Healthcare and wider societal implications of stillbirth: a population-based cost-of-illness study.

Science.gov (United States)

Campbell, H E; Kurinczuk, J J; Heazell, Aep; Leal, J; Rivero-Arias, O

2018-01-01

To extend previous work and estimate health and social care costs, litigation costs, funeral-related costs, and productivity losses associated with stillbirth in the UK. A population-based cost-of-illness study using a synthesis of secondary data. The National Health Service (NHS) and wider society in the UK. Stillbirths occurring within a 12-month period and subsequent events occurring over the following 2 years. Costs were estimated using published data on events, resource use, and unit costs. Mean health and social care costs, litigation costs, funeral-related costs, and productivity costs for 2 years, reported for a single stillbirth and at a national level. Mean health and social care costs per stillbirth were £4191. Additionally, funeral-related costs were £559, and workplace absence (parents and healthcare professionals) was estimated to cost £3829 per stillbirth. For the UK, the annual health and social care costs were estimated at £13.6 million, and total productivity losses amounted to £706.1 million (98% of this cost was attributable to the loss of the life of the baby). The figures for total productivity losses were sensitive to the perspective adopted about the loss of life of the baby. This work expands the current intelligence on the costs of stillbirth beyond the health service to costs for parents and society, and yet these additional findings must still be regarded as conservative estimates of the true economic costs. The costs of stillbirth are significant, affecting the health service, parents, professionals, and society. Why and how was the study carried out? The personal, social, and emotional consequences of stillbirth are profound. Placing a monetary value on such consequences is emotive, yet necessary, when deciding how best to invest limited healthcare resources. We estimated the average costs associated with a single stillbirth and the costs for all stillbirths occurring in the UK over a 1-year period. What were the main

Cause of death and associated conditions of stillbirths

OpenAIRE

Naveen Prasanna; Kavita Mahadevappa; Ramalingappa C. Antaratani; Laxmikant Lokare

2015-01-01

Background: Fetal death is a psychological trauma for the expecting mother and their family. Most of the countries worldwide lack data on stillbirths. Simply counting stillbirths is the first step in analysis and prevention and hence stillbirths need to count. Purpose of the study is to know the incidence, cause of stillbirths and to plan cause specific interventions to reduce stillbirths. Methods: This is a prospective cross-sectional study of patients with stillbirths from September 201...

A qualitative study exploring women’s beliefs about physical activity after stillbirth

Science.gov (United States)

2014-01-01

Background Research provides strong evidence for improvements in depressive symptoms as a result of physical activity participation in many populations including pregnant and post-partum women. Little is known about how women who have experienced stillbirth (defined as fetal death at 20 or more weeks of gestation) feel about physical activity or use physical activity following this experience. The purpose of this study was to qualitatively explore women’s beliefs about physical activity following a stillbirth. Methods This was an exploratory qualitative research study. Participants were English-speaking women between the ages of 19 and 44 years who experienced a stillbirth in the past year from their recruitment date. Interviews were conducted over the phone or in-person based on participants’ preferences and location of residence and approximately 30–45 minutes in length. Results Twenty-four women participated in the study (M age = 33 ± 3.68 years; M time since stillbirth = 6.33 ± 3.06 months). Women’s beliefs about physical activity after stillbirth were coded into the following major themes: barriers to physical activity (emotional symptoms and lack of motivation, tired, lack of time, guilt, letting go of a pregnant body, and seeing other babies), benefits to physical activity (feeling better emotionally/mentally, helping women to cope or be therapeutic), importance of physical activity (working through grief, time for self), motivators for physical activity (body shape/weight, health, more children, be a role model, already an exerciser). Health care providers and their role in physical activity participation was also a major theme. Conclusions This is the first study to qualitatively explore beliefs about physical activity in women after a stillbirth. Women who have experienced stillbirth have unique beliefs about physical activity related to their experience with stillbirth. Findings from this study may help to improve the health

Interventions for investigating and identifying the causes of stillbirth.

Science.gov (United States)

Wojcieszek, Aleena M; Shepherd, Emily; Middleton, Philippa; Gardener, Glenn; Ellwood, David A; McClure, Elizabeth M; Gold, Katherine J; Khong, Teck Yee; Silver, Robert M; Erwich, Jan Jaap Hm; Flenady, Vicki

2018-04-30

Identification of the causes of stillbirth is critical to the primary prevention of stillbirth and to the provision of optimal care in subsequent pregnancies. A wide variety of investigations are available, but there is currently no consensus on the optimal approach. Given their cost and potential to add further emotional burden to parents, there is a need to systematically assess the effect of these interventions on outcomes for parents, including psychosocial outcomes, economic costs, and on rates of diagnosis of the causes of stillbirth. To assess the effect of different tests, protocols or guidelines for investigating and identifying the causes of stillbirth on outcomes for parents, including psychosocial outcomes, economic costs, and rates of diagnosis of the causes of stillbirth. We searched Cochrane Pregnancy and Childbirth's Trials Register (31 August 2017), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (15 May 2017). We planned to include randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. We planned to include studies published as abstract only, provided there was sufficient information to allow us to assess study eligibility. We planned to exclude cross-over trials.Participants included parents (including mothers, fathers, and partners) who had experienced a stillbirth of 20 weeks' gestation or greater.This review focused on interventions for investigating and identifying the causes of stillbirth. Such interventions are likely to be diverse, but could include:* review of maternal and family history, and current pregnancy and birth history;* clinical history of present illness;* maternal investigations (such as ultrasound, amniocentesis, antibody screening, etc.);* examination of the stillborn baby (including full autopsy, partial autopsy or noninvasive components, such as magnetic resonance imaging (MRI), computerised tomography (CT) scanning, and radiography);* umbilical cord examination

Reducing stillbirths: interventions during labour

Science.gov (United States)

Darmstadt, Gary L; Yakoob, Mohammad Yawar; Haws, Rachel A; Menezes, Esme V; Soomro, Tanya; Bhutta, Zulfiqar A

2009-01-01

Background Approximately one million stillbirths occur annually during labour; most of these stillbirths occur in low and middle-income countries and are associated with absent, inadequate, or delayed obstetric care. The low proportion of intrapartum stillbirths in high-income countries suggests that intrapartum stillbirths are largely preventable with quality intrapartum care, including prompt recognition and management of intrapartum complications. The evidence for impact of intrapartum interventions on stillbirth and perinatal mortality outcomes has not yet been systematically examined. Methods We undertook a systematic review of the published literature, searching PubMed and the Cochrane Library, of trials and reviews (N = 230) that reported stillbirth or perinatal mortality outcomes for eight interventions delivered during labour. Where eligible randomised controlled trials had been published after the most recent Cochrane review on any given intervention, we incorporated these new trial findings into a new meta-analysis with the Cochrane included studies. Results We found a paucity of studies reporting statistically significant evidence of impact on perinatal mortality, especially on stillbirths. Available evidence suggests that operative delivery, especially Caesarean section, contributes to decreased stillbirth rates. Induction of labour rather than expectant management in post-term pregnancies showed strong evidence of impact, though there was not enough evidence to suggest superior safety for the fetus of any given drug or drugs for induction of labour. Planned Caesarean section for term breech presentation has been shown in a large randomised trial to reduce stillbirths, but the feasibility and consequences of implementing this intervention routinely in low-/middle-income countries add caveats to recommending its use. Magnesium sulphate for pre-eclampsia and eclampsia is effective in preventing eclamptic seizures, but studies have not demonstrated impact

From grief, guilt pain and stigma to hope and pride ? a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth

OpenAIRE

Burden, Christy; Bradley, Stephanie; Storey, Claire; Ellis, Alison; Heazell, Alexander E. P.; Downe, Soo; Cacciatore, Joanne; Siassakos, Dimitrios

2016-01-01

Background Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been systematically analysed or understood before now across the world. Our study aimed to systematically review, evaluate and summarise the current evidence regarding the psychosocial impact of stillbirth to parents and their families, ...

Decision influences and aftermath: parents, stillbirth and autopsy.

Science.gov (United States)

Horey, Dell; Flenady, Vicki; Conway, Liz; McLeod, Emma; Yee Khong, Teck

2014-08-01

Stillbirth, among the most distressing experiences an adult may face, is also a time when parents must decide whether an autopsy or other post-mortem examinations will be performed on their infant. Autopsies can reveal information that might help explain stillbirth, yet little is known about how people make this difficult decision. This study examines the influences on decisions about autopsy after stillbirth among Australian parents. The study involved secondary analysis of transcripts of three focus groups using qualitative content analysis. Seventeen parents of 14 stillborn babies participated in consultations around the revision of a perinatal mortality audit guideline. Parents shared the decision making. Four decision drivers were identified: parents' preparedness or readiness to make decisions; parental responsibility; concern for possible consequences of an autopsy and the role of health professionals. Each decision driver involved reasons both for and against autopsy. Two decision aftermath were also present: some parents who agreed to an autopsy were dissatisfied with the way the autopsy results were given to them and some parents who did not have an autopsy for their infant expressed some form of regret or uncertainty about the choice they made. To make decisions about autopsy after stillbirth, parents need factual information about autopsy procedures, recognition that there might be fear of blame, an environment of trust, and health services and professionals prepared and skilled for difficult conversations. © 2012 John Wiley & Sons Ltd.

Radiation and stillbirths in Sellafield workers

International Nuclear Information System (INIS)

Anon.

1999-01-01

Full text: In The Lancet (23 October 1999), Dr Louise Parker and colleagues from the Departments of Child Health and Statistics, University of Newcastle upon Tyne, UK, report the findings of a new study on stillbirths among offspring of male radiation workers at Sellafield. By linking the birth registration and stillbirth records in Cumbria from 1950 to 1989 to the database of workers at Sellafield, Dr Parker's team examined the stillbirth risk according to the father's exposure to radiation before conception of the child. From the birth documents of 248 097 livebirths and 3715 stillbirths, the team identified 130 stillbirths and 9078 livebirths to wives and partners of male radiation workers employed at Sellafield. Lifetime exposure, and that in the 90 days before conception, was derived from annual-exposure summaries for each worker. Exposures recorded on individual film badges for the fathers of each stillborn child and for four matched controls were also examined. The researchers found that although, as a group, babies of radiation workers were not more likely to be stillborn than babies of other Cumbrian fathers, there was an increased risk of stillbirth with increasing exposure of a father to external radiation. Although confounding factors also associated with stillbirth, such as whether the mother smoked, cannot be completely excluded, the researchers state that 'extensive checks confirmed that the statistical models were a good fit to the data and there was no statistical evidence of unmeasured factors'. However, the researchers are cautious in drawing any conclusions regarding causality. In the Commentary given in The Lancet, Hazel Inskip from the University of Southampton advises that the possible risk of stillbirth should be kept in perspective, and comments that 'there is no obvious mechanism for the association', but does concede that 'the greater increase in risk for stillbirths with neural-tube defects is at least focused on a more specific disorder

Socioeconomic inequalities in stillbirth rates in Europe

DEFF Research Database (Denmark)

Zeitlin, Jennifer; Mortensen, Laust; Prunet, Caroline

2016-01-01

in their country. Conclusions: Data on stillbirths and socioeconomic status from routine systems showed widespread and consistent socioeconomic inequalities in stillbirth rates in Europe. Further research is needed to better understand differences between countries in the magnitude of the socioeconomic gradient.......Background: Previous studies have shown that socioeconomic position is inversely associated with stillbirth risk, but the impact on national rates in Europe is not known. We aimed to assess the magnitude of social inequalities in stillbirth rates in European countries using indicators generated...... from routine monitoring systems. Methods: Aggregated data on the number of stillbirths and live births for the year 2010 were collected for three socioeconomic indicators (mothers' educational level, mothers' and fathers' occupational group) from 29 European countries participating in the Euro...

Stillbirths in urban Guinea-Bissau

DEFF Research Database (Denmark)

Bjerregaard-Andersen, Morten; Lund, Najaaraq; Joergensen, Anne Sofie Pinstrup

2018-01-01

-Bissau. Methods The study was carried out by the Bandim Health Project (BHP), a Health and Demographic Surveillance System site in the capital Bissau. We assessed stillbirth rates in a hospital cohort consisting of all deliveries at the maternity ward at the National Hospital Simão Mendes (HNSM......), and in a community cohort, which only included women from the BHP area. Stillbirth was classified as fresh (FSB) if fetal movements were reported on the day of delivery. Results From October 1 2007 to April 15 2013, a total of 38164 deliveries were registered at HNSM, among them 3762 stillbirths (99/1000 births...

Addressing Stillbirth in India Must Include Men.

Science.gov (United States)

Roberts, Lisa; Montgomery, Susanne; Ganesh, Gayatri; Kaur, Harinder Pal; Singh, Ratan

2017-07-01

Millennium Development Goal 4, to reduce child mortality, can only be achieved by reducing stillbirths globally. A confluence of medical and sociocultural factors contribute to the high stillbirth rates in India. The psychosocial aftermath of stillbirth is a well-documented public health problem, though less is known of the experience for men, particularly outside of the Western context. Therefore, men's perceptions and knowledge regarding reproductive health, as well as maternal-child health are important. Key informant interviews (n = 5) were analyzed and 28 structured interviews were conducted using a survey based on qualitative themes. Qualitative themes included men's dual burden and right to medical and reproductive decision making power. Wives were discouraged from expressing grief and pushed to conceive again. If not successful, particularly if a son was not conceived, a second wife was considered a solution. Quantitative data revealed that men with a history of stillbirths had greater anxiety and depression, perceived less social support, but had more egalitarian views towards women than men without stillbirth experience. At the same time fathers of stillbirths were more likely to be emotionally or physically abusive. Predictors of mental health, attitudes towards women, and perceived support are discussed. Patriarchal societal values, son preference, deficient women's autonomy, and sex-selective abortion perpetuate the risk for future poor infant outcomes, including stillbirth, and compounds the already higher risk of stillbirth for males. Grief interventions should explore and take into account men's perceptions, attitudes, and behaviors towards reproductive decision making.

National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis.

Science.gov (United States)

Cousens, Simon; Blencowe, Hannah; Stanton, Cynthia; Chou, Doris; Ahmed, Saifuddin; Steinhardt, Laura; Creanga, Andreea A; Tunçalp, Ozge; Balsara, Zohra Patel; Gupta, Shivam; Say, Lale; Lawn, Joy E

2011-04-16

Stillbirths do not count in routine worldwide data-collating systems or for the Millennium Development Goals. Two sets of national stillbirth estimates for 2000 produced similar worldwide totals of 3·2 million and 3·3 million, but rates differed substantially for some countries. We aimed to develop more reliable estimates and a time series from 1995 for 193 countries, by increasing input data, using recent data, and applying improved modelling approaches. For international comparison, stillbirth is defined as fetal death in the third trimester (≥1000 g birthweight or ≥28 completed weeks of gestation). Several sources of stillbirth data were identified and assessed against prespecified inclusion criteria: vital registration data; nationally representative surveys; and published studies identified through systematic literature searches, unpublished studies, and national data identified through a WHO country consultation process. For 2009, reported rates were used for 33 countries and model-based estimates for 160 countries. A regression model of log stillbirth rate was developed and used to predict national stillbirth rates from 1995 to 2009. Uncertainty ranges were obtained with a bootstrap approach. The final model included log(neonatal mortality rate) (cubic spline), log(low birthweight rate) (cubic spline), log(gross national income purchasing power parity) (cubic spline), region, type of data source, and definition of stillbirth. Vital registration data from 79 countries, 69 nationally representative surveys from 39 countries, and 113 studies from 42 countries met inclusion criteria. The estimated number of global stillbirths was 2·64 million (uncertainty range 2·14 million to 3·82 million) in 2009 compared with 3·03 million (uncertainty range 2·37 million to 4·19 million) in 1995. Worldwide stillbirth rate has declined by 14·5%, from 22·1 stillbirths per 1000 births in 1995 to 18·9 stillbirths per 1000 births in 2009. In 2009, 76·2% of

Effects of stillbirth and dystocia on subsequent reproductive performance in Japanese Black cattle.

Science.gov (United States)

Sasaki, Yosuke; Uematsu, Mizuho; Kitahara, Go; Osawa, Takeshi; Sueyoshi, Masuo

2014-06-01

The objective of this study was to determine the effects of stillbirth and dystocia on subsequent reproductive performance in Japanese Black cattle. Data were collected for 34,763 calvings from 13,186 animals on 826 farms. Stillbirth was associated with a decreased first service conception rate compared to cows with a normal calving (44.4 versus 54.0%, respectively, P dystocia (P dystocia had inferior subsequent reproductive performance compared with those with a normal calving. Copyright © 2014 Elsevier Ltd. All rights reserved.

Stillbirths : recall to action in high-income countries

NARCIS (Netherlands)

Flenady, Vicki; Wojcieszek, Aleena M.; Middleton, Philippa; Ellwood, David; Erwich, Jan Jaap; Coory, Michael; Khong, T. Yee; Silver, Robert M.; Smith, Gordon C. S.; Boyle, Frances M.; Lawn, Joy E.; Blencowe, Hannah; Leisher, Susannah Hopkins; Gross, Mechthild M.; Horey, Dell; Farrales, Lynn; Bloomfield, Frank; McCowan, Lesley; Brown, Stephanie J.; Joseph, K. S.; Zeitlin, Jennifer; Reinebrant, Hanna E.; Ravaldi, Claudia; Vannacci, Alfredo; Cassidy, Jillian; Cassidy, Paul; Farquhar, Cindy; Wallace, Euan; Siassakos, Dimitrios; Heazell, Alexander E. P.; Storey, Claire; Sadler, Lynn; Petersen, Scott; Froen, J. Frederik; Goldenberg, Robert L.

2016-01-01

Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19 439 late gestation ( 28 weeks or more) stillbirths could have been avoided in 2015.

An evaluation of classification systems for stillbirth.

Science.gov (United States)

Flenady, Vicki; Frøen, J Frederik; Pinar, Halit; Torabi, Rozbeh; Saastad, Eli; Guyon, Grace; Russell, Laurie; Charles, Adrian; Harrison, Catherine; Chauke, Lawrence; Pattinson, Robert; Koshy, Rachel; Bahrin, Safiah; Gardener, Glenn; Day, Katie; Petersson, Karin; Gordon, Adrienne; Gilshenan, Kristen

2009-06-19

Audit and classification of stillbirths is an essential part of clinical practice and a crucial step towards stillbirth prevention. Due to the limitations of the ICD system and lack of an international approach to an acceptable solution, numerous disparate classification systems have emerged. We assessed the performance of six contemporary systems to inform the development of an internationally accepted approach. We evaluated the following systems: Amended Aberdeen, Extended Wigglesworth; PSANZ-PDC, ReCoDe, Tulip and CODAC. Nine teams from 7 countries applied the classification systems to cohorts of stillbirths from their regions using 857 stillbirth cases. The main outcome measures were: the ability to retain the important information about the death using the InfoKeep rating; the ease of use according to the Ease rating (both measures used a five-point scale with a score <2 considered unsatisfactory); inter-observer agreement and the proportion of unexplained stillbirths. A randomly selected subset of 100 stillbirths was used to assess inter-observer agreement. InfoKeep scores were significantly different across the classifications (p < or = 0.01) due to low scores for Wigglesworth and Aberdeen. CODAC received the highest mean (SD) score of 3.40 (0.73) followed by PSANZ-PDC, ReCoDe and Tulip [2.77 (1.00), 2.36 (1.21), 1.92 (1.24) respectively]. Wigglesworth and Aberdeen resulted in a high proportion of unexplained stillbirths and CODAC and Tulip the lowest. While Ease scores were different (p < or = 0.01), all systems received satisfactory scores; CODAC received the highest score. Aberdeen and Wigglesworth showed poor agreement with kappas of 0.35 and 0.25 respectively. Tulip performed best with a kappa of 0.74. The remainder had good to fair agreement. The Extended Wigglesworth and Amended Aberdeen systems cannot be recommended for classification of stillbirths. Overall, CODAC performed best with PSANZ-PDC and ReCoDe performing well. Tulip was shown to have the

Performance and financial consequences of stillbirth in Holstein dairy cattle.

Science.gov (United States)

Mahnani, A; Sadeghi-Sefidmazgi, A; Keshavarzi, H

2018-03-01

Stillbirth is an economically important trait on dairy farms. Knowledge of the consequences of, and the economic losses associated with stillbirth can help the producer when making management decisions. The objectives of this study were to determine the effects of stillbirth on productive and reproductive performance as well as financial losses due to stillbirth incidence in Iranian Holstein dairy farms. Economic and performance data were collected from nine Holstein dairy farms in Isfahan and Khorasan provinces of Iran from March 2008 to December 2013. The final data set included 160 410 calving records from 53 265 cows. A linear mixed model was developed to evaluate the effects of stillbirth on performance of primiparous and multiparous cows separately and overall. An economic model was used to estimate the economic losses due to stillbirth. The incidence of stillbirth cases per cow per year was 4.2% on average (3.4% to 6.8% at herd level). The least square means results showed that a case of stillbirth significantly (P0.05). Overall, a case of stillbirth reduced 305-day milk yield by 544.0±76.5 kg/cow per lactation. Stillbirth had no significant effects on 305-day fat and protein percentages in either primiparous or multiparous cows. Overall, cows that gave birth to stillborn calves had significantly increased days open by 14.6±2.6 days and the number of inseminations per conception by 0.2 compared with cows that gave birth to live calves (Pfinancial losses associated with stillbirth incidence averaged US$ 938 per case (range from $US 767 to $US 1189 in the nine investigated farms). The loss of a calf was not the only cost associated with stillbirth, as it accounted for 71.0% of the total cost. The costs of dystocia (7.6%) and culling and replacement expenses (6.3%) were the next most important costs associated with stillbirth. These results can be used to assess the potential return from management strategies to reduce the occurrence of stillbirths.

Auditing stillbirths at Lower Umfolozi War Memorial Regional Hospital

African Journals Online (AJOL)

on stillbirths in developing countries and rural settings, where the majority of such births occur. ... The stillbirth rate at LUWMRH is much higher than that at other regional ... deaths, stillbirths, early and late neonatal deaths, cases of birth.

Baird-Pattinson Aetiological Classification and Phases of Delay Contributing to Stillbirths in a Nigerian Tertiary Hospital

Directory of Open Access Journals (Sweden)

Jacob Olumuyiwa Awoleke

2016-01-01

Full Text Available Purpose. This study aims to identify triggers of stillbirth in the study setting and to make suggestions to reduce the prevalence. Method. A three-year retrospective case-control study of stillbirths at Ekiti State University Teaching Hospital. Results. The stillbirth rate was 33 per 1000 births. Based on Baird-Pattinson classification of the primary obstetric causes of stillbirth, adverse intrapartum events, hypertensive diseases, and unexplained intrapartum fetal deaths were topmost causes of stillbirths. In comparison with the controls, other identified predictors of SB were grand multiparity (p=0.016, delays in seeking medical care and/or in receiving treatment (p=0.001, wrong initial diagnosis (p=0.001, inadequate intrapartum monitoring (p=0.001, and inappropriate clinical management (p=0.001. Conclusion. Stillbirth rate remains high in our setting. Elimination of obstacles to accessing care, effective management of hypertensive disorders in pregnancy, updated health facilities, improved dedication to duty, and retraining of health workers will reduce the prevalence.

Thyroid function testing in women who had a stillbirth

NARCIS (Netherlands)

Nijkamp, Janna W.; Korteweg, Fleurisca J.; Groen, Henk; Timmer, Albertus; Van den Berg, Gerrit; Bossuyt, Patrick M.; Mol, Ben Willem J.; Erwich, Jan Jaap H. M.

ContextThyroid dysfunction is thought to be associated with stillbirth. Therefore, thyroid function is often recommended in the diagnostic investigations for stillbirth. ObjectiveWe aimed to evaluate the added value of thyroid function testing in the diagnostic investigations for stillbirth. Design

Risk factors and classification of stillbirth in a Middle Eastern population: a retrospective study.

Science.gov (United States)

Kunjachen Maducolil, Mariam; Abid, Hafsa; Lobo, Rachael Marian; Chughtai, Ambreen Qayyum; Afzal, Arjumand Muhammad; Saleh, Huda Abdullah Hussain; Lindow, Stephen W

2017-12-21

To estimate the incidence of stillbirth, explore the associated maternal and fetal factors and to evaluate the most appropriate classification of stillbirth for a multiethnic population. This is a retrospective population-based study of stillbirth in a large tertiary unit. Data of each stillbirth with a gestational age >/=24 weeks in the year 2015 were collected from electronic medical records and analyzed. The stillbirth rate for our multiethnic population is 7.81 per 1000 births. Maternal medical factors comprised 52.4% in which the rates of hypertensive disorders, diabetes and other medical disorders were 22.5%, 20.8% and 8.3%, respectively. The most common fetal factor was intrauterine growth restriction (IUGR) (22.5%) followed by congenital anomalies (21.6%). All cases were categorized using the Wigglesworth, Aberdeen, Tulip, ReCoDe and International Classification of Diseases-perinatal mortality (ICD-PM) classifications and the rates of unclassified stillbirths were 59.2%, 46.6%, 16.6%, 11.6% and 7.5%, respectively. An autopsy was performed in 9.1% of cases reflecting local religious and cultural sensitivities. This study highlighted the modifiable risk factors among the Middle Eastern population. The most appropriate classification was the ICD-PM. The low rates of autopsy prevented a detailed evaluation of stillbirths, therefore it is suggested that a minimally invasive autopsy [postmortem magnetic resonance imaging (MRI)] may improve the quality of care.

Community-based stillbirth rates and risk factors in rural Sarlahi, Nepal.

Science.gov (United States)

Lee, Anne C; Mullany, Luke C; Tielsch, James M; Katz, Joanne; Khatry, Subarna K; Leclerq, Steven C; Adhikari, Ramesh K; Darmstadt, Gary L

2011-06-01

To assess stillbirth rates and antepartum risk factors in rural Nepal. Data were collected prospectively during a cluster-randomized, community-based trial in Sarlahi, Nepal, from 2002 to 2006. Multivariate regression modeling was performed to calculate adjusted relative risk estimates. Among 24531 births, the stillbirth rate was 35.4 per 1000 births (term stillbirth rate 21.2 per 1000 births). Most births occurred at home without a skilled birth attendant. The majority (69%) of intrapartum maternal deaths resulted in stillbirth. The adjusted RR (aRR) of stillbirth was 2.74 among nulliparas and 1.47 among mothers with history of a child death. Mothers above the age of 30 years carried a 1.59-fold higher risk for stillbirth than mothers who were 20-24 years old. The stillbirth risk was lower among households where the father had any formal education (aRR 0.70). Land ownership (aRR 0.85) and Pahadi ethnicity (aRR 0.67; reference: Madhesi ethnicity) were associated with significantly lower risks of stillbirth. Stillbirth rates were high in rural Nepal, with the majority of stillbirths occurring at full-term gestation. Nulliparity, history of prior child loss, maternal age above 30 years, Madhesi ethnicity, and socioeconomic disadvantage were significant risk factors for stillbirth. Clinicaltrials.govNCT00 109616. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Stillbirths in relation to the coastline of Cumbria, 1950-89.

Science.gov (United States)

Dummer, T J; Pearce, M S; Dickinson, H O; Charlton, M E; Salotti, J; Parker, L

1999-04-01

The nuclear installation at Sellafield, in west Cumbria in the north of England, has discharged radioactive waste into the Irish Sea since 1952. The objective of this paper was to investigate whether women living near to the coast in Cumbria had an increased risk of having stillborn children. A retrospective cohort analysis was carried out using all 259,050 births (4017 stillbirths) to women normally resident in Cumbria during 1950-89, allowing for year of birth, social class and birth order using (i) comparison of observed and expected numbers of stillbirths in distance bands relative to the coast, (ii) comparison of cumulative observed and expected numbers of stillbirths by distance from the coast, and (iii) logistic regression analysis of stillbirth risk in relation to distance from the coast. Comparison of observed and expected numbers of stillbirths in distance bands within 10 km of the coast did not provide evidence of an excess risk of stillbirth closer to the coast. The comparison of the cumulative observed and expected numbers of stillbirths within 10 km of the coast supported this result. Logistic regression analysis of all births in Cumbria showed that distance from the coast did not significantly influence stillbirth risk (P > 0.05). There was no evidence to suggest an increased risk of stillbirth in mothers resident nearer to the coast.

Identification of factors associated with stillbirth in the Indian state of Bihar using verbal autopsy: A population-based study.

Directory of Open Access Journals (Sweden)

Rakhi Dandona

2017-08-01

Full Text Available India was estimated to have the largest numbers of stillbirths globally in 2015, and the Indian government has adopted a target of <10 stillbirths per 1,000 births by 2030 through the India Newborn Action Plan (INAP. The objective of this study was to use verbal autopsy interviews to examine factors associated with stillbirth in the Indian state of Bihar and make recommendations for the INAP to better inform the setting of priorities and actions to reduce stillbirths.Verbal autopsy interviews were conducted for deaths including stillbirths that occurred from January 2011 to March 2014 in a sample of 109,689 households (87.1% participation in 1,017 clusters representative of the state of Bihar. The Population Health Metrics Research Consortium shortened verbal autopsy questionnaire was used for each interview, and cause of death was assigned using the SmartVA automated algorithm. A stillbirth was defined as a foetal death with a gestation period of ≥28 weeks wherein the foetus did not show any sign of life. We report on the stillbirth epidemiology and present case studies from the qualitative data on the health provider interface that can be used to improve success of improved, skilled care at birth and delivery interventions. The annualised stillbirth incidence was 21.2 (95% CI 19.7 to 22.6 per 1,000 births, with it being higher in the rural areas. A total of 1,132 stillbirths were identified; 686 (62.2% were boys, 327 (29.7% were firstborn, and 760 (68.9% were delivered at a health facility. Of all the stillbirths, 54.5% were estimated to be antepartum. Only 6,161 (55.9% of the women reported at least 1 antenatal care visit, and 33% of the women reported not consuming the iron folic acid tablets during pregnancy. Significant differences were seen in delivery-related variables and associated maternal conditions based on the place of delivery and type of stillbirth. Only 6.1% of the women reported having undergone a test to rule out syphilis

An evaluation of classification systems for stillbirth

Directory of Open Access Journals (Sweden)

Pattinson Robert

2009-06-01

Full Text Available Abstract Background Audit and classification of stillbirths is an essential part of clinical practice and a crucial step towards stillbirth prevention. Due to the limitations of the ICD system and lack of an international approach to an acceptable solution, numerous disparate classification systems have emerged. We assessed the performance of six contemporary systems to inform the development of an internationally accepted approach. Methods We evaluated the following systems: Amended Aberdeen, Extended Wigglesworth; PSANZ-PDC, ReCoDe, Tulip and CODAC. Nine teams from 7 countries applied the classification systems to cohorts of stillbirths from their regions using 857 stillbirth cases. The main outcome measures were: the ability to retain the important information about the death using the InfoKeep rating; the ease of use according to the Ease rating (both measures used a five-point scale with a score Results InfoKeep scores were significantly different across the classifications (p ≤ 0.01 due to low scores for Wigglesworth and Aberdeen. CODAC received the highest mean (SD score of 3.40 (0.73 followed by PSANZ-PDC, ReCoDe and Tulip [2.77 (1.00, 2.36 (1.21, 1.92 (1.24 respectively]. Wigglesworth and Aberdeen resulted in a high proportion of unexplained stillbirths and CODAC and Tulip the lowest. While Ease scores were different (p ≤ 0.01, all systems received satisfactory scores; CODAC received the highest score. Aberdeen and Wigglesworth showed poor agreement with kappas of 0.35 and 0.25 respectively. Tulip performed best with a kappa of 0.74. The remainder had good to fair agreement. Conclusion The Extended Wigglesworth and Amended Aberdeen systems cannot be recommended for classification of stillbirths. Overall, CODAC performed best with PSANZ-PDC and ReCoDe performing well. Tulip was shown to have the best agreement and a low proportion of unexplained stillbirths. The virtues of these systems need to be considered in the development of an

Risk factors for stillbirths at Universty of Maiduguri teaching hospital ...

African Journals Online (AJOL)

Risk factors for stillbirths at Universty of Maiduguri teaching hospital, ... Background:Stillbirth rate is an important indicator of access to and quality of antenatal and delivery care. ... Key words: stillbirth, prevalence, aetiologic determinants ...

Stillbirth in an Anglophone minority of Canada

DEFF Research Database (Denmark)

Auger, Nathalie; Daniel, Mark; Mortensen, Laust Hvas

2015-01-01

OBJECTIVES: We assessed trends in stillbirth over time for Francophones and Anglophones of Quebec, a large Canadian province with publically funded health care and an English-speaking minority. METHODS: We calculated stillbirth rates for Francophones and Anglophones, and estimated hazard ratios (HR...

Identification of factors associated with stillbirth in the Indian state of Bihar using verbal autopsy: A population-based study.

Science.gov (United States)

Dandona, Rakhi; Kumar, G Anil; Kumar, Amit; Singh, Priyanka; George, Sibin; Akbar, Mohammad; Dandona, Lalit

2017-08-01

India was estimated to have the largest numbers of stillbirths globally in 2015, and the Indian government has adopted a target of autopsy interviews to examine factors associated with stillbirth in the Indian state of Bihar and make recommendations for the INAP to better inform the setting of priorities and actions to reduce stillbirths. Verbal autopsy interviews were conducted for deaths including stillbirths that occurred from January 2011 to March 2014 in a sample of 109,689 households (87.1% participation) in 1,017 clusters representative of the state of Bihar. The Population Health Metrics Research Consortium shortened verbal autopsy questionnaire was used for each interview, and cause of death was assigned using the SmartVA automated algorithm. A stillbirth was defined as a foetal death with a gestation period of ≥28 weeks wherein the foetus did not show any sign of life. We report on the stillbirth epidemiology and present case studies from the qualitative data on the health provider interface that can be used to improve success of improved, skilled care at birth and delivery interventions. The annualised stillbirth incidence was 21.2 (95% CI 19.7 to 22.6) per 1,000 births, with it being higher in the rural areas. A total of 1,132 stillbirths were identified; 686 (62.2%) were boys, 327 (29.7%) were firstborn, and 760 (68.9%) were delivered at a health facility. Of all the stillbirths, 54.5% were estimated to be antepartum. Only 6,161 (55.9%) of the women reported at least 1 antenatal care visit, and 33% of the women reported not consuming the iron folic acid tablets during pregnancy. Significant differences were seen in delivery-related variables and associated maternal conditions based on the place of delivery and type of stillbirth. Only 6.1% of the women reported having undergone a test to rule out syphilis. For 34.2% of the stillbirths, the possible risk factor for stillbirth was unexplained. For the remaining 65.8% of the women who reported at least

The impact of stillbirth on bereaved parents: A qualitative study.

Science.gov (United States)

Nuzum, Daniel; Meaney, Sarah; O'Donoghue, Keelin

2018-01-01

To explore the lived experiences and personal impact of stillbirth on bereaved parents. Semi-structured in-depth interviews analysed by Interpretative Phenomenological Analysis (IPA) on a purposive sample of parents of twelve babies born following fetal death at a tertiary university maternity hospital in Ireland with a birth rate of c8,500 per annum and a stillbirth rate of 4.6/1000. Stillbirth had a profound and enduring impact on bereaved parents. Four superordinate themes relating to the human impact of stillbirth emerged from the data: maintaining hope, importance of the personhood of the baby, protective care and relationships (personal and professional). Bereaved parents recalled in vivid detail their experiences of care following diagnosis of stillbirth and their subsequent care. The time between diagnosis of a life-limiting anomaly or stillbirth and delivery is highlighted as important for parents as they find meaning in their loss. The impact of stillbirth on bereaved parents is immense and how parents are cared for is recalled in precise detail as they revisit their experience. Building on existing literature, these data bring to light the depth of personal experience and impact of stillbirth for parents and provides medical professionals with valuable insights to inform their care of bereaved parents and the importance of clear and sensitive communication.

Predictors of autopsy following stillbirth in Queensland, Australia: A population-based study.

Science.gov (United States)

Ibiebele, Ibinabo; Boyle, Frances M; Horey, Dell; Lourie, Rohan; Wilson, Patricia; Coory, Michael; Flenady, Vicki

2017-02-01

Accurate determination of causes of stillbirth is critical to effective prevention. Autopsy remains the gold standard investigation for stillbirth; however, with low autopsy rates many stillbirths are likely to be 'unexplored' rather than 'unexplained'. To determine factors associated with autopsy following stillbirth. Routinely collected population-based data on all singleton stillbirths of at least 400 g birthweight or 20 weeks gestation in Queensland between July 2000 and December 2011 were examined. Adjusted odds ratios (aOR, 99% CI) were calculated accounting for sociodemographic, pregnancy and medical factors. Of interest was initially unexplained stillbirth on the death certificate; analysis was stratified by gestational age group (autopsy performed. Initially unexplained stillbirth was associated with decreased odds of autopsy at late gestation (28-36 weeks, aOR 0.63 (99% CI 0.42-0.93); ≥37 weeks, aOR 0.53 (99% CI 0.35-0.81)) as was intrapartum stillbirth (autopsy following stillbirth. Pregnancy factors are associated with stillbirth autopsy. These findings have implications for development of appropriate information for parents and education of clinical staff. Further research is needed into factors influencing autopsy following stillbirth. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Perinatal mortality classification: an analysis of 112 cases of stillbirth.

Science.gov (United States)

Reis, Ana Paula; Rocha, Ana; Lebre, Andrea; Ramos, Umbelina; Cunha, Ana

2017-10-01

This was a retrospective cohort analysis of stillbirths that occurred from January 2004 to December 2013 in our institution. We compared Tulip and Wigglesworth classification systems on a cohort of stillbirths and analysed the main differences between these two classifications. In this period, there were 112 stillbirths of a total of 31,758 births (stillbirth rate of 3.5 per 1000 births). There were 99 antepartum deaths and 13 intrapartum deaths. Foetal autopsy was performed in 99 cases and placental histopathological examination in all of the cases. The Wigglesworth found 'unknown' causes in 47 cases and the Tulip classification allocated 33 of these. Fourteen cases remained in the group of 'unknown' causes. Therefore, the Wigglesworth classification of stillbirths results in a higher proportion of unexplained stillbirths. We suggest that the traditional Wigglesworth classification should be substituted by a classification that manages the available information.

Rates of stillbirth by gestational age and cause in Inuit and First Nations populations in Quebec.

Science.gov (United States)

Auger, Nathalie; Park, Alison L; Zoungrana, Hamado; McHugh, Nancy Gros-Louis; Luo, Zhong-Cheng

2013-04-02

Inuit and First Nations populations have higher rates of stillbirth than non-Aboriginal populations in Canada do, but little is known about the timing and cause of stillbirth in Aboriginal populations. We compared gestational age- and cause-specific stillbirth rates in Inuit and First Nations populations with the rates in the non-Aboriginal population in Quebec. Data included singleton stillbirths and live births at 24 or more gestational weeks among Quebec residents from 1981 to 2009. We calculated odds ratios (ORs), rate differences and 95% confidence intervals (CIs) for the retrospective cohort of Inuit and First Nations births relative to non-Aboriginal births using fetuses at risk (i.e., ongoing pregnancies) as denominators and adjusting for maternal characteristics. The main outcomes were stillbirth by gestational age (24-27, 28-36, ≥ 37 wk) and cause of death. Rates of stillbirth per 1000 births were greater among Inuit (6.8) and First Nations (5.7) than among non-Aboriginal (3.6) residents. Relative to the non-Aboriginal population, the risk of stillbirth was greater at term (≥ 37 wk) than before term for both Inuit (OR 3.1, 95% CI 1.9 to 4.8) and First Nations (OR 2.6, 95% CI 2.1 to 3.3) populations. Causes most strongly associated with stillbirth were poor fetal growth, placental disorders and congenital anomalies among the Inuit, and hypertension and diabetes among the First Nations residents. Stillbirth rates in Aboriginal populations were particularly high at term gestation. Poor fetal growth, placental disorders and congenital anomalies were important causes of stillbirth among the Inuit, and diabetic and hypertensive complications were important causes in the First Nations population. Prevention may require improvements in pregnancy and obstetric care.

Stillbirth prevalence in Brazil: an exploration of regional differences.

Science.gov (United States)

Carvalho, Taiana Silva; Pellanda, Lucia Campos; Doyle, Pat

Brazil is a large, heterogeneous, and diverse country, marked by social, economic, and regional inequalities. Stillbirth is a global concern, especially in low- and middle-income countries. This study investigated the prevalence and possible determinants of stillbirth in different regions of Brazil. This is a cross-sectional study including all women of reproductive age who had had a pregnancy in the last five years, enrolled in the most recent Brazilian Demographic and Health Survey (DHS/PNDS-2006/07). Logistic regression was used to assess the association between region and other maternal characteristics and stillbirth risk. The prevalence of stillbirth in Brazil was 14.82 per 1000 births, with great variation by region of the country, and a higher prevalence among the most deprived. The North and Northeast regions had the highest odds of stillbirth compared to the Center-West, which persisted after adjustment for multiple confounders - including deprivation level and ethnicity. Low maternal age and maternal obesity were also related to higher odds of stillbirth. In Brazil, the region influences stillbirth risk, with much higher risk in the North and Northeast. Variation in socioeconomic level does not explain this finding. Further research on the subject should explore other possible explanations, such as antenatal care and type of delivery, as well as the role of the private and public health systems in determining stillbirth. Preventive strategies should be directed to these historically disadvantaged regions, such as guaranteeing access and quality of care during pregnancy and around the time of birth. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Maternal region of birth and stillbirth in Victoria, Australia 2000-2011: A retrospective cohort study of Victorian perinatal data.

Directory of Open Access Journals (Sweden)

Miranda L Davies-Tuck

Full Text Available There is growing evidence from high-income countries that maternal country of birth is a risk factor for stillbirth. We aimed to examine the association between maternal region of birth and stillbirth between 2000 and 2011 inclusive in Victoria, Australia.Retrospective population based cohort study of all singleton births at 24 or more weeks gestational age from 2000-2011 in Victoria, Australia. Stillbirths due to termination of pregnancy, babies with congenital anomalies and Indigenous mothers were excluded. Main Outcome Measure: Stillbirth.Over the 12-year period there were 685,869 singleton births and 2299 stillbirths, giving an overall stillbirth rate of 3·4 per 1000 births. After adjustment for risk factors, compared to women born in Australia/New Zealand, women born in South Asia (aOR 1.27, 95% CI 1.01-1.53, p = 0.01, were more likely to have a stillbirth whereas women born in South East and East Asia were (aOR 0.60, (95% CI 0.49-0.72, p<0.001 less likely to have a stillbirth. Additionally, the increasing rate of stillbirth as gestation length progressed began to rise earlier and more steeply in the South Asian compared to Australian/New Zealand born women. The following risk factors were also significantly associated with an increased odds of stillbirth in multivariate analyses: maternal age <20 and 35 years and more, nulliparity, low socio-economic status, previous stillbirth, no ultrasound reported in 1st trimester, pre-existing hypertension, antepartum haemorrhage and failure to detect growth restriction antenatally.Maternal region of birth is an independent risk factor for stillbirth. Improvements in the rate of stillbirth, particularly late pregnancy stillbirth, are likely to be gained in high-income settings where clinical care is informed by maternal region of birth.

Care in subsequent pregnancies following stillbirth: an international survey of parents.

Science.gov (United States)

Wojcieszek, A M; Boyle, F M; Belizán, J M; Cassidy, J; Cassidy, P; Erwich, Jjhm; Farrales, L; Gross, M M; Heazell, Aep; Leisher, S H; Mills, T; Murphy, M; Pettersson, K; Ravaldi, C; Ruidiaz, J; Siassakos, D; Silver, R M; Storey, C; Vannacci, A; Middleton, P; Ellwood, D; Flenady, V

2018-01-01

the next pregnancy than parents who have not had a stillborn baby before. The next pregnancy after stillbirth is often an extremely anxious time for parents, as they worry about whether their baby will survive. In this study we asked 2716 parents from 40 countries about the care they received during their first pregnancy after stillbirth. Parents were recruited mainly through the International Stillbirth Alliance and completed on online survey that was available in six languages. Findings Parents often had extra antenatal visits and extra ultrasound scans in the next pregnancy, but they rarely had extra emotional support. Also, many parents felt their care providers did not always listen to them and spend enough time with them, involve them in decisions, and take their concerns seriously. Parents were more likely to receive various forms of extra care in the next pregnancy if their baby had died later in pregnancy compared to earlier in pregnancy. Limitations In this study we only have information from parents who were able and willing to complete an online survey. Most of the parents were involved in charity and support groups and most parents lived in developed countries. We do not know how well the findings relate to other parents. Finally, our study does not include parents who may have tried for another pregnancy but were not able to conceive. Potential impact This study can help to improve care through the development of best practice guidelines for pregnancies following stillbirth. The results suggest that parents need better emotional support in these pregnancies, and more opportunities to participate actively in decisions about care. Extra support should be available no matter how far along in pregnancy the previous stillborn baby died. © 2016 Royal College of Obstetricians and Gynaecologists.

Stillbirths and male irradiation

Energy Technology Data Exchange (ETDEWEB)

Boice, John D. Jr. [International Epidemiology Institute, Rockville, MD (United States)]. E-mail: boicej@compuserve.com; Robison, Leslie L. [University of Minnesota, Minneapolis, MN (United States); Mertens, Ann [University of Texas M D Anderson Cancer Center, Houston, TX (United States); Stovall, Marilyn; Green, Daniel M.; Mulvihill, John J.; ); Roswell Park Cancer Institute, Buffalo, NY (United States); University of Oklahoma, Oklahoma City, OK (US))

2000-09-01

Little (1999) recently reviewed the evidence that paternal preconception irradiation in the Sellafield workforce (Parker et al 1999) and among Japanese atomic bomb survivors (Otake et al 1990) might be associated with an increased risk of stillbirth. He concluded that the association reported for radiation workers was statistically incompatible with the absence of an association seen among the exposed Japanese parents. These studies and analyses illustrate the considerable difficulty in assessing stillbirths conceived by men exposed to ionising radiation at work. For example, occupational doses may not be sufficiently large to result in a detectable effect and maternal factors that are associated with stillbirths and important to adjust for may not be available. These papers also bring to focus a relevant but not well-studied public health issue, namely, what are the reproductive risks for men and women exposed to potential mutagens? We wish to emphasise here the theoretical and practical advantages of addressing this issue in persons not with low dose occupational or acute atomic bomb exposures, but with higher dose medical experiences; in particular, in survivors of cancers of childhood, adolescents, and young adulthood (Blatt 1999, Bryne et al 1998, Sankila et al 1998, Green et al 1997, Hawkins and Stevens 1996). Letter-to-the-editor.

Validity and reliability of stillbirth data using linked self-reported and administrative datasets.

Science.gov (United States)

Hure, Alexis J; Chojenta, Catherine L; Powers, Jennifer R; Byles, Julie E; Loxton, Deborah

2015-01-01

A high rate of stillbirth was previously observed in the Australian Longitudinal Study of Women's Health (ALSWH). Our primary objective was to test the validity and reliability of self-reported stillbirth data linked to state-based administrative datasets. Self-reported data, collected as part of the ALSWH cohort born in 1973-1978, were linked to three administrative datasets for women in New South Wales, Australia (n = 4374): the Midwives Data Collection; Admitted Patient Data Collection; and Perinatal Death Review Database. Linkages were obtained from the Centre for Health Record Linkage for the period 1996-2009. True cases of stillbirth were defined by being consistently recorded in two or more independent data sources. Sensitivity, specificity, positive predictive value, negative predictive value, percent agreement, and kappa statistics were calculated for each dataset. Forty-nine women reported 53 stillbirths. No dataset was 100% accurate. The administrative datasets performed better than self-reported data, with high accuracy and agreement. Self-reported data showed high sensitivity (100%) but low specificity (30%), meaning women who had a stillbirth always reported it, but there was also over-reporting of stillbirths. About half of the misreported cases in the ALSWH were able to be removed by identifying inconsistencies in longitudinal data. Data linkage provides great opportunity to assess the validity and reliability of self-reported study data. Conversely, self-reported study data can help to resolve inconsistencies in administrative datasets. Quantifying the strengths and limitations of both self-reported and administrative data can improve epidemiological research, especially by guiding methods and interpretation of findings.

Mothers’ access to supportive hospital services after the loss of a baby through stillbirth or neonatal death

Directory of Open Access Journals (Sweden)

J Conry

2008-11-01

Full Text Available Every year, 3-5% of pregnant mothers in South Africa lose their babies to a stillbirth or neonatal death. These mothers need adequate services to prevent complications in their grieving process. Most of these babies are lost in hospital settings, so the treatment medical staff provide is vital. This study examined mothers’ experiences of accessing hospital, religious, formal and social services after a stillbirth or neonatal death. An exploratory research design was used to conduct applied research. A semi-structured interview schedule was used with a sample of 15 mothers who had lost a baby in the last 5 years. The findings were analysed quantitatively and qualitatively. The primary focus of this article is the quantitative findings relating to hospital services. The sample was small and these results cannot be generalised, but some conclusions are reached and recommendations are made to service providers in hospitals working with mothers who have lost babies. Mothers generally experienced the support services from hospitals as inadequate, compared to what hospitals could offer. Mothers that receive support after the loss of a baby generally cope better. This support thus assists them in the grieving process. Hospital staff can be trained to provide these services. Opsomming In Suid-Afrika verloor 3-5% swanger moeders hulle babas deur stilgeboorte of neonatale dood. Hierdie moeders benodig voldoende dienste om komplikasies in die rouproses te verhoed. Die behandeling deur mediese personeel is uiters belangrik omdat die meeste van dié babas in ‘n hospitaalopset sterf. Hierdie studie het moeders se ervarings van die toeganklikheid van hospitaal-, godsdienstige, formele en sosiale dienste na die dood van hulle babas deur stilgeboorte of neonatale dood ondersoek. Toegepaste navorsing is met behulp van ‘n verkennende navorsingsontwerp gedoen. ‘n Semi-gestruktureerde onderhoudskedule is gebruik met ‘n steekproef van 15 moeders wat hulle

Parents’ concerns about future pregnancy after stillbirth: a qualitative study

LENUS (Irish Health Repository)

Meaney, Sarah

2016-07-01

As stillbirth has a devastating impact, it is imperative to understand the importance of clinical and emotional care after stillbirth and how it influences subsequent pregnancies. The aim of the study was to gain insight into the consideration and planning of a subsequent pregnancy by parents in the weeks following stillbirth.

Ambient air pollution the risk of stillbirth: A prospective birth cohort study in Wuhan, China.

Science.gov (United States)

Yang, Shaoping; Tan, Yafei; Mei, Hui; Wang, Fang; Li, Na; Zhao, Jinzhu; Zhang, Yiming; Qian, Zhengmin; Chang, Jen Jen; Syberg, Kevin M; Peng, Anna; Mei, Hong; Zhang, Dan; Zhang, Yan; Xu, Shunqing; Li, Yuanyuan; Zheng, Tongzhang; Zhang, Bin

2018-04-01

, NO 2 and CO increases the risk of stillbirth and the most susceptible gestational period to ambient air pollution exposure was in the third trimester. Further toxicological and prospective cohort studies with improved exposure assessments are needed to confirm the causal link between air pollutants and stillbirth. Copyright © 2018 The Authors. Published by Elsevier GmbH.. All rights reserved.

Maternal region of birth and stillbirth in Victoria, Australia 2000-2011: A retrospective cohort study of Victorian perinatal data.

Science.gov (United States)

Davies-Tuck, Miranda L; Davey, Mary-Ann; Wallace, Euan M

2017-01-01

There is growing evidence from high-income countries that maternal country of birth is a risk factor for stillbirth. We aimed to examine the association between maternal region of birth and stillbirth between 2000 and 2011 inclusive in Victoria, Australia. Retrospective population based cohort study of all singleton births at 24 or more weeks gestational age from 2000-2011 in Victoria, Australia. Stillbirths due to termination of pregnancy, babies with congenital anomalies and Indigenous mothers were excluded. Main Outcome Measure: Stillbirth. Over the 12-year period there were 685,869 singleton births and 2299 stillbirths, giving an overall stillbirth rate of 3·4 per 1000 births. After adjustment for risk factors, compared to women born in Australia/New Zealand, women born in South Asia (aOR 1.27, 95% CI 1.01-1.53, p = 0.01), were more likely to have a stillbirth whereas women born in South East and East Asia were (aOR 0.60, (95% CI 0.49-0.72, pAsian compared to Australian/New Zealand born women. The following risk factors were also significantly associated with an increased odds of stillbirth in multivariate analyses: maternal age <20 and 35 years and more, nulliparity, low socio-economic status, previous stillbirth, no ultrasound reported in 1st trimester, pre-existing hypertension, antepartum haemorrhage and failure to detect growth restriction antenatally. Maternal region of birth is an independent risk factor for stillbirth. Improvements in the rate of stillbirth, particularly late pregnancy stillbirth, are likely to be gained in high-income settings where clinical care is informed by maternal region of birth.

Psycho-social impact of stillbirths on women and their families in Tamil Nadu, India - a qualitative study.

Science.gov (United States)

Gopichandran, Vijayaprasad; Subramaniam, Sudharshini; Kalsingh, Maria Jusler

2018-04-20

Stillbirth has serious psycho-social consequences on the parents and on the family. The psychological impact of stillbirth is strongly influenced by the social and cultural context. There is very scarce information on this from the Indian context. This qualitative study was conducted to understand the psycho-social impact, aggravating factors, coping styles and health system response to stillbirths. A qualitative study was conducted using in-depth interviews with mothers who experienced stillbirth in the past 1 year and their families. A total of 8 women and two health care providers were interviewed by trained interviewers. The interviews were transcribed into the local language and thematic analysis was performed by the researchers retaining the transcripts in the local language. Themes were identified, and a conceptual framework was developed. Women who experienced stillbirths suffered from serious forms of grief and guilt. These emotions were aggravated by the insensitive health system, health care providers, friends, and neighbours, as well as strained marital relationship and financial burdens. The women and their families were disturbed by the 'suddenness' of the stillbirth and frantically searched for the cause. They were frustrated when they couldn't find the cause and blamed various people in their lives. The women and their families perceived poor quality of services provided in the health system and reported that the health care providers were inconsiderate and insensitive. On the other hand, the health care providers reported that they were over-worked, and the health facilities were under-staffed. The community health workers reported that they felt caught in the crossfire between the health facility staff and the family who suffered the stillbirth. The women reported several coping mechanisms including isolation, immersion in work, placing maternal love on other children, the anticipation of next pregnancy and religiosity. Stillbirth is a major cause

Maternal smoking during pregnancy and risk of stillbirth

DEFF Research Database (Denmark)

Bjørnholt, Sarah M; Leite, Mimmi; Albieri, Vanna

2016-01-01

INTRODUCTION: Maternal smoking during pregnancy has been associated with an increased risk of stillbirth. Only a few studies have been conducted to determine whether smoking affects the risk of antepartum and intrapartum stillbirth differently or whether smoking cessation in early pregnancy reduc...

Advanced paternal age and stillbirth rate

DEFF Research Database (Denmark)

Urhøj, Stine Kjær; Andersen, Per Kragh; Mortensen, Laust Hvas

2017-01-01

Advanced paternal age has been associated with a variety of rare conditions and diseases of great public health impact. An increased number of de novo point mutations in sperm with increasing age have been suggested as a mechanism, which would likely also affect fetal viability. We examined...... the association between paternal age and stillbirth rate in a large nationwide cohort. We identified all pregnancies in Denmark from 1994 to 2010 carried to a gestational age of at least 22 completed weeks (n = 944,031) as registered in national registers and linked to individual register data about the parents....... The hazard ratio of stillbirth according to paternal age was estimated, adjusted for maternal age in 1-year categories, year of outcome, and additionally parental educational levels. The relative rate of stillbirth (n = 4946) according to paternal age was found to be J-shaped with the highest hazard ratio...

Social support: An approach to maintaining the health of women who have experienced stillbirth

OpenAIRE

Allahdadian, Maryam; Irajpour, Alireza; Kazemi, Ashraf; Kheirabadi, Gholamreza

2015-01-01

Background: Stillbirth is one of the deepest losses that can inflict a broad range of cognitive, mental, spiritual, and physical turmoil. Many researchers believe that the failure to provide the care required by health teams during the hard times is the main determinant of maternal mental health in the future. In other words, social support can significantly improve the mental health outcomes of mothers after stillbirth. This study aimed to explore social support to aid mothers in adaptation ...

Setting research priorities to improve global newborn health and prevent stillbirths by 2025

DEFF Research Database (Denmark)

Yoshida, Sachiyo; Martines, José; Lawn, Joy E

2016-01-01

for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities...... for 2013-2025. METHODS: We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated...... into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. RESULTS: Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program...

The provision of spiritual and pastoral care following stillbirth in Ireland: a mixed methods study.

Science.gov (United States)

Nuzum, Daniel; Meaney, Sarah; O'Donoghue, Keelin

2016-06-01

The death of a baby is recognised as one of the most difficult bereavements with life-long impact for parents. How bereaved parents are cared for influences their grief journey. Optimal holistic care is provided when the physical, emotional, spiritual and social needs of parents are attended to. This study reviewed how spiritual care is provided to bereaved parents following stillbirth in maternity units in Ireland and the impact of stillbirth on healthcare chaplains. This was a mixed methods study using semistructured qualitative interviews with hospital chaplains in Irish maternity units. Quantitative data about the provision of services to bereaved parents were collated from the interviews. Qualitative data were analysed thematically to identify key themes. 20 chaplains from 17 units participated in the study (85% of Irish maternity units). 12 chaplains (60%) are formally accredited chaplains; only one has received specialist training in perinatal bereavement care. 11 chaplains (55%) provide follow-up bereavement care. Seven chaplains (35%) did not feel part of the multidisciplinary team. The main themes that emerged were the impact of stillbirth, suffering and the challenge to faith creating inner conflict and doubt. The provision of spiritual care following stillbirth in Ireland is diverse. Spiritual care in this specialised area by chaplains who are not professionally trained and accredited potentially impacts quality and depth of care. Chaplains experience considerable impact and challenge to personal faith and belief as they provide care. Recommendations are made for ongoing education and greater support for chaplains. 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/

Prevalence and risk factors for stillbirths in a tertiary hospital in Niger ...

African Journals Online (AJOL)

work is properly cited. Prevalence and risk ... women. There were 309(53.1%) male stillbirths and 273(46.9%) female stillbirths. Male foetuses ... Key words: Stillbirth, miscarriage, perinatal mortality, anaemia in pregnancy, obstructed labour ...

Determinants of stillbirth among women deliveries at Amhara region, Ethiopia.

Science.gov (United States)

Lakew, Demeke; Tesfaye, Dereje; Mekonnen, Haile

2017-11-13

Stillbirth is one of general medical issues that could contribute significantly to creating nations like Ethiopia. This study aimed to determine the prevalence and related factors of stillbirth among deliveries at Amhara region, Ethiopia. The study used the Ethiopian Mini Demographic and Health Survey (EMDHS) data collected from 2555 eligible Amhara region women in 2014. Bi-variable and multi-variable binary logistic regression analysis was used. The prevalence of stillbirth outcomes became 85 per 1000 (total live birth). Besides, majority of women did not attend any formal education and had no antenatal care follow up. Women whose age at first birth below 18 years were 1859(72.8%) and the mean preceding birth interval were 33.6 months. Even women who attended primary and above education were about 50% and they were less likely to have had stillbirth outcomes than those who had no education (AOR: 0.505, 95% CI 0.311-0.820) and women having higher household wealth index were less likely to have had stillbirth outcomes as it is compared to the reference category. Moreover, women having preceding birth interval above 36 months were about 89% of less likely to end up stillbirth outcomes as compared to women having preceding birth interval below 24 months (AOR: 0.109, 95% CI 0.071-8.0.168). It could be inferred that a stillbirth result is one of the general medical issues in Amhara Region. Among different factors considered in this study, age, age at first birth, wealth index, birth order number and preceding birth interval in months were found to be significantly associated factors for stillbirth. Therefore, more awareness of early birth, widening birth interval, enhancing maternal care (for aged women) and early birth order number could be recommended.

Socioeconomic inequalities in stillbirth rates in Europe: measuring the gap using routine data from the Euro-Peristat Project.

Science.gov (United States)

Zeitlin, Jennifer; Mortensen, Laust; Prunet, Caroline; Macfarlane, Alison; Hindori-Mohangoo, Ashna D; Gissler, Mika; Szamotulska, Katarzyna; van der Pal, Karin; Bolumar, Francisco; Andersen, Anne-Marie Nybo; Ólafsdóttir, Helga Sól; Zhang, Wei-Hong; Blondel, Béatrice; Alexander, Sophie

2016-01-19

Previous studies have shown that socioeconomic position is inversely associated with stillbirth risk, but the impact on national rates in Europe is not known. We aimed to assess the magnitude of social inequalities in stillbirth rates in European countries using indicators generated from routine monitoring systems. Aggregated data on the number of stillbirths and live births for the year 2010 were collected for three socioeconomic indicators (mothers' educational level, mothers' and fathers' occupational group) from 29 European countries participating in the Euro-Peristat project. Educational categories were coded using the International Standard Classification of Education (ISCED) and analysed as: primary/lower secondary, upper secondary and postsecondary. Parents' occupations were grouped using International Standard Classification of Occupations (ISCO-08) major groups and then coded into 4 categories: No occupation or student, Skilled/ unskilled workers, Technicians/clerical/service occupations and Managers/professionals. We calculated risk ratios (RR) for stillbirth by each occupational group as well as the percentage population attributable risks using the most advantaged category as the reference (post-secondary education and professional/managerial occupations). Data on stillbirth rates by mothers' education were available in 19 countries and by mothers' and fathers' occupations in 13 countries. In countries with these data, the median RR of stillbirth for women with primary and lower secondary education compared to women with postsecondary education was 1.9 (interquartile range (IQR): 1.5 to 2.4) and 1.4 (IQR: 1.2 to 1.6), respectively. For mothers' occupations, the median RR comparing outcomes among manual workers with managers and professionals was 1.6 (IQR: 1.0-2.1) whereas for fathers' occupations, the median RR was 1.4 (IQR: 1.2-1.8). When applied to the entire set of countries with data about mothers' education, 1606 out of 6337 stillbirths (25�

Patterns of stillbirth and dystocia in Ontario cow-calf herds.

Science.gov (United States)

McDermott, J J; Allen, O B; Martin, S W; Alves, D M

1992-01-01

The association between a number of individual animal and herd level factors and calving problems in beef cows and heifers were examined. Data were from the 1987 calving season for a subset of 123 herds which maintained individual-animal records, from a sample of 180 randomly selected Ontario cow-calf herds. The median herd dystocia rate was 5.8% and 24.4% of herds had no dystocias. The median herd stillbirth rate was 2.8%, and 33.3% of herds had no stillbirths. Dystocias and stillbirths were much more common in heifers than in cows. Separate statistical models of dystocia and stillbirth for cows and heifers were created. Dystocia in cows was associated with calf sex, previous calving assistance and large breed type and birth weight. Variations in 1987 cow herd dystocia rates were associated with calving season, location and density, and the herd dystocia rate in 1986. Dystocia in heifers was associated with large breed type and calf birth weight. Herd-level management practices associated with increased heifer dystocia rates included breeding heifers to calve earlier than cows and rearing heifers together with the cow herd. Stillbirths for both cows and heifers were associated with calving assistance, particularly hard assistance. Herd-level management and other factors were unassociated with stillbirths. PMID:1586893

Stillbirth Rate in a Teaching Hospital in South‑Eastern Nigeria: A ...

African Journals Online (AJOL)

Intrauterine fetal death or stillbirth is variously defined in different countries, by gestation or birth weight. The varieties of definitions make comparisons of stillbirth rates difficult. In the United Kingdom (UK), a stillbirth is defined as the delivery of a baby with no signs of life after 24 weeks of pregnancy.[1] However, the World ...

Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control study.

Directory of Open Access Journals (Sweden)

Lesley M E McCowan

Full Text Available Our objective was to test the primary hypothesis that maternal non-left, in particular supine going-to-sleep position, would be a risk factor for late stillbirth (≥28 weeks of gestation.A multicentre case-control study was conducted in seven New Zealand health regions, between February 2012 and December 2015. Cases (n = 164 were women with singleton pregnancies and late stillbirth, without congenital abnormality. Controls (n = 569 were women with on-going singleton pregnancies, randomly selected and frequency matched for health region and gestation. The primary outcome was adjusted odds of late stillbirth associated with self-reported going-to-sleep position, on the last night. The last night was the night before the late stillbirth was thought to have occurred or the night before interview for controls. Going-to-sleep position on the last night was categorised as: supine, left-side, right-side, propped or restless. Multivariable logistic regression adjusted for known confounders.Supine going-to-sleep position on the last night was associated with increased late stillbirth risk (adjusted odds ratios (aOR 3.67, 95% confidence interval (CI 1.74 to 7.78 with a population attributable risk of 9.4%. Other independent risk factors for late stillbirth (aOR, 95% CI were: BMI (1.04, 1.01 to 1.08 per unit, maternal age ≥40 (2.88, 1.31 to 6.32, birthweight <10th customised centile (2.76, 1.59 to 4.80, and <6 hours sleep on the last night (1.81, 1.14 to 2.88. The risk associated with supine-going-to-sleep position was greater for term (aOR 10.26, 3.00 to 35.04 than preterm stillbirths (aOR 3.12, 0.97 to 10.05.Supine going-to-sleep position is associated with a 3.7 fold increase in overall late stillbirth risk, independent of other common risk factors. A public health campaign encouraging women not to go-to-sleep supine in the third trimester has potential to reduce late stillbirth by approximately 9%.

Stillbirth and Infant Mortality

DEFF Research Database (Denmark)

Nøhr, Ellen Aagaard

2012-01-01

mechanisms behind these associations remain largely unknown. Although maternal obesity is associated with a wide range of complications in the mother and neonate that may impair fetal and infant survival, the increased risk of stillbirth and infant mortality is virtually unchanged when accounting...

Exposure to pistachio pesticides and stillbirth: a case-control study.

Science.gov (United States)

Razi, Saeid; Rezaeian, Mohsen; Dehkordi, Fatemeh Ghani; Manshoori, Azita; Goujani, Reza; Vazirinejad, Reza

2016-01-01

Stillbirth is an undesirable outcome of pregnancy. In light of the increasing use of pesticides and growing concerns about the possible health effects of agricultural pesticides, we investigated the effect of exposure to pistachio pesticides on stillbirth in pregnant mothers. This case-control study was conducted in Rafsanjan, Iran from 2011 to 2012. A total of 125 females who had a recent stillbirth were included as the case group, and 250 controls were selected from females who had a recent live birth. For each case, two controls with the nearest propensity score to the case were selected. Data were collected using a protocol developed by the researcher that involved interviewing respondents and reviewing their medical records. Conditional multivariate and univariate logistic regression analysis were performed and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The ORs of stillbirth in mothers living in pistachio gardens and those who were exposed to sprayed pesticides, in comparison to the controls, were 14.1 (95% CI, 3.3 to 63.4) and 5.0 (95% CI, 1.2 to 28.6), respectively. No significant differences were found in stillbirth rates according to the distance between the mother's residence and a pistachio garden or involvement in agricultural activities. The results of our study showed that exposure to pistachio pesticides during pregnancy may increase the likelihood of stillbirth in mothers.

Stillbirth and stigma: the spoiling and repair of multiple social identities.

Science.gov (United States)

Brierley-Jones, Lyn; Crawley, Rosalind; Lomax, Samantha; Ayers, Susan

This study investigated mothers' experiences surrounding stillbirth in the United Kingdom, their memory making and sharing opportunities, and the effect these opportunities had on them. Qualitative data were generated from free text responses to open-ended questions. Thematic content analysis revealed that "stigma" was experienced by most women and Goffman's (1963) work on stigma was subsequently used as an analytical framework. Results suggest that stillbirth can spoil the identities of "patient," "mother," and "full citizen." Stigma was reported as arising from interactions with professionals, family, friends, work colleagues, and even casual acquaintances. Stillbirth produces common learning experiences often requiring "identity work" (Murphy, 2012). Memory making and sharing may be important in this work and further research is needed. Stigma can reduce the memory sharing opportunities for women after stillbirth and this may explain some of the differential mental health effects of memory making after stillbirth that is documented in the literature.

Prevalence and risk factors for stillbirths in a tertiary hospital in Niger ...

African Journals Online (AJOL)

Background: Stillbirth is a silent but major cause of perinatal mortality and source of foetal wastage. Aim: To determine the prevalence of stillbirth, demographic characteristics and identify the possible risk factors in our Hospital. Methods: This was a ten year cross-sectional retrospective study of stillbirths between 1st ...

Posttraumatic Stress Disorder Following Stillbirth: Trauma Characteristics, Locus of Control, Posttraumatic Cognitions.

Science.gov (United States)

Chung, Man Cheung; Reed, Jacqueline

2017-06-01

This study examined the incidence of PTSD and psychiatric co-morbidity among women who experienced stillbirth and investigated the relationship between locus of control, trauma characteristics of stillbirth, posttraumatic cognitions, PTSD and co-morbid psychiatric symptoms following stillbirth. Fifty women recorded information on stillbirth experiences, and completed the Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28, Edinburgh Post-natal Depression Scale, Rotter's Locus of Control Scale and the Posttraumatic Cognitions Inventory. 60, 28 and 12 % met the diagnostic criteria for probable full-PTSD, partial and no-PTSD respectively. Sixty-two percent and 54 % scored at or above the cutoff of the General Health Questionnaire-28 and postnatal depression respectively. Women who experienced stillbirth reported significantly more psychiatric co-morbid and post-natal depressive symptoms than the comparison group. Both groups were similar in locus of control. Women who experienced stillbirth reported negative cognitions about the self the most. After adjusting for postnatal depression, trauma characteristics were significantly correlated with Posttraumatic cognitions which, in turn, were significantly correlated with PTSD and psychiatric co-morbidity. Locus of control was not significantly correlated with psychological outcomes. Mediational analyses showed that negative cognitions about self mediated the relationship between trauma characteristics and psychiatric co-morbidity only. Women reported a high incidence of probable PTSD and co-morbid psychiatric symptoms following stillbirth. Stillbirth trauma characteristics influenced how they negatively perceived themselves. This then specifically influenced general psychological problems rather than PTSD symptoms.

Fetal growth and risk of stillbirth: a population-based case-control study.

Science.gov (United States)

Bukowski, Radek; Hansen, Nellie I; Willinger, Marian; Reddy, Uma M; Parker, Corette B; Pinar, Halit; Silver, Robert M; Dudley, Donald J; Stoll, Barbara J; Saade, George R; Koch, Matthew A; Rowland Hogue, Carol J; Varner, Michael W; Conway, Deborah L; Coustan, Donald; Goldenberg, Robert L

2014-04-01

Stillbirth is strongly related to impaired fetal growth. However, the relationship between fetal growth and stillbirth is difficult to determine because of uncertainty in the timing of death and confounding characteristics affecting normal fetal growth. We conducted a population-based case-control study of all stillbirths and a representative sample of live births in 59 hospitals in five geographic areas in the US. Fetal growth abnormalities were categorized as small for gestational age (SGA) (90th percentile) at death (stillbirth) or delivery (live birth) using population, ultrasound, and individualized norms. Gestational age at death was determined using an algorithm that considered the time-of-death interval, postmortem examination, and reliability of the gestational age estimate. Data were weighted to account for the sampling design and differential participation rates in various subgroups. Among 527 singleton stillbirths and 1,821 singleton live births studied, stillbirth was associated with SGA based on population, ultrasound, and individualized norms (odds ratio [OR] [95% CI]: 3.0 [2.2 to 4.0]; 4.7 [3.7 to 5.9]; 4.6 [3.6 to 5.9], respectively). LGA was also associated with increased risk of stillbirth using ultrasound and individualized norms (OR [95% CI]: 3.5 [2.4 to 5.0]; 2.3 [1.7 to 3.1], respectively), but not population norms (OR [95% CI]: 0.6 [0.4 to 1.0]). The associations were stronger with more severe SGA and LGA (95th percentile). Analyses adjusted for stillbirth risk factors, subset analyses excluding potential confounders, and analyses in preterm and term pregnancies showed similar patterns of association. In this study 70% of cases and 63% of controls agreed to participate. Analysis weights accounted for differences between consenting and non-consenting women. Some of the characteristics used for individualized fetal growth estimates were missing and were replaced with reference values. However, a sensitivity analysis using individualized norms

Auditing stillbirths at Lower Umfolozi War Memorial Regional Hospital

African Journals Online (AJOL)

Background. Although the total number of stillbirths worldwide was estimated at 2.6 million in 2009, there is currently a dearth of literature on stillbirths in developing countries and rural settings, where the majority of such births occur. The 'Hands Up' Mortality and Morbidity Extraction Tool (HUMMET), developed at Lower ...

Caesarean delivery and subsequent stillbirth or miscarriage: systematic review and meta-analysis.

Directory of Open Access Journals (Sweden)

Sinéad M O'Neill

Full Text Available OBJECTIVE: To compare the risk of stillbirth and miscarriage in a subsequent pregnancy in women with a previous caesarean or vaginal delivery. DESIGN: Systematic review of the published literature including seven databases: CINAHL; the Cochrane library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge from 1945 until November 11(th 2011, using a detailed search-strategy and cross-checking of reference lists. STUDY SELECTION: Cohort, case-control and cross-sectional studies examining the association between previous caesarean section and subsequent stillbirth or miscarriage risk. Two assessors screened titles to identify eligible studies, using a standardised data abstraction form and assessed study quality. DATA SYNTHESIS: 11 articles were included for stillbirth, totalling 1,961,829 pregnancies and 7,308 events. Eight eligible articles were included for miscarriage, totalling 147,017 pregnancies and 12,682 events. Pooled estimates across the stillbirth studies were obtained using random-effect models. Among women with a previous caesarean an increase in odds of 1.23 [95% CI 1.08, 1.40] for stillbirth was yielded. Subgroup analyses including unexplained stillbirths yielded an OR of 1.47 [95% CI 1.20, 1.80], an OR of 2.11 [95% CI 1.16, 3.84] for explained stillbirths and an OR of 1.27 [95% CI 0.95, 1.70] for antepartum stillbirths. Only one study reported adjusted estimates in the miscarriage review, therefore results are presented individually. CONCLUSIONS: Given the recent revision of the National Institute for Health and Clinical Excellence guidelines (NICE, providing women the right to request a caesarean, it is essential to establish whether mode of delivery has an association with subsequent risk of stillbirth or miscarriage. Overall, compared to vaginal delivery, the pooled estimates suggest that caesarean delivery may increase the risk of stillbirth by 23%. Results for the miscarriage review were inconsistent and lack of adjustment

Risk factors for stillbirth and dystocia in Japanese Black cattle.

Science.gov (United States)

Uematsu, Mizuho; Sasaki, Yosuke; Kitahara, Go; Sameshima, Hiroshi; Osawa, Takeshi

2013-10-01

Stillbirth and dystocia are major factors reducing the productivity of beef cattle. The objective of this study was to determine the effect of season, parity and gestation length on the rates of stillbirth and dystocia in Japanese Black cattle. Calving records were obtained from 905 farms in Miyazaki Prefecture, Japan. Data were collected from 41,116 calvings in 15,378 (14.42% primiparous). There were 1013 stillbirths (2.46%) and 3514 dystocias (8.55%). The stillbirth rate in winter (December to February) (3.18%) was higher (odds ratio (OR) [95% confidence interval]: 1.008 [1.004-1.012]) than that in summer (June to August). Similarly, the dystocia rates in winter (OR: 1.011 [1.004-1.019]) and spring (March to May) (OR: 1.020 [1.013-1.027]) were significantly higher than in summer. For primiparous cows, the rates of stillbirth (OR: 1.010 [1.004-1.015]) and dystocia (OR: 1.053 [1.042-1.064]) were higher than in cows with fifth parity (reference parity). Stillbirth rates were higher in cows at ≥ 301 days of pregnancy (OR: 1.049 [1.035-1.062]) and those at ≤ 270 days of pregnancy (OR: 2.072 [2.044-2.101]) than those at between 281 and 290 days of pregnancy. Likewise, dystocia rates were higher in cows at ≥ 301 days of pregnancy (OR: 1.033 [1.008-1.059]) and those at ≤ 270 days of pregnancy (OR: 1.124 [1.095-1.154]) than those at between 281 and 290 days of pregnancy. Winter, primiparity, and long and short gestation lengths were risk factors for stillbirth and dystocia in this cohort of Japanese Black cattle. Copyright © 2013 Elsevier Ltd. All rights reserved.

Exposure to pistachio pesticides and stillbirth: a case-control study

Directory of Open Access Journals (Sweden)

Saeid Razi

2016-04-01

Full Text Available OBJECTIVES Stillbirth is an undesirable outcome of pregnancy. In light of the increasing use of pesticides and growing concerns about the possible health effects of agricultural pesticides, we investigated the effect of exposure to pistachio pesticides on stillbirth in pregnant mothers. METHODS This case-control study was conducted in Rafsanjan, Iran from 2011 to 2012. A total of 125 females who had a recent stillbirth were included as the case group, and 250 controls were selected from females who had a recent live birth. For each case, two controls with the nearest propensity score to the case were selected. Data were collected using a protocol developed by the researcher that involved interviewing respondents and reviewing their medical records. Conditional multivariate and univariate logistic regression analysis were performed and odds ratios (ORs and 95% confidence intervals (CIs were calculated. RESULTS The ORs of stillbirth in mothers living in pistachio gardens and those who were exposed to sprayed pesticides, in comparison to the controls, were 14.1 (95% CI, 3.3 to 63.4 and 5.0 (95% CI, 1.2 to 28.6, respectively. No significant differences were found in stillbirth rates according to the distance between the mother’s residence and a pistachio garden or involvement in agricultural activities. CONCLUSIONS The results of our study showed that exposure to pistachio pesticides during pregnancy may increase the likelihood of stillbirth in mothers.

Cause-specific stillbirth and exposure to chemical constituents and sources of fine particulate matter.

Science.gov (United States)

Ebisu, Keita; Malig, Brian; Hasheminassab, Sina; Sioutas, Constantinos; Basu, Rupa

2018-01-01

The stillbirth rate in the United States is relatively high, but limited evidence is available linking stillbirth with fine particulate matter (PM 2.5 ), its chemical constituents and sources. In this study, we explored associations between cause-specific stillbirth and prenatal exposures to those pollutants with using live birth and stillbirth records from eight California locations during 2002-2009. ICD-10 codes were used to identify cause of stillbirth from stillbirth records. PM 2.5 total mass and chemical constituents were collected from ambient monitors and PM 2.5 sources were quantified using Positive Matrix Factorization. Conditional logistic regression was applied using a nested case-control study design (N = 32,262). We found that different causes of stillbirth were associated with different PM 2.5 sources and/or chemical constituents. For stillbirths due to fetal growth, the odds ratio (OR) per interquartile range increase in gestational age-adjusted exposure to PM 2.5 total mass was 1.23 (95% confidence interval (CI): 1.06, 1.44). Similar associations were found with resuspended soil (OR=1.25, 95% CI: 1.10, 1.42), and secondary ammonium sulfate (OR=1.45, 95% CI: 1.18, 1.78). No associations were found between any pollutants and stillbirths caused by maternal complications. This study highlighted the importance of investigating cause-specific stillbirth and the differential toxicity levels of specific PM 2.5 sources and chemical constituents. Copyright © 2017 Elsevier Inc. All rights reserved.

A comparison of the risk of stillbirth associated with paternal pre-conception irradiation in the Sellafield workforce with that of stillbirth and untoward pregnancy outcome among Japanese atomic bomb survivors

International Nuclear Information System (INIS)

Little, M.P.

1999-01-01

A comparison is made of the relative risks associated with paternal pre-conception irradiation of stillbirth and untoward pregnancy outcome (stillbirths, congenital malformations, neonatal deaths) in the offspring of the Japanese atomic bomb survivors and of stillbirth in the offspring of Sellafield workers. It is concluded that the pre-conception exposure risks of stillbirth in the offspring of Sellafield workers are statistically incompatible with the Japanese data at the 5% level. Other human and experimental data relating to the induction of congenital abnormalities are briefly reviewed. (author)

Parents' concerns about future pregnancy after stillbirth: a qualitative study.

Science.gov (United States)

Meaney, Sarah; Everard, Claire M; Gallagher, Stephen; O'Donoghue, Keelin

2017-08-01

As stillbirth has a devastating impact, it is imperative to understand the importance of clinical and emotional care after stillbirth and how it influences subsequent pregnancies. The aim of the study was to gain insight into the consideration and planning of a subsequent pregnancy by parents in the weeks following stillbirth. A qualitative semi-structured interview format was utilized. Interpretative phenomenological analysis was employed as the analytic strategy. The recruitment strategy focused on couples whereby the parents of ten stillborn babies were contacted; however, five men declined to participate in the study. The final sample of 15 parents were all Irish: ten of whom were female and five of whom were male. Findings revealed two superordinate themes relating to a subsequent pregnancy after stillbirth: aspirations for future pregnancy and expectations of future care. Parents disclosed how the prospect of a subsequent pregnancy was daunting with fears about the potential loss of another child. Despite these fears, parents' aspirations differed in the days following stillbirth; mothers wished to plan a future pregnancy while fathers were reluctant to consider any pregnancies. Parents were unsure of what to expect in terms of the level of care that would be provided to them in a subsequent pregnancy. Additional appointments at the maternity hospital were considered crucial to provide reassurance during a subsequent pregnancy. These findings underscore the far-reaching and contrasting effects of stillbirth on parents. These complex needs highlight the importance of the multidisciplinary team approach. © 2016 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Stillbirth With Group B Streptococcus Disease Worldwide: Systematic Review and Meta-analyses.

Science.gov (United States)

Seale, Anna C; Blencowe, Hannah; Bianchi-Jassir, Fiorella; Embleton, Nicholas; Bassat, Quique; Ordi, Jaume; Menéndez, Clara; Cutland, Clare; Briner, Carmen; Berkley, James A; Lawn, Joy E; Baker, Carol J; Bartlett, Linda; Gravett, Michael G; Heath, Paul T; Ip, Margaret; Le Doare, Kirsty; Rubens, Craig E; Saha, Samir K; Schrag, Stephanie; Meulen, Ajoke Sobanjo-Ter; Vekemans, Johan; Madhi, Shabir A

2017-11-06

There are an estimated 2.6 million stillbirths each year, many of which are due to infections, especially in low- and middle-income contexts. This paper, the eighth in a series on the burden of group B streptococcal (GBS) disease, aims to estimate the percentage of stillbirths associated with GBS disease. We conducted systematic literature reviews (PubMed/Medline, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde, World Health Organization Library Information System, and Scopus) and sought unpublished data from investigator groups. Studies were included if they reported original data on stillbirths (predominantly ≥28 weeks' gestation or ≥1000 g, with GBS isolated from a sterile site) as a percentage of total stillbirths. We did meta-analyses to derive pooled estimates of the percentage of GBS-associated stillbirths, regionally and worldwide for recent datasets. We included 14 studies from any period, 5 with recent data (after 2000). There were no data from Asia. We estimated that 1% (95% confidence interval [CI], 0-2%) of all stillbirths in developed countries and 4% (95% CI, 2%-6%) in Africa were associated with GBS. GBS is likely an important cause of stillbirth, especially in Africa. However, data are limited in terms of geographic spread, with no data from Asia, and cases worldwide are probably underestimated due to incomplete case ascertainment. More data, using standardized, systematic methods, are critical, particularly from low- and middle-income contexts where the highest burden of stillbirths occurs. These data are essential to inform interventions, such as maternal GBS vaccination. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Challenges and Priorities for Surveillance of Stillbirths: A Report on Two Workshops

OpenAIRE

Duke, C. Wes; Correa, Adolfo; Romitti, Paul A.; Martin, Joyce; Kirby, Russell S.

2009-01-01

Stillbirths, those with and without birth defects, are an important public health topic. The National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention conducted two workshops during April and July 2005. Both workshops explored the challenges of conducting surveillance of stillbirths. Workshop participants considered an approach that added the surveillance of stillbirths, those with and without birth defects, as part of existing populatio...

Utility of newborn screening cards for detecting CMV infection in cases of stillbirth.

Science.gov (United States)

Howard, Jonathan; Hall, Beverley; Brennan, Lyndall Eve; Arbuckle, Susan; Craig, Maria E; Graf, Nicole; Rawlinson, William

2009-03-01

CMV infection may cause intrauterine deaths including stillbirths (intrauterine deaths at > or =20 weeks gestation). In 2005, there were 1979 stillbirths in Australia, which is almost double the number of deaths reported for all children between 1 and 14 years age. We evaluated the diagnostic utility of testing for the presence of CMV in newborn blood screening cards (NBSC) collected from stillborn babies, who had no known cause of death after post-mortem. Blood taken at post-mortem by cardiac puncture of 107 stillborn babies between July 2005 and December 2006, was spotted onto NBSC. CMV infection was detected using nested PCR targeting the glycoprotein gene, gp58. Of the 107 stillborn infants, 10 (9%) were CMV positive. The rate of CMV infection did not differ between early stillbirths (8%) and late stillbirths (9%). The use of NBSC is a convenient and accurate method for CMV detection in stillbirths. It is easily collected, less laborious than viral culture, diagnostically useful and could be applied for epidemiological and retrospective investigation of the virus in the stillbirth population.

Global report on preterm birth and stillbirth (4 of 7): delivery of interventions.

Science.gov (United States)

Victora, Cesar G; Rubens, Craig E

2010-02-23

The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies. Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment. Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention. Equitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and

The endocrine disruptors among the environmental risk factors for stillbirth

International Nuclear Information System (INIS)

Roncati, Luca; Piscioli, Francesco; Pusiol, Teresa

2016-01-01

Persistent organic pollutants have been lately taken into consideration for their adverse effects, as possible stillbirth contributors; stillbirth can be in fact considered the most dramatic pregnancy complication. Congenital abnormalities account for few stillbirths and many related disorders are potentially modifiable or often coexist, such as maternal infections, non-communicable diseases, lifestyle factors and maternal age. Causal pathways for stillbirth frequently involve impaired placental function, either with fetal growth restriction or preterm labour. For this reason, many current efforts are focusing on the study of endocrine disruptor (ED) placental transfer, to better understand the in utero exposure dynamics. In this regard, our research group has investigated, by gas chromatography–mass spectrometry, the EDs presence in brain samples of 24 stillbirths, collected over a 3-year period (2012–2014), coming from the Northeast Italy, a notorious area devoted to apple cultivation. Surprisingly, organochlorine pesticides (OCPs), well-known EDs, have been detected in 11 samples. Apart from the noteworthy evidence of pesticides' bio-persistence, this finding implies a redefinition of the placental barrier concept: not a real safety system, but a time-deferral mechanism of absorption. The term ‘placental barrier’ in fact refers to a 4-membrane structure, made up by two epithelial layers, which exactly lining the chorionic villi, and by two endothelial layers, belonging to the feeding vessels for the fetus. It is an effective barrier only for a low administration of water-soluble substances, which encounter obstacle to cross four instead of two membranes. High doses of water-soluble compounds can reach appreciable concentration in the fetal blood, and the lipid-soluble chemicals, such as EDs, are able to pass the placental barrier, through a simple mechanism of passive diffusion, even in minimal concentrations. After crossing the placental barrier, it is

The endocrine disruptors among the environmental risk factors for stillbirth

Energy Technology Data Exchange (ETDEWEB)

Roncati, Luca, E-mail: emailmedical@gmail.com [Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, Rovereto, TN (Italy); Department of Diagnostic and Clinical Medicine and of Public Health, University of Modena and Reggio Emilia, Modena, MO (Italy); Piscioli, Francesco; Pusiol, Teresa [Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, Rovereto, TN (Italy)

2016-09-01

Persistent organic pollutants have been lately taken into consideration for their adverse effects, as possible stillbirth contributors; stillbirth can be in fact considered the most dramatic pregnancy complication. Congenital abnormalities account for few stillbirths and many related disorders are potentially modifiable or often coexist, such as maternal infections, non-communicable diseases, lifestyle factors and maternal age. Causal pathways for stillbirth frequently involve impaired placental function, either with fetal growth restriction or preterm labour. For this reason, many current efforts are focusing on the study of endocrine disruptor (ED) placental transfer, to better understand the in utero exposure dynamics. In this regard, our research group has investigated, by gas chromatography–mass spectrometry, the EDs presence in brain samples of 24 stillbirths, collected over a 3-year period (2012–2014), coming from the Northeast Italy, a notorious area devoted to apple cultivation. Surprisingly, organochlorine pesticides (OCPs), well-known EDs, have been detected in 11 samples. Apart from the noteworthy evidence of pesticides' bio-persistence, this finding implies a redefinition of the placental barrier concept: not a real safety system, but a time-deferral mechanism of absorption. The term ‘placental barrier’ in fact refers to a 4-membrane structure, made up by two epithelial layers, which exactly lining the chorionic villi, and by two endothelial layers, belonging to the feeding vessels for the fetus. It is an effective barrier only for a low administration of water-soluble substances, which encounter obstacle to cross four instead of two membranes. High doses of water-soluble compounds can reach appreciable concentration in the fetal blood, and the lipid-soluble chemicals, such as EDs, are able to pass the placental barrier, through a simple mechanism of passive diffusion, even in minimal concentrations. After crossing the placental barrier

Auditing stillbirths at Lower Umfolozi War Memorial Regional Hospital: A 12-month review.

Science.gov (United States)

Govender, I

2017-11-27

Although the total number of stillbirths worldwide was estimated at 2.6 million in 2009, there is currently a dearth of literature on stillbirths in developing countries and rural settings, where the majority of such births occur. The 'Hands Up' Mortality and Morbidity Extraction Tool (HUMMET), developed at Lower Umfolozi War Memorial Regional Hospital (LUWMRH) in 2010, outlines a systematic approach to summarising individual cases of adverse perinatal outcomes. To depict the HUMMET form by describing the detailed demographic and obstetric profile of patients who delivered a stillborn infant at LUWMRH, as well as risk factors associated with these stillbirths between 1 April 2014 and 31 March 2015. The findings add to a global initiative advanced by the Lancet series on stillbirths, aimed at raising awareness of stillbirth statistics in low- and middle-income countries. A total of 310 detailed stillbirth case summaries of 305 patients were collected during the study period, representing 90% of the total number of stillborn infants delivered at LUWMRH. A retrospective audit of the HUMMET forms was conducted and the cases were further summarised in a Microsoft Excel spreadsheet that allowed for a univariate analysis of the variables. The stillbirth rate at LUWMRH is much higher than that at other regional hospitals owing to the number of at-risk referrals and emergency cases from surrounding clinics and district hospitals. Referrals were from local clinics (49%) and district hospitals (45%), 35% of stillbirths were due to abruptio placentae and a large proportion were associated with gestational hypertension, pre-eclampsia and/or eclampsia. Avoidable factors were predominantly a late patient response to reduced fetal movements and delays in transfer to hospital. Twenty percent of stillbirths were associated with inappropriate monitoring or management of the obstetric condition at the district hospital. The HUMMET form provides a systematic approach to analysing cases

Prevalence and risk factors for stillbirths in Holstein cows in a hot environment

Directory of Open Access Journals (Sweden)

Miguel Mellado

2017-07-01

Full Text Available Risk factors for stillbirth were studied in a dairy operation in northern Mexico (25°N. Data set consisted of 29406 full term calving records. Factors affecting stillbirths were analyzed using a step-wise multivariable logistic regression models. The predictive indicators of stillbirth risk were: temperature-humidity index (THI during pregnancy and at calving, season of calving, calf birth weight, gestation length, semen characteristics (conventional or sexed, gender of calves, hour of calving and type of parturition (normal or dystocic. Throughout the study period, 7.3 (95%, confidence interval= 7.0–7.6 of every 100 calving events had a stillborn calf. Stillborns were higher with severe dystocia compared with non-assisted births (29.0% vs. 6.2%, p278 d compared with calves with shorter gestation periods (2.8% vs. 30.0%, p83 units had 1.3 higher risk of stillbirths than cows suffering reduced heat stress (p<0.0001. Evidence for a greater (p<0.001 stillbirth rates in cows with parturitions between 18:00 and 19:00 h compared with cows calving during other hours of the day was found (9.1% vs. 7.1%. Together, these results demonstrate that ameliorating heat stress during the peripartum period is an important management practice to reduce stillbirths in Holstein cows in this warm climate. Additionally, a greater attention of parturition around sunset can lower the current stillbirth rates.

Sex of prior children and risk of stillbirth in subsequent pregnancies

DEFF Research Database (Denmark)

Nielsen, Henriette Svarre; Mortensen, Laust Hvas; Nygaard, Ulrikka

2010-01-01

(singleton) between 1980 and 1998 (n = 499,731) using the Danish Birth Registry. These women had subsequent singleton births through 2004 (n = 558,314). We assessed the risk of stillbirth conditional on sex of prior children. RESULTS: The risk of stillbirth was increased by 12% after deliver of boys compared...

Prevalence and risk factors for stillbirths in Holstein cows in a hot environment

OpenAIRE

Miguel Mellado; María I. Chávez; Ulises Macías-Cruz; Leonel Avendaño-Reyes; Evaristo Carrillo; José E. García

2017-01-01

Risk factors for stillbirth were studied in a dairy operation in northern Mexico (25°N). Data set consisted of 29406 full term calving records. Factors affecting stillbirths were analyzed using a step-wise multivariable logistic regression models. The predictive indicators of stillbirth risk were: temperature-humidity index (THI) during pregnancy and at calving, season of calving, calf birth weight, gestation length, semen characteristics (conventional or sexed), gender of calves, hour of cal...

From grief, guilt pain and stigma to hope and pride - a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth.

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Burden, Christy; Bradley, Stephanie; Storey, Claire; Ellis, Alison; Heazell, Alexander E P; Downe, Soo; Cacciatore, Joanne; Siassakos, Dimitrios

2016-01-19

Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been systematically analysed or understood before now across the world. Our study aimed to systematically review, evaluate and summarise the current evidence regarding the psychosocial impact of stillbirth to parents and their families, with the aim of improving guidance in bereavement care worldwide. Systematic review and meta-summary (quantitative aggregation of qualitative findings) of quantitative, qualitative, and mixed-methods studies. All languages and countries were included. Two thousand, six hundred and nineteen abstracts were identified; 144 studies were included. Frequency effect sizes (FES %) were calculated for each theme, as a measure of their prevalence in the literature. Themes ranged from negative psychological symptoms post bereavement (77 · 1) and in subsequent pregnancies (27 · 1), to disenfranchised grief (31 · 2), and incongruent grief (28 · 5), There was also impact on siblings (23 · 6) and on the wider family (2 · 8). They included mixed-feelings about decisions made when the baby died (12 · 5), avoidance of memories (13 · 2), anxiety over other children (7 · 6), chronic pain and fatigue (6 · 9), and a different approach to the use of healthcare services (6 · 9). Some themes were particularly prominent in studies of fathers; grief suppression (avoidance)(18 · 1), employment difficulties, financial debt (5 · 6), and increased substance use (4 · 2). Others found in studies specific to mothers included altered body image (3 · 5) and impact on quality of life (2 · 1). Counter-intuitively, Some themes had mixed connotations. These included parental pride in the baby (5 · 6), motivation for engagement in healthcare

Stillbirths: What Can Be Done To Confront An Invisible Public Health Problem In Pakistan?

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Shaikh, Babar Tasneem; Hafeez, Assad; Hamid, Saima

2017-01-01

Pakistan has been ranked highest and appears worst in stillbirths' rate according to the recent global estimates. Reasons could be manifold; socio-cultural, health system related country specific, and some of these of course déjà vu, i.e., the biomedical causes. Yet, a fresh stocktaking is necessary to understand the complex phenomenon in a country, awfully affected by this menace. Maternal, neonatal and child health program needs to be informed and geared up toward addressing the actual reasons behind this heavy toll of stillbirths in Pakistan. Maternal health indicators would never be improved, if the issue of stillbirths is not stalled at the earliest. Besides known medical reasons, this account attempts to document the health systems related factors, and more so the social determinants behind the whole scenario, so that appropriate and customized interventions could be suggested, developed and implemented. This paper will be a piece of evidence for policy corridors, program managers, development partners, non-governmental organizations, public health institutions, students, and researchers to enhance their understanding of a major public health problem, and to recognize the strengths and opportunities in the health system of Pakistan to cope with this challenge.

Stillbirth evaluation: a stepwise assessment of placental pathology and autopsy.

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Miller, Emily S; Minturn, Lucy; Linn, Rebecca; Weese-Mayer, Debra E; Ernst, Linda M

2016-01-01

The American Congress of Obstetricians and Gynecologists places special emphasis on autopsy as one of the most important tests for evaluation of stillbirth. Despite a recommendation of an autopsy, many families will decline the autopsy based on religious/cultural beliefs, fear of additional suffering for the child, or belief that no additional information will be obtained or of value. Further, many obstetric providers express a myriad of barriers limiting their recommendation for a perinatal autopsy despite their understanding of its value. Consequently, perinatal autopsy rates have been declining. Without the information provided by an autopsy, many women are left with unanswered questions regarding cause of death for their fetus and without clear management strategies to reduce the risk of stillbirth in future pregnancies. To avoid this scenario, it is imperative that clinicians are knowledgeable about the benefit of autopsy so they can provide clear information on its diagnostic utility and decrease potential barriers; in so doing the obstetrician can ensure that each family has the necessary information to make an informed decision. We sought to quantify the contribution of placental pathologic examination and autopsy in identifying a cause of stillbirth and to identify how often clinical management is modified due to each result. This is a cohort study of all cases of stillbirth from 2009 through 2013 at a single tertiary care center. Records were reviewed in a stepwise manner: first the clinical history and laboratory results, then the placental pathologic evaluation, and finally the autopsy. At each step, a cause of death and the certainty of that etiology were coded. Clinical changes that would be recommended by information available at each step were also recorded. Among the 144 cases of stillbirth examined, 104 (72%) underwent autopsy and these cases constitute the cohort of study. The clinical and laboratory information alone identified a cause of death

The association between gestational weight gain and risk of stillbirth: a population-based cohort study.

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Yao, Ruofan; Park, Bo Y; Foster, Sarah E; Caughey, Aaron B

2017-10-01

To estimate the risk of stillbirth associated with excessive and inadequate weight gain during pregnancy. Retrospective cohort study using the Texas vital records database between 2006 and 2011, with 2,230,310 births (5502 stillbirths) was included for analysis. Pregnancies were categorized as adequate weight gain, excessive weight gain, inadequate weight gain, or weight loss based on the Institute of Medicine 2009 recommendations. Hazard ratios (HRs) for stillbirth were estimated for each gestational weight-gain stratum using adequate weight gain as the comparison group. The analysis was performed separately for each body mass index (BMI) class. Both inadequate weight gain and weight loss were associated with an increased risk of stillbirth for all BMI classes except the morbidly obese group. Highest risk was seen in weight-loss groups after 36 completed weeks (normal weight: HR = 18.85 [8.25-43.09]; overweight: HR = 5.87 [2.99-11.55]; obese: HR = 3.44 [2.34-5.05]). Weight loss was associated with reduced stillbirth risk in morbidly obese women between 24 and 28 weeks (HR = 0.56 [0.34-0.95]). Excess weight gain was associated with an increased risk of stillbirth among obese and morbidly obese women, with highest risk after 36 completed weeks (obese: HR = 2.00 [1.55-2.58]; morbidly obese: HR = 3.16 [2.17-4.62]). In contrast, excess weight gain was associated with reduced risk of stillbirth in normal-weight women between 24 and 28 weeks (HR = 0.57 [0.44-0.70]) and in overweight women between 29 and 33 weeks (HR = 0.62 [0.45-0.85]). Analysis for the underweight group was limited by sample size. Both excessive weight gain and inadequate weight gain were not associated with stillbirth in this group. Stillbirth risk increased with inadequate weight gain and weight loss in all BMI classes except the morbidly obese group, where weight demonstrated a protective effect. Conversely, excessive weight gain was associated with higher risk of stillbirth among

Term stillbirth caused by oral Fusobacterium nucleatum.

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Han, Yiping W; Fardini, Yann; Chen, Casey; Iacampo, Karla G; Peraino, Victoria A; Shamonki, Jaime M; Redline, Raymond W

2010-02-01

Intrauterine infection is a recognized cause of adverse pregnancy outcome, but the source of infection is often undetermined. We report a case of stillbirth caused by Fusobacterium nucleatum that originated in the mother's mouth. A woman with pregnancy-associated gingivitis experienced an upper respiratory tract infection at term, followed by stillbirth a few days later. F. nucleatum was isolated from the placenta and the fetus. Examination of different microbial floras from the mother identified the same clone in her subgingival plaque but not in the supragingival plaque, vagina, or rectum. F. nucleatum may have translocated from the mother's mouth to the uterus when the immune system was weakened during the respiratory infection. This case sheds light on patient management for those with pregnancy-associated gingivitis.

Prevalence and risk factors for stillbirths in Holstein cows in a hot environment

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Mellado, M.; Chávez, M.I.; Macías-Cruz, U.; Avendaño-Reyes, L.; Carrillo, E.; García, J.E.

2017-07-01

Risk factors for stillbirth were studied in a dairy operation in northern Mexico (25°N). Data set consisted of 29406 full term calving records. Factors affecting stillbirths were analyzed using a step-wise multivariable logistic regression models. The predictive indicators of stillbirth risk were: temperature-humidity index (THI) during pregnancy and at calving, season of calving, calf birth weight, gestation length, semen characteristics (conventional or sexed), gender of calves, hour of calving and type of parturition (normal or dystocic). Throughout the study period, 7.3 (95%, confidence interval= 7.0–7.6) of every 100 calving events had a stillborn calf. Stillborns were higher with severe dystocia compared with non-assisted births (29.0% vs. 6.2%, p<0.0001) and calves with birth weights <35 kg compared with heavier calves at calving (19.3% vs. 2.3%, p<0.0001), and was lower in calves whose gestation length was >278 d compared with calves with shorter gestation periods (2.8% vs. 30.0%, p<0.0001). Cows in a severe state of heat stress prenatally and at birth (THI >83 units) had 1.3 higher risk of stillbirths than cows suffering reduced heat stress (p<0.0001). Evidence for a greater (p<0.001) stillbirth rates in cows with parturitions between 18:00 and 19:00 h compared with cows calving during other hours of the day was found (9.1% vs. 7.1%). Together, these results demonstrate that ameliorating heat stress during the peripartum period is an important management practice to reduce stillbirths in Holstein cows in this warm climate. Additionally, a greater attention of parturition around sunset can lower the current stillbirth rates.

Prevalence and risk factors for stillbirths in Holstein cows in a hot environment

International Nuclear Information System (INIS)

Mellado, M.; Chávez, M.I.; Macías-Cruz, U.; Avendaño-Reyes, L.; Carrillo, E.; García, J.E.

2017-01-01

Risk factors for stillbirth were studied in a dairy operation in northern Mexico (25°N). Data set consisted of 29406 full term calving records. Factors affecting stillbirths were analyzed using a step-wise multivariable logistic regression models. The predictive indicators of stillbirth risk were: temperature-humidity index (THI) during pregnancy and at calving, season of calving, calf birth weight, gestation length, semen characteristics (conventional or sexed), gender of calves, hour of calving and type of parturition (normal or dystocic). Throughout the study period, 7.3 (95%, confidence interval= 7.0–7.6) of every 100 calving events had a stillborn calf. Stillborns were higher with severe dystocia compared with non-assisted births (29.0% vs. 6.2%, p<0.0001) and calves with birth weights <35 kg compared with heavier calves at calving (19.3% vs. 2.3%, p<0.0001), and was lower in calves whose gestation length was >278 d compared with calves with shorter gestation periods (2.8% vs. 30.0%, p<0.0001). Cows in a severe state of heat stress prenatally and at birth (THI >83 units) had 1.3 higher risk of stillbirths than cows suffering reduced heat stress (p<0.0001). Evidence for a greater (p<0.001) stillbirth rates in cows with parturitions between 18:00 and 19:00 h compared with cows calving during other hours of the day was found (9.1% vs. 7.1%). Together, these results demonstrate that ameliorating heat stress during the peripartum period is an important management practice to reduce stillbirths in Holstein cows in this warm climate. Additionally, a greater attention of parturition around sunset can lower the current stillbirth rates.

Setting research priorities to improve global newborn health and prevent stillbirths by 2025

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José Martines

2016-06-01

Full Text Available In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025.

Global report on preterm birth and stillbirth (4 of 7: delivery of interventions

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Rubens Craig E

2010-02-01

Full Text Available Abstract Background The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies. Barriers to scaling up interventions Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment. Strategies and examples Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1 detection and treatment of syphilis; (2 emergency Cesarean section; (3 newborn resuscitation; and (4 kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention. Conclusion Equitable and successful scale-up of preterm birth and stillbirth

Excessively delayed maternal reaction after their perception of decreased fetal movements in stillbirths: Population-based study in Japan.

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Koshida, Shigeki; Ono, Tetsuo; Tsuji, Shunichiro; Murakami, Takashi; Arima, Hisatomi; Takahashi, Kentaro

2017-12-01

Fetal movement is the most common method to evaluate fetal well-being. Furthermore, maternal perception of decreased fetal movements is associated with perinatal demise. Previously, we showed that perception of decreased fetal movements was the most common reason for mothers visiting the outpatient department among those who had stillbirths in our region. Further investigation of stillbirths with decreased fetal movements is essential to find a possible way of preventing stillbirth. To investigate maternal reaction time after their perceiving decreased fetal movements among stillbirths in our region of Japan. This is a population-based study of stillbirths in Shiga Prefecture, Japan conducted from 2007 to 2011. We sent a questionnaire to each obstetrician who had submitted the stillbirth certificate. We reviewed and evaluated the questionnaires returned from the obstetricians. There were 66 cases (35%) with decreased fetal movements among 188 stillbirths in Shiga during the study period. The number of maternal visits to outpatient department after perception of decreased fetal movements within 24h was only seven (11%) among 64 stillbirths diagnosed at outpatient department. We conclude that delayed maternal visit after perceiving decreased fetal movements is frequently observed in stillbirths. Promoting more thorough maternal education on fetal movements, including emphasizing earlier visitation after perceiving decreased fetal movements, may prevent stillbirths. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Pregnancy weight gain by gestational age and stillbirth: a population-based cohort study.

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Johansson, K; Hutcheon, J A; Bodnar, L M; Cnattingius, S; Stephansson, O

2017-11-21

To study the association between total and early pregnancy (gain and risk of stillbirth, stratified by early-pregnancy body mass index (BMI). Population-based cohort study. Stockholm-Gotland Region, Sweden. Pregnant women with singleton births (n = 160 560). Pregnancy weight gain was standardised into gestational age-specific z-scores. For analyses of total pregnancy weight gain, a matched design with an incidence density sampling approach was used. Findings were also contrasted with current Institute of Medicine (IOM) weight gain recommendations. Stillbirth defined as fetal death at ≥22 completed weeks of gestation. For all BMI categories, there was no statistical association between total or early pregnancy weight gain and stillbirth within the range of a weight gain z-score of -2.0 SD to +2.0 SD. Among normal-weight women, the adjusted odds ratio of stillbirth for lower (-2.0 to -1.0 SD) and higher (+1.0 to +1.9 SD) total weight gain was 0.85 (95% CI; 0.48-1.49) and 1.03 (0.60-1.77), respectively, as compared with the reference category. Further, there were no associations between total or early pregnancy weight gain and stillbirth within the range of weight gain currently recommended by the IOM. For the majority of the BMI categories, the point estimates at the extremes of weight gain values (gain and increased risks of high weight gain, but estimates were imprecise and not statistically significant. We found no associations between total or early pregnancy weight gain and stillbirth across the range of weight gain experienced by most women. There was no association between weight gain during pregnancy and stillbirth among most women. © 2017 Karolinska Institutet. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

Quantification of the association between malaria in pregnancy and stillbirth: a systematic review and meta-analysis.

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Moore, Kerryn A; Simpson, Julie A; Scoullar, Michelle J L; McGready, Rose; Fowkes, Freya J I

2017-11-01

2·6 million stillbirths occur annually worldwide. The association between malaria in pregnancy and stillbirth has yet to be comprehensively quantified. We aimed to quantify the association between malaria in pregnancy and stillbirth, and to assess the influence of malaria endemicity on the association. We did a systematic review of the association between confirmed malaria in pregnancy and stillbirth. We included population-based cross-sectional, cohort, or case-control studies (in which cases were stillbirths or perinatal deaths), and randomised controlled trials of malaria in pregnancy interventions, identified before Feb 28, 2017. We excluded studies in which malaria in pregnancy was not confirmed by PCR, light microscopy, rapid diagnostic test, or histology. The primary outcome was stillbirth. We pooled estimates of the association between malaria in pregnancy and stillbirth using meta-analysis. We used meta-regression to assess the influence of endemicity. The study protocol is registered with PROSPERO, protocol number CRD42016038742. We included 59 studies of 995 records identified, consisting of 141 415 women and 3387 stillbirths. Plasmodium falciparum malaria detected at delivery in peripheral samples increased the odds of stillbirth (odds ratio [OR] 1·81 [95% CI 1·42-2·30]; I 2 =26·1%; 34 estimates), as did P falciparum detected in placental samples (OR 1·95 [1·48-2·57]; I 2 =33·6%; 31 estimates). P falciparum malaria detected and treated during pregnancy was also associated with stillbirth, but to a lesser extent (OR 1·47 [95% CI 1·13-1·92]; 19 estimates). Plasmodium vivax malaria increased the odds of stillbirth when detected at delivery (2·81 [0·77-10·22]; three estimates), but not when detected and treated during pregnancy (1·09 [0·76-1·57]; four estimates). The association between P falciparum malaria in pregnancy and stillbirth was two times greater in areas of low-to-intermediate endemicity than in areas of high endemicity (ratio

International comparisons of preterm birth: higher rates of late preterm birth are associated with lower rates of stillbirth and neonatal death.

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Lisonkova, S; Sabr, Y; Butler, B; Joseph, K S

2012-12-01

To examine international rates of preterm birth and potential associations with stillbirths and neonatal deaths at late preterm and term gestation. Ecological study. Canada, USA and 26 countries in Europe. All deliveries in 2004. Information on preterm birth (Statistics Canada, the EURO-PERISTAT project and the National Center for Health Statistics. Pearson correlation coefficients and random-intercept Poisson regression were used to examine the association between preterm birth rates and gestational age-specific stillbirth and neonatal death rates. Rate ratios with 95% confidence intervals were estimated after adjustment for maternal age, parity and multiple births. Stillbirths and neonatal deaths ≥ 32 and ≥ 37 weeks of gestation. International rates of preterm birth (births. Preterm birth rates at 32-36 weeks were inversely associated with stillbirths at ≥ 32 weeks (adjusted rate ratio 0.94, 95% CI 0.92-0.96) and ≥ 37 weeks (adjusted rate ratio 0.88, 95% CI 0.85-0.91) of gestation and inversely associated with neonatal deaths at ≥ 32 weeks (adjusted rate ratio 0.88, 95% CI 0.85-0.91) and ≥ 37 weeks (adjusted rate ratio 0.82, 95% CI 0.78-0.86) of gestation. Countries with high rates of preterm birth at 32-36 weeks of gestation have lower stillbirth and neonatal death rates at and beyond 32 weeks of gestation. Contemporary rates of preterm birth are indicators of both perinatal health and obstetric care services. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach.

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Almasi-Hashiani, Amir; Sepidarkish, Mahdi; Safiri, Saeid; Khedmati Morasae, Esmaeil; Shadi, Yahya; Omani-Samani, Reza

2017-05-17

The present inquiry set to determine the economic inequality in history of stillbirth and understanding determinants of unequal distribution of stillbirth in Tehran, Iran. A population-based cross-sectional study was conducted on 5170 pregnancies in Tehran, Iran, since 2015. Principal component analysis (PCA) was applied to measure the asset-based economic status. Concentration index was used to measure socioeconomic inequality in stillbirth and then decomposed into its determinants. The concentration index and its 95% CI for stillbirth was -0.121 (-0.235 to -0.002). Decomposition of the concentration index showed that mother's education (50%), mother's occupation (30%), economic status (26%) and father's age (12%) had the highest positive contributions to measured inequality in stillbirth history in Tehran. Mother's age (17%) had the highest negative contribution to inequality. Stillbirth is unequally distributed among Iranian women and is mostly concentrated among low economic status people. Mother-related factors had the highest positive and negative contributions to inequality, highlighting specific interventions for mothers to redress inequality. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Confronting stillbirths and newborn deaths in areas of conflict and political instability: a neglected global imperative.

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Wise, Paul H; Darmstadt, Gary L

2015-08-01

Despite considerable improvements in reproductive and newborn health throughout the world, relatively poor outcomes persist in areas plagued by conflict or political instability. To assess the contribution of areas of conflict and instability to global patterns of stillbirths and newborn deaths and to identify opportunities for effective intervention in these areas. Analysis of the available data on stillbirths and neonatal mortality in association with conflict and governance indicators, and review of epidemiological and political literature pertaining to the provision of health and public services in areas of conflict and instability. Of the 15 countries with the highest neonatal mortality rates in the world, 14 are characterized by chronic conflict or political instability. If India and China are excluded, countries experiencing chronic conflict or political instability account for approximately 42% of all neonatal deaths worldwide. Efforts to address adverse reproductive and newborn outcomes in these areas must adapt recommended intervention protocols to the special security and governance conditions associated with unstable political environment. Despite troubling relative and absolute indicators, the special requirements of improving reproductive and neonatal outcomes in areas affected by conflict and political instability have not received adequate attention. New integrated political and technical strategies will be required. This should include moving beyond traditional approaches concerned with complex humanitarian emergencies. Rather, global efforts must be based on a deeper understanding of the specific governance requirements associated with protracted and widespread health requirements. A focus on women's roles, regional strategies which take advantage of relative stability and governance capacity in neighbouring states, virtual infrastructure, and assistance regimens directed specifically to unstable areas may prove useful.

Stillbirth and stigma: the spoiling and repair of multiple social identities

OpenAIRE

Brierley-Jones, L.; Crawley, R.; Lomax, S.; Ayers, S.

2014-01-01

This study investigated mothers' experiences surrounding stillbirth in the United Kingdom, their memory making and sharing opportunities, and the effect these opportunities had on them. Qualitative data were generated from free text responses to open-ended questions. Thematic content analysis revealed that "stigma" was experienced by most women and Goffman's (1963) work on stigma was subsequently used as an analytical framework. Results suggest that stillbirth can spoil the identities of "pat...

SSRI Use During Pregnancy and Risk of Stillbirth and Neonatal Mortality

DEFF Research Database (Denmark)

Jimenez-Solem, Espen; Andersen, Jon Trærup; Petersen, Morten

2013-01-01

OBJECTIVE The authors investigated whether in utero exposure to selective serotonin reuptake inhibitors (SSRIs) increases the risk of stillbirth or neonatal mortality. METHOD The authors conducted a population-based cohort study using the Danish Fertility Database to identify every birth in Denmark...... between 1995 and 2008. Time of exposure to SSRIs was calculated on the basis of standard treatment dosages and dispensed pack sizes according to the prescription register. Exposure was divided into first-, second-, and third-trimester exposure. Multivariate logistic regression models were used. RESULTS...... The authors identified 920,620 births; the incidence of stillbirths was 0.45%, and the incidence of neonatal mortality was 0.34%. A total of 12,425 offspring were exposed to an SSRI during pregnancy. Stillbirth was not associated with first-trimester SSRI use (adjusted odds ratio=0.77, 95% CI=0...

Level, causes, and risk factors of stillbirth: a population-based case control study from Chandigarh, India.

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Newtonraj, Ariarathinam; Kaur, Manmeet; Gupta, Madhu; Kumar, Rajesh

2017-11-13

Globally, India ranks first in the absolute number of stillbirths. Hence, the level, causes, and risk factors of stillbirths were estimated to facilitate designing of prevention strategy. Capture and recapture method was used to identify 301 stillbirths from 1st July 2013 to 31st August 2014 in Chandigarh Union Territory of India. Verbal autopsies (n = 181) were done at household level to identify causes of stillbirths. Risk factors were determined using case-control approach. Women who had a stillbirth in the past 3 months were enrolled as cases (n = 181) and those who had live-birth in same neighbourhood were included as controls (n = 181). Statistical differences in the distribution of characteristics of cases and controls were tested by t test and chi square test respectively for quantitative and categorical variables. In logistic regression models adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated for various risk factors. Stillbirth rate was estimated to be 16/1000 birth. Antepartum causes were more common (68%) than intrapartum causes (32%). Among maternal conditions, hypertension (18.2%) and chorio-amnionitis (13.8%), and among foetal conditions, growth restriction (19.9%) and congenital anomalies (18.8%) were the leading causes. In about half of the stillbirths foetal (48%) and maternal (44.7%) causes were unidentifiable. Risk factors of stillbirths were: higher maternal age (aOR 1.1, 95%CI 1.0-1.2), vaginal delivery (aOR 8.1, 95%CI 2.6-26), induced labour (aOR 2.6, 95%CI 1.5-4.5), green or light brown liquor (aOR 2.0, 95%CI 1.1-3.8), preterm delivery (aOR 6.4, 95%CI 3.7-11) and smaller household size (aOR 1.2, 95% CI 1.1-1.3). Stillbirth rate was high in Chandigarh Union Territory of India. Major causes and risk factors amenable to interventions were infections, hypertension, congenital malformations, foetal growth restriction, pre-maturity and household size. Therefore, better maternity ante-natal and intra-natal care is

The effect of folic acid, protein energy and multiple micronutrient supplements in pregnancy on stillbirths

Directory of Open Access Journals (Sweden)

Bhutta Zulfiqar A

2011-04-01

Full Text Available Abstract Background Pregnancy is a state of increased requirement of macro- and micronutrients, and malnourishment or inadequate dietary intake before and during pregnancy, can lead to adverse perinatal outcomes including stillbirths. Many nutritional interventions have been proposed during pregnancy according to the nutritional status of the mother and baseline risk factors for different gestational disorders. In this paper, we have reviewed three nutritional interventions including peri-conceptional folic acid supplementation, balanced protein energy supplementation and multiple micronutrients supplementation during pregnancy. This paper is a part of a series to estimate the effect of interventions on stillbirths for input to Live Saved Tool (LiST model. Methods We systematically reviewed all published literature to identify studies evaluating effectiveness of peri-conceptional folic acid supplementation in reducing neural tube defects (NTD, related stillbirths and balanced protein energy and multiple micronutrients supplementation during pregnancy in reducing all-cause stillbirths. The primary outcome was stillbirths. Meta-analyses were generated where data were available from more than one study. Recommendations were made for the Lives Saved Tool (LiST model based on rules developed by the Child Health Epidemiology Reference Group (CHERG. Results There were 18 studies that addressed peri-conceptional folic acid supplementation for prevention of neural tube defects (NTDs. Out of these, 7 studies addressed folic acid supplementation while 11 studies evaluated effect of folic acid fortification. Pooled results from 11 fortification studies showed that it reduces primary incidence of NTDs by 41 % [Relative risk (RR 0.59; 95 % confidence interval (CI 0.52-0.68]. This estimate has been recommended for inclusion in the LiST as proxy for reduction in stillbirths. Pooled results from three studies considered to be of low quality and suggest that

A study protocol of a three-group randomized feasibility trial of an online yoga intervention for mothers after stillbirth (The Mindful Health Study).

Science.gov (United States)

Huberty, Jennifer; Matthews, Jeni; Leiferman, Jenn; Cacciatore, Joanne; Gold, Katherine J

2018-01-01

In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress disorder (PTSD) and a fourfold increased risk of depressive symptoms. Because the majority of women who have experienced the death of their baby become pregnant within 12-18 months and the lack of intervention studies conducted within this population, novel approaches targeting physical and mental health, specific to the needs of this population, are critical. Evidence suggests that yoga is efficacious, safe, acceptable, and cost-effective for improving mental health in a variety of populations, including pregnant and postpartum women. To date, there are no known studies examining online-streaming yoga as a strategy to help mothers cope with PTSD symptoms after stillbirth. The present study is a two-phase randomized controlled trial. Phase 1 will involve (1) an iterative design process to develop the online yoga prescription for phase 2 and (2) qualitative interviews to identify cultural barriers to recruitment in non-Caucasian women (i.e., predominately Hispanic and/or African American) who have experienced stillbirth ( N  = 5). Phase 2 is a three-group randomized feasibility trial with assessments at baseline, and at 12 and 20 weeks post-intervention. Ninety women who have experienced a stillbirth within 6 weeks to 24 months will be randomized into one of the following three arms for 12 weeks: (1) intervention low dose (LD) = 60 min/week online-streaming yoga ( n  = 30), (2) intervention moderate dose (MD) = 150 min/week online-streaming yoga ( n  = 30), or (3) stretch and tone control (STC) group = 60 min/week of stretching/toning exercises ( n  = 30). This study will explore the feasibility and acceptability of a 12-week, home-based, online-streamed yoga intervention, with varying doses

Setting research priorities to improve global newborn health and prevent stillbirths by 2025.

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Yoshida, Sachiyo; Martines, José; Lawn, Joy E; Wall, Stephen; Souza, Joăo Paulo; Rudan, Igor; Cousens, Simon; Aaby, Peter; Adam, Ishag; Adhikari, Ramesh Kant; Ambalavanan, Namasivayam; Arifeen, Shams Ei; Aryal, Dhana Raj; Asiruddin, Sk; Baqui, Abdullah; Barros, Aluisio Jd; Benn, Christine S; Bhandari, Vineet; Bhatnagar, Shinjini; Bhattacharya, Sohinee; Bhutta, Zulfiqar A; Black, Robert E; Blencowe, Hannah; Bose, Carl; Brown, Justin; Bührer, Christoph; Carlo, Wally; Cecatti, Jose Guilherme; Cheung, Po-Yin; Clark, Robert; Colbourn, Tim; Conde-Agudelo, Agustin; Corbett, Erica; Czeizel, Andrew E; Das, Abhik; Day, Louise Tina; Deal, Carolyn; Deorari, Ashok; Dilmen, Uğur; English, Mike; Engmann, Cyril; Esamai, Fabian; Fall, Caroline; Ferriero, Donna M; Gisore, Peter; Hazir, Tabish; Higgins, Rosemary D; Homer, Caroline Se; Hoque, D E; Irgens, Lorentz; Islam, M T; de Graft-Johnson, Joseph; Joshua, Martias Alice; Keenan, William; Khatoon, Soofia; Kieler, Helle; Kramer, Michael S; Lackritz, Eve M; Lavender, Tina; Lawintono, Laurensia; Luhanga, Richard; Marsh, David; McMillan, Douglas; McNamara, Patrick J; Mol, Ben Willem J; Molyneux, Elizabeth; Mukasa, G K; Mutabazi, Miriam; Nacul, Luis Carlos; Nakakeeto, Margaret; Narayanan, Indira; Olusanya, Bolajoko; Osrin, David; Paul, Vinod; Poets, Christian; Reddy, Uma M; Santosham, Mathuram; Sayed, Rubayet; Schlabritz-Loutsevitch, Natalia E; Singhal, Nalini; Smith, Mary Alice; Smith, Peter G; Soofi, Sajid; Spong, Catherine Y; Sultana, Shahin; Tshefu, Antoinette; van Bel, Frank; Gray, Lauren Vestewig; Waiswa, Peter; Wang, Wei; Williams, Sarah LA; Wright, Linda; Zaidi, Anita; Zhang, Yanfeng; Zhong, Nanbert; Zuniga, Isabel; Bahl, Rajiv

2016-06-01

In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025. We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national

Prospective Audit of Avoidable Factors in Institutional Stillbirths and ...

African Journals Online (AJOL)

AJRH Managing Editor

We conducted a prospective audit of stillbirths and early neonatal deaths at Tikur Anbessa. Hospital in Addis Ababa, ... investigated to determine causes of death and the circumstances that ..... role of significant hypothermia and hypoglycemia.

Cognitive predictors and risk factors of PTSD following stillbirth: a short-term longitudinal study.

OpenAIRE

Horsch, A.; Jacobs, I.; McKenzie-McHarg, K.

2015-01-01

This short-term longitudinal study investigated cognitive predictors and risk factors of posttraumatic stress disorder (PTSD) in mothers following stillbirth. After a stillbirth at ≥ 24 weeks gestational age, 65 women completed structured clinical interviews and questionnaires assessing PTSD symptoms, cognitive predictors (appraisals, dysfunctional strategies), and risk factors (perceived social support, trauma history, obstetric history) at 3 and 6 months. PTSD symptoms decreased between 3 a...

Pre-pregnancy weight and the risk of stillbirth and neonatal death

DEFF Research Database (Denmark)

Kristensen, J; Vestergaard, M; Wisborg, K

2005-01-01

OBJECTIVE: To evaluate the association between maternal pre-pregnancy body mass index (BMI) and the risk of stillbirth and neonatal death and to study the causes of death among the children. DESIGN: Cohort study of pregnant women receiving routine antenatal care in Aarhus, Denmark. SETTING: Aarhus...... University Hospital, Denmark, 1989-1996. POPULATION: A total of 24,505 singleton pregnancies (112 stillbirths, 75 neonatal deaths) were included in the analyses. METHODS: Information on maternal pre-pregnancy weight, height, lifestyle factors and obstetric risk factors were obtained from self......-administered questionnaires and hospital files. We classified the population according to pre-pregnancy BMI as underweight (BMI

A comparative study of educational inequality in the risk of stillbirth in Denmark, Finland, Norway and Sweden 1981-2000

DEFF Research Database (Denmark)

Rom, Ane L; Mortensen, Laust Hvas; Cnattingius, Sven

2010-01-01

Background The stillbirth rates in Denmark, Finland, Norway and Sweden are among the lowest in the world, but socioeconomic disparities in stillbirth still exist. This study examined the educational patterns in the risk of stillbirth in Denmark, Finland, Norway and Sweden from 1981 to 2000. Methods...... From the national birth registries, all singleton live births and stillbirths with a gestational age of at least 28 weeks were selected in Denmark (n=1¿182¿888), Finland (n=419¿729), Norway (n=1¿006¿767) and Sweden (n=1¿974¿101). The births were linked with individual data on parental...

Effect of creatine supplementation during the last week of gestation on birth intervals, stillbirth, and preweaning mortality in pigs

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We hypothesized that creatine supplementation would reduce birth intervals, stillbirth rate, and preweaning survival in pigs because of its reported improvement of athletic performance in humans. In Exp. 1, gilts (n = 42) and first parity sows (n = 75) were mated at estrus. Beginning on d 110 of ges...

Incidence of stillbirth and perinatal mortality and their associated factors among women delivering at Harare Maternity Hospital, Zimbabwe: a cross-sectional retrospective analysis

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Welch Kathy

2005-05-01

care system, increasing the probability that she would seek timely emergency care that would reduce the likelihood of death of her infant in utero. Improved quality of obstetric care during labor and delivery may help reduce the number of fresh stillbirths and early neonatal deaths.

Late stillbirth post mortem examination in New Zealand: Maternal decision-making.

Science.gov (United States)

Cronin, Robin S; Li, Minglan; Wise, Michelle; Bradford, Billie; Culling, Vicki; Zuccollo, Jane; Thompson, John M D; Mitchell, Edwin A; McCowan, Lesley M E

2018-03-05

For parents who experience stillbirth, knowing the cause of their baby's death is important. A post mortem examination is the gold standard investigation, but little is known about what may influence parents' decisions to accept or decline. We aimed to identify factors influencing maternal decision-making about post mortem examination after late stillbirth. In the New Zealand Multicentre Stillbirth Study, 169 women with singleton pregnancies, no known abnormality at recruitment, and late stillbirth (≥28weeks gestation), from seven health regions were interviewed within six weeks of birth. The purpose of this paper was to explore factors related to post mortem examination decision-making and the reasons for declining. We asked women if they would make the same decision again. Maternal decision to decline a post mortem (70/169, 41.4%) was more common among women of Māori (adjusted odds ratio (aOR) 4.99 95% confidence interval (CI) 1.70-14.64) and Pacific (aOR 3.94 95% CI 1.47-10.54) ethnicity compared to European, and parity two or more (aOR 2.95 95% CI 1.14-7.62) compared to primiparous. The main reason for declining was that women 'did not want baby to be cut'. Ten percent (7/70) who declined said they would not make this decision again. No woman who consented regretted her decision. Ethnic differences observed in women's post mortem decision-making should be further explored in future studies. Providing information of the effect of post mortem on the baby's body and the possible emotional benefits of a post mortem may assist women faced with this decision in the future. © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Sow-level risk factors for stillbirth of piglets in organic sow herds

DEFF Research Database (Denmark)

Rangstrup-Christensen, Lena; Krogh, Mogens Agerbo; Pedersen, Lene Juul

2017-01-01

In Danish organic pig production, one-third of total born piglets die before weaning, and stillbirth has previously crudely been estimated to account for 27% of the total preweaning mortality. The objective of this study was to evaluate season, litter size, parity and body condition of the sow...... as risk factors for stillbirth in nine commercial Danish organic pig herds. The study was conducted over a 1-year period, and the data included registrations on 5170 farrowings with 82 906 total born piglets. The average number of total born piglets per litter was 16.0, and the number of stillborn piglets...

Cesarean Section and Rate of Subsequent Stillbirth, Miscarriage, and Ectopic Pregnancy: A Danish Register-Based Cohort Study

Science.gov (United States)

O'Neill, Sinéad M.; Agerbo, Esben; Kenny, Louise C.; Henriksen, Tine B.; Kearney, Patricia M.; Greene, Richard A.; Mortensen, Preben Bo; Khashan, Ali S.

2014-01-01

Background With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. Methods and Findings We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n = 832,996), with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy) or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28) was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI) of 0.03% for stillbirth, and a number needed to harm (NNH) of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31) and elective cesarean (HR 1.11, 95% CI 0.91, 1.35), although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15) and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21), yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85). Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment, causes of

The meaning of rituals after a stillbirth: A qualitative study of mothers with a stillborn baby.

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Tseng, Ying-Fen; Hsu, Min-Tao; Hsieh, Yueh-Tzu; Cheng, Hsiu-Rong

2018-03-01

To explore the meaning of rituals that women and their families perform after a stillbirth. A cultural taboo in Taiwan prohibits discussing death; thus, parents of stillborn babies have no established public mourning or burial ceremonies to perform for their stillborn children. Stillbirths are often treated as if they had never happened. Qualitative descriptive study. In-depth interviews, which were transcribed and content analysed, were conducted with a purposive sample of 16 women discharged from two teaching hospitals in Taiwan after they had a stillbirth. Families engaged in rituals for two underlying reasons: to benefit the deceased child and the immediate family. The meanings of the rituals for the child are presented through three themes: (i) sending the baby's spirit to a safe place, (ii) protecting it from suffering and (iii) preparing it for a better reincarnation. The meanings of rituals for the families are presented through four themes: (i) releasing parental guilt by doing their best for the deceased child, (ii) cutting bonds with the child, (iii) avoiding additional misfortune should they mishandle the funeral and (iv) praying for a successful subsequent pregnancy. Death-related rituals are highly culturally diverse. This study fills a gap about Asian cultures. Participating in rituals permits a mother to do something for her deceased child, helps relieve her guilt and lets her cope with the stillbirth. Rituals after a stillbirth can help a woman recover from grieving and allow her to hope for a successful subsequent pregnancy. Health professionals should discuss with bereaved parents what rituals they would like to perform and then respect their decisions. A continuum of care and support that exists from the prenatal diagnosis through the stillbirth and beyond is recommended for parents and families during this difficult time. © 2017 John Wiley & Sons Ltd.

Incidence and Determinants of Stillbirth amongst Parturients in Two ...

African Journals Online (AJOL)

Journal of Basic and Clinical Reproductive Sciences · January - June 2014 · Vol 3 · Issue 1. 15 ... Conclusion: The fetal mortality (stillbirth) rate was low and the determinants were identified. Public ... conception, irrespective of the duration of pregnancy and .... tract infection (UTI), anemia, diabetes mellitus, antepartum.

Maternal consumption of coffee during pregnancy and stillbirth and infant death in first year of life: prospective study

DEFF Research Database (Denmark)

Wisborg, Kirsten; Kesmodel, Ulrik; Bech, Bodil Hammer

2003-01-01

pregnancy had an increased risk of stillbirth compared with women who did not drink coffee (odds ratio=3.0, 95% confidence interval 1.5 to 5.9). After adjustment for smoking habits and alcohol intake during pregnancy, the relative risk of stillbirth decreased slightly. Adjustment for parity, maternal age......Objective To study the association between coffee consumption during pregnancy and the risk of stillbirth and infant death in the first year of life. Design Prospective follow up study. Setting Aarhus University Hospital, Denmark, 1989-96. Participants 18 478 singleton pregnancies in women...... with valid information about coffee consumption during pregnancy. Main outcome measures Stillbirth (delivery of a dead fetus at >28 weeks’ gestation) and infant death (death of a liveborn infant during the first year of life). Results Pregnant women who drank eight or more cups of coffee per day during...

Prospective risk of stillbirth and neonatal complications in twin pregnancies

DEFF Research Database (Denmark)

Cheong-See, Fiona; Schuit, Ewoud; Arroyo-Manzano, David

2016-01-01

OBJECTIVE: To determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, and Cochrane databases (until December 2015). REVIEW METHODS: ...

Socioeconomic inequalities in stillbirth rates in Europe: measuring the gap using routine data from the Euro-Peristat Project

NARCIS (Netherlands)

Zeitlin, J.; Mortensen, L.; Prunet, C.; Macfarlane, A.; Hindori-Mohangoo, A.D.; Gissler, M.; Szamotulska, K.; Pal, K. van der; Bolumar, F.; Andersen, A.M.; Ólafsdóttir, H.S.; Zhang, W.H.; Blondel, B.; Alexander, S.

2016-01-01

Background: Previous studies have shown that socioeconomic position is inversely associated with stillbirth risk, but the impact on national rates in Europe is not known. We aimed to assess the magnitude of social inequalities in stillbirth rates in European countries using indicators generated from

Epistatic interactions on chromosome 14 influencing stillbirth in Fleckvieh cattle

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Gábor Mészáros

2016-09-01

Full Text Available Single nucleotide polymorphism (SNP data of 7384 Fleckvieh bulls was analyzed to identify epistatic interactions influencing stillbirth. Deregressed breeding values were used as phenotypes. The epistatic effects were identified as significant interaction terms from pairwise linear regressions performed for each SNP after accounting for multiple testing. Majority of the detected epistatic effects were located in the 9-31Mb region of chromosome 14, corresponding to the most significant region from the genome wide association. Additional epistatic SNPs at 50.5Mb and 80.5 Mb at the same chromosome were detected. The region around 25 Mb contained genes connected to height and body size such as PLAG1, CHCHD7, LYN, RDHE2 (SDR16C5 and PENK. The other interesting region at 50.5Mb contained the TRPS1 gene influencing bone malformations. Both regions have been identified as candidates influencing stillbirth.

Does antenatal care timing influence stillbirth risk in the third trimester? A secondary analysis of perinatal death audit data in South Africa.

Science.gov (United States)

Lavin, T; Pattinson, R C

2018-01-01

To explore stillbirth risk across gestation in three provinces of South Africa with different antenatal care schedules. Retrospective audit of perinatal death data using South Africa's Perinatal Problem Identification Programme. In 2008, the Basic Antenatal Care Programme was introduced in Limpopo and Mpumalanga provinces, reducing appointments to five visits at booking, 20, 26, 32, 38 weeks and 41 weeks if required. In the Western Cape province seven appointments remained at booking, 20, 26, 32, 34, 36, 38 and 41 weeks if required. All audited stillbirths (n = 4211) between October 2013 to August 2015 in Limpopo, Mpumalanga and Western Cape. Stillbirth risk (26-42 weeks of gestation, >1000 g) across gestation was calculated using Yudkin's method. Stillbirth risk was compared between provinces and relative risks were calculated between Limpopo/ Mpumalanga and Western Cape. Stillbirth risk across gestation. Stillbirth risk peaked at 38 weeks of gestation in Limpopo (relative risk [RR] 3.11, 95% CI 2.40-4.03, P risk at 38 weeks gestation in Limpopo and Mpumalanga were statistically greater than both the 37 and 39 weeks gestation within provinces (P risk occurs after a 6-week absence of antenatal care. This calls for a refocus on the impact of reduced antenatal care visits during the third trimester. Reduced antenatal care in the third trimester may increase stillbirth risk. © 2017 Royal College of Obstetricians and Gynaecologists.

Taiwanese women's process of recovery from stillbirth: a qualitative descriptive study.

Science.gov (United States)

Tseng, Ying-Fen; Chen, Chung-Hey; Wang, Hsiu-Hung

2014-06-01

The purpose of this qualitative descriptive study was to portray the recovery process of Taiwanese women after stillbirth. Data were generated through individual in-depth interviews with 21 women selected using purposeful sampling. Three stages in an emotional journey of recovery were suffering from silent grief, searching for a way out, and achieving peace of mind and mental stability. Throughout their journey, the women's overarching concern was where the deceased child had gone and whether it was well. Together these stages composed A pathway to peace of mind, a mental journey on which women struggled to spiritually connect with the lost baby and finally sought a personal pathway to emotional peace. Findings can inform healthcare providers in providing culturally sensitive care for Taiwanese women to facilitate healing after a stillbirth. © 2014 Wiley Periodicals, Inc.

Spontaneous Abortion, Stillbirth and Hyperthyroidism: A Danish Population-Based Study

Science.gov (United States)

Andersen, Stine Linding; Olsen, Jørn; Wu, Chun Sen; Laurberg, Peter

2014-01-01

Objectives Pregnancy loss in women suffering from hyperthyroidism has been described in case reports, but the risk of pregnancy loss caused by maternal hyperthyroidism in a population is unknown. We aimed to evaluate the association between maternal hyperthyroidism and pregnancy loss in a population-based cohort study. Study Design All pregnancies in Denmark from 1997 to 2008 leading to hospital visits (n = 1,062,862) were identified in nationwide registers together with information on maternal hyperthyroidism for up to 2 years after the pregnancy [hospital diagnosis/prescription of antithyroid drug (ATD)]. The Cox proportional hazards model was used to estimate adjusted hazard ratio (aHR) with 95% confidence interval (CI) for spontaneous abortion (gestational age hyperthyroidism was diagnosed before/during the pregnancy (n = 5,229), spontaneous abortion occurred more often both in women treated before the pregnancy alone [aHR 1.28 (95% CI 1.18-1.40)] and in women treated with ATD in early pregnancy [1.18 (1.07-1.31)]. When maternal hyperthyroidism was diagnosed and treated for the first time in the 2-year period after the pregnancy (n = 2,361), there was a high risk that the pregnancy under study had terminated with a stillbirth [2.12 (1.30-3.47)]. Conclusions Both early (spontaneous abortion) and late (stillbirth) pregnancy loss were more common in women suffering from hyperthyroidism. Inadequately treated hyperthyroidism in early pregnancy may have been involved in spontaneous abortion, and undetected high maternal thyroid hormone levels present in late pregnancy may have attributed to an increased risk of stillbirth. PMID:25538898

Causes of Stillbirth and Time of Death in Swedish Holstein Calves Examined Post Mortem

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Elvander M

2003-09-01

Full Text Available This study was initiated due to the observation of increasing and rather high levels of stillbirths, especially in first-calving Swedish Holstein cows (10.3%, 2002. Seventy-six Swedish Holstein calves born to heifers at 41 different farms were post mortem examined in order to investigate possible reasons for stillbirth and at what time in relation to full-term gestation they had occurred. The definition of a stillborn calf was dead at birth or within 24 h after birth after at least 260 days of gestation. Eight calves were considered as having died already in uterus. Slightly less than half of the examined calves (46.1% were classified as having died due to a difficult calving. Four calves (5.3% had different kinds of malformations (heart defects, enlarged thymus, urine bladder defect. Approximately one third of the calves (31.6% were clinically normal at full-term with no signs of malformation and born with no indication of difficulties at parturition or any other reason that could explain the stillbirth. The numbers of male and female calves were rather equally distributed within the groups. A wide variation in post mortem weights was seen in all groups, although a number of the calves in the group of clinically normal calves with unexplained reason of death were rather small and, compared with e.g. those calves categorised as having died due to a difficult calving, their average birth weight was 6 kg lower (39.9 ± 1.7 kg vs. 45.9 ± 1.5 kg, p ≤ 0.01. It was concluded that the cause of stillbirth with a non-infectious aetiology is likely to be multifactorial and difficult calving may explain only about half of the stillbirths. As much as one third of the calves seemed clinically normal with no obvious reason for death. This is a target group of calves that warrants a more thorough investigation in further studies.

Socioenvironmental predictors of abortion and stillbirths in an industrial community in Egypt.

Science.gov (United States)

Hafez, A S; Fahim, H I; Badawy, H A

2001-01-01

between the studied women in Helwan and Tenth of Ramadan City. The overall prevalence of abortion and stillbirths among women in the studied areas were 29.2% and 4.5%, respectively. However, the prevalence of such reproductive health hazards among women in Helwan was significantly higher than in Tenth of Ramadan City. Also the results of environmental study indicated that Helwan has higher mean values of total dust count, suspended and respirable dust concentrations as well as lead concentration in the ambient air than in Tenth of Ramadan City. The Logistic regression analysis showed that the respirable dust concentration in the air and smoking inside houses are the significant independent factors for the occurrence of abortion. Moreover, Lead concentration in the air and women education is the main predictors of both abortion and stillbirths. Accordingly, the Egyptian authorities should attempt to improve air quality in urban industrial communities to promote reproductive health and prevent woman' s health hazards.

Aetiology of stillbirths and neonatal deaths in rural Ghana: implications for health programming in developing countries.

Science.gov (United States)

Edmond, Karen M; Quigley, Maria A; Zandoh, Charles; Danso, Samuel; Hurt, Chris; Owusu Agyei, Seth; Kirkwood, Betty R

2008-09-01

In developing countries many stillbirths and neonatal deaths occur at home and cause of death is not recorded by national health information systems. A community-level verbal autopsy tool was used to obtain data on the aetiology of stillbirths and neonatal deaths in rural Ghana. Objectives were to describe the timing and distribution of causes of stillbirths and neonatal deaths according to site of death (health facility or home). Data were collected from 1 January 2003 to 30 June 2004; 20,317 deliveries, 696 stillbirths and 623 neonatal deaths occurred over that time. Most deaths occurred in the antepartum period (28 weeks gestation to the onset of labour) (33.0%). However, the highest risk periods were during labour and delivery (intrapartum period) and the first day of life. Infections were a major cause of death in the antepartum (10.1%) and neonatal (40.3%) periods. The most important cause of intrapartum death was obstetric complications (59.3%). There were significantly fewer neonatal deaths resulting from birth asphyxia in the home than in the health facilities and more deaths from infection. Only 59 (20.7%) mothers of neonates who died at home reported that they sought care from an appropriate health care provider (doctor, nurse or health facility) during their baby's illness. The results from this study highlight the importance of studying community-level data in developing countries and the high risk of intrapartum stillbirths and infectious diseases in the rural African mother and neonate. Community-level interventions are urgently needed, especially interventions that reduce intrapartum deaths and infection rates in the mother and infant.

Women's decision making and experience of subsequent pregnancy following stillbirth.

Science.gov (United States)

Lee, Louise; McKenzie-McHarg, Kirstie; Horsch, Antje

2013-01-01

This study sought to increase understanding of women's thoughts and feelings about decision making and the experience of subsequent pregnancy following stillbirth (intrauterine death after 24 weeks' gestation). Eleven women were interviewed, 8 of whom were pregnant at the time of the interview. Modified grounded theory was used to guide the research methodology and to analyze the data. A model was developed to illustrate women's experiences of decision making in relation to subsequent pregnancy and of subsequent pregnancy itself. The results of the current study have significant implications for women who have experienced stillbirth and the health professionals who work with them. Based on the model, women may find it helpful to discuss their beliefs in relation to healing and health professionals to provide support with this in mind. Women and their partners may also benefit from explanations and support about the potentially conflicting emotions they may experience during this time. © 2013 by the American College of Nurse-Midwives.

Stillbirths and associated factors in a peri-urban District in Ghana ...

African Journals Online (AJOL)

To determine stillbirth rate and identify causal factors associated with it in the ... parity, gestation, mode of delivery, obstetric complications, sex and weight of the baby; ante-natal attendance and treatment of malaria in pregnancy, whether the ...

Customized vs INTERGROWTH-21st standards for the assessment of birthweight and stillbirth risk at term.

Science.gov (United States)

Francis, Andre; Hugh, Oliver; Gardosi, Jason

2018-02-01

Fetal growth abnormalities are linked to stillbirth and other adverse pregnancy outcomes, and use of the correct birthweight standard is essential for accurate assessment of growth status and perinatal risk. Two competing, conceptually opposite birthweight standards are currently being implemented internationally: customized gestation-related optimal weight (GROW) and INTERGROWTH-21 st . We wanted to compare their performance when applied to a multiethnic international cohort, and evaluate their usefulness in the assessment of stillbirth risk at term. We analyzed routinely collected maternity data from 10 countries with a total of 1.25 million term pregnancies in their respective main ethnic groups. The 2 standards were applied to determine small for gestational age (SGA) and large for gestational age (LGA) rates, with associated relative risk and population-attributable risk of stillbirth. The customized standard (GROW) was based on the term optimal weight adjusted for maternal height, weight, parity, and ethnic origin, while INTERGROWTH-21 st was a fixed standard derived from a multiethnic cohort of low-risk pregnancies. The customized standard showed an average SGA rate of 10.5% (range 10.1-12.7) and LGA rate of 9.5% (range 7.3-9.9) for the set of cohorts. In contrast, there was a wide variation in SGA and LGA rates with INTERGROWTH-21 st , with an average SGA rate of 4.4% (range 3.1-16.8) and LGA rate of 20.6% (range 5.1-27.5). This variation in INTERGROWTH-21 st SGA and LGA rates was correlated closely (R = ±0.98) to the birthweights predicted for the 10 country cohorts by the customized method to derive term optimal weight, suggesting that they were mostly due to physiological variation in birthweight. Of the 10.5% of cases defined as SGA according to the customized standard, 4.3% were also SGA by INTERGROWTH-21 st and had a relative risk of 3.5 (95% confidence interval, 3.1-4.1) for stillbirth. A further 6.3% (60% of the whole customized SGA) were not SGA

Stillbirth rates in singleton pregnancies in a stable population at Karl ...

African Journals Online (AJOL)

address this major problem. The American ... weighs ≥1 000 g. Since knowledge about the local trend in stillbirth .... cigarette smoking during pregnancy, as well as smoking by the ..... Vergani P, Cozzolino S, Pozzi E, et al. Identifying the ...

The impact of endemic and epidemic malaria on the risk of stillbirth in two areas of Tanzania with different malaria transmission patterns

Directory of Open Access Journals (Sweden)

Mutabingwa TK

2006-10-01

Full Text Available Abstract Background The impact of malaria on the risk of stillbirth is still under debate. The aim of the present analysis was to determine comparative changes in stillbirth prevalence between two areas of Tanzania with different malaria transmission patterns in order to estimate the malaria attributable component. Methods A retrospective analysis was completed of stillbirth differences between primigravidae and multigravidae in relation to malaria cases and transmission patterns for two different areas of Tanzania with a focus on the effects of the El Niño southern climatic oscillation (ENSO. One area, Kagera, experiences outbreaks of malaria, and the other area, Morogoro, is holoendemic. Delivery and malaria data were collected over a six year period from records of the two district hospitals in these locations. Results There was a significantly higher prevalence of low birthweight in primigravidae compared to multigravidae for both data sets. Low birthweight and stillbirth prevalence (17.5% and 4.8% were significantly higher in Kilosa compared to Ndolage (11.9% and 2.4%. There was a significant difference in stillbirth prevalence between Ndolage and Kilosa between malaria seasons (2.4% and 5.6% respectively, p Conclusion Malaria exposure during pregnancy has a delayed effect on birthweight outcomes, but a more acute effect on stillbirth risk.

Risk of stillbirth and infant deaths after assisted reproductive technology: a Nordic study from the CoNARTaS group

DEFF Research Database (Denmark)

Henningsen, Anna-Karina Aaris; Wennerholm, U. B.; Gissler, M.

2014-01-01

the analyses to opposite-sex twins. LIMITATIONS, REASON FOR CAUTION: We were not able to adjust for potential confounders, such as a prior history of stillbirth, induction of labour, body mass index or smoking. WIDER IMPLICATIONS OF THE FINDINGS: The risk of stillbirth in ART versus SC singletons was only...

PARENTS 2 study protocol: pilot of Parents' Active Role and ENgagement in the review of Their Stillbirth/perinatal death.

Science.gov (United States)

Bakhbakhi, Danya; Siassakos, Dimitrios; Storey, Claire; Heazell, Alexander; Lynch, Mary; Timlin, Laura; Burden, Christy

2018-01-10

The perinatal mortality review meeting that takes place within the hospital following a stillbirth or neonatal death enables clinicians to learn vital lessons to improve care for women and their families for the future. Recent evidence suggests that parents are unaware that a formal review following the death of their baby takes place. Many would welcome the opportunity to feedback into the meeting itself. Parental involvement in the perinatal mortality review meeting has the potential to improve patient satisfaction, drive improvements in patient safety and promote an open culture within healthcare. Yet evidence on the feasibility of involving bereaved parents in the review process is lacking. This paper describes the protocol for the Parents' Active Role and Engangement iN the review of their Stillbirth/perinatal death study (PARENTS 2) , whereby healthcare professionals' and stakeholders' perceptions of parental involvement will be investigated, and parental involvement in the perinatal mortality review will be piloted and evaluated at two hospitals. We will investigate perceptions of parental involvement in the perinatal mortality review process by conducting four focus groups. A three-round modified Delphi technique will be employed to gain a consensus on principles of parental involvement in the perinatal mortality review process. We will use three sequential rounds, including a national consensus meeting workshop with experts in stillbirth, neonatal death and bereavement care, and a two-stage anonymous online questionnaire. We will pilot a new perinatal mortality review process with parental involvement over a 6-month study period. The impact of the new process will be evaluated by assessing parents' experiences of their care and parents' and staff perceptions of their involvement in the process by conducting further focus groups and using a Parent Generated Index questionnaire. This study has ethical approval from the UK Health Research Authority. We will

A population-based case-control study of stillbirth: the relationship of significant life events to the racial disparity for African Americans.

Science.gov (United States)

Hogue, Carol J R; Parker, Corette B; Willinger, Marian; Temple, Jeff R; Bann, Carla M; Silver, Robert M; Dudley, Donald J; Koch, Matthew A; Coustan, Donald R; Stoll, Barbara J; Reddy, Uma M; Varner, Michael W; Saade, George R; Conway, Deborah; Goldenberg, Robert L

2013-04-15

Stillbirths (fetal deaths occurring at ≥20 weeks' gestation) are approximately equal in number to infant deaths in the United States and are twice as likely among non-Hispanic black births as among non-Hispanic white births. The causes of racial disparity in stillbirth remain poorly understood. A population-based case-control study conducted by the Stillbirth Collaborative Research Network in 5 US catchment areas from March 2006 to September 2008 identified characteristics associated with racial/ethnic disparity and interpersonal and environmental stressors, including a list of 13 significant life events (SLEs). The adjusted odds ratio for stillbirth among women reporting all 4 SLE factors (financial, emotional, traumatic, and partner-related) was 2.22 (95% confidence interval: 1.43, 3.46). This association was robust after additional control for the correlated variables of family income, marital status, and health insurance type. There was no interaction between race/ethnicity and other variables. Effective ameliorative interventions could have a substantial public health impact, since there is at least a 50% increased risk of stillbirth for the approximately 21% of all women and 32% of non-Hispanic black women who experience 3 or more SLE factors during the year prior to delivery.

Variability in Very Preterm Stillbirth and In-Hospital Mortality Across Europe

DEFF Research Database (Denmark)

Draper, Elizabeth S; Manktelow, Bradley N; Cuttini, Marina

2017-01-01

to determine what proportion of the variation in stillbirth and in-hospital VPT mortality rates persists after adjusting for population demographics, case-mix, and timing of death. METHODS: Standardized data collection for a geographically defined prospective cohort of VPTs (22(+0)-31(+6) weeks gestation...

Heavy metals in miscarriages and stillbirths in developing nations

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Cecilia Nwadiuto Amadi

2017-06-01

Full Text Available Objectives: Cases of miscarriage and stillbirths due to heavy metal poisoning continue to be on the rise in developing nations. In these countries like Nigeria, the menace of miscarriage is not readily linked to heavy metal exposure. This could be as a result of insufficient scientific data available due to poor documentation and inadequate public health education on the consequences of these heavy metals on maternal health. The heavy metals mercury, lead and cadmium are toxicants which have been shown to cross the placental barrier to accumulate in fetal tissues. Methods: For this review, relevant databases were searched for original scientific reports and a total of 100 articles were retained for analysis. Required data was extracted from these studies and their methodology assessed. Results: Miscarriages and stillbirths were observed from exposure to five heavy metals namely; mercury, arsenic, lead, chromium and cadmium. These heavy metals were associated with increased incidence of miscarriages in developing nations. In Nigeria, women with history of miscarriage had blood lead levels >25 µg/dL during pregnancy with approximately 41.61% increase in miscarriage incidence. Cadmium blood level was found to be 85.96 ± 1.09 μg/dl with a 9.50% increase in miscarriage incidence in women exposed to mercury in comparison to the unexposed group. For chromium, a 1.60% increase in the incidence of miscarriage in women exposed to chromium was reported. For cadmium and arsenic, 83.93% and 5.88% increase in incidence were reported respectively. Similar data were obtained for Jamaica (mercury = 7.29 ± 9.10 μg/l, Egypt (Cadmium = 1.17%; Lead = 32.33%. Conclusion: Medical practitioners and Toxicologists involved in women health in sub-Sahara Africa SSA should consider if these heavy metals can become additional biomarkers in the diagnosis of miscarriages and stillbirths.

Bereaved parents' experience of stillbirth in UK hospitals: a qualitative interview study.

Science.gov (United States)

Downe, Soo; Schmidt, Ellie; Kingdon, Carol; Heazell, Alexander E P

2013-01-01

To obtain the views of bereaved parents about their interactions with healthcare staff when their baby died just before or during labour. Qualitative in-depth interview study, following an earlier national survey. All interviews took place during 2011, either face-to-face or on the telephone. Data analysis was informed by the constant comparative technique from grounded theory. Every National Health Service (NHS) region in the UK was represented. Bereaved parents who had completed an e-questionnaire, via the website of Sands (Stillbirth and Neonatal Death Society). Of the 304 survey respondents who gave provisional consent, 29 families were approached to take part, based on maximum variation sampling and data saturation. 22 families (n=25) participated. Births took place between 2002 and 2010. Specific practices were identified that were particularly helpful to the parents. Respondents talked about their interactions with hospital staff as having profound effects on their capacity to cope, both during labour and in the longer term. The data generated three key themes: 'enduring and multiple loss': 'making irretrievable moments precious'; and the 'best care possible to the worst imaginable'. The overall synthesis of findings is encapsulated in the meta-theme 'One chance to get it right.' This pertains to the parents and family themselves, clinical and support staff who care for them directly, and the NHS organisations that indirectly provide the resources and governance procedures that may (or may not) foster a caring ethos. Positive memories and outcomes following stillbirth depend as much on genuinely caring staff attitudes and behaviours as on high-quality clinical procedures. All staff who encounter parents in this situation need to see each meeting as their one chance to get it right.

Cognitive predictors and risk factors of PTSD following stillbirth: a short-term longitudinal study.

Science.gov (United States)

Horsch, Antje; Jacobs, Ingo; McKenzie-McHarg, Kirstie

2015-04-01

This short-term longitudinal study investigated cognitive predictors and risk factors of posttraumatic stress disorder (PTSD) in mothers following stillbirth. After a stillbirth at ≥ 24 weeks gestational age, 65 women completed structured clinical interviews and questionnaires assessing PTSD symptoms, cognitive predictors (appraisals, dysfunctional strategies), and risk factors (perceived social support, trauma history, obstetric history) at 3 and 6 months. PTSD symptoms decreased between 3 and 6 months (Cohen's d ranged .34-.52). Regression analyses also revealed a specific positive relationship between Rumination and concurrent frequency of PTSD symptoms (β = .45). Negative Self-View and Negative World-View related positively and Self-Blame related negatively to concurrent number of PTSD symptoms (β = .48, .44, -.45, respectively). Suppression and Distraction predicted a decrease and Numbing predicted an increase in time-lagged number of PTSD symptoms (β = -.33, -.28, .30, respectively). Risk factors for PTSD symptoms were younger age (β = -.25), lower income (β = -.29), fewer previous pregnancies (β = -.31), and poorer perceived social support (β = -.26). Interventions addressing negative appraisals, dysfunctional strategies, and social support are recommended for mothers with PTSD following stillbirth. Knowledge of cognitive predictors and risk factors of PTSD may inform the development of a screening instrument. Copyright © 2015 Wiley Periodicals, Inc., A Wiley Company.

Weight change between successive pregnancies and risks of stillbirth and infant mortality: a nationwide cohort study.

Science.gov (United States)

Cnattingius, Sven; Villamor, Eduardo

2016-02-06

Maternal overweight and obesity are risk factors for stillbirth and infant mortality. Whether temporal changes in maternal weight affect these risks is not clear. We aimed to assess whether change of BMI between first and second pregnancies affects risks of stillbirth and infant mortality in the second-born offspring. In a Swedish population-based cohort of women who gave birth to their first and second child between Jan 1, 1992, and Dec 31, 2012, we investigated associations between change in maternal body-mass index (BMI) during early pregnancy from first to second pregnancies and risks of stillbirth and neonatal, postneonatal, and infant mortality after the second pregnancy. Relative risks (RRs) for each outcome according to BMI change categories were calculated with binomial regression. Complete information was available for 456,711 (77.7%) of 587,710 women who had their first and second single births in the study period. Compared with women with a stable BMI (change between -1 kg/m(2) and Karolinska Institutet. Copyright © 2016 Elsevier Ltd. All rights reserved.

The impact of endemic and epidemic malaria on the risk of stillbirth in two areas of Tanzania with different malaria transmission patterns

NARCIS (Netherlands)

Wort, Ulrika Uddenfeldt; Hastings, Ian; Mutabingwa, T. K.; Brabin, Bernard J.

2006-01-01

BACKGROUND: The impact of malaria on the risk of stillbirth is still under debate. The aim of the present analysis was to determine comparative changes in stillbirth prevalence between two areas of Tanzania with different malaria transmission patterns in order to estimate the malaria attributable

Stillbirth and congenital anomalies in migrants in Europe

DEFF Research Database (Denmark)

Andersen, Anne-Marie Nybo; Gundlund, Anna; Villadsen, Sarah Fredsted

2016-01-01

The risk of giving birth to a stillborn child or a child with severe congenital anomaly is higher for women who have immigrated to Europe as compared to the majority population in the receiving country. The literature, however, reveals great differences between migrant groups, even within migrants...... disparity is a result of the socioeconomic disadvantage most migrants face. Consanguinity has been considered as another cause for the increased stillbirth risk and the high risk of congenital anomaly observed in many migrant groups. Utilization and quality of care during pregnancy and childbirth...

Exposure to tobacco smoke in utero and risk of stillbirth and death in the first year of life

DEFF Research Database (Denmark)

Wisborg, Kirsten; Kesmodel, Ulrik Schiøler; Henriksen, Tine Brink

2001-01-01

to tobacco smoke in utero was associated with an increased risk of stillbirth (odds ratio = 2.0, 95% confidence interval: 1.4, 2.9), and infant mortality was almost doubled in children born to women who had smoked during pregnancy compared with children of nonsmokers (odds ratio = 1.8, 95% confidence...... interval: 1.3, 2.6). Among children of women who stopped smoking during the first trimester, stillbirth and infant mortality was comparable with that in children of women who had been nonsmokers from the beginning of pregnancy. Conclusions were not changed after adjustment in a logistic regression model...... for the sex of the child; parity; or maternal age, height, weight, marital status, years of education, occupational status, and alcohol and caffeine intake during pregnancy. Approximately 25% of all stillbirths and 20% of all infant deaths in a population with 30% pregnant smokers could be avoided if all...

Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982-2011): a cross-sectional, population-based study.

Science.gov (United States)

Kujala, Sanni; Waiswa, Peter; Kadobera, Daniel; Akuze, Joseph; Pariyo, George; Hanson, Claudia

2017-01-01

To identify mortality trends and risk factors associated with stillbirths and neonatal deaths 1982-2011. Population-based cross-sectional study based on reported pregnancy history in Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda. A pregnancy history survey was conducted among women aged 15-49 years living in the HDSS during May-July 2011 (n = 10 540). Time trends were analysed with cubic splines and linear regression. Potential risk factors were examined with multilevel logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI). 34 073 births from 1982 to 2011 were analysed. The annual rate of decrease was 0.9% for stillbirths and 1.8% for neonatal mortality. Stillbirths were associated with several risk factors: multiple births (AOR 2.57, CI 1.66-3.99), previous adverse outcome (AOR 6.16, CI 4.26-8.88) and grand multiparity among 35- to 49-year-olds (AOR 1.97, CI 1.32-2.89). Neonatal deaths were associated with multiple births (AOR 6.16, CI 4.80-7.92) and advanced maternal age linked with parity of 1-4 (AOR 2.34, CI 1.28-4.25) and grand multiparity (AOR 1.44, CI 1.09-1.90). Education, marital status and household wealth were not associated with the outcomes. The slow decline in mortality rates and easily identifiable risk factors calls for improving quality of care at birth and a rethinking of how to address obstetric risks, potentially a revival of the risk approach in antenatal care. © 2016 John Wiley & Sons Ltd.

Risk of low birth weight and stillbirth associated with indoor air pollution from solid fuel use in developing countries.

Science.gov (United States)

Pope, Daniel P; Mishra, Vinod; Thompson, Lisa; Siddiqui, Amna Rehana; Rehfuess, Eva A; Weber, Martin; Bruce, Nigel G

2010-01-01

Exposure to indoor air pollution from solid fuel use (IAP) has been linked to approximately 1.5 million annual deaths (World Health Organization (http://www.who.int/indoorair/publications/fuelforlife/en/index.html)) due to acute lower respiratory infections in children effect meta-analyses (I(2) = 0%) found that IAP was associated with increased risk of percentage LBW (odds ratio = 1.38, 95% confidence interval: 1.25, 1.52) and stillbirth (odds ratio = 1.51, 95% confidence interval: 1.23, 1.85) and reduced mean birth weight (-95.6 g, 95% confidence interval: -68.5, -124.7). Evidence from secondhand smoke, ambient air pollution, and animal studies--and suggested plausible mechanisms--substantiate these associations. Because a majority of pregnant women in developing countries, where rates of LBW and stillbirth are high, are heavily exposed to IAP, increased relative risk translates into substantial population attributable risks of 21% (LBW) and 26% (stillbirth).

Improving maternal and child health systems in Fiji through a perinatal mortality audit.

Science.gov (United States)

Raman, Shanti; Iljadica, Alexandra; Gyaneshwar, Rajat; Taito, Rigamoto; Fong, James

2015-05-01

To develop a standardized process of perinatal mortality audit (PMA) and improve the capacity of health workers to identify and correct factors underlying preventable deaths in Fiji. In a pilot study, clinicians and healthcare managers in obstetrics and pediatrics were trained to investigate stillbirths and neonatal deaths according to current guidelines. A pre-existing PMA datasheet was refined for use in Fiji and trialed in three divisional hospitals in 2011-12. Key informant interviews identified factors influencing PMA uptake. Overall, 141 stillbirths and neonatal deaths were analyzed (57 from hospital A and 84 from hospital B; forms from hospital C excluded because incomplete/illegible). Between-site variations in mortality were recorded on the basis of the level of tertiary care available; 28 (49%) stillbirths were recorded in hospital A compared with 53 (63%) in hospital B. Substantial health system factors contributing to preventable deaths were identified, and included inadequate staffing, problems with medical equipment, and lack of clinical skills. Leadership, teamwork, communication, and having a standardized process were associated with uptake of PMA. The use of PMAs by health workers in Fiji and other Pacific island countries could potentially rectify gaps in maternal and neonatal service delivery. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

[Maternal refusal to consent to a cesarean delivery, stillbirth].

Science.gov (United States)

Defline, A; Obadia, M; El Djerbi, A; Plevy, P; Lepercq, J

2014-01-01

The doctor-lawyer perspective that we discuss is a maternal refusal to consent to a cesarean delivery for a fetal indication in June 2011. Despite repeated information of the risks during a three-week hospitalization for pre-eclampsia, after being assured of the proper understanding of the seriousness of the situation by the patient and spouse, and after consideration to transfer to another hospital, the reiterated refusal led to a late fetal extraction resulting in term stillbirth. Copyright © 2013. Published by Elsevier Masson SAS.. All rights reserved.

Customised and Noncustomised Birth Weight Centiles and Prediction of Stillbirth and Infant Mortality and Morbidity: A Cohort Study of 979,912 Term Singleton Pregnancies in Scotland.

Directory of Open Access Journals (Sweden)

Stamatina Iliodromiti

2017-01-01

Full Text Available There is limited evidence to support the use of customised centile charts to identify those at risk of stillbirth and infant death at term. We sought to determine birth weight thresholds at which mortality and morbidity increased and the predictive ability of noncustomised (accounting for gestational age and sex and partially customised centiles (additionally accounting for maternal height and parity to identify fetuses at risk.This is a population-based linkage study of 979,912 term singleton pregnancies in Scotland, United Kingdom, between 1992 and 2010. The main exposures were noncustomised and partially customised birth weight centiles. The primary outcomes were infant death, stillbirth, overall mortality (infant and stillbirth, Apgar score <7 at 5 min, and admission to the neonatal unit. Optimal thresholds that predicted outcomes for both non- and partially customised birth weight centiles were calculated. Prediction of mortality between non- and partially customised birth weight centiles was compared using area under the receiver operator characteristic curve (AUROC and net reclassification index (NRI.Birth weight ≤25th centile was associated with higher risk for all mortality and morbidity outcomes. For stillbirth, low Apgar score, and neonatal unit admission, risk also increased from the 85th centile. Similar patterns and magnitude of associations were observed for both non- and partially customised birth weight centiles. Partially customised birth weight centiles did not improve the discrimination of mortality (AUROC 0.61 [95%CI 0.60, 0.62] compared with noncustomised birth weight centiles (AUROC 0.62 [95%CI 0.60, 0.63] and slightly underperformed in reclassifying pregnancies to different risk categories for both fatal and non-fatal adverse outcomes (NRI -0.027 [95% CI -0.039, -0.016], p < 0.001. We were unable to fully customise centile charts because we lacked data on maternal weight and ethnicity. Additional analyses in an

Cebocephaly, alobar holoprosencephaly, spina bifida, and sirenomelia in a stillbirth.

Science.gov (United States)

Chen, C P; Shih, S L; Liu, F F; Jan, S W

1997-01-01

Cebocephaly and sirenomelia are uncommon birth defects. Their association is extremely rare; however, the presence of spina bifida with both conditions is not unexpected. We report on a female still-birth with cebocephaly, alobar holoprosencephaly, cleft palate, lumbar spina bifida, sirenomelia, a single umbilical artery, and a 46,XX karyotype, but without maternal diabetes mellitus. Our case adds to the examples of overlapping cephalic and caudal defects, possibly related to vulnerability of the midline developmental field or axial mesodermal dysplasia spectrum. Images PMID:9132501

Endocrine Profiles, Haematology and Pregnancy Outcomes of Late Pregnant Holstein Dairy Heifers Sired by Bulls Giving a High or Low Incidence of Stillbirth

Directory of Open Access Journals (Sweden)

Kindahl H

2004-03-01

Full Text Available The high incidence of stillbirth in Swedish Holstein heifers has increased continuously during the last 15 years to an average of 11% today. The pathological reasons behind the increased incidence of stillbirth are unknown. The present experiment was undertaken to investigate possible causes of stillbirth and to study possible physiological markers for predicting stillbirth. Twenty Swedish Holstein dairy heifers sired by bulls with breeding values for a high risk of stillbirth (n = 12 (experimental group and a low risk of stillbirth (n = 8 (control group, group B were selected based on information in the Swedish AI-data base. The experimental group consisted of 2 subgroups of heifers (groups A1 and A2 inseminated with 2 different bulls with 3.5% and 9% higher stillbirth rates than the average, and the control group consisted of heifers pregnant with 5 different bulls with 0%–6% lower stillbirth rates than the average. The bull used for group A1 had also calving difficulties due to large calves as compared to the bull in group A2 showing no calving difficulties. The heifers were supervised from 6–7 months of pregnancy up to birth, and the pregnancies and parturitions were compared between groups regarding hormonal levels, haematology, placental characteristics and calf viability. In group A1, 1 stillborn, 1 weak and 4 normal calves were recorded. In group A2, 2 stillborn and 4 normal calves were registered. All animals in the control group gave birth to a normal living calf without any assistance. The weak calf showed deviating profiles of body temperature, saturated oxygen and heart rates, compared with the normal living calves. No differences of the placentome thickness, measured in vivo by ultrasonography were seen between the groups. The number of leukocytes and differential cell counts in groups A1 and A2 followed the profiles found in the control group. In group A1, a slight decrease of oestrone sulphate (E1SO4 levels was found in the

Rethinking Student Services: Assessing and Improving Service Quality.

Science.gov (United States)

Zammuto, Raymond F.; And Others

1996-01-01

A study investigated the quality of services in four student enrollment services administrative sub-units (recruiting, admissions, records and registration, financial aid) at a public comprehensive university, using student and staff evaluations and program evaluations. Specific changes needed to improve service delivery are identified and…

Continue service improvement at CERN computing centre

International Nuclear Information System (INIS)

Lopez, M Barroso; Everaerts, L; Meinhard, H; Baehler, P; Haimyr, N; Guijarro, J M

2014-01-01

Using the framework of ITIL best practises, the service managers within CERN-IT have engaged into a continuous improvement process, mainly focusing on service operation. This implies an explicit effort to understand and improve all service management aspects in order to increase efficiency and effectiveness. We will present the requirements, how they were addressed and share our experiences. We will describe how we measure, report and use the data to continually improve both the processes and the services being provided. The focus is not the tool or the process, but the results of the continuous improvement effort from a large team of IT experts providing services to thousands of users, supported by the tool and its local team. This is not an initiative to address user concerns in the way the services are managed but rather an on-going working habit of continually reviewing, analysing and improving the service management processes and the services themselves, having in mind the currently agreed service levels and whose results also improve the experience of the users about the current services.

Psychological stress during pregnancy and stillbirth: prospective study

DEFF Research Database (Denmark)

Wisborg, K.; Barklin, A.; Hedegaard, M.

2008-01-01

habits, alcohol and caffeine intake during pregnancy, education and cohabitation failed to change the result. The results remained essentially unchanged after exclusion of preterm deliveries. Exclusion of women with complications during pregnancy such as diabetes, hypertension, vaginal bleeding......OBJECTIVE: To study the association between psychological stress during pregnancy and stillbirth. DESIGN: Prospective follow-up study. SETTING: Aarhus University Hospital, Skejby, Denmark,1989-98. POPULATION: A total of 19 282 singleton pregnancies in women with valid information about...... psychological stress during pregnancy. METHODS: Information about psychological stress during pregnancy was obtained from questionnaires and measured by the 12-item General Health Questionnaires (GHQ). A score was generated by the sum of all the answers, each contributing a value between 0 (low psychological...

Stillbirth history and Toxoplasma gondii infection in women attending public health centers in a northern Mexican City

Science.gov (United States)

Alvarado-Esquivel, C.; Pacheco-Vega, S. J.; Salcedo-Jaquez, M.; Sánchez-Anguiano, L. F.; Hernández-Tinoco, J.; Rábago-Sánchez, E.; Centeno-Tinoco, M. M.; Flores-Garcia, I. D.; Ramos-Nevarez, A.; Cerrillo-Soto, S. M.; Guido-Arreola, C. A.; Beristain-García, I.; Liesenfeld, O.; Berumen-Segovia, L. O.; Saenz-Soto, L.; Sifuentes-Álvarez, A.

2015-01-01

Through a cross-sectional study design, 150 women attending public health centers with a history of stillbirths were examined for anti-Toxoplasma gondii IgG and IgM antibodies in Durango City, Mexico. Bivariate and multivariate analyses were used to assess the association of T. gondii seropositivity with the characteristics of the women with stillbirth history. Of the 150 women (mean age: 32.09 ± 9.16 years) studied, 14 (9.3%) had anti-T. gondii IgG antibodies and six (42.9%) of them were also positive for anti-T. gondii IgM antibodies. Multivariate analysis showed that T. gondii seropositivity was associated with high frequency (4–7 days a week) of eating meat (OR = 5.52; 95% CI: 1.48–20.59; P = 0.01), history of lymphadenopathy (OR = 4.52; 95% CI: 1.14–17.82; P = 0.03), and history of surgery (OR = 8.68; 95% CI: 1.04–72.15; P = 0.04). This is the first study on the seroepidemiology of T. gondii infection in women with a history of stillbirths in Mexico. The association of T. gondii exposure with a history of surgery warrants for further research. Risk factors for T. gondii infection found in the present survey may help to design optimal educational programs to avoid T. gondii infection. PMID:26185685

76 FR 24339 - Streamlining Service Delivery and Improving Customer Service

Science.gov (United States)

2011-05-02

... accessed by the Internet or mobile phone and improved processes that deliver services faster and more... ``Conversations with America'' to Further Improve Customer Service). However, with advances in technology and... major initiative (signature initiative) that will use technology to improve the customer experience; (b...

Screening and triage of intrauterine growth restriction (IUGR in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths

Directory of Open Access Journals (Sweden)

Siddiqui Saad

2011-04-01

significance. This intervention could be potentially recommended for high income settings or middle income countries with improving rates and standards of facility based care. Based on the Delphi, a combination of screening with maternal BMI, Symphysis fundal height and targeted ultrasound followed by the appropriate management could potentially reduce antepartum and intrapartum stillbirth by 20% respectively. This estimate is presently being recommended for inclusion in the LiST. Conclusion There is insufficient evidence to recommend in favor or against fetal movement counting for routine use for testing fetal well being. Doppler velocimetry of umbilical and fetal arteries and appropriate intervention is associated with 29 % (95 % CI 2% to 48 % reduction in perinatal mortality. Expert opinion suggests that detection and management of IUGR with the help of maternal BMI, symphysial-fundal height measurement and targeted ultrasound could be effective in reducing IUGR related stillbirths by 20%.

Acute effects of air pollution on spontaneous abortion, premature delivery, and stillbirth in Ahvaz, Iran: a time-series study.

Science.gov (United States)

Dastoorpoor, Maryam; Idani, Esmaeil; Goudarzi, Gholamreza; Khanjani, Narges

2018-02-01

Living in areas with high air pollution may have adverse effects on human health. There are few studies about the association between breathing polluted air and adverse pregnancy outcomes in the Middle East. The aim of this study was to determine the relationship between air pollution and spontaneous abortion, premature birth, and stillbirth in Ahvaz. A time-series study was conducted. Data about spontaneous abortion, premature deliveries, and stillbirth was collected from Ahvaz Imam Khomeini Hospital. Air pollution data including NO, CO, NO 2 , PM 10 , SO 2 , O 3 , and climate data were, respectively, collected from the Environmental Protection Agency and the Khuzestan Province Meteorology Office from March 2008 until March 2015. The relationship between air pollutants with the number of abortions, premature births, and stillbirths was found using a quasi-Poisson distributed lag model, adjusted by trend, seasonality, temperature, relative humidity, weekdays, and holidays. The average daily dust in Ahvaz on 7.2% days of the year was higher than 500 μg/m 3 (very dangerous). Findings from this study indicate a significant association between each 10-unit increase in SO 2 and spontaneous abortion in lag 0 and 9 days. There was a significant relation between each 10-unit increase in NO 2 and CO, and premature birth in lag 0. Also, we found a significant association between each 10-unit increase in CO and premature delivery in lag 1; PM 10 and premature delivery in lags 10, 11, and 12; and NO and premature delivery in lags 3, 4, 10, 11, 12, and 13 (p value polluted air during pregnancy may increase adverse pregnancy outcomes and stillbirth. Pregnant women should avoid polluted air.

Improving of enterprise consumer service system

Directory of Open Access Journals (Sweden)

Yа.М. Laguta

2015-12-01

Full Text Available The problems of consumer services at domestic enterprises are showed. The shortcomings in the service of enterprise operation are analyzed. The basic features of the functioning of the service system forming medium are determined. The authors develop the measures to improve the quality of services which can contribute to their development, expansion of the customer base, increase in sales volume (goods and services as well as improving efficiency and profitability. Taking into account the current environment of enterprises the proposed measures are formed. The article proves the expediency of the use of the client-oriented approach to a customer, the use of software programs and the improvement of the CRM-system at enterprises, the introduction of «7P» concept.

Investigation of the role of computed tomography as an adjunct to autopsy in the evaluation of stillbirth.

LENUS (Irish Health Repository)

2012-01-31

INTRODUCTION: The number of parents agreeing to autopsy following stillbirth is declining, which has undermined clinicians\\' ability to assess causes of intrauterine death and can impact counselling regarding recurrence. Post-mortem radiological imaging is a potential alternative method of investigating perinatal loss. The aim of this study was to assess the role of multi-detector computed tomography (MDCT) in the investigation of stillbirth. STUDY DESIGN: Following ethical approval and written consent, parents were offered MDCT of the stillborn infant. MDCT was performed with 3D reconstruction, and images were analysed for image quality, anthropomorphic measurements and pathologic findings. Body part and organ-specific measurements were performed; including head, chest and abdominal circumferences, and muscle and liver mass was also measured. Findings were correlated with obstetric history, post-mortem skeletal survey (plain radiography), and formal autopsy. RESULTS: Fourteen third-trimester stillborn infants were scanned. Image quality was moderate to excellent for most body structures. CT was better than plain radiography for imaging skeletal structures and large solid organs and demonstrated a range of pathologies including renal vein thrombosis, mesenteric calcification and skeletal hyperostosis that were not seen on plain radiographs. MDCT did not overlook autopsy findings and provided some additional information. CONCLUSION: This study confirms the feasibility of MDCT in the investigation of third trimester stillbirth. MDCT image quality is acceptable and the examination can demonstrate a range of anatomic and pathologic findings. Initially, its value may be as an important adjunct to conventional autopsy.

Investigation of the role of computed tomography as an adjunct to autopsy in the evaluation of stillbirth

International Nuclear Information System (INIS)

O’Donoghue, Keelin; O’Regan, Kevin N.; Sheridan, Carmel P.; O’Connor, Owen J.; Benson, Jodie; McWilliams, Sebastian; Moore, Niamh; Murphy, Mary J.; Chopra, Raj; Higgins, John R.; Maher, Michael M.

2012-01-01

Introduction: The number of parents agreeing to autopsy following stillbirth is declining, which has undermined clinicians’ ability to assess causes of intrauterine death and can impact counselling regarding recurrence. Post-mortem radiological imaging is a potential alternative method of investigating perinatal loss. The aim of this study was to assess the role of multi-detector computed tomography (MDCT) in the investigation of stillbirth. Study design: Following ethical approval and written consent, parents were offered MDCT of the stillborn infant. MDCT was performed with 3D reconstruction, and images were analysed for image quality, anthropomorphic measurements and pathologic findings. Body part and organ-specific measurements were performed; including head, chest and abdominal circumferences, and muscle and liver mass was also measured. Findings were correlated with obstetric history, post-mortem skeletal survey (plain radiography), and formal autopsy. Results: Fourteen third-trimester stillborn infants were scanned. Image quality was moderate to excellent for most body structures. CT was better than plain radiography for imaging skeletal structures and large solid organs and demonstrated a range of pathologies including renal vein thrombosis, mesenteric calcification and skeletal hyperostosis that were not seen on plain radiographs. MDCT did not overlook autopsy findings and provided some additional information. Conclusion: This study confirms the feasibility of MDCT in the investigation of third trimester stillbirth. MDCT image quality is acceptable and the examination can demonstrate a range of anatomic and pathologic findings. Initially, its value may be as an important adjunct to conventional autopsy.

Improving the Service with the Servqual Method

Science.gov (United States)

Midor, Katarzyna; Kučera, Marian

2018-03-01

At the time when economy is growing, there is strong competition in the market, and customers have increasingly higher expectations as regards quality of service and products. Under such conditions, organizations need to improve. One of the areas of improvement for an organization is to research the level of customer satisfaction. The article presents results of customer satisfaction surveys conducted by the Servqual method in a pharmaceutical service company. Use of this method allowed to improve the services provided by that pharmaceutical wholesaler, identify areas that need to be improved as soon as possible in order to improve the level of service provided.

Effects of maternal education on infant mortality and stillbirths in Denmark

DEFF Research Database (Denmark)

Olsen, O; Madsen, Mette

1999-01-01

and has increased in the lowest educational group. In conclusion, social inequality in infant mortality in Denmark is pronounced and cannot be explained by differences in smoking habits. The social gap between different educational groups has widened during the last decade, but may partly be explained......,814 births. When adjusted for mother's age, parity, and smoking, the stillbirth rate was independent of mother's educational level, but a clear social gradient in infant mortality was observed. Compared with a similar study in 1982-83, infant mortality has decreased most in the highest educational group...

Prenatal Alcohol Exposure and Miscarriage, Stillbirth, Preterm Delivery, and Sudden Infant Death Syndrome

OpenAIRE

Bailey, Beth A.; Sokol, Robert J.

2011-01-01

In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. This research has some inherent difficulties, such as the collection of accurate information about alcohol consumption during pregnancy and controlling for comorbid exposure...

Trihalomethanes in public drinking water and stillbirth and low birth weight rates: an intervention study.

Science.gov (United States)

Iszatt, Nina; Nieuwenhuijsen, Mark J; Bennett, James E; Toledano, Mireille B

2014-12-01

During 2003-2004, United Utilities water company in North West England introduced enhanced coagulation (EC) to four treatment works to mitigate disinfection by-product (DBP) formation. This enabled examination of the relation between DBPs and birth outcomes whilst reducing socioeconomic confounding. We compared stillbirth, and low and very low birth weight rates three years before (2000-2002) with three years after (2005-2007) the intervention, and in relation to categories of THM change. We created exposure metrics for EC and trihalomethane (THM) concentration change (n=258 water zones). We linked 429,599 live births and 2279 stillbirths from national birth registers to the water zone at birth. We used Poisson regression to model the differences in birth outcome rates with an interaction between before/after the intervention and EC or THM change. EC treatment reduced chloroform concentrations more than non-treatment (mean -29.7 µg/l vs. -14.5 µg/l), but not brominated THM concentrations. Only 6% of EC water zones received 100% EC water, creating exposure misclassification concerns. EC intervention was not associated with a statistically significant reduction in birth outcome rates. Areas with the highest chloroform decrease (30 - 65 μg/l) had the greatest percentage decrease in low -9 % (-12, -5) and very low birth weight -16% (-24, -8) rates. The interaction between before/after intervention and chloroform change was statistically significant only for very low birth weight, p=0.02. There were no significant decreases in stillbirth rates. In a novel approach for studying DBPs and adverse reproductive outcomes, the EC intervention to reduce DBPs did not affect birth outcome rates. However, a measured large decrease in chloroform concentrations was associated with statistically significant reductions in very low birth weight rates. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar

DEFF Research Database (Denmark)

Maaløe, N.; Housseine, N.; Meguid, T.

2018-01-01

Objective: To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia. Design: Quasi-experimental pre-post study investigating the causal pathway through changes in clinical practice. Setting: Tanzanian low-resource ref......Objective: To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia. Design: Quasi-experimental pre-post study investigating the causal pathway through changes in clinical practice. Setting: Tanzanian low......-resource referral hospital, Mnazi Mmoja Hospital.Population: Facility deliveries during baseline (1 October 2014 until 31 January 2015) and the 9th to 12th intervention month (1 October 2014 until 31 January 2015). Methods: Birth outcome was extracted from all cases of labouring women during baseline (n = 3690...

Causes of death among full term stillbirths and early neonatal deaths in the Region of Southern Denmark

DEFF Research Database (Denmark)

Basu, Millie; Johnsen, Iben Birgit Gade; Wehberg, Sonja

2018-01-01

OBJECTIVE: We examined the causes of death amongst full term stillbirths and early neonatal deaths. METHODS: Our cohort includes women in the Region of Southern Denmark, who gave birth at full term to a stillborn infant or a neonate who died within the first 7 days from 2010 through 2014. Demogra......OBJECTIVE: We examined the causes of death amongst full term stillbirths and early neonatal deaths. METHODS: Our cohort includes women in the Region of Southern Denmark, who gave birth at full term to a stillborn infant or a neonate who died within the first 7 days from 2010 through 2014....... Demographic, biometric and clinical variables were analyzed to assess the causes of death using two classification systems: causes of death and associated conditions (CODAC) and a Danish system based on initial causes of fetal death (INCODE). RESULTS: A total of 95 maternal-infant cases were included. Using...

Improving Customer Service in Elderly Care

OpenAIRE

Nielsen, Chris

2015-01-01

The elderly care sector is increasingly facing more competition and demanding customers. This leads to a growing pressure on elderly care home providers to find new and improved solutions that will enhance their level of customer service. The will ensure that the elderly service provider is remaining competitive in the elderly care service marketplace. The purpose of this thesis is to identify areas for improvements and propose implementable solutions for enhancing the elderly care custom...

Perfil de natimortalidade de acordo com ordem de nascimento, peso e sexo de leitões Stillbirth pattern according to birth order, birth weight, and gender of piglets

Directory of Open Access Journals (Sweden)

V.F. Borges

2008-10-01

Full Text Available Foram acompanhados 575 partos para avaliar a influência da ordem de nascimento, do sexo e do peso dos leitões na ocorrência de natimortos. Dos 7061 leitões, 90,2%, 6,0% e 3,8% nasceram vivos, natimortos ou mumificados, respectivamente. O percentual de partos com natimortos foi 44,5%. Partos com dois ou mais natimortos foram responsáveis por 63,1% das perdas por natimortalidade, embora tenham sido responsáveis por 17,2% das leitegadas. O percentual de natimortos aumentou com a ordem de nascimento; a maior taxa de natimortos, 21,7%, ocorreu a partir da 14ª ordem. A taxa de natimortalidade foi de 3,6% e 10,1% nos leitões de primeira a nona e de 10ª a 13ª ordem, respectivamente. Em leitões com até 500g a taxa de natimortos foi de 52,1%, mais alta que a de leitões mais pesados. Em leitões com 501 a 1200g foi de 10,1%, maior que entre os com mais de 1200g (4,0%. Não houve efeito de sexo dos leitões na ocorrência de natimortos, que foi de 6,2% e 5,8% para machos e fêmeas, respectivamente. A natimortalidade é maior entre os leitões com baixo peso ou com ordem de nascimento elevada.To examine the influence of birth order, gender, and birth weight of piglets on stillbirth, records of 575 farrowings were analyzed. Out of 7,061 piglets, 90.2%, 6.0%, and 3.8% were born alive, stillborns and mummified, respectively. The percentage of farrowings with stillborns was 44.5%. Farrowings with two or more stillborns accounted for 63.1% of losses, although they produced 17.2% of the litters. Stillbirth rate increased with the increase of the birth order. Piglets born from the 14th order onward had the highest stillbirth rate (21.7%. Piglets born from the 1st to the 9th and from the 10th to the 13th order had stillbirth rates of 3.6% and 10.1%, respectively. For piglets weighting up to 500g, the stillbirth rate was 52.1%, which was higher than that recorded for heavier piglets. Piglets weighting from 501 to 1,200g had a stillbirth rate of 10

The Service Pledge for Breast Cancer – Improving services through patient involvement

International Nuclear Information System (INIS)

Freeman, Shauna; Kester, Ross; Greenbrook, Sally; O’Connor, Ruairi; Rawlings, Sarah

2012-01-01

A guiding principle for today’s National Health Service is for services to reflect the needs and choices of patients and carers. There is evidence that meaningful patient involvement and engagement of people in their own care supports relationships with NHS professionals, and improves the quality and experience of healthcare. This paper reviews the Service Pledge for Breast Cancer, developed by the charity Breakthrough Breast Cancer as a tried and tested route to delivering effective patient involvement and examines some implications for radiotherapy services. The Service Pledge, which has benefitted an estimated 19,000 patients across the UK, is a tool that enables healthcare professionals and patients to work in partnership to improve local breast cancer services. Based on the results of a patient survey and in depth interviews to determine to what extent standards of care are being met at each participating hospital, improvement goals are identified helping turn the patient voice into constructive action. Improvement goals resulting from the Service Pledge range from small changes that make a real difference to patients, through to much larger changes to local breast services. To date, there has been limited involvement of radiotherapy staff in the Service Pledge, yet radiographers play an important role in the treatment of breast cancer as most patients will be offered radiotherapy. However, radiotherapy services have been criticised for not being patient -centred and for not providing enough information, psychological and emotional support before, during and after treatment. It is contended that radiographers are ideally placed to address many of these concerns and engage further with patients through projects such as the Service Pledge, empowering their patients to voice what is most important to them and driving the quality improvements that emerge.

Simulation for IT Service Desk Improvement

Directory of Open Access Journals (Sweden)

Peter Bober

2014-07-01

Full Text Available IT service desk is a complex service that IT service company provides to its customers. This article provides a methodology which uses discrete-event simulation to help IT service management to make decision and to plan service strategy. Simulation model considers learning ability of service desk agents and growth of knowledge database of the company. Model shows how the learning curve influences the time development of service desk quality and efficiency. This article promotes using simulation to define quantitative goals for the service desk improvement.

Rethinking Library Service: Improving the User Experience with Service Blueprinting

Science.gov (United States)

Pretlow, Cassi; Sobel, Karen

2015-01-01

Service blueprinting is a process that businesses use for analyzing and improving service. Originally presented in the Harvard Business Review in 1984, it has retained a strong following ever since. At present, it is experiencing a revival at numerous academic institutions. The authors of this article present the process of service blueprinting.…

Can a community-based maternal care package in rural Ethiopia increase the use of health facilities for childbirth and reduce the stillbirth rate?

Directory of Open Access Journals (Sweden)

Atnafu H

2016-08-01

Full Text Available Habtamu Atnafu, Zelalem Belete, Hirut Kinfu, Mebkyou Tadesse, Mohammed Amin, Karen D Ballard Hamlin Fistula Ethiopia, Addis Ababa Fistula Hospital, Addis Ababa, EthiopiaObjective: To measure the impact of a maternal health package on health facility delivery and stillbirth rates.Methods: This is a cross-sectional study in Ethiopia where a maternal package was integrated into eight health centers across three regions. The package included trained midwives with a mentoring program, transport for referral, and equipment and accommodation for the midwives. Ten health centers without the package but in the same districts as the intervention centers and eight without the package in different districts were randomly selected as the comparison groups. Women living in the catchment areas of the 26 health centers, who delivered a baby in the past 12 months, were randomly selected to complete a face-to-face survey about maternal health experiences.Results: The maternal package did not significantly affect the stillbirth or facility delivery rates. Women were positively influenced to deliver in a health facility if their husbands were involved in the decision concerning the place of birth and if they had prior maternal experience in the health center. Barriers to delivering in a health facility included distance and ability to read and write.Conclusion: Women served by health centers with a maternal health package did not have significantly fewer stillbirths and were not more likely to deliver their babies in a health facility. Husbands played an important role in influencing the decisions to deliver in a health facility. Keywords: maternal health, institutional delivery, stillbirth, predictive factors, Ethiopia, global health

A "client perspective" helps improve services.

Science.gov (United States)

1998-01-01

Egypt's Ministry of Health launched a campaign in 1992 to improve client satisfaction with family planning clinic services in the country. In the program, family planning clinic supervisors are being trained to use a checklist of 101 indicators to evaluate services, ranging from the availability of contraceptive commodities to the condition of facilities. Television messages and posters disseminated throughout communities instruct potential clients to look for gold stars on the doors of family planning clinics across the country, indicators of a clinic which meets quality service standards. This program is currently used by almost 4000 clinics nationwide. Family planning services worldwide have long focused upon increasing levels of contraceptive use. More recently, however, they are also focusing upon the quality of services provided. Frameworks for improving services tend to emphasize better ways to interact with clients, and often address how to approach specific management concerns, such as maintaining adequate contraceptive supplies. Client interaction, management concerns, and how quality makes a difference are discussed.

Decline in stillbirths and perinatal mortality after implementation of a more aggressive induction policy in post-date pregnancies

DEFF Research Database (Denmark)

Zizzo, Anne R.; Kirkegaard, Ida; Pinborg, Anja

2017-01-01

logistic regression analyses were used to estimate risks in the years after (2012–2014) vs. before (2008–2010) new national guidelines, adjusted for maternal age, BMI, and parity. Results: We observed a decline in stillbirths from 0.9‰ to 0.5‰ [odds ratio (OR)adjusted 0.50, 95% CI 0.29–0.89, p = 0......) earlier induction at 41+0 weeks in the case of maternal age >40 years or body mass index (BMI) >35 kg/m2 and (3) fetal surveillance at GA 41+0 weeks. Material and methods: This national cohort study included all pregnancies that reached 41+0 weeks of gestation in 2008–2014 (n = 102 167). Multivariate...... in stillbirths and perinatal mortality after implementation of new Danish guidelines for post-date pregnancies. The risk of interventions as cesarean section and vacuum extraction remained stable despite an increase in labor inductions....

Strategies for improving quality and methods for innovation services

Directory of Open Access Journals (Sweden)

Bajić Milan

2009-01-01

Full Text Available Contemporary concepts of business of service organisations, focus their researches on measuring quality of the services and identification of mistakes. The aim of strategies is the improvement of quality. Marketing concepts shows that the constant creation of new products and the modification of characteristics on the old products, makes possible market strategy that stimulates development of activities. This paper is focusing on the improving of service using the strategies that can innovate and improve the services. Paper seeks to demonstrate one of possible observations and importance of performance, combined with blueprinting of services and benchmarking as a useful strategies for improving and innovation of services.

Stillbirth and the law: options for law reform and issues for the coronial jurisdiction.

Science.gov (United States)

Freckelton, Ian

2013-09-01

In spite of its relative frequency, stillbirth is a phenomenon that has been relatively little discussed and requires further research for comprehensive clinical understanding. It impacts upon the legal system by way of the need to determine whether a life has come into being such that legal consequences such as criminal law, probate law and the coronial jurisdiction can attach to it. This requires contemporary clinically informed interpretation and application of the ancient "born alive rule" in respect of the ramifications of matters such as pulseless electrical activity in the heart, brain activity and agonal gasping. In the coronial domain, arguments have been put in South Australia, Victoria and Northern Ireland in recent cases and discussion has taken place publicly about whether coroners should be permitted to investigate and make findings and recommendations about cases of stillbirth. The article identifies merit in principle in such a development but highlights the need for care about such reform to the law lest it engender inconsistency in respect of important threshold definitions of "life" and "death" lest it generate incoherent approaches of the law on the subject, and lest it have unforeseen counter-therapeutic consequences for the grieving parents of infants who have been stillborn. It notes, too, that such a change to the ambit of coronial jurisdiction would have important resourcing ramifications.

Are consumer surveys valuable as a service improvement tool in health services? A critical appraisal.

Science.gov (United States)

Patwardhan, Anjali; Patwardhan, Prakash

2009-01-01

In the recent climate of consumerism and consumer focused care, health and social care needs to be more responsive than ever before. Consumer needs and preferences can be elicited with accepted validity and reliability only by strict methodological control, customerisation of the questionnaire and skilled interpretation. To construct, conduct, interpret and implement improved service provision, requires a trained work force and infrastructure. This article aims to appraise various aspects of consumer surveys and to assess their value as effective service improvement tools. The customer is the sole reason organisations exist. Consumer surveys are used worldwide as service and quality of care improvement tools by all types of service providers including health service providers. The article critically appraises the value of consumer surveys as service improvement tools in health services tool and its future applications. No one type of survey is the best or ideal. The key is the selection of the correct survey methodology, unique and customised for the particular type/aspect of care being evaluated. The method used should reflect the importance of the information required. Methodological rigor is essential for the effectiveness of consumer surveys as service improvement tools. Unfortunately so far there is no universal consensus on superiority of one particular methodology over another or any benefit of one specific methodology in a given situation. More training and some dedicated resource allocation is required to develop consumer surveys. More research is needed to develop specific survey methodology and evaluation techniques for improved validity and reliability of the surveys as service improvement tools. Measurement of consumer preferences/priorities, evaluation of services and key performance scores, is not easy. Consumer surveys seem impressive tools as they provide the customer a voice for change or modification. However, from a scientific point

Performance improvement plan in customer technical services

International Nuclear Information System (INIS)

Lachambre, L.

1995-01-01

This presentation centred around the philosophy, goals, and initiatives associated with Gaz Metropolitain's performance improvement plan. Various aspects of the plan including customer surveys, new customer service policies, the creation of small working units, the decentralization of the Montreal service department, and customer-harmonized shift schedules were explored. Implementation of new service plans and contracts, the formation of improvement groups related to human resources, human resource and productivity management, leadership training, and the use of performance indicators were also explained

IMMEDIATE MENTAL CONSEQUENCES OF THE GREAT EAST JAPAN EARTHQUAKE AND FUKUSHIMA NUCLEAR POWER PLANT ACCIDENT ON MOTHERS EXPERIENCING MISCARRIAGE, ABORTION, AND STILLBIRTH: THE FUKUSHIMA HEALTH MANAGEMENT SURVEY.

Science.gov (United States)

Yoshida-Komiya, Hiromi; Goto, Aya; Yasumura, Seiji; Fujimori, Keiya; Abe, Masafumi

2015-01-01

The Fukushima Pregnancy and Birth Survey was launched to monitor pregnant mothers' health after the Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant (NPP) accident. Several lines of investigations have indicated that a disaster impacts maternal mental health with childbirth. However, there is no research regarding mental health of mothers with fetal loss after a disaster. In this report, we focus on those women immediately after the Great East Japan Earthquake and Fukushima NPP accident and discuss their support needs. Data regarding 61 miscarriages, 5 abortions, and 22 stillbirths were analyzed among the women who were pregnant at the time of the accident in the present study. We used a two-item case-finding instrument for depression screening, and compared the childbirth group with the fetal loss groups. We also analyzed mothers' opinions written as free-form text. Among the three fetal loss groups, the proportion of positive depression screens was significantly higher in the miscarriage and stillbirth group than in the childbirth group. Mothers' opinions were grouped into six categories, with pregnancy-related items being most common, especially in the miscarriage and stillbirth groups. A higher proportion of Fukushima mothers with fetal loss, especially those with miscarriage and stillbirth, had depressive symptoms compared to those who experienced childbirth. Health care providers need to pay close attention to this vulnerable group and respond to their concerns regarding the effects on their fertility.

Improving Reference Service: The Case for Using a Continuous Quality Improvement Method.

Science.gov (United States)

Aluri, Rao

1993-01-01

Discusses the evaluation of library reference service; examines problems with past evaluations, including the lack of long-term planning and a systems perspective; and suggests a method for continuously monitoring and improving reference service using quality improvement tools such as checklists, cause and effect diagrams, Pareto charts, and…

Improving Motivation in the Service Department

OpenAIRE

Sosingot-Sundström, Sevarine

2015-01-01

The objective of this study is to improve motivation of the employees in the Service Department. What motivates employees in this century beyond the normal norms of job security and money. The study is based on improving the motivation of the Service Department of Company X. This research was based on the service’s department low score in motivation after the results of the 2012 annual staff survey. The research aims to find out the cause(s) for the low motivation and also find a solution tha...

A model for ageing-home-care service process improvement

OpenAIRE

Yu, Shu-Yan; Shie, An-Jin

2017-01-01

The purpose of this study was to develop an integrated model to improve service processes in ageing-home-care. According to the literature, existing service processes have potential service failures that affect service quality and efficacy. However, most previous studies have only focused on conceptual model development using New Service Development (NSD) and fail to provide a systematic model to analyse potential service failures and facilitate managers developing solutions to improve the se...

Causes of death among full term stillbirths and early neonatal deaths in the Region of Southern Denmark.

Science.gov (United States)

Basu, Millie Nguyen; Johnsen, Iben Birgit Gade; Wehberg, Sonja; Sørensen, Rikke Guldberg; Barington, Torben; Nørgård, Bente Mertz

2018-02-23

We examined the causes of death amongst full term stillbirths and early neonatal deaths. Our cohort includes women in the Region of Southern Denmark, who gave birth at full term to a stillborn infant or a neonate who died within the first 7 days from 2010 through 2014. Demographic, biometric and clinical variables were analyzed to assess the causes of death using two classification systems: causes of death and associated conditions (CODAC) and a Danish system based on initial causes of fetal death (INCODE). A total of 95 maternal-infant cases were included. Using the CODAC and INCODE classification systems, we found that the causes of death were unknown in 59/95 (62.1%). The second most common cause of death in CODAC was congenital anomalies in 10/95 (10.5%), similar to INCODE with fetal, genetic, structural and karyotypic anomalies in 11/95 (11.6%). The majority of the mothers were healthy, primiparous, non-smokers, aged 20-34 years and with a normal body mass index (BMI). Based on an unselected cohort from an entire region in Denmark, the cause of stillbirth and early neonatal deaths among full term infants remained unknown for the vast majority.

Placental Dysfunction Underlies Increased Risk of Fetal Growth Restriction and Stillbirth in Advanced Maternal Age Women.

Science.gov (United States)

Lean, Samantha C; Heazell, Alexander E P; Dilworth, Mark R; Mills, Tracey A; Jones, Rebecca L

2017-08-29

Pregnancies in women of advanced maternal age (AMA) are susceptible to fetal growth restriction (FGR) and stillbirth. We hypothesised that maternal ageing is associated with utero-placental dysfunction, predisposing to adverse fetal outcomes. Women of AMA (≥35 years) and young controls (20-30 years) with uncomplicated pregnancies were studied. Placentas from AMA women exhibited increased syncytial nuclear aggregates and decreased proliferation, and had increased amino acid transporter activity. Chorionic plate and myometrial artery relaxation was increased compared to controls. AMA was associated with lower maternal serum PAPP-A and sFlt and a higher PlGF:sFlt ratio. AMA mice (38-41 weeks) at E17.5 had fewer pups, more late fetal deaths, reduced fetal weight, increased placental weight and reduced fetal:placental weight ratio compared to 8-12 week controls. Maternofetal clearance of 14 C-MeAIB and 3 H-taurine was reduced and uterine arteries showed increased relaxation. These studies identify reduced placental efficiency and altered placental function with AMA in women, with evidence of placental adaptations in normal pregnancies. The AMA mouse model complements the human studies, demonstrating high rates of adverse fetal outcomes and commonalities in placental phenotype. These findings highlight placental dysfunction as a potential mechanism for susceptibility to FGR and stillbirth with AMA.

Improving Indonesian Construction Consulting Services

Directory of Open Access Journals (Sweden)

Rizal Z. Tamin

2015-05-01

Full Text Available Indonesian construction consulting services are facing a complex problem in fulfilling the nation’s expectations regarding high quality infrastructure development and the construction industry’s competitiveness. A study of this problem and a formulation of solutions to improve the situation are presented in this paper. A survey was carried out in Jakarta, West Java, East Java, and North Sumatra provinces to collect data related to this problem. A focus group discussion and a workshop with all stakeholders were conducted to formulate improvement actions that need to be taken. It was revealed that the problems faced include, among others, the limited number of professional engineers compared to the number of national consultancy companies, the uneven distribution of engineers in Indonesian regions, an imperfect procurement system, and low-quality work output in general. Recommended actions include improvement of the government’s role in consulting services nurturing and facilitation, development of partnerships, and amelioration of the professional engineer and consultant certification system.

Zika Virus Infection and Stillbirths: A Case of Hydrops Fetalis, Hydranencephaly and Fetal Demise.

Directory of Open Access Journals (Sweden)

Manoel Sarno

2016-02-01

Full Text Available The rapid spread of Zika virus in the Americas and current outbreak of microcephaly in Brazil has raised attention to the possible deleterious effects that the virus may have on fetuses.We report a case of a 20-year-old pregnant woman who was referred to our service after a large Zika virus outbreak in the city of Salvador, Brazil with an ultrasound examination that showed intrauterine growth retardation of the fetus at the 18th gestational week. Ultrasound examinations in the 2nd and 3rd trimesters demonstrated severe microcephaly, hydranencephaly, intracranial calcifications and destructive lesions of posterior fossa, in addition to hydrothorax, ascites and subcutaneous edema. An induced labor was performed at the 32nd gestational week due to fetal demise and delivered a female fetus. ZIKV-specific real-time polymerase chain reaction amplification products were obtained from extracts of cerebral cortex, medulla oblongata and cerebrospinal and amniotic fluid, while extracts of heart, lung, liver, vitreous body of the eye and placenta did not yield detectable products.This case report provides evidence that in addition to microcephaly, there may be a link between Zika virus infection and hydrops fetalis and fetal demise. Given the recent spread of the virus, systematic investigation of spontaneous abortions and stillbirths may be warranted to evaluate the risk that ZIKV infection imparts on these outcomes.

Zika Virus Infection and Stillbirths: A Case of Hydrops Fetalis, Hydranencephaly and Fetal Demise.

Science.gov (United States)

Sarno, Manoel; Sacramento, Gielson A; Khouri, Ricardo; do Rosário, Mateus S; Costa, Federico; Archanjo, Gracinda; Santos, Luciane A; Nery, Nivison; Vasilakis, Nikos; Ko, Albert I; de Almeida, Antonio R P

2016-02-01

The rapid spread of Zika virus in the Americas and current outbreak of microcephaly in Brazil has raised attention to the possible deleterious effects that the virus may have on fetuses. We report a case of a 20-year-old pregnant woman who was referred to our service after a large Zika virus outbreak in the city of Salvador, Brazil with an ultrasound examination that showed intrauterine growth retardation of the fetus at the 18th gestational week. Ultrasound examinations in the 2nd and 3rd trimesters demonstrated severe microcephaly, hydranencephaly, intracranial calcifications and destructive lesions of posterior fossa, in addition to hydrothorax, ascites and subcutaneous edema. An induced labor was performed at the 32nd gestational week due to fetal demise and delivered a female fetus. ZIKV-specific real-time polymerase chain reaction amplification products were obtained from extracts of cerebral cortex, medulla oblongata and cerebrospinal and amniotic fluid, while extracts of heart, lung, liver, vitreous body of the eye and placenta did not yield detectable products. This case report provides evidence that in addition to microcephaly, there may be a link between Zika virus infection and hydrops fetalis and fetal demise. Given the recent spread of the virus, systematic investigation of spontaneous abortions and stillbirths may be warranted to evaluate the risk that ZIKV infection imparts on these outcomes.

Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality

Directory of Open Access Journals (Sweden)

Berman Stuart

2011-04-01

Full Text Available Abstract Background Globally syphilis is an important yet preventable cause of stillbirth, neonatal mortality and morbidity. Objectives This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4MU benzathine penicillin (or equivalent on syphilis-related stillbirths and neonatal mortality. Methods We conducted a systematic literature review of multiple databases to identify relevant studies. Data were abstracted into standardised tables and the quality of evidence was assessed using adapted GRADE criteria. Where appropriate, meta-analyses were undertaken. Results Moderate quality evidence (3 studies supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98% with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin. The results of meta-analyses suggest that treatment with penicillin is associated with an 82% reduction in stillbirth (95% c.i. 67 – 90% (8 studies, a 64% reduction in preterm delivery (95% c.i. 53 – 73% (7 studies and an 80% reduction in neonatal deaths (95% c.i. 68 – 87% (5 studies. Although these effect estimates were large and remarkably consistent across studies, few of the studies adjusted for potential confounding factors and thus the overall quality of the evidence was considered low. However, given these large observed effects and a clear biological mechanism for effectiveness the GRADE recommendation is strong. Conclusion Detection and appropriate, timely penicillin treatment is a highly effective intervention to reduce adverse syphilis-related pregnancy outcomes. More research is required to identify the most cost-effective strategies for achieving maximum coverage of screening for all pregnant women, and access to treatment if required.

Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality

Science.gov (United States)

2011-01-01

Background Globally syphilis is an important yet preventable cause of stillbirth, neonatal mortality and morbidity. Objectives This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4MU benzathine penicillin (or equivalent) on syphilis-related stillbirths and neonatal mortality. Methods We conducted a systematic literature review of multiple databases to identify relevant studies. Data were abstracted into standardised tables and the quality of evidence was assessed using adapted GRADE criteria. Where appropriate, meta-analyses were undertaken. Results Moderate quality evidence (3 studies) supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98%) with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin. The results of meta-analyses suggest that treatment with penicillin is associated with an 82% reduction in stillbirth (95% c.i. 67 – 90%) (8 studies), a 64% reduction in preterm delivery (95% c.i. 53 – 73%) (7 studies) and an 80% reduction in neonatal deaths (95% c.i. 68 – 87%) (5 studies). Although these effect estimates were large and remarkably consistent across studies, few of the studies adjusted for potential confounding factors and thus the overall quality of the evidence was considered low. However, given these large observed effects and a clear biological mechanism for effectiveness the GRADE recommendation is strong. Conclusion Detection and appropriate, timely penicillin treatment is a highly effective intervention to reduce adverse syphilis-related pregnancy outcomes. More research is required to identify the most cost-effective strategies for achieving maximum coverage of screening for all pregnant women, and access to treatment if required. PMID:21501460

Do efforts to standardize, assess and improve the quality of health service provision to adolescents by government-run health services in low and middle income countries, lead to improvements in service-quality and service-utilization by adolescents?

Science.gov (United States)

Chandra-Mouli, Venkatraman; Chatterjee, Subidita; Bose, Krishna

2016-02-06

Researchers and implementers working in adolescent health, and adolescents themselves question whether government-run health services in conservative and resource-constrained settings can be made adolescent friendly. This paper aims to find out what selected low and middle income country (LMIC) governments have set out to do to improve the quality of health service provision to adolescents; whether their efforts led to measurable improvements in quality and to increased health service-utilization by adolescents. We gathered normative guidance and reports from eight LMICs in Asia, Africa, Central and Eastern Europe and the Western Pacific. We analysed national quality standards for adolescent friendly health services, findings from the assessments of the quality of health service provision, and findings on the utilization of health services. Governments of LMICs have set out to improve the accessibility, acceptability, equity, appropriateness and effectiveness of health service provision to adolescents by defining standards and actions to achieve them. Their actions have led to measurable improvements in quality and to increases in health service utilisation by adolescents. With support, government-run health facilities in LMICs can improve the quality of health services and their utilization by adolescents.

Improved methods for operating public transportation services.

Science.gov (United States)

2013-03-01

In this joint project, West Virginia University and the University of Maryland collaborated in developing improved methods for analyzing and managing public transportation services. Transit travel time data were collected using GPS tracking services ...

Factors associated with the grief after stillbirth: a comparative study between Brazilian and Canadian women

Directory of Open Access Journals (Sweden)

Gisele Ferreira Paris

Full Text Available Abstract OBJECTIVE To verify the association between complicated grief and sociodemographic, reproductive, mental, marital satisfaction, and professional support characteristics in women after stillbirth. METHOD Cross-sectional study with 26 women who had stillbirth in 2013, living in the city of Maringá, Brazil, and eight women who attended the Centre d'Études et de Rechercheen Intervention Familiale at the University of Quebec en Outaouais, in Canada. The instrument was administered as an interview to a small number of mothers of infants up to three months (n=50, who did not participate in the validation study. RESULTS By applying the short version of the Perinatal Grief Scale, the prevalence of complicated grief in Brazilian women was found to be higher (35% in relation to Canadian women (12%.Characteristics of the Brazilian women associated with the grief period included the presence of previous pregnancy with live birth, absence of previous perinatal loss, postpartum depression, and lack of marital satisfaction. For the Canadians it was observed that 80% of the women presenting no grief made use of the professional support group. In both populations the occurrence of complicated grief presented a higher prevalence in women with duration of pregnancy higher than 28 weeks. CONCLUSION The women that must be further investigated during the grief period are those living in Brazil, making no use of a professional support group, presenting little to no marital satisfaction, having no religion, and of a low educational level.

Improving Service Delivery of the Finance and Budget Section ...

African Journals Online (AJOL)

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Action research was conducted in May and June 2004 aimed at improving service delivery of ... improve service delivery. (Quinby,1985). Furthermore, the intervention stage in which the development of ..... Educational leadership,. 42, 17-21.

Climate Services to Improve Public Health

Science.gov (United States)

Jancloes, Michel; Thomson, Madeleine; Costa, María Máñez; Hewitt, Chris; Corvalan, Carlos; Dinku, Tufa; Lowe, Rachel; Hayden, Mary

2014-01-01

A high level expert panel discussed how climate and health services could best collaborate to improve public health. This was on the agenda of the recent Third International Climate Services Conference, held in Montego Bay, Jamaica, 4–6 December 2013. Issues and challenges concerning a demand led approach to serve the health sector needs, were identified and analysed. Important recommendations emerged to ensure that innovative collaboration between climate and health services assist decision-making processes and the management of climate-sensitive health risk. Key recommendations included: a move from risk assessment towards risk management; the engagement of the public health community with both the climate sector and development sectors, whose decisions impact on health, particularly the most vulnerable; to increase operational research on the use of policy-relevant climate information to manage climate- sensitive health risks; and to develop in-country capacities to improve local knowledge (including collection of epidemiological, climate and socio-economic data), along with institutional interaction with policy makers. PMID:24776719

Impact of exposure to cooking fuels on stillbirths, perinatal, very early and late neonatal mortality - a multicenter prospective cohort study in rural communities in India, Pakistan, Kenya, Zambia and Guatemala.

Science.gov (United States)

Patel, Archana B; Meleth, Sreelatha; Pasha, Omrana; Goudar, Shivaprasad S; Esamai, Fabian; Garces, Ana L; Chomba, Elwyn; McClure, Elizabeth M; Wright, Linda L; Koso-Thomas, Marion; Moore, Janet L; Saleem, Sarah; Liechty, Edward A; Goldenberg, Robert L; Derman, Richard J; Hambidge, K Michael; Carlo, Waldemar A; Hibberd, Patricia L

2015-01-01

Consequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on neonatal deaths and stillbirths is poorly understood. In a large multi-country observational study, we examined whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20 and deaths through day 7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal mortality (day 0-2) and later neonatal mortality (day 3-28). Questions addressing household fuel use were asked at pregnancy, delivery, and neonatal follow-up visits in a prospective cohort study of pregnant women in rural communities in five low and lower middle income countries participating in the Global Network for Women and Children's Health's Maternal and Newborn Health Registry. The study was conducted between May 2011 and October 2012. Polluting fuels included kerosene, charcoal, coal, wood, straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG), natural gas and biogas. We studied the outcomes of 65,912 singleton pregnancies, 18 % from households using clean fuels (59 % LPG) and 82 % from households using polluting fuels (86 % wood). Compared to households cooking with clean fuels, there was an increased risk of perinatal mortality among households using polluting fuels (adjusted relative risk (aRR) 1.44, 95 % confidence interval (CI) 1.30-1.61). Exposure to HAP increased the risk of having a macerated stillbirth (adjusted odds ratio (aOR) 1.66, 95%CI 1.23-2.25), non-macerated stillbirth (aOR 1.43, 95 % CI 1.15-1.85) and very early neonatal mortality (aOR 1.82, 95 % CI 1.47-2.22). Perinatal mortality was associated with exposure to HAP from week 20 of pregnancy through at least day 2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels on global perinatal mortality may have previously been underestimated. Clinical

Improving processes in financial service organizations: where to begin?

NARCIS (Netherlands)

Lokkerbol, J.; Does, R.J.M.M.; de Mast, J.; Schoonhoven, M.

2012-01-01

Purpose - The purpose of this paper is to create actionable knowledge, thereby supporting and stimulating practitioners to improve processes in the financial services sector. Design/methodology/approach - This paper is based on a case base of improvement projects in financial service organizations.

Voice of the customer---a roadmap for service improvement.

Science.gov (United States)

Uberoi, Ravinder S; Nayak, Yogamaya; Sachdeva, Pritindira; Sibal, Anupam

2013-01-01

Patient satisfaction surveys help a great deal in identifying ways of improving a hospital's services. Ultimately, that translates into better care and happier patients. Moreover, it shows the staff and the community that the hospital is serious about quality and is looking for ways to improve. This article describes how the Voice of the Customer (VOC) Survey can be used as a tool for improving services. Regular monitoring of VOC scores is essential for minimizing the gaps between service delivery and patient expectations. The present study showcases the various initiatives undertaken to improve the VOC scores from an original 4.40 to 4.77 (on a 5 point scale) at the hospital under study.

Measures to improve the quality of hotel services

Directory of Open Access Journals (Sweden)

Anca MADAR

2017-07-01

Full Text Available This article aims to exemplify how, starting from the evaluation of customer satisfaction on service quality, the hotel units’ management, can apply different measures and strategies to improve it. To achieve the target, a marketing research survey is conducted based on a sample of 120 customers of Hotel „Kronwell” at the end of 2013. After analysing customer’ responses a series of measures have been taken to improve the quality of services offered by this hotel, then at the end of 2015 a new research was achieved, based on the same questionnaire. The results of this research highlight the increasing of customer satisfaction as a result of improving the quality of hotel services, supported by growth in net profit, turnover and decrease of employees’ number.

Improving ecosystem service frameworks to address wicked problems

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Kathryn K. Davies

2015-06-01

Full Text Available Complex problems often result from the multiple interactions between human activities and ecosystems. The interconnected nature of ecological and social systems should be considered if these "wicked problems" are to be addressed. Ecosystem service approaches provide an opportunity to link ecosystem function with social values, but in practice the essential role that social dynamics play in the delivery of outcomes remains largely unexplored. Social factors such as management regimes, power relationships, skills, and values, can dramatically affect the definition and delivery of ecosystem services. Input from a diverse group of stakeholders improves the capacity of ecosystem service approaches to address wicked problems by acknowledging diverse sets of values and accounting for conflicting world views. Participatory modeling can incorporate both social and ecological dynamics into decision making that involves stakeholders, but is itself a complex social undertaking that may not yield precise or predictable outcomes. We explore the efficacy of different types of participatory modeling in relation to the integration of social values into ecosystem services frameworks and the generation of four important elements of social capital needed to address wicked problems: enhancing social learning and capacity building; increasing transparency; mediating power; and building trust. Our findings indicate that mediated modeling, group mapping, and mental/conceptual modeling are likely to generate elements of social capital that can improve ecosystem service frameworks. Participatory simulation, system dynamic modeling, and Bayesian belief networks, if utilized in isolation, were found to have a low likelihood of generating the social capital needed to improve ecosystem services frameworks. Scenario planning, companion modeling, group model building, and participatory mapping all generate a moderate to high level of social capital elements that improve the

Applying GRA and QFD to Improve Library Service Quality

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Chen, Yen-Ting; Chou, Tsung-Yu

2011-01-01

This paper applied Grey Relational Analysis (GRA) to Quality Function Deployment (QFD) to identify service improvement techniques for an academic library. First, reader needs and their importance, and satisfaction degrees were examined via questionnaires. Second, the service improvement techniques for satisfying the reader needs were developed by…

Investigation of stillbirths, perinatal mortality and weakness in beef calves with low-selenium whole blood concentrations

Directory of Open Access Journals (Sweden)

Anthony J. Davis

2016-07-01

Full Text Available In this on-farm investigation, we report on stillbirths, weakness and perinatal mortality seen in calves on a commercial beef farm in the Roossenekal area, Mpumalanga province, South Africa. Post-mortem examination of these calves and histopathological examination of organ and tissue samples did not indicate an infectious aetiology. Affected calves had marginal to deficient whole blood selenium concentrations. Whole blood samples collected from adult cattle on this farm and five neighbouring farms were deficient in selenium. The potential contributions of other minerals to the symptoms seen are a subject of ongoing investigation, but selenium deficiency was marked in this herd and required urgent correction. Methods to correct the deficiency included the use of injectable products, and an oral selenium supplement chelated to methionine. Selenium availability to plants is primarily determined by the selenium content of the parent bedrock, the presence of other minerals and the pH of the soil. The apparent sudden onset of this problem implicates a soil factor as being responsible for reducing selenium’s bioavailability in this area. Selenium deficiency can have a significant impact on human health. HIV and/or AIDS, various forms of cancer and several specific clinical syndromes are associated with selenium deficiency in humans, and the impact on human health in this area also requires further investigation. Keywords: vitamin E; selenium deficiency; cattle; one-health; Mpumalanga Province; soil pH; acid rain; stillbirths; white muscle disease; HIV

Determining service improvement priority in a zoological park

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Ronald Sukwadi

2014-01-01

Full Text Available Purpose: The objective of this research is to determine the service improvement priority based on tourist judgements and experiences on service quality in a zoological park. Design/methodology/approach: A powerful integrated model was developed to acquire accurate critical service attributes and their priority ranks that can promote tourist satisfaction and tourist loyalty. Drawing on relevant literature, a model was proposed based on tourists’ perspective by integrating structural equation model (SEM with SERVQUAL and refined Kano models. Findings and Originality/value: Based on the analysis of data through some quantitative tools, the study helped in prioritizing the critical service attributes, which, if adopted, improved, and implemented, could lead to satisfaction of tourists. This will help a zoological park to propose more efficient and value-added improvement policies of the service Research limitations/implications: The primary limitation in the scope its sample. Because the study involved only one Zoological Park in Indonesia, the results cannot be generalized across a national wide spectrum. Originality/value: The study was the first to successfully apply an integrated model in tourism sector, which has previously not been used. The study has hopefully opened up an area of research and methodology that could provide considerable further benefits for researchers interested in this topic. Moreover, the integrated model has proven to be useful in determining the priority rank of critical service quality attributes.

Improved servicing equipment for steam generators

International Nuclear Information System (INIS)

Hedtke, James C.

1998-01-01

To help keep personnel exposure as low as reasonably achievable and reduce critical path outage time, most nuclear plants of PWR design in the USA are now using improved equipment to service their steam generators (SGs) during outages. Because of the success of this equipment in the USA, two Belgian plants and one English plant have purchased this equipment, and other nuclear plants in Europe are also considering procurement. The improved SG servicing equipment discussed in this paper discusses consists of nozzle dams, segmented multi-stud tensioner, primary manway cover handling tool set, shield door and fastener cleaner. This equipment is specifically designed for the individual plant application and can also be specified for replacement SG projects. All of the equipment can be used without modification of the existing SGs. (author)

MULTIMODAL FEEDBACK PROVISION IN IMPROVING PRE-SERVICE TEACHERS’ COMPETENCE

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Fazri Nur Yusuf

2017-09-01

Full Text Available Studies on potentials of feedback over English language teaching seem not to have not been well-revealed, including studies on the use of feedback to improve English pre-service teachers’ competence. The present study investigates to what extent a multimodal feedback can influence pre-service teachers’ teaching, and which teaching aspects are influenced. Twenty five pre-service teachers taking Microteaching Course served as respondents supervised by a course advisor. The data were collected by teacher observation in a rating-scale form, self-appraisal, and interviews. The data were analyzed by using correlated sample t-test and the eight teaching components proposed by Brown (2001. The results showed that after multimodal feedback provision, pre-service teachers indicated an improvement significantly in seven out of eight teaching aspects. The provision of multimodal feedback could improve their teaching competence on preparation, instructional objective elicitation, mastery of instructional materials, use of media, and classroom management, including classroom language. But, the results do not indicate that they perform well on reflection and follow-up due to some reasons. In addition, the results evince that multimodal feedback provision could improve pre-service teachers’ pedagogical competence when the multimodal feedback is integrated with content, interpersonal relationship, and management.

Effective interventions on service quality improvement in a physiotherapy clinic.

Science.gov (United States)

Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

2014-01-01

Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (PService quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

Effect of parents occupational exposures on risk of stillbirth, preterm delivery, and small-for-gestational-age in infants

International Nuclear Information System (INIS)

Savitz, D.A.; Whelan, E.A.; Kleckner, R.C.

1989-01-01

Epidemiologic research on the effects of parental occupational exposures on fetal development has been limited. The National Natality and Fetal Mortality surveys obtained applicable data of probability samples of live births and fetal deaths which occurred in the US in 1980 among married women. Analyses were conducted for case groups of stillbirths (2,096 mothers, 3,170 fathers), preterm deliveries (<37 weeks completed gestation) (363 mothers, 552 fathers), and small-for gestational-age infants (218 mothers, 371 fathers) compared with controls. Occupational exposures were defined by industry of employment and by imputed exposures based on a job-exposure linkage system. For stillbirth, maternal work in the rubber, plastics, and synthetics industry and lead exposure and paternal employment in the textile industry had the largest odds ratios. Preterm birth was most strongly associated with maternal lead exposure, corroborating previous findings. Twofold increased risk of preterm delivery was found with paternal employment in the glass, clay, and stone; textile; and mining industries. Paternal exposures to x-rays and polyvinyl alcohol were associated with 1.5-fold increase in risk. The occupation of the mother was not associated with delivery of a small-for-gestational-age infant, in contrast to paternal employment in the art and textile industries. Several toxic agents were associated with risk elevation of 1.3 or greater for fathers, most notably benzene

The Climate Services Partnership (CSP): Working Together to Improve Climate Services Worldwide

Science.gov (United States)

Zebiak, S.; Brasseur, G.; Members of the CSP Coordinating Group

2012-04-01

Throughout the world, climate services are required to address urgent needs for climate-informed decision-making, policy and planning. These needs were explored in detail at the first International Conference on Climate Services (ICCS), held in New York in October 2011. After lengthy discussions of needs and capabilities, the conference culminated in the creation of the Climate Services Partnership (CSP). The CSP is an informal interdisciplinary network of climate information users, providers, donors and researchers interested in improving the provision and development of climate services worldwide. Members of the Climate Services Partnership work together to share knowledge, accelerate learning, develop new capacities, and establish good practices. These collaborative efforts will inform and support the evolution and implementation of the Global Framework for Climate Services. The Climate Services Partnership focuses its efforts on three levels. These include: 1. encouraging and sustaining connections between climate information providers, users, donors, and researchers 2. gathering, synthesizing and disseminating current knowledge on climate services by way of an online knowledge management platform 3. generating new knowledge on critical topics in climate service development and provision, through the creation of focused working groups on specific topics To date, the Climate Services Partnership has made progress on all three fronts. Connections have been fostered through outreach at major international conferences and professional societies. The CSP also maintains a website and a monthly newsletter, which serves as a resource for those interested in climate services. The second International Conference on Climate Services (ICCS2) will be held in Berlin in September. The CSP has also created a knowledge capture system that gathers and disseminates a wide range of information related to the development and provision of climate services. This includes an online

Is ambient heat exposure levels associated with miscarriage or stillbirths in hot regions? A cross-sectional study using survey data from the Ghana Maternal Health Survey 2007

Science.gov (United States)

Asamoah, Benedict; Kjellstrom, Tord; Östergren, Per-Olof

2018-03-01

It is well established that high ambient heat could cause congenital abnormalities resulting in miscarriage or stillbirth among certain species of mammals. However, this has not been systematically studied in real field settings among humans, despite the potential value of such knowledge for estimating the impact of global warming on the human species. This study sought to test the hypothesis that maternal heat exposure during pregnancy in hot regions is associated with increased prevalence of spontaneous abortions or stillbirths and to develop an analytical strategy to use existing data from maternal health surveys and existing data on historical heat levels at a geographic grid cell level. A subsample of the Ghana Maternal Health Survey 2007 was used in this study. This study sample consisted of 1136 women with pregnancy experiences between 2004 and 2007, out of which 141 women had a pregnancy that terminated in miscarriage or stillbirth. Induced-abortion cases were excluded. The linkage between ambient heat exposure and pregnancy outcome followed the epidemiological time-place-person principle, by linking timing of pregnancy outcome with historical data of local area heat levels for each month, as estimated in an international database. Maternal heat exposure level was estimated using calculated levels of the wet-bulb globe temperature (WBGT), which takes into account temperature, humidity, heat radiation, and air movement over the skin (wind speed). The values we used applied to exposure in the shade or in buildings without cooling (no solar heat radiation) and a standard air movement of 1 m/s. We applied two exposure durations: yearly average and monthly average for second month of pregnancy. In one analysis, we restricted the sample to four regions with time-homogeneous ambient heat. Analysis was made using logistic regression. About 12% of the latest pregnancies ended in either miscarriage (9.6%) or stillbirth (2.8%). The odds ratios indicated 12 to 15

Partnership working and improved service delivery: views of staff providing sexual health services.

Science.gov (United States)

Pow, Janette; Elliott, Lawrie; Raeside, Robert; Themessl-Huber, Markus; Claveirole, Anne

2013-07-01

Successful partnership working has theoretically been linked to improvements in service delivery and is dependent on the strength of the partnership, trust, communication, professional roles and resource sharing. Empirical evidence to confirm the relationships between these factors and improved service provision, however, is lacking. Our aim was to assess the views of staff as to the conditions required for partnership working. This study was a cross-sectional survey of 687 staff offering sexual health education, information or support to young people in the Healthy Respect intervention area in Scotland. Views of each variable were scored and structural equation modelling was used to assess the theoretical model. Responses were received from 284 (41%) staff. Greater strength of partnership was directly associated with increasing the number of referrals. Establishing professional roles between organizations was also associated with increasing the number of referrals. Strength of partnership was indirectly associated with working more effectively with young people and this relationship depended on clear communication, trust, established professional roles and shared resources. Effective partnership working depends on a number of interdependent relationships between organizations, which act synergistically to improve organizational outcomes. Effective partnership working leads to improved service delivery though there is a need for better controlled studies which demonstrate the effect on health outcomes.

A qualitative study of attitudes and values surrounding stillbirth and neonatal mortality among grandmothers, mothers, and unmarried girls in rural Amhara and Oromiya regions, Ethiopia: unheard souls in the backyard.

Science.gov (United States)

Sisay, Mitike Molla; Yirgu, Robel; Gobezayehu, Abebe Gebremariam; Sibley, Lynn M

2014-01-01

In Ethiopia, neonatal mortality and stillbirth are high and underreported. This study explored values related to neonatal mortality and stillbirth and the visibility of these deaths in rural Ethiopia among 3 generations of women. We conducted a qualitative study in 6 rural districts of the Oromiya and Amhara regional states during May 2012. We included 30 focus groups representing grandmothers, married women (mothers), and unmarried girls in randomly selected kebeles (villages). Until the 40th day of life, neonates are considered to be strangers to the community (not human). Their deaths are not talked about; they are buried in the house or in the backyard. Mothers are forbidden to mourn their loss lest they offend God and bring on future neonatal losses. Women who repeatedly lose their neonates may be blamed, mistreated, and dishonored through divorce. Neonatal death and stillbirth are attributed to supernatural powers, although some women and girls associate these deaths with poverty and lack of education. The desire for increased visibility of neonatal death is mixed. Unlike the grandmothers and unmarried girls, most of the married women want death to be visible to draw the attention of policy makers. Women prefer home birth and consider themselves lucky to be able to give birth at home. At present, there is no national vital registration system. Neonatal death and stillbirth are hidden and the magnitude is likely underrepresented. The delayed recognition of personhood, attribution of death to supernatural causes, social repercussions for women who experience a pregnancy loss, preference for home birth, and lack of a vital registration system all contribute to the invisibility of perinatal deaths. Increasing the visibility of (and counting) these deaths may require multifaceted behavior-change interventions. © 2014 by the American College of Nurse-Midwives.

Room service improves patient food intake and satisfaction with hospital food.

Science.gov (United States)

Williams, R; Virtue, K; Adkins, A

1998-07-01

Cancer therapy causes side effects that interfere with oral intake. Frequently, patients undergoing such therapy suffer from anorexia, nausea, vomiting, food aversions, dysgeusia, and xerostomia, all which adversely affect oral intake. Adequate nutrition intake is an important part of therapy for the cancer patient, especially when that patient is a child. Children who are well nourished are better able to withstand infection and tolerate therapy. Parents and staff at our hospital have worked diligently to improve patient's oral intake with limited success. Hence, a multidisciplinary team was organized to develop a new approach to food services that would improve patients' oral intake. The team initiated patient "room service," and patients were allowed to call the kitchen when they were ready to eat. The system works much like room service in a hotel. After the introduction of room service, patients' caloric intake improved significantly (P = .008), and protein intake increased by 18%. Patient satisfaction with hospital food service also improved; excellent ratings increased by as much as 35%. We conclude that room service is a viable alternative to traditional food services in the pediatric oncology setting and may be useful in other patient populations, such as maternity and general pediatrics.

Assessing customer satisfaction for improving NOAA's climate products and services

Science.gov (United States)

Meyers, J. C.; Hawkins, M. D.; Timofeyeva, M. M.

2009-12-01

NOAA's National Weather Service (NWS) Climate Services Division (CSD) is developing a comprehensive climate user requirements process with the ultimate goal of producing climate services that meet the needs of NWS climate information users. An important part of this effort includes engaging users through periodical surveys conducted by the Claes Fornell International (CFI) Group using the American Customer Satisfaction Index (ACSI). The CFI Group conducted a Climate Services Satisfaction (CSS) Survey in May of 2009 to measure customer satisfaction with current products and services and to gain insight on areas for improvement. The CSS Survey rates customer satisfaction on a range of NWS climate services data and products, including Climate Prediction Center (CPC) outlooks, drought monitoring, and ENSO monitoring and forecasts, as well as NWS local climate data services. In addition, the survey assesses the users of the products to give the NWS insight into its climate customer base. The survey also addresses specific topics such as NWS forecast category names, probabilistic nature of climate products, and interpretation issues. The survey results identify user requirements for improving existing NWS climate services and introducing new ones. CSD will merge the survey recommendations with available scientific methodologies and operational capabilities to develop requirements for improved climate products and services. An overview of the 2009 survey results will be presented, such as users' satisfaction with the accuracy, reliability, display and functionality of products and services.

Assessment of Extension Service Delivery on Improved Cassava ...

African Journals Online (AJOL)

Extension service delivery is too often merely seen as a vehicle for spreading scientific and technical progress and technology transfer. In the real sense, however, dissemination of knowledge is not a one way affair from scientists to producers. The study was conducted to assess extension service delivery on improved ...

The quality infrastructure measuring, analyzing, and improving library services

CERN Document Server

Murphy, Sarah Anne

2013-01-01

Summarizing specific tools for measuring service quality alongside tips for using these tools most effectively, this book helps libraries of all kinds take a programmatic approach to measuring, analyzing, and improving library services.

Improving coal quality and service

Energy Technology Data Exchange (ETDEWEB)

NONE

2001-06-01

Russia's new coal export industry has quickly produced a generation of extremely experienced operators. While improvements are happening, can buyers also expect the service, flexibility and quality control that they get from other export sources? In the light of the first-ever Coaltrans Russia conference held in April the article reports on developments in Russia's coal industry, quoting from many of the papers presented. 5 photos.

Placental telomere shortening in stillbirth: a sign of premature senescence?

Science.gov (United States)

Ferrari, Francesca; Facchinetti, Fabio; Saade, George; Menon, Ramkumar

2016-01-01

The objective of this study is to investigate placental telomere shortening in unexplained stillbirths (SBs) as an indication of premature senescence. Placentas were collected from 42 unexplained SB (>22 weeks), 43 term and 15 preterm live births, at the Policlinico Hospital of Modena (Italy). DNA extracted from placentae was studied for telomere length by real time PCR. Standard curves were generated for telomere lengths from single copy gene amplifications using a reference DNA. The telomere length for each sample was derived based on the ratio of telomere length between the sample and single copy gene standard (T/S ratio). The mean ratio of placental telomere in term live births was 5.181 ± 3.841. A twofold decrease in telomere length was seen in SBs (over all 2.455 ± 1.239; p PTBs) (6.382 ± 5.525; p < 0.01), whereas SBs telomere length were similar to those of preterm premature rupture of membranes (pPROM) (3.296 ± 3.599; p = ns). Substantial reduction in telomere length in SBs is indicative of placental senescence. These data provide mechanistic insights that premature aging may lead to placental dysfunction as an initiator of fetal demise in unexplained SBs.

Improving service quality in NHS Trust hospitals: lessons from the hotel sector.

Science.gov (United States)

Desombre, T; Eccles, G

1998-01-01

This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction.

Quality-improvement initiatives focused on enhancing customer service in the outpatient pharmacy.

Science.gov (United States)

Poulin, Tenley J; Bain, Kevin T; Balderose, Bonnie K

2015-09-01

The development and implementation of quality-improvement initiatives to enhance customer service in an outpatient pharmacy of a Veterans Affairs (VA) medical center are described. Historically low customer service satisfaction rates with the outpatient pharmacy at the Philadelphia Veterans Affairs Medical Center prompted this quality-improvement project. A three-question survey was designed to be easily and quickly administered to veterans in the outpatient pharmacy waiting area. Using 5-point Likert scale, veterans were asked to rate (1) their overall experience with the outpatient pharmacy service and (2) their satisfaction with the customer service provided by the pharmacy department. They were also asked how they thought the pharmacy department could improve its customer service. After receiving feedback from the survey, several quality-improvement initiatives were developed. The initiatives were categorized as environmental, personnel, communicative, and technological. For each initiative, one or more tasks were developed and the initiatives were subsequently implemented over eight months. After each task was completed, veterans were surveyed to measure the impact of the change. A total of 79 veterans were surveyed before the implementation of the quality-improvement initiatives, and 49% and 68% rated their experience with the outpatient pharmacy and customer service favorably, respectively. Twenty-five veterans were surveyed after the implementation of numerous quality-improvement interventions, with 44% and 72% rating their experience with the outpatient pharmacy and customer service favorably. Customer service satisfaction with an outpatient pharmacy service at a VA medical center was enhanced through the implementation of various quality-improvement initiatives. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Improving quality of service in the internet

OpenAIRE

Flückiger, François

2000-01-01

The Internet transport technology was designed to be robust, resilient to link or node outages, and with no single point of failure. The resulting connectionless system supports what is called a "best effort datagram delivery service", the perfo rmance of which is often greatly unpredictable. To improve the predictability of IP-based networks, several Quality of Service technologies have been designed over the past decade. The first one, RSVP, based on reservation of resources, is operational...

A Framework and Improvements of the Korea Cloud Services Certification System.

Science.gov (United States)

Jeon, Hangoo; Seo, Kwang-Kyu

2015-01-01

Cloud computing service is an evolving paradigm that affects a large part of the ICT industry and provides new opportunities for ICT service providers such as the deployment of new business models and the realization of economies of scale by increasing efficiency of resource utilization. However, despite benefits of cloud services, there are some obstacles to adopt such as lack of assessing and comparing the service quality of cloud services regarding availability, security, and reliability. In order to adopt the successful cloud service and activate it, it is necessary to establish the cloud service certification system to ensure service quality and performance of cloud services. This paper proposes a framework and improvements of the Korea certification system of cloud service. In order to develop it, the critical issues related to service quality, performance, and certification of cloud service are identified and the systematic framework for the certification system of cloud services and service provider domains are developed. Improvements of the developed Korea certification system of cloud services are also proposed.

A Framework and Improvements of the Korea Cloud Services Certification System

Directory of Open Access Journals (Sweden)

Hangoo Jeon

2015-01-01

Full Text Available Cloud computing service is an evolving paradigm that affects a large part of the ICT industry and provides new opportunities for ICT service providers such as the deployment of new business models and the realization of economies of scale by increasing efficiency of resource utilization. However, despite benefits of cloud services, there are some obstacles to adopt such as lack of assessing and comparing the service quality of cloud services regarding availability, security, and reliability. In order to adopt the successful cloud service and activate it, it is necessary to establish the cloud service certification system to ensure service quality and performance of cloud services. This paper proposes a framework and improvements of the Korea certification system of cloud service. In order to develop it, the critical issues related to service quality, performance, and certification of cloud service are identified and the systematic framework for the certification system of cloud services and service provider domains are developed. Improvements of the developed Korea certification system of cloud services are also proposed.

A Framework and Improvements of the Korea Cloud Services Certification System

Science.gov (United States)

Jeon, Hangoo

2015-01-01

Cloud computing service is an evolving paradigm that affects a large part of the ICT industry and provides new opportunities for ICT service providers such as the deployment of new business models and the realization of economies of scale by increasing efficiency of resource utilization. However, despite benefits of cloud services, there are some obstacles to adopt such as lack of assessing and comparing the service quality of cloud services regarding availability, security, and reliability. In order to adopt the successful cloud service and activate it, it is necessary to establish the cloud service certification system to ensure service quality and performance of cloud services. This paper proposes a framework and improvements of the Korea certification system of cloud service. In order to develop it, the critical issues related to service quality, performance, and certification of cloud service are identified and the systematic framework for the certification system of cloud services and service provider domains are developed. Improvements of the developed Korea certification system of cloud services are also proposed. PMID:26125049

Are patient surveys valuable as a service-improvement tool in health services? An overview

Directory of Open Access Journals (Sweden)

Patwardhan A

2012-05-01

Full Text Available Anjali Patwardhan,1 Charles H Spencer21Nationwide Children’s Hospital Columbus, 2Ohio State University, Columbus, OH, USAAbstract: Improving the quality of care in international health services was made a high priority in 1977. The World Health Assembly passed a resolution to greatly improve “Health for all” by the year 2000. Since 1977, the use of patient surveys for quality improvement has become a common practice in the health-care industry. The use of surveys reflects the concept that patient satisfaction is closely linked with that of organizational performance, which is in turn closely linked with organizational culture. This article is a review of the role of patient surveys as a quality-improvement tool in health care. The article explores the characteristics, types, merits, and pitfalls of various patient surveys, as well as the impact of their wide-ranging application in dissimilar scenarios to identify gaps in service provision. It is demonstrated that the conducting of patient surveys and using the results to improve the quality of care are two different processes. The value of patient surveys depends on the interplay between these two processes and several other factors that can influence the final outcome. The article also discusses the business aspect of the patient surveys in detail. Finally, the authors make future recommendations on how the patient survey tool can be best used to improve the quality of care in the health-care sector.Keywords: patient surveys, quality improvement, service gaps 

From theory to practice: improving the impact of health services research

Directory of Open Access Journals (Sweden)

Levine Robert

2005-01-01

Full Text Available Abstract Background While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers. Discussion Recognizing the importance of theory calls for new expectations in the practice of health services research. These include: the formation of interdisciplinary research teams; broadening the training for those who will practice health services research; and supportive organizational conditions that promote collaboration between researchers and decision makers. Further, funding bodies can provide a significant role in guiding and supporting the use of theory in the practice of health services research. Summary Institutions and researchers should incorporate the use of theory if health services research is to fulfill its potential for improving the delivery of health care.

Improving high quality, equitable maternal health services in Malawi ...

International Development Research Centre (IDRC) Digital Library (Canada)

Improving high quality, equitable maternal health services in Malawi (IMCHA) ... In response, the Ministry of Health implemented a Standards-Based Management and Recognition for Reproductive Health initiative to improve ... Total funding.

Public Willingness to Pay to Improve Services for Individuals With Serious Mental Illness.

Science.gov (United States)

Stone, Elizabeth M; McGinty, Emma E

2018-05-08

This study measured Americans' willingness to pay an additional $50 in taxes to improve health care and social services for individuals with serious mental illness. A nationally representative online survey was conducted with 1,010 respondents. Analysis examined how respondents' demographic characteristics and attitudes toward individuals with serious mental illness correlated with their willingness to pay additional taxes to improve health care and social services for this vulnerable population. A majority of respondents expressed willingness to pay $50 in additional taxes to improve health care services (60%) and social services (58%) for individuals with serious mental illness. Those with more negative attitudes toward individuals with serious mental illness were less willing to pay additional taxes to improve either service type. Many Americans are willing to pay additional taxes to improve health care and social services for individuals with serious mental illness.

Developing the Service Template: From measurement to agendas for improvement

OpenAIRE

Williams, CS; Saunders, M

2007-01-01

Traditional survey based measures of service quality are argued to be problematic when reflecting individual services and turning measurement into action. This paper reviews developments to an alternative measurement approach, the Service Template Process and offers an extension to it. The extended process appears able to measure service users’ and deliverers’ perceptions of service quality independently. It also enables participants to jointly agree an agenda for quality improvement. The e...

AREVA NP products and services for NPP operation and maintenance improvement

International Nuclear Information System (INIS)

Dechelette, Anne; Rat, Guy Le

2009-01-01

AREVA supplies customized services throughout the reactor improvement process according to clients' requirements: safety, performance, availability, obsolescence, operating and maintenance conditions, environment and technical assistance. Form design studies to on site modification and implementation including requalification tests, AREVA, as OEM*, has various products and services in the field of Engineering and Upgrading to satisfy client demands. In keeping with Inpo's AP913 approach, AREVA is particularly skilled in this methodology to help utilities improve availability factor and maintenance programs. AREVA has customized its services to many utilities in cooperating with local partners, suppliers, and engineering service providers through partnerships, consortiums, joint ventures, etc. AREVA's knowledge of the fleet's operation and maintenance experience helps NPP clients to identify the most cost effective improvements and approaches. Different examples of modifications of modifications and improvements performed in France and abroad illustrate AREVA's involvement in the NPP continuous upgrade process

MBI FRAMEWORK EXTENSION TOWARDS CLOUD SERVICE IMPROVEMENT FROM CONSUMER PERSPECTIVE

Directory of Open Access Journals (Sweden)

Soňa Karkošková

2017-03-01

Full Text Available Cloud computing is changing the way that organizations utilize IT resources with a corresponding impact on the role of IT management. To help organizations with managing their business informatics, Management of Business Informatics (MBI framework has been developed. The problem was that this framework did not explicitly reflect managing cloud services from cloud service consumer perspective and specifically did not address managing of cloud service improvement from consumer perspective. Therefore, analysis of MBI framework was performed from cloud service consumer viewpoint to design extension of MBI framework towards cloud service improvement management. Proposal of MBI framework extension in an output of research process according to Design Science Research Methodology and its evaluation approach is based on methodology for the design and implementation of case studies for scientific purposes and on descriptive evaluation method using scenario.

Improve services project -- Republic of the Marshall Islands.

Science.gov (United States)

Langidrik, J

1995-01-01

The Republic of the Marshall Islands has 60 dispensary sites, each staffed by 1 health assistant, to cover 80-800 people/site on 34 atolls. Until the spring of 1994, only curative services were available on a regular basis, and preventive services were provided by traveling health teams from the urban centers. In 1994, the health assistants in selected outer islands were trained to administer immunizations from vaccines which are sent regularly by air. Additional project sites are being selected. In 1993, 2 dispensaries initiated a project to 1) increase the number of women with access to prenatal care during the first trimester, 2) increase immunization levels, 3) improve access to preventive services, and 4) improve reporting and record-keeping systems. This project includes an important training component for the health assistant, the wife of the health assistant, the traditional birth attendant, the youth peer educator, community leaders, and a member of the local council. By 1994, this project was expanded to 13 dispensaries on 2 atolls. In 1995, 18 more dispensaries on 4 more atolls will be able to offer these additional services.

Evaluating Fidelity to a Modified NIATx Process Improvement Strategy for Improving HIV Services in Correctional Facilities.

Science.gov (United States)

Pankow, Jennifer; Willett, Jennifer; Yang, Yang; Swan, Holly; Dembo, Richard; Burdon, William M; Patterson, Yvonne; Pearson, Frank S; Belenko, Steven; Frisman, Linda K

2018-04-01

In a study aimed at improving the quality of HIV services for inmates, an organizational process improvement strategy using change teams was tested in 14 correctional facilities in 8 US states and Puerto Rico. Data to examine fidelity to the process improvement strategy consisted of quantitative ratings of the structural and process components of the strategy and qualitative notes that explicate challenges in maintaining fidelity to the strategy. Fidelity challenges included (1) lack of communication and leadership within change teams, (2) instability in team membership, and (3) issues with data utilization in decision-making to implement improvements to services delivery.

Improving care planning and coordination for service users with medical co-morbidity transitioning between tertiary medical and primary care services.

Science.gov (United States)

Cranwell, K; Polacsek, M; McCann, T V

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments. Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services. Little is known about mental health nurses' perspectives about how to address these problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive. The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation. Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity. Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments. Introduction Mental health service users with medical co-morbidity frequently experience difficulties accessing appropriate treatment in medical hospitals, and often there is poor collaboration within and between services. Little is known about mental health nurses' perspectives on how to address these problems. Aim To explore mental health nurses

Energizing Local Values For Tourism Services Improvement

Directory of Open Access Journals (Sweden)

Budi Purnomo

2012-06-01

Full Text Available People in most cultures would probably agree that politeness is needed during their interaction. However there may be differing opinions as to when they should be polite. In tourism industry, tourism service providers’ act as hosts and tourists act as guests. Typically hosts will try to act politely and use appropriate politeness norms when serving guests to ensure their satisfaction. The research findings show that the tourism service providers in Central Java use various unggah-ungguh ‘politeness norms’ when serving English speaking tourists and Indonesian speaking tourists. Besides that, there are some violations made by the tourism service providers in using unggah-ungguh ‘politeness norms’. The research findings also show that there are similar and different perspectives on unggah-ungguh ‘politeness norms’ between English speaking tourists with Western culture backgrounds and Indonesian speaking tourists with Indonesian culture backgrounds towards the politeness norms used by the tourism service providers in Central Java. The findings imply the needs of energizing unggah-ungguh ‘politeness norms’ which is discovered from well known noble Javanese values used by the tourism service providers for tourism service improvement.

Service quality improvement of ground staff at Don Mueang International Airport

Directory of Open Access Journals (Sweden)

Sittichai Sricharoenpramong

2018-01-01

Full Text Available The purposes of this research were to: 1 evaluate the service quality of the ground staff at Don Mueang International Airport (DMK, 2 compare the ground staff quality service perception of Thai passengers at DMK, and 3 provide guidelines for service quality improvement of the DMK airlines ground staff. A sample size of 400 Thai domestic passengers was accidentally selected at DMK. A questionnaire was used as a research tool for data collection. Five dimensions of service quality were evaluated: reliability, responsiveness, assurance, empathy, and tangibles. It was found that the service quality of ground staff was moderate. The highest dimension of service quality realization was tangibles, followed successively by reliability, assurance, empathy, and responsiveness. The passengers' perception of the ground staff's service quality varied by gender and age group. Guidelines were proposed for the improvement of ground staff service quality at DMK based on the findings. Keywords: airport, ground staff, quality of service

Quality improvement initiatives in a case management service: case study.

Science.gov (United States)

Davies, Deborah J

2015-01-01

This article explores the importance of quality practices in underpinning the person-centred approach at a Community Options Program (COP) case management service in northern NSW. The NSW community care sector does not have a statutory excellence body to identify, promote and support improved practices and quality and safety across community services, and therefore the COP provider decided to establish a dedicated role to focus on the quality improvement of its service. The subsequent quality improvement initiatives have included mapping the clients' journey through the service, identifying areas to standardise practice, and creating service pathways. The clients' journey was used as the framework to identify where standardised practice was required, and a robust process was implemented to develop over 25 good practice guidelines and tools that addressed the variations in practice and enabled the service pathways to be developed. Prior to trialling the guidelines and tools, staff received education sessions on the anticipated changes to practice, and the practicality and applicability of the guidelines were evaluated at the end of the trials. This information was reviewed and the guidelines were amended accordingly before being rolled out. The guidelines have been in use for over 12 months and have provided the benchmark against which to audit practice, and have resulted in key performance improvements such as an increase in client review rates and a rise in the feedback response rate from clients, with a noticeable shift in the comments about the brokered support worker to acknowledging the role of their case manager. Formalising informal supports for those clients that lived alone also increased, which means these people are less reliant on services and there is a reduced risk of social isolation.

Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services.

Science.gov (United States)

Stoneman, Alice; Atkinson, David; Davey, Maureen; Marley, Julia V

2014-10-07

Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia. Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI. A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change. Well

Improving the delivery of preventive care services.

Science.gov (United States)

Hung, Dorothy Y

2007-05-01

Performance of preventive services is an important indicator of high-quality health care, but many recommended services are not regularly offered in primary care practices. Health risk assessments, counseling, and referral to community-based programs help address risk behaviors, many of which are leading causes of preventable death and disability in the United States. This study examined various influences on the delivery of preventive services designed to address smoking, excessive consumption of alcohol, unhealthy diets, and sedentary lifestyles. More than 300 health care providers in 52 practices nationwide have contributed data to this study. Staff participation in quality improvement enhanced work relationships and also diminished the effect of practice size on the performance of preventive care. The use of nurse practitioners, allied health professionals, clinician reminders, and patient registries were positively associated with care delivery.

A modified Continuous Quality Improvement approach to improve culturally and socially inclusive care within rural health services.

Science.gov (United States)

Mitchell, Olivia; Malatzky, Christina; Bourke, Lisa; Farmer, Jane

2018-03-23

The sickest Australians are often those belonging to non-privileged groups, including Indigenous Australians, gay, lesbian, bisexual, transsexual, intersex and queer people, people from culturally and linguistically diverse backgrounds, socioeconomically disadvantaged groups, and people with disabilities and low English literacy. These consumers are not always engaged by, or included within, mainstream health services, particularly in rural Australia where health services are limited in number and tend to be generalist in nature. The aim of this study was to present a new approach for improving the sociocultural inclusivity of mainstream, generalist, rural, health care organisations. This approach combines a modified Continuous Quality Improvement framework with Participatory Action Research principles and Foucault's concepts of power, discourse and resistance to develop a change process that deconstructs the power relations that currently exclude marginalised rural health consumers from mainstream health services. It sets up processes for continuous learning and consumer responsiveness. The approach proposed could provide a Continuous Quality Improvement process for creating more inclusive mainstream health institutions and fostering better engagement with many marginalised groups in rural communities to improve their access to health care. The approach to improving cultural inclusion in mainstream rural health services presented in this article builds on existing initiatives. This approach focuses on engaging on-the-ground staff in the need for change and preparing the service for genuine community consultation and responsive change. It is currently being trialled and evaluated. © 2018 National Rural Health Alliance Ltd.

Implementing service improvement projects within pre-registration nursing education: a multi-method case study evaluation.

Science.gov (United States)

Baillie, Lesley; Bromley, Barbara; Walker, Moira; Jones, Rebecca; Mhlanga, Fortune

2014-01-01

Preparing healthcare students for quality and service improvement is important internationally. A United Kingdom (UK) initiative aims to embed service improvement in pre-registration education. A UK university implemented service improvement teaching for all nursing students. In addition, the degree pathway students conducted service improvement projects as the basis for their dissertations. The study aimed to evaluate the implementation of service improvement projects within a pre-registration nursing curriculum. A multi-method case study was conducted, using student questionnaires, focus groups with students and academic staff, and observation of action learning sets. Questionnaire data were analysed using SPSS v19. Qualitative data were analysed using Ritchie and Spencer's (1994) Framework Approach. Students were very positive about service improvement. The degree students, who conducted service improvement projects in practice, felt more knowledgeable than advanced diploma students. Selecting the project focus was a key issue and students encountered some challenges in practice. Support for student service improvement projects came from action learning sets, placement staff, and academic staff. Service improvement projects had a positive effect on students' learning. An effective partnership between the university and partner healthcare organisations, and support for students in practice, is essential. Copyright © 2013 Elsevier Ltd. All rights reserved.

IMPROVING THE LOGISTICAL PROCESSES IN CORPORATE SERVICE SYSTEM

Directory of Open Access Journals (Sweden)

Irina MAKAROVA

2016-03-01

Full Text Available The study deals with enhancing the reliability of freight cars by improving the corporate service system. Assessing of the quality of spare parts suppliers is discussed. An algorithm for supplier selection and an evaluation method, based on cluster analysis of indicators of supplier reliability, is proposed. Alternative developments for a service network, in view of expanding of the car fleet powered by natural gas-based fuel have been considered.

Stillbirth in dairy calves is influenced independently by dystocia and body shape.

Science.gov (United States)

Barrier, A C; Mason, C; Dwyer, C M; Haskell, M J; Macrae, A I

2013-08-01

The objectives of this study were to determine (1) if stillborn calves born following dystocia present with specific injuries/pathological changes compared to stillborns delivered without difficulty, and (2) whether such stillborns differ in conformation from dystocic calves that survive. Post-mortem examinations were carried out on 20 stillborns that were either unassisted (N) or were 'farm-staff'-assisted/normally presented (FN) at birth. Evidence of greater trauma and bruising was observed in the FN calves and parameters such as body length, birth-weight and thyroid:body weight were similar. In a second part of the study birth-weight, body length and height, girth length, body mass (BMI), and ponderal (PI) indices were assessed in 490 calves. Regardless of the severity of dystocia, stillborns had greater body lengths and lower BMIs and PIs than calves born alive (Pdystocia. Half of the stillborns had breathed indicating they were alive and possibly had experienced pain/distress at time of delivery. Body conformation was related to stillbirth independently of dystocia, a finding likely reflecting inadequate prenatal development. Copyright © 2013 Elsevier Ltd. All rights reserved.

Improving the efficacy of healthcare services for Aboriginal Australians.

Science.gov (United States)

Gwynne, Kylie; Jeffries, Thomas; Lincoln, Michelle

2018-01-16

Objective The aim of the present systematic review was to examine the enablers for effective health service delivery for Aboriginal Australians. Methods This systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Papers were included if they had data related to health services for Australian Aboriginal people and were published between 2000 and 2015. The 21 papers that met the inclusion criteria were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Seven papers were subsequently excluded due to weak methodological approaches. Results There were two findings in the present study: (1) that Aboriginal people fare worse than non-Aboriginal people when accessing usual healthcare services; and (2) there are five enablers for effective health care services for Australian Aboriginal people: cultural competence, participation rates, organisational, clinical governance and compliance, and availability of services. Conclusions Health services for Australian Aboriginal people must be tailored and implementation of the five enablers is likely to affect the effectiveness of health services for Aboriginal people. The findings of the present study have significant implications in directing the future design, funding, delivery and evaluation of health care services for Aboriginal Australians. What is known about the topic? There is significant evidence about poor health outcomes and the 10-year gap in life expectancy between Aboriginal and non-Aboriginal people, and limited evidence about improving health service efficacy. What does this paper add? This systematic review found that with usual health care delivery, Aboriginal people experience worse health outcomes. This paper identifies five strategies in the literature that improve the effectiveness of health care services intended for Aboriginal people. What are the implications for

Previous utilization of service does not improve timely booking in ...

African Journals Online (AJOL)

Previous utilization of service does not improve timely booking in antenatal care: Cross sectional study ... Journal Home > Vol 24, No 3 (2010) > ... Results: Past experience on antenatal care service utilization did not come out as a predictor for ...

Strategic planning for saving the lives of mothers, newborns and children and preventing stillbirths in KwaZulu-Natal province South Africa: modelling using the Lives Saved Tool (LiST).

Science.gov (United States)

McGee, Shelley-Ann; Chola, Lumbwe; Tugendhaft, Aviva; Mubaiwa, Victoria; Moran, Neil; McKerrow, Neil; Kamugisha, Leonard; Hofman, Karen

2016-01-19

KwaZulu-Natal province in South Africa has the largest population of children under the age of five and experiences the highest number of child births per annum in the country. Its population has also been ravaged by the dual epidemics of HIV and TB and it has struggled to meet targets for maternal and child mortality. In South Africa's federal system, provinces have decision-making power on the prioritization and allocation of resources within their jurisdiction. As part of strategic planning for 2015-2019, KwaZulu-Natal provincial authorities requested an assessment of current mortality levels in the province and identification and costing of priority interventions for saving additional maternal, newborn and child lives, as well as preventing stillbirths in the province. The Lives Saved Tool (LiST) was used to determine the set of interventions, which could save the most additional maternal and child lives and prevent stillbirths from 2015-2019, and the costs of these. The impact of family planning was assessed using two scenarios by increasing baseline coverage of modern contraception by 0.5 percentage points or 1 percentage point per annum. A total of 7,043 additional child and 297 additional maternal lives could be saved, and 2,000 stillbirths could be prevented over five years. Seventeen interventions account for 75% of additional lives saved. Increasing family planning contributes to a further reduction of up to 137 maternal and 3,168 child deaths. The set of priority interventions scaled up to achievable levels, with no increase in contraception would require an additional US$91 million over five years or US$1.72 per capita population per year. By increasing contraceptive prevalence by one percentage point per year, overall costs to scale up to achievable coverage package, decrease by US$24 million over five years. Focused attention on a set of key interventions could have a significant impact on averting stillbirths and maternal and neonatal mortality in

Improving Customer Service at the Agricultural Development Banks ...

African Journals Online (AJOL)

Improving Customer Service at the Agricultural Development Banks in Ghana: An Application of the Queuing Theory. ... African Journal of Management Research. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue ...

Improving Library and Information Services: Use of Appropriate ...

African Journals Online (AJOL)

Information Communication Technology in Nigerian Libraries. Murtala Aliyu ... The focus of this paper is on how to improve services in libraries and information centers in. Nigeria by ..... games, video and educational materials. Database on ...

Death losses due to stillbirth, neonatal death and diseases in cloned cattle derived from somatic cell nuclear transfer and their progeny: a result of nationwide survey in Japan.

Science.gov (United States)

Watanabe, Shinya; Nagai, Takashi

2009-06-01

To obtain the data concerning death losses due to stillbirth, neonatal death and diseases in cloned cattle derived from somatic cell nuclear transfer (SCNT) and their progeny produced by Japanese institutions, a nationwide survey was carried out in July-August, 2006. As a result, lifetime data concerning 482 SCNT cattle (97.5% of cattle produced in the country at that time) and 202 progeny of SCNT cattle were accumulated and the death loss of these cattle was analyzed. Although 1/3 of delivered SCNT calves died during the perinatal period due to stillbirth and neonatal death, incidence of death loss due to diseases in SCNT cattle surviving more than 200 days after birth seems to be the same as these in conventionally bred cattle. In contrast, progeny of SCNT cattle showed the same level in death loss as observed in conventionally bred cattle throughout their lifetime. These results suggest that robust health would be expected in SCNT cattle surviving to adulthood and their progeny.

Improving Acceptance, Integration, and Health Among LGBT Service Members

Science.gov (United States)

2017-10-01

through multiple rounds of internal testing and quality assurance procedures. Recruitment for the Phase II survey was initiated on August 25, 2017...Award Numbers: W81XWH-15-1-0701 Title: Improving Acceptance, Integration, and Health Among LGBT Service Members Principal Investigators...burden to Department of Defense, Washington Headquarters Services , Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis

SCM: A method to improve network service layout efficiency with network evolution

Science.gov (United States)

Zhao, Qi; Zhang, Chuanhao

2017-01-01

Network services are an important component of the Internet, which are used to expand network functions for third-party developers. Network function virtualization (NFV) can improve the speed and flexibility of network service deployment. However, with the evolution of the network, network service layout may become inefficient. Regarding this problem, this paper proposes a service chain migration (SCM) method with the framework of “software defined network + network function virtualization” (SDN+NFV), which migrates service chains to adapt to network evolution and improves the efficiency of the network service layout. SCM is modeled as an integer linear programming problem and resolved via particle swarm optimization. An SCM prototype system is designed based on an SDN controller. Experiments demonstrate that SCM could reduce the network traffic cost and energy consumption efficiently. PMID:29267299

SCM: A method to improve network service layout efficiency with network evolution.

Science.gov (United States)

Zhao, Qi; Zhang, Chuanhao; Zhao, Zheng

2017-01-01

Network services are an important component of the Internet, which are used to expand network functions for third-party developers. Network function virtualization (NFV) can improve the speed and flexibility of network service deployment. However, with the evolution of the network, network service layout may become inefficient. Regarding this problem, this paper proposes a service chain migration (SCM) method with the framework of "software defined network + network function virtualization" (SDN+NFV), which migrates service chains to adapt to network evolution and improves the efficiency of the network service layout. SCM is modeled as an integer linear programming problem and resolved via particle swarm optimization. An SCM prototype system is designed based on an SDN controller. Experiments demonstrate that SCM could reduce the network traffic cost and energy consumption efficiently.

X Marks the Spot: Creating and Managing a Single Service Point to Improve Customer Service and Maximize Resources

Science.gov (United States)

Venner, Mary Ann; Keshmiripour, Seti

2016-01-01

This article will describe how merging service points in an academic library is an opportunity to improve customer service and utilize staffing resources more efficiently. Combining service points provides libraries with the ability to create a more positive library experience for patrons by minimizing the ping-pong effect for assistance. The…

Operations and quality management for public service delivery improvement.

Directory of Open Access Journals (Sweden)

Paulin Mbecke

2014-10-01

Full Text Available Public service management reforms have not yet contributed to poverty eradication and generally socio-economic development of many African countries. The reforms suggested and implemented to date still prove to be weak in addressing the many challenges faced by the public service in delivering goods and services to the population. The failure of the current public service management calls for a consideration of business-driven approaches and practices that facilitate effectiveness, efficiency, competitiveness and flexibility in goods and services provision. The critical social theory methodology and the literature review technique described and raised awareness on service delivery chaos in South Africa. A public service reform that focuses on operations and quality management is one of the ways of improving and sustaining service delivery in South Africa. Operations management is an essential tool for the planning, execution, control, monitoring and evaluation of production processes. Quality management, in the other hand, is essential to ensure best quality of goods and services produced by the public service within acceptable time and available resources to meet or exceed people’s expectations. The operations and quality management framework proposed in this article is a potential alternative to the current service delivery crisis in South Africa.

Reproductive health services in Malawi: an evaluation of a quality improvement intervention.

Science.gov (United States)

Rawlins, Barbara J; Kim, Young-Mi; Rozario, Aleisha M; Bazant, Eva; Rashidi, Tambudzai; Bandazi, Sheila N; Kachale, Fannie; Sanghvi, Harshad; Noh, Jin Won

2013-01-01

this study was to evaluate the impact of a quality improvement initiative in Malawi on reproductive health service quality and related outcomes. (1) post-only quasi-experimental design comparing observed service quality at intervention and comparison health facilities, and (2) a time-series analysis of service statistics. sixteen of Malawi's 23 district hospitals, half of which had implemented the Performance and Quality Improvement (PQI) intervention for reproductive health at the time of the study. a total of 98 reproductive health-care providers (mostly nurse-midwives) and 139 patients seeking family planning (FP), antenatal care (ANC), labour and delivery (L&D), or postnatal care (PNC) services. health facility teams implemented a performance and quality improvement (PQI) intervention over a 3-year period. Following an external observational assessment of service quality at baseline, facility teams analysed performance gaps, designed and implemented interventions to address weaknesses, and conducted quarterly internal assessments to assess progress. Facilities qualified for national recognition by complying with at least 80% of reproductive health clinical standards during an external verification assessment. key measures include facility readiness to provide quality care, observed health-care provider adherence to clinical performance standards during service delivery, and trends in service utilisation. intervention facilities were more likely than comparison facilities to have the needed infrastructure, equipment, supplies, and systems in place to offer reproductive health services. Observed quality of care was significantly higher at intervention than comparison facilities for PNC and FP. Compared with other providers, those at intervention facilities scored significantly higher on client assessment and diagnosis in three service areas, on clinical management and procedures in two service areas, and on counselling in one service area. Service statistics

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

Science.gov (United States)

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

The Mystery Shopper Technique as a way of improving hotel gastronomy services

Directory of Open Access Journals (Sweden)

Ewa Wszendybył-Skulska

2015-04-01

Full Text Available The problems connected with the issue of service quality is an important aspect in the service industry, however it is difficult to measure. It may be quite difficult to estimate it unequivocally and objectively due to the fact that each service includes more or fewer materi-al elements. It is impossible to improve something that has not been measured and estimated before and one does not know whether it fulfils the requirements. Hotel gastronomy services are a kind of service that are partly materialized which makes the quality estimation easier. Nevertheless, one ought to remember that they are also shaped by non-material elements that influence the final quality estimation which seems to be problematic. The so-called Mystery Shopper Technique as a way of improving the quality of hotel gastronomy services is pre-sented in the article.

Improvements in ecosystem services from investments in natural capital.

Science.gov (United States)

Ouyang, Zhiyun; Zheng, Hua; Xiao, Yi; Polasky, Stephen; Liu, Jianguo; Xu, Weihua; Wang, Qiao; Zhang, Lu; Xiao, Yang; Rao, Enming; Jiang, Ling; Lu, Fei; Wang, Xiaoke; Yang, Guangbin; Gong, Shihan; Wu, Bingfang; Zeng, Yuan; Yang, Wu; Daily, Gretchen C

2016-06-17

In response to ecosystem degradation from rapid economic development, China began investing heavily in protecting and restoring natural capital starting in 2000. We report on China's first national ecosystem assessment (2000-2010), designed to quantify and help manage change in ecosystem services, including food production, carbon sequestration, soil retention, sandstorm prevention, water retention, flood mitigation, and provision of habitat for biodiversity. Overall, ecosystem services improved from 2000 to 2010, apart from habitat provision. China's national conservation policies contributed significantly to the increases in those ecosystem services. Copyright © 2016, American Association for the Advancement of Science.

Improving Acceptance, Integration and Health among LGBT Service Members

Science.gov (United States)

2017-10-01

these stressors on LGBT service members is poorly understood, with very little data available on the unique physical and mental health needs of these...Bullying • Overall health • Healthcare utilization • Lost duty days • Sick call visits • Physical health symptoms • Sexual/gender identity disclosure...Award Numbers: W81XWH-15-1-0699 Title: Improving Acceptance, Integration and Health among LGBT Service Members Principal Investigators: Jeremy

Innovation in user-centered skills and performance improvement for sustainable complex service systems.

Science.gov (United States)

Karwowski, Waldemar; Ahram, Tareq Z

2012-01-01

In order to leverage individual and organizational learning and to remain competitive in current turbulent markets it is important for employees, managers, planners and leaders to perform at high levels over time. Employee competence and skills are extremely important matters in view of the general shortage of talent and the mobility of employees with talent. Two factors emerged to have the greatest impact on the competitiveness of complex service systems: improving managerial and employee's knowledge attainment for skills, and improving the training and development of the workforce. This paper introduces the knowledge-based user-centered service design approach for sustainable skill and performance improvement in education, design and modeling of the next generation of complex service systems. The rest of the paper cover topics in human factors and sustainable business process modeling for the service industry, and illustrates the user-centered service system development cycle with the integration of systems engineering concepts in service systems. A roadmap for designing service systems of the future is discussed. The framework introduced in this paper is based on key user-centered design principles and systems engineering applications to support service competitiveness.

Challenge of improving postoperative pain management: case studies of three acute pain services in the UK National Health Service.

Science.gov (United States)

Powell, A E; Davies, H T O; Bannister, J; Macrae, W A

2009-06-01

Previous national survey research has shown significant deficits in routine postoperative pain management in the UK. This study used an organizational change perspective to explore in detail the organizational challenges faced by three acute pain services in improving postoperative pain management. Case studies were conducted comprising documentary review and semi-structured interviews (71) with anaesthetists, surgeons, nurses, other health professionals, and managers working in and around three broadly typical acute pain services. Although the precise details differed to some degree, the three acute pain services all faced the same broad range of inter-related challenges identified in the organizational change literature (i.e. structural, political, cultural, educational, emotional, and physical/technological challenges). The services were largely isolated from wider organizational objectives and activities and struggled to engage other health professionals in improving postoperative pain management against a background of limited resources, turbulent organizational change, and inter- and intra-professional politics. Despite considerable efforts they struggled to address these challenges effectively. The literature on organizational change and quality improvement in health care suggests that it is only by addressing the multiple challenges in a comprehensive way across all levels of the organization and health-care system that sustained improvements in patient care can be secured. This helps to explain why the hard work and commitment of acute pain services over the years have not always resulted in significant improvements in routine postoperative pain management for all surgical patients. Using this literature and adopting a whole-organization quality improvement approach tailored to local circumstances may produce a step-change in the quality of routine postoperative pain management.

Improving Acceptance, Integration, and Health Among LGBT Service Members

Science.gov (United States)

2016-10-01

lifting of the bans – remains alive and well, with some LGBT service members experiencing interpersonal and institutional discrimination ...being among LGBT service members and improve unit cohesion. The military has always been a leader in understanding and implementing gender and...matters. These should be people that you know and who know you. These should be people you have had contact with in the past 3 months or so – either in

The AskIT Service Desk: A Model for Improving Productivity and Reducing Costs

Energy Technology Data Exchange (ETDEWEB)

Ashcraft, Phillip Lynn [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Fogle, Blythe G. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Cummings, Susan M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Lopez, Leon [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-07-29

This was prepared for the business process improvement presentation to the Department of Energy. Los Alamos National Laboratory provides a single point of contact, the AskIT Service Desk, to address issues that impact customer productivity. At the most basic level, what customers want is for their calls to be received, to get a response from a knowledgeable analyst, and to have their issues resolved and their requests fulfilled. Providing a centralized, single point of contact service desk makes initiating technical or business support simple for the customer and improves the odds of immediately resolving the issue or correctly escalating the request to the next support level when necessary. Fulfilling customer requests through automated workflow also improves customer productivity and reduces costs. Finally, customers should be provided the option to solve their own problems through easy access to self-help resources such as frequently asked questions (FAQs) and how-to guides. To accomplish this, everyone who provides and supports services must understand how these processes and functions work together. Service providers and those who support services must “speak the same language” and share common objectives. The Associate Directorate for Business Innovation (ADBI) began the journey to improve services by selecting a known service delivery framework (Information Technology Infrastructure Library, or ITIL). From this framework, components that contribute significant business value were selected.

Improved waste management services – Will the Act make a difference?

CSIR Research Space (South Africa)

Oelofse, Suzanna HH

2009-05-01

Full Text Available This document focuses on the improved waste management services and the Waste Act 59 of 2008. It provide in formation on the Integrated Waste Management Plans, technical capacity – infrastructure, the backlog in adequate service provision, the facts...

Applying Quality Function Deployment Model in Burn Unit Service Improvement.

Science.gov (United States)

Keshtkaran, Ali; Hashemi, Neda; Kharazmi, Erfan; Abbasi, Mehdi

2016-01-01

Quality function deployment (QFD) is one of the most effective quality design tools. This study applies QFD technique to improve the quality of the burn unit services in Ghotbedin Hospital in Shiraz, Iran. First, the patients' expectations of burn unit services and their priorities were determined through Delphi method. Thereafter, burn unit service specifications were determined through Delphi method. Further, the relationships between the patients' expectations and service specifications and also the relationships between service specifications were determined through an expert group's opinion. Last, the final importance scores of service specifications were calculated through simple additive weighting method. The findings show that burn unit patients have 40 expectations in six different areas. These expectations are in 16 priority levels. Burn units also have 45 service specifications in six different areas. There are four-level relationships between the patients' expectations and service specifications and four-level relationships between service specifications. The most important burn unit service specifications have been identified in this study. The QFD model developed in the study can be a general guideline for QFD planners and executives.

Improving queuing service at McDonald's

Science.gov (United States)

Koh, Hock Lye; Teh, Su Yean; Wong, Chin Keat; Lim, Hooi Kie; Migin, Melissa W.

2014-07-01

Fast food restaurants are popular among price-sensitive youths and working adults who value the conducive environment and convenient services. McDonald's chains of restaurants promote their sales during lunch hours by offering package meals which are perceived to be inexpensive. These promotional lunch meals attract good response, resulting in occasional long queues and inconvenient waiting times. A study is conducted to monitor the distribution of waiting time, queue length, customer arrival and departure patterns at a McDonald's restaurant located in Kuala Lumpur. A customer survey is conducted to gauge customers' satisfaction regarding waiting time and queue length. An android app named Que is developed to perform onsite queuing analysis and report key performance indices. The queuing theory in Que is based upon the concept of Poisson distribution. In this paper, Que is utilized to perform queuing analysis at this McDonald's restaurant with the aim of improving customer service, with particular reference to reducing queuing time and shortening queue length. Some results will be presented.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

Directory of Open Access Journals (Sweden)

Janya McCalman

2018-03-01

Full Text Available Continuous quality improvement (CQI processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

Science.gov (United States)

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. PMID:29623271

Improvement in the distribution of services in multi-agent systems with SCODA

Directory of Open Access Journals (Sweden)

Jesús Ángel ROMÁN GALLEGO

2016-06-01

Full Text Available The distribution of services on multi-agent systems allows it to reduce to the agents their computational load. The functionality of the system does not reside in the agents themselves, however it is ubiquitously distributed so that allows you to perform tasks in parallel avoiding an additional computational cost to the elements in the system. The distribution of services that offers SCODA (Distributed and Specialized Agent Communities allows an intelligent management of these services provided by agents of the system and the parallel execution of threads that allow to respond to requests asynchronously, which implies an improvement in the performance of the system at both the computational level as the level of quality of service in the control of these services. The comparison carried out in the case of study that is presented in this paper demonstrates the existing improvement in the distribution of services on systems based on SCODA.

LibAnswers: Analyzing tickets (questions) to improve our library's virtual reference service(s)

KAUST Repository

Ramli, Rindra M.

2017-05-01

Analyze the questions received in LibAnswers (ticketing system) in order to improve the quality of our virtual reference services. Tickets that were received between June 2015 to April 2017 were analyzed and categorized. It was noted that most questions asked revolved around electronic resources issues as well as circulation/access issues.

LibAnswers: Analyzing tickets (questions) to improve our library's virtual reference service(s)

KAUST Repository

Ramli, Rindra M.; Ba-Rayyan, Faten A.

2017-01-01

Analyze the questions received in LibAnswers (ticketing system) in order to improve the quality of our virtual reference services. Tickets that were received between June 2015 to April 2017 were analyzed and categorized. It was noted that most questions asked revolved around electronic resources issues as well as circulation/access issues.

Improving physiotherapy services to Indigenous children with physical disability: Are client perspectives missed in the continuous quality improvement approach?

Science.gov (United States)

Greenstein, Caroline; Lowell, Anne; Thomas, David Piers

2016-06-01

To compare the outcomes of two cycles of continuous quality improvement (CQI) at a paediatric physiotherapy service with findings from interviews with clients and their carers using the service. Case study based at one paediatric physiotherapy service Community-based paediatric allied health service in Northern Australia. Forty-nine clinical records and four staff at physiotherapy service, five Indigenous children with physical disability aged 8-21 years, and nine carers of Indigenous children aged 0-21 years (current or previous clients). The CQI process based on the Audit and Best Practice for Chronic Disease involved a clinical audit; a workshop where clinicians assessed their health care systems, identified weaknesses and strengths, and developed goals and strategies for improvement; and reassessment through a second audit and workshop. Twelve open-ended, in-depth interviews were conducted with previous or current clients selected through purposive and theoretical sampling. CQI and interview results were then compared. Comparison of findings from the two studies Both CQI and interview results highlighted service delivery flexibility and therapists' knowledge, support and advocacy as service strengths, and lack of resources and a child-friendly office environment as weaknesses. However, the CQI results reported better communication and client input into the service than the interview results. The CQI process, while demonstrating improvements in clinical and organisational aspects of the service, did not always reflect or address the primary concerns of Indigenous clients and underlined the importance of including clients in the CQI process. © 2015 National Rural Health Alliance Inc.

Measuring and improving customer satisfaction with government services

Science.gov (United States)

Glen D. Alexander

1995-01-01

Two years ago, Ohio State Park developed a methodology of measuring customer satisfaction, to gauge the effectiveness of our customer service. What follows is a discussion of our installation of systems to measure and improve customer satisfaction, the interpretation of the data, and the positive results we have enjoyed.

Decentralisation in Uganda: Prospects for Improved Service Delivery

African Journals Online (AJOL)

Financial decentralisation, on the other hand, attempted to assign responsibilities and taxes between the centre and local governments, to enable the transfer of grants and other resources to different parts of the country, and to improve service delivery. This paper will review different government, public and academic ...

Improving Internal Customer Service

Science.gov (United States)

1990-09-01

34Companies are recognizing that treating customers and associates like people has a very high value" (21:20). 2 Customer service has become more that... customer service is also a strategy with the focus towards people , not product (24:1). Customers are demanding quality service for several reasons...34 (39:45). External Customers . External customers are an organization’s ultimate consumers . They purchase the end product or service an organization

Improving outpatient services for elderly patients in Taiwan: a qualitative study.

Science.gov (United States)

Kuo, Ren-Jieh; Wu, Yung-Hung; Hsu, Tsung-Shin; Chen, Liang-Kung

2011-01-01

The rapid pace of population aging poses significant importance of establishing an age-friendly health care system, including outpatient, inpatient, intermediate, and long-term care. The main purpose of this study is to evaluate the quality of outpatient services for elderly patients in Taiwan. Quality function deployment (QFD) is a tool effectively shortening the research-and-development period, reducing costs, and fulfilling customer needs (CNs). This study applied Kano's model and the analytic network process (ANP) to improve the basic framework of QFD. Kano's model enables a thorough understanding of elderly patients' needs and problems with regard to medical care services, so that appropriate outpatient services can be offered to them from the outset. In addition, adapting the supermatrix of ANP to the calculation of the house of quality (HoQ) will reduce subjective judgments. Using Kano's model and an integrated ANP-QFD approach, we extracted five needs of elderly patients and calculated their priorities: 'Professional medical care services convincing patients' (27%), 'With sufficient knowledge to answer patients' questions' (23.5%), 'Providing fast services to solve patients' problems' (19.3%), 'Voluntarily serving patients' (19.1%), and 'Providing proper medical equipment to patients' (11.1%). We then identified six outpatient service attributes deserving of improvement and their priorities: 'Physician with a high level of professionalism and giving clear interpretation of patient's condition' (25%), 'Staff with good communication skills and assistance to patients' (22%), 'High standardization of operating procedures' (18%), 'Staff getting on-the-job training periodically' (15%), 'Facilities sufficient and fitting for elderly patients' (10%), and 'Applying IT (internet) to help patients to receive medical care' (10%). In conclusion, we reconstructed an integrated QFD model which will not only reduce costs but also reveal the crucial outpatient service items

Effects on in-service education on improving science teaching in Swaziland

NARCIS (Netherlands)

Stronkhorst, Robert; van den Akker, Jan

2006-01-01

This paper discusses the findings of an evaluative and interpretive study into the potential of in-service education to improve science education in Swaziland. Short-term and long-term effects of an in-service intervention are evaluated in terms of changes in classroom processes. The teaching

DS-CDMA system outer loop power control and improvement for multi-service

Institute of Scientific and Technical Information of China (English)

Guan Mingxiang; Guo Qing; Li Xing

2008-01-01

When a new user accesses the CDMA system, the load will change drastically, and therefore, the advanced outer loop power control (OLPC) technology has to be adopted to enrich the target signal interference ratio (SIR) and improve the system performance. The existing problems about DS-CDMA outer loop power control for multi-service are introduced and the power control theoretical model is analyzed. System simulation is adopted on how to obtain the theoretical performance and parameter optimization of the power control algorithm. The OLPC algorithm is improved and the performance comparisons between the old algorithm and the improved algorithm are given. The results show good performance of the improved OLPC algorithm and prove the validity of the improved method for multi-service.

Exploring inequalities in access to and use of maternal health services in South Africa

Directory of Open Access Journals (Sweden)

Silal Sheetal P

2012-05-01

away women in early-labour, shouting at patients, and insensitivity towards those who had experienced stillbirths, also inhibited access and compromised quality of care. Conclusions To move towards achieving its MDGs, South Africa cannot just focus on increasing levels of obstetric coverage, but must systematically address the access constraints facing women during pregnancy and delivery. More needs to be done to respond to these “patient-oriented” barriers by improving how and where services are provided, particularly in rural areas and for poor women, as well as altering the attitudes and actions of health care providers.

Strategies for Improving the Quality of Polling Service in Wireless Metropolitan Area Network

Directory of Open Access Journals (Sweden)

Yang Zhi-Jun

2017-01-01

Full Text Available Four kinds of service types are defined in IEEE 802.16. In order to provide the Quality of Service (Qos for different services, the system must use a reasonable resource allocation method and scheduling algorithm to efficiently and fairly allocate bandwidth resources. Although in the IEEE 802.16 MAC, for the uplink real-time polling service (rtPS and non-real-time polling service (nrtPS business type of data transmission are used to polling, but do not provide business-based services. In this paper, the distinction between priority service of rtPS and nrtPS is carried out, and the simulation experiment is used to analyze the performance characteristics of the protocol under the distinction of high and low priority. Wherein the theoretical values of the average delay and the information packets are compared with the experimental values. The average query cycle and throughput are also evaluated. Which proves the validity of the improved service strategy and improves the service characteristics of the system.

Australian mental health consumers contributions to the evaluation and improvement of recovery-oriented service provision.

Science.gov (United States)

Marshal, Sarah L; Oades, Lindsay G; Growe, Trevor P

2010-01-01

One key component of recovery-oriented mental health services, typically overlooked, involves genuine collaboration between researchers and consumers to evaluate and improve services delivered within a recovery framework. Eighteen mental health consumers working with staff who had received training in the Collaborative Recovery Model (CRM) took part in in-depth focus group meetings, of approximately 2.5 hours each, to generate feedback to guide improvement of the CRM and its use in mental health services. Consumers identified clear avenues for improvement for the CRM both specific to the model and broadly applicable to recovery-oriented service provision. Findings suggest consumers want to be more engaged and empowered in the use of the CRM from the outset. Improved sampling procedures may have led to the identification of additional dissatisfied consumers. Collaboration with mental health consumers in the evaluation and improvement of recovery-oriented practice is crucial with an emphasis on rebuilding mental health services that are genuinely oriented to support recovery.

Development of a method of continuous improvement of services using the Business Intelligence tools

Directory of Open Access Journals (Sweden)

Svetlana V. Kulikova

2018-01-01

Full Text Available The purpose of the study was to develop a method of continuous improvement of services using the Business Intelligence tools.Materials and methods: the materials are used on the concept of the Deming Cycle, methods and Business Intelligence technologies, Agile methodology and SCRUM.Results: the article considers the problem of continuous improvement of services and offers solutions using methods and technologies of Business Intelligence. In this case, the purpose of this technology is to solve and make the final decision regarding what needs to be improved in the current organization of services. In other words, Business Intelligence helps the product manager to see what is hidden from the “human eye” on the basis of received and processed data. Development of a method based on the concept of the Deming Cycle and Agile methodologies, and SCRUM.The article describes the main stages of development of method based on activity of the enterprise. It is necessary to fully build the Business Intelligence system in the enterprise to identify bottlenecks and justify the need for their elimination and, in general, for continuous improvement of the services. This process is represented in the notation of DFD. The article presents a scheme for the selection of suitable agile methodologies.The proposed concept of the solution of the stated objectives, including methods of identification of problems through Business Intelligence technology, development of the system for troubleshooting and analysis of results of the introduced changes. The technical description of the project is given.Conclusion: following the work of the authors there was formed the concept of the method for the continuous improvement of the services, using the Business Intelligence technology with the specifics of the enterprises, offering SaaS solutions. It was also found that when using this method, the recommended development methodology is SCRUM. The result of this scientific

Production layout improvement in emergency services: a participatory approach.

Science.gov (United States)

Zanatta, Mateus; Amaral, Fernando Gonçalves

2012-01-01

Volunteer fire department is a service that responds emergency situations in places where there are no military emergency services. These services need to respond quickly, because time is often responsible for the operation success besides work environment and setup time interfere with the prompt response to these calls and care efficiency. The layout design is one factor that interferes with the quick setup. In this case, the spaces arrangement can result in excessive or unnecessary movements; also the equipment provision may hinder the selection and collection of these or even create movement barriers for the workers. This work created a new layout for the emergency assistance service, considering the human factors related to work through the task analysis and workers participation on the alternatives of improvement. The results showed an alternate layout with corridors and minimization of unusable sites, allowing greater flexibility and new possibilities of requirements.

Prevalence of Brucellosis among Women Presenting with Abortion/Stillbirth in Huye, Rwanda

Directory of Open Access Journals (Sweden)

Nadine Rujeni

2014-01-01

Full Text Available The incidence of human brucellosis is not documented in Rwanda despite several reports on the disease in cattle. Because brucellosis has been associated with abortion, the aim of this study was to investigate the prevalence of positive serology in women presenting with abortion and/or stillbirth. The study was done in Huye District, in the Southern Province of Rwanda, and the patients were recruited from both the University Teaching Hospital of Butare (CHUB and Kabutare District Hospital. Serum samples were collected and the Rose Bengal plate test (RBPT was performed on each sample. A questionnaire was also used to investigate potential contacts with animals and/or consumption of raw milk. A total of 60 women were recruited and 15 (i.e., 25% were Brucella seropositive. The questionnaire showed that those with seropositivity either were in contact with domestic animals (cattle, goat, or sheep or were consuming raw cow’s milk. Human brucellosis appears to be of public health importance in Rwanda and more attention should be drawn on the disease. The current study provides a basis for larger studies to establish the incidence of human brucellosis in Rwanda. More mechanistic studies will also demonstrate the pathogenicity of Brucella in human placentas.

[Professional's expectations to improve quality of care and social services utilization in geriatric oncology].

Science.gov (United States)

Antoine, Valéry; de Wazières, Benoît; Houédé, Nadine

2015-02-01

Coordination of a multidisciplinary and multi-professional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social services utilization. Descriptive study in a French University Hospital. A 6-item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. The 37 respondents identified a total of 166 needs to improve quality of care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health care planning, were defined to answer to professional's needs with the aim of optimizing cancer treatment and global cares. Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014-2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Copyright © 2014 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Improving mental health service responses to domestic violence and abuse.

Science.gov (United States)

Trevillion, Kylee; Corker, Elizabeth; Capron, Lauren E; Oram, Siân

2016-10-01

Domestic violence and abuse is a considerable international public health problem, which is associated with mental disorders in both women and men. Nevertheless, victimization and perpetration remain undetected by mental health services. This paper reviews the evidence on mental health service responses to domestic violence, including identifying, referring, and providing care for people experiencing or perpetrating violence. The review highlights the need for mental health services to improve rates of identification and responses to domestic violence and abuse, through the provision of specific training on domestic violence and abuse, the implementation of clear information sharing protocols and evidence-based interventions, and the establishment of care referral pathways. This review also highlights the need for further research into mental health service users who perpetrate domestic violence and abuse.

Improving the Efficiency of Medical Services Systems: A New Integrated Mathematical Modeling Approach

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Davood Shishebori

2013-01-01

Full Text Available Nowadays, the efficient design of medical service systems plays a critical role in improving the performance and efficiency of medical services provided by governments. Accordingly, health care planners in countries especially with a system based on a National Health Service (NHS try to make decisions on where to locate and how to organize medical services regarding several conditions in different residence areas, so as to improve the geographic equity of comfortable access in the delivery of medical services while accounting for efficiency and cost issues especially in crucial situations. Therefore, optimally locating of such services and also suitable allocating demands them, can help to enhance the performance and responsiveness of medical services system. In this paper, a multiobjective mixed integer nonlinear programming model is proposed to decide locations of new medical system centers, link roads that should be constructed or improved, and also urban residence centers covered by these medical service centers and link roads under investment budget constraint in order to both minimize the total transportation cost of the overall system and minimize the total failure cost (i.e., maximize the system reliability of medical service centers under unforeseen situations. Then, the proposed model is linearized by suitable techniques. Moreover, a practical case study is presented in detail to illustrate the application of the proposed mathematical model. Finally, a sensitivity analysis is done to provide an insight into the behavior of the proposed model in response to changes of key parameters of the problem.

IMPROVING LOGISTICS SERVICES THROUGH THE TECHNOLOGY USED IN FLEET MANAGEMENT

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Mauro Vivaldini

2012-12-01

Full Text Available Outsourcing logistics has established itself in the area of the LSP (Logistics Service Provider, which offers a range of services to its customers. In this line, transportation is characterized as one of the most important services, and therefore efficient fleet management is essential for establishing a high level of customer service. With advances in technology and vehicle tracking systems, this approach of management has gained new possibilities for the improvement of logistics services. By studying the specific case of an LSP, this paper investigates the use of these technologies in the management of their business and services. The results indicate that the LSP seeks to increase its services and to streamline information in order to respond to customer needs in real time. It is also evident in this case under study that the combination of the technology available together with the fleet management system has become a distinguishing feature for this LSP, one which increases their skills and important information for both customers and business.

Fee-for-service cancer rehabilitation programs improve health-related quality of life.

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Kirkham, A A; Neil-Sztramko, S E; Morgan, J; Hodson, S; Weller, S; McRae, T; Campbell, K L

2016-08-01

Rigorously applied exercise interventions undertaken in a research setting result in improved health-related quality of life (hrqol) in cancer survivors, but research to demonstrate effective translation of that research to practice is needed. The objective of the present study was to determine the effect of fee-for-service cancer rehabilitation programs in the community on hrqol and on self-reported physical activity and its correlates. After enrolment and 17 ± 4 weeks later, new clients (n = 48) to two fee-for-service cancer rehabilitation programs completed the 36-Item Short Form Health Survey (rand-36: rand Corporation, Santa Monica, CA, U.S.A.), the Godin Leisure-Time Exercise Questionnaire, and questions about physical activity correlates. Normal fee-for-service operations were maintained, including a fitness assessment and individualized exercise programs supervised in a group or one-on-one setting, with no minimum attendance required. Fees were associated with the assessment and with each exercise session. Of the 48 participants, 36 (75%) completed both questionnaires. Improvements in the physical functioning, role physical, pain, and energy/fatigue scales on the rand-36 exceeded minimally important differences and were of a magnitude similar to improvements reported in structured, rigorously applied, and free research interventions. Self-reported levels of vigorous-intensity (p = 0.021), but not moderate-intensity (p = 0.831) physical activity increased. The number of perceived barriers to exercise (p = 0.035) and the prevalence of fatigue as a barrier (p = 0.003) decreased. Exercise self-efficacy improved only in participants who attended 11 or more sessions (p = 0.002). Exercise enjoyment did not change (p = 0.629). Enrolment in fee-for-service cancer rehabilitation programs results in meaningful improvements in hrqol comparable to those reported by research interventions, among other benefits. The fee-for-service model could be an effective model for

In-flight food delivery and waste collection service: the passengers’ perspective and potential improvement

Science.gov (United States)

Romli, F. I.; Rahman, K. Abdul; Ishak, F. D.

2016-10-01

Increased competition in the commercial air transportation industry has made service quality of the airlines as one of the key competitive measures to attract passengers against their rivals. In-flight services, particularly food delivery and waste collection, have a notable impact on perception of the overall airline's service quality because they are directly and interactively provided to passengers during flight. An online public survey is conducted to explore general passengers' perception of current in-flight food delivery and waste collection services, and to identify potential rooms for improvement. The obtained survey results indicate that in-flight service does have an effect on passengers' choice of airlines. Several weaknesses of the current service method and possible improvements have been established from the collected responses.

Perinatal services and outcomes in Quang Ninh province, Vietnam.

Science.gov (United States)

Nga, Nguyen T; Målqvist, Mats; Eriksson, Leif; Hoa, Dinh P; Johansson, Annika; Wallin, Lars; Persson, Lars-Åke; Ewald, Uwe

2010-10-01

We report baseline results of a community-based randomized trial for improved neonatal survival in Quang Ninh province, Vietnam (NeoKIP; ISRCTN44599712). The NeoKIP trial seeks to evaluate a method of knowledge implementation called facilitation through group meetings at local health centres with health staff and community key persons. Facilitation is a participatory enabling approach that, if successful, is well suited for scaling up within health systems. The aim of this baseline report is to describe perinatal services provided and neonatal outcomes. Survey of all health facility registers of service utilization, maternal deaths, stillbirths and neonatal deaths during 2005 in the province. Systematic group interviews of village health workers from all communes. A Geographic Information System database was also established. Three quarters of pregnant women had ≥3 visits to antenatal care. Two hundred and five health facilities, including 18 hospitals, provided delivery care, ranging from 1 to 3258 deliveries/year. Totally there were 17 519 births and 284 neonatal deaths in the province. Neonatal mortality rate was 16/1000 live births, ranging from 10 to 44/1000 in the different districts, with highest rates in the mountainous parts of the province. Only 8% had home deliveries without skilled attendance, but those deliveries resulted in one-fifth of the neonatal deaths. A relatively good coverage of perinatal care was found in a Vietnamese province, but neonatal mortality varied markedly with geography and level of care. A remaining small proportion of home deliveries generated a substantial part of mortality. © 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Paediatrica.

THE EFFECTS OF ROOM SERVICE TO IMPROVE PATIENTS’ FOOD SATISFACTION AND FOOD ACCEPTANCE

OpenAIRE

Muhammad Iqbal; Susetyowati Susetyowati; Martalena Br Purba

2017-01-01

The improvement of patients’ food satisfaction and acceptance in the hospitals is primarily needed in the food service  system.  Room service is a new concept in the food service area. This study aims to compare the effects of two different types of food service systems; room service and conventional service system. The study with quasi-experimental design is conducted to the subject of 66 inpatients who were taken using a quota sampling method. Subjects were divided into different groups, th...

Using creative problem solving (TRIZ) in improving the quality of hospital services.

Science.gov (United States)

LariSemnani, Behrouz; Mohebbi Far, Rafat; Shalipoor, Elham; Mohseni, Mohammad

2014-08-14

TRIZ is an initiative and SERVQUAL is a structured methodology for quality improvement. Using these tools, inventive problem solving can be applied for quality improvement, and the highest quality can be reached using creative quality improvement methodology. The present study seeks to determine the priority of quality aspects of services provided for patients in the hospital as well as how TRIZ can help in improving the quality of those services. This Study is an applied research which used a dynamic qualitative descriptive survey method during year 2011. Statistical population includes every patient who visited in one of the University Hospitals from March 2011. There existed a big gap between patients' expectations from what seemingly is seen (the design of the hospital) and timely provision of services with their perceptions. Also, quality aspects of services were prioritized as follows: keeping the appearance of hospital (the design), accountability, assurance, credibility and having empathy. Thus, the only thing which mattered most for all staff and managers of studied hospital was the appearance of hospital as well as its staff look. This can grasp a high percentage of patients' satisfaction. By referring to contradiction matrix, the most important principles of TRIZ model were related to tangible factors including principles No. 13 (discarding and recovering), 25 (self-service), 35 (parameter changes), and 2 (taking out). Furthermore, in addition to these four principles, principle No. 24 (intermediary) was repeated most among the others. By utilizing TRIZ, hospital problems can be examined with a more open view, Go beyond The conceptual framework of the organization and responded more quickly to patients ' needs.

Improving Preservice Teachers’ Self-Efficacy through Service Learning: Lessons Learned

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Carianne Bernadowski

2013-07-01

Full Text Available University students have been barraged with service learning opportunities both as course required and as volunteer opportunities in recent years. Currently, many universities now require students to participate in engaged learning as a graduation requirement. Situated in Bandura’s theory of self-efficacy, this study examines the effects service learning has on students teaching self-efficacy when required to participate in an activity (course connected, compared to when they chose to volunteer in service learning projects. As instructors of preservice teachers it is our commitment to prepare these students to their maximum potential. Identifying best practices for teacher preparation is an overarching goal of this study. A pre/post survey examined students’ self-perceptions for each service opportunity in regards to their perceived teaching self-efficacy. Results indicate that students’ self-efficacy improved when service learning was connected or imbedded in the context of learning and connected to a specific course. These findings indicate course connected service learning has a greater impact on preservice teachers’ perceptions of their ability to be effective future classroom teachers. Therefore course connected service learning can be viewed as a best practice in preservice teaching instruction.

Libraries and E-Commerce: Improving Information Services and Beyond.

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Harris, Lesley Ellen

2000-01-01

Explains e-commerce and discusses how it can be used by special libraries. Highlights include library goals; examples of successful uses of e-commerce; how e-commerce can improve information services, including access to information, new information resources, delivery of information, and broadening information markets; and developing an…

Improving student satisfaction of Andalas University Dormitory through Service Quality and Importance Performance Analysis

Science.gov (United States)

Putri, Nilda Tri; Anggraini, Larisa

2018-03-01

Residential satisfaction of university dormitories serve as one of the significant aspects in the framework of sustainability in higher education. This research investigated the quality of dormitory services in Andalas University Dormitory based on student’s satisfaction. According to management residential, the enrollment of residential student has increased gradually in Andalas University. In 2016, capacity of residential student is 1686, but only 1081 students can stay at dormitory because some rooms in bad condition. There are a lot of problems and complaints regarding dormitory’s service quality i.e water problems, leaky rooms and bathrooms, cleanliness and inadequate facilities in residential college. In addition, there are 20% of last year student’s residential check out before the time of contract runs out. The aim of this research are understanding the level of GAP exists between expectation and perception students’ residential in the content of service quality and evaluating the improvement priority services using Importance Performance Analysis. This study is measuring service quality by using Responsiveness, Assurance, Empathy, Reliability and Tangible dimension. A negative GAP indicates that the actual services are than what was expected and the GAP is highlighted area for improvement. Based on IPA, management should improve this following dimension services : responsiveness, tangible and assurance dimension.

Indigenous health: effective and sustainable health services through continuous quality improvement.

Science.gov (United States)

Bailie, Ross S; Si, Damin; O'Donoghue, Lyn; Dowden, Michelle

2007-05-21

The Australian government's Healthy for Life program is supporting capacity development in Indigenous primary care using continuous quality improvement (CQI) techniques. An important influence on the Healthy for Life program has been the ABCD research project. The key features contributing to the success of the project are described. The ABCD research project: uses a CQI approach, with an ongoing cycle of gathering data on how well organisational systems are functioning, and developing and then implementing improvements; is guided by widely accepted principles of community-based research, which emphasise participation; and adheres to the principles and values of Indigenous health research and service delivery. The potential for improving health outcomes in Aboriginal and Torres Strait Islander communities using a CQI approach should be strengthened by clear clinical and managerial leadership, supporting service organisations at the community level, and applying participatory-action principles.

Don't fix it, make it better! : using frontline service employees to improve recovery performance

NARCIS (Netherlands)

Heijden, van der G.A.H.; Schepers, J.J.L.; Nijssen, E.J.; Ordanini, A.

2013-01-01

This study examines how frontline service employees (FSEs) can learn from recovery services and improve their performance accordingly. While research recognizes that FSEs can fulfill an innovation role by sourcing customer knowledge and developing ideas for performance improvement, it remains

Implementation of the systems approach to improve a pharmacist-managed vancomycin dosing service.

Science.gov (United States)

Gagnon, David J; Roberts, Russel; Sylvia, Lynne

2014-12-01

Quality improvements achieved by applying the systems approach to assess the clinical effectiveness, operational efficiency, and financial feasibility of a pharmacist-managed vancomycin dosing service are described. Faced with increased patient volumes and resource demands, the pharmacy department at Tufts Medical Center conducted an evaluation of its adult inpatient vancomycin dosing service using the systems approach, which emphasizes multidisciplinary assessment of system inputs, processes, and outcomes and consensus-building methods to identify needed changes and recommended action steps. A multidisciplinary committee composed of representatives of the medical center's pharmacy, internal medicine, infectious diseases, nursing, phlebotomy, and clinical laboratory services was assembled; in a series of three moderated monthly sessions, committee members deliberated and ultimately reached consensus on a list of action items. Relative to a concurrent intradepartmental assessment of the vancomycin dosing service based solely on pharmacist feedback, the systems approach identified a greater number and wider array of needed improvements in key program areas. Quality improvements implemented as a direct result of the systems-based analysis included a policy change authorizing pharmacists to order serum vancomycin determinations without physician cosignature and inclusion of a vancomycin dosing algorithm in the institutional antibiotic dosing guide. Future changes based on deliverable action items will result in a structured process to help direct program resources toward the patients most in need of pharmacist-managed vancomycin dosing services. The systems approach allowed for a comprehensive multidisciplinary evaluation of the service, as indicated by the identification of process improvements not identified by the department of pharmacy alone. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Improving patient access to videofluoroscopy services: Role of the practitioner-led clinic

Energy Technology Data Exchange (ETDEWEB)

Newman, Roger D., E-mail: Roger.Newman@lthtr.nhs.uk [Dept. of Speech and Language Therapy, Lancashire Teaching Hospitals, Sharoe Green lane, Fulwood, Preston PR2 9HT (United Kingdom); University of Salford (United Kingdom); Nightingale, Julie [University of Salford (United Kingdom)

2011-11-15

Quality Issue: Although costly and time consuming, videofluoroscopic swallowing (VFS) examinations are the gold standard for imaging of oro-pharyngeal dysphagia, and demand is likely to increase with an ageing population. Traditional radiologist-led VFS services in the UK are gradually being replaced by practitioner-led clinics undertaken jointly by speech and language therapists and radiographers. This article explores the impact on patient access of a practitioner-led VFS clinic at a large teaching hospital. Initial Assessment: Specific information pertaining to VFS patient waiting times and service quality was collected for a twelve month period both pre- and post-clinic formation. Choice of Solution: Additional capacity was achieved with the introduction of the practitioner-led clinic, with overall patient access improving by 111%. Mean waiting times for in-patients reduced by 75%, many of whom had the procedure on the same day as referral, with out-patients waiting times reducing by 62.5%. Evaluation: The data demonstrates that patient access and report turnaround times are significantly improved, with no adverse effects as measured by inadequate studies, incorrect reports, complaints and documented radiation dose levels. Lessons Learnt: Practitioner-led VFS services can be recommended as a safe and efficient method of improving service provision.

Improving patient access to videofluoroscopy services: Role of the practitioner-led clinic

International Nuclear Information System (INIS)

Newman, Roger D.; Nightingale, Julie

2011-01-01

Quality Issue: Although costly and time consuming, videofluoroscopic swallowing (VFS) examinations are the gold standard for imaging of oro-pharyngeal dysphagia, and demand is likely to increase with an ageing population. Traditional radiologist-led VFS services in the UK are gradually being replaced by practitioner-led clinics undertaken jointly by speech and language therapists and radiographers. This article explores the impact on patient access of a practitioner-led VFS clinic at a large teaching hospital. Initial Assessment: Specific information pertaining to VFS patient waiting times and service quality was collected for a twelve month period both pre- and post-clinic formation. Choice of Solution: Additional capacity was achieved with the introduction of the practitioner-led clinic, with overall patient access improving by 111%. Mean waiting times for in-patients reduced by 75%, many of whom had the procedure on the same day as referral, with out-patients waiting times reducing by 62.5%. Evaluation: The data demonstrates that patient access and report turnaround times are significantly improved, with no adverse effects as measured by inadequate studies, incorrect reports, complaints and documented radiation dose levels. Lessons Learnt: Practitioner-led VFS services can be recommended as a safe and efficient method of improving service provision.

Software Process Improvement Journey: IBM Australia Application Management Services

Science.gov (United States)

2005-03-01

See Section 5.1.2) - Client Relationship Management ( CRM ) processes-specifically, Solution Design and Solution Delivery - Worldwide Project Management ...plex systems life-cycle management , rapid solutions development, custom development, package selection and implementation, maintenance, minor...CarnegieMellon ___ Software Engineering Institute Software Process Improvement Journey: IBM Australia Application Management Services Robyn Nichols

Pricing, subsidies, and the poor : demand for improved water services in Central America

OpenAIRE

Walker, Ian; Ordonez, Fidel; Serrano, Pedro; Halpern, Jonathan

2000-01-01

Reformulating tariff and subsidy policies is central to improving water and sanitation services in developing countries. The traditional model of state enterprise service provision, coupled with residential tariffs set well below the cost of service, has generally delivered unsatisfactory results. Low internal generation of funds has impeded expansion of networks into poor communities and ...

Trace saver: A tool for network service improvement and personalised analysis of user centric statistics

Science.gov (United States)

Bilal, Muhammad; Asfand-e-Yar, Mockford, Steve; Khan, Wasiq; Awan, Irfan

2012-11-01

Mobile technology is among the fastest growing technologies in today's world with low cost and highly effective benefits. Most important and entertaining areas in mobile technology development and usage are location based services, user friendly networked applications and gaming applications. However, concern towards network operator service provision and improvement has been very low. The portable applications available for a range of mobile operating systems which help improve the network operator services are desirable by the mobile operators. This paper proposes a state of the art mobile application Tracesaver, which provides a great achievement over the barriers in gathering device and network related information, for network operators to improve their network service provision. Tracesaver is available for a broad range of mobile devices with different mobile operating systems and computational capabilities. The availability of Tracesaver in market has proliferated over the last year since it was published. The survey and results show that Tracesaver is being used by millions of mobile users and provides novel ways of network service improvement with its highly user friendly interface.

A New Manufacturing Service Selection and Composition Method Using Improved Flower Pollination Algorithm

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Wenyu Zhang

2016-01-01

Full Text Available With an increasing number of manufacturing services, the means by which to select and compose these manufacturing services have become a challenging problem. It can be regarded as a multiobjective optimization problem that involves a variety of conflicting quality of service (QoS attributes. In this study, a multiobjective optimization model of manufacturing service composition is presented that is based on QoS and an environmental index. Next, the skyline operator is applied to reduce the solution space. And then a new method called improved Flower Pollination Algorithm (FPA is proposed for solving the problem of manufacturing service selection and composition. The improved FPA enhances the performance of basic FPA by combining the latter with crossover and mutation operators of the Differential Evolution (DE algorithm. Finally, a case study is conducted to compare the proposed method with other evolutionary algorithms, including the Genetic Algorithm, DE, basic FPA, and extended FPA. The experimental results reveal that the proposed method performs best at solving the problem of manufacturing service selection and composition.

[Supply medicinal products improvement in outpatient care in a hospital pharmacy service].

Science.gov (United States)

Santiago Pérez, A; Peña Pedrosa, J A; Alguacil Pau, A I; Pérez Morales, A; Molina Muñoz, P; Benítez Giménez, M T

Pharmaceutical care to outpatients is currently one of the main occupations of hospital pharmacy services (PEX). There are several questionnaires to measure the satisfaction of the PEX of a pharmacy service, and the results of these questionnaires can generate improvement actions that result in satisfaction. To verify if a satisfaction questionnaire for outpatients is valid for the generation of improvements in the care provided, and if after its implementation, the same questionnaire is able to detect changes in satisfaction. Prospective study of a single center carried out in a tertiary hospital in 2015 and 2016. A questionnaire previously validated with 16 Likert-type items was used. Demographic and classification data were collected. A descriptive analysis was performed and the internal consistency was calculated using the Cronbach's α value. A total of 258 questionnaires were collected in 2015 and 493 in 2016. There were no differences in the baseline characteristics of the patients and users of the service. The items with the lowest satisfaction scores in 2015 (comfort of the waiting room, dispensing privacy, drug pick-up time and medication pick-up time) guided the improvement actions to be implemented. In 2016 there was an improvement in the waiting time until collection in 12.3% (p = 0.002); in the comfort of the waiting room 4.9% (p = 0.304); business hours for medication collection, 10.7% (p = 0.013); and in the confidentiality of the dispensation 4% (p = 0.292). The remaining scores fluctuated minimally, with no statistical significance at all. A 5.1% improvement in overall satisfaction was found (p improve the care received in an outpatient unit of a pharmacy service. This same questionnaire is a tool to monitor the changes implemented to improve the care received. Copyright © 2018 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Integration of EA and IT service to improve performance at higher education organizations

Directory of Open Access Journals (Sweden)

Hermanto Agus

2018-01-01

Full Text Available One of the perceived benefits of the use of information technology is the increased accuracy and speed of information that greatly helped the operations of an institution or organization. Politeknik XYZ as one of the organizations / institutions in the field of education, now need to consider the strategic role of information technology in supporting academic activities and develop a wide range of academic services, especially for students. Accordingly, in this study has been carried out the planning and improvement of information technology services in accordance with EA and IT Service standards, based on analysis using ACMM maturity level. The end result of architectural planning and service enhancement developed with TOGAF and ITIL is to be used as a reference in the improvement the role of information systems and technology in supporting business process organizations at Polytechnic XYZ. This study demonstrates the importance of raising awareness of the interdependent relationship between architecture and quality of service management in the organization of information technology.

How to improve psychiatric services: a perspective from critical psychiatry.

Science.gov (United States)

de Silva, Prasanna

2017-09-02

Concern has been expressed from both within and outwith psychiatry about the relative lack of improvement of mental health services. Critical psychiatry is an emerging school of thought, mainly the product of practicing clinicians, which could be useful in remedying this situation. This article outlines, for psychiatrists and doctors of other specialities, practices which could be improved, and the competencies required to achieve this, in terms of knowledge, skills and attitudes.

Improving the system of warranty service of trucks in foreign markets

Directory of Open Access Journals (Sweden)

Irina MAKAROVA

2015-03-01

Full Text Available The article is devoted to the practical methods development of improving one of the ways to ensure the health of trucks in the system warranty. Methodology is aimed at optimizing the processes of formation of warranty spare parts kits during the implementation of KAMAZ trucks in foreign markets. The example is given to demonstrate the importance of different factors in the formation of the warranty set for different regions. The algorithm was developed to assess the qualitative composition formed warranty package that will optimize the planning and organization of activity centers to improve operational reliability of commercial trucks. A basis for acceptance of the scientifically-proved decisions is the statistical data analysis of requests monitoring that allows organizing duly replacement of parts with expired service life, and also promotes customer servicing quality improvement and reliability of trucks by prevention of its failures.

Efficacy of a process improvement intervention on delivery of HIV services to offenders: a multisite trial.

Science.gov (United States)

Pearson, Frank S; Shafer, Michael S; Dembo, Richard; Del Mar Vega-Debién, Graciela; Pankow, Jennifer; Duvall, Jamieson L; Belenko, Steven; Frisman, Linda K; Visher, Christy A; Pich, Michele; Patterson, Yvonne

2014-12-01

We tested a modified Network for the Improvement of Addiction Treatment (NIATx) process improvement model to implement improved HIV services (prevention, testing, and linkage to treatment) for offenders under correctional supervision. As part of the Criminal Justice Drug Abuse Treatment Studies, Phase 2, the HIV Services and Treatment Implementation in Corrections study conducted 14 cluster-randomized trials in 2011 to 2013 at 9 US sites, where one correctional facility received training in HIV services and coaching in a modified NIATx model and the other received only HIV training. The outcome measure was the odds of successful delivery of an HIV service. The results were significant at the .05 level, and the point estimate for the odds ratio was 2.14. Although overall the results were heterogeneous, the experiments that focused on implementing HIV prevention interventions had a 95% confidence interval that exceeded the no-difference point. Our results demonstrate that a modified NIATx process improvement model can effectively implement improved rates of delivery of some types of HIV services in correctional environments.

Managing Quality by Action Research--Improving Quality Service Delivery in Higher Education as a Marketing Strategy.

Science.gov (United States)

Corbitt, Brian

1998-01-01

Describes two action research projects undertaken at an Australian university to improve quality of services to foreign students and improve the institution's image through word of mouth, or informal marketing. Each project, although small, facilitated changes or improvements to a targeted service. The role of management in empowering employees…

Improving healthcare for Aboriginal Australians through effective engagement between community and health services.

Science.gov (United States)

Durey, Angela; McEvoy, Suzanne; Swift-Otero, Val; Taylor, Kate; Katzenellenbogen, Judith; Bessarab, Dawn

2016-07-07

Effectively addressing health disparities between Aboriginal and non-Aboriginal Australians is long overdue. Health services engaging Aboriginal communities in designing and delivering healthcare is one way to tackle the issue. This paper presents findings from evaluating a unique strategy of community engagement between local Aboriginal people and health providers across five districts in Perth, Western Australia. Local Aboriginal community members formed District Aboriginal Health Action Groups (DAHAGs) to collaborate with health providers in designing culturally-responsive healthcare. The purpose of the strategy was to improve local health service delivery for Aboriginal Australians. The evaluation aimed to identify whether the Aboriginal community considered the community engagement strategy effective in identifying their health service needs, translating them to action by local health services and increasing their trust in these health services. Participants were recruited using purposive sampling. Qualitative data was collected from Aboriginal participants and health service providers using semi-structured interviews or yarning circles that were recorded, transcribed and independently analysed by two senior non-Aboriginal researchers. Responses were coded for key themes, further analysed for similarities and differences between districts and cross-checked by the senior lead Aboriginal researcher to avoid bias and establish reliability in interpreting the data. Three ethics committees approved conducting the evaluation. Findings from 60 participants suggested the engagement process was effective: it was driven and owned by the Aboriginal community, captured a broad range of views and increased Aboriginal community participation in decisions about their healthcare. It built community capacity through regular community forums and established DAHAGs comprising local Aboriginal community members and health service representatives who met quarterly and were

Strategies for improved French-language health services

Science.gov (United States)

Gauthier, Alain P.; Timony, Patrick E.; Serresse, Suzanne; Goodale, Natalie; Prpic, Jason

2015-01-01

Abstract Objective To identify strategies to improve the quality of health services for Francophone patients. Design A series of semistructured key informant interviews. Setting Northeastern Ontario. Participants A total of 18 physicians were interviewed. Ten physicians were interviewed in French, 7 physicians were women, and 10 physicians were located in urban communities. Methods Purposive and snowball sampling strategies were used to conduct a series of semistructured key informant interviews with family physicians practising in communities with a large Francophone population. Principles of grounded theory were applied, guided by a framework for patient-professional communication. Results were inductively derived following an iterative data collection–data analysis process and were analyzed using a detailed thematic approach. Main findings Respondents identified several strategies for providing high-quality French-language health services. Some were unique to non–French-speaking physicians (eg, using appropriate interpreter services), some were unique to French-speaking physicians (eg, using a flexible dialect), and some strategies were common to all physicians serving French populations (eg, hiring bilingual staff or having pamphlets and posters in both French and English). Conclusion Physicians interviewed for this study provided high-quality health care by attributing substantial importance to effective communication. While linguistic patient-to-physician concordance is ideal, it might not always be possible. Thus, conscious efforts to attenuate communication barriers are necessary, and several effective strategies exist. PMID:26505060

Re-engineering pre-employment check-up systems: a model for improving health services.

Science.gov (United States)

Rateb, Said Abdel Hakim; El Nouman, Azza Abdel Razek; Rateb, Moshira Abdel Hakim; Asar, Mohamed Naguib; El Amin, Ayman Mohammed; Gad, Saad abdel Aziz; Mohamed, Mohamed Salah Eldin

2011-01-01

The purpose of this paper is to develop a model for improving health services provided by the pre-employment medical fitness check-up system affiliated to Egypt's Health Insurance Organization (HIO). Operations research, notably system re-engineering, is used in six randomly selected centers and findings before and after re-engineering are compared. The re-engineering model follows a systems approach, focusing on three areas: structure, process and outcome. The model is based on six main components: electronic booking, standardized check-up processes, protected medical documents, advanced archiving through an electronic content management (ECM) system, infrastructure development, and capacity building. The model originates mainly from customer needs and expectations. The centers' monthly customer flow increased significantly after re-engineering. The mean time spent per customer cycle improved after re-engineering--18.3 +/- 5.5 minutes as compared to 48.8 +/- 14.5 minutes before. Appointment delay was also significantly decreased from an average 18 to 6.2 days. Both beneficiaries and service providers were significantly more satisfied with the services after re-engineering. The model proves that re-engineering program costs are exceeded by increased revenue. Re-engineering in this study involved multiple structure and process elements. The literature review did not reveal similar re-engineering healthcare packages. Therefore, each element was compared separately. This model is highly recommended for improving service effectiveness and efficiency. This research is the first in Egypt to apply the re-engineering approach to public health systems. Developing user-friendly models for service improvement is an added value.

Does a voucher program improve reproductive health service delivery and access in Kenya?

Science.gov (United States)

Njuki, Rebecca; Abuya, Timothy; Kimani, James; Kanya, Lucy; Korongo, Allan; Mukanya, Collins; Bracke, Piet; Bellows, Ben; Warren, Charlotte E

2015-05-23

Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, attitudes, and experiences of healthcare providers and facility managers in the Kenya reproductive health output-based approach voucher program. A total of 69 in-depth interviews with healthcare providers and facility managers in 30 voucher accredited facilities were conducted. The study hypothesized that a voucher program would be associated with improvements in reproductive health service provision. Data were transcribed and analyzed by adopting a thematic framework analysis approach. A combination of inductive and deductive analysis was conducted based on previous research and project documents. Facility managers and providers viewed the RH-OBA program as a feasible system for increasing service utilization and improving quality of care. Perceived benefits of the program included stimulation of competition between facilities and capital investment in most facilities. Awareness of family planning (FP) and gender-based violence (GBV) recovery services voucher, however, remained lower than the maternal health voucher service. Relations between the voucher management agency and accredited facilities as well as existing health systems challenges affect program functions. Public and private sector healthcare providers and facility managers perceive value in the voucher program as a healthcare financing model. They recognize that it has the potential to significantly increase demand for reproductive health services, improve quality of care and reduce inequities in the use of reproductive health services. To improve program functioning going forward, there is need to ensure the benefit package and criteria for beneficiary identification are well understood and that the public facilities are permitted greater autonomy to utilize revenue generated from the voucher program.

The Dilemma of Accountability and Good Governance for Improved Public Service Delivery in Nigeria

Directory of Open Access Journals (Sweden)

Kehinde David Adejuwon

2012-12-01

Full Text Available The public sector in Nigeria is irrefutably beset with gross  incompetence and ineffective management. Perplexing difficulties endure in the Nigerian public sector in spite of a number of reform programmes that have been designed to enhance efficient and effective service delivery for almost two decades. The fact that public service has failed dismally to achieve its laudable objectives is the reason for the vote of no confidence passed on its administrators by majority of the Nigerian populace. The article examines the dilemma of accountability and good governance in Nigeria and demonstrates that the critical point in achieving meaningful developments in the country intrinsically lay with improved service delivery in the public sector. The basic reason why the public service has become the scorn of the people is because for too long, both the government and public servants have paid lip service to the crucial issue of effective and efficient service delivery. The article argues that improved service delivery will improve both the performance and the image of public service and re-awaken the citizens’ interest and trust in them to do business with public servants. It suggests that  in order to bring sanity back to the Nigerian Public Service,  all unprofessional tendencies such as ethnicity bias and nepotism in appointments and promotions, lack of security of tenure of office, and appointment of non-career public servants into key positions in the public service must stop. Also,  effective service delivery must be tailored to the circumstances of Nigeria. The study made use of secondary data obtained from various sources. It therefore concludes that without a reawakening of the culture of accountability and transparency lost over the years, the trusting relationship needed to forge between the government and the governed for the actualization of good governance will not materialize.

A METHOD FOR IMPROVEMENT OF OBJECTIVITY OF E-SERVICE QUALITY EVALUATION

Directory of Open Access Journals (Sweden)

Renata Mekovec

2007-12-01

Full Text Available Measurement and improvement of e-service quality is important for sustaining competitive advantage of an e-commerce web site. A number of e-service quality measures have recently been developed that predominantly rely on the subjective evaluation of diverse quality attributes. To increase the objectivity of e-service quality measurement a recently developed measure of e-service quality has been adapted in a way that replaces its Likert type scales for evaluation of specific attributes with check-lists that include specific observable elements for appraisal and a scoring procedure. The consistency of scoring with this adaptation of an e-service quality measure was investigated in comparison to the use of the standard measure with Likert type scales and by the use of untrained and trained evaluators. The results of the empirical evaluation indicate a greater inter-rater consistency when the adapted/objective measure is used for evaluation of the efficiency dimension of e-service quality.

Improvement in the quality of the catering service of a rehabilitation hospital.

Science.gov (United States)

Donini, L M; Castellaneta, E; De Guglielmi, S; De Felice, M R; Savina, C; Coletti, C; Paolini, M; Cannella, C

2008-02-01

Malnutrition due to undernutrition or overnutrition is highly prevalent in hospital in-patients and it decisively conditions patients clinical outcome. One of the most influencing factors of malnutrition in hospitalized patients is--at least in part--the Catering Service Quality. Is to verify, over a 5 year period, the course of the quality of the institutional Catering Service, verifying the effectiveness of the quality improvement process used. Quality control was performed by objective (meal order accuracy, proper distribution of food in trolleys, route time from the kitchen to the ward and time of food distribution, food weight and temperature, waste assessment) and subjective assessment (quality was measured by giving the patients a questionnaire after meals). The survey included: 572 meals and 591 interviews. A significant amount of "qualitative" errors (lack of respect for patient preferences or at the moment of supplying the food trolley) have been found. Over the time and the amount of patients that wasted a considerable amount of the portion served was considerably reduced food temperature have been improved. Also patient satisfaction with menu variability, portion size, temperature and cooking quality improved over time. The overall ratings of meals under observation improved too in fact, positive opinions ranged from 18% in 2002 to 48.3% in 2006. Ongoing research and quality verification, which include all catering service workers, yields a constant improvement in quality. Patients in healthcare settings should receive a service they appreciates, but it should be--at the same time--correct from a nutritional point of view. For this reason, it is necessary a continuous mediation between customers satisfaction and nutritionists work, dieticians and nursing staff. From this point of view the educational approach becomes essential to feed patient compliance to dietetic treatment that will continue after discharge.

Using family and staff experiences of a botulinum toxin-A service to improve service quality.

Science.gov (United States)

Burton, K L O; Bau, K; Lewis, J; Aroyan, K R; Botha, B; Botman, A G M; Stewart, K; Waugh, M-C A; Paget, S P

2017-11-01

The decision for families to proceed with botulinum toxin-A (BoNT-A) injections for managing childhood conditions involving hypertonia can be complex. Family-centred care is a service model that facilitates supporting families in this decision-making process. Understanding families' experiences of services is critical to developing family-centred care. The aim of this project was therefore to increase understanding of the experiences of families of children attending a BoNT-A service in order to improve the service and its family-centred approach to care. Sixteen staff of a BoNT-A service participated in a patient journey mapping exercise. Nine families of the service participated in in-depth interviews. Interviews were audio-recorded and transcribed verbatim. Data from the staff session and interviews were analysed independently using grounded, hermeneutic thematic analysis. Staff sessions revealed 5 core themes that related to impacting on the family experience. Family interviews revealed 4 core themes, with 7 subthemes and 1 latent theme. Areas of importance identified by families relating to BoNT-A treatment included acknowledgement of individual needs, care coordination, empowerment of families and patients, consistency in service delivery, and the distressing nature of appointment and decision-making. Comparison of the data from the staff patient journey mapping and family interviews suggested that staff have a good but incomplete understanding of the factors important to families, highlighting the need for consumer engagement in establishing family-centred care. The themes identified can guide the provision of family-centred BoNT-A injection clinics. © 2017 John Wiley & Sons Ltd.

Cancer Services and Their Initiatives to Improve the Care of Indigenous Australians

Directory of Open Access Journals (Sweden)

Emma V. Taylor

2018-04-01

Full Text Available Indigenous Australians continue to experience significantly poorer outcomes from cancer than non-Indigenous Australians. Despite the importance of culturally appropriate cancer services in improving outcomes, there is a lack of awareness of current programs and initiatives that are aimed at meeting the needs of Indigenous patients. Telephone interviews were used to identify and describe the Indigenous-specific programs and initiatives that are implemented in a subset of the services that participated in a larger national online survey of cancer treatment services. Fourteen services located across Australia participated in the interviews. Participants identified a number of factors that were seen as critical to delivering culturally appropriate treatment and support, including having a trained workforce with effective cross-cultural communication skills, providing best practice care, and improving the knowledge, attitudes, and understanding of cancer by Indigenous people. However, over a third of participants were not sure how their service compared with others, indicating that they were not aware of how other services are doing in this field. There are currently many Indigenous-specific programs and initiatives that are aimed at providing culturally appropriate treatment and supporting Indigenous people affected by cancer across Australia. However, details of these initiatives are not widely known and barriers to information sharing exist. Further research in this area is needed to evaluate programs and initiatives and showcase the effective approaches to Indigenous cancer care.

Improving inpatient postnatal services: midwives views and perspectives of engagement in a quality improvement initiative

Directory of Open Access Journals (Sweden)

Wray Julie

2011-11-01

Full Text Available Abstract Background Despite major policy initiatives in the United Kingdom to enhance women's experiences of maternity care, improving in-patient postnatal care remains a low priority, although it is an aspect of care consistently rated as poor by women. As part of a systems and process approach to improving care at one maternity unit in the South of England, the views and perspectives of midwives responsible for implementing change were sought. Methods A Continuous Quality Improvement (CQI approach was adopted to support a systems and process change to in-patient care and care on transfer home in a large district general hospital with around 6000 births a year. The CQI approach included an initial assessment to identify where revisions to routine systems and processes were required, developing, implementing and evaluating revisions to the content and documentation of care in hospital and on transfer home, and training workshops for midwives and other maternity staff responsible for implementing changes. To assess midwifery views of the quality improvement process and their engagement with this, questionnaires were sent to those who had participated at the outset. Results Questionnaires were received from 68 (46% of the estimated 149 midwives eligible to complete the questionnaire. All midwives were aware of the revisions introduced, and two-thirds felt these were more appropriate to meet the women's physical and emotional health, information and support needs. Some midwives considered that the introduction of new maternal postnatal records increased their workload, mainly as a consequence of colleagues not completing documentation as required. Conclusions This was the first UK study to undertake a review of in-patient postnatal services. Involvement of midwives at the outset was essential to the success of the initiative. Midwives play a lead role in the planning and organisation of in-patient postnatal care and it was important to obtain their

Radiological information systems: improvements in service, economy, and quality control?

International Nuclear Information System (INIS)

Gross-Fengels, W.; Weber, M.

1997-01-01

By means of complete service control and standardized accounting processes, radiological information systems clearly contribute to improved results. They provide the prerequisites for the establishment of expanded networks and allow comprisons with comparable institutions. The quality of patient care can be improved since, for example, the production time from referral to finished result becomes shorter. Direct access to patient and findings data from several positions is possible. Preliminary results can be viewed immediately. The patient's history is accessible to authorized users at all times. The exact reproducibility and assignment of services leads to more clarity. By means of the information available form RIS, rapid adaptive processes can be undertaken. The system assists the to fulfill the requirements of health regulations. The above-mentioned relationships demonstrate that the EDP systems are well accepted by physicians, medical assistants, and administrators and represent an indispensable aid for solving problems. (orig.) [de

Defense Logistics Agency Disposition Services Needs to Improve Demilitarization Program Self-Assessment Evaluations - Redacted

Science.gov (United States)

2016-12-20

from mandatory disclosure under the Freedom of Information Act. Defense Logistics Agency Disposition Services Needs to Improve Demilitarization...Project No. D2016-D000RD-0057.000) │ i Results in Brief Defense Logistics Agency Disposition Services Needs to Improve Demilitarization Program Self...Assessment Evaluations Visit us at www.dodig.mil December 20, 2016 Objective Our audit objective was to determine whether the Defense Logistics Agency

Artificial intelligence guides system's best practices, cutting costs and improving services.

Science.gov (United States)

1999-06-01

One for the history books. Clinical care improvement initiatives guided by a sophisticated artificial intelligence program have helped a major Virginia integrated health system make dramatic improvements in the cost and quality of its health care services. Find out how the technological innovation has earned Sentara Health System a place in the permanent collection of the Smithsonian's National Museum of American History.

The Armed Services and Model Employer Status for Child Support Enforcement: A Proposal to Improve Service of Process

National Research Council Canada - National Science Library

Cook, Alan L

1996-01-01

.... The Order directed DoD and other federal agencies to study methods of improving service of process for child support enforcement on their employees and uniformed members, with particular emphasis...

Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children: Why, What, and How to Undertake Estimates?

Science.gov (United States)

Lawn, Joy E; Bianchi-Jassir, Fiorella; Russell, Neal J; Kohli-Lynch, Maya; Tann, Cally J; Hall, Jennifer; Madrid, Lola; Baker, Carol J; Bartlett, Linda; Cutland, Clare; Gravett, Michael G; Heath, Paul T; Ip, Margaret; Le Doare, Kirsty; Madhi, Shabir A; Rubens, Craig E; Saha, Samir K; Schrag, Stephanie; Sobanjo-Ter Meulen, Ajoke; Vekemans, Johan; Seale, Anna C

2017-11-06

Improving maternal, newborn, and child health is central to Sustainable Development Goal targets for 2030, requiring acceleration especially to prevent 5.6 million deaths around the time of birth. Infections contribute to this burden, but etiological data are limited. Group B Streptococcus (GBS) is an important perinatal pathogen, although previously focus has been primarily on liveborn children, especially early-onset disease. In this first of an 11-article supplement, we discuss the following: (1) Why estimate the worldwide burden of GBS disease? (2) What outcomes of GBS in pregnancy should be included? (3) What data and epidemiological parameters are required? (4) What methods and models can be used to transparently estimate this burden of GBS? (5) What are the challenges with available data? and (6) How can estimates address data gaps to better inform GBS interventions including maternal immunization? We review all available GBS data worldwide, including maternal GBS colonization, risk of neonatal disease (with/without intrapartum antibiotic prophylaxis), maternal GBS disease, neonatal/infant GBS disease, and subsequent impairment, plus GBS-associated stillbirth, preterm birth, and neonatal encephalopathy. We summarize our methods for searches, meta-analyses, and modeling including a compartmental model. Our approach is consistent with the World Health Organization (WHO) Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER), published in The Lancet and the Public Library of Science (PLoS). We aim to address priority epidemiological gaps highlighted by WHO to inform potential maternal vaccination. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Improving productivity levels: family planning services for factory workers.

Science.gov (United States)

Darmokusumo, H V

1989-10-01

In May 1984, the Minister of Manpower in Indonesia, the Chairman of the BKKBN, and representatives of the employers' and workers' organizations of Indonesia issued a joint decree pledging that they would work together to enhance the implementation of the family planning program among workers in the organized sector. 1 objective of the decree is to improve workers' productivity and the standard of living of workers and their families by implementing a family planning program. 1 baseline survey and a clinic-based survey in 5 provinces revealed that 90% of women workers are between 21-40, or are of reproductive age, and are sexually active. Only about 50% are practicing family planning; the other 50% are afraid to practice family planning due to potential side effects of various methods. This fear was most often caused by negative rumors spread by unsatisfied family planning clients. Placing materials for family planning promotion such as instructional posters and video programs advertising contraceptive services in the work setting may increase knowledge and help alleviate some of this fear. Other studies of family planning services show that employees prefer female medical doctors or midwives as service providers, employees are willing to pay for services (but can only afford a small fee), and family planning service points should be near employees' work sites.

25 CFR 256.25 - Is my Federal government-assisted dwelling eligible for services under the Housing Improvement...

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Is my Federal government-assisted dwelling eligible for services under the Housing Improvement Program? 256.25 Section 256.25 Indians BUREAU OF INDIAN AFFAIRS... dwelling eligible for services under the Housing Improvement Program? Yes. You may receive services under...

Using internal marketing to improve organizational commitment and service quality.

Science.gov (United States)

Tsai, Yafang; Wu, Shih-Wang

2011-12-01

The purpose of this article was to explore the structural relationships among internal marketing, organizational commitment and service quality and to practically apply the findings. Internal marketing is a way to assist hospitals in improving the quality of the services that they provide while executing highly labour-intensive tasks. Through internal marketing, a hospital can enhance the organizational commitment of its employees to attain higher service quality. This research uses a cross-sectional study to survey nursing staff perceptions about internal marketing, organizational commitment and service quality. The results of the survey are evaluated using equation models. The sample includes three regional hospitals in Taiwan. Three hundred and fifty questionnaires were distributed and 288 valid questionnaires were returned, yielding a response rate of 82.3%. The survey process lasted from 1 February to 9 March 2007. The data were analysed with SPSS 12.0, including descriptive statistics based on demographics. In addition, the influence of demographics on internal marketing, organizational commitment and service quality is examined using one-way anova. The findings reveal that internal marketing plays a critical role in explaining employee perceptions of organizational commitment and service quality. Organizational commitment is the mediator between internal marketing and service quality. The results indicate that internal marketing has an impact on both organizational commitment and service quality. Internal marketing should be emphasized to influence frontline nursing staff, thereby helping to create better organizational commitment and service quality. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Implementation of occupational health service improvements through application of total quality management processes.

Science.gov (United States)

Thomas, Elizabeth Anne

2011-06-01

The occupational health services department for a manufacturing division of a high-technology firm was redesigned from an outsourced model, in which most services were provided by an outside clinic vendor, to an in-house service model, in which services were provided by an on-site nurse practitioner. The redesign and implementation, accomplished by a cross-functional team using Total Quality Management processes, resulted in a comprehensive occupational health services department that realized significant cost reduction, increased compliance with regulatory and company requirements, and improved employee satisfaction. Implications of this project for occupational health nurses are discussed.

Value for money of changing healthcare services? Economic evaluation of quality improvement

Science.gov (United States)

Severens, J

2003-01-01



 There are many instances of perceived or real inefficiencies in health service delivery. Both healthcare providers and policy makers need to know the impact and cost of applying strategies to change the behaviour of individuals or organisations. Quality improvement or implementation research is concerned with evaluating the methods of behavioural change. Addressing inefficiencies in healthcare services raises a series of issues, beginning with how inefficiency itself should be defined. The basic concepts of cost analysis and economic evaluations are explained and a model for working through the economic issues of quality improvement is discussed. This model combines the costs and benefits of corrected inefficiency with the costs and degree of behavioural change achieved by a quality improvement method in the policy maker's locality. It shows why it may not always be cost effective for policy makers to address suboptimal behaviour. Both the interpretation of quality improvement research findings and their local application need careful consideration. The limited availability of applicable quality improvement research may make it difficult to provide robust advice on the value for money of many behavioural quality improvement strategies. PMID:14532369

Fedora Content Modelling for Improved Services for Research Databases

DEFF Research Database (Denmark)

Elbæk, Mikael Karstensen; Heller, Alfred; Pedersen, Gert Schmeltz

A re-implementation of the research database of the Technical University of Denmark, DTU, is based on Fedora. The backbone consists of content models for primary and secondary entities and their relationships, giving flexible and powerful extraction capabilities for interoperability and reporting....... By adopting such an abstract data model, the platform enables new and improved services for researchers, librarians and administrators....

Engaging service providers in improving industry performance

International Nuclear Information System (INIS)

Oberth, R.

2012-01-01

Effective task leadership is the key to achieving results in the nuclear industry and in most other industries. One of the themes of this conference is to discuss how the nuclear industry can undertake Issue-Identification and Definition as a means of 'identifying what needs attention' and then 'defining what needs to be done to make that happen'. I will explore this theme from the perspective of the 'Service Provider' - which by the definition of this conference includes everyone not within an operating utility - meaning 'those involved in everything from inspection and repair to research and plant architecture' - basically the member companies of my association, OCI. Our members take the definition of the roles and responsibilities of the 'Service Provider' community very seriously. In the context of this discussion a key utility function is the early definition of requirements and expectations of Service Providers in supplying to these requirements. Let's explore for a moment the Service Provider role and perspective. Service Providers are by nature pro-active - they seek ways to engage with utilities (and tier one vendors) to solve problems and achieve good outcomes. They come to industry conferences like this one to learn about upcoming utility programs and supply opportunities and how they can improve performance. Service Providers particularly want to hear senior utility people comment on emerging issues even those at the very early identification stage. Some Clarification of Roles is in Order - as that is the focus of this conference: 'Issue-Identification and Definition'. 'Issue-Identification' is the utility's job - it is the utility's role to identify as early as possible 'what needs attention and what their needs and expectations are'. This takes place before service provider engagement. 'Issue-Definition' is more challenging. It means 'determining and prioritizing what needs to be done to deal with the situation at hand'. This typically involves

Improving the patient booking service to reduce the number of missed appointments at East London NHS Foundation Trust Community Musculoskeletal Physiotherapy Service.

Science.gov (United States)

Tan, Elizabeth; Shah, Amar; De Souza, Warren; Harrison, Mark; Chettur, Chris; Onathukattil, Maimoona; Smart, Michelle; Mata, Marlon; Chitewe, Auzewell; Binley, Emma

2017-01-01

The East London National Health Service Foundation Trust (ELFT) Community Musculoskeletal (MSK) Physiotherapy Service had reported a high rate of non-attendance at scheduled appointments. This was leading to delayed access to treatment for patients and a reduced capacity for service users, as well as a waste of clinical resources. The aim of this quality improvement project was therefore to reduce the percentage of missed appointments within this department. This study was undertaken by the ELFT community MSK service, with support from the ELFT Quality Improvement team. To begin with, patient complaints were explored; these indicated that the main reason for missing appointments was due to issues with the patient booking service. Baseline data were initially collected for both new referrals and follow-up patients. The proposed changes were then introduced, which included text message reminders, first via a manual platform and then via an automated system. Ongoing data were recorded to note the effectiveness of these changes. Following the intervention, non-attendance of newly referred patients reduced by 43.35% (23.76%-13.46%) after both cycles. Non-attendance of follow-up patients reduced by 44.14% (23.74%-13.26%) after the second cycle alone. By listening to the opinions of service users, it was possible to improve the patient booking system and the flexibility of appointments. This resulted in a reduction in the percentage of appointments missed. These changes will continue to be monitored within this department to ensure sustainability but there is also now potential for similar interventions to be trialled in other health service departments.

Improving ELM-Based Service Quality Prediction by Concise Feature Extraction

Directory of Open Access Journals (Sweden)

Yuhai Zhao

2015-01-01

Full Text Available Web services often run on highly dynamic and changing environments, which generate huge volumes of data. Thus, it is impractical to monitor the change of every QoS parameter for the timely trigger precaution due to high computational costs associated with the process. To address the problem, this paper proposes an active service quality prediction method based on extreme learning machine. First, we extract web service trace logs and QoS information from the service log and convert them into feature vectors. Second, by the proposed EC rules, we are enabled to trigger the precaution of QoS as soon as possible with high confidence. An efficient prefix tree based mining algorithm together with some effective pruning rules is developed to mine such rules. Finally, we study how to extract a set of diversified features as the representative of all mined results. The problem is proved to be NP-hard. A greedy algorithm is presented to approximate the optimal solution. Experimental results show that ELM trained by the selected feature subsets can efficiently improve the reliability and the earliness of service quality prediction.

Improvement of maternal health services through the use of mobile phones.

Science.gov (United States)

Noordam, A Camielle; Kuepper, Barbara M; Stekelenburg, Jelle; Milen, Anneli

2011-05-01

To analyse, on the basis of the literature, the potential of mobile phones to improve maternal health services in Low and Middle Income Countries (LMIC). Wide search for scientific and grey literature using various terms linked to: maternal health, mobile telecommunication and LMIC. Applications requiring an internet connection were excluded as this is not widely available in LMIC yet. Few projects exist in this field and little evidence is available as yet on the impact of mobile phones on the quality of maternal health services. Projects focus mainly on the delay in receiving care--that is in recognizing the need and making the decision to seek care--and the delay in arriving at the health facility. This is achieved by connecting lesser trained health workers to specialists and coordination of referrals. Ongoing projects focus on empowering women to seek health care. There is broad agreement that access to communication is one of several essential components to improve maternal health services and hence the use of mobile phones has much potential. However, there is a need for robust evidence on constraints and impacts, especially when financial and human resources will be invested. Concurrently, other ways in which mobile phones can be used to benefit maternal health services need to be further explored, taking into consideration privacy and confidentiality. © 2011 Blackwell Publishing Ltd.

Improving the effectiveness of service delivery in the public healthcare sector: the case of ophthalmology services in Malaysia.

Science.gov (United States)

Foo, Chee Yoong; Lim, Ka Keat; Sivasampu, Sheamini; Dahian, Kamilah Binti; Goh, Pik Pin

2015-08-28

Rising demand of ophthalmology care is increasingly straining Malaysia's public healthcare sector due to its limited human and financial resources. Improving the effectiveness of ophthalmology service delivery can promote national policy goals of population health improvement and system sustainability. This study examined the performance variation of public ophthalmology service in Malaysia, estimated the potential output gain and investigated several factors that might explain the differential performance. Data for 2011 and 2012 on 36 ophthalmology centres operating in the Ministry of Health hospitals were used in this analysis. We first consulted a panel of ophthalmology service managers to understand the production of ophthalmology services and to verify the production model. We then assessed the relative performance of these centres using Data Envelopment Analysis (DEA). Efficiency scores (ES) were decomposed into technical, scale, and congestion component. Potential increase in service output was estimated. Sensitivity analysis of model changes was performed and stability of the result was assessed using bootstrap approach. Second stage Tobit regression was conducted to determine if hospital type, availability of day services and population characteristics were related to the DEA scores. In 2011, 33% of the ophthalmology centres were found to have ES > 1 (mean ES = 1.10). Potential output gains were 10% (SE ± 2.92), 7.4% (SE ± 2.06), 6.9% (SE ± 1.97) if the centres could overcome their technical, scale and congestion inefficiencies. More centres moved to the performance frontier in 2012 (mean ES = 1.07), with lower potential output gain. The model used has good stability. Robustness checks show that the DEA correctly identified low performing centres. Being in state hospital was significantly associated with better performance. Using DEA to benchmarking service performance of ophthalmology care could provide insights for policy

Improving Service Quality by Using Organizational Citizenship Behavior: Iranian Evidence

Directory of Open Access Journals (Sweden)

Nour-Mohammad Yaghoubi

2011-09-01

Full Text Available Nowadays, with increasing service industries, service marketing and service quality have become an important challenge to organizations. The attempts of organizations in this situation are witnesses to this matter. In the past years, the organizations tried to reach service quality appropriation and satisfaction of self-external customers by concepts and approaches of external marketing. One of the important features of service is the direct interaction with customers and having customer-oriented behaviors. Furthermore, with introducing the internal marketing and the important roles of it, an internal customer of organizations, on achievement of organizational plans, was noted to internal marketing more and more than before. So, the study researchers are going to argue about internal marketing and the effect of it on organizational citizenship behaviors and service quality and the important role of it on development and improvement of service quality by using organizational citizenship behaviors. For this purpose, first the researchers have studied internal marketing and its important components and then have done the same to the other items and finally have applied a quantitative study on all of them. It should be mentioned that the researchers have employed SPSS 17.0 and Lisrel 8.54 for data analysis. The findings of the present study illustrated that there is an appropriate interaction among all the items, which has been studied here and the structural equations for the conceptual framework of this study are goodness of fit.

Analysis of the characteristics of taxi services as a prerequisite for their improvement

Directory of Open Access Journals (Sweden)

Vujić Nenad

2014-01-01

Full Text Available The expansion of services sector is the characteristics of modern and developed societies that influence national economy. Therefore, the analysis of services, as a concept and part of marketing is very significant. In this sense, the paper researches a particular service - the taxi services in the capital of Serbia. Through this research, the authors try to define the groups of customer of taxi services and their preference and attitudes. The research was performed in period May to July 2014, by direct contact with customer of taxi services. The results of research have confirmed the initial hypothesis and provide possibilities for further insight into the way of using taxi services and general circumstances that characterize them in mentioned region. On this basis, it is provided proposals for improvement of taxi services and easier outreach of target groups.

Exploring, Documenting, and Improving Humanitarian Service Learning through Engineers Without Borders USA

OpenAIRE

Buchanan, Elizabeth; Berg, Devin; Lee, Tina; Buchanan, Elizabeth; Lacksonen, Tom

2017-01-01

Exploring, Documenting, and Improving Humanitarian Service Learning through Engineers without Borders-USA is a four-year project exploring a variety of challenges and opportunities in university-based service learning programs. Specifically, this project looks holistically at the inception and evolution of a new Engineers Without Borders USA chapter, while analyzing characteristics, values, and demographics of individuals involved in EWB community-based humanitarian projects in multiple chapt...

Opportunities and Challenges of Cloud Computing to Improve Health Care Services

Science.gov (United States)

2011-01-01

Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses 4 aspects (management, technology, security, and legal) to evaluate the opportunities and challenges of this computing model. Strategic planning that could be used by a health organization to determine its direction, strategy, and resource allocation when it has decided to migrate from traditional to cloud-based health services is also discussed. PMID:21937354

Opportunities and challenges of cloud computing to improve health care services.

Science.gov (United States)

Kuo, Alex Mu-Hsing

2011-09-21

Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses 4 aspects (management, technology, security, and legal) to evaluate the opportunities and challenges of this computing model. Strategic planning that could be used by a health organization to determine its direction, strategy, and resource allocation when it has decided to migrate from traditional to cloud-based health services is also discussed.

Productivity and quality improvements in health care through airboss mobile messaging services.

Science.gov (United States)

Shah, P J; Martinez, R; Cooney, E

1997-01-01

The US health care industry is in the midst of revolutionary changes. Under tremendous pressures from third-party payers and managed care programs to control costs while providing high quality medical services, health care entities are now looking at information technologies to help them achieve their goals. These goals typically include improved productivity, efficiency and decision-making capabilities among staff members. Moreover, hospitals and other health care facilities that provide a broad and integrated range of inpatient and outpatient care, wellness and home care services are in the best position to offer comprehensive packages to managed care and private insurers. Many health care providers and administrators are considered mobile employees. This mobility can range from intra-building and intra-campus to multi-site and metropolitan areas. This group often relies on a variety of information technologies such as personal computers, communicating laptops, pagers, cellular phones, wireline phones, cordless phones and fax machines to stay in touch and handle information needs. These health care professionals require mobile information access and messaging tools to improve communications, control accessibility and enhance decision-making capabilities. AirBoss mobile messaging services could address the health care industry's need for improved messaging capabilities for its mobile employees. The AirBoss family of services supports integrated voice services, data messaging, mobile facsimile and customized information delivery. This paper describes overview of the current mobile data networking capability, the AirBoss architecture, the health care-related applications it addresses and long-term benefits. In addition, a prototype application for mobile home health care workers is illustrated. This prototype application provides integrated e-mail, information services, web access, real-time access and update of patient records from wireline or wireless networks

Reorganisation of healthcare services for children and families: Improving collaboration, service quality, and worker well-being.

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Martinussen, Monica; Kaiser, Sabine; Adolfsen, Frode; Patras, Joshua; Richardsen, Astrid M

2017-07-01

This study is an evaluation of a reorganisation of different services for children and their families in a Norwegian municipality. The main aim of the reorganisation was to improve interprofessional collaboration through integrating different social services for children and their parents. The evaluation was guided by the Job Demands-Resources Model with a focus on social and healthcare workers' experiences of their work, including job demands and resources, service quality, and well-being at work. The survey of the employees was conducted at three measurement points: before (T 1 ) and after (T 2 , T 3 ) the reorganisation took place, and included between 87 and 122 employees. A secondary aim was to examine the impact of different job resources and job demands on well-being (burnout, engagement, job satisfaction), and service quality. A one-way ANOVA indicated a positive development on many scales, such as collaboration, work conflict, leadership, and perceived service quality, especially from T 1 to T 2 . No changes were detected in burnout, engagement, or job satisfaction over time. Moderated regression analyses (at T 3 ) indicated that job demands were particularly associated with burnout, and job resources with engagement and job satisfaction. Perceived service quality was predicted by both job demands and resources, in addition to the interaction between workload and collaboration. The reorganisation seems to have contributed to a positive development in how collaboration, work conflict, leadership, and service quality were evaluated, but that other changes are needed to increase worker well-being. The value of the study rests on the findings that support co-locating and merging services for children and their families, and that collaboration is an important resource for healthcare professionals.

What do customers want from improved residential electricity services? Evidence from a choice experiment

International Nuclear Information System (INIS)

Huh, Sung-Yoon; Woo, JongRoul; Lim, Sesil; Lee, Yong-Gil; Kim, Chang Seob

2015-01-01

Improvements in customer satisfaction as well as product/service quality represent a common objective of all businesses, and electricity services are no exception. Using choice experiments and a mixed logit model, this study quantitatively analyzes customers' preferences and their marginal willingness to pay for improved residential electricity services. The study provides an ex ante evaluation of customers' acceptance of hypothetical electricity services. According to the results, customers consider the electricity bill and the electricity mix as the two most important attributes when choosing their electricity services. Customers are willing to pay 2.2% more in the average electricity bill (an additional monthly electricity bill of KRW 1,064; USD 0.96) for a significant increase in the share of renewable energy, which is far less than the actual cost of achieving this renewable target. Therefore, it is better to maintain the current electricity mix in principle, and the renewable share should be gradually expanded instead of making a sudden change in the electricity mix. In addition, customers are willing to pay KRW 6,793 (USD 6.15) more to reduce blackouts once in a year and KRW 64/year (USD 0.06/year) to reduce a minute of each blackout. -- Highlights: •Customers' preferences for improved residential electricity services are analyzed. •Empirical setting is a sample of residents in South Korea. •The electricity bills and electricity mix are important to customers. •Increase in electricity bill of different electricity mix is considered

Service Blueprint for Improving Clinical Guideline Adherence via Mobile Health Technology

OpenAIRE

Y. O'Connor; C. Heavin; S. O' Connor; J. Gallagher; J. Wu; J. O'Donoghue

2015-01-01

Background: To improve the delivery of paediatric healthcare in low resource settings, Community Health Workers (CHW) have been provided with a paper-based set of protocols known as Community Case Management (CCM). Yet research has shown that CHW adherence to CCM guidelines is poor, ultimately impacting health service delivery. Digitising the CCM guidelines via mobile technology is argued in extant literature to improve CHW adherence. However, little research exist which ...

Responses of Aboriginal and Torres Strait Islander Primary Health-Care Services to Continuous Quality Improvement Initiatives.

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Larkins, Sarah; Woods, Cindy E; Matthews, Veronica; Thompson, Sandra C; Schierhout, Gill; Mitropoulos, Maxwell; Patrao, Tania; Panzera, Annette; Bailie, Ross Stewart

2015-01-01

Indigenous primary health-care (PHC) services participating in continuous quality improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining quality improvement initiatives. The aim of this study is to examine trends in quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time and examine health service characteristics associated with positive and negative trends in quality of care. PHC services providing care for Indigenous people in urban, rural, and remote northern Australia that had completed at least three annual audits of service delivery for at least one aspect of care (n = 73). Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analyzed. Health center performance was classified into six patterns of change over time: consistent high improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in quality of care. Trends in quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model, or accreditation status with positive or negative trends in quality of care. The variable trends in quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the

Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery

Directory of Open Access Journals (Sweden)

Soeteman M

2015-03-01

Full Text Available Marijn Soeteman,1 Vera Peters,2 Jamiu O Busari1,3 1Department of Pediatrics, Atrium Medical Center, Heerlen, 2Faculty of Health, Medicine and Life Sciences, 3Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands Objective: In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infrastructural changes to our clinic’s waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1 accessibility to caregivers and 2 quality of service and available amenities. Design: We conducted a multi-method survey using 1 a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2 specially designed questionnaires to investigate patients’ perceptions of our wait time and how to improve our services. Results: The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55% felt that 10–20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%. Finally, a large number of patients (97% were satisfied with the quality of service and with the accessibility to caregivers (94%. Conclusion: The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of

Continuous quality improvement intervention for adolescent and young adult HIV testing services in Kenya improves HIV knowledge.

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Wagner, Anjuli D; Mugo, Cyrus; Bluemer-Miroite, Shay; Mutiti, Peter M; Wamalwa, Dalton C; Bukusi, David; Neary, Jillian; Njuguna, Irene N; O'Malley, Gabrielle; John-Stewart, Grace C; Slyker, Jennifer A; Kohler, Pamela K

2017-07-01

To determine whether continuous quality improvement (CQI) improves quality of HIV testing services for adolescents and young adults (AYA). CQI was introduced at two HIV testing settings: Youth Centre and Voluntary Counseling and Testing (VCT) Center, at a national referral hospital in Nairobi, Kenya. Primary outcomes were AYA satisfaction with HIV testing services, intent to return, and accurate HIV prevention and transmission knowledge. Healthcare worker (HCW) satisfaction assessed staff morale. T tests and interrupted time series analysis using Prais-Winsten regression and generalized estimating equations accounting for temporal trends and autocorrelation were conducted. There were 172 AYA (Youth Centre = 109, VCT = 63) during 6 baseline weeks and 702 (Youth Centre = 454, VCT = 248) during 24 intervention weeks. CQI was associated with an immediate increase in the proportion of AYA with accurate knowledge of HIV transmission at Youth Centre: 18 vs. 63% [adjusted risk difference (aRD) 0.42,95% confidence interval (CI) 0.21 to 0.63], and a trend at VCT: 38 vs. 72% (aRD 0.30, 95% CI -0.04 to 0.63). CQI was associated with an increase in the proportion of AYA with accurate HIV prevention knowledge in VCT: 46 vs. 61% (aRD 0.39, 95% CI 0.02-0.76), but not Youth Centre (P = 0.759). In VCT, CQI showed a trend towards increased intent to retest (4.0 vs. 4.3; aRD 0.78, 95% CI -0.11 to 1.67), but not at Youth Centre (P = 0.19). CQI was not associated with changes in AYA satisfaction, which was high during baseline and intervention at both clinics (P = 0.384, P = 0.755). HCW satisfaction remained high during intervention and baseline (P = 0.746). CQI improved AYA knowledge and did not negatively impact HCW satisfaction. Quality improvement interventions may be useful to improve adolescent-friendly service delivery.

Improved gas installations and services. Phase 1: Analysis project. Part report

International Nuclear Information System (INIS)

Nielsen, K.J.

1996-05-01

As Danish gas companies receive a large number of complaints related to the installation and operation of gas installations it was suggested that a course for personnel should be established in order to raise the standard of services and installation requirements. The first phase of the described project was to evaluate the quality of the gas installers' services so as to determine which aspects of installation and services should be emphasized during such a course. Interviews were carried out and questionnaires (illustrated within the document) sent out to installaters etc. Recommendations include that the level of information given to customers should be raised, also in relation to maintenance, and that installation should be improved. Analyses of the degree of customers' satisfaction, of the nature of the quality of services etc. expected, subjects for further training in this area and details of the training system are dealt with

Household demand for improved sanitation services in Kumasi, Ghana: A contingent valuation study

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Whittington, Dale; Lauria, Donald T.; Wright, Albert M.; Choe, Kyeongae; Hughes, Jeffrey A.; Swarna, Venkateswarlu

1993-06-01

A contingent valuation survey was conducted in Kumasi, Ghana, to estimate households' willingness to pay for two types of improved sanitation services: improved ventilated pit latrines and water closets connected to a sewer system. Over 1200 randomly selected households throughout the city were interviewed. Most households were willing to pay more for improved sanitation service than they were currently paying for their existing sanitation system (mostly public and bucket latrines), but in absolute terms the potential revenues from households are not large, of the order of US$1.40 per household per month (about 1-2% of household income). The results of the study confirm the conventional wisdom that conventional sewerage is not affordable to the vast majority of households without massive government subsidies. On the other hand, it appears that only modest subsidies are required to achieve relatively high levels of coverage with on-site sanitation (improved ventilated pit latrines). This is because improved ventilated pit latrines are much cheaper than conventional sewerage and because most households are willing to pay about as much for a ventilated pit latrine as for a water closet connected to a sewer. Several tests were conducted to check the accuracy of respondents' answers to contingent valuation questions. The findings indicate that contingent valuation surveys can be successfully carried out in cities in developing countries for public services such as sanitation and that reasonably reliable information can be obtained on household demand for different sanitation technologies.

Improving marketing strategies of sea freight forwarding services - Thien Hong Joint Stock company

OpenAIRE

Pham, Thanh Huyen

2015-01-01

Analyzing and improving marketing strategies of Thien Hong Joint Stock company - a newborn company in the field of sea freight forwarding service in Vietnam. This thesis focused on the 4Ps (product, price, placement, promotion) in marketing strategy, how to apply the theory of services marketing in a business to business company and a special industry effectively.

Adoption of Lean Thinking and Service Improvement for Care Home Service

OpenAIRE

Chuang-Chun Chiou

2014-01-01

Ageing population is a global trend; therefore the need of care service has been increasing dramatically. There are three basic forms of service delivered to the elderly: institution, community, and home. Particularly, the institutional service can be seen as an extension of medical service. The nursing home or so-called care home which is equipped with professional staff and facilities can provide a variety of service including rehabilitation service, short-term care, and long term care. Sim...

Cost and impact of a quality improvement programme in mental health services.

Science.gov (United States)

Beecham, Jennifer; Ramsay, Angus; Gordon, Kate; Maltby, Sophie; Walshe, Kieran; Shaw, Ian; Worrall, Adrian; King, Sarah

2010-04-01

To estimate the cost and impact of a centrally-driven quality improvement initiative in four UK mental health communities. Total costs in year 1 were identified using documentation, a staff survey, semi-structured interviews and discussion groups. Few outcome data were collected within the programme so thematic analysis was used to identify the programme's impact within its five broad underlying principles. The survey had a 40% response. Total costs ranged between pound164,000 and pound458,000 per site, plus staff time spent on workstreams. There was a very hazy view of the resources absorbed and poor recording of expenditure and activity. The initiative generated little demonstrable improvements in service quality but some participants reported changes in attitudes. Given the difficult contexts, short time-scales and capacity constraints, the programme's lack of impact is not surprising. It may, however, represent a worthwhile investment in cultural change which might facilitate improvements in how services are delivered.

PRECISE:PRivacy-prEserving Cloud-assisted quality Improvement Service in hEalthcare.

Science.gov (United States)

Chen, Feng; Wang, Shuang; Mohammed, Noman; Cheng, Samuel; Jiang, Xiaoqian

2014-10-01

Quality improvement (QI) requires systematic and continuous efforts to enhance healthcare services. A healthcare provider might wish to compare local statistics with those from other institutions in order to identify problems and develop intervention to improve the quality of care. However, the sharing of institution information may be deterred by institutional privacy as publicizing such statistics could lead to embarrassment and even financial damage. In this article, we propose a PRivacy-prEserving Cloud-assisted quality Improvement Service in hEalthcare (PRECISE), which aims at enabling cross-institution comparison of healthcare statistics while protecting privacy. The proposed framework relies on a set of state-of-the-art cryptographic protocols including homomorphic encryption and Yao's garbled circuit schemes. By securely pooling data from different institutions, PRECISE can rank the encrypted statistics to facilitate QI among participating institutes. We conducted experiments using MIMIC II database and demonstrated the feasibility of the proposed PRECISE framework.

Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia.

Directory of Open Access Journals (Sweden)

Sheila Cyril

Full Text Available Childhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers' perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities' participation in these services.We conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia.Thematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers.This study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health conditions of CALD

Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia

Science.gov (United States)

Cyril, Sheila; Green, Julie; Nicholson, Jan M.; Agho, Kingsley; Renzaho, Andre M. N.

2016-01-01

Background Childhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD) migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers’ perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities’ participation in these services. Methods We conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia. Results Thematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers. Conclusion This study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health

Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia.

Science.gov (United States)

Cyril, Sheila; Green, Julie; Nicholson, Jan M; Agho, Kingsley; Renzaho, Andre M N

2016-01-01

Childhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD) migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers' perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities' participation in these services. We conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia. Thematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers. This study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health conditions of CALD communities to ensure

Factors influencing improved attendance in the UK fire service.

Science.gov (United States)

Litchfield, I; Hinckley, P

2016-12-01

Sickness absence rates in the UK continue to exceed those in much of the developed world, with an annual cost to employers of £29 billion. Rates of sickness absence in the public sector are higher than those in the private sector, with the exception of the fire service where they are consistently lower. To understand the influences that increase attendance among operational firefighters. A series of semi-structured interviews undertaken with operational staff to explore their attitudes to sickness absence. Review and analysis of participant responses identified a number of key themes, namely employee well-being, including physical fitness and mental health; employee engagement with the fire service as manifested by culture, experience, nature of the job and leadership; organizational factors including the staffing model and relationship with occupational health services and policy, which describes both refinements to and implementation of targeted policies. Previously observed factors such as improved fitness and the distinct firefighter culture play a role, yet other factors emerged that could explain the differences. These include the greater work-life balance offered by their shift patterns, the terms and conditions of employment and perhaps most importantly the evolution of precisely targeted policies that understand the unique nature of the operational fire service. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine.

Service quality that improves customer satisfaction in a university: a case study in Institut Teknologi Indonesia

Science.gov (United States)

Theresia, L.; Bangun, R.

2017-12-01

Universities should provide better service quality to get more customers. The purpose of this study was to find service quality which has impact on the increasing of customer satisfaction in a university. This study is a case study in Institut Teknologi Indonesia (ITI). The result of the study will help ITI to improve its service quality to increase customer satisfaction. This study employs path analysis technique. The data were collected through questionnaires developed from the literature. Questionnaires have two parts namely 1) service quality and 2) customer satisfaction. Service quality is measured through 22 questions with five service quality dimensions: 1) Tangibles, 2) Reliability, 3) Responsiveness, 4) Assurance and 5) Empathy. Customer Satisfaction is measured through 4 questions. The data then are processed by SPSS. The results showed that the students preferred to tangible quality improvement than intangible aspect.

Room Service Improves Nutritional Intake and Increases Patient Satisfaction While Decreasing Food Waste and Cost.

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McCray, Sally; Maunder, Kirsty; Krikowa, Renee; MacKenzie-Shalders, Kristen

2018-02-01

Room service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs. The aim of this study was to comprehensively evaluate the nutritional intake, plate waste, patient satisfaction, and patient meal costs of room service compared to a traditional foodservice model. A retrospective analysis of quality-assurance data audits was undertaken to assess patient nutritional intake between a facility utilizing a traditional foodservice model and a facility utilizing room service and in a pre-post study design to assess plate waste, patient satisfaction, and patient meal costs before and after the room service implementation. Audit data were collected for eligible adult inpatients in Mater Private Hospital Brisbane and Mater Hospital Brisbane, Australia, between July 2012 and May 2015. The primary outcome measures were nutritional intake, plate waste, patient satisfaction, and patient meal costs. Independent samples t-tests and χ 2 analyses were conducted between pre and post data for continuous data and categorical data, respectively. Pearson χ 2 analysis of count data for sex and reasons for plate waste for data with counts more than five was used to determine asymptotic (two-sided) significance and n-1 χ 2 used for the plate waste analysis. Significance was assessed at P<0.05. This study reported an increased nutritional intake, improved patient satisfaction, and reduced plate waste and patient meal costs with room service compared to a traditional foodservice model. Comparison of nutritional intake between a traditional foodservice model (n=85) and room service (n=63) showed statistically significant increases with room service in both energy (1,306 kcal/day vs 1,588 kcal/day; P=0

Using a service sector segmented approach to identify community stakeholders who can improve access to suicide prevention services for veterans.

Science.gov (United States)

Matthieu, Monica M; Gardiner, Giovanina; Ziegemeier, Ellen; Buxton, Miranda

2014-04-01

Veterans in need of social services may access many different community agencies within the public and private sectors. Each of these settings has the potential to be a pipeline for attaining needed health, mental health, and benefits services; however, many service providers lack information on how to conceptualize where Veterans go for services within their local community. This article describes a conceptual framework for outreach that uses a service sector segmented approach. This framework was developed to aid recruitment of a provider-based sample of stakeholders (N = 70) for a study on improving access to the Department of Veterans Affairs and community-based suicide prevention services. Results indicate that although there are statistically significant differences in the percent of Veterans served by the different service sectors (F(9, 55) = 2.71, p = 0.04), exposure to suicidal Veterans and providers' referral behavior is consistent across the sectors. Challenges to using this framework include isolating the appropriate sectors for targeted outreach efforts. The service sector segmented approach holds promise for identifying and referring at-risk Veterans in need of services. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

QUALITY MANAGEMENT TOOLS APPLYING IN THE STRATEGY OF LOGISTICS SERVICES QUALITY IMPROVEMENT

Directory of Open Access Journals (Sweden)

Agnieszka Czajkowska

2015-11-01

Full Text Available Combination of factors such as: properly organized logistics process, lack of nonconformities, transport damages avoiding and transport in accordance Just In Time idea significantly reduces costs and streamlines the entire production process. This paper proposes the quality management tool for the logistics services assessment based on the results obtained in the selected company operating in Eastern Europe. Customers’ expectations and perceptions were compared using the SERVQUAL method that concerns the service quality assessment in five areas such as: materiality, reliability, promptness, competency and empathy. The research method SERVQUAL allows assessing the service quality level and identifying company areas that requires corrective actions within the improvement process.

Lexical Link Analysis Application: Improving Web Service to Acquisition Visibility Portal Phase III

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2015-04-30

ååì~ä=^Åèìáëáíáçå= oÉëÉ~êÅÜ=póãéçëáìã= qÜìêëÇ~ó=pÉëëáçåë= sçäìãÉ=ff= = Lexical Link Analysis Application: Improving Web Service to Acquisition...2015 2. REPORT TYPE 3. DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Lexical Link Analysis Application: Improving Web Service...processes. Lexical Link Analysis (LLA) can help, by applying automation to reveal and depict???to decisionmakers??? the correlations, associations, and

Improving health services to displaced persons in Aceh, Indonesia: a balanced scorecard.

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Chan, Grace J; Parco, Kristin B; Sihombing, Melva E; Tredwell, Susan P; O'Rourke, Edward J

2010-09-01

After the Indian Ocean tsunami in December 2004, the International Organization for Migration constructed temporary health clinics to provide medical services to survivors living in temporary accommodation centres throughout Aceh, Indonesia. Limited resources, inadequate supervision, staff turnover and lack of a health information system made it challenging to provide quality primary health services. A balanced scorecard was developed and implemented in collaboration with local health clinic staff and district health officials. Performance targets were identified. Staff collected data from clinics and accommodation centres to develop 30 simple performance measures. These measures were monitored periodically and discussed at meetings with stakeholders to guide the development of health interventions. Two years after the tsunami, 34 000 displaced persons continued to receive services from temporary health clinics in two districts of Aceh province. From March to December 2007, the scorecard was implemented in seven temporary health clinics. Interventions stimulated and tracked by the scorecard showed measurable improvements in preventive medicine, child health, capacity building of clinic staff and availability of essential drugs. By enhancing communication, the scorecard also led to qualitative benefits. The balanced scorecard is a practical tool to focus attention and resources to facilitate improvement in disaster rehabilitation settings where health information infrastructure is poor. Introducing a mechanism for rapid improvement fostered communication between nongovernmental organizations, district health officials, clinic health workers and displaced persons.

Traditional birth attendant training for improving health behaviours and pregnancy outcomes

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Sibley, Lynn M; Sipe, Theresa Ann; Barry, Danika

2014-01-01

rate was lower but not significant (adjusted OR 0.74, 95% CI 0.45 to 1.22). Additionally trained TBAs versus trained TBAs: three large cluster-randomised trials compared TBAs who received additional training in initial steps of resuscitation, including bag-valve-mask ventilation, with TBAs who had received basic training in safe, clean delivery and immediate newborn care. Basic training included mouth-to-mouth resuscitation (two studies) or bag-valve-mask resuscitation (one study). There was no significant difference in the perinatal death rate between the intervention and control clusters (one study, adjusted OR 0.79, 95% CI 0.61 to 1.02) and no significant difference in late neonatal death rate between intervention and control clusters (one study, adjusted risk ratio (RR) 0.47, 95% CI 0.20 to 1.11). The neonatal death rate, however, was 45% lower in intervention compared with the control clusters (one study, 22.8% versus 40.2%, adjusted RR 0.54, 95% CI 0.32 to 0.92). We conducted a meta-analysis on two outcomes: stillbirths and early neonatal death. There was no significant difference between the additionally trained TBAs versus trained TBAs for stillbirths (two studies, mean weighted adjusted RR 0.99, 95% CI 0.76 to 1.28) or early neonatal death rate (three studies, mean weighted adjusted RR 0.83, 95% CI 0.68 to 1.01). Authors’ conclusions The results are promising for some outcomes (perinatal death, stillbirth and neonatal death). However, most outcomes are reported in only one study. A lack of contrast in training in the intervention and control clusters may have contributed to the null result for stillbirths and an insufficient number of studies may have contributed to the failure to achieve significance for early neonatal deaths. Despite the additional studies included in this updated systematic review, there remains insufficient evidence to establish the potential of TBA training to improve peri-neonatal mortality. PMID:22895949

A new three-dimensional manufacturing service composition method under various structures using improved Flower Pollination Algorithm

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Zhang, Wenyu; Yang, Yushu; Zhang, Shuai; Yu, Dejian; Chen, Yong

2018-05-01

With the growing complexity of customer requirements and the increasing scale of manufacturing services, how to select and combine the single services to meet the complex demand of the customer has become a growing concern. This paper presents a new manufacturing service composition method to solve the multi-objective optimization problem based on quality of service (QoS). The proposed model not only presents different methods for calculating the transportation time and transportation cost under various structures but also solves the three-dimensional composition optimization problem, including service aggregation, service selection, and service scheduling simultaneously. Further, an improved Flower Pollination Algorithm (IFPA) is proposed to solve the three-dimensional composition optimization problem using a matrix-based representation scheme. The mutation operator and crossover operator of the Differential Evolution (DE) algorithm are also used to extend the basic Flower Pollination Algorithm (FPA) to improve its performance. Compared to Genetic Algorithm, DE, and basic FPA, the experimental results confirm that the proposed method demonstrates superior performance than other meta heuristic algorithms and can obtain better manufacturing service composition solutions.

Service Learning for Improvement of Customer Service Education in LIS

Science.gov (United States)

Colón-Aguirre, Mónica

2017-01-01

This work explores the ways in which academic librarians specializing in areas related to user services consider the courses they took as part of obtaining their library and information science (LIS) degree prepared them to deal with issues of customer service in their current work. Effective customer service is a central aspect of accomplishing…

A team approach to improving colorectal cancer services using administrative health data

OpenAIRE

Porter Geoffrey; Urquhart Robin; Bu Jingyu; Kendell Cynthia; MacIntyre Maureen; Dewar Ron; Kephart George; Asada Yukiko; Grunfeld Eva

2012-01-01

Abstract Background Colorectal cancer (CRC) is the third most commonly diagnosed cancer in Canada and accounts for 11.9% of all cancer-related mortality. Fortunately, previous studies have provided evidence of improved outcomes from access to timely and appropriate health services along the disease trajectory in CRC. As a result, the CIHR/CCNS Team in Access to Colorectal Cancer Services in Nova Scotia (Team ACCESS) was created to build colorectal cancer (CRC) research capacity in Nova Scotia...

A Model-driven and Service-oriented framework for the business process improvement

Directory of Open Access Journals (Sweden)

Andrea Delgado

2010-07-01

Full Text Available Business Process Management (BPM importance and benefits for organizations to focus on their business processes is nowadays broadly recognized, as business and technology areas are embracing and adopting the paradigm. The Service Oriented Computing (SOC paradigm bases software development on services to realize business processes. The implementation of business processes as services helps in reducing the gap between these two areas, easing the communication and understanding of business needs. The Model Driven Development (MDD paradigm bases software development in models, metamodels and languages that allow transformation between them. The automatic generation of service models from business process models is a key issue to support the separation of its definition from its technical implementation. In this article, we present MINERVA framework which applies Model Driven Development (MDD and Service Oriented Computing (SOC paradigms to business processes for the continuous business process improvement in organizations, giving support to the stages defined in the business process lifecycle from modeling to evaluation of its execution.

A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center.

Science.gov (United States)

Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas

2013-01-01

There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics.

Integration of social media with healthcare big data for improved service delivery

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Sibulela Mgudlwa

2018-04-01

Full Text Available Background: In the last decade, social media users across the world have crossed 1 billion, making it one of the fastest growing sources of big data. Also, people needing healthcare continue to increase in every society. Through accessibility, communication and interaction between health practitioners and patients, this type of ever-growing, social media subscriber–based platform can be of significant use in improving healthcare delivery to society. However, users encounter serious challenges in their attempts to make use of social media and big data for health-related services. The challenges are primarily caused by factors such as integration, complexity, security and privacy. The challenges are mainly owing to the sensitive nature of the healthcare environment, as a result of personalisation and privacy of information.   Objectives: The objectives of the study were to examine and gain a better understanding of the complexities that are associated with the use of social media and healthcare big data, through influencing factors, and to develop a framework that can be used to improve health-related services to the patients.   Methods: The interpretivist approach was employed, within which qualitative data were collected. This included documents and existing literature in the areas of social media and healthcare big data. To have a good spread of both previous and current state of events within the phenomena being studied, literature published between 2006 and 2016 were gathered. The data were interpretively analysed.   Results: Based on the analysis of the data, factors of influence were found, which were used to develop a model. The model illustrates how the factors of influence can enable and at the same time constrain the use of social media for healthcare services. The factors were interpreted from which a framework was developed. The framework is intended to guide integration of social media with healthcare big data through which

DOD Service Acquisition: Improved Use of Available Data Needed to Better Manage and Forecast Service Contract Requirements

Science.gov (United States)

2016-02-01

Requirements Report to Congressional Committees February 2016 GAO-16-119 United States Government Accountability Office United States...Government Accountability Office Highlights of GAO-16-119, a report to congressional committees February 2016 DOD SERVICE ACQUISITION Improved...attention on government operations that it identifies as high risk due to their greater vulnerabilities to fraud , waste, abuse, and mismanagement or

VISIONS Vehicular communication Improvement : solution based on IMS Operational Nodes and Services

OpenAIRE

Lequerica Roca, Iván

2013-01-01

Digital services and communications in vehicular scenarios provide the essential assets to improve road transport in several ways like reducing accidents, improving traffic efficiency and optimizing the transport of goods and people. Vehicular communications typically rely on VANET (Vehicular Ad hoc Networks). In these networks vehicles communicate with each other without the need of infrastructure. VANET are mainly oriented to disseminate information to the vehicles in certain geographic are...

WHO Better Outcomes in Labour Difficulty (BOLD) project: innovating to improve quality of care around the time of childbirth.

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Oladapo, Olufemi T; Souza, João Paulo; Bohren, Meghan A; Tunçalp, Özge; Vogel, Joshua P; Fawole, Bukola; Mugerwa, Kidza; Gülmezoglu, A Metin

2015-05-26

As most pregnancy-related deaths and morbidities are clustered around the time of childbirth, quality of care during this period is critical to the survival of pregnant women and their babies. Despite the wide acceptance of partograph as the central tool to optimize labour outcomes for over 40 years, its use has not successfully improved outcomes in many settings for several reasons. There are also increasing questions about the validity and applicability of its central feature - "the alert line" - to all women regardless of their labour characteristics. Apart from the known deficiencies in labour care, attempts to improve quality of care in low resource settings have also failed to address and integrate women's birth experience into quality improvement processes. It was against this background that the World Health Organization (WHO) embarked on the Better Outcomes in Labour Difficulty (BOLD) project to improve the quality of intrapartum care in low- and middle-income countries. The main goal of the BOLD project is to reduce intrapartum-related stillbirths, maternal and newborn mortalities and morbidities by addressing the critical barriers to the process of good quality intrapartum care and enhancing the connection between health systems and communities. The project seeks to achieve this goal by (1) developing an evidence-based, easy to use, labour monitoring-to-action decision-support tool (currently termed Simplified, Effective, Labour Monitoring-to-Action - SELMA); and (2) by developing innovative service prototypes/tools, co-designed with users of health services (women, their families and communities) and health providers, to promote access to respectful, dignified and emotionally supportive care for pregnant women and their companions at the time of birth ("Passport to Safer Birth"). This two-pronged approach is expected to positively impact on important domains of quality of care relating to both provision and experience of care. In this paper, we briefly

Improvement of Endovascular Stroke Treatment: A 24-Hour Neuroradiological On-Site Service Is Not Enough

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Omid Nikoubashman

2018-01-01

Full Text Available Background and Purpose. With the advent of endovascular stroke treatment (EST with mechanical thrombectomy, stroke treatment has also become more challenging. Purpose of this study was to investigate whether a fulltime neuroradiological on-site service and workflow optimization with a structured documentation of the interdisciplinary stroke workflow resulted in improved procedural times. Material and Methods. Procedural times of 322 consecutive patients, who received EST (1 before (n=96 and (2 after (n=126 establishing a 24-hour neuroradiological on-site service as well as (3 after implementation of a structured interdisciplinary workflow documentation (“Stroke Check” (n=100, were analysed. Results. A fulltime neuroradiological on-site service resulted in a nonsignificant improvement of procedural times during out-of-hours admissions (p≥0.204. Working hours and out-of-hours procedural times improved significantly, if additional workflow optimization was realized (p≤0.026. Conclusions. A 24-hour interventional on-site service is a major prerequisite to adequately provide modern reperfusion therapies in patients with acute ischemic stroke. However, simple measures like standardized and focused documentation that affect the entire interdisciplinary pre- and intrahospital stroke rescue chain seem to be important.

Improvement of radiology services based on the process management approach

International Nuclear Information System (INIS)

Amaral, Creusa Sayuri Tahara; Rozenfeld, Henrique; Costa, Janaina Mascarenhas Hornos; Magon, Maria de Fatima de Andrade; Mascarenhas, Yvone Maria

2011-01-01

The health sector requires continuous investments to ensure the improvement of products and services from a technological standpoint, the use of new materials, equipment and tools, and the application of process management methods. Methods associated with the process management approach, such as the development of reference models of business processes, can provide significant innovations in the health sector and respond to the current market trend for modern management in this sector (Gunderman et al. (2008) ). This article proposes a process model for diagnostic medical X-ray imaging, from which it derives a primary reference model and describes how this information leads to gains in quality and improvements.

MANAGING OPERATIONS IMPROVEMENT IN ROMANIAN PUBLIC SERVICES

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BALOI IONUT-COSMIN

2015-07-01

Full Text Available This paper aims to develop a pleading for the transfer of best practices to improving the operational activity in the Romanian public institutions. The practice of implementation demonstrates that the perception of many executives in the Romanian private enterprises regarding the set of tools to improve processes and assimilation of lean philosophy is not a very favorable and encouraging one. It can be said that only some large enterprises had successfully introduced in their daily practice and organization the improvement principles, the operational optimization and the elimination of waste sources. In the SMEs, and especially in the services the experiences are isolated, but they have demonstrated the usefulness (the frequency of saving goals indicate, indeed, the need for proliferation of continuous improvement principles. Regarding the public organizations, the implementation of the new management system of designing and operating the current practices is pretty unknown, accepted at declarative level, but becomes, when is planned and implemented rather a burden on managers who should take on this challenge. Both in public management and private management, today the focus is on people and relationships (processes and projects, starting of course with the work organization. The good practices successfully proved in the private management in the recent decades are transferred today to public institutions; and the Romanian public organizations tend to adapt, also in terms of processes optimization. The study aims to analyze the functioning of the hypothetical management system of processes improvements, respectively the applying of lean tools and principles within the public Romanian institution. They are treated some dysfunctions observed within the process of understanding the utility aspects and throughout the assuming of operational improvement goals within these organizations. The qualitative observations, the critical interpretations and

[Can implementation of intensified perinatal survey be effective in improving the quality of perinatal care?].

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Troszyński, Michał

2010-01-01

Intensive scientific research and rapid technical progress have influenced the rapid fall in term newborn mortality. At the same time new problems have arisen such as saving the lives of infants with low and very low birth weight. Solving these problems needs reorganization of perinatal care, better equipment, especially in reference units and in outpatient clinics, as well as more intensive staff training. to obtain information whether implementation of intensified perinatal survey of fetus and newborn mortality can improve the quality of perinatal care in Poland. Implementation of the survey based on Central Statistics Office (GUS) data, Ministry of Health MZ-29 section X Document and the author's own studies. In the year 2008 newborn with birth weight less than 2500 g, constituted 6,06% liveborn infants, newborn weighing from 1000 to 2499 g - 5%, those with weight from 500 to 999 g - 0.51% of all live born infants. These figures differ according to voivodeship. The intensive survey concerning birth weight and perinatal mortality indeces in voivodeshipPoland, as well as in individual voivodeships, showed differences between data from the Central Statistics Office and data from the Ministry of Health MZ-29 document. This may be due to different methods of registrating newborn deaths eg. newborns transfered in the first weekoflife from the maternity ward to intensive care neonatal ward or to other specialistic departaments. Another reason for the difference may be discharge of the newborn data according to the place of birth or the mother's place of permanent domicile registration. This causes disturbances in flow of infomation resulting in ineffective analysis of perinatal mortality and of perinatal care evaluation. In the ongoing analysis it was found that in Poland stillbirths occur twice as often as perinatal deaths (4.3 per thousands) stillbirths and 2.15 per thousands perinatal deaths), with significant differences between voivodeships. This makes it

The effectiveness of CPI model to improve positive attitude toward science (PATS) for pre-service physics teacher

Science.gov (United States)

Sunarti, T.; Wasis; Madlazim; Suyidno; Prahani, B. K.

2018-03-01

In the previous research, learning material based Construction, Production, and Implementation (CPI) model has been developed to improve scientific literacy and positive attitude toward science for pre-service physics teacher. CPI model has 4 phases, included: 1) Motivation; 2) Construction (Cycle I); 3) Production (Cycle II); and 4) Evaluation. This research is aimed to analyze the effectiveness of CPI model towards the improvement Positive Attitude toward Science (PATS) for pre-service physics teacher. This research used one group pre-test and post-test design on 160 pre-service physics teacher divided into 4 groups at Lambung Mangkurat University and Surabaya State University (Indonesia), academic year 2016/2017. Data collection was conducted through questioner, observation, and interview. Positive attitude toward science for pre-service physics teacher measurement were conducted through Positive Attitude toward Science Evaluation Sheet (PATSES). The data analysis technique was done by using Wilcoxon test and n-gain. The results showed that there was a significant increase in positive attitude toward science for pre-service physics teacher at α = 5%, with n-gain average of high category. Thus, the CPI model is effective for improving positive attitude toward science for pre-service physics teacher.

Improving Service Quality in Technical Education: Use of Interpretive Structural Modeling

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Debnath, Roma Mitra; Shankar, Ravi

2012-01-01

Purpose: The purpose of this paper is to identify the relevant enablers and barriers related to technical education. It seeks to critically analyze the relationship amongst them so that policy makers can focus on relevant parameters to improve the service quality of technical education. Design/methodology/approach: The present study employs the…

Individual and Synergetic Effects of Transit Service Improvement Strategies : Simulation and Validation

NARCIS (Netherlands)

West, J; Cats, O.

2017-01-01

Assessment of transit service improvements such as bus lanes, allowing boarding through all doors, and headway-based holding control requires detailed simulation capabilities. However, because the usage of models advanced enough to simultaneously analyze physical and operational measures has been

Case-mix tool, costs and effectiveness in improving primary care mental health and substance abuse services.

Science.gov (United States)

Riihimäki, Kirsi; Heiska-Johansson, Ainomaija; Ketola, Eeva

2018-02-01

Despite its importance in improving care and developing services, high-quality data evaluating cost-effectiveness and services in different case-mix populations is scarce in primary care. The objective was to investigate the service use of those mental health and substance abuse patients, who use lots of services. Primary health care diagnosis-related groups (pDRG) is a tool to evaluate service provider system and improve efficiency, productivity and quality. We viewed all pDRG results available from the year 2015 concerning municipal mental health and substance abuse services. In primary care mental health and substance abuse services, the most common ICD-10-codes were depression and substance abuse. One-fifth of patients produced 57% of costs. Their medium of appointments was 16 per year versus 6 per year of all patients. Only 54% of their diagnoses were recorded in the electronic health records versus 75% of all patients. They made 5.7 different pDRG episodes, including 1.8 episodes of depression, per patient. The average episode cost for this patient group was 301€. pDRG makes health care production transparent also in mental health and substance abuse services. It is easy to identify patients, who use a lot of services and thus induce the majority of costs, and focus on their needs in managing and developing services.

Necessity and feasibility of improving mental health services in China: A systematic qualitative review.

Science.gov (United States)

Zhao, Xudong; Liu, Liang; Hu, Chengping; Chen, Fazhan; Sun, Xirong

2017-07-01

It has been nearly 40 years since the reform and opening up of Mainland China. The mental health services system has developed rapidly as a part of the profound socioeconomic changes that ensued. However, its development has not been as substantial as other areas of medical care. For the current qualitative systematic review, we searched databases, including China Biology Medicine disc, Weipu, China National Knowledge Infrastructure, Wanfang digital periodical full text data, China's important newspaper full text database, China Statistical Yearbook database, etc. The content of primary research, literature, and policy papers about the evolution and development of Chinese mental health services was systemically reviewed and analysed by using thematic analysis. Two main themes relative to the necessity and feasibility of reforming the current mental health services system emerged. We discuss 5 corresponding subthemes under the umbrella of the necessity of improving the current treatment, rehabilitation, prevention, and service systems and 7 requirements for the feasibility of reforming the current system. We conclude that as the development of the Chinese economy and the spirit of humanistic care continue, the improvement and reformation of the mental health services system are both necessary and feasible. Copyright © 2017 John Wiley & Sons, Ltd.

Group guidance services to improved creativity for teachers

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Solihatun Solihatun

2017-11-01

Full Text Available Creativity in the learning process by teachers is very important in order to support the task at school. Teacher creativity allows teachers to apply various learning methods that encourage students' interest to learn from the classroom. Besides, creativity for teachers is needed to support student development. This study aims to determine the level of creativity of teachers through group guidance services. Subjects in this study involved 10 teachers at Gemma Insani Indonesia Depok. Data analysis used a quantitative approach with pre-test and post-test control group of one design. The results show effective group guidance to improve teacher creativity at Gemma Insani Indonesia Depok.

Performance-based financing for improving HIV/AIDS service delivery: a systematic review.

Science.gov (United States)

Suthar, Amitabh B; Nagata, Jason M; Nsanzimana, Sabin; Bärnighausen, Till; Negussie, Eyerusalem K; Doherty, Meg C

2017-01-04

Although domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based financing [PBF]) may help countries achieve more with available resources. We systematically reviewed effects of PBF on HIV/AIDS service delivery to inform WHO guidelines. PubMed, WHO Index Medicus, conference databases, and clinical trial registries were searched in April 2015 for randomised trials, comparative contemporaneous studies, or time-series studies. Studies evaluating PBF in people with HIV were included when they reported service quality, access, or cost. Meta-analyses were not possible due to limited data. This study is registered with PROSPERO, number CRD42015023207. Four studies, published from 2009 to 2015 and including 173,262 people, met the eligibility criteria. All studies were from Sub-Saharan Africa. PBF did not improve individual testing coverage (relative risk [RR], 1.00, 95% confidence interval [CI] 0.89 to 1.13), improved couples testing coverage (RR 1.11, 95% CI 1.02 to 1.20), and improved pregnant women testing coverage (RR 1.29, 95% CI 1.28-1.30). PBF improved coverage of antiretrovirals in pregnant women (RR 1.55, 95% CI 1.50 to 1.59), infants (RR 1.92, 95% CI 1.84 to 2.01), and adults (RR 1.74, 1.64 to 1.85). PBF reduced attrition (RR 0.84, 95% CI 0.74 to 0.96) and treatment failure (odds ratio 0.55, 95% CI 0.32 to 0.97). Potential harms were not reported. Although the limited data suggests PBF positively affected HIV service access and quality, critical health system and governance knowledge gaps remain. More research is needed to inform national policymaking.

Surgical assessment clinic - One stop emergency out-patient clinic for rapid assessment, reduced admissions and improved acute surgical service: A quality improvement study

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Christina A.W. Macano

2017-11-01

Conclusion: By providing suitable guidance for referring practitioners we have optimised our clinic use significantly and improved our acute ambulatory surgical care. We have reduced admissions, provided rapid treatment and have established a service that helps address the ever increasing demand on acute services within the NHS.

The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial.

Science.gov (United States)

Lloyd-Evans, Brynmor; Fullarton, Kate; Lamb, Danielle; Johnston, Elaine; Onyett, Steve; Osborn, David; Ambler, Gareth; Marston, Louise; Hunter, Rachael; Mason, Oliver; Henderson, Claire; Goater, Nicky; Sullivan, Sarah A; Kelly, Kathleen; Gray, Richard; Nolan, Fiona; Pilling, Stephen; Bond, Gary; Johnson, Sonia

2016-03-22

As an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users' experiences of care, service use, staff well-being, and team model fidelity. Twenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services' electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study's primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline

Integrating adaptive management and ecosystem services concepts to improve natural resource management: Challenges and opportunities

Science.gov (United States)

Epanchin-Niell, Rebecca S.; Boyd, James W.; Macauley, Molly K.; Scarlett, Lynn; Shapiro, Carl D.; Williams, Byron K.

2018-05-07

Executive Summary—OverviewNatural resource managers must make decisions that affect broad-scale ecosystem processes involving large spatial areas, complex biophysical interactions, numerous competing stakeholder interests, and highly uncertain outcomes. Natural and social science information and analyses are widely recognized as important for informing effective management. Chief among the systematic approaches for improving the integration of science into natural resource management are two emergent science concepts, adaptive management and ecosystem services. Adaptive management (also referred to as “adaptive decision making”) is a deliberate process of learning by doing that focuses on reducing uncertainties about management outcomes and system responses to improve management over time. Ecosystem services is a conceptual framework that refers to the attributes and outputs of ecosystems (and their components and functions) that have value for humans.This report explores how ecosystem services can be moved from concept into practice through connection to a decision framework—adaptive management—that accounts for inherent uncertainties. Simultaneously, the report examines the value of incorporating ecosystem services framing and concepts into adaptive management efforts.Adaptive management and ecosystem services analyses have not typically been used jointly in decision making. However, as frameworks, they have a natural—but to date underexplored—affinity. Both are policy and decision oriented in that they attempt to represent the consequences of resource management choices on outcomes of interest to stakeholders. Both adaptive management and ecosystem services analysis take an empirical approach to the analysis of ecological systems. This systems orientation is a byproduct of the fact that natural resource actions affect ecosystems—and corresponding societal outcomes—often across large geographic scales. Moreover, because both frameworks focus on

Optimizing Bus Passenger Complaint Service through Big Data Analysis: Systematized Analysis for Improved Public Sector Management

Directory of Open Access Journals (Sweden)

Weng-Kun Liu

2016-12-01

Full Text Available With the advances in industry and commerce, passengers have become more accepting of environmental sustainability issues; thus, more people now choose to travel by bus. Government administration constitutes an important part of bus transportation services as the government gives the right-of-way to transportation companies allowing them to provide services. When these services are of poor quality, passengers may lodge complaints. The increase in consumer awareness and developments in wireless communication technologies have made it possible for passengers to easily and immediately submit complaints about transportation companies to government institutions, which has brought drastic changes to the supply–demand chain comprised of the public sector, transportation companies, and passengers. This study proposed the use of big data analysis technology including systematized case assignment and data visualization to improve management processes in the public sector and optimize customer complaint services. Taichung City, Taiwan, was selected as the research area. There, the customer complaint management process in public sector was improved, effectively solving such issues as station-skipping, allowing the public sector to fully grasp the service level of transportation companies, improving the sustainability of bus operations, and supporting the sustainable development of the public sector–transportation company–passenger supply chain.

Using a Service Planning Approach to Improve the Impact of Earth Observations in the Developing World

Science.gov (United States)

Irwin, D.; Frankel-Reed, J.

2017-12-01

SERVIR is joint development initiative of the National Aeronautics and Space Administration (NASA) and the United States Agency for International Development (USAID), working in partnership with leading regional organizations around the world to help developing countries use information provided by Earth observing satellites and geospatial technologies to empower decision-makers with tools, products, and services to better address critical issues related to food security, water resources, natural disasters, and land use. Since its launch in 2005, SERVIR has grown into a global network of four active hubs that are improving awareness, increasing access to information, and supporting analysis to help people in Africa, Hindu Kush Himalaya, and the Lower Mekong regions better manage today's complex environmental challenges. To help improve the impact of SERVIR activities throughout the global network, a Service Planning Approach was developed with three main steps that involve: 1) consultation and needs assessment, 2) service design and 3) service delivery. To successfully accomplish these steps, SERVIR has created a series of capacity building tools that focus on specific activities to better engage stakeholders, design a more successful service, and to conduct end-to-end monitoring, evaluation, and learning. Currently, all four SERVIR hubs in different regions of the world are implementing this Service Planning Approach and helping to improve it by providing feedback based on their implementation. This presentation will describe the SERVIR Service Planning Approach and discuss the various tools, which ultimately can empower remote sensing scientists and application developers to obtain a greater impact from the Earth Observation products they develop.

Improvement of radiology services based on the process management approach.

Science.gov (United States)

Amaral, Creusa Sayuri Tahara; Rozenfeld, Henrique; Costa, Janaina Mascarenhas Hornos; Magon, Maria de Fátima de Andrade; Mascarenhas, Yvone Maria

2011-06-01

The health sector requires continuous investments to ensure the improvement of products and services from a technological standpoint, the use of new materials, equipment and tools, and the application of process management methods. Methods associated with the process management approach, such as the development of reference models of business processes, can provide significant innovations in the health sector and respond to the current market trend for modern management in this sector (Gunderman et al. (2008) [4]). This article proposes a process model for diagnostic medical X-ray imaging, from which it derives a primary reference model and describes how this information leads to gains in quality and improvements. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

An Improved Abstract State Machine Based Choreography Specification and Execution Algorithm for Semantic Web Services

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Shahin Mehdipour Ataee

2018-01-01

Full Text Available We identify significant weaknesses in the original Abstract State Machine (ASM based choreography algorithm of Web Service Modeling Ontology (WSMO, which make it impractical for use in semantic web service choreography engines. We present an improved algorithm which rectifies the weaknesses of the original algorithm, as well as a practical, fully functional choreography engine implementation in Flora-2 based on the improved algorithm. Our improvements to the choreography algorithm include (i the linking of the initial state of the ASM to the precondition of the goal, (ii the introduction of the concept of a final state in the execution of the ASM and its linking to the postcondition of the goal, and (iii modification to the execution of the ASM so that it stops when the final state condition is satisfied by the current configuration of the machine. Our choreography engine takes as input semantic web service specifications written in the Flora-2 dialect of F-logic. Furthermore, we prove the equivalence of ASMs (evolving algebras and evolving ontologies in the sense that one can simulate the other, a first in literature. Finally, we present a visual editor which facilitates the design and deployment of our F-logic based web service and goal specifications.

Internal Market Orientation Framework as a Source of Improving Service Quality within the Malaysian Hotel Industry

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Lahap J.

2014-01-01

Full Text Available This paper is developed as a means to discover the importance of improving service quality within the Malaysian Hotel Industry. To support that contention it was found that there are a number of methodologies or approaches that can be used to improve service delivery. Recent publications show that there is an emerging methodology sought to improve employee performance and one of the approaches are known as Internal Market Orientation. The Internal Market Orientation model consists of three dimensions and they are: i Internal Market Intelligence Generation (IMIG, ii Internal Communication (IC, and iii Response to Intelligence (RTI. Despite of that this study will only highlight the third dimensions of the framework that is Response to Intelligence. A number of conclusive findings were found and it can be used to enhance employee performance and it is as well has the ability to improving the quality of service towards hotel guests. Notwithstanding, the findings of this study can be used to improve the competitive advantage of Malaysian Hotels and therefore, assisting the country to achieve competitiveness and leads to the creation of premier tourist destination in the world.

Improving Parolees' Participation in Drug Treatment and Other Services through Strengths Case Management.

Science.gov (United States)

Prendergast, Michael; Cartier, Jerome J

2008-01-01

In an effort to increase participation in community aftercare treatment for substance-abusing parolees, an intervention based on a transitional case management (TCM) model that focuses mainly on offenders' strengths has been developed and is under testing. This model consists of completion, by the inmate, of a self-assessment of strengths that informs the development of the continuing care plan, a case conference call shortly before release, and strengths case management for three months post-release to promote retention in substance abuse treatment and support the participant's access to designated services in the community. The post-release component consists of a minimum of one weekly client/case manager meeting (in person or by telephone) for 12 weeks. The intervention is intended to improve the transition process from prison to community at both the individual and systems level. Specifically, the intervention is designed to improve outcomes in parolee admission to, and retention in, community-based substance-abuse treatment, parolee access to other needed services, and recidivism rates during the first year of parole. On the systems level, the intervention is intended to improve the communication and collaboration between criminal justice agencies, community-based treatment organizations, and other social and governmental service providers. The TCM model is being tested in a multisite study through the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative funded by the National Institute of Drug Abuse.

An Improved Model for Headway-Based Bus Service Unreliability Prevention with Vehicle Load Capacity Constraint at Bus Stops

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Weiya Chen

2012-01-01

Full Text Available This paper presents an improved model for improving headway-based bus route service reliability at bus stops using real-time preventive operation control, taking into account dynamic interaction among random passenger demand, stochastic driving conditions of route segments, and vehicle load capacity constraint. In this model, the real-time information of passenger demand and vehicle operation is involved to predict the imminent unacceptable headway deviation, in the case of which some in-time preventive control strategies are deployed according to the given control rules. As a case study, a single fixed bus route with high-frequency services was simulated and different scenarios of real-time preventive operation control were performed. Headway adherence and average passenger wait time were used to measure bus service reliability. The results show that the improved model is closer to the real bus route service, and using real-time information to predict potential service unreliability and trigger in-time preventive control can reduce bus bunching and avoid big gap.

Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo

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Aveledi Blandine

2009-12-01

Full Text Available Abstract Background Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC. Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC and family planning (FP. Methods Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities. Results None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive. Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC. Conclusions Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1 providing necessary equipment and renovations to health facilities; 2 improving supply management systems; 3 providing comprehensive competency

A magnet nursing service approach to nursing's role in quality improvement.

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Bolton, Linda Burnes; Goodenough, Anne

2003-01-01

The heightened focus on quality and the rise of health care consumerism are manifestations of numerous interrelated dynamics, especially including the aging of the "baby boomers" and greater prevalence of chronic conditions, the explosion of biomedical scientific knowledge and technology, changes in prevailing methods of health care financing, a recent prolonged period of economic prosperity, widespread concerns about patient safety, return of disproportionate health care cost, and the democratization of medical knowledge consequent to widespread use of the Internet. Quality improvement in nursing was first introduced by Florence Nightingale during the Crimean War. Today, nursing quality continues to look at process, but has evolved to an emphasis on patient care outcomes. This article discusses nursing quality structure, processes, and outcomes at a large, teaching, tertiary medical center in Los Angeles, California. The medical center is one of two designated magnet nursing services in California. Nursing's role in achieving clinical and service quality for patients, communities, and staff are essential characteristics of magnet-designated nursing service organizations.

Persuasive Evidence: Improving Customer Service through Evidence Based Librarianship

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Wendy A. Abbott

2006-03-01

Full Text Available Objective - To demonstrate how evidence based practice has contributed to informaing decisions and resolving issues if concern in service delivery at Bond University Librray. Methods - This paper critically analyses three evidence based research projects conducted at Bond University Library. Each project combined a range of research methods including surveys, literature reviews and the analysis of internal performance data to find solutions to problems in library service delivery. The first research project investigated library opening hours and the feasability of twenty-four hour opening. Another project reseached questions about the management of a collection of feature films on DVD and video. The thrd project investigated issues surrounding the teaching of EndNote to undergarduate students. Results - Despite some deficiencies in the methodologies used, each evidence based research project had positive outcomes. One of the highlights asn an essential feature of the process at Bond University Library was the involvement of stakeholders. The ability to build consensus and agree action plans with stakeholders was an important outcome of that process. Conclusion - Drawing on the experience of these research projects, the paper illustrates the benefits of evidence based information practice to stimulate innovation and improve library services. Librarians, like most professionals, need to continue to develop the skills and a culture to effectively carry out evidence based practice.

Influence of housing systems on stillbirth and mortality rate in preweaning pigs farrowed by different gilt breeds

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Wiebke Wellbrock

2010-01-01

Full Text Available The aim of this paper was to investigate the influence of housing systems on stillbirth and mortality rate in preweaning pigs farrowed by different gilt breeds. The investigation included first farrowings of 225 Large White (LW gilts, 297 Swedish Landrace (SL gilts and 260 crossbreed gilts (LWxSL in the period of five years. Despite of positive influence of straw through decreased number of stillborn pigs, especially in LW gilts, in further process of production until weaning, less appropriate microclimatic conditions developed in farrowing houses with straw, especially if accompanied with poor ventilation, can result with higher number of perished pigs and lower number of weaned pigs. Most sensible to unsuitable microclimatic conditions in straw bedded farrowing houses, according to the number of perished pigs before weaning, were the pigs from SL gilts, while the pigs from crossbreed gilts LWxSL were the most resistant. These results suggest that adding straw requires special attention on influence of such production on microclimate conditions in pigs’ biozone in order to maintain its initial benefits in the time of farrowing through the whole preweaning period, especially in pure breeds of gilts.

Improving Service Management in the Internet of Things

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Sammarco, Chiara; Iera, Antonio

2012-01-01

In the Internet of Things (IoT) research arena, many efforts are devoted to adapt the existing IP standards to emerging IoT nodes. This is the direction followed by three Internet Engineering Task Force (IETF) Working Groups, which paved the way for research on IP-based constrained networks. Through a simplification of the whole TCP/IP stack, resource constrained nodes become direct interlocutors of application level entities in every point of the network. In this paper we analyze some side effects of this solution, when in the presence of large amounts of data to transmit. In particular, we conduct a performance analysis of the Constrained Application Protocol (CoAP), a widely accepted web transfer protocol for the Internet of Things, and propose a service management enhancement that improves the exploitation of the network and node resources. This is specifically thought for constrained nodes in the abovementioned conditions and proves to be able to significantly improve the node energetic performance when in the presence of large resource representations (hence, large data transmissions).

Time-lapse culture with morphokinetic embryo selection improves pregnancy and live birth chances and reduces early pregnancy loss: a meta-analysis.

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Pribenszky, Csaba; Nilselid, Anna-Maria; Montag, Markus

2017-11-01

Embryo evaluation and selection is fundamental in clinical IVF. Time-lapse follow-up of embryo development comprises undisturbed culture and the application of the visual information to support embryo evaluation. A meta-analysis of randomized controlled trials was carried out to study whether time-lapse monitoring with the prospective use of a morphokinetic algorithm for selection of embryos improves overall clinical outcome (pregnancy, early pregnancy loss, stillbirth and live birth rate) compared with embryo selection based on single time-point morphology in IVF cycles. The meta-analysis of five randomized controlled trials (n = 1637) showed that the application of time-lapse monitoring was associated with a significantly higher ongoing clinical pregnancy rate (51.0% versus 39.9%), with a pooled odds ratio of 1.542 (P loss (15.3% versus 21.3%; OR: 0.662; P = 0.019) and a significantly increased live birth rate (44.2% versus 31.3%; OR 1.668; P = 0.009). Difference in stillbirth was not significant between groups (4.7% versus 2.4%). Quality of the evidence was moderate to low owing to inconsistencies across the studies. Selective application and variability were also limitations. Although time-lapse is shown to significantly improve overall clinical outcome, further high-quality evidence is needed before universal conclusions can be drawn. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Improve the Efficiency of the Service Process as a Result of the Muda Ideology

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Lorenc, Augustyn; Przyłuski, Krzysztof

2018-06-01

The aim of the paper was to improve service processes carried out by Knorr-Bremse Systemy Kolejowe Polska sp. z o.o. Particularly, emphasise unnecessary movements and physical efforts of employees. The indirect goal was to find a solution in the simplest possible way using the Muda ideology. In order to improve the service process at the beginning was executed the process mapping for the devices to be repaired, ie. brake callipers, electro-hydraulic units and auxiliary release units. The processes were assessed and shown as Pareto-Lorenz analysis. In order to determine the most time consuming process. Based on the obtained results use of a column crane with articulated arm was proposed to facilitate the transfer of heavy components between areas. The final step was to assess the effectiveness of the proposed solution in terms of time saving. From the company perspective results of the analysis are important. The proposed solution not only reduces total service time but also contributes to crew's work comfort.

Quality Quandaries: Improving a customer value stream at a financial service provider

NARCIS (Netherlands)

Kuiper, A.; van de Hoef, R.; Wesseling, M.; Lameijer, B.A.; Does, R.J.M.M.

2016-01-01

In the wake of the financial crisis, the financial sector had to make tremendous efforts in being more transparent and cost efficient (Blom and Kuenen 2009). As a consequence, over the last decade, various financial service providers have embraced a range of methods for improving their customer

A collaborative approach to improve the assessment of physical health in adult consumers with schizophrenia in Queensland mental health services.

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Plever, Sally; McCarthy, Irene; Anzolin, Melissa; Emmerson, Brett; Khatun, Mohsina

2016-02-01

The objective of this study was to apply a quality improvement collaborative to increase the number of physical health assessments conducted with consumers diagnosed with schizophrenia in adult community mental health services across Queensland. Sixteen adult mental health service organisations voluntarily took part in the statewide collaborative initiative to increase the number of physical health assessments completed on persons with a diagnosis of schizophrenia spectrum disorders managed through the community mental health service. Improvement in the physical health assessment clinical indicator was demonstrated across the state over a 3-year period with an increase in the number of physical health assessments recorded from 12% to 58%. Significant improvements were made over a 3-year period by all mental health services involved in the collaborative, supporting the application of a quality improvement methodology to drive change across mental health services. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Impact of mobile phone-based technology to improve health, population and nutrition services in Rural Bangladesh: a study protocol.

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Uddin, Jasim; Biswas, Tuhin; Adhikary, Gourab; Ali, Wazed; Alam, Nurul; Palit, Rajesh; Uddin, Nizam; Uddin, Aftab; Khatun, Fatema; Bhuiya, Abbas

2017-07-06

Mobile phone-based technology has been used in improving the delivery of healthcare services in many countries. However, data on the effects of this technology on improving primary healthcare services in resource-poor settings are limited. The aim of this study is to develop and test a mobile phone-based system to improve health, population and nutrition services in rural Bangladesh and evaluate its impact on service delivery. The study will use a quasi-experimental pre-post design, with intervention and comparison areas. Outcome indicators will include: antenatal care (ANC), delivery care, postnatal care (PNC), neonatal care, expanded programme on immunization (EPI) coverage, and contraceptive prevalence rate (CPR). The study will be conducted over a period of 30 months, using the existing health systems of Bangladesh. The intervention will be implemented through the existing service-delivery personnel at various primary-care levels, such as community clinic, union health and family welfare centre, and upazila health complex. These healthcare providers will be given mobile phones equipped with Apps for sending text and voice messages, along with the use of Internet and device for data-capturing. Training on handling of the Smartphones, data-capturing and monitoring will be given to selected service providers. They will also be trained on inputs, editing, verifying, and monitoring the outcome variables. Mobile phone-based technology has the potential to improve primary healthcare services in low-income countries, like Bangladesh. It is expected that our study will contribute to testing and developing a mobile phone-based intervention to improve the coverage and quality of services. The learning can be used in other similar settings in the low-and middle-income countries.

THE EFFECTS OF ROOM SERVICE TO IMPROVE PATIENTS’ FOOD SATISFACTION AND FOOD ACCEPTANCE

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Muhammad Iqbal

2017-01-01

Full Text Available The improvement of patients’ food satisfaction and acceptance in the hospitals is primarily needed in the food service  system.  Room service is a new concept in the food service area. This study aims to compare the effects of two different types of food service systems; room service and conventional service system. The study with quasi-experimental design is conducted to the subject of 66 inpatients who were taken using a quota sampling method. Subjects were divided into different groups, the treatment groups (room service and control groups (conventional. Leftover food between groups was compared for 9 large meals to determine acceptability. Food satisfaction is measured on the last day with using questionnaire. The study was conducted in April-June 2014. Chi-Square test and logistic regression were used for analysis of research data. There were significant differences food satisfaction (RR=4.6; p=0.0001 and food acceptance (RR=1.94; p=0.0488 between control and treatment group. The logistic regression test showed that room service group had higher food satisfaction and food acceptance level than control group after controlling confounding factors, which were 12,11 times (95% CI 3,593 – 37,219 and 2,38 times (95% CI 0,68-8,31, respectively. The room service increases food satisfaction and food acceptance of patients compared with conventional systems.

Predictors of acceptance of offered care management intervention services in a quality improvement trial for dementia.

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Kaisey, Marwa; Mittman, Brian; Pearson, Marjorie; Connor, Karen I; Chodosh, Joshua; Vassar, Stefanie D; Nguyen, France T; Vickrey, Barbara G

2012-10-01

Care management approaches have been proven to improve outcomes for patients with dementia and their family caregivers (dyads). However, acceptance of services in these programs is incomplete, impacting effectiveness. Acceptance may be related to dyad as well as healthcare system characteristics, but knowledge about factors associated with program acceptance is lacking. This study investigates patient, caregiver, and healthcare system characteristics associated with acceptance of offered care management services. This study analyzed data from the intervention arm of a cluster randomized controlled trial of a comprehensive dementia care management intervention. There were 408 patient-caregiver dyads enrolled in the study, of which 238 dyads were randomized to the intervention. Caregiver, patient, and health system factors associated with participation in offered care management services were assessed through bivariate and multivariate regression analyses. Out of the 238 dyads, 9 were ineligible for this analysis, leaving data of 229 dyads in this sample. Of these, 185 dyads accepted offered care management services, and 44 dyads did not. Multivariate analyses showed that higher likelihood of acceptance of care management services was uniquely associated with cohabitation of caregiver and patient (p management participation could result in increased adoption of successful programs to improve quality of care. Using these factors to revise both program design as well as program promotion may also benefit external validity of future quality improvement research trials. Copyright © 2011 John Wiley & Sons, Ltd.

Application of multimedia services in the broadband environment to improve logistic needs of the army

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Radiša R. Stefanović

2012-07-01

Full Text Available The paper analyzes the flow of some multimedia services, and points to the possibility of applying some of the services in the broadband environment to improve the logistic needs of the army. The need to convey information in different forms (from text, data, graphics, still pictures to video motion pictures is increasing continually. Requests for information transfer in high resolution require increasing the flow to several dozens of Mb/s. Broadband represents the platform for a wide range of multimedia services. Each multimedia service requires a certain flow which can be partially decreased with advanced coding techniques.

Constraints in animal health service delivery and sustainable improvement alternatives in North Gondar, Ethiopia

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Hassen Kebede

2014-11-01

Full Text Available Poor livestock health services remain one of the main constraints to livestock production in many developing countries, including Ethiopia. A study was carried out in 11 districts of North Gondar, from December 2011 to September 2012, with the objective of identifying the existing status and constraints of animal health service delivery, and thus recommending possible alternatives for its sustainable improvement. Data were collected by using pre-tested questionnaires and focus group discussion. Findings revealed that 46.34% of the responding farmers had taken their animals to government veterinary clinics after initially trying treatments with local medication. More than 90.00% of the clinical cases were diagnosed solely on clinical signs or even history alone. The antibacterial drugs found in veterinary clinics were procaine penicillin (with or without streptomycin, oxytetracycline and sulphonamides, whilst albendazole, tetramisole and ivermectin were the only anthelmintics. A thermometer was the only clinical aid available in all clinics, whilst only nine (45.00% clinics had a refrigerator. In the private sector, almost 95.00% were retail veterinary pharmacies and only 41.20% fulfilled the requirement criteria set. Professionals working in the government indicated the following problems: lack of incentives (70.00%, poor management and lack of awareness (60.00% and inadequate budget (40.00%. For farmers, the most frequent problems were failure of private practitioners to adhere to ethical procedures (74.00% and lack of knowledge of animal diseases and physical distance from the service centre (50.00%. Of all responding farmers, 58.54% preferred the government service, 21.14% liked both services equally and 20.33% preferred the private service. Farmers’ indiscriminate use of drugs from the black market (23.00% was also mentioned as a problem by private practitioners. Sustainable improvement of animal health service delivery needs increased

Constraints in animal health service delivery and sustainable improvement alternatives in North Gondar, Ethiopia.

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Kebede, Hassen; Melaku, Achenef; Kebede, Elias

2014-11-12

Poor livestock health services remain one of the main constraints to livestock production in many developing countries, including Ethiopia. A study was carried out in 11 districts of North Gondar, from December 2011 to September 2012, with the objective of identifying the existing status and constraints of animal health service delivery, and thus recommending possible alternatives for its sustainable improvement. Data were collected by using pre-tested questionnaires and focus group discussion. Findings revealed that 46.34% of the responding farmers had taken their animals to government veterinary clinics after initially trying treatments with local medication. More than 90.00% of the clinical cases were diagnosed solely on clinical signs or even history alone. The antibacterial drugs found in veterinary clinics were procaine penicillin (with or without streptomycin), oxytetracycline and sulphonamides, whilst albendazole, tetramisole and ivermectin were the only anthelmintics. A thermometer was the only clinical aid available in all clinics, whilst only nine (45.00%) clinics had a refrigerator. In the private sector, almost 95.00% were retail veterinary pharmacies and only 41.20% fulfilled the requirement criteria set. Professionals working in the government indicated the following problems: lack of incentives (70.00%), poor management and lack of awareness (60.00%) and inadequate budget (40.00%). For farmers, the most frequent problems were failure of private practitioners to adhere to ethical procedures (74.00%) and lack of knowledge of animal diseases and physical distance from the service centre (50.00%). Of all responding farmers, 58.54% preferred the government service, 21.14% liked both services equally and 20.33% preferred the private service. Farmers' indiscriminate use of drugs from the black market (23.00%) was also mentioned as a problem by private practitioners. Sustainable improvement of animal health service delivery needs increased awareness for all

Financial Mechanisms to Improve the Supply of Ecosystem Services from Privately-Owned Australian Native Forests

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Ian Ferguson

2016-02-01

Full Text Available Much of Australia’s native forest is privately-owned and is needing investment to maintain and improve the supply of a wide range of ecosystem services. This paper reviews mechanisms presently used in Australia to improve the supply of ecosystem services, with particular emphasis on financial mechanisms. Auction, green bond and biobanking schemes are widely and, so far, successfully used in a number of States, especially in projects where the actions required and ecosystem services can be readily measured. Measurement of biodiversity and biodiversity-based services remains problematic, despite some fairly widespread application of different measurement systems. Inadequate or variable measurement systems could engender a loss of investor interest if equivalence or gains cannot be appropriately verified. A new Biodiversity Investment Scheme is proposed, based on the structure used commercially in Managed Investment Schemes. The choice of mechanism, however, will be mainly determined by landowner attitudes to assignment of property rights, and by scale, the extent of public versus private consumption goods, and the transaction costs and risks.

Policies and means to assess and improve service quality in electricity supply systems

International Nuclear Information System (INIS)

Lagostena, L.; Mirra, C.; Noferi, P.L.; Sani, G.

1992-03-01

Quality of electricity supply to users consists of a series of characteristics of the voltage at the points of delivery. This report shows how service quality, in the past basically related to the tolerance of voltage and frequency with respect to the nominal value, as well as, to the continuity of supply, is nowadays assessed also in relation to other aspects, generally referred to as disturbances. Short interruptions, voltage dips, transient overvoltages, harmonics and flicker are mainly taken into consideration. A description is given of the approach adopted by ENEL (the Italian Electricity Board) in order to evaluate and, if required, improve the quality of service, based upon the acquisition of data related to faults, interruptions and disturbances. These data are processed in order to obtain significant indices on the state of the network and on the effectiveness of the actions which can be implemented. Finally, the measures which may lead to an improvement in the quality of service are identified, and potential advantages, in terms of the reduction of non-supplied energy and number of faults, of adopting appropriate automatic devices and optimizing maintenance work on some distribution networks are illustrated

A lean six sigma approach to improve municipal service processes

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Engelbert Zefaj

2017-03-01

Full Text Available This research aims to identify the current state of process management for municipal subsidies and is proposing to improve the process by reducing motion, deadlines and excessive actions and to eliminate duplication of processes and overproduction. Time spent and process effi ciency is the subject tackled in this research. Several areas of action that affect the overall process as departments, regulations, time, experts, movements, materials and procedures have been explored. Lean six sigma/DMAIC model is used as an adequate mechanism for the implementation of this project which aims to improve the quality of service. The result of the research is not limited to only one specific process, the applied model in this study can be used to improve many processes in municipalities. Currently, in order to receive a fi nal response from municipal authorities for subsidies allocation, 41hr of process time, 160 hr of calendar time and 232 hr of wait time are needed. The process effi ciency is only 10%.

Improving service quality of hospital front office using an integrated Kano model and quality function deployment

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Anjar Priyono

2017-11-01

Full Text Available Purpose: The aims of this study are twofold: first, it attempts to investigate service attributes in a hospital front office; and second, to identify strategies to improve those service attributes. Design/methodology/approach: This study used integration of Quality Function Deployment and Kano Model. The research instrument, which takes the SERVQUAL model as its starting point, was developed using a comprehensive set of techniques, including a literature review of relevant topics, interviews and focus group discussions. Using a sample of 140 customers of an international hospital situated in Yogyakarta, Indonesia, 14 service attributes required by customers were identified. The attributes, which were further categorised into 5 attractive, 4 one-dimensional and 5 ‘must-be’ attributes, were analysed using the Kano Model. Findings: Using the integrated QFD and Kano Model, the service attributes needed for improvement were identified. The results are different from those when the company used either SERVQUAL or QFD alone. This study also reveals that benchmarking with competitor might produce misleading results. The results are different when the analysis combined a comprehensive method of QFD and Kano Model. Practical implications: Service providers will benefit from the findings of this study, as both the service attributes and technical requirements that require improvement as a priority are identified. Originality/value: It is the first time that front office quality of hospital is examined using integrated method of SERVQUAL, QFD and Kano Model. The recommendations proposed from this comprehensive method offer novel solution that has never been found in existing study.

Improving Service Utilization for Parents with Substance Abuse Problems: Experimenting with Recovery Coaches in Child Welfare.

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