WorldWideScience

Sample records for standard care practices

  1. 7 CFR 205.238 - Livestock health care practice standard.

    Science.gov (United States)

    2010-01-01

    ...) Provision of a feed ration sufficient to meet nutritional requirements, including vitamins, minerals... Requirements § 205.238 Livestock health care practice standard. (a) The producer must establish and maintain... appropriate housing, pasture conditions, and sanitation practices to minimize the occurrence and spread of...

  2. Knowledge and Practice of Standard Precautions by Health-Care ...

    African Journals Online (AJOL)

    2018-02-23

    Feb 23, 2018 ... the knowledge and practices of SP among HCWs in tertiary health-care facilities. ... washed the exposed part with water, soap, and disinfectant (52.1%). ..... 15. Amoran O, Onwube O. Infection control and practice of standard precautions among healthcare workers in Northern Nigeria. J Glob Infect Dis 2013 ...

  3. Developing palliative care practice guidelines and standards for nursing home-based palliative care teams: a Delphi study.

    Science.gov (United States)

    Temkin-Greener, Helena; Ladwig, Susan; Caprio, Tom; Norton, Sally; Quill, Timothy; Olsan, Tobie; Cai, Xueya; Mukamel, Dana B

    2015-01-01

    Lack of nursing home (NH)-specific palliative care practice guidelines has been identified as a barrier to improving palliative and end-of-life (EOL) quality of care. The objectives of this study were to (1) assess which of the guidelines developed by the National Consensus Project, and the corresponding preferred care practices endorsed by the National Quality Forum, are important and feasible to implement in NHs; and (2) identify the operational standards for palliative care teams in NHs. Two-round mail Delphi study. Based on the existing literature, a set of 7 domains with associated 22 palliative practice guidelines was drafted. We invited 48 NH leaders, including clinicians, to review the importance (10-point Likert scale) and the feasibility (5-point Likert scale) of these guidelines. Participants were also asked about palliative care team composition rounding frequency. The response rate to both rounds was 85%. With regard to importance, the mean rating for all guidelines was 8 or higher (ie, highly important), but there was variability in agreement with regard to 5 of the guidelines. The same 5 guidelines were also considered more difficult to implement (eg, costly, unrealistic). Overall, 17 palliative care guidelines were identified for use by NH palliative care teams. Five disciplines (social work, certified nurse assistant, nurse, physician, and nurse practitioner or physician assistant) were identified as comprising a core team and 3 were proposed as extended or ad hoc members. The palliative care guidelines and team standards identified in this study may be helpful in providing practical direction to NH administrators and staff looking to improve palliative care practice for their residents. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  4. A Standardized Shift Handover Protocol: Improving Nurses’ Safe Practice in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Javad Malekzadeh

    2013-08-01

    Full Text Available Introduction: For maintaining the continuity of care and improving the quality of care, effective inter-shift information communication is necessary. Any handover error can endanger patient safety. Despite the importance of shift handover, there is no standard handover protocol in our healthcare settings. Methods In this one-group pretest-posttest quasi-experimental study conducted in spring and summer of 2011, we recruited a convenience sample of 56 ICU nurses. The Nurses’ Safe Practice Evaluation Checklist was used for data collection. The Content Validity Index and the inter-rater correlation coefficient of the checklist was 0.92 and 89, respectively. We employed the SPSS 11.5 software and the Mc Nemar and paired-samples t test for data analysis. Results: Study findings revealed that nurses’ mean score on the Safe Practice Evaluation Checklist increased significantly from 11.6 (2.7 to 17.0 (1.8 (P < 0.001. Conclusion: using a standard handover protocol for communicating patient’s needs and information improves nurses’ safe practice in the area of basic nursing care.

  5. Academy of Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Dietetic Technicians, Registered.

    Science.gov (United States)

    2013-06-01

    DTRs face complex situations every day. Competently addressing the unique needs of each situation and applying standards appropriately is essential to providing safe, timely, person-centered quality care and service. All DTRs are advised to conduct their practice based on the most recent edition of the Academy's Code of Ethics and the Scope of Practice in Nutrition and Dietetics, the Scope of Practice for the DTR, the 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for DTRs. These resources provide minimum standards and tools for demonstrating competence and safe practice, and are used collectively to gauge and guide a DTR's performance in nutrition and dietetics practice. The SOP and SOPP for the DTR are self-evaluation tools that promote quality assurance and performance improvement. Self-assessment provides opportunities to identify areas for enhancement, new learning and skill development, and to encourage progression of career growth. All DTRs are advised to have in their personal libraries the most recent copy of the Academy's Scope of Practice in Nutrition and Dietetics and its components: The 2012 Academy Standards of Practice in Nutrition Care and Standards of Professional Performance for DTRs; the Code of Ethics; and the Scope of Practice for the DTR. To ensure that credentialed dietetics practitioners always have access to the most current materials, each resource is maintained on the Academy's website. The documents will continue to be reviewed and updated as new trends in the profession of nutrition and dietetics and external influences emerge.

  6. Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial.

    Science.gov (United States)

    Samsson, Karin S; Bernhardsson, Susanne; Larsson, Maria E H

    2016-06-10

    Physiotherapist-led orthopaedic triage, where physiotherapists diagnose and determine management plans, aims to enhance effectiveness and provide the best care. However, scientific evidence for the effectiveness of this model of care remains limited, and there are few studies reporting on patients' perceptions of the care provided. The purpose of this study was to evaluate patients' perceived quality of care in a physiotherapist-led orthopaedic triage in primary care, compared with standard practice. In a randomised controlled trial, patients of working age referred for orthopaedic consultation at a primary healthcare clinic in Sweden received either physiotherapist-led triage (n = 102) or standard practice (orthopaedic surgeon assessment) (n = 101). Neither subjects nor clinicians were blinded. The questionnaire Quality from the Patient's Perspective (QPP) was used to evaluate perceived quality of care focusing on the caregivers' medical-technical competence and identity-orientated approach. Also, to what extent patients' expectations were met, and their intention to follow advice was evaluated. For this study, 163 patients (80 %) were analysed (physiotherapist-led triage (n = 83), standard practice (n = 80)). Participants perceived significantly higher quality of care with the triage than with the standard practice in regards to receiving best possible examination and treatment (medical-technical competence) (p quality of care in a physiotherapist-led orthopaedic triage compared with standard practice. Patients in both groups reported that they perceived good quality of care, with the patients in the physiotherapist-led triage reporting significantly higher perceived quality of care than those in the standard practice group. This model of care seems to meet patients' expectations and result in a greater intention to follow advice and instructions for self-management. Our findings are in line with existing literature that this model of care

  7. Academy of Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians.

    Science.gov (United States)

    2013-06-01

    RDs face complex situations every day. Competently addressing the unique needs of each situation and applying standards appropriately is essential to providing safe, timely, person-centered quality care and service. All RDs are advised to conduct their practice based on the most recent edition of the Academy's Code of Ethics and the Scope of Practice in Nutrition and Dietetics, the Scope of Practice for the Registered Dietitian, the 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for RDs, and the applicable focus area SOP and SOPP for RDs. These resources provide minimum standards and tools for demonstrating competence and safe practice, and are used collectively to gauge and guide an RD's performance in nutrition and dietetics practice. The SOP and SOPP for the RD are self-evaluation tools that promote quality assurance and performance improvement. Self-assessment provides opportunities to identify areas for enhancement, new learning, and skill development, and to encourage progression of career growth. All RDs are advised to have in their personal libraries the most recent copy of the Academy's Scope of Practice in Nutrition and Dietetics and its components: The 2012 Academy Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians; applicable focus area SOP and SOPP; the Code of Ethics; and the Scope of Practice for the Registered Dietitian. To ensure that credentialed dietetics practitioners always have access to the most current materials, each resource is maintained on the Academy's website. The documents will continue to be reviewed and updated as new trends in the profession of nutrition and dietetics and external influences emerge.

  8. Medical tourism in plastic surgery: ethical guidelines and practice standards for perioperative care.

    Science.gov (United States)

    Iorio, Matthew L; Verma, Kapil; Ashktorab, Samaneh; Davison, Steven P

    2014-06-01

    The goal of this review was to identify the safety and medical care issues that surround the management of patients who had previously undergone medical care through tourism medicine. Medical tourism in plastic surgery occurs via three main referral patterns: macrotourism, in which a patient receives treatments abroad; microtourism, in which a patient undergoes a procedure by a distant plastic surgeon but requires postoperative and/or long-term management by a local plastic surgeon; and specialty tourism, in which a patient receives plastic surgery from a non-plastic surgeon. The ethical practice guidelines of the American Medical Association, International Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and American Board of Plastic Surgeons were reviewed with respect to patient care and the practice of medical tourism. Safe and responsible care should start prior to surgery, with communication and postoperative planning between the treating physician and the accepting physician. Complications can arise at any time; however, it is the duty and ethical responsibility of plastic surgeons to prevent unnecessary complications following tourism medicine by adequately counseling patients, defining perioperative treatment protocols, and reporting complications to regional and specialty-specific governing bodies. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  9. Association of Implementation of Practice Standards for Electrocardiographic Monitoring With Nurses' Knowledge, Quality of Care, and Patient Outcomes: Findings From the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial.

    Science.gov (United States)

    Funk, Marjorie; Fennie, Kristopher P; Stephens, Kimberly E; May, Jeanine L; Winkler, Catherine G; Drew, Barbara J

    2017-02-01

    Although continuous electrocardiographic (ECG) monitoring is ubiquitous in hospitals, monitoring practices are inconsistent. We evaluated implementation of American Heart Association practice standards for ECG monitoring on nurses' knowledge, quality of care, and patient outcomes. The PULSE (Practical Use of the Latest Standards of Electrocardiography) Trial was a 6-year multisite randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We measured outcomes at baseline, time 2 after group 1 hospitals received the intervention, and time 3 after group 2 hospitals received the intervention. Measurement periods were 15 months apart. The 2-part intervention consisted of an online ECG monitoring education program and strategies to implement and sustain change in practice. Nurses' knowledge (N=3013 nurses) was measured by a validated 20-item online test, quality of care related to ECG monitoring (N=4587 patients) by on-site observation, and patient outcomes (mortality, in-hospital myocardial infarction, and not surviving a cardiac arrest; N=95 884 hospital admissions) by review of administrative, laboratory, and medical record data. Nurses' knowledge improved significantly immediately after the intervention in both groups but was not sustained 15 months later. For most measures of quality of care (accurate electrode placement, accurate rhythm interpretation, appropriate monitoring, and ST-segment monitoring when indicated), the intervention was associated with significant improvement, which was sustained 15 months later. Of the 3 patient outcomes, only in-hospital myocardial infarction declined significantly after the intervention and was sustained. Online ECG monitoring education and strategies to change practice can lead to improved nurses' knowledge, quality of care, and patient outcomes. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01269736. © 2017 American Heart Association, Inc.

  10. Standard for metric practice

    International Nuclear Information System (INIS)

    Anon.

    1981-01-01

    This standard gives guidance for application of the modernized metric system in the United States. The International System of Units, developed and maintained by the General Conference on Weights and Measures (abbreviated CGPM from the official French name Conference Generale des Poids et Measures) is intended as a basis for worldwide standardization of measurement units. The name International System of Units and the international abbreviation SI 2 were adopted by the 11th CGPM in 1960. SI is a complete, coherent system that is being universally adopted

  11. Improving the standards of midwifery education and practice and extending the role of a midwife in Korean women and children's health care.

    Science.gov (United States)

    Lee, Kyung Hye

    2003-12-01

    A midwife is a medical professional who has a nursing license, and is also licensed as a midwife with one additional year of education. In this globalization era, a midwife's role is increasing in importance for women and children's health care worldwide. The primary purpose was to analyze midwifery education programs in Korea and other nations. The secondary purpose was to define strategies to improve midwifery education and practice, and to extend the role of a midwife women and children's health care in Korea. 1) The definition of a midwife and midwifery practice recognized internationally by World Health Organization (WHO) and International Council of Nurse Midwives (ICNM) was identified. 2) Midwifery education programs of Korea, U.S.A., Sweden, Australia, and Japan, were investigated and discussed. 3) Core competencies for the basic midwifery practice suggested by ACNM of the U.S.A. were reviewed as standard of midwifery practice. 4) As for the midwifery education system, a Masters degree program in a college of nursing is suggested. 5) The role of a midwife includes not only health care of childbirth women and newborn babies, but also a lifelong health care of women as well as her family and children. An effort to extend the midwife's role and to improve service is imperative. The Laws/Acts related to midwives should be revised in regard to education, and practices, and the national examination for midwifery licensure needs revision to qualify for international approval. Also, midwifery curriculum and standards of practice need to be evaluated periodically, and an effective system needs to be established to renew midwife licenses.

  12. A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs.

    Science.gov (United States)

    Miralpeix, Ester; Nick, Alpa M; Meyer, Larissa A; Cata, Juan; Lasala, Javier; Mena, Gabriel E; Gottumukkala, Vijaya; Iniesta-Donate, Maria; Salvo, Gloria; Ramirez, Pedro T

    2016-05-01

    Enhanced recovery after surgery (ERAS) programs aim to hasten functional recovery and improve postoperative outcomes. However, there is a paucity of data on ERAS programs in gynecologic surgery. We reviewed the published literature on ERAS programs in colorectal surgery, general gynecologic surgery, and gynecologic oncology surgery to evaluate the impact of such programs on outcomes, and to identify key elements in establishing a successful ERAS program. ERAS programs are associated with shorter length of hospital stay, a reduction in overall health care costs, and improvements in patient satisfaction. We suggest an ERAS program for gynecologic oncology practice involving preoperative, intraoperative, and postoperative strategies including; preadmission counseling, avoidance of preoperative bowel preparation, use of opioid-sparing multimodal perioperative analgesia (including loco-regional analgesia), intraoperative goal-directed fluid therapy (GDT), and use of minimally invasive surgical techniques with avoidance of routine use of nasogastric tube, drains and/or catheters. Postoperatively, it is important to encourage early feeding, early mobilization, timely removal of tubes and drains, if present, and function oriented multimodal analgesia regimens. Successful implementation of an ERAS program requires a multidisciplinary team effort and active participation of the patient in their goal-oriented functional recovery program. However, future outcome studies should evaluate the efficacy of an intervention within the pathway, include objective measures of symptom burden and control, study measures of functional recovery, and quantify outcomes of the program in relation to the rates of adherence to the key elements of care in gynecologic oncology such as oncologic outcomes and return to intended oncologic therapy (RIOT). Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Photographing Injuries in the Acute Care Setting: Development and Evaluation of a Standardized Protocol for Research, Forensics, and Clinical Practice.

    Science.gov (United States)

    Bloemen, Elizabeth M; Rosen, Tony; Cline Schiroo, Justina A; Clark, Sunday; Mulcare, Mary R; Stern, Michael E; Mysliwiec, Regina; Flomenbaum, Neal E; Lachs, Mark S; Hargarten, Stephen

    2016-05-01

    Photographing injuries in the acute setting allows for improved documentation as well as assessment by clinicians and others who have not personally examined a patient. This tool is important, particularly for telemedicine, tracking of wound healing, the evaluation of potential abuse, and injury research. Despite this, protocols to ensure standardization of photography in clinical practice, forensics, or research have not been published. In preparation for a study of injury patterns in elder abuse and geriatric falls, our goal was to develop and evaluate a protocol for standardized photography of injuries that may be broadly applied. We conducted a literature review for techniques and standards in medical, forensic, and legal photography. We developed a novel protocol describing types of photographs and body positioning for eight body regions, including instructional diagrams. We revised it iteratively in consultation with experts in medical photography; forensics; and elder, child, and domestic abuse. The resulting protocol requires a minimum of four photos of each injury at multiple distances with and without a ruler/color guide. To evaluate the protocol's efficacy, multiple research assistants without previous photography experience photographed injuries from a convenience sample of elderly patients presenting to a single large, urban, academic emergency department. A selection of these patients' images were then evaluated in a blinded fashion by four nontreating emergency medicine physicians and the inter-rater reliability between these physicians was calculated. Among the 131 injuries, from 53 patients, photographed by 18 photographers using this protocol, photographs of 25 injuries (10 bruises, seven lacerations, and eight abrasions) were used to assess characterization of the injury. Physicians' characterizations of the injuries were reliable for the size of the injury (κ = 0.91, 95% confidence interval [CI] = 0.77 to 1.00), side of the body (κ = 0.97, 95

  14. Pregnancy and care practices

    OpenAIRE

    ARÉVALO SÁNCHEZ, ELIZABETH

    2010-01-01

    The purposeofthisresearch istovalue thecarepractices that mothers perform on themselves and on the baby to whom she is going to give birth. 150 pregnant women that go to the Centro Operativo Local Engativá medical facility, registered on project 7317: "Preganant Families: healthy and desired babies of the Administrative DepartmentofSocialWellbeing", using a quantitative and descriptive methodology. We applied the "Instrument to value those care practices that are performed on themselves and o...

  15. The use of patient-reported outcomes becomes standard practice in the routine clinical care of lung–heart transplant patients

    Directory of Open Access Journals (Sweden)

    Maria J Santana

    2010-09-01

    measures in the routine clinical care of lung–heart transplant patients resulted in a reduction of the duration of patient–clinician encounters. The experience was well accepted by patients and clinicians. We conclude that the routine use of PROs in lung–heart transplant patients has become standard practice.Keywords: patient-reported outcome measures, Chronic Respiratory Questionnaire, Health Utilities Index, routine clinical care, lung transplant

  16. [Transsexuality--standards of care].

    Science.gov (United States)

    Eicher, W

    1995-01-01

    After the description of transsexualism as a nosological entity by Harry Benjamin standards of care emerged which are useful and protective for patients and doctors involved in treatment. The diagnosis is established by the finding of an irreversibly transposed gender identity. This has to be confirmed by an expert who is competent in counselling gender identity problems. He will give his written opinion which is the indication for the hormonal treatment to be done at least for half a year prior to operation and which leads to virilization or effeminization and which is the preparation for genital surgery. Standards of female-to-male surgery are: 1. Breast-transformation 2. Colpohysterectomy with adnexectomy, possibly by the vaginal route. Surrogates for testes and phalloplasties are only in the experimental stage and not standard. Standards of male-to-female surgery are: 1. Castration by extirpation of testes. 2. Resection of penis shaft with total resection of the spongy bodies. 3. Neovagina by inverted penis-skin technique. 4. Plasty of labia majora and minora and a clitoris. 5. In case of insufficient gynecomastia breast-augmentation. After the operation, follow-up examinations are necessary by the surgeon until complete healing. A supportive psychological care by the expert who has evaluated the transposition of gender identity would be useful. It could be done also by the gynecologist who makes the follow-up examinations in male to female transsexuals. He is also competent for the life-long hormonal substitution.

  17. The development of professional practice standards for Australian general practice nurses.

    Science.gov (United States)

    Halcomb, Elizabeth; Stephens, Moira; Bryce, Julianne; Foley, Elizabeth; Ashley, Christine

    2017-08-01

    The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses. Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. Concurrent mixed methods design. Data collection was conducted during 2013-2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard. The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses' practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance. © 2017 John Wiley & Sons Ltd.

  18. An International Comparison of Nutrition Education Standards, Occupational Standards and Scopes of Practice for Personal Trainers.

    Science.gov (United States)

    Barnes, Katelyn; Ball, Lauren; Desbrow, Ben

    2017-12-01

    Personal trainers are well placed to provide nutrition care in line with their recommended scope of practice. However, providing nutrition care beyond their recommended scope of practice has been identified as an industry risk. The International Confederation of Registers for Exercise Professionals (ICREPs) have international standards for nutrition knowledge and skills that are recommended for all fitness professionals, including personal trainers. This study investigates whether the ICREPs standards align with i) national nutrition education standards and ii) national nutrition occupational standards and scopes of practice for personal trainers within ICREPs affiliated countries. Content analysis of each standard and/or scope of practice was undertaken to extract nutrition statements. Extracted statements were matched with nutrition components of the ICREPs standards to result in a score based on the number of aligned ICREPs knowledge and skills criteria. Ten countries, with 16 organizations, were identified as being involved in the development of national education standards, occupational standards, or scopes of practice for personal trainers. The educational and occupational standards varied widely among countries and had minimal alignment with the ICREPs standards. As such, the expected role of personal trainers in providing nutrition care appeared to differ between countries. Further work is required to support personal trainers to develop a level of knowledge and skills that enables the provision of safe, consistent, and effective nutrition care.

  19. Acute care nurses' spiritual care practices.

    Science.gov (United States)

    Gallison, Barry S; Xu, Yan; Jurgens, Corrine Y; Boyle, Suzanne M

    2013-06-01

    The purpose of this study was to identify barriers in providing spiritual care to hospitalized patients. A convenience sample (N = 271) was recruited at an academic medical center in New York City for an exploratory, descriptive questionnaire. The Spiritual Care Practice (SCP) questionnaire assesses spiritual care practices and perceived barriers to spiritual care. The SCP determines the percentage that provides spiritual support and perceived barriers inhibiting spiritual care. The participation rate was 44.3% (N = 120). Most (61%) scored less than the ideal mean on the SCP. Although 96% (N = 114) believe addressing patients spiritual needs are within their role, nearly half (48%) report rarely participating in spiritual practices. The greatest perceived barriers were belief that patient's spirituality is private, insufficient time, difficulty distinguishing proselytizing from spiritual care, and difficulty meeting needs when spiritual beliefs were different from their own. Although nurses identify themselves as spiritual, results indicate spirituality assessments are inadequate. Addressing barriers will provide nurses opportunities to address spirituality. Education is warranted to improve nurses' awareness of the diversity of our society to better meet the spiritual needs of patients. Understanding these needs provide the nurse with opportunities to address spirituality and connect desires with actions to strengthen communication and the nurse-patient relationship.

  20. Medical devices regulations, standards and practices

    CERN Document Server

    Ramakrishna, Seeram; Wang, Charlene

    2015-01-01

    Medical Devices and Regulations: Standards and Practices will shed light on the importance of regulations and standards among all stakeholders, bioengineering designers, biomaterial scientists and researchers to enable development of future medical devices. Based on the authors' practical experience, this book provides a concise, practical guide on key issues and processes in developing new medical devices to meet international regulatory requirements and standards. Provides readers with a global perspective on medical device regulationsConcise and comprehensive information on how to desig

  1. Caring finance practices

    NARCIS (Netherlands)

    I.P. van Staveren (Irene)

    2013-01-01

    textabstractThe 2008 financial crisis has demonstrated the failure of both utilitarian and deontological ethics in finance. Alternatives do not need to be created from nothing, because the crisis itself has stimulated the emergence of ethically sound finance practices from within the sector. This

  2. Standards of Practice: Applying Genetics and Genomics Resources to Oncology
.

    Science.gov (United States)

    Kerber, Alice S; Ledbetter, Nancy J

    2017-04-01

    Knowledge about genetics and genomics and its application to oncology care is rapidly expanding and evolving. As a result, oncology nurses at all levels must develop and maintain their knowledge of genetics and genomics, as well as be aware of resources to guide practice. This article focuses on implementation of the standards described in the updated Genetics/Genomics Nursing: Scope and Standards of Practice by the basic practitioner.
.

  3. The uses and implications of standards in general practice consultations

    DEFF Research Database (Denmark)

    Lippert, Maria Laura; Reventlow, Susanne; Kousgaard, Marius Brostrøm

    2017-01-01

    Quality standards play an increasingly important role in primary care through their inscription in various technologies for improving professional practice. While ‘hard’ biomedical standards have been the most common and debated, current quality development initiatives increasingly seek to include...... was observed among general practitioners who strictly adhered to the procedural standards on the interactional aspects of care. Thus, when allowed to function as an overall frame for consultations, those standards supported adherence to general recommendations regarding which elements to be included in chronic...... as manifestations of an inherent conflict between principles of patient-centredness and formal biomedical quality standards. However, this study suggests that standards on the ‘softer’ aspects of care may just as well interfere with a clinical approach relying on situated and attentive interactions with patients....

  4. Nursing care and collaborative practice.

    Science.gov (United States)

    Kesby, Sheila G

    2002-05-01

    This article argues that the time is right for nurses in the UK to become the case managers in all healthcare settings. The re-launch of family health nursing, as a model for the organization and delivery of nursing care in the community, and the advent of the GP practice-based self-managed integrated nursing teams, offer the means by which to take up the opportunities presented by recent legislation and the national strategies for promoting partnership working and collaborative practice. Nurses could approach this by combining their current involvement with developing the single assessment process for older people with the overall development of interprofessional collaborative practice across all boundaries in health and social services. Despite the new opportunities, this will not be straightforward because of the still existing problems associated with the health and social care divide. In order to generate high quality care, it is imperative for nurses and their patients that the profession gains control and ownership of its own policy, remit and practice. Nursing care should be defined according to the patient's condition, so that their dependency level, diagnostic picture and potential for rehabilitation govern the eligibility criteria for health or social care and not the level of technicality in the task itself.

  5. Identification of Standards for Pharmaceutical Care in Benin City ...

    African Journals Online (AJOL)

    The goal of this study is to identify practice standards that can be effectively applied in the implementation of pharmaceutical care in Nigeria. Method: The survey instrument (a pre-tested self-administered questionnaire) was distributed to pharmacists in Benin City. Each questionnaire contained the 52 suggested practice ...

  6. Practice standards for emergency nursing: An international review.

    Science.gov (United States)

    Jones, Tamsin; Shaban, Ramon Z; Creedy, Debra K

    2015-11-01

    Presentations to emergency departments (EDs) and patient acuity continue to increase. Whilst strategies to deliver safe patient care in the ED are evolving, emergency nurses need to be well educated through specialist qualifications to enable delivery of advanced patient care. This paper presents a comparative analysis of available international practice and competency standards for nurses graduating from emergency nursing courses in Australia, Canada, New Zealand, the United Kingdom, and the United States. CINAHL, Scopus, Ovid MEDLINE, and Embase were searched for papers, published in English, using the terms: 'emergency', 'accident and emergency', 'nursing', 'competency', 'practice standards', 'scope of practice', 'regulation', and 'specialist standards'. Secondary sources from relevant reference lists and professional websites were also searched. The standards from the five countries were common across five domains: clinical expertise, communication, teamwork, resources and environment, and legal. None of the standards were specific to the emergency nursing graduate, and there was variability in the level of expertise required for which the standards apply. The available practice standards demonstrated some commonality. Consideration of the utility of a universal framework for informing the development of emergency nursing practice standards and emergency nursing curriculum for nurses wishing to specialise is needed. Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

  7. Best practice in wound care

    OpenAIRE

    Pelikánová, Markéta

    2016-01-01

    The topic of this Bachelors' Thesis is "Best Practices in Wound Care". The thesis focuses on acute and chronic wounds. It sets the following objectives: The main objective of the research was to evaluate the current practice of general nurses in surgical departments of regional health hospitals in the Usti region. The research was focused on the ways of education regarding the dressing material innovations, participation in conferences and seminars and eventually on its frequency and benefits...

  8. Epilepsy care in general practice.

    LENUS (Irish Health Repository)

    Varley, J

    2009-06-01

    Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247\\/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.

  9. The quest to standardize hemodialysis care.

    Science.gov (United States)

    Hegbrant, Jörgen; Gentile, Giorgio; Strippoli, Giovanni F M

    2011-01-01

    A large global dialysis provider's core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality program are setting treatment targets; implementing evidence-based guidelines and clinical protocols; consistently, regularly, prospectively and accurately collecting data from all clinics in the network; processing collected data to provide feedback to clinics in a timely manner, incorporating information on interclinic and intercountry variations; and revising targets, guidelines and clinical protocols based on sound scientific data. The key activities for ensuring patient safety include a standardized approach to education, i.e. a uniform education program including control of theoretical knowledge and clinical competencies; implementation of clinical policies and procedures in the organization in order to reduce variability and potential defects in clinic practice; and auditing of clinical practice on a regular basis. By applying a standardized and systematic continuous quality improvement approach throughout the entire organization, it has been possible for Diaverum to progressively improve medical performance and ensure patient safety. Copyright © 2011 S. Karger AG, Basel.

  10. Improving oral care practice in long-term care.

    Science.gov (United States)

    Dyck, Daryl; Bertone, Mary; Knutson, Kim; Campbell, Amy

    2012-11-01

    At Deer Lodge Centre, oral care practice for adult dependent patients often included the use of sponge swabs and liquid mouth rinse, but the facility had no formal policy outlining best practice. The authors sought to develop such a policy by answering two main questions: Are sponge swabs effective in cleaning the oral cavity? What oral care is required for individuals with dysphagia and those who depend on others for oral care? After a review of the literature for pertinent guidance, a new protocol for oral care, based on tooth brushing and use of antibacterial gel, was implemented for one care unit. Patients showed improvements in oral health, specifically reductions in tartar, swollen and bleeding gums, ulcerations, debris and severe halitosis. Staff members were initially resistant to change, but resistance declined as they witnessed the benefits of tooth brushing. The use of sponge swabs also declined. This intervention confirmed that tooth brushing is appropriate as the gold standard of good oral care and showed that sponge swabs are ineffective for removing plaque. These principles have become the foundation of oral care policies and care plans at this facility.

  11. Nursing competency standards in primary health care: an integrative review.

    Science.gov (United States)

    Halcomb, Elizabeth; Stephens, Moira; Bryce, Julianne; Foley, Elizabeth; Ashley, Christine

    2016-05-01

    This paper reports an integrative review of the literature on nursing competency standards for nurses working in primary health care and, in particular, general practice. Internationally, there is growing emphasis on building a strong primary health care nursing workforce to meet the challenges of rising chronic and complex disease. However, there has been limited emphasis on examining the nursing workforce in this setting. Integrative review. A comprehensive search of relevant electronic databases using keywords (e.g. 'competencies', 'competen*' and 'primary health care', 'general practice' and 'nurs*') was combined with searching of the Internet using the Google scholar search engine. Experts were approached to identify relevant grey literature. Key websites were also searched and the reference lists of retrieved sources were followed up. The search focussed on English language literature published since 2000. Limited published literature reports on competency standards for nurses working in general practice and primary health care. Of the literature that is available, there are differences in the reporting of how the competency standards were developed. A number of common themes were identified across the included competency standards, including clinical practice, communication, professionalism and health promotion. Many competency standards also included teamwork, education, research/evaluation, information technology and the primary health care environment. Given the potential value of competency standards, further work is required to develop and test robust standards that can communicate the skills and knowledge required of nurses working in primary health care settings to policy makers, employers, other health professionals and consumers. Competency standards are important tools for communicating the role of nurses to consumers and other health professionals, as well as defining this role for employers, policy makers and educators. Understanding the content

  12. Good Practice Standards – a Regulation Tool

    DEFF Research Database (Denmark)

    Sørensen, Marie Jull

    2013-01-01

    The purpose of this article is to identify the considerations weighed in regulation with good practice standards. In this article, potential due process problems with regulation via legal standards are identified and compared to other considerations, which this regulation technique meets....

  13. Ethical and professional standards compliance among practicing ...

    African Journals Online (AJOL)

    This study investigated ethical and professional standards compliance among practicing librariansin university libraries in Benue State. The purpose of the study was todetermine the extent to which librarians in university libraries comply with ethics and professional standards in librarianship. The study adopted a descriptive ...

  14. Perioperative nurses' perceptions of caring practices.

    Science.gov (United States)

    McNamara, S A

    1995-02-01

    This study was designed to determine how caring is practiced in perioperative nursing. The theory of nursing by M. Jean Watson, RN, PhD, FAAN, provided the conceptual framework for the study. The researcher used a qualitative, descriptive methodology to analyze data collected in audiotaped interviews with five perioperative nurses and used standard qualitative research procedures for transcribing and analyzing the interview data. The five study participants identified their perceptions of caring behaviors with conscious and unconscious patients in the preoperative, intraoperative, and postoperative periods. They described the essential structure of caring as the establishment of a human care relationship and provision of a supportive, protective, and/or corrective psychological, physical, and spiritual environment.

  15. Consumer input into standards revision: changing practice.

    Science.gov (United States)

    Beal, G; Chan, A; Chapman, S; Edgar, J; McInnis-Perry, G; Osborne, M; Mina, E S

    2007-02-01

    As part of ongoing quality improvement initiatives, the Canadian Standards for Psychiatric-Mental Health Nursing were recently revised. For the first time since the standards were published in 1995, the input of consumers of mental health services was sought. Thirty-one consumers from across Canada participated in focus groups, and answered questions related to the domains of practice as identified in the standards document. Through this input, consumers were able to inform the committee regarding areas of satisfaction and dissatisfaction from their unique perspective. Through this article, the process of consumer collaboration is illustrated in relation to how it shaped Standards revision, and finally how it affected the practitioners involved.

  16. Compassionate care? A critical discourse analysis of accreditation standards.

    Science.gov (United States)

    Whitehead, Cynthia; Kuper, Ayelet; Freeman, Risa; Grundland, Batya; Webster, Fiona

    2014-06-01

    We rely upon formal accreditation and curricular standards to articulate the priorities of professional training. The language used in standards affords value to certain constructs and makes others less apparent. Leveraging standards can be a useful way for educators to incorporate certain elements into training. This research was designed to look for ways to embed the teaching and practice of compassionate care into Canadian family medicine residency training. We conducted a Foucauldian critical discourse analysis of compassionate care in recent formal family medicine residency training documents. Critical discourse analysis is premised on the notion that language is connected to practices and to what is accorded value and power. We assembled an archive of texts and examined them to analyse how compassionate care is constructed, how notions of compassionate care relate to other key ideas in the texts, and the implications of these framings. There were very few words, metaphors or statements that related to concepts of compassionate care in our archive. Even potential proxies, notably the doctor-patient relationship and patient-centred care, were not primarily depicted in ways that linked them to ideas of compassion or caring. There was a reduction in language related to compassionate care in the 2013 standards compared with the standards published in 2006. Our research revealed negative findings and a relative absence of the construct of compassionate care in our archival documents. This work demonstrates how a shift in curricular focus can have the unintended consequence of making values that are taken for granted less visible. Given that standards shape training, we must pay attention not only to what we include, but also to what we leave out of formal documents. We risk losing important professional values from training programmes if they are not explicitly highlighted in our standards. © 2014 John Wiley & Sons Ltd.

  17. Standardized care plan of postpartum mastitis

    Directory of Open Access Journals (Sweden)

    Maria Ángeles Carrasco García

    2012-07-01

    Full Text Available Introduction: Puerperal mastitis or mastitis Breastfeeding is a postpartum condition that represents one of the main reasons for abandoning breastfeeding. Mainly usually occurs between weeks 2 and 3 ª postpartum. The scientific evidence confirms that the stop breastfeeding before an attack of mastitis is not conducive to recovery and that of exclusive breastfeeding and no restrictions are effective measures to prevent milk stasis and the spread of infection.Objective: The main objective is to unify criteria for the care and integrated health care levels of care through continuity of care to promote breast-specific care to prevent the emergence of this disease.Methodology: Development of a standardized care plan to enable effective communication between professionals and implementation of quality care.Conclusions: The midwife and the nurse plays an important role in identifying those women with early-onset symptoms of postpartum mastitis in the middle, both in the maternity ward and in the primary care clinic.

  18. [Rivaroxaban versus standard of care in venous thromboembolism prevention following hip or knee arthroplasty in daily clinical practice (Spanish data from the international study XAMOS)].

    Science.gov (United States)

    Granero, J; Díaz de Rada, P; Lozano, L M; Martínez, J; Herrera, A

    2016-01-01

    To analyse the effectiveness and safety of rivaroxaban vs. standard treatment (ST) in the prevention of venous thromboembolism after hip or knee replacement in daily clinical practice in Spain. A sub-analysis of the Spanish data in the XAMOS international observational study that included patients>18 years who received 10mg o.d. rivaroxaban or ST. up to 3 months after surgery. incidence of symptomatic/asymptomatic thromboembolic events, bleeding, mortality, and other adverse events; use of health resources and satisfaction after hospital discharge. Of the total 801 patients included, 410 received rivaroxaban and 391 ST (64.7% heparin, 24.0% fondaparinux, 11% dabigatran). The incidence of symptomatic thromboembolic events and major bleeding was similar in both groups (0.2% vs. 0.8% wit ST and 0.7% vs. 1.3% with ST [EMA criteria]/0.0% vs. 0.3% with ST [RECORD criteria]). The adverse events incidence associated with the drug was significantly higher rivaroxaban (overall: 4.4% vs. 0.8% with ST, P=.001; serious: 1.5% vs. 0.0% with ST, P=.03). The rivaroxaban used less health resources after discharge, and the majority considered the tolerability as «very good« and the treatment as «very comfortable». Rivaroxaban is at least as effective as ST in the prevention of venous thromboembolism prevention in daily clinical practice, with a similar incidence of haemorrhages. It provides greater satisfaction/comfort, and less health resources after discharge. These results should be interpreted taking into account the limitations inherent in observational studies. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  19. Practicing discernment: pastoral care in crisis situations.

    Science.gov (United States)

    Landes, Scott D

    2010-01-01

    This article correlates a particular experience of providing pastoral care for a person in a crisis situation with a particular understanding of the practice of pastoral care. Through engaging in correlative practical theology, it highlights the need for practicing discernment when providing pastoral care for persons utilizing narratives to work through crisis situations.

  20. Randomised clinical trial of early specialist palliative care plus standard care versus standard care alone in patients with advanced cancer

    DEFF Research Database (Denmark)

    Grønvold, Mogens; Petersen, Morten Aagaard; Damkier, Anette

    2017-01-01

    Palliative Care Trial (DanPaCT) (ClinicalTrials.gov NCT01348048) is a multicentre randomised clinical trial comparing early referral to a specialist palliative care team plus standard care versus standard care alone. The planned sample size was 300. At five oncology departments, consecutive patients...

  1. Comparison of Unmanned Aerial Vehicle Technology Versus Standard Practice in Identification of Hazards at a Mass Casualty Incident Scenario by Primary Care Paramedic Students.

    Science.gov (United States)

    Jain, Trevor; Sibley, Aaron; Stryhn, Henrik; Hubloue, Ives

    2018-01-31

    Introduction The proliferation of unmanned aerial vehicles (UAV) has the potential to change the situational awareness of incident commanders allowing greater scene safety. The aim of this study was to compare UAV technology to standard practice (SP) in hazard identification during a simulated multi-vehicle motor collision (MVC) in terms of time to identification, accuracy and the order of hazard identification. A prospective observational cohort study was conducted with 21 students randomized into UAV or SP group, based on a MVC with 7 hazards. The UAV group remained at the UAV ground station while the SP group approached the scene. After identifying hazards the time and order was recorded. The mean time (SD, range) to identify the hazards were 3 minutes 41 seconds (1 minute 37 seconds, 1 minute 48 seconds-6 minutes 51 seconds) and 2 minutes 43 seconds (55 seconds, 1 minute 43 seconds-4 minutes 38 seconds) in UAV and SP groups corresponding to a mean difference of 58 seconds (P=0.11). A non-parametric permutation test showed a significant (P=0.04) difference in identification order. Both groups had 100% accuracy in hazard identification with no statistical difference in time for hazard identification. A difference was found in the identification order of hazards. (Disaster Med Public Health Preparedness. 2018;page 1 of 4).

  2. Practical application of standards in special libraries

    Directory of Open Access Journals (Sweden)

    Nada Češnovar

    1998-01-01

    Full Text Available Special libraries in Slovenia represent an important part of information infrastructure.They operate in the spheres of economy, culture, politics, health, and others.Although they perform an important role in the process of professional training of the employees they are too often set aside.Our government is undoubtedly aware of the deficiency of normative regulation in these areas; however, passing of certain acts is often delayed because there is no direct damage to the state itself if they are not passed. New standards for special libraries regulating their operation have been prepared. Their practical application will be tested in practice. Several years of experience as a counsellor to special libraries enable the author an insight into the use of standards. Standards are certainly an indispensable "reading" for special libraries although they are certainly not perfect.

  3. 7 CFR 28.105 - Practical forms of cotton standards.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Practical forms of cotton standards. 28.105 Section 28... REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Regulations Under the United States Cotton Standards Act Practical Forms of Cotton Standards § 28.105 Practical forms of cotton standards. (a) Practical forms of the...

  4. Best practice eye care models.

    Science.gov (United States)

    Qureshi, Babar M; Mansur, Rabiu; Al-Rajhi, Abdulaziz; Lansingh, Van; Eckert, Kristen; Hassan, Kunle; Ravilla, Thulasiraj; Muhit, Mohammad; Khanna, Rohit C; Ismat, Chaudhry

    2012-01-01

    Since the launching of Global Initiative, VISION 2020 "the Right to Sight" many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor.

  5. Best practice eye care models

    Directory of Open Access Journals (Sweden)

    Babar M Qureshi

    2012-01-01

    Full Text Available Since the launching of Global Initiative, VISION 2020 "the Right to Sight" many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor.

  6. Standards of practice in interventional neuroradiology.

    Science.gov (United States)

    Jansen, Olav; Szikora, Istvan; Causin, Francesco; Brückmann, Hartmut; Lobotesis, Kyriakos

    2017-06-01

    The growing importance of INR has resulted in the need to define and promote professional standards of clinical practice. Several professional organizations have published guidelines recently for the neurointerventional treatment of cerebrovascular diseases, including technical and personal recommendations, but detailed definitions of technical and organizational conditions needed for the safe and effective performance of such treatments are lacking. To fill this gap ESNR, ESMINT and the UEMS Division for Neuroradiology established a working group, to develop a consensus paper on "Standards of Practice in Interventional Neuroradiology". This document is the result of the Consensus Working Group and has following review gained approval by the Executive Boards of ESNR and ESMINT and by the members of the UEMS Division for Neuroradiology in 2017.

  7. Consensus Statement of Standards for Interventional Cardiovascular Nursing Practice.

    Science.gov (United States)

    White, Kevin; Macfarlane, Heather; Hoffmann, Bernadette; Sirvas-Brown, Helene; Hines, Kathryn; Rolley, John Xavier; Graham, Sandi

    2017-11-10

    Interventional cardiovascular nursing is a critical care nursing specialty providing complex nursing interventions to patients prone to clinical deterioration, through the combined risks of the pathophysiology of their illness and undergoing technically complex interventional cardiovascular procedures. No guidelines were identified worldwide to assist health care providers and educational institutions in workforce development and education guidelines to minimise patients' risk of adverse events. The Interventional Nurses Council (INC) developed a definition and scope of practice for interventional cardiac nursing (ICN's) in 2013. The INC executive committee established a working party of seven representatives from Australia and New Zealand. Selection was based on expertise in interventional cardiovascular nursing and experience providing education and mentoring in the clinical and postgraduate environment. A literature search of the electronic databases Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Health Source was performed, using the search terms: clinical deterioration, ST elevation myocardial infarction, vital signs, primary percutaneous coronary intervention, PCI, AMI, STEMI, acute coronary syndrome, peri-procedural care, unstable angina, PCI complications, structural heart disease, TAVI, TAVR, cardiac rhythm management, pacing, electrophysiology studies, vascular access, procedural sedation. Articles were limited to the cardiac catheterisation laboratory and relevance to nursing based outcomes. Reference lists were examined to identify relevant articles missed in the initial search. The literature was compared with national competency standards, quality and safety documents and the INC definition and scope of practice. Consensus of common themes, a taxonomy of education and seven competency domains were achieved via frequent teleconferences and two face-to-face meetings. The working party finalised the

  8. Eliciting reflections on caring theory in elderly caring practice.

    Science.gov (United States)

    Elisabeth Ranheim, Albertine; Kärner, Anita; Berterö, Carina

    2011-01-01

    Caring theories are the description and conceptualization of the care that is given in caring practise by nurses and other professional caregivers with the aim of verbalizing and communicating caring phenomena. Intermittently, a theory -practice gap is given expression- that theory does not go along with clinical practice in caring.The aim of this study was an investigation into the possible disparity between theory and practice in caring by analysing nurses' lived experience of the understanding of caring theory in practice in the context of municipal elderly care.Hermeneutical phenomenology was the research approach used to explore the lived experience of caring science theories in caring practice from the perspective of 12 nurses working in municipal care for elderly.The findings shows that the nurses Impulsively described their experience of detachment to caring theory, but when describing their caring intentions, the relationship to theory became apparent, and even confirmed their practice. As such, a seedbed exists for caring theory to be reflected on and cultivated in caring praxis. However, as the nurses describe, the caring theory must be sensitive enough for the nursing practitioners to accept.The gap revealed itself on an organisational level, as the nurses' commission in municipal care did not correspond with their caring intention.We believe it is important to seriously consider what we want to achieve as a caring profession. We have to reflect on our responsibility as culture carriers and knowledge developers. We must make the disparate forces of intention and organisation become one intertwining force.

  9. Description of practice as an ambulatory care nurse: psychometric properties of a practice-analysis survey.

    Science.gov (United States)

    Baghi, Heibatollah; Panniers, Teresa L; Smolenski, Mary C

    2007-01-01

    Changes within nursing demand that a specialty conduct periodic, appropriate practice analyses to continually validate itself against preset standards. This study explicates practice analysis methods using ambulatory care nursing as an exemplar. Data derived from a focus group technique were used to develop a survey that was completed by 499 ambulatory care nurses. The validity of the instrument was assessed using principal components analysis; reliability was estimated using Cronbach's alpha coefficient. The focus group with ambulatory care experts produced 34 knowledge and activity statements delineating ambulatory care nursing practice. The survey data produced five factors accounting for 71% of variance in the data. The factors were identified as initial patient assessment, professional nursing issues and standards, client care management skills, technical/clinical skills, and system administrative operations. It was concluded that practice analyses delineate a specialty and provide input for certification examinations aimed at measuring excellence in a field of nursing.

  10. Bicalutamide 150 mg plus standard care vs standard care alone for early prostate cancer

    DEFF Research Database (Denmark)

    McLeod, David G; Iversen, Peter; See, William A

    2006-01-01

    To evaluate, in the ongoing Early Prostate Cancer (EPC) trial programme, the efficacy and tolerability of bicalutamide 150 mg once daily in addition to standard care for localized or locally advanced, nonmetastatic prostate cancer....

  11. Oncologic prevention and suggested working standards in primary health care

    Directory of Open Access Journals (Sweden)

    Konstantinović Dejan

    2016-01-01

    Full Text Available On the ground of the available data, this paper presents the problem of malignant diseases in Central Serbia, and most common carcinogens. Division of carcinogens, cancerogenesis and natural history of disease, early detection of cancer and palliative management are explained. The role and capacities of primary health care doctors in treatment of patients with suspect malignant disease are presented. Authors are suggesting standards for medical tasks and contemporary principles in approach to patients with malignant diseases in everyday practice.

  12. From "Pastoral Care" to "Care": Meanings and Practices

    Science.gov (United States)

    Calvert, Mike

    2009-01-01

    Pastoral care is the term used in education in the United Kingdom to describe the structures, practices and approaches to support the welfare, well-being and development of children and young people. This article takes a historical perspective and charts the shifts in priorities that pastoral care practice has taken over the past 50 years. The…

  13. Standard practice for instrumented indentation testing

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2007-01-01

    1.1 This practice defines the basic steps of Instrumented Indentation Testing (IIT) and establishes the requirements, accuracies, and capabilities needed by an instrument to successfully perform the test and produce the data that can be used for the determination of indentation hardness and other material characteristics. IIT is a mechanical test that measures the response of a material to the imposed stress and strain of a shaped indenter by forcing the indenter into a material and monitoring the force on, and displacement of, the indenter as a function of time during the full loading-unloading test cycle. 1.2 The operational features of an IIT instrument, as well as requirements for Instrument Verification Annex A1), Standardized Reference Blocks (Annex A2) and Indenter Requirements (Annex A3) are defined. This practice is not intended to be a complete purchase specification for an IIT instrument. 1.3 With the exception of the non-mandatory Appendix X4, this practice does not define the analysis necessary...

  14. Oxaliplatin/5-fluorouracil-based adjuvant chemotherapy as a standard of care for colon cancer in clinical practice: Outcomes of the ACCElox registry.

    Science.gov (United States)

    Park, Young Suk; Ji, Jiafu; Zalcberg, John Raymond; El-Serafi, Mostafa; Buzaid, Antonio; Ghosn, Marwan

    2015-12-01

    The ACCElox registry was set up to assess therapeutic management of early-stage colon cancer with oxaliplatin/5-fluorouracil (5-FU)-based regimen and the duration of adjuvant chemotherapy in current clinical practice. This prospective observational study was conducted between 2006 and 2008 in 19 countries on 1548 newly diagnosed patients with stage II/III colon cancer, who had complete resection of the primary tumor and treated with at least one dose of oxaliplatin. The patient/disease characteristics, dose intensity, toxicity management, treatment delay and duration of disease-free survival (DFS)/relapse were assessed. About 73 and 27% of the patients were diagnosed with stage III (Dukes C) and stage II (Dukes B2) colon cancer, respectively. Overall, 74.4% patients completed the prescribed chemotherapy (FOLFOX 88%) and 97.6% patients received at least two cycles of oxaliplatin chemotherapy. The median actual dose intensity of oxaliplatin per cycle was 85 mg/m(2) . Relapse within 3 years occurred in 18.4% of patients with similar rate in all three groups (FOLFOX - 18.1%, FLOX - 19%, XELOX - 18.6%). At 3 years follow-up only 72 deaths were reported. The most common adverse events (AEs) at any cycle were neutropenia (63.9%), thrombocytopenia (23.3%), diarrhea (9.7%), sensory neuropathy (4.5%) and infection (2.6%). Disorders of central and peripheral nervous systems were frequently reported AEs at 6 months (54.3%, grade ≥1) and 12 months (36.4%, grade ≥1) of follow-up. Majority of the patients completed the prescribed oxaliplatin/5-FU regimen. There was no significant difference in the DFS among these regimens. Our results confirm the favorable benefit/risk profile of oxaliplatin/5-FU-based regimens in this setting in clinical practice. © 2015 Wiley Publishing Asia Pty Ltd.

  15. ESDIS Standards Office (ESO): Requirements, Standards and Practices

    Science.gov (United States)

    Mitchell, Andrew E.; Mcinerney, Mark Allen; Enloe, Yonsok K.; Conover, Helen T.; Doyle, Allan

    2016-01-01

    The ESDIS Standards Office assists the ESDIS Project in formulating standards policy for NASA Earth Science Data Systems (ESDS), coordinates standards activities within ESDIS, and provides technical expertise and assistance with standards related tasks within the NASA Earth Science Data System Working Groups (ESDSWG). This poster summarizes information found on the earthdata.nasa.gov site that describes the ESO.

  16. Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing.

    Science.gov (United States)

    O'Connell, Jane; Gardner, Glenn; Coyer, Fiona

    2014-12-01

    This paper presents a discussion on the application of a capability framework for advanced practice nursing standards/competencies. There is acceptance that competencies are useful and necessary for definition and education of practice-based professions. Competencies have been described as appropriate for practice in stable environments with familiar problems. Increasingly competencies are being designed for use in the health sector for advanced practice such as the nurse practitioner role. Nurse practitioners work in environments and roles that are dynamic and unpredictable necessitating attributes and skills to practice at advanced and extended levels in both familiar and unfamiliar clinical situations. Capability has been described as the combination of skills, knowledge, values and self-esteem which enables individuals to manage change, be flexible and move beyond competency. A discussion paper exploring 'capability' as a framework for advanced nursing practice standards. Data were sourced from electronic databases as described in the background section. As advanced practice nursing becomes more established and formalized, novel ways of teaching and assessing the practice of experienced clinicians beyond competency are imperative for the changing context of health services. Leading researchers into capability in health care state that traditional education and training in health disciplines concentrates mainly on developing competence. To ensure that healthcare delivery keeps pace with increasing demand and a continuously changing context there is a need to embrace capability as a framework for advanced practice and education. © 2014 John Wiley & Sons Ltd.

  17. Self-care practice of patients with arterial hypertension in primary health care

    Directory of Open Access Journals (Sweden)

    Cláudia Rayanna Silva Mendes

    2016-02-01

    Full Text Available Objective: to evaluate the practice of self-care performed by patients with systemic arterial hypertension in primary health care. Methods: this is a descriptive and cross-sectional study, conducted with 92 individuals with arterial hypertension in a primary care unit. The data collection occurred through script and data analyzed using descriptive statistics (frequency, mean and standard deviation and through the understanding of the adaption between capacity and self-care demand. Results: it was identified as a practice of self-care: adequate water intake, salt intake and restricted coffee, satisfactory sleep period, abstinence from smoking and alcoholism, continuing pharmacological treatment and attending medical appointments. As the demands: inadequate feeding, sedentary lifestyle, had no leisure activities, self-reported stress, and limited knowledge. Conclusion: although patients performed treatment a few years ago, still showed up self-care deficits, highlighting the need for nurses to advise and sensitize about the importance of self-care practice.

  18. A Continuous Quality Improvement Project to Implement Infant-Driven Feeding as a Standard of Practice in the Newborn/Infant Intensive Care Unit.

    Science.gov (United States)

    Chrupcala, Kimberly A; Edwards, Taryn M; Spatz, Diane L

    2015-01-01

    To increase the number of neonates who were fed according to cues prior to discharge and potentially decrease length of stay. Continuous quality improvement. Eighty-five bed level IV neonatal intensive care unit. Surgical and nonsurgical neonates of all gestational ages. Neonates younger than 32 weeks gestation, who required intubation, continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), or did not have suck or gag reflexes were excluded as potential candidates for infant-driven feeding. The project was conducted over a 13-month period using the following methods: (a) baseline data collection, (b) designation of Infant Driven Feeding (IDF) Champions, (c) creation of a multidisciplinary team, (d) creation of electronic health record documentation, (e) initial staff education, (f) monthly team meetings, (g) reeducation throughout the duration of the project, and (h) patient-family education. Baseline data were collected on 20 neonates with a mean gestational age of 36 0/7(th) weeks and a mean total length of stay (LOS) of 43 days. Postimplementation data were collected on 150 neonates with a mean gestational age of 36 1/7(th) weeks and a mean total LOS of 36.4 days. A potential decrease in the mean total LOS of stay by 6.63 days was achieved during this continuous quality improvement (CQI) project. Neonates who are fed according to cues can become successful oral feeders and can be safely discharged home regardless of gestational age or diagnosis. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  19. Caring during clinical practice: Midwives’ perspective

    Directory of Open Access Journals (Sweden)

    Mmajapi E. Chokwe

    2013-09-01

    Full Text Available Background: Caring forms the core of nursing and midwifery. Despite caring being an important emotional aspect of midwifery and nursing, there are general public complaints about uncaring behaviour in midwifery. Therefore, there is a need to explore caring from midwives’ point of view with the hope of identifying solutions and recommendations for midwifery practice. Furthermore, the study aimed to stimulate debate and discussion about the caring behaviour of midwives.Objective: To explore caring during clinical practice as perceived and experienced by midwives.Method: The study was contextual, exploratory and qualitative. The participants were midwives working in state and private hospitals in Tshwane,South Africa where BTech II and III midwifery learners were allocated for work integrated learning (WIL. Data collection was carried out through self-report using a questionnaire and focus group. Questionnaires were distributed to 40 midwives at private and state hospitals in Tshwane. This was followed by two focus group sessions to ensure that data is enriched. The hermeneutic interpretive approach was used to analyse data, and analysis continued until saturation.Results: Themes of caring and uncaring related to patient care and midwives emerged. Thefindings illustrated that the midwives had excellent theoretical knowledge of caring, but someof them did not display caring behaviour during clinical practice.Conclusion: Some of the midwives did not display caring behaviour. Implication for practicewas provided based on the research findings. Recommendations included measures of improving caring behaviours during midwifery practice.

  20. Instrument Rating Practical Test Standards for Airplane, Helicopter, Airship

    Science.gov (United States)

    1994-10-01

    The Instrument Rating Practical Test Standards (PTS) book has : been published by the Federal Aviation Administration (FAA) to : establish the standards for the instrument rating practical test for : airplanes, helicopters, and airships. FAA inspecto...

  1. Confronting the caring crisis in clinical practice.

    Science.gov (United States)

    Ma, Fang; Li, Jiping; Zhu, Dan; Bai, Yangjuan; Song, Jianhua

    2013-10-01

    In light of the call for humanistic caring in the contemporary health care system globally and in China, the issue of improving the caring skills that are essential to student success, high-quality nursing practice and positive patient outcomes is at the forefront of nursing education. The aim of this mixed-methods quantitative and qualitative study was to investigate baccalaureate nursing students' caring ability in the context of China and to explore the role of clinical practice learning in the development of students' caring skills. A two-phase, descriptive study utilising a mixed methodology consisting of a caring ability survey and focus group interviews was conducted. In the quantitative phase, 598 baccalaureate nursing students at two colleges in Yunnan Province in southwest China were surveyed using the Caring Ability Inventory (CAI). In the qualitative phase, 16 of the students who had participated in the quantitative phase were interviewed. Students obtained lower scores on the CAI than have been reported elsewhere by other researchers. In addition, students in the clinical stage of training scored lower than students in the pre-clinical stage. Three themes concerning facilitation by and three themes concerning the obstructive effects of clinical practice learning in the development of caring ability were identified. Themes pertaining to facilitation were: (i) promoting a sense of professional responsibility and ethics; (ii) providing an arena in which to practise caring, and (iii) learning from positive role models. Themes pertaining to obstruction were: (i) a critical practice learning environment; (ii) encountering inappropriate clinical teachers, and (iii) experiencing shock at the contrast between an idealised and the real environment. The key to developing students' ability to care lies in highlighting caring across the entire health care system. By diminishing exposure to negative role models, and adopting appropriate pedagogical ideas about

  2. Standard practice for ultrasonic testing of wrought products

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2013-01-01

    1.1 Purpose—This practice establishes the minimum requirements for ultrasonic examination of wrought products. Note 1—This standard was adopted to replace MIL-STD-2154, 30 Sept. 1982. This standard is intended to be used for the same applications as the document which it replaced. Users should carefully review its requirements when considering its use for new, or different applications, or both. 1.2 Application—This practice is applicable for examination of materials such as, wrought metals and wrought metal products. 1.2.1 Wrought Aluminum Alloy Products—Examination shall be in accordance with Practice B 594. 1.3 Acceptance Class—When examination is performed in accordance with this practice, engineering drawings, specifications, or other applicable documents shall indicate the acceptance criteria. Five ultrasonic acceptance classes are defined in Table 1. One or more of these classes may be used to establish the acceptance criteria or additional or alternate criteria may be specified. 1.4 Ord...

  3. Continuity of care in home health-care practice: two management paradoxes.

    Science.gov (United States)

    Gjevjon, Edith R; Romøren, Tor I; Kjøs, Bente Ø; Hellesø, Ragnhild

    2013-01-01

      To explore continuity of care from a manager's perspective: How do managers understand the concept of continuity of care and how do they assess continuity of care in home health-care? How do managers work to ensure continuity of care when managing care provision for patients in their homes?   Continuity of care is considered a prerequisite for service quality. Managers can influence continuity of care through managing day-to-day work.   Semi-structured interviews of a purposive sample of 16 managers from 12 municipal units. Theory-driven and data-driven analysis was applied.   Ideally, to promote continuity of care, the number of carers should be limited. Yet, in practice, discontinuity of care was accepted as a working compromise. The managers faced two paradoxes: the continuity ideal vs. the practicalities of home health-care, and caring for patients vs. caring for staff.   The managers were forced to prioritize, in conflict with ideals or professional standards, patients' wellbeing or the wellbeing of the staff. Ensuring continuity of care for all patients did not seem feasible.   The study highlights management paradoxes: possible unintended consequences of prioritizing needs for continuity of care should be objects of reflection in care management. © 2012 Blackwell Publishing Ltd.

  4. Creation of minimum standard tool for palliative care in India and self-evaluation of palliative care programs using it

    Directory of Open Access Journals (Sweden)

    M R Rajagopal

    2014-01-01

    Full Text Available Background: It is important to ensure that minimum standards for palliative care based on available resources are clearly defined and achieved. Aims: (1 Creation of minimum National Standards for Palliative Care for India. (2 Development of a tool for self-evaluation of palliative care organizations. (3 Evaluation of the tool in India. In 2006, Pallium India assembled a working group at the national level to develop minimum standards. The standards were to be evaluated by palliative care services in the country. Materials and Methods: The working group prepared a "standards" document, which had two parts - the first composed of eight "essential" components and the second, 22 "desirable" components. The working group sent the document to 86 hospice and palliative care providers nationwide, requesting them to self-evaluate their palliative care services based on the standards document, on a modified Likert scale. Results: Forty-nine (57% palliative care organizations responded, and their self-evaluation of services based on the standards tool was analyzed. The majority of the palliative care providers met most of the standards identified as essential by the working group. A variable percentage of organizations had satisfied the desirable components of the standards. Conclusions: We demonstrated that the "standards tool" could be applied effectively in practice for self-evaluation of quality of palliative care services.

  5. Beliefs and practices in health care

    OpenAIRE

    MELGUIZO HERRERA, ESTELA; ALZATE POSADA, MARTHA LUCÍA

    2010-01-01

    The objective is to review the concepts of beliefs and practices of health care as cultural expressions in order to highlight to caregivers the necessary aspects for them to provide a culturally consistent care, a more human and effective one. From the conception of culture as a human creation which influences and shapes people's beliefs and practices, some definitions of the concepts as of social psicology, anthropology, sociology and transcultural nursing aspects are revised. We found that ...

  6. Practice of pharmaceutical care in community pharmacies in Jordan ...

    African Journals Online (AJOL)

    Purpose: To describe the current role played by pharmacists in delivering pharmaceutical care (PC) in community pharmacies in Jordan (current activities and practices undertaken in the community and extent of provision of PC standards), pharmacists' perspectives on PC implementation and barriers to implementing PC ...

  7. Primary Care Physicians' Dementia Care Practices: Evidence of Geographic Variation

    Science.gov (United States)

    Fortinsky, Richard H.; Zlateva, Ianita; Delaney, Colleen; Kleppinger, Alison

    2010-01-01

    Purpose: This article explores primary care physicians' (PCPs) self-reported approaches and barriers to management of patients with dementia, with a focus on comparisons in dementia care practices between PCPs in 2 states. Design and Methods: In this cross-sectional study, questionnaires were mailed to 600 randomly selected licensed PCPs in…

  8. Practices around Customization of Standard Systems

    DEFF Research Database (Denmark)

    Dittrich, Yvonne; Vaucouleur, Sebastien

    2008-01-01

    of these software development practices is available. We present an empirical study on customization practices based on video recordings, interviews and a survey. The observed and reported practices challenge some of the principles of software engineering. Based on the analysis, we discuss the specificity...

  9. How Professional Standards Guide Practice for School Principals

    Science.gov (United States)

    Militello, Matthew; Fusarelli, Bonnie; Alsbury, Thomas; Warren, Thomas P.

    2013-01-01

    Purpose: The purpose of this study is to provide an empirical measure of how principals enact prescribed leadership standards into practice. The aim of the study was to ascertain how current school principals perceive the practice of a specific set of leadership standards. Design/methodology/approach: A total of 61 practicing school principals in…

  10. Newborn cord care practices in Haiti.

    Science.gov (United States)

    Walsh, Susan; Norr, Kathleen; Sankar, Girija; Sipsma, Heather

    2015-10-01

    Newborn cord infections commonly lead to neonatal sepsis and death, particularly in low-resource countries where newborns may receive unhygienic cord care. Topical application of chlorhexidine to the newborn's cord has been shown to prevent infection. Such benefits may be particularly important in Haiti. We explored current cord care practices by conducting a qualitative study using five focus groups among key community stakeholders (mothers of newborns/children under age two years, pregnant women, traditional birth attendants, community health workers, traditional healers) in Petit-Goâve, Haiti. Data collection was guided by the Health Belief Model. Results suggest community stakeholders recognise that infants are susceptible to cord infection and that cord infection is a serious threat to newborns. Long-held traditional cord care practices are potential barriers to adopting a new cord care intervention. However, all groups acknowledged that traditional practices could be harmful to the newborn while expressing a willingness to adopt practices that would protect the newborn. Results demonstrate potential acceptability for altering traditional cord care practices among neonatal caretakers in Haiti. An informational campaign designed to educate local health workers and new mothers to eliminate unhygienic cord applications while promoting chlorhexidine application may be a strong approach for preventing neonatal cord infections.

  11. Health care in small prisons: incorporating high-quality standards.

    Science.gov (United States)

    Rieder, Jean-Pierre; Casillas, Alejandra; Mary, Gérard; Secretan, Anne-Dominique; Gaspoz, Jean-Michel; Wolff, Hans

    2013-01-01

    In the past, health management in Geneva's six post-trial prisons had been variable and inconsistent. In 2008, the unit of penitentiary medicine of the Geneva University Hospitals was mandated to re-organize and provide health care at all six prison facilities. The specific aim of this paper is to outline the example as a practical solution to some of the common challenges in unifying the structure and process of health services across multiple small facilities, while meeting European prison health and local quality standards. Geneva's post-trial prisons are small and close to one another in geographical proximity - ideal conditions for the construction of a health mobile team (HMT). This multidisciplinary mobile team operated like a community ambulatory care model; it was progressively launched in all prison facilities in Geneva. The authors incorporated an implementation strategy where health providers partnered with prison and community stakeholders in the health delivery model's development and adaption process. The model's strategic initiatives are described along the following areas, in light of other international prison health activity and prior care models: access to a health care professional, equivalence of care, patient consent, confidentiality, humanitarian interventions, and professional competence and independence. From the perspective of the HMT members, the authors provide the "lessons learned" through this experience, especially to providers who are working on prison health services reform and coordination improvement. The paper particularly stresses the importance of partnering with community health stakeholders and prison staff, a key component to the approach.

  12. CQI in the acute care setting: an opportunity to influence acute care practice.

    Science.gov (United States)

    Williams, Helen F; Fallone, Sue

    2008-01-01

    Continuous quality improvement is a tool and a methodology that allows nephrology nurses to monitor, evaluate, and creatively improve their working environment. Using an established, consistent, and easily understood format enables information sharing and facilitates progress toward establishing best practice guidelines and standards. Strengthening the nursing knowledge base improves the care provided to patients, which improves outcomes. Use of CQI methods can facilitate better processes, which in turn influence acute care practice. The cycle and the process never end since new knowledge is critical to provide the best care to patients. The Acute Care SIG will continue the PDCA cycle to Act in response to the changing needs of patients in the acute care setting and to our membership in the acute care arena.

  13. Nursing Practice in Primary Care and Patients' Experience of Care.

    Science.gov (United States)

    Borgès Da Silva, Roxane; Brault, Isabelle; Pineault, Raynald; Chouinard, Maud-Christine; Prud'homme, Alexandre; D'Amour, Danielle

    2018-01-01

    Nurses are identified as a key provider in the management of patients in primary care. The objective of this study was to evaluate patients' experience of care in primary care as it pertained to the nursing role. The aim was to test the hypothesis that, in primary health care organizations (PHCOs) where patients are systematically followed by a nurse, and where nursing competencies are therefore optimally used, patients' experience of care is better. Based on a cross-sectional analysis combining organizational and experience of care surveys, we built 2 groups of PHCOs. The first group of PHCOs reported having a nurse who systematically followed patients. The second group had a nurse who performed a variety of activities but did not systematically follow patients. Five indicators of care were constructed based on patient questionnaires. Bivariate and multivariate linear mixed models with random intercepts and with patients nested within were used to analyze the experience of care indicators in both groups. Bivariate analyses revealed a better patient experience of care in PHCOs where a nurse systematically followed patients than in those where a nurse performed other activities. In multivariate analyses that included adjustment variables related to PHCOs and patients, the accessibility indicator was found to be higher. Results indicated that systematic follow-up of patients by nurses improved patients' experience of care in terms of accessibility. Using nurses' scope of practice to its full potential is a promising avenue for enhancing both patients' experience of care and health services efficiency.

  14. Health care practices in ancient Greece: The Hippocratic ideal

    Science.gov (United States)

    Kleisiaris, Christos F.; Sfakianakis, Chrisanthos; Papathanasiou, Ioanna V.

    2014-01-01

    Asclepius and Hippocrates focused medical practice on the natural approach and treatment of diseases, highlighting the importance of understanding the patient’s health, independence of mind, and the need for harmony between the individual, social and natural environment, as reflected in the Hippocratic Oath. The aim of this study was to present the philosophy of care provision in ancient Greece and to highlight the influence of the Hippocratic ideal in modern health care practices. A literature review was carried out using browser methods in international databases. According to the literature, “healthy mind in a healthy body” was the main component of the Hippocratic philosophy. Three main categories were observed in the Hippocratic provision of care: health promotion, interventions on trauma care, and mental care and art therapy interventions. Health promotion included physical activity as an essential part of physical and mental health, and emphasized the importance of nutrition to improve performance in the Olympic Games. Interventions on trauma care included surgical practices developed by Hippocrates, mainly due to the frequent wars in ancient Greece. Mental care and art therapy interventions were in accordance with the first classification of mental disorders, which was proposed by Hippocrates. In this category music and drama were used as management tools in the treatment of illness and in the improvement of human behavior. The role of Asclepieion of Kos was highlighted which clearly indicates a holistic health care model in care provision. Finally, all practices regarded detailed recordings and evaluation of information within the guidelines. The Hippocratic philosophy on health care provision focused on the holistic health care model, applying standards and ethical rules that are still valid today. PMID:25512827

  15. Nursing care documentation practice: The unfinished task of nursing care in the University of Gondar Hospital.

    Science.gov (United States)

    Kebede, Mihiretu; Endris, Yesuf; Zegeye, Desalegn Tegabu

    2017-09-01

    Even though nursing care documentation is an important part of nursing practice, it is commonly left undone. The objective of this study was to assess nursing care documentation practice and the associated factors among nurses who are working at the University of Gondar Hospital. An institution-based cross-sectional study was conducted among 220 nurses working at the University of Gondar Hospital inpatient wards from March 20 to April 30, 2014. Data were collected using a structured and pre-tested self-administered questionnaire. Data were entered into Epi Info version 7 and analyzed with SPSS version 20. Descriptive statistics, bivariate, and multivariate logistic regression analyses were carried out. Two hundred and six nurses returned the questionnaire. Good nursing care documentation practice among nurses was 37.4%. A low nurse-to-patient ratio AOR = 2.15 (95%CI [1.155, 4.020]), in-service training on standard nursing process AOR = 2.6 (95%CI[1.326, 5.052]), good knowledge AOR = 2.156(95% CI [1.092, 4.254]), and good attitude toward nursing care documentation AOR = 2.22 (95% CI [1.105, 4.471] were significantly associated with nursing care documentation practice. Most of the nursing care provided remains undocumented. Nurse-to-patient ratio, in-service training, knowledge, and attitude of nurses toward nursing care documentation were factors associated with nursing care documentation practice.

  16. Academy of Nutrition and Dietetics: revised 2015 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in pediatric nutrition.

    Science.gov (United States)

    Nevin-Folino, Nancy; Ogata, Beth N; Charney, Pamela J; Holt, Katrina; Brewer, Holly L; Sharrett, Mary K; Carney, Liesje N

    2015-03-01

    All of the health care professions recognize that care of infants and children is best managed as a specialty area of practice. Nutrition plays a key role in normal growth and development. Appropriate nutrition care is vital adjuvant therapy for infants and children with acute or chronic illness. Provision of nutrition services in pediatric practice requires that registered dietitian nutritionists (RDNs) have advanced knowledge in the focus area of pediatric nutrition. Therefore, the Pediatric Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed this revision of the Standards of Practice and Standards of Professional Performance for RDNs in Pediatric Nutrition as a resource for RDNs working in pediatric nutrition to assess skill level and to identify needs for professional development to advance practice in pediatric nutrition. This revision reflects recent advances in pediatric nutrition and replaces the previous Standards published in 2009. The Standards of Practice represent the four steps of the Nutrition Care Process as applied to the care of patients/clients. The Standards of Professional Performance represent six domains of professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. The Standards of Practice and Standards of Professional Performance are complementary resources for RDNs working in pediatric nutrition and dietetics practice. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  17. Job satisfaction of home care assistants related to managerial practices.

    Science.gov (United States)

    Buelow, J R; Winburn, K; Hutcherson, J

    1999-01-01

    This article addresses the question. "How do specific managerial practices support home care assistants' job satisfaction?" Staff from three home care agencies were surveyed regarding their perceptions of specific managerial practices and intrinsic job satisfaction. Results of a hierarchical regression model indicate that supportive leadership practices, client-centered in-service training style, and mission implementation together explained 52% of the variance in intrinsic job satisfaction. Supportive leadership was described as the extent to which a supervisor communicates effectively, shows personal concern or caring, and maintains high professional standards. Mission implementation was defined as how strongly the staff felt the mission influenced the hiring process, orientation, in-services, and everyday management. Effective in-services included discussions of types of clients and how to effectively handle common challenges.

  18. Oswer integrated health and safety standard operating practices. Directive

    International Nuclear Information System (INIS)

    1993-02-01

    The directive implements the OSWER (Office of Solid Waste and Emergency Response) Integrated Health and Safety Standards Operating Practices in conjunction with the OSHA (Occupational Safety and Health Act) Worker Protection Standards, replacing the OSWER Integrated Health and Safety Policy

  19. Business management and the environment of care standards.

    Science.gov (United States)

    Keil, O R

    1997-01-01

    In summary, the entire JCAHO manual is built around the concept of "know thyself." This expectation creates the need to engage in a substantial rework of existing practices to remove communication barriers and to eliminate turf warfare. The focus of the standards is on the patient. All aspects of the patient-care delivery cycle are examined during survey, as are key elements of the business-management activities. The EC standards are a case study of business management. They expect leadership and planning, development of human resources, management of information, and improvement of performance. They expect that all four of these management tools will be exercised by all managers and staff members who have an impact on or are impacted by the seven elements of the EC function. The primary focus is on teamwork among providers and maximizing benefits to patients.

  20. Patient stoma care: educational theory in practice.

    Science.gov (United States)

    Williams, Jenny

    Patients undergoing stoma formation encounter many challenges including psychosocial issues, relationship concerns and fear of leakage. Leakage, inappropriate product usage and poor patient adaptation post stoma formation has cost implications for the NHS. Developing good, practical stoma care skills has been identified as improving patient outcomes, promoting the provision of quality care and improving efficiency within the NHS. However, a thorough literature search indicated that there is little research available on patient stoma care education. This is considered surprising by Metcalf (1999), O'Connor (2005) and the author of this article. This article considers and adapts generic educational theory to make it pertinent to patient stoma care education in order to bridge the gap between theory and practice.

  1. Obstetric care practice in Birbhum District, West Bengal, India.

    Science.gov (United States)

    Bharati, Susmita; Pal, Manoranjan; Bharati, Premananda

    2007-08-01

    The study area is the Birbhum district of the State of West Bengal in India. It is one of the backward districts in India. The paper investigates the existing pattern of obstetric health care practices and the factors associated with the utilization of such care. The present analysis includes 495 adult married women of both rural and urban areas of nine Blocks of Birbhum district. Besides performing chi2 tests to see the association of the relevant individual and household characteristics, logistic regression was also carried out to measure the effect of these characteristics on the use of obstetric health care. In Birbhum district of West Bengal 65 percent mothers go to doctors for antenatal check-up during their pregnancy, but only 26 percent mothers deliver their babies in institutions and 30 percent mothers get the help of professional health assistants during delivery. Educated women have emphasized role in the practice of obstetric health care. Husband's education and the standard of living of the family also have some effect on the practice of antenatal check up, place of delivery and assistance of health professional. While most of the family background variables have significant effect on the practice of antenatal check up, these variables do not have much effect on the choice of delivery or seeking assistance of health professionals. Contrary to the popular belief the working status of women does not have favourable influence on the obstetric health care practices. In developing countries like India, it is the poverty, which compels the women to take jobs-that too in low paid jobs especially in rural backward areas. The status of literacy of mothers and standard of living of the family are of prime importance in improving the obstetric health care practices.

  2. Translating person-centered care into practice

    DEFF Research Database (Denmark)

    Zoffmann, Vibeke; Hörnsten, Åsa; Storbækken, Solveig

    2016-01-01

    OBJECTIVE: Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided......) health care professionals' background and training; (7) fidelity assessment; (8) reported effects. RESULTS: Although all approaches promoted autonomous motivation, they differed in other ways. Their original settings explain why IIS and GSD strive for life-illness integration, whereas MI focuses...

  3. 75 FR 65052 - Consensus Standards, Standard Practice for Maintenance of Airplane Electrical Wiring Systems

    Science.gov (United States)

    2010-10-21

    ... Practice for Maintenance of Airplane Electrical Wiring Systems AGENCY: Federal Aviation Administration, DOT...'s F2799-09 Standard Practice for Maintenance of Airplane Electrical Wiring Systems (Standard Practice) as an acceptable means of compliance to 14 CFR part 23 sections concerning electrical wiring...

  4. 75 FR 65051 - Consensus Standards, Standard Practice for Inspection of Airplane Electrical Wiring Systems

    Science.gov (United States)

    2010-10-21

    ... Practice for Inspection of Airplane Electrical Wiring Systems AGENCY: Federal Aviation Administration, DOT...'s F2696-08 Standard Practice for Inspection of Airplane Electrical Wiring Systems (Standard Practice) as an acceptable means of compliance to 14 CFR part 23 sections concerning electrical wiring systems...

  5. Standard practice for leaks using ultrasonics

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2011-01-01

    1.1 Practice A, Pressurization—This practice covers procedures for calibration of ultrasonic instruments, location, and estimated measurements of gas leakage to atmosphere by the airborne ultrasonic technique. 1.2 In general practice this should be limited to leaks detected by two classifications of instruments, Class I and Class II. Class I instruments should have a minimum detectable leak rate of 6.7 × 10−7 mol/s (1.5 × 10−2 std. cm3/s at 0°C) or more for the pressure method of gas leakage to atmosphere. Class II instruments should have a minimal detectable leak rate of 6.7 × 10−6 mol/s (1.5 × 10−1 std. cm3/s at 0°C) or more for the pressure method of gas leakage to atmosphere. Refer to Guide E432 for additional information. 1.3 Practice B, Ultrasonic Transmitter—For object under test not capable of being pressurized but capable of having ultrasonic tone placed/injected into the test area to act as an ultrasonic leak trace source. 1.3.1 This practice is limited to leaks producing leakage o...

  6. Standard Practice for Quality Management Systems for Nondestructive Testing Agencies

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2009-01-01

    1.1 This practice covers general requirements for the establishment and maintenance of a quality management system for agencies engaged in nondestructive testing (NDT). 1.2 This practice utilizes criteria contained in Practice E 543. 1.3 This practice utilizes criteria contained in American National Standard ANSI/ISO/ASQ Q9001–2000, Quality management systems—Requirements. 1.4 This practice recognizes the importance of establishing minimum safety criteria. 1.5 The use of SI or inch-pound units, or combinations thereof, will be the responsibility of the technical committee whose standards are referred to in this standard. 1.6 This practice does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this practice to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

  7. Synoptic meteorology manual of standard practices

    Energy Technology Data Exchange (ETDEWEB)

    Jenne, D.E.

    1954-03-22

    This report, dated March 22, 1954 details work procedures for the 200- West Area at HAPO. Topics discussed include emergency procedures, safety and housekeeping practices, policies and procedures, instruments and equipment located at the 622 tower, instruments and equipment located offsite, observational procedures, form entries, and card punching, and weather forecasting.

  8. SYNERGY ENTERPRISES AND STANDARDIZATION OF WORKING PRACTICE

    Directory of Open Access Journals (Sweden)

    Mikhail N. Konotopov

    2014-01-01

    Full Text Available This article examines the main causes of low productivity in domestic enterprises, as well as the issues of production processes standardization and the coordination of work in relation to the possible organizational interventions aimed at improving the synergy of workforce joint activities.

  9. Assessment of pharmaceutical care practices of community ...

    African Journals Online (AJOL)

    We undertook to assess the pharmaceutical care practices of community pharmacists in patients with co-morbidity of hypertension and diabetes in Delta State. A seventeen item questionnaire consisting of 5 points response scale was developed and administered to pharmacists in the community setting. The questionnaire ...

  10. Newborn care practices in rural Bangladesh

    Directory of Open Access Journals (Sweden)

    Islam MT

    2015-07-01

    Full Text Available Mohammad Tajul Islam,1 Nazrul Islam,2 Yukie Yoshimura,1 Monjura Khatun Nisha,3 Nawzia Yasmin4 1Safe Motherhood Promotion Project, Japan International Cooperation Agency (JICA, Dhaka, Bangladesh; 2School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; 3International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b; 4Department of Public Health, State University of Bangladesh, Dhaka, Bangladesh Background: Neonatal mortality is high in Bangladesh. Most of the neonatal deaths are preventable through simple and cost-effective essential newborn care interventions. Studies to document the determinants of unhealthy newborn care practices are scarce. Objective: The objective of this study is to describe the pattern of neonatal care practices and their determinants in rural Bangladesh. Methodology: This study is based on baseline data of a community-based intervention to assess impact of limited postnatal care services on maternal and neonatal health-seeking behavior. Data from 510 women, who had a live birth at home 1 year prior to survey, of six randomly selected unions of an Upazila (subdistrict were analyzed. Results: Majority of the respondents were at an age group of 20–34 years. Only 6% had delivery by skilled providers. Immediate drying and wrapping, and giving colostrums to newborns were almost universal. Unhealthy practices, like unclean cord care (42%, delayed initiation of breastfeeding (60%, use of prelacteals (36%, and early bathing (71% were very common. Muslims were more likely to give early bath (adjusted odds ratio [OR]: 2.01; 95% confidence interval [CI]: 1.13–3.59; P=0.018 and delay in initiating breastfeeding (adjusted OR: 1.45; 95% CI: 1.18–1.78; P<0.001 to newborns. Practice of giving prelacteals was associated with teenage mothers (adjusted OR: 2.26; 95% CI: 1.19–4.28; P=0.013 and women’s lack of education (adjusted OR: 2.64; 95% CI: 1.46–4.77; P=0

  11. Sandia software guidelines. Volume 3. Standards, practices, and conventions

    Energy Technology Data Exchange (ETDEWEB)

    1986-07-01

    This volume is one in a series of Sandia Software Guidelines intended for use in producing quality software within Sandia National Laboratories. In consonance with the IEEE Standard for Software Quality Assurance Plans, this volume identifies software standards, conventions, and practices. These guidelines are the result of a collective effort within Sandia National Laboratories to define recommended deliverables and to document standards, practices, and conventions which will help ensure quality software. 66 refs., 5 figs., 6 tabs.

  12. Advanced nursing practice in paediatric critical care.

    Science.gov (United States)

    Llewellyn, Leanne E; Day, Helen L

    2008-02-01

    Following the successful implementation of High Dependency Care: a model for development at King's College hospital in 2005, the authors wished to consider the addition of a fourth tier to the model. A review of the clinical environment was undertaken and it was suggested that the introduction of an advanced nurse practitioner could contribute to the education and continuation of the outreach service detailed in the model, as well as to the improvement of critical care services and career development opportunities for nurses within the unit. A survey was undertaken to identify the views of medical and nursing staff about essential roles and responsibilities of advanced nurse practitioners in this area. This would then direct the development of a teaching and competency programme that could promote advanced practice in the critical care environment. There was no consensus on the tasks advanced nurse practitioners can undertake, the appropriate mentors in the clinical environment, the level of education they must achieve, nor the time in which this should be completed. There was confusion about the qualifications required for advanced nursing practice, mentorship and training. However, there was support for this role and respondents confirmed the view that advanced nursing practiced would be beneficial in patient care delivery.

  13. Standards for the mental health care of people with severe ...

    African Journals Online (AJOL)

    Adele

    Psychiatry; Psychiatric Services (previously Hospital and Community Psychiatry); ... Objective: Mental health care standards have been developed to describe what is an acceptable and adequate quality of mental health care for service .... has been developed for substance dependence in-patient centres.9 The standards, ...

  14. Standards for the mental health care of people with severe ...

    African Journals Online (AJOL)

    Part one describes conceptual issues underlying the development of South African standards for people with severe psychiatric disorders. Mental health care standards seek to describe what is an acceptable and adequate quality of mental health care for service users. A focus on service quality is especially crucial in ...

  15. EROMIA in inflammatory arthritis: the next step in standard practice.

    Science.gov (United States)

    Palmer, Deborah; El Miedany, Yasser

    Patient reported outcome measures (PROMs) have been increasingly recognized as important tools in rheumatoid arthritis. PROMs add up to a composite score that directly reflects changes in outcomes of immediate importance to patients on a daily basis, such as pain, sleep, fatigue, functional impairment and quality of life. Prospective collection of the patients' information in databases has been attempted, mainly in research studies. This work was carried out to assess the possibility of systematically collecting and aggregating a focused set of clinical data in the standard clinical practice, directly and comfortably from the point of care and on an ongoing basis, using EROMIA software. Recording the patients' data electronically has significantly (P<0.01) saved time in comparison with written paper format. It also significantly (P<0.001) saved time in retrieving patients' recorded data. In addition to the traditional disease outcome measures, disease comorbidities such as falls and cardiovascular risks could be recorded. Recording tender and swollen joints individually was made possible. EROMIA offered a hospital-based integrated monitoring database that echoes daily clinical practice. It does not require advanced computer knowledge.

  16. Hair transplantation: Standard guidelines of care

    Directory of Open Access Journals (Sweden)

    Patwardhan Narendra

    2008-03-01

    Full Text Available Hair transplantation is a surgical method of hair restoration. Physician qualification : The physician performing hair transplantation should have completed post graduation training in dermatology; he should have adequate background training in dermatosurgery at a centre that provides education training in cutaneous surgery. In addition, he should obtain specific hair transplantation training or experience at the surgical table(hands on under the supervision of an appropriately trained and experienced hair transplant surgeon. In addition to the surgical technique, training should include instruction in local anesthesia and emergency resuscitation and care. Facility : Hair transplantation can be performed safely in an outpatient day case dermatosurgical facility. The day case theatre should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place and all nursing staff should be familiar with the emergency plan. It is preferable, but not mandatory to have a standby anesthetist. Indication for hair transplantation is pattern hair loss in males and also in females. In female pattern hair loss, investigations to rule out any underlying cause for hair loss such as anemia and thyroid deficiency should be carried out. Hair transplantation can also be performed in selected cases of scarring alopecia, eyebrows and eye lashes, by experienced surgeons. Preoperative counseling and informed consent :Detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and if more procedures are needed for proper results, it should be clearly mentioned. Patient should be provided with adequate opportunity to seek information through brochures, computer presentations, and personal discussions. Need for concomitant medical therapy should be emphasized. Patients should understand

  17. Theories of Practice: Raising the Standard of Early Childhood Education

    Science.gov (United States)

    Mooney, Carol Garhart

    2015-01-01

    As an educator, you care deeply about working with young children and strive for quality in your program. This book explains why learning about foundational theory supports the ways you care for and teach children. With stories, anecdotes, and a discussion about the strong connection between theory and best practices, this guide will help you…

  18. The common core mathematics standards transforming practice through team leadership

    CERN Document Server

    Hull, Ted H; Balka, Don S

    2012-01-01

    Transform math instruction with effective CCSS leadership The Common Core State Standards for mathematics describe the "habits of mind" that teachers should develop in their students without which the content standards cannot be successfully implemented. This professional development resource helps principals and math leaders grapple with the changes that must be addressed so that teachers can implement the practices required by the CCSS. Included are: A clear explanation of the CCSS for Mathematical Practice  Techniques to help leadership teams collaboratively implement and maintain the new standards A proficiency matrix with examples of instructional strategies for helping students reach competency in each standard.

  19. CIRSE Standards of Practice Guidelines on Gastrostomy

    Energy Technology Data Exchange (ETDEWEB)

    Sutcliffe, James, E-mail: jasutcliffe@gmail.com; Wigham, Andrew, E-mail: a.wigham@doctors.org.uk [Oxford University Hospitals NHS Trust, Radiology Department (United Kingdom); Mceniff, Niall, E-mail: nmceniff@stjames.ie [St. James’s Hospital, Radiology (DiagIm) (Ireland); Dvorak, Petr, E-mail: petr-dvorak@email.cz [Faculty Hospital Charles University, Radiology Department (Czech Republic); Crocetti, Laura, E-mail: laura.crocetti@med.unipi.it [University of Pisa, Diagnostic Imaging and Intervention, Department of Hepatology and Liver Transplants (Italy); Uberoi, Raman, E-mail: Raman.Uberoi@ouh.nhs.uk [Oxford University Hospitals NHS Trust, Radiology Department (United Kingdom)

    2016-07-15

    PurposeSurgical Gastrostomy has been around since the 19th century but in 1980 the first successful percutaneous endoscopic gastrostomy was reported. A year later the first successful percutaneous gastrostomy was performed using fluoroscopic guidance. The technique for percutaneous insertion and the equipment used has been refined since then and it is now considered the gold standard for gastrostomy insertion. Here we present guidelines for image-guided enteral feeding tubes in adults.Material and MethodWe performed a review and analysis of the scientific literature, other national and international guidelines and expert opinion.ResultsStudies have shown fluoroscopic techniques have consistently higher success rates with lower rates of major complications than endoscopic techniques. However, the Achilles' heel of many fluoroscopic techniques is the requirement for smaller gastrostomy tube sizes resulting in them being more prone to blockages and thus requiring further intervention.ConclusionRadiological feeding tube insertion is a safe and effective procedure. Success rates are higher, and complication rates lower than PEG or surgical gastrostomy tube placement and innovative techniques for gastric and jejunal access mean that there are very few cases in which RIG is not possible. The principal weakness of radiologically inserted gastrostomies is the limitiation on tube size which leads to a higher rate of tube blockage. Per-oral image-guided gastrostomies have to an extent addressed this but have not been popularised. Currently many centres still consider endoscopic gastrostomies as the first line unless patients are too unwell to undergo this procedure or previous attempts have failed, in which case radioloically inserted gastrostomies are the technique of choice.

  20. Reshaping supervisory practice in home care.

    Science.gov (United States)

    Knollmueller, R N

    1988-06-01

    Reshaping supervisory practice in home care is not an if but a when issue. We need the best wisdom in how to reshape the practice so that it builds on the experience of the individual and the agency. It is time to deliberately plan to change from the paper-shuffling tendency among supervisors toward supporting more people-oriented activity and to rediscover the pivotal role that supervisors have in keeping a community healthy, staff stimulated, and the agency solvent. Some summary points to consider in reshaping supervisory practice include: (1) redefine supervision to reflect what is desired, needed, and possible, (2) recognize the contribution from change theory and apply it, (3) recapture the commitment and philosophy of supervision from the past, (4) reward the supervisor commensurate with the scope of practice expected, (5) reverse selection of supervisors from preservers of territory to manager as idea entrepreneur, (6) respond to varying and dynamic models of supervisory practice, (7) recharge the supervisor through timely in-service programs, continuing education, and formal academic study, (8) require educational content and practice from colleges and universities that stimulate creative supervisory skills and improve job satisfaction, (9) respect the work of the supervisor and provide appropriate support to achieve success, (10) reconsider current supervisory models and expand opportunities for professional growth among staff, and (11) reshape the supervisory role from one of controller to facilitator and innovator.

  1. Academy of Nutrition and Dietetics: standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in adult weight management.

    Science.gov (United States)

    Jortberg, Bonnie; Myers, Eileen; Gigliotti, Linda; Ivens, Barbara J; Lebre, Monica; Burke March, Susan; Nogueira, Isadora; Nwankwo, Robin; Parkinson, Meredith R; Paulsen, Barbara; Turner, Tonya

    2015-04-01

    Weight management encompasses the inter-relationship of nutrition, physical activity, and health behavior change. Nutrition is key for the prevention and treatment of obesity and chronic disease and maintenance of overall health. Thus, the Weight Management Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) in Adult Weight Management as a resource for RDNs working in weight management. This document allows RDNs to assess their current skill levels and to identify areas for further professional development in this expanding practice area. This document describes the current standards for weight management practice for RDNs. The Standards of Practice represent the four steps in the Nutrition Care Process as applied to the care of patients/clients. The Standards of Professional Performance consist of six domains of professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how the standard can be applied to practice. The indicators describe three skill levels (competent, proficient, and expert) for RDNs working in weight management. The Standards of Practice and Standards of Professional Performance are complementary resources for the Registered Dietitian Nutritionist in weight management. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  2. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice.

    Science.gov (United States)

    Coughlin, Mary; Gibbins, Sharyn; Hoath, Steven

    2009-10-01

    This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units. Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America's Joint Commission's concept of 'core measures' for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model. Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes.

  3. Standard guidelines of care for vitiligo surgery

    Directory of Open Access Journals (Sweden)

    Parsad Davinder

    2008-03-01

    Full Text Available Vitiligo surgery is an effective method of treatment for selected, resistant vitiligo patches in patients with vitiligo. Physician′s qualifications: The physician performing vitiligo surgery should have completed postgraduate training in dermatology which included training in vitiligo surgery. If the center for postgraduation does not provide education and training in cutaneous surgery, the training may be obtained at the surgical table (hands-on under the supervision of an appropriately trained and experienced dermatosurgeon at a center that routinely performs the procedure. Training may also be obtained in dedicated workshops. In addition to the surgical techniques, training should include local anesthesia and emergency resuscitation and care. Facility: Vitiligo surgery can be performed safely in an outpatient day care dermatosurgical facility. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place, with which all nursing staff should be familiar. Vitiligo grafting for extensive areas may need general anesthesia and full operation theater facility in a hospital setting and the presence of an anesthetist is recommended in such cases. Indications for vitiligo surgery : Surgery is indicated for stable vitiligo that does not respond to medical treatment. While there is no consensus on definitive parameters for stability, the Task Force suggests the absence of progression of disease for the past one year as a definition of stability. Test grafting may be performed in doubtful cases to detect stability. Preoperative counseling and Informed consent: A detailed consent form elaborating the procedure and possible complications should be signed by the patient. The patient should be informed of the nature of the disease and that the determination of stability is only a vague guide. The consent form should specifically state the limitations of the procedure

  4. Practical Realism: Against Standard Scientific Realism and Anti-Realism

    Directory of Open Access Journals (Sweden)

    Rein Vihalemm

    2012-12-01

    Full Text Available In this paper, the elaboration of the concept of practical realist philosophy of science which began in the author's previous papers is continued. It is argued that practical realism is opposed to standard scientific realism, on the one hand, and antirealism, on the other. Standard scientific realism is challengeable due to its abstract character, as being isolated from practice. It is based on a metaphysical-ontological presupposition which raises the problem of the God's Eye point of view (as it was called by Hilary Putnam. Joseph Rouse's conception of science as practice, Sami Pihlström's pragmatic realism, and even Ilkka Niiniluoto's critical scientific realism are interpreted as practical realist conceptions. Pihlström suggests that the contemporary scientific realist should be prepared to accept the pragmatically naturalized Kantian transcendental perspective on realism. It is argued, however, that this realistically naturalized Kantianism can be nothing more than practical realism, as originated by Karl Marx.

  5. Developing communities of practice in health care

    DEFF Research Database (Denmark)

    Jørgensen, Rasmus; Edwards, Kasper

    Purpose Standard operating procedures (SOPs) are a part of healthcare operations but relying on explicit knowledge is not necessarily sufficient to continuously adapt and improve processes. The theory of communities of practice (CoP) proposes an approach to knowledge sharing that could supplement...... to improve practice performance, but knowledge about developing and measuring CoP is lacking (Ison et al. 2014). We propose a method to develop a CoP and the method is tested in a blood analysis unit at ‘Nordsjællands Hospital’ in Denmark. Design/methodology/approach The interventions were identified from....../value The development method improved knowledge sharing and the SOP. The method confirmed some earlier findings regarding CoP development and raises new questions regarding participant engagement, researcher role and start-up workshop. Practical implications The results indicate that knowledge sharing within operations...

  6. Standards of care and quality indicators for multidisciplinary care models for psoriatic arthritis in Spain.

    Science.gov (United States)

    Gratacós, Jordi; Luelmo, Jesús; Rodríguez, Jesús; Notario, Jaume; Marco, Teresa Navío; de la Cueva, Pablo; Busquets, Manel Pujol; Font, Mercè García; Joven, Beatriz; Rivera, Raquel; Vega, Jose Luis Alvarez; Álvarez, Antonio Javier Chaves; Parera, Ricardo Sánchez; Carrascosa, Jose Carlos Ruiz; Martínez, Fernando José Rodríguez; Sánchez, José Pardo; Olmos, Carlos Feced; Pujol, Conrad; Galindez, Eva; Barrio, Silvia Pérez; Arana, Ana Urruticoechea; Hergueta, Mercedes; Coto, Pablo; Queiro, Rubén

    2018-02-07

    To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients.

  7. Measurement of Quality of Nursing Practice in Congenital Cardiac Care.

    Science.gov (United States)

    Connor, Jean Anne; Mott, Sandra; Green, Angela; Larson, Carol; Hickey, Patricia

    2016-03-01

    The impact of nursing care on patients' outcomes has been demonstrated in adult and pediatric settings. However, limited attention has been given to standardized measurement of pediatric nursing care. A collaborative group, the Consortium for Congenital Cardiac Care Measurement of Nursing Practice, was formed to address this gap. The purpose of this study was to assess the current state of measurement of the quality of pediatric cardiovascular nursing in freestanding children's hospitals across the United States. A qualitative descriptive design was used to assess the state of measurement of nursing care from the perspective of experts in pediatric cardiovascular nursing. Nurse leaders from 20 sites participated in audiotaped phone interviews. The data were analyzed by using conventional content analysis. Each level of data coding was increasingly comprehensive. Guided by Donabedian's quality framework of structure, process, and outcome, 2 encompassing patterns emerged: (1) structure and process of health care delivery and (2) structure and process of evaluation of care. Similarities in the structure of health care delivery included program expansion and subsequent hiring of nurses with a bachelor of science in nursing and experienced nurses to provide safety and optimal outcomes for patients. Programs varied in how they evaluated care in terms of structure, measurement, collection and dissemination of data. External factors and response to internal processes of health care delivery were similar in different programs; evaluation was more varied. Seven opportunities for measurement that address both structure and process of nursing care were identified to be developed as benchmarks. ©2016 American Association of Critical-Care Nurses.

  8. [The aesthetic practice of care ethics].

    Science.gov (United States)

    Yang, Wan-I

    2013-08-01

    Situated between the doctor and the patient, nurses play a central role in the doctor-patient relationship. Nurses attend to patients' exhaustion and take responsibility for the "Other," in Lévinas' sense of the word. In discussions of the doctor-patient relationship, the patient is often regarded as the "Other". This perspective seeks to challenge the traditional contention that the doctor plays the dominant role. In the structure of this relationship, the doctor, responsible for providing diagnoses, is the subject and the patient is the object. The latter constantly feels frustrated and helpless and requires the comfort of the nurse. In this sense, the nurse, having the direct contact with the patient, constantly sees the faces of the patients. In the care relationship, the patient's frustration and helplessness will sometimes be expressed to the nurse if the patient cannot be affectively affirmed. In this type of situation, the nurse bears not simply his / her routine work, but also affective devotion and endurance. On the one hand, the nurse must practice professional medical care in the face of patients' affective feelings and emotions and, on the other hand, he / she must treat the patient as a relative and suppress inner feelings and emotions. How does a nurse situate herself into the doctor-patient relationship? As the nurse is asked to treat the patient as a relative, how does he / she face inner emotions? This paper reflects on the possibility of the aesthetic practice of care ethics.

  9. Diversity in diabetes care programmes and views on high quality diabetes care: are we in need of a standardized framework?

    Directory of Open Access Journals (Sweden)

    Liesbeth A.D. Borgermans

    2008-04-01

    concerted action to develop a standardized framework on high quality diabetes care that is complemented by a practical tool to provide guidance to the design, implementation and evaluation of diabetes care programmes.

  10. ACCCN Workforce Standards for Intensive Care Nursing: Systematic and evidence review, development, and appraisal.

    Science.gov (United States)

    Chamberlain, Diane; Pollock, Wendy; Fulbrook, Paul

    2017-12-12

    The intensive care nursing workforce plays an essential role in the achievement of positive healthcare outcomes. A growing body of evidence indicates that inadequate nurse staffing and poor skill mix are associated with negative outcomes for patients, and potentially compromises nurses' ability to maintain the safety of those in their care. In Australia, the Australian College of Critical Care Nurses (ACCCN) has previously published a position statement on intensive care staffing. There was a need for a stronger more evidence based document to support the intensive nursing workforce. To undertake a systematic and evidence review of the evidence related to intensive care nurse staffing and quality of care, and determine evidence-based professional standards for the intensive care nursing workforce in Australia. The National Health and Medical Research Council standard for clinical practice guidelines methodology was employed. The English language literature, for the years 2000-2015 was searched. Draft standards were developed and then peer- and consumer-reviewed. A total of 553 articles was retrieved from the initial searches. Following evaluation, 231 articles met the inclusion criteria and were assessed for quality using established criteria. This evidence was used as the basis for the development of ten workforce standards, and to establish the overall level of evidence in support of each standard. All draft standards and their subsections were supported multi-professionally (median score >6) and by consumers (85-100% agreement). Following minor revisions, independent appraisal using the AGREE II tool indicated that the standards were developed with a high degree of rigour. The ACCCN intensive care nursing nurse workforce standards are the first to be developed using a robust, evidence-based process. The standards represent the optimal nurse workforce to achieve the best patient outcomes and to maintain a sustainable intensive care nursing workforce for Australia

  11. Standard Practice for Effects of Cleaners on Unpainted Aircraft Surfaces

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2008-01-01

    1.1 This practice describes the procedure used to determine the effect of cleaners on unpainted aircraft surfaces. Visual observation is used for determining streaking or permanent stains which require polishing to remove. 1.2 The values stated in inch-pound units are to be regarded as the standard. The values given in parentheses are for information. 1.3 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

  12. Setting the legal standard of care for treatment and evidence-based medicine: a case study of antenatal corticosteroids.

    Science.gov (United States)

    McMurtrie, Lachlan

    2006-11-01

    This article argues that liability for negligent medical treatment should be predicated upon a standard of care reflecting what is medically and scientifically reasonable. Legal science (jurisprudence) and medical science (evidence-based medicine) should be reconciled to improve patient care and outcomes. The use of antenatal corticosteroids in obstetrics during the 1990s illustrates how most jurisprudence for setting the standard of care for treatment is ill equipped to meet the fundamental aims of tort law. The proliferation of evidence-based medical practice provides a unique opportunity for the law to encourage best medical practice when setting the standard of care for treatment. It is argued that, eventually, the law should recognise clinical practice guidelines as the prima facie standard of care for treatment. This will provide legal certainty, appropriate medical practitioner accountability, and ultimately improve patient care and outcomes.

  13. Evidence-based standard care of malignant glioma

    International Nuclear Information System (INIS)

    Shinoda, Jun; Yano, Hirohito; Sakai, Noboru

    2004-01-01

    The amount of scientific evidence regarding therapy for primary cases of glioblastoma and anaplastic astrocytoma is small compared with that for malignant tumors in other organs, and recommended therapeutic strategies derived from this evidence are not diverse. Evidence-based standard care of these tumors is very limited. At this moment, the benchmark treatment for these malignant gliomas is gross resection of the tumor bulk followed by local external beam radiotherapy (50-60 Gy) in combination with nitrosourea-based chemotherapy. Additional stereotactic radiosurgery or other strategies for localized therapeutic boosting have also been recommended. However, the clinical outcomes obtained through these standard treatments are unfortunately not always satisfactory. Novel therapeutic strategies for malignant gliomas are expected to develop and we hope that some scientific evidence would emerge from clinical trials using these novel strategies. New scientific evidence for practical and novel treatments appropriate for patients with malignant gliomas may come to be available as the evaluation of patients' quality of life is used as an end point for the analysis of clinical results, in addition to the commonly used survival analysis. (author)

  14. Tumescent liposuction: standard guidelines of care.

    Science.gov (United States)

    Mysore, Venkataram

    2008-01-01

    Tumescent liposuction is a technique for the removal of subcutaneous fat under a special form of local anesthesia called tumescent anesthesia. PHYSICIAN'S QUALIFICATIONS: The physician performing liposuction should have completed postgraduate training in dermatology or a surgical specialty and should have had adequate training in dermatosurgery at a center that provides training in cutaneous surgery. In addition, the physician should obtain specific liposuction training or experience at the surgical table ("hands on") under the supervision of an appropriately trained and experienced liposuction surgeon. In addition to the surgical technique, training should include instruction in fluid and electrolyte balance, potential complications of liposuction, tumescent and other forms of anesthesia as well as emergency resuscitation and care. Liposuction can be performed safely in an outpatient day care surgical facility, or a hospital operating room. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place with which all nursing staff should be familiar. A physician trained in emergency medical care and acute cardiac emergencies should be available in the premises. It is recommended but not mandatory, that an anesthetist be asked to stand by. Liposuction is recommended for all localized deposits of fat. Novices should restrict themselves to the abdomen, thighs, buttocks and male breasts. Arms, the medial side of the thigh and the female breast need more experience and are recommended for experienced surgeons. Liposuction may be performed for non-cosmetic indications such as hyperhidrosis of axillae after adequate experience has been acquired, but is not recommended for the treatment of obesity. Detailed history is to be taken with respect to any previous disease, drug intake and prior surgical procedures. Liposuction is contraindicated in patients with severe cardiovascular disease

  15. Competencies for psychology practice in primary care.

    Science.gov (United States)

    McDaniel, Susan H; Grus, Catherine L; Cubic, Barbara A; Hunter, Christopher L; Kearney, Lisa K; Schuman, Catherine C; Karel, Michele J; Kessler, Rodger S; Larkin, Kevin T; McCutcheon, Stephen; Miller, Benjamin F; Nash, Justin; Qualls, Sara H; Connolly, Kathryn Sanders; Stancin, Terry; Stanton, Annette L; Sturm, Lynne A; Johnson, Suzanne Bennett

    2014-01-01

    This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.

  16. Tumescent liposuction: Standard guidelines of care

    Directory of Open Access Journals (Sweden)

    Mysore Venkataram

    2008-03-01

    Full Text Available Definition : Tumescent liposuction is a technique for the removal of subcutaneous fat under a special form of local anesthesia called tumescent anesthesia. Physician′s qualifications : The physician performing liposuction should have completed postgraduate training in dermatology or a surgical specialty and should have had adequate training in dermatosurgery at a center that provides training in cutaneous surgery. In addition, the physician should obtain specific liposuction training or experience at the surgical table ("hands on" under the supervision of an appropriately trained and experienced liposuction surgeon. In addition to the surgical technique, training should include instruction in fluid and electrolyte balance, potential complications of liposuction, tumescent and other forms of anesthesia as well as emergency resuscitation and care. Facility : Liposuction can be performed safely in an outpatient day care surgical facility, or a hospital operating room. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place with which all nursing staff should be familiar. A physician trained in emergency medical care and acute cardiac emergencies should be available in the premises. It is recommended but not mandatory, that an anesthetist be asked to stand by. Indications: Liposuction is recommended for all localized deposits of fat. Novices should restrict themselves to the abdomen, thighs, buttocks and male breasts. Arms, the medial side of the thigh and the female breast need more experience and are recommended for experienced surgeons. Liposuction may be performed for non-cosmetic indications such as hyperhidrosis of axillae after adequate experience has been acquired, but is not recommended for the treatment of obesity. Preoperative evaluation : Detailed history is to be taken with respect to any previous disease, drug intake and prior surgical

  17. Standards for TB care in India: A tool for universal access to TB care.

    Science.gov (United States)

    Nair, Sreenivas Achuthan; Sachdeva, K S; Malik, Parmar; Chandra, S; Ramachandran, R; Kulshrestha, N; Chopra, K K; Khaparde, S D

    2015-10-01

    In 2014, Government of India in collaboration with World Health Organization Country Office for India released the policy document on Standards for tuberculosis (TB) care in India after in-depth deliberation with national and international experts. The standards for TB care represent what is expected for quality TB care from the Indian healthcare system including both public and private systems. The details of each standard have been compiled in this review article. It is envisioned that the standards detailed in the manuscript are adapted by all TB care providers across the country. Copyright © 2015 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

  18. Implementing a nurse information system in a nurse-managed primary care practice: a process in progress.

    Science.gov (United States)

    Wong, S T; Bernick, L A; Portillo, C; Stewart, A; Taylor, D; Duderrstadt, K; Gilliss, C L

    1999-03-01

    As part of a larger project, a nurse-managed primary care clinic (Valencia Pediatric and Family Practice) sought to implement a nursing information system for the purposes of (1) patient record keeping, (2) capturing advanced practice nursing interventions and outcomes and transforming them into standardized language, (3) project data management, and (4) evaluating advanced practice nursing care thereby improving and standardizing quality of care. This article represents the background information for selection of a data management system and early experiences of implementation.

  19. Regulatory practices and safety standards for nuclear power plants

    International Nuclear Information System (INIS)

    1989-01-01

    The International Symposium on Regulatory Practices and Safety Standards for Nuclear Power Plants was jointly organized by the International Atomic Energy Agency (IAEA), for Nuclear Energy Agency of the OECD and the Government of the Federal Republic of Germany with the objective of providing an international forum for the exchange of information on regulatory practices and safety standards for nuclear power plants. The Symposium was held in Munich, Federal Republic of Germany, from 7 to 10 November 1988. It was attended by 201 experts from some 32 Member States and 4 international organizations. Fifty-one papers from 19 Member States and 2 international organizations were presented and discussed in 5 technical sessions covering the following subjects: National Regulatory Practices and Safety Standards (14 papers); Implementation of Regulatory Practices - Technical Issues (8 papers); Implementation of Regulatory Practices - Operational Aspects (8 papers); Developments and Trends in Safety Standards and Practices (11 papers); International Aspects (10 papers). A separate abstract was prepared for each of these papers. Refs, figs and tabs

  20. Standard guidelines for care: Sclerotherapy in dermatology

    Directory of Open Access Journals (Sweden)

    Niti Khunger

    2011-01-01

    Full Text Available Definition: Sclerotherapy is defined as the targeted elimination of small vessels, varicose veins and vascular anomalies by the injection of a sclerosant. The aim of sclerotherapy is to damage the vessel wall and transform it into a fibrous cord that cannot be recanalized. It is a simple, cost-effective, efficacious and esthetically acceptable modality for both therapeutic and esthetic purposes. Indications: Therapeutic indications include varicose veins and vascular malformations. Esthetic indications include telangiectasias and reticular veins. In the management of varicose veins, it may need to be combined with other surgical methods of treatment, such as ligation of the saphenofemoral junction, stab ligation of perforators and stripping. A surgical opinion may be necessary. Methodology: A thorough knowledge of the anatomy and physiology of the venous system of the legs, basic principles of venous insufficiency, methods of diagnosis and, in addition, uses, mechanisms of action and complications of sclerosing agents and proper compression techniques are important pre-requisites to successful sclerotherapy. Although various sclerosing agents are available, polidoconal and sodium tetradecyl sulfate are most commonly used. More recently, these sclerosants have been used in microfoam form for increased efficacy. The basic principle of a successful sclerotherapy technique is the use of an optimal volume and concentration of the sclerosant according to the size of the vessel. The sclerosant is injected carefully into the vessel and compression is applied. Contraindications: Contraindications include superficial and deep venous thrombosis, sapheno-femoral junction incompetence, pregnancy, myocardial decompensation, migraine, hypercoagulable state, serious systemic illness, dependency edema, immobility, arterial disease, diabetes mellitus and allergic reactions to sclerosants. Complications: While sclerotherapy is usually a safe procedure

  1. Standard practice for production and evaluation of field metallographic replicas

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2001-01-01

    1.1 This practice covers recognized methods for the preparation and evaluation of cellulose acetate or plastic film replicas which have been obtained from metallographically prepared surfaces. It is designed for the evaluation of replicas to ensure that all significant features of a metallographically prepared surface have been duplicated and preserved on the replica with sufficient detail to permit both LM and SEM examination with optimum resolution and sensitivity. 1.2 This practice may be used as a controlling document in commercial situations. 1.3 The values stated in SI units are to be regarded as the standard. Inch-pound units given in parentheses are for information only. 1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

  2. Burn patient care lost in good manufacturing practices?

    Science.gov (United States)

    Dimitropoulos, G.; Jafari, P.; de Buys Roessingh, A.; Hirt-Burri, N.; Raffoul, W.; Applegate, L.A.

    2016-01-01

    Summary Application of cell therapies in burn care started in the early 80s in specialized hospital centers world-wide. Since 2007, cell therapies have been considered as “Advanced Therapy Medicinal Products” (ATMP), so classified by European Directives along with associated Regulations by the European Parliament. Consequently, regulatory changes have transformed the standard linear clinical care pathway into a more complex one. It is important to ensure the safety of cellular therapies used for burn patients and to standardize as much as possible the cell sources and products developed using cell culture procedures. However, we can definitely affirm that concentrating the bulk of energy and resources on the implementation of Good Manufacturing Practice (GMP) alone will have a major negative impact on the care of severely burned patients world-wide. Developing fully accredited infrastructures and training personnel (required by the new directives), along with obtaining approval for clinical trials to go ahead, can be a lengthy process.We discuss whether or not these patients could benefit from cell therapies provided by standard in-hospital laboratories, thus avoiding having to meet rigid regulations concerning the use of industrial pharmaceutical products. “Hospital Exemption” could be a preferred means to offer burn patients a customized and safe product, as many adaptations may be required throughout their treatment pathway. Patients who are in need of rapid treatment will be the ones to suffer the most from regulations intended to help them. PMID:28149232

  3. Standard practice for conducting atmospheric corrosion tests on metals

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2010-01-01

    1.1 This practice covers and defines conditions for exposure of metals and alloys to the weather. It sets forth the general procedures that should be followed in any atmospheric test. It is presented as an aid in conducting atmospheric corrosion tests so that some of the pitfalls of such testing may be avoided. As such, it is concerned mainly with panel exposures to obtain data for comparison purposes. 1.2 The values stated in inch-pound units are to be regarded as standard. The values given in parentheses are mathematical conversions to SI units that are provided for information only and are not considered standard. 1.3 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of whoever uses this standard to consult and establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

  4. Academy of nutrition and dietetics: revised 2014 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in sports nutrition and dietetics.

    Science.gov (United States)

    Steinmuller, Patricia L; Kruskall, Laura J; Karpinski, Christine A; Manore, Melinda M; Macedonio, Michele A; Meyer, Nanna L

    2014-04-01

    Sports nutrition and dietetics addresses relationships of nutrition with physical activity, including weight management, exercise, and physical performance. Nutrition plays a key role in the prevention and treatment of obesity and chronic disease and for maintenance of health, and the ability to engage in physical activity, sports, and other aspects of physical performance. Thus, the Sports, Cardiovascular, and Wellness Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed the Revised 2014 Standards of Practice and Standards of Professional Performance as a resource for Registered Dietitian Nutritionists working in sports nutrition and dietetics to assess their current skill levels and to identify areas for further professional development in this emerging practice area. The revised document reflects advances in sports nutrition and dietetics practice since the original standards were published in 2009 and replaces those standards. The Standards of Practice represents the four steps in the Nutrition Care Process as applied to the care of patients/clients. The Standards of Professional Performance covers six standards of professional performance: quality in practice, competence and accountability, provision of services, application of research, communication and application of knowledge, and utilization and management of resources. Within each standard, specific indicators provide measurable action statements that illustrate how the standards can be applied to practice. The indicators describe three skill levels (competent, proficient, and expert) for Registered Dietitian Nutritionists working in sports nutrition and dietetics. The Standards of Practice and Standards of Professional Performance are complementary resources for Registered Dietitian Nutritionists in sports nutrition and dietetics practice. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc

  5. Diagnostic spirometry in primary care: Proposed standards for general practice compliant with American Thoracic Society and European Respiratory Society recommendations: a General Practice Airways Group (GPIAG)1 document, in association with the Association for Respiratory Technology & Physiology (ARTP)2 and Education for Health3 1 www.gpiag.org 2 www.artp.org 3 www.educationforhealth.org.uk.

    Science.gov (United States)

    Levy, Mark L; Quanjer, Philip H; Booker, Rachel; Cooper, Brendan G; Holmes, Steve; Small, Iain

    2009-09-01

    Primary care spirometry services can be provided by trained primary care staff, peripatetic specialist services, or through referral to hospital-based or laboratory spirometry. The first of these options is the focus of this Standards Document. It aims to provide detailed information for clinicians, managers and healthcare commissioners on the key areas of quality required for diagnostic spirometry in primary care--including training requirements and quality assurance. These proposals and recommendations are designed to raise the standard of spirometry and respiratory diagnosis in primary care and to provide the impetus for debate, improvement and maintenance of quality for diagnostic (rather than screening) spirometry performed in primary care. This document should therefore challenge current performance and should constitute an aspirational guide for delivery of this service.

  6. Standardized nomenclatures: keys to continuity of care, nursing accountability and nursing effectiveness.

    Science.gov (United States)

    Keenan, G; Aquilino, M L

    1998-01-01

    Standardized nursing nomenclatures must be included in clinical documentation systems to generate data that more accurately represent nursing practice than outcomes-related measures currently used to support important policy decisions. NANDA, NIC, and NOC--comprehensive nomenclatures for the needed variables of nursing diagnoses, interventions, and outcomes--are described. Added benefits of using NANDA, NIC, and NOC in everyday practice are outlined, including facilitation of the continuity of care of patients in integrated health systems.

  7. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel

    2015-01-01

    AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... postoperative intermediate care after emergency abdominal surgery, the InCare trial. DESIGN: A qualitative study with individual semi-structured interviews. METHODS: We analysed interviews using Systematic Text Condensation. RESULTS: Eighteen patients (nine intervention/nine controls) were strategically sampled...... from the InCare trial. Data analysis resulted in three distinct descriptions of intermediate care; two of standard surgical ward care. Intermediate care was described as 'luxury service' or 'a life saver.' The latter description was prevalent among patients with a perceived complicated disease course...

  8. How Well Do Randomized Controlled Trials Reflect Standard Care: A Comparison between Scientific Research Data and Standard Care Data in Patients with Intermittent Claudication undergoing Supervised Exercise Therapy.

    Science.gov (United States)

    Dörenkamp, S; Mesters, E P E; Nijhuis-van der Sanden, M W G; Teijink, J A W; de Bie, R A; Hoogeboom, T J

    2016-01-01

    The aim of the present study was to assess the degree and impact of patient selection of patients with intermittent claudication undergoing supervised exercise therapy in Randomized Controlled Trials (RCTs) by describing commonly used exclusion criteria, and by comparing baseline characteristics and treatment response measured as improvement in maximum walking distance of patients included in RCTs and patients treated in standard care. We compared data from RCTs with unselected standard care data. First, we systematically reviewed RCTs that investigated the effect of supervised exercise therapy in patients with intermittent claudication. For each of the RCTs, we extracted and categorized the eligibility criteria and their justifications. To assess whether people in RCTs (n = 1,440) differed from patients treated in daily practice (n = 3,513), in terms of demographics, comorbidity and walking capacity, we assessed between group-differences using t-tests. To assess differences in treatment response, we compared walking distances at three and six months between groups using t-tests. Differences of ≥15% were set as a marker for a clinically relevant difference. All 20 included RCTs excluded large segments of patients with intermittent claudication. One-third of the RCTs eligibility criteria were justified. Despite, the numerous eligibility criteria, we found that baseline characteristics were largely comparable. A statistically significant and (borderline) clinically relevant difference in treatment response after three and six months between trial participants and standard care patients was found. Improvements in maximum walking distance after three and six months were significantly and clinically less in trial participants. The finding that baseline characteristics of patients included in RCTs and patients treated in standard care were comparable, may indicate that RCT eligibility criteria are used implicitly by professionals when referring patients to standard

  9. Practical statistics for nursing and health care

    CERN Document Server

    Fowler, Jim; Chevannes, Mel

    2002-01-01

    Nursing is a growing area of higher education, in which an introduction to statistics is an essential component. There is currently a gap in the market for a 'user-friendly' book which is contextulised and targeted for nursing. Practical Statistics for Nursing and Health Care introduces statistical techniques in such a way that readers will easily grasp the fundamentals to enable them to gain the confidence and understanding to perform their own analysis. It also provides sufficient advice in areas such as clinical trials and epidemiology to enable the reader to critically appraise work published in journals such as the Lancet and British Medical Journal. * Covers all basic statistical concepts and tests * Is user-friendly - avoids excessive jargon * Includes relevant examples for nurses, including case studies and data sets * Provides information on further reading * Starts from first principles and progresses step by step * Includes 'advice on' sections for all of the tests described.

  10. Open Source, Open Standards, and Health Care Information Systems

    Science.gov (United States)

    2011-01-01

    Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy. PMID:21447469

  11. Introduction to Educational Administration: Standards, Theories, and Practice. Second Edition

    Science.gov (United States)

    Fiore, Douglas J.

    2009-01-01

    Organized around the ISLLC standards, this text introduces students to the concepts and theories of educational leadership. The new edition adds coverage of such topics as data usage, ethics, innovative hiring practices, and student discipline. Appearing in the second edition are chapter-ending sections called "Point-Counterpoint" which prompt…

  12. Care erosion in hospitals: Problems in reflective nursing practice and the role of cognitive dissonance.

    Science.gov (United States)

    de Vries, Jan; Timmins, Fiona

    2016-03-01

    Care erosion - gradual decline in care level - is an important problem in health care today. Unfortunately, the mechanism whereby it occurs is complex and poorly understood. This paper seeks to address this by emphasising problems in reflective nursing practice. Critical reflection on quality of care which should drive good care instead spawns justifications, denial, and trivialisation of deficient care. This perpetuates increasingly poor care levels. We argue that cognitive dissonance theory provides a highly effective understanding of this process and suggest for this approach to be incorporated in all efforts to address care erosion. The paper includes a detailed discussion of examples and implications for practice, in particular the need to restore critical reflection in nursing, the importance of embracing strong values and standards, and the need for increased awareness of signs of care erosion. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Fundamental care guided by the Careful Nursing Philosophy and Professional Practice Model©.

    Science.gov (United States)

    Meehan, Therese Connell; Timmins, Fiona; Burke, Jacqueline

    2018-02-05

    To propose the Careful Nursing Philosophy and Professional Practice Model© as a conceptual and practice solution to current fundamental nursing care erosion and deficits. There is growing awareness of the crucial importance of fundamental care. Efforts are underway to heighten nurses' awareness of values that motivate fundamental care and thereby increase their attention to effective provision of fundamental care. However, there remains a need for nursing frameworks which motivate nurses to bring fundamental care values to life in their practice and strengthen their commitment to provide fundamental care. This descriptive position paper builds on the Careful Nursing Philosophy and Professional Practice Model© (Careful Nursing). Careful Nursing elaborates explicit nursing values and addresses both relational and pragmatic aspects of nursing practice, offering an ideal guide to provision of fundamental nursing care. A comparative alignment approach is used to review the capacity of Careful Nursing to address fundamentals of nursing care. Careful Nursing provides a value-based comprehensive and practical framework which can strengthen clinical nurses' ability to articulate and control their practice and, thereby, more effectively fulfil their responsibility to provide fundamental care and measure its effectiveness. This explicitly values-based nursing philosophy and professional practice model offers nurses a comprehensive, pragmatic and engaging framework designed to strengthen their control over their practice and ability to provide high quality fundamental nursing care. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  14. Standard practice for determining rail-to-Earth resistance

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    1999-01-01

    1.1 This practice covers the procedures necessary to follow for measuring resistance-to-earth of the running rails which are used as the conductors for returning the train operating current to the substation in electric mass transit systems. 1.2 The values stated in SI units are to be regarded as the standard. The values given in parentheses are for information only. 1.3 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

  15. CPD Aligned to Competency Standards to Support Quality Practice

    Directory of Open Access Journals (Sweden)

    Rose Nash

    2017-02-01

    Full Text Available As medication experts, pharmacists are key members of the patient’s healthcare team. Pharmacists must maintain their competence to practice to remain responsive to the increasingly complex healthcare sector. This paper seeks to determine how competence training for pharmacists may enhance quality in their professional development. Results of two separately administered surveys (2012 and 2013 were compared to examine the reported continued professional development (CPD practices of Australian pharmacists. Examination of results from both studies enabled a focus on how the competency standards inform CPD practice.In the survey administered in 2012, 91% (n = 253/278 pharmacists reported that they knew their current registration requirements. However, in the survey administered in 2013, only 43% (n = 46/107 reported utilization of the National Competency Standards Framework for Pharmacists in Australia (NCS to self-asses their practice as part of their annual re-registration requirements. Fewer, 23% (n = 25/107, used the NCS to plan their CPD. This may be symptomatic of poor familiarity with the NCS, uncertainty around undertaking self-directed learning as part of a structured learning plan and/or misunderstandings around what CPD should include. This is supported by thematic analysis of pharmacists’ social media comments. Initial and ongoing competence training to support meaningful CPD requires urgent attention in Australia. The competence (knowledge, skills and attributes required to engage in meaningful CPD practice should be introduced and developed prior to entry into practice; other countries may find they are in a similar position.

  16. The Cardiology Audit and Registration Data Standards (CARDS), European data standards for clinical cardiology practice

    NARCIS (Netherlands)

    M.R. Flynn (Rachel); C. Barrett (Conor); F.G. Cosio (Francisco); A.K. Gitt (Anselm); L.C. Wallentin (Lars); P. Kearney (Peter); M. Lonergan (Moira); E. Shelley (Emer); M.L. Simoons (Maarten)

    2005-01-01

    textabstractAIMS: Systematic registration of data from clinical practice is important for clinical care, local, national and international registries, and audit. Data to be collected for these different purposes should be harmonized. Therefore, during Ireland's Presidency of the European Union (EU)

  17. Health transition in Africa: practical policy proposals for primary care.

    Science.gov (United States)

    Maher, D; Smeeth, L; Sekajugo, J

    2010-12-01

    Sub-Saharan Africa is undergoing health transition as increased globalization and accompanying urbanization are causing a double burden of communicable and noncommunicable diseases. Rates of communicable diseases such as HIV/AIDS, tuberculosis and malaria in Africa are the highest in the world. The impact of noncommunicable diseases is also increasing. For example, age-standardized mortality from cardiovascular disease may be up to three times higher in some African than in some European countries. As the entry point into the health service for most people, primary care plays a key role in delivering communicable disease prevention and care interventions. This role could be extended to focus on noncommunicable diseases as well, within the context of efforts to strengthen health systems by improving primary-care delivery. We put forward practical policy proposals to improve the primary-care response to the problems posed by health transition: (i) improving data on communicable and noncommunicable diseases; (ii) implementing a structured approach to the improved delivery of primary care; (iii) putting the spotlight on quality of clinical care; (iv) aligning the response to health transition with health system strengthening; and (v) capitalizing on a favourable global policy environment. Although these proposals are aimed at primary care in sub-Saharan Africa, they may well be relevant to other regions also facing the challenges of health transition. Implementing these proposals requires action by national and international alliances in mobilizing the necessary investments for improved health of people in developing countries in Africa undergoing health transition.

  18. [Activating therapeutic care in geriatrics : Evaluation of a practice concept].

    Science.gov (United States)

    Acklau, Stefanie; Gödecker, Lisa; Kaden, Andrea; Jahn, Patrick

    2016-10-01

    The special feature of the concept of activating therapeutic care in geriatrics (ATP-G) is based on the focus of nursing and therapeutic elements specifically related to the elderly. Further significance lies in the bottom-up development of this concept, which shows a close proximity to the nursing practice. The research project targeted the characteristics of ATP-G from a nursing point of view. Furthermore, the resulting elements of professional nursing care understanding for inpatient geriatric rehabilitation were used to build a scientific and theoretical foundation of the ATP-G concept. In this study 12 semi-structured interviews with professional caregivers were realized. The data collection was undertaken in three different facilities of inpatient geriatric (early) rehabilitation, chosen by lot. The data analysis was based on the methodology of qualitative content analysis according to Mayring. The research project showed that the basic elements described in the ATP-G concept are consistent with the view of nursing practitioners and therefore reflect the characteristic features of routine daily practice; nonetheless, some new aspects were found, primarily the importance of interdisciplinary teamwork in geriatric settings. There were also difficulties related to the ATP-G concept which were experienced as restraints by the questioned professionals. Further research should therefore investigate the structures for optimal implementation of the ATP-G concept into standard practice.

  19. Critical care nursing practice and education in Rwanda | Munyiginya ...

    African Journals Online (AJOL)

    Critical care nursing practice and education in Rwanda is a young specialty. There are very few critical care nurses practising in either hospital or academic settings, and typically nurses taking care of critically ill patients receive only a brief period of informal education prior to practising. Intensive care units are found ...

  20. Teacher Perspectives on the Practice of Continuity of Care

    Science.gov (United States)

    Longstreth, Sascha; Garrity, Sarah; Ritblatt, Shulamit N.; Olson, Kelsey; Virgilio, Ashley; Dinh, Hilary; Padamada, Shane

    2016-01-01

    This study aims to address gaps in the literature on continuity of care through focus group interviews with teachers at public early care and education programs in San Diego County, California, USA. To better understand various perspectives on continuity of care, focus groups were conducted at programs that currently practice continuity of care,…

  1. Intensive care nurses? opinions and practice for oral care of mechanically ventilated patients

    OpenAIRE

    Adib-Hajbaghery, Mohsen; Ansari, Akram; Azizi-Fini, Ismail

    2013-01-01

    Context: Oral care is an essential aspect of critical care nursing. However, no study has been published on oral care practice of Iranian and Asian nurses. The majority of published studies were conducted in western and European countries. Aims: This study aimed to evaluate the nurses′ opinions and practice about oral care in patients under mechanical ventilation. Settings and Design: A cross-sectional study was conducted on 130 intensive care nurses from 6 intensive care units in the univers...

  2. Structuring diabetes care in general practices: many improvements, remaining challenges.

    LENUS (Irish Health Repository)

    Jennings, S

    2009-08-07

    BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

  3. Standard practice for modified salt spray (fog) testing

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2009-01-01

    1.1 This practice covers and sets forth conditions for five modifications in salt spray (fog) testing for specification purposes. These are in chronological order of their development: 1.1.1 Annex A1, acetic acid-salt spray test, continuous. 1.1.2 Annex A2, cyclic acidified salt spray test. 1.1.3 Annex A3, seawater acidified test, cyclic (SWAAT). 1.1.4 Annex A4, SO2 salt spray test, cyclic. 1.1.5 Annex A5, dilute electrolyte cyclic fog dry test. 1.2 This practice does not prescribe the type of modification, test specimen or exposure periods to be used for a specific product, nor the interpretation to be given to the results. 1.3 The values stated in SI units are to be regarded as standard. No other units of measurement are included in this standard. 1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to consult and establish appropriate safety and health practices and determine the applicabilit...

  4. A systems approach to accepted standards of care: Shifting the blame

    Directory of Open Access Journals (Sweden)

    David G. Glance

    2011-09-01

    Full Text Available In healthcare, from a legal perspective, the standard ofacceptable practice has been generally set by the courts anddefined as healthcare professionals acting in a manner thatis widely accepted by their peers as meeting an acceptablestandard of care. This view, however, reflects the state ofhow practice “is” rather than what it “ought to be”. What isought to be depends on whether you take a “person” or“system” oriented approach to practice.The increasing pressures of lack of money and resources,and an ever-increasing need for care are bringing pressureon the health services to move to a system approach andthis is gaining acceptance both with clinicians and thuseventually the courts.A systems-type approach to healthcare will, by necessity,embrace clinical protocols and guidelines supported byclinical information systems. It will also see blame for errorsshifting from clinicians to the organisations that employthem.This paper argues that a continued use of a person-basedapproach to healthcare, developed through an historicalrecord of practice by individual clinicians, is no longeradequate defence in a case of supposed negligence.When the healthcare system has codified clinical guidelinesand digital data gathered across thousands of clinicians andtheir patients, it is possible to compute adequate levels ofcare and expect clinicians and the healthcare system ingeneral to meet these minimum standards.Future negligence decisions will rely on a systems-basedbest practice standard of care determined through evidencerather than opinion

  5. Oral care practices for orally intubated critically ill adults.

    Science.gov (United States)

    Feider, Laura L; Mitchell, Pamela; Bridges, Elizabeth

    2010-03-01

    Ventilator-associated pneumonia is a major threat to patients receiving mechanical ventilation in hospitals. Oral care is a nursing intervention that may help prevent ventilator-associated pneumonia. To describe oral care practices performed by critical care nurses for orally intubated critically ill patients and compare these practices with recommendations for oral care in the 2005 AACN Procedure Manual for Critical Care and the guidelines from the Centers for Disease Control and Prevention. A descriptive, cross-sectional design with a 31-item Web-based survey was used to describe oral care practices reported by 347 randomly selected members of the American Association of Critical-Care Nurses. Oral care was performed every 2 (50%) or 4 (42%) hours, usually with foam swabs (97%). Oral care was reported as a high priority (47%). Nurses with 7 years or more of critical care experience performed oral care more often (P=.008) than did less experienced nurses. Nurses with a bachelor's degree in nursing used foam swabs (P=.001), suctioned the mouth before the endotracheal tube (P=.02), and suctioned after oral care (Ptoothpaste (40%), brushing with a foam swab (90%), using chlorhexidine gluconate oral rinse (49%), suctioning the oral cavity (84%), and assessing the oral cavity (73%). Oral care practices and policies differed for all those items. Survey results indicate that discrepancies exist between reported practices and policies. Oral care policies appear to be present, but not well used.

  6. Caring theory and practice--entering a simultaneous concept analysis.

    Science.gov (United States)

    Ranheim, Albertine; Kärner, Anita; Berterö, Carina

    2012-01-01

    To better understand the approach of caring in nursing and the role of theory in practice, we wanted to consolidate the caring theory of Watson with the empirical findings from the three studies performed to reveal nurses' caring intentions and their lived experience of reflecting caring theory in practice. Through a simultaneous concept analysis of nine concepts, caring science theory was consolidated with the findings of the three empirical studies to reveal the dynamics of caring theory and caring practice. These nine concepts were found to be interrelated with the advanced concept of mediating care, which emphasizes that mediating care calls for an authenticity of being and ability--an ability to be present to self and others in the dynamism of openness and frames of thought. © 2012 Wiley Periodicals, Inc.

  7. Ethics in pastoral care and counseling: a contemporary review of updated standards in the field.

    Science.gov (United States)

    Eliason, Grafton Todd; Lepore, Mark; Holmes, Douglas

    2013-06-01

    This article reviews ethical responsibilities that must be considered when engaging in pastoral care, counseling, and psychotherapy. It discusses important contemporary issues counselors will want to contemplate in pursuing a high quality of care in their counseling practices. Examples and case studies are provided. Readers will be able to: Understand the function of ethical standards in the practice of counseling Be able to differentiate between pastoral care, pastoral counseling, and pastoral psychotherapy and their ethical implications Understand the importance of identifying one's limitations in counseling situations and how to proceed under such circumstances. Understand the need for pastoral counselors to attain the necessary credentials for practice in the area of counseling they intend to undertake. Become aware of the legal requirements when engaged in a counseling relationship.

  8. INTERPOL DVI best-practice standards--An overview.

    Science.gov (United States)

    Sweet, David

    2010-09-10

    A description of the International Criminal Police Organization and its role in disaster victim identification is provided along with a summary of the standards developed and circulated to responders in INTERPOL member countries (188 throughout the world) to insure evidence-based DVI practices. Following the INTERPOL-mediated DVI response in 2005 to the SE Asia tsunami, many lessons learned have been recorded. Based on these current standards, INTERPOL's approach to DVI reflects a modern approach and philosophy. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  9. Standards for the mental health care of people with severe ...

    African Journals Online (AJOL)

    Adele

    Introduction. In the first part of this two-part series, a number of conceptual issues regarding the development of stan- dards for the mental health care of people with severe psychiatric disorders in South Africa were addressed.1. This part presents the methods that were followed to develop standards, and the results of the ...

  10. Psychosocial Assessment as a Standard of Care in Pediatric Cancer

    NARCIS (Netherlands)

    Kazak, Anne E.; Abrams, Annah N.; Banks, Jaime; Christofferson, Jennifer; DiDonato, Stephen; Grootenhuis, Martha A.; Kabour, Marianne; Madan-Swain, Avi; Patel, Sunita K.; Zadeh, Sima; Kupst, Mary Jo

    2015-01-01

    This paper presents the evidence for a standard of care for psychosocial assessment in pediatric cancer. An interdisciplinary group of investigators utilized EBSCO, PubMed, PsycINFO, Ovid, and Google Scholar search databases, focusing on five areas: youth/family psychosocial adjustment, family

  11. Chronic Care Team Profile: a brief tool to measure the structure and function of chronic care teams in general practice.

    Science.gov (United States)

    Proudfoot, Judith G; Bubner, Tanya; Amoroso, Cheryl; Swan, Edward; Holton, Christine; Winstanley, Julie; Beilby, Justin; Harris, Mark F

    2009-08-01

    At a time when workforce shortages in general practices are leading to greater role substitution and skill-mix diversification, and the demand on general practices for chronic disease care is increasing, the structure and function of the general practice team is taking on heightened importance. To assist general practices and the organizations supporting them to assess the effectiveness of their chronic care teamworking, we developed an interview tool, the Chronic Care Team Profile (CCTP), to measure the structure and function of teams in general practice. This paper describes its properties and potential use. An initial pool of items was derived from guidelines of best-practice for chronic disease care and performance standards for general practices. The items covered staffing, skill-mix, job descriptions and roles, training, protocols and procedures within the practice. The 41-item pool was factor analysed, retained items were measured for internal consistency and the reduced instrument's face, content and construct validity were evaluated. A three-factor solution corresponding to non-general practitioner staff roles in chronic care, administrative functions and management structures provided the best fit to the data and explained 45% of the variance in the CCTP. Further analyses suggested that the CCTP is reliable, valid and has some utility. The CCTP measures aspects of the structure and function of general practices which are independent of team processes. It is associated with the job satisfaction of general practice staff and the quality of care provided to patients with chronic illnesses. As such, the CCTP offers a simple and useful tool for general practices to assess their teamworking in chronic disease care.

  12. Standards of practice for forensic mental health nurses--identifying contemporary practice.

    Science.gov (United States)

    Martin, Trish; Maguire, Tessa; Quinn, Chris; Ryan, Jo; Bawden, Louise; Summers, Monica

    2013-01-01

    Forensic mental health nursing is a recognized field of nursing in most countries. Despite a growing body of literature describing aspects of practice, no publication has been found that captures the core knowledge, skills, and attitudes of forensic mental health nurses. One group of nurses in Australia have pooled their knowledge of relevant literature and their own clinical experience and have written standards of practice for forensic mental health nursing. This paper identifies the need for standards, provides a summary of the standards of practice for forensic mental health nurses, and concludes with how these standards can be used and can articulate to others the desired and achievable level of performance in the specialty area.

  13. Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals.

    Science.gov (United States)

    Brignole, Michele; Ungar, Andrea; Bartoletti, Angelo; Ponassi, Irene; Lagi, Alfonso; Mussi, Chiara; Ribani, Maria Angela; Tava, Gianni; Disertori, Marcello; Quartieri, Fabio; Alboni, Paolo; Raviele, Antonio; Ammirati, Fabrizio; Scivales, Alessandro; De Santo, Tiziana

    2006-08-01

    The study hypothesis was that a decision-making approach improves diagnostic yield and reduces resource consumption for patients with syncope who present as emergencies at general hospitals. This was a prospective, controlled, multi-centre study. Patients referred from 5 November to 7 December 2001 were managed according to usual practice, whereas those referred from 4 October to 5 November 2004 were managed according to a standardized-care pathway in strict adherence to the recommendations of the guidelines of the European Society of Cardiology. In order to maximize its application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally-to verify adherence to the diagnostic pathway and give advice on its correct application. The 'usual-care' group comprised 929 patients and the 'standardized-care' group 745 patients. The baseline characteristics of the two study populations were similar. At the end of the evaluation, the standardized-care group was seen to have a lower hospitalization rate (39 vs. 47%, P=0.001), shorter in-hospital stay (7.2+/-5.7 vs. 8.1+/-5.9 days, P=0.04), and fewer tests performed per patient (median 2.6 vs. 3.4, P=0.001) than the usual-care group. More standardized-care patients had a diagnosis of neurally mediated (65 vs. 46%, P=0.001) and orthostatic syncope (10 vs. 6%, P=0.002), whereas fewer had a diagnosis of pseudo-syncope (6 vs. 13%, P=0.001) or unexplained syncope (5 vs. 20%, P=0.001). The mean cost per patient and the mean cost per diagnosis were 19 and 29% lower in the standardized-care group (P=0.001). A standardized-care pathway significantly improved diagnostic yield and reduced hospital admissions, resource consumption, and overall costs.

  14. Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension

    Science.gov (United States)

    Ono, Sarah S.; Crabtree, Benjamin F.; Hemler, Jennifer R.; Balasubramanian, Bijal A.; Edwards, Samuel T.; Green, Larry A.; Kaufman, Arthur; Solberg, Leif I.; Miller, William L.; Woodson, Tanisha Tate; Sweeney, Shannon M.; Cohen, Deborah J.

    2018-01-01

    Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension—technological and quality improvement support, practice capacity building, and linking with community resources—to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services. PMID:29401016

  15. Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension.

    Science.gov (United States)

    Ono, Sarah S; Crabtree, Benjamin F; Hemler, Jennifer R; Balasubramanian, Bijal A; Edwards, Samuel T; Green, Larry A; Kaufman, Arthur; Solberg, Leif I; Miller, William L; Woodson, Tanisha Tate; Sweeney, Shannon M; Cohen, Deborah J

    2018-02-01

    Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension-technological and quality improvement support, practice capacity building, and linking with community resources-to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services.

  16. Standard Practice for Sampling for Particulate Contamination by Tape Lift

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2006-01-01

    1.1 This practice covers procedures for sampling surfaces to determine the presence of particulate contamination, 5 m and larger. The practice consists of the application of a pressure-sensitive tape to the surface followed by the removal of particulate contamination with the removal of the tape. The tape with the adhering particles is then mounted on counting slides. Counting and measuring of particles is done by standard techniques. 1.2 This practice describes the materials and equipment required to perform sampling of surfaces for particle counting and sizing. 1.3 The criteria for acceptance or rejection of a part for conformance to surface cleanliness level requirements shall be determined by the user and are not included in this practice. 1.4 This practice is for use on surfaces that are not damaged by the application of adhesive tape. The use of this practice on any surface of any material not previously tested or for which the susceptibility to damage is unknown is not recommended. In general, metal...

  17. Academy of Nutrition and Dietetics: Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Public Health and Community Nutrition.

    Science.gov (United States)

    Bruening, Meg; Udarbe, Adrienne Z; Yakes Jimenez, Elizabeth; Stell Crowley, Phyllis; Fredericks, Doris C; Edwards Hall, Leigh Ann

    2015-10-01

    The need and demand for population-level disease prevention has increased, especially with the passage of the Affordable Care Act, a worldwide increase in obesity and chronic disease, and a global emphasis on preventative health care that includes behavioral, environmental, and policy interventions. In response to these evolving needs, the Public Health and Community Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed Standards of Practice and Standards of Professional Performance as tools for registered dietitian nutritionists (RDNs) currently in practice or interested in working in public health and community nutrition, to assess their current skill levels and to identify areas for professional development. The Standards of Practice address the four steps of the Nutrition Care Process for community and public health RDNs, which are assessment, diagnosis, intervention, and evaluation/monitoring. The Standards of Professional Performance consist of the following six domains of professional performance for community and public health RDNs: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate the ways in which RDNs can address client and population nutrition and health. The indicators describe three skill levels (competent, proficient, and expert) for RDNs. These tools highlight the unique scope of expertise that RDNs provide to the field of public health and community nutrition. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  18. Primary care multidisciplinary teams in practice: a qualitative study.

    Science.gov (United States)

    Leach, Brandi; Morgan, Perri; Strand de Oliveira, Justine; Hull, Sharon; Østbye, Truls; Everett, Christine

    2017-12-29

    Current recommendations for strengthening the US healthcare system consider restructuring primary care into multidisciplinary teams as vital to improving quality and efficiency. Yet, approaches to the selection of team designs remain unclear. This project describes current primary care team designs, primary care professionals' perceptions of ideal team designs, and perceived facilitating factors and barriers to implementing ideal team-based care. Qualitative study of 44 health care professionals at 6 primary care practices in North Carolina using focus group discussions and surveys. Data was analyzed using framework content analysis. Practices used a variety of multidisciplinary team designs with the specific design being influenced by the social and policy context in which practices were embedded. Practices overwhelmingly located barriers to adopting ideal multidisciplinary teams as being outside of their individual practices and outside of their control. Participants viewed internal organizational contexts as the major facilitators of multidisciplinary primary care teams. The majority of practices described their ideal team design as including a social worker to meet the needs of socially complex patients. Primary care multidisciplinary team designs vary across practices, shaped in part by contextual factors perceived as barriers outside of the practices' control. Facilitating factors within practices provide a culture of support to team members, but they are insufficient to overcome the perceived barriers. The common desire to add social workers to care teams reflects practices' struggles to meet the complex demands of patients and external agencies. Government or organizational policies should avoid one-size-fits-all approaches to multidisciplinary care teams, and instead allow primary care practices to adapt to their specific contextual circumstances.

  19. Educating advanced practice nurses in using social media in rural health care.

    Science.gov (United States)

    Rutledge, Carolyn M; Renaud, Michelle; Shepherd, Laurel; Bordelon, Michele; Haney, Tina; Gregory, Donna; Ayers, Paula

    2011-10-03

    Health care in the United States is facing a crisis in providing access to quality care for those in underserved and rural regions. Advanced practice nurses are at the forefront of addressing such issues, through modalities such as health care technology. Many nursing education programs are seeking strategies for better educating students on technology utilization. Health care technology includes electronic health records, telemedicine, and clinical decision support systems. However, little focus has been placed on the role of social media in health care. This paper describes an educational workshop using standardized patients and hands-on experiences to introduce advanced practice nurses in a Doctor of Nursing Practice program to the role of social media in addressing issues inherent in the delivery of rural health care. The students explore innovative approaches for utilizing social media for patient and caregiver support as well as identify online resources that assist providers in a rural setting.

  20. Sharing best practice in stoma care nursing.

    Science.gov (United States)

    Willams, Julia

    A problem shared is a problem halved; a very poignant proverb that forms the essence of this year's World Council of Enterostomal Therapists (WCET) UK conference in Coventry. Sharing experiences from practice is invalid if clinical practice is to grow and develop. It raises awareness, offering the opportunity to question and review practice. Sharing practice offers opportunities to enquiring minds.

  1. Standard practice for manufacturing characterization of digital detector arrays

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2007-01-01

    1.1 This practice describes the evaluation of Digital Detector Arrays (DDAs), and assures that one common standard exists for quantitative comparison of DDAs so that an appropriate DDA is selected to meet NDT requirements. 1.2 This practice is intended for use by manufacturers or integrators of DDAs to provide quantitative results of DDA characteristics for NDT user or purchaser consumption. Some of these tests require specialized test phantoms to assure consistency among results among suppliers or manufacturers. These tests are not intended for users to complete, nor are they intended for long term stability tracking and lifetime measurements. However, they may be used for this purpose, if so desired. 1.3 The values stated in SI units are to be regarded as the standard. The values given in parentheses are for information only. 1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropr...

  2. The metagenomic data life-cycle: standards and best practices

    Energy Technology Data Exchange (ETDEWEB)

    ten Hoopen, Petra; Finn, Robert D.; Bongo, Lars Ailo; Corre, Erwan; Fosso, Bruno; Meyer, Folker; Mitchell, Alex; Pelletier, Eric; Pesole, Graziano; Santamaria, Monica; Willassen, Nils Peder; Cochrane, Guy

    2017-06-16

    Metagenomics data analyses from independent studies can only be compared if the analysis workflows are described in a harmonised way. In this overview, we have mapped the landscape of data standards available for the description of essential steps in metagenomics: (1) material sampling, (2) material sequencing (3) data analysis and (4) data archiving & publishing. Taking examples from marine research, we summarise essential variables used to describe material sampling processes and sequencing procedures in a metagenomics experiment. These aspects of metagenomics dataset generation have been to some extent addressed by the scientific community but greater awareness and adoption is still needed. We emphasise the lack of standards relating to reporting how metagenomics datasets are analysed and how the metagenomics data analysis outputs should be archived and published. We propose best practice as a foundation for a community standard to enable reproducibility and better sharing of metagenomics datasets, leading ultimately to greater metagenomics data reuse and repurposing.

  3. Theory construction based on standards of care: a proposed theory of the peaceful end of life.

    Science.gov (United States)

    Ruland, C M; Moore, S M

    1998-01-01

    The contribution of developing a theory from this standard of care is that it can express a new unifying idea about the phenomenon of peaceful end of life for terminally ill patients. It allows for generating and testing hypotheses that can provide new insights into the nature of this phenomenon and can contribute to increased knowledge about nursing interventions that help patients toward a peaceful end of life. The process of theory development from standards of care as described in this article also can be applied to other phenomena. Clinical practice abounds with opportunities for theory development, yet nurses often do not use theories to guide their practice. Until now, little guidance has been provided to tap the richness of clinical knowledge for the development of middle-range theories. Whereas the method described in this article may still be further refined, it offers a promising approach for the development of theories that are applicable to practice and move beyond the scope of grand theories. Thus deriving theories from standards of care can offer an important contribution to the development of the discipline's scientific knowledge base and enhanced practice.

  4. CPC Initiative - Participating Primary Care Practices

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen...

  5. Standard Practice for QCM Measurement of Spacecraft Molecular Contamination in Space

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2004-01-01

    1.1 This practice provides guidance for making decisions concerning the use of a quartz crystal microbalance (QCM) and a thermoelectrically cooled quartz crystal microbalance (TQCM) in space where contamination problems on spacecraft are likely to exist. Careful adherence to this document should ensure adequate measurement of condensation of molecular constituents that are commonly termed “contamination” on spacecraft surfaces. 1.2 A corollary purpose is to provide choices among the flight-qualified QCMs now existing to meet specific needs. 1.3 The values stated in SI units are to be regarded as the standard. The values given in parentheses are for information only. 1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

  6. Development of indicators for patient care and monitoring standards for secondary health care services of Mumbai.

    Science.gov (United States)

    Malik, Seema S; D'Souza, Roshni Cynthia; Pashte, Pramod Mukund; Satoskar, Smita Manohar; D'Souza, Remilda Joyce

    2015-01-01

    The Qualitative aspect of health care delivery is one of the major factors in reducing morbidity and mortality in a health care setup. The expanding suburban secondary health care delivery facilities of the Municipal Corporation of Greater Mumbai are an important part of the healthcare backbone of Mumbai and therefore the quality of care delivered here needed standardization. The project was completed over a period of one year from Jan to Dec, 2013 and implemented in three phases. The framework with components and sub-components were developed and formats for data collection were standardized. The benchmarks were based on past performance in the same hospital and probability was used for development of normal range. An Excel spreadsheet was developed to facilitate data analysis. The indicators comprise of 3 components--Statutory Requirements, Patient care & Cure and Administrative efficiency. The measurements made, pointed to the broad areas needing attention. The Indicators for patient care and monitoring standards can be used as a self assessment tool for health care setups for standardization and improvement of delivery of health care services.

  7. 45 CFR 162.406 - Standard unique health identifier for health care providers.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Standard unique health identifier for health care... for Health Care Providers § 162.406 Standard unique health identifier for health care providers. (a) Standard. The standard unique health identifier for health care providers is the National Provider...

  8. Sunscreen compliance with regional clinical practice guidelines and product labeling standards in New Zealand.

    Science.gov (United States)

    Sporer, Matthias E; Mathy, Joanna E; Kenealy, John; Mathy, Jon A

    2016-03-01

    INTRODUCTION For general practitioners, practice nurses and community pharmacists in New Zealand, a core duty is to educate patients about sun protection. We aimed to evaluate compliance of locally available sunscreens with regional clinical practice guidelines and sunscreen labelling standards, to assist clinicians in advising consumers on sunscreen selection. METHODS We audited all sunscreens available at two Auckland stores for three New Zealand sunscreen retailers. We then assessed compliance with accepted regional clinical practice guidelines for sun protection from the New Zealand Guidelines Group. We further assessed compliance with regional Australia/New Zealand consumer standards for sunscreen labelling. RESULTS All sunscreens satisfied clinical guidelines for broad-spectrum protection, and 99% of sunscreens met or exceeded clinical guidelines for minimal Sun Protection Factor. Compliance with regional standardized labelling guidelines is voluntary in New Zealand and 27% of audited sunscreens were not fully compliant with SPF labelling standards. DISCUSSION Sunscreens were generally compliant with clinical guidelines for minimal sun protection. However there was substantial noncompliance with regional recommendations for standardized sunscreen labelling. Primary health care clinicians should be aware that this labelling noncompliance may mislead patients into thinking some sunscreens offer more sun protection than they do. Mandatory compliance with the latest regional labelling standards would simplify sunscreen selection by New Zealand consumers. KEYWORDS Sunscreen; Sun Protection Factor; SPF; Skin Neoplasms; Melanoma; Skin Cancer Prevention.

  9. Attitude and practice of health care providers towards autopsies in ...

    African Journals Online (AJOL)

    Background: Attitude and practice of health care professionals toward autopsy are important as they will give information regarding factors that contribute to the low rate of autopsies in children under five years. Objective: To evaluate the attitude and practice of health care providers towards autopsies in children under five ...

  10. The Practice of Self-Care among Counseling Students

    Science.gov (United States)

    Mayorga, Mary G.; Devries, Sabina R.; Wardle, Elizabeth Ann

    2015-01-01

    Self-care behavior is recognized as an important component for the helping professional who practices in the field of counseling or who is training to become a helping professional. Occupational stress and burnout in the field of counseling is of great concern. This study examined the practice of self-care among master level counseling students to…

  11. Knowledge, Attitude and Practice of Eye Health Care amongst ...

    African Journals Online (AJOL)

    Objective: To evaluate the knowledge, attitude and practice of eye health care amongst doctors in Lagos. Methodology: Open and closed-ended questionnaires were given to respondents. The questionnaire contained information about age, sex, general knowledge as well as practice of eye care. Results: A total of 104 ...

  12. Development of a spiritual self-care practice scale.

    Science.gov (United States)

    White, Mary L; Schim, Stephanie Myers

    2013-01-01

    Development of a valid, reliable instrument to measure spiritual self-care practices of patients with heart failure. African American patients (N = 142) with heart failure participated in the study. Spiritual advisors from several religious groups reviewed the Spiritual Self-Care Practices Scale (SSCPS) for content validity. Construct validity was determined using a principal components factor analysis. Reliability was established using Cronbach's alpha coefficients. Religious advisors provided suggestions to improve content validity. Four factors consistent with spiritual practices (personal spiritual practices, spiritual practices, physical spiritual practices, and interpersonal spiritual practices) emerged from the factor analysis. The alpha coefficient was moderate at 0.64. Results indicated the SSCPS was reliable and valid for measuring spiritual self-care practices among African Americans with heart failure. Additional testing is needed to confirm results in other patient groups with chronic illnesses.

  13. Normative grounds of health care practice in Brazilian nursing.

    Science.gov (United States)

    Andrade, Selma Regina de; Piccoli, Talita; Ruoff, Andriela Backes; Ribeiro, Janara Caroline; Sousa, Fernando Miguel de

    2016-01-01

    to understand the normative grounds of health care practice in Brazilian nursing. qualitative study with the use of document research, carried out based on resolutions of the Federal Nursing Council. From a total of 263 resolutions, in the period from 1975 to 2015, 38 which were in accordance with the objective of the study were selected. three analytical categories were systematized: Normative grounds of health care practice by the nursing team, under coordination/supervision of the nurse; Normative grounds of the care performed privately by the nurse; and Management and administrative aspects which affect and permeate the practice of health care in nursing. the set of normative grounds of health care practice by the nursing team leads to the reflection on the possible overlapping of attributions between professional levels and requires expansion to the other fields of nursing which are coherent with the health care network model.

  14. Nursing diagnoses: factors affecting their use in charting standardized care plans.

    Science.gov (United States)

    Lee, Ting-Ting

    2005-05-01

    The purpose of this study was to explore factors that may affect nurses' use of nursing diagnoses in charting standardized nursing care plans in their daily practice. Care plans have been viewed as providing a structured approach to the assessment, planning and delivery of patient care. Nonetheless, the challenge for many institutions is to help professional nursing staff refine their understanding of nursing diagnoses and charting skills, to identify patient problems and propose appropriate care plans. Twelve clinical nurses working at a medical center in Taiwan underwent one-on-one in-depth interviews from May to July 2000. Data analysis was based on Miles and Huberman's data reduction, data display, and a conclusion verification process to investigate the charting process. Nurses tended to match patient conditions to the designated nursing diagnoses, be unfamiliar with statements of related factors, use objective data to describe patient conditions, ignore descriptions of nursing goals, dutifully check interventions without always executing them, and choose the same evaluation to meet hospital requirements. These findings suggest that using educational programmes for enhancing nurses' ability to use nursing diagnoses and exploring the process of diagnostic reasoning would improve the quality of patient documentation. The trend in health care is to focus on chart audit to reveal indicators of quality of care. Therefore, the experience of nurses in this study could be applied to in-service training programmes by institutions that are replacing traditional, manually written care plans with a standardized care planning system, thus helping other nurses through this transition process.

  15. Bridging generic and professional care practices for Muslim patients through use of Leininger's culture care modes.

    Science.gov (United States)

    Wehbe-Alamah, Hiba

    2008-04-01

    The purpose of this article is to provide knowledge of traditional Muslim generic (folk) care beliefs, expressions and practices derived from research and descriptive sources, in order to assist nurses and other health care professionals to integrate generic (folk) into professional care practices. Muslim generic (folk) care beliefs and practices related to the caregiving process, health, illness, dietary needs, dress, privacy, modesty, touch, gender relations, eye contact, abortion, contraception, birth, death and bereavement were explored. A discussion involving the use of Leininger's culture care preservation and/or maintenance, culture care accommodation and/or negotiation and culture care repatterning and/or restructuring action modes to bridge the gap between generic (folk) and professional (etic) care practices and to consequently promote culturally congruent care is presented.

  16. Engaging patients in primary care practice transformation: theory, evidence and practice.

    Science.gov (United States)

    Sharma, Anjana E; Grumbach, Kevin

    2017-06-01

    Patient engagement is a fundamental strategy for achieving patient centred care and is receiving increasing attention in primary care reform efforts such as the patient-centred medical home and related care models. Much of the prior published theory and evidence supporting patient engagement has focused on improving engagement in individual care. Much less is understood about engaging patients as partners in practice improvement at the primary care clinic or practice level. We review the historical and policy context for the growing interest in the USA and UK in patient engagement at the primary care practice level, highlight findings from systematic reviews of the research evidence on practice-level patient engagement and discuss practical considerations for implementing patient engagement. We conclude that while there are persuasive ethical and social justice reasons for empowering patient involvement in practice improvement at the clinic level, research conducted to date in primary care provides suggestive but not yet resounding evidence in support of the instrumental triple aim benefit of practice-level patient engagement. We propose a research agenda to better understand the process and outcomes of practice-level patient engagement and its potential advantages to both the practice and the patients and communities served. Better evidence as well as resources to support and incentivize effective and feasible engagement methods are needed to catalyse greater diffusion of practice-level patient engagement in primary care practices. © The Author 2016. Published by Oxford University Press.

  17. The knowledge and practice of self-care management among ...

    African Journals Online (AJOL)

    questionnaire that assessed 4 levels of diabetes self-care knowledge and practices which are respectively diet, blood glucose monitoring, physical activities and foot care. Results: Participants had a self-care knowledge gap in some areas of diabetes self- management. As many as 54.9% (n=44) of participants did not know ...

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

    African Journals Online (AJOL)

    ... observational checklist were the instruments for data collection. Findings revealed poor knowledge of concept, components, timing of visits on focused antenatal care and non compliance with the guidelines for the practice of focused antenatal care, because of health workers lack of knowledge on focused antenatal care.

  19. Guidelines for Psychological Practice in Health Care Delivery Systems

    Science.gov (United States)

    American Psychologist, 2013

    2013-01-01

    Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…

  20. Teaching Counselors Self-Care through Mindfulness Practices

    Science.gov (United States)

    Newsome, Sandy; Christopher, John Chambers; Dahlen, Penny; Christopher, Suzanne

    2006-01-01

    Few counseling programs directly address the importance of self-care in reducing stress and burnout in their curricula. A course entitled Mind/Body Medicine and the Art of Self-Care was created to address personal and professional growth opportunities through self-care and mindfulness practices (meditation, yoga, gong, and conscious relaxation…

  1. Reinventing your primary care practice: becoming an MDCEO™

    Directory of Open Access Journals (Sweden)

    Conard SE

    2013-03-01

    Full Text Available Scott E Conard,1 Maureen Reni Courtney21ACAP Health, Dallas, 2College of Nursing, University of Texas, Arlington, TX, USAAbstract: Primary care medicine in the United States is undergoing a revolutionary shift. Primary care providers and their staff have an extraordinary chance to create and participate in exciting new approaches to care. New strategies will require courage, flexibility, and openness to change by every member of the practice team, especially the lead clinician who is most often the physician, but can also be the nurse practitioner or physician's assistant. Providers must first recognize their need to alter their fundamental identity to incorporate a new kind of leadership role—that of the MDCEO™ (i.e., the individual clinician who leads the practice to ensure that quality, service, and financial systems are developed and effectively managed. This paper provides a practical vision and rationale for the required transition in primary care, pointing the way for how to achieve new practice effectiveness through new leadership roles. It also provides a model to evaluate the status of a primary care practice. The authors have extensive experience in working with primary care providers to radically evolve their clinical practices to become MDCEOs™. The MDCEO™ will articulate the vision and strategy for the practice, define and foster the practice culture, and create and facilitate team development and overall high level functioning. Each member of the team can then begin to lead their part of the practice: a 21st century population-oriented, purpose-based practice resulting in increased quality of care, improved patient outcomes, greater financial success, and enhanced peace of mind.Keywords: primary health care organization and administration, health care reform, leadership, patient-centered care

  2. Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.

    Science.gov (United States)

    Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N

    2013-01-01

    Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.

  3. Standard practice for conducting moist SO2 tests

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2002-01-01

    1.1 This practice covers the apparatus and procedure to be used in conducting qualitative assessment tests in accordance with the requirements of material or product specifications by means of specimen exposure to condensed moisture containing sulfur dioxide. 1.2 The exposure conditions may be varied to suit particular requirements and this practice includes provisions for use of different concentrations of sulfur dioxide and for tests either running continuously or in cycles of alternate exposure to the sulfur dioxide containing atmosphere and to the ambient atmosphere. 1.3 The variant of the test to be used, the exposure period required, the type of test specimen, and the criteria of failure are not prescribed by this practice. Such details are provided in appropriate material and product purchase specifications. 1.4 The values stated in SI units are to be regarded as the standard. The values given in parentheses are for information only. 1.5 This standard does not purport to address all of the safety c...

  4. Using standardized patient encounters to teach longitudinal continuity of care in a family medicine clerkship.

    Science.gov (United States)

    Vest, Bonnie M; Lynch, Abigail; McGuigan, Denise; Servoss, Timothy; Zinnerstrom, Karen; Symons, Andrew B

    2016-08-17

    Despite demonstrated benefits of continuity of care, longitudinal care experiences are difficult to provide to medical students. A series of standardized patient encounters was developed as an innovative curricular element to address this gap in training for medical students in a family medicine clerkship. The objective of this paper is to describe the development and implementation of the curriculum, evaluate the effectiveness of the curriculum for increasing student confidence around continuity of care and chronic disease management, and explore student opinions of the value of the experience. The encounters simulate continuity of care in typical family medicine practice over four standardized patient visits, providing students with experience in longitudinal relationships, ongoing management of chronic and acute conditions, lifestyle counseling, and the use of an electronic medical record. Perceptions of the curriculum were obtained using a pre-post survey asking students to self-rate experience and confidence in continuity relationships, chronic disease management, and lifestyle counseling. Students were also asked about the overall effectiveness of the encounters for simulating family practice and continuity of care. Open-ended comments were gathered through weekly reflection papers submitted by the students. Of 138 third-year medical students, 137 completed the pre-survey, 126 completed the post-survey, and 125 (91%) completed both the pre- and the post-survey. Evaluation results demonstrated that students highly valued the experience. Complete confidence data for 116 students demonstrated increased confidence pre-post (t(115) = 14.92, p continuity of care. This curriculum offers a promising approach to providing students with continuity of care experience. The model addresses a general lack of training in continuity of care in medical schools and provides a standardized method for teaching chronic disease management and continuity relationships.

  5. Family Medicine Maternity Care Call to Action: Moving Toward National Standards for Training and Competency Assessment.

    Science.gov (United States)

    Magee, Susanna R; Eidson-Ton, W Suzanne; Leeman, Larry; Tuggy, Michael; Kim, Thomas O; Nothnagle, Melissa; Breuner, Joseph; Loafman, Mark

    2017-03-01

    Maternity care is an integral part of family medicine, and the quality and cost-effectiveness of maternity care provided by family physicians is well documented. Considering the population health perspective, increasing the number of family physicians competent to provide maternity care is imperative, as is working to overcome the barriers discouraging maternity care practice. A standard that clearly defines maternity care competency and a systematic set of tools to assess competency levels could help overcome these barriers. National discussions between 2012 and 2014 revealed that tools for competency assessment varied widely. These discussions resulted in the formation of a workgroup, culminating in a Family Medicine Maternity Care Summit in October 2014. This summit allowed for expert consensus to describe three scopes of maternity practice, draft procedural and competency assessment tools for each scope, and then revise the tools, guided by the Family Medicine and OB/GYN Milestones documents from the respective residency review committees. The summit group proposed that achievement of a specified number of procedures completed should not determine competency; instead, a standardized competency assessment should take place after a minimum number is performed. The traditionally held required numbers for core procedures were reassessed at the summit, and the resulting consensus opinion is proposed here. Several ways in which these evaluation tools can be disseminated and refined through the creation of a learning collaborative across residency programs is described. The summit group believed that standardization in training will more clearly define the competencies of family medicine maternity care providers and begin to reduce one of the barriers that may discourage family physicians from providing maternity care.

  6. Direct observation of the nutrition care practices of Australian general practitioners

    Directory of Open Access Journals (Sweden)

    Ball LE

    2014-06-01

    Full Text Available INTRODUCTION: Nutrition care refers to nutrition-related advice or counselling provided by health professionals in an attempt to improve the nutrition behaviour of patients. AIM: The aim of this study was to describe the practices of a sample of Australian general practitioners (GPs when providing nutrition care to adult patients. METHODS: Eighteen GPs (13 male, 5 female were observed by fourth-year medical students during their general practice rotation. Each GP was observed for five consultations that included nutrition care, totalling 90 observed consultations. In each consultation, students completed a 31-item nutrition care checklist of nutrition care practices that could feasibly occur in a standard consultation. Each practice was marked with either a ‘yes’ (completed, ‘no’ (did not complete or ‘completed by practice nurse prior to or after the consultation’. RESULTS: Twenty-eight nutrition care practices were observed at least once. The most frequently observed practices were measuring and discussing blood pressure (76.7%; n=69, followed by general questions about current diet (74.4%; n=67. Approximately half of the consultations included a statement of a nutrition-related problem (52.2%; n=47, and the provision of nutrition advice that focused on a nutrient (45.6%; n=41 or food group (52.2%; n=47. Consultations with male GPs, as well as GPs with more than 25 years of experience, were associated with an increased number of nutrition care practices per consultation. DISCUSSION: The GPs performed nutrition care practices in varying frequencies. Further research is required to identify the most effective GP nutrition care practices to improve the nutrition behaviour of patients.

  7. Standard concentration infusions in paediatric intensive care: the clinical approach.

    Science.gov (United States)

    Perkins, Joanne; Aguado-Lorenzo, Virginia; Arenas-Lopez, Sara

    2017-05-01

    The use of standard concentrations of intravenous infusions has been advocated by international organisations to increase intravenous medication safety in paediatric and neonatal critical care. However, there is no guidance on how to identify and implement these infusions leading to great interunit variability. To identify the most appropriate clinical concentrations required by our paediatric intensive care unit (PICU) population with regard to accuracy of delivery and overall fluid allowance. Firstly a matrix was used to balance the concentration, dose and infusion volume (weight range 1.5-50 kg). Results were further refined considering: patient fluid allowance based on fluid volume targets, infusion pump accuracy and challenging each infusion against clinical scenarios requiring administration of multiple drug infusions found in PICU. Consideration was given to the standard concentrations routinely used in adults, in order to assess whether alignment with paediatrics was possible for some of the concentrations proposed. Finally a risk assessment of the infusions was conducted using the NPSA 20 tool. Twenty-five drugs identified as the most commonly used intravenous infusions in the unit. For the majority of the medicines, three weight bands of standard concentrations were necessary to cover the children's weight ranges and kept within predefined fluid requirements and accuracy of delivery. This work shows a patient focused systematic approach for defining and evaluating standardised concentrations in intensive care children. © 2016 Royal Pharmaceutical Society.

  8. Quality Oncology Practice Initiative Certification Program: measuring implementation of chemotherapy administration safety standards in the outpatient oncology setting.

    Science.gov (United States)

    Gilmore, Terry R; Schulmeister, Lisa; Jacobson, Joseph O

    2013-03-01

    The Quality Oncology Practice Initiative (QOPI) Certification Program (QCP) evaluates individual outpatient oncology practice performance in areas that affect patient care and safety and builds on the American Society of Clinical Oncology (ASCO) QOPI by assessing the compliance of a practice with certification standards based on the ASCO/Oncology Nursing Society standards for safe chemotherapy administration. To become certified, a practice must attain a benchmark quality score on certification measures in QOPI and attest that it complies with 17 QCP standards. Structured on-site reviews, initially performed in randomly selected practices, became mandatory beginning in September 2011. Of 111 practices that have undergone on-site review, only two were fully concordant with all of the standards (median, 11; range, seven to 17). Most practices were subsequently able to modify practice to become QOPI certified. The QCP addresses the call from the Institute of Medicine to close the quality gap by aligning evidence-based guidelines and consensus-driven standards with requirements for oncology practices to develop and maintain structural safety components, such as policies and procedures that ensure practice performance. On-site practice evaluation is a high-impact component of the program.

  9. The myth of standardized workflow in primary care.

    Science.gov (United States)

    Holman, G Talley; Beasley, John W; Karsh, Ben-Tzion; Stone, Jamie A; Smith, Paul D; Wetterneck, Tosha B

    2016-01-01

    Primary care efficiency and quality are essential for the nation's health. The demands on primary care physicians (PCPs) are increasing as healthcare becomes more complex. A more complete understanding of PCP workflow variation is needed to guide future healthcare redesigns. This analysis evaluates workflow variation in terms of the sequence of tasks performed during patient visits. Two patient visits from 10 PCPs from 10 different United States Midwestern primary care clinics were analyzed to determine physician workflow. Tasks and the progressive sequence of those tasks were observed, documented, and coded by task category using a PCP task list. Variations in the sequence and prevalence of tasks at each stage of the primary care visit were assessed considering the physician, the patient, the visit's progression, and the presence of an electronic health record (EHR) at the clinic. PCP workflow during patient visits varies significantly, even for an individual physician, with no single or even common workflow pattern being present. The prevalence of specific tasks shifts significantly as primary care visits progress to their conclusion but, notably, PCPs collect patient information throughout the visit. PCP workflows were unpredictable during face-to-face patient visits. Workflow emerges as the result of a "dance" between physician and patient as their separate agendas are addressed, a side effect of patient-centered practice. Future healthcare redesigns should support a wide variety of task sequences to deliver high-quality primary care. The development of tools such as electronic health records must be based on the realities of primary care visits if they are to successfully support a PCP's mental and physical work, resulting in effective, safe, and efficient primary care. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. Technical attainment, practical success and practical knowledge: hermeneutical bases for child nursing care.

    Science.gov (United States)

    de Mello, Débora Falleiros; de Lima, Regina Aparecida Garcia

    2009-01-01

    This reflective study aimed to present some aspects of the concepts technical attainment, practical success and practical knowledge, with a view to a broader understanding of child nursing care. Health care is considered in the perspective of reconstructive practices, characterized as contingencies, highlighting the importance of the connection between technical attainment and practical success and the valuation of practical knowledge, based on philosophical hermeneutics, in the context of practical philosophy. Child health nursing can deal with technical attainment and practical success jointly, and also understand practical knowledge in the longitudinality of care. Health promotion, disease prevention, recovery and rehabilitation of child health should be indissociably associated with contextualized realities, shared between professionals and families, aiming to follow the child's growth and development, produce narratives, identify experiences, choices and decision making to broaden health care.

  11. General practice registrars' views on maternity care in general practice in New Zealand.

    Science.gov (United States)

    Preston, Hanna; Jaye, Chrystal; Miller, Dawn L

    2015-12-01

    The number of general practitioners (GPs) providing maternity care in New Zealand has declined dramatically since legislative changes of the 1990s. The Ministry of Health wants GPs to provide maternity care again. To investigate New Zealand general practice registrars' perspectives on GPs' role in maternity care; specifically, whether maternity services should be provided by GPs, registrars' preparedness to provide such services, and training opportunities available or required to achieve this. An anonymous online questionnaire was distributed to all registrars enrolled in The Royal New Zealand College of General Practitioners' (RNZCGP's) General Practice Education Programme (GPEP) in 2012, via their online learning platform OWL. 165 of the 643 general practice registrars responded (25.7% response rate). Most (95%) believe that GPs interested and trained in maternity care should consider providing antenatal, postnatal or shared care with midwives, and 95% believe women should be able to access maternity care from their general practice. When practising as a GP, 90% would consider providing antenatal and postnatal care, 47.3% shared care, and 4.3% full pregnancy care. Professional factors including training and adequate funding were most important when considering providing maternity care as a GP. Ninety-five percent of general practice registrars who responded to our survey believe that GPs should provide some maternity services, and about 90% would consider providing maternity care in their future practice. Addressing professional issues of training, support and funding are essential if more GPs are to participate in maternity care in New Zealand.

  12. Knowledge, attitude, and practice of quality standards in small-sized public hospitals, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Fahad Khamis Alomari

    2015-01-01

    Full Text Available Objectives: The aim of this study was to assess current situations in small size hospitals regarding knowledge of staff, their attitude and practice of quality standards, in order to set a plan to improve the current situations and overcome barriers of quality practice. Materials and Methods: A descriptive cross-sectional research was conducted by a validated self-administered questionnaire using systematic random technique. Results: The study included about 37.7% Physicians followed by 28.3% nurses, and 18.8% administrators. Median percentage of participants′ knowledge and attitude scores regarding healthcare quality was 48% and 80% respectively. Meanwhile, the median percentage of participants′ perception toward hospital support and implementation of healthcare quality was 54% and 50% respectively. The main barriers for quality standards implementation and practicing were; staff resistance (84.8% followed by deficient knowledge (81.1%. Knowledge showed significant positive correlation with hospital application of quality standards (P = 0.001. Conclusion: The researcher concluded that improvement of knowledge and attitude toward implementation of quality standards as well as leadership commitment to quality and change management were a critical element for organisational shifting transformation to implementing quality of care. Focusing on small hospital and providing more support with all resources for implementation of quality standards through proper education and training for all staff categories are highly recommended.

  13. Heart Failure Care in General Practice

    NARCIS (Netherlands)

    Valk, M.J.M.

    2017-01-01

    Heart failure (HF) is an increasing health care problem worldwide, and a multidisciplinary approach with a general practitioner (GP) in the health care team is considered optimal. HF management has improved substantially over the last two decades, mainly for patients with HF with a reduced ejection

  14. Using standardized insulin orders to improve patient safety in a tertiary care centre.

    Science.gov (United States)

    Doyle, Mary-Anne; Brez, Sharon; Sicoli, Silvana; De Sousa, Filomena; Keely, Erin; Malcom, Janine C

    2014-04-01

    To standardize insulin prescribing practices for inpatients, improve management of hypoglycemia, reduce reliance on sliding scales, increase use of basal-bolus insulin and improve patient safety. Patients with diabetes were admitted to 2 pilot inpatient units followed by corporate spread to all insulin-treated patients on noncritical care units in a Canadian tertiary care multicampus teaching hospital. Standardized preprinted insulin and hypoglycemia management orders, decision support tools and multidisciplinary education strategies were developed, tested and implemented by way of the Model for Improvement and The Ottawa Model for Research Process. Clinical and balance measures were evaluated through statistical process control. Patient safety was improved through a reduction in hypoglycemia and decreased dependence on correctional scales. Utilization of the preprinted orders approached the target of 70% at the end of the test period and was sustained at 89% corporately 3 years post-implementation. The implementation of a standardized, preprinted insulin order set facilitates best practices for insulin therapy, improves patient safety and is highly supported by treating practitioners. The utilization of formal quality-improvement methodology promoted efficiency, enhanced sustainability, increased support among clinicians and senior administrators, and was effective in instituting sustained practice change in a complex care centre. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  15. National implementation of standards of practice for non-prescription medicines in Australia.

    Science.gov (United States)

    Benrimoj, Shalom I; Gilbert, Andrew L; de Almeida Neto, Abilio C; Kelly, Fiona

    2009-04-01

    In Australia, there are two categories of non-prescription medicines: pharmacy medicines and pharmacist only medicines. Standards were developed to define and describe the professional activities required for the provision of these medicines at a consistent and measurable level of practice. Our objective was to implement nationally a quality improvement package in relation to the Standards of Practice for the Provision of Non-Prescription Medicines. Approximately 50% of Australian pharmacies (n = 2,706) were randomly selected by local registering authorities. Trained pharmacy educators audited each community pharmacy in the study three times, 7 weeks apart on Standards of Practice for the Provision of Non-Prescription Medicines, Visit 1 involved the educator explaining the project and conducting an assessment of the pharmacy's level of compliance. Behaviour of community pharmacists and their staff in relation to these standards was measured by conducting pseudo-patron visits. Pseudopatron visits were conducted at Visit 2, with the educator providing immediate feedback and coaching and a compliance assessment. Visit 3 involved a compliance assessment, and a second pseudo-patron visit for those pharmacies that had performed poorly at the first visit. At Visit 1, the lowest levels of compliance were to the standards relating to the documentation process (44%) and customer care and advice (46%). By Visit 2, more than 80% of pharmacies had met most criteria. At Visit 3, compliance had significantly improved compared to Visits 1 and 2 (P < 0.001). The lowest levels of compliance were to criteria which required written operating procedures for specific tasks, but these also improved significantly over time (P < 0.001). Professional practice in relation to the handling of pharmacist only and pharmacy medicines improved considerably as measured by the auditing process, and the results indicate that Australian pharmacies are well-equipped to provide high quality service to

  16. Telemedicine compared with standard care in type 2 diabetes mellitus

    DEFF Research Database (Denmark)

    Rasmussen, Ole W.; Lauszus, F. F.; Loekke, M.

    2016-01-01

    Introduction Good metabolic control is important in type 2 diabetes mellitus to improve quality of life, work ability and life expectancy, and the use of telemedicine has proved efficient as an add-on to the usual treatment. However, few studies in type 2 diabetes patients have directly compared...... telemedicine with conventional outpatient treatment, and we wanted to evaluate whether telemedicine, compared with standard care, provides equivalent clinical outcomes. Methods Forty patients with type 2 diabetes mellitus allocated from October 2011-July 2012 were randomized to either treatment at home...... pressure (-1 vs -7%), and systolic diurnal blood pressure (0 vs -1%) were found. Nine consultations were missed in the standard outpatient group and none in the telemedicine group. Conclusions In the direct comparison of home video consultations vs standard outpatient treatment in type 2 diabetes mellitus...

  17. Telemedicine compared with standard care in type 2 diabetes mellitus

    DEFF Research Database (Denmark)

    Rasmussen, O. W.

    2015-01-01

    Objectives: For patients with T2DM does telemedicine, compared with standard care, provide equivalent clinical outcomes? Methods: Forty patients with type 2 diabetes mellitus allocated from October 2011 until July 2012 randomized to either treatment at home by video conferences only or the standard...... outpatient treatment. Primary outcomes were HbA1c and blood glucose levels and secondary outcomes were 24-h blood pressure, cholesterol levels, and albuminuria. The videotelephone was installed and serviced by the telephone company, TDC, Denmark, as a broadband solution. Results: The improvements in the two...... treatments, given as changes in percent of telemedicine vs. standard, showed significant differences in HbA1c (-15 vs. -11 %), mean blood glucose (-18 vs. -13 %,.and in cholesterol (-7 vs. -6 %). No differences in LDL (-4 vs. -6 %), weight (-1 vs. 2 %), diastolic diurnal blood pressure (-1 vs. -7...

  18. Nursing care practices at an outpatient care center from an integrative perspective.

    Science.gov (United States)

    Pinto, Ione Carvalho; Marciliano, Carla Santa Maria; Zacharias, Fabiana Costa Machado; Stina, Ana Paula Neroni; Passeri, Ivana Astolphi Gandra; Bulgarelli, Alexandre Favero

    2012-01-01

    to analyze nursing care practices at a Specialized Outpatient Care Center from the perspective of an integrative health care activity. Interviews with 24 nursing professionals were undertaken. For data analysis, Thematic Content Analysis as proposed by Bardin was applied, resulting in the following themes: the team size and its commitment to health care; professional practices and activity of the nursing team. The size of the nursing team was considered insufficient, which compromises the quality of care and results in work overload and dissatisfaction of the nursing professionals. On the other hand, they were satisfied with the tasks performed day-to-day and related integrality to individual care, considered it essential and usually practiced it daily. It is considered that the nursing team has the potential and commitment to develop their care practice combined with the integrative perspective, and therefore providing quality health care to the population.

  19. Early mobility in the intensive care unit: Standard equipment vs a mobility platform.

    Science.gov (United States)

    Roberts, Melanie; Johnson, Laura Adele; Lalonde, Trent L

    2014-11-01

    Despite the general belief that mobility and exercise play an important role in the recovery of functional status, mobility is difficult to implement in patients in intensive care units. To compare a mobility platform with standard equipment, assessing efficiency (decreased time and staff required to prepare patient), effectiveness (increased activity time), and safety (no falls, unplanned tube removals, or emergency situations) for intensive care patients. This observational study was approved by the institutional review board, and informed consent was obtained from the patient or the medical decision maker. Intensive care patients were assigned to a room in the usual manner, with platforms in odd-numbered rooms and standard equipment in even-numbered rooms. Standardized data collection tools were designed to collect data for 24 hours for each patient. The nurses caring for the patients completed the data collection tools in real time during the activity. The stages of activity and the physiological states that would preclude mobility were very specifically defined for the research study. Data were collected for a total of 71 patients and 238 activities. Important (although not significant) descriptive statistics regarding early mobility in the intensive care unit were discovered. The unintended result of the research study was a change in the culture and practice regarding early mobility in the intensive care unit. Early mobility can be implemented in intensive care units. Standard equipment can be used to mobilize such patients safely; however, for patients who ambulate, a platform may increase efficiency and effectiveness. ©2014 American Association of Critical-Care Nurses.

  20. Malnutrition and nutritional care practices in hospital wards for older people.

    Science.gov (United States)

    Vanderwee, Katrien; Clays, Els; Bocquaert, Ilse; Verhaeghe, Sofie; Lardennois, Miguel; Gobert, Micheline; Defloor, Tom

    2011-04-01

    This paper is a report of a study conducted to gain a better insight into the current nutritional care practices in Belgian hospital wards for older people, and to study the association between these practices and the prevalence of malnutrition. In 1999, the Council of Europe assessed nutritional care practices and support in 12 European countries and showed them to be sparse and inconsistent. At the time of research, no studies had described the association between nutritional care practices and malnutrition prevalence in Belgium. In 2007, a cross-sectional survey was carried out in a representative sample of Belgian hospital wards for older people. In total, 2094 patients from 140 wards for older people were included. The overall prevalence rate of malnutrition in wards for older people was 31.9%. Nutritional care practices such as nutritional screening and assessment, use of a standardized screening instrument and a nutritional protocol were suboptimal. Multilevel analysis revealed that ward characteristics explained for 9.1% whether a patient was malnourished or not. None of the registered nutritional care practices could explain a patient's individual risk. Malnutrition is a frequently occurring problem on hospital wards for older people. Increased consciousness among healthcare professionals and hospital policy makers of the importance of nutritional care will contribute to further improvement in care quality. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

  1. Practical uses of botanicals in skin care.

    Science.gov (United States)

    Stallings, Alison F; Lupo, Mary P

    2009-01-01

    Cosmeceuticals are the fastest growing sector of the cosmetic industry, and the future of antiaging cosmeceuticals in particular is very promising. Botanical extracts that support the health, texture, and integrity of the skin, hair, and nails are widely used in cosmetic formulations. They form the largest category of cosmeceutical additives found in the marketplace today due to the rising consumer interest and demand for natural products. Various plant extracts that formed the basis of medical treatments in ancient civilizations and many traditional cultures are still used today in cleansers, moisturizers, astringents, and many other skin care products. New botanical skin care treatments are emerging, presenting dermatologists and their patients the challenge of understanding the science behind these cosmeceuticals. Thus, dermatologists must have a working knowledge of these botanicals and keep up with how they evolve to provide optimal medical care and answer patient questions. The most popular botanicals commonly incorporated into skin care protocols are discussed.

  2. Practice-based research networks: the laboratories of primary care research.

    Science.gov (United States)

    Lindbloom, Erik J; Ewigman, Bernard G; Hickner, John M

    2004-04-01

    Medical research has traditionally been based in academic centers, and the findings are frequently not applicable in community primary care settings. The result is a large gap between the possible and the practical in delivering high-quality primary medical care in the United States. Practice-based research networks (PBRNs), laboratories for primary care clinical research, are the appropriate vehicles for uniting the worlds of community primary care practice and clinical research. Although they have received little attention in the mainstream of clinical and health services research, PBRNs have already reported a variety of findings useful for primary care providers, and these networks have helped to identify key issues in healthcare delivery that affect important outcomes. In this report, we outline the rationale for and history of PBRNs. We describe the organization and work of several productive PBRNs, giving examples of their studies that have changed the standards of modern primary care practice. Finally, we describe a developing electronic process for identifying research questions obtained directly from primary care providers that can be used to focus the national primary care research agenda on questions of clinical relevance and importance. As electronic technologies are fully developed and tested, they will facilitate communication between clinicians and researchers, thereby improving the effectiveness and efficiency of practice-based research.

  3. Standard practice for scanning electron microscope beam Size characterization

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2004-01-01

    1.1 This practice provides a reproducible means by which one aspect of the performance of a scanning electron microscope (SEM) may be characterized. The resolution of an SEM depends on many factors, some of which are electron beam voltage and current, lens aberrations, contrast in the specimen, and operator-instrument-material interaction. However, the resolution for any set of conditions is limited by the size of the electron beam. This size can be quantified through the measurement of an effective apparent edge sharpness for a number of materials, two of which are suggested. This practice requires an SEM with the capability to perform line-scan traces, for example, Y-deflection waveform generation, for the suggested materials. The range of SEM magnification at which this practice is of utility is from 1000 to 50 000 × . Higher magnifications may be attempted, but difficulty in making precise measurements can be expected. 1.2 This standard does not purport to address all of the safety concerns, if any, ass...

  4. Towards best practice in physical and physiological employment standards.

    Science.gov (United States)

    Petersen, Stewart R; Anderson, Gregory S; Tipton, Michael J; Docherty, David; Graham, Terry E; Sharkey, Brian J; Taylor, Nigel A S

    2016-06-01

    While the scope of the term physical employment standards is wide, the principal focus of this paper is on standards related to physiological evaluation of readiness for work. Common applications of such employment standards for work are in public safety and emergency response occupations (e.g., police, firefighting, military), and there is an ever-present need to maximize the scientific quality of this research. Historically, most of these occupations are male-dominated, which leads to potential sex bias during physical demands analysis and determining performance thresholds. It is often assumed that older workers advance to positions with lower physical demand. However, this is not always true, which raises concerns about the long-term maintenance of physiological readiness. Traditionally, little attention has been paid to the inevitable margin of uncertainty that exists around cut-scores. Establishing confidence intervals around the cut-score can reduce for this uncertainty. It may also be necessary to consider the effects of practise and biological variability on test scores. Most tests of readiness for work are conducted under near perfect conditions, while many emergency responses take place under far more demanding and unpredictable conditions. The potential impact of protective clothing, respiratory protection, load carriage, environmental conditions, nutrition, fatigue, sensory deprivation, and stress should also be considered when evaluating readiness for work. In this paper, we seek to establish uniformity in terminology in this field, identify key areas of concern, provide recommendations to improve both scientific and professional practice, and identify priorities for future research.

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

    Science.gov (United States)

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

    2017-01-01

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

  6. Standardization of care in patients with lower extremity ulcers venous etiology

    Directory of Open Access Journals (Sweden)

    Diego López Muñoz

    2012-11-01

    Full Text Available The ulcer of the lower extremity is a common chronic disease process in daily practice, in which there is wide variability in treatment. Venous ulcers account for 70% of all vascular ulcers. They occur mainly as there is a valve dysfunction as a result of venous incompetence in the lower limbs. Due to the impact they pose is necessary to apply a corrective treatment and also to demonstrate effectiveness in repairing these ulcers. Our goals are to unify and standardize criteria for action by nursing language records and all perform a standardization of care for these patients. This has been an analysis of the needs of care in patients with ulcers of the lower extremity venous etiology methodology by applying nurse. The patient assessment is made by functional health patterns of M. Gordon, for the diagnosis, interventions and outcome criteria necessary use the NNN taxonomy (NANDA-NIC-NOC. We obtained a total of 3 major diagnostic labels, encoded according to NANDA taxonomy for nursing care quality required 13 interventions. Plant 5 outcome criteria to evaluate the effectiveness and quality of nurse activity. Standardized care plans are a valuable tool. Its use ensures that share a common language, unified performance criteria, achieved quality care for our patients.

  7. Primary care practice organization influences colorectal cancer screening performance.

    Science.gov (United States)

    Yano, Elizabeth M; Soban, Lynn M; Parkerton, Patricia H; Etzioni, David A

    2007-06-01

    To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors. Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001). Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (pmanagement and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.

  8. Explorations in body image care: Peplau and practice knowledge.

    Science.gov (United States)

    Price, B

    1998-06-01

    Practitioners in mental health care have long utilized the work of Hildegard Peplau, both for nursing discourse and for practice. At a time when the role of theory in practice is once more being debated, and when theories are being applied in new contexts, this paper examines the contribution that Peplau's work may have to offer altered body image nursing care. A case study is used to highlight concepts in practice, the paper examining the ways in which Peplau's Theory of Interpersonal Relations complement the other elements of practice knowledge that the nurse uses to assist patients and lay carers alike.

  9. Implementation of chronic illness care in German primary care practices--how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling.

    Science.gov (United States)

    Petersen, Juliana J; Paulitsch, Michael A; Mergenthal, Karola; Gensichen, Jochen; Hansen, Heike; Weyerer, Siegfried; Riedel-Heller, Steffi G; Fuchs, Angela; Maier, Wolfgang; Bickel, Horst; König, Hans-Helmut; Wiese, Birgitt; van den Bussche, Hendrik; Scherer, Martin; Dahlhaus, Anne

    2014-08-07

    In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views. This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice). The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice. This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the

  10. Sustainability in care through an ethical practice model.

    Science.gov (United States)

    Nyholm, Linda; Salmela, Susanne; Nyström, Lisbet; Koskinen, Camilla

    2018-03-01

    While sustainability is a key concept in many different domains today, it has not yet been sufficiently emphasized in the healthcare sector. Earlier research shows that ethical values and evidence-based care models create sustainability in care practice. The aim of this study was to gain further understanding of the ethical values central to the realization of sustainability in care and to create an ethical practice model whereby these basic values can be made perceptible and active in care practice. Part of the ongoing "Ethical Sustainable Caring Cultures" research project, a hermeneutical application research design was employed in this study. Dialogues were used, where scientific researchers and co-researchers were given the opportunity to reflect on ethical values in relation to sustainability in care. An ethical practice model with ethos as its core was created from the results of the dialogues. In the model, ethos is encircled by the ethical values central to sustainability: dignity, responsibility, respect, invitation, and vows. The model can be used as a starting point for ethical conversations that support carers' reflections on the ethical issues seen in day-to-day care work and the work community, allowing ethical values to become visible throughout the entire care culture. It is intended as a tool whereby carers can more deeply understand an organization's common basic values and what they entail in regard to sustainability in care.

  11. [Chronic pruritus : Care in daily practice].

    Science.gov (United States)

    Ständer, S; Ständer, H F; Steinke, S; Bruland, P; Dugas, M; Augustin, M

    2016-08-01

    Chronic pruritus is a highly prevalent, multifactorial symptom requiring extensive diagnostics, treatment and consideration of accompanying symptoms (reduced quality of life, sleep disorders, psychic factors). Patient care is thus complex and requires consideration of individual treatment goals. Patients indicate their wish for a symptom-free life an explanation of the causes and a trustful physician-patient relationship. The targeted use of questionnaires is thus advisable in order to structurally survey the history, pruritus intensity, quality of life and treatment progression. Nevertheless, there are many administrative and economical hurdles in the health care system to overcome in order to provide patients with chronic pruritus the best possible care, also per the recommended guidelines. The development of specialized centers and training courses for medical practitioners is thus urgently needed.

  12. Computer use in primary care practices in Canada.

    Science.gov (United States)

    Anisimowicz, Yvonne; Bowes, Andrea E; Thompson, Ashley E; Miedema, Baukje; Hogg, William E; Wong, Sabrina T; Katz, Alan; Burge, Fred; Aubrey-Bassler, Kris; Yelland, Gregory S; Wodchis, Walter P

    2017-05-01

    To examine the use of computers in primary care practices. The international Quality and Cost of Primary Care study was conducted in Canada in 2013 and 2014 using a descriptive cross-sectional survey method to collect data from practices across Canada. Participating practices filled out several surveys, one of them being the Family Physician Survey, from which this study collected its data. All 10 Canadian provinces. A total of 788 family physicians. A computer use scale measured the extent to which family physicians integrated computers into their practices, with higher scores indicating a greater integration of computer use in practice. Analyses included t tests and 2 tests comparing new and traditional models of primary care on measures of computer use and electronic health record (EHR) use, as well as descriptive statistics. Nearly all (97.5%) physicians reported using a computer in their practices, with moderately high computer use scale scores (mean [SD] score of 5.97 [2.96] out of 9), and many (65.7%) reported using EHRs. Physicians with practices operating under new models of primary care reported incorporating computers into their practices to a greater extent (mean [SD] score of 6.55 [2.64]) than physicians operating under traditional models did (mean [SD] score of 5.33 [3.15]; t 726.60 = 5.84; P computer use across provinces. Most family physicians in Canada have incorporated computers into their practices for administrative and scholarly activities; however, EHRs have not been adopted consistently across the country. Physicians with practices operating under the new, more collaborative models of primary care use computers more comprehensively and are more likely to use EHRs than those in practices operating under traditional models of primary care. Copyright© the College of Family Physicians of Canada.

  13. Voriconazole therapeutic drug monitoring practices in the intensive care

    NARCIS (Netherlands)

    van Wanrooy, Marjolijn J. P.; Rodgers, Michael G. G.; Span, Lambert F. R.; Zijlstra, Jan G.; Uges, Donald R. A.; Kosterink, Jos G. W.; van der Werf, Tjip S.; Alffenaar, Jan-Willem C.

    BACKGROUND: Routine therapeutic drug monitoring of voriconazole appears to be beneficial. This study investigated the therapeutic drug monitoring practices in intensive care to derive possible recommendations for improvement. METHODS: A retrospective chart review was performed for patients aged ≥ 18

  14. A practical guide to microscope care and maintenance.

    Science.gov (United States)

    Petrak, Lara J; Waters, Jennifer C

    2014-01-01

    Optimal microscope performance requires regular maintenance and quality control testing. This chapter is a practical guide to microscope care with an emphasis on preventing, identifying and troubleshooting common issues. © 2014 Elsevier Inc. All rights reserved.

  15. Geriatric Care as an Introductory Pharmacy Practice Experience

    OpenAIRE

    Woelfel, Joseph A.; Boyce, Eric; Patel, Rajul A.

    2011-01-01

    Objective. To describe the design, delivery, and impact of a geriatric introductory pharmacy practice experience (IPPE) to develop students’ skills related to consultant pharmacists’ roles and patient care responsibilities.

  16. Managing practice innovations in prison health care services.

    Science.gov (United States)

    Walsh, Liz; Freshwater, Dawn

    Prison health care is undergoing significant organisational change. This article highlights the potential for practice development in this setting, giving two examples of ongoing developments undertaken as part of a programme of research and development in mental health.

  17. Increasing market opportunities through standardization and responsible care program

    Directory of Open Access Journals (Sweden)

    Robert MUHA

    2012-01-01

    Full Text Available The development of Environment Management Systems (EMS commenced as a response to global environmental issues and as a recognition of awareness that sustainable development is prerequisite for keeping the natural system in a proper balance. Transport of dangerous goods by road is quite a complex activity that poses a major potential threat to people and the environment. Therefore, the introduction of certain system tools (standardization of business contributes to a safer and better road transport operations of dangerous goods. Chemical industry combining their efforts for safety and the environment under the Responsible care program (RC. Such efforts have resulted in the development Safety and Quality Assessment System (SQAS to assess the haulers. This paper presents tools standardization of business as an opportunity to improve the market positions of dangerous goods haulers.

  18. Increasing market opportunities through standardization and responsible care program

    Directory of Open Access Journals (Sweden)

    Robert MUHA

    2011-01-01

    Full Text Available The development of Environment Management Systems (EMS commenced as a response to global environmental issues and as a recognition of awareness that sustainable development is prerequisite for keeping the natural system in a proper balance. Transport of dangerous goods by road is quite a complex activity that poses a major potential threat to people and the environment. Therefore, the introduction of certain system tools (standardization of business contributes to a safer and better road transport operations of dangerous goods. Chemical industry combining their efforts for safety and the environment under the Responsible care program (RC. Such efforts have resulted in the development Safety and Quality Assessment System (SQAS to assess the haulers. This paper presents tools standardization of business as an opportunity to improve the market positions of dangerous goods haulers.

  19. Effective population management practices in diabetes care - an observational study

    DEFF Research Database (Denmark)

    Frølich, Anne; Bellows, Jim; Nielsen, Bo Friis

    2010-01-01

    Of fifteen diabetes care management practices, our data indicate that high performance is most associated with provider alerts and more weakly associated with action plans and with guideline distribution and training. Lack of convergence in the literature on effective care management practices su...... suggests that factors contributing to high performance may be highly context-dependent or that the factors involved may be too numerous or their implementation too nuanced to be reliably identified in observational studies....

  20. Nutritional practices in full-day-care pre-schools.

    LENUS (Irish Health Repository)

    Jennings, A

    2011-06-01

    Full-day-care pre-schools contribute significantly to the nutritional intake and acquisition of dietary habits of the pre-school child. The present study investigated nutritional practices in full-day-care pre-schools in Dublin, Ireland, aiming to determine the nutritional support that pre-school managers deem necessary, thereby facilitating the amelioration of existing pre-school nutritional training and practices.

  1. Effectiveness of a quality-improvement program in improving management of primary care practices

    Science.gov (United States)

    Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

    2011-01-01

    Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the

  2. Theoretical concepts about "Intelligence" - practices and standards in democratic societies

    Directory of Open Access Journals (Sweden)

    Mr.Sc. Bahri Gashi

    2013-06-01

    Full Text Available My thesis consists of theoretical analysis on the need for recognition of academic concepts to shape and design research field intelligence community activity, careful analysis of the terms and concepts that are strongly linked to intelligence work methodology, theoretical aspects description given practice best to regulate this specific area in our academic studies, has made the study to take proper shape with bold shades of comparative empirical analysis. My study aims to summarize, to analyze existing approaches and break the "taboo theories," floats mysteriously present new knowledge, summed up in this multidisciplinary field study, now theories only considering the nature of scientific thought for recognition theoretical concepts and legal regulation best practice intelligence services in democratic societies. emocratic societies. Treatment of this complex matter such as "intelligent services submission principle" of democracy is very difficult. Is between the concept of democracy is to be open and transparent, and intelligent service logic in the concept is to be closed and secret. Generally in "strategic studies and Peace” security for the creation of "security system" argued by the authors Buzan and Herring. Concept Intelligent based on the theory: "The essence of intelligence is the adequate response to a stimulus." Is the essence of this analysis?

  3. Standard practice for preparing sulfur prints for macrostructural evaluation

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2008-01-01

    1.1 This practice provides information required to prepare sulfur prints (also referred to as Baumann Prints) of most ferrous alloys to reveal the distribution of sulfide inclusions. 1.2 The sulfur print reveals the distribution of sulfides in steels with bulk sulfur contents between about 0.010 and 0.40 weight percent. 1.3 Certain steels contain complex sulfides that do not respond to the test solutions, for example, steels containing titanium sulfides or chromium sulfides. 1.4 The sulfur print test is a qualitative test. The density of the print image should not be used to assess the sulfur content of a steel. Under carefully controlled conditions, it is possible to compare print image intensities if the images are formed only by manganese sulfides. 1.5 The sulfur print image will reveal details of the solidification pattern or metal flow from hot or cold working on appropriately chosen and prepared test specimens. 1.6 This practice does not address acceptance criteria based on the use of the method. ...

  4. Client Involvement in Home Care Practice

    DEFF Research Database (Denmark)

    Glasdam, Stinne; Henriksen, Nina; Kjær, Lone

    2013-01-01

    ‘Client involvement’ has been a mantra within health policies, education curricula and healthcare institutions over many years, yet very little is known about how ‘client involvement’ is practised in home-care services. The aim of this article is to analyse ‘client involvement’ in practise seen...

  5. Narratives and communication in health care practice

    DEFF Research Database (Denmark)

    Sørensen, Mariann B.

    2014-01-01

    included in various official visions papers and recommendations. The main question is pedagogical: How do practitioners in the health sector i.e. in nursing deal with these perspectives? The materials are the Danish Health Board´s program of rehabilitation and palliative care, data from a focus group study...

  6. [Blood pressure measurement by primary care physicians: comparison with the standard method].

    Science.gov (United States)

    Asai, Y; Kawamoto, R; Nago, N; Kajii, E

    2000-04-01

    physicians use home BP readings in diagnosis or treatment of hypertension, but about half of physicians with ambulatory BP monitors use their measured readings. Primary care physicians used various techniques for routine BP measurement and no physician completely followed the standard. Such measurements may affect the diagnosis and treatment of hypertension, but measuring all BPs solely by the standard is not practical. We need to have a practical and efficient method of BP measurement for routine practice in the primary care setting.

  7. Building teams in primary care: A practical guide.

    Science.gov (United States)

    Ghorob, Amireh; Bodenheimer, Thomas

    2015-09-01

    Primary care is changing to a team-based model. A number of high-performing primary-care practices in the United States have succeeded in making the transition to team-based care. Site visits were conducted to 29 high-performing primary-care practices. Observations made in these practices were summarized for common elements exhibited by care teams. A limited literature search was done to review corroborating evidence. Teams observed in the 29 practices were found to exhibit 9 elements: a stable team structure, colocation, a culture shift in progress from physician-driven to team-based care, defined roles with training and skill checks to reinforce those roles, standing orders and protocols, defined workflows and workflow mapping, staffing ratios adequate to facilitate new roles, ground rules, and modes of communication, including team meetings, huddles, and minute-to-minute interaction. These 9 elements may be helpful to practices making the transition to team-based care. (c) 2015 APA, all rights reserved).

  8. [Minimum Standards for the Spatial Accessibility of Primary Care: A Systematic Review].

    Science.gov (United States)

    Voigtländer, S; Deiters, T

    2015-12-01

    Regional disparities of access to primary care are substantial in Germany, especially in terms of spatial accessibility. However, there is no legally or generally binding minimum standard for the spatial accessibility effort that is still acceptable. Our objective is to analyse existing minimum standards, the methods used as well as their empirical basis. A systematic literature review was undertaken of publications regarding minimum standards for the spatial accessibility of primary care based on a title word and keyword search using PubMed, SSCI/Web of Science, EMBASE and Cochrane Library. 8 minimum standards from the USA, Germany and Austria could be identified. All of them specify the acceptable spatial accessibility effort in terms of travel time; almost half include also distance(s). The travel time maximum, which is acceptable, is 30 min and it tends to be lower in urban areas. Primary care is, according to the identified minimum standards, part of the local area (Nahbereich) of so-called central places (Zentrale Orte) providing basic goods and services. The consideration of means of transport, e. g. public transport, is heterogeneous. The standards are based on empirical studies, consultation with service providers, practical experiences, and regional planning/central place theory as well as on legal or political regulations. The identified minimum standards provide important insights into the effort that is still acceptable regarding spatial accessibility, i. e. travel time, distance and means of transport. It seems reasonable to complement the current planning system for outpatient care, which is based on provider-to-population ratios, by a gravity-model method to identify places as well as populations with insufficient spatial accessibility. Due to a lack of a common minimum standard we propose - subject to further discussion - to begin with a threshold based on the spatial accessibility limit of the local area, i. e. 30 min to the next primary

  9. Primary Care Practice Transformation and the Rise of Consumerism.

    Science.gov (United States)

    Shrank, William H

    2017-04-01

    Americans are increasingly demanding the same level of service in healthcare that they receive in other services and products that they buy. This rise in consumerism poses challenges for primary care physicians as they attempt to transform their practices to succeed in a value-based reimbursement landscape, where they are rewarded for managing costs and improving the health of populations. In this paper, three examples of consumer-riven trends are described: retail healthcare, direct and concierge care, and home-based diagnostics and care. For each, the intersection of consumer-driven care and the goals of value-based primary care are explored. If the correct payment and connectivity enablers are in place, some examples of consumer-driven care are well-positioned to support primary care physicians in their mission to deliver high-quality, efficient care for the populations they serve. However, concerns about access and equity make other trends less consistent with that mission.

  10. Independent practice associations and physician-hospital organizations can improve care management for smaller practices.

    Science.gov (United States)

    Casalino, Lawrence P; Wu, Frances M; Ryan, Andrew M; Copeland, Kennon; Rittenhouse, Diane R; Ramsay, Patricia P; Shortell, Stephen M

    2013-08-01

    Pay-for-performance, public reporting, and accountable care organization programs place pressures on physicians to use health information technology and organized care management processes to improve the care they provide. But physician practices that are not large may lack the resources and size to implement such processes. We used data from a unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which independent practice associations (IPAs) and physician-hospital organizations (PHOs) might make it possible for these smaller practices to share resources to improve care. Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients. On average, practices participating in these organizations provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did (10.4 versus 3.8). Half of these processes were provided only by IPAs or PHOs. These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations.

  11. INTERPROFESSIONAL EDUCATION AND COLLABORATIVE PRACTICE. A PATHWAY TO BETTER PATIENT CARE, IMPROVED HEALTH, AND LOWER COSTS.

    Science.gov (United States)

    Friedrichsen, Steven

    2016-01-01

    Dentistry usually concerns itself with managing the scope of practice relationships with areas historically performed by dentists as solo practitioners. Many trends in health care-such as electronic records, Big Data, consolidated reimbursement systems, effective but expensive technology, the economies of group practice-are now overwhelming the boundaries of tasks performed in isolation. The Commission on Dental Accreditation has added a standard that dental education programs must prepare professionals to function in these new environments.

  12. Holistic Health Care: A Challenge to Podiatric Medical Practice.

    Science.gov (United States)

    Levy, Leonard A.; Levine, Peter M.

    1980-01-01

    As the profession of podiatric medicine becomes more closely identified with the delivery of primary care, it is suggested that it is essential for practicing podiatrists and students to have more educational opportunities in the field of holistic health care, psychiatry, and the behavioral sciences. (Author/MLW)

  13. Continuity of Care in a University-Based Practice

    Science.gov (United States)

    Breslau, Naomi; Reeb, Kenneth G.

    1975-01-01

    Effects of changes in a pediatric practice--expansion of the number of pediatricians and incorporation into a university hospital setting--on continuity of care and utilization were examined, results showing a marked decline in the continuity of sick visits. Discussion emphasizes the need for a deliberate plan of continuity in primary care.…

  14. Hand Washing Practices and Compliance among Health Care ...

    African Journals Online (AJOL)

    Hand Washing Practices and Compliance among Health Care Workers in the Intensive Care Unit of a Teaching Hospital in Nigeria. ... Posters and education materials on proper hand washing techniques should be made available in and around the ICU. Regular provision of soap and water, paper towels and hand dryers ...

  15. Determinants of cord care practices among mothers in Benin City ...

    African Journals Online (AJOL)

    2011-10-04

    Oct 4, 2011 ... [1-3] A number of factors ... Objective: The objective of this study was to determine the factors that influence cord care practices among mothers ..... name while a girl loses her identity with marriage.[13,14] The effects of son preference ripple into other spheres such as parental care, nutrition, and education.

  16. Cord care practices among mothers attending immunization clinic at ...

    African Journals Online (AJOL)

    A structured, pretested questionnaire was used as test instrument to investigate the care of the umbilical cord of their infants in their last deliveries. Results: Harmful or non-beneficial cord care practices were common (79.5%) among mothers in Benin City. Most delivery units used thread (65.6%) and plastic cord clamp ...

  17. Newborn care seeking practices in Central and Southern Ethiopia ...

    African Journals Online (AJOL)

    Newborn care seeking practices in Central and Southern Ethiopia and implications for community based programming. Y Amare, T Degefie, B Mulligan. Abstract. Background: In Ethiopia, close to 120,000 newborns die annually and newborn mortality now constitutes 42% of under-five deaths. The use of health care for ...

  18. Religious culture and health promotion: care, practice, object

    Directory of Open Access Journals (Sweden)

    Viola Timm

    2015-06-01

    structures it made possible in that it remains irreducible to mere means to an end. As means to an end, the scientific-technological complex aims at total mastery of the future of the biopolitical1 and material domains. In a reflection on technology(7, on the other hand, follows the traces of its existence in the world in a marked departure from the standard conception of it as mere instrumentality, that is, as means to an end, by uncovering the hidden meaning and potentiality in the poetic-cultural linguistic formations that not only reflect its phenomenological horizon, but structure its presence. Though remains religious experience in a blind spot, this analysis still continues nevertheless prescribed and inscribed in a language profoundly altered by the material artifacts of a textual and sacramental religious history in the German context(7. Excavating the religious-historical genealogy of our contemporary notions of care, its object and practice, and the organizational principles of the public sphere it structures is one side of the task this volume sets for itself. The other side of the question is practical and aims to begin to focus an academic discourse that can support, value, and safeguard traditional religious practices today, not as means to an end, but as cultural structures vital to public space design and health promotion, and as a point of check-and-balance to political structures that tend to monopolize their grip on the public sphere. The goal is to harmonize the two distinct and until now largely antagonistic origins of contemporary scientific thought and health promotion, the rational Greco-Germanic tradition, supported by physics, metaphysics and phenomenology, and the sacramental - originally Hebraic - Catholic tradition, which organizes the ontological anchors of caritas. This journal, Brazilian Journal in Health Promotion, is looking forward to the development of theoretical paradigms that can support research at the intersection between health

  19. 78 FR 38735 - Autopsy Performance Criteria: Standards, Guidelines and Best Practices

    Science.gov (United States)

    2013-06-27

    ... DEPARTMENT OF JUSTICE Office of Justice Programs [OJP (NIJ) Docket No. 1626] Autopsy Performance Criteria: Standards, Guidelines and Best Practices AGENCY: National Institute of Justice, DOJ. ACTION... entitled, ``Autopsy Performance Criteria: Standards, Guidelines and Best Practices''. The opportunity to...

  20. Private Pilot Practical Test Standards for Lighter-Than-Air Balloon, Airship

    Science.gov (United States)

    1996-06-01

    The Private Pilot - Lighter-Than-Air (Balloon and Airship) Practical Test Standards (PTS) book has been published by the Federal Aviation Administration (FAA) to establish the standards for private pilot certification practical tests for the lighter-...

  1. Flight Instructor Practical Test Standards for Lighter-Than-Air: Balloon, Airship

    Science.gov (United States)

    1995-03-01

    The Flight Instructor - Lighter-Than-Air Practical Test Standards (PTS) : book has been published by the Federal Aviation Administration (FAA) to : establish the standards for flight instructor certification practical tests for : the lighter-than-air...

  2. Commercial Pilot Practical Test Standards for Lighter-Than-Air Balloon, Airship

    Science.gov (United States)

    1997-05-01

    The Commercial Pilot Lighter-Than-Air Practical Test Standards (PTS) book has been published by the Federal Aviation Administration (FAA) to establish the standards for commercial pilot certification practical tests for the lighter-than-air category,...

  3. Some practical applications of fundamental standards in radiation protection

    International Nuclear Information System (INIS)

    Duhamel, Francis; Lavie, Jean-Marie

    1964-05-01

    After some general considerations on the recommendations made by the International Commission on Radiological Protection (ICRP) regarding standards of internal or external exposure of organs or tissues to different types of radiations, and a recall of the main problems raised by acute radio-exposures (dose assessment in case of accident, assessment of the dose due to an emergency intervention in case of accident, classification of radio-elements), this report describes how ICRP recommendations have been implemented by the CEA, and tries to relate the problem of acute radio-exposures to the problem of chronic radio-exposures. This study is limited to the case of workers and to internal contamination by inhalation, but can be easily extended to other groups or other contamination types. The authors thus recall some fundamental data and definitions regarding values recommended by the ICRP for chronic radio-exposure and for acute exposure (acceptable exposure, accidental exposure, concerted exposure, units), present and comment how standards are practically applied for dose calculation and assessment. Formulas allow a quick assessment of radiological consequences of an acute radio-exposure, or vice-versa [fr

  4. Standard practice for torque calibration of testing machines and devices

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2009-01-01

    1.1 This practice covers procedures and requirements for the calibration of torque for static and quasi-static torque capable testing machines or devices. These may, or may not, have torque indicating systems and include those devices used for the calibration of hand torque tools. Testing machines may be calibrated by one of the three following methods or combination thereof: 1.1.1 Use of standard weights and lever arms. 1.1.2 Use of elastic torque measuring devices. 1.1.3 Use of elastic force measuring devices and lever arms. 1.1.4 Any of the methods require a specific uncertainty of measurement and a traceability derived from national standards of mass and length. 1.2 The procedures of 1.1.1, 1.1.2, and 1.1.3 apply to the calibration of the torque-indicating systems associated with the testing machine, such as a scale, dial, marked or unmarked recorder chart, digital display, etc. In all cases the buyer/owner/user must designate the torque-indicating system(s) to be calibrated and included in the repor...

  5. Pharmacovigilance Perceptions and Practice of Health Care ...

    African Journals Online (AJOL)

    This study aimed at documenting the perception and practice of pharmacovigilance amongst health workers in Lagos State. It also tried to identify the reasons for underreporting and steps that could be adapted to increase reporting rates in Nigeria. The study was a questionnaire based cross-sectional study. Multistage ...

  6. Digital atmospheres: affective practices of care in Elefriends.

    Science.gov (United States)

    Tucker, Ian M; Goodings, Lewis

    2017-05-01

    This article develops the concept of digital atmosphere to analyse the affective power of social media to shape practices of care and support for people living with mental distress. Using contemporary accounts of affective atmospheres, the article focuses on feelings of distress, support and care that unfold through digital atmospheres. The power of social media intersects with people's support and care-seeking practices in multiple ways and not in a straightforward model of 'accessing or providing support'. Indeed, we find that the caring relations developed through social media often need to be cared for themselves. The article draws on online and interview data from a larger project investigating how practices of care and support are (re)configured in the mental health-related social media site Elefriends. Users have to negotiate the disruption of moving support online, as well as the possibility of becoming subject to a fragility in care, in which caring for oneself becomes bound up in the ambiguities of caring for others. We argue that understanding how experiences of distress are shaped by social media is essential for understanding the implications of the increased digitisation of mental healthcare. © 2017 Foundation for the Sociology of Health & Illness.

  7. Practice versus politics in Danish day-care centers

    DEFF Research Database (Denmark)

    Clasen, Line; Jensen de López, Kristine M.

    2016-01-01

    or the programme users’ perspectives. This study sheds light on the practices of Danish pedagogues when engaging in shared book reading with children with the aim of: (1) foreseeing the success of the implementation of the first Danish ELP; and (2) comparing day-care centres’ practices to Danish ‘New Nordic School...

  8. Cost-Effectiveness Analysis of 1-Year Treatment with Golimumab/Standard Care and Standard Care Alone for Ulcerative Colitis in Poland.

    Directory of Open Access Journals (Sweden)

    Ewa Stawowczyk

    Full Text Available The objective of this study was to assess the cost-effectiveness of induction and maintenance treatment up to 1 year of ulcerative colitis with golimumab/standard care and standard care alone in Poland.A Markov model was used to estimate the expected costs and effects of golimumab/standard care and a standard care alone. For each treatment option the costs and quality adjusted life years were calculated to estimate the incremental cost-utility ratio. The analysis was performed from the perspective of the Polish public payer and society over a 30-years time horizon. The clinical parameters were derived mainly from the PURSUIT-SC and PURSUIT-M clinical trials. Different direct and indirect costs and utility values were assigned to the various model health states.The treatment of ulcerative colitis patients with golimumab/standard care instead of a standard care alone resulted in 0.122 additional years of life with full health. The treatment with golimumab/standard care was found to be more expensive than treatment with the standard care alone from the public payer perspective and from social perspective. The incremental cost-utility ratio of golimumab/standard care compared to the standard care alone is estimated to be 391,252 PLN/QALY gained (93,155 €/QALYG from public payer perspective and 374,377 PLN/QALY gained (89,137 €/QALYG from social perspective.The biologic treatment of ulcerative colitis patients with golimumab/standard care is more effective but also more costly compared with standard care alone.

  9. A survey of oral care practices in South African intensive care units ...

    African Journals Online (AJOL)

    The majority of nurses had had some formal training in oral care, but would appreciate an opportunity to improve their knowledge and skills. Conclusions. There is a variety of oral care practices for ventilated patients. The introduction of evidence-based oral care guidelines into units that do not currently have these ...

  10. Barriers to the Implementation of Continuity-of-Care Practices in Child Care Centers

    Science.gov (United States)

    Aguillard, Amber E.; Pierce, Sarah H.; Benedict, Joan H.; Burts, Diane C.

    2005-01-01

    This study examined barriers to the implementation of continuity-of-care practices in child care centers. We collected qualitative and quantitative data for 52 children at four centers that advertise their programs as continuity programs. Of the 52 children, only 7 of the children had been cared for in a single child-caregiver dyad between the…

  11. Cancer Survivorship Care in Advanced Primary Care Practices: A Qualitative Study of Challenges and Opportunities.

    Science.gov (United States)

    Rubinstein, Ellen B; Miller, William L; Hudson, Shawna V; Howard, Jenna; O'Malley, Denalee; Tsui, Jennifer; Lee, Heather Sophia; Bator, Alicja; Crabtree, Benjamin F

    2017-12-01

    Despite a decade of effort by national stakeholders to bring cancer survivorship to the forefront of primary care, there is little evidence to suggest that primary care has begun to integrate comprehensive services to manage the care of long-term cancer survivors. To explain why primary care has not begun to integrate comprehensive cancer survivorship services. Comparative case study of 12 advanced primary care practices in the United States recruited from March 2015 to February 2017. Practices were selected from a national registry of 151 workforce innovators compiled for the Robert Wood Johnson Foundation. Practices were recruited to include diversity in policy context and organizational structure. Researchers conducted 10 to 12 days of ethnographic data collection in each practice, including interviews with practice personnel and patient pathways with cancer survivors. Fieldnotes, transcripts, and practice documents were analyzed within and across cases to identify salient themes. Description of cancer survivorship care delivery in advanced patient-centered medical homes, including identification of barriers and promotional factors related to that care. The 12 practices came from multiple states and policy contexts and had a mix of clinicians trained in family or internal medicine. All but 3 were recognized as National Committee on Quality Assurance level 3 patient-centered medical homes. None of the practices provided any type of comprehensive cancer survivorship services. Three interdependent explanatory factors emerged: the absence of a recognized, distinct clinical category of survivorship in primary care; a lack of actionable information to treat this patient population; and current information systems unable to support survivorship care. To increase the potential for primary care transformation efforts to integrate survivorship services into routine care, survivorship must become a recognized clinical category with actionable care plans supported by a

  12. [Use of ineffective practices in Primary Health Care: professional opinions].

    Science.gov (United States)

    Domínguez Bustillo, L; Barrasa Villar, J I; Castán Ruíz, S; Moliner Lahoz, F J; Aibar Remón, C

    2014-01-01

    To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD]=1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  13. Early goal-directed nutrition versus standard of care in adult intensive care patients

    DEFF Research Database (Denmark)

    Allingstrup, Matilde Jo; Kondrup, Jens; Wiis, Jørgen

    2017-01-01

    estimated nutritional requirements by indirect calorimetry and 24-h urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition. In the standard of care group we aimed at providing 25 kcal/kg/day by enteral nutrition. If this was not met by day 7......Purpose: We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients. Methods: We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU. In the EGDN group we......, patients were supplemented with parenteral nutrition. The primary outcome was physical component summary (PCS) score of SF-36 at 6 months. We performed multiple imputation for data of the non-responders. Results: We randomised 203 patients and included 199 in the intention-to-treat analyses; baseline...

  14. An assessment of gynecological cytology screening practices among health care providers nationwide.

    Science.gov (United States)

    Darwish-Yassine, May; Garvin, Ann D; Johnston, Carolyn M; Zoschnick, Lauren; Conners, Amy; Laing, Shannon; Wojcik, Christopher

    2015-05-01

    The Michigan Public Health Institute and the Michigan Cancer Consortium's Cervical Cancer Committee conducted a national survey of health care providers, thanks to funding from the Centers for Disease Control Cooperative Agreement 5U47CI000743-02. Papanicolaou test screening practices were examined, emphasizing the relationship between clinical and laboratory practices. This survey found differing screening practices among providers of women's health care. To collect information from family medicine practitioners, women's nurse practitioners, obstetricians and gynecologists, and certified nurse-midwives on Papanicolaou and human papillomavirus testing; to discuss how those practices align with current cytology screening and follow-up recommendations from professional organizations (US Preventive Services Task Force, American Cancer Society, American College of Obstetricians and Gynecologists, and American Society for Colposcopy, and Cervical Pathology); and ultimately, to make recommendations aimed at standardizing practice performance. This survey was conducted in part to examine clinicians' practices and their perceptions of laboratory performance, to evaluate items that are known to enhance quality of care, and to examine factors that may prohibit universal implementation of best standards of care. The survey used a self-administered questionnaire, distributed to 9366 clinicians, with 1601 (17.1%) completed surveys. This assessment shows a clear lack of consensus among practitioners in performing Papanicolaou testing. It demonstrates how differently patients are tested, based on the providers' screening practices, and demonstrates specific cervical cancer screening practice disparities between and among the 4 provider groups, both in Papanicolaou testing and in the use of human papillomavirus testing. A unified mandate for screening is needed to standardize screening practices.

  15. Sexual Harassment of Newcomers in Elder Care. An Institutional Practice?

    Directory of Open Access Journals (Sweden)

    Jo Krøjer

    2014-03-01

    Full Text Available Sexual harassment is illegal and may have very damaging effects on the people exposed to it. One would expect organizations, employers, and institutions to take very good care to prevent employees from exposure to sexual harassment from anyone in their workplace. And yet, many people, mostly women, are exposed to sexual harassment at work. In care work, such behaviour is often directed toward their female caregiver by elderly citizens in need of care. Contemporary Nordic studies of working life and work environment have primarily investigated the interpersonal dimensions of sexual harassment, thus focusing on the relation between elderly citizens in need of care and their professional caregivers. In this article, we argue that sexual harassment from the elderly toward newcomers in elder care should also be seen as an effect of institutional practices. Based upon a Foucauldianinspired notion of practice-making, the article carries out a secondary analysis of three different empirical studies in order to explore how sexual harassment is produced and maintained through institutional practices in elder care. The term institution in this perspective includes three dimensions; a political, an educational (educational institutions in health and elder care, and a work organizational dimension. By examining elder care in these different dimensions, we identify how sexual harassment of professional caregivers is produced and maintained through institutional practice-making in elder care. The article thus contributes to our knowledge on working life by expanding and qualifying the understanding of the problematic working environment in care work, and by offering an alternative theoretical and analytical approach to the study of sexual harassment. Together, these insights suggest how elder care institutions might act to prevent sexual harassment toward caregivers.

  16. Depending on Practice: Paul Ricoeur and the Ethics of Care

    Directory of Open Access Journals (Sweden)

    Eoin Carney

    2015-09-01

    Full Text Available Continuing on from recent discussions on the overlap between Paul Ricoeur’s philosophy and care ethics, this article will aim to clarify the status of practice in Ricoeur’s work. I will argue that even though Ricoeur’s philosophy is indeed marked by its “desire for a foundation,” as care ethicist Joan Tronto has pointed out, this aim is more of a fragile wager than a principle, and is always at risk of being overturned by practices and other worldviews. I will demonstrate this point by arguing that (1 Ricoeur’s hermeneutic approach to practice leads to the view that objective methods of knowledge and explanation are always grounded by the broader hermeneutic task of practical understanding and care for the self; (2 in moral reasoning, Ricoeur’s analysis of the conflict between respect for the rule and respect for persons results in his prioritizing of respect for the singular other rather than the universal rule, meaning that the other can always disrupt and reorient universal or foundational modes of reasoning; and finally (3 within healthcare relations Ricoeur aims to develop an alternative understanding of respect that places it in a dialectical relation with care. These practice-oriented readings of hermeneutics, morality, and respect aim to open up a dialogue between care ethics and philosophical approaches that have often been placed outside of care ethics.

  17. Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

    DEFF Research Database (Denmark)

    Vester-Andersen, M; Waldau, T; Wetterslev, J

    2015-01-01

    in patients who had emergency abdominal surgery. METHODS: This was a randomized clinical trial carried out in seven Danish hospitals. Eligible for inclusion were patients with an Acute Physiology And Chronic Health Evaluation (APACHE) II score of at least 10 who were ready to be transferred to the surgical...... ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. RESULTS: In total, 286 patients were included in the modified intention-to-treat analysis. The trial......BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care...

  18. Intensive care nurses' practice related to experience and shift worked.

    Science.gov (United States)

    da Silva, Rafael Celestino; Ferreira, Márcia de Assunção; Apostolidis, Thémis

    2016-06-01

    To analyse the social representations of nurses about intensive care practices comparing the variables 1) time since graduation and 2) shift worked. Qualitative field research using social representation theory. Individual interviews were conducted and lexical analysis was applied. Intensive Care Unit of a federal hospital with 21 clinical nurses. Day shift nurses are more pragmatic and operationally oriented because they deal directly with the general functioning of the unit. Less experienced nurses face difficulties dealing with intensive care contexts, but have a critical view of their practices, while more experienced nurses apply practical knowledge in their decision-making and actions. The relationship of proximity or distance from patients, mediated by technology, is related to the domains of knowledge that are required to manage technology and to the role technology plays in intensive care. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Nursing satisfaction after standardizing the chronic wounds care

    Directory of Open Access Journals (Sweden)

    Francisco José García Sánchez

    2009-09-01

    Full Text Available The Management of Primary Attention of Ciudad Real and the Management of Area of Puertollano elaborated, jointly during year 2005, Manual in Prevention and a Treatment of Chronic Wounds with the objective to standardize and to protocol the welfare practice in this matter. During the month of February of 2006 an anonymous survey with 6 questions is elaborated to know the satisfaction the professionals after the implantation of this tool, presented/displayed a cross-sectional descriptive study that throws the following global results: The necessity to implant a manual is valued with 8,97 on 10. The format of pocket chosen for the manual is valued with 8,94 on 10. The presentation of the manual is valued with 8.88 on 10. Speakers are valued with 8,63 on 10. The contents of the manual obtain a score of 8.90 on 10. The utility of the manual is valued with 8.87 on 10.The results indicate that the professionals demanded a tool that standardized the clinical practice in the prevention and treatment of chronic wounds. It seems to be that it has been guessed right in the format of the same one (pocket and emphasizes the utility that they give the same one, although statistically significantly appear differences between both managements.

  20. Organizational Context Matters: A Research Toolkit for Conducting Standardized Case Studies of Integrated Care Initiatives

    Directory of Open Access Journals (Sweden)

    Jenna M. Evans

    2017-06-01

    Full Text Available Introduction: The variable success of integrated care initiatives has led experts to recommend tailoring design and implementation to the organizational context. Yet, organizational contexts are rarely described, understood, or measured with sufficient depth and breadth in empirical studies or in practice. We thus lack knowledge of when and specifically how organizational contexts matter. To facilitate the accumulation of evidence, we developed a research toolkit for conducting case studies using standardized measures of the (inter-organizational context for integrating care.  Theory and Methods: We used a multi-method approach to develop the research toolkit: (1 development and validation of the Context and Capabilities for Integrating Care (CCIC Framework, (2 identification, assessment, and selection of survey instruments, (3 development of document review methods, (4 development of interview guide resources, and (5 pilot testing of the document review guidelines, consolidated survey, and interview guide.  Results: The toolkit provides a framework and measurement tools that examine 18 organizational and inter-organizational factors that affect the implementation and success of integrated care initiatives.  Discussion and Conclusion: The toolkit can be used to characterize and compare organizational contexts across cases and enable comparison of results across studies. This information can enhance our understanding of the influence of organizational contexts, support the transfer of best practices, and help explain why some integrated care initiatives succeed and some fail.

  1. Collaborative care for depression in general practice

    DEFF Research Database (Denmark)

    Brinck-Claussen, Ursula Ødum; Curth, Nadja Kehler; Davidsen, Annette Sofie

    2017-01-01

    Background: Depression is a common illness with great human costs and a significant burden on the public economy. Previous studies have indicated that collaborative care (CC) has a positive effect on symptoms when provided to people with depression, but CC has not yet been applied in a Danish...... in the Capital Region of Denmark. The primary outcome is depression symptoms (Beck’s Depression Inventory (BDI-II)) after 6 months. Secondary outcomes include depression symptoms (BDI-II) after 15 months, anxiety symptoms (Beck’s Anxiety Inventory (BAI)), level of functioning (Global Assessment of Function (GAF...

  2. The Importance of Spiritual Care in Nursing Practice.

    Science.gov (United States)

    Veloza-Gómez, Mónica; Muñoz de Rodríguez, Lucy; Guevara-Armenta, Claudia; Mesa-Rodríguez, Sandra

    2016-02-12

    Explore what spiritual care means to nurses who work in emergency care units. Nine nursing professionals from an emergency care unit at a private health institution affiliated with the Universidad de La Sabana participated in this descriptive qualitative study. Nonparticipant observation, field notes, and in-depth interviews with a question guide were used to collect the data, which were analyzed by means of content analysis. Three themes and their corresponding subthemes were identified with respect to the significance of spiritual care: (1) interpretation of spiritual care, (2) the patient and the family in spiritual care, and (3) the role of the nurse in spiritual care. These findings provide a deeper understanding of spiritual care in terms of its significance. They also acknowledge its importance to nursing practice in emergency care units. The significance of spiritual care is based on theoretical, scientific, and humanistic points of reference (the discipline of nursing) that strengthen the therapeutic relationship between the patient/family-nurse dyad. The study also offers evidence for holistic nursing practice that requires theoretical-academic, administrative, and assistance support. © The Author(s) 2016.

  3. Communication that heals: mindful communication practices from palliative care leaders.

    Science.gov (United States)

    Omilion-Hodges, Leah M; Swords, Nathan M

    2016-01-01

    Though research has begun to highlight the centrality of communication in palliative care, studies have yet to focus on the use of mindful communication. Mindful communication is associated with increases in patient care and decreases in physician burnout. Through in-depth, semi-structured interviews the authors sought mindful communication practices from palliative care leaders in American Hospital Association Circle of Life® award-wining units. Four key mindful communication practices emerged: Know your audience, ask questions, discard scripts, and recognize your role. The discussion articulates how key mindful communication practices may be used as a stage model, where key practices may be used individually or in concert, by sole practitioners or within interdisciplinary teams and by new and seasoned clinicians. Theoretical contributions and areas for future inquiry are also discussed.

  4. Paving the way for a gold standard of care for infertility treatment: improving outcomes through standardization of laboratory procedures.

    Science.gov (United States)

    Schoolcraft, William; Meseguer, Marcos

    2017-10-01

    Infertility affects over 70 million couples globally. Access to, and interest in, assisted reproductive technologies is growing worldwide, with more couples seeking medical intervention to conceive, in particular by IVF. Despite numerous advances in IVF techniques since its first success in 1978, almost half of the patients treated remain childless. The multifactorial nature of IVF treatment means that success is dependent on many variables. Therefore, it is important to examine how each variable can be optimized to achieve the best possible outcomes for patients. The current approach to IVF is fragmented, with various protocols in use. A systematic approach to establishing optimum best practices may improve IVF success and live birth rates. Our vision of the future is that technological advancements in the laboratory setting are standardized and universally adopted to enable a gold standard of care. Implementation of best practices for laboratory procedures will enable clinicians to generate high-quality gametes, and to produce and identify gametes and embryos of maximum viability and implantation potential, which should contribute to improving take-home healthy baby rates. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2...... diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by insurance data analysis. Intervention: We compared protocol-based care management including structured assessment, action planning...

  6. How to practice person-centred care: A conceptual framework.

    Science.gov (United States)

    Santana, Maria J; Manalili, Kimberly; Jolley, Rachel J; Zelinsky, Sandra; Quan, Hude; Lu, Mingshan

    2018-04-01

    Globally, health-care systems and organizations are looking to improve health system performance through the implementation of a person-centred care (PCC) model. While numerous conceptual frameworks for PCC exist, a gap remains in practical guidance on PCC implementation. Based on a narrative review of the PCC literature, a generic conceptual framework was developed in collaboration with a patient partner, which synthesizes evidence, recommendations and best practice from existing frameworks and implementation case studies. The Donabedian model for health-care improvement was used to classify PCC domains into the categories of "Structure," "Process" and "Outcome" for health-care quality improvement. The framework emphasizes the structural domain, which relates to the health-care system or context in which care is delivered, providing the foundation for PCC, and influencing the processes and outcomes of care. Structural domains identified include: the creation of a PCC culture across the continuum of care; co-designing educational programs, as well as health promotion and prevention programs with patients; providing a supportive and accommodating environment; and developing and integrating structures to support health information technology and to measure and monitor PCC performance. Process domains describe the importance of cultivating communication and respectful and compassionate care; engaging patients in managing their care; and integration of care. Outcome domains identified include: access to care and Patient-Reported Outcomes. This conceptual framework provides a step-wise roadmap to guide health-care systems and organizations in the provision PCC across various health-care sectors. © 2017 The Authors Health Expectations published by John Wiley & Sons Ltd.

  7. [Healthcare professionals' knowledge, attitudes and practices in relation to standard hospital precautions].

    Science.gov (United States)

    Mandana Bambenongama, Norbert; Losimba Likwela, Joris

    2013-01-01

    The infectious risk in the healthcare setting is potentially ubiquitous. Several infectious agents may be transmitted to healthcare professionals, most of which are carried by blood and body fluids. The aim of this study was to assess knowledge, attitudes and practices of healthcare workers in delivery rooms and operating theatres about standard precautions in healthcare settings in order to deduce the actions to be implemented to improve their security. A descriptive cross-sectional survey was conducted in September 2011. A questionnaire was sent to 96 people using the direct interview technique. Only 20% of study subjects were familiar with the main bloodborne viruses (HBV, HCV and HIV). 67.8% of them considered that standard precautions must be applied only to women in labour and suspected HIV-positive patients. Almost all respondents (91.1%) had already been subject to at least one AES during the last 12 months. Respondents appeared to have a poor knowledge of the recommended actions following an AES. Recapping of needles after care is a practice reported by 55.6% of respondents. Routine use of protective barriers is unsatisfactory. The frequent failure of systematic application of standard precautions in healthcare settings by healthcare workers in the city of Isiro should lead the Ministry of Health to implement a process designed to increase awareness about standard precautions and improve the equipment necessary for strict compliance with these precautions.

  8. Palliative care in Enugu, Nigeria: Challenges to a new practice

    Directory of Open Access Journals (Sweden)

    Tonia C Onyeka

    2011-01-01

    Full Text Available Everyone, young and old, male and female, rich and poor, should have access to excellent care during the course of a serious illness and at the end of life. Therefore, a denial of such care becomes an infringement of the individual′s human rights. Because of the efforts of pioneers in this field of Medicine in Africa and beyond, both living and immortalized, we can now say that palliative care in the African context is affordable and achievable. In this article, some of the challenges faced in setting up and running a new palliative care practice in an emerging and developing economy are examined.

  9. 25 CFR 20.335 - What is the payment standard for Adult Care Assistance?

    Science.gov (United States)

    2010-04-01

    ... FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Direct Assistance Adult Care Assistance § 20.335 What is the payment standard for Adult Care Assistance? The approved payment for adult care assistance will... 25 Indians 1 2010-04-01 2010-04-01 false What is the payment standard for Adult Care Assistance...

  10. Monitoring the standard of care of diabetes mellitus type 2 in a ...

    African Journals Online (AJOL)

    Nadiah A. Alshaheen

    2011-09-26

    Sep 26, 2011 ... Monitoring the standard of care of diabetes mellitus type 2 ... Monitoring;. Compliance;. Primary center. Abstract Background: Complying of diabetic patients with the standard administered medical care at primary health care units is an important ... ical care and patient self-management education to prevent.

  11. Physical Activity Practices, Policies and Environments in Washington State Child Care Settings: Results of a Statewide Survey.

    Science.gov (United States)

    Tandon, Pooja S; Walters, Kelly M; Igoe, Bridget M; Payne, Elizabeth C; Johnson, Donna B

    2017-03-01

    Objectives Child care is an important setting for the promotion of physical activity (PA) in early childhood. The purpose of this study was to examine the associations between specific PA environments and recommended practices in child care settings as well as the degree to which child care settings met recommended standards for total PA time. Methods In 2013, all programs licensed to care for children ages 2-5 in WA state were surveyed about their PA related practices. Logistic regression was used to determine odds of meeting best-practice standards for outdoor time and PA. Results The response rate was 45.8 % from centers (692/1511) and 32.1 % from homes (1281/3991). Few programs reported meeting best-practice standards for the amount of time children spend being physically active (centers: 12.1 %, homes: 20.1 %) and outdoor time (centers: 21.8 %, homes: 21.7 %). Programs where children go outside regardless of weather and those reporting more adult-led PA had higher odds of meeting best-practice standards for both PA and outdoor time. Meeting best-practice standards for outdoor time was the strongest predictor of meeting best-practice standards for total PA time [centers: OR 15.9 (9.3-27.2), homes: OR 5.2 (3.8-7.1)]. Conclusions for Practice There is considerable room for improvement in licensed child care settings in WA to meet best-practice standards for young children's outdoor and PA time. Initiatives that create policies and environments encouraging outdoor play and adult-led PA in child care have the potential to increase physical activity in substantial numbers of young children.

  12. Virtual standardized patients: an interactive method to examine variation in depression care among primary care physicians

    Science.gov (United States)

    Hooper, Lisa M.; Weinfurt, Kevin P.; Cooper, Lisa A.; Mensh, Julie; Harless, William; Kuhajda, Melissa C.; Epstein, Steven A.

    2009-01-01

    Background Some primary care physicians provide less than optimal care for depression (Kessler et al., Journal of the American Medical Association 291, 2581–90, 2004). However, the literature is not unanimous on the best method to use in order to investigate this variation in care. To capture variations in physician behaviour and decision making in primary care settings, 32 interactive CD-ROM vignettes were constructed and tested. Aim and method The primary aim of this methods-focused paper was to review the extent to which our study method – an interactive CD-ROM patient vignette methodology – was effective in capturing variation in physician behaviour. Specifically, we examined the following questions: (a) Did the interactive CD-ROM technology work? (b) Did we create believable virtual patients? (c) Did the research protocol enable interviews (data collection) to be completed as planned? (d) To what extent was the targeted study sample size achieved? and (e) Did the study interview protocol generate valid and reliable quantitative data and rich, credible qualitative data? Findings Among a sample of 404 randomly selected primary care physicians, our voice-activated interactive methodology appeared to be effective. Specifically, our methodology – combining interactive virtual patient vignette technology, experimental design, and expansive open-ended interview protocol – generated valid explanations for variations in primary care physician practice patterns related to depression care. PMID:20463864

  13. A community collaborative to develop consensus guidelines to standardize out-of-hospital maintenance care of central venous catheters.

    Science.gov (United States)

    Nailon, Regina; Rupp, Mark E

    2015-01-01

    Central venous catheter (CVC) maintenance is integral to preventing complications and improving outcomes. This process is made more challenging when patients transition from hospital to home care or to an outpatient infusion setting, because different CVC maintenance practices and care parameters confuse patients and care providers alike. Through collaboration and consensus building, a group of metropolitan home health and home infusion agencies developed a standardized approach to CVC maintenance care. This article discusses the multiagency collaborative and resulting guideline and other educational materials that better enable providers, patients, and families to maintain CVC integrity and achieve optimal outcomes.

  14. Implementation strategy for advanced practice nursing in primary health care in Latin America and the Caribbean.

    Science.gov (United States)

    Oldenburger, David; De Bortoli Cassiani, Silvia Helena; Bryant-Lukosius, Denise; Valaitis, Ruta Kristina; Baumann, Andrea; Pulcini, Joyce; Martin-Misener, Ruth

    2017-06-08

    SYNOPSIS Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.

  15. Comparison between indigenous and Western postnatal care practices in Mopani District, Limpopo Province, South Africa

    Directory of Open Access Journals (Sweden)

    Roinah N. Ngunyulu

    2015-05-01

    Full Text Available Background: Postnatal care begins immediately after the expulsion of the placenta and continues for six to eight weeks post-delivery. High standard of care is required during the postnatal period because mothers and babies are at risk and vulnerable to complications related to postpartum haemorrhage and infections. Midwives and traditional birth attendants are responsible for the provision of postnatal care in different settings, such as clinics and hospitals, and homes. Methods: A qualitative, exploratory, descriptive and contextual research approach was followed in this study. Unstructured interviews were conducted with the traditional birth attendants. An integrated literature review was conducted to identify the Western postnatalcare practices. Tesch’s process was followed during data analysis. Findings: The following main categories were identified: similarities between indigenous and Western postnatal care practices, and differences between indigenous and Western postnatal care practices. Based on these findings, training of midwives and traditional birth attendants was recommended in order to empower them with knowledge and skills regarding the indigenous and Western postnatal care practices. Conclusions: It is evident that some indigenous postnatal care practices have adverse effects on the health of postnatal women and their newborn infants, but these are unknown to the traditional birth attendants. The employment of indigenous postnatal care practices by the traditional birth attendants is also influenced by their cultural beliefs, norms, values and attitudes. Therefore, there is an urgent need to train midwives and traditional birth attendants regarding the indigenous and Western postnatal care to improve the health of postnatal women and their babies.

  16. Comparison between indigenous and Western postnatal care practices in Mopani District, Limpopo Province, South Africa

    Directory of Open Access Journals (Sweden)

    Roinah N. Ngunyulu

    2015-02-01

    Full Text Available Background: Postnatal care begins immediately after the expulsion of the placenta and continues for six to eight weeks post-delivery. High standard of care is required during the postnatal period because mothers and babies are at risk and vulnerable to complications related to postpartum haemorrhage and infections. Midwives and traditional birth attendants are responsible for the provision of postnatal care in different settings, such as clinics and hospitals, and homes.Methods: A qualitative, exploratory, descriptive and contextual research approach was followed in this study. Unstructured interviews were conducted with the traditional birth attendants. An integrated literature review was conducted to identify the Western postnatalcare practices. Tesch’s process was followed during data analysis.Findings: The following main categories were identified: similarities between indigenous and Western postnatal care practices, and differences between indigenous and Western postnatal care practices. Based on these findings, training of midwives and traditional birth attendants was recommended in order to empower them with knowledge and skills regarding the indigenous and Western postnatal care practices.Conclusions: It is evident that some indigenous postnatal care practices have adverse effects on the health of postnatal women and their newborn infants, but these are unknown to the traditional birth attendants. The employment of indigenous postnatal care practices by the traditional birth attendants is also influenced by their cultural beliefs, norms, values and attitudes. Therefore, there is an urgent need to train midwives and traditional birth attendants regarding the indigenous and Western postnatal care to improve the health of postnatal women and their babies.

  17. Common care practices among effective community-based specialist palliative care teams: a qualitative study.

    Science.gov (United States)

    Seow, Hsien; Bainbridge, Daryl; Brouwers, Melissa; Bryant, Deanna; Tan Toyofuku, Sue; Kelley, Mary Lou

    2017-04-19

    Evidence has shown that, despite wide variation in models of care, community-based specialist palliative care teams can improve outcomes and reduce acute care use at end of life. The goal of this study was to explore similarities in care practices among effective and diverse specialist teams to inform the development of other community-based teams. Interviews with 78 providers and administrators from 11 distinct community-based specialist palliative care teams from Ontario, Canada were conducted. Interviews were audio-recorded, transcribed and analysed using an inductive approach to identify common themes. 3 key themes across all teams emerged. First, the distinct models of care were generally summarised into 3 models: primary care and specialist providers either collaborated by transferring, sharing or consulting in care. Second, teams explicitly or implicitly followed 7 common care practices related to: specialised expertise 24/7; intrateam communication; timeliness; physical symptom and psychosocial-spiritual management; education; peace and fulfilment; and advocacy for patient preferences. Third, all teams emphasised the importance of team building, even more than using clinical tools and processes. Despite wide variation in models of care among community-based specialist palliative care teams, this large qualitative study identified several common themes in care practices that can guide the development of other teams. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  18. Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care.

    Science.gov (United States)

    Cifuentes, Maribel; Davis, Melinda; Fernald, Doug; Gunn, Rose; Dickinson, Perry; Cohen, Deborah J

    2015-01-01

    clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators. © Copyright 2015 by the American Board of Family Medicine.

  19. Cost-Utility Analysis of Infliximab with Standard Care versus Standard Care Alone for Induction and Maintenance Treatment of Patients with Ulcerative Colitis in Poland.

    Science.gov (United States)

    Stawowczyk, Ewa; Kawalec, Paweł; Pilc, Andrzej

    2016-05-01

    To assess the cost-effectiveness of infliximab with standard care (e.g., azathioprine, prednisolone, mesalazine, and 6-mercaptopurine) versus standard care alone for induction and maintenance treatment of patients with ulcerative colitis (UC) in Poland. Cost-utility decision analytic model. A Markov model was used to estimate the expected costs and effects of infliximab/standard care and standard care alone. For each treatment option, costs and quality-adjusted life-years (QALYs) were calculated to estimate the incremental cost-utility ratio. The target population consisted of a hypothetical cohort of adult patients with moderately to severely active UC who had an inadequate response to standard treatment, including corticosteroids and 6-mercaptopurine or azathioprine, or who were intolerant to or had medical contraindications to such therapies. The analysis was performed from the perspective of the Polish public payer over a 30-year time horizon. The clinical parameters were derived mainly from the Active Ulcerative Colitis Trial (ACT) 1 and ACT 2 and from the Ulcerative Colitis Long-term Remission and Maintenance with Adalimumab (ULTRA) 2 clinical trial. Different costs and utility values were assigned to the various health states in the model; utility values were derived from a previously published study. Treatment of patients who received infliximab/standard care instead of standard care alone resulted in 0.174 additional QALYs. Treatment with infliximab/standard care was found to be more expensive than treatment with standard care alone from the Polish National Health Fund perspective. The incremental cost-utility ratio of infliximab/standard care compared with standard care alone was estimated to be 402,420 Polish zlotys (PLN)/QALY gained (95% confidence interval [CI] 253,936-531,450 PLN/QALY gained), which is equivalent to $106,743 (U.S. dollars)/QALY gained (95% CI $67,357-140,968 [U.S. dollars]/QALY gained). Treatment with infliximab/standard care instead

  20. Practical ethical theory for nurses responding to complexity in care.

    Science.gov (United States)

    Fairchild, Roseanne Moody

    2010-05-01

    In the context of health care system complexity, nurses need responsive leadership and organizational support to maintain intrinsic motivation, moral sensitivity and a caring stance in the delivery of patient care. The current complexity of nurses' work environment promotes decreases in work motivation and moral satisfaction, thus creating motivational and ethical dissonance in practice. These and other work-related factors increase emotional stress and burnout for nurses, prompting both new and seasoned nurse professionals to leave their current position, or even the profession. This article presents a theoretical conceptual model for professional nurses to review and make sense of the ethical reasoning skills needed to maintain a caring stance in relation to the competing values that must coexist among nurses, health care administrators, patients and families in the context of the complex health care work environments in which nurses are expected to practice. A model, Nurses' Ethical Reasoning Skills, is presented as a framework for nurses' thinking through and problem solving ethical issues in clinical practice in the context of complexity in health care.

  1. Consumerism: forcing medical practices toward patient-centered care.

    Science.gov (United States)

    Ozmon, Jeff

    2007-01-01

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

  2. In search of joy in practice: a report of 23 high-functioning primary care practices.

    Science.gov (United States)

    Sinsky, Christine A; Willard-Grace, Rachel; Schutzbank, Andrew M; Sinsky, Thomas A; Margolius, David; Bodenheimer, Thomas

    2013-01-01

    We highlight primary care innovations gathered from high-functioning primary care practices, innovations we believe can facilitate joy in practice and mitigate physician burnout. To do so, we made site visits to 23 high-performing primary care practices and focused on how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make the job of primary care feasible and enjoyable as a life's vocation. Innovations identified include (1) proactive planned care, with previsit planning and previsit laboratory tests; (2) sharing clinical care among a team, with expanded rooming protocols, standing orders, and panel management; (3) sharing clerical tasks with collaborative documentation (scribing), nonphysician order entry, and streamlined prescription management; (4) improving communication by verbal messaging and in-box management; and (5) improving team functioning through co-location, team meetings, and work flow mapping. Our observations suggest that a shift from a physician-centric model of work distribution and responsibility to a shared-care model, with a higher level of clinical support staff per physician and frequent forums for communication, can result in high-functioning teams, improved professional satisfaction, and greater joy in practice.

  3. Sustainable ubiquitous home health care--architectural considerations and first practical experiences.

    Science.gov (United States)

    Marschollek, Michael; Wolf, Klaus-H; Bott, Oliver-J; Geisler, Mirko; Plischke, Maik; Ludwig, Wolfram; Hornberger, Andreas; Haux, Reinhold

    2007-01-01

    Despite the abundance of past home care projects and the maturity of the technologies used, there is no widespread dissemination as yet. The absence of accepted standards and thus interoperability and the inadequate integration into transinstitutional health information systems (tHIS) are perceived as key factors. Based on the respective literature and previous experiences in home care projects we propose an architectural model for home care as part of a transinstitutional health information system using the HL7 clinical document architecture (CDA) as well as the HL7 Arden Syntax for Medical Logic Systems. In two short case studies we describe the practical realization of the architecture as well as first experiences. Our work can be regarded as a first step towards an interoperable - and in our view sustainable - home care architecture based on a prominent document standard from the health information system domain.

  4. Best Practices for Chiropractic Care of Children: A Consensus Update.

    Science.gov (United States)

    Hawk, Cheryl; Schneider, Michael J; Vallone, Sharon; Hewitt, Elise G

    2016-01-01

    Chiropractic care is the most common complementary and integrative medicine practice used by children in the United States, and it is used frequently by children internationally as well. The purpose of this project was to update the 2009 recommendations on best practices for chiropractic care of children. A formal consensus process was completed based on the existing recommendations and informed by the results of a systematic review of relevant literature from January 2009 through March 2015. The primary search question for the systematic review was, "What is the effectiveness of chiropractic care, including spinal manipulation, for conditions experienced by children (chiropractic care including spinal manipulation among children (chiropractic management of infants, children, and adolescents. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  5. Neonatal care practices in sub-Saharan Africa: a systematic review of quantitative and qualitative data.

    Science.gov (United States)

    Bee, Margaret; Shiroor, Anushree; Hill, Zelee

    2018-04-16

    from five countries (Ethiopia, Ghana, Malawi, Tanzania and Uganda). There is a need for more research from a wider geographical area, more research on newborn care practices at health facilities and standardization in measuring newborn care practices. The findings of this study could inform behaviour change interventions to improve the uptake of immediate newborn care practices.

  6. Realising dignity in care home practice: an action research project.

    Science.gov (United States)

    Gallagher, Ann; Curtis, Katherine; Dunn, Michael; Baillie, Lesley

    2017-06-01

    More than 400,000 older people reside in over 18,000 care homes in England. A recent social care survey found up to 50% of older people in care homes felt their dignity was undermined. Upholding the dignity of older people in care homes has implications for residents' experiences and the role of Registered Nurses. The study aimed to explore how best to translate the concept of dignity into care home practice, and how to support this translation process by enabling Registered Nurses to provide ethical leadership within the care home setting. Action research with groups of staff (Registered Nurses and non-registered caregivers) and groups of residents and relatives in four care homes in the south of England to contribute to the development of the dignity toolkit. Action research groups were facilitated by 4 researchers (2 in each care home) to discuss dignity principles and experiences within care homes. These groups reviewed and developed a dignity toolkit over six cycles of activity (once a month for 6 months). The Registered Nurses were individually interviewed before and after the activity. Hard copy and online versions of a dignity toolkit, with tailored versions for participating care homes, were developed. Registered Nurses and caregivers identified positive impact of making time for discussion about dignity-related issues. Registered Nurses identified ongoing opportunities for using their toolkit to support all staff. Nurses and caregivers expressed feelings of empowerment by the process of action research. The collaborative development of a dignity toolkit within each care home has the potential to enable ethical leadership by Registered Nurses that would support and sustain dignity in care homes. Action research methods empower staff to maintain dignity for older people within the care home setting through the development of practically useful toolkits to support everyday care practice. Providing opportunities for caregivers to be involved in such

  7. Future improvements and implementation of animal care practices within the animal testing regulatory environment.

    Science.gov (United States)

    Guittin, Pierre; Decelle, Thierry

    2002-01-01

    Animal welfare is an increasingly important concern when considering biomedical experimentation. Many of the emerging regulations and guidelines specifically address animal welfare in laboratory animal care and use. The current revision of the appendix of the European Convention, ETS123 (Council of Europe), updates and improves on the current animal care standardization in Europe. New guidelines from the Organisation for Economic Co-operation and Development and the European Federation of Pharmaceutical Industries Association focus specifically on safety testing. These guidelines will affect the way toxicity studies are conducted and therefore the global drug development process. With the 3Rs principles taken into account, consideration regarding animal welfare will demand changes in animal care practices in regulatory safety testing. The most significant future improvements in animal care and use practices are likely to be environmental enrichment, management of animal pain and distress, and improved application of the humane endpoints. Our challenge is to implement respective guidelines based on scientific data and animal welfare, through a complex interplay of regulatory objective and public opinion. The current goal is to work toward solutions that continue to provide relevant animal models for risk assessment in drug development and that are science based. In this way, future improvements in animal care and use practices can be founded on facts, scientific results, and analysis. Some of these improvements become common practice in some countries. International harmonization can facilitate the development and practical application of "best scientific practices" by the consensus development process that harmonization requires. Since the implementation of good laboratory practices (GLP) standards in safety testing, these new regulations and recommendations represent a new way forward for animal safety studies.

  8. The Practice Guidelines for Primary Care of Acute Abdomen 2015.

    Science.gov (United States)

    Mayumi, Toshihiko; Yoshida, Masahiro; Tazuma, Susumu; Furukawa, Akira; Nishii, Osamu; Shigematsu, Kunihiro; Azuhata, Takeo; Itakura, Atsuo; Kamei, Seiji; Kondo, Hiroshi; Maeda, Shigenobu; Mihara, Hiroshi; Mizooka, Masafumi; Nishidate, Toshihiko; Obara, Hideaki; Sato, Norio; Takayama, Yuichi; Tsujikawa, Tomoyuki; Fujii, Tomoyuki; Miyata, Tetsuro; Maruyama, Izumi; Honda, Hiroshi; Hirata, Koichi

    2016-01-01

    Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine in collaboration with four other medical societies launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines [all clinical questions (CQs) and recommendations are shown in supplementary information]. A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on 9 subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen.

  9. Economies of scope in Danish primary care practices

    DEFF Research Database (Denmark)

    Kristensen, Troels; Rose Olsen, Kim

    2011-01-01

    Aim: We analyze total operating costs and activities in Danish General Practice units to assess whether there are unexploited economies of scope in the production of primary care services. Methods: We apply stochastic frontier analysis to derive cost functions and associated cost complementarities...... between GP services and overall economies of scope. Data: Cross-section data for a sample of 331 primary care practices with 1-8 GPs from the year 2006. This is a unique combined dataset consisting of survey and register data. Results: We find a trend towards cost complementarities between the production...

  10. Primary care providers' lived experiences of genetics in practice.

    Science.gov (United States)

    Harding, Brittany; Webber, Colleen; Ruhland, Lucia; Dalgarno, Nancy; Armour, Christine M; Birtwhistle, Richard; Brown, Glenn; Carroll, June C; Flavin, Michael; Phillips, Susan; MacKenzie, Jennifer J

    2018-04-26

    To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners' additional concerns included cost, distance, and poor patient engagement. PCPs' perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.

  11. Interprofessional practice in different patient care settings: A qualitative exploration.

    Science.gov (United States)

    DiazGranados, Deborah; Dow, Alan W; Appelbaum, Nital; Mazmanian, Paul E; Retchin, Sheldon M

    2018-03-01

    Increasing interprofessional practice is seen as a path to improved quality, decreased cost, and enhanced patient experience. However, little is known about how context shapes interprofessional work and how interventions should be crafted to account for a specific setting of interprofessional practice. To better understand, how the work of interprofessional practice differs across patient care settings we sought to understand the social processes found in varying work contexts to better understand how care is provided. A case study design was used in this study to yield a picture of patient care across three different settings. Qualitative analysis of teams from three healthcare settings (rehabilitation, acute care, and code team) was conducted, through the use of ten in-depth semi-structured interviews. Interview data from each participant were analyzed via an inductive content analysis approach based upon theories of work and teams from organisational science, a framework for interprofessional practice, and competencies for interprofessional education. The work processes of interprofessional practice varied across settings. Information exchange was more physician-centric and decision-making was more physician dominant in the non-rehabilitation settings. Work was described as concurrent only for the code team. Goal setting varied by setting and interpersonal relationships were only mentioned as important in the rehabilitation setting. The differences observed across settings identify some insights into how context shapes the process of interprofessional collaboration and some research questions that need further study.

  12. Perspectives from practice: complexities of personal care workers.

    Science.gov (United States)

    Martyn, Julie-Anne; Zanella, Sally; Wilkinson, Adele

    2017-11-14

    Personal care workers (PCWs) make up the bulk of the workforce in residential and community care services. The knowledge and skill set needed for safe and effective practice in care settings is extensive. A diverse range of registered training organisations (RTOs) offering Certificate III and IV in Individual Support (aging, home and community) are tasked with producing job-ready PCWs. However, the curricula of these programs vary. Additionally, a national code of conduct for healthcare workers became effective in October 2015 as a governance framework for PCWs. The language of the code statements is ambiguous making it unclear how this framework should be translated by RTOs and applied in the preservice practice preparation of PCWs. Employers of PCWs need to feel confident that the content of the preservice education of PCWs satisfactorily prepares them for the diverse contexts of their practice. Likewise, the health professionals who supervise PCWs must be assured about the knowledge and skills of the PCW if they are to safely delegate care activities. The perspectives presented in this discussion make it clear that investigation into the nebulous nature of PCW education, regulation and practice is needed to identify the shortcomings and enable improved practice.

  13. Long-Term Care Workforce Issues: Practice Principles for Quality Dementia Care.

    Science.gov (United States)

    Gilster, Susan D; Boltz, Marie; Dalessandro, Jennifer L

    2018-01-18

    This article is one in a series of articles in this supplement addressing best practice for quality dementia care. The Alzheimer's Association, in revising their Dementia Care Practice Recommendations for 2017 has identified staff across the long-term care spectrum as a distinct and important determinant of quality dementia care. The purpose of this article is to highlight areas for developing and supporting a dementia-capable workforce. The Alzheimer's Association Principles For Advocacy To Assure Quality Dementia Care Across Settings provide a framework to examine interventions to support the dementia care workforce in long-term care settings. Evidence-based approaches that represent these principles are discussed: (a) staffing, (b) staff training, (c) compensation, (d) supportive work environments, (e) career growth and retention, and (f) engagement with family. Although not all settings currently require attention to the principles described, this article proposes these principles as best practice recommendations. Recommendations and future research considerations to further improve the lives of those who live and work in nursing homes, assisted living, hospice, and home care, are proposed. Additional areas to improve the quality of a dementia care workforce person-centered care information, communication and interdepartmental teamwork, and ongoing evaluation are discussed. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. The senses in practice: enhancing the quality of care for residents with dementia in care homes.

    Science.gov (United States)

    Brown Wilson, Christine; Swarbrick, Caroline; Pilling, Mark; Keady, John

    2013-01-01

    The study aimed to develop, deliver, and evaluate a training programme in care homes to enhance the quality of care for people living with dementia based on the principles of relationship-centred care expressed through the Senses Framework. There are increasing numbers of people living with dementia worldwide with a growing proportion requiring residential long-term care. This makes the quest for enhancing the quality of care and quality of life for people with dementia ever more pressing. A mixed-methods design was used adopting a Practice Development approach. The findings from one care home in the North West of England are reported. Eight facilitated workshops based on the principles of relationship-centred care were completed and evaluated in 2010, using pre- and postintervention design. A focus group was undertaken with staff on completion of the study to gain a more comprehensive understanding of the practice/training context, augmented by case examples of changes in practice identified from the study workshops. Structured questionnaires were used to profile the care home before and after the training. Following the workshops, staff felt more able to collect and use biographical information. In particular, staff reported how this information supported them to initiate meaningful conversations with the person with dementia as part of everyday care routines, thus improving overall feelings of well-being. Using a biographical approach to care planning structured through the Senses Framework helped staff to develop a greater understanding of the person with dementia. © 2012 Blackwell Publishing Ltd.

  15. Knowledge and practice related to gestational diabetes among primary health care providers in Morocco: Potential for a defragmentation of care?

    Science.gov (United States)

    Utz, Bettina; Assarag, Bouchra; Essolbi, Amina; Barkat, Amina; Delamou, Alexandre; De Brouwere, Vincent

    2017-08-01

    The objective of this study was to assess knowledge and practices of general practitioners, nurses and midwives working at primary health care facilities in Morocco regarding screening and management of gestational diabetes (GDM). Structured interviews with 100 doctors, midwives and nurses at 44 randomly selected public health care centers were conducted in Marrakech and Al Haouz. All data were descriptively analyzed. Ethical approval for the study was granted by the institutional review boards in Belgium and Morocco. Public primary health care providers have a basic understanding of gestational diabetes but screening and management practices are not uniform. Although 56.8% of the doctors had some pre-service training on gestational diabetes, most nurses and midwives lack such training. After diagnosing GDM, 88.5% of providers refer patients to specialists, only 11.5% treat them as outpatients. Updating knowledge and skills of providers through both pre- and in-service-training needs to be supported by uniform national standards enabling first line health care workers to manage women with GDM and thus increase access and provide a continuity in care. Findings of this study will be used to pilot a model of GDM screening and initial management through the primary level of care. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  16. The quality of COPD care in general practice

    DEFF Research Database (Denmark)

    Rasmussen, F.V.; Borgeskov, H.; Dollerup, J.

    2008-01-01

    We investigated whether the quality of management of COPD in general practice could be improved by the participation of general practitioners and their staff in a COPD-specific educational programme. One-hundred and fifty-four doctors participated in the study, and 2549 patient record forms were...... programme can improve the quality of COPD care in general practice Udgivelsesdato: 2008/8/25...

  17. Digital health technology and trauma: development of an app to standardize care.

    Science.gov (United States)

    Hsu, Jeremy M

    2015-04-01

    Standardized practice results in less variation, therefore reducing errors and improving outcome. Optimal trauma care is achieved through standardization, as is evidenced by the widespread adoption of the Advanced Trauma Life Support approach. The challenge for an individual institution is how does one educate and promulgate these standardized processes widely and efficiently? In today's world, digital health technology must be considered in the process. The aim of this study was to describe the process of developing an app, which includes standardized trauma algorithms. The objective of the app was to allow easy, real-time access to trauma algorithms, and therefore reduce omissions/errors. A set of trauma algorithms, relevant to the local setting, was derived from the best available evidence. After obtaining grant funding, a collaborative endeavour was undertaken with an external specialist app developing company. The process required 6 months to translate the existing trauma algorithms into an app. The app contains 32 separate trauma algorithms, formatted as a single-page flow diagram. It utilizes specific smartphone features such as 'pinch to zoom', jump-words and pop-ups to allow rapid access to the desired information. Improvements in trauma care outcomes result from reducing variation. By incorporating digital health technology, a trauma app has been developed, allowing easy and intuitive access to evidenced-based algorithms. © 2015 Royal Australasian College of Surgeons.

  18. The use of an integrated care pathway for evidence-based practice and clinical governance in abortion care.

    Science.gov (United States)

    Graham, O; Jayadeva, P; Guthrie, K

    2010-05-01

    The aim of the study was to assess the effectiveness of an integrated care pathway (ICP) for delivery of evidence-based practice in abortion care. All women re-admitted after an abortion had their records audited for adherence to national and local guidelines using information in the ICP and general gynaecology case notes. A total of 100 women were re-admitted into the gynaecological wards of hospitals in Hull and East Riding of Yorkshire after an abortion, between January 2000 and December 2006. Out of 8,476 medical or surgical induced abortions undertaken at 14 weeks gestation or under, the overall readmission rate was 1.2%. The ICP showed that 97% of women had chlamydia screening prior to the abortion; all women had a contraceptive discussion and 43% left using a long-acting reversible method of contraception (LARC). However, data outside the care pathway was not documented, and hence the standard of care given on readmission was difficult to locate and variable in quality. The ICP clinical record is demonstrated to be a useful tool for high quality record-keeping and ensuring all patients receive the same standard of pre-assessment care. Although this service has an acceptably low-risk profile in terms of re-admission, we propose the addition of a re-admission episode to the current ICP to further enhance clinical care post-abortion.

  19. Requirements for a minimum standard of care for phenylketonuria: the patients’ perspective

    Science.gov (United States)

    2013-01-01

    Phenylketonuria (PKU, ORPHA716) is an inherited disorder that affects about one in every 10,000 children born in Europe. Early and continuous application of a modified diet is largely successful in preventing the devastating brain damage associated with untreated PKU. The management of PKU is inconsistent: there are few national guidelines, and these tend to be incomplete and implemented sporadically. In this article, the first-ever pan- European patient/carer perspective on optimal PKU care, the European Society for Phenylketonuria and Allied Disorders (E.S.PKU) proposes recommendations for a minimum standard of care for PKU, to underpin the development of new pan-European guideline for the management of PKU. New standards of best practice should guarantee equal access to screening, treatment and monitoring throughout Europe. Screening protocols and interpretation of screening results should be standardised. Experienced Centres of Expertise are required, in line with current European Union policy, to guarantee a defined standard of multidisciplinary treatment and care for all medical and social aspects of PKU. Women of childbearing age require especially intensive management, due to the risk of severe risks to the foetus conferred by uncontrolled PKU. All aspects of treatment should be reimbursed to ensure uniform access across Europe to guideline-driven, evidence-based care. The E.S.PKU urges PKU healthcare professionals caring for people with PKU to take the lead in developing evidence based guidelines on PKU, while continuing to play an active role in serving as the voice of patients and their families, whose lives are affected by the condition. PMID:24341788

  20. Conscientious objection to sexual and reproductive health services: international human rights standards and European law and practice.

    Science.gov (United States)

    Zampas, Christina; Andión-Ibañez, Ximena

    2012-06-01

    The practice of conscientious objection often arises in the area of individuals refusing to fulfil compulsory military service requirements and is based on the right to freedom of thought, conscience and religion as protected by national, international and regional human rights law. The practice of conscientious objection also arises in the field of health care, when individual health care providers or institutions refuse to provide certain health services based on religious, moral or philosophical objections. The use of conscientious objection by health care providers to reproductive health care services, including abortion, contraceptive prescriptions, and prenatal tests, among other services is a growing phenomena throughout Europe. However, despite recent progress from the European Court of Human Rights on this issue (RR v. Poland, 2011), countries and international and regional bodies generally have failed to comprehensively and effectively regulate this practice, denying many women reproductive health care services they are legally entitled to receive. The Italian Ministry of Health reported that in 2008 nearly 70% of gynaecologists in Italy refuse to perform abortions on moral grounds. It found that between 2003 and 2007 the number of gynaecologists invoking conscientious objection in their refusal to perform an abortion rose from 58.7 percent to 69.2 percent. Italy is not alone in Europe, for example, the practice is prevalent in Poland, Slovakia, and is growing in the United Kingdom. This article outlines the international and regional human rights obligations and medical standards on this issue, and highlights some of the main gaps in these standards. It illustrates how European countries regulate or fail to regulate conscientious objection and how these regulations are working in practice, including examples of jurisprudence from national level courts and cases before the European Court of Human Rights. Finally, the article will provide recommendations

  1. Rethinking the intensive care environment: considering nature in nursing practice.

    Science.gov (United States)

    Minton, Claire; Batten, Lesley

    2016-01-01

    With consideration of an environmental concept, this paper explores evidence related to the negative impacts of the intensive care unit environment on patient outcomes and explores the potential counteracting benefits of 'nature-based' nursing interventions as a way to improve care outcomes. The impact of the environment in which a patient is nursed has long been recognised as one determinant in patient outcomes. Whilst the contemporary intensive care unit environment contains many features that support the provision of the intensive therapies the patient requires, it can also be detrimental, especially for long-stay patients. This narrative review considers theoretical and evidence-based literature that supports the adoption of nature-based nursing interventions in intensive care units. Research and theoretical literature from a diverse range of disciplines including nursing, medicine, psychology, architecture and environmental science were considered in relation to patient outcomes and intensive care nursing practice. There are many nature-based interventions that intensive care unit nurses can implement into their nursing practice to counteract environmental stressors. These interventions can also improve the environment for patients' families and nurses. Intensive care unit nurses must actively consider and manage the environment in which nursing occurs to facilitate the best patient outcomes. © 2015 John Wiley & Sons Ltd.

  2. 75 FR 20901 - Standards for Business Practices and Communication Protocols for Public Utilities

    Science.gov (United States)

    2010-04-22

    ...; Order No. 676-F] Standards for Business Practices and Communication Protocols for Public Utilities... practices and electronic communications for public utilities)\\1\\ to incorporate by reference business... members. \\4\\ See Standards for Business Practices and Communication Protocols for Public Utilities, Order...

  3. 77 FR 24427 - Standards for Business Practices and Communication Protocols for Public Utilities

    Science.gov (United States)

    2012-04-24

    ...] Standards for Business Practices and Communication Protocols for Public Utilities AGENCY: Federal Energy... Standards for Business Practices and Communication Protocols for Public Utilities, Order No. 676, FERC Stats... Business Practices and Communication Protocols for Public Utilities, Order No. 676-F, FERC Stats. & Regs...

  4. 78 FR 14654 - Standards for Business Practices and Communication Protocols for Public Utilities

    Science.gov (United States)

    2013-03-07

    ...; Order No. 676-G] Standards for Business Practices and Communication Protocols for Public Utilities... practices and electronic communications for public utilities to incorporate by reference updated business... regulations at 18 CFR 38.2(a) (which establish standards for business practices and electronic communications...

  5. Developing a prenatal nursing care International Classification for Nursing Practice catalogue.

    Science.gov (United States)

    Liu, L; Coenen, A; Tao, H; Jansen, K R; Jiang, A L

    2017-09-01

    This study aimed to develop a prenatal nursing care catalogue of International Classification for Nursing Practice. As a programme of the International Council of Nurses, International Classification for Nursing Practice aims to support standardized electronic nursing documentation and facilitate collection of comparable nursing data across settings. This initiative enables the study of relationships among nursing diagnoses, nursing interventions and nursing outcomes for best practice, healthcare management decisions, and policy development. The catalogues are usually focused on target populations. Pregnant women are the nursing population addressed in this project. According to the guidelines for catalogue development, three research steps have been adopted: (a) identifying relevant nursing diagnoses, interventions and outcomes; (b) developing a conceptual framework for the catalogue; (c) expert's validation. This project established a prenatal nursing care catalogue with 228 terms in total, including 69 nursing diagnosis, 92 nursing interventions and 67 nursing outcomes, among them, 57 nursing terms were newly developed. All terms in the catalogue were organized by a framework with two main categories, i.e. Expected Changes of Pregnancy and Pregnancy at Risk. Each category had four domains, representing the physical, psychological, behavioral and environmental perspectives of nursing practice. This catalogue can ease the documentation workload among prenatal care nurses, and facilitate storage and retrieval of standardized data for many purposes, such as quality improvement, administration decision-support and researches. The documentations of prenatal care provided data that can be more fluently communicated, compared and evaluated across various healthcare providers and clinic settings. © 2016 International Council of Nurses.

  6. Health care waste management practice in a hospital.

    Science.gov (United States)

    Paudel, R; Pradhan, B

    2010-10-01

    Health-care waste is a by-product of health care. Its poor management exposes health-care workers, waste handlers and the community to infections, toxic effects and injuries including damage of the environment. It also creates opportunities for the collection of disposable medical equipment, its re-sale and potential re-use without sterilization, which causes an important burden of disease worldwide. The purpose of this study was to find out health care waste management practice in hospital. A cross-sectional study was conducted in Narayani Sub-Regional Hospital, Birgunj from May to October 2006 using both qualitative and quantitative methods. Study population was four different departments of the hospital (Medical/Paediatric, Surgical/Ortho, Gynae/Obstetric and Emergency), Medical Superintendent, In-charges of four different departments and all sweepers. Data was collected using interview, group discussion, observation and measurement by weight and volume. Total health-care waste generated was 128.4 kg per day while 0.8 kg per patient per day. The composition of health care waste was found to be 96.8 kg (75.4%) general waste, 24.1 kg (8.8%) hazardous waste and 7.5 kg (5.8%) sharps per day by weight. Health staffs and sweepers were not practicing the waste segregation. Occupational health and safety was not given due attention. Majority of the sweepers were unaware of waste management and need of safety measures to protect their own health. Health care waste management practice in the hospital was unsatisfactory because of the lack of waste management plan and carelessness of patients, visitors and staffs. Therefore the hospital should develop the waste management plan and strictly follow the National Health Care Waste Management Guideline.

  7. Characteristics of primary care practices associated with high quality of care.

    Science.gov (United States)

    Beaulieu, Marie-Dominique; Haggerty, Jeannie; Tousignant, Pierre; Barnsley, Janet; Hogg, William; Geneau, Robert; Hudon, Éveline; Duplain, Réjean; Denis, Jean-Louis; Bonin, Lucie; Del Grande, Claudio; Dragieva, Natalyia

    2013-09-03

    No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0-35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8-14.4), presence of allied health professionals (15.3; 95% CI 5.4-25.2) and/or specialist physicians (19.6; 95% CI 8.3-30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0-12.4) and average organizational access to the practice (4.9; 95% CI 2.6-7.2). The number of physicians (1.2; 95% CI 0.6-1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1-2.5) were modestly associated with high-quality care. We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.

  8. Diabetic foot care: Self reported knowledge and practice among ...

    African Journals Online (AJOL)

    Background: Diabetes Mellitus (DM) foot complications are a leading cause of mortality in developing countries and the prevalence of diabetes is expected to increase in the next decades in these countries. The aim of this study was to determine the knowledge and practice of foot care among diabetes patients attending ...

  9. Values and Ethics in Child and Youth Care Practice

    Science.gov (United States)

    Gharabaghi, Kiaras

    2008-01-01

    The implications of the practitioner's personal values are explored in relation to the professional issues of child and youth care practice. Values are inevitably a component of decision-making and therefore are integrally connected to ethics in the field. The prevalence of subjectivity over objectivity is emphasized in relation to in-the-moment…

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

    NARCIS (Netherlands)

    Hiddink, G.J.

    1996-01-01


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

  11. Involvement of the Client in Home Care Practice

    DEFF Research Database (Denmark)

    Glasdam, Stinne; Kjær, Lone; Præstegaard, Jeanette

    Background: Through the last 35 years, ‘client involvement’ has been a mantra within health policies, education curriculums and health care institutions, yet very little is known about how ‘client involvement’ is practiced in the meetings with clients and health professionals. Aim: To analyse...

  12. Newborn care seeking practices in Central and Southern Ethiopia ...

    African Journals Online (AJOL)

    admin

    Objective: To investigate local perspectives and practices related to newborn care-seeking and the factors affecting them. .... In Arbe Gonna, they rub the newborn with a herb called hamessa, or take the baby to a health facility like many mothers in the other communities. Sore skin is .... Levels & Trends in Child Mortality.

  13. Psychiatric Nursing Faculty Practice: Care within the Community Context.

    Science.gov (United States)

    Richie, Mary Fern; And Others

    1996-01-01

    Psychiatric nursing faculty practice offers the academic nurse opportunity to generate salary support and integrate students into the real world of mental health care. It promotes scholarship and knowledge-building and has a direct impact on the lives of patients. (Author/JOW)

  14. Attitude and Practices of Sedation amongst Critical Care Nurses ...

    African Journals Online (AJOL)

    Summary: Sedation is necessary for the alleviation of anxiety so as to improve patient comfort and facilitate medical interventions and invasive procedures in the Intensive Care Unit (ICU). Methods: A cross-sectional survey of the attitudes and practice of sedation amongst all nurses working in the Kenyatta National Hospital ...

  15. Oral hygiene practices and oral health care seeking behaviours ...

    African Journals Online (AJOL)

    Aim: To determine the oral hygiene practices and oral health care seeking behaviours among primary school teachers. Materials and Methods: A cross sectional descriptive study was conducted among primary school teachers from public schools in Ndola district, Zambia.The primary schools were selected using stratified ...

  16. Knowledge and practice of pharmaceutical care by community ...

    African Journals Online (AJOL)

    There is a global strategy to improve health through prompt identification and treatment of diseases. The pharmacy profession has remodelled its roles in an attempt to meet these global expectations through pharmaceutical care. The objective of this study was therefore to assess the knowledge and practice of ...

  17. The quality of COPD care in general practice in Denmark

    DEFF Research Database (Denmark)

    Lange, Peter; Rasmussen, Finn Vejlø; Borgeskov, Hanne

    2007-01-01

    We studied the quality of care for COPD patients in a large sample of general practices in Denmark. We focussed on whether participation by general practitioners (GPs) in an educational programme could enhance the use of spirometry in the diagnosis and staging of the disease and improve adherence...

  18. Newborn cord care practices amongst mothers in Port Harcourt ...

    African Journals Online (AJOL)

    This study explored cord care practices amongst mothers in Port Harcourt. Methods: This was a cross-sectional study carried out amongst mothers presenting with children 0-6 months old to the Paediatric Outpatient and Infant Welfare Clinics of the University of Port Harcourt Teaching Hospital. Data were collected using a ...

  19. Health Care Practices for Medical Textiles in Government Hospitals

    Science.gov (United States)

    Akubue, B. N.; Anikweze, G. U.

    2015-01-01

    The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…

  20. A Self-Care Practice Theory of Nursing the Elderly.

    Science.gov (United States)

    Sullivan, Toni J.; Munroe, Donna J.

    1986-01-01

    Describes a practice theory of nursing for the elderly which focuses on maintaining the maximum amount of independence of elderly patients through a nursing focus on the full range of human functional abilities. Interrelates varied health related characteristics and requirements of the elderly with theoretical components of self-care nursing…

  1. Knowledge, attitude, and practice of primary health care physicians ...

    African Journals Online (AJOL)

    Background: Primary health care (PHC) physicians manage most patients with osteoarthritis (OA). In Saudi Arabia, very little is known about the management of OA by PHC physicians. This study aims to assess knowledge, attitude, and practice of PHC physicians in the management of OA. Materials and Methods: During ...

  2. C++ Coding Standards 101 Rules, Guidelines, and Best Practices

    CERN Document Server

    Sutter, Herb

    2005-01-01

    Consistent, high-quality coding standards improve software quality, reduce time-to-market, promote teamwork, eliminate time wasted on inconsequential matters, and simplify maintenance. Now, two of the world's most respected C++ experts distill the rich collective experience of the global C++ community into a set of coding standards that every developer and development team can understand and use as a basis for their own coding standards.

  3. Medical practices and cancer care networks: examples in oncology.

    Science.gov (United States)

    Ray-Coquard, Isabelle; Chauvin, Franck; Lurkin, Antoine; Ducimetière, Françoise; Jacquin, Jean Philippe; Agostini, Cécile; Pouchard, Isabelle; Meyer, Bernard; Farsi, Fadila; Castel, Patrick; Perrier, Lionel; Philip, Thierry

    2006-02-01

    Understanding medical practices or the whys and wherefores of care decision-making is among the major objectives of medical, economic and sociological research in the current political environment. Although variations of medical practice have long been known to exist, causes and deciding factors remain obscure. This is one of the reasons why medical auditing became widely used in the past years. Using methods similar to those of clinical research, we will explore existing medical practices and their implications, with the aim to propose possible improvements. Elaborating clinical practice guidelines and promoting cancer network activities might prove promising and have a significant impact on clinical practice. This article provides a state-of-the-art overview of the subject, notably in the domain of oncology where substantial advances are being made.

  4. The Experience of Advanced Practice Nurses in US Emergency Care Settings.

    Science.gov (United States)

    Wolf, Lisa A; Delao, Altair M; Perhats, Cydne; Moon, Michael D; Carman, Margaret J

    2017-09-01

    Little information has been published regarding the actual practice, training, and validation of basic skills and competencies needed by the advanced practice registered nurse (APRN) in the emergency care setting. The purpose of this study was to (1) identify skills being performed by APRNs practicing in emergency care settings (2); explore types of training; and (3) describe competency validation. Additionally, we explored frequency of skill use and facilitators and barriers to performing a skill to the full extent of training and education. An exploratory mixed-methods study was performed incorporating a self-report survey and focus group interviews. The educational path to advanced practice nursing in emergency care settings is not standardized. Few programs incorporate or address the need for APRNs to receive acute care training across the life span, which is the hallmark of emergency nursing practice. Similarly, training is reported as fragmented, and validation of skills for both nurse practitioners and clinical nurse specialists can vary. APRN practice autonomy is affected by the presence of other providers (specifically physicians), institutional culture, and state boards of nursing that regulate practice. Integrated educational and orientation programs are needed that address high-acuity patients across the life span. Additionally, a more nuanced approach to assessing APRN capabilities as a combination of hard (clinical emergency) and soft (communication and organizational) skills may be an appropriate framework within which to examine the advanced practice role. Future research should continue to evaluate training, competency assessment, and outcomes for APRNs in the emergency care setting. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  5. The Future of LGBT Cancer Care: Practice and Research Implications.

    Science.gov (United States)

    Rice, David; Schabath, Matthew B

    2018-02-01

    To synthesize state of the knowledge collected in this volume and propose future directions for lesbian, gay, bisexual and transgender (LGBT) cancer practice, education, research, and advocacy. Current and extant literature. Health care disparities that are known but not yet fully elucidated in the LGBT population carry into the cancer arena. Substantially more effort is required in the domains of patient care, nursing practice, nursing and patient-facing services provider education, patient education, nursing and interprofessional research, governmental commitment, professional organization action, and patient advocacy. Professional nurses are committed to the uniqueness of each individual and respect and value the health and well-being of each individual. To that commitment, oncology nurses are positioned to advance the research in the field, which will help to clarify the issues and concerns related to LGBT cancer, address the health care inequities in this important population, and lead to improved outcomes for all. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. THE CONTEMPORARY PARENTING PRACTICE AND EARLY CHILDHOOD CARE NETWORK

    Directory of Open Access Journals (Sweden)

    Nathalia Teixeira Caldas Campana

    2017-09-01

    Full Text Available The possibility for women to engage in professional career and the fact that men are more involved in caring for their children raise awareness to the need for research on contemporary parental practice. The aim of this study was to check for changes in the form parents take care of their children, the key challenges they face and how pediatricians and school workers participate in this process. The methodology used is qualitative and based on semi-structured interviews with five middle-class heterosexual couples who have children up to three years old and their respective pediatricians and school supervisors. Results show that parenthood is transitioning from the traditional model to a more egalitarian practice. Pediatricians act as advisors and parents share with school workers the direct care for children. It is suggested that naturalistic perspectives and time for paternity leave must be questioned in order to promote an egalitarian parenthood.

  7. Enveloped Lives: Practicing Health and Care in Lithuania.

    Science.gov (United States)

    Praspaliauskiene, Rima

    2016-12-01

    This article analyzes informal medical payments that the majority of Lithuanians give or feel compelled to give to doctors before or after treatment. It focuses on how patients and their caretakers encounter, practice, and enact informal payments in health care and how these payments create a reality of health care that is not limited to an economic rationality. Within such a frame, rather than being considered a gift or bribe, it conceptualizes these little white envelopes as a practice of health and care. The article shows how an envelope of money given to a doctor transcends the material patient-doctor transaction and emerges as a productive force for coping with illness, medical encounters, and misfortunes. © 2016 by the American Anthropological Association.

  8. Intensive care bereavement practices across New Zealand and Australian intensive care units: a qualitative content analysis.

    Science.gov (United States)

    Coombs, Maureen; Mitchell, Marion; James, Stephen; Wetzig, Krista

    2017-10-01

    End-of-life and bereavement care is an important consideration in intensive care. This study describes the type of bereavement care provided in intensive care units across Australia and New Zealand. Inductive qualitative content analysis was conducted on free-text responses to a web-based survey exploring unit-based bereavement practice distributed to nurse managers in 229 intensive care units in New Zealand and Australia. A total of 153 (67%) surveys were returned with 68 respondents making free-text responses. Respondents were mainly Australian (n = 54, 85·3%), from the public sector (n = 51, 75%) and holding Nurse Unit Managers/Charge Nurse roles (n = 39, 52·9%). From the 124 free-text responses, a total of 187 individual codes were identified focussing on bereavement care practices (n = 145, 77·5%), educational provision to support staff (n = 15, 8%) and organisational challenges (n = 27, 14·4%). Bereavement care practices described use of memory boxes, cultural specificity, annual memorial services and use of community support services. Educational provision identified local in-service programmes, and national bereavement courses for specialist bereavement nurse coordinators. Organisational challenges focussed on lack of funding, especially for provision of bereavement follow-up. This is the first Australasian-wide survey, and one of the few international studies, describing bereavement practices within intensive care, an important aspect of nursing practice. However, with funding for new bereavement services and education for staff lacking, there are continued challenges in developing bereavement care. Given knowledge about the impact of these areas of care on bereaved family members, this requires review. Nurses remain committed to supporting bereaved families during and following death in intensive care. With limited resource to support bereavement care, intensive care nurses undertake a range of bereavement care practices at time of death

  9. International Child Care Practices study: breastfeeding and pacifier use.

    Science.gov (United States)

    Nelson, E A S; Yu, Ly-Mee; Williams, Sheila

    2005-08-01

    Although the Baby-Friendly Hospital Initiative advises that no pacifiers be given to breastfeeding infants, both breastfeeding and pacifier use may protect against sudden infant death syndrome. The International Child Care Practice Study data set on child care practices associated with sudden infant death syndrome risk from 21 centers in 17 countries was used to describe infant-feeding practices and pacifier use and assess factors associated with breastfeeding. At approximately 3 months of age, rates of breastfeeding only (4%-80%) and pacifier use(12.5%-71%) varied between centers. Pacifier use was negatively associated with breastfeeding, and a dose-response effect was noted. Other negative (multiple birth, smoking by mother) and positive (intention to breastfeed, bed sharing, mothers' education) associations with breastfeeding only were identified. Although causality should not be inferred, these associations are consistent with previous studies. Advice on pacifiers should include potential benefits as well as risks.

  10. Practical wisdom: competencies required in alleviating suffering in palliative care.

    Science.gov (United States)

    Ohlén, Joakim

    2002-01-01

    The aim of this article is to reflect upon the competencies required to alleviate suffering in palliative care. The knowledge to prudently and wisely act in a situation involving human relationships can be defined in terms of practical abilities and contextual skills. In the setting of the care of the very ill and dying, practical wisdom such as the carer's ability to meet the suffering person and to act with sensitivity and openness, becomes important. From this, learning to alleviate suffering emerges as receiving insight and wisdom from the suffering person's experience of suffering. This means that the testimony of suffering persons--what they have endured, given up and experienced--becomes as significant as theoretical and practical knowledge of suffering. The professional carer needs to learn how to be open to and interpret what the suffering person, living with suffering and death in the midst of life, can teach.

  11. Practices in Human Dignity in Palliative Care: A Qualitative Study.

    Science.gov (United States)

    Akin Korhan, Esra; Üstün, Çağatay; Uzelli Yilmaz, Derya

    Respecting and valuing an individual's existential dignity forms the basis of nursing and medical practice and of nursing care. The objective of the study was to determine the approach to human dignity that nurses and physicians have while providing palliative care. This qualitative study was performed using a phenomenological research design. In-depth semistructured interviews were conducted in 9 nurses and 5 physicians with human dignity approach in palliative care. Following the qualitative Colaizzi method of analyzing the data, the statements made by the nurses and physicians during the interviews were grouped under 8 categories. Consistent with the questionnaire format, 8 themes and 43 subthemes of responses were determined describing the human dignity of the nurse and the physicians. The results of the study showed that in some of the decisions and practices of the nurses giving nursing care and physicians giving medical care to palliative care patients, while they displayed ethically sensitive behavior, on some points, they showed approaches that violated human dignity and showed lack of awareness of ethical, medical, and social responsibilities.

  12. The acute care nurse practitioner in collaborative practice.

    Science.gov (United States)

    Buchanan, L

    1996-01-01

    Nurse-physician relationships remain, for the most part, hierarchical in nature. A hierarchical structure allows the person at the top, most notably the physician, the highest level of authority and power for decision making. Other health care providers are delegated various tasks related to the medical plan of care. One role of nonmedical health care providers, including nurses, is to support the medical plan of care and increase the productivity of physicians. Medical centers have house staff, usually interns and residents, who work collaboratively with the attending physicians in care delivery. At one medical center, a shortage of medical house staff for internal medicine prompted the development and evaluation of an alternative service. The alternative service utilized master prepared, certified nurse practitioners on a nonteaching service to provide care for selected types of medical patients. Physicians consulted with nurse practitioners, but retained decision-making authority concerning patient admission to the service. This paper describes the development and evaluation of an alternative service based on a collaborative practice model and the role of nurse practitioners working under such a model. Discussion includes suggestions for process guideline development for organizations that want to improve collaborative practice relationships between unit nursing staff, nurse practitioners, and physicians.

  13. Teaching and learning care--exploring nursing students' clinical practice.

    Science.gov (United States)

    Solvoll, Betty-Ann; Heggen, Kristin M

    2010-01-01

    Care has always been a key element of nursing. This paper presents findings from research on the following issue: What opportunities and limitations do nursing students encounter when learning nursing care? The study has a qualitative design with field methodology and the study of documents. Six nursing students have been closely monitored during their clinical studies in hospitals, nursing homes and home-based nursing. The study shows that nursing students are likely to possess the potential to provide care for sick and unknown people. The motivation for their commitment to patients may contain an egoistical orientation and runs contrary to former ideals of the nurse's self-sacrificing altruism. Moreover the study shows that there is a potential in the clinical field and in the university college to reflective considerations on experience of care. While clinical practice often has focus on practical problem-solving and procedures, the college tends to focus on abstract theory. Both of these promote the privatisation and neglect of the students' experience of care. The paper concludes with a call for teaching and learning strategies targeting the use of nursing students' personal experience of care.

  14. Identifying the barriers to use of standardized nursing language in the electronic health record by the ambulatory care nurse practitioner.

    Science.gov (United States)

    Conrad, Dianne; Hanson, Patricia A; Hasenau, Susan M; Stocker-Schneider, Julia

    2012-07-01

    This study identified the perceived user barriers to documentation of nursing practice utilizing standardized nursing language (SNL) in the electronic health record (EHR) by ambulatory care nurse practitioners (NPs). A researcher-developed survey was sent to a randomized sample of ambulatory care NPs in the United States who belonged to the American Academy of Nurse Practitioners (n= 1997). Surveyed ambulatory care NPs placed a higher value on documenting medical care versus nursing care. Only 17% of respondents currently use SNL and 30% believe that SNL is not important or appropriate to document NP practice. Barriers to using SNL in EHRs included lack of reimbursement for nursing documentation, lack of time to document, and lack of availability of SNL in electronic records. Respondents identified NP practice as a blend of medical as well as nursing care but NPs have not embraced the current SNLs as a vehicle to document the nursing component of their care, particularly in EHRs. Until these barriers are addressed and discreet data in the form of SNL are available and utilized in the EHR, the impact of the NPs care will be unidentifiable for outcomes reporting. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

  15. A randomised controlled trial of caseload midwifery care: M@NGO (Midwives @ New Group practice Options)

    Science.gov (United States)

    2011-01-01

    Background Australia has an enviable record of safety for women in childbirth. There is nevertheless growing concern at the increasing level of intervention and consequent morbidity amongst childbearing women. Not only do interventions impact on the cost of services, they carry with them the potential for serious morbidities for mother and infant. Models of midwifery have proliferated in an attempt to offer women less fragmented hospital care. One of these models that is gaining widespread consumer, disciplinary and political support is caseload midwifery care. Caseload midwives manage the care of approximately 35-40 a year within a small Midwifery Group Practice (usually 4-6 midwives who plan their on call and leave within the Group Practice.) We propose to compare the outcomes and costs of caseload midwifery care compared to standard or routine hospital care through a randomised controlled trial. Methods/design A two-arm RCT design will be used. Women will be recruited from tertiary women's hospitals in Sydney and Brisbane, Australia. Women allocated to the caseload intervention will receive care from a named caseload midwife within a Midwifery Group Practice. Control women will be allocated to standard or routine hospital care. Women allocated to standard care will receive their care from hospital rostered midwives, public hospital obstetric care and community based general medical practitioner care. All midwives will collaborate with obstetricians and other health professionals as necessary according to the woman's needs. Discussion Data will be collected at recruitment, 36 weeks antenatally, six weeks and six months postpartum by web based or postal survey. With 750 women or more in each of the intervention and control arms the study is powered (based on 80% power; alpha 0.05) to detect a difference in caesarean section rates of 29.4 to 22.9%; instrumental birth rates from 11.0% to 6.8%; and rates of admission to neonatal intensive care of all neonates from 9

  16. Setting standards for planning off duty and audit of practice.

    Science.gov (United States)

    Walker, Linda; Minchin, Anne; Pickard, Jane

    The off duty or rostering system is an important part of managing any ward or department. This article looks at the issues that need to be considered when drawing up and managing off duty. It recommends standards for off-duty planning and shares the results of an audit carried out against some of these standards in one NHS trust.

  17. Standard Practice for Dosimetry of Proton Beams for use in Radiation Effects Testing of Electronics

    International Nuclear Information System (INIS)

    McMahan, Margaret A.; Blackmore, Ewart; Cascio, Ethan W.; Castaneda, Carlos; von Przewoski, Barbara; Eisen, Harvey

    2008-01-01

    Representatives of facilities that routinely deliver protons for radiation effect testing are collaborating to establish a set of standard best practices for proton dosimetry. These best practices will be submitted to the ASTM International for adoption

  18. Standard Practice for Dosimetry of Proton Beams for use in Radiation Effects Testing of Electronics

    Energy Technology Data Exchange (ETDEWEB)

    McMahan, Margaret A.; Blackmore, Ewart; Cascio, Ethan W.; Castaneda, Carlos; von Przewoski, Barbara; Eisen, Harvey

    2008-07-25

    Representatives of facilities that routinely deliver protons for radiation effect testing are collaborating to establish a set of standard best practices for proton dosimetry. These best practices will be submitted to the ASTM International for adoption.

  19. Standard practice for digital imaging and communication nondestructive evaluation (DICONDE) for computed radiography (CR) test methods

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2010-01-01

    1.1 This practice facilitates the interoperability of computed radiography (CR) imaging and data acquisition equipment by specifying image data transfer and archival storage methods in commonly accepted terms. This practice is intended to be used in conjunction with Practice E2339 on Digital Imaging and Communication in Nondestructive Evaluation (DICONDE). Practice E2339 defines an industrial adaptation of the NEMA Standards Publication titled Digital Imaging and Communications in Medicine (DICOM, see http://medical.nema.org), an international standard for image data acquisition, review, storage and archival storage. The goal of Practice E2339, commonly referred to as DICONDE, is to provide a standard that facilitates the display and analysis of NDE results on any system conforming to the DICONDE standard. Toward that end, Practice E2339 provides a data dictionary and a set of information modules that are applicable to all NDE modalities. This practice supplements Practice E2339 by providing information objec...

  20. Maintenance standards, care and control of the radiation protection material

    International Nuclear Information System (INIS)

    Brasesco, L.

    2004-01-01

    The present protocol in Radiology, Tomography, surgical block and intensive care unit in the Britanic Hospital from Uruguay.Between their topics find care procedures in protective clothes, periodic and control methods, material record,and staff assigned

  1. Use of midlevel practitioners to achieve labor cost savings in the primary care practice of an MCO.

    Science.gov (United States)

    Roblin, Douglas W; Howard, David H; Becker, Edmund R; Kathleen Adams, E; Roberts, Melissa H

    2004-06-01

    To estimate the savings in labor costs per primary care visit that might be realized from increased use of physician assistants (PAs) and nurse practitioners (NPs) in the primary care practices of a managed care organization (MCO). Twenty-six capitated primary care practices of a group model MCO. Data on approximately two million visits provided by 206 practitioners were extracted from computerized visit records for 1997-2000. Computerized payroll ledgers were the source of annual labor costs per practice from 1997-2000. Likelihood of a visit attended by a PA/NP versus MD was modeled using logistic regression, with practice fixed effects, by department (adult medicine, pediatrics) and year. Parameter estimates and practice fixed effects from these regressions were used to predict the proportion of PA/NP visits per practice per year given a standard case mix. Least squares regressions, with practice fixed effects, were used to estimate the association of this standardized predicted proportion of PA/NP visits with average annual practitioner and total labor costs per visit, controlling for other practice characteristics. On average, PAs/NPs attended one in three adult medicine visits and one in five pediatric medicine visits. Likelihood of a PA/NP visit was significantly higher than average among patients presenting with minor acute illness (e.g., acute pharyngitis). In adult medicine, likelihood of a PA/NP visit was lower than average among older patients. Practitioner labor costs per visit and total labor costs per visit were lower (p<.01 and p=.08, respectively) among practices with greater use of PAs/NPs, standardized for case mix. Primary care practices that used more PAs/NPs in care delivery realized lower practitioner labor costs per visit than practices that used less. Future research should investigate the cost savings and cost-effectiveness potential of delivery designs that change staffing mix and division of labor among clinical disciplines.

  2. Standards of diabetic care successes and failures of a patient ...

    African Journals Online (AJOL)

    Objective. To determine: (i) some aspects of the quality of medical care provided for adult diabetic patients in primary care settings; and (ii) changes in these variables 1 year after attending a specialist diabetes clinic that provided 2 - 3 hours of self-care education. Design. An analysis of the prevalences of obesity, ...

  3. Twelve best practices for team training evaluation in health care.

    Science.gov (United States)

    Weaver, Sallie J; Salas, Eduardo; King, Heidi B

    2011-08-01

    Evaluation and measurement are the building blocks of effective skill development, transfer of training, maintenance and sustainment of effective team performance, and continuous improvement. Evaluation efforts have varied in their methods, time frame, measures, and design. On the basis of the existing body of work, 12 best practice principles were extrapolated from the science of evaluation and measurement into the practice of team training evaluation. Team training evaluation refers to efforts dedicated to enumerating the impact of training (1) across multiple dimensions, (2) across multiple settings, and (3) over time. Evaluations of efforts to optimize teamwork are often afterthoughts in an industry that is grounded in evidence-based practice. The best practices regarding team training evaluation are provided as practical reminders and guidance for continuing to build a balanced and robust body of evidence regarding the impact of team training in health care. THE 12 BEST PRACTICES: The best practices are organized around three phases of training: planning, implementation, and follow-up. Rooted in the science of team training evaluation and performance measurement, they range from Best Practice 1: Before designing training, start backwards: think about traditional frameworks for evaluation in reverse to Best Practice 7: Consider organizational, team, or other factors that may help (or hinder) the effects of training and then to Best Practice 12: Report evaluation results in a meaningful way, both internally and externally. Although the 12 best practices may be perceived as intuitive, they are intended to serve as reminders that the notion of evidence-based practice applies to quality improvement initiatives such as team training and team development as equally as it does to clinical intervention and improvement efforts.

  4. Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices: A Modeling Study.

    Science.gov (United States)

    Basu, Sanjay; Phillips, Russell S; Bitton, Asaf; Song, Zirui; Landon, Bruce E

    2015-10-20

    Physicians have traditionally been reimbursed for face-to-face visits. A new non-visit-based payment for chronic care management (CCM) of Medicare patients took effect in January 2015. To estimate financial implications of CCM payment for primary care practices. Microsimulation model incorporating national data on primary care use, staffing, expenditures, and reimbursements. National Ambulatory Medical Care Survey and other published sources. Medicare patients. 10 years. Practice-level. Comparison of CCM delivery approaches by staff and physicians. Net revenue per full-time equivalent (FTE) physician; time spent delivering CCM services. If nonphysician staff were to deliver CCM services, net revenue to practices would increase despite opportunity and staffing costs. Practices could expect approximately $332 per enrolled patient per year (95% CI, $234 to $429) if CCM services were delivered by registered nurses (RNs), approximately $372 (CI, $276 to $468) if services were delivered by licensed practical nurses, and approximately $385 (CI, $286 to $485) if services were delivered by medical assistants. For a typical practice, this equates to more than $75 ,00 of net annual revenue per FTE physician and 12 hours of nursing service time per week if 50% of eligible patients enroll. At a minimum, 131 Medicare patients (CI, 115 to 140 patients) must enroll for practices to recoup the salary and overhead costs of hiring a full-time RN to provide CCM services. If physicians were to deliver all CCM services, approximately 25% of practices nationwide could expect net revenue losses due to opportunity costs of face-to-face visit time. The CCM program may alter long-term primary care use, which is difficult to predict. Practices that rely on nonphysician team members to deliver CCM services will probably experience substantial net revenue gains but must enroll a sufficient number of eligible patients to recoup costs. None.

  5. Lasers for vascular lesions: Standard guidelines of care

    Directory of Open Access Journals (Sweden)

    C R Srinivas

    2011-01-01

    Full Text Available Introduction: Lasers are a good therapeutic tool for congenital and acquired vascular lesions. Technological advances in lasers have reduced the adverse effects and increased the efficacy. Machines: Among the various lasers used for treating vascular lesions, pulsed dye laser (PDL has the best efficacy and safety data. The other machines that are widely available are Nd:YAG laser and intense pulse light (IPL. Rationale and scope of guideline: Much variation exists in different machines and techniques, and therefore, establishing standard guidelines has limitations. The guidelines recommended here indicate minimum standards of care for lasers on vascular lesions based on current evidence. Physician Qualification: Laser may be administered by a dermatologist, who has received adequate background training in lasers during post-graduation or later at a center that provides education and training in lasers, or in focused workshops, which provide such trainings. He/she should have adequate knowledge of the lesions being treated, machines, parameters, cooling systems, and aftercare. Facility: The procedure may be performed in the physician′s minor procedure room with adequate laser safety measures. Indications: PWS, hemangioma, facial telangiectasia, rosacea, spider angioma, pyogenic granuloma, venous lakes, leg veins. Contraindications: Absolute: Active local infection, photo-aggravated skin diseases, and medical conditions. Relative: Unstable vitiligo, psoriasis, keloid and keloidal tendencies, patient on isotretinoin, patient who is not cooperative or has unrealistic expectation. Patient Selection: Patient selection should be done after detailed counseling with respect to the course of lesions, different treatment options, possible results, cost, need for multiple treatments, and possible postoperative complications. Treatment Sessions: The number of treatments per lesion varies from 2 to 12 or more at 6-8 week intervals. All lesions may not clear

  6. 2017 update of the European Federation for Colposcopy (EFC) performance standards for the practice of colposcopy.

    Science.gov (United States)

    Petry, K Ulrich; Nieminen, Pekka J; Leeson, Simon C; Bergeron, Christine O M A; Redman, Charles W E

    2018-03-16

    A refinement of quality indicators (QIs) is described whereby the quality of care can be measured across colposcopy services in different countries and healthcare settings. A five-round Delphi process was conducted at successive satellite meetings from 2011 to 2015 of leading European colposcopists to refine the most high-scoring QIs relevant to colposcopic practice. A review and refinement of the wording of the standards and their criteria was undertaken by national society representatives. Six quality indicators were identified and refined. "Documentation of whether the squamocolumnar junction (SCJ) has been visible or not" was changed into "for cervical colposcopy transformation zone (TZ) type (1, 2 or 3) should be documented". The standard "percentage of cases having a colposcopic examination prior to treatment for abnormal cytology" was changed to "percentage of cases having a colposcopic examination prior to treatment for abnormal cervical screening test". The standard "percentage of all excisional treatments/conizations containing CIN2+ (cervical intra-epithelial neoplasia grade two or worse)" was changed into "percentage of excisional treatments/conizations having a definitive histology of CIN2+. Definitive histology is highest grade from any diagnostic or therapeutic biopsies". The standard "percentage of excised lesions/conizations with clear margins" was unchanged. The remaining two QIs define the minimum caseloads required for colposcopists. However, "cytology" was replaced by "screening results" to acknowledge the introduction of human papillomavirus testing to European screening programmes. Six QIs were identified to define good practice in colposcopy. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  7. Obama health care for all Americans: practical implications.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2009-01-01

    Rapidly rising health care costs over the decades have prompted the application of business practices to medicine with goals of improving the efficiency, restraining expenses, and increasing quality. Average health insurance premiums and individual contributions for family coverage have increased approximately 120% from 1999 to 2008. Health care spending in the United States is stated to exceed 4 times the national defense, despite the wars in Iraq and Afghanistan. The U.S. health care system has been blamed for inefficiencies, excessive administrative expenses, inflated prices, inappropriate waste, and fraud and abuse. While many people lack health insurance, others who do have health insurance allegedly receive care ranging from superb to inexcusable. In criticism of health care in the United States and the focus on savings, methodologists, policy makers, and the public in general seem to ignore the major disadvantages of other global health care systems and the previous experiences of the United States to reform health care. Health care reform is back with the Obama administration with great expectations. It is also believed that for the first time since 1993, momentum is building for policies that would move the United States towards universal health insurance. President Obama has made health care a central part of his domestic agenda, with spending and investments in Children's Health Insurance Program (CHIP), American Recovery and Reinvestment Act of 2009, and proposed 2010 budget. It is the consensus now that since we have a fiscal emergency, Washington is willing to deal with the health care crisis. Many of the groups long opposed to reform, appear to be coming together to accept a major health care reform. Reducing costs is always at the center of any health care debate in the United States. These have been focused on waste, fraud, and abuse; administrative costs; improving the quality with health technology information dissemination; and excessive

  8. Family meetings in palliative care: Multidisciplinary clinical practice guidelines

    Directory of Open Access Journals (Sweden)

    O'Hanlon Brendan

    2008-08-01

    Full Text Available Abstract Background Support for family carers is a core function of palliative care. Family meetings are commonly recommended as a useful way for health care professionals to convey information, discuss goals of care and plan care strategies with patients and family carers. Yet it seems there is insufficient research to demonstrate the utlility of family meetings or the best way to conduct them. This study sought to develop multidisciplinary clinical practice guidelines for conducting family meetings in the specialist palliative care setting based on available evidence and consensus based expert opinion. Methods The guidelines were developed via the following methods: (1 A literature review; (2 Conceptual framework; (3 Refinement of the guidelines based on feedback from an expert panel and focus groups with multidisciplinary specialists from three palliative care units and three major teaching hospitals in Melbourne, Australia. Results The literature review revealed that no comprehensive exploration of the conduct and utility of family meetings in the specialist palliative care setting has occurred. Preliminary clinical guidelines were developed by the research team, based on relevant literature and a conceptual framework informed by: single session therapy, principles of therapeutic communication and models of coping and family consultation. A multidisciplinary expert panel refined the content of the guidelines and the applicability of the guidelines was then assessed via two focus groups of multidisciplinary palliative care specialists. The complete version of the guidelines is presented. Conclusion Family meetings provide an opportunity to enhance the quality of care provided to palliative care patients and their family carers. The clinical guidelines developed from this study offer a framework for preparing, conducting and evaluating family meetings. Future research and clinical implications are outlined.

  9. [Self-care and empowerment in diabetes care: use of instruments in clinical practice - a review].

    Science.gov (United States)

    Sigurdardóttir, Arún K; Benediktsson, Rafn; Jonsdóttir, Helga

    2009-05-01

    Prevalence of diabetes is increasing worldwide. Education is regarded as an essential part in diabetes care to enable people with diabetes self-care. Self-care in diabetes can be demanding and it is regarded impossible to separate treatment and education. Clinical guidelines in diabetes care recommend using empowerment approach in diabetes education. The empowerment approach emphasizes that people with diabetes are assisted to make informed decisions. Instruments measuring knowledge, self-care, empowerment, well-being and distress were translated into Icelandic, according to internationally accepted guidelines. The questionnaires were tested in a cross-sectional study and used in an educational intervention study. It was found that the instruments are practical and useful and can be used in clinical practice in Iceland. It is argued that in diabetes care, health care practitioners should make more use of appointed instruments that enable them to focus their care on specific needs of each person. The care should be based on answers from the instruments and goals which people with diabetes choose to work towards. The education should be based on the empowerment approach.

  10. 47 CFR 73.508 - Standards of good engineering practice.

    Science.gov (United States)

    2010-10-01

    ... be constructed with the safety provisions of the current national electrical code as approved by the American National Standards Institute. These stations must be operated, tuned, and adjusted so that...

  11. Redesigning Health Care Practices to Address Childhood Poverty.

    Science.gov (United States)

    Fierman, Arthur H; Beck, Andrew F; Chung, Esther K; Tschudy, Megan M; Coker, Tumaini R; Mistry, Kamila B; Siegel, Benjamin; Chamberlain, Lisa J; Conroy, Kathleen; Federico, Steven G; Flanagan, Patricia J; Garg, Arvin; Gitterman, Benjamin A; Grace, Aimee M; Gross, Rachel S; Hole, Michael K; Klass, Perri; Kraft, Colleen; Kuo, Alice; Lewis, Gena; Lobach, Katherine S; Long, Dayna; Ma, Christine T; Messito, Mary; Navsaria, Dipesh; Northrip, Kimberley R; Osman, Cynthia; Sadof, Matthew D; Schickedanz, Adam B; Cox, Joanne

    2016-04-01

    Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty. Copyright © 2016 Academic Pediatric Association. All rights reserved.

  12. Practice Guidelines for Primary Care of Acute Abdomen 2015.

    Science.gov (United States)

    Mayumi, Toshihiko; Yoshida, Masahiro; Tazuma, Susumu; Furukawa, Akira; Nishii, Osamu; Shigematsu, Kunihiro; Azuhata, Takeo; Itakura, Atsuo; Kamei, Seiji; Kondo, Hiroshi; Maeda, Shigenobu; Mihara, Hiroshi; Mizooka, Masafumi; Nishidate, Toshihiko; Obara, Hideaki; Sato, Norio; Takayama, Yuichi; Tsujikawa, Tomoyuki; Fujii, Tomoyuki; Miyata, Tetsuro; Maruyama, Izumi; Honda, Hiroshi; Hirata, Koichi

    2016-01-01

    Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine, in collaboration with four other medical societies, launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines (all clinical questions and recommendations were shown in supplementary information). A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on nine subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  13. Training doctors for primary care in China: Transformation of general practice education.

    Science.gov (United States)

    Li, Donald

    2016-01-01

    China is known for developing a cadre of "Barefoot Doctors" to address her rural healthcare needs in past. The tradition of barefoot doctors has inspired similar developments in several other countries across world. Recently China has embarked upon an ambitious new mission to create a primary care workforce consisting of trained general practitioners having international standard skillsets. This editorial provides an insight into the current status of policy deliberations with regards to training of primary care doctors and a new surge in general practice education in China.

  14. The 2011 WPATH Standards of Care and Penile Reconstruction in Female-to-Male Transsexual Individuals

    Directory of Open Access Journals (Sweden)

    Gennaro Selvaggi

    2012-01-01

    Full Text Available The World Professional Association for Transgender Health (WPATH currently publishes the Standards of Care (SOC, to provide clinical guidelines for health care of transsexual, transgender and gender non-conforming persons in order to maximize health and well-being by revealing gender dysphoria. An updated version (7th version, 2011 of the WPATH SOC is currently available. Differences between the 6th and the 7th versions of the SOC are shown; the SOC relevant to penile reconstruction in female-to-male (FtM persons are emphasized, and we analyze how the 2011 WPATH SOC is influencing the daily practice of physicians involved in performing a penile reconstruction procedure for these patients. Depending by an individual’s goals and expectations, the most appropriate surgical technique should be performed: the clinic performing penile reconstruction should be able to offer the whole range of techniques, such as: metoidioplasty, pedicle and free flaps phalloplasty procedures. The goals that physicians and health care institutions should achieve in the next years, in order to improve the care of female-to-male persons, consist in: informing in details the individuals applying for penile reconstruction about all the implications; referring specific individuals to centers capable to deliver a particular surgical technique; implementing the surgery with the most updated refinements.

  15. The 2011 WPATH Standards of Care and Penile Reconstruction in Female-to-Male Transsexual Individuals

    Science.gov (United States)

    Selvaggi, Gennaro; Dhejne, Cecilia; Landen, Mikael; Elander, Anna

    2012-01-01

    The World Professional Association for Transgender Health (WPATH) currently publishes the Standards of Care (SOC), to provide clinical guidelines for health care of transsexual, transgender and gender non-conforming persons in order to maximize health and well-being by revealing gender dysphoria. An updated version (7th version, 2011) of the WPATH SOC is currently available. Differences between the 6th and the 7th versions of the SOC are shown; the SOC relevant to penile reconstruction in female-to-male (FtM) persons are emphasized, and we analyze how the 2011 WPATH SOC is influencing the daily practice of physicians involved in performing a penile reconstruction procedure for these patients. Depending by an individual's goals and expectations, the most appropriate surgical technique should be performed: the clinic performing penile reconstruction should be able to offer the whole range of techniques, such as: metoidioplasty, pedicle and free flaps phalloplasty procedures. The goals that physicians and health care institutions should achieve in the next years, in order to improve the care of female-to-male persons, consist in: informing in details the individuals applying for penile reconstruction about all the implications; referring specific individuals to centers capable to deliver a particular surgical technique; implementing the surgery with the most updated refinements. PMID:22654902

  16. The importance of tacit knowledge in practices of care.

    Science.gov (United States)

    Reinders, H

    2010-03-01

    The paper argues that a high quality personal relationship between professionals and clients is a necessary condition of professional knowledge. This epistemological claim is developed against the background of current methods of quality assessment that rely on objectively measurable 'indicators'. A philosophical analysis regarding the nature of professional knowledge in the care sector. The analysis proceeds from Michael Polanyi's concept of tacit knowledge to account for the personal dimension of professional expertise in the care sector. Quantitative methods of quality assessment understand 'quality of care' as being independent from the professional who generates it. Consequently, quality assessment as currently practiced necessarily renders the personal dimension of professional knowledge invisible, thereby excluding it from managerial attention and support. To indicate the relevance of Polanyi's concept of tacit knowledge, the paper offers some observations from the practice of care in a group home for people with intellectual disabilities. The paper concludes that a high quality relationship between professionals and their clients is crucial for quality of care. This relationship generates the positive interaction that enables professionals to gain adequate insight in the needs of their clients.

  17. Systematic review: Health care transition practice service models.

    Science.gov (United States)

    Betz, Cecily L; O'Kane, Lisa S; Nehring, Wendy M; Lobo, Marie L

    2016-01-01

    Nearly 750,000 adolescents and emerging adults with special health care needs (AEA-SHCN) enter into adulthood annually. The linkages to ensure the seamless transfer of care from pediatric to adult care and transition to adulthood for AEA-SHCN have yet to be realized. The purpose of this systematic review was to investigate the state of the science of health care transition (HCT) service models as described in quantitative investigations. A four-tier screening approach was used to obtain reviewed articles published from 2004 to 2013. A total of 17 articles were included in this review. Transfer of care was the most prominent intervention feature. Overall, using the Effective Public Health Practice Project criteria, the studies were rated as weak. Limitations included lack of control groups, rigorous designs and methodology, and incomplete intervention descriptions. As the findings indicate, HCT is an emerging field of practice that is largely in the exploratory stage of model development. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Practicing radiation oncology today - Part I: Meeting the challenge of managed care

    International Nuclear Information System (INIS)

    Botnick, Leslie E.; Cohen, Hilary H.; Hinkle, Milton; Rose, Christopher M.

    1996-01-01

    Objective: The change in health care delivery is forcing radiation oncologists to examine every aspect of how they organize themselves, deliver care, evaluate the quality of that care, and how they are reimbursed for this process. While managed care has been implicated as the new paradigm that will change the way that health care is delivered, the authors maintain that outcomes research may be just as important a stimulus for change. This course will attempt to examine how managed care and outcomes research are impacting upon radiation oncology practice, and what radiation oncologists can do to maintain patient care standards. This course will introduce certain concepts that will be discussed in subsequent courses on Informatics and Evaluating New Technology. Topics Covered: 1. The Managed Care Nomenclature Explained: HMO's, PPO's, POS's, Carve-Outs 2. Outcomes Research: What it can and cannot do 3. Moving from QA to CQI to Benchmarking 4. Using Analytical Tools to Evaluate Capital Purchases and Operational Requirements 5. Evaluating Staffing Needs: Traditional jobs, Cross-training, Outsourcing, Physician extenders 6. Introduction to Evaluation of Technology 7. Introduction to Evaluation of Informatics 8. Potential gains from Shared Services 9. Networking vs. Mergers vs. Oncology IPA's vs. MSO's 10. Evaluating Managed Care Strategies and Contracts

  19. Integrated monitoring: Setting new standards for the next decade of clinical trial practice

    Directory of Open Access Journals (Sweden)

    Kamala Rai

    2011-01-01

    Full Text Available The new age clinical research professional is now geared toward an "integrated monitoring" approach. A number of critical activities at the site level and at the sponsor′s organization need convergence to harness rich dividends in early study start and quick close of the study. The field monitor needs full integration to ensure standard of care, train the site in protocol, select the right site, ensure regulatory support, ensure excellent project management skills, coach, support the logistics team, manage the vendor, ensure good documentation practices, develop patient recruitment and retention, lean the applicable process, as well as ensure effective site management amongst the myriad activities assigned toward developing the drug in the clinic.

  20. Practice constraints, behavioral problems, and dementia care: primary care physicians' perspectives.

    Science.gov (United States)

    Hinton, Ladson; Franz, Carol E; Reddy, Geetha; Flores, Yvette; Kravitz, Richard L; Barker, Judith C

    2007-11-01

    To examine how practice constraints contribute to barriers in the health care of persons with dementia and their families, particularly with respect to behavioral aspects of care. Cross-sectional qualitative interview study of primary care physicians. Physicians' offices. Forty primary care physicians in Northern California. Open-ended interviews lasted 30-60 minutes and were structured by an interview guide covering clinician background and practice setting, clinical care of a particular patient, and general approach to managing patients with AD or dementia. Interviews were transcribed and themes reflecting constraints of practice were identified through a systematic coding process. Recurring themes (i.e., those present in > or = 25% of physician interviews) included insufficient time, difficulty in accessing and communicating with specialists, low reimbursement, poor connections with community social service agencies, and lack of interdisciplinary teams. Physician narratives suggest that these constraints may lead to delayed detection of behavior problems, "reactive" as opposed to proactive management of dementia, and increased reliance on pharmacological rather than psychosocial approaches. Physicians often feel challenged in caring for dementia patients, particularly those who are more behaviorally complex, because of time and reimbursement constraints as well as other perceived barriers. Our results suggest that more effective educational interventions (for families and physicians) and broader structural changes are needed to better meet the needs of the elderly with dementia and their families now and in the future. Without these changes, dementia care is likely to continue to fall short.

  1. Knowledge, attitudes and practices in the provision of nutritional care.

    LENUS (Irish Health Repository)

    Fletcher, Antoinette

    2012-02-01

    The nutritional care of patients is one of the primary responsibilities of all registered nurses (Persenius et al, 2008). A poor nutritional status can lead to malnutrition, which can have serious consequences for an individual\\'s quality of life (Field and Smith, 2008). This paper commences with an introduction to the concept of nutrition, provides an overview of nutritional guidelines and nutritional screening tools which identify those at risk of malnutrition. It reviews the literature on nurses\\' knowledge, attitudes and practices in the provision of nutritional care and debates challenges and opportunities encountered to help nurses ensure adequate patient nutrition.

  2. Prevalence and Medication Management of Dementia by a Medical Practice Providing Onsite Care in Assisted Living.

    Science.gov (United States)

    Kronhaus, Alan; Fuller, Steven; Zimmerman, Sheryl; Reed, David

    2016-07-01

    Assisted living (AL) is an important provider of long-term residential care to people with dementia, but little research has used clinician's records-arguably the most reliable and valid source of medically related information. This article uses clinician records to examine the prevalence of dementia, treatment with dementia-specific medications and antipsychotic medications, and how prescribing varies by assisted living residence (ALR) and resident characteristics. Analysis of medical records from a long-term care medical practice. Ninety ALRs that had onsite care provided to some or all of their residents by one group practice that specializes in home-based primary care. Records for 3175 AL residents. Thirty-six variables related to the ALR, resident demographics, and medical conditions and pharmaceutical treatment. Seventy-six percent of patients had a documented diagnosis of dementia, 41% who were treated with a medication for dementia other than an antipsychotic, and 37% who received an antipsychotic. Dementia medications were more likely to be prescribed to patients with dementia living in ALRs that had a memory care unit, and also to patients who were not Medicaid beneficiaries. Antipsychotic prescribing was similarly more common for residents with dementia living in ALRs that had memory care units. The 76% prevalence rate of dementia in ALRs larger than 25 beds may be a more accurate reflection of the prevalence of dementia reported elsewhere, because it is based on diagnoses documented by patients' primary care clinicians. The reporting of treatment rates for dementia medications and antipsychotics, and how they vary in relation to ALR and resident characteristics, is meant to generate discussion about "best practices" and standards of care in the medication management of dementia and its behavioral comorbidities-topics that have received scant attention to date other than widespread attention to the need to reduce antipsychotic prescribing. Copyright

  3. Surgical Process Improvement: Impact of a Standardized Care Model With Electronic Decision Support to Improve Compliance With SCIP Inf-9.

    Science.gov (United States)

    Cook, David J; Thompson, Jeffrey E; Suri, Rakesh; Prinsen, Sharon K

    2014-01-01

    The absence of standardization in surgical care process, exemplified in a "solution shop" model, can lead to unwarranted variation, increased cost, and reduced quality. A comprehensive effort was undertaken to improve quality of care around indwelling bladder catheter use following surgery by creating a "focused factory" model within the cardiac surgical practice. Baseline compliance with Surgical Care Improvement Inf-9, removal of urinary catheter by the end of surgical postoperative day 2, was determined. Comparison of baseline data to postintervention results showed clinically important reductions in the duration of indwelling bladder catheters as well as marked reduction in practice variation. Following the intervention, Surgical Care Improvement Inf-9 guidelines were met in 97% of patients. Although clinical quality improvement was notable, the process to accomplish this-identification of patients suitable for standardized pathways, protocol application, and electronic systems to support the standardized practice model-has potentially greater relevance than the specific clinical results. © 2013 by the American College of Medical Quality.

  4. Current End-of-Life Care Needs and Care Practices in Acute Care Hospitals

    Directory of Open Access Journals (Sweden)

    Amy J. Thurston

    2011-01-01

    Full Text Available A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8% and urbanite (79.5%, and cancer was the most common diagnosis (36.2%. Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3% had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital.

  5. Cultural Diversity Training: The Necessity of Cultural Competence for Health Care Providers and in Nursing Practice.

    Science.gov (United States)

    Young, Susan; Guo, Kristina L

    2016-01-01

    The purpose of this article is to discuss the need to provide culturally sensitive care to the growing number of diverse health care consumers. A literature review of national standards and research on cultural competency was conducted and specifically focused on the field of nursing. This study supports the theory that cultural competence is learned over time and is a process of inner reflection and awareness. The domains of awareness, skill, and knowledge are essential competencies that must be gained by health care providers and especially for nurses. Although barriers to providing culturally sensitive care exist, gaining a better understanding of cultural competence is essential to developing realistic education and training techniques, which will lead to quality professional nursing practice for increasingly diverse populations.

  6. The quality of COPD care in general practice

    DEFF Research Database (Denmark)

    Rasmussen, F.V.; Borgeskov, H.; Dollerup, J.

    2008-01-01

    included in the first audit and 2394 in the second audit. We observed a significantly increased utilisation of spirometry from the first (52.7%) to the second audit (71.4%) (p quality of management. We conclude that participation in an educational......We investigated whether the quality of management of COPD in general practice could be improved by the participation of general practitioners and their staff in a COPD-specific educational programme. One-hundred and fifty-four doctors participated in the study, and 2549 patient record forms were...... programme can improve the quality of COPD care in general practice Udgivelsesdato: 2008/8/25...

  7. Standard Practice for Evaluating Solar Absorptive Materials for Thermal Applications

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2007-01-01

    1.1 This practice covers a testing methodology for evaluating absorptive materials used in flat plate or concentrating collectors, with concentrating ratios not to exceed five, for solar thermal applications. This practice is not intended to be used for the evaluation of absorptive surfaces that are (1) used in direct contact with, or suspended in, a heat-transfer liquid, (that is, trickle collectors, direct absorption fluids, etc.); (2) used in evacuated collectors; or (3) used in collectors without cover plate(s). 1.2 Test methods included in this practice are property measurement tests and aging tests. Property measurement tests provide for the determination of various properties of absorptive materials, for example, absorptance, emittance, and appearance. Aging tests provide for exposure of absorptive materials to environments that may induce changes in the properties of test specimens. Measuring properties before and after an aging test provides a means of determining the effect of the exposure. 1.3 Th...

  8. Standard practices for sampling uranium-Ore concentrate

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2010-01-01

    1.1 These practices are intended to provide the nuclear industry with procedures for obtaining representative bulk samples from uranium-ore concentrates (UOC) (see Specification C967). 1.2 These practices also provide for obtaining a series of representative secondary samples from the original bulk sample for the determination of moisture and other test purposes, and for the preparation of pulverized analytical samples (see Test Methods C1022). 1.3 These practices consist of a number of alternative procedures for sampling and sample preparation which have been shown to be satisfactory through long experience in the nuclear industry. These procedures are described in the following order. Stage Procedure Section Primary Sampling One-stage falling stream 4 Two-stage falling stream 5 Auger 6 Secondary Sampling Straight-path (reciprocating) 7 Rotating (Vezin) 8, 9 Sample Preparation 10 Concurrent-drying 11-13 Natural moisture 14-16 Calcination 17, 18 Sample Packaging 19 Wax s...

  9. Nursing Care Hour Standards Study. Part 2 thru Part 4

    Science.gov (United States)

    1981-09-01

    performs self - care activities, then only those direct nursing care activities performed by nursing personnel are scored. The system was designed so...assistance provided to other staff members per- forming the activity. If the patient performs self - care activities, then score only those nursing...arrival at bedside, clamp/unclamp .5 catheter, record time and urine output if appropriate. PERITONEAL DIALYSIS - INITIATION: Place equipment at bedside

  10. Neck Pain: Clinical Practice Guidelines Help Ensure Quality Care.

    Science.gov (United States)

    2017-07-01

    In 2008, physical therapists published the first neck pain clinical practice guidelines. These guidelines have been updated and are now available in the July 2017 issue of JOSPT. To update these guidelines, physical therapists teamed with the International Collaboration on Neck Pain to identify leading practices. These revised guidelines provide direction to clinicians as they screen, evaluate, diagnose, and make treatment-based classifications of neck pain. They also outline the best nonsurgical treatment options based on the published literature. At the end of the day, the best care is a combination of the leading science, the clinical expertise of your health care provider, and your input as the patient. These guidelines help inform the first step in this process. J Orthop Sports Phys Ther 2017;47(7):513. doi:10.2519/jospt.2017.0508.

  11. Tracing detached and attached care practices in nursing education

    DEFF Research Database (Denmark)

    Soffer, Ann Katrine B.

    2014-01-01

    of care are not explicated in the curriculum or textbooks; however, they surfaced once this crooked approach to studying care in a simulated practice was applied. The article starts from the assertion that detached engagements are not recognized within the field of nursing education as an equal component...... to attachments. Yet empirical cases from the skills lab and hospitals illustrate how students sometimes felt emotionally attached to plastic dummies and how experienced nurses sometimes practised a degree of detachment in relation to human patients. Detached engagements will therefore be presented as part......The implementation of skills labs in Danish nursing education can, in itself, be viewed as a complexity. The students are expected to eventually carry out their work in a situated hospital practice, but they learn their professional skills in a different space altogether, detached and removed from...

  12. Needle phobia--changing venepuncture practice in ambulatory care.

    Science.gov (United States)

    Thurgate, Claire; Heppell, Sue

    2005-11-01

    Needle phobia is a term used in practice to describe an anticipatory fear of needle insertion. A proportion of children display high levels of fear, pain and behavioural distress when exposed to, or anticipating, needle insertion. A difficult routine venepuncture in our ambulatory care unit led staff to review practice and develop a three-step approach to overcoming 'needle phobia': relaxation, control and graded exposure. These developments have resulted in the unit becoming a local referral centre for children and young people between the ages of 5-19 years with this problem. Time and skill are needed to prevent or overcome this distressing problem which can be caused by health care professionals not listening to children and young people.

  13. Struggles of Professionalism and Emotional Labour in Standardized Mental Health Care

    Directory of Open Access Journals (Sweden)

    Annette Kamp

    2016-03-01

    Full Text Available This article points out how recent public sector reforms under headings as New Public Management, Lean and Quality Reforms entail different forms for standardization, and examines how this development instigates a transformation of interdisciplinary and highly skilled emotional labor in mental healthcare. It is based on an ethnographic study of a Danish child psychiatric unit, which ‘produces’ diagnoses and treatment/therapy for children and their families. We illustrate how the enforcement of standardization upsets the balance between the humanistic and medical aspects of psychiatry as a discipline and field of practice, and show how this development challenges professional identities, interdisciplinary collaboration and hierarchical relations. The development is however negotiated, reformulated, and opposed, in teams of mental health professionals. In this context of increasing standardization, highly skilled emotional labor unfolds. We point out how acceleration and leaning of work procedures increases the emotional labor in relation to clients, partners, and colleagues. But paradoxically, at the same time, emotional labor becomes still more invisible as it is excluded from the standardized schemes. The study illustrates the crucial role of emotional labor in mental care work and points out how it is left to the professionals to negotiate paradoxes and make ends meet.

  14. Umbilical cord-care practices in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Coffey, Patricia S; Brown, Siobhan C

    2017-02-20

    Neonatal sepsis is the third leading cause of deaths for infants in their first month of life. The newly cut umbilical cord can be a pathway for bacteria that can cause newborn sepsis and death. Optimal umbilical cord care practices for newborns and during the first week of life, especially in settings with poor hygiene, has the potential to avoid these preventable neonatal deaths. The purpose of this review of cord care practices is to assist in the development of behavior-change strategies to support introduction of novel cord-care regimens, particularly 7.1% chlorhexidine digluconate for umbilical cord care. We searched domestic and international databases for articles that were published in English between January 1, 2000, and August 24, 2016. We found 321 articles and reviewed 65 full-text articles using standardized inclusion criteria. The primary criteria for inclusion was a description of substances applied to the umbilical cord stump in the days following birth. We included 46 articles in this review of umbilical cord-care practices. Articles included data from 15 low- and middle-income countries in sub-Saharan Africa (8 countries), Asia (5 countries), North Africa (1 country), and Latin America and the Caribbean (1 country). Findings from this review suggest that documentation of cord-care practices is not consistent throughout low- and middle-income countries, yet existing literature depicts a firm tradition of umbilical cord care in every culture. Cord-care practices vary by country and by regions or cultural groups within a country and employ a wide range of substances. The desire to promote healing and hasten cord separation are the underlying beliefs related to application of substances to the umbilical cord. The frequency of application of the substance (either the number of days or the number of times per day the substance was applied), and source and cost of products used is not well-characterized. This desire to actively care for the umbilical

  15. Umbilical cord-care practices in low- and middle-income countries: a systematic review

    Directory of Open Access Journals (Sweden)

    Patricia S. Coffey

    2017-02-01

    Full Text Available Abstract Background Neonatal sepsis is the third leading cause of deaths for infants in their first month of life. The newly cut umbilical cord can be a pathway for bacteria that can cause newborn sepsis and death. Optimal umbilical cord care practices for newborns and during the first week of life, especially in settings with poor hygiene, has the potential to avoid these preventable neonatal deaths. The purpose of this review of cord care practices is to assist in the development of behavior-change strategies to support introduction of novel cord-care regimens, particularly 7.1% chlorhexidine digluconate for umbilical cord care. Methods We searched domestic and international databases for articles that were published in English between January 1, 2000, and August 24, 2016. We found 321 articles and reviewed 65 full-text articles using standardized inclusion criteria. The primary criteria for inclusion was a description of substances applied to the umbilical cord stump in the days following birth. Results We included 46 articles in this review of umbilical cord-care practices. Articles included data from 15 low- and middle-income countries in sub-Saharan Africa (8 countries, Asia (5 countries, North Africa (1 country, and Latin America and the Caribbean (1 country. Findings from this review suggest that documentation of cord-care practices is not consistent throughout low- and middle-income countries, yet existing literature depicts a firm tradition of umbilical cord care in every culture. Cord-care practices vary by country and by regions or cultural groups within a country and employ a wide range of substances. The desire to promote healing and hasten cord separation are the underlying beliefs related to application of substances to the umbilical cord. The frequency of application of the substance (either the number of days or the number of times per day the substance was applied, and source and cost of products used is not well

  16. Best practice interprofessional stroke care collaboration and simulation: The student perspective.

    Science.gov (United States)

    MacKenzie, Diane; Creaser, Gail; Sponagle, Kim; Gubitz, Gordon; MacDougall, Peter; Blacquiere, Dylan; Miller, Stephen; Sarty, Gordon

    2017-11-01

    Interprofessional practice (IPP) is the accepted standard of care for clients following a stroke. A brief, embedded and evidence-based IPP team simulation was designed to address stroke care knowledge and IPP competencies for students within limited curriculum space. Each team was required to construct a collaborative care plan for their patient during the simulation and submit the care plan for evaluation of best practice stroke care knowledge and implementation with evidence of interprofessional collaboration (IPC). A total of 302 students (274 on-site, 28 by distance technology) representing four professions comprised of 55 teams took part in this experience. Post-simulation, voluntary and anonymous programme evaluations were completed using the standardised interprofessional collaborative competency assessment scale (ICCAS) and open-ended free-text responses to five questions. There was a significant improvement for all pre-post ratings on the ICCAS regardless of profession or previous interprofessional experience. Additionally, the open-ended responses indicated perceived changes to role clarification, communication, and teamwork. The combined interpretation of the programme evaluation results supports interprofessional team simulation as an effective and efficient learning experience for students regardless of previous interprofessional experience, and demonstrated positive changes in stroke best-practice knowledge and IPC competencies.

  17. American Society for Parenteral and Enteral Nutrition and Academy of Nutrition and Dietetics: Revised 2014 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition Support.

    Science.gov (United States)

    Brantley, Susan L; Russell, Mary K; Mogensen, Kris M; Wooley, Jennifer A; Bobo, Elizabeth; Chen, Yimin; Malone, Ainsley; Roberts, Susan; Romano, Michelle M; Taylor, Beth

    2014-12-01

    This 2014 revision of the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitians Nutritionists (RDNs) in Nutrition Support represents an update of the 2007 Standards composed by content experts of the American Society for Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics. The revision is based upon the Revised 2012 SOP in Nutrition Care and SOPP for RDs, which incorporates the Nutrition Care Process and the six domains of professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. These SOP and SOPP are designed to promote the provision of safe, effective, and efficient nutrition support services, facilitate evidence-based practice, and serve as a professional evaluation resource for RDNs who specialize or wish to specialize in nutrition support therapy. These standards should be applied in all patient/client care settings in which RDNs in nutrition support provide care. These settings include, but are not limited to, acute care, ambulatory/outpatient care, and home and alternate site care. The standards highlight the value of the nutrition support RDN's roles in quality management, regulatory compliance, research, teaching, consulting, and writing for peer-reviewed professional publications. The standards assist the RDN in nutrition support to distinguish his or her level of practice (competent, proficient, or expert) and would guide the RDN in creating a personal development plan to achieve increasing levels of knowledge, skill, and ability in nutrition support practice. © 2014 American Society for Parenteral and Enteral Nutrition.

  18. Finding Alignment: The Perceptions and Integration of the Next Generation Science Standards Practices by Elementary Teachers

    Science.gov (United States)

    Smith, Janette; Nadelson, Louis

    2017-01-01

    Preparing elementary-level teachers to teach in alignment with the eight Next Generation Science Standards (NGSS) practices could prove to be a daunting endeavor. However, the process may be catalyzed by leveraging elements of teacher science instruction that inherently attend to the practice standards. In this study, we investigated the science…

  19. 40 CFR 63.4293 - What work practice standards must I meet?

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 12 2010-07-01 2010-07-01 true What work practice standards must I meet? 63.4293 Section 63.4293 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Other Textiles Emission Limitations § 63.4293 What work practice standards must I meet? (a) For any...

  20. Redefining the Practice of Peer Review Through Intelligent Automation Part 1: Creation of a Standardized Methodology and Referenceable Database.

    Science.gov (United States)

    Reiner, Bruce I

    2017-10-01

    Conventional peer review practice is compromised by a number of well-documented biases, which in turn limit standard of care analysis, which is fundamental to determination of medical malpractice. In addition to these intrinsic biases, other existing deficiencies exist in current peer review including the lack of standardization, objectivity, retrospective practice, and automation. An alternative model to address these deficiencies would be one which is completely blinded to the peer reviewer, requires independent reporting from both parties, utilizes automated data mining techniques for neutral and objective report analysis, and provides data reconciliation for resolution of finding-specific report differences. If properly implemented, this peer review model could result in creation of a standardized referenceable peer review database which could further assist in customizable education, technology refinement, and implementation of real-time context and user-specific decision support.

  1. Use of antibiotics and compliance with standard practices in Poultry ...

    African Journals Online (AJOL)

    Indiscriminate use of antibiotics has led to the problem of bacterial resistance which is a major global threat to human and animal medicine. Thus, ethical issues are being raised on the practices of poultry farmers in the health management of poultry birds, as studies continue to emphasize the contribution of poultry industry ...

  2. Standard practice for radiological examination using digital detector arrays

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2010-01-01

    1.1 This practice establishes the minimum requirements for radiological examination for metallic and nonmetallic material using a digital detector array (DDA) system. 1.2 The requirements in this practice are intended to control the quality of radiologic images and are not intended to establish acceptance criteria for parts or materials. 1.3 This practice covers the radiologic examination with DDAs including DDAs described in Practice E2597 such as a device that contains a photoconductor attached to a Thin Film Transistor (TFT) read out structure, a device that has a phosphor coupled directly to an amorphous silicon read-out structure, and devices where a phosphor is coupled to a CMOS (Complementary metal–oxide–semiconductor) array, a Linear Detector Array (LDA) or a CCD (charge coupled device) crystalline silicon read-out structure. 1.4 The DDA shall be selected for an NDT application based on knowledge of the technology described in Guide , and of the selected DDA properties provided by the manufactu...

  3. Physiotherapy practices in Intensive Care Units across Maharashtra

    OpenAIRE

    Yeole, Ujwal Lakshman; Chand, Ankita Ramesh; Nandi, Biplab B.; Gawali, Pravin P.; Adkitte, Roshan G.

    2015-01-01

    Purpose: To find out the current physiotherapy practices in Intensive Care Unit (ICU) across Maharashtra. Materials and Methods: Study design was exploratory cross-sectional survey. Questionnaires were sent to the physiotherapists working in hospitals across Maharashtra state, India. Four weeks for completion of questionnaire was given in an attempt to ensure good response rates. Result: Of 200, 73 questionnaires were received representing a 36% response rate. The study revealed that 76% of t...

  4. Renewable Electricity Standards: Good Practices and Design Considerations

    Energy Technology Data Exchange (ETDEWEB)

    Cox, Sadie [National Renewable Energy Lab. (NREL), Golden, CO (United States); Esterly, Sean [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-01-02

    In widespread use globally, renewable electricity standards (RES) are one of the most widely adopted renewable energy policies and a critical regulatory vehicle to accelerate renewable energy deployment. This policy brief provides an introduction to key RES design elements, lessons from country experience, and support resources to enable more detailed and country-specific RES policy design.

  5. Health-seeking behaviors and self-care practices of people with filarial lymphoedema in Nepal: a qualitative study.

    Science.gov (United States)

    Adhikari, Ram Kumar; Sherchand, Jeevan Bahadur; Mishra, Shiva Raj; Ranabhat, Kamal; Pokharel, Amrit; Devkota, Pramila; Mishra, Durga; Ghimire, Yadu Chandra; Gelal, Khageshwor; Paudel, Rajan; Wagle, Rajendra Raj

    2015-01-01

    Background. Lymphatic filariasis is endemic in Nepal. This study aimed to investigate health-seeking behaviors and self-care practices of people with filarial Lymphoedema in Nepal. Methods. A cross-sectional study was conducted using qualitative methods in three endemic districts. Twenty-three patients with current Lymphoedema were recruited in the study. Results. Hydrocele was found to be a well-known condition and a major health problem in the studied communities. People with Lymphoedema primarily sought health care from traditional healers, whereas sometimes home-based care was their first treatment. Later Ayurvedic and allopathic hospital-based care were sought. Respondents reported various psychological problems such as difficulty in engaging in sexual intercourse, anxiety, worry and stress, depression, low self-esteem, feeling weak, fear of being abandoned, and fear of transmitting disease to the children. Standard foot care practices except washing were largely absent. Conclusions. Lymphoedema in the limbs and hydrocele were found to be major health problems. The traditional health care providers were the first contact of care for the majority of respondents. Only a few patients had been practicing standard foot care practices.

  6. Health-Seeking Behaviors and Self-Care Practices of People with Filarial Lymphoedema in Nepal: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Ram Kumar Adhikari

    2015-01-01

    Full Text Available Background. Lymphatic filariasis is endemic in Nepal. This study aimed to investigate health-seeking behaviors and self-care practices of people with filarial Lymphoedema in Nepal. Methods. A cross-sectional study was conducted using qualitative methods in three endemic districts. Twenty-three patients with current Lymphoedema were recruited in the study. Results. Hydrocele was found to be a well-known condition and a major health problem in the studied communities. People with Lymphoedema primarily sought health care from traditional healers, whereas sometimes home-based care was their first treatment. Later Ayurvedic and allopathic hospital-based care were sought. Respondents reported various psychological problems such as difficulty in engaging in sexual intercourse, anxiety, worry and stress, depression, low self-esteem, feeling weak, fear of being abandoned, and fear of transmitting disease to the children. Standard foot care practices except washing were largely absent. Conclusions. Lymphoedema in the limbs and hydrocele were found to be major health problems. The traditional health care providers were the first contact of care for the majority of respondents. Only a few patients had been practicing standard foot care practices.

  7. General Practice Messaging Standard Version 3.0, May 2014

    LENUS (Irish Health Repository)

    Sweeney, J

    2014-11-01

    Electronic health records (EHR) support clinical management, administration, quality assurance, research, and service planning. The aim of this study was to evaluate a clinical data management programme to improve consistency, completeness and accuracy of EHR information in a large primary care centre with 10 General Practitioners (GPs). A Clinical Data Manager was appointed to implement a Data Management Strategy which involved coding consultations using ICPC-2 coding, tailored support and ongoing individualised feedback to clinicians. Over an eighteen month period there were improvements in engagement with and level of coding. Prior to implementation (August 2011) 4 of the 10 GPs engaged in regular coding and 69% of their consultation notes were coded. After 12 months, all 10 GPs and 6 nurses were ICPC-2 coding their consultations and monthly coding levels had increased to 98%. This structured Data Management Strategy provides a feasible sustainable way to improve information management in primary care.

  8. Minimum Standards Required for Licensing of Day Care Family Homes.

    Science.gov (United States)

    Arkansas State Dept. of Human Services, Little Rock. Div. of Social Services.

    State licensing requirements for day care family homes in Arkansas are collected in this publication. Contents focus on the licensing authority, definition of a family day care home and application requirements, administration, personnel, program and activities, discipline and guidance, records, food service and nutrition, building and grounds,…

  9. Pain assessment practices in Swedish and Norwegian neonatal care units.

    Science.gov (United States)

    Andersen, Randi Dovland; Munsters, Josanne M A; Vederhus, Bente Johanne; Gradin, Maria

    2017-12-28

    The use of measurement scales to assess pain in neonates is considered a prerequisite for effective management of pain, but these scales are still underutilised in clinical practice. The aim of this study was to describe and compare pain assessment practices including the use of pain measurement scales in Norwegian and Swedish neonatal care units. A unit survey investigating practices regarding pain assessment and the use of pain measurement scales was sent to all neonatal units in Sweden and Norway (n = 55). All Norwegian and 92% of Swedish units responded. A majority of the participating units (86.5%) assessed pain. Swedish units assessed and documented pain and used pain measurement scales more frequently than Norwegian units. The most frequently used scales were different versions of Astrid Lindgren's Pain Scale (ALPS) in Sweden and Echelle Douleur Inconfort Noveau-Ne (EDIN), ALPS and Premature Infant Pain Profile (PIPP) in Norway. Norwegian head nurses had more confidence in their pain assessment method and found the use of pain measurement scales more important than their Swedish colleagues. The persisting difference between Swedish and Norwegian units in pain assessment and the use of pain measurement scales are not easily explained. However, the reported increased availability and reported use of pain measurement scales in neonatal care units in both countries may be seen as a contribution towards better awareness and recognition of pain, better pain management and potentially less suffering for vulnerable neonates. © 2017 Nordic College of Caring Science.

  10. User-generated quality standards for youth mental health in primary care: a participatory research design using mixed methods.

    Science.gov (United States)

    Graham, Tanya; Rose, Diana; Murray, Joanna; Ashworth, Mark; Tylee, André

    2014-10-01

    To develop user-generated quality standards for young people with mental health problems in primary care using a participatory research model. 50 young people aged 16-25 from community settings and primary care participated in focus groups and interviews about their views and experiences of seeking help for mental health problems in primary care, cofacilitated by young service users and repeated to ensure respondent validation. A second group of young people also aged 16-25 who had sought help for any mental health problem from primary care or secondary care within the last 5 years were trained as focus groups cofacilitators (n=12) developed the quality standards from the qualitative data and participated in four nominal groups (n=28). 46 quality standards were developed and ranked by young service users. Agreement was defined as 100% of scores within a two-point region. Group consensus existed for 16 quality standards representing the following aspects of primary care: better advertising and information (three); improved competence through mental health training and skill mix within the practice (two); alternatives to medication (three); improved referral protocol (three); and specific questions and reassurances (five). Alternatives to medication and specific questions and reassurances are aspects of quality which have not been previously reported. We have demonstrated the feasibility of using participatory research methods in order to develop user-generated quality standards. The development of patient-generated quality standards may offer a more formal method of incorporating the views of service users into quality improvement initiatives. This method can be adapted for generating quality standards applicable to other patient groups. 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.

  11. Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System.

    Science.gov (United States)

    Foss Durant, Anne; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

    2015-01-01

    In early 2010, leaders within Kaiser Permanente (KP) Northern California's Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes.

  12. Clinical accuracy of point-of-care urine culture in general practice

    DEFF Research Database (Denmark)

    Holm, Anne; Cordoba, Gloria; Sørensen, Tina Møller

    2017-01-01

    OBJECTIVE: To assess the clinical accuracy (sensitivity (SEN), specificity (SPE), positive predictive value and negative predictive value) of two point-of-care (POC) urine culture tests for the identification of urinary tract infection (UTI) in general practice. DESIGN: Prospective diagnostic...... accuracy study comparing two index tests (Flexicult™ SSI-Urinary Kit or ID Flexicult™) with a reference standard (urine culture performed in the microbiological department). SETTING: General practice in the Copenhagen area patients. Adult female patients consulting their general practitioner with suspected...... uncomplicated, symptomatic UTI. MAIN OUTCOME MEASURES: (1) Overall accuracy of POC urine culture in general practice. (2) Individual accuracy of each of the two POC tests in this study. (3) Accuracy of POC urine culture in general practice with enterococci excluded, since enterococci are known to multiply...

  13. Caring from a Christian Worldview: Exploring Nurses' Source of Caring, Faith Practices, and View of Nursing.

    Science.gov (United States)

    Rieg, Linda S; Newbanks, Shirlene; Sprunger, Rose

    2017-12-12

    This study explored Christian nurses' views of their source of caring (Deity or other), adherence to biblical faith practices, and view of nursing as a job, career, profession, or calling. Participants who reported Deity (God, Christ, Holy Spirit) as their source of caring were more likely to view nursing as a calling and report a higher degree of volunteering (serving), giving (financially to a religious community), devotions and prayer (personal walk), and fellowship (meeting with a community of other believers). Results have implications for understanding the concept of caring within the context of a Christian worldview.

  14. Standard practice for liquid penetrant examination for general industry

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2009-01-01

    1.1 This practice covers procedures for penetrant examination of materials. Penetrant testing is a nondestructive testing method for detecting discontinuities that are open to the surface such as cracks, seams, laps, cold shuts, shrinkage, laminations, through leaks, or lack of fusion and is applicable to in-process, final, and maintenance testing. It can be effectively used in the examination of nonporous, metallic materials, ferrous and nonferrous metals, and of nonmetallic materials such as nonporous glazed or fully densified ceramics, as well as certain nonporous plastics, and glass. 1.2 This practice also provides a reference: 1.2.1 By which a liquid penetrant examination process recommended or required by individual organizations can be reviewed to ascertain its applicability and completeness. 1.2.2 For use in the preparation of process specifications and procedures dealing with the liquid penetrant testing of parts and materials. Agreement by the customer requesting penetrant inspection is strongly rec...

  15. Radiotherapy skin care: A survey of practice in the UK

    International Nuclear Information System (INIS)

    Harris, Rachel; Probst, Heidi; Beardmore, Charlotte; James, Sarah; Dumbleton, Claire; Bolderston, Amanda; Faithfull, Sara; Wells, Mary; Southgate, Elizabeth

    2012-01-01

    Aim: The primary objective of the survey was to evaluate clinical skin care practice in radiotherapy departments across the United Kingdom. Methods and sample: A questionnaire containing sixty-one questions grouped into eight themed sections was developed and a link to an on-line survey, using the Survey Monkey™ tool, was e-mailed to all radiotherapy department managers in the United Kingdom (N = 67). Each recipient was invited to provide one response per department. Key results: Fifty-four departments responded within the allocated timeframe giving a final response rate of 81%. Products and their use for skin conditions varied and some outdated and unfounded practices were still being used which did not always reflect the current evidence base. The amount of data routinely collected on skin toxicity was limited making it difficult to quantify the extent of skin morbidity following radiotherapy. Conclusion: The survey demonstrated variability in skin care practice in radiotherapy departments across the UK, with limited practice based on evidence or on skin toxicity measurement and monitoring.

  16. Regulatory practices and standards: the international scene and trends

    International Nuclear Information System (INIS)

    Vinck, W.; Essler, W.; Maurer, H.A.; Reijen, G. van.

    1978-01-01

    At national level, codification of standards governing the licensing and operation of nuclear installations is very different, ranging from criteria to regulations, according to the degree of the obligation imposed by national authorities; it also reflects the variety of national situations and the peculiarities of the legal and political systems. The need to agree upon a level of nuclear safety which is generally recognised as satisfactory and to exchange scientific and technological information in this field has greatly stimulated international co-operation, in particular within the framework of specialized international organisations such as IAEA, ISO, Euratom and OECD/NEA. Harmonization of such standards is particularly important from the viewpoint of public opinion in the countries concerned. In addition, the intrinsic safety of nuclear power plants, assurances as to the duration of plant life should increasingly be highlighted in future. (NEA) [fr

  17. Standard practice for classification of computed radiology systems

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2005-01-01

    1.1 This practice describes the evaluation and classification of a computed radiography (CR) system, a particular phosphor imaging plate (IP), system scanner and software, in combination with specified metal screens for industrial radiography. It is intended to ensure that the evaluation of image quality, as far as this is influenced by the scanner/IP system, meets the needs of users. 1.2 The practice defines system tests to be used to classify the systems of different suppliers and make them comparable for users. 1.3 The CR system performance is described by signal and noise parameters. For film systems, the signal is represented by gradient and the noise by granularity. The signal-to-noise ratio is normalized by the basic spatial resolution of the system and is part of classification. The normalization is given by the scanning aperture of 100 µm diameter for the micro-photometer, which is defined in Test Method E1815 for film system classification. This practice describes how the parameters shall be meas...

  18. Registered Nurses’ Patient Education in Everyday Primary Care Practice

    Directory of Open Access Journals (Sweden)

    Anne-Louise Bergh

    2015-08-01

    Full Text Available Nurses’ patient education is important for building patients’ knowledge, understanding, and preparedness for self-management. The aim of this study was to explore the conditions for nurses’ patient education work by focusing on managers’ discourses about patient education provided by nurses. In 2012, data were derived from three focus group interviews with primary care managers. Critical discourse analysis was used to analyze the transcribed interviews. The discursive practice comprised a discourse order of economic, medical, organizational, and didactic discourses. The economic discourse was the predominant one to which the organization had to adjust. The medical discourse was self-evident and unquestioned. Managers reorganized patient education routines and structures, generally due to economic constraints. Nurses’ pedagogical competence development was unclear, and practice-based experiences of patient education were considered very important, whereas theoretical pedagogical knowledge was considered less important. Managers’ support for nurses’ practical- and theoretical-based pedagogical competence development needs to be strengthened.

  19. Registered Nurses’ Patient Education in Everyday Primary Care Practice

    Science.gov (United States)

    Bergh, Anne-Louise; Friberg, Febe; Persson, Eva; Dahlborg-Lyckhage, Elisabeth

    2015-01-01

    Nurses’ patient education is important for building patients’ knowledge, understanding, and preparedness for self-management. The aim of this study was to explore the conditions for nurses’ patient education work by focusing on managers’ discourses about patient education provided by nurses. In 2012, data were derived from three focus group interviews with primary care managers. Critical discourse analysis was used to analyze the transcribed interviews. The discursive practice comprised a discourse order of economic, medical, organizational, and didactic discourses. The economic discourse was the predominant one to which the organization had to adjust. The medical discourse was self-evident and unquestioned. Managers reorganized patient education routines and structures, generally due to economic constraints. Nurses’ pedagogical competence development was unclear, and practice-based experiences of patient education were considered very important, whereas theoretical pedagogical knowledge was considered less important. Managers’ support for nurses’ practical- and theoretical-based pedagogical competence development needs to be strengthened. PMID:28462314

  20. The level of observing standard tracheostomy care and some barriers from perspective of nurses

    Directory of Open Access Journals (Sweden)

    Mosazade Sari Z

    2015-05-01

    Full Text Available Background & objective: Tracheostomy is one of the most common surgical procedures in intensive care unit. Although the implementation of standard care can lead to decrease the postoperative complications, but some factors causes the negative attitude in nurses and consequently lead to implementing the routine and non-standard care. The current study was conducted aimed to determine the level of observing standard tracheostomy care and some barriers from perspective of nurses.  Materials and Methods: In this descriptive-analytical study 42 nurses who were working in two selected hospitals in Tehran in 2013 were entered the study through census. Data were gathered through researcher made questionnaire for demographic data, observation checklist for standard tracheopstomy care and its barriers. The researcher observed 3 times concerning the how to care of tracheostomy by nurses and then nurses completed the demographic and barriers to standard care questionnaires. Data were analyzed by SPSS 21using one sample T-test, independent T-test, chi-square, ANOVA and Pearsons’ correlation coefficient.  Results: According to results, only 2 nurses (4.8 percent performed the standard tracheostomy care. The Most barriers affecting on the standard tracheostomy care were the administrative barriers (54.76 percent. Also, there was a moderate positive correlation between standard care with administrative barriers (r=0.46, p=0.002, personal barriers (r=0.38, p=0.012 and all of the barriers (r= 0.46, p=0.002. Conclusion: Most tracheostomy care are not according to standard protocols and most important barriers of its implementation are administrative barriers. With attention to the importance of this care, some necessary measures must be taken to resolve the barriers.

  1. 7 CFR 205.206 - Crop pest, weed, and disease management practice standard.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Crop pest, weed, and disease management practice... Requirements § 205.206 Crop pest, weed, and disease management practice standard. (a) The producer must use management practices to prevent crop pests, weeds, and diseases including but not limited to: (1) Crop...

  2. Scientific and Practical Commentary on Specialists’ Professional Standards in Thermal

    Directory of Open Access Journals (Sweden)

    M. Yu. Semenov

    2016-01-01

    Full Text Available The professional standards for heat treatment specialists such as "Specialist in thermal equipment installation and tests", "Specialist in analysis and diagnosis of heat treatment process systems", "Specialist in automation and mechanization of heat treatment process systems" were developed according to the Rules for the Development, Approval, and Application of Professional Standards adopted by a Decree of the Government of the Russian Federation dated 01.22.2013 № 23.The article objective is to find a way that allows directors of machine-building plants to understand the provisions of abovementioned professional standards.This commentary was developed with participation of experts, who were in charge of the professional standards.When developing the professional standards it was taken into consideration that, presently, the most promising are vacuum and ion processes of heat and thermo-chemical treatment.In this connection a new classification of the thermal equipment and manufacturing processes has been realized according to criterion of technical complexity. This classification puts the thermal equipment and manufacturing processes into simple, complex, and specifically complex.As proposed, the specifically complex thermal equipment is a multi-zone thermal one with each zone being under precise temperature control, and a vacuum or ion equipment for thermal and thermochemical treatment with integrated cooling system. The complex thermal equipment is an equipment for heat and thermochemical treatment in controlled atmosphere, and a multichamber or continuous heat treatment furnaces, as well as vacuum and ion-plasma equipment, except for specifically complex thermal equipment. The simple thermal equipment is a heat treatment one except for complex and specifically complex thermal equipment.The article gives concrete examples of simple, complex and specifically complex thermal equipment.The criteria to classify the heat treatment technological

  3. The Model Standards Project: Creating Inclusive Systems for LGBT Youth in Out-of-Home Care

    Science.gov (United States)

    Wilber, Shannan; Reyes, Carolyn; Marksamer, Jody

    2006-01-01

    This article describes the Model Standards Project (MSP), a collaboration of Legal Services for Children and the National Center for Lesbian Rights. The MSP developed a set of model professional standards governing the care of lesbian, gay, bisexual and transgender (LGBT) youth in out-of-home care. This article provides an overview of the…

  4. User embracement in practices care in psychosocial care centers the perspective of local managers

    Directory of Open Access Journals (Sweden)

    Andreza Kelly Cardoso da Silva Soares

    2017-03-01

    Full Text Available Introduction: Psychosocial care centres (CAPS, strategic IN articulation of psychosocial care network and health system gateway, propose to the reorganization of health practices, by adopting a new ethic of care, based on respect to the singularity of the subjects and in the reception to the health needs of the users. Reception is a device for transforming practices and humanizing health care.  Objective: To analyse the operation of the host users of CAPS from the perspective of local coordinators in Fortaleza, Ceará, Brazil.  Method: Qualitative research with case study design, performed with CAPS coordinators of the city of Fortaleza, Ceará, Brazil. Data were collected through semi-structured interviews and observation, being submitted to the analysis of thematic content.  Results: The host constituted innovative device in mental health practices, as triggered the construction of new ways of dealing with the subject in psychological distress, by incorporating technologies such as qualified listening, building autonomy, with attention focused on the user. Provided a reorientation of work and service processes, requesting the articulation for network care. In addition, it was configured as a strategy for humanization in the CAPS. Was presented, however, operational difficulties related to the environment and to the effectiveness of the network of attention.  Final considerations: The host device configured for reorienting health practices, enhancing the consolidation of psychosocial care model, with humanization and increased solvability. However, challenges remain to be overcome, related to the environment and to the effectiveness of the network of care.

  5. Application of Orem's self-care deficit theory and standardized nursing languages in a case study of a woman with diabetes.

    Science.gov (United States)

    Kumar, Coleen P

    2007-01-01

    This paper aims to illustrate the process of theory-based nursing practice by presenting a case study of a clinical nurse specialist's assessment and care of a woman with type 2 diabetes. Orem's self-care deficit theory and standardized nursing language, NANDA, NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification), guided assessment and the identification of outcomes and interventions related to the client's management of diabetes. Theory-based nursing care and standardized nursing language enhanced the client's ability to self-manage the chronic illness: diabetes. Nursing theory and standardized nursing language enhance communication among nurses and support a client's ability to self-manage a chronic illness.

  6. School Librarian as Inquisitor of Practice: Reimagine, Reflect, and React with the New Standards

    Science.gov (United States)

    Burns, Elizabeth

    2018-01-01

    The modern school library is a complex social setting "grounded in standards and best practice" (AASL 2018). The new "National School Library Standards" have refreshed the student learning standards and aligned new Shared Foundations to the school library. Additionally, the competencies for learners are now complemented by…

  7. Ohio High School Biology Teachers' Views of State Standard for Evolution: Impacts on Practice

    Science.gov (United States)

    Borgerding, Lisa A.

    2012-01-01

    High school biology teachers face many challenges as they teach evolution. State standards for evolution may provide support for sound evolution instruction. This study attempts to build upon previous work by investigating teachers' views of evolution standards and their evolution practices in a state where evolution standards have been…

  8. 40 CFR 63.3493 - What work practice standards must I meet?

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 12 2010-07-01 2010-07-01 true What work practice standards must I meet? 63.3493 Section 63.3493 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standards for Hazardous Air...

  9. 40 CFR 63.4493 - What work practice standards must I meet?

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 12 2010-07-01 2010-07-01 true What work practice standards must I meet? 63.4493 Section 63.4493 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standards for Hazardous Air...

  10. 40 CFR 63.4093 - What work practice standards must I meet?

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 12 2010-07-01 2010-07-01 true What work practice standards must I meet? 63.4093 Section 63.4093 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standards for Hazardous Air...

  11. 40 CFR 63.4693 - What work practice standards must I meet?

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 12 2010-07-01 2010-07-01 true What work practice standards must I meet? 63.4693 Section 63.4693 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standards for Hazardous Air...

  12. 40 CFR 63.9591 - What work practice standards must I meet?

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 14 2010-07-01 2010-07-01 false What work practice standards must I meet? 63.9591 Section 63.9591 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission Standards for...

  13. 40 CFR 63.4893 - What work practice standards must I meet?

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 12 2010-07-01 2010-07-01 true What work practice standards must I meet? 63.4893 Section 63.4893 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standards for Hazardous Air...

  14. 40 CFR 63.8192 - What work practice standards must I meet?

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 13 2010-07-01 2010-07-01 false What work practice standards must I meet? 63.8192 Section 63.8192 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission Standards for...

  15. 40 CFR 63.3893 - What work practice standards must I meet?

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 12 2010-07-01 2010-07-01 true What work practice standards must I meet? 63.3893 Section 63.3893 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standards for Hazardous Air...

  16. The practice of health care: wisdom as a model.

    Science.gov (United States)

    Edmondson, Ricca; Pearce, Jane

    2007-09-01

    Reasoning and judgement in health care entail complex responses to problems whose demands typically derive from several areas of specialism at once. We argue that current evidence- or value-based models of health care reasoning, despite their virtues, are insufficient to account for responses to such problems exhaustively. At the same time, we offer reasons for contending that health professionals in fact engage in forms of reasoning of a kind described for millennia under the concept of wisdom. Wisdom traditions refer to forms of deliberation which combine knowledge, reflection and life experience with social, emotional and ethical capacities. Wisdom is key in dealing with problems which are vital to human affairs but lack prescribed solutions. Uncertainty and fluidity must be tolerated in seeking to resolve them. We illustrate the application of wisdom using cases in psychiatry, where non-technical aspects of problems are often prominent and require more systematic analysis than conventional approaches offer, but we argue that our thesis applies throughout the health care field. We argue for the relevance of a threefold model of reasoning to modern health care situations in which multifaceted teamwork and complex settings demand wise judgement. A model based on practical wisdom highlights a triadic process with features activating capacities of the self (professional), other (patient and/or carers and/or colleagues) and aspects of the problem itself. Such a framework could be used to develop current approaches to health care based on case review and experiential learning.

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

    Science.gov (United States)

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

    2017-12-01

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

  18. Comparison of current practices of cardiopulmonary perfusion technology in Iran with American Society of Extracorporeal Technology's standards.

    Science.gov (United States)

    Faravan, Amir; Mohammadi, Nooredin; Alizadeh Ghavidel, Alireza; Toutounchi, Mohammad Zia; Ghanbari, Ameneh; Mazloomi, Mehran

    2016-01-01

    Standards have a significant role in showing the minimum level of optimal optimum and the expected performance. Since the perfusion technology staffs play an the leading role in providing the quality services to the patients undergoing open heart surgery with cardiopulmonary bypass machine, this study aimed to assess the standards on how Iranian perfusion technology staffs evaluate and manage the patients during the cardiopulmonary bypass process and compare their practice with the recommended standards by American Society of Extracorporeal Technology. In this descriptive study, data was collected from 48 Iranian public hospitals and educational health centers through a researcher-created questionnaire. The data collection questionnaire assessed the standards which are recommended by American Society of Extracorporeal Technology. Findings showed that appropriate measurements were carried out by the perfusion technology staffs to prevent the hemodilution and avoid the blood transfusion and unnecessary blood products, determine the initial dose of heparin based on one of the proposed methods, monitor the anticoagulants based on ACT measurement, and determine the additional doses of heparin during the cardiopulmonary bypass based on ACT or protamine titration. It was done only in 4.2% of hospitals and health centers. Current practices of cardiopulmonary perfusion technology in Iran are inappropriate based on the standards of American Society of Cardiovascular Perfusion. This represents the necessity of authorities' attention to the validation programs and development of the caring standards on one hand and continuous assessment of using these standards on the other hand.

  19. National BTS bronchiectasis audit 2012: is the quality standard being adhered to in adult secondary care?

    Science.gov (United States)

    Hill, Adam T; Routh, Chris; Welham, Sally

    2014-03-01

    A significant step towards improving care of patients with non-cystic fibrosis bronchiectasis was the creation of the British Thoracic Society (BTS) national guidelines and the quality standard. A BTS bronchiectasis audit was conducted between 1 October and 30 November 2012, in adult patients with bronchiectasis attending secondary care, against the BTS quality standard. Ninety-eight institutions took part, submitting a total of 3147 patient records. The audit highlighted the variable adoption of the quality standard. It will allow the host institutions to benchmark against UK figures and drive quality improvement programmes to promote the quality standard and improve patient care.

  20. Managing the primary care practice on the Web

    Science.gov (United States)

    Van Grevenhof P; Rahman; Cabanela; Naessens; Lassig

    2000-01-01

    Physicians and administrators have little hope of responding appropriately to the challenges of the health care market without data to support decision making. Desired Mayo Clinic s Primary Care Practice was to have the ability to access and integrate data from many platforms in many formats from the Enterprise and bring this information to the desktop in a robust interactive display. The solution was delivery of the data to the Web through an interface using Java with access to Online Analytical Processing (OLAP) tools for summarization, graphical display and reporting. Communicating major trends, assisting in planning and management, visually displaying alerts in summary data and individual patients that are all possible through an easy-to-use Web application. To really understand what the summarized data represents, the physicians must be able to drill down, download and explore their own detail data. A pilot project was developed to test the capabilities of the development environment, the acceptance Web tools, the ability to deliver timely information and the methodology of using a multi-dimensional database to define the data. The Family Medicine practice at four separate locations was chosen for the demonstration project. Two practices in Rochester, MN and practices in two smaller towns, totaling 50 physicians and administrative personnel, were the first clients using the system. A cross-functional team examined a variety of development issues such as data sources, data definitions, levels of security, data analysis types, and style of display. Demonstrations of the prototype met with an overwhelming positive response from administrators and department leaders. The Physician Patient Management solution collects, analyzes, and communicates the information needed to meet today s health care challenges.

  1. A survey on critical care resources and practices in low- and middle-income countries.

    Science.gov (United States)

    Vukoja, Marija; Riviello, Elisabeth; Gavrilovic, Srdjan; Adhikari, Neill K J; Kashyap, Rahul; Bhagwanjee, Satish; Gajic, Ognjen; Kilickaya, Oguz

    2014-09-01

    Timely and appropriate care is the key to achieving good outcomes in acutely ill patients, but the effectiveness of critical care may be limited in resource-limited settings. This study sought to understand how to implement best practices in intensive care units (ICU) in low- and middle-income countries (LMIC) and to develop a point-of-care training and decision-support tool. An internationally representative group of clinicians performed a 22-item capacity-and-needs assessment survey in a convenience sample of 13 ICU in Eastern Europe (4), Asia (4), Latin America (3), and Africa (2), between April and July 2012. Two ICU were from low-income, 2 from low-middle-income, and 9 from upper-middle-income countries. Clinician respondents were asked about bed capacity, patient characteristics, human resources, available medications and equipment, access to education, and processes of care. Thirteen clinicians from each of 13 hospitals (1 per ICU) responded. Surveyed hospitals had median of 560 (interquartile range [IQR]: 232, 1,200) beds. ICU had a median of 9 (IQR: 7, 12) beds and treated 40 (IQR: 20, 67) patients per month. Many ICU had ≥ 1 staff member with some formal critical care training (n = 9, 69%) or who completed Fundamental Critical Care Support (n = 7, 54%) or Advanced Cardiac Life Support (n = 9, 69%) courses. Only 2 ICU (15%) used any kind of checklists for acute resuscitation. Ten (77%) ICU listed lack of trained staff as the most important barrier to improving the care and outcomes of critically ill patients. In a convenience sample of 13 ICU from LMIC, specialty-trained staff and standardized processes of care such as checklists are frequently lacking. ICU needs-assessment evaluations should be expanded in LMIC as a global priority, with the goal of creating and evaluating context-appropriate checklists for ICU best practices. Copyright © 2014 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

  2. Perception on Informed Consent Regarding Nursing Care Practices in a Tertiary Care Center.

    Science.gov (United States)

    Paudel, B; Shrestha, G K

    Background Consent for care procedures is mandatory after receipt of adequate information. It maintains patient's rights and autonomy to make thoughtful decisions. Poor communication often leads to poor health quality. Objective To assess hospitalized patients' perception on informed consent regarding nursing care practices in a tertiary care center. Method This is a descriptive cross-sectional study among 113 admitted patients conducted in February 2012 at Dhulikhel Hospital, Nepal. Patients of various wards were selected using purposive non-probability sampling with at least 3 days of hospitalization. Close ended structured questionnaire was used to assess patients' perception on three different areas of informed consent (information giving, opportunity to make decision and taking prior consent). Result Among the participants 71.6% perceived positively regarding informed consent towards nursing care practices with a mean score of 3.32 ± 1.28. Patients' perception on various areas of informed consent viz. information giving, opportunities to make specific decision and taking prior consent were all positive with mean values of 3.43±1.12, 2.88±1.23, 3.65±1.49 respectively. Comparison of mean perception of informed consent with various variables revealed insignificant correlation (p-value >0.05) for age, educational level and previous hospitalization while it was significant (p-value perception on informed consent towards nursing care practices. Communication skills of nurses affect the perception of patients' regardless of age, education level and past experiences.

  3. Child Care: States Face Difficulties Enforcing Standards and Promoting Quality. Report to Congressional Requesters.

    Science.gov (United States)

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This report discusses efforts to ensure and promote quality child care through enforcement of state standards and other activities. The Child Care and Development Block Grant Act of 1990 authorized the dispersing of funds to states for child care services through the United States Department of Health and Human Services (HHS). These funds are used…

  4. Monitoring the standard of care of diabetes mellitus type 2 in a ...

    African Journals Online (AJOL)

    Background: Complying of diabetic patients with the standard administered medical care at primary health care units is an important issue. Revealing the rates of compliance provide important information that can be used both by the medical staff to evaluate the administered medical care and by the patients to evaluate ...

  5. Tailoring intervention procedures to routine primary health care practice; an ethnographic process evaluation

    Directory of Open Access Journals (Sweden)

    Bruijnzeels Marc

    2007-08-01

    Full Text Available Abstract Background Tailor-made approaches enable the uptake of interventions as they are seen as a way to overcome the incompatibility of general interventions with local knowledge about the organisation of routine medical practice and the relationship between the patients and the professionals in practice. Our case is the Quattro project which is a prevention programme for cardiovascular diseases in high-risk patients in primary health care centres in deprived neighbourhoods. This programme was implemented as a pragmatic trial and foresaw the importance of local knowledge in primary health care and internal, or locally made, guidelines. The aim of this paper is to show how this prevention programme, which could be tailored to routine care, was implemented in primary care. Methods An ethnographic design was used for this study. We observed and interviewed the researchers and the practice nurses. All the research documents, observations and transcribed interviews were analysed thematically. Results Our ethnographic process evaluation showed that the opportunity of tailoring intervention procedures to routine care in a pragmatic trial setting did not result in a well-organised and well-implemented prevention programme. In fact, the lack of standard protocols hindered the implementation of the intervention. Although it was not the purpose of this trial, a guideline was developed. Despite the fact that the developed guideline functioned as a tool, it did not result in the intervention being organised accordingly. However, the guideline did make tailoring the intervention possible. It provided the professionals with the key or the instructions needed to achieve organisational change and transform the existing interprofessional relations. Conclusion As tailor-made approaches are developed to enable the uptake of interventions in routine practice, they are facilitated by the brokering of tools such as guidelines. In our study, guidelines facilitated

  6. Health and Safety Checklist for Early Care and Education Programs to Assess Key National Health and Safety Standards.

    Science.gov (United States)

    Alkon, Abbey; Rose, Roberta; Wolff, Mimi; Kotch, Jonathan B; Aronson, Susan S

    2016-01-01

    The project aims were to (1) develop an observational Health and Safety Checklist to assess health and safety practices and conditions in early care and education (ECE) programs using Stepping Stones To Caring For Our Children, 3rd Edition national standards, (2) pilot test the Checklist, completed by nurse child care health consultants, to assess feasibility, ease of completion, objectivity, validity, and reliability, and (3) revise the Checklist based on the qualitative and quantitative results of the pilot study. The observable national health and safety standards were identified and then rated by health, safety, and child care experts using a Delphi technique to validate the standards as essential to prevent harm and promote health. Then, child care health consultants recruited ECE centers and pilot tested the 124-item Checklist. The pilot study was conducted in Arizona, California and North Carolina. The psychometric properties of the Checklist were assessed. The 37 participating ECE centers had 2627 children from ethnically-diverse backgrounds and primarily low-income families. The child care health consultants found the Checklist easy to complete, objective, and useful for planning health and safety interventions. The Checklist had content and face validity, inter-rater reliability, internal consistency, and concurrent validity. Based on the child care health consultant feedback and psychometric properties of the Checklist, the Checklist was revised and re-written at an 8th grade literacy level. The Health and Safety Checklist provides a standardized instrument of observable, selected national standards to assess the quality of health and safety in ECE centers.

  7. Small business size standards; health care. Small Business Administration. Final rule.

    Science.gov (United States)

    2000-11-17

    The Small Business Administration is adopting new size standards for 19 Health Care industries and retaining the existing $5 million size standard for the remaining 11 Health Care industries. The North American Industry Classification System classifies Health Care industries under Subsector 621, Ambulatory Health Care Services; Subsector 622, Hospitals; and Subsector 623, Nursing and Residential Care Facilities. These revisions are made to more appropriately define the size of businesses in these industries that SBA believes should be eligible for Federal small business assistance programs.

  8. Standard Practice for Ionization Gage Application to Space Simulators

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    1970-01-01

    1.1 This practice provides application criteria, definitions, and supplemental information to assist the user in obtaining meaningful vacuum ionization gage measurements below 10−1 N/m2 (10−3 torr) in space-simulation facilities. Since a variety of influences can alter observed vacuum measurements, means of identifying and assessing potential problem areas receive considerable attention. This practice must be considered informational, for it is impossible to specify a means of applying the vacuum-measuring equipment to guarantee accuracy of the observed vacuum measurement. Therefore, the user's judgment is essential so that if a problem area is identified, suitable steps can be taken to either minimize the effect, correct the observed readings as appropriate, or note the possible error in the observation. 1.2 While much of the discussion is concerned with the application of hot-cathode ionization gages, no exclusion is made of cold-cathode designs. Since a great deal more experience with hot-cathode gage...

  9. Exploring practice variation in preventive pressure-ulcer care using data from a clinical data repository.

    Science.gov (United States)

    Cho, InSook; Park, Hyeoun-Ae; Chung, Eunja

    2011-01-01

    The aims of this study were to explore pressure ulcer incidences and practice variations in the nursing intervention provided for preventive pressure-ulcer care to patients either with pressure ulcers or at risk of pressure ulcers, and to examine them in relation to the patients' medical problems and the characteristics of the nurses who cared for them. The narrative nursing notes of 427 intensive-care patients who were discharged in 2007 that were documented at the point-of-care using standardized nursing statements were extracted from a clinical data repository at a teaching hospital in Korea and analyzed. The frequencies of five nursing interventions for pressure-ulcer prevention were compared between pressure-ulcer and pressure-ulcer risk groups, as were the characteristics of the nurses who were treating the patients in these two groups. Nursing interventions for pressure-ulcer prevention were also assessed relative to the patients' medical problems. The overall incidence of pressure ulcers was 15.0%. Position change was the most popular nursing intervention provided for pressure-ulcer prevention in both the pressure-ulcer and at-risk groups, followed by skin care. There was a statistically significant tendency toward a greater frequency of providing skin care and nutritional care in the at-risk group than in the pressure-ulcer group. There was no statistically significant difference in the mean frequencies of nursing interventions relative to the patients' medical problems in the pressure-ulcer group. However, frequencies of nursing interventions did differ significantly between patients with neurological problems and those with other medical problems in the at-risk group. Analysis of the nurses' characteristics revealed that more nursing interventions were documented by those who were younger, less experienced, and more educated. A standardized nursing-terminology-based electronic nursing record system allowed us to monitor the variations in nursing practice

  10. Practical standard for nuclear power plant life management programs: 2007

    International Nuclear Information System (INIS)

    2006-03-01

    The standard specifies the method of implementing nuclear power plant life management programs. The plant life management programs evaluate the integrity of the plant structures, systems and components, assessing if appropriate measures are taken against existing aging phenomena, if there are possibilities of occurrence and development of aging phenomena and if a sufficient level of margin is maintained to assure the integrity throughout the future operating period. The programs also assess the validity of the current maintenance activities, such as trend monitoring, walkdowns, periodic tests and inspections, repair and replacement work for the purpose of preventive maintenance, and utilization of lessons learned from past trouble experience, in order to newly identify maintenance measures. The technical evaluation on aging phenomena is conducted to establish the 10 year maintenance program for nuclear power plants until the plant reaches 30 years of service. The standard was established and issued by the Atomic Energy Society of Japan (AESJ) through the discussion of experts in the associated fields. (T. Tanaka)

  11. Radiation protection standards: A practical exercise in risk assessment

    International Nuclear Information System (INIS)

    Clarke, Roger H.

    1992-01-01

    Within 12 months of the discovery of x-rays in 1895, it was reported that large doses of radiation were harmful to living human tissues. The first radiation protection standards were set to avoid the early effects of acute irradiation. By the 1950s, evidence was mounting for late somatic effects - mainly a small excess of cancers - in irradiated populations. In the late 1980's, sufficient human epidemiological data had been accumulated to allow a comprehensive assessment of carcinogenic radiation risks following the delivery of moderately high doses. Workers and the public are exposed to lower doses and dose-rates than the groups from whom good data are available so that risks have had to be estimated for protection purposes. However, in the 1990s, some confirmation of these risk factors has been derived occupationally exposed populations. If an estimate is made of the risk per unit dose, then in order to set dose limits, an unacceptable level of risk must be established for both workers and the public. There has been and continues to be a debate about the definitions of 'acceptable' and 'tolerable' and the attributing of numerical values to these definitions. This paper discusses the issues involved in the quantification of these terms and their application to setting dose limits on risk grounds. Conclusions are drawn about the present protection standards and the application of the methods to other fields of risk assessment. (author)

  12. Canadian Laboratory Standards for Sexually Transmitted Infections: Best Practice Guidelines

    Directory of Open Access Journals (Sweden)

    Max A Chernesky

    2005-01-01

    Full Text Available Sexually transmitted infections (STI continue to spread, and show no international boundaries. Diseases such as gonorrhea and syphilis, which we thought were under control in Canadian populations, have increased in incidence. Sexually transmitted or associated syndromes such as cervicitis, enteric infections, epididymitis, genital ulcers, sexually related hepatitis, ophthalmia neonatorum, pelvic inflammatory disease, prostatitis and vulvovaginitis present a challenge for the physician to identify the microbial cause, treat the patient and manage contacts. During the past 10 years, new technologies developed for the diagnosis of STIs have provided a clearer understanding of the real accuracy of traditional tests for the diagnosis of infections caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, herpes simplex viruses, hepatitis B virus, human papillomaviruses, HIV, Haemophilus ducreyi, Trichomonas vaginalis and mycoplasmas. This has presented a major challenge to the diagnostic laboratory, namely, selecting the most sensitive and specific test matched with the most appropriate specimens to provide meaningful and timely results to facilitate optimal patient care.

  13. Testing a European set of indicators for the evaluation of the management of primary care practices.

    NARCIS (Netherlands)

    Engels, Y.M.P.; Dautzenberg, M.; Campbell, S.; Broge, B.; Boffin, N.; Marshall, M.; Elwyn, G.; Vodopivec-Jamsek, V.; Gerlach, F.M.; Samuelson, M.; Grol, R.P.T.M.

    2006-01-01

    BACKGROUND: Effective practice management is an important prerequisite for offering good clinical care. Internationally valid, reliable and feasible indicators and instruments are needed to describe and compare the management of primary care practices in Europe. OBJECTIVE: This paper describes

  14. Retinopathy of prematurity practices: a national survey of Canadian Neonatal Intensive Care Units.

    Science.gov (United States)

    Sabri, Kourosh; Woodward, Mary Angela; Easterbrook, Bethany; Shivananda, Sandesh

    2018-01-02

    To examine current level three Neonatal Intensive Care Unit (NICU) practices related to ROP screening and treatment. A cross-sectional survey was sent to 29 level three NICU's across Canada to survey current screening inclusion criteria, treatment options, supportive care and post-screening events for ROP. 22/29 (76%) level three NICU's responded. Ten different ROP screening inclusion criteria were found to be in use with significant variation in gestational age and birth weight criteria. Many other national variations also exist regarding the supportive and procedural protocols surrounding ROP screening as well as mode of treatment for ROP. Despite national guidelines, significant variation in ROP screening inclusion criteria practices exist among neonatal units in Canada. Therefore, there is an urgent need for better evidence-based screening guidelines as well as a need to standardize supportive measures surrounding ROP screening and treatment.

  15. The Practice of Respect in the Intensive Care Unit.

    Science.gov (United States)

    Brown, Samuel M; Azoulay, Elie; Benoit, Dominique; Butler, Terri Payne; Folcarelli, Patricia; Geller, Gail; Rozenblum, Ronen; Sands, Ken; Sokol-Hessner, Lauge; Talmor, Daniel; Turner, Kathleen; Howell, Michael D

    2018-01-22

    Although "respect" and "dignity" are intuitive concepts, little formal work has addressed their systematic application in the intensive care unit (ICU) setting. After convening a multidisciplinary group of relevant experts, we undertook a review of relevant literature and collaborative discussions focused on the practice of respect in the ICU. We report here the output of this process, including a summary of current knowledge, a conceptual framework, and a research program for understanding and improving the practice of respect and dignity in the ICU. We separate our report into findings and proposals. Findings include: (1) dignity and respect are interrelated; (2) ICU patients and families are vulnerable to disrespect; (3) violations of respect and dignity appear to be common in the ICU and overlap substantially with dehumanization; (4) disrespect may be associated with both primary and secondary harms; (5) systemic barriers complicate understanding and the reliable practice of respect in the ICU. Proposals include (1) initiating and/or expanding a field of research on the practice of respect in the ICU; (2) treating "failures of respect" as analogous to patient safety events and using existing quality and safety mechanisms for improvement; and (3) identifying both benefits and potential unintended consequences of efforts to improve the practice of respect. Respect and dignity are important considerations in the ICU, even as substantial additional research remains to be done.

  16. Cost of best-practice primary care management of chronic disease in a remote Aboriginal community.

    Science.gov (United States)

    Gador-Whyte, Andrew P; Wakerman, John; Campbell, David; Lenthall, Sue; Struber, Janet; Hope, Alex; Watson, Colin

    2014-06-16

    To estimate the cost of completing all chronic care tasks recommended by the Central Australian Rural Practitioners Association Standard Treatment Manual (CARPA STM) for patients with type 2 diabetes and chronic kidney disease (CKD). The study was conducted at a health service in a remote Central Australian Aboriginal community between July 2010 and May 2011. The chronic care tasks required were ascertained from the CARPA STM. The clinic database was reviewed for data on disease prevalence and adherence to CARPA STM guidelines. Recommended tasks were observed in a time-and-motion study of clinicians' work. Clinicians were interviewed about systematic management and its barriers. Expenditure records were analysed for salary and administrative costs. Diabetes and CKD prevalence; time spent on chronic disease care tasks; completion of tasks recommended by the CARPA STM; barriers to systematic care identified by clinicians; and estimated costs of optimal primary care management of all residents with diabetes or CKD. Projected annual costs of best-practice care for diabetes and CKD for this community of 542 people were $900 792, of which $645 313 would be met directly by the local primary care service. Estimated actual expenditure for these conditions in 2009-10 was $446 585, giving a projected funding gap of $198 728 per annum, or $1733 per patient. High staff turnover, acute care workload and low health literacy also hindered optimal chronic disease care. Barriers to optimal care included inadequate funding and workforce issues. Reduction of avoidable hospital admissions and overall costs necessitates adequate funding of primary care of chronic disease in remote communities.

  17. [Sedation and analgesia practices among Spanish neonatal intensive care units].

    Science.gov (United States)

    Avila-Alvarez, A; Carbajal, R; Courtois, E; Pertega-Diaz, S; Muñiz-Garcia, J; Anand, K J S

    2015-08-01

    Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. A multicenter, observational, longitudinal and prospective study. Thirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam. The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (Pneonates admitted to intensive care units receive sedatives or analgesics. There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the "state of the art", and could serve as the basis of preparing clinical practice guidelines at a national level. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  18. Strategic Review Process for an Accountable Care Organization and Emerging Accountable Care Best Practices.

    Science.gov (United States)

    Conway, Sarah J; Himmelrich, Sarah; Feeser, Scott A; Flynn, John A; Kravet, Steven J; Bailey, Jennifer; Hebert, Lindsay C; Donovan, Susan H; Kachur, Sarah G; Brown, Patricia M C; Baumgartner, William A; Berkowitz, Scott A

    2018-02-02

    Accountable Care Organizations (ACOs), like other care entities, must be strategic about which initiatives they support in the quest for higher value. This article reviews the current strategic planning process for the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Track 1 ACO. It reviews the 3 focus areas for the 2017 strategic review process - (1) optimizing care coordination for complex, at-risk patients, (2) post-acute care, and (3) specialty care integration - reviewing cost savings and quality improvement opportunities, associated best practices from the literature, and opportunities to leverage and advance existing ACO and health system efforts in each area. It then reviews the ultimate selection of priorities for the coming year and early thoughts on implementation. After the robust review process, key stakeholders voted to select interventions targeted at care coordination, post-acute care, and specialty integration including Part B drug and imaging costs. The interventions selected incorporate a mixture of enhancing current ACO initiatives, working collaboratively and synergistically on other health system initiatives, and taking on new projects deemed targeted, cost-effective, and manageable in scope. The annual strategic review has been an essential and iterative process based on performance data and informed by the collective experience of other organizations. The process allows for an evidence-based strategic plan for the ACO in pursuit of the best care for patients.

  19. Assessing methods for measurement of clinical outcomes and quality of care in primary care practices

    Directory of Open Access Journals (Sweden)

    Green Michael E

    2012-07-01

    Full Text Available Abstract Purpose To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC practices. Methods This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30 were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources. Results Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening. Conclusions Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were

  20. Auditing the standard of anaesthesia care in obstetric units.

    Science.gov (United States)

    Mörch-Siddall, J; Corbitt, N; Bryson, M R

    2001-04-01

    We undertook an audit of 15 obstetric units in the north of England over a 10-month period to ascertain to what extent they conformed to the Obstetric Anaesthetists' Association 'Recommended Minimum Standards for Obstetric Anaesthetic Services' using a quality assurance approach. We demonstrated that all units conformed to the majority of standards but did not conform in at least one major and minor area.

  1. Costs and benefits of transforming primary care practices: a qualitative study of North Carolina's Improving Performance in Practice.

    Science.gov (United States)

    Reiter, Kristin L; Halladay, Jacqueline R; Mitchell, C Madeline; Ward, Kimberly; Lee, Shoou-Yih D; Steiner, Beat; Donahue, Katrina E

    2014-01-01

    Primary care organizations must transform care delivery to realize the Institute for Healthcare Improvement's Triple Aim of better healthcare, better health, and lower healthcare costs. However, few studies have considered the financial implications for primary care practices engaged in transformation. In this qualitative, comparative case study, we examine the practice-level personnel and nonpersonnel costs and the benefits involved in transformational change among 12 primary care practices participating in North Carolina's Improving Performance in Practice (IPIP) program. We found average annual opportunity costs of $21,550 ($6,659 per full-time equivalent provider) for maintaining core IPIP activities (e.g., data management, form development and maintenance, meeting attendance). This average represents the cost of a 50% full-time equivalent registered nurse or licensed practical nurse. Practices were able to limit transformation costs by scheduling meetings during relatively slow patient care periods and by leveraging resources such as the assistance of IPIP practice coaches. Still, the costs of practice transformation were not trivial and would have been much higher in the absence of these efforts. Benefits of transformation included opportunities for enhanced revenue through reimbursement incentives and practice growth, improved efficiency and care quality, and maintenance of certification. Given the potentially high costs for some practices, policy makers may need to consider reimbursement and other strategies to help primary care practices manage the costs of practice redesign.

  2. Standard Practice for Preparation of Aerospace Contamination Control Plans

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2009-01-01

    1.1 This practice is intended to assist in the preparation of formal plans for contamination control, especially of aerospace critical surfaces. Requirements may be established at the systems level, either by the customer or the systems integrator, or at the subsystem level. Subsystem requirements may be imposed by the responsible subsystem supplier or they may be flowed down from the systems organization (4.7). The extent of detail and level of cleanliness required can vary with the particular application and type of hardware being built, but all aspects of contamination control must be included in a final plan. Therefore, each of the following elements must be considered for inclusion in a contamination control plan (CCP): 1.1.1 Cleanliness requirements for deliverable hardware addressing particulate, molecular, or biological contaminants or combination thereof. Specify contamination limits and any budget allocations. 1.1.2 Implementation plans to achieve, verify, and maintain the specified cleanliness re...

  3. Nursing Care Hour Standards Study. Part 5 thru Part 8

    Science.gov (United States)

    1981-09-01

    with lotion, replace pajama top, and then remove equipment from area. SHAVING: Place equipment at bedside; wet and lather face/or use 1 an electric ...bath water, put tooth- paste on toothbrush ; and remove equipment from area when patient has completed AM Care, PM CARE: Place equipment at bedside...DISTRIBUTION". Defense Docurentation Center (2) HQDA (DASG-HC-S) Dir, Joint Vedical Library, Offices of The Surgeons General, USA /USAF, The Pentagon, Rm 18-473, W.-ashington, DC 20310 ) AiIS, Stinmon Library (1)

  4. Association of Group Prenatal Care in US Family Medicine Residencies With Maternity Care Practice: A CERA Secondary Data Analysis.

    Science.gov (United States)

    Barr, Wendy B; Tong, Sebastian T; LeFevre, Nicholas M

    2017-03-01

    Group prenatal care has been shown to improve both maternal and neonatal outcomes. With increasing adaption of group prenatal care by family medicine residencies, this model may serve as a potential method to increase exposure to and interest in maternity care among trainees. This study aims to describe the penetration, regional and program variations, and potential impacts on future maternity care practice of group prenatal care in US family medicine residencies. The CAFM Educational Research Alliance (CERA) conducted a survey of all US family medicine residency program directors in 2013 containing questions about maternity care training. A secondary data analysis was completed to examine relevant data on group prenatal care in US family medicine residencies and maternity care practice patterns. 23.1% of family medicine residency programs report provision of group prenatal care. Programs with group prenatal care reported increased number of vaginal deliveries per resident. Controlling for average number of vaginal deliveries per resident, programs with group prenatal care had a 2.35 higher odds of having more than 10% of graduates practice obstetrics and a 2.93 higher odds of having at least one graduate in the past 5 years enter an obstetrics fellowship. Residency programs with group prenatal care models report more graduates entering OB fellowships and practicing maternity care. Implementing group prenatal care in residency training can be one method in a multifaceted approach to increasing maternity care practice among US family physicians.

  5. Standard practice for alternate actinide calibration for inductively coupled plasma-mass spectrometry

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2004-01-01

    1.1 This practice provides guidance for an alternate linear calibration for the determination of selected actinide isotopes in appropriately prepared aqueous solutions by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). This alternate calibration is mass bias adjusted using thorium-232 (232Th) and uranium-238 (238U) standards. One of the benefits of this standard practice is the ability to calibrate for the analysis of highly radioactive actinides using calibration standards at much lower specific activities. Environmental laboratories may find this standard practice useful if facilities are not available to handle the highly radioactive standards of the individual actinides of interest. 1.2 The instrument response for a series of determinations of known concentration of 232Th and 238U defines the mass versus response relationship. For each standard concentration, the slope of the line defined by 232Th and 238U is used to derive linear calibration curves for each mass of interest using interference equ...

  6. Expanding access to rheumatology care: the rheumatology general practice toolbox.

    LENUS (Irish Health Repository)

    Conway, R

    2015-02-01

    Management guidelines for many rheumatic diseases are published in specialty rheumatology literature but rarely in general medical journals. Musculoskeletal disorders comprise 14% of all consultations in primary care. Formal post-graduate training in rheumatology is limited or absent for many primary care practitioners. Primary care practitioners can be trained to effectively treat complex diseases and have expressed a preference for interactive educational courses. The Rheumatology General Practice (GP) Toolbox is an intensive one day course designed to offer up to date information to primary care practitioners on the latest diagnostic and treatment guidelines for seven common rheumatic diseases. The course structure involves a short lecture on each topic and workshops on arthrocentesis, joint injection and DXA interpretation. Participants evaluated their knowledge and educational experience before, during and after the course. Thirty-two primary care practitioners attended, who had a median of 13 (IQR 6.5, 20) years experience in their specialty. The median number of educational symposia attended in the previous 5 years was 10 (IQR-5, 22.5), with a median of 0 (IQR 0, 1) in rheumatology. All respondents agreed that the course format was appropriate. Numerical improvements were demonstrated in participant\\'s confidence in diagnosing and managing all seven common rheumatologic conditions, with statistically significant improvements (p < 0.05) in 11 of the 14 aspects assessed. The Rheumatology Toolbox is an effective educational method for disseminating current knowledge in rheumatology to primary care physicians and improved participant\\'s self-assessed competence in diagnosis and management of common rheumatic diseases.

  7. Childhood obesity: knowledge, attitudes, and practices of European pediatric care providers.

    Science.gov (United States)

    Mazur, Artur; Matusik, Pawel; Revert, Krista; Nyankovskyy, Sergey; Socha, Piotr; Binkowska-Bury, Monika; Grzegorczyk, Joanna; Caroli, Margherita; Hassink, Sandra; Telega, Grzegorz; Malecka-Tendera, Ewa

    2013-07-01

    To determine and compare attitudes, skills, and practices in childhood obesity management in 4 European countries with different obesity prevalence, health care systems, and economic situations. A cross-sectional survey was distributed to primary health care providers from France, Italy, Poland, and Ukraine. The questionnaire was returned by 1119 participants with a response rate of 32.4%. The study revealed that most of the primary health care providers were convinced of their critical role in obesity management but did not feel sufficiently competent to perform effectively. The adherence to recommended practices such as routine weight and height measurements, BMI calculation, and plotting growth parameters on recommended growth charts was poor. Most primary health care providers recognized the need for continuing professional education in obesity management, stressing the importance of appropriate dietary counseling. The study underlines insufficient implementation of national guidelines for management of obesity regardless of the country and its health system. It also makes clear that the critical problem is not elaboration of guidelines but rather creating support systems for implementation of the medical standards among the primary care practitioners.

  8. South Vietnamese Rural Mothers’ Knowledge, Attitude, and Practice in Child Health Care

    Directory of Open Access Journals (Sweden)

    Dinh Thac

    2016-01-01

    Full Text Available A study of 600 rural under-five mothers’ knowledge, attitude, and practice (KAP in child care was performed in 4 southern provinces of Vietnam. The mothers were randomly selected and interviewed about sociodemographic factors, health seeking behaviour, and practice of home care of children and neonates. 93.2% of the mothers were literate and well-educated, which has been shown to be important for child health care. 98.5% were married suggesting a stable family, which is also of importance for child health. Only 17.3% had more than 2 children in their family. The mother was the main caretaker in 77.7% of the families. Only 1% would use quacks as their first health contact, but 25.2% would use a private clinic, which therefore eases the burden on the government system. Nearly 69% had given birth in a hospital, 27% in a commune health station, and only 2.7% at home without qualified assistance. 89% were giving exclusive breast feeding at 6 months, much more frequent than in the cities. The majority of the mothers could follow IMCI guideline for home care, although 25.2% did not deal correctly with cough and 38.7% did not deal correctly with diarrhoea. Standard information about Integrated Management of Childhood Illnesses (IMCI based home care is still needed.

  9. Application and adaptation of Symphonology Bioethical Theory (SBT in pastoral care practice

    Directory of Open Access Journals (Sweden)

    M.M. Khechane

    2008-01-01

    Full Text Available In an environment which is ethically and from a human rights point of view overly sensitive and in which interculturism is becoming more and more a norm, pastoral care practitioners need to be committed to providing services that are ethical, intercultural and respecting of patients’ rights. This article demonstrates how application of the Symphonology Bioethical Theory (SBT as the framework for practice in pastoral care and counselling can help Pastoral Care Practitioners (PCP to be ethical while upholding patients’ human rights, and it can also help to bridge the intercultural chasm while simultaneously explaining the rationale for the practice. Symphonology is a context-driven, ethical decision- making model guiding holistic interaction between patients and PCPs. The Symphonological decision-making matrix is based on a practitioner-patient agreement for pastoral care that emphasizes patient preferences, pastoral psychological and theological knowledge, the pastoral care content and the context of the situation. The goal of the PCP is to ethically incarnate the divine presence and thus to bring about hope and emancipation to the patient using the bioethical standards of autonomy, freedom, objectivity, self-assertion, benevolence and fidelity.

  10. [Advanced nursing practice: a must for the quality of care and mental health services].

    Science.gov (United States)

    Ricard, Nicole; Page, Claire; Laflamme, France

    2014-01-01

    supported the development of new models of advanced practice in mental health. These developments have been particularly significant in the United States and Australia. In United States, during the 1990s, at least four models of advanced practice in mental health nursing have been developed leading to wide variations in the roles, education, job titles, scope of practice and legal authorizations. Consequently, a consensus model of uniform standards of practice, accreditation and education has been proposed. This LACE model (Licensure, Accreditation, Certification, Education) will be in effect in 2015. Australia has adopted a more systematic approach, unified and progressive to facilitate the development of advanced mental health nursing practice. Australia who, through their many publications, retains more attention since a clear definition of the role of the nurse practitioner in mental health and a legal framework has been adopted at the national level. The Australian experience and the finding from studies suggest that mental health nurse practitioners and nurses who are specialized in mental health have the potential to make a significant contribution to enhancing access to and quality of mental health care through flexible an innovative approaches. So there are more and more evidence and indications that Quebec should invest in enhancing the skills of mental health nurses through the development of advanced nursing practice and integration of this new model in primary care. In addition, researches, funded by the Canadian Services Research Foundation (CHSRF, 2010), shows that the contribution of advanced nursing practice has never been stronger and there is a broad consensus to its value for the Canadian health care system (Dicenso.et Lukosius-Briant, 2010). The implementation of advanced practice nursing role in mental health is part of best practices required to improve care and mental health services and should be taken into account in future Action Plan 2014-2020.

  11. Practice patterns in prescribing oral care products by dental practitioners

    Directory of Open Access Journals (Sweden)

    Alena B. Abdrashitova

    2017-05-01

    Full Text Available This paper describes the practice patterns of dental practitioners in how they choose oral care products for prescriptions to their patients. One hundred seventy-three respondents were selected for a medico-sociological study. They were divided into 3 groups based on their work experience: less than 5 years (30.0%, 5–9 years (40.0% and 10–14 years (30.0%. The majority of respondents were dental therapists (71.0%, and the rest were paedodontists, dental surgeons, periodontists and orthodontists (11.0%, 7.0%, 4.0% and 1.0%, respectively. The study was conducted using a questionnaire specially developed by us, which consisted of 34 questions grouped into several domains. Analysis of the obtained results has shown that the majority of dental practitioners (88.7% were competent in prescribing oral care products. Professionals with work experience over 10 years often choose oral care products incorrectly; 80.6% of them believe that long-term use of personal oral care products containing antiseptic components affects the oral microbial flora, which suggests that it is necessary to amend the existing classification of toothpastes.

  12. Creating collaborative learning environments for transforming primary care practices now.

    Science.gov (United States)

    Miller, William L; Cohen-Katz, Joanne

    2010-12-01

    The renewal of primary care waits just ahead. The patient-centered medical home (PCMH) movement and a refreshing breeze of collaboration signal its arrival with demonstration projects and pilots appearing across the country. An early message from this work suggests that the development of collaborative, cross-disciplinary teams may be essential for the success of the PCMH. Our focus in this article is on training existing health care professionals toward being thriving members of this transformed clinical care team in a relationship-centered PCMH. Our description of the optimal conditions for collaborative training begins with delineating three types of teams and how they relate to levels of collaboration. We then describe how to create a supportive, safe learning environment for this type of training, using a different model of professional socialization, and tools for building culture. Critical skills related to practice development and the cross-disciplinary collaborative processes are also included. Despite significant obstacles in readying current clinicians to be members of thriving collaborative teams, a few next steps toward implementing collaborative training programs for existing professionals are possible using competency-based and adult learning approaches. Grasping the long awaited arrival of collaborative primary health care will also require delivery system and payment reform. Until that happens, there is an abundance of work to be done envisioning new collaborative training programs and initiating a nation-wide effort to motivate and reeducate our colleagues. PsycINFO Database Record (c) 2010 APA, all rights reserved.

  13. Pharmaceutical care in community pharmacies: practice and research in Denmark

    DEFF Research Database (Denmark)

    Herborg, Hanne; Sørensen, Ellen Westh; Frøkjaer, Bente

    2007-01-01

    OBJECTIVE: To review the current status of Danish community pharmacy in both practice and research and discuss future trends. FINDINGS: Denmark has a social welfare system that provides health care, social services, and pensions to its population. Medical care and surgery are free. Prescription...... medicines are reimbursed by an average of 56%. Community pharmacies are privately owned, but the health authorities regulate drug prices and the number of pharmacies. At present, Denmark has 322 pharmacies, corresponding to 1 pharmacy per 16,700 inhabitants. All pharmacies provide prescription and over......-the-counter products, advice about medicine use, dose dispensing, generic substitutions, and administration of individual reimbursement registers. Except for very simple processes, compounding is centralized at 3 pharmacies. Many pharmacies offer measurement of blood glucose, blood pressure, and cholesterol, and 60...

  14. Cancer patients' use of family practice and secondary care

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Kjeldgaard, Anette Hvenegaard; Olesen, Frede

    Aims: We know that in Denmark some 90% of citizens have contact with family practice (FP) during a year and around 40% has contact with secondary care.  This demands efforts to create integrated and shared care. The aim of this study is to document the pattern of contacts with FP among patients...... population b) about 33,000 patients diagnosed with cancer in 2007, and c) about 220,000 patients living with a previous diagnosis of cancer.        Results: Data for the total population is known. The total number of contacts with FP in daytime is about 38.4 million, with out of hours service about 2...

  15. Auditing Practice Style Variation in Pediatric Inpatient Asthma Care.

    Science.gov (United States)

    Silber, Jeffrey H; Rosenbaum, Paul R; Wang, Wei; Ludwig, Justin M; Calhoun, Shawna; Guevara, James P; Zorc, Joseph J; Zeigler, Ashley; Even-Shoshan, Orit

    2016-09-01

    Asthma is the most prevalent chronic illness among children, remaining a leading cause of pediatric hospitalizations and representing a major financial burden to many health care systems. To implement a new auditing process examining whether differences in hospital practice style may be associated with potential resource savings or inefficiencies in treating pediatric asthma admissions. A retrospective matched-cohort design study, matched for asthma severity, compared practice patterns for patients admitted to Children's Hospital Association hospitals contributing data to the Pediatric Hospital Information System (PHIS) database. With 3 years of PHIS data on 48 887 children, an asthma template was constructed consisting of representative children hospitalized for asthma between April 1, 2011, and March 31, 2014. The template was matched with either a 1:1, 2:1, or 3:1 ratio at each of 37 tertiary care children's hospitals, depending on available sample size. Treatment at each PHIS hospital. Cost, length of stay, and intensive care unit (ICU) utilization. After matching patients (n = 9100; mean [SD] age, 7.1 [3.6] years; 3418 [37.6%] females) to the template (n = 100, mean [SD] age, 7.2 [3.7] years; 37 [37.0%] females), there was no significant difference in observable patient characteristics at the 37 hospitals meeting the matching criteria. Despite similar characteristics of the patients, we observed large and significant variation in use of the ICUs as well as in length of stay and cost. For the same template-matched populations, comparing utilization between the 12.5th percentile (lower eighth) and 87.5th percentile (upper eighth) of hospitals, median cost varied by 87% ($3157 vs $5912 per patient; P audit, hospitals and stakeholders can better understand where this excess variation occurs and can help to pinpoint practice styles that should be emulated or avoided.

  16. 45 CFR 162.404 - Compliance dates of the implementation of the standard unique health identifier for health care...

    Science.gov (United States)

    2010-10-01

    ... standard unique health identifier for health care providers. 162.404 Section 162.404 Public Welfare... REQUIREMENTS Standard Unique Health Identifier for Health Care Providers § 162.404 Compliance dates of the implementation of the standard unique health identifier for health care providers. (a) Health care providers. A...

  17. Standard filtration practices may significantly distort planktonic microbial diversity estimates

    Directory of Open Access Journals (Sweden)

    Cory Cruz Padilla

    2015-06-01

    Full Text Available Fractionation of biomass by filtration is a standard method for sampling planktonic microbes. It is unclear how the taxonomic composition of filtered biomass changes depending on sample volume. Using seawater from a marine oxygen minimum zone, we quantified the 16S rRNA gene composition of biomass on a prefilter (1.6 μm pore-size and a downstream 0.2 μm filter over sample volumes from 0.05 to 5 L. Significant community shifts occurred in both filter fractions, and were most dramatic in the prefilter community. Sequences matching Vibrionales decreased from ~40-60% of prefilter datasets at low volumes (0.05-0.5 L to less than 5% at higher volumes, while groups such at the Chromatiales and Thiohalorhabdales followed opposite trends, increasing from minor representation to become the dominant taxa at higher volumes. Groups often associated with marine particles, including members of the Deltaproteobacteria, Planctomycetes and Bacteroidetes, were among those showing the greatest increase with volume (4 to 27-fold. Taxon richness (97% similarity clusters also varied significantly with volume, and in opposing directions depending on filter fraction, highlighting potential biases in community complexity estimates. These data raise concerns for studies using filter fractionation for quantitative comparisons of aquatic microbial diversity, for example between free-living and particle-associated communities.

  18. Practice environments and job satisfaction and turnover intentions of nurse practitioners: Implications for primary care workforce capacity.

    Science.gov (United States)

    Poghosyan, Lusine; Liu, Jianfang; Shang, Jingjing; D'Aunno, Thomas

    Health care professionals, organizations, and policy makers are calling for expansion of the nurse practitioner (NP) workforce in primary care to assure timely access and high-quality care. However, most efforts promoting NP practice have been focused on state level scope of practice regulations, with limited attention to the organizational structures. We examined NP practice environments in primary care organizations and the extent to which they were associated with NP retention measures. Data were collected through mail survey of NPs practicing in 163 primary care organizations in Massachusetts in 2012. NP practice environment was measured by the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has four subscales: Professional Visibility, NP-Administration Relations, NP-Physician Relations, and Independent Practice and Support. Two global items measured job satisfaction and NPs' intent to leave their job. We aggregated NP level data to organization level to attain measures of practice environments. Multilevel logistic regression models were used. NPs rated the relationship between NPs and physicians favorably, contrary to the relationship between NPs and administrators. All subscales measuring NP practice environment had similar influence on the outcome variables. With every unit increase in each standardized subscale score, the odds of job satisfaction factors increased about 20% whereas the odds of intention of turnover decreased about 20%. NPs from organizations with higher mean scores on the NP-Administration subscale had higher satisfaction with their jobs (OR = 1.24, 95% CI [1.12, 1.39]) and had lower intent to leave (OR = 0.79, 95% CI [0.70, 0.90]). NPs were more likely to be satisfied with their jobs and less likely to report intent to leave if their organizations support NP practice, favorable relations with physicians and administration, and clear role visibility. Creating productive practice environments that can retain NPs

  19. Everyday practice and unnoticed professional competence in day care work

    DEFF Research Database (Denmark)

    Ahrenkiel, Annegrethe; Warring, Niels; Nielsen, Birger Steen

    for learning outcomes. For the social educators this has meant more time being spent on formal learning activities, and they have received the new demands with mixed feelings: on the one hand they can help the social educators getting more acknowledged for doing some valuable and visible work. On the other...... based workshops) the paper will discuss work practice in an everyday life perspective. This perspective opens for understanding professional competence as part of creating coherence in children’s and families’ lives as well as during the day in the day care centers. It also opens for a discussion of how...

  20. Communicating Effectively in Pediatric Cancer Care: Translating Evidence into Practice

    Directory of Open Access Journals (Sweden)

    Lindsay J. Blazin

    2018-03-01

    Full Text Available Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers. This review aims to identify key communication skills that healthcare providers can employ throughout the illness journey to provide information, encourage shared decision-making, promote therapeutic alliance, and empathically address end-of-life concerns. By reviewing the relevant evidence and providing practical tips for skill development, we strive to help healthcare providers understand the value of effective communication and master these critical skills.

  1. Communicating Effectively in Pediatric Cancer Care: Translating Evidence into Practice.

    Science.gov (United States)

    Blazin, Lindsay J; Cecchini, Cherilyn; Habashy, Catherine; Kaye, Erica C; Baker, Justin N

    2018-03-11

    Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers. This review aims to identify key communication skills that healthcare providers can employ throughout the illness journey to provide information, encourage shared decision-making, promote therapeutic alliance, and empathically address end-of-life concerns. By reviewing the relevant evidence and providing practical tips for skill development, we strive to help healthcare providers understand the value of effective communication and master these critical skills.

  2. Audit, guidelines and standards: clinical governance for hip fracture care in Scotland.

    Science.gov (United States)

    Currie, Colin T; Hutchison, James D

    To report on experience of national-level audit, guidelines and standards for hip fracture care in Scotland. Scottish Hip Fracture Audit (from 1993) documents case-mix, process and outcomes of hip fracture care in Scotland. Evidence-based national guidelines on hip fracture care are available (1997, updated 2002). Hip fracture serves as a tracer condition by the health quality assurance authority for its work on older people, which reported in 2004. Audit data are used locally to document care and support and monitor service developments. Synergy between the guidelines and the audit provides a means of improving care locally and monitoring care nationally. External review by the quality assurance body shows to what extent guideline-based standards relating to A&E care, pre-operative delay, multidisciplinary care and audit participation are met. Three national-level initiatives on hip fracture care have delivered: Reliable and large-scale comparative information on case-mix, care and outcomes; evidence-based recommendations on care; and nationally accountable standards inspected and reported by the national health quality assurance authority. These developments are linked and synergistic, and enjoy both clinical and managerial support. They provide an evolving framework for clinical governance, with casemix-adjusted outcome assessment for hip fracture care as a next step.

  3. Integration of Palliative Care Advanced Practice Nurses Into Intensive Care Unit Teams.

    Science.gov (United States)

    O'Mahony, Sean; Johnson, Tricia J; Amer, Shawn; McHugh, Marlene E; McHenry, Janet; Fosler, Laura; Kvetan, Vladimir

    2017-05-01

    Referrals to palliative care for patients at the end of life in the intensive care unit (ICU) often happen late in the ICU stay, if at all. The integration of a palliative medicine advanced practice nurse (APN) is one potential strategy for proactively identifying patients who could benefit from this service. To evaluate the association between the integration of palliative medicine APNs into the routine operations of ICUs and hospital costs at 2 different institutions, Montefiore Medical Center (MMC) and Rush University Medical Center. The association between collaborative palliative care consultation service programs and hospital costs per patient was evaluated for the 2 institutions. Hospital costs were compared for patients with and without a referral to palliative care using Mann-Whitney U tests. Hospital nonroom and board costs at the Weiler campus of MMC were significantly lower for patients with palliative care compared with those who did not receive palliative care (Median = US$6643 vs US$12 399, P integration of APNs into a palliative care team for case finding may be a promising strategy, but more work is needed to determine whether reductions in cost are significant.

  4. Does the practice of blood film microscopy for detection and quantification of malaria parasites in northwest Ethiopia fit the standard?

    Science.gov (United States)

    Biadglegne, Fantahun; Belyhun, Yeshambel; Ali, Jemal; Walle, Fisha; Gudeta, Nigussu; Kassu, Afework; Mulu, Andargachew

    2014-11-01

    The diagnosis of malaria in clinical laboratories mainly depends on blood smear microscopy and this technique remains the most widely used in Ethiopia. Despite the importance of blood smear microscopy for patient's diagnosis and treatment, little effort has been made to precisely determine and identify sources of error in malaria smear microscopic diagnosis and quantification of parasitaemia. The main objective of the present study was to assess the laboratory practices of health care laboratories carrying out blood films microscopy. A cross sectional study was conducted in northwestern Ethiopia involving 29 health care institutes. A structured and pretested questionnaire were used to collect relevant information on the physical conditions, laboratory logistics and laboratory practices carrying out blood smear microscopy. There was inadequacy of laboratory reagents, guidelines and materials. Most of the health institutes have been practicing re-utilization of microscope slides for malaria microscopy. The technical procedure (preparing of reagents, making of blood films and staining of the slides) were found to be below the standard in 50% of the health institutes. Refresher training and quality assessment has been done only in two and six of the health institutes in the past five years, respectively. In most of the health care laboratories studied, availability of laboratory logistics and technical practices for malaria microscopy were found to be below the standard set by World Health Organization. Improving logistics access for malaria microscopy at all level of health care is important to increase accuracy of diagnosis and quantification of malaria parasites. Moreover, continued training and regular supervision of the staff and implementation of quality control program in the area is also crucial.

  5. From Paper to Practice; Indexing Systems and Ethical Standards.

    Science.gov (United States)

    Astaneh, Behrooz; Masoumi, Sarah

    2017-04-11

    Currently one of the main goals of editors is to attain a higher visibility for their journals. On the other hand, authors strive to publish their research in journals indexed in eminent databases such as Scopus, Thompson Reuters' Web of Science (ISI), Medline, etc. Therefore, clarifying the standards of indexing is of great importance. One of the most important issues in publication is the ethical considerations, which are mainly described by organizations, such as the International Committee of Medical Journal Editors and the Committee on Publication Ethics. In this study, we examined the ethical requirements of high impact databases for indexing journals to investigate whether they mention or mandate journals to adhere to publication ethics. We found that only Scopus mandated journals to state clear ethical policies on their website as a criterion for being indexed while Medline and Directory of Open Access Journals advised journals to adhere to ethics, not mandated, and Web of Science (ISI) and PubMed Central made no mention of ethics as a required criterion for indexing. Based on this short review, there seems to be a gap between the requirements of indexing systems and international guidelines for publication ethics. Currently, most indexing systems have only partially recommended journals to consider ethical issues. In such an atmosphere, we cannot expect journals or as a result, authors to professionally, completely, and whole heartedly implement ethical guidelines as a mandatory rule in their journals and research, when the indexing systems that most editors want to be indexed in and most authors want to be cited in do not mandate such guidelines.

  6. Qigong in Cancer Care: Theory, Evidence-Base, and Practice.

    Science.gov (United States)

    Klein, Penelope

    2017-01-12

    Background: The purpose of this discussion is to explore the theory, evidence base, and practice of Qigong for individuals with cancer. Questions addressed are: What is qigong? How does it work? What evidence exists supporting its practice in integrative oncology? What barriers to wide-spread programming access exist? Methods: Sources for this discussion include a review of scholarly texts, the Internet, PubMed, field observations, and expert opinion. Results: Qigong is a gentle, mind/body exercise integral within Chinese medicine. Theoretical foundations include Chinese medicine energy theory, psychoneuroimmunology, the relaxation response, the meditation effect, and epigenetics. Research supports positive effects on quality of life (QOL), fatigue, immune function and cortisol levels, and cognition for individuals with cancer. There is indirect, scientific evidence suggesting that qigong practice may positively influence cancer prevention and survival. No one Qigong exercise regimen has been established as superior. Effective protocols do have common elements: slow mindful exercise, easy to learn, breath regulation, meditation, emphasis on relaxation, and energy cultivation including mental intent and self-massage. Conclusions : Regular practice of Qigong exercise therapy has the potential to improve cancer-related QOL and is indirectly linked to cancer prevention and survival. Wide-spread access to quality Qigong in cancer care programming may be challenged by the availability of existing programming and work force capacity.

  7. Qigong in Cancer Care: Theory, Evidence-Base, and Practice

    Directory of Open Access Journals (Sweden)

    Penelope Klein

    2017-01-01

    Full Text Available Background: The purpose of this discussion is to explore the theory, evidence base, and practice of Qigong for individuals with cancer. Questions addressed are: What is qigong? How does it work? What evidence exists supporting its practice in integrative oncology? What barriers to wide-spread programming access exist? Methods: Sources for this discussion include a review of scholarly texts, the Internet, PubMed, field observations, and expert opinion. Results: Qigong is a gentle, mind/body exercise integral within Chinese medicine. Theoretical foundations include Chinese medicine energy theory, psychoneuroimmunology, the relaxation response, the meditation effect, and epigenetics. Research supports positive effects on quality of life (QOL, fatigue, immune function and cortisol levels, and cognition for individuals with cancer. There is indirect, scientific evidence suggesting that qigong practice may positively influence cancer prevention and survival. No one Qigong exercise regimen has been established as superior. Effective protocols do have common elements: slow mindful exercise, easy to learn, breath regulation, meditation, emphasis on relaxation, and energy cultivation including mental intent and self-massage. Conclusions: Regular practice of Qigong exercise therapy has the potential to improve cancer-related QOL and is indirectly linked to cancer prevention and survival. Wide-spread access to quality Qigong in cancer care programming may be challenged by the availability of existing programming and work force capacity.

  8. Estrogen formulations and beauty care practices in Japanese women

    Directory of Open Access Journals (Sweden)

    Takeda T

    2012-01-01

    Full Text Available Takashi Takeda, Tze Fang Wong, Mari Kitamura, Nobuo YaegashiDepartment of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi, JapanPurpose: Traditionally, oral estrogens have been used for hormone replacement therapy. However, in Japan, additional estrogen formulations have been used, including transdermal patches and transdermal gels. The latter have a unique commonality with cosmetics because both of them are applied to the skin. Beauty care is one of the most important lifestyle factors for women, and it has been reported that the amount of attention paid to beauty care has an effect in determining whether or not women will choose to undergo HRT during menopause. Therefore, our study focused on estrogen formulations and beauty care practices.Patients and methods: Fifty women who use hormone replacement therapy were recruited from the outpatient clinic of Tohoku University Hospital. They were treated with oral conjugated estrogen (n = 11, transdermal 17ß -estradiol patch (n = 11, and transdermal 17ß-estradiol gel (n = 28. They completed a questionnaire to assess their lifestyle (beauty care practices and exercise habits and their compliance. The transdermal gel users were further interviewed about their subjective impressions regarding “smell”, “sticky feeling”, “spreadability”, and “irritation” on the skin using a five-grade scale.Results: There were no differences in the usability of medicines and patient compliance among the estrogen formulations. We observed a positive tendency between the level of beauty care and transdermal gel use (P = 0.0645, ordinary logistic regression analysis. The gel users placed top priority on a lack of “sticky feeling” but the subjective impression regarding “sticky feeling” was worst among the four factors (P < 0.01, Steel–Dwass test. Correspondence analysis showed that the subjective impressions of transdermal gel corresponding to usability in the

  9. Standards for the mental health care of people with severe ...

    African Journals Online (AJOL)

    Adele

    health charter, assists the public health sector to listen to the views and needs expressed by local health users; develop a set of norms and standards; improve the quality of relationship between users and providers; increase the levels of acceptability and transparency; decrease corruption and malpractice; and transform ...

  10. Micro-Meso-Macro Practice Tensions in Using Patient-Reported Outcome and Experience Measures in Hospital Palliative Care.

    Science.gov (United States)

    Krawczyk, Marian; Sawatzky, Richard; Schick-Makaroff, Kara; Stajduhar, Kelli; Öhlen, Joakim; Reimer-Kirkham, Sheryl; Mercedes Laforest, Esther; Cohen, Robin

    2018-03-01

    This article applies a micro-meso-macro analytical framework to understand clinicians' experiences and perspectives of using patient-reported outcome and experience measures (PROMs and PREMs) in routine hospital-based palliative care. We structure our discussion through qualitative analysis of a design and implementation project for using an electronic tablet-based tool among hospital-based palliative clinicians to assess patients' and their family caregivers' quality of life concerns and experiences of care. Our analysis identified three categories of practice tensions shaping clinicians' use of PROMs and PREMs in routine care: tensions surrounding implementation, tensions in standardization and quantification, and tensions that arose from scope of practice concerns. Our findings highlight that clinicians necessarily work within the confluence of multiple system priorities, that navigating these priorities can result in irreducible practice tensions, and that awareness of these tensions is a critical consideration when integrating PROMs and PREMs into routine practice.

  11. Design of a quality and performance improvement project for small primary care practices: reflections on the Center for Practice Innovation.

    Science.gov (United States)

    Marsteller, Jill A; Woodward, Paula; Underwood, William S; Hsiao, Chun-Ju; Barr, Michael S

    2011-01-01

    Small practices often lack the human, financial and technical resources to make necessary practice improvements and infrastructure investments in order to achieve sustainable change that promotes quality and efficiency. To report on an effort to assist small primary care practices in improving quality of care and efficiency of practice management to meet the needs of patients, improve physician satisfaction and enhance the ability of these small practices to survive. We report on an intervention design and the reflections of the implementers on what they learned and what went well or poorly during implementation. Results of the intervention are reported separately (in Quality in Primary Care). Thirty practices underwent the entire intervention. The practices were selected on the basis of practice size, diversity in patient factors, apparent dedication to making practice improvements and geographic location. The main components of the intervention were two site visits to the participating practices by Center for Practice Innovation (CPI); now known as the Centre for Practice Improvement and Innovation, team members. The CPI team provided ongoing advice and support in focus areas selected by practices after initial site visit and assessment. A customised session focusing on the practice report and on helping practices to think about which areas they wished to improve was more effective in engaging practices than didactic presentation. Quality and practice management improvements were observed in information posting, patient education, staff communication and patient safety practices. Having a strong physician champion and a strong office manager determined to make quality improvement changes were important elements for successful change. In addition, practices with greater stability of staff and strong finances were more likely to meet project goals. Small practices today are facing a range of important challenges. The CPI sought to provide successful guidance to

  12. 75 FR 60616 - Commission Guidance Regarding Auditing, Attestation, and Related Professional Practice Standards...

    Science.gov (United States)

    2010-10-01

    ... Regarding Auditing, Attestation, and Related Professional Practice Standards Related To Brokers and Dealers... Oversight Board in the Dodd-Frank Wall Street Reform and Consumer Protection Act to establish auditing... 60617

  13. Russian standards and design practice of ensuring NPP reliability under severe external loading conditions

    International Nuclear Information System (INIS)

    Birbraer, A.N.

    1993-01-01

    Russian Standards and design practice of ensuring NPP reliability under severe external loading conditions are described. The main attention is paid to the seismic design requirements. Explosions, aircraft impact, and tornado are briefly examined too (author)

  14. Best practices in selecting performance measures and standards for effective asset management.

    Science.gov (United States)

    2011-06-01

    "This report assesses and provides guidance on best practices in performance measurement, management and standards : setting for effective Transportation Asset Management (TAM). The study is conducted through a literature review, a : survey of the 50...

  15. Patient-centered Fertility Care: From Theory to Practice

    Directory of Open Access Journals (Sweden)

    Fatemeh Jafarzadeh-Kenarsari

    2016-07-01

    Full Text Available Background & aim: Healthcare areas, especially fertility care (commonly accompanied with high emotions, as well as long-term and recurring treatment periods could exclusively benefit from patient-centered care (PCC. Despite evident advantages of PCC, this approach has not been practiced as a routine procedure in current clinical environments yet, even in western developed countries. Therefore, this review aimed to evaluate the significance and different aspects of PCC, while emphasizing on patient-centered fertility care, its challenges, and applicable recommendations in this regard. Methods: This narrative review was conducted on 29 relevant medical and clinical papers (published during 1990-2015 collected using various national and international databases (e.g., SID, Magiran, Medlib, Google scholar, Proquest, Pubmed, Wiley, Science direct, and Scopus. Key words and phrases used in this review were “infertility”, “fertility care”, “childlessness”, “patient-centered care”, “patient-centered fertility care” “shared decision-making”, “infertile patient preferences”, and “patient involvement in fertility care”. Results: According to the literature, implementation challenges of patient-centered fertility care were reported as different individual and organizational factors. These factors include lack of professional motivation to change, underestimating the significance of patient-centeredness by healthcare professionals, difficulty in translation of feedback into concrete measures, lack of time and financial resources, insufficient experience of healthcare professionals with regard to identification of needs and preferences of patients, traditional organizational culture, and common misconceptions. Conclusion: Promotion of patient-centered fertility services requires the identification of infertile needs and priorities of individuals, designation of interventional and supportive programs based on sociocultural

  16. Time to clarify--the value of advanced practice nursing roles in health care.

    Science.gov (United States)

    Lowe, Grainne; Plummer, Virginia; O'Brien, Anthony Paul; Boyd, Leanne

    2012-03-01

    This article presents a discussion of the importance of providing meaningful advanced practice nursing role definition and clarity to improve international standards of nursing titles and scopes of practice. A plethora of international literature exists discussing advanced practice nursing roles and their contribution to healthcare delivery in various countries. However, lack of consistency around title, role definition and scope of practice remains. CINAHL and Medline databases were searched using 'nurse practitioner', 'nurse practitioner role', 'nurse practitioner practice', 'nurse practitioner in public health', 'advanced practice nursing roles' and 'development of new nursing roles' with articles limited to years 1995-2010. Citations used in those articles were also explored. All cited articles were in the English language. This article supports the need to strengthen the Nurse Practitioner role in health care and professional clarity is identified as a strategy to enhance this. Themes around role clarity, professional identity, ability to enhance healthcare provision and inter-professional issues are examined. The need to more clearly articulate advanced nursing roles in light of the evolution of the Nurse Practitioner role is highlighted. Much work has already occurred in this domain and a means of adapting and broadening these developments for a wider, more global audience whilst maintaining local context is discussed. Although evidence exists that advanced practice nursing roles are increasing internationally, uncertainty around role clarity remains. This is problematic because the valuable contribution of nursing roles is lost, if the ability to clearly express their function does not exist. © 2011 Blackwell Publishing Ltd.

  17. The sensible health care professional: a care ethical perspective on the role of caregivers in emotionally turbulent practices.

    Science.gov (United States)

    Baur, Vivianne; van Nistelrooij, Inge; Vanlaere, Linus

    2017-12-01

    This article discusses the challenging context that health care professionals are confronted with, and the impact of this context on their emotional experiences. Care ethics considers emotions as a valuable source of knowledge for good care. Thinking with care ethical theory and looking through a care ethical lens at a practical case example, the authors discern reflective questions that (1) shed light on a care ethical approach toward the role of emotions in care practices, and (2) may be used by practitioners and facilitators for care ethical reflection on similar cases, in the particular and concrete context where issues around emotional experiences arise. The authors emphasize the importance of allowing emotions to exist, to acknowledge them and to not repress them, so that they can serve as a vehicle for ethical behavior in care practices. They stress the difference between acknowledging emotions and expressing them limitlessly. Formational practices and transformational research practices are being proposed to create moral space in care institutions and to support health care professionals to approach the emotionally turbulent practices they encounter in a way that contributes to good care for all those involved.

  18. Practice improvement, part II: collaborative practice and team-based care.

    Science.gov (United States)

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    The Institute of Medicine recommends interprofessional teams to address patients' complex needs. Team care should be structured in a way that uses the highest training levels of its members. Team communication is enhanced through regular meetings (eg, team huddles), and office efficiency is improved through identifying and solving underlying system-level issues (ie, second-order problem solving). Inclusive leadership principles are used to strengthen team practices and meet chronic care model goals. Setting clear goals with measurable outcomes, creating clinical and administrative systems, establishing a clear division of labor among team members who have occupational diversity, and providing ongoing training all facilitate team building. Increasing opportunities for team members to work together, such as with group visits, and providing interprofessional education are ways to encourage adoption of interprofessional practice. Reimbursement for team care includes per member per month payments for such services as care management, pay-for-performance benchmark payments, and payment for non-face-to-face services. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  19. Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices.

    Science.gov (United States)

    Elshaug, Adam G; Hiller, Janet E; Tunis, Sean R; Moss, John R

    2007-10-31

    Internationally, many health care interventions were diffused prior to the standard use of assessments of safety, effectiveness and cost-effectiveness. Disinvestment from ineffective or inappropriately applied practices is a growing priority for health care systems for reasons of improved quality of care and sustainability of resource allocation. In this paper we examine key challenges for disinvestment from these interventions and explore potential policy-related avenues to advance a disinvestment agenda. We examine five key challenges in the area of policy driven disinvestment: 1) lack of resources to support disinvestment policy mechanisms; 2) lack of reliable administrative mechanisms to identify and prioritise technologies and/or practices with uncertain clinical and cost-effectiveness; 3) political, clinical and social challenges to removing an established technology or practice; 4) lack of published studies with evidence demonstrating that existing technologies/practices provide little or no benefit (highlighting complexity of design) and; 5) inadequate resources to support a research agenda to advance disinvestment methods. Partnerships are required to involve government, professional colleges and relevant stakeholder groups to put disinvestment on the agenda. Such partnerships could foster awareness raising, collaboration and improved health outcome data generation and reporting. Dedicated funds and distinct processes could be established within the Medical Services Advisory Committee and Pharmaceutical Benefits Advisory Committee to, a) identify technologies and practices for which there is relative uncertainty that could be the basis for disinvestment analysis, and b) conduct disinvestment assessments of selected item(s) to address existing practices in an analogous manner to the current focus on new and emerging technology. Finally, dedicated funding and cross-disciplinary collaboration is necessary to build health services and policy research capacity

  20. Audit and feedback by medical students to improve the preventive care practices of general practice supervisors.

    Science.gov (United States)

    Gilkes, Lucy A; Liira, Helena; Emery, Jon

    Medical students benefit from their contact with clinicians and patients in the clinical setting. However, little is known about whether patients and clinicians also benefit from medical students. We developed an audit and feedback intervention activity to be delivered by medical students to their general practice supervisors. We tested whether the repeated cycle of audit had an effect on the preventive care practices of general practitioners (GPs). The students performed an audit on topics of preventive medicine and gave feedback to their supervisors. Each supervisor in the study had more than one student performing the audit over the academic year. After repetitive cycles of audit and feedback, the recording of social history items by GPs improved. For example, recording alcohol history increased from 24% to 36%. This study shows that medical students can be effective auditors, and their repeated audits may improve their general practice supervisors' recording of some aspects of social history.

  1. Voriconazole Therapeutic Drug Monitoring Practices in Intensive Care.

    Science.gov (United States)

    van Wanrooy, Marjolijn J P; Rodgers, Michael G G; Span, Lambert F R; Zijlstra, Jan G; Uges, Donald R A; Kosterink, Jos G W; van der Werf, Tjip S; Alffenaar, Jan-Willem C

    2016-06-01

    Routine therapeutic drug monitoring of voriconazole seems to be beneficial. This study investigated the therapeutic drug monitoring practices in intensive care to derive possible recommendations for improvement. A retrospective chart review was performed for patients aged ≥18 years who started treatment with voriconazole, which lasted for at least 3 days while being admitted to an intensive care unit to assess possible differences between the patients with and without voriconazole trough concentrations measured. In 64 (76%) of the 84 patients, voriconazole trough concentrations were measured. The groups differed significantly with respect to the duration of voriconazole treatment and intensive care unit admission. Time of sampling was very early and therefore inappropriate for 49% of the first measured voriconazole trough concentrations and in 48% of the subsequent measured concentrations. Of the 349 trough concentrations measured, 129 (37%) were outside the therapeutic window. In 11% of these cases, no recommendation was provided without identifiable reason. In addition, 27% of recommended dose adjustments were not implemented, probably because the advice was not suited for the specific clinical situation. The performance of voriconazole therapeutic drug monitoring can still be improved although voriconazole concentrations were monitored in most patients. A multidisciplinary approach-for instance by means of antifungal stewardship-will probably be able to overcome problems encountered such as timing of sampling, incompleteness of data in clinical context, and lack of implementation of recommendations.

  2. Practice of preventive dentistry for nursing staff in primary care.

    Science.gov (United States)

    Jiménez-Báez, María Valeria; Acuña-Reyes, Raquel; Cigarroa-Martínez, Didier; Ureña-Bogarín, Enrique; Orgaz-Fernández, Jose David

    2014-01-01

    Determine the domain of preventive dentistry in nursing personnel assigned to a primary care unit. Prospective descriptive study, questionnaire validation, and prevalence study. In the first stage, the questionnaire for the practice of preventive dentistry (CPEP, for the term in Spanish) was validated; consistency and reliability were measured by Cronbach's alpha, Pearson's correlation, factor analysis with intra-class correlation coefficient (ICC). In the second stage, the domain in preventive dental nurses was explored. The overall internal consistency of CPEP is α= 0.66, ICC= 0.64, CI95%: 0.29-0.87 (p >0.01). Twenty-one subjects in the study, average age 43, 81.0% female, average seniority of 12.5 were included. A total of 71.5% showed weak domain, 28.5% regular domain, and there was no questionnaire with good domain result. The older the subjects were, the smaller the domain; female nurses showed greater mastery of preventive dentistry (29%, CI95%: 0.1-15.1) than male nurses. Public health nurses showed greater mastery with respect to other categories (50%, CI95%: 0.56-2.8). The CDEP has enough consistency to explore the domain of preventive dentistry in health-care staff. The domain of preventive dentistry in primary care nursing is poor, required to strengthen to provide education in preventive dentistry to the insured population.

  3. Practical Interventions to Enhance Resident Ownership of Patient Care.

    Science.gov (United States)

    Soeprono, Thomas; Markman, Jesse; Grodesky, Michael; Cowley, Deborah

    2017-06-19

    In the modern training environment, some question whether trainees have the opportunity to develop ownership of patient care, which includes concepts such as advocacy, autonomy, commitment, communication, follow-through, knowledge about the patient, responsibility, and teamwork. Despite descriptions of what ownership is, there is little discussion of how to foster ownership during residency. The objective of this study was to solicit psychiatry resident and faculty perspectives on ways to enhance resident ownership in training. Twenty-nine of 74 (39.2%) residents and 31 of 68 (45.6%) faculty members surveyed provided narrative responses to a voluntary, anonymous, electronic survey asking two structured, open-ended questions about what factors make it more or less likely that a resident will take "ownership" of patient care. The coding process produced four overarching categories of themes (attending, resident, educational program, and environment) that reflect domains for possible interventions to increase ownership, with conceptual guidance from the Theory of Planned Behavior. From these factors, the authors propose a number of practical yet theory-based interventions which include setting expectations, modeling, promoting autonomy, countertransference supervision, changing residency culture, and longer rotations. These interventions address subjective norms, attitudes, perceived ability and control, environment, and actual resident abilities, all of which, according to the Theory of Planned Behavior, would be likely to influence patient care ownership. Future studies could develop curricula and examine the effectiveness of the interventions proposed here in reinforcing or developing ownership in physicians.

  4. Mobile computing and the quality of home care nursing practice.

    Science.gov (United States)

    Paré, Guy; Sicotte, Claude; Moreault, Marie-Pierre; Poba-Nzaou, Placide; Nahas, Georgette; Templier, Mathieu

    2011-01-01

    We investigated the effects of the introduction of mobile computing on the quality of home care nursing practice in Québec. The software, which structured and organized the nursing activities in patients' homes, was installed sequentially in nine community health centres. The completeness of the nursing notes was compared in 77 paper records (pre-implementation) and 73 electronic records (post-implementation). Overall, the introduction of the software was associated with an improvement in the completeness of the nursing notes. All 137 nurse users were asked to complete a structured questionnaire. A total of 101 completed questionnaires were returned (74% response rate). Overall, the nurses reported a very high level of satisfaction with the quality of clinical information collected. A total of 57 semi-structured interviews were conducted and most nurses believed that the new software represented a user-friendly tool with a clear and understandable structure. A postal questionnaire was sent to approximately 1240 patients. A total of 223 patients returned the questionnaire (approximately 18% response rate). Overall, patients felt that the use of mobile computing during home visits allowed nurses to manage their health condition better and, hence, provide superior care services. The use of mobile computing had positive and significant effects on the quality of care provided by home nurses.

  5. Psychosocial care for cancer: a framework to guide practice, and actionable recommendations for Ontario

    Science.gov (United States)

    Turnbull Macdonald, G.C.; Baldassarre, F.; Brown, P.; Hatton–Bauer, J.; Li, M.; Green, E.; Lebel, S.

    2012-01-01

    Objectives We set out to create a psychosocial oncology care framework and a set of relevant recommendations that can be used to improve the quality of comprehensive cancer care for Ontario patients and their families.meet the psychosocial health care needs of cancer patients and their families at both the provider and system levels. Data Sources and Methods The adapte process and the practice guideline development cycle were used to adapt the 10 recommendations from the 2008 U.S. Institute of Medicine standard Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs into the psychosocial oncology care framework. In addition, the evidence contained in the original document was used, in combination with the expertise of the working group, to create a set of actionable recommendations. Refinement after formal external review was conducted. Data Extraction and Synthesis The new framework consists of 8 defining domains. Of those 8 domains, 7 were adapted from recommendations in the source document; 1 new domain, to raise awareness about the need for psychosocial support of cancer patients and their families, was added. To ensure high-quality psychosocial care and services, 31 actionable recommendations were created. The document was submitted to an external review process. More than 70% of practitioners rated the quality of the advice document as high and reported that they would recommend its use. Conclusions This advice document advocates for a multidisciplinary approach to cancer care in response to the distress experienced by cancer patients and their families. The recommendations will be useful in future to measure performance, quality of practice, and access to psychosocial services. PMID:22876147

  6. Human rights in patient care: a theoretical and practical framework.

    Science.gov (United States)

    Cohen, Jonathan; Ezer, Tamar

    2013-12-12

    The concept of "human rights in patient care" refers to the application of human rights principles to the context of patient care. It provides a principled alternative to the growing discourse of "patients' rights" that has evolved in response to widespread and severe human rights violations in health settings. Unlike "patients' rights," which is rooted in a consumer framework, this concept derives from inherent human dignity and neutrally applies universal, legally recognized human rights principles, protecting both patients and providers and admitting of limitations that can be justified by human rights norms. It recognizes the interrelation between patient and provider rights, particularly in contexts where providers face simultaneous obligations to patients and the state ("dual loyalty") and may be pressured to abet human rights violations. The human rights lens provides a means to examine systemic issues and state responsibility. Human rights principles that apply to patient care include both the right to the highest attainable standard of health, which covers both positive and negative guarantees in respect of health, as well as civil and political rights ranging from the patient's right to be free from torture and inhumane treatment to liberty and security of person. They also focus attention on the right of socially excluded groups to be free from discrimination in the delivery of health care. Critical rights relevant to providers include freedom of association and the enjoyment of decent work conditions. Some, but not all, of these human rights correspond to rights that have been articulated in "patients' rights" charters. Complementary to—but distinct from—bioethics, human rights in patient care carry legal force and can be applied through judicial action. They also provide a powerful language to articulate and mobilize around justice concerns, and to engage in advocacy through the media and political negotiation. As "patients' rights" movements and

  7. American Organization of Nurse Executives Care Innovation and Transformation program: improving care and practice environments.

    Science.gov (United States)

    Oberlies, Amanda Stefancyk

    2014-09-01

    The American Organization of Nurse Executives conducted an evaluation of the hospitals participating in the Care Innovation and Transformation (CIT) program. A total of 24 hospitals participated in the 2-year CIT program from 2012 to 2013. Reported outcomes include increased patient satisfaction, decreased falls, and reductions in nurse turnover and overtime. Nurses reported statistically significant improvements in 4 domains of the principles and elements of a healthful practice environment developed by the Nursing Organizations Alliance.

  8. HPV Vaccination of Boys in Primary Care Practices

    Science.gov (United States)

    Allison, Mandy A.; Dunne, Eileen F.; Markowitz, Lauri E.; O’Leary, Sean T.; Crane, Lori A.; Hurley, Laura P.; Stokley, Shannon; Babbel, Christine I.; Brtnikova, Michaela; Beaty, Brenda L.; Kempe, Allison

    2018-01-01

    OBJECTIVE In October 2011, the Advisory Committee on Immunization Practices (ACIP) recommended the quadrivalent human papillomavirus vaccine (HPV4) for the routine immunization schedule for 11- to 12-year-old boys. Before October 2011, HPV4 was permissively recommended for boys. We conducted a study in 2010 to provide data that could guide efforts to implement routine HPV4 immunization in boys. Our objectives were to describe primary care physicians’: 1) knowledge and attitudes about human papillomavirus (HPV)-related disease and HPV4, 2) recommendation and administration practices regarding HPV vaccine in boys compared to girls, 3) perceived barriers to HPV4 administration in boys, and 4) personal and practice characteristics associated with recommending HPV4 to boys. METHODS We conducted a mail and Internet survey in a nationally representative sample of pediatricians and family medicine physicians from July 2010 to September 2010. RESULTS The response rate was 72% (609 of 842). Most physicians thought that the routine use of HPV4 in boys was justified. Although it was permissively recommended, 33% recommended HPV4 to 11- to 12-year-old boys and recommended it more strongly to older male adolescents. The most common barriers to HPV4 administration were related to vaccine financing. Physicians who reported recommending HPV4 for 11- to 12-year-old boys were more likely to be from urban locations, perceive that HPV4 is efficacious, perceive that HPV-related disease is severe, and routinely discuss sexual health with 11- to 12-year-olds. CONCLUSIONS Although most physicians support HPV4 for boys, physician education and evidence-based tools are needed to improve implementation of a vaccination program for males in primary care settings. PMID:24011749

  9. Council for Exceptional Children: Standards for Evidence-Based Practices in Special Education

    Science.gov (United States)

    TEACHING Exceptional Children, 2014

    2014-01-01

    In this article, the "Council for Exceptional Children (CEC)" presents Standards for Evidence-Based Practices in Special Education. The statement presents an approach for categorizing the evidence base of practices in special education. The quality indicators and the criteria for categorizing the evidence base of special education…

  10. CEC's Standards for Classifying the Evidence Base of Practices in Special Education

    Science.gov (United States)

    Cook, Bryan G.; Buysse, Virginia; Klingner, Janette; Landrum, Timothy J.; McWilliam, R. A.; Tankersley, Melody; Test, David W.

    2015-01-01

    As an initial step toward improving the outcomes of learners with disabilities, special educators have formulated guidelines for identifying evidence-based practices. We describe the Council of Exceptional Children's new set of standards for identifying evidence-based practices in special education and how they (a) were systematically vetted by…

  11. 7 CFR 205.203 - Soil fertility and crop nutrient management practice standard.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Soil fertility and crop nutrient management practice... Requirements § 205.203 Soil fertility and crop nutrient management practice standard. (a) The producer must... nutrients and soil fertility through rotations, cover crops, and the application of plant and animal...

  12. Getting High School Students Ready for College: A Quantitative Study of Standards-Based Grading Practices

    Science.gov (United States)

    Townsley, Matt; Varga, Matt

    2018-01-01

    Some high schools are moving towards standards-based grading in an attempt to produce consistent grading practices; however, the change's impact on college readiness is not clear. The purpose of this study was to explore the effect of high school's grading practices as it relates to ACT scores and grade point averages (GPAs). Existing data were…

  13. Implementing Dementia Care Mapping as a practice development tool in dementia care services: a systematic review.

    Science.gov (United States)

    Surr, Claire A; Griffiths, Alys W; Kelley, Rachael

    2018-01-01

    Dementia Care Mapping (DCM) is an observational tool set within a practice development process. Following training in the method, DCM is implemented via a cyclic process of briefing staff, conducting mapping observations, data analysis and report preparation, feedback to staff and action planning. Recent controlled studies of DCM's efficacy have found heterogeneous results, and variability in DCM implementation has been indicated as a potential contributing factor. This review aimed to examine the primary research evidence on the processes and the barriers and facilitators to implementing DCM as a practice development method within formal dementia care settings. PUBMED, PsycINFO, CINAHL, The Cochrane Library-Cochrane reviews, HMIC (Ovid), Web of Science and Social Care Online were searched using the term "Dementia Care Mapping". Inclusion criterion was primary research studies in any formal dementia care settings where DCM was used as a practice development tool and which included discussion/critique of the implementation processes. Assessment of study quality was conducted using the Mixed Methods Appraisal Tool. Twelve papers were included in the review, representing nine research studies. The papers included discussion of various components of the DCM process, including mapper selection and preparation; mapping observations; data analysis, report writing and feedback; and action planning. However, robust evidence on requirements for successful implementation of these components was limited. Barriers and facilitators to mapping were also discussed. The review found some consensus that DCM is more likely to be successfully implemented if the right people are selected to be trained as mappers, with appropriate mapper preparation and ongoing support and with effective leadership for DCM within the implementing organization/unit and in organizations that already have a person-centered culture or ethos. Future development of the DCM tool should consider ways to save on

  14. One World, One Standard for Burn Care: Nursing's Role in Global Health

    Directory of Open Access Journals (Sweden)

    Sheryl A Ramstad

    2017-06-01

    Full Text Available In 1978, a landmark United Nations conference in Alma-Ata declared the goal of health for all by the year 2000 (WHO, 1978. Yet, today significant disparities exist between the health care afforded individuals in resource-limited countries and those in the industrialized world. Nursing, as a global profession, can become a powerful force for change so that better health is universally achieved. Problem/Background: This project started with a partnership between a burn center in the United States and a pediatric burn center (Burn Center in Peru, a country in which it is estimated that 15,000 children endure burn injuries each year (Huby-Vidaurre, 2016. Most are under the age of five, and suffer scald burns from pots with hot liquids left to cool on the floors of their homes. Pressure garment therapy (PGT is a major treatment to reduce scarring for pediatric burn survivors in the United States since the early 1970s, but is unavailable in Peru. Strategy: The Doctor of Nursing Practice project leader worked with the Burn Center team to develop a plan to use PGT as an intervention to address disfiguring scarring among pediatric burn survivors, utilizing the twinning approach. Methods: This quality improvement project involved interdisciplinary collaboration and international partnerships between resource-rich and resource-challenged nations. Obtaining supplies needed to promote PGT in Peru required cultivating relationships with many people in the United States, including translators and interpreters to assist in overcoming language barriers among the participants, manufacturers and distributors of pressure garments to donate fabrics, and people regularly traveling to Peru who transported the donated PGT materials. It also involved working closely with the Burn Center team on developing a culture conducive to conforming to an international standard of practice. Results: Resources were successfully leveraged to build a sustainable PGT program for all

  15. Gold standards for primary care of burn management

    Directory of Open Access Journals (Sweden)

    Fatih Zor

    2009-01-01

    Full Text Available Every year, about 2.5 million people are affected from burns in the world. In our country there is no reliable database related to this subject. There are ongoing studies about the epidemiology of burns in Turkey. After burn injury had represent many various complications, such as myocardial infarction, cardiac deficiency, acute hypertension, endocarditis, thromboembolism, pulmonary edema, pneumonia, respiratuar failure, renal failure, gastric ulcus, ileus, sepsis, coagulopathy and anemia. Such complications can preventable or treatable. In this respect, preventive management in the first step burn treatment had very importantly in burn cases. Skin is a barrier which protects evaporative heat loss. In cases of acute burn, hypothermia occurs related to skin loss. For these cases, care must be taken to keep the patient warm. In addition fluid resuscitation is very important in these cases. Furthermore, the damaged tissues are highly susceptible to infection in burned patients. Burn care and rehabilitation includes challenging and complex procedures. Briefly, treatments of burn cases require a multidisciplinary and meticulous approach.

  16. Deriving allowable properties of lumber : a practical guide for interpretation of ASTM standards

    Science.gov (United States)

    Alan Bendtsen; William L. Galligan

    1978-01-01

    The ASTM standards for establishing clear wood mechanical properties and for deriving structural grades and related allowable properties for visually graded lumber can be confusing and difficult for the uninitiated to interpret. This report provides a practical guide to using these standards for individuals not familiar with their application. Sample stress...

  17. Arts Shoved Aside: Changing Art Practices in Primary Schools since the Introduction of National Standards

    Science.gov (United States)

    Irwin, Michael Ray

    2018-01-01

    This article reports on the understandings and practices of primary teachers in implementing the arts curriculum since the 2010 introduction of National Standards in Numeracy and Literacy within the New Zealand Education system. The ever-mounting pressure on schools to perform to these standards has resulted in a reduction of emphasis and time…

  18. 40 CFR 63.7294 - What work practice standard must I meet for soaking?

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 13 2010-07-01 2010-07-01 false What work practice standard must I meet for soaking? 63.7294 Section 63.7294 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission...

  19. Oral care of critically ill patients: practice of attending nurses at the ...

    African Journals Online (AJOL)

    Background: Oral care has been rated as a basic nursing care activity which provides respite and comfort to patients, who due to critical illness cannot perform this activity themselves. Oral care practices vary widely with attending nurses providing different level of care at varying frequency.Research in health care ...

  20. Case Management Ethics: High Professional Standards for Health Care's Interconnected Worlds.

    Science.gov (United States)

    Sminkey, Patrice V; LeDoux, Jeannie

    2016-01-01

    The purpose of this discussion is to draw attention to the considerable pressure on professional case managers today to coordinate with multiple stakeholders, with responsibilities that put them at the forefront of contact with payers and providers. This discussion raises awareness of how case managers, and board-certified case managers in particular, must demonstrate that they adhere to the highest ethical standards, as codified by the Commission for Case Manager Certification's Code of Professional Conduct for Case Managers. This discussion applies to case management practices and work settings across the full continuum of health care. As advocates for clients (individuals receiving case management services) and their families/support systems, case managers must adhere to the highest of ethical and professional standards. The Code of Professional Conduct for Case Managers is an indispensable resource for case managers to ensure that they place the public interest above their own, respect the rights and inherent dignity of clients, maintain objectivity in their relationships with clients, and act with integrity and fidelity with clients and others, as stipulated by the code.