety-net teaching clinic with resident physician providers. Two similar clinics served as controls. Using a cross-sectional design, we measured the effect on patient and resident satisfaction using the Consumer Assessment of Healthcare Providers and Systems survey and a validated teaching clinic survey, respectively. Both surveys were conducted at baseline and 1 year after the intervention. We also measured the effect on emergency department and hospital utilization. Following implementation of our intervention, the clinic’s score on the National Committee for Quality Assurance’s PCMH certification tool improved from 35 to 53 of 100 possible points, although our clinic did not achieve all must-pass elements to qualify as a PCMH. During the 1-year study period, 4676 patients were exposed to the intervention; 39.9% of these used at least 1 program component. Compared with baseline, patient-reported access and overall satisfaction improved to a greater extent in the intervention clinic, and the composite satisfaction rating increased from 48% to 65% in the intervention clinic vs from 50% to 59% in the control sites (P = .04). The improvements were particularly notable for questions relating to access. For example, satisfaction with urgent appointment scheduling increased from 12% to 53% in the intervention clinic vs from 14% to 18% in the control clinics (P < .001). Resident satisfaction also improved in the intervention clinic: the composite satisfaction score increased from 39% to 51% in the intervention clinic vs a decrease from 46% to 42% in the control clinics (P = .01). Emergency department utilization did not differ significantly between the intervention and control clinics, and hospitalizations increased from 26 to 27 visits

  3. Nursing Home - Pain - Percentage of Residents Reporting Pain

    Data.gov (United States)

    U.S. Department of Health & Human Services — Adequate pain management is an important indicator of quality of care and quality of life. Nursing home staff should check patients regularly to see if they are...

  4. Factory-built integrated solar homes - A progress report

    Energy Technology Data Exchange (ETDEWEB)

    Rawlings, L.K.

    1995-12-31

    Over the past fifteen years, hundreds of people across the US have built for themselves highly advanced residences which integrated passive solar architecture; photovoltaic power systems; high-efficiency lights, appliances, and HVAC (heating, ventilating, and cooling) equipment; high-level insulation and airtight construction; and other renewable energy and energy-efficient technologies. Such a home can be referred to as an {open_quotes}integrated solar home{close_quotes}. As the essential technologies have improved in performance, price, and availability, the performance of such homes has steadily advanced to the point where they could provide amenities at more-or-less normal US standards of luxury, yet require as little as 5% to 10% of the level of fossil fuel or biomass use that are required in an average US home. However, the resources required to build such a home, both in terms of the time and dedication needed for research, design, and construction of the homes, and in terms of the additional cost of the renewable energy/energy efficient features, have prevented such construction from moving beyond a tiny handful of highly motivated homeowners and into the mainstream of residential construction. This paper has design summaries of six different houses.

  5. [Contribution of the rehabilitation approach for home medical care--a case study of a patient with higher cortical dysfunction].

    Science.gov (United States)

    Kato, Nobuko; Suzuki, Miki

    2004-12-01

    Although the main theme of this meeting is the continuous care process from acute phase to chronic phase, it is also strongly emphasized on rehabilitation medicine. However, most of the patients who really need rehabilitation have not followed such a process. We will show you a patient with traumatic brain injury, who returned home directly from an acute phase hospital, who had difficulties in ADL and QOL. We took initiatives in medical and care services in order to support the patient and his family to alleviate his difficulties in ADL and QOL. Thereafter, he was able to continue living at home with more comfort. We must offer adequate medical rehabilitation and other necessary support providing medical services and welfare before a patient returns home.

  6. Electronic health communication: an educational application for this principle of the Patient-centered Medical Home.

    Science.gov (United States)

    Barnhart, Amber; Lausen, Harald; Smith, Tracey; Lopp, Lauri

    2010-05-01

    The Patient-centered Medical Home (PCMH) relies on comprehensive, consistent, and accessible communication for the patient with all members of their health care team. "E-medicine" and health information technology (HIT) create many new possibilities in addition to standard face-to-face encounters. There is interest by both physicians and patients for enhanced access through electronic communication. However, there is little published literature regarding specific educational programs for medical professionals using electronic communication with patients. Faculty in a required 6-week family medicine clerkship developed, implemented, and evaluated an electronic health communication curriculum. This curriculum consists of a didactic session on electronic health communication including anticipated errors of communication and common clinical pitfalls. Each clerkship student receives a weekly e-mail from a standardized patient centered on a clinical question. Additionally, each e-mail contains a different communication challenge or predicted error. Students receive feedback each week on the e-mails and are evaluated with an objective structured clinical exam (OSCE) during the final week. The results of the weekly e-mails and the final OSCE show that students improve overall but continue to make predicted errors in communication despite didactic instruction and actual practice. These results reinforce the need for medical student education on electronic health communication with patients.

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

    Science.gov (United States)

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

    2013-01-01

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

  8. Review of medical reports on pedophilia.

    Science.gov (United States)

    Hughes, John R

    2007-10-01

    The present report is a review of all 554 papers published on Medline on pedophilia. The first discussion is the history of the disorder from ancient Greece to the present time, especially the influence of the liberal country of the Netherlands, the North American Man-Boy Love Association, and the sexual crisis in the Catholic Church. One important question is the relationship between homosexual pedophilia and adult homosexuality. Evidence for and against this relationship is presented. Next discussed are the characteristics of the victim and the long lasting serious effects of sexual abuse. Laboratory correlations are included, especially phallometric tests in order to objectively measure the physical responses to sexual stimuli. Electrophysiological and radiographic tests are also mentioned, including electroencephalography, computed tomography, magnetic resonance imaging, and positron emission tomography scans. An important section is the characterization of pedophiles with emphasis on their frequent previous sexual abuse, their past, their present, and their anticipated future. The final topic is treatment of this disorder with surgery, medication, behavioral therapy and the combination of medication and behavioral therapy.

  9. Home use of misoprostol for early medical abortion in a low resource setting: secondary analysis of a randomized controlled trial.

    Science.gov (United States)

    Iyengar, Kirti; Klingberg-Allvin, Marie; Iyengar, Sharad D; Paul, Mandira; Essén, Birgitta; Gemzell-Danielsson, Kristina

    2016-02-01

    Although home use of misoprostol for early medical abortion is considered to be safe, effective and feasible, it has not become standard service delivery practice. The aim of this study was to compare the efficacy, safety, and acceptability of home use of misoprostol with clinic misoprostol in a low-resource setting. This was a secondary analysis of a randomized controlled trial conducted in six primary care clinics in India. Women seeking medical abortion within up to nine gestational weeks (n = 731) received mifepristone in the clinic and were allocated either to home or clinic administration of misoprostol. Follow-up contact was after 10-15 days. Of 731 participants, 73% were from rural areas and 55% had no formal education. Complete abortion rates in the home and clinic misoprostol groups were 94.2 and 94.4%, respectively. The rate of adverse events was similar in both groups (0.3%). A greater proportion of home users (90.2%) said that they would opt for misoprostol at home in the event of a future abortion compared with clinic users (79.7%) who would opt for misoprostol at the clinic in a similar situation (p = 0.0002). Ninety-six percent women using misoprostol at home or in the clinic were satisfied with their abortion experience. Home-use of misoprostol for early medical abortion is as effective and acceptable as clinic use, in low resource settings. Women should be offered a choice of this option regardless of distance of their residence from the clinic and communication facilities. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  10. The epidemiology and type of medication errors reported to the National Poisons Information Centre of Ireland.

    LENUS (Irish Health Repository)

    Cassidy, Nicola

    2012-02-01

    INTRODUCTION: Medication errors are widely reported for hospitalised patients, but limited data are available for medication errors that occur in community-based and clinical settings. Epidemiological data from poisons information centres enable characterisation of trends in medication errors occurring across the healthcare spectrum. AIM: The objective of this study was to characterise the epidemiology and type of medication errors reported to the National Poisons Information Centre (NPIC) of Ireland. METHODS: A 3-year prospective study on medication errors reported to the NPIC was conducted from 1 January 2007 to 31 December 2009 inclusive. Data on patient demographics, enquiry source, location, pharmaceutical agent(s), type of medication error, and treatment advice were collated from standardised call report forms. Medication errors were categorised as (i) prescribing error (i.e. physician error), (ii) dispensing error (i.e. pharmacy error), and (iii) administration error involving the wrong medication, the wrong dose, wrong route, or the wrong time. RESULTS: Medication errors were reported for 2348 individuals, representing 9.56% of total enquiries to the NPIC over 3 years. In total, 1220 children and adolescents under 18 years of age and 1128 adults (>\\/= 18 years old) experienced a medication error. The majority of enquiries were received from healthcare professionals, but members of the public accounted for 31.3% (n = 736) of enquiries. Most medication errors occurred in a domestic setting (n = 2135), but a small number occurred in healthcare facilities: nursing homes (n = 110, 4.68%), hospitals (n = 53, 2.26%), and general practitioner surgeries (n = 32, 1.36%). In children, medication errors with non-prescription pharmaceuticals predominated (n = 722) and anti-pyretics and non-opioid analgesics, anti-bacterials, and cough and cold preparations were the main pharmaceutical classes involved. Medication errors with prescription medication predominated for

  11. Evaluating the Impact of Information Technology Tools to Support the Asthma Medical Home.

    Science.gov (United States)

    Matiz, L Adriana; Robbins-Milne, Laura; Krause, M Christine; Peretz, Patricia J; Rausch, John C

    2016-02-01

    This study aimed to evaluate the impact of information technology tools on the outcomes of children with asthma in the medical home. A registry was established for children aged 4 to 18 years with an ICD-9 code for asthma. Changes to the electronic health record included modifications to notes, care plans, and orders. A retrospective analysis of emergency department and in-patient utilization for a cohort of patients was conducted from July 2009 through June 2013. Of the study population (n = 1217), 65% had a classification of asthma severity and 63% were risk-stratified. Seventy percent had a control assessment at least once. Care plan use increased from 5% to 22% and enrollment in care coordination increased from 0.1% to 4%. After 3 years, there was a reduction of emergency department and inpatient admissions for asthma (P information technology tools was associated with improved asthma outcomes.

  12. Report: Review of Hotline Complaint on Employee Granted Full-Time Work-at-Home Privilege

    Science.gov (United States)

    Report #10-P-0002, October 7, 2009. We found an unauthorized, full-time work-at-home arrangement that has existed for 9 years and allows a NETI employee to work from home in Ohio instead of an office in Washington, DC.

  13. Enhancing State Medical Home Capacity through a Care Coordination Technical Assistance Model.

    Science.gov (United States)

    Berry, Susan; Barovechio, Patti; Mabile, Emily; Tran, Tri

    2017-07-14

    Introduction A practice-based care coordination (CC) model was developed by Louisiana's Title V Children's Special Health Services (CSHS) program to meet the overwhelming needs of the New Orleans post-Katrina population. The pilot clinic demonstrated an improvement in medical home (MH) capacity over the course of 3 months. The purpose of the current study is to evaluate the replicability of the model and sustainability of MH improvement over at least 2 years, while identifying factors that may modify the effect of the intervention. Methods The CSHS CC model utilizing a practice based care coordinator was implemented in 15 academic primary care pediatric clinics. Increase in MH capacity was determined using the MH Index-Short Version (MHI-SV) tool. Results The analysis of the MHI-SV scores for the ten clinics with >2 years of data demonstrated a significant improvement with each of the ten MHI-SV indicators. The mean clinic MHI-SV score improved from 19.70 to 34.15 on a scale of 10-50. Characteristics associated with the greatest MHI score improvement were rural geographic location, having an electronic health record, and using social workers or nurses as care coordinators. Characteristics associated with lower MHI scores were physician or care coordinator turnover and using stand-alone databases rather than tracking CC activities within the central patient record. Conclusion This study provides a flexible framework for implementing CC services in pediatric, family medicine, and medicine-pediatric practices, and demonstrates the value of CC as a driver for improvement in medical home capacity.

  14. Implications of Comprehensive Mental Health Services Embedded in an Adolescent Obstetric Medical Home.

    Science.gov (United States)

    Ashby, Bethany; Ranadive, Nikhil; Alaniz, Veronica; St John-Larkin, Celeste; Scott, Stephen

    2016-06-01

    Purpose Mental health issues in perinatal adolescents are well documented and studies have shown high rates of depressive disorders among this population. Treatment is challenging because pregnant adolescents are poorly adherent with mental health services. We describe a novel integrated mental health care program for pregnant and parenting adolescent mothers and their children. Methods The Colorado Adolescent Maternity Program (CAMP) is a comprehensive, multidisciplinary teen pregnancy and parenting medical home program serving an ethnically diverse and low socioeconomic status population in the Denver metro area. We describe the Healthy Expectations Adolescent Response Team (HEART), an embedded mental health care program focused on improving identification of mental health symptoms and increasing rates mental health treatment in adolescent mothers. Results From January 1, 2011-January 16 2014, 894 pregnant adolescents were enrolled in CAMP and 885 patients were screened for mental health issues. Prior to HEART's inception, 20 % of patients were identified as having mood symptoms in the postpartum period. Successful referrals to community mental health facilities occurred in only 5 % of identified patients. Following the creation of HEART, 41 % of patients were identified as needing mental health services. Nearly half of the identified patients (47 %) engaged in mental health treatment with the psychologist. Demographic factors including age, parity, ethnicity, and parent and partner involvement did not have a significant impact on treatment engagement. Trauma history was associated with lower treatment engagement. Conclusion Our findings suggest that an embedded mental health program in an adolescent obstetric and pediatric medical home is successful in improving identification and engagement in mental health treatment. Key components of the program include universal screening, intensive social work and case management involvement, and ready access to onsite

  15. Teamwork and delegation in medical homes: primary care staff perspectives in the Veterans Health Administration.

    Science.gov (United States)

    True, Gala; Stewart, Greg L; Lampman, Michelle; Pelak, Mary; Solimeo, Samantha L

    2014-07-01

    The patient-centered medical home (PCMH) relies on a team approach to patient care. For organizations engaged in transitioning to a PCMH model, identifying and providing the resources needed to promote team functioning is essential. To describe team-level resources required to support PCMH team functioning within the Veterans Health Administration (VHA), and provide insight into how the presence or absence of these resources facilitates or impedes within-team delegation. Semi-structured interviews with members of pilot teams engaged in PCMH implementation in 77 primary care clinics serving over 300,000 patients across two VHA regions covering the Mid-Atlantic and Midwest United States. A purposive sample of 101 core members of pilot teams, including 32 primary care providers, 42 registered nurse care managers, 15 clinical associates, and 12 clerical associates. Investigators from two evaluation sites interviewed frontline primary care staff separately, and then collaborated on joint analysis of parallel data to develop a broad, comprehensive understanding of global themes impacting team functioning and within-team delegation. We describe four themes key to understanding how resources at the team level supported ability of primary care staff to work as effective, engaged teams. Team-based task delegation was facilitated by demarcated boundaries and collective identity; shared goals and sense of purpose; mature and open communication characterized by psychological safety; and ongoing, intentional role negotiation. Our findings provide a framework for organizations to identify assets already in place to support team functioning, as well as areas in need of improvement. For teams struggling to make practice changes, our results indicate key areas where they may benefit from future support. In addition, this research sheds light on how variation in medical home implementation and outcomes may be associated with variation in team-based task delegation.

  16. Current Status of Home Medical Care Waste Collection by Nurses in Japan.

    Science.gov (United States)

    Ikeda, Yukihiro

    2017-02-01

    A questionnaire survey was conducted to determine the current status of home medical care (HMC) waste collection by nurses for individual items and whether the collection rate differs with city size. The questionnaire was mailed to 1,022 nursing offices, of which 645 offices provided valid responses. Offices were classified into three groups according to the local population size. Responses indicated that used syringes and needles, except for pen-type self-injection needles, were collected by >50% of HMC nurses. On the other hand, enteral nutrients, nutritional adjustment diet vessels, feeding tubes, portable injectors, ventilator masks, endotracheal suction catheters, tracheal cannulas, continuous ambulatory peritoneal dialysis (CAPD) bags, and urinary catheters and bags had a low collection rate in comparison with syringes or needles. The collection percentage of used syringes, needles, and infusion needles (p < 0.05) and that for infusion bags, tubes, and catheters (p < 0.001) differed among the three population groups. Although municipalities are responsible for collect all HMC waste, sharp or infectious items should be collected by HMC doctors or nurses. On the contrary, nonhazardous HMC waste should be collected by municipalities. This paper illustrates the status of waste collection of individual home medical care (HMC) items by HMC nurses. Infectious waste, such as needles and syringes, is collected by nurses. The collection rate of infectious waste by nurses in large cities was low compared with that in small cities. Although municipalities are responsible for collecting all HMC waste, sharp or infectious items should be collected by HMC doctors or nurses, whereas nonhazardous HMC waste should be collected by the municipalities.

  17. Parent-Reported Medication Use in a Head Start Population

    Science.gov (United States)

    Brinkman, Tara M.; Carlson, John S.

    2008-01-01

    This study investigates the prevalence of medication use within a Head Start population. Parent-reported data (N = 1,397) from initial enrollment information indicated 6.8% of children were taking 34 different types of medication. More than two thirds (69%) of those on medication were prescribed more than one medication, and more than one third…

  18. Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes : an uncontrolled before and after study

    NARCIS (Netherlands)

    van Welie, Steven; Wijma, Linda; Beerden, Tim; van Doormaal, Jasperien; Taxis, Katja

    2016-01-01

    OBJECTIVES: Residents of nursing homes often have difficulty swallowing (dysphagia), which complicates the administration of solid oral dosage formulations. Erroneously crushing medication is common, but few interventions have been tested to improve medication safety. Therefore, we evaluated the eff

  19. Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes : an uncontrolled before and after study

    NARCIS (Netherlands)

    van Welie, Steven; Wijma, Linda; Beerden, Tim; van Doormaal, Jasperien; Taxis, Katja

    2016-01-01

    Objectives: Residents of nursing homes often have difficulty swallowing (dysphagia), which complicates the administration of solid oral dosage formulations. Erroneously crushing medication is common, but few interventions have been tested to improve medication safety. Therefore, we evaluated the eff

  20. Learning from medication errors through a nationwide reporting programme

    NARCIS (Netherlands)

    Cheung, K.C.

    2015-01-01

    One of the strategies to enhance patient safety is the spontaneous reporting and analysis of medication errors. Sharing this information with other healthcare providers will help to prevent the reoccurrence of similar medication errors. In The Netherlands medication errors can be reported to a natio

  1. Pharmacist self-reported antidepressant medication counseling.

    Science.gov (United States)

    Cannon-Breland, Michelle L; Westrick, Salisa C; Kavookjian, Jan; Berger, Bruce A; Shannon, David M; Lorenz, Raymond A

    2013-01-01

    To identify the extent of pharmacists' self-reported antidepressant counseling (SRAC) and to identify factors that may affect pharmacists' decisions to provide antidepressant counseling. Cross-sectional study. Alabama community pharmacies in 2011. Full-time pharmacists from 600 community pharmacies. Self-administered survey; three mail contacts with alternate electronic surveys were used. Pharmacists' SRAC behavior and its relationship with pharmacists' illness perceptions of depression, self-efficacy, and organizational and environmental influences. 600 surveys were sent; 22 were undeliverable, 1 was partially completed (understanding of depression, and 36% discussed options for managing adverse effects with no more than a few patients. More than one-quarter (28.6%) never asked patients whether they had barriers to taking antidepressants. Pharmacists' perceptions regarding consequences, control/cure, and the episodic nature of depression, as well as their self-efficacy, had significant relationships ( P < 0.05) with pharmacists' involvement in antidepressant counseling. Low rates of pharmacists' involvement in antidepressant counseling were reported. Pharmacists must become more involved in counseling patients about their antidepressant medications and overcoming barriers preventing greater involvement.

  2. Personal digital assistant with a barcode reader--a medical decision support system for nurses in home care.

    Science.gov (United States)

    Johansson, Pauline E; Petersson, Göran I; Nilsson, Gunilla C

    2010-04-01

    Inappropriate medication among elderly people increases the risk of adverse drug-drug interactions, drug-related falls and hospital admissions. In order to prevent these effects it is necessary to obtain a profile of the patients' medication. A personal digital assistant (PDA) can be used as a medical decision support system (MDSS) to obtain a profile of the patients' medication and to check for inappropriate drugs and drug combinations, and to reduce medication errors. The aim of the present study was to evaluate nurses' experiences of using a MDSS in a PDA with a barcode reader, in order to obtain profiles of the patients' medication, regarding drug-drug interactions, therapeutic duplications, and warnings for drugs unsuitable for elderly in home care. The LIFe-reader is a MDSS in a PDA with a barcode reader. By scanning the drug packages in the patients' home, the LIFe-reader obtained profiles of the patients' medication and checked for drug-drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly people. The LIFe-reader also contained, e.g. drug information and medical reference works. Nurses (n=15) used the LIFe-reader for five weeks during their nursing home care practice assignment. The nurses answered questionnaires about the content and functions of the LIFe-reader before, during and after the nursing home care practice assignment, and were interviewed in focus groups. Descriptive statistics were used and content analysis was applied for qualitative data. By using the LIFe-reader, the majority of the nurses found it easy to obtain profiles of the patients' medication and check for drug-drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly people. Most nurses regarded the LIFe-reader to reduce drug-related risks of falling, and some thought it could reduce the drug-related admissions to hospitals. The scanning function was described as easy and time saving, although not always possible to

  3. Payment and Care for Hematopoietic Cellular Transplant Patients: Toward a Specialized Medical Home for Complex Care Patients.

    Science.gov (United States)

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

    2017-09-26

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

  4. Changes in clinical and hotel expenditures following publication of the nursing home compare report card.

    Science.gov (United States)

    Mukamel, Dana B; Spector, William D; Zinn, Jacqueline; Weimer, David L; Ahn, Richard

    2010-10-01

    Nursing Home Compare first published clinical quality measures at the end of 2002. It is a quality report card that for the first time offers consumers easily accessible information about the clinical quality of nursing homes. It led to changes in consumers' demand, increasing the relative importance of clinical versus hotel aspects of quality in their search and choice of a nursing home. To examine the hypothesis that nursing homes responding to these changes in demand shifted the balance of resources from hotel to clinical activities. The study included 10,022 free-standing nursing homes nationwide during 2001 to 2006. RESEARCH DESIGN AND DATA: A retrospective multivariate statistical analysis of trends in the ratio of clinical to hotel expenditures, using Medicare cost reports, Minimum Data Set and Online Survey, Certification and Reporting data, controlling for changes in residents' acuity and facility fixed effects. Inference is based on robust standard errors. The ratio of clinical to hotel expenditures averaged 1.78. It increased significantly (P hotel expenditures following publication of the report card suggests that nursing homes responded as expected to the changes in the elasticity of demand with respect to clinical quality brought about by the public reporting of clinical quality measures. The response was stronger among nursing homes facing stronger incentives.

  5. Resource Sharing in Higher Education: Home Economics Administrators' Report.

    Science.gov (United States)

    Ley, Connie; Webb-Lupo, Anita

    1988-01-01

    A total of 117 members of the National Council of Administrators of Home Economics completed the Resource Sharing Inventory. Forty-five percent provide some examples of how their department shared resources with other departments. Administrator attitude was the factor identified as most likely to encourage resource sharing. (CH)

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

    OpenAIRE

    Jones, AL; Cochran, SD; Leibowitz, A.; Wells, KB; Kominski, G; Mays, VM

    2015-01-01

    © 2015 Society of General Internal Medicine BACKGROUND: The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. OBJECTIVE: To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services...

  7. An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective

    OpenAIRE

    Achterberg Wilco; Francke Anneke L; Ament Andre; Mistiaen Patriek; Halfens Ruud; Huizinga Janneke; Post Henri

    2010-01-01

    Abstract Background Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of the Australian Medical Sheepskin were investigated from the perspective of a nursing home. Methods An economic model was developed in which monetary costs and monetary savings in respect of ...

  8. The role of the pharmacist in patient-centered medical home practices: current perspectives

    Directory of Open Access Journals (Sweden)

    Lewis NJW

    2014-06-01

    Full Text Available Nancy JW Lewis,1 Leslie A Shimp,2 Stuart Rockafellow,2 Jeffrey M Tingen,2 Hae Mi Choe,3 Marie A Marcelino21Private consultancy practice, Rochester Hills, MI, USA; 2Clinical, Social and Administrative Department, University of Michigan College of Pharmacy, Ann Arbor, MI, USA; 3Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USAAbstract: Patient-centered medical homes (PCMHs are the centerpiece of primary care transformation in the US. They are intended to improve care coordination and communication, enhance health care quality and patient experiences, and lower health care costs by linking patients to a physician-led interdisciplinary health care team. PCMHs are widely supported by health care associations, payers, and employers. Health care accreditation organizations have created performance measures that promote the adoption of PCMH core attributes. Public and private payers are increasingly providing incentives and bonuses related to performance measure status. Evidence-based prescription, medication adherence, medication use coordination, and systems to support medication safety are all necessary components of PCMHs. Pharmacists have unique knowledge and skills that can complement the care provided by other PCMH team members. Their experience in drug therapy assessments, medication therapy management, and population health has documented benefits, both in terms of patient health outcomes and health care costs. Through collaborative care, pharmacists can assist physicians and other prescribers in medication management and thus improve prescriber productivity and patient access to care. Pharmacists are engaged in PCMHs through both employment and contractual arrangements. While some pharmacists serve a unique PCMH, others work within practice networks that serve practices within a geographical area. Financial support for pharmacist-provided services includes university funding, external grant funding

  9. Communication between key stakeholders within a medical home: a qualitative study.

    Science.gov (United States)

    Nelson, Catherine S; Tandon, S Darius; Duggan, Anne K; Serwint, Janet R

    2009-04-01

    The objective of this study was to determine perceived benefits, detriments, and barriers to communication between pediatric providers and home visitors. The authors performed a cross-sectional, qualitative study consisting of 3 focus groups with paraprofessional home visitors (n=12), 6 with parents receiving home visiting (n=33), and 4 with pediatric providers whose patients received home visiting (n=19). Emerging themes were generated by an inductive analytic approach. Perceived benefits included home visitors assisting parents with communication, giving providers family information, and reinforcing providers' guidance. Detriments included parental concern of sharing confidential information and providers becoming aware of family issues for which they are unprepared to act. Barriers included parental consent, logistics of home visitor-provider communication, and providers' lack of knowledge about home visitor programs/roles. Greater coordination between home visitation programs and pediatric providers may strengthen home visiting services and reinforce advice and anticipatory guidance given by providers.

  10. Voluntary Medical Incident Reporting Tool to Improve Physician Reporting of Medical Errors in an Emergency Department

    Directory of Open Access Journals (Sweden)

    Nnaemeka G. Okafor

    2015-12-01

    Full Text Available Introduction: Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. Methods: A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. Results: The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Conclusion: Error reporting frequency can be dramatically improved by using a web-based, userfriendly, voluntary, and non-punitive reporting system.

  11. Teaching while learning while practicing: reframing faculty development for the patient-centered medical home.

    Science.gov (United States)

    Clay, Michael A; Sikon, Andrea L; Lypson, Monica L; Gomez, Arthur; Kennedy-Malone, Laurie; Bussey-Jones, Jada; Bowen, Judith L

    2013-09-01

    Soaring costs of health care, patients living longer with chronic illnesses, and continued attrition of interest in primary care contribute to the urgency of developing an improved model of health care delivery. Out of this need, the concept of the team-based, patient-centered medical home (PCMH) has developed. Amidst implementation in academic settings, clinical teachers face complex challenges not previously encountered: teaching while simultaneously learning about the PCMH model, redesigning clinical delivery systems while simultaneously delivering care within them, and working more closely in expanded interprofessional teams.To address these challenges, the authors reviewed three existing faculty development models and recommended four important adaptations for preparing clinical teachers for their roles as system change agents and facilitators of learning in these new settings. First, many faculty find themselves in the awkward position of teaching concepts they have yet to master themselves. Professional development programs must recognize that, at least initially, health professions learners and faculty will be learning system redesign content and skills together while practicing in the evolving workplace. Second, all care delivery team members influence learning in the workplace. Thus, the definition of faculty must expand to include nurses, pharmacists, social workers, medical assistants, patients, and others. These team members will need to accept their roles as educators. Third, learning to deliver health care in teams will require support of both interprofessional collaboration and intraprofessional identity development. Fourth, learning to manage change and uncertainty should be part of the core content of any faculty development program within the PCMH.

  12. Is the medical home for adult patients with sickle cell disease a reality or an illusion?

    Science.gov (United States)

    Ballas, Samir K; Vichinsky, Elliott P

    2015-01-01

    Recently, the patient-centered medical home (PCMH) emerged as a viable method to improve delivery of medical care. Due to all the promotion about the effectiveness of the PCMH, patients with sickle cell disease, their families and the community hoped that this could be a possible solution to the problems that arise in the treatment of adult patients with sickle cell disease. Review of the literature and review of the criteria for the establishment of a PCMH show that the PCMH is not an ideal model for patients with sickle cell disease because finding a personal physician, which is the first criteria of a functional PCMH, is a major problem in the process of transitioning the care of patients with sickle cell disease from pediatrics to adult care. Moreover, garnering hospital support to defray the initial costs to establish a PCMH for adults with sickle cell disease is unlikely given the already high costs of care for patients with sickle cell disease. Moreover, recent studies have shown insufficient evidence to determine the presumed beneficial effects of the PCMH, especially in patients with chronic disease.

  13. Nurses and Psychologists Advancing the Patient-Centered Medical Home Model.

    Science.gov (United States)

    Corso, Kent A; Gage, Donna

    2016-01-01

    As America experiences the largest health care revolution of the past 50 years, clinicians and administrators are refocusing their attention on the goals of the Quadruple Aim. Motivation and capabilities among stakeholders vary as practical tools and an adequate workforce remain elusive. At the same time, the patient-centered medical home (PCMH) model is spreading rapidly but demonstrating variable results. Positive PCMH outcomes seem to reflect high-quality teamwork. A primary care physician shortage is looming, and increasing numbers of health professionals are being pushed into the PCMH, mandated to provide "integrated" care. Even now, the majority of our Graduate Medical Education programs do not train clinicians in team-based workflow models and interaction skills. Consequently, PCMH teams will only optimize and realize the model's true potential if they learn to coordinate, communicate, and collaborate effectively. This means all PCMH staff members achieve solid teamwork skills and work at the top of their license. The authors discuss resources for improving coordination, communication, and collaboration among members of PCMH teams, and strategies for including other professionals.

  14. Medicare and Medicaid programs; CY 2015 Home Health Prospective Payment System rate update; Home Health Quality Reporting Requirements; and survey and enforcement requirements for home health agencies. Final rule.

    Science.gov (United States)

    2014-11-06

    This final rule updates Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2015. As required by the Affordable Care Act, this rule implements the second year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule provides information on our efforts to monitor the potential impacts of the rebasing adjustments and the Affordable Care Act mandated face-to-face encounter requirement. This rule also implements: Changes to simplify the face-to-face encounter regulatory requirements; changes to the HH PPS case-mix weights; changes to the home health quality reporting program requirements; changes to simplify the therapy reassessment timeframes; a revision to the Speech-Language Pathology (SLP) personnel qualifications; minor technical regulations text changes; and limitations on the reviewability of the civil monetary penalty provisions. Finally, this rule also discusses Medicare coverage of insulin injections under the HH PPS, the delay in the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), and a HH value-based purchasing (HH VBP) model.

  15. The Study of Electronic Medical Record Adoption in a Medicare Certified Home Health Agency Using a Grounded Theory Approach

    Science.gov (United States)

    May, Joy L.

    2013-01-01

    The purpose of this qualitative grounded theory study was to examine the experiences of clinicians in the adoption of Electronic Medical Records in a Medicare certified Home Health Agency. An additional goal for this study was to triangulate qualitative research between describing, explaining, and exploring technology acceptance. The experiences…

  16. Survey of 5 European countries suggests that more elements of patient-centered medical homes could improve primary care

    NARCIS (Netherlands)

    Faber, M.J.; Voerman, G.E.; Erler, A.; Eriksson, T.; Baker, R.; Lepeleire, J. De; Grol, R.P.T.M.; Burgers, J.S.

    2013-01-01

    The patient-centered medical home is a US model for comprehensive care. This model features a personal physician or registered nurse who is augmented by a proactive team and information technology. Such a model could prove useful for advanced European systems as they strive to improve primary care,

  17. SuperAssist: A User-Assistant Collaborative Environment for the supervision of medical instrument use at home

    NARCIS (Netherlands)

    Blanson Henkemans, O.A.; Neerincx, M.A.; Lindenberg, J.; Mast, C.A.P.G. van der

    2007-01-01

    With the rise of Transmural care, patients increasingly use medical instruments at home. Maintenance and troubleshooting greatly determines the safety and accuracy of these instruments. For the supervision of these complex tasks, we developed a User-Assistant Collaborative Environment (U-ACE). We

  18. Doctor-patient communication without family is most frequently practiced in patients with malignant tumors in home medical care settings.

    Science.gov (United States)

    Kimura, Takuma; Imanaga, Teruhiko; Matsuzaki, Makoto

    2014-01-01

    Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.

  19. Giving rheumatology patients online home access to their electronic medical record (EMR): advantages, drawbacks and preconditions according to care providers

    NARCIS (Netherlands)

    Vaart, van der R.; Drossaert, C.H.C.; Taal, E.; Laar, van de M.A.F.J.

    2013-01-01

    Technology enables patients home access to their electronic medical record (EMR), via a patient portal. This study aims to analyse (dis)advantages, preconditions and suitable content for this service, according to rheumatology health professionals. A two-phase policy Delphi study was conducted. Firs

  20. Perspectives on medical malpractice self-insurance financial reporting.

    Science.gov (United States)

    Frese, Richard C; Kitchen, Patrick J

    2012-11-01

    Financial reporting of medical malpractice self-insurance is evolving. The Financial Accounting Standards Board Accounting Standards Codification Section 954-450-25 provides guidance for accounting and financial reporting for medical malpractice. Discounting of medical malpractice liabilities has been reassessed in recent years. Malpractice litigation reform efforts continue in several states. Accountable care organizations could increase the frequency of medical malpractice claims because of patients' heightened expectations regarding quality of care.

  1. Polypharmacy and Renal Failure in Nursing Home Residents: Results of the Inappropriate Medication in Patients with Renal Insufficiency in Nursing Homes (IMREN) Study.

    Science.gov (United States)

    Dörks, Michael; Herget-Rosenthal, Stefan; Schmiemann, Guido; Hoffmann, Falk

    2016-01-01

    Polypharmacy has become an emerging public health issue in recent years, since use of multiple medications or polypharmacy is beneficial for many conditions, but may also have negative effects like adverse drug reactions. The risk further increases in patients with chronic renal failure, a comorbidity very frequent in nursing home residents. Since more than 50% of all drugs were renally excreted, dose adjustments in patients with renal failure are required. To assess polypharmacy in German nursing homes, in particular in residents with renal failure. Multi-center cross-sectional study in 21 nursing homes in Bremen and Lower Saxony/Germany. Baseline data were analysed using descriptive statistics. Multivariable logistic regression model and 95% confidence intervals were used to study the association of renal failure and polypharmacy. Of all 852 residents, the analysis comprised those 685 with at least one serum creatinine value so that the estimated creatinine clearance could be calculated. Of those, 436 (63.6%) had a severe or moderate renal failure, defined as estimated creatinine clearance Polypharmacy (5-9 drugs) was found in 365 (53.3%) and excessive polypharmacy (≥10 drugs) in 112 (16.4%) residents. Diuretics and psycholeptics were the most commonly used drug classes. Severe renal failure (estimated creatinine clearance polypharmacy (OR: 2.8, 95% CI 1.4-5.7). Both, polypharmacy and renal failure are common in German nursing home residents and an association of both could be found. Further studies are needed to assess the appropriateness of polypharmacy in these patients.

  2. Stimulant and atypical antipsychotic medications for children placed in foster homes.

    Directory of Open Access Journals (Sweden)

    L Oriana Linares

    Full Text Available OBJECTIVES: The purpose of this study is to examine the use of prescribed psychoactive medications in a prospective cohort of children shortly after they entered foster homes; and to identify demographics, maltreatment history, psychiatric diagnoses including ADHD comorbidity, and level of aggression that contribute to prescribed use of stimulant and atypical antipsychotic medication over time. METHODS: The sample included N = 252 children (nested in 95 sibling groups followed for three years up to 4 yearly waves. RESULTS: Nearly all (89% met criteria for at least one of eight psychiatric diagnoses and 31% (75/252 used one or more prescribed psychoactive medications. Over half (55% were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD; of these 38% used stimulants and 36% used atypical antipsychotics. Of the 75 medicated children, 19% received ≥3 different classes of drugs over the course of the study. Stimulants (69% and atypical antipsychotics (65% were the most frequently used drugs among medicated children. Adjusted odds ratios (AOR showed that male gender (AOR = 3.2; 95% CI = 1.5-9.3, African American vs Latino ethnicity (AOR = 5.4; 95% CI = 2.1-14.2, ADHD regardless of Oppositional Defiant (ODD or Conduct (CD comorbidity (AOR = 6.0, 95% CI = 1.3-27.5, ODD or CD (AOR = 11.1, 95% CI = 2.1-58.6, and Separation Anxiety (AOR = 2.0, 95% CI = 1.0-4.0 psychiatric disorders were associated with the use of prescribed stimulants; while male gender (AOR = 3.8, 95% CI = 1.5-9.3, African American vs Latino (AOR = 5.1, 95% CI = 1.2-9.2 or Mixed/Other ethnicity (AOR = 3.3, 95% CI = 1.9-13.7, ADHD regardless of ODD or CD comorbidity (AOR = 5.8, 95% CI = 1.2-28.7, ODD or CD (AOR = 13.9, 95% CI = 3.3-58.5, Major Depression/Dysthymia (AOR = 2.8, 95% CI = 1.1-6.7 psychiatric disorders, and history of sexual abuse (AOR = 4.6, 95% CI = 1.3-18.4 were

  3. Patients' confidence in methods of blood pressure assessment and their reported adherence to antihypertensive medications.

    Science.gov (United States)

    Alvarez, Paul; Zeng, Jennifer; Tuttle, Laura; Viera, Anthony J

    2017-10-01

    Adherence to antihypertensive medications is often less than optimal. Research suggests that patients have limited confidence regarding whether office blood pressure (BP) assessments represent their 'true' BP, which may further promote poor adherence to BP-lowering medication. We assessed peoples' confidence in the methods of BP assessment and examined the associations between patients' confidence levels and medication adherence comparing office and home BP-monitoring techniques. We surveyed US adults aged 30 years or older (N=1010), all of whom had undergone an office BP measurement within the past 6 months. Respondents who indicated being prescribed antihypertensive medication (N=429) were asked to indicate their level of confidence on a 1-9 scale that BP measurements represented their true BP, and their adherence to antihypertensive medication using the eight-item Morisky Medical Adherence Scale (MMAS-8). Respondents had equal confidence that both office BP measurements and home monitoring measurements reflected their true BP (median=7). Respondents indicated that they would have slightly more confidence in ambulatory BP monitoring (median=8). As respondents' confidence in the assessments of BP from office measurements and home monitoring increased from 1 to 9, the mean MMAS-8 score, adjusted for age, race, and education, increased from 5.38 to 6.25 (P=0.053) and from 5.50 to 6.14 (P=0.25), respectively. As patients' confidence in a BP assessment method increases, so too does their reported adherence to prescribed antihypertensive medications. This finding further supports the incorporation of methods in which patients can feel confident that the measurements are representative of their 'true' BP.

  4. The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran's health administration.

    Science.gov (United States)

    Solimeo, Samantha L; Ono, Sarah S; Lampman, Michelle A M; Paez, Monica B W; Stewart, Gregory L

    2015-01-01

    In this paper we present results of a mixed methods study conducted to identify barriers to team function among staff implementing patient aligned care teams - the Department of Veterans Affairs' patient centered medical home (PCMH) model. Using a convergent mixed methods design, we administered a standardized survey measure (Team and Individual Role Perception Survey) to assess work role challenge and engagement; and conducted discussion groups to gather context pertaining to role change. We found that the role of primary care providers is highly challenging and did not become less difficult over the initial year of implementation. Unexpectedly over the course of the first year nurse care managers reported a decrease in their perceptions of empowerment and clerical associates reported less skill variety. Qualitative data suggest that more skilled team members fail to delegate and share tasks within their teams. We characterize this interprofessional knowledge factor as an empowerment paradox where team members find it difficult to share tasks in ways that are counter to traditionally structured hierarchical roles. Health care systems seeking to implement PCMH should dedicate resources to facilitating within-team role knowledge and negotiation.

  5. Home Health Agency (HHA) Medicare Cost Report Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — These data files contain the highest level of cost report status for cost reports in all reported fiscal years. For example, if the Healthcare Cost Report...

  6. Prospective study of home use of mifepristone and misoprostol for medical abortion up to 10weeks of pregnancy in Kazakhstan.

    Science.gov (United States)

    Platais, Ingrida; Tsereteli, Tamar; Grebennikova, Galina; Lotarevich, Tatyana; Winikoff, Beverly

    2016-09-01

    To evaluate the efficacy of at-home medical abortion in Kazakhstan. A comparative, non-randomized study was undertaken at three clinics in Kazakhstan between October 10, 2013, and November 27, 2014. Women who sought medical abortion and had an intrauterine pregnancy of up to 70days were enrolled. All participants took 200mg mifepristone followed by 600μg sublingual misoprostol 24-48hours later. Women were offered the choice to take mifepristone at the clinic or at home; all took misoprostol at home. Abortion completion was assessed at an in-clinic follow-up appointment scheduled for all participants 2weeks after mifepristone administration. Of 290 enrolled women, 185 (63.8%) chose to self-administer mifepristone at home. Three (1.0%) of 289 women included in outcome analyses required surgical intervention for incomplete abortion. Therefore, the overall success rate was 99.0% (95% confidence interval 97.0%-99.7%). No serious adverse events occurred. Outpatient medical abortion with mifepristone and misoprostol is safe and effective up to 70days of pregnancy. This service should be offered to women in Kazakhstan. ClinicalTrials.gov: NCT02018796. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Work-home interface stress: an important predictor of emotional exhaustion 15 years into a medical career.

    Science.gov (United States)

    Hertzberg, Tuva Kolstad; Rø, Karin Isaksson; Vaglum, Per Jørgen Wiggen; Moum, Torbjørn; Røvik, Jan Ole; Gude, Tore; Ekeberg, Øivind; Tyssen, Reidar

    2016-01-01

    The importance of work-home interface stress can vary throughout a medical career and between genders. We studied changes in work-home interface stress over 5 yr, and their prediction of emotional exhaustion (main dimension of burn-out), controlled for other variables. A nationwide doctor cohort (NORDOC; n=293) completed questionnaires at 10 and 15 yr after graduation. Changes over the period were examined and predictors of emotional exhaustion analyzed using linear regression. Levels of work-home interface stress declined, whereas emotional exhaustion stayed on the same level. Lack of reduction in work-home interface stress was an independent predictor of emotional exhaustion in year 15 (β=-0.21, p=0.001). Additional independent predictors were reduction in support from colleagues (β=0.11, p=0.04) and emotional exhaustion at baseline (β=0.62, pwork-home interface stress among women, and reduction of collegial support and lack of reduction in working hours among men. Thus, change in work-home interface stress is a key independent predictor of emotional exhaustion among doctors 15 yr after graduation. Some gender differences in predictors of emotional exhaustion were found.

  8. Expert Meeting Report. Windows Options for New and Existing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Ojczyck, C. [Univ. of Minnesota, St. Paul, MN (United States); Carmody, J. [Univ. of Minnesota, St. Paul, MN (United States); Haglund, K. [Univ. of Minnesota, St. Paul, MN (United States)

    2013-05-01

    The NorthernSTAR Building America Partnership held an Expert Meeting on Windows Options for New and Existing Homes on November 14, 2011, at the Nolte Building on the campus of the University of Minnesota in Minneapolis, MN. Featured speakers included John Carmody and Pat Huelman of the University of Minnesota, Charlie Curcija of Lawrence Berkeley National Laboratory, Jim Larson of Cardinal Glass Industries, Peter Yost of Building Green, Peter Baker of Building Science Corporation, and Theresa Weston of Du Pont Innovations. Audience participation was actively encouraged during each presentation to uncover need and promote dialog among researchers and industry professionals.

  9. Expert Meeting Report: Windows Options for New and Existing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Ojczyk, C.; Carmody, J.; Haglund, K.

    2013-05-01

    The NorthernSTAR Building America Partnership held an Expert Meeting on Windows Options for New and Existing Homes on November 14, 2011 at the Nolte Building on the campus of the University of Minnesota in Minneapolis, MN. Featured speakers included John Carmody and Pat Huelman of the University of Minnesota, Charlie Curcija of Lawrence Berkeley National Laboratory, Jim Larson of Cardinal Glass Industries, Peter Yost of Building Green, Peter Baker of Building Science Corporation, and Theresa Weston of Du Pont Innovations. Audience participation was actively encouraged during each presentation to uncover need and promote dialog among researchers and industry professionals.

  10. Final report [Homes Tours and Green Building Program Development

    Energy Technology Data Exchange (ETDEWEB)

    MacRae, Lani

    2000-06-28

    The US Department of Energy Office of Building Technology, State and Community Programs sponsored EcoTecture Solutions, Inc. (dba Sustainable Living Alliance {trademark}) in producing two home tours showcasing energy- and resource-efficient buildings in Austin, Texas, held on October 16, 1999, and Albuquerque, New Mexico, held on May 20, 2000. Lists are given of the notable building technologies, passive solar design features, and energy- and water-efficient technologies and design employed in the houses. There were over 1200 visitors to the 22 residential and 3 commercial buildings included in the tour.

  11. Encouraging Patient Portal Use in the Patient-Centered Medical Home: Three Stakeholder Perspectives.

    Science.gov (United States)

    Fix, Gemmae M; Hogan, Timothy P; Amante, Daniel J; McInnes, D Keith; Nazi, Kim M; Simon, Steven R

    2016-11-22

    Health care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, thus playing a prominent role within the patient-centered medical home (PCMH). However, despite enthusiasm, adoption remains low. We examined factors in the PCMH context that may affect efforts to improve enrollment in a patient portal. Using a sociotechnical approach, we conducted qualitative, semistructured interviews with patients and providers from 3 primary care clinics and with national leaders from across a large integrated health care system. We gathered perspectives and analyzed data from 4 patient focus groups and one-on-one interviews with 1 provider from each of 3 primary care clinics and 10 program leaders. We found that leaders were focused on marketing in primary care, whereas patients and providers were often already aware of the portal. In contrast, both patients and providers cited administrative and logistical barriers impeding enrollment. Further, although leadership saw the PCMH as the logical place to focus enrollment efforts, providers and patients were more circumspect and expressed concern about how the patient portal would affect their practice and experience of care. Further, some providers expressed ambivalence about patients using the portal. Despite absence of consensus on how and where to encourage portal adoption, there was wide agreement that promoting enrollment was a worthwhile goal. Patients, clinicians, and national leaders agreed that efforts were needed to increase enrollment in the patient portal. Opinions diverged regarding the suitability of the PCMH and, specifically, the primary care clinic for promoting patient portal enrollment. Policymakers should consider diverse stakeholder perspectives in advance of interventions to increase technology adoption.

  12. MODELING CHRONIC DISEASE PATIENT FLOWS DIVERTED FROM EMERGENCY DEPARTMENTS TO PATIENT-CENTERED MEDICAL HOMES.

    Science.gov (United States)

    Diaz, Rafael; Behr, Joshua; Kumar, Sameer; Britton, Bruce

    Chronic Disease is defined as a long lasting health condition, which can develop and/or worsen over an extended time, but which can also be controlled. The monetary and budgetary toll due to its persistent nature has become unsustainable and requires pressing actions to limit their incidence and burden. This paper demonstrates the utility of the System Dynamics approach to simulate the behavior of key factors involved in the implementation of chronic disease management. We model the patient flow diversion from emergency departments (ED) to patient-centered medical homes (PCMH), with emphasis on the visit rates, as well as the effect of insurance coverage, in an effort to assure continuity of quality care for Asthma patients at lower costs. The model is used as an evaluative method to identify conditions of a maintained health status through adequate policy planning, in terms of resources and capacity. This approach gives decision makers the ability to track the level of implementation of the intervention and generate knowledge about dynamics between population demands and the intervention effectiveness. The functionality of the model is demonstrated through the consideration of hypothetical scenarios executed using sensitivity analysis.

  13. Evaluation of computer-based medical histories taken by patients at home

    Science.gov (United States)

    Kowaloff, Hollis B; Davis, Roger B; Delbanco, Tom; Locke, Steven E; Safran, Charles; Bleich, Howard L

    2012-01-01

    The authors developed a computer-based general medical history to be taken by patients in their homes over the internet before their first visit with their primary care doctor, and asked six doctors and their participating patients to assess this history and its effect on their subsequent visit. Forty patients began the history; 32 completed the history and post-history assessment questionnaire and were for the most part positive in their assessment; and 23 continued on to complete their post-visit assessment questionnaire and were for the most part positive about the helpfulness of the history and its summary at the time of their visit with the doctor. The doctors in turn strongly favored the immediate, routine use of two modules of the history—the family and social histories—for all their new patients. The doctors suggested further that the summaries of the other modules of the history be revised and shortened to make it easier for them to focus on clinical issues in the order of their preference. PMID:22237866

  14. Conformity of pediatric/adolescent HIV clinics to the patient-centered medical home care model.

    Science.gov (United States)

    Yehia, Baligh R; Agwu, Allison L; Schranz, Asher; Korthuis, P Todd; Gaur, Aditya H; Rutstein, Richard; Sharp, Victoria; Spector, Stephen A; Berry, Stephen A; Gebo, Kelly A

    2013-05-01

    The patient-centered medical home (PCMH) has been introduced as a model for providing high-quality, comprehensive, patient-centered care that is both accessible and coordinated, and may provide a framework for optimizing the care of youth living with HIV (YLH). We surveyed six pediatric/adolescent HIV clinics caring for 578 patients (median age 19 years, 51% male, and 82% black) in July 2011 to assess conformity to the PCMH. Clinics completed a 50-item survey covering the six domains of the PCMH: (1) comprehensive care, (2) patient-centered care, (3) coordinated care, (4) accessible services, (5) quality and safety, and (6) health information technology. To determine conformity to the PCMH, a novel point-based scoring system was devised. Points were tabulated across clinics by domain to obtain an aggregate assessment of PCMH conformity. All six clinics responded. Overall, clinics attained a mean 75.8% [95% CI, 63.3-88.3%] on PCMH measures-scoring highest on patient-centered care (94.7%), coordinated care (83.3%), and quality and safety measures (76.7%), and lowest on health information technology (70.0%), accessible services (69.1%), and comprehensive care (61.1%). Clinics moderately conformed to the PCMH model. Areas for improvement include access to care, comprehensive care, and health information technology. Future studies are warranted to determine whether greater clinic PCMH conformity improves clinical outcomes and cost savings for YLH.

  15. Attitudes to reporting medication error among differing healthcare professionals.

    Science.gov (United States)

    Sarvadikar, Ajit; Prescott, Gordon; Williams, David

    2010-08-01

    Medication error reporting is an important measure to prevent medication error incidents in a healthcare system and can serve as an important tool for improving patient safety. This study aimed to investigate attitudes of healthcare professionals (doctors, nurses, and pharmacists) in reporting medication errors. Fifty-six healthcare professionals working at a 900-bed tertiary referral hospital were surveyed. A questionnaire using two different clinical scenarios (involving oral and intravenous administration of a drug) and four questions with an ascending order of worsening patient outcome was used. A Likert scale ranging from 1 (unlikely) to 5 (likely) was used to describe the likelihood of reporting a medication error. The overall response rate was 57% (43% for doctors, 68% for nurses, and 64% for pharmacists). Results showed that doctors were unlikely to report less-serious medication errors (median value of 2 on the Likert scale). Nurses and pharmacists (median value of 5) were likely to report less-serious as well as serious medication errors despite their fears of receiving disciplinary action. All healthcare professionals were more likely to report an error as the clinical scenarios had a progressively worsening outcome for the patient. These results suggest that among healthcare professionals, there are differing attitudes to reporting medication errors. Differing approaches are therefore required to encourage medication error reporting among different healthcare professionals. Future study is required to further investigate these findings and improve reporting rates.

  16. Impact of technological innovation on a nursing home performance and on the medication-use process safety.

    Science.gov (United States)

    Baril, Chantal; Gascon, Viviane; Brouillette, Christel

    2014-03-01

    Despite the fact that since 1985 the government of Québec increased by 5.75 % on average the amount of money spent on healthcare per year, little improvement was noted. It is obvious that an optimal use of resources is essential to reduce waiting times and provide safer and faster services to patients. The use of new technology can contribute to improve the healthcare system efficiency. Our study aims to assess the impact of a medication distribution technology on 1) the performance of a health and social services center's pharmacy, 2) the performance of one care unit in a nursing home and on 3) the medication-use process safety. To measure performance we were inspired by the Lean approach. The results show that medication distribution technology is considered as an effective way to significantly detect medication errors, to allow nurses to focus more on patients and pharmacy to react more rapidly to changes in patient medications.

  17. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience

    Directory of Open Access Journals (Sweden)

    Linda Thomas-Hemak

    2015-02-01

    Full Text Available Purpose. The effect of patient centered medical home (PCMH curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents.Methods. Twenty four (24 Internal Medicine residents—12 Traditional (TR track residents and 12 Teaching Health Center (THC track residents—began training in Academic Year (AY 2011 at the Wright Center for Graduate Medical Education (WCGME. They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents.Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance.Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA’s Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents.

  18. Effects and Satisfaction of Medical Device Safety Information Reporting System Using Electronic Medical Record

    Science.gov (United States)

    Jang, Hye Jung; Choi, Young Deuk

    2017-01-01

    Objectives This paper describes an evaluation study on the effectiveness of developing an in-hospital medical device safety information reporting system for managing safety information, including adverse incident data related to medical devices, following the enactment of the Medical Device Act in Korea. Methods Medical device safety information reports were analyzed for 190 cases that took place prior to the application of a medical device safety information reporting system and during a period when the reporting system was used. Also, questionnaires were used to measure the effectiveness of the medical device safety information reporting system. The analysis was based on the questionnaire responses of 15 reporters who submitted reports in both the pre- and post-reporting system periods. Results Sixty-two reports were submitted in paper form, but after the system was set up, this number more than doubled to 128 reports in electronic form. In terms of itemized reporting, a total of 45 items were reported. Before the system was used, 23 items had been reported, but this increased to 32 items after the system was put to use. All survey variables of satisfaction received a mean of over 3 points, while positive attitude, potential benefits, and positive benefits all exceeded 4 points, each receiving 4.20, 4.20, and 4.13, respectively. Among the variables, time-consuming and decision-making had the lowest mean values, each receiving 3.53. Satisfaction was found to be high for system quality and user satisfaction, but relatively low for time-consuming and decision-making. Conclusions We were able to verify that effective reporting and monitoring of adverse incidents and the safety of medical devices can be implemented through the establishment of an in-hospital medical device safety information reporting system that can enhance patient safety and medical device risk management. PMID:28523207

  19. Effects and Satisfaction of Medical Device Safety Information Reporting System Using Electronic Medical Record.

    Science.gov (United States)

    Jang, Hye Jung; Choi, Young Deuk; Kim, Nam Hyun

    2017-04-01

    This paper describes an evaluation study on the effectiveness of developing an in-hospital medical device safety information reporting system for managing safety information, including adverse incident data related to medical devices, following the enactment of the Medical Device Act in Korea. Medical device safety information reports were analyzed for 190 cases that took place prior to the application of a medical device safety information reporting system and during a period when the reporting system was used. Also, questionnaires were used to measure the effectiveness of the medical device safety information reporting system. The analysis was based on the questionnaire responses of 15 reporters who submitted reports in both the pre- and post-reporting system periods. Sixty-two reports were submitted in paper form, but after the system was set up, this number more than doubled to 128 reports in electronic form. In terms of itemized reporting, a total of 45 items were reported. Before the system was used, 23 items had been reported, but this increased to 32 items after the system was put to use. All survey variables of satisfaction received a mean of over 3 points, while positive attitude, potential benefits, and positive benefits all exceeded 4 points, each receiving 4.20, 4.20, and 4.13, respectively. Among the variables, time-consuming and decision-making had the lowest mean values, each receiving 3.53. Satisfaction was found to be high for system quality and user satisfaction, but relatively low for time-consuming and decision-making. We were able to verify that effective reporting and monitoring of adverse incidents and the safety of medical devices can be implemented through the establishment of an in-hospital medical device safety information reporting system that can enhance patient safety and medical device risk management.

  20. Use of CAHPS® patient experience survey data as part of a patient-centered medical home quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Quigley DD

    2015-07-01

    Full Text Available Denise D Quigley,1 Peter J Mendel,1 Zachary S Predmore,2 Alex Y Chen,3 Ron D Hays41RAND Corporation, Santa Monica, CA, 2RAND Corporation, Boston, MA, 3AltaMed Health Services Corporation, 4Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USAObjective: To describe how practice leaders used Consumer Assessment of Healthcare Providers and Systems (CAHPS® Clinician and Group (CG-CAHPS data in transitioning toward a patient-centered medical home (PCMH.Study design: Interviews conducted at 14 primary care practices within a large urban Federally Qualified Health Center in California.Participants: Thirty-eight interviews were conducted with lead physicians (n=13, site clinic administrators (n=13, nurse supervisors (n=10, and executive leadership (n=2.Results: Seven themes were identified on how practice leaders used CG-CAHPS data for PCMH transformation. CAHPS® was used: 1 for quality improvement (QI and focusing changes for PCMH transformation; 2 to maintain focus on patient experience; 3 alongside other data; 4 for monitoring site-level trends and changes; 5 to identify, analyze, and monitor areas for improvement; 6 for provider-level performance monitoring and individual coaching within a transparent environment of accountability; and 7 for PCMH transformation, but changes to instrument length, reading level, and the wording of specific items were suggested.Conclusion: Practice leaders used CG-CAHPS data to implement QI, develop a shared vision, and coach providers and staff on performance. They described how CAHPS® helped to improve the patient experience in the PCMH model, including access to routine and urgent care, wait times, provider spending enough time and listening carefully, and courteousness of staff. Regular reporting, reviewing, and discussing of patient-experience data alongside other clinical quality and productivity measures at multilevels of the organization was critical in maximizing the

  1. Home Use of a Pyrethroid-Containing Pesticide and Facial Paresthesia in a Toddler: A Case Report

    Directory of Open Access Journals (Sweden)

    Alexandra Perkins

    2016-08-01

    Full Text Available Paresthesias have previously been reported among adults in occupational and non-occupational settings after dermal contact with pyrethroid insecticides. In this report, we describe a preverbal 13-month-old who presented to his primary care pediatrician with approximately 1 week of odd facial movements consistent with facial paresthesias. The symptoms coincided with a period of repeat indoor spraying at his home with a commercially available insecticide containing two active ingredients in the pyrethroid class. Consultation by the Northwest Pediatric Environmental Health Specialty Unit and follow-up by the Washington State Department of Health included urinary pyrethroid metabolite measurements during and after the symptomatic period, counseling on home clean up and use of safer pest control methods. The child’s symptoms resolved soon after home cleanup. A diagnosis of pesticide-related illness due to pyrethroid exposure was made based on the opportunity for significant exposure (multiple applications in areas where the child spent time, supportive biomonitoring data, and the consistency and temporality of symptom findings (paresthesias. This case underscores the vulnerability of children to uptake pesticides, the role of the primary care provider in ascertaining an exposure history to recognize symptomatic illness, and the need for collaborative medical and public health efforts to reduce significant exposures in children.

  2. Adaptation of oral medication in people institutionalized in nursing homes for whom medication is crushed: The ADECUA Study

    OpenAIRE

    2016-01-01

    Purpose: To evaluate the effect of pharmacist interventions in the adaptation of pharmaceutical forms in elders institutionalized in nursing homes whose medicines are crushed, which may have a clinical relevance. Methods: Quasi-experimental, multicenter, transversal and prospective study carried out in 10 nursing homes. Subjects for whom drugs were being crushed were identified. Their treatments were reviewed in order to identify drugs that should not be crushed. In these cases,...

  3. The Mother and Infant Home Visiting Program Evaluation: Early Findings on the Maternal, Infant, and Early Childhood Home Visiting Program. A Report to Congress. OPRE Report 2015-11

    Science.gov (United States)

    Michalopoulos, Charles; Lee, Helen; Duggan, Anne; Lundquist, Erika; Tso, Ada; Crowne, Sarah Shea; Burrell, Lori; Somers, Jennifer; Filene, Jill H.; Knox, Virginia

    2015-01-01

    "The Mother and Infant Home Visiting Program Evaluation: Early Findings on the Maternal, Infant, and Early Childhood Home Visiting Program--A Report to Congress" presents the first findings from the Mother and Infant Home Visiting Program Evaluation (MIHOPE), the legislatively mandated national evaluation of the Maternal, Infant, and…

  4. [Home enteral nutrition. Annual report 1999. NADYA-SENPE Group].

    Science.gov (United States)

    Gómez Candela, C; Cos Blanco, A I; Iglesias Rosado, C; Planas Vilá, M; Castellá, M; García Luna, P P; Parejo, J; Chamorro Quirós, J; Irles Rocamora, J A; Pérez de la Cruz, A; Carbonell, M D; Parés Marimón, R M; Gómez Enterría, P; Salas, J; Mancha, A; Ferrón Vidán, F; Celador Almaraz, A; Bobis, M A; Martín Peña, G; Martí Bonmatí, E; Morejón, E; Jiménez Sanz, M; Martínez, I; Muñoz, A; de la Rubia Nieto, A; Ordóñez González, J; Tusón Rovira, C; Carrera Macazaga, J A

    2002-01-01

    During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with

  5. Impact of educational intervention on prescribing inappropriate medication to elderly nursing homes residents

    OpenAIRE

    Ilić Darko; Bukumirić Zoran; Janković Slobodan

    2015-01-01

    Introduction. Problems with polypharmacy, adverse drug reactions and non-adherence are especially frequent among elderly nursing home residents. Objective. The aim of our study was to evaluate effectiveness of a specific form of staff education on appropriateness of prescribing in a cluster of nursing homes for the elderly. Methods. The study was designed as before-and-after trial of educational intervention on appropriateness of prescribing in nursing home...

  6. Medical Services: Nursing Records and Reports

    Science.gov (United States)

    2007-11-02

    11) Item 11. Self–explanatory. (12) Item 12. Record if electrosurgical unit (ESU) was used by “X” in the YES or NO block. Enter medical maintenance...Guard cc cubic centimeter CNS clinical nurse specialist ESU electrosurgical unit expir expiration HR health record (records filed in DA Form 3444

  7. 45 CFR 60.7 - Reporting medical malpractice payments.

    Science.gov (United States)

    2010-10-01

    ... Information § 60.7 Reporting medical malpractice payments. (a) Who must report. Each entity, including an... to the reporting entity— (i) Name and address of the entity making the payment, (ii) Name, title, and...) Relationship of the reporting entity to the physician, dentist, or other health care practitioner for...

  8. Spreading a Medical Home Redesign: Effects on Emergency Department Use and Hospital Admissions

    Science.gov (United States)

    Reid, Robert J.; Johnson, Eric A.; Hsu, Clarissa; Ehrlich, Kelly; Coleman, Katie; Trescott, Claire; Erikson, Michael; Ross, Tyler R.; Liss, David T.; Cromp, DeAnn; Fishman, Paul A.

    2013-01-01

    PURPOSE The patient-centered medical home (PCMH) is being rapidly deployed in many settings to strengthen US primary care, improve quality, and control costs; however, evidence supporting this transformation is still lacking. We describe the Group Health experience in attempting to replicate the effects on health care use seen in a PCMH prototype clinic via a systemwide spread using Lean as the change strategy. METHODS We used an interrupted time series analysis with a patient-month unit of analysis over a 4-year period that included baseline, implementation, and stabilization periods for 412,943 patients. To account for secular trends across these periods, we compared changes in use of face-to-face primary care visits, emergency department visits, and inpatient admissions with those of a nonequivalent comparison group of patients served by community network practices. RESULTS After accounting for secular trends among network patients, patients empaneled to the PCMH clinics had 5.1% and 6.7% declines in primary care office visits in early and later stabilization years, respectively, after the implementation year. This trend was accompanied by a 123% increase in the use of secure electronic message threads and a 20% increase in telephone encounters. Declines were also seen in emergency department visits at 1 and 2 years (13.7% and 18.5%) compared with what would be expected based on secular trends in network practices. No statistically significant changes were found for hospital admissions. CONCLUSIONS The Group Health experience shows it is possible to reduce emergency department use with PCMH transformation across a diverse set of clinics using a clear change strategy (Lean) and sufficient resources and supports. PMID:23690382

  9. Continuity in a VA patient-centered medical home reduces emergency department visits.

    Directory of Open Access Journals (Sweden)

    Krisda H Chaiyachati

    Full Text Available One major goal of the Patient-Centered Medical Home (PCMH is to improve continuity of care between patients and providers and reduce the utilization of non-primary care services like the emergency department (ED.To characterize continuity under the Veterans Health Administration's PCMH model--the Patient Aligned Care Team (PACT, at one large Veterans Affair's (VA's primary care clinic, determine the characteristics associated with high levels of continuity, and assess the association between continuity and ED visits.Retrospective, observational cohort study of patients at the West Haven VA (WHVA Primary Care Clinic from March 2011 to February 2012.The 13,495 patients with established care at the Clinic, having at least one visit, one year before March 2011.Our exposure variable was continuity of care--a patient seeing their assigned primary care provider (PCP at each clinic visit. The outcome of interest was having an ED visit.The patients encompassed 42,969 total clinic visits, and 3185 (24% of them had 15,458 ED visits. In a multivariable logistic regression analysis, patients with continuity of care--at least one visit with their assigned PCP--had lower ED utilization compared to individuals without continuity (adjusted odds ratio [AOR] 0.54; 95% CI: 0.41, 0.71, controlling for frequency of primary care visits, comorbidities, insurance, distance from the ED, and having a trainee PCP assigned. Likewise, the adjusted rate of ED visits was 544/1000 person-year (PY for patients with continuity vs. 784/1000 PY for patients without continuity (p = 0.001. Compared to patients with low continuity (50% continuity were less likely to utilize the ED.Strong continuity of care is associated with decreased ED utilization in a PCMH model and improving continuity may help reduce the utilization of non-primary care services.

  10. Medication Use and Its Potential Impact on the Oral Health Status of Nursing Home Residents in Flanders (Belgium).

    Science.gov (United States)

    Janssens, Barbara; Petrovic, Mirko; Jacquet, Wolfgang; Schols, Jos M G A; Vanobbergen, Jacques; De Visschere, Luc

    2017-09-01

    Polypharmacy is considered the most important etiologic factor of hyposalivation, which in turn can initiate oral health problems. To describe the medication use of nursing home residents, to identify the medications related to hyposalivation and to find possible associations between the different classes of medication, the number of medications, and the oral health status of the residents. A cross-sectional study. The study population consisted of the residents of a nonrandom sample of 23 nursing homes from 2 Belgian provinces, belonging to the oral health care network Gerodent. All residents of the sample visited the Gerodent mobile dental clinic between October 2010 and April 2012. For each resident, oral health data, demographic data, and an overview of the total medication intake were collected. The study sample consisted of 1226 nursing home residents with a mean age of 83.9 years [standard deviation (SD) 8.5]. The mean number of medications per person was 9.0 (SD 3.6, range 0-23, median 9.0). Of all prescribed medication, 49.6% had a potential hyposalivatory effect with a mean number per person of 4.5 (SD 2.2, range 0-15, median 4.0). In the bivariate analyses, associations were found between medication use and oral health of residents with natural teeth: the higher the number of medications (with risk of dry mouth) and the overall risk of medication-related dry mouth, the lower the number of natural teeth (P = .022, P = .005, and P = .017, respectively). In contrast, the total treatment need tended to decrease with rising medication intake, resulting in a clear increase of the treatment index with rising medication intake (P = .003, P < .001 and P = .002). The logistic regression model analysis confirmed that the proportion of carious teeth diminished and the treatment index increased in case of rising medication intake, especially when considering the number of medications with a risk of dry mouth and the overall risk of medication

  11. Developing a user-centered voluntary medical incident reporting system.

    Science.gov (United States)

    Hua, Lei; Gong, Yang

    2010-01-01

    Medical errors are one of leading causes of death among adults in the United States. According to the Institute of Medicine, reporting of medical incidents could be a cornerstone to learn from errors and to improve patient safety, if incident data are collected in a properly structured format which is useful for the detection of patterns, discovery of underlying factors, and generation of solutions. Globally, a number of medical incident reporting systems were deployed for collecting observable incident data in care delivery organizations (CDO) over the past several years. However, few researches delved into design of user-centered reporting system for improving completeness and accuracy of medical incident collection, let alone design models created for other institutes to follow. In this paper, we introduce the problems identified in a current using voluntary reporting system and our effort is being made towards complete, accurate and useful user-centered new reporting system through a usability engineering process.

  12. One Family's Journey: Medical Home and the Network of Supports It Offers Children and Youth with Special Health Care Needs, Part Two--Care Coordination

    Science.gov (United States)

    Kondrad, Monica; Zehr, Bonnie; Hanna, Christine; Rote, Vicki; Jain, Sweety

    2007-01-01

    The Medical Home series follows fictional parents Amita and Samir and their premature daughter, Anjali. In Part Two, Amita and Samir bring Anjali home from the hospital, contact the care coordinator who will be responsible for Anjali's care, and go to their first appointment with the pediatrician. Emphasis is placed on the manner in which the…

  13. Home Performance with Energy Star (HPwES) Program Report

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2013-01-01

    This report summarizes the Department’s review of comments received on the HPwES v2 proposal and presents a multi-year action plan to both address Department goals and incorporate industry feedback.

  14. Effects of Pharmacist-Led Patient Education on Diabetes-Related Knowledge and Medication Adherence: A Home-Based Study

    Science.gov (United States)

    Chow, Ee Pin; Hassali, Mohamed Azmi; Saleem, Fahad; Aljadhey, Hisham

    2016-01-01

    Objective: Patient education is key to the management of acute and chronic conditions. However, the majority of such educational interventions have been reported from health-care settings. In contrast, this study aims to evaluate whether a home-based intervention can result in better understanding about type 2 diabetes mellitus and can increase…

  15. Effects of Pharmacist-Led Patient Education on Diabetes-Related Knowledge and Medication Adherence: A Home-Based Study

    Science.gov (United States)

    Chow, Ee Pin; Hassali, Mohamed Azmi; Saleem, Fahad; Aljadhey, Hisham

    2016-01-01

    Objective: Patient education is key to the management of acute and chronic conditions. However, the majority of such educational interventions have been reported from health-care settings. In contrast, this study aims to evaluate whether a home-based intervention can result in better understanding about type 2 diabetes mellitus and can increase…

  16. Model of transpersonal caring in nursing home care according to Favero and Lacerda: case report.

    Science.gov (United States)

    Rodrigues, Jéssica Alline Pereira; Lacerda, Maria Ribeiro; Favero, Luciane; Gomes, Ingrid Meireles; Méier, Marineli Joaquim; Wall, Marilene Loewen

    2016-09-29

    The aim of this paper is to report the experiences of applying a model of transpersonal caring in nursing home care according to Favero and Lacerda to adult patients after hematopoietic stem cell transplantation. This is a case report on the application of this model to an outpatient monitored by a bone marrow transplant service. In addition to the initial outpatient contact, the patient received home care visits in October 2014. Data were recorded in the field diary and analysed according to the Care Model and Clinical Caritas Process. The provided care served as support to meet basic human needs, and strengthen the belief system. It also promoted the necessary emotional care to cope with the treatment and professional maturity in the caring relationship. The experience description revealed that the model can support the application of the Theory of Human Caring in home care and the use of care models in practice, professional training, and research development.

  17. Medical marijuana: CAS releases report, government cuts research funding.

    Science.gov (United States)

    Betteridge, Glenn

    2006-12-01

    In June 2006, the Canadian AIDS Society (CAS) released a comprehensive report with recommendations to overcome barriers to the use of cannabis for medical purposes faced by people living with HIV/AIDS in Canada. On 25 September 2006, as part of package of spending cuts, the federal government announced plans to eliminate its marijuana medical research program.

  18. Selection bias in family reports on end of life with dementia in nursing homes

    OpenAIRE

    Steen, van, M.; Deliens, L.; Ribbe, M.W.; Onwuteaka-Philipsen, B. D.

    2012-01-01

    Background: Selective participation in retrospective studies of families recruited after the patient's death may threaten generalizability of reports on end-of-life experiences. Objectives: To assess possible selection bias in retrospective study of dementia at the end of life using family reports. Methods: Two physician teams covering six nursing home facilities in the Netherlands reported on 117 of 119 consecutive decedents within two weeks after death unaware of after-death family ...

  19. Changes in the relationship between nursing home financial performance and quality of care under public reporting.

    Science.gov (United States)

    Park, Jeongyoung; Werner, Rachel M

    2011-07-01

    The relationship between financial performance and quality of care in nursing homes is not well defined and prior work has been mixed. The recent focus on improving the quality of nursing homes through market-based incentives such as public reporting may have changed this relationship, as public reporting provides nursing homes with increased incentives to engage in quality-based competition. If quality improvement activities require substantial production costs, nursing home profitability may become a more important predictor of quality under public reporting. This study explores the relationship between financial performance and quality of care and test whether this relationship changes under public reporting. Using a 10-year (fiscal years 1997-2006) panel data set of 9444 skilled nursing facilities in the US, this study employs a facility fixed-effects with and without instrumental variables approach to test the effect of finances on quality improvement and correct for potential endogeneity. The results show that better financial performance, as reflected by the 1-year lagged total profit margin, is modestly associated with higher quality but only after public reporting is initiated. These findings have important policy implications as federal and state governments use market-based incentives to increase demand for high-quality care and induce providers to compete based on quality.

  20. An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective

    Directory of Open Access Journals (Sweden)

    Achterberg Wilco

    2010-08-01

    Full Text Available Abstract Background Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of the Australian Medical Sheepskin were investigated from the perspective of a nursing home. Methods An economic model was developed in which monetary costs and monetary savings in respect of the sheepskin were balanced against each other. The model was applied to a fictional (Dutch nursing home with 100 beds for rehabilitation patients and a time horizon of one year. Input variables for the model consisted of investment costs for using the sheepskin (purchase and laundry, and savings through the prevented cases of pressure ulcers. The input values for the investment costs and for the effectiveness were empirically based on a trial with newly admitted rehabilitation patients from eight nursing homes. The input values for the costs of pressure ulcer treatment were estimated by means of four different approaches. Results Investment costs for using the Australian Medical Sheepskin were larger than the monetary savings obtained by preventing pressure ulcers. Use of the Australian Medical Sheepskin involves an additional cost of approximately €2 per patient per day. Preventing one case of a sacral pressure ulcer by means of the Australian Medical Sheepskin involves an investment of €2,974 when the sheepskin is given to all patients. When the sheepskin is selectively used for more critical patients only, the investment to prevent one case of sacral pressure ulcers decreases to €2,479 (pressure ulcer risk patients or €1,847 (ADL-severely impaired patients. The factors with the strongest influence on the balance are the frequency of changing the sheepskin and the costs of washing related to this. The economic model was hampered by considerable

  1. [Actual state of medical activities as "home pharmacy" including preventive medicine in community pharmacy and their regional differences].

    Science.gov (United States)

    Suzuki, Junzo; Ohtsu, Yumiko; Hashimoto, Miwako; Kaiho, Fusao

    2008-12-01

    To determine the "home pharmacy" activities including preventive medicine in community pharmacies and their regional differences, we conducted two questionnaire surveys of pharmacies belonging to the pharmacists' association in four areas, two metropolitan areas (Kita-tama area and Minato-ku in Tokyo) and two rural areas (Ueda-shi in Nagano and Aira-gun in Kagoshima) in 1998 and 2007. The questionnaire consisted of 42 questions including the scale and characteristics of the pharmacy, the offering of information to patients and information collection from patients, and activities related to home care medicine, environmental sanitation, and healthcare. Based on 14 factors in the questionnaire, an index of "Community Medicine Contributed by Home Pharmacies" was evaluated to represent the extent of activity including preventive medicine in pharmacy. The median of the indexes in the four areas rose in 2007, and was the highest in Ueda-shi. However, the increase in the index was found to result from increases in activity related to clinical medicine such as the use of "Medication Notebooks" and the circulation of "Pharmaceutical Instructions" and did not result from increased activity related to preventive medicine. Factors to promote preventive medicine activity are discussed based on the data from Aira-gun where the greatest home care medicine activity occurred and from Ueda-shi where the greatest environmental sanitation and healthcare activities occurred.

  2. #DDOD Use Case: Consolidated reporting of medical device recalls

    Data.gov (United States)

    U.S. Department of Health & Human Services — SUMMARY DDOD use case request for consolidated, consistent reporting of medical device recalls. WHAT IS A USE CASE? A “Use Case” is a request that was made by the...

  3. Use of home videotapes to confirm parental reports of regression in autism.

    Science.gov (United States)

    Goldberg, Wendy A; Thorsen, Kara L; Osann, Kathryn; Spence, M Anne

    2008-07-01

    The current study examined consistency between parental reports on early language development and behaviors in non-language domains and observer-coded videotapes of young children with and without autism spectrum disorder (ASD) and autistic regression. Data are reported on 56 children (84% male) with ASD (early onset or autistic regression) and 14 typically developing children (57% male) who had home videotapes. Unique to the current study is the independent identification of loss/no loss for each child by both parental report and observer-coded home videotapes and the examination of agreement between these two methods. Results indicate substantial concordance between parental report and observer codes for onset and loss of expressive language, but minimal concordance for loss in non-language domains, suggesting a need for supplementation of parental reports in these areas.

  4. Effects of a pharmacist-led pediatrics medication safety team on medication-error reporting.

    Science.gov (United States)

    Costello, Jennifer L; Torowicz, Deborah Lloyd; Yeh, Timothy S

    2007-07-01

    The effects of a pharmacist-led pediatrics medication safety team (PMST) on the frequency and severity of medication errors reported were studied. This study was conducted in a pediatric critical care center (PCCC) in three phases. Phase 1 consisted of retrospective collection of medication-error reports before any interventions were made. Phases 2 and 3 included prospective collection of medication-error reports after several interventions. Phase 2 introduced a pediatrics clinical pharmacist to the PCCC. A pediatrics clinical pharmacist-led PMST (including a pediatrics critical care nurse and pediatrics intensivist), a new reporting form, and educational forums were added during phase 3 of the study. In addition, education focus groups were held for all intensive care unit staff. Outcomes for all phases were measured by the number of medication-error reports processed, the number of incidents, error severity, and the specialty of the reporter. Medication-error reporting increased twofold, threefold, and sixfold between phases 1 and 2, phases 2 and 3, and phases 1 and 3, respectively. Error severity decreased over the three time periods. In phases 1, 2, and 3, 46%, 8%, and 0% of the errors were classified as category D or E, respectively. Conversely, the reporting of near-miss errors increased from 9% in phase 1 to 38% in phase 2 and to 51% in phase 3. An increase in the number of medication errors reported and a decrease in the severity of errors reported were observed in a PCCC after implementation of a PMST, provision of education to health care providers, and addition of a clinical pharmacist.

  5. Medication Incidents Related to Automated Dose Dispensing in Community Pharmacies and Hospitals - A Reporting System Study

    Science.gov (United States)

    Cheung, Ka-Chun; van den Bemt, Patricia M. L. A.; Bouvy, Marcel L.; Wensing, Michel; De Smet, Peter A. G. M.

    2014-01-01

    Introduction Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. Methods The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers. Main Outcome Measures Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. Results From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. Conclusion A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident

  6. US Army Medical Research and Development Report.

    Science.gov (United States)

    1979-10-01

    findings in this report are not to be construed as an official Department of the Army position unless so designated by other authorized documents...characteristics. ACHIEVEMENTS: A commercial dental X-ray film processor unit devel- oped and marketed by the Air Techniques Inc. Company of New Hyde Park, NY, was...has been designed which will increase the usefulness of the standard r. ubered containers. Prototypes will be procured during 2nd Quarter FY80. 83 D

  7. Gender-sensitive reporting in medical research

    Directory of Open Access Journals (Sweden)

    Heidari Shirin

    2012-03-01

    Full Text Available Abstract Sex and gender differences influence the health and wellbeing of men and women. Although studies have drawn attention to observed differences between women and men across diseases, remarkably little research has been pursued to systematically investigate these underlying sex differences. Women continue to be underrepresented in clinical trials, and even in studies in which both men and women participate, systematic analysis of data to identify potential sex-based differences is lacking. Standards for reporting of clinical trials have been established to ensure provision of complete, transparent and critical information. An important step in addressing the gender imbalance would be inclusion of a gender perspective in the next Consolidated Standards of Reporting Trials (CONSORT guideline revision. Uniform Requirements for Manuscripts Submitted to Biomedical Journals, as a set of well-recognized and widely used guidelines for authors and biomedical journals, should similarly emphasize the ethical obligation of authors to present data analyzed by gender as a matter of routine. Journal editors are also promoters of ethical research and adequate standards of reporting, and requirements for inclusion of gender analyses should be integrated into editorial policies as a matter of urgency.

  8. Improving Patients\\\\\\' Care through Electronic Medical Error Reporting System

    Directory of Open Access Journals (Sweden)

    Fatemeh Rangraz Jeddi

    2015-06-01

    Full Text Available Medical errors are unintentional acts that take place due to the negligence or lead to undesirable consequences in medical practice. The purpose of this study was to design a conceptual model for medical error reporting system. This applied descriptive cross-sectional research employed Delphi method carried out from 2012 to 2013. The study population was medical and paramedical personnel of health workers and paramedical personnel of hospitals, deputy of treatment, faculty members of Kashan University of Medical Sciences in addition to the internet and library resources. Sample size included 30 expert individuals in the field of medical errors. The one-stage stratified sampling procedure was used. The items with opposition ranging 0 to 25 were confirmed and those exceeding 50 were rejected whereas the items with the opposition 25 to 50 were reevaluated in the second session. This process continued for three times and the items that failed to be approved were eliminated in the model. Based on the results of this research, repeated informing about and reporting operation at on-line bases that have access to the incidence of error detected on time, identifying cause and damage due to the incidence reported confidential and anonymously immediately after the occurrence is necessary. Analysis of data quantitatively and qualitatively by using computer software is needed. Classifying the errors reports based on feedback provision according to the cause of error is needed. In addition, confidential report and possible manual retrieval were suggested It is essential to determine the means of reporting and items in the reporting form including time, cause and damage of medical error, media of reporting and method of recording and analysis.

  9. A qualitative evaluation of the crucial attributes of contextual information necessary in EHR design to support patient-centered medical home care.

    Science.gov (United States)

    Weir, Charlene R; Staggers, Nancy; Gibson, Bryan; Doing-Harris, Kristina; Barrus, Robyn; Dunlea, Robert

    2015-04-16

    Effective implementation of a Primary Care Medical Home model of care (PCMH) requires integration of patients' contextual information (physical, mental, social and financial status) into an easily retrievable information source for the healthcare team and clinical decision-making. This project explored clinicians' perceptions about important attributes of contextual information for clinical decision-making, how contextual information is expressed in CPRS clinical documentation as well as how clinicians in a highly computerized environment manage information flow related to these areas. A qualitative design using Cognitive Task Analyses and a modified Critical Incident Technique were used. The study was conducted in a large VA with a fully implemented EHR located in the western United States. Seventeen providers working in a PCMH model of care in Primary Care, Home Based Care and Geriatrics reported on a recent difficult transition requiring contextual information for decision-making. The transcribed interviews were qualitatively analyzed for thematic development related to contextual information using an iterative process and multiple reviewers with ATLAS@ti software. Six overarching themes emerged as attributes of contextual information: Informativeness, goal language, temporality, source attribution, retrieval effort, and information quality. These results indicate that specific attributes are needed to in order for contextual information to fully support clinical decision-making in a Medical Home care delivery environment. Improved EHR designs are needed for ease of contextual information access, displaying linkages across time and settings, and explicit linkages to both clinician and patient goals. Implications relevant to providers' information needs, team functioning and EHR design are discussed.

  10. An overview of intravenous-related medication administration errors as reported to MEDMARX, a national medication error-reporting program.

    Science.gov (United States)

    Hicks, Rodney W; Becker, Shawn C

    2006-01-01

    Medication errors can be harmful, especially if they involve the intravenous (IV) route of administration. A mixed-methodology study using a 5-year review of 73,769 IV-related medication errors from a national medication error reporting program indicates that between 3% and 5% of these errors were harmful. The leading type of error was omission, and the leading cause of error involved clinician performance deficit. Using content analysis, three themes-product shortage, calculation errors, and tubing interconnectivity-emerge and appear to predispose patients to harm. Nurses often participate in IV therapy, and these findings have implications for practice and patient safety. Voluntary medication error-reporting programs afford an opportunity to improve patient care and to further understanding about the nature of IV-related medication errors.

  11. Homeworking: Home Office or Home Sweatshop? Report on Current Conditions of Homeworkers in Toronto's Garment Industry. NALL Working Paper.

    Science.gov (United States)

    Ng, Roxana; Wong, Renita Yuk-Lin; Choi, Angela

    The current conditions of home workers in the garment industry in Toronto, Canada, were examined through in-depth telephone interviews with 30 Chinese-speaking immigrant women who were employed as home workers in 1999. The paper dicusses the formal training and informal learning experiences of immigrant woman who are garment workers. A comparison…

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

    Science.gov (United States)

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

    2015-02-03

    health workers and users, we begin to unpack how potential health equity impacts of medical tourism in an emerging destination are understood by local stakeholders who are not directing sector development. This further outlines how these groups employ knowledge from their home context to ground and reconcile their hopes and concerns for the impacts posed by medical tourism.

  13. Reporting Helicopter Emergency Medical Services in Major Incidents

    DEFF Research Database (Denmark)

    Fattah, Sabina; Johnsen, Anne Siri; Sollid, Stephen J M

    2016-01-01

    OBJECTIVE: Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported with a consensus-based template could facilitate the collection, analysis, and exchange of experiences...... interacted through e-mail. We asked these experts to define data variables and rank which were most important to report during an immediate prehospital medical response to a major incident. Five rounds were conducted. RESULTS: In the first round, the experts suggested 98 variables. After 5 rounds, 21...

  14. Quarterly report of Biological and Medical Research Division, April 1955

    Energy Technology Data Exchange (ETDEWEB)

    Brues, A.M.

    1955-04-01

    This report is a compilation of 48 investigator prepared summaries of recent progress in individual research programs of the Biology and Medical Division of the Argonne National Laboratory for the quarterly period ending April,1955. Individual reports are about 3-6 pages in length and often contain research data.

  15. Business continuity after catastrophic medical events: the Joplin medical business continuity report.

    Science.gov (United States)

    Carlton, Paul K; Bringle, Dottie

    2012-01-01

    On May 22, 2011, The St Johns Mercy Medical Center in Joplin, MO, was destroyed by an F-5 tornado. There were 183 patients in the building at that time in this 367-bed Medical Center. The preparation and response were superbly done and resulted in many lives saved. This report is focused on the reconstitution phase of this disaster response, which includes how to restore business continuity. As 95 percent of our medical capacity resides in the private sector in the United States, we must have a proper plan for how to restore business continuity or face the reality of the medical business failing and not providing critical medical services to the community. A tornado in 2007 destroyed a medical center in Sumter County, GA, and it took more than 365 days to restore business continuity at a cost of $18M. The plan executed by the Mercy Medical System after the disaster in Joplin restored business continuity in 88 days and cost a total of $6.6M, with all assets being reusable. The recommendation from these lessons learned is that every county, state, and Federal Emergency Management Agency region has a plan on the shelf to restore business continuity and the means to be able to do so. The hard work that the State of Missouri and the Mercy Medical System did after this disaster can serve as a model for the nation in how to quickly recover from any loss of medical capability.

  16. MEDICAL MYSTERY: ECTRODACTYLY A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Subhra Mandal

    2015-03-01

    Full Text Available Congenital absence of all or part of one or more fingers or toes is defined as Ectrodactyly. It is the word derived from Greek ektroma meaning “abortion” and dactyly meaning digits. Also called split hand or foot malformation (SHFM, Ectrodactyly is a rare limb malformation with median cleft of hand and foot and aplasia or hypoplasia of the phalanges, metacarpals and metatarsals. Irregular pattern of inheritance exists for ectrodactyly; may be autosomal dominant, autosomal recessive or X linked. In this condition, the median cleft of the hand gives the hand, the appearance of lobster claws- so also called ‘Lobster Claw Hand”. Ectrodactyly may be very commonly associated with other anomalies of face, eyes and skeletal system. We report a rare case of unilateral ectrodactyly of right hand .The present case is not associated with any other anomaly as described in various textbooks and reference articles. The details of etiology, diagnosis, genetic causes, association with other anomalies and treatment will be discussed.

  17. Multi-professional clinical medication reviews in care homes for the elderly: study protocol for a randomised controlled trial with cost effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Sach Tracey

    2011-10-01

    Full Text Available Abstract Background Evidence demonstrates that measures are needed to optimise therapy and improve administration of medicines in care homes for older people. The aim of this study is to determine the clinical and cost effectiveness of a novel model of multi-professional medication review. Methods A cluster randomised controlled trial design, involving thirty care homes. In line with current practice in medication reviews, recruitment and consent will be sought from general practitioners and care homes, rather than individual residents. Care homes will be segmented according to size and resident mix and allocated to the intervention arm (15 homes or control arm (15 homes sequentially using minimisation. Intervention homes will receive a multi-professional medication review at baseline and at 6 months, with follow-up at 12 months. Control homes will receive usual care (support they currently receive from the National Health Service, with data collection at baseline and 12 months. The novelty of the intervention is a review of medications by a multi-disciplinary team. Primary outcome measures are number of falls and potentially inappropriate prescribing. Secondary outcome measures include medication costs, health care resource use, hospitalisations and mortality. The null hypothesis proposes no difference in primary outcomes between intervention and control patients. The primary outcome variable (number of falls will be analysed using a linear mixed model, with the intervention specified as a fixed effect and care homes included as a random effect. Analyses will be at the level of the care home. The economic evaluation will estimate the cost-effectiveness of the intervention compared to usual care from a National Health Service and personal social services perspective. The study is not measuring the impact of the intervention on professional working relationships, the medicines culture in care homes or the generic health-related quality of life of

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

    Science.gov (United States)

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

    2014-06-01

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

  19. Closing the quality gap: revisiting the state of the science (vol. 2: the patient-centered medical home).

    Science.gov (United States)

    Williams, John W; Jackson, George L; Powers, Benjamin J; Chatterjee, Ranee; Bettger, Janet Prvu; Kemper, Alex R; Hasselblad, Vic; Dolor, Rowena J; Irvine, R Julian; Heidenfelder, Brooke L; Kendrick, Amy S; Gray, Rebecca

    2012-07-01

    As part of the Closing the Quality Gap: Revisiting the State of the Science series of the Agency for Healthcare Research and Quality (AHRQ), this systematic review sought to identify completed and ongoing evaluations of the comprehensive patient-centered medical home (PCMH), summarize current evidence for this model, and identify evidence gaps. We searched PubMed®, CINAHL®, and the Cochrane Database of Systematic Reviews for published English-language studies, and a wide variety of databases and Web resources to identify ongoing or recently completed studies. Two investigators per study screened abstracts and full-text articles for inclusion, abstracted data, and performed quality ratings and evidence grading. Our functional definition of PCMH was based on the definition used by AHRQ. We included studies that explicitly claimed to be evaluating PCMH and those that did not but which met our functional definition. Seventeen studies with comparison groups evaluated the effects of PCMH (Key Question [KQ] 1). Older adults in the United States were the most commonly studied population (8 of 17 studies). PCMH interventions had a small positive impact on patient experiences (including patient-perceived care coordination) and small to moderate positive effects on preventive care services (moderate strength of evidence [SOE]). Staff experiences were also improved by a small to moderate degree (low SOE). There were too few studies to estimate effects on clinical or most economic outcomes. Twenty-one of 27 studies reported approaches that addressed all 7 major PCMH components (KQ 2), including team-based care, sustained partnership, reorganized care or structural changes to care, enhanced access, coordinated care, comprehensive care, and a systems-based approach to quality. A total of 51 strategies were used to address the 7 major PCMH components. Twenty-two of 27 studies reported information on financial systems used to implement PCMH, implementation strategies, and

  20. Closing the quality gap: revisiting the state of the science (vol. 2: the patient-centered medical home).

    Science.gov (United States)

    Williams, John W; Jackson, George L; Powers, Benjamin J; Chatterjee, Ranee; Bettger, Janet Prvu; Kemper, Alex R; Hasselblad, Vic; Dolor, Rowena J; Irvine, R Julian; Heidenfelder, Brooke L; Kendrick, Amy S; Gray, Rebecca

    2012-01-01

    OBJECTIVES As part of the Closing the Quality Gap: Revisiting the State of the Science series of the Agency for Healthcare Research and Quality (AHRQ), this systematic review sought to identify completed and ongoing evaluations of the comprehensive patient-centered medical home (PCMH), summarize current evidence for this model, and identify evidence gaps. DATA SOURCES We searched PubMed®, CINAHL®, and the Cochrane Database of Systematic Reviews for published English-language studies, and a wide variety of databases and Web resources to identify ongoing or recently completed studies. REVIEW METHODS Two investigators per study screened abstracts and full-text articles for inclusion, abstracted data, and performed quality ratings and evidence grading. Our functional definition of PCMH was based on the definition used by AHRQ. We included studies that explicitly claimed to be evaluating PCMH and those that did not but which met our functional definition. RESULTS Seventeen studies with comparison groups evaluated the effects of PCMH (Key Question [KQ] 1). Older adults in the United States were the most commonly studied population (8 of 17 studies). PCMH interventions had a small positive impact on patient experiences (including patient-perceived care coordination) and small to moderate positive effects on preventive care services (moderate strength of evidence [SOE]). Staff experiences were also improved by a small to moderate degree (low SOE). There were too few studies to estimate effects on clinical or most economic outcomes. Twenty-one of 27 studies reported approaches that addressed all 7 major PCMH components (KQ 2), including team-based care, sustained partnership, reorganized care or structural changes to care, enhanced access, coordinated care, comprehensive care, and a systems-based approach to quality. A total of 51 strategies were used to address the 7 major PCMH components. Twenty-two of 27 studies reported information on financial systems used to

  1. Effect of a blackout in pediatric patients with home medical devices during the 2011 eastern Japan earthquake.

    Science.gov (United States)

    Nakayama, Tojo; Tanaka, Soichiro; Uematsu, Mitsugu; Kikuchi, Atsuo; Hino-Fukuyo, Naomi; Morimoto, Tetsuji; Sakamoto, Osamu; Tsuchiya, Shigeru; Kure, Shigeo

    2014-02-01

    during the eastern Japan earthquake in 2011 and the following prolonged blackout, pediatric patients with home medical devices sought electricity at the pediatric department. We retrospectively studied the effect of this earthquake and the following blackout. we hand-reviewed pediatric admission records in Tohoku University Hospital for new inpatients attributed to the earthquake from March 11, 2011 to April 12, 2011. A survey by questionnaire regarding the situation during the earthquake was performed for parents of technology-assisted patients. during the study period, 24 pediatric patients were admitted to the pediatric department. Eighteen technology-assisted pediatric patients, including those with home respirators, accounted for 75% of new pediatric admissions. Patients who were admitted for electricity shortage stayed in the hospital for a mean of 11.0days (3-25days). The questionnaire survey showed that 55% of technology-assisted patients were admitted to medical centers for evacuation. The majority of patients (89%) with ventilators were eventually admitted to medical centers during the earthquake. Most of the parents of technology-assisted patients experienced a prolonged petrol shortage and difficulty in communications with medical centers. the current study suggests that technology-assisted pediatric patients with neurological disorders as the primary disease can overwhelm the capacity of hospital inpatient facilities in certain situations. Disaster preparedness should consider assuring power requirements in healthcare facilities and preparing backup power generators lasting for at least 24h for these patients. Preparing alternative measures for emergent electricity and communications could remedy serious conditions during a disaster. Copyright © 2013 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  2. Exploring patient satisfaction: a secondary analysis of a randomized clinical trial of spinal manipulation, home exercise, and medication for acute and subacute neck pain.

    Science.gov (United States)

    Leininger, Brent D; Evans, Roni; Bronfort, Gert

    2014-10-01

    The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care, neck pain, and global satisfaction. This study was a secondary analysis of patient satisfaction from a randomized trial of spinal manipulation therapy (SMT) delivered by doctors of chiropractic, home exercise and advice (HEA) delivered by exercise therapists, and medication (MED) prescribed by a medical doctors for acute/subacute neck pain. Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model. The relationship between specific aspects of care and (1) change in neck pain (primary outcome of the randomized trial) and (2) global satisfaction were assessed using Pearson's correlation and multiple linear regression. Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants. Spinal manipulation therapy and HEA groups reported similar satisfaction with information provided during treatment; however, the SMT group was more satisfied with general care. Satisfaction with general care (r = -0.75 to -0.77; R(2) = 0.55-0.56) had a stronger relationship with global satisfaction compared with satisfaction with information provided (r = -0.65 to 0.67; R(2) = 0.39-0.46). The relationship between satisfaction with care and neck pain was weak (r = 0.17-0.38; R(2) = 0.08-0.21). Individuals with acute/subacute neck pain were more satisfied with specific aspects of care received during spinal manipulation therapy or home exercise interventions compared to receiving medication. The relationship between neck pain and satisfaction with care was weak. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  3. Perception of Nigerian medical students on adverse drug reaction reporting.

    Science.gov (United States)

    Abubakar, Abdullahi Rabiu; Chedi, Bashir A Z; Mohammed, Khalid Garba; Haque, Mainul

    2015-01-01

    Spontaneous reporting (SPR) and intensive monitoring are the conventional systems used for detecting, recording, and reporting adverse drug reactions (ADRs). Using spontaneous reporting a lot of successes has been made as existing ADRs were identified and new ones prevented through this methods. The aim of this appraisal was to evaluate the knowledge, attitude, and the practice of medical students with regards to ADRs reporting and to see if differences exist between the level of study and genders. The questionnaire was adopted, modified, and validated from previous studies. It comprised of 25 questions. It was administered year-IV and V medical students of Bayero University Kano, Nigeria. The data collected were coded and analyzed using the Statistical Package for the Social Sciences (SPSS) version 20, currently known as IBM SPSS Statistics. The response rate was 74%. Among the 108 participants, 80% got the definition of ADRs correct; 63% of them knew the precise functions of pharmacovigilance (PV). In addition, 82% strongly agreed that ADR reporting is health care workers responsibility; 82% also said PV should be taught in detail. Meanwhile, 99% have noticed patient experiencing ADRs; 67% said even mild ADRs should be reported. The outcome of this study showed good knowledge and attitude with respect to ADRs and PV among the medical students surveyed. Unfortunately, the practice of medical students was found to be unsatisfactory. There is a need to upgrade the students teaching the curriculum with respect to ADRs monitoring.

  4. Perception of Nigerian medical students on adverse drug reaction reporting

    Directory of Open Access Journals (Sweden)

    Abdullahi Rabiu Abubakar

    2015-01-01

    Full Text Available Spontaneous reporting (SPR and intensive monitoring are the conventional systems used for detecting, recording, and reporting adverse drug reactions (ADRs. Using spontaneous reporting a lot of successes has been made as existing ADRs were identified and new ones prevented through this methods. The aim of this appraisal was to evaluate the knowledge, attitude, and the practice of medical students with regards to ADRs reporting and to see if differences exist between the level of study and genders. The questionnaire was adopted, modified, and validated from previous studies. It comprised of 25 questions. It was administered year-IV and V medical students of Bayero University Kano, Nigeria. The data collected were coded and analyzed using the Statistical Package for the Social Sciences (SPSS version 20, currently known as IBM SPSS Statistics. The response rate was 74%. Among the 108 participants, 80% got the definition of ADRs correct; 63% of them knew the precise functions of pharmacovigilance (PV. In addition, 82% strongly agreed that ADR reporting is health care workers responsibility; 82% also said PV should be taught in detail. Meanwhile, 99% have noticed patient experiencing ADRs; 67% said even mild ADRs should be reported. The outcome of this study showed good knowledge and attitude with respect to ADRs and PV among the medical students surveyed. Unfortunately, the practice of medical students was found to be unsatisfactory. There is a need to upgrade the students teaching the curriculum with respect to ADRs monitoring.

  5. Organizational safety culture and medical error reporting by Israeli nurses.

    Science.gov (United States)

    Kagan, Ilya; Barnoy, Sivia

    2013-09-01

    To investigate the association between patient safety culture (PSC) and the incidence and reporting rate of medical errors by Israeli nurses. Self-administered structured questionnaires were distributed to a convenience sample of 247 registered nurses enrolled in training programs at Tel Aviv University (response rate = 91%). The questionnaire's three sections examined the incidence of medication mistakes in clinical practice, the reporting rate for these errors, and the participants' views and perceptions of the safety culture in their workplace at three levels (organizational, departmental, and individual performance). Pearson correlation coefficients, t tests, and multiple regression analysis were used to analyze the data. Most nurses encountered medical errors from a daily to a weekly basis. Six percent of the sample never reported their own errors, while half reported their own errors "rarely or sometimes." The level of PSC was positively and significantly correlated with the error reporting rate. PSC, place of birth, error incidence, and not having an academic nursing degree were significant predictors of error reporting, together explaining 28% of variance. This study confirms the influence of an organizational safety climate on readiness to report errors. Senior healthcare executives and managers can make a major impact on safety culture development by creating and promoting a vision and strategy for quality and safety and fostering their employees' motivation to implement improvement programs at the departmental and individual level. A positive, carefully designed organizational safety culture can encourage error reporting by staff and so improve patient safety. © 2013 Sigma Theta Tau International.

  6. Development of an electronic medical report delivery system to 3G GSM mobile (cellular) phones for a medical imaging department.

    Science.gov (United States)

    Lim, Eugene Y; Lee, Chiang; Cai, Weidong; Feng, Dagan; Fulham, Michael

    2007-01-01

    Medical practice is characterized by a high degree of heterogeneity in collaborative and cooperative patient care. Fast and effective communication between medical practitioners can improve patient care. In medical imaging, the fast delivery of medical reports to referring medical practitioners is a major component of cooperative patient care. Recently, mobile phones have been actively deployed in telemedicine applications. The mobile phone is an ideal medium to achieve faster delivery of reports to the referring medical practitioners. In this study, we developed an electronic medical report delivery system from a medical imaging department to the mobile phones of the referring doctors. The system extracts a text summary of medical report and a screen capture of diagnostic medical image in JPEG format, which are transmitted to 3G GSM mobile phones.

  7. Returning persons with a medical condition to their home country : still a contentious issue

    NARCIS (Netherlands)

    Flegar, Veronika

    2015-01-01

    Deportation of persons with a medical condition: the Dutch National ombudsman criticizes the immigration authorities of the Netherlands for an insufficiently clear evaluation of the medical resources available in the country of origin. At the same time, Judge Pinto de Albuquerque points to the meage

  8. Solar Mosaic Inc. Mosaic Home Solar Loan SunShot 9 Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Walsh, Colin James [Solar Mosaic Inc., Oakland, CA (United States)

    2017-02-09

    The 6686 Mosaic SunShot award has helped Solar Mosaic Inc to progress from an early stage startup focused on commercial crowdfunding to a leading multi-state residential solar lender. The software platform is now used by the majority of the nation's top solar installers and offers a variety of simple home solar loans. Mosaic is has originated approximately $1Bil in solar loans to date to put solar on over 35k rooftops. The company now lends to homeowners with a wide range of credit scores across multiple states and mitigates boundaries preventing them from profiting from ownership of a home solar system. The project included milestones in 5 main categories: 1. Lending to homeowners outside of CA 2. Lending to homeowners with FICO scores under 700 3. Packaging O&M with the home solar loan 4. Allowing residential installers to process home solar loans via API 5. Lowering customer acquisition costs below $1500 This report includes a detailed review of the final results achieved and key findings.

  9. Medical Clowning and Psychosis: A Case Report and Theoretical Review.

    Science.gov (United States)

    Gruber, Alex; Levin, Raz; Lichtenberg, Pesach

    2015-01-01

    The medical clown has become an accepted therapeutic figure in non-psychiatric hospital departments in recent years. However, the potential role of the clown in psychiatry, especially for the treatment of psychosis, has not been investigated. We report here on the functioning of a medical clown in an inpatient psychiatric department. A program using psychodramatic group therapy techniques with the clown serving as moderator was developed. We describe the case of one individual diagnosed with schizophrenia who in the course of four and a half months of group therapy led by the medical clown was able to adopt a succession of surprising roles. This process may have contributed to the patient's remission. We discuss the special capacity of medical clowns to encourage communication and indulge in fantasy while returning to consensual reality. We suggest that this may have particular relevance in work with psychotic individuals.

  10. ParaMED Home: A protocol for a randomised controlled trial of paramedic assessment and referral to access medical care at home

    Directory of Open Access Journals (Sweden)

    Johnston Steven

    2011-06-01

    Full Text Available Abstract Background In Australia approximately 25% of Emergency Department (ED attendances are via ambulance. ED overcrowding in Australia, as in many countries, is common. Measures to reduce overcrowding include the provision of enhanced timely primary care in the community for appropriate low risk injury and illness. Therefore paramedic assessment and referral to a community home hospital service, in preference to transfer to ED, may confer clinical and cost benefit. Methods/Design A randomised controlled trial. Consenting adult patients that call an ambulance and are assessed by paramedics as having an eligible low risk problem will be randomised to referral to ED via ambulance transfer or referral to a rapid response service that will assess and treat the patient in their own residence. The primary outcome measure is requirement for unplanned medical attention (in or out of hospital in the first 48 hours. Secondary outcomes will include a number of other clinical endpoints. A cost effectiveness analysis will be conducted. Discussion If this trial demonstrates clinical non-inferiority and cost savings associated with the primary assessment service, it will provide one means to safely address ED overcrowding. Trial Registration Australian and New Zealand Clinical Trials Registry Number 12610001064099

  11. Medication error report: Intrathecal administration of labetalol during obstetric anesthesia

    Directory of Open Access Journals (Sweden)

    Baisakhi Laha

    2015-01-01

    Full Text Available Labetalol, a combined alfa and beta-adrenergic receptor antagonist, is used as an antihypertensive drug. We report a case of an acute rise in blood pressure and lower limb pain due to the inadvertent intrathecal administration of labetalol, mistaking it for bupivacaine, during obstetric anesthesia. The situation was rescued by converting to general anesthesia. The cesarean delivery was uneventful, and mother as well as newborn child showed no ill-effect. This particular medication error was attributable to a failure on the part of the doctors administering the injection to read and cross-check medication labels and the practice of keeping multiple injections together. In the absence of an organized medication error reporting system and action on that basis, such events may recur in future.

  12. Parent report and electronic medical record agreement on asthma education provided and children's tobacco smoke exposure.

    Science.gov (United States)

    Harrington, Kathleen F; Haven, Kristen M; Nuño, Velia Leybas; Magruder, Theresa; Bailey, William C; Gerald, Lynn B

    2013-11-01

    To examine the concordance between parent report and electronic medical record documentation of asthma health education provided during a single clinic visit and second-hand tobacco smoke exposure among children with asthma. Parents of children with asthma were recruited from two types of clinics using different electronic medical record systems: asthma-specialty or general pediatric health department clinics. After their child's outpatient visit, parents were interviewed by trained study staff. Interview data were compared to electronic medical records for agreement in five categories of asthma health education and for the child's environmental tobacco smoke exposure. Kappa statistics were used to identify strength of agreement. Chi square and t-tests were used to examine differences between clinic types. Of 255 parents participating in the study 90.6% were African American and 96.1% were female. Agreement was poor across all clinics but was higher within the asthma specialty clinics than the health department clinics for smoke exposure (κ = 0.410 versus 0.205), asthma diagnosis/disease process (κ = 0.213 versus -0.016) and devices reviewed (κ = 0.253 versus -0.089) with parents generally reporting more education provided. For the 203 children with complete medical records, 40.5% did not have any documentation regarding smoking exposure in the home and 85.2% did not have any documentation regarding exposure elsewhere. We found low concordance between the parent's report and the electronic medical record for smoke exposure and asthma education provided. Un- or under-documented smoke exposure and health education have the potential to affect continuity of care for pediatric patients with asthma.

  13. Accession Medical Standards Analysis and Research Activity Annual Report 2001

    Science.gov (United States)

    2006-05-31

    The Accession Medical Standards Analysis and Research Activity annual Report 2001 summarizes work done to support the development of evidence-based...Hepatitis, Temporomandibular Disorders, Thyroid Disorders, Diabetes Mellitus, Abnormal Pap Smear, Enuresis, and Varicocele. Over 1,575,000 enlisted

  14. 75 FR 17859 - Grants to States for Construction or Acquisition of State Home Facilities-Update of Authorized Beds

    Science.gov (United States)

    2010-04-08

    ... Administrative practice and procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse..., Health facilities, Health professions, Health records, Homeless, Medical and dental schools, Medical devices, Medical research, Mental health programs, Nursing homes, Reporting and recordkeeping requirements...

  15. Out-of-Home Placement for Children and Adolescents With Disabilities-Addendum: Care Options for Children and Adolescents With Disabilities and Medical Complexity.

    Science.gov (United States)

    Friedman, Sandra L; Norwood, Kenneth W

    2016-12-01

    Children and adolescents with significant intellectual and developmental disabilities and complex medical problems require safe and comprehensive care to meet their medical and psychosocial needs. Ideally, such children and youth should be cared for by their families in their home environments. When this type of arrangement is not possible, there should be exploration of appropriate, alternative noncongregate community-based settings, especially alternative family homes. Government funding sources exist to support care in the community, although there is variability among states with regard to the availability of community programs and resources. It is important that families are supported in learning about options of care. Pediatricians can serve as advocates for their patients and their families to access community-based services and to increase the availability of resources to ensure that the option to live in a family home is available to all children with complex medical needs.

  16. Rationale and design of a patient-centered medical home intervention for patients with end-stage renal disease on hemodialysis.

    Science.gov (United States)

    Porter, Anna C; Fitzgibbon, Marian L; Fischer, Michael J; Gallardo, Rani; Berbaum, Michael L; Lash, James P; Castillo, Sheila; Schiffer, Linda; Sharp, Lisa K; Tulley, John; Arruda, Jose A; Hynes, Denise M

    2015-05-01

    In the U.S., more than 400,000 individuals with end-stage renal disease (ESRD) require hemodialysis (HD) for renal replacement therapy. ESRD patients experience a high burden of morbidity, mortality, resource utilization, and poor quality of life (QOL). Under current care models, ESRD patients receive fragmented care from multiple providers at multiple locations. The Patient-Centered Medical Home (PCMH) is a team approach, providing coordinated care across the healthcare continuum. While this model has shown some early benefits for complex chronic diseases such as diabetes, it has not been applied to HD patients. This study is a non-randomized quasi-experimental intervention trial implementing a Patient-Centered Medical Home for Kidney Disease (PCMH-KD). The PCMH-KD extends the existing dialysis care team (comprised of a nephrologist, dialysis nurse, dialysis technician, social worker, and dietitian) by adding a general internist, pharmacist, nurse coordinator, and a community health worker, all of whom will see the patients together, and separately, as needed. The primary goal is to implement a comprehensive, multidisciplinary care team to improve care coordination, quality of life, and healthcare use for HD patients. Approximately 240 patients will be recruited from two sites; a non-profit university-affiliated dialysis center and an independent for-profit dialysis center. Outcomes include (i) patient-reported outcomes, including QOL and satisfaction; (ii) clinical outcomes, including blood pressure and diet; (iii) healthcare use, including emergency room visits and hospitalizations; and (iv) staff perceptions. Given the significant burden that patients with ESRD on HD experience, enhanced care coordination provides an opportunity to reduce this burden and improve QOL.

  17. Pediatric glaucoma medical therapy: who more accurately reports medication adherence, the caregiver or the child?

    Directory of Open Access Journals (Sweden)

    Moore DB

    2015-11-01

    Full Text Available Daniel B Moore,1 Rebecca F Neustein,2 Sarah K Jones,1 Alan L Robin,3 Kelly W Muir1,4 1Duke Eye Center, Duke University Medical Center, Durham, NC, 2Emory School of Medicine, Atlanta, GA, 3Department of Ophthalmology, Johns Hopkins School of Medicine and International Health, Bloomberg School of Public Health, Baltimore, MD, 4Health Services Research & Development, Durham VA Medical Center, Durham, NC, USA Abstract: As they grow older, most children with glaucoma must eventually face the transition to self-administering medications. We previously reported factors associated with better or worse medication adherence in children with glaucoma, using an objective, electronic monitor. Utilizing the same data set, the purpose of the current study was to determine whose report (the caregiver’s or the child’s corresponded better with electronically monitored adherence. Of the 46 participants (22 girls, the mean age of children primarily responsible, and caregiver primarily responsible for medication administration was 15±2 and 10±2 years, respectively. For the children whose caregiver regularly administered the eyedrops, the caregiver’s assessment of drop adherence was associated with measured adherence (P=0.012, but the child’s was not (P=0.476. For the children who self-administered eyedrops, neither the child’s (P=0.218 nor the caregiver’s (P=0.395 assessment was associated with measured percent adherence. This study highlights potential errors when relying on self-reporting of compliance in patients and caregivers with pediatric glaucoma, particularly when the child is responsible for administering their own eyedrops. Frank discussions about the importance of medication adherence and how to improve compliance may help both the child and caregiver better communicate with the treating provider. Keywords: glaucoma, children, adherence

  18. Polypharmacy, potentially inappropriate medication and cognitive status in Austrian nursing home residents: results from the OSiA study.

    Science.gov (United States)

    Alzner, Reinhard; Bauer, Ulrike; Pitzer, Stefan; Schreier, Maria Magdalena; Osterbrink, Jürgen; Iglseder, Bernhard

    2016-04-01

    There is little research investigating polypharmacy and potentially inappropriate medications (PIM) in connection with cognitive status in residents of Austrian nursing homes. Our findings result from a cross-sectional survey of 425 residents (315 women, 110 men, mean 83.6 years) from 12 Austrian nursing homes. The number of systemically administered permanent prescription drugs was 8.99 ± 3.9 and decreased significantly with increasing cognitive impairment. Irrespective of cognitive status, polypharmacy (> 5 individual substances) was present in approximately 75% of the residents. Hyper-polypharmacy (> 10 individual substances) was present among almost 50% of the cognitively intact residents, and hence, significantly more frequent as compared with the group with the lowest cognitive performance (23.4%). At least one PIM was found in 72.4% of residents regardless of cognitive status. Predominantly, PIMs consisted of tranquilizers, antipsychotics, osmotic laxatives, non-steroidal anti-inflammatory drugs (NSAIDs) and anticholinergics, where only the number of NSAIDs decreased significantly with increasing cognitive impairment. In summary, our study shows a continued high prevalence of polypharmacy and PIM in long-term care institutions in Austria.

  19. Organizational culture, continuous quality improvement, and medication administration error reporting.

    Science.gov (United States)

    Wakefield, B J; Blegen, M A; Uden-Holman, T; Vaughn, T; Chrischilles, E; Wakefield, D S

    2001-01-01

    This study explores the relationships among measures of nurses' perceptions of organizational culture, continuous quality improvement (CQI) implementation, and medication administration error (MAE) reporting. Hospital-based nurses were surveyed using measures of organizational culture and CQI implementation. These data were combined with previously collected data on perceptions of MAE reporting. A group-oriented culture had a significant positive correlation with CQI implementation, whereas hierarchical and rational culture types were negatively correlated with CQI implementation. Higher barriers to reporting MAE were associated with lower perceived reporting rates. A group-oriented culture and a greater extent of CQI implementation were positively (but not significantly) associated with the estimated overall percentage of MAEs reported. We conclude that health care organizations have implemented CQI programs, yet barriers remain relative to MAE reporting. There is a need to assess the reliability, validity, and completeness of key quality assessment and risk management data.

  20. Energy-efficient mortgages and home energy rating systems: A report on the nation`s progress

    Energy Technology Data Exchange (ETDEWEB)

    Farhar, B.C.; Eckert, J.

    1993-09-01

    This report summarizes progress throughout the nation in establishing voluntary programs linking home energy rating systems (HERS) and energy-efficient mortgages (EEMs). These programs use methods for rating the energy efficiency of new and existing homes and predicting energy cost savings so lenders can factor in energy cost savings when underwriting mortgages. The programs also encourage lenders to finance cost-effective energy-efficiency improvements to existing homes with low-interest mortgages or other instruments. The money saved on utility bills over the long term can more than offset the cost of such energy-efficiency improvements. The National Collaborative on HERS and EEMs recommended that this report be prepared.

  1. A report on student abuse during medical training.

    Science.gov (United States)

    Maida, Ana Margarita; Vásquez, Alicia; Herskovic, Viviana; Calderón, José Luis; Jacard, Marcela; Pereira, Ana; Widdel, Lars

    2003-09-01

    The purpose of this study was to determine the incidence, and the consequences, of abusive situations as perceived by students during the course of their medical training. A descriptive study was carried out surveying the entire 2000 fifth-year class of 181 in the Medical School of the University of Chile. The questionnaire was answered by 144 students. Results showed that 91.7% of the students who responded had suffered at least one episode of abuse while enrolled in medical school. The main offenders were teachers and peers. Verbal abuse was the most common (85.4%), followed by psychological (79.9%), sexual(26.4%) and physical (23.6%) abuse. Students reported that abuse had effects on their mental health, social life and the image they had of physicians; 17% considered dropping out of school as a consequence of this experience. Efforts should be addressed to prompt educators to reflect on their role.

  2. FINANCIAL AVAILABILITY OF IN-HOME MEDICAL TREATMENT OF PATIENTS WITH ALZHEIMER’S DISEASE

    Directory of Open Access Journals (Sweden)

    Mariana Arnaoudova

    2016-07-01

    Full Text Available Background: Alzheimer's disease (AD is a progressive neurodegenerative disorder and presents a great burden for the person, family and society as a whole. Since 2012, in Bulgaria, AD is accepted as a disorder of a great socio-economic significance and the drugs for home treatment are included in the reimbursement list of the National Health Insurance Fund (NHIF. Objective: To trace the access to treatment of Alzheimer’s in-home patients, as a result of generic substitution on the base of share distribution of the original and generic products. Methods: We collected data for the sales of pharmaceutical products (PP’s, containing donepezil hydrochloride and memantine hydrochloride from a distributor for the Northeast region of Bulgaria (Varna in the period 2014-2015. An analysis of the percentage share distribution of the original and generic products was conducted. Results: According to our results original product Aricept accounts for only 4%, while the market share for its generics is 96%. In this group the share to be paid from NHIF is 25%, the remaining 75% from the cost is paid by the patients. The original product Axura occupies 8% market share, the generics- 92%. In this group the share to be paid from NHIF is 50% for generics, while Axura was removed from the Positive reimbursement list. We comment the significant differences in the sale shares in several directions. Conclusion: The reduction of expenses, with the use of generics, would help more patients to receive an optimal treatment and the savings could be redirected for other costly treatments.

  3. A "Medical Mission" at Home: The Needs of Rural America in Terms of Otolaryngology Care

    Science.gov (United States)

    Winters, Ryan; Pou, Anna; Friedlander, Paul

    2011-01-01

    Objectives: Describe the population, Medicaid, uninsured, and otolaryngology practice demographics for 7 representative rural Southeastern states, and propose academic-affiliated outreach clinics as a service to help meet the specialty care needs of an underserved rural population, based on the "medical mission" model employed in…

  4. Academic genres in EFL medical educational contexts: The medical case-report

    Directory of Open Access Journals (Sweden)

    Eugenio Cianflone

    2015-11-01

    Full Text Available In genre analysis literature medical case-reports can be said to be almost underrepresented when compared to other scholarly specimens that have been thoroughly researched, like the research article, the master’s thesis or the doctoral dissertation. As a written academic variety little is known to English as a foreign language practitioners about the medical case report’s format and about its use in language for specific purposes classes. The aim of this note is to offer a preliminary description of the case-report’s main sections and to suggest some activities to be exploited in English as a foreign language classes. The hope is that these insights can call genre analysts’ attention on this medical genre to develop appropriate research that will result in new educational texts.

  5. Changing Patterns of Glucose-Lowering Medication Use in VA Nursing Home Residents with Diabetes, 2005 – 2011

    Science.gov (United States)

    Lee, Sei J.; Stijacic-Cenzer, Irena; Barnhart, Caroline; McClymont, Keelan; Steinman, Michael A

    2015-01-01

    Objective Although nursing home (NH) residents make up a large and growing proportion of Americans with diabetes mellitus, little is known about how glucose-lowering medications are used in this population. We sought to examine glucose-lowering medication use in Veterans Affairs (VA) NH residents with diabetes between 2005–2011. Research Design and Methods Retrospective cohort study, utilizing linked laboratory, pharmacy, administrative and NH Minimum Dataset (MDS) 2.0 databases in 123 VA NHs. A total of 9,431 long-stay (>90 days) VA NH residents over age 65 followed for 52,313 person-quarters. We identified receipt of glucose lowering medications including insulin, metformin, sulfonylureas, thiazolidinediones and others (alpha-glucosidase inhibitors, meglitinides, glucagon like peptide-1 analogs, dipeptidyl peptidase-4 inhibitors and amylin analogues) per quarter. Results The rates of sulfonylurea use in long-stay NH residents dropped dramatically from 24% in 2005 to 12% in 2011 (p<0.001), driven in large part by the dramatic decrease in glyburide use (10% to 2%, p<0.001). There was sharp drop in thiazolidinedione use in 2007 (4% to <1%, p<0.001). Metformin use was stable, ranging between 7% to 9% (p=0.24). Insulin use increased slightly from 30% to 32% (p<0.001). Use of other classes of glucose-lowering medications was stable (p=0.22) and low, remaining below 1.3%. Conclusions and Relevance Between 2005 and 2011, there were dramatic declines in use of sulfonylureas and thiazolidinediones in VA NH residents, suggesting that prescribing practices can be quickly changed in this setting. PMID:26272298

  6. Validity of parent-reported weight and height of preschool children measured at home or estimated without home measurement: a validation study

    Directory of Open Access Journals (Sweden)

    Cox Bianca

    2011-07-01

    Full Text Available Abstract Background Parental reports are often used in large-scale surveys to assess children's body mass index (BMI. Therefore, it is important to know to what extent these parental reports are valid and whether it makes a difference if the parents measured their children's weight and height at home or whether they simply estimated these values. The aim of this study is to compare the validity of parent-reported height, weight and BMI values of preschool children (3-7 y-old, when measured at home or estimated by parents without actual measurement. Methods The subjects were 297 Belgian preschool children (52.9% male. Participation rate was 73%. A questionnaire including questions about height and weight of the children was completed by the parents. Nurses measured height and weight following standardised procedures. International age- and sex-specific BMI cut-off values were employed to determine categories of weight status and obesity. Results On the group level, no important differences in accuracy of reported height, weight and BMI were identified between parent-measured or estimated values. However, for all 3 parameters, the correlations between parental reports and nurse measurements were higher in the group of children whose body dimensions were measured by the parents. Sensitivity for underweight and overweight/obesity were respectively 73% and 47% when parents measured their child's height and weight, and 55% and 47% when parents estimated values without measurement. Specificity for underweight and overweight/obesity were respectively 82% and 97% when parents measured the children, and 75% and 93% with parent estimations. Conclusions Diagnostic measures were more accurate when parents measured their child's weight and height at home than when those dimensions were based on parental judgements. When parent-reported data on an individual level is used, the accuracy could be improved by encouraging the parents to measure weight and height

  7. British Coal Corporation Medical Service annual report 1988-89

    Energy Technology Data Exchange (ETDEWEB)

    1992-01-01

    This annual report reviews the work of British Coal's Medical Service over the period 1988-89. Recruitment was at a lower level resulting in a reduction in the number of pre-employment medical examinations. Statistics are given for these, and for consultations during the year. The work of the rescue service is described. Results of surveys on the prevalence of pneumoconiosis in coal miners from 1961 to 1988 are presented in detail. The fall in prevalence continued. Continued attention has been paid to compliance with COSHH regulations, to encouraging the use of physiotherapy and to educating workers in lifting and handling methods. Following an incidence of Legionnaires Disease an investigation was carried out to identify the source of infection in an underground refrigeration plant. Studies on the mortality of coke workers have progressed. Reports are given on first aid and nursing services and on the administration of pethridine to injured miners.

  8. Musculoskeletal pain and reported workplace assault: a prospective study of clinical staff in nursing homes.

    Science.gov (United States)

    Miranda, Helena; Punnett, Laura; Gore, Rebecca J

    2014-02-01

    This study examined prospectively the effect of workplace violence on musculoskeletal symptoms among nursing home workers. Previously we reported a cross-sectional relationship between physical assaults at work and musculoskeletal pain. This follow-up provides stronger evidence of the effect of workplace violence on musculoskeletal outcomes within the same workforce over two years. Nursing home workers who responded to three consecutive annual surveys formed the study cohort (n = 344). The outcomes were any musculoskeletal pain, widespread pain, pain intensity, pain interference with work and sleep, and co-occurring pain with depression. The main predictor was self-reported physical assault at work during the 3 months preceding each survey. Prevalence ratios (PRs) were assessed with log-binomial regression, adjusting for other workplace and individual factors. Every fourth nursing home worker, and 34% of nursing aides, reported persistent workplace assault over the 2 years. Among respondents assaulted frequently, two thirds experienced moderate to extreme musculoskeletal pain, and more than 50% had pain interfering with work and/or sleep. Baseline exposure to assault predicted pain outcomes 1 year later. Repeated exposure was associated with a linear increase over 2 years in the risks of pain intensity, interference with work, and interference with sleep; co-occurring pain and depression had an adjusted PR of 3.6 (95% CI = 1.7-7.9). Workplace assault, especially when repeated over time, increases the risk of pain that may jeopardize workers' ability to remain employed. More effective assault prevention would protect and support the workforce needed to care for our increasing elderly and disabled population.

  9. Self-reported study habits for enhancing medical students’ performance in the National Medical Unified Examination

    Science.gov (United States)

    Idris, Amr; Al Saadi, Tareq; Edris, Basel; Sawaf, Bisher; Zakaria, Mhd. Ismael; Alkhatib, Mahmoud; Turk, Tarek

    2016-01-01

    Background: The National Medical Unified Examination (NMUE) is currently required for graduation, joining postgraduate medical training, and practicing medicine in Syria. Objective: To investigate self-reported study habits that correlate with high performance on the NMUE. Methods: First through 3rd year residents at the three main hospitals in Damascus, Syria, were asked to complete a retrospective cross-sectional survey investigating their study habits and previous scores. Results: Significantly higher score was associated with >15 study h/day and allocating 1–40% of study time for practicing questions. Mean NMUE score was not significantly different in relation to preparation months for examination or for those who reported spending all their time studying alone compared with spending any amount of time in a group setting. Scores of 231–240 on the Syrian scientific high school exam correlated with significantly higher NMUE performance compared with fewer scores, except scores of 221–230. For every 10 point increase in medical school cumulative grades, the NMUE score increased 3.6 (95% confidence interval 2.5–4.8). Conclusion: The NMUE score was significantly affected by hours spent studying per day, number of practice questions completed, percentage of study time allocated for doing questions, Syrian scientific high school exam scores, and the cumulative medical school class grades. It was not significantly affected by preparation months or studying in a group setting. More studies are needed to further describe and investigate the factors that might affect performance in the NMUE. PMID:27144140

  10. Healthy Homes Tools

    Science.gov (United States)

    Peek, Gina; Lyon, Melinda; Russ, Randall

    2012-01-01

    Extension is focusing on healthy homes programming. Extension educators are not qualified to diagnose consumers' medical problems as they relate to housing. We cannot give medical advice. Instead, we can help educate consumers about home conditions that may affect their well-being. Extension educators need appropriate healthy homes tools to…

  11. Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge

    DEFF Research Database (Denmark)

    Beck, Anne Marie; Kjær, Stine; Hansen, Birthe Stenbæk

    2013-01-01

    , rehabilitation capacity), nutritional status (weight, BMI, energy and protein intake), need of social services (home care, home nursing, meals-on-wheels) and mortality.Results:One hundred and fifty-two patients were included; 132 (87%) completed the first and 124 (82%) the second data collection after 12 weeks......Objective:To assess the additional benefits of individualized nutritional counselling by a registered dietitian in geriatric patients' home after discharge from hospital, in relation to risk of re-admissions, functional status, nutritional status, use of social services and mortality.......Design:Twelve-week single-blind randomized controlled study.Setting and subjects:Geriatric medical patients (65+ years) at nutritional risk.Interventions:Participants were randomly allocated to receive a visit in their homes, either three individualized nutritional counselling by a registered dietitian complemented...

  12. National Coal Board Medical Service annual report 1981-82

    Energy Technology Data Exchange (ETDEWEB)

    1983-01-01

    Sections report on: medical examinations and consultations; protection from health hazards, such as pneumoconiosis and other prescribed diseases; problems such as vitamin D in miners' blood, Legionnaires' disease, rehabilitation and physiotherapy, high pressure injection injuries, pump packing; National Coal Board (Coal Products) Ltd.; injuries and treatment; and nursing service. A list of staff and their publications and a supplement on occupational toxicology are included.

  13. Pilot States Program report: Home energy ratings systems and energy-efficient mortgages

    Energy Technology Data Exchange (ETDEWEB)

    Farhar, B.

    2000-04-04

    This report covers the accomplishments of the home energy ratings systems/energy-efficient mortgages (HERS/EEMs) pilot states from 1993 through 1998, including such indicators as funding, ratings and EEMs achieved, active raters, and training and marketing activities. A brief description of each HERS program's evolution is included, as well as their directors' views of the programs' future prospects. Finally, an analysis is provided of successful HERS program characteristics and factors that appear to contribute to HERS program success.

  14. Medication errors reported to the National Medication Error Reporting System in Malaysia: a 4-year retrospective review (2009 to 2012).

    Science.gov (United States)

    Samsiah, A; Othman, Noordin; Jamshed, Shazia; Hassali, Mohamed Azmi; Wan-Mohaina, W M

    2016-12-01

    Reporting and analysing the data on medication errors (MEs) is important and contributes to a better understanding of the error-prone environment. This study aims to examine the characteristics of errors submitted to the National Medication Error Reporting System (MERS) in Malaysia. A retrospective review of reports received from 1 January 2009 to 31 December 2012 was undertaken. Descriptive statistics method was applied. A total of 17,357 MEs reported were reviewed. The majority of errors were from public-funded hospitals. Near misses were classified in 86.3 % of the errors. The majority of errors (98.1 %) had no harmful effects on the patients. Prescribing contributed to more than three-quarters of the overall errors (76.1 %). Pharmacists detected and reported the majority of errors (92.1 %). Cases of erroneous dosage or strength of medicine (30.75 %) were the leading type of error, whilst cardiovascular (25.4 %) was the most common category of drug found. MERS provides rich information on the characteristics of reported MEs. Low contribution to reporting from healthcare facilities other than government hospitals and non-pharmacists requires further investigation. Thus, a feasible approach to promote MERS among healthcare providers in both public and private sectors needs to be formulated and strengthened. Preventive measures to minimise MEs should be directed to improve prescribing competency among the fallible prescribers identified.

  15. Future Supply of Medical Radioisotopes for the UK Report 2014

    CERN Document Server

    Neilly, Brian; Ballinger, Jim; Buscombe, John; Clarke, Rob; Ellis, Beverley; Flux, Glenn; Fraser, Louise; Hall, Adrian; Owen, Hywel; Paterson, Audrey; Perkins, Alan; Scarsbrook, Andrew

    2015-01-01

    The UK has no research nuclear reactors and relies on the importation of 99Mo and other medical radioisotopes (e.g. Iodine-131) from overseas (excluding PET radioisotopes). The UK is therefore vulnerable not only to global shortages, but to problems with shipping and importation of the products. In this context Professor Erika Denton UK national Clinical Director for Diagnostics requested that the British Nuclear Medicine Society lead a working group with stakeholders including representatives from the Science & Technology Facilities Council (STFC) to prepare a report. The group had a first meeting on 10 April 2013 followed by a working group meeting with presentations on 9th September 2013 where the scope of the work required to produce a report was agreed. The objectives of the report are: to describe the status of the use of medical radioisotopes in the UK; to anticipate the potential impact of shortages for the UK; to assess potential alternative avenues of medical radioisotope production for the UK m...

  16. Clinical Pharmacist Team-Based Care in a Safety Net Medical Home: Facilitators and Barriers to Chronic Care Management.

    Science.gov (United States)

    Price-Haywood, Eboni G; Amering, Sarah; Luo, Qingyang; Lefante, John J

    2017-04-01

    Collaborative care models incorporating pharmacists have been shown to improve quality of care for patients with hypertension and/or diabetes. Little is known about how to integrate such services outside of clinical trials. The authors implemented a 22-month observational study to evaluate pharmacy collaborative care for hypertension and diabetes in a safety net medical home that incorporated population risk stratification, clinical decision support, and medication dose adjustment protocols. Patients in the pharmacy group saw their primary care provider (PCP) more often and had higher baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) and A1c levels compared to patients who only received care from their PCPs. There were no significant differences in the proportion of patients achieving treatment goals (SBP patients who underwent collaborative care versus those who did not. Age, race, and number of PCP encounters were associated with BP and A1c trends. The median time to achieve disease control was longer in the pharmacy group. Although 70% of all patients with poorly controlled hypertension achieved treatment goals within 7 months, less than 50% of patients with poorly controlled diabetes achieved A1c culture, health information technology and related workflows, and pharmacy caseload optimization. Future studies should further examine implementation strategies that work best in specific settings to optimize the benefits of team-based care with clinical pharmacists.

  17. [Medical prescription and informed consent for the use of physical restraints in nursing homes in the Canary Islands (Spain)].

    Science.gov (United States)

    Estévez-Guerra, Gabriel J; Fariña-López, Emilio; Penelo, Eva

    2016-11-30

    To identify the frequency of completion of informed consent and medical prescription in the clinical records of older patients subject to physical restraint, and to analyse the association between patient characteristics and the absence of such documentation. A cross-sectional and descriptive multicentre study with direct observation and review of clinical records was conducted in nine public nursing homes, comprising 1,058 beds. 274 residents were physically restrained. Informed consent was not included in 82.5% of cases and was incomplete in a further 13.9%. There was no medical prescription in 68.3% of cases and it was incomplete in a further 12.0%. The only statistical association found was between the lack of prescription and the patients' advanced age (PR=1.03; p <0.005). Failure to produce this documentation contravenes the law. Organisational characteristics, ignorance of the legal requirements or the fact that some professionals may consider physical restraint to be a risk-free procedure may explain these results. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curacao

    NARCIS (Netherlands)

    Boersma, Adriana A.; Jong, Betty Meyboom-de; Kleiverda, Gunilla

    2011-01-01

    Objective To evaluate the efficacy and safety of home administration of buccal misoprostol after mifepristone for medical abortion up to 70 days' gestation in a general practice in Curacao, where induced abortion is severely restricted by law. Methods In a prospective study 330 women received 200 mg

  19. Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curacao

    NARCIS (Netherlands)

    Boersma, Adriana A.; Jong, Betty Meyboom-de; Kleiverda, Gunilla

    2011-01-01

    Objective To evaluate the efficacy and safety of home administration of buccal misoprostol after mifepristone for medical abortion up to 70 days' gestation in a general practice in Curacao, where induced abortion is severely restricted by law. Methods In a prospective study 330 women received 200 mg

  20. One Family's Journey: Medical Home and the Network of Supports It Offers Children and Youth with Special Healthcare Needs--The Transition Process Starts Early

    Science.gov (United States)

    MacDonald, Sarah; Sagerman, Paul G.; Boyd, Laura; Sanabria, Kathy

    2008-01-01

    This seventh installment of a 12-article Medical Home series describes the experiences of a fictitious couple, Amita and Samir, as they learn to adapt to the reality of raising a pre-adolescent girl, Anjali, with special needs. Anjali, due to her premature birth, had been suffering from recurrent asthma attacks. This article discusses how Anjali…

  1. Consistency in performance evaluation reports and medical records.

    Science.gov (United States)

    Lu, Mingshan; Ma, Ching-to Albert

    2002-12-01

    In the health care market managed care has become the latest innovation for the delivery of services. For efficient implementation, the managed care organization relies on accurate information. So clinicians are often asked to report on patients before referrals are approved, treatments authorized, or insurance claims processed. What are clinicians responses to solicitation for information by managed care organizations? The existing health literature has already pointed out the importance of provider gaming, sincere reporting, nudging, and dodging the rules. We assess the consistency of clinicians reports on clients across administrative data and clinical records. For about 1,000 alcohol abuse treatment episodes, we compare clinicians reports across two data sets. The first one, the Maine Addiction Treatment System (MATS), was an administrative data set; the state government used it for program performance monitoring and evaluation. The second was a set of medical record abstracts, taken directly from the clinical records of treatment episodes. A clinician s reporting practice exhibits an inconsistency if the information reported in MATS differs from the information reported in the medical record in a statistically significant way. We look for evidence of inconsistencies in five categories: admission alcohol use frequency, discharge alcohol use frequency, termination status, admission employment status, and discharge employment status. Chi-square tests, Kappa statistics, and sensitivity and specificity tests are used for hypothesis testing. Multiple imputation methods are employed to address the problem of missing values in the record abstract data set. For admission and discharge alcohol use frequency measures, we find, respectively, strong and supporting evidence for inconsistencies. We find equally strong evidence for consistency in reports of admission and discharge employment status, and mixed evidence on report consistency on termination status. Patterns of

  2. Neuropsychology reports for childhood brain tumor survivors: implementation of recommendations at home and school.

    Science.gov (United States)

    Cheung, Lorraine L T; Wakefield, Claire E; Ellis, Sarah J; Mandalis, Anna; Frow, Eleanor; Cohn, Richard J

    2014-06-01

    As pediatric brain tumor survivors may experience cognitive decline post-treatment, a neuropsychology assessment is often conducted. The assessment evaluates the child's cognitive functioning and highlights potential challenges. Whilst neuropsychology reports provide recommendations for the home and school, how this translates in practice is under researched. This study explored parent and teacher understanding of neuropsychology reports, implementation rates for recommendations and their perceived effectiveness. Barriers to implementation were also investigated. Twenty-five semi-structured interviews were conducted with 17 parents and 8 teachers of childhood brain tumor survivors from 15 Australian families who had received a neuropsychology report within 2 years of the interview. Twenty-four neuropsychology reports encompassing 131 recommendations were reviewed. The qualitative methodological framework of Miles and Huberman [Miles M, Huberman A. Qualitative data analysis: An expanded sourcebook. London: Sage; 1994] was used to analyze interview transcripts with QSR NVivo 9.0. The majority of parents and teachers had a sound understanding of the report. Implementation of recommendations at home and school was 47% and 41%, respectively. Recommendations that did not require extra effort and organization appeared more likely to be implemented, however, those perceived to be more effective or helpful did not necessarily have higher implementation rates. Key reported barriers to implementation barrier were patient reluctance, and a lack of parents' willingness to adopt the recommendation. Patient understanding and willingness play a significant role in the implementation of neuropsychology recommendations. Collaboration and clear communication between the patient, teacher, parent, and neuropsychologist is vital for effective management. © 2014 Wiley Periodicals, Inc.

  3. Accurate Completion of Medical Report on Diagnosing Death.

    Science.gov (United States)

    Savić, Slobodan; Alempijević, Djordje; Andjelić, Sladjana

    2015-01-01

    Diagnosing death and issuing a Death Diagnosing Form (DDF) represents an activity that carries a great deal of public responsibility for medical professionals of the Emergency Medical Services (EMS) and is perpetually exposed to the control of the general public. Diagnosing death is necessary so as to confirm true, to exclude apparent death and consequentially to avoid burying a person alive, i.e. apparently dead. These expert-methodological guidelines based on the most up-to-date and medically based evidence have the goal of helping the physicians of the EMS in accurately filling out a medical report on diagnosing death. If the outcome of applied cardiopulmonary resuscitation measures is negative or when the person is found dead, the physician is under obligation to diagnose death and correctly fill out the DDF. It is also recommended to perform electrocardiography (EKG) and record asystole in at least two leads. In the process of diagnostics and treatment, it is a moral obligation of each Belgrade EMS physician to apply all available achievements and knowledge of modern medicine acquired from extensive international studies, which have been indeed the major theoretical basis for the creation of these expert-methodological guidelines. Those acting differently do so in accordance with their conscience and risk professional, and even criminal sanctions.

  4. Descriptive analysis of medication errors reported to the Egyptian national online reporting system during six months.

    Science.gov (United States)

    Shehata, Zahraa Hassan Abdelrahman; Sabri, Nagwa Ali; Elmelegy, Ahmed Abdelsalam

    2016-03-01

    This study analyzes reports to the Egyptian medication error (ME) reporting system from June to December 2014. Fifty hospital pharmacists received training on ME reporting using the national reporting system. All received reports were reviewed and analyzed. The pieces of data analyzed were patient age, gender, clinical setting, stage, type, medication(s), outcome, cause(s), and recommendation(s). Over the course of 6 months, 12,000 valid reports were gathered and included in this analysis. The majority (66%) came from inpatient settings, while 23% came from intensive care units, and 11% came from outpatient departments. Prescribing errors were the most common type of MEs (54%), followed by monitoring (25%) and administration errors (16%). The most frequent error was incorrect dose (20%) followed by drug interactions, incorrect drug, and incorrect frequency. Most reports were potential (25%), prevented (11%), or harmless (51%) errors; only 13% of reported errors lead to patient harm. The top three medication classes involved in reported MEs were antibiotics, drugs acting on the central nervous system, and drugs acting on the cardiovascular system. Causes of MEs were mostly lack of knowledge, environmental factors, lack of drug information sources, and incomplete prescribing. Recommendations for addressing MEs were mainly staff training, local ME reporting, and improving work environment. There are common problems among different healthcare systems, so that sharing experiences on the national level is essential to enable learning from MEs. Internationally, there is a great need for standardizing ME terminology, to facilitate knowledge transfer. Underreporting, inaccurate reporting, and a lack of reporter diversity are some limitations of this study. Egypt now has a national database of MEs that allows researchers and decision makers to assess the problem, identify its root causes, and develop preventive strategies. © The Author 2015. Published by Oxford University

  5. Medication error reporting by community pharmacists in Vermont.

    Science.gov (United States)

    Kennedy, Amanda G; Littenberg, Benjamin

    2004-01-01

    To document community pharmacists' awareness and use of the United States Pharmacopeia Medication Errors Reporting (USP MER) program. Telephone survey. Community pharmacies in Vermont. One self-identified community pharmacist from each community pharmacy. Each operating community pharmacy in Vermont was contacted by telephone between June 2002 and February 2003. The first individual to self-identify himself or herself as a pharmacist was asked to participate. The telephone surveys were conducted using a standard script. Survey responses to questions about awareness and use of USP MER. A pharmacist was contacted in 98% (122/124) of all operating community pharmacies in Vermont. Nine (7%) pharmacists refused to participate, leaving 113 pharmacists who responded to the survey. Although more than one half of all respondents (70/113; 62%) had heard of USP MER, less than one quarter (24/113; 21%) had ever submitted a report. Significantly more pharmacists employed by independent pharmacies had submitted a report, compared with pharmacists from other pharmacy types (chain, supermarket, mass merchandiser; P = .03). Submitting reports through a corporate hierarchy or to a corporate program was the reason most frequently cited by pharmacists for not submitting reports directly to USP MER (37%). Whether corporate reports were forwarded to USP MER is unknown. The majority of Vermont community pharmacists were aware of USP MER. However, use was low. Barriers to reporting to a common system such as USP MER may differ depending on pharmacy type. Further research to document the barriers to submitting reports is warranted.

  6. Contemporary Issues in Medicine--Medical Informatics and Population Health: Report II of the Medical School Objectives Project.

    Science.gov (United States)

    Academic Medicine, 1999

    1999-01-01

    The report of the Association of American Medical Colleges' Medical School Objectives Program presents the work of two expert panels. One, on medical informatics, identified five important physician roles: lifelong learner, clinician, educator, researcher, and manager. Another panel established a definition for "population health perspective"…

  7. Web-based social media for professional medical education: Perspectives of senior stakeholders in the nursing home sector.

    Science.gov (United States)

    Kitching, Fiona; Winbolt, Margaret; MacPhail, Aleece; Ibrahim, Joseph E

    2015-12-01

    Participatory web-based platforms, including social media, have been recognised as valuable learning tools in healthcare education for over a decade. Use of these platforms is now widespread in tertiary education. It is less widely accepted as a tool for continuing professional education and development at the industry level. This study explores perspectives of senior stakeholders in the nursing home sector to explore perceived benefits, barriers and risks for use in professional education. Qualitative data were collected through semi-structured interviews of 'high level' clinical and executive staff from a cross section of nursing home stakeholder organisations. Established printed educational material (PEM) was used as a case study for adaptation to web-based social applications. Questions were designed to gather information about the interviewee's views on the potential to apply PEM to programs such as blogs, Twitter and YouTube to deliver education and aid communication in the sector. Twelve participants from eleven stakeholder organisations took part in the study. Most participants were cautious about the use of social media programs in continuing professional education. Participants described the benefits (contemporary information, delivered rapidly, varying formats) and barriers (credibility of information, potential misinterpretation, sector demographics, time constraints) to uptake of these programs. The majority of participants preferred formal e-learning programs to web-based social media applications. Reservations expressed about the use of social media, such as accuracy, legal and privacy risks to the organisation reflected those previously expressed by the broader medical community. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Demand and predictors for post-discharge medical counseling in home care patients: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Shih-Tan Ding

    Full Text Available RATIONALE: Post-discharge care is challenging due to the high rate of adverse events after discharge. However, details regarding post-discharge care requirements remain unclear. Post-discharge medical counseling (PDMC by telephone service was set-up to investigate its demand and predictors. METHODS: This prospective study was conducted from April 2011 to March 2012 in a tertiary referral center in northern Taiwan. Patients discharged for home care were recruited and educated via telephone hotline counseling when needed. The patient's characteristics and call-in details were recorded, and predictors of PDMC use and worsening by red-flag sign were analyzed. RESULTS: During the study period, 224 patients were enrolled. The PDMC was used 121 times by 65 patients in an average of 8.6 days after discharge. The red-flag sign was noted in 17 PDMC from 16 patients. Of the PDMC used, 50% (n = 60 were for symptom change and the rest were for post-discharge care problems and issues regarding other administrative services. Predictors of PDMC were underlying malignancy and lower Barthel index (BI. On the other hand, lower BI, higher adjusted Charlson co-morbidity index (CCI, and longer length of hospital stay were associated with PDMC and red-flag sign. CONCLUSIONS: Demand for PDMC may be as high as 29% in home care patients within 30 days after discharge. PDMC is needed more by patients with malignancy and lower BI. More focus should also be given to those with lower BI, higher CCI, and longer length of hospital stay, as they more frequently have red flag signs.

  9. Acceptability of Home-Assessment Post Medical Abortion and Medical Abortion in a Low-Resource Setting in Rajasthan, India. Secondary Outcome Analysis of a Non-Inferiority Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Mandira Paul

    Full Text Available Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education.To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India.Secondary outcome of a randomised, controlled, non-inferiority trial.Outpatient primary health care clinics in rural and urban Rajasthan, India.Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85 mg/l and were below 18 years.Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1:1 in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol, using opaque sealed envelopes. Blinding during outcome assessment was not possible.Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups.731 women were randomized to the clinic follow-up group (n = 353 or home-assessment group (n = 378. 623 (85% women were successfully followed up, of those 597 (96% were satisfied and 592 (95% found the abortion better or as expected, with no difference between study groups. The majority, 355 (57% women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%, in the home-assessment group preferred

  10. Compact Neutron Generators for Medical, Home Land Security, and Planetary Exploration

    CERN Document Server

    Reijonen, Jani

    2005-01-01

    The Plasma and Ion Source Technology Group at Lawrence Berkeley National Laboratory has developed various types of advanced D-D (neutron energy 2.5 MeV), D-T (14 MeV) and T-T (0 - 9 MeV) neutron generators for wide range of applications. These applications include medical (Boron Neutron Capture Therapy), homeland security (Prompt Gamma Activation Analysis, Fast Neutron Activation Analysis and Pulsed Fast Neutron Transmission Spectroscopy) and planetary exploration in form of neutron based, sub-surface hydrogen detection systems. These neutron generators utilize RF induction discharge to ionize the deuterium/tritium gas. This discharge method provides high plasma density for high output current, high atomic species from molecular gases, long life operation and versatility for various discharge chamber geometries. Three main neutron generator developments are discussed here: high neutron output co-axial neutron generator for BNCT applications, point neutron generator for security applications, compact and sub-c...

  11. Shuttle OFT medical report: Summary of medical results from STS-1, STS-2, STS-3, and STS-4

    Science.gov (United States)

    Pool, S. L. (Editor); Johnson, P. C., Jr. (Editor); Mason, J. A. (Editor)

    1983-01-01

    The medical operations for the orbital test flights which includes a review of the health of the crews before, during, and immediately after the four shuttle orbital flights are reported. Health evaluation, health stabilization program, medical training, medical "kit" carried in flight, tests and countermeasures for space motion sickness, cardiovascular, biochemistry and endocrinology results, hematology and immunology analyses, medical microbiology, food and nutrition, potable water, Shuttle toxicology, radiological health, and cabin acoustical noise are reviewed. Information on environmental effects of Shuttle launch and landing, medical information management, and management, planning, and implementation of the medical program are included.

  12. Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics.

    Science.gov (United States)

    Helfrich, Christian D; Dolan, Emily D; Fihn, Stephan D; Rodriguez, Hector P; Meredith, Lisa S; Rosland, Ann-Marie; Lempa, Michele; Wakefield, Bonnie J; Joos, Sandra; Lawler, Lauren H; Harvey, Henry B; Stark, Richard; Schectman, Gordon; Nelson, Karin M

    2014-12-01

    Team-based care is central to the patient-centered medical home (PCMH), but most PCMH evaluations measure team structure exclusively. We assessed team-based care in terms of team structure, process and effectiveness, and the association with improvements in teams׳ abilities to deliver patient-centered care. We fielded a cross-sectional survey among 913 VA primary care clinics implementing a PCMH model in 2012. The dependent variable was clinic-level respondent-reported improvements in delivery of patient-centered care. Independent variables included three sets of measures: (1) team structure, (2) team process, and (3) team effectiveness. We adjusted for clinic workload and patient comorbidity. 4819 surveys were returned (25% estimated response rate). The highest ratings were for team structure (median of 89% of respondents being assigned to a teamlet, i.e., a PCP working with the same clinical associate, nurse care manager and clerk) and lowest for team process (median of 10% of respondents reporting the lowest level of stress/chaos). In multivariable regression, perceived improvements in patient-centered care were most strongly associated with participatory decision making (β=32, Peffectiveness measures, often omitted from PCMH evaluations, had stronger associations with perceived improvements in patient-centered care than team structure measures. Team process and effectiveness measures may facilitate synthesis of evaluation findings and help identify positive outlier clinics. Published by Elsevier Inc.

  13. The experiential marketing of home medical equipment%浅谈家用医疗器械的体验营销

    Institute of Scientific and Technical Information of China (English)

    张睿智

    2013-01-01

    With the implementation of new medical reform and the health consciousness enhancement, home medical equipment market demand is increasing. Based on the introduction of the experiential marketing, the author explores the experiential marketing strategy of home medical equipment, and analyzes the marketing process issues that should be paid attention to.%  新医改的实施,居民保健意识的增强,家用医疗器械市场需求不断增加。本文在介绍体验营销的基础上,探讨家用医疗器械体验营销的策略,并剖析了营销过程中需要注意的问题。

  14. Recurrent hypersomnia: Report of medication-responsive cases

    Science.gov (United States)

    Perin, Bruna V.; Rodrigues, Iorrana; Giasson, Franciele T.B.; Balen, Matheus; Posenato, Naiana; Forcelini, Cassiano M.

    2015-01-01

    Introduction Recurrent hypersomnia (RH) is a rare disorder without established treatment. Methods We report 2 RH medication-responsive cases with typical characteristics of Kleine–Levin syndrome (KLS). Case-reports A 10 y.o. girl and a 14 y.o. boy presented with sudden sleepiness for 3–9 days (every 2–3 weeks). Physical examination, brain images and blood tests were normal. Polysomnographic findings were heterogenous, including disrupted sleep architecture. MSLTs revealed 2–3 SOREMPs and short sleep latency. Carbamazepine rendered girl׳s sleep normalization, while risperidone normalized boy׳s sleep cycles. Conclusions Facing the absence of clinical trials in RH, reports of responsive cases are the available therapeutic evidence. PMID:26483951

  15. Residual Effects of Sleep Medications Are Commonly Reported and Associated with Impaired Patient-Reported Outcomes among Insomnia Patients in the United States

    Directory of Open Access Journals (Sweden)

    Timothy Fitzgerald

    2015-01-01

    Full Text Available Study Objective. To measure the association of symptoms attributed to residual effects of sleep medication (e.g., drowsiness, difficulty concentrating, and impaired memory on self-reported functioning and satisfaction with these medications. Methods. Individuals using prescription medications for insomnia were invited to complete an Internet-based survey. Respondents were compared according to the presence of self-reported residual effects; relationships between severity of these effects and outcomes were modeled using regression. Measures included the Brief Insomnia Questionnaire, Work Productivity and Activity Impairment Questionnaire, and SATMED-Q. Subgroup analyses were conducted with patients aged ≥65 years. Approximately 80% reported experiencing ≥1 residual effect. The severity of residual effects was associated with increased residual effect-related work impairment, including absenteeism (RR = 1.46, p<0.001, presenteeism (RR = 1.12, p<0.001, overall work impairment (RR = 1.13, p<0.001, and nonwork activity impairment (RR = 1.11, p<0.001. More severe residual symptoms were also associated with increased difficulty in home management (Beta = .31, p<0.001, ability to work (Beta = .31, p<0.001, social relationships, (Beta = .32, p<0.001, close personal relationships (Beta = .30, p<0.001, and lower medication satisfaction (Beta = -.37, p<0.001. Conclusions. Individuals using medications for insomnia commonly experience symptoms considered as residual effects, and these symptoms are associated with greater interference of sleep-related problems at work, at home, and with social relationships.

  16. Consumer-reported handling of raw poultry products at home: results from a national survey.

    Science.gov (United States)

    Kosa, Katherine M; Cates, Sheryl C; Bradley, Samantha; Chambers, Edgar; Godwin, Sandria

    2015-01-01

    Salmonella and Campylobacter cause an estimated combined total of 1.8 million foodborne infections each year in the United States. Most cases of salmonellosis and campylobacteriosis are associated with eating raw or undercooked poultry or with cross-contamination. Between 1998 and 2008, 20% of Salmonella and 16% of Campylobacter foodborne disease outbreaks were associated with food prepared inside the home. A nationally representative Web survey of U.S. adult grocery shoppers (n = 1,504) was conducted to estimate the percentage of consumers who follow recommended food safety practices when handling raw poultry at home. The survey results identified areas of low adherence to current recommended food safety practices: not washing raw poultry before cooking, proper refrigerator storage of raw poultry, use of a food thermometer to determine doneness, and proper thawing of raw poultry in cold water. Nearly 70% of consumers reported washing or rinsing raw poultry before cooking it, a potentially unsafe practice because "splashing" of contaminated water may lead to the transfer of pathogens to other foods and other kitchen surfaces. Only 17.5% of consumers reported correctly storing raw poultry in the refrigerator. Sixty-two percent of consumers own a food thermometer, and of these, 26% or fewer reported using one to check the internal temperature of smaller cuts of poultry and ground poultry. Only 11% of consumers who thaw raw poultry in cold water reported doing so correctly. The study results, coupled with other research findings, will inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella and Campylobacter.

  17. Selection bias in family reports on end of life with dementia in nursing homes.

    Science.gov (United States)

    van der Steen, Jenny T; Deliens, Luc; Ribbe, Miel W; Onwuteaka-Philipsen, Bregje D

    2012-12-01

    Selective participation in retrospective studies of families recruited after the patient's death may threaten generalizability of reports on end-of-life experiences. To assess possible selection bias in retrospective study of dementia at the end of life using family reports. Two physician teams covering six nursing home facilities in the Netherlands reported on 117 of 119 consecutive decedents within two weeks after death unaware of after-death family participation in the study. They reported on characteristics; treatment and care; overall patient outcomes such as comfort, nursing care, and outcomes; and their own perspectives on the experience. We compared results between decedents with and without family participation. The family response rate was 55%. There were no significant differences based on participation versus nonparticipation in demographics and other nursing home resident characteristics, treatment and care, or overall resident outcome. However, among participating families, physicians perceived higher-quality aspects of nursing care and outcome, better consensus between staff and family on treatment, and a more peaceful death. Participation was less likely with involvement of a new family member in the last month. Families may be more likely to participate in research with more harmonious teamwork in end-of-life caregiving. Where family participation is an enrollment criterion, comparing demographics alone may not capture possible selection bias, especially in more subjective measures. Selection bias toward more positive experiences, which may include the physician's and probably also the family's experiences, should be considered if representativeness is aimed for. Future work should address selection bias in other palliative settings and countries, and with prospective recruitment.

  18. Association between underweight and hospitalization, emergency room visits, and mortality among patients in community medical homes

    Directory of Open Access Journals (Sweden)

    Takahashi PY

    2013-01-01

    Full Text Available Paul Y Takahashi.1 Jennifer L St Sauver,2 Timothy C Olson,1 Jill M Huber,1 Stephen S Cha,2 Jon O Ebbert11Division of Primary Care Internal Medicine, 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USABackground: In older adults, underweight (body mass index [BMI] < 18.5 has been associated with increased mortality. This increased mortality risk may be associated with increased health care utilization. We evaluated the relationship between underweight and hospitalization, emergency room visits, and mortality.Methods: An analysis of a retrospective cohort study was conducted at a multisite academic primary care medical practice in Minnesota. The patients were ≥60 years of age, impaneled within primary care on January 1, 2011, and had a BMI measurement recorded between January 1, 2011, and December 31, 2011. Individuals were excluded if they refused review of their medical record. The primary measurement was BMI, which was categorized as underweight (BMI < 18.5 or normal and obese (BMI ≥ 18.5. The outcomes were hospitalization, emergency room visits, and mortality in the 2011 calendar year. Associations between underweight and each outcome were calculated using logistic regression. Interactions between underweight and gender were assessed in the logistic regression models. The final results were adjusted for age, gender, comorbid health conditions, and single living status.Results: The final cohort included 21,019 patients, of whom 220 (1% were underweight. Underweight patients had a higher likelihood of hospitalization compared with patients with higher BMI (adjusted odds ratio [OR] 1.64; 95% confidence interval [CI] 1.21–2.22. Underweight patients were also more likely to visit the emergency room (adjusted OR 1.70; 95% CI 1.28–2.25 or to die (adjusted OR 3.64; 95% CI 2.33–5.69. Men with a BMI < 18.5 compared with those having a BMI ≥ 18.5 had the highest odds of hospitalization (OR 3.45; 95% CI 1.59–7

  19. Development of a new diabetes medication self-efficacy scale and its association with both reported problems in using diabetes medications and self-reported adherence.

    Science.gov (United States)

    Sleath, Betsy; Carpenter, Delesha M; Blalock, Susan J; Davis, Scott A; Hickson, Ryan P; Lee, Charles; Ferreri, Stefanie P; Scott, Jennifer E; Rodebaugh, Lisa B; Cummings, Doyle M

    2016-01-01

    Although there are several different general diabetes self-efficacy scales, there is a need to develop a self-efficacy scale that providers can use to assess patient's self-efficacy regarding medication use. The purpose of this study was to: 1) develop a new diabetes medication self-efficacy scale and 2) examine how diabetes medication self-efficacy is associated with patient-reported problems in using diabetes medications and self-reported adherence. Adult English-speaking patients with type 2 diabetes were recruited from a family medicine clinic and a pharmacy in Eastern North Carolina, USA. The patients were eligible if they reported being nonadherent to their diabetes medicines on a visual analog scale. Multivariable regression was used to examine the relationship between self-efficacy and the number of reported diabetes medication problems and adherence. The diabetes medication self-efficacy scale had strong reliability (Cronbach's alpha =0.86). Among a sample (N=51) of mostly African-American female patients, diabetes medication problems were common (6.1±3.1) and a greater number of diabetes medications were associated with lower medication adherence (odds ratio: 0.35; 95% confidence interval: 0.13, 0.89). Higher medication self-efficacy was significantly related to medication adherence (odds ratio: 1.17; 95% confidence interval: 1.05, 1.30) and inversely related to the number of self-reported medication problems (β=-0.13; P=0.006). Higher diabetes medication self-efficacy was associated with fewer patient-reported medication problems and better medication adherence. Assessing medication-specific self-efficacy may help to identify medication-related problems that providers can help the patients address, potentially improving adherence and patient outcomes.

  20. Development of a new diabetes medication self-efficacy scale and its association with both reported problems in using diabetes medications and self-reported adherence

    Science.gov (United States)

    Sleath, Betsy; Carpenter, Delesha M; Blalock, Susan J; Davis, Scott A; Hickson, Ryan P; Lee, Charles; Ferreri, Stefanie P; Scott, Jennifer E; Rodebaugh, Lisa B; Cummings, Doyle M

    2016-01-01

    Background Although there are several different general diabetes self-efficacy scales, there is a need to develop a self-efficacy scale that providers can use to assess patient’s self-efficacy regarding medication use. The purpose of this study was to: 1) develop a new diabetes medication self-efficacy scale and 2) examine how diabetes medication self-efficacy is associated with patient-reported problems in using diabetes medications and self-reported adherence. Patients and methods Adult English-speaking patients with type 2 diabetes were recruited from a family medicine clinic and a pharmacy in Eastern North Carolina, USA. The patients were eligible if they reported being nonadherent to their diabetes medicines on a visual analog scale. Multivariable regression was used to examine the relationship between self-efficacy and the number of reported diabetes medication problems and adherence. Results The diabetes medication self-efficacy scale had strong reliability (Cronbach’s alpha =0.86). Among a sample (N=51) of mostly African-American female patients, diabetes medication problems were common (6.1±3.1) and a greater number of diabetes medications were associated with lower medication adherence (odds ratio: 0.35; 95% confidence interval: 0.13, 0.89). Higher medication self-efficacy was significantly related to medication adherence (odds ratio: 1.17; 95% confidence interval: 1.05, 1.30) and inversely related to the number of self-reported medication problems (β=−0.13; P=0.006). Conclusion Higher diabetes medication self-efficacy was associated with fewer patient-reported medication problems and better medication adherence. Assessing medication-specific self-efficacy may help to identify medication-related problems that providers can help the patients address, potentially improving adherence and patient outcomes. PMID:27354769

  1. Reporting bias in medical research - a narrative review

    Directory of Open Access Journals (Sweden)

    Kölsch Heike

    2010-04-01

    Full Text Available Abstract Reporting bias represents a major problem in the assessment of health care interventions. Several prominent cases have been described in the literature, for example, in the reporting of trials of antidepressants, Class I anti-arrhythmic drugs, and selective COX-2 inhibitors. The aim of this narrative review is to gain an overview of reporting bias in the medical literature, focussing on publication bias and selective outcome reporting. We explore whether these types of bias have been shown in areas beyond the well-known cases noted above, in order to gain an impression of how widespread the problem is. For this purpose, we screened relevant articles on reporting bias that had previously been obtained by the German Institute for Quality and Efficiency in Health Care in the context of its health technology assessment reports and other research work, together with the reference lists of these articles. We identified reporting bias in 40 indications comprising around 50 different pharmacological, surgical (e.g. vacuum-assisted closure therapy, diagnostic (e.g. ultrasound, and preventive (e.g. cancer vaccines interventions. Regarding pharmacological interventions, cases of reporting bias were, for example, identified in the treatment of the following conditions: depression, bipolar disorder, schizophrenia, anxiety disorder, attention-deficit hyperactivity disorder, Alzheimer's disease, pain, migraine, cardiovascular disease, gastric ulcers, irritable bowel syndrome, urinary incontinence, atopic dermatitis, diabetes mellitus type 2, hypercholesterolaemia, thyroid disorders, menopausal symptoms, various types of cancer (e.g. ovarian cancer and melanoma, various types of infections (e.g. HIV, influenza and Hepatitis B, and acute trauma. Many cases involved the withholding of study data by manufacturers and regulatory agencies or the active attempt by manufacturers to suppress publication. The ascertained effects of reporting bias included the

  2. National Coal Board Medical Service annual report 1980-1981

    Energy Technology Data Exchange (ETDEWEB)

    1982-01-01

    Sections report on: medical examinations and consultations; protection from health hazards such as pneumoconiosis and other prescribed diseases; problems such as vitamin D in the blood of miners, Legionaires' disease, Perthe's disease, rehabilitation and physiotherapy, chemical hazards, public health and hygiene, noise, and the use of visual display units; diseases from coal products such as in coke and tar manufacture; first aid services, morphia, and nursing service; and back pain in the mining industry. A list of staff and their publications is also included.

  3. Factors and Behaviors to Consider when Implementing Patient Centered Medical Home

    Science.gov (United States)

    2014-10-29

    to listen more and not assume that all patients are lacking knowledge regarding basic healthcare and biology/human anatomy and physiology ...MONITOR’S ACRONYM(S) TriService Nursing Research TSNRP Program, 4301 Jones Bridge RD Bethesda, MD 20814 11. SPONSOR/MONITOR’S REPORT NUMBER... Nursing : Knowing which individual characteristics predict important health outcomes will allow targeted interventions to improve outcomes. Nurses need

  4. Campbell Creek Research Homes: FY2013 Annual Performance Report OCT.1, 2012 SEP. 30, 2013

    Energy Technology Data Exchange (ETDEWEB)

    Jackson, Roderick K [ORNL; Boudreaux, Philip R [ORNL; Munk, Jeffrey D [ORNL; Gehl, Anthony C [ORNL; Lyne, Christopher T [ORNL; Odukomaiya, Wale O [ORNL

    2014-05-01

    1.INTRODUCTION AND PROJECT OVERVIEW The Campbell Creek project is funded and managed by the Tennessee Valley Authority (TVA) Technology Innovation, Energy Efficiency, Power Delivery and Utilization Office. Technical support is provided under contract by the Oak Ridge National Laboratory (ORNL) and the Electric Power Research Institute (EPRI). The project was designed to determine the relative energy efficiency of typical new home construction, of retrofitting of existing homes, and of high-performance new homes built from the ground up for energy efficiency. This project was designed to compare three houses that represent current construction practices: a base case (Builder House CC1); a modified house that could represent a major energy-efficient retrofit (Retrofit House CC2); and a house constructed from the ground up to be a high-performance home (High Performance House CC3). To enable a valid comparison, it was necessary to simulate occupancy in all three houses and extensively monitor the structural components and the energy usage by component. In October 2013, the base case was also modified by replacing the builder-grade heating, ventilation, and air-conditioning (HVAC) system with a high-efficiency variable-speed unit. All three houses are two-story, slab-on-grade, framed construction. CC1 and CC2 are approximately 2,400 ft2. CC3 has a pantry option, used primarily as a mechanical equipment room, that adds approximately 100 ft2. All three houses are all-electric (with the exception of a gas log fireplace that is not used during the testing) and use air-source heat pumps for heating and cooling. The three homes are located in Knoxville in the Campbell Creek Subdivision. CC1 and CC2 are next door to each other with a south-facing orientation; CC3 has a north-facing orientation and is located across the street and a couple of houses down. The energy data collected will be used to determine the benefits of retrofit packages and high-performance new home

  5. Non-Space Heating Electrical Consumption in Manufactured Homes: Residential Construction Demonstration Project Cycle II : Final Report.

    Energy Technology Data Exchange (ETDEWEB)

    Onisko, Stephen A.; Roos, Carolyn; Baylon, David

    1993-06-01

    This report summarizes submeter data of the non-space heating electrical energy use in a sample of manufactured homes. These homes were built to Super Good Cents insulation standards in 1988 and 1989 under the auspices of RCDP Cycle 2 of the Bonneville Power Administration. They were designed to incorporate innovations in insulation and manufacturing techniques developed to encourage energy conservation in this important housing type. Domestic water heating (DWH) and other non-space heat energy consumption, however, were not generally affected by RCDP specifications. The purpose of this study is to establish a baseline for energy conservation in these areas and to present a method for estimating total energy saving benefits associated with these end uses. The information used in this summary was drawn from occupant-read submeters and manufacturersupplied specifications of building shell components, appliances and water heaters. Information was also drawn from a field review of ventilation systems and building characteristics. The occupant survey included a census of appliances and occupant behavior in these manufactured homes. A total of 150 manufactured homes were built under this program by eight manufacturers. An additional 35 homes were recruited as a control group. Of the original 185 houses, approximately 150 had some usable submeter data for domestic hot water and 126 had usable submeter data for all other nonheating consumption. These samples were used as the basis for all consumption analysis. The energy use characteristics of these manufactured homes were compared with that of a similar sample of RCDP site-built homes. In general, the manufactured homes were somewhat smaller and had fewer occupants than the site-built homes. The degree to which seasonal variations were present in non-space heat uses was reviewed.

  6. There is no "i" in teamwork in the patient-centered medical home: defining teamwork competencies for academic practice.

    Science.gov (United States)

    Leasure, Emily L; Jones, Ronald R; Meade, Lauren B; Sanger, Marla I; Thomas, Kris G; Tilden, Virginia P; Bowen, Judith L; Warm, Eric J

    2013-05-01

    Evidence suggests that teamwork is essential for safe, reliable practice. Creating health care teams able to function effectively in patient-centered medical homes (PCMHs), practices that organize care around the patient and demonstrate achievement of defined quality care standards, remains challenging. Preparing trainees for practice in interprofessional teams is particularly challenging in academic health centers where health professions curricula are largely siloed. Here, the authors review a well-delineated set of teamwork competencies that are important for high-functioning teams and suggest how these competencies might be useful for interprofessional team training and achievement of PCMH standards. The five competencies are (1) team leadership, the ability to coordinate team members' activities, ensure appropriate task distribution, evaluate effectiveness, and inspire high-level performance, (2) mutual performance monitoring, the ability to develop a shared understanding among team members regarding intentions, roles, and responsibilities so as to accurately monitor one another's performance for collective success, (3) backup behavior, the ability to anticipate the needs of other team members and shift responsibilities during times of variable workload, (4) adaptability, the capability of team members to adjust their strategy for completing tasks on the basis of feedback from the work environment, and (5) team orientation, the tendency to prioritize team goals over individual goals, encourage alternative perspectives, and show respect and regard for each team member. Relating each competency to a vignette from an academic primary care clinic, the authors describe potential strategies for improving teamwork learning and applying the teamwork competences to academic PCMH practices.

  7. Small primary care practices face four hurdles--including a physician-centric mind-set--in becoming medical homes.

    Science.gov (United States)

    Nutting, Paul A; Crabtree, Benjamin F; McDaniel, Reuben R

    2012-11-01

    Transforming small independent practices to patient-centered medical homes is widely believed to be a critical step in reforming the US health care system. Our team has conducted research on improving primary care practices for more than fifteen years. We have found four characteristics of small primary care practices that seriously inhibit their ability to make the transformation to this new care model. We found that small practices were extremely physician-centric, lacked meaningful communication among physicians, were dominated by authoritarian leadership behavior, and were underserved by midlevel clinicians who had been cast into unimaginative roles. Our analysis suggests that in addition to payment reform, a shift in the mind-set of primary care physicians is needed. Unless primary care physicians can adopt new mental models and think in new ways about themselves and their practices, it will be very difficult for them and their practices to create innovative care teams, become learning organizations, and act as good citizens within the health care neighborhood.

  8. Attitudes Toward Collaboration Among Practitioners in Newly Established Medical Homes: A Survey of Nurses, General Practitioners, and Specialists.

    Science.gov (United States)

    Alcusky, Matthew; Ferrari, Luciano; Rossi, Giuseppina; Liu, Mengdan; Hojat, Mohammadreza; Maio, Vittorio

    2016-11-01

    The objective was to evaluate the attitudes toward collaboration of nurses, general practitioners (GPs), and specialists practicing in newly established Medical Homes (MHs) in Parma Local Health Authority (LHA), Emilia-Romagna region, Italy. The 15-item Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered electronically to 172 physicians (66 GPs, 106 specialists) and 113 nurses practicing in 12 MHs. In all, 191 surveys (45 GPs, 59 specialists, 87 nurses) were completed (67% response rate). The mean total score among nurses (51.5, standard deviation [SD] = 3.7) reflected a significantly (P < .01) more positive attitude toward collaboration compared with GPs (47.8, SD = 4.6) and specialists (45.3, SD = 7.7). Discrepancies in attitudes are concerning because conflicting perceptions of professional roles may impede a successful transition to integrated care within MHs in Parma LHA. Internationally, further research into understanding interprofessional relationships within MHs is needed to inform policy and build a necessary culture of team-based care. © The Author(s) 2015.

  9. Veteran family reintegration, primary care needs, and the benefit of the patient-centered medical home model.

    Science.gov (United States)

    Hinojosa, Ramon; Hinojosa, Melanie Sberna; Nelson, Karen; Nelson, David

    2010-01-01

    Men and women returning from the wars in Afghanistan and Iraq face a multitude of difficulties while integrating back into civilian life, but the importance of their veteran status is often overlooked in primary care settings. Family physicians have the potential to be the first line of defense to ensure the well-being of veterans and their families because many will turn to nonmilitary and non-Veterans Affairs providers for health care needs. An awareness of the unique challenges faced by this population is critical to providing care. A patient-centered medical home orientation can help the family physician provide veterans and their families the care they need. Specific recommendations for family physicians include screening their patient population; providing timely care; treating the whole family; and integrating care from multiple disciplines and specialties, providing veterans and families with "one-stop shopping" care. An awareness of the unique challenges faced by veterans and their families translates into better overall outcomes for this population.

  10. 76 FR 44086 - Agency Information Collection (Report of Medical Examination for Disability Evaluation) Activity...

    Science.gov (United States)

    2011-07-22

    ... AFFAIRS Agency Information Collection (Report of Medical Examination for Disability Evaluation) Activity.... 2900-0052.'' SUPPLEMENTARY INFORMATION: Title: Report of Medical Examination for Disability Evaluation... submit the collection of information abstracted below to the Office of Management and Budget (OMB)...

  11. Triggered by Medication Used in Dental Procedures: A Case Report

    Directory of Open Access Journals (Sweden)

    Aristo Vojdani

    2012-01-01

    Full Text Available Enhanced intestinal permeability and food sensitivity are two of the many proven causes of gastrointestinal disorders. This present report describes a woman with no previous gastrointestinal (GI complaints, who underwent dental root canal, bone graft, and implant procedures. Postsurgery she experienced an allergic reaction to the combined medications. In the weeks that followed, she presented with multiple food intolerances. Four weeks after the final dental procedure, she was assessed serologically for mucosal immune function, salivary, and blood-gluten reactivity, intestinal permeability, and other food sensitivities. Compared to her test reports from two months prior to her first dental procedure, the patient’s results showed high total secretory IgA (SIgA and elevated salivary antibodies to alpha-gliadin, indicating abnormal mucosal immunity and loss of tolerance to gluten. Her serologic assessments revealed immunoglobulin G (IgG and IgA antibodies to a range of wheat/gluten proteins and peptides, gut bacterial endotoxins and tight junction proteins. These test results indicate gut dysbiosis, enhanced intestinal permeability, systemic gluten-reactivity, and immune response to other dietary macromolecules. The present case suggests that patients who experience severe allergic or pseudoallergic reactions to medication should be assessed and monitored for gut dysfunction. If left untreated this could lead to autoimmune reactions to self tissues.

  12. Website design: technical, social and medical issues for self-reporting by elderly patients.

    Science.gov (United States)

    Taylor, Mark J; Stables, Rod; Matata, Bashir; Lisboa, Paulo J G; Laws, Andy; Almond, Peter

    2014-06-01

    There is growing interest in the use of the Internet for interacting with patients, both in terms of healthcare information provision and information gathering. In this article, we examine the issues in designing healthcare websites for elderly users. In particular, this article uses a year-long case study of the development of a web-based system for self-reporting of symptoms and quality of life with a view to examine the issues relating to website design for elderly users. The issues identified included the technical, social and medical aspects of website design for elderly users. The web-based system developed was based on the European Quality of Life 5-Dimensions health-status questionnaire, a commonly used tool for patient self-reporting of quality of life, and the more specific coronary revascularisation outcome questionnaire. Currently, self-reporting is generally administered in the form of paper-based questionnaires to be completed in the outpatient clinic or at home. There are a variety of issues relating to elderly users, which imply that websites for elderly patients may involve different design considerations to other types of websites.

  13. Medication incidents related to automated dose dispensing in community pharmacies and hospitals--a reporting system study.

    Science.gov (United States)

    Cheung, Ka-Chun; van den Bemt, Patricia M L A; Bouvy, Marcel L; Wensing, Michel; De Smet, Peter A G M

    2014-01-01

    Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers. Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident.

  14. Exploring patients' reasons for participation in a medical education home visit program: a qualitative study in Malaysia.

    Science.gov (United States)

    Tan, Chai-Eng; Jaffar, Aida; Tohit, Noorlaili; Hamzah, Zuhra; Hashim, Syahnaz Mohd

    2017-06-01

    Direct contact with patients for medical education is essential in healthcare professional training. Patients who were recruited for a medical education home visit program in Malaysia did so on a voluntary basis without remuneration. This paper aims to explore their reasons for participation in this program. An exploratory qualitative study was conducted on patients who had been visited during the 2012/2013 academic session. Purposive sampling was done to select adult participants from varying ethnicities and ages from the list of patients. In-depth interviews were conducted at the participants' homes and were audio recorded. The transcripts of these interviews were analyzed using thematic analysis. A total of nine in-depth interviews were conducted. Four main themes were identified from thematic analysis: 1) Perceived meaning of the visit; 2) Perceived benefits and risks; 3) Past healthcare experiences; 4) Availability for visits. The home visits meant different things to different participants, including a teaching-learning encounter, a social visit, a charitable deed or a healthcare check-up. The benefits and risks of accepting unknown students to their homes and sharing their health issues with them had been weighed prior to participation. Prior experience with healthcare services such as gratitude to healthcare providers or having a relative in the healthcare profession increased their receptivity for involvement. Lastly, enabling factors such as availability of time would determine their acceptance for home visits. Patients agree to participate in medical education activities on a voluntary basis for various reasons. Providing good healthcare service and sufficient preparation are crucial to increase patient receptivity for such activities.

  15. Stroke and Nursing Home care: a national survey of nursing homes.

    LENUS (Irish Health Repository)

    Cowman, Seamus

    2010-01-01

    BACKGROUND: Although stroke is recognised as a major factor in admission to nursing home care, data is lacking on the extent and nature of the disabilities and dependency in nursing homes arising from stroke. A national study conducted in nursing homes can quantify the number of residents with stroke in nursing homes, their disability and levels of dependency. METHODS: A cross-sectional survey research design was used. A total of 572 public and private nursing homes were identified nationally and a stratified random selection of 60 nursing homes with 3,239 residents was made. In half of the nursing homes (n = 30) efforts were made to interview all residents with stroke Survey instruments were used to collect data from residents with stroke and nursing home managers on demography, patient disability, and treatment. RESULTS: Across all nursing homes (n = 60), 18% (n = 570) of the residents had previously had a stroke. In homes (n = 30), where interviews with residents with stroke (n = 257), only 7% (n = 18) residents were capable of answering for themselves and were interviewed. Data on the remaining 93% (n = 239) residents were provided by the nursing home manager. Nurse Managers reported that 73% of residents with stroke had a high level of dependency. One in two residents with stroke was prescribed antidepressants or sedative medication. Only 21% of stroke residents were prescribed anticoagulants, 42% antiplatelets, and 36% cholesterol lowering medications. Stroke rehabilitation guidelines were lacking and 68% reported that there was no formal review process in place. CONCLUSIONS: This study provides seminal findings on stroke and nursing home services in Ireland. We now know that one in six nursing home residents in a national survey are residents with a stroke, and have a wide range of disabilities. There is currently little or no structured care (beyond generic care) for stroke survivors who reside in nursing homes in Ireland.

  16. Stroke and Nursing Home care: a national survey of nursing homes

    Directory of Open Access Journals (Sweden)

    McGee Hannah

    2010-01-01

    Full Text Available Abstract Background Although stroke is recognised as a major factor in admission to nursing home care, data is lacking on the extent and nature of the disabilities and dependency in nursing homes arising from stroke. A national study conducted in nursing homes can quantify the number of residents with stroke in nursing homes, their disability and levels of dependency. Methods A cross-sectional survey research design was used. A total of 572 public and private nursing homes were identified nationally and a stratified random selection of 60 nursing homes with 3,239 residents was made. In half of the nursing homes (n = 30 efforts were made to interview all residents with stroke Survey instruments were used to collect data from residents with stroke and nursing home managers on demography, patient disability, and treatment. Results Across all nursing homes (n = 60, 18% (n = 570 of the residents had previously had a stroke. In homes (n = 30, where interviews with residents with stroke (n = 257, only 7% (n = 18 residents were capable of answering for themselves and were interviewed. Data on the remaining 93% (n = 239 residents were provided by the nursing home manager. Nurse Managers reported that 73% of residents with stroke had a high level of dependency. One in two residents with stroke was prescribed antidepressants or sedative medication. Only 21% of stroke residents were prescribed anticoagulants, 42% antiplatelets, and 36% cholesterol lowering medications. Stroke rehabilitation guidelines were lacking and 68% reported that there was no formal review process in place. Conclusions This study provides seminal findings on stroke and nursing home services in Ireland. We now know that one in six nursing home residents in a national survey are residents with a stroke, and have a wide range of disabilities. There is currently little or no structured care (beyond generic care for stroke survivors who reside in nursing homes in Ireland.

  17. Acceptability of Home-Assessment Post Medical Abortion and Medical Abortion in a Low-Resource Setting in Rajasthan, India. Secondary Outcome Analysis of a Non-Inferiority Randomized Controlled Trial

    Science.gov (United States)

    Paul, Mandira; Iyengar, Kirti; Essén, Birgitta; Gemzell-Danielsson, Kristina; Iyengar, Sharad D.; Bring, Johan; Soni, Sunita; Klingberg-Allvin, Marie

    2015-01-01

    Background Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective To investigate women’s acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Design Secondary outcome of a randomised, controlled, non-inferiority trial. Setting Outpatient primary health care clinics in rural and urban Rajasthan, India. Population Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1:1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Main Outcome Measures Women’s acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. Results 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82

  18. Acceptability of Home-Assessment Post Medical Abortion and Medical Abortion in a Low-Resource Setting in Rajasthan, India. Secondary Outcome Analysis of a Non-Inferiority Randomized Controlled Trial.

    Science.gov (United States)

    Paul, Mandira; Iyengar, Kirti; Essén, Birgitta; Gemzell-Danielsson, Kristina; Iyengar, Sharad D; Bring, Johan; Soni, Sunita; Klingberg-Allvin, Marie

    2015-01-01

    Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Secondary outcome of a randomised, controlled, non-inferiority trial. Outpatient primary health care clinics in rural and urban Rajasthan, India. Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1:1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as

  19. Family physicians' ability to perform population management is associated with adoption of other aspects of the patient-centered medical home.

    Science.gov (United States)

    Ottmar, Jessica; Blackburn, Brenna; Phillips, Robert L; Peterson, Lars E; Jaén, Carlos Roberto

    2015-04-01

    The patient-centered medical home (PCMH) model is considered a promising approach to improving population health, but how elements of these advanced practice models relate to population health capability is unknown. To measure associations between family physicians' performance of population management with PCMH components, a cross-sectional survey was conducted with physicians accessing the American Board of Family Medicine Web site in 2011. Bivariate analysis and logistic regression tested associations between physician and practice demographics and specific PCMH features. The primary outcome was performance of population management. The final sample included 3855 physicians, 37.3% of whom reported performing population management. Demographic characteristics significantly associated with greater use of population management were female sex and graduation from an international medical school. PCMH components that remained associated with population management after adjustment were access to clinical case managers (odds ratio [OR]=2.01, 95% confidence interval [95% CI]: 1.69, 2.39), behavioral health collaboration (OR=1.49, 95% CI: 1.26, 1.77), having an electronic health record that supports meaningful use (OR=1.47, 95% CI: 1.25, 1.74), recent participation in a quality improvement project (OR=2.47, 95% CI: 2.12, 2.89), and routine measurement of patient difficulty securing an appointment (OR=2.87, 95% CI: 2.45, 3.37). Performance of population management was associated with several PCMH elements and resources not present in traditional primary care offices. Attention to these elements likely will enhance delivery of population management services in primary care.

  20. Nursing home administrators' perspectives on a study feedback report: a cross sectional survey.

    Science.gov (United States)

    Boström, Anne-Marie; Cranley, Lisa A; Hutchinson, Alison M; Cummings, Greta G; Norton, Peter G; Estabrooks, Carole A

    2012-09-13

    This project is part of the Translating Research in Elder Care (TREC) program of research, a multi-level and longitudinal research program being conducted in 36 nursing homes in three Canadian Prairie Provinces. The overall goal of TREC is to improve the quality of care for older persons living in nursing homes and the quality of work life for care providers. The purpose of this paper is to report on development and evaluation of facility annual reports (FARs) from facility administrators' perspectives on the usefulness, meaningfulness, and understandability of selected data from the TREC survey. A cross sectional survey design was used in this study. The feedback reports were developed in collaboration with participating facility administrators. FARs presented results in four contextual areas: workplace culture, feedback processes, job satisfaction, and staff burnout. Six weeks after FARs were mailed to each administrator, we conducted structured telephone interviews with administrators to elicit their evaluation of the FARs. Administrators were also asked if they had taken any actions as a result of the FAR. Descriptive and inferential statistics, as well as content analysis for open-ended questions, were used to summarize findings. Thirty-one facility administrators (representing thirty-two facilities) participated in the interviews. Six administrators had taken action and 18 were planning on taking action as a result of FARs. The majority found the four contextual areas addressed in FAR to be useful, meaningful, and understandable. They liked the comparisons made between data from years one and two and between their facility and other TREC study sites in their province. Twenty-two indicated that they would like to receive information on additional areas such as aggressive behaviours of residents and information sharing. Twenty-four administrators indicated that FARs contained enough information, while eight found FARs 'too short'. Administrators who reported

  1. Nursing home administrators’ perspectives on a study feedback report: a cross sectional survey

    Directory of Open Access Journals (Sweden)

    Boström Anne-Marie

    2012-09-01

    Full Text Available Abstract Background This project is part of the Translating Research in Elder Care (TREC program of research, a multi-level and longitudinal research program being conducted in 36 nursing homes in three Canadian Prairie Provinces. The overall goal of TREC is to improve the quality of care for older persons living in nursing homes and the quality of work life for care providers. The purpose of this paper is to report on development and evaluation of facility annual reports (FARs from facility administrators’ perspectives on the usefulness, meaningfulness, and understandability of selected data from the TREC survey. Methods A cross sectional survey design was used in this study. The feedback reports were developed in collaboration with participating facility administrators. FARs presented results in four contextual areas: workplace culture, feedback processes, job satisfaction, and staff burnout. Six weeks after FARs were mailed to each administrator, we conducted structured telephone interviews with administrators to elicit their evaluation of the FARs. Administrators were also asked if they had taken any actions as a result of the FAR. Descriptive and inferential statistics, as well as content analysis for open-ended questions, were used to summarize findings. Results Thirty-one facility administrators (representing thirty-two facilities participated in the interviews. Six administrators had taken action and 18 were planning on taking action as a result of FARs. The majority found the four contextual areas addressed in FAR to be useful, meaningful, and understandable. They liked the comparisons made between data from years one and two and between their facility and other TREC study sites in their province. Twenty-two indicated that they would like to receive information on additional areas such as aggressive behaviours of residents and information sharing. Twenty-four administrators indicated that FARs contained enough information, while eight

  2. Division of Biological and Medical Research annual report 1978

    Energy Technology Data Exchange (ETDEWEB)

    Rosenthal, M.W. (ed.)

    1978-01-01

    The research during 1978 in the Division of Biological and Medical Research, Argonne National Laboratory, is summarized. Studies related to nuclear energy include responses of beagles to continuous low-level /sup 60/Co gamma radiation, and development of leukemic indicators; comparison of lifetime effects in mice of low-level neutron and /sup 60/Co gamma radiation; genetic effects of high LET radiations; and metabolic and therapeutic studies of heavy metals. Studies of nonnuclear energy sources deal with characterization and toxicological evaluation of effluents of fluidized bed combustion and coal gasification; electrical storage systems; electric fields associated with energy transmission; and development of population projection models and assessment of human risk. Basic research studies include fundamental structural and biophysical investigations; circadian rhythms; mutagenesis in bacteria and mammalian cells; cell killing, damage, and repair in mammalian cells; carcinogenesis and cocarcinogenesis; the use of liposomes as biological carriers; and studies of environmental influences on life-span, physiological performance, and circadian cycles. In the area of medical development, proteins in urine and tissues of normal and diseased humans are analyzed, and advanced analytical procedures for use of stable isotopes in clinical research and diagnosis are developed and applied. The final sections of the report cover support facilities, educational activities, the seminar program, staff talks, and staff publications.

  3. Relationship between staff-reported culture change and occupancy rate and organizational commitment among nursing homes in South Korea.

    Science.gov (United States)

    Lee, Minhong; Choi, Jae-Sung; Lim, Jinseop; Kim, Young Sun

    2013-04-01

    This study aims to examine culture change in nursing homes in South Korea and to identify the outcomes of culture change implementation. Data were taken from survey responses from 223 top- or mid-level staff among nursing homes in South Korea that were selected through a proportionate random-stratified sampling method from four regions nationwide. Culture change in nursing homes was operationalized by five person-directed care (PDC) constructs and three organizational environment constructs, and outcome quality was indicated by changes to occupancy rate and organizational commitment. After controlling for facility characteristics, the effect of staff-reported culture change on occupancy rate and organizational commitment was analyzed through the multiple-regression method. Consistent with previous research, this study revealed positive effects of culture change for nursing homes in South Korea. The study found that staff-reported culture change correlated with occupancy rate and organizational commitment. Given that culture change variables were significantly related to occupancy rate and organizational commitment, the findings of the study provide a persuasive argument that policies and/or programs to support culture change in nursing homes should be enhanced. Management-level workers in these facilities should have the skills and knowledge to foster more PDC and a more person-directed environment.

  4. Becoming a patient-centered medical home: a 9-year transition for a network of Federally Qualified Health Centers.

    Science.gov (United States)

    Calman, Neil S; Hauser, Diane; Weiss, Linda; Waltermaurer, Eve; Molina-Ortiz, Elizabeth; Chantarat, Tongtan; Bozack, Anne

    2013-01-01

    The patient-centered medical home (PCMH) model has great potential for optimizing the care of chronically ill patients, yet there is much to be learned about various implementations of this model and their impact on patient care processes and outcomes. We examined changes in patterns of health care use in a network of Federally Qualified Health Centers throughout a 9-year period of practice transformation that included recognition of all centers by the National Committee for Quality Assurance (NCQA) as Level 3 PCMH practices. We analyzed deidentified data from electronic health records for the period 2003 to 2011 to identify patterns of service use for all 4,595 patients with diabetes. We also examined a subsample of 545 patients who were in care throughout the study period to track improvement in glycated hemoglobin levels as a clinical measure over time. Through the transition to a PCMH, the mean number of encounters with outreach, diabetes educators, and psychosocial services increased for all diabetic patients; virtually all patients had visits with a primary care clinician, but the mean number of visits decreased slightly. Among patients in the subsample, mean annual levels of glycated hemoglobin decreased steadily during the 9-year study period, mainly driven by a reduction in patients having baseline levels exceeding 9%. This retrospective study conducted in a real-world setting using electronic health record data demonstrates a shift in resource use by diabetic patients from the primary care clinician to other members of the care team. The findings suggest that PCMH implementation has the potential to alter processes of care and improve outcomes of care, especially among those with higher disease burden.

  5. Use of RE-AIM to develop a multi-media facilitation tool for the patient-centered medical home

    Directory of Open Access Journals (Sweden)

    Glasgow Russell E

    2011-10-01

    Full Text Available Abstract Background Much has been written about how the medical home model can enhance patient-centeredness, care continuity, and follow-up, but few comprehensive aids or resources exist to help practices accomplish these aims. The complexity of primary care can overwhelm those concerned with quality improvement. Methods The RE-AIM planning and evaluation model was used to develop a multimedia, multiple-health behavior tool with psychosocial assessment and feedback features to facilitate and guide patient-centered communication, care, and follow-up related to prevention and self-management of the most common adult chronic illnesses seen in primary care. Results The Connection to Health Patient Self-Management System, a web-based patient assessment and support resource, was developed using the RE-AIM factors of reach (e.g., allowing input and output via choice of different modalities, effectiveness (e.g., using evidence-based intervention strategies, adoption (e.g., assistance in integrating the system into practice workflows and permitting customization of the website and feedback materials by practice teams, implementation (e.g., identifying and targeting actionable priority behavioral and psychosocial issues for patients and teams, and maintenance/sustainability (e.g., integration with current National Committee for Quality Assurance recommendations and clinical pathways of care. Connection to Health can work on a variety of input and output platforms, and assesses and provides feedback on multiple health behaviors and multiple chronic conditions frequently managed in adult primary care. As such, it should help to make patient-healthcare team encounters more informed and patient-centered. Formative research with clinicians indicated that the program addressed a number of practical concerns and they appreciated the flexibility and how the Connection to Health program could be customized to their office. Conclusions This primary care practice

  6. Measurement of overall quality of life in nursing homes through self report : the role of cognitive impairment

    NARCIS (Netherlands)

    Gerritsen, Debby Lydia; Steverink, Nardi; Ooms, Marcel E.; de Vet, Henrica C. W.; Ribbe, Miel W.

    2007-01-01

    Measuring quality of life is a necessity for adequate interventions. This paper concerns the usefulness of six self-report measures for overall quality of life for nursing home residents with various levels of cognitive impairment. It was investigated which proportion of residents from four cognitio

  7. Building America FY 2016 Annual Report: Building America Is Driving Real Solutions in the Race to Zero Energy Homes -- Appendix

    Energy Technology Data Exchange (ETDEWEB)

    Farrar, Sara [National Renewable Energy Lab. (NREL), Golden, CO (United States); Rothgeb, Stacey [National Renewable Energy Lab. (NREL), Golden, CO (United States); Polly, Ben [National Renewable Energy Lab. (NREL), Golden, CO (United States); Earle, Lieko [National Renewable Energy Lab. (NREL), Golden, CO (United States); Merrigan, Tim [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2017-01-01

    This document is a set of appendices presenting technical discussion and references as a companion to the 'Building America FY 2016 Annual Report: Building America Is Driving Real Solutions in the Race to Zero Energy Homes' publication.

  8. Measurement of overall quality of life in nursing homes through self report : the role of cognitive impairment

    NARCIS (Netherlands)

    Gerritsen, Debby Lydia; Steverink, Nardi; Ooms, Marcel E.; de Vet, Henrica C. W.; Ribbe, Miel W.

    Measuring quality of life is a necessity for adequate interventions. This paper concerns the usefulness of six self-report measures for overall quality of life for nursing home residents with various levels of cognitive impairment. It was investigated which proportion of residents from four

  9. Building America FY 2016 Annual Report: Building America Is Driving Real Solutions in the Race to Zero Energy Homes -- Appendix

    Energy Technology Data Exchange (ETDEWEB)

    Sara Farrar, Stacey Rothgeb, Ben Polly, Lieko Earle, Tim Merrigan

    2017-01-01

    This document is a set of appendices presenting technical discussion and references as a companion to the 'Building America FY 2016 Annual Report: Building America Is Driving Real Solutions in the Race to Zero Energy Homes' publication.

  10. Internationalisation at Home in a Global Perspective: A critical Survey of the 3rd Global Survey Report of IAU

    NARCIS (Netherlands)

    Beelen, J.

    2011-01-01

    This article takes the 3rd Global Survey Report of the International Association of Universities (IAU) as a starting point. The results of this worldwide survey were published in September 2010. The article discusses four questions from the survey that include internationalisation at Home (IaH) and

  11. Measurement of overall quality of life in nursing homes through self report : the role of cognitive impairment

    NARCIS (Netherlands)

    Gerritsen, Debby Lydia; Steverink, Nardi; Ooms, Marcel E.; de Vet, Henrica C. W.; Ribbe, Miel W.

    2007-01-01

    Measuring quality of life is a necessity for adequate interventions. This paper concerns the usefulness of six self-report measures for overall quality of life for nursing home residents with various levels of cognitive impairment. It was investigated which proportion of residents from four cognitio

  12. Case reports in medical education: a platform for training medical students, residents, and fellows in scientific writing and critical thinking.

    Science.gov (United States)

    Florek, Aleksandra G; Dellavalle, Robert P

    2016-04-06

    A case report is a detailed narrative that usually illustrates a diagnostic or therapeutic problem experienced by one or several patients. Case reports commonly serve as the first line of evidence for new interventions or they function as alarms that an issue exists with an already established therapy. Case reports are of minor importance in evidence-based medicine; however, they make meaningful contributions to both the knowledge and education of medical students, residents, and fellows. Case reports are written with the goal of sharing information for medical, scientific, or educational purposes. They often serve as medical or even undergraduate students' first experience with medical writing and they provide a solid foundation for manuscript preparation and publication. In the last few decades, there has been an exponential increase in medical student research, specifically in the number of manuscripts published by medical students. It is important to foster this academic spirit among students by encouraging them to become involved in research. This editorial will focus on the value and educational benefits of writing case reports for medical students, university students, residents, and fellows.

  13. British Coal Medical Service annual report 1989-90

    Energy Technology Data Exchange (ETDEWEB)

    1990-01-01

    The report contains detailed results of surveys on the prevalence of pneumoconiosis in coal miners of various age groups from 1962 to 1989. Only 0.6% of 14,300 men X-rayed in 1989 showed any sign of the disease and the overall figure for the 112 collieries surveyed after the completed seventh round of surveys was 0.7%. Emphasis has continued on dust control measures on coal faces and in drivages - dust concentration of 3.1 mg/m {sup 3} in 1989-90 was in keeping with the trend since 1970. A 'cohort' of young miners is being monitored to develop an early warning system to identify changes in the incidence of pneumoconiosis. The role of Medical Service in treating injuries, skin diseases, back pain etc. and problems caused by noise and chemicals is explained. Continued attention has been paid to implication of the COSHH regulations and audiometry has been introduced to all British Coal's employees. Services are now provided to workers of Coal Products Ltd. Reports of first aid and nursing services are included. Use of pethidine for relieving pain is now being advocated. 6 figs., 20 tabs.

  14. 10 CFR 35.3045 - Report and notification of a medical event.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Report and notification of a medical event. 35.3045... Report and notification of a medical event. (a) A licensee shall report any event, except for an event... migrated outside the treatment site). (b) A licensee shall report any event resulting from intervention of...

  15. Medical Surveillance Monthly Report (MSMR). Volume 15, Number 6, July-August 2008

    Science.gov (United States)

    2008-08-01

    laboratory specialist; cytology specialist; hemodialysis technician; medical, histopathology, cytotechnology apprentice, journeyman, or craftsman; iv...reported by August 7, 2007 and 2008 †Seventy medical events/conditions specified by Tri-Service Reportable Events Guidelines and Case Definitions , May...Service Reportable Events Guidelines and Case Definitions , May 2004. Note: Completeness and timeliness of reporting vary by facility. JULY – AUGUST

  16. Maternal Reports of Home Literacy Experiences in Multilingual Mauritius: A Case Study of Pre-Schoolers

    Science.gov (United States)

    Auleear Owodally, Ambarin Mooznah

    2014-01-01

    While the extant literature has highlighted the important contribution of home literacy experiences to early literacy development, limited research has been carried out among children living in postcolonial contexts, where there is a mismatch between the home and school language. Such is the case of Mauritius. The present exploratory case study…

  17. Inservice Education: Consultation and Related Services for Nursing Home Personnel. Final Report.

    Science.gov (United States)

    United Hospital Fund of New York, NY.

    A project to demonstrate how a team of instructor/consultants could function on a regional basis to help upgrade inservice education programs in nursing homes was conducted. The design of this Nursing Home Training Program was structured to allow for changes in demonstrated services in accordance with reactions of participants. An advisory and an…

  18. Emergency Medical Services Perspectives on Identifying and Reporting Victims of Elder Abuse, Neglect, and Self-Neglect.

    Science.gov (United States)

    Rosen, Tony; Lien, Cynthia; Stern, Michael E; Bloemen, Elizabeth M; Mysliwiec, Regina; McCarthy, Thomas J; Clark, Sunday; Mulcare, Mary R; Ribaudo, Daniel S; Lachs, Mark S; Pillemer, Karl; Flomenbaum, Neal E

    2017-07-13

    Emergency Medical Services (EMS) providers, who perform initial assessments of ill and injured patients, often in a patient's home, are uniquely positioned to identify potential victims of elder abuse, neglect, or self-neglect. Despite this, few organized programs exist to ensure that EMS concerns are communicated to or further investigated by other health care providers, social workers, or the authorities. To explore attitudes and self-reported practices of EMS providers surrounding identification and reporting of elder mistreatment. Five semi-structured focus groups with 27 EMS providers. Participants reported believing they frequently encountered and were able to identify potential elder mistreatment victims. Many reported infrequently discussing their concerns with other health care providers or social workers and not reporting them to the authorities due to barriers: 1) lack of EMS protocols or training specific to vulnerable elders; 2) challenges in communication with emergency department providers, including social workers, who are often unavailable or not receptive; 3) time limitations; and 4) lack of follow-up when EMS providers do report concerns. Many participants reported interest in adopting protocols to assist in elder protection. Additional strategies included photographically documenting the home environment, additional training, improved direct communication with social workers, a dedicated location on existing forms or new form to document concerns, a reporting hotline, a system to provide feedback to EMS, and community paramedicine. EMS providers frequently identify potential victims of elder abuse, neglect, and self-neglect, but significant barriers to reporting exist. Strategies to empower EMS providers and improve reporting were identified. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Identifying medication error chains from critical incident reports: a new analytic approach.

    Science.gov (United States)

    Huckels-Baumgart, Saskia; Manser, Tanja

    2014-10-01

    Research into the distribution of medication errors usually focuses on isolated stages within the medication use process. Our study aimed to provide a novel process-oriented approach to medication incident analysis focusing on medication error chains. Our study was conducted across a 900-bed teaching hospital in Switzerland. All reported 1,591 medication errors 2009-2012 were categorized using the Medication Error Index NCC MERP and the WHO Classification for Patient Safety Methodology. In order to identify medication error chains, each reported medication incident was allocated to the relevant stage of the hospital medication use process. Only 25.8% of the reported medication errors were detected before they propagated through the medication use process. The majority of medication errors (74.2%) formed an error chain encompassing two or more stages. The most frequent error chain comprised preparation up to and including medication administration (45.2%). "Non-consideration of documentation/prescribing" during the drug preparation was the most frequent contributor for "wrong dose" during the administration of medication. Medication error chains provide important insights for detecting and stopping medication errors before they reach the patient. Existing and new safety barriers need to be extended to interrupt error chains and to improve patient safety.

  20. Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units.

    Science.gov (United States)

    Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B

    Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.

  1. Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)

    NARCIS (Netherlands)

    Chalmers, J. R.; Simpson, E.; Apfelbacher, C. J.; Thomas, K. S.; von Kobyletzki, L.; Schmitt, J.; Singh, J. A.; Svensson, A.; Williams, H. C.; Abuabara, K.; Aoki, V.; Ardeleanu, M.; Awici-Rasmussen, M.; Barbarot, S.; Berents, T. L.; Block, J.; Bragg, A.; Burton, T.; Clemmensen, K. K. Bjerring; Creswell-Melville, A.; Dinesen, M.; Drucker, A.; Eckert, L.; Flohr, C.; Garg, M.; Gerbens, L. A. A.; Graff, A. L. B.; Hanifin, J.; Heinl, D.; Humphreys, R.; Ishii, H. A.; Kataoka, Y.; Leshem, Y. A.; Marquort, B.; Massuel, M. -A.; Merhand, S.; Mizutani, H.; Murota, H.; Murrell, D. F.; Nakahara, T.; Nasr, I.; Nograles, K.; Ohya, Y.; Osterloh, I.; Pander, Jan; Prinsen, C.; Purkins, L.; Ridd, M.; Sach, T.; Schuttelaar, M. -L. A.; Shindo, S.; Smirnova, J.; Sulzer, A.; Gjerde, E. Synnove; Takaoka, R.; Talmo, H. Vestby; Tauber, M.; Torchet, F.; Volke, A.; Wahlgren, C. -F.; Weidinger, S.; Weisshaar, E.; Wollenberg, A.; Yamaga, K.; Zhao, C. Y.; Spuls, P. I.

    This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in Malmo, Sweden on 23-24 April 2015 (HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient-reported symptoms and

  2. Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)

    DEFF Research Database (Denmark)

    Chalmers, J. R.; Simpson, Elizabeth M; Apfelbacher, C. J.

    2016-01-01

    This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in Malmö, Sweden on 23–24 April 2015 (HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient-reported symptoms and q...

  3. Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)

    NARCIS (Netherlands)

    Chalmers, J. R.; Simpson, E.; Apfelbacher, C. J.; Thomas, K. S.; von Kobyletzki, L.; Schmitt, J.; Singh, J. A.; Svensson, A.; Williams, H. C.; Abuabara, K.; Aoki, V.; Ardeleanu, M.; Awici-Rasmussen, M.; Barbarot, S.; Berents, T. L.; Block, J.; Bragg, A.; Burton, T.; Clemmensen, K. K. Bjerring; Creswell-Melville, A.; Dinesen, M.; Drucker, A.; Eckert, L.; Flohr, C.; Garg, M.; Gerbens, L. A. A.; Graff, A. L. B.; Hanifin, J.; Heinl, D.; Humphreys, R.; Ishii, H. A.; Kataoka, Y.; Leshem, Y. A.; Marquort, B.; Massuel, M. -A.; Merhand, S.; Mizutani, H.; Murota, H.; Murrell, D. F.; Nakahara, T.; Nasr, I.; Nograles, K.; Ohya, Y.; Osterloh, I.; Pander, Jan; Prinsen, C.; Purkins, L.; Ridd, M.; Sach, T.; Schuttelaar, M. -L. A.; Shindo, S.; Smirnova, J.; Sulzer, A.; Gjerde, E. Synnove; Takaoka, R.; Talmo, H. Vestby; Tauber, M.; Torchet, F.; Volke, A.; Wahlgren, C. -F.; Weidinger, S.; Weisshaar, E.; Wollenberg, A.; Yamaga, K.; Zhao, C. Y.; Spuls, P. I.

    2016-01-01

    This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in Malmo, Sweden on 23-24 April 2015 (HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient-reported symptoms and qual

  4. Measuring diversity in medical reports based on categorized attributes and international classification systems

    Directory of Open Access Journals (Sweden)

    Přečková Petra

    2012-04-01

    Full Text Available Abstract Background Narrative medical reports do not use standardized terminology and often bring insufficient information for statistical processing and medical decision making. Objectives of the paper are to propose a method for measuring diversity in medical reports written in any language, to compare diversities in narrative and structured medical reports and to map attributes and terms to selected classification systems. Methods A new method based on a general concept of f-diversity is proposed for measuring diversity of medical reports in any language. The method is based on categorized attributes recorded in narrative or structured medical reports and on international classification systems. Values of categories are expressed by terms. Using SNOMED CT and ICD 10 we are mapping attributes and terms to predefined codes. We use f-diversities of Gini-Simpson and Number of Categories types to compare diversities of narrative and structured medical reports. The comparison is based on attributes selected from the Minimal Data Model for Cardiology (MDMC. Results We compared diversities of 110 Czech narrative medical reports and 1119 Czech structured medical reports. Selected categorized attributes of MDMC had mostly different numbers of categories and used different terms in narrative and structured reports. We found more than 60% of MDMC attributes in SNOMED CT. We showed that attributes in narrative medical reports had greater diversity than the same attributes in structured medical reports. Further, we replaced each value of category (term used for attributes in narrative medical reports by the closest term and the category used in MDMC for structured medical reports. We found that relative Gini-Simpson diversities in structured medical reports were significantly smaller than those in narrative medical reports except the "Allergy" attribute. Conclusions Terminology in narrative medical reports is not standardized. Therefore it is nearly

  5. 77 FR 55221 - Agency Information Collection Activities: Report of Medical Examination and Vaccination Record...

    Science.gov (United States)

    2012-09-07

    ... Medical Examination and Vaccination Record, Form I-693; Revision of a Currently Approved Collection ACTION...: Report of Medical Examination and Vaccination Record. (3) Agency form number, if any, and the...

  6. Family physicians' effort to stay in charge of the medical treatment when patients have home care by district nurses. A grounded theory study

    Directory of Open Access Journals (Sweden)

    Hylander Ingrid

    2009-06-01

    Full Text Available Abstract Background District nurses (DNs provide home care for old persons with a mixture of chronic diseases, symptoms and reduced functional ability. Family physicians (FPs have been criticised for their lack of involvement in this care. The aim of this study was to obtain increased knowledge concerning the FP's experience of providing medical treatment for patients with home care provided by DNs by developing a theoretical model that elucidates how FPs handle the problems they encounter regarding the individual patients and their conditions. Methods Semi-structured interviews were conducted with 13 Swedish FPs concerning one of their registered patients with home care by a DN, and the treatment of this patient. Grounded theory methodology (GTM was used in the analyses. Results The core category was the effort to stay in charge of the medical treatment. This involved three types of problems: gaining sufficient insight, making adequate decisions, and maintaining appropriate medical treatment. For three categories of patients, the FPs had problems staying in charge. Patients with reduced functional ability had problems providing information and maintaining treatment. Patients who were "fixed in their ways" did not provide information and did not comply with recommendations, and for patients with complex conditions, making adequate decisions could be problematic. To overcome the problems, four different strategies were used: relying on information from others, supporting close observation and follow-up by others, being constantly ready to change the goal of the treatment, and relying on others to provide treatment. Conclusion The patients in this study differed from most other patients seen at the healthcare centre as the consultation with the patient could not provide the usual foundation for decisions concerning medical treatment. Information from and collaboration with the DN and other home care providers was essential for the FP's effort to

  7. Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curaçao.

    Science.gov (United States)

    Boersma, Adriana A; Meyboom-de Jong, Betty; Kleiverda, Gunilla

    2011-04-01

    To evaluate the efficacy and safety of home administration of buccal misoprostol after mifepristone for medical abortion up to 70 days' gestation in a general practice in Curaçao, where induced abortion is severely restricted by law. In a prospective study 330 women received 200 mg mifepristone and were instructed to take four tablets (800 μg) of misoprostol via the buccal route 24-36 h later, at home. One week later, follow-up took place. The outcome could be evaluated in 307 of the 330 women. The efficacy of the mifepristone-buccal misoprostol procedure was 97.7% (300/307). In seven women vacuum aspirations for continuing pregnancy or incomplete abortion following treatment were required. Success rates at 64-70 days' gestation were the same as for gestations of less than 64 days duration. The main adverse effects were nausea and diarrhoea. Home administration of buccal misoprostol 24-36 h after mifepristone is a safe and effective method of medical abortion up to 70 days. It could be applied in a general practice in Curaçao, where induced abortion is legally restricted.

  8. Final Scientific/Technical Report: Context-Aware Smart Home Energy Manager (CASHEM)

    Energy Technology Data Exchange (ETDEWEB)

    Foslien, Wendy K. [Honeywell International Inc., Golden Valley, MN (United States); Curtner, Keith L. [Honeywell International Inc., Golden Valley, MN (United States)

    2013-01-15

    Because of growing energy demands and shortages, residential home owners are turning to energy conservation measures and smart home energy management devices to help them reduce energy costs and live more sustainably. In this context, the Honeywell team researched, developed, and tested the Context Aware Smart Home Energy Manager (CASHEM) as a trusted advisor for home energy management. The project focused on connecting multiple devices in a home through a uniform user interface. The design of the user interface was an important feature of the project because it provided a single place for the homeowner to control all devices and was also where they received coaching. CASHEM then used data collected from homes to identify the contexts that affect operation of home appliances. CASHEM's goal was to reduce energy consumption while keeping the user's key needs satisfied. Thus, CASHEM was intended to find the opportunities to minimize energy consumption in a way that fit the user's lifestyle.

  9. Case report medical eponyms: an applied clinical informatics opportunity.

    Science.gov (United States)

    Baskaran, L N Guptha Munugoor; Greco, P J; Kaelber, D C

    2012-01-01

    Medical eponyms are medical words derived from people's names. Eponyms, especially similar sounding eponyms, may be confusing to people trying to use them because the terms themselves do not contain physiologically descriptive words about the condition they refer to. Through the use of electronic health records (EHRs), embedded applied clinical informatics tools including synonyms and pick lists that include physiologically descriptive terms associated with any eponym appearing in the EHR can significantly enhance the correct use of medical eponyms. Here we describe a case example of two similar sounding medical eponyms--Wegener's disease and Wegner's disease-- which were confused in our EHR. We describe our solution to address this specific example and our suggestions and accomplishments developing more generalized approaches to dealing with medical eponyms in EHRs. Integrating brief physiologically descriptive terms with medical eponyms provides an applied clinical informatics opportunity to improve patient care.

  10. Division of Biological and Medical Research annual technical report 1982

    Energy Technology Data Exchange (ETDEWEB)

    Rosenthal, M.W. (ed.)

    1983-05-01

    This report summarizes research during 1982 in the Division of Biological and Medical Research, Argonne National Laboratory. Studies in Carcinogenesis address mechanisms of chemical and radiation carcinogenesis including the processes of tumor initiation and promotion. The studies employ rat liver and mouse skin models as well as human rodent cell culture systems. The use of liposomes for metal mobilization is also explored. Low Level Radiation studies include delineation of the hematopoietic and other responses of dogs to continuous low level gamma irradiation, comparison of lifetime effects in mice of low level neutron and gamma irradiation, and study of the genetic effects of high LET radiation. Molecular Biology research develops two-dimensional electrophoresis systems for diagnosis and detection of cancer and other diseases. Fundamental structural and biophysical investigations of immunoglobulins and other key proteins are included, as are studies of cell growth, and of molecular and cellular effects of solar uv light. Research in Toxicology uses cellular, physiological, whole animal, and chronobiological end points and chemical separations to elucidate mechanisms and evaluate hazards of coal conversion by-products, actinides, and toxic metals. The final sections cover support facilities, educational activities, seminars, staff talks, staff, and funding agencies.

  11. Division of Biological and Medical Research annual technical report, 1981

    Energy Technology Data Exchange (ETDEWEB)

    Rosenthal, M.W. (ed.)

    1982-06-01

    This report summarizes research during 1981 in the Division of Biological and Medical Research, Argonne National Laboratory. Studies in Low Level Radiation include comparison of lifetime effects in mice of low level neutron and gamma irradiation, delineation of the responses of dogs to continuous low level gamma irradiation, elucidation of mechanisms of radiation damage and repair in mammalian cells, and study of the genetic effects of high LET radiations. Carcinogenesis research addresses mechanisms of tumor initiation and promotion in rat liver, chemical carcinogenesis in cultured mammalian cells, and molecular and genetic mechanisms of chemical and ultraviolet mutagenesis in bacteria. Research in Toxicology uses a variety of cellular, whole animal, and chronobiological end points, chemical separations, and statistical models to evaluate the hazards and mechanisms of actions of metals, coal gasification by products, and other energy-related pollutants. Human Protein Index studies develop two-dimensional electrophoresis systems for diagnosis and detection of cancer and other disease. Biophysics research includes fundamental structural and biophysical investigations of immunoglobulins and key biological molecules using NMR, crystallographic, and x-ray and neutron small-angle scattering techniques. The final sections cover support facilities, educational activities, seminars, staff talks, staff, and funding agencies.

  12. PIGMI: a design report for Pion Generator for Medical Irradiations

    Energy Technology Data Exchange (ETDEWEB)

    Hansborough, L.D. (comp.)

    1981-09-01

    PIGMI (Pion Generator for Medical Irradiations) is an integrated linear accelerator (linac) system developed under the auspices of the National Cancer Institute for specific application to cancer treatment in a hospital environment. In its full configuration, PIGMI is a proton linac that is far smaller, less expensive, and more reliable than previous machines that produce pions. Subsets of PIGMI technology can be used with equal advantage to generate beams of other particles (such as neutrons, protons, or heavy ions) that may be of interest for radiotherapy, radioisotope production, or other applications. The dramatic performance and cost advantages of this new breed of acceleraor result from a number of improvements. In the low-energy portion of the machine, a new type of low-energy linac (the radio-frequency quadrupole(RFQ)) produces an exceptionally good quality beam, and uses a very simple 30-kV injector. In the second part of the machine (the drift-tube linac (DTL)), high accelerating gradients are now achievable with consequent reductions in machine length. Another new structure (the disk and washer (DAW)) will be used in the third and final section of the accelerator; this portion will also be relatively short and require few power amplifiers. The entire machine is designed for ease of operation and high reliability. The pion-production machine, discussed in this report, accelerates a 100-..mu..A average proton-beam current to 650 MeV; use of an efficient pion-collection channel would result in an average pion flux of over 100 rad/min in a volume of about 1 l. Pion-channel design is not treated in this report. Accelerator construction cost is estimated at $10 million (1980 dollars); site preparation and treatment facility costs would bring the cost of a complete facility to an estimated $25 million.

  13. The Relationship between Planned and Reported Home Infant Sleep Locations among Mothers of Late Preterm and Term Infants

    Science.gov (United States)

    Tully, Kristin P.; Holditch-Davis, Diane; Brandon, Debra

    2015-01-01

    Objective To compare maternal report of planned and practiced home sleep locations of infants born late preterm (34 0/7 to 36 6/7 gestational weeks) with those infants born term (≥ 37 0/7 gestational weeks) over the first postpartum month. Methods Open-ended semi-structured maternal interviews were conducted in a U.S. hospital following birth and by phone at one month postpartum during 2010–2012. Participants were 56 mother-infant dyads: 26 late preterm and 30 term. Results Most women planned to room share at home with their infants and reported doing so for some or all of the first postpartum month. More women reported bed sharing during the first postpartum month than had planned to do so in both the late preterm and term groups. The primary reason for unplanned bed sharing was to soothe nighttime infant fussiness. Those participants who avoided bed sharing at home commonly discussed their fear for infant safety. A few parents reported their infants were sleeping propped on pillows and co-sleeping on a recliner. Some women in both the late preterm and term groups reported lack of opportunity to obtain a bassinet prior to childbirth. Conclusions The discrepancy between plans for infant sleep location at home and maternally reported practices were similar in late preterm and term groups. Close maternal proximity to their infants at night was derived from the need to assess infant well-being, caring for infants, and women’s preferences. Bed sharing concerns related to infant safety and the establishment of an undesirable habit, and alternative arrangements included shared recliner sleep. PMID:25626714

  14. Medication Error Reporting Rate and its Barriers and Facilitators among Nurses

    Directory of Open Access Journals (Sweden)

    Snor Bayazidi

    2012-11-01

    Full Text Available Introduction: Medication errors are among the most prevalent medical errors leading to morbidity and mortality. Effective prevention of this type of errors depends on the presence of a well-organized reporting system. The purpose of this study was to explore medication error reporting rate and its barriers and facilitators among nurses in teaching hospitals of Urmia University of Medical Sciences (Iran.Methods: In a descriptive study in 2011, 733 nurses working in Urmia teaching hospitals were included. Data was collected using a questionnaire based on Haddon matrix. The questionnaire consisted of three items about medication error reporting rate, eight items on barriers of reporting, and seven items on facilitators of reporting. The collected data was analyzed by descriptive statistics in SPSS14.Results:The rate of reporting medication errors among nurses was far less than medication errors they had made. Nurses perceived that the most important barriers of reporting medication errors were blaming individuals instead of the system, consequences of reporting errors, and fear of reprimand and punishment. Some facilitating factors were also determined. Conclusion: Overall, the rate of medication errors was found to be much more than what had been reported by nurses. Therefore, it is suggested to train nurses and hospital administrators on facilitators and barriers of error reporting in order to enhance patient safety.

  15. Feasibility of Measuring Tobacco Smoke Air Pollution in Homes: Report from a Pilot Study.

    Science.gov (United States)

    Rosen, Laura; Zucker, David; Hovell, Melbourne; Brown, Nili; Ram, Amit; Myers, Vicki

    2015-11-30

    Tobacco smoke air pollution (TSAP) measurement may persuade parents to adopt smoke-free homes and thereby reduce harm to children from tobacco smoke in the home. In a pilot study involving 29 smoking families, a Sidepak was used to continuously monitor home PM(2.5) during an 8-h period, Sidepak and/or Dylos monitors provided real-time feedback, and passive nicotine monitors were used to measure home air nicotine for one week. Feedback was provided to participants in the context of motivational interviews. Home PM(2.5) levels recorded by continuous monitoring were not well-accepted by participants because of the noise level. Also, graphs from continuous monitoring showed unexplained peaks, often associated with sources unrelated to indoor smoking, such as cooking, construction, or outdoor sources. This hampered delivery of a persuasive message about the relationship between home smoking and TSAP. By contrast, immediate real-time PM(2.5) feedback (with Sidepak or Dylos monitor) was feasible and provided unambiguous information; the Dylos had the additional advantages of being more economical and quieter. Air nicotine sampling was complicated by the time-lag for feedback and questions regarding shelf-life. Improvement in the science of TSAP measurement in the home environment is needed to encourage and help maintain smoke-free homes and protect vulnerable children. Recent advances in the use of mobile devices for real-time feedback are promising and warrant further development, as do accurate methods for real-time air nicotine air monitoring.

  16. Ensuring the continuity of care of cardiorespiratory diseases at home. Monitoring equipment and medical data exchange over semantically annotated web services.

    Science.gov (United States)

    Spyropoulos, B; Tzavaras, A; Botsivaly, M; Koutsourakis, K

    2010-01-01

    A significant portion of care related to cardiorespiratory diseases is provided at home, usually but not exclusively, after the discharge of a patient from hospital. It is the purpose of the present study to present the technical means which we have developed, in order to support the adaptation of the continuity of care of cardiorespiratory diseases at home. We have developed an integrated system that includes: first, a prototype laptop-based portable monitoring system that comprises low-cost commercially available components, which enable the periodical or continuous monitoring of vital signs at home; second, software supporting medical decision-making related to tachycardia and ventricular fibrillation, as well as fuzzy-rules-based software supporting home-ventilation optimization; third, a typical continuity of care record (CCR) adapted to support also the creation of a homecare plan; and finally, a prototype ontology, based upon the HL7 clinical document architecture (CDA), serving as basis for the development of semantically annotated web services that allow for the exchange and retrieval of homecare information. The flexible design and the adaptable data-exchange mechanism of the developed system result in a useful and standard-compliant tool, for cardiorespiratory disease-related homecare. The ongoing laboratory testing of the system shows that it is able to contribute to an effective and low-cost package solution, supporting patient supervision and treatment. Furthermore, semantic web technologies prove to be the perfect solution for both the conceptualization of a continuity of care data exchange procedure and for the integration of the structured medical data.

  17. Medical Surveillance Monthly Report. Volume 18, Number 6, June 2011

    Science.gov (United States)

    2011-06-01

    other bacteria -caused gastroenteritis were relatively stable during the period (range: 3.4 per 100,000 p-yrs [in 2003] to 5.0 per 100,000 p-yrs [in...active component, U.S. Armed Forces, 2007-2010 ___________7 Acute gastroenteritis outbreak at the Armed Forces Retirement Home, Washington, DC...January 2011 ____________________________________________________________ 11 Surveillance snapshot: Gastroenteritis -related hospitalizations

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

    Science.gov (United States)

    Holecek, Andrea

    2011-01-01

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

  19. PA7 Developing a culture of medication safety in the palliative care home setting - supporting choices in place of care and death.

    Science.gov (United States)

    Short, Caroline; Scott, Anne

    2015-04-01

    It is common informal practice in Australia for carers to be trained to administer PRN subcutaneous medications, especially in the last few days of life. A safe, legal and ethical framework for practice was needed to support end of life decision-making. To develop a culture of safety in the palliative care home setting by applying a Health Promoting Palliative Care philosophy, Kellehear (1999), to enable choice in place of care and death. Team brainstorming and literature review - developed: Carer education programme to evaluate a carer's preparedness to administer subcutaneous medications. Guideline Evaluation and Communication strategy Support Focus Ease of access to equipment Piloted 2009 RESULTS: Pilot 93% participants achieved wish to die at home - consistent at approximately 90% medication errors reduced. Carer confidence increased to confident and most confident. Hospital admissions reduced - remains approximately 8-10% of all days on service spent in hospital. Staff safety and satisfaction increased with reduction in after-hours home visits - averages remain at one or two per year. After-hours phone calls did not increase in response to practice changes. Health promotion, enablement and promotion of autonomy and support rather than control and disablement are powerful determinants of carer's ability to cope when caring for the dying, and enduring bereavement. This project is now standard practice and has transformed community practice of palliative care empowering consumers and health professionals with such potential. However, in response to criticism of this practice the carer's perspective will be captured in a carer survey. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. DOE Center of Excellence in Medical Laser Applications. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Jacques, S.L. (Oregon Medical Laser Center, Portland, OR (United States))

    1998-01-01

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

  1. Motivation in medical students: a PhD thesis report.

    Science.gov (United States)

    Kusurkar, Rashmi

    2012-08-01

    The aims of this thesis were to gather insights and investigate the factors influencing, outcomes and applications of medical students' motivation. This thesis consists of three literature reviews, four research papers and two application papers. Two research studies investigated the relationships of student motivation with study strategy, effort and academic performance through structural equation modelling and cluster analysis. The relationships of age, maturity, gender and educational background with motivation were investigated through multiple regression analysis. The results of this thesis were 1. Developments in medical education appear to have undervalued student motivation. 2. Motivation is an independent variable in medical education; intrinsic motivation is significantly associated with deep study strategy, high study effort and good academic performance. 3. Motivation is a dependent variable in medical education and is significantly affected by age, maturity, gender, educational background; intrinsic motivation is enhanced by providing students with autonomy, feedback and emotional support. 4. Strength of motivation for medical school can be reliably measured by Strength of Motivation for Medical School questionnaire. The conclusion of this thesis was that it is important to give consideration to motivation in medical education because intrinsic motivation leads to better learning and performance and it can be enhanced through giving students autonomy in learning, feedback about competence and emotional support.

  2. Cyberbullying among primary school students in Turkey: self-reported prevalence and associations with home and school life.

    Science.gov (United States)

    Arslan, Sevda; Savaser, Sevim; Hallett, Victoria; Balci, Serap

    2012-10-01

    The current study examined the self-reported prevalence and nature of cyberbullying and victimization among second, third, and fourth grade students (N=372) and explored associated features of home and school life. Of the children in the current sample, 27 percent had been victims of cyberbullying, 18 percent had been aggressors, and 15 percent had been both cyberbullies and victims. Boys were significantly more likely to carry out cyberbullying than girls. Cyberbullying exposure (as both a bully and a victim) was significantly associated with low levels of self-reported school satisfaction (bullies odds ratio [OR]: 2.45; victims OR: 2.10; pcyberbully. Increased awareness and regulation is now required within schools and within the home to tackle this escalating problem.

  3. Community health worker integration into the health care team accomplishes the triple aim in a patient-centered medical home: a Bronx tale.

    Science.gov (United States)

    Findley, Sally; Matos, Sergio; Hicks, April; Chang, Ji; Reich, Douglas

    2014-01-01

    Community health workers are ideally suited to the care coordination niche within the patient-centered medical home (PCMH) team, but there are few case studies detailing how to accomplish this integration. This qualitative study documents how community health workers (CHWs) were integrated into a PCMH in South Bronx, New York. Results show that integration was linked to clear definition of their care coordination role within the care team, meticulous recruitment, training and supervision by a senior CHW, shared leadership of the care management team, and documented value for money. By helping the team understand patients' backgrounds, constraints, and preferences, they helped everyone genuinely focus on the patient.

  4. Imprinting Salmon and Steelhead Trout for Homing, 1983 Annual Report of Research.

    Energy Technology Data Exchange (ETDEWEB)

    Slatick, Emil

    1984-09-01

    The National Marine Fisheries Service (NMFS), under contract to the Bonneville Power Administration, began conducting research on imprinting Pacific salmon and steelhead for homing in 1978. In the juvenile marking phase, over 4 million juvenile salmon and steelhead were marked and released in 23 experiments. The primary objectives were to determine a triggering mechanism to activate the homing imprint, if a single imprint or a sequential imprint is necessary to assure homing, and the relationship between the physiological condition of fish and their ability to imprint. Ten experimental studies are discussed. Six of the studies employed a variety of techniques for imprinting fish. The remaining four tested the feasibility of imprinting fish by a short-distance voluntary migration before transport. In five experiments, survival was enhanced by the imprint-transportation procedures, and homing to the homing site area was partly successful. Returns from the Astoria, Oregon, release of fall chinook salmon from Big Creek Hatchery (Knappa, Oregon), for example, showed that limited short distance migration imprinting should provide 2-3 time more fish to the various fisheries while providing adequate returns to the hatchery for egg take each year. 21 refs., 12 figs, 12 tabs.

  5. Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists

    Directory of Open Access Journals (Sweden)

    Bloembergen Peter

    2011-03-01

    Full Text Available Abstract Background Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious disease management. The clinical microbiologist therefore reports to the clinician clinically relevant preliminary results at any moment during the diagnostic process, mostly by telephone. Telephone reporting is error prone, however. Electronic reporting of culture results instead of reporting on paper may shorten the turnaround time and may ensure correct communication of results. The purpose of this study was to assess the impact of the implementation of electronic reporting of final microbiology results on medical decision making. Methods In a pre- and post-interview study using a semi-structured design we asked medical specialists in our hospital about their use and appreciation of clinical microbiology results reporting before and after the implementation of an electronic reporting system. Results Electronic reporting was highly appreciated by all interviewed clinicians. Major advantages were reduction of hardcopy handling and the possibility to review results in relation to other patient data. Use and meaning of microbiology reports differ significantly between medical specialties. Most clinicians need preliminary results for therapy decisions quickly. Therefore, after the implementation of electronic reporting, telephone consultation between clinician and microbiologist remained the key means of communication. Conclusions Overall, electronic reporting increased the workflow efficiency of the medical specialists, but did not have an impact on their decision-making.

  6. Home-Use Tests - Cholesterol

    Science.gov (United States)

    ... Medical Procedures In Vitro Diagnostics Home Use Tests Cholesterol Share Tweet Linkedin Pin it More sharing options ... a home-use test kit to measure total cholesterol. What cholesterol is: Cholesterol is a fat (lipid) ...

  7. Home Sweet Home

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    A family-run nursing home that gives elderly people the feel of a real of a real home Jiang Shaoju’s three-year-old family-run nursing home for the elderly in Dalian breaks all stereotypes people might attach to traditional homes for the aged.There are no nurses in uniforms,no numbered bedding and there is a lot of laughter. Jiang,56,has given almost every one of the 12 elderly women in her nursing home a nickname.She calls 92-year-old Xuan Shoulan"vice principal"because Xuan likes giving orders to others in the house and

  8. Medication review and transitions of care: a case report of a decade-old medication error.

    Science.gov (United States)

    Comer, Rachel; Lizer, Mitsi

    2015-03-01

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

  9. Solar heating and cooling of mobile homes, Phase II. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Jacobsen, A.A.

    1976-12-01

    The specific objectives of the Phase II program were: (1) through system testing, confirm the feasibility of a solar heated and cooled mobile home; (2) update system performance analysis and provide solar heating and cooling computer model verification; (3) evaluate the performance of both an absorption and a Rankine air conditioning system; (4) perform a consumer demand analysis through field survey to ascertain the acceptance of solar energy into the mobile home market; and (5) while at field locations to conduct the consumer demand analysis, gather test data from various U.S. climatic zones. Results are presented and discussed. (WHK)

  10. Snails home

    Science.gov (United States)

    Dunstan, D. J.; Hodgson, D. J.

    2014-06-01

    Many gardeners and horticulturalists seek non-chemical methods to control populations of snails. It has frequently been reported that snails that are marked and removed from a garden are later found in the garden again. This phenomenon is often cited as evidence for a homing instinct. We report a systematic study of the snail population in a small suburban garden, in which large numbers of snails were marked and removed over a period of about 6 months. While many returned, inferring a homing instinct from this evidence requires statistical modelling. Monte Carlo techniques demonstrate that movements of snails are better explained by drift under the influence of a homing instinct than by random diffusion. Maximum likelihood techniques infer the existence of two groups of snails in the garden: members of a larger population that show little affinity to the garden itself, and core members of a local garden population that regularly return to their home if removed. The data are strongly suggestive of a homing instinct, but also reveal that snail-throwing can work as a pest management strategy.

  11. Guideline report. Medical ultrasound imaging: progress and opportunities.

    Science.gov (United States)

    Burns, M

    1989-01-01

    Utilization of medical ultrasound has expanded rapidly during the past several years. In 1988, sales of ultrasound equipment will approach $600 million, which is higher than any other individual imaging modality, including the most capital intensive, such as magnetic resonance imaging (MRI), computed tomography (CT), and cath lab angiography. This growth would have been difficult to predict previously, since ultrasound appeared to be a relatively mature imaging modality not too long ago. There are several reasons for this growth. Technological developments have been quite rapid; ultrasound has become easier to use, image quality has improved dramatically, and diagnostic accuracy has been enhanced. There has been a proliferation of new equipment at all ends of the price spectrum, allowing the user a wide choice in instrument performance, multi-function capabilities, and automated features to increase patient throughput. The DRG environment and the prospect for more pre-admission tests have also been a stimulus. Hospital buying activity has expanded, and many more ultrasound exams are now being conducted on an outpatient basis. Sales to freestanding imaging centers and individual physicians have similarly increased. The hospital user is willing to pay a large premium for advanced technical performance and is prepared to retire or replace older technology in less than three years. This replacement cycle is much shorter than the four to five year period which existed prior to 1985. By comparison, some of the more traditional imaging areas, such as radiology, have replacement rates of eight to ten years. The reason for early replacement is obvious. Ultrasound exams in hospitals generate revenues at a rate that justifies the purchase of the most advanced equipment. It also improves the referral rate and positions the hospital as a high quality provider. Even with low utilization rates, an ultrasound instrument can normally pay for itself in less than one year of regular

  12. Evaluation of a Home-Based Environmental and Educational Intervention to Improve Health in Vulnerable Households: Southeastern Pennsylvania Lead and Healthy Homes Program

    Directory of Open Access Journals (Sweden)

    Deepa Mankikar

    2016-09-01

    Full Text Available This evaluation examined whether participation in a home-based environmental educational intervention would reduce exposure to health and safety hazards and asthma-related medical visits. The home intervention program focused on vulnerable, low-income households, where children had asthma, were at risk for lead poisoning, or faced multiple unsafe housing conditions. Home visitors conducted two home visits, two months apart, consisting of an environmental home assessment, Healthy Homes education, and distribution of Healthy Homes supplies. Measured outcomes included changes in participant knowledge and awareness of environmental home-based hazards, rate of children’s asthma-related medical use, and the presence of asthma triggers and safety hazards. Analysis of 2013–2014 baseline and post-intervention program data for a cohort of 150 families revealed a significantly lower three-month rate (p < 0.05 of children’s asthma-related doctor visits and hospital admissions at program completion. In addition, there were significantly reduced reports of the presence of home-based hazards, including basement or roof leaks (p = 0.011, plumbing leaks (p = 0.019, and use of an oven to heat the home (p < 0.001. Participants’ pre- and post- test scores showed significant improvement (p < 0.05 in knowledge and awareness of home hazards. Comprehensive home interventions may effectively reduce environmental home hazards and improve the health of asthmatic children in the short term.

  13. Medical Surveillance Monthly Report. Volume 17, Number 5, May 2010

    Science.gov (United States)

    2010-05-01

    locations Number of reports all eventsb Food-borne Vaccine preventable Campylo- bacter Salmonella Shigella Hepatitis A Hepatitis B Varicella c 2009 2010...timeliness of reporting vary by facility. Navy Reporting locations Number of reports all eventsb Food-borne Vaccine preventable Campylo- bacter ...facility. Reporting locations Number of reports all eventsb Food-borne Vaccine preventable Campylo- bacter Salmonella Shigella Hepatitis A Hepatitis B

  14. 76 FR 59407 - Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and...

    Science.gov (United States)

    2011-09-26

    ... ``Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information... HUMAN SERVICES Food and Drug Administration Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information on Non-Standardized Allergenic Extracts in the Diagnosis...

  15. Relevance of medical reports in criminal investigations of cases of suspected child abuse.

    Science.gov (United States)

    Janßen, Katharina; Greif, Dominik; Rothschild, Markus A; Banaschak, Sibylle

    2017-01-20

    If a case of physical child abuse is suspected in Germany, the general feeling is often that "it does not matter whether you make a report or not" because, generally, no conviction is made anyway. This study investigates the juridical analysis of complaint cases of physical child abuse [criminal complaint parag. 225 StGB (German penal code) with filial victim]. It focuses on the doctor's role and the impact of their practice in relation to a later conviction. It is based on the analysis of 302 files of the enquiry from 2004-2009 from the department of public prosecution in Cologne, Germany. Besides general epidemiological data on the reporting person, the affected child and the presumed offender, the documents were reassessed for the relevance of medical reports for successful convictions. Only 7% (n = 21) of 302 complaints led to a conviction. In 38.1% (n = 8) of those cases, a medical report was mentioned as a piece of evidence, and just in two cases a (legal) medical report was quoted and mentioned as relevant for the conviction. 50% of the complaint cases with legal medical expertise led to a trial. In contrast, only 30.2% with a common medical report and 7.3% without a report led to a trial. The results show how a medical report existed in only a few cases. In those cases, the rate of performed trials was higher than for those without a medical report, but the report played a minor part when reasoning a verdict.

  16. Evaluation of home respiratory therapy delivered to patients in the Ministry of Health's Home Medical Program (HMP) and administered through the Madinah HMP Center, Kingdom of Saudi Arabia, 2013.

    Science.gov (United States)

    Alhelali, Rana A; McNabb, Scott J N; Memish, Ziad A

    2016-03-01

    This was an evaluation of home respiratory therapy (HRT) services administered through the Madinah Home Medical Program (MHMP) Center of the Ministry of Health (MoH), Kingdom of Saudi Arabia (KSA). Using a retrospective design and descriptive analyses, we analyzed 83 patient records for the clinical care received, outcomes, and patient satisfaction. We also assessed a subset from an economic perspective. Demographically, 72% were >60 years of age, 80% were female, and 90% were Saudi. Asthma accounted for 34% of the diagnosed respiratory diseases, followed by chronic obstructive pulmonary disease (11%). Most patients (71%) required two or three respiratory modalities: 94% used oxygen therapy and 14% were on mechanical ventilation. A full 90% of HMP patients expressed a high level of satisfaction with the HMP overall care, and 43% saw an improvement in their condition. The MHMP lowered healthcare costs for HRT-receiving patients by decreasing the frequency of emergency room (ER) and outpatient visits by 50.8% from 59 to 30 visits. HRT administered through the MHMP Center improved clinical outcomes and increased patient satisfaction while reducing hospital utilization and associated costs. A prospective study is recommended to assess HMP services in comparison with hospitalization.

  17. What students experienced: a narrative analysis of essays written by first-year medical students participating in a geriatrics home visit.

    Science.gov (United States)

    O'Donnell, Linsey; Carson, Lesley; Forciea, Mary Ann; Kinosian, Bruce; Shea, Judy; Yudin, Jean; Miller, Rachel K

    2013-09-01

    To develop a house call experience for first-year medical students introducing them to challenges that homebound, chronically ill elderly adults face. During the semester, two students were paired with a preceptor to see two to three patients. The house call practices of the Division of Geriatric Medicine at the University of Pennsylvania and the Philadelphia Veterans Affairs Hospital. One hundred sixty-five first-year medical students. Pairs of students worked together to write an essay after the visit. Essays addressed specific areas, as detailed in a provided checklist, including noting patients' functional limitations, identifying community supports available to patients, and writing about general surprises that the students discovered during their visit. These data were then measured using narrative analysis. In all domains, students identified core goals and objectives. In the first domain (meeting challenges of functional limitations), students recognized the importance of family support. In the second domain (mentioning of functional limitation), high levels of compliance were seen. In the third domain (community support), students mentioned specific formal supports. In the fourth domain (surprises during the visit), students identified many important geriatrics concepts. In writing their essays, students demonstrated a high level of recognition of functional impairment and noted the importance of family, social networks, and home environment in enabling homebound, chronically ill elderly adults to stay in their homes. Many students also demonstrated an awareness of the possibilities of independence and happiness despite significant illness and disability. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  18. Graduation Resources in Medical Case Reports Written by Native and Non-Native Medical Writers

    Directory of Open Access Journals (Sweden)

    Muna Abdulhussein Swear

    2015-06-01

    Full Text Available The Appraisal Theory includes three subsystems of evaluation; Attitude, Engagement, and Graduation. This study  focuses on Graduation subsystem which  is used by writers to amplify or diminish the scope of these two subsystems. It consists of Focus and Force options. Focus expressions are usually non-gradable they tend to sharpen or soften the utterances.  Force, on the other hand modulates gradable expressions; which can be emphasized or downtoned the writer's utterances in terms of Intensification and Quantification. This pilot test is conducted to characterize the Force: Graduation of the heteroglossic resources in 20 MCR written in English by NS and NNS (Malaysian medical writers. MCR is a medical genre that has proven recently to be very important in the advancement of medical researches and in serving pedagogical purposes to offer a description to the practical strength of the clinical decision-making. Many incidents of Force: Graduation are collected for the purpose of analysis. The analysis includes investigating   the gradable heteroglossic resources in the MCRs of both groups of writers and examining the differences in employing these resources. The results indicate a little bit more frequent occurrence in the NS medical writers MCRs gradable heteroglossic expressions compared with those of NNS medical writers. Additionally, the use of these resources in the discussion sections of both groups is higher than in the other sections for both writers. Keywords: graduation resources, appraisal theory, corpus-based research

  19. Safety analysis report for medical radioisotope transport cask

    Energy Technology Data Exchange (ETDEWEB)

    Seo, K. S.; Ku, J. H.; Lee, J. C. [Korea Atomic Energy Research Institute, Taejon (Korea)

    1999-10-01

    KAERI has been producing radioisotopes for medical and industrial use and supplying them to radioisotope-using hospitals and industries. RI transport cask of A type package has been developed to transport medical radioisotopes from the HANARO to the hospitals. The safety analyses were performed under normal transport conditions in accordance with standards of transport regulations. As a results, it should be verified that the cask maintains the shielding and structural integrities under prescribed condition by the regulations. 8 refs., 20 figs., 7 tabs. (Author)

  20. Development of a data base on radon in US homes and applications. Final technical report

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, B.L.

    1991-12-31

    This research led to the development of the compilation of data on radon in homes which is included in this document. This research also contributed to the development of two papers analyzing the results. These are a case control study test and tests of the liner no-threshold theory for lung cancer induced by exposure to radon in residential buildings.

  1. Enhancing Home Involvement to Address Barriers to Learning: A Collaborative Process. A Center Report

    Science.gov (United States)

    Center for Mental Health in Schools at UCLA, 2011

    2011-01-01

    For schools to significantly enhance home involvement will require (1) broadening the focus beyond thinking only in terms of parents and (2) enhancing the range of ways in which schools connect with primary caretakers. Particular attention must be given to outreaching to those who are reluctant to engage with the school, especially if they have a…

  2. A Role Model Approach to Job Transition for Disadvantaged Cooperative Home Economics Students. Final Report.

    Science.gov (United States)

    Pestle, Ruth

    A pilot project implemented a role-model approach to job transition for disadvantaged cooperative home economics students in Tulsa and Oklahoma City, Oklahoma. From 1974 through 1976, 21 students in four urban high schools were matched with role models on the job. Sixteen of these students retained their jobs. The matches included many different…

  3. Development of a data base on radon in US homes and applications. Final technical report

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, B.L.

    1991-12-31

    This research led to the development of the compilation of data on radon in homes which is included in this document. This research also contributed to the development of two papers analyzing the results. These are a case control study test and tests of the liner no-threshold theory for lung cancer induced by exposure to radon in residential buildings.

  4. Observational report with regard to thermal comfort in nursing homes; Signaleringsrapport inzake thermische behaaglijkheid in verpleeghuizen

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-07-08

    A large number of studies on the subject of thermal (dis)comfort for patients in nursing homes in the summer is summarized. [Dutch] In dit signaleringsrapport is een groot aantal onderzoeken samengevat welke door of in opdracht van het Bouwcollege zijn uitgevoerd op het gebied van thermische (on)behaaglijkheid voor patienten (somatisch en psychogeriatrisch) in verpleeghuizen onder zomeromstandigheden.

  5. [Hypersensitivity pneumonitis-like disease caused by exposure to Mycobacterium avium complex in bathtub water at home: a case report].

    Science.gov (United States)

    Kanno, Kiyoshi; Akai, Masaya; Kato, Tomohiro; Tada, Toshihiko; Watanabe, Kizuku; Shiozaki, Kouhei; Hase, Mitsuo

    2012-05-01

    We report here a case of hypersensitivity pneumonitis-like disease in an adult, likely due to exposure to Mycobacterium avium complex (MAC) in his bathtub water at home. A 63-year-old man was referred to our hospital with exertional dyspnea. Chest computed tomography showed bilateral, diffuse, centrilobular ground-glass nodules. Bronchoalveolar lavage showed marked lymphocytosis. Transbronchial biopsy showed epithelioid cell granulomas and lymphocyte alveolitis. Cultures of the patient's sputum and bathtub water yielded MAC. Variable-number tandem repeat analysis of the MAC strains in the sputum and bathtub water samples showed that the strains were genetically identical. The clinical condition of the patient improved at home under chemotherapy by avoiding the use of the bathtub.

  6. Medical Surveillance Monthly Report. Volume 18, Number 9

    Science.gov (United States)

    2011-09-01

    paralysis , sei- zures, coma, and in most cases death.2 Currently, there is no eff ective treat- ment for symptomatic rabies, and pro- gression to...m pt om (l in es ) No. of TBI-related medical encounters Memory loss Headache Dizziness Sleep disturbance Insomnia Tinnitus 2010 2009 2008

  7. Do Pregnant Women Report Use of Dispensed Medications?

    DEFF Research Database (Denmark)

    Olesen, Charlotte; Søndergaard, Charlotte; Thrane, Nana

    2001-01-01

    Surveillance of drug safety in pregnancy often draws on administrative prescription registries. Noncompliance in the use of prescribed medication may be frequent among pregnant women owing to their fear of fetotoxic side effects. To estimate compliance in the use of prescription drugs dispensed...

  8. Towards formal medical reporting: An evaluation in endoscopy

    NARCIS (Netherlands)

    P.W. Moorman (Peter)

    1995-01-01

    textabstractFor clinical practice, the patient record is the principal repository for information concerning a patient's health care. For centuries, medical notes were brief comments used by their author to trigger a fuller recollection of his patients. In the late nineteenth century, physicians sta

  9. Medical Surveillance Monthly Report. Volume 21, Number 6

    Science.gov (United States)

    2014-06-01

    high-fat or high-cholesterol diet, diabetes, and certain medications.1–5 Pregnancy and history of pregnancy are also associated with an increased...should advise service members at greatest risk for gallbladder disease of the modifi able lifestyle changes that could prevent gallstone formation

  10. Exploring the relationship between self-reported research experience and performance in medical school and internship.

    Science.gov (United States)

    Dong, Ting; Durning, Steven J; Gilliland, William R; Waechter, Donna M; Cruess, David F; DeZee, Kent J; Calloway, Margaret; Artino, Anthony R

    2012-09-01

    To investigate the relationship between self-reported research experience and medical students' performance in medical school and internship. We collected data from seven year-groups (1993-1999; N = 1,112) and examined 7 performance outcomes: medical school preclinical grade point average (GPA), medical school clinical GPA, cumulative medical school GPA, U.S. Medical Licensing Examination Step 1 and 2 scores, and scores on a previously validated program director's survey of intern professionalism and expertise. We then conducted a series of multiple linear regressions to determine the relations between self-reported research experience and our seven outcomes. When compared to those who reported no prior research experience, students who reported research experience performed significantly better on U.S. Medical Licensing Examination Step 1 and had a higher medical school preclinical GPA. However, these same students scored significantly lower on intern professionalism and expertise ratings. Self-reported research experience did not show statistically significant correlations with the other outcome variables. The results from our large, multiyear, cohort study suggest that prior research experience may account for some variance in outcomes in the early stages of medical school education, but that variance explained diminishes considerably as trainees progress into the more senior phases of education. On the other hand, prior research experience may be negatively related to students' performance in internship. In all cases, however, effect sizes are small.

  11. Automated semantic indexing of imaging reports to support retrieval of medical images in the multimedia electronic medical record.

    Science.gov (United States)

    Lowe, H J; Antipov, I; Hersh, W; Smith, C A; Mailhot, M

    1999-12-01

    This paper describes preliminary work evaluating automated semantic indexing of radiology imaging reports to represent images stored in the Image Engine multimedia medical record system at the University of Pittsburgh Medical Center. The authors used the SAPHIRE indexing system to automatically identify important biomedical concepts within radiology reports and represent these concepts with terms from the 1998 edition of the U.S. National Library of Medicine's Unified Medical Language System (UMLS) Metathesaurus. This automated UMLS indexing was then compared with manual UMLS indexing of the same reports. Human indexing identified appropriate UMLS Metathesaurus descriptors for 81% of the important biomedical concepts contained in the report set. SAPHIRE automatically identified UMLS Metathesaurus descriptors for 64% of the important biomedical concepts contained in the report set. The overall conclusions of this pilot study were that the UMLS metathesaurus provided adequate coverage of the majority of the important concepts contained within the radiology report test set and that SAPHIRE could automatically identify and translate almost two thirds of these concepts into appropriate UMLS descriptors. Further work is required to improve both the recall and precision of this automated concept extraction process.

  12. Veterinary Medical Education in Florida. Report and Recommendations of the Postsecondary Education Planning Commission, Report No. 3, 1987.

    Science.gov (United States)

    Florida State Postsecondary Education Commission, Tallahassee.

    A report on veterinary medical education in Florida and the need for veterinary care in Florida is presented. Overviews of the veterinary profession and veterinary medical education are also given, including the areas of history, careers in the field, licensure, salaries, animal disease research, accreditation, curriculum, enrollment, educational…

  13. Development of a new diabetes medication self-efficacy scale and its association with both reported problems in using diabetes medications and self-reported adherence

    Directory of Open Access Journals (Sweden)

    Sleath B

    2016-06-01

    Full Text Available Betsy Sleath,1,2 Delesha M Carpenter,1 Susan J Blalock,1 Scott A Davis,1 Ryan P Hickson,1 Charles Lee,3 Stefanie P Ferreri,4 Jennifer E Scott,5 Lisa B Rodebaugh,6 Doyle M Cummings6,7 1Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, 2Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, 3Polyglot Systems, Inc., Morrisville, 4Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, 5Consortium for Implementation Science, Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, 6Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, 7Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA Background: Although there are several different general diabetes self-efficacy scales, there is a need to develop a self-efficacy scale that providers can use to assess patient’s self-efficacy regarding medication use. The purpose of this study was to: 1 develop a new diabetes medication self-efficacy scale and 2 examine how diabetes medication self-efficacy is associated with patient-reported problems in using diabetes medications and self-reported adherence. Patients and methods: Adult English-speaking patients with type 2 diabetes were recruited from a family medicine clinic and a pharmacy in Eastern North Carolina, USA. The patients were eligible if they reported being nonadherent to their diabetes medicines on a visual analog scale. Multivariable regression was used to examine the relationship between self-efficacy and the number of reported diabetes medication problems and adherence. Results: The diabetes medication self-efficacy scale had strong reliability (Cronbach’s alpha =0.86. Among a sample

  14. Medical Surveillance Monthly Report. Volume 16, Number 6, June 2009

    Science.gov (United States)

    2009-06-01

    Campylo- bacter Giardia Salmonella Shigella Hepatitis A Hepatitis B Varicella 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009 2008 2009...Completeness and timeliness of reporting vary by facility Reporting locations Number of reports all events† Food-borne Vaccine preventable Campylo- bacter

  15. [Assessment of our home care and home palliative care].

    Science.gov (United States)

    Midorikawa, Yasuhiko; Suzushino, Seiko; Tamotsu, Kiyokazu

    2014-12-01

    We conducted home care and home palliative care from the department of home care. We provided home care services to 190 patients(105 men, 85 women)in October 2013. Their average age was 78.7(range: 32-102)years old, and home care had been underway from 1 day to 8 years, 10 months. Among all participants, 168(88.4%)suffered from malignant diseases, 168 patients had died, and over half of deceased patients(88 out of 168)had died at home. We used opioids for control of cancer pain, carried out home parenteral nutrition(HPN), home enteral nutrition(HEN), percutaneous endoscopic gastrostomy( PEG), and removed pleural effusion and ascites during home care. In order to facilitate the practice of palliative care by the palliative care team, which consists of various medical staff in the hospital, we are giving high priority to education and enlightenment in the hospital. To provide enlightenment, education, and cooperation between regional home care and home palliative care, we are also conducting educational lectures in the regional party of the Iwaki city medical associate, and providing combined educational-medical training for home care and home palliative care by various medical staff.

  16. The essential role of medical ethics education in achieving professionalism: the Romanell Report.

    Science.gov (United States)

    Carrese, Joseph A; Malek, Janet; Watson, Katie; Lehmann, Lisa Soleymani; Green, Michael J; McCullough, Laurence B; Geller, Gail; Braddock, Clarence H; Doukas, David J

    2015-06-01

    This article-the Romanell Report-offers an analysis of the current state of medical ethics education in the United States, focusing in particular on its essential role in cultivating professionalism among medical learners. Education in ethics has become an integral part of medical education and training over the past three decades and has received particular attention in recent years because of the increasing emphasis placed on professional formation by accrediting bodies such as the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education. Yet, despite the development of standards, milestones, and competencies related to professionalism, there is no consensus about the specific goals of medical ethics education, the essential knowledge and skills expected of learners, the best pedagogical methods and processes for implementation, and optimal strategies for assessment. Moreover, the quality, extent, and focus of medical ethics instruction vary, particularly at the graduate medical education level. Although variation in methods of instruction and assessment may be appropriate, ultimately medical ethics education must address the overarching articulated expectations of the major accrediting organizations. With the aim of aiding medical ethics educators in meeting these expectations, the Romanell Report describes current practices in ethics education and offers guidance in several areas: educational goals and objectives, teaching methods, assessment strategies, and other challenges and opportunities (including course structure and faculty development). The report concludes by proposing an agenda for future research.

  17. Economic evaluation of the impact of medication errors reported by U.S. clinical pharmacists.

    Science.gov (United States)

    Samp, Jennifer C; Touchette, Daniel R; Marinac, Jacqueline S; Kuo, Grace M

    2014-01-01

    Medication errors defined as "any preventable event that may cause or lead to inappropriate medication use or patient harm" have been highlighted as a top national priority in a report issued by the Institute of Medicine. However, little information is available on precise costs of medication errors. This study estimated the cost of medication errors reported by clinical pharmacists using a modified societal perspective. Information on 779 medication errors was collected in the Medication Error Detection, Amelioration and Prevention (MEDAP) study that documented medication errors observed by clinical pharmacists during a consecutive 14-day period. The rate of medication errors, outcomes (number of errors resulting in temporary/permanent patient harm, prolonged hospitalization, or life-sustaining therapy), and interventions (communication, medication changes, patient monitoring, and treatment referrals) were collected. A decision model was developed to estimate the economic impact of medication errors reported by clinical pharmacists. Event probabilities were derived from MEDAP data. Direct costs were obtained through reviews of the literature, hospital charge data, and Medicare and Medicaid reimbursement. One-way and Monte Carlo sensitivity analyses were used to explore uncertainty in the values. In the base case, the mean expected cost of a medication error was $88.57. In the Monte Carlo simulation, the mean cost was $89.35 (± $30.17 SD). One-way sensitivity analysis revealed that changes in the probability of medication errors causing hospitalization and the cost of hospitalization had the greatest variability on the outcome ($50.44-$155.81 [probability of hospitalization], $32.59-$136.40 [cost of hospitalization]). Medication errors are costly to the health care system. A better understanding of medication error costs may be used to justify initiatives to reduce the risk and inefficiency associated with these errors. © 2013 American College of Clinical

  18. Survey of nursing perceptions of medication administration practices, perceived sources of errors and reporting behaviours.

    Science.gov (United States)

    Armutlu, Markirit; Foley, Mary-Lou; Surette, Judy; Belzile, Eric; McCusker, Jane

    2008-01-01

    In January 2003, St. Mary's Hospital Center in Montreal, Quebec, established an interdisciplinary Committee on the Systematic Approach to Medication Error Control to review the whole process of medication administration within the hospital and to develop a systematic approach to medication error control. A cross-sectional survey on medication administration practices, perceived sources of errors and medication error reporting of nurses, adapted from a nursing practice survey and medication variance report (Sim and Joyner 2002), was conducted over a two-week period in February 2004. The results were analyzed by years of experience (greater or less than five years) and patient care unit of practice. The perceived source of error most often cited was transcription (processing), and the second most frequently cited source was the legibility of handwritten medication orders (prescribing). The results demonstrate no significant difference in medication safety practices or in perceptions of errors by years of experience. Nurses appear to adapt to the safety culture of the unit rather quickly, certainly within their first five years on the unit. Good medication error reporting behaviour was noted, with no differences between all comparative groups within both years of experience and unit of practice. Quality improvement initiatives to improve the safety of medication administration practices have included the development of a nursing medication administration handbook, the revision of policies and procedures related to medication administration safety, the standardization of solutions and limited variety of high-risk medication dosages and the reduction of handwritten reorders. The need for ongoing education and information sessions on policies and procedures specific to safe medication practices for all nurses, regardless of years of experience, was identified.

  19. The Relation of Recent Tampon Use, Douching, Coitus, and Vaginal Medications for Reported Cervical Cytology Results

    Science.gov (United States)

    1993-01-01

    or cervical intraepithelial neoplasia (CIN) on the pathology report. Assumptions Tampon use is drying to the vaginal epithelium and has been...SUBTITLE 5, FUNDING NUMBERS The Relation of Recent Tamplon Use, Douching, Coitus, and Vaginal Medications for Reported Cervical Cytology Results. 6. AUTHOR...11¾ .. ?j’ 󈧎 U..- THE RELATION OF RECENT TAMPON USE, DOUCHING, COITUS, AND VAGINAL MEDICATIONS TO REPORTED CERVICAL CYTOLOGY RESULTS By MARYANN

  20. Public Reporting of Nursing Home Quality of Care: Lessons from the United States Experience for Canadian Policy Discussion

    Science.gov (United States)

    Hutchinson, Alison M.; Draper, Kellie; Sales, Anne E.

    2009-01-01

    While the demand for continuing care services in Canada grows, the quality of such services has come under increasing scrutiny. Consideration has been given to the use of public reporting of quality data as a mechanism to stimulate quality improvement and promote public accountability for and transparency in service quality. The recent adoption of the Resident Assessment Instrument (RAI) throughout a number of Canadian jurisdictions means that standardized quality data are available for comparisons among facilities across regions, provinces and nationally. In this paper, we explore current knowledge on public reporting in nursing homes in the United States to identify what lessons may inform policy discussion regarding potential use of public reporting in Canada. Based on these findings, we make recommendations regarding how public reporting should be progressed and managed if Canadian jurisdictions were to implement this strategy. PMID:21037828

  1. Imprinting Hatchery Reared Salmon and Steelhead Trout for Homing, Volume II of III; Data Summaries, 1978-1983 Final Report.

    Energy Technology Data Exchange (ETDEWEB)

    Slatick, Emil; Ringe, R.R.; Zaugg, Waldo S. (Northwest and Alaska Fisheries Science Center, Coastal Zone and Estuarine Studies Division, Seattle, WA)

    1988-02-02

    The main functions of the National Marine Fisheries Service (NMFS) aquaculture task biologists and contractual scientists involved in the 1978 homing studies were primarily a surveillance of fish physiology, disease, and relative survival during culture in marine net-pens, to determine if there were any unusual factors that might affect imprinting and homing behavior. The studies were conducted with little background knowledge of the implications of disease and physiology on imprinting and homing in salmonids. The health status or the stocks were quite variable as could be expected. The Dworshak and Wells Hatcheries steelhead suffered from some early stresses in seawater, probably osmoregulatory. The incidences of latent BKD in the Wells and Chelan Hatcheries steelhead and Kooskia Hatchery spring chinook salmon were extremely high, and how these will affect survival in the ocean is not known. Gill enzyme activity in the Dworshak and Chelan Hatcheries steelhead at release was low. Of the steelhead, survival in the Tucannon Hatchery stock will probably be the highest, with Dworshak Hatchery stock the lowest. This report contains the data for the narratives in Volume I.

  2. [Home care in Sapporo].

    Science.gov (United States)

    Yazaki, Kazuo

    2003-12-01

    We established a clinic specialized in home care in Sapporo in July 2001. In these 2 years we have provided medical home care service to 160 patients, and 97 are still receiving regular service. At first we accepted any patients living within 16 km from the clinic. However, bad traffic conditions in winter made it difficult to visit patients living in districts far away from the clinic. Therefore, we planned a network of home care physicians in Sapporo. Now 12 home care physicians hold monthly meetings. In Sapporo, meetings of home care related workers are organized in each ward, as suggested by the Sapporo Medical Association. There is a relatively good supply of home care related services and resources, including availability of an important number of visiting nurses. Patients being taken care of at home who present an acute exacerbation of symptoms are relatively easily accepted by acute hospitals. But those who have difficulties in continuing home care due to a sudden change in family conditions are not easily accepted by nursing hospitals. Recently, the number of group homes and lodging houses for elderly persons has markedly increased in Sapporo. It might have some problems in medical support in the near future.

  3. Medication Errors: A Characterisation of Spontaneously Reported Cases in EudraVigilance.

    Science.gov (United States)

    Newbould, Victoria; Le Meur, Steven; Goedecke, Thomas; Kurz, Xavier

    2017-07-11

    Medication errors recently became the focus of regulatory guidance in pharmacovigilance to support reporting, evaluation and prevention of medication errors. This study aims to characterise spontaneously reported cases of medication errors in EudraVigilance over the period 2002-2015 before the release of EU good practice guidance. Case reports were identified through the adverse reaction section where a Medical Dictionary for Regulatory Activities (MedDRA(®)) term is reported and included in the Standardised MedDRA(®) Query (SMQ) for medication errors. These case reports were further categorised by MedDRA(®) terms, geographical region, patient age group and Anatomical Therapeutic Chemical classification system of suspect medicinal product(s). A total of 147,824 case reports were retrieved, 41,355 of which were from the European Economic Area (EEA). Approximately 60% of these case reports were retrieved with the narrow SMQ. The absolute number of medication error case reports and the proportion to the total number of reports in EudraVigilance increased during the study period, with peaks seen around 2005 and 2012 for cases with EEA origin. Fifty-two percent of case reports in which age was provided occurred in adults, 30% in the elderly and 18% in children, with almost half of these in children aged 2 months to 2 years. Case reports of medication errors in EudraVigilance steadily increased between 2005 and 2015, the reasons for which may be multifactorial, including increased awareness, changes to the MedDRA(®) terminology and the 2012 EU pharmacovigilance legislation and associated guidance for stakeholders, or a generally increased risk for errors as more medications become available.

  4. Stylistic features of case reports as a genre of medical discourse.

    Science.gov (United States)

    Lysanets, Yuliia; Morokhovets, Halyna; Bieliaieva, Olena

    2017-03-13

    The present paper discusses the lexical and grammatical peculiarities of English language medical case reports, taking into account their communicative purposes and intentions. The objective of the research is to clarify the principal mechanisms of producing an effective English language medical case report and thus to provide recommendations and guidelines for medical professionals who will deal with this genre. The analysis of medical case reports will largely focus on the most significant linguistic peculiarities, such as the use of active and passive voice, the choice of particular verb tenses, and pronouns. The selected medical case reports will be considered using methods of lexico-grammatical analysis, quantitative examination, and contextual, structural, narrative, and stylistic analyses. The research revealed a range of important stylistic features of medical case reports which markedly distinguish them from other genres of medical scientific writing: educational and instructive intentions, conciseness and brevity, direct and personal tone, and material presented in a narrative style. The present research has shown that the communicative strategies of the analyzed discourse, mentioned immediately above, are effectively implemented by means of specific lexical units and grammatical structures: the dominance of active voice sentences, past simple tense, personal pronouns, and modal verbs. The research has also detected the occasional use of the present perfect, present simple, and future simple tenses and passive voice which also serve particular communicative purposes of medical case reports. Medical case reports possess a range of unique characteristics which differ from those of research articles and other scientific genres within the framework of written medical discourse. It is to be emphasized that it is highly important for medical professionals to master the major stylistic principles and communicative intentions of medical case report as a genre in

  5. Finding a Sense of Home across the Pacific in Old Age- Chinese American Senior's Report of Life Satisfaction in a Foreign Land.

    Science.gov (United States)

    Zhan, Heying Jenny; Wang, Qi; Fawcett, Zoe; Li, Xiaoqing; Fan, Xiying

    2017-03-01

    Finding a sense of home for international migrants is challenging. It is even more so for older adults who migrate to a foreign country later in life to follow their adult children. This study examines Chinese immigrant elders' report of their sense of home and life-satisfaction. Based on 21 intensive interviews and107 surveys with elderly immigrants of Chinese descent, this research finds that a comfortable living condition in a natural and built environment contribute to Chinese elders' narrative of a sense of home. The lack of English language, however, makes immigrant Chinese elders feel very unsettled. Being together with children and having good social benefits are major pull factors that contribute to immigrant elders' decision to settle down in a foreign country. Those who report a stronger sense of home tend to report a higher level of life satisfaction. In conclusion, the authors argue that immigrant elders are defining their sense of home with a greater sense of independence from their adult children. Favorable social policies toward older adults, such as Medicare, Medicaid, low income housing, and social services, are important factors that make older immigrants feel a sense of home in a foreign land, although the inability to communicate is a barrier to a complete sense of home for transnational migrants in old age.

  6. Cypermethrin Poisoning and Anti-cholinergic Medication- A Case Report

    Directory of Open Access Journals (Sweden)

    Dr Sudip Parajuli

    2006-07-01

    Full Text Available A 30 years old male was brought to emergency department of Manipal Teaching Hospital, Pokhara, Nepal with alleged history of consumption of pyrethroid compound ‘cypermethrin’. It was found to be newer insecticide poisoning reported in Nepal. We reported this case to show effectiveness of anti-cholinergic like hyosciane and chlorpheniramine maleate in the treatment of cypermethrin poisoning.

  7. A study of the changes in how medically related events are reported in Japanese newspapers.

    Science.gov (United States)

    Kishi, Yukiko; Murashige, Naoko; Kodama, Yuko; Hamaki, Tamae; Murata, Kazuhiro; Nakada, Haruka; Komatsu, Tsunehiko; Narimatsu, Hiroto; Kami, Masahiro; Matsumura, Tomoko

    2010-01-01

    Media reports of medically related events have a major effect on the healthcare community but there have been few detailed investigations conducted to investigate their content. The Nikkei Telecom 21 database was used to investigate the number of reports concerning medically related events between 1992 and 2007 in Japan's 5 national newspapers. For this period, both the total number of articles and the number of articles containing medically-related keywords were determined. The number of reports relating to medically related occurrences increased sharply from 1999 to 2000 and displayed a decrease from 2003 before increasing again in 2008. As of 2008, such reports account for 0.17% of total newspaper articles. The use of the word 'iryokago' (medical professional negligence or error) drastically increased in 1999 but showed a consistent decrease from 2004. On the other hand the frequency of reports relating to 'litigation' and 'punishment' increased rapidly in 1999 before leveling off. Despite this, the number of articles relating to medically related occurrences that were caused by doctor shortages and system errors increased sharply between 2006 and the present. Results indicate that the manner in which newspapers report medically related events is undergoing major changes.

  8. and lsquo;WhatsApp' as an adjunct to home based pin tract care: a case report

    Directory of Open Access Journals (Sweden)

    Ganesh Singh Dharmshaktu

    2014-08-01

    Full Text Available Mobile based technology can be a cheap and handy adjunct to a home based programme for managing pin tract care in chronic orthopaedic cases. The text message and image based mobile platforms may serve as an evaluation tool relieving patient of agony of long and painful commutes on simple health issues like wound dressings. A case report depicting versatility of the idea with regard to its efficacy in clinical scenario is presented here. [Int J Res Med Sci 2014; 2(4.000: 1746-1747

  9. Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report.

    Science.gov (United States)

    Reiman, Amanda; Welty, Mark; Solomon, Perry

    2017-01-01

    Introduction: Prescription drug overdoses are the leading cause of accidental death in the United States. Alternatives to opioids for the treatment of pain are necessary to address this issue. Cannabis can be an effective treatment for pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to opioid-based medications. Medical cannabis patients report that cannabis is just as effective, if not more, than opioid-based medications for pain. Materials and Methods: The current study examined the use of cannabis as a substitute for opioid-based pain medication by collecting survey data from 2897 medical cannabis patients. Discussion: Thirty-four percent of the sample reported using opioid-based pain medication in the past 6 months. Respondents overwhelmingly reported that cannabis provided relief on par with their other medications, but without the unwanted side effects. Ninety-seven percent of the sample "strongly agreed/agreed" that they are able to decrease the amount of opiates they consume when they also use cannabis, and 81% "strongly agreed/agreed" that taking cannabis by itself was more effective at treating their condition than taking cannabis with opioids. Results were similar for those using cannabis with nonopioid-based pain medications. Conclusion: Future research should track clinical outcomes where cannabis is offered as a viable substitute for pain treatment and examine the outcomes of using cannabis as a medication assisted treatment for opioid dependence.

  10. Reporting and disclosing medical errors: pediatricians' attitudes and behaviors.

    Science.gov (United States)

    Garbutt, Jane; Brownstein, Dena R; Klein, Eileen J; Waterman, Amy; Krauss, Melissa J; Marcuse, Edgar K; Hazel, Erik; Dunagan, Wm Claiborne; Fraser, Victoria; Gallagher, Thomas H

    2007-02-01

    To characterize pediatricians' attitudes and experiences regarding communicating about errors with the hospital and patients' families. Cross-sectional survey. St Louis, Mo, and Seattle, Wash. University-affiliated hospital and community pediatricians and pediatric residents. Anonymous 68-item survey (paper or Web-based) administered between July 2003 and March 2004. Physician attitudes and experiences about error communication. Four hundred thirty-nine pediatric attending physicians and 118 residents participated (62% response rate). Most respondents had been involved in an error (39%, serious; 72%, minor; 61%, near miss; 7%, none). Respondents endorsed reporting errors to the hospital (97%, serious; 90%, minor; 82%, near miss), but only 39% thought that current error reporting systems were adequate. Most pediatricians had used a formal error reporting mechanism, such as an incident report (65%), but many also used informal reporting mechanisms, such as telling a supervisor (47%) or senior physician (38%), and discussed errors with colleagues (72%). Respondents endorsed disclosing errors to patients' families (99%, serious; 90%, minor; 39%, near miss), and many had done so (36%, serious; 52%, minor). Residents were more likely than attending physicians to believe that disclosing a serious error would be difficult (96% vs 86%; P = .004) and to want disclosure training (69% vs 56%; P = .03). Pediatricians are willing to report errors to hospitals and disclose errors to patients' families but believe current reporting systems are inadequate and struggle with error disclosure. Improving error reporting systems and encouraging physicians to report near misses, as well as providing training in error disclosure, could help prevent future errors and increase patient trust.

  11. Medical Surveillance Monthly Report (MSMR). Volume 3, Number 7, October 1997

    Science.gov (United States)

    1997-10-01

    MSMRVol. 03 / No. 07 7 Active Duty Other FIGURE II. Reportable sexually transmitted diseases, US Army medical treatment facilities* Cases per...Training Area in southeastern Queensland. Pre- exercise activities : Assessment of exer- cise-relevant medical threats identified the follow- ing: injuries...eastern Australia during the rainy season, the RRv threat was considered both operationally and medi- cally significant. Pre- exercise activities

  12. Reporting of Medication Information in Applied Studies of People with Autism

    Science.gov (United States)

    Weeden, Marc; Porter, Lindsay K.; Durgin, Amy; Redner, Ryan N.; Kestner, Kathryn M.; Costello, Mack; Cleary, Kathleen; Edwards, Timothy L.; Hayes, Sarah M.; Poling, Alan

    2011-01-01

    The present research determined if articles describing attempts to improve the behavior of people with autism reported whether or not participants were receiving medication and, if so, whether an interaction between the intervention and the medication was mentioned. Fifty-one articles published from 2004 through 2008 were examined. Information…

  13. Use of a Fish Transportation Barge for Increasing Returns of Steelhead Imprinted for Homing, Final Report.

    Energy Technology Data Exchange (ETDEWEB)

    Harmon, Jerrel R.

    1989-08-01

    The objective of this 7-year National Fisheries Service study, which began is 1982, was to determine if transporting juvenile steelhead (Oncorhynchus mykiss) by truck and barge from Dworshak National Fish Hatchery (NFH), on the Clearwater River, to a release site on the Columbia River below Bonneville Dam would result in increased returns of adults to the various fisheries and to the hatchery homing site. During 1982 and 1983, over 500,000 marked juvenile steelhead were serially released as controls from the hatchery or barged as test fish to below Bonneville Dam. Recoveries of marked adults to various recovery sites are complete. Fish released in 1983 showed a stronger homing ability and more rapid upstream migration than test fish released in 1982. Most adults from both control and test releases in 1983 and control releases in 1982 migrated a considerable distance upstream and overwintered in the Snake and Clearwater Rivers--behavior similar to Clearwater River fish previously transported from Lower Granite Dam. In contrast, many of the adults from test releases in 1982 failed to migrate upstream during the fall, overwintered in the Columbia River, and migrated upstream the following spring. Survival of control fish released at Dworshak NFH in late April 1982 was substantially higher than survival of those released in mid-May. Survival and homing of control fish released in late April and early May 1983 were over 10 times that for fish released in late May. Return of adults from normal hatchery releases in 1982 was the highest ever observed at Dworshak NFH.

  14. Medication/Drug Allergy

    Science.gov (United States)

    ... Science Education & Training Home Conditions Medication/Drug Allergy Medication/Drug Allergy Make an Appointment Find a Doctor ... immediate or delayed. What Is an Allergy to Medication/Drugs? Allergies to drugs/medications are complicated, because ...

  15. Division of Biological and Medical Research annual report, 1975

    Energy Technology Data Exchange (ETDEWEB)

    Rosenthal, M W [ed.

    1975-01-01

    Separate abstracts were prepared for 15 sections of the report. Educational activities, outside lectures by divisional staff, seminars, and publications are also listed. An organizational chart and author index are included. (HLW)

  16. Predictors of compliance with a home-based exercise program added to usual medical care in preventing postmenopausal osteoporosis: an 18-month prospective study.

    Science.gov (United States)

    Mayoux-Benhamou, M A; Roux, C; Perraud, A; Fermanian, J; Rahali-Kachlouf, H; Revel, M

    2005-03-01

    This prospective 18-month study was designed to assess long-term compliance with a program of exercise aimed to prevent osteoporosis after an educational intervention and to uncover determinants of compliance. A total of 135 postmenopausal women were recruited by flyers or instructed by their physicians to participate in an educational session added to usual medical care. After a baseline visit and dual-energy X-ray absorptiometry, volunteers participated in a 1-day educational session consisting of a lecture and discussion on guidelines for appropriate physical activity and training in a home-based exercise program taught by a physical therapist. Scheduled follow-up visits were 1, 6, and 18 months after the educational session. Compliance with the exercise program was defined as an exercise practice rate 50% or greater than the prescribed training. The 18-month compliance rate was 17.8% (24/135). The main reason for withdrawal from the program was lack of motivation. Two variables predicted compliance: contraindication for hormone replacement therapy (odds ratio [OR] = 0.13; 95% confidence interval [95% CI], 0.04 to 0.46) and general physical function scores from an SF-36 questionnaire (OR=1.26; 95% CI, 1.03 to 1.5). To a lesser extent, osteoporosis risk, defined as a femoral T-score exercise, only a minority of postmenopausal women adhered to a home-based exercise program after 18 months.

  17. Medical imaging findings in Cobb syndrome: two case reports

    Institute of Scientific and Technical Information of China (English)

    WANG Guang-bin; XU Lei; ZHAO Bin; CAI Shi-feng; SHI Hao; LI Hui-hua; QU Lei

    2005-01-01

    @@ Cobb syndrome, also known as cutaneomeningospinal angiomatosis, is a rare clinical entity characterized by the combination of a vascular skin nevus and an angioma in the spinal canal at the same metamere.1 It was first described by Berenbruch in 1890 and did not receive recognition until Cobb's description2 in 1915. Only few documents about this disease had been reported.1 We present two cases here and review the other reported cases.

  18. Patient Reported Outcomes in a New Home-Based Rehabilitation Programme for Prostate Cancer Patients

    DEFF Research Database (Denmark)

    Villumsen, Brigitta R.; Grønbech Jørgensen, Martin; Frystyk, Jan

    2015-01-01

    The most optimal exercise plan for men with prostate cancer (PC) receiving androgen deprivation therapy needs to be identified. We plan to investigate a 12-week home-based health programme (exergaming) on physical function, fatigue and metabolic parameters in this group. In addition, our study...... observations show that most of the participants fulfil the criteria for being diagnosed with metabolic syndrome. Finally this study will assess the safety and efficacy of a novel exergaming modality for PC patients and the results are expected to influence recommendations on exercise given to this patient...

  19. Patient Reported Outcomes in a New Home-Based Rehabilitation Programme for Prostate Cancer Patients

    DEFF Research Database (Denmark)

    Villumsen, Brigitta R.; Grønbech Jørgensen, Martin; Frystyk, Jan

    2015-01-01

    will explore the satisfaction and experience with the health game programme. To the best of our knowledge this is the first RCT study to investigate the effect of a home based health game programme on PC patients. No statistical analysis have been made thus far because inclusion is ongoing, however baseline...... observations show that most of the participants fulfil the criteria for being diagnosed with metabolic syndrome. Finally this study will assess the safety and efficacy of a novel exergaming modality for PC patients and the results are expected to influence recommendations on exercise given to this patient...

  20. Medical attention seeking dance injuries: systematic review of case reports.

    Science.gov (United States)

    Anand Prakash, Akilesh

    2017-02-01

    The objective of this study was to conduct a systematic review of case reports documenting the epidemiology of unique and rare musculoskeletal injuries in dancers. A systematic review was conducted online using PubMed and Google Scholar, as per PRISMA guidelines up to July 30, 2016. Predefined eligibility criteria were applied, and the data thus compiled was analysed. Study quality was assessed based on CARE guidelines. 72 studies reporting 92 dance injuries were included in the review. The average age of dancers was 23 years (SD = 10 years) with majority being females (65%). Chronic injuries were the most common presentation with lower extremity injuries being the commonest. Foot and knee injuries were the top two articulations involved across injuries and groups. Overall bony injuries were most frequently reported, with stress injury being the most common type. Conservative approach was the most commonly reported treatment approach across case reports. The methodological quality of case reports included in the study varied considerably and lacked uniformity. The evidence provided, though not sufficient for any recommendation, it should alert the physicians and those concerned with the primary care of the dancers to be vigilant of the eccentricity and severity of the injuries, their atypical presentation, mode, mechanism and trend, thereby being prepared for the unexpected.

  1. Medical Malpractice: Insurance Costs Increased but Varied among Physicians and Hospitals. Report to Congressional Requesters.

    Science.gov (United States)

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This report concerns the medical malpractice situation in the United States and contains information on the cost of malpractice insurance for physicians and hospitals. The report contains an executive summary and four chapters. Chapter 1 reviews the background of the problem and the objectives, scope, and methodology of the report. Chapter 2…

  2. Adverse drug reactions reported by consumers for nervous system medications in Europe 2007 to 2011

    DEFF Research Database (Denmark)

    Aagaard, Lise; Hansen, Ebba Holme

    2013-01-01

    Reporting of adverse drug reactions (ADRs) has traditionally been the sole province of healthcare professionals. In the European Union, more countries have allowed consumers to report ADRs directly to the regulatory agencies. The aim of this study was to characterize ADRs reported by European...... consumer for nervous system medications....

  3. 76 FR 27380 - Proposed Information Collection (Report of Medical Examination for Disability Evaluation...

    Science.gov (United States)

    2011-05-11

    ... AFFAIRS Proposed Information Collection (Report of Medical Examination for Disability Evaluation); Comment... opportunity for public comment on the proposed collection of certain information by the agency. Under the... Register concerning each proposed collection of information, including each proposed extension of...

  4. 78 FR 41125 - Interim Enforcement Policy for Permanent Implant Brachytherapy Medical Event Reporting

    Science.gov (United States)

    2013-07-09

    ... COMMISSION Interim Enforcement Policy for Permanent Implant Brachytherapy Medical Event Reporting AGENCY... Commission (NRC) is issuing an interim Enforcement Policy that allows the staff to exercise enforcement...'s permanent implant brachytherapy program. This interim policy affects NRC licensees that...

  5. Safety Analysis Report: X17B2 beamline Synchrotron Medical Research Facility

    Energy Technology Data Exchange (ETDEWEB)

    Gmuer, N.F.; Thomlinson, W.

    1990-02-01

    This report contains a safety analysis for the X17B2 beamline synchrotron medical research facility. Health hazards, risk assessment and building systems are discussed. Reference is made to transvenous coronary angiography. (LSP)

  6. Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience

    Science.gov (United States)

    2016-01-01

    Abstract Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes—all core attributes of a medical home. This qualitative study looked at 4 different PHCO models—3 from the United States and 1 from Australia—with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system. PMID:26636485

  7. Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience.

    Science.gov (United States)

    Takach, Mary

    2016-10-01

    Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes-all core attributes of a medical home. This qualitative study looked at 4 different PHCO models-3 from the United States and 1 from Australia-with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system.

  8. Reporting of Cardiovascular Medical Device Adverse Events to Pharmaceuticals and Medical Devices Agency, Japan

    Directory of Open Access Journals (Sweden)

    Nobuhiro Handa

    2015-09-01

    Comments: Although Japanese MAHs complied with the obligation to report AEs, they often failed to share AEs with healthcare providers. Registry may be a potential solution, although the cooperation of healthcare providers to input data is essential.

  9. Tuition for Children Who Cannot Attend School Due to Illness in Scotland: Experiences of Home Tutors

    Science.gov (United States)

    Acevedo, Mercedes; Gilchrist, Anne

    2007-01-01

    We have explored the working patterns and perceptions of a group of teachers who provide home tuition for children who cannot attend school due to medical problems. These teachers reported high levels of experience in teaching, enthusiasm for their work, and clear managerial structures. Home tutors found it very rewarding to build relationships…

  10. Disregarded use of herbal medical products and dietary supplements among surgical and medical patients as estimated by home inspection and interview

    DEFF Research Database (Denmark)

    Glintborg, Bente; Andersen, Stig Ejdrup; Spang-Hanssen, Eva

    2005-01-01

    PURPOSE: More and more patients use herbal medical products (HMP) and dietary supplements (DS). Due to the possibility of drug interactions and side effects, it is important that physicians are aware of the use. The aim of the present cross sectional survey was to analyse the consumption of HMP......% of the 211 HMP and DS used daily prior to admission were recorded in the hospital files. CONCLUSIONS: The use of HMP and DS was frequent among surgical and medical patients. The use was often not recorded in the hospital files and patients' knowledge of possible side effects and drug-interactions was minimal....... the products on demand. The most frequently used product was multivitamins (82 patients = 41%). Totally, 61% of the products were used on the patients' own initiative. In 3% of the used products, patients were aware of possible side effects. No patients were aware of possible drug interactions. Only 21...

  11. Habitus of home and traditional drinking: a qualitative analysis of reported middle-class alcohol use.

    Science.gov (United States)

    Brierley-Jones, Lyn; Ling, Jonathan; McCabe, Karen E; Wilson, Graeme B; Crosland, Ann; Kaner, Eileen F S; Haighton, Catherine A

    2014-09-01

    There is evidence that alcohol consumption among those in middle-class occupations consistently exceeds safe levels, yet there has been little research into why this occurs. This article explores the meanings associated with alcohol use among professional, managerial and clerical workers. Qualitative data were collected from five focus groups of male and female employees aged 21-55 (N =49: 32 male, 17 female). Each focus group was conducted on the premises of a medium-scale or large-scale employer, four public sector and one private sector, in the north-east of England. Using Bourdieu's concepts of 'habitus', 'capitals' and 'fields' we found that, among these middle-class occupational groups, alcohol use was associated with two habitus: a 'home drinking' habitus and a 'traditional drinking' habitus. Those of the home drinking habitus particularly used wine as a source of cultural capital and a means of distinction, whereas those in the traditional habitus consumed lager, beer and spirits to have fun in social settings. A small minority appeared to belong to a third, omnivorous, habitus where a wide range of alcoholic drinks were consumed in a variety of contexts. Existing public health initiatives to reduce alcohol consumption may require modification to accommodate a range of drinking cultures. © 2014 The Authors. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

  12. NCRP report 160 and what it means for medical imaging and nuclear medicine.

    Science.gov (United States)

    Bolus, Norman E

    2013-12-01

    The purpose of this paper is to briefly explain report 160 of the National Council on Radiation Protection and Measurement and the significance of the report to medical imaging as a whole and nuclear medicine specifically. The implications of the findings of report 160 have had repercussions and will continue to affect all of ionizing radiation medical imaging. The nuclear medicine community should have an understanding of why and how report 160 is important. After reading this article, the nuclear medicine technologist will be familiar with the main focus of report 160, the significant change that has occurred since the 1980s in the ionizing radiation exposure of people in the United States, the primary background source of ionizing radiation in the United States, the primary medical exposure to ionizing radiation in the United States, trends in nuclear medicine procedures and patient exposure, and a comparison of population doses between 2006 and the early 1980s as outlined in report 160.

  13. An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective.

    NARCIS (Netherlands)

    Mistiaen, P.; Ament, A.; Francke, A.L.; Achterberg, W.; Halfens, R.; Huizinga, J.; Post, H.

    2010-01-01

    BACKGROUND: Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of t

  14. Effect of emergency medicine pharmacists on medication-error reporting in an emergency department.

    Science.gov (United States)

    Weant, Kyle A; Humphries, Roger L; Hite, Kimberly; Armitstead, John A

    2010-11-01

    The effect of an emergency medicine (EM) clinical pharmacist on medication-error reporting in an emergency department (ED) was studied. The medication-error reports for patients seen at a university's ED between September 1, 2005, and February 28, 2009, were retrospectively reviewed. Errors reported before the addition of an EM pharmacist (from September 1, 2005, through February 28, 2006) were compared with those reported after the addition of two EM pharmacists (from September 1, 2008, through February 28, 2009). The severity of errors and the provider who reported the errors were characterized. A total of 402 medication errors were reported over the two time periods. Pharmacy personnel captured significantly more errors than did other health care personnel (94.5% versus 5.7%, p pharmacists resulted in 14.8 times as many medication-error reports as were made when no EM pharmacist was in the ED. More errors that actually occurred were captured with two pharmacists providing care (95.7% versus 4.3%, p errors documented were ordering errors (79.8%). Of these, 73.7% were captured after the addition of two EM pharmacists. Performance (40.0%) and knowledge (27.9%) deficits were the most common contributing factors to medication errors. During the study period after the addition of two EM pharmacists in the ED, 371 medication-error reports were completed, compared with 31 reports during the study period before the addition of the pharmacists. Pharmacy personnel reported the majority of medication errors during both study periods.

  15. A study of the changes in how medically related events are reported in Japanese newspapers

    Directory of Open Access Journals (Sweden)

    Yukiko Kishi

    2010-08-01

    Full Text Available Yukiko Kishi1, Naoko Murashige2, Yuko Kodama1, Tamae Hamaki1, Kazuhiro Murata3, Haruka Nakada1, Tsunehiko Komatsu3, Hiroto Narimatsu1,4, Masahiro Kami1, Tomoko Matsumura11Division of Social Communication System for Advanced Clinical Research, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan; 2Ministry of Health, Labor and Welfare, Aide of the Minister, Health Sector Reform Office, Tokyo, Japan; 3Department of Hematology, Teikyo University Chiba Medical Center, Chiba, Japan, 4Advanced Molecular Epidemiology Research Institute, Faculty of Medicine, Yamagata University, Yamagata, JapanAbstract: Media reports of medically related events have a major effect on the healthcare ­community but there have been few detailed investigations conducted to investigate their content. The Nikkei Telecom 21 database was used to investigate the number of reports concerning medically related events between 1992 and 2007 in Japan’s 5 national newspapers. For this period, both the total number of articles and the number of articles containing medically-related keywords were determined. The number of reports relating to medically related occurrences increased sharply from 1999 to 2000 and displayed a decrease from 2003 before increasing again in 2008. As of 2008, such reports account for 0.17% of total newspaper articles. The use of the word ‘iryokago’ (medical professional negligence or error drastically increased in 1999 but showed a consistent decrease from 2004. On the other hand the frequency of reports relating to ‘litigation’ and ‘punishment’ increased rapidly in 1999 before leveling off. Despite this, the number of articles relating to medically related occurrences that were caused by doctor shortages and system errors increased sharply between 2006 and the present. Results indicate that the manner in which newspapers report medically related events is undergoing major changes.Keywords: coverage, incident, doctor shortage

  16. Relevance of the Flexner Report to contemporary medical education in South Asia.

    Science.gov (United States)

    Amin, Zubair; Burdick, William P; Supe, Avinash; Singh, Tejinder

    2010-02-01

    A century after the publication of Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (the Flexner Report), the quality of medical education in much of Asia is threatened by weak regulation, inadequate public funding, and explosive growth of private medical schools. Competition for students' fees and an ineffectual accreditation process have resulted in questionable admission practices, stagnant curricula, antiquated learning methods, and dubious assessment practices. The authors' purpose is to explore the relevance of Flexner's observations, as detailed in his report, to contemporary medical education in South Asia, to analyze the consequences of growth, and to recommend pragmatic changes. Major drivers for growth are the supply-demand mismatch for medical school positions, weak governmental regulation, private sector participation, and corruption. The consequences are urban-centric growth, shortage of qualified faculty, commercialization of postgraduate education, untenable assessment practices, emphasis on rote learning, and inadequate clinical exposure. Recommendations include strengthening accreditation standards and processes possibly by introducing regional or national student assessment, developing defensible student assessment systems, recognizing health profession education as a field of scholarship, and creating a tiered approach to faculty development in education. The relevance of Flexner's recommendations to the current status of medical education in South Asia is striking, in terms of both the progressive nature of his thinking in 1910 and the need to improve medical education in Asia today. In a highly connected world, the improvement of Asian medical education will have a global impact.

  17. Testing feedback message framing and comparators to address prescribing of high-risk medications in nursing homes: protocol for a pragmatic, factorial, cluster-randomized trial.

    Science.gov (United States)

    Ivers, Noah M; Desveaux, Laura; Presseau, Justin; Reis, Catherine; Witteman, Holly O; Taljaard, Monica K; McCleary, Nicola; Thavorn, Kednapa; Grimshaw, Jeremy M

    2017-07-14

    Audit and feedback (AF) interventions that leverage routine administrative data offer a scalable and relatively low-cost method to improve processes of care. AF interventions are usually designed to highlight discrepancies between desired and actual performance and to encourage recipients to act to address such discrepancies. Comparing to a regional average is a common approach, but more recipients would have a discrepancy if compared to a higher-than-average level of performance. In addition, how recipients perceive and respond to discrepancies may depend on how the feedback itself is framed. We aim to evaluate the effectiveness of different comparators and framing in feedback on high-risk prescribing in nursing homes. This is a pragmatic, 2 × 2 factorial, cluster-randomized controlled trial testing variations in the comparator and framing on the effectiveness of quarterly AF in changing high-risk prescribing in nursing homes in Ontario, Canada. We grouped homes that share physicians into clusters and randomized these clusters into the four experimental conditions. Outcomes will be assessed after 6 months; all primary analyses will be by intention-to-treat. The primary outcome (monthly number of high-risk medications received by each patient) will be analysed using a general linear mixed effects regression model. We will present both four-arm and factorial analyses. With 160 clusters and an average of 350 beds per cluster, assuming no interaction and similar effects for each intervention, we anticipate 90% power to detect an absolute mean difference of 0.3 high-risk medications prescribed. A mixed-methods process evaluation will explore potential mechanisms underlying the observed effects, exploring targeted constructs including intention, self-efficacy, outcome expectations, descriptive norms, and goal prioritization. An economic analysis will examine cost-effectiveness analysis from the perspective of the publicly funded health care system. This protocol

  18. Medical Surveillance Monthly Report (MSMR). Volume 20, Number 7

    Science.gov (United States)

    2013-07-01

    involves social support, education, group therapy, mind- body medicine, virtual reality, hypnosis, spiritual counseling, cognitive behavioral therapy...culties, bereavement, acculturation diffi - culties) (n=11,145) (Table 2). Rates of any mental health problems (as reported with V-codes) were

  19. Medical and Health Divisions quarterly report, July, August, September, 1948

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-11-01

    This quarterly report describes progress in four programs entitled (1) The Metabolic Properties of Plutonium and Allied Materials, (2) Biological Studies of Radiation Effects, (3) Biological Effects of Radiation from External and Internal Sources and (4) Health Chemistry and Physics. Progress in each program is separately indexed and abstracted for the database.

  20. Medical Surveillance Monthly Report, Volume 20, Number 8

    Science.gov (United States)

    2013-08-01

    1,2,9,10 Th is report also describes the frequency and use of ICD-9 codes for sepsis, septic shock, and bactere - mia among U.S. service members. M E T H...in the 3rd through 8th diagnostic positions of the associated hospitalization records. Of the 178 hospitalizations with bactere - mia in the

  1. Medical and Health Divisions quarterly report, July, August, September, 1948

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-11-01

    This quarterly report describes progress in four programs entitled (1) The Metabolic Properties of Plutonium and Allied Materials, (2) Biological Studies of Radiation Effects, (3) Biological Effects of Radiation from External and Internal Sources and (4) Health Chemistry and Physics. Progress in each program is separately indexed and abstracted for the database.

  2. Measuring and Reporting Physician's Performance in a University Medical Center.

    Science.gov (United States)

    Kazan-Fishman, Ana Lucia

    This paper describes a Patient Satisfaction survey and database used to measure and report on physician performance at the Ohio State University Health System (OSUHS). The OSUHS averages 6,000 inpatients in any given month, and more than 7,000 emergency patients and 70,000 outpatient encounters. Data from the Patient Satisfaction measures are…

  3. Medical and Health Divisions quarterly report, January, February, March 1948

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1948-05-24

    This quarterly progress report describes four programs namely (1) The Metabolic Properties of Plutonium and Allied Materials (2) Biological studies of radiation effects, (3) Biological effects of radiation from external and internal sources, and (4) Health Physics and Chemistry. Progress for each program has been separately indexed and abstracted for the database.

  4. The INTERNIST-1/QUICK MEDICAL REFERENCE Project—Status Report

    Science.gov (United States)

    Miller, Randolph A.; McNeil, Melissa A.; Challinor, Sue M.; Masarie, Fred E.; Myers, Jack D.

    1986-01-01

    INTERNIST-1 and its successor, QUICK MEDICAL REFERENCE (QMR), are computer programs designed to provide health care professionals with diagnostic assistance in general internal medicine. Both programs rely on the INTERNIST-1 computerized knowledge base, which comprehensively describes 570 diseases in internal medicine. The philosophies behind the development of each program differ. Whereas INTERNIST-1 functions solely as a high-powered diagnostic consultant program, the QMR program acts more as an information tool, providing users with multiple ways of reviewing and manipulating the diagnostic information in the program's knowledge base. At the lowest level, the program can be viewed as an electronic textbook of medicine. In addition, the QMR program has the ability to assist users with generating hypotheses in complex patient cases. The QMR program has not been evaluated formally as an information tool for practicing physicians. A preliminary study indicates that QMR's case-analysis capabilities are of potential benefit in most patients in internal medicine admitted for diagnostic evaluation. PMID:3544509

  5. Rhetorical Structure and Linguistic Features of Case Presentations in Case Reports in Taiwanese and International Medical Journals

    Science.gov (United States)

    Hung, Hsuan; Chen, Pi-Ching; Tsai, Jing-Jane

    2012-01-01

    The case presentation is the core section of a medical case report. Issues in the teaching of case report writing have recently been the subject of great interest in medical education, especially in the era of globalization. Given that Taiwanese medical students, residents and junior physicians are requested to write case reports in English and…

  6. Nursing home and nursing home physician: the Dutch experience.

    NARCIS (Netherlands)

    Schols, J.M.G.A.; Crebolder, H.F.J.M.; Weel, C. van

    2004-01-01

    Dutch nursing home care today includes a broad range of institutional and outreaching care functions. Medical care is an essential part of this care. Nursing home medicine in The Netherlands has developed as an officially acknowledged medical specialty. This is unique because The Netherlands is the

  7. Medical Surveillance Monthly Report. Volume 22, Number 10, October 2015

    Science.gov (United States)

    2015-10-01

    transmitted to humans via the bite of an infected mosquito of the genus Aedes (A. aegypti or A. albopictus). Acute disease is primarily characterized by... prevent illness due to CHIKV infection. Several studies have reported persis- tent and chronic joint pains lasting months to years aft er the...Surveillance Branch, Silver Spring, MD Acknowledgements: Th e authors thank Rohit Chitale, PhD (Centers for Disease Control and Prevention

  8. Medical Surveillance Monthly Report. Volume 16, Number 7, July 2009

    Science.gov (United States)

    2009-07-01

    a zoonotic tick-borne disease that is caused by infection with a spirochetal bacterium of the genus Borrelia. It has a worldwide distribution and is...pollution (indoor and outdoor), infestation-related allergens (e.g., cockroaches, mice, rats), and stress (e.g., violence ).12 This report suggests that...accession standard: a survival analysis of military recruits, 1995 to 1997. Mil Med. 2000 Nov;165(11):852-4. 9. AMSARA, Defense Technology Information

  9. Medical Surveillance Monthly Report. Volume 19, Number 5

    Science.gov (United States)

    2012-05-01

    are leading causes of death among individuals in their late teens and early twenties.5,6 Since 1998 in the military, sui- cide has been the second... sexually transmitted infections (e.g., her- pes simplex virus [HSV2]) to receive MHD diagnoses aft er detection of their infec- tions. Th is report...human papillomavirus (HPV) is the most common sexually transmitted pathogen detected among U.S. service members. An estimated 169,682 incident diagnoses

  10. Adverse medical complications: an under-reported contributory cause of death in New York City.

    Science.gov (United States)

    Gill, J R; Ely, S F; Toriello, A; Hirsch, C S

    2014-04-01

    The current death certification system in the USA fails to accurately track deaths due to adverse medical events. The aim of this study was to demonstrate the under-reporting of deaths due to adverse medical events due to limitations in the current death certification/reporting system, and the benefits of using the term 'therapeutic complication' as the manner of death. Retrospective review and comparison of death certificates and vital statistical coding. The manner of death is certified as a therapeutic complication when death is caused by predictable complications of appropriate therapy, and would not have occurred but for the medical intervention. Based on medical examiner records, complications that caused or contributed to deaths over a five-year period were examined retrospectively. These fatalities were compared with deaths coded as medical and surgical complications by the New York City Bureau of Vital Statistics. The Medical Examiner's Office certified 2471 deaths as therapeutic complications and 312 deaths as accidents occurring in healthcare facilities. In contrast, the New York City Bureau of Vital Statistics reported 188 deaths due to complications of medical and surgical care. Use of the term 'therapeutic complication' as the manner of death identified nearly 14 times more deaths than were reported by the New York City Bureau of Vital Statistics. If these therapeutic complications and medical accidents were considered as a 'disease', they would rank as the 10th leading cause of death in New York City, surpassing homicides and suicides in some years. Nationwide policy shifts that use the term 'therapeutic complication' would improve the capture and reporting of these deaths, thus allowing better identification of fatal adverse medical events in order to focus on and assess preventative strategies. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  11. Patient vs provider reports of aberrant medication-taking behavior among opioid-treated patients with chronic pain who report misusing opioid medication.

    Science.gov (United States)

    Nikulina, Valentina; Guarino, Honoria; Acosta, Michelle C; Marsch, Lisa A; Syckes, Cassandra; Moore, Sarah K; Portenoy, Russell K; Cruciani, Ricardo A; Turk, Dennis C; Rosenblum, Andrew

    2016-08-01

    During long-term opioid therapy for chronic noncancer pain, monitoring medication adherence of patients with a history of aberrant opioid medication-taking behaviors (AMTB) is an essential practice. There is limited research, however, into the concordance among existing monitoring tools of self-report, physician report, and biofluid screening. This study examined associations among patient and provider assessments of AMTB and urine drug screening using data from a randomized trial of a cognitive-behavioral intervention designed to improve medication adherence and pain-related outcomes among 110 opioid-treated patients with chronic pain who screened positive for AMTB and were enrolled in a pain program. Providers completed the Aberrant Behavior Checklist (ABC) and patients completed the Current Opioid Misuse Measure (COMM) and the Chemical Coping Inventory (CCI). In multivariate analyses, ABC scores were compared with COMM and CCI scores, while controlling for demographics and established risk factors for AMTB, such as pain severity. Based on clinical cutoffs, 84% of patients reported clinically significant levels of AMTB and providers rated 36% of patients at elevated levels. Provider reports of AMTB were not correlated with COMM or CCI scores. However, the ABC ratings of experienced providers (nurse practitioners/attending physicians) were higher than those of less experienced providers (fellows) and were correlated with CCI scores and risk factors for AMTB. Associations between patient- and provider-reported AMTB and urine drug screening results were low and largely nonsignificant. In conclusion, concordance between patient and provider reports of AMTB among patients with chronic pain prescribed opioid medication varied by provider level of training.

  12. The Relationship Between Nursing Experience and Education and the Occurrence of Reported Pediatric Medication Administration Errors.

    Science.gov (United States)

    Sears, Kim; O'Brien-Pallas, Linda; Stevens, Bonnie; Murphy, Gail Tomblin

    2016-01-01

    Medication errors are one of the most common incidents in the hospitals. They can be harmful, and they are even more detrimental for pediatric patients. This study explored the relationship between nursing experience, education, the frequency and severity of reported pediatric medication administration errors (PMAEs). The data for this study were collected from a larger pan Canadian study. A survey tool was developed to collect self-reported data from nurses. In addition to descriptive statistics, a Poisson regression or a multiple linear regression was completed to address the research questions, and a Boneferrai correction was conducted to adjust for the small sample size. Results demonstrated that on units with more nurses with a higher level of current experience, more PMAEs were reported (p=.001), however; the PMAEs reported by these nurses were not as severe (p=.003). Implications to advance both safe medication delivery in the pediatric setting and safe culture of reporting for both actual and potential errors are identified.

  13. Changes to Hospital Inpatient Volume After Newspaper Reporting of Medical Errors.

    Science.gov (United States)

    Fukuda, Haruhisa

    2017-06-30

    The aim of this study was to investigate the influence of medical error case reporting by national newspapers on inpatient volume at acute care hospitals. A case-control study was conducted using the article databases of 3 major Japanese newspapers with nationwide circulation between fiscal years 2012 and 2013. Data on inpatient volume at acute care hospitals were obtained from a Japanese government survey between fiscal years 2011 and 2014. Panel data were constructed and analyzed using a difference-in-differences design. Acute care hospitals in Japan. Hospitals named in articles that included the terms "medical error" and "hospital" were designated case hospitals, which were matched with control hospitals using corresponding locations, nurse-to-patient ratios, and bed numbers. Medical error case reporting in newspapers. Changes to hospital inpatient volume after error reports. The sample comprised 40 case hospitals and 40 control hospitals. Difference-in-differences analyses indicated that newspaper reporting of medical errors was not significantly associated (P = 0.122) with overall inpatient volume. Medical error case reporting by newspapers showed no influence on inpatient volume. Hospitals therefore have little incentive to respond adequately and proactively to medical errors. There may be a need for government intervention to improve the posterror response and encourage better health care safety.

  14. The language spoken at home and disparities in medical and dental health, access to care, and use of services in US children.

    Science.gov (United States)

    Flores, Glenn; Tomany-Korman, Sandra C

    2008-06-01

    Fifty-five million Americans speak a non-English primary language at home, but little is known about health disparities for children in non-English-primary-language households. Our study objective was to examine whether disparities in medical and dental health, access to care, and use of services exist for children in non-English-primary-language households. The National Survey of Childhood Health was a telephone survey in 2003-2004 of a nationwide sample of parents of 102 353 children 0 to 17 years old. Disparities in medical and oral health and health care were examined for children in a non-English-primary-language household compared with children in English- primary-language households, both in bivariate analyses and in multivariable analyses that adjusted for 8 covariates (child's age, race/ethnicity, and medical or dental insurance coverage, caregiver's highest educational attainment and employment status, number of children and adults in the household, and poverty status). Children in non-English-primary-language households were significantly more likely than children in English-primary-language households to be poor (42% vs 13%) and Latino or Asian/Pacific Islander. Significantly higher proportions of children in non-English-primary-language households were not in excellent/very good health (43% vs 12%), were overweight/at risk for overweight (48% vs 39%), had teeth in fair/poor condition (27% vs 7%), and were uninsured (27% vs 6%), sporadically insured (20% vs 10%), and lacked dental insurance (39% vs 20%). Children in non-English-primary-language households more often had no usual source of medical care (38% vs 13%), made no medical (27% vs 12%) or preventive dental (14% vs 6%) visits in the previous year, and had problems obtaining specialty care (40% vs 23%). Latino and Asian children in non-English-primary-language households had several unique disparities compared with white children in non-English-primary-language households. Almost all disparities

  15. Medical Surveillance Monthly Report. Volume 24, Number 1, January 2017

    Science.gov (United States)

    2017-01-31

    Thrombocytopenia 287 D69 Malaria complicating pregnancy 647.4 O98.6 Signs, symptoms, or other abnor- malities consistent with malaria 276.2, 518.82, 584.9, 723.1... stress or depression.10,18 To date, there have been no extensive analyses of CT trends during pre-deploy- ment, deployment, post-deployment, and...adjustment disorders, or other deployment-related stressors.5,9 For example, self-reported high levels of fam- ily and personal life stress among active

  16. US Army Medical Research and Development Technical Report

    Science.gov (United States)

    1975-07-01

    jytotoxic Reactions Produced by MUST-Water Constituents • — ^ &,-FT—Bahr, M.D. J. A. Boccia , Ljet MC, USA R. K. Shoemaker, CPT, MSC, USA...Bahr, M.D. Joseph A. Boccia , LTC, MC, USA Robert H. Shoemaker, CPT, MSC, USA Report Control Symbol: RCS-MEDDH-288(R1) Security Classification...Performing 90 Gunter F. Bahr, M.D., Chairman; Joseph A. Boccia , M.D., LTC, MC, USA: Robert H. Shoe- maker, Ph.D., CPT, MSC, USA I Technical

  17. Cost-effectiveness of the Australian Medical Sheepskin for the prevention of pressure ulcers in somatic nursing home patients: study protocol for a prospective multi-centre randomised controlled trial (ISRCTN17553857).

    NARCIS (Netherlands)

    Mistiaen, P.; Achterberg, W.P.; Ament, A.; Halfen, R.; Huizinga, J.; Montgomery, K.; Post, H.; Francke, A.

    2008-01-01

    BACKGROUND: Pressure ulcers are a major problem, especially in nursing home patients, although they are regarded as preventable and there are many pressure relieving methods and materials. One such pressure relieving material is the recently developed Australian Medical Sheepskin, which has been sho

  18. Combined surgical and medical treatment of giant prolactinoma: case report

    Directory of Open Access Journals (Sweden)

    Rădoi Mugurel

    2016-06-01

    Full Text Available The operative management of giant pituitary prolactinoma represents a significant challenge for neurosurgeons, due to the degree of local tumor infiltration into adjacent structures such as cavernous sinus. The degree of parasellar tumor extension can be classified according to the Knosp grading system’ while suprasellar extension is qualified in accordance with the modified Hardys classification system. This report describes the case of a male patient with a giant pituitary prolactinoma in which a partial tumor resection via a subfrontal approach was achieved. Typically, resection rates of less than 50% have been reported following surgery on giant pituitary adenomas. Prolactin levels were very high, consistent with invasive giant prolactinoma. Our patient was treated with Cabergoline which eventually normalized the prolactin level and significantly reduced the size of the residual tumor. This case serves to illustrate that in the presence of significant suprasellar and parasellar extension, multi-modal treatment strategies with surgery and dopamine agonist, is the gold standard in the management of locally aggressive pituitary prolactinomas.

  19. Reporting and Charting Residents' Behaviors and Care in an Adult Residential Care Home. Adult Residential Care Home 12, Lesson Plan No. 2.

    Science.gov (United States)

    Basuel, Terry

    Designed as part of a 40-hour course on adult residential care homes (ARCH's), this lesson plan was developed to explain the importance of and correct procedures for charting (i.e., keeping a written record of observations and care of ARCH residents). The objectives of the 50-minute lesson are to enable students to: (1) list reasons why the…

  20. Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy

    Directory of Open Access Journals (Sweden)

    Moura LMVR

    2016-10-01

    Full Text Available Lidia M V R Moura,1 Thiago S Carneiro,1 Andrew J Cole,1 John Hsu,2,3 Barbara G Vickrey,4 Daniel B Hoch1 1Department of Neurology, 2Mongan Institute for Health Policy, Department of Medicine, Massachusetts General Hospital, 3Department of Health Care Policy, Harvard Medical School, Boston, MA, 4Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA Background and aim: Adherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED side effects at every visit is associated with increased patient-reported medication adherence.Patients and methods: This study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1 phone interview (patient-reported and 2 medical records abstraction (physician-documented. Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering “no” to all questions.Results: Sixty-two (25% patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P=0.04. Among the participants, evidence that AED side effects were addressed was present in 48 (77% medical records and reported by 51 (82% patients. Twenty-eight (45% patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%. There was no association between addressing AED side effects (neither physician-documented nor patient-reported and complete medication adherence (P=0.22 and 0.20.Discussion and