Association between medication supplies and healthcare costs in older adults from an urban healthcare system.

Science.gov (United States)

Stroupe, K T; Murray, M D; Stump, T E; Callahan, C M

2000-07-01

The amount of medication dispensed to older adults for the treatment of chronic disease must be balanced carefully. Insufficient medication supplies lead to inadequate treatment of chronic disease, whereas excessive supplies represent wasted resources and the potential for toxicity. We used an electronic medical record system to determine the distribution of medications supplied to older urban adults and to examine the correlations of these distributions with healthcare costs and use. A cross-sectional study using data acquired over 3 years (1994-1996). A tax-supported urban public healthcare system consisting of a 300-bed hospital, an emergency department, and a network of community-based ambulatory care centers. Patients were >60 years of age and had at least one prescription refill and at least two ambulatory visits or one hospitalization during the 3-year period. Focusing on 12 major categories of drugs used to treat chronic diseases, we determined the amounts and direct costs of these medications dispensed to older adult patients. Amounts of medications that were needed by patients to medicate themselves adequately were compared with the medication supply actually dispensed considering all sources of care (primary, emergency, and inpatient). We calculated the excess drug costs attributable to oversupply of medication (>120% of the amount needed) and the drug cost reduction caused by undersupply of medication (120% of the supply needed. The total direct cost of targeted medications for 3 years was $1.96 million or, on average, $654,000 annually. During the 3-year period, patients receiving >120% of their needed medications had excess direct medication costs of $279,084 or $144 per patient, whereas patients receiving <80% of drugs needed had reduced medication costs of $423,438 or $634 per patient. Multivariable analyses revealed that both under- and over-supplies of medication were associated with a greater likelihood of emergency department visits and hospital

78 FR 54731 - Update to the List of Basic Medical Supplies

Science.gov (United States)

2013-09-05

..., tape, wrist bands, documents, brochures, and graphics Non-electronic patient medical record file... DEPARTMENT OF THE TREASURY Office of Foreign Assets Control Update to the List of Basic Medical... defined as basic medical supplies. SUMMARY: The Department of the Treasury's Office of Foreign Assets...

[Study on medical service supply public-private partnership mode: based on the view of public economics].

Science.gov (United States)

Dai, Yue; Sun, Hong; Zhou, Li

2015-02-01

Due to the quasi-public attributes of medical service, the supply mode and system could influence equity and fairness of general people's health. Based on the view of public economics, the purpose of this paper was to explain the economic nature of medical service supply. By analyzing the practice of public-private partnership (PPP) mode in medical care supply and the related public economic issues, we summarized the feasibility and risks of PPP model in Chinese medical care supply market. Finally, we discussed the innovative medical service system provided by government, public hospitals, and social capitals together. Therefore, to guarantee further development of this new medical service supply--PPP mode, we should pay attention to some practical problems, such as the share of cooperation cost and the balance between the benefit and risk among all partners.

Impact of supply problems of preservative-free glaucoma medications on patients and hospital staff.

Science.gov (United States)

Shah, Shima; Theodossiades, Julia; Chapman, Kristin; Murdoch, Ian

2015-03-01

Glaucoma is a chronic ocular disease, which is usually managed with long-term daily medical therapy, in the form of eye drops. Patients who are intolerant to preservatives in topical medicines require preservative-free versions. From early 2011 patients attending Moorfields Eye Hospital, London, UK, started to report recurring problems with the supply of the following preservative-free glaucoma medications: Timolol 0.25% (Timoptol 0.25%, MSD UK); Dorzolamide (Trusopt, MSD UK); Dorzolamide and Timolol 0.5% (Cosopt, MSD UK). This study investigates the impact of the supply problems of these medications at Moorfields Eye Hospital from a patient, administrative and clinical perspective. Information was sought by interviewing both patients and hospital staff, and by a retrospective case note review between April 2010 and May 2013. Many hospital roles, both administrative and clinical, were involved in attempting to resolve the impact of the supply problems. All staff reported a considerable increase in their workload. At the peak of the problem, the glaucoma secretaries received about 150 enquiries per week. A review of 83 sets of patient notes, retrieved from a random sample of 125 patients, showed that 22% encountered a supply problem. Of these, more than one-third attended Moorfields Eye Hospital Accident & Emergency (A&E) for repeat supplies and 89% eventually had their medication changed. In telephone interviews with 39 of a random sample of 50 patients (a subset of the 83 notes retrieved), 59% of the interviewees reported a supply problem. Of these, one-third attended Moorfields Eye Hospital A&E for repeat supplies and half eventually required an alternative medication. Some patients reported going to considerable lengths to obtain ongoing supplies in the community. This study shows that medication supply problems can have a major impact on patients and hospital services. Supply problems occur across many fields of medicine and with increasing frequency. The

Supply chain integration scales validation and benchmark values

Directory of Open Access Journals (Sweden)

Juan A. Marin-Garcia

2013-06-01

Full Text Available Purpose: The clarification of the constructs of the supply chain integration (clients, suppliers, external and internal, the creation of a measurement instrument based on a list of items taken from earlier papers, the validation of these scales and a preliminary benchmark to interpret the scales by percentiles based on a set of control variables (size of the plant, country, sector and degree of vertical integration. Design/methodology/approach: Our empirical analysis is based on the HPM project database (2005-2007 timeframe. The international sample is made up of 266 plants across ten countries: Austria, Canada, Finland, Germany, Italy, Japan, Korea, Spain, Sweden and the USA. In each country. We analized the descriptive statistics, internal consistency testing to purify the items (inter-item correlations, Cronbach’s alpha, squared multiple correlation, corrected item-total correlation, exploratory factor analysis, and finally, a confirmatory factor analysis to check the convergent and discriminant validity of the scales. The analyses will be done with the SPSS and EQS programme using the maximum likelihood parameter estimation method. Findings: The four proposed scales show excellent psychometric properties. Research limitations/implications: with a clearer and more concise designation of the supply chain integration measurement scales more reliable and accurate data could be taken to analyse the relations between these constructs with other variables of interest to the academic l fields. Practical implications: providing scales that are valid as a diagnostic tool for best practices, as well as providing a benchmark with which to compare the score for each individual plant against a collection of industrial companies from the machinery, electronics and transportation sectors. Originality/value: supply chain integration may be a major factor in explaining the performance of companies. The results are nevertheless inconclusive, the vast range

Content Validity of a Tool Measuring Medication Errors.

Science.gov (United States)

Tabassum, Nishat; Allana, Saleema; Saeed, Tanveer; Dias, Jacqueline Maria

2015-08-01

The objective of this study was to determine content and face validity of a tool measuring medication errors among nursing students in baccalaureate nursing education. Data was collected from the Aga Khan University School of Nursing and Midwifery (AKUSoNaM), Karachi, from March to August 2014. The tool was developed utilizing literature and the expertise of the team members, expert in different areas. The developed tool was then sent to five experts from all over Karachi for ensuring the content validity of the tool, which was measured on relevance and clarity of the questions. The Scale Content Validity Index (S-CVI) for clarity and relevance of the questions was found to be 0.94 and 0.98, respectively. The tool measuring medication errors has an excellent content validity. This tool should be used for future studies on medication errors, with different study populations such as medical students, doctors, and nurses.

The Vanuatu medical supply system – documenting opportunities and challenges to meet the Millennium Development Goals

Science.gov (United States)

Brown, Andrew; Gilbert, Ben

2012-01-01

Objectives: Limited human resources are widely recognised as a barrier to achieve health-related Millennium Development Goals. Availability of medical supplies and suitably trained health personnel are crucial to ensuring a well-functioning medical supply system. The objective of this paper is to identify the factors which influence the availability of medical supplies within the health facilities of Vanuatu. Methods: A qualitative triangulated strategy using semi-structured interviews, observational workplace surveys and semi-structured focus groups was developed. This research was approved by the Human Ethics Committee of the University of Canberra and was funded through a direct grant from the United Nations Population Fund Suva, Pacific sub regional office. Results: During two weeks of data collection, 21 interviews were conducted, observational workplace surveys were completed in 19 facilities and 22 personnel participated in three focus groups across three provinces. The interviewees had a wide range of primary professional groupings and were representative of the Vanuatu health workforce. A complex array of medical supply issues are described from within the three tiered structure of the medical supply system. Conclusion: The results of this research have further informed our understanding of the competencies required by healthcare personnel to conduct medical supply management activities effectively in Pacific Island countries. As a result of this research, a platform is provided for the government of Vanuatu to engage development partners to work toward a sustainable medical supply system. PMID:23093895

The Vanuatu medical supply system – documenting opportunities and challenges to meet the Millennium Development Goals

OpenAIRE

Brown, Andrew; Gilbert, Ben

2012-01-01

Objectives: Limited human resources are widely recognised as a barrier to achieve health-related Millennium Development Goals. Availability of medical supplies and suitably trained health personnel are crucial to ensuring a well-functioning medical supply system. The objective of this paper is to identify the factors which influence the availability of medical supplies within the health facilities of Vanuatu. Methods: A qualitative triangulated strategy using semi-structured interviews, obser...

Australia's rural medical workforce: Supply from its medical schools against career stage, gender and rural-origin.

Science.gov (United States)

McGrail, Matthew R; Russell, Deborah J

2017-10-01

The aim of this study was to explore the association between career stage and rural medical workforce supply among Australian-trained medical graduates. Descriptive analysis using the national Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal study. Australian-trained GPs and other specialists who participated in the MABEL study, 2008-2013. Proportions of GPs and specialists working in rural locations, according to career stage (establishing, early, mid and late), gender and childhood-origin type (rural versus metropolitan). Logistic regression models revealed that establishing- and early-career GPs had significantly higher likelihood (OR 1.67 and 1.38, respectively) of working rurally, but establishing and early-career doctors were significantly less likely (OR 0.34 and 0.43, respectively) to choose general practice, contributing proportionally fewer rural GPs overall (OR 0.77 and 0.75, respectively) compared to late-career doctors. For specialists, there were no significant associations between career cohorts and rural practice. Overall, there was a significantly lower likelihood (OR 0.83) of establishing-career doctors practising rurally. Women were similarly likely to be rural GPs but less likely to be rural specialists, while rural-origin was consistently associated with higher odds of rural practice. The supply of Australia's rural medical workforce from its medical schools continues to be challenging, with these data highlighting both their source and associations with doctors at different career stages. Despite large investments through rural medical training and rural workforce recruitment and retention policies, these data confirm continued reliance on internationally trained medical graduates for large proportions of rural supply is likely. © 2016 National Rural Health Alliance Inc.

Emergency Physicians as Good Samaritans: Survey of Frequency, Locations, Supplies and Medications

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Taylor W. Burkholder, MD, MPH

2016-01-01

Full Text Available Introduction: Little is known about the frequency and locations in which emergency physicians (EPs are bystanders to an accident or emergency; equally uncertain is which contents of an “emergency kit” may be useful during such events. The aim of this study was to describe the frequency and locations of Good Samaritan acts by EPs and also determine which emergency kit supplies and medications were most commonly used by Good Samaritans. Methods: We conducted an electronic survey among a convenience sample of EPs in Colorado. Results: Respondents reported a median frequency of 2.0 Good Samaritan acts per five years of practice, with the most common locations being sports and entertainment events (25%, road traffic accidents (21%, and wilderness settings (19%. Of those who had acted as Good Samaritans, 86% reported that at least one supply would have been useful during the most recent event, and 66% reported at least one medication would have been useful. The most useful supplies were gloves (54%, dressings (34%, and a stethoscope (20%, while the most useful medications were oxygen (19%, intravenous fluids (17%, and epinephrine (14%. Conclusion: The majority of EPs can expect to provide Good Samaritan care during their careers and would be better prepared by carrying a kit with common supplies and medications where they are most likely to use them.

Educational testing validity and reliability in pharmacy and medical education literature.

Science.gov (United States)

Hoover, Matthew J; Jung, Rose; Jacobs, David M; Peeters, Michael J

2013-12-16

To evaluate and compare the reliability and validity of educational testing reported in pharmacy education journals to medical education literature. Descriptions of validity evidence sources (content, construct, criterion, and reliability) were extracted from articles that reported educational testing of learners' knowledge, skills, and/or abilities. Using educational testing, the findings of 108 pharmacy education articles were compared to the findings of 198 medical education articles. For pharmacy educational testing, 14 articles (13%) reported more than 1 validity evidence source while 83 articles (77%) reported 1 validity evidence source and 11 articles (10%) did not have evidence. Among validity evidence sources, content validity was reported most frequently. Compared with pharmacy education literature, more medical education articles reported both validity and reliability (59%; particles in pharmacy education compared to medical education, validity, and reliability reporting were limited in the pharmacy education literature.

The Development and Empirical Validation of an E-based Supply Chain Strategy Optimization Model

DEFF Research Database (Denmark)

Kotzab, Herbert; Skjoldager, Niels; Vinum, Thorkil

2003-01-01

Examines the formulation of supply chain strategies in complex environments. Argues that current state‐of‐the‐art e‐business and supply chain management, combined into the concept of e‐SCM, as well as the use of transaction cost theory, network theory and resource‐based theory, altogether can...... be used to form a model for analyzing supply chains with the purpose of reducing the uncertainty of formulating supply chain strategies. Presents e‐supply chain strategy optimization model (e‐SOM) as a way to analyze supply chains in a structured manner as regards strategic preferences for supply chain...... design, relations and resources in the chains with the ultimate purpose of enabling the formulation of optimal, executable strategies for specific supply chains. Uses research results for a specific supply chain to validate the usefulness of the model....

The Papua New Guinea medical supply system - documenting opportunities and challenges to meet the Millennium Development Goals

OpenAIRE

Brown, Andrew N; Gilbert, Ben

2014-01-01

Objectives Limited human resources are widely recognised as an impediment to achieving the health-related Millennium Development Goals in Pacific Island Countries, with the availability of medical supplies and suitably trained health personnel crucial to ensuring a well-functioning medical supply chain. This paper presents our findings as we seek to answer the research question ?What factors influence the availability of medical supplies within the health facilities of Papua New Guinea?? Meth...

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

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Juan Francisco Peris Martí

2017-07-01

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

The Papua New Guinea medical supply system - documenting opportunities and challenges to meet the Millennium Development Goals.

Science.gov (United States)

Brown, Andrew N; Gilbert, Ben

2014-01-01

Limited human resources are widely recognised as an impediment to achieving the health-related Millennium Development Goals in Pacific Island Countries, with the availability of medical supplies and suitably trained health personnel crucial to ensuring a well-functioning medical supply chain. This paper presents our findings as we seek to answer the research question 'What factors influence the availability of medical supplies within the health facilities of Papua New Guinea?' We used a qualitative, triangulated strategy using semi-structured interviews, workplace observation and semi-structured focus groups. The parallel use of the interview tool and workplace observation tool allowed identification of 'know-do' gaps between what the interviewee said they did in their work practices, and the actual evidence of these practices. Focus groups provided further opportunities for raising and elaborating issues. During 2 weeks of data collection we conducted 17 interviews and 15 observational workplace surveys in 15 facilities. Sixteen health personnel participated in 3 focus groups across 2 provinces and one district. An array of medical supply issues across all levels of the medical supply chain were revealed, including standard operating procedures, facilities, transport, emergency medical kits, the cold chain and record keeping. The influence of health worker training and competency was found to be common across all of these issues. The factors influencing the availability of medical supplies in PNG consist of a range of interrelating issues, consisting of both simple and complex problems involving the different levels and cadres of workers within the medical supply chain. Health systems sustainability theory suggests that a coordinated approach which addresses the inter-related nature of these issues, led by the PNG government and supported by suitable development partners, will be required for sustainable health systems change to occur. These changes are necessary

Medical Supplies Shortages and Burnout among Greek Health Care Workers during Economic Crisis: a Pilot Study

Science.gov (United States)

Rachiotis, George; Kourousis, Christos; Kamilaraki, Maria; Symvoulakis, Emmanouil K.; Dounias, George; Hadjichristodoulou, Christos

2014-01-01

Greece has been seriously affected by the economic crisis. In 2011 there were reports of 40% reduction to public hospital budgets. Occasional shortages of medical supplies have been reported in mass media. We attempted to pivotally investigate the frequency of medical supplies shortages in two Greek hospital units of the National Health System and to also assess their possible impact on burnout risk of health care workers. We conducted a cross-sectional study (n=303) of health care workers in two Greek hospitals who were present at the workplace during a casually selected working day (morning shift work). The Maslach Burnout Inventory (MBI) was used as the measure of burnout. An additional questionnaire was used about demographics, and working conditions (duration of employment, cumulative night shifts, type of hospital including medical supplies shortages and their impact on quality of healthcare. The prevalence of emotional exhaustion, depersonalization and low personal accomplishment was 44.5%, 43.2% and 51.5%, respectively. Medical supply shortages were significantly associated with emotional exhaustion and depersonalization. This finding provides preliminary evidence that austerity has affected health care in Greece. Moreover, the medical supply shortages in Greek hospitals may reflect the unfolding humanitarian crisis of the country. PMID:24688306

Elaboration and Validation of the Medication Prescription Safety Checklist 1

Science.gov (United States)

Pires, Aline de Oliveira Meireles; Ferreira, Maria Beatriz Guimarães; do Nascimento, Kleiton Gonçalves; Felix, Márcia Marques dos Santos; Pires, Patrícia da Silva; Barbosa, Maria Helena

2017-01-01

ABSTRACT Objective: to elaborate and validate a checklist to identify compliance with the recommendations for the structure of medication prescriptions, based on the Protocol of the Ministry of Health and the Brazilian Health Surveillance Agency. Method: methodological research, conducted through the validation and reliability analysis process, using a sample of 27 electronic prescriptions. Results: the analyses confirmed the content validity and reliability of the tool. The content validity, obtained by expert assessment, was considered satisfactory as it covered items that represent the compliance with the recommendations regarding the structure of the medication prescriptions. The reliability, assessed through interrater agreement, was excellent (ICC=1.00) and showed perfect agreement (K=1.00). Conclusion: the Medication Prescription Safety Checklist showed to be a valid and reliable tool for the group studied. We hope that this study can contribute to the prevention of adverse events, as well as to the improvement of care quality and safety in medication use. PMID:28793128

Development, Validation, and Implementation of a Medical Judgment Metric

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Rami A. Ahmed DO, MHPE

2017-06-01

Full Text Available Background: Medical decision making is a critical, yet understudied, aspect of medical education. Aims: To develop the Medical Judgment Metric (MJM, a numerical rubric to quantify good decisions in practice in simulated environments; and to obtain initial preliminary evidence of reliability and validity of the tool. Methods: The individual MJM items, domains, and sections of the MJM were built based on existing standardized frameworks. Content validity was determined by a convenient sample of eight experts. The MJM instrument was pilot tested in four medical simulations with a team of three medical raters assessing 40 participants with four levels of medical experience and skill. Results: Raters were highly consistent in their MJM scores in each scenario (intraclass correlation coefficient 0.965 to 0.987 as well as their evaluation of the expected patient outcome (Fleiss’s Kappa 0.791 to 0.906. For each simulation scenario, average rater cut-scores significantly predicted expected loss of life or stabilization (Cohen’s Kappa 0.851 to 0.880. Discussion : The MJM demonstrated preliminary evidence of reliability and validity.

Canada's ongoing role in global medical isotope supply

International Nuclear Information System (INIS)

Wiens, R.A.

2014-01-01

Canada has been a leader in the production of medical isotopes, most notably Molybednum-99 (Mo-99) and Cobalt-60 (Co-60) used for diagnosis, prevention and treatment of disease, since the inception of the technology in the 1950s. These products have become critical components of healthcare, impacting the daily lives of millions of people around the world. The technological, political, social and commercial climate for production of these isotopes has changed dramatically over the many decades since their use began. Canada's role in assuring long-term stability of supply continues to evolve, and at Nordion we are identifying ways to meet the new and significant challenges associated with these changes. As a supplier to this global industry, Canada is presented with not only high expectations, but also unique opportunities for advancement of policy, science and technology in support of the longevity of the medical isotope and gamma sterilization industries. This paper will examine the current drivers for change in the global medical isotope supply chain, provide an overview of new and enhanced technology options, and identify the steps necessary for Canada to maintain and expand its strong position in this critical industry. (author)

Validation of Medical Tourism Service Quality Questionnaire (MTSQQ) for Iranian Hospitals.

Science.gov (United States)

Qolipour, Mohammad; Torabipour, Amin; Khiavi, Farzad Faraji; Malehi, Amal Saki

2017-03-01

Assessing service quality is one of the basic requirements to develop the medical tourism industry. There is no valid and reliable tool to measure service quality of medical tourism. This study aimed to determine the reliability and validity of a Persian version of medical tourism service quality questionnaire for Iranian hospitals. To validate the medical tourism service quality questionnaire (MTSQQ), a cross-sectional study was conducted on 250 Iraqi patients referred to hospitals in Ahvaz (Iran) from 2015. To design a questionnaire and determine its content validity, the Delphi Technique (3 rounds) with the participation of 20 medical tourism experts was used. Construct validity of the questionnaire was assessed through exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach's alpha coefficient. Data were analyzed by Excel 2007, SPSS version18, and Lisrel l8.0 software. The content validity of the questionnaire with CVI=0.775 was confirmed. According to exploratory factor analysis, the MTSQQ included 31 items and 8 dimensions (tangibility, reliability, responsiveness, assurance, empathy, exchange and travel facilities, technical and infrastructure facilities and safety and security). Construct validity of the questionnaire was confirmed, based on the goodness of fit quantities of model (RMSEA=0.032, CFI= 0.98, GFI=0.88). Cronbach's alpha coefficient was 0.837 and 0.919 for expectation and perception questionnaire. The results of the study showed that the medical tourism SERVQUAL questionnaire with 31 items and 8 dimensions was a valid and reliable tool to measure service quality of medical tourism in Iranian hospitals.

Increasing The Supply of Medical Personnel: Needs and Alternatives. Evaluative Studies Series.

Science.gov (United States)

Steward, Charles T., Jr.; Siddayao, Corazon M.

This paper considers medical personnel shortages, especially the shortage of physicians, and the different ways to alleviate these shortages. Chapter I gives a brief history (1963-1972) of legislation intended to increase medical manpower supply and Chapter II discusses the causes of the shortage, analyzing the elements affecting demand for…

Medication supply, healthcare outcomes and healthcare expenses: longitudinal analyses of patients with type 2 diabetes and hypertension.

Science.gov (United States)

Chen, Chi-Chen; Blank, Robert H; Cheng, Shou-Hsia

2014-09-01

Patients with chronic conditions largely depend on proper medications to maintain health. This study aims to examine, for patients with diabetes and hypertension, whether the appropriateness of the quantity of drug obtained is associated with favorable healthcare outcomes and lower expenses. This study utilized a longitudinal design with a seven-year follow-up period from 2002 to 2009 under a universal health insurance program in Taiwan. The patients under study were those aged 18 years or older and newly diagnosed with type 2 diabetes or hypertension in 2002. Generalized estimating equations were performed to examine the relationship between medication supply and health outcomes as well as expenses. The results indicate that while compared with patients with an appropriate medication supply, patients with either an undersupply or an oversupply of medications tended to have poorer healthcare outcomes. The study also found that an excess supply of medications for patients with diabetes or hypertension resulted in higher total healthcare expenses. Either an undersupply or an oversupply of medication was associated with unfavorable healthcare outcomes, and that medication oversupply was associated with the increased consumption of health resources. Our findings suggest that improving appropriate medication supply is beneficial for the healthcare system. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Gamma irradiation for food preservation and sterilization of medical supplies

International Nuclear Information System (INIS)

Syed Abid Husain; Mohammad Said Kadis

1981-01-01

A new technology in food preservation by using gamma irradiation was introduced and its advantages over a number of conventional processes were discussed. The new technique is also applicable in the sterilization of medical supplies. It is relatively simple and does not require very highly skilled manpower

The Papua New Guinea medical supply system - documenting opportunities and challenges to meet the Millennium Development Goals

Science.gov (United States)

2014-01-01

Objectives Limited human resources are widely recognised as an impediment to achieving the health-related Millennium Development Goals in Pacific Island Countries, with the availability of medical supplies and suitably trained health personnel crucial to ensuring a well-functioning medical supply chain. This paper presents our findings as we seek to answer the research question ‘What factors influence the availability of medical supplies within the health facilities of Papua New Guinea?’ Methods We used a qualitative, triangulated strategy using semi-structured interviews, workplace observation and semi-structured focus groups. The parallel use of the interview tool and workplace observation tool allowed identification of ‘know-do’ gaps between what the interviewee said they did in their work practices, and the actual evidence of these practices. Focus groups provided further opportunities for raising and elaborating issues. Results During 2 weeks of data collection we conducted 17 interviews and 15 observational workplace surveys in 15 facilities. Sixteen health personnel participated in 3 focus groups across 2 provinces and one district. An array of medical supply issues across all levels of the medical supply chain were revealed, including standard operating procedures, facilities, transport, emergency medical kits, the cold chain and record keeping. The influence of health worker training and competency was found to be common across all of these issues. Conclusion The factors influencing the availability of medical supplies in PNG consist of a range of interrelating issues, consisting of both simple and complex problems involving the different levels and cadres of workers within the medical supply chain. Health systems sustainability theory suggests that a coordinated approach which addresses the inter-related nature of these issues, led by the PNG government and supported by suitable development partners, will be required for sustainable health

An Exploration of Healthcare Inventory and Lean Management in Minimizing Medical Supply Waste in Healthcare Organizations

Science.gov (United States)

Hicks, Rodney

2013-01-01

The purpose of this study was to understand how lean thinking and inventory management technology minimize expired medical supply waste in healthcare organizations. This study was guided by Toyota's theory of lean and Mintzberg's theory of management development to explain why the problem of medical supply waste exists. Government…

An ecological perspective on medical care: environmental, occupational, and public health impacts of medical supply and pharmaceutical chains.

Science.gov (United States)

Vatovec, Christine; Senier, Laura; Bell, Michael

2013-09-01

Healthcare organizations are increasingly examining the impacts of their facilities and operations on the natural environment, their workers, and the broader community, but the ecological impacts of specific healthcare services provided within these institutions have not been assessed. This paper provides a qualitative assessment of healthcare practices that takes into account the life-cycle impacts of a variety of materials used in typical medical care. We conducted an ethnographic study of three medical inpatient units: a conventional cancer ward, palliative care unit, and a hospice center. Participant observations (73 participants) of healthcare and support staff including physicians, nurses, housekeepers, and administrators were made to inventory materials and document practices used in patient care. Semi-structured interviews provided insight into common practices. We identified three major domains that highlight the cumulative environmental, occupational health, and public health impacts of medical supplies and pharmaceuticals used at our research sites: (1) medical supply procurement; (2) generation, handling, and disposal of medical waste; and (3) pharmaceutical handling and disposal. Impacts discovered through ethnographic inquiry included occupational exposures to chemotherapy and infectious waste, and public health exposures to pharmaceutical waste. This study provides new insight into the environmental, occupational, and public health impacts resulting from medical practices. In many cases, the lack of clear guidance and regulations regarding environmental impacts contributed to elevated harms to the natural environment, workers, and the broader community.

Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti

Directory of Open Access Journals (Sweden)

Michelle R. Holm

2015-01-01

Full Text Available Background: In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. Objective: We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP would optimize medication availability and decrease medication shortages. Design: We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. Results: The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of ‘real-time’ medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055, respectively, and the mean logins per day increased from 24.3 to 31.5, p<0.0001, respectively. The PCIP allows the hospital staff to identify and order medications with a critically low supply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. Conclusions: An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital.

[Medical and environmental aspects of the drinking water supply crisis].

Science.gov (United States)

Él'piner, L I

2013-01-01

Modern data determining drinking water supply crisis in Russia have been considered. The probability of influence of drinking water quality used by population on current negative demographic indices was shown. The necessity of taking into account interests of public health care in the process of formation of water management decisions was grounded. To achieve this goal the application of medical ecological interdisciplinary approach was proposed Its use is mostly effective in construction of goal-directed medical ecological sections for territorial schemes of the rational use and protection of water resources. Stages of the elaboration of these sections, providing the basing of evaluation and prognostic medical and environmental constructions on similar engineering studies of related disciplinary areas (hydrological, hydrogeological, hydrobiological, hydrochemical, environmental, socio-economic, technical and technological) were determined.

Exploring the effects of telehealth on medical human resources supply: a qualitative case study in remote regions

Directory of Open Access Journals (Sweden)

Duplantie Julie

2007-01-01

Full Text Available Abstract Background The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians' and managers' perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions. Methods A case study in Eastern Quebec was performed to explore this complex phenomenon. The analytical framework was based on two literature reviews and a Delphi study. Data were collected from semi-structured interviews with 41 physicians and 22 managers. Transcripts were produced and interview content was coded independently by two judges and validated by an expert panel. Results Interviews have highlighted the potential impact of telehealth on several factors influencing the recruitment and retention of physicians in rural and remote regions. The potential effects of telehealth on physicians' choice of practice location could be seen at the professional, organizational, educational and individual levels. For instance, telehealth could improve work satisfaction by allowing a regional on-call duty system and a better follow-up of patients. However, there are also certain limits related to telehealth, such as the fear that it would eventually replace all continuing medical education activities and onsite specialists in remoteregions. Conclusion Telehealth is likely to have an impact on several factors related to medical workforce supply in remote and rural regions. However, the expected benefits will materialize if and only if this technology is properly integrated into organizations as a support to professional practice.

Four tenets of modern validity theory for medical education assessment and evaluation.

Science.gov (United States)

Royal, Kenneth D

2017-01-01

Validity is considered by many to be the most important criterion for evaluating a set of scores, yet few agree on what exactly the term means. Since the mid-1800s, scholars have been concerned with the notion of validity, but over time, the term has developed a variety of meanings across academic disciplines and contexts. Accordingly, when scholars with different academic backgrounds, many of whom hold deeply entrenched perspectives about validity conceptualizations, converge in the field of medical education assessment, it is a recipe for confusion. Thus, it is important to work toward a consensus about validity in the context of medical education assessment. Thus, the purpose of this work was to present four fundamental tenets of modern validity theory in an effort to establish a framework for scholars in the field of medical education assessment to follow when conceptualizing validity, interpreting validity evidence, and reporting research findings.

Dosimetric studies for gamma radiation validation of medical devices

International Nuclear Information System (INIS)

Soliman, Y.S.; Beshir, W.B.; Abdel-Fattah, A.A.; Abdel-Rehim, F.

2013-01-01

The delivery and validation of a specified dose to medical devices are key concerns to operators of gamma radiation facilities. The objective of the present study was to characterize the industrial gamma radiation facility and map the dose distribution inside the product-loading pattern during the validation and routine control of the sterilization process using radiochromic films. Cardboard phantoms were designed to achieve the homogeneity of absorbed doses. The uncertainty of the dose delivered during validation of the sterilization process was assessed. - Highlights: ► Using γ-rays for sterilization of hollow fiber dialyzers and blood tubing sets according to ISO 11137, 2006. ► Dosimetry studies of validations of γ-irradiation facility and sterilized medical devices. ► Places of D min and D max have been determined using FWT-60 films. ► Determining the target minimum doses required to meet the desired SAL of 10 −6 for the two products.

[Public sector participation in the supply of dyslipidemia medication in a population-based study].

Science.gov (United States)

Petris, Airton José; Souza, Regina Kazue Tanno de; Bortoletto, Maira Sayuri Sakay

2016-12-01

The use of medications for the treatment of dyslipidemia is relevant in the control of cardiovascular disease. This article aims to analyze the prevalence, the use and the participation of the public sector in the supply of medication for adults aged 40 years and above using pharmacotherapy for dyslipidemia control living in a city in the southern region of Brazil. A cross-sectional, population-based study was conducted. Household interviews were staged with 1180 individuals aged over 40 living in Cambé, State of Paraná, of which 967 took laboratory examinations. The prevalence of dyslipidemia was 69.2%, of which 16.1% were taking medication. Among individuals undergoing treatment for dyslipidemia, 22.2% had adequate test results. Lipid-lowering medication used were simvastatin (81.5%) and bezafibrate (6.5%), mainly obtained by direct payment to private pharmacies and drug stores (52.2%) and NHS services (33.6%). A high prevalence of dyslipidemias was observed in population terms, together with a low level of dyslipidemia control and low participation of the public sector regarding the supply of medication compared to acquisition through direct payment for medication in private pharmacies. These results suggest a limited range of public policy for control of dyslipidemia.

[Use of medical treatment data outside of the patient supply: best way pseudonymisation].

Science.gov (United States)

Schütze, B

2012-04-01

The use of data pending during the patient supply to research, quality assurance as also to education is desirable. However, this use is not allowed in every German federal land without approval of the patient. Just in the case of retrospective research an approval of the patient is often not to be received. For the use of medical routine data for the research the pseudonymisation is good therefore. Pseudonymisation is a procedure by which all person-related data within a data record is replaced by one artificial identifier. Therefore pseudonymisation facilitates the linking of medical data and the data identifying the patient only under certain, before defined and controllable conditions. Through that medical data can be passed on to third party without this third party being able to identify the person who the medical data belong to. Under consideration of the present possibilities of the information technology as also the available technical preparations for the use of the pseudonymisation and the advantages being inherent in the pseudonymisation the pseudonymisation represents the method of choice during the use of data of the patient supply to the research, quality assurance as well as education. © Georg Thieme Verlag KG Stuttgart · New York.

Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti.

Science.gov (United States)

Holm, Michelle R; Rudis, Maria I; Wilson, John W

2015-01-01

In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP) would optimize medication availability and decrease medication shortages. We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of 'real-time' medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055), respectively, and the mean logins per day increased from 24.3 to 31.5, psupply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital.

Sterilization validation for medical compresses at IRASM multipurpose irradiation facility

International Nuclear Information System (INIS)

Alexandru, Mioara; Ene, Mihaela

2007-01-01

In Romania, IRASM Radiation Processing Center is the unique supplier of radiation sterilization services-industrial scale (ISO 9001:2000 and ISO 13485:2003 certified). Its Laboratory of Microbiological Testing is the sole third party competent laboratory (GLPractice License, ISO 17025 certification in progress) for pharmaceutics and medical devices as well. We here refer to medical compresses as a distinct category of sterile products, made from different kind of hydrophilic materials (cotton, non-woven, polyurethane foam) with or without an impregnated ointment base (paraffin, plant extracts). These products are included in the class of medical devices, but for the sterilization validation, from microbiological point of view, there are important differences in testing method compared to the common medical devices (syringes, catheters, etc). In this paper, we present some results and practical solutions chosen to perform a sterilization validation, compliant with ISO 11137: 2006

Medical isotope development and supply opportunities in the 21st century

International Nuclear Information System (INIS)

Troyer, G.L.; Schenter, R.E.

2009-01-01

Research in extending medical isotopes for the diagnosis and treatment of numerous health maladies is hampered by outages and upsets in major supply sources. Investigations in cures for brain cancer ( 211 At), HIV/AIDS virus ( 213 Bi), and even bacterial vectors are either in reduced progress mode or have been cancelled until isotopes become available. Examples of several key radioactive medical isotopes include 99m Tc for diagnostics, 131 I for non-Hodgkin's Lymphoma and thyroid cancer, 225 Ac for acute myelogenous leukemia, and 67 Cu for lymphoma cancer. Possibilities for developing commercially viable sources using compact accelerators and next generation research and production reactors are discussed. (author)

[The primary medical sanitary care and characteristics of drinking water supply of population].

Science.gov (United States)

Nechaev, V S; Saurina, O S

2016-01-01

The article considers characteristics of organization ofprimary medical sanitary care on territory with carcinogenic risks related to drinking water supply as exemplified by the Orlovskaia oblast. The importance of registration by local health authorities the sources of permanent chemical pollution of drinking water. The analysis of the State program of the Orlovskaia oblast “The development of health care in the Orlovskaia oblast in 2013-2020". The necessity of additional inclusion of issue related to healthy drinking water supply of population to prevent development of malignant neoplasms and prevalence of oncologic morbidity on oblast territory.

Optimizing clinical trial supply requirements: simulation of computer-controlled supply chain management.

Science.gov (United States)

Peterson, Magnus; Byrom, Bill; Dowlman, Nikki; McEntegart, Damian

2004-01-01

Computer-controlled systems are commonly used in clinical trials to control dispensing and manage site inventories of trial supplies. Typically such systems are used with an interactive telephone or web system that provide an interface with the study site. Realizing the maximum savings in medication associated with this approach has, in the past, been problematic as it has been difficult to fully estimate medication requirements due to the complexities of these algorithms and the inherent variation in the clinical trial recruitment process. We describe the traditional and automated methods of supplying sites. We detail a simulation approach that models the automated system. We design a number of simulation experiments using this model to investigate the supply strategy properties that influence medication overage and other strategy performance metrics. The computer-controlled medication system gave superior performance to the traditional method. In one example, a 75% overage of wasted medication in the traditional system was associated with higher supply failure than an automated system strategy with an overage of 47%. In a further example, we demonstrate that the impact of using a country stratified as opposed to site stratified scheme affects the number of deliveries and probability of supply failures more than the amount of drug wasted with respective increases of 20, 2300 and 4%. Medication savings with automated systems are particularly significant in repeat dispensing designs. We show that the number of packs required can fall by as much as 50% if one uses a predictive medication algorithm. We conclude that a computer-controlled supply chain enables medication savings to be realized and that it is possible to quantify the distribution of these savings using a simulation model. The simulation model can be used to optimize the prestudy medication supply strategy and for midstudy monitoring using real-time data contained in the study database.

Validity evidence for the measurement of the strength of motivation for medical school.

Science.gov (United States)

Kusurkar, Rashmi; Croiset, Gerda; Kruitwagen, Cas; ten Cate, Olle

2011-05-01

The Strength of Motivation for Medical School (SMMS) questionnaire is designed to determine the strength of motivation of students particularly for medical study. This research was performed to establish the validity evidence for measuring strength of motivation for medical school. Internal structure and relations to other variables were used as the sources of validity evidence. The SMMS questionnaire was filled out by 1,494 medical students in different years of medical curriculum. The validity evidence for the internal structure was analyzed by principal components analysis with promax rotation. Validity evidence for relations to other variables was tested by comparing the SMMS scores with scores on the Academic Motivation Scale (AMS) and the exhaustion scale of Maslach Burnout Inventory-Student Survey (MBI-SS) for measuring study stress. Evidence for internal consistency was determined through the Cronbach's alpha for reliability. The analysis showed that the SMMS had a 3-factor structure. The validity in relations to other variables was established as both, the subscales and full scale scores significantly correlated positively with the intrinsic motivation scores and with the more autonomous forms of extrinsic motivation, the correlation decreasing and finally becoming negative towards the extrinsic motivation end of the spectrum. They also had significant negative correlations with amotivation scale of the AMS and exhaustion scale of MBI-SS. The Cronbach's alpha for reliability of the three subscales and full SMMS scores was 0.70, 0.67, 0.55 and 0.79. The strength of motivation for medical school has a three factor structure and acceptable validity evidence was found in our study.

Medical staff organization in nursing homes: scale development and validation.

Science.gov (United States)

Katz, Paul R; Karuza, Jurgis; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent; Caprio, Thomas; Caprio, Anthony; Dauenhauer, Jason; Lima, Julie

2009-09-01

To construct a multidimensional self-report scale to measure nursing home (NH) medical staff organization (NHMSO) dimensions and then pilot the scale using a national survey of medical directors to provide data on its psychometric properties. Instrument development process consisting of the proceedings from the Nursing Home Physician Workforce Conference and focus groups followed by cognitive interviews, which culminated in a survey of a random sample of American Medical Directors Association (AMDA) affiliated medical directors. Analyses were conducted on surveys matched to Online Survey Certification and Reporting (OSCAR) data from freestanding nonpediatric nursing homes. A total of 202 surveys were available for analysis and comprised the final sample. Dimensions were identified that measured the extent of medical staff organization in nursing homes and included staff composition, appointment process, commitment (physiciancohesion; leadership turnover/capability), departmentalization (physician supervision, autonomy and interdisciplinary involvement), documentation, and informal dynamics. The items developed to measure each dimension were reliable (Cronbach's alpha ranged from 0.81 to 0.65).Intercorrelations among the scale dimensions provided preliminary evidence of the construct validity of the scale. This report, for the first time ever, defines and validates NH medical staff organization dimensions, a critical first step in determining the relationship between physician practice and the quality of care delivered in the NH.

Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students.

Science.gov (United States)

Shim, Eun-Jung; Jeon, Hong Jin; Kim, Hana; Lee, Kwang-Min; Jung, Dooyoung; Noh, Hae-Lim; Roh, Myoung-Sun; Hahm, Bong-Jin

2016-11-24

Medical students face a variety of stressors associated with their education; if not promptly identified and adequately dealt with, it may bring about several negative consequences in terms of mental health and academic performance. This study examined psychometric properties of the Korean version of the Higher Education Stress Inventory (K-HESI). The reliability and validity of the K-HESI were examined in a large scale multi-site survey involving 7110 medical students. The K-HESI, Beck Depression Inventory (BDI) and questions regarding quality of life (QOL) and self-rated physical health (SPH) were administered. Exploratory factor analysis of the K-HESI identified seven factors: Low commitment; financial concerns; teacher-student relationship; worries about future profession; non-supportive climate; workload; and dissatisfaction with education. A subsequent confirmatory factor analysis supported the 7-factor model. Internal consistency of the K-HESI was satisfactory (Cronbach's α = .78). Convergent validity was demonstrated by its positive association with the BDI. Known group validity was supported by the K-HESI's ability to detect significant differences on the overall and subscale scores of K-HESI according to different levels of QOL and SPH. The K-HESI is a psychometrically valid tool that comprehensively assesses various relevant stressors related to medical education. Evidence-based stress management in medical education empirically guided by the regular assessment of stress using reliable and valid measure is warranted.

A flexible super-capacitive solid-state power supply for miniature implantable medical devices.

Science.gov (United States)

Meng, Chuizhou; Gall, Oren Z; Irazoqui, Pedro P

2013-12-01

We present a high-energy local power supply based on a flexible and solid-state supercapacitor for miniature wireless implantable medical devices. Wireless radio-frequency (RF) powering recharges the supercapacitor through an antenna with an RF rectifier. A power management circuit for the super-capacitive system includes a boost converter to increase the breakdown voltage required for powering device circuits, and a parallel conventional capacitor as an intermediate power source to deliver current spikes during high current transients (e.g., wireless data transmission). The supercapacitor has an extremely high area capacitance of ~1.3 mF/mm(2), and is in the novel form of a 100 μm-thick thin film with the merit of mechanical flexibility and a tailorable size down to 1 mm(2) to meet various clinical dimension requirements. We experimentally demonstrate that after fully recharging the capacitor with an external RF powering source, the supercapacitor-based local power supply runs a full system for electromyogram (EMG) recording that consumes ~670 μW with wireless-data-transmission functionality for a period of ~1 s in the absence of additional RF powering. Since the quality of wireless powering for implantable devices is sensitive to the position of those devices within the RF electromagnetic field, this high-energy local power supply plays a crucial role in providing continuous and reliable power for medical device operations.

The Air Force Mobile Forward Surgical Team (MFST): Using the Estimating Supplies Program to Validate Clinical Requirement

National Research Council Canada - National Science Library

Nix, Ralph E; Onofrio, Kathleen; Konoske, Paula J; Galarneau, Mike R; Hill, Martin

2004-01-01

.... The primary objective of the study was to provide the Air Force with the ability to validate clinical requirements of the MFST assemblage, with the goal of using NHRC's Estimating Supplies Program (ESP...

The Supply of Medical Isotopes - An Assessment of the Market Economics, Alternative Technologies and Proposed Policy Approach to Achieving Sustainability

Energy Technology Data Exchange (ETDEWEB)

Cameron, R.; Lokhov, A.Y.; Westmacott, C. [Nuclear Development Division, OECD Nuclear Energy Agency, 12, boulevard des Iles, 92130 Issy-les-Moulineaux (France)

2011-07-01

At the request of its member countries, the OECD Nuclear Energy Agency (NEA) has become involved in global efforts to ensure a reliable supply of molybdenum-99 ({sup 99}Mo) and its decay product, technetium-99m ({sup 99m}Tc), the most widely used medical radioisotope. The NEA established the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR). The main objective of the HLG-MR is to strengthen the reliability of {sup 99}Mo and {sup 99m}Tc supply in the short, medium and long term. In order to reach this objective, the group has been reviewing the {sup 99}Mo supply chain, working to identify the key areas of vulnerability, the issues that need to be addressed and the mechanisms that could be used to help resolve them. The collective efforts of HLG-MR members and nuclear medicine stakeholders have allowed for a comprehensive assessment of the key areas of vulnerability in the supply chain and an identification of the issues that need to be addressed. As a result of the work undertaken to date, the NEA has released three reports under the new The Supply of Medical Radioisotopes series. These reports discuss the uneconomical situation of the supply chain, other vulnerabilities within the supply chain and alternative technologies to produce {sup 99}Mo/{sup 99m}Tc. From this work, the NEA Secretariat and the HLG-MR have started to develop the policy approach and recommendations for governments, industry and other stakeholders that will outline the foundation for ensuring the long-term supply of {sup 99}Mo/{sup 99m}Tc. (author)

Validation of an abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9 among patients on antihypertensive medications

Directory of Open Access Journals (Sweden)

Desrosiers Marie-Pierre

2009-04-01

Full Text Available Abstract Background The 14-item Treatment Satisfaction Questionnaire for Medication (TSQM Version 1.4 is a reliable and valid instrument to assess patients' satisfaction with medication, providing scores on four scales – side effects, effectiveness, convenience and global satisfaction. In naturalistic studies, administering the TSQM with the side effects domain could provoke the physician to assess the presence or absence of adverse events in a way that is clinically atypical, carrying the potential to interfere with routine medical care. As a result, an abbreviated 9-item TSQM (TSQM-9, derived from the TSQM Version 1.4 but without the five items of the side effects domain was created. In this study, an interactive voice response system (IVRS-administered TSQM-9 was psychometrically evaluated among patients taking antihypertensive medication. Methods A total of 3,387 subjects were invited to participate in the study from an online panel who self-reported taking a prescribed antihypertensive medication. The subjects were asked to complete the IVRS-administered TSQM-9 at the start of the study, along with the modified Morisky scale, and again within 7 to 14 days. Standard psychometric analyses were conducted; including Cronbach's alpha, intraclass correlation coefficients, structural equation modeling, Spearman correlation coefficients and analysis of covariance (ANCOVA. Results A total of 396 subjects completed all the study procedures. Approximately 50% subjects were male with a good racial/ethnic mix: 58.3% white, 18.9% black, 17.7% Hispanic and 5.1% either Asian or other. There was evidence of construct validity of the TSQM-9 based on the structural equation modeling findings of the observed data fitting the Decisional Balance Model of Treatment Satisfaction even without the side effects domain. TSQM-9 domains had high internal consistency as evident from Cronbach's alpha values of 0.84 and greater. TSQM-9 domains also demonstrated good test

Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students

Directory of Open Access Journals (Sweden)

Eun-Jung Shim

2016-11-01

Full Text Available Abstract Background Medical students face a variety of stressors associated with their education; if not promptly identified and adequately dealt with, it may bring about several negative consequences in terms of mental health and academic performance. This study examined psychometric properties of the Korean version of the Higher Education Stress Inventory (K-HESI. Methods The reliability and validity of the K-HESI were examined in a large scale multi-site survey involving 7110 medical students. The K-HESI, Beck Depression Inventory (BDI and questions regarding quality of life (QOL and self-rated physical health (SPH were administered. Results Exploratory factor analysis of the K-HESI identified seven factors: Low commitment; financial concerns; teacher-student relationship; worries about future profession; non-supportive climate; workload; and dissatisfaction with education. A subsequent confirmatory factor analysis supported the 7-factor model. Internal consistency of the K-HESI was satisfactory (Cronbach’s α = .78. Convergent validity was demonstrated by its positive association with the BDI. Known group validity was supported by the K-HESI’s ability to detect significant differences on the overall and subscale scores of K-HESI according to different levels of QOL and SPH. Conclusions The K-HESI is a psychometrically valid tool that comprehensively assesses various relevant stressors related to medical education. Evidence-based stress management in medical education empirically guided by the regular assessment of stress using reliable and valid measure is warranted.

[Supply and demand of medical specialists in the health facilities of the Ministry of Health: national, regional and by type of specialty gaps].

Science.gov (United States)

Zevallos, Leslie; Pastor, Reyna; Moscoso, Betsy

2011-06-01

To characterize the supply, demand and the gap of medical specialists in facilities of the Ministry of Health of Peru (MINSA) at the national, regional and specialty type levels. Observational, descriptive study through which we calculated the supply of medical specialists using secondary sources of MINSA. The analysis of the demand for medical specialists was based on two methodologies: the need for specialists according to the guidelines of classification of the health facilities and according to the epidemiological and demographic profile. The arithmetic difference between the estimated demand and the supply was the procedure used to calculate the gap of medical specialists. The Ministry of Health has a total supply at the national level of 6,074 medical specialists of which 61.5% belong to the clinical specialties, 33.2% to the surgical specialties, 4.9% specialities related to aid to diagnosis and treatment and 0.4% to public health specialties. According to the categorization guideline there is a total demand of 11,176 medical specialists and according to the epidemiological and demographic profile of 11,738. The national estimated gaps found are similar in both methods, although they differ widely across regions and by type of specialty. At the regional level, the gaps are greater in Loreto, Piura, Puno and Madre de Dios when estimating the defficit in relation to the supply. Regarding the speciality, the gap is greater in the four basic specialties: gynecology and obstetrics, pediatrics, internal medicine and general surgery. There is a waid gap between supply and demand of medical specialists at the national and regional levels, as a whole representing approximately 45% of the current offer, regardless of the estimation method.

Cross-cultural Adaptation and Validation of the Medication Regimen Complexity Index Adapted to Spanish.

Science.gov (United States)

Saez de la Fuente, Javier; Such Diaz, Ana; Cañamares-Orbis, Irene; Ramila, Estela; Izquierdo-Garcia, Elsa; Esteban, Concepcion; Escobar-Rodríguez, Ismael

2016-11-01

The most widely used validated instrument to assess the complexity of medication regimens is the Medication Regimen Complexity Index (MRCI). This study aimed to translate, adapt, and validate a reliable version of the MRCI adapted to Spanish (MRCI-E). The cross-cultural adaptation process consisted of an independent translation by 3 clinical pharmacists and a backtranslation by 2 native English speakers. A reliability analysis was conducted on 20 elderly randomly selected patients. Two clinical pharmacists calculated the MRCI-E from discharge treatments and 2 months later. For the validity analysis, the sample was augmented to 60 patients. Convergent validity was assessed by analyzing the correlation between the number of medications; discriminant validity was stratified by gender; and predictive validity was determined by analyzing the ability to predict readmission and mortality at 3 and 6 months. The MRCI-E retained the original structure of 3 sections. The reliability analysis demonstrated an excellent internal consistency (Cronbach's α=0.83), and the intraclass correlation coefficient exceeded 0.9 in all cases. The correlation coefficient with the number of medications was 0.883 ( Pdifferences were found when stratified by gender (3.6; 95%CI=-2.9 to 10.2; P=0.27). Patients who were readmitted at 3 months had a higher MRCI-E score (10.7; 95%CI=4.4 to 17.2; P=0.001). The differences remained significant in patients readmitted at 6 months, but differences in mortality were not detected. The MRCI-E retains the reliability and validity of the original index and provides a suitable tool to assess the complexity of medication regimens in Spanish.

Thinking in Pharmacy Practice: A Study of Community Pharmacists' Clinical Reasoning in Medication Supply Using the Think-Aloud Method.

Science.gov (United States)

Croft, Hayley; Gilligan, Conor; Rasiah, Rohan; Levett-Jones, Tracy; Schneider, Jennifer

2017-12-31

Medication review and supply by pharmacists involves both cognitive and technical skills related to the safety and appropriateness of prescribed medicines. The cognitive ability of pharmacists to recall, synthesise and memorise information is a critical aspect of safe and optimal medicines use, yet few studies have investigated the clinical reasoning and decision-making processes pharmacists use when supplying prescribed medicines. The objective of this study was to examine the patterns and processes of pharmacists' clinical reasoning and to identify the information sources used, when making decisions about the safety and appropriateness of prescribed medicines. Ten community pharmacists participated in a simulation in which they were required to review a prescription and make decisions about the safety and appropriateness of supplying the prescribed medicines to the patient, whilst at the same time thinking aloud about the tasks required. Following the simulation each pharmacist was asked a series of questions to prompt retrospective thinking aloud using video-stimulated recall. The simulated consultation and retrospective interview were recorded and transcribed for thematic analysis. All of the pharmacists made a safe and appropriate supply of two prescribed medicines to the simulated patient. Qualitative analysis identified seven core thinking processes used during the supply process: considering prescription in context, retrieving information, identifying medication-related issues, processing information, collaborative planning, decision making and reflection; and align closely with other health professionals. The insights from this study have implications for enhancing awareness of decision making processes in pharmacy practice and informing teaching and assessment approaches in medication supply.

Connecting Technological Innovation in Artificial Intelligence to Real-world Medical Practice through Rigorous Clinical Validation: What Peer-reviewed Medical Journals Could Do

Science.gov (United States)

2018-01-01

Artificial intelligence (AI) is projected to substantially influence clinical practice in the foreseeable future. However, despite the excitement around the technologies, it is yet rare to see examples of robust clinical validation of the technologies and, as a result, very few are currently in clinical use. A thorough, systematic validation of AI technologies using adequately designed clinical research studies before their integration into clinical practice is critical to ensure patient benefit and safety while avoiding any inadvertent harms. We would like to suggest several specific points regarding the role that peer-reviewed medical journals can play, in terms of study design, registration, and reporting, to help achieve proper and meaningful clinical validation of AI technologies designed to make medical diagnosis and prediction, focusing on the evaluation of diagnostic accuracy efficacy. Peer-reviewed medical journals can encourage investigators who wish to validate the performance of AI systems for medical diagnosis and prediction to pay closer attention to the factors listed in this article by emphasizing their importance. Thereby, peer-reviewed medical journals can ultimately facilitate translating the technological innovations into real-world practice while securing patient safety and benefit.

Connecting Technological Innovation in Artificial Intelligence to Real-world Medical Practice through Rigorous Clinical Validation: What Peer-reviewed Medical Journals Could Do.

Science.gov (United States)

Park, Seong Ho; Kressel, Herbert Y

2018-05-28

Artificial intelligence (AI) is projected to substantially influence clinical practice in the foreseeable future. However, despite the excitement around the technologies, it is yet rare to see examples of robust clinical validation of the technologies and, as a result, very few are currently in clinical use. A thorough, systematic validation of AI technologies using adequately designed clinical research studies before their integration into clinical practice is critical to ensure patient benefit and safety while avoiding any inadvertent harms. We would like to suggest several specific points regarding the role that peer-reviewed medical journals can play, in terms of study design, registration, and reporting, to help achieve proper and meaningful clinical validation of AI technologies designed to make medical diagnosis and prediction, focusing on the evaluation of diagnostic accuracy efficacy. Peer-reviewed medical journals can encourage investigators who wish to validate the performance of AI systems for medical diagnosis and prediction to pay closer attention to the factors listed in this article by emphasizing their importance. Thereby, peer-reviewed medical journals can ultimately facilitate translating the technological innovations into real-world practice while securing patient safety and benefit.

Novel remote electronic medication supply model for opioid-dependent outpatients with polypharmacy--first long-term case study.

Science.gov (United States)

Allemann, Samuel S; Dürsteler, Kenneth M; Strasser, Johannes; Vogel, Marc; Stoeckle, Marcel; Hersberger, Kurt E; Arnet, Isabelle

2017-08-16

Patients with substance use disorders grow older thanks to effective treatments. Together with a high prevalence of comorbidities, psychological problems, and low social support, these patients are at high risk for medication non-adherence. Established treatment facilities face challenges to accommodate these complex patients within their setting. Electronic medication management aids (e-MMAs) might be appropriate to simultaneously monitor and improve adherence for these patients. We report the first long-term experiences with a novel remote electronic medication supply model for two opioid-dependent patients with HIV. John (beginning dementia, 52 years, 6 tablets daily at 12 am) and Mary (frequent drug holidays, 48 years, 5-6 tablets daily at 8 pm) suffered from disease progression due to non-adherence. We electronically monitored adherence and clinical outcomes during 659 (John) and 953 (Mary) days between July 2013 and April 2016. Both patients retrieved over 90% of the pouches within 75 min of the scheduled time. Technical problems occurred in 4% (John) and 7.2% (Mary) of retrievals, but on-site support was seldom required. Viral loads fell below detection limits during the entire observation period. Continuous medication supply and persistence with treatment of over 1.7 years, timing adherence of more than 90%, and suppressed HIV viral load are first results supporting the feasibility of the novel supply model for patients on opioid-assisted treatment and polypharmacy.

The Supply of Medical Radioisotopes. Final Report of the Third Mandate of the High-level Group on the Security of Supply of Medical Radioisotopes (2013-2015)

International Nuclear Information System (INIS)

Charlton, Kevin; )

2016-07-01

At the request of its member countries, the Organisation for Economic Co-operation and Development (OECD) Nuclear Energy Agency (NEA) became involved in global efforts to ensure a secure supply of molybdenum-99 ( 99 Mo)/technetium-99m ( 99m Tc). In April 2009, the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) was created and received an initial, two-year mandate from the NEA Steering Committee for Nuclear Energy to examine the causes of supply shortages of 99 Mo/ 99m Tc and develop a policy approach to address them. In its first mandate, the HLG-MR conducted a comprehensive economic study of the 99 Mo/ 99m Tc supply chain, which identified the key areas of vulnerability and major issues to be addressed. The HLG-MR released a policy approach, including six principles (Appendix 1) and supporting recommendations to help resolve the issues in the 99 Mo/ 99m Tc market. In the second mandate (2011-2013), the HLG-MR worked to encourage the implementation of the six policy principles and promoted an industry transition away from the use of highly enriched uranium (HEU) targets for 99 Mo production. Projects were undertaken by the NEA that resulted in the publication of documents and reports to assist in implementing the HLG-MR policy approach. The second mandate showed that, while commendable progress had occurred in many areas, there were still major issues in the 99 Mo/ 99m Tc market, with some continued government subsidisation, insufficient ORC and inadequate reimbursement for 99 mTc. Potential future periods of supply shortage were identified, particularly concerning the likely loss of significant capacity around 2016. In the third mandate, the HLG-MR continued its efforts to help ensure the global security of supply of 99 Mo/ 99m Tc through implementation of the six policy principles. The NEA undertook a further self-assessment review of the 99 Mo/ 99m Tc supply chain, focusing again on progress with implementing FCR and paid ORC and

Validity of a hospital-based obstetric register using medical records as reference

DEFF Research Database (Denmark)

Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Johansen, Nanna Roed

2015-01-01

BACKGROUND: Data from hospital-based registers and medical records offer valuable sources of information for clinical and epidemiological research purposes. However, conducting high-quality epidemiological research requires valid and complete data sources. OBJECTIVE: To assess completeness...... and validity of a hospital-based clinical register - the Obstetric Database - using a national register and medical records as references. METHODS: We assessed completeness of a hospital-based clinical register - the Obstetric Database - by linking data from all women registered in the Obstetric Database...... Database therefore offers a valuable source for examining clinical, administrative, and research questions....

The Supply of Medical Radioisotopes. Results from the Second Self-assessment of the Global 99Mo/99mTc Supply Chain

International Nuclear Information System (INIS)

Peykov, Pavel; Cameron, Ron

2014-07-01

At the request of its member countries, the OECD Nuclear Energy Agency (NEA) became involved in global efforts to ensure a secure supply of 99 Mo/ 99m Tc. Since June 2009, the NEA and its High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) examined the issues that led to supply shortages and developed a policy approach, including six principles and supporting recommendations to address those issues. The governments of HLG-MR member countries agreed to implement the policy approach, within three years of its adoption, i.e. by June 2014. In the second mandate of the HLG-MR (2011-2013), the NEA secretariat undertook a review of the 99 Mo/ 99m Tc supply chain, based on input from key supply chain participants, with a focus on full-cost recovery, outage reserve capacity and the governments' role in the market. The results from this first self-assessment were published in Implementation of the HLG-MR Policy Approach: Results from a Self-assessment by the Global 99 Mo/ 99m Tc Supply Chain (NEA, 2013a). In its third mandate (2013-2015), the HLG-MR has continued to evaluate progress towards the implementation of the six policy principles and encourage governments and supply chain participants to take actions for secure supply of 99 Mo/ 99m Tc in the future. This report provides information from the second self-assessment by supply chain participants and analyses the progress made towards the implementation of the HLG-MR policy approach, compared with the first self-assessment. The focus of the second self-assessment is on all agreed policy principles (Principle 6 calls for periodic reviews of the supply chain and is being implemented by undertaking the self-assessment.) The report is organised as follows: Chapter 2 presents a brief summary of the HLG-MR policy approach, including the six principles that are critical to achieving long-term security of supply, and supporting recommendations. Chapter 3 explains the objectives and methodology of the

Validation of the generic medical interview satisfaction scale: the G-MISS questionnaire.

Science.gov (United States)

Maurice-Szamburski, Axel; Michel, Pierre; Loundou, Anderson; Auquier, Pascal

2017-02-14

Patients have about seven medical consultations a year. Despite the importance of medical interviews in the healthcare process, there is no generic instrument to assess patients' experiences in general practices, medical specialties, and surgical specialties. The main objective was to validate a questionnaire assessing patients' experiences with medical consultations in various practices. The G-MISS study was a prospective multi-center trial that enrolled patients from May to July 2016. A total of 2055 patients were included from general practices, medical specialties, and surgical specialties. Patients filled out a questionnaire assessing various aspects of their experience and satisfaction within 1 week after their medical interview. The validation process relied on item response theory. Internal validity was examined using exploratory factorial analysis. The statistical model used the root mean square error of approximation, confirmatory fit index, and standard root mean square residual as fit indices. Scalability and reliability were assessed with the Rasch model and Cronbach's alpha coefficients, respectively. Scale properties across the three subgroups were explored with differential item functioning. The G-MISS final questionnaire contained 16 items, structured in three dimensions of patients' experiences: "Relief", "Communication", and "Compliance". A global index of patients' experiences was computed as the mean of the dimension scores. All fit indices from the statistical model were satisfactory (RMSEA = 0.03, CFI = 0.98, SRMR = 0.06). The overall scalability had a good fit to the Rasch model. Each dimension was reliable, with Cronbach's alpha ranging from 0.73 to 0.86. Differential item functioning across the three consultation settings was negligible. Patients undergoing medical or surgical specialties reported higher scores in the "Relief" dimension compared with general practice (83.0 ± 11.6 or 82.4 ± 11.6 vs. 73.2 ± 16

Trainees' Perceptions of Feedback: Validity Evidence for Two FEEDME (Feedback in Medical Education) Instruments.

Science.gov (United States)

Bing-You, Robert; Ramesh, Saradha; Hayes, Victoria; Varaklis, Kalli; Ward, Denham; Blanco, Maria

2018-01-01

Construct: Medical educators consider feedback a core component of the educational process. Effective feedback allows learners to acquire new skills, knowledge, and attitudes. Learners' perceptions of feedback are an important aspect to assess with valid methods in order to improve the feedback skills of educators and the feedback culture. Although guidelines for delivering effective feedback have existed for several decades, medical students and residents often indicate that they receive little feedback. A recent scoping review on feedback in medical education did not reveal any validity evidence on instruments to assess learner's perceptions of feedback. The purpose of our study was to gather validity evidence on two novel FEEDME (Feedback in Medical Education) instruments to assess medical students' and residents' perceptions of the feedback that they receive. After the authors developed an initial instrument with 54 items, cognitive interviews with medical students and residents suggested that 2 separate instruments were needed, one focused on the feedback culture (FEEDME-Culture) and the other on the provider of feedback (FEEDME-Provider). A Delphi study with 17 medical education experts and faculty members assessed content validity. The response process was explored involving 31 medical students and residents at 2 academic institutions. Exploratory factor analysis and reliability analyses were performed on completed instruments. Two Delphi consultation rounds refined the wording of items and eliminated several items. Learners found both instruments easy and quick to answer; it took them less than 5 minutes to complete. Learners preferred an electronic format of the instruments over paper. Factor analysis revealed a two- and three-factor solution for the FEEDME-Culture and FEEDME-Provider instruments, respectively. Cronbach's alpha was greater than 0.80 for all factors. Items on both instruments were moderately to highly correlated (range, r = .3-.7). Our

Reliability and validity of the Treatment Satisfaction Questionnaire for Medication among Portuguese-speaking Brazilian patients with hypertension.

Science.gov (United States)

Sauer Liberato, Ana Carolina; Cunha Matheus Rodrigues, Roberta; Kim, MyoungJin; Mallory, Caroline

2016-07-01

This study examined the reliability and validity of the Brazilian Portuguese version of the Treatment Satisfaction Questionnaire for Medication (version 1.4) among patients with hypertension. Understanding the patient experience with treatment satisfaction will contribute to improved medication adherence and control of hypertension. Hypertension is a serious problem in Brazil that is associated with chronic illness controlled, in part, by consistent adherence to medications. Patient satisfaction with medication treatment is associated with adherence to medication. The Treatment Satisfaction Questionnaire for Medication (version 1.4) is a promising instrument for measuring medication; however, to date there has been no report of the reliability and validity of the instrument with Portuguese-speaking adults with hypertension in Brazil. Cross-sectional descriptive exploratory study. A convenience sample of 300 patients with hypertension in an outpatient setting in the southeast region of São Paulo state in Brazil completed the Treatment Satisfaction Questionnaire for Medication (version 1.4). The instrument, comprised of four subscales, was evaluated for reliability using correlation analyses and internal consistency. Confirmatory factor analysis was used to determine factorial validity. Correlational analyses, internal consistency (Cronbach's alpha) and hierarchical confirmatory factor analysis demonstrate adequate support for the four-factor dimensionality, reliability and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4). This study provides modest evidence for internal consistency and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4) in Portuguese-speaking adult Brazilians with hypertension. Future testing should focus on extending reliability testing, discriminant validity and potential translation and literacy issues in this population. Within known limitations, clinicians will

Validity Evidence for the Measurement of the Strength of Motivation for Medical School

Science.gov (United States)

Kusurkar, Rashmi; Croiset, Gerda; Kruitwagen, Cas; ten Cate, Olle

2011-01-01

The Strength of Motivation for Medical School (SMMS) questionnaire is designed to determine the strength of motivation of students particularly for medical study. This research was performed to establish the validity evidence for measuring strength of motivation for medical school. Internal structure and relations to other variables were used as…

Architectures for Green-Field Supply Chain Integration: Supply Chain Integration Design

OpenAIRE

Radanliev, Petar

2015-01-01

This paper applied case study research to design architectures for green-field supply chain integration. The integration design is based on a case study of a supply chain integration of 5 companies, operating in different, but supply chain complimenting industry sectors. The case study research is applied to design and validate the architectures in a real world scenario. The supply\\ud chain integration architectures enable the conversion of individual into integrated strategies. The architect...

Impact of universal medical insurance system on the accessibility of medical service supply and affordability of patients in China

Science.gov (United States)

Zhang, Zhiguo; Ren, Jing; Zhang, Jie; Pan, Xiaoyun; Zhang, Liang; Jin, Si

2018-01-01

Background China’s universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China. Methods Segmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS. The rates of catastrophic payments and seeking-care choices for UMIS beneficiaries were selected to measure the affordability and medical service flow of patients after the implementation of UMIS. Results China’s UMIS was established in 2008. After that, the trending increase of the expenditure of the UMIS was higher than that of increase in revenue compared to previous years. Up to 2014, the UMIS had covered 97.5% of the entire population in China. After introduction of the UMIS, there were significant increases in licensed physicians, nurses, and hospital beds per 1000 individuals. In addition, hospital outpatient visits and inpatient visits per year increased compared to the pre-UMIS period. The average fatality rate of inpatients in the overall hospital and general hospital and the average fatality rate due to acute myocardial infarction (AMI) in general hospitals was significantly decreased. In contrast, no significant and prospective changes were observed in rural physicians per 1000 individuals, inpatient visits and inpatient fatality rate in the community centers and township hospitals compared to the pre-UMIS period. After 2008, the rates of catastrophic payments for UMIS inpatients at different income levels were declining at three levels of hospitals. Whichever income level, the rate of catastrophic payments for

Quantitative Validation of the Integrated Medical Model (IMM) for ISS Missions

Science.gov (United States)

Young, Millennia; Arellano, J.; Boley, L.; Garcia, Y.; Saile, L.; Walton, M.; Kerstman, E.; Reyes, D.; Goodenow, D. A.; Myers, J. G.

2016-01-01

Lifetime Surveillance of Astronaut Health (LSAH) provided observed medical event data on 33 ISS and 111 STS person-missions for use in further improving and validating the Integrated Medical Model (IMM). Using only the crew characteristics from these observed missions, the newest development version, IMM v4.0, will simulate these missions to predict medical events and outcomes. Comparing IMM predictions to the actual observed medical event counts will provide external validation and identify areas of possible improvement. In an effort to improve the power of detecting differences in this validation study, the total over each program ISS and STS will serve as the main quantitative comparison objective, specifically the following parameters: total medical events (TME), probability of loss of crew life (LOCL), and probability of evacuation (EVAC). Scatter plots of observed versus median predicted TMEs (with error bars reflecting the simulation intervals) will graphically display comparisons while linear regression will serve as the statistical test of agreement. Two scatter plots will be analyzed 1) where each point reflects a mission and 2) where each point reflects a condition-specific total number of occurrences. The coefficient of determination (R2) resulting from a linear regression with no intercept bias (intercept fixed at zero) will serve as an overall metric of agreement between IMM and the real world system (RWS). In an effort to identify as many possible discrepancies as possible for further inspection, the -level for all statistical tests comparing IMM predictions to observed data will be set to 0.1. This less stringent criterion, along with the multiple testing being conducted, should detect all perceived differences including many false positive signals resulting from random variation. The results of these analyses will reveal areas of the model requiring adjustment to improve overall IMM output, which will thereby provide better decision support for

Assessing the impact of a medical librarian on identification of valid and actionable practice gaps for a continuing medical education committee.

Science.gov (United States)

Bartkowiak, Barbara A; Safford, Lindsey A; Stratman, Erik J

2014-01-01

Identifying educational needs related to professional practice gaps can be a complex process for continuing medical education (CME) committees and for physicians who submit activity applications. Medical librarians possess unique skills that may be useful for identifying practice gaps relevant to CME committees. We assessed this assumption by assessing a medical librarian's contributions to practice gap identification for the Marshfield Clinic's CME Committee. We reviewed all locally relevant, locally actionable practice gaps identified annually by various stakeholders and presented to our CME Committee from 2010 to 2013. Total numbers of practice gaps identified, total categorized as actionable, and numbers of subsequent activities resulting from these gaps were calculated for each year. Medical librarian totals were compared to those of other CME committee stakeholders to determine the relative contribution. The medical librarian identified unique, actionable published practice gaps that directly contributed to CME activity planning. For each study year, contributions by the medical librarian grew, from 0 of 27 actionable gaps validated by CME Committee in 2010 to 49 of 108 (45.4%) in 2013. With the librarian's assistance, the number of valid practice gaps submitted between 2010 and 2013 by stakeholders climbed from 23 for 155 activities (14.8%) to 133 for 157 activities (84.7%). Medical librarians can provide a valuable service to CME committees by identifying valid professional practice gaps that inform decisions about educational activities aimed at improving clinical practice. Medical librarians bring into deliberations unique information, including national health policy priorities, practice gaps found in the literature, and point-of-care search engine statistics. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for

Development and validation of a new assessment tool for suturing skills in medical students.

Science.gov (United States)

Sundhagen, Henriette Pisani; Almeland, Stian Kreken; Hansson, Emma

2018-01-01

In recent years, emphasis has been put on that medical student should demonstrate pre-practice/pre-registration core procedural skills to ensure patient safety. Nonetheless, the formal teaching and training of basic suturing skills to medical students have received relatively little attention and there is no standard for what should be tested and how. The aim of this study was to develop and validate, using scientific methods, a tool for assessment of medical students' suturing skills, measuring both micro- and macrosurgical qualities. A tool was constructed and content, construct, concurrent validity, and inter-rater, inter-item, inter-test reliability were tested. Three groups were included: students with no training in suturing skills, students who have had training, plastic surgery. The results show promising reliability and validity when assessing novice medical students' suturing skills. Further studies are needed on implementation of the instrument. Moreover, how the instrument can be used to give formative feedback, evaluate if a required standard is met and for curriculum development needs further investigation.Level of Evidence: Not ratable.

The predictive validity of the BioMedical Admissions Test for pre-clinical examination performance.

Science.gov (United States)

Emery, Joanne L; Bell, John F

2009-06-01

Some medical courses in the UK have many more applicants than places and almost all applicants have the highest possible previous and predicted examination grades. The BioMedical Admissions Test (BMAT) was designed to assist in the student selection process specifically for a number of 'traditional' medical courses with clear pre-clinical and clinical phases and a strong focus on science teaching in the early years. It is intended to supplement the information provided by examination results, interviews and personal statements. This paper reports on the predictive validity of the BMAT and its predecessor, the Medical and Veterinary Admissions Test. Results from the earliest 4 years of the test (2000-2003) were matched to the pre-clinical examination results of those accepted onto the medical course at the University of Cambridge. Correlation and logistic regression analyses were performed for each cohort. Section 2 of the test ('Scientific Knowledge') correlated more strongly with examination marks than did Section 1 ('Aptitude and Skills'). It also had a stronger relationship with the probability of achieving the highest examination class. The BMAT and its predecessor demonstrate predictive validity for the pre-clinical years of the medical course at the University of Cambridge. The test identifies important differences in skills and knowledge between candidates, not shown by their previous attainment, which predict their examination performance. It is thus a valid source of additional admissions information for medical courses with a strong scientific emphasis when previous attainment is very high.

Development and Validation of the Motivations for Selection of Medical Study (MSMS Questionnaire in India.

Directory of Open Access Journals (Sweden)

Sonu Goel

Full Text Available Understanding medical students' motivation to select medical studies is particularly salient to inform practice and policymaking in countries-such as India-where shortage of medical personnel poses crucial and chronical challenges to healthcare systems. This study aims to develop and validate a questionnaire to assess the motivation of medical students to select medical studies.A Motivation for Selection of Medical Study (MSMS questionnaire was developed using extensive literature review followed by Delphi technique. The scale consisted of 12 items, 5 measuring intrinsic dimensions of motivations and 7 measuring extrinsic dimensions. Exploratory factor analysis (EFA, confirmatory factor analysis (CFA, validity, reliability and data quality checks were conducted on a sample of 636 medical students from six medical colleges of three North Indian states.The MSMS questionnaire consisted of 3 factors (subscales and 8 items. The three principal factors that emerged after EFA were the scientific factor (e.g. research opportunities and the ability to use new cutting edge technologies, the societal factor (e.g. job security and the humanitarian factor (e.g. desire to help others. The CFA conducted showed goodness-of-fit indices supporting the 3-factor model.The three extracted factors cut across the traditional dichotomy between intrinsic and extrinsic motivation and uncover a novel three-faceted motivation construct based on scientific factors, societal expectations and humanitarian needs. This validated instrument can be used to evaluate the motivational factors of medical students to choose medical study in India and similar settings and constitutes a powerful tool for policymakers to design measures able to increase selection of medical curricula.

A New Lebanese Medication Adherence Scale: Validation in Lebanese Hypertensive Adults.

Science.gov (United States)

Bou Serhal, R; Salameh, P; Wakim, N; Issa, C; Kassem, B; Abou Jaoude, L; Saleh, N

2018-01-01

A new Lebanese scale measuring medication adherence considered socioeconomic and cultural factors not taken into account by the eight-item Morisky Medication Adherence Scale (MMAS-8). Objectives were to validate the new adherence scale and its prediction of hypertension control, compared to MMAS-8, and to assess adherence rates and factors. A cross-sectional study, including 405 patients, was performed in outpatient cardiology clinics of three hospitals in Beirut. Blood pressure was measured, a questionnaire filled, and sodium intake estimated by a urine test. Logistic regression defined predictors of hypertension control and adherence. 54.9% had controlled hypertension. 82.4% were adherent by the new scale, which showed good internal consistency, adequate questions (KMO coefficient = 0.743), and four factors. It predicted hypertension control (OR = 1.217; p value = 0.003), unlike MMAS-8, but the scores were correlated (ICC average measure = 0.651; p value < 0.001). Stress and smoking predicted nonadherence. This study elaborated a validated, practical, and useful tool measuring adherence to medications in Lebanese hypertensive patients.

A New Lebanese Medication Adherence Scale: Validation in Lebanese Hypertensive Adults

Directory of Open Access Journals (Sweden)

R. Bou Serhal

2018-01-01

Full Text Available Background. A new Lebanese scale measuring medication adherence considered socioeconomic and cultural factors not taken into account by the eight-item Morisky Medication Adherence Scale (MMAS-8. Objectives were to validate the new adherence scale and its prediction of hypertension control, compared to MMAS-8, and to assess adherence rates and factors. Methodology. A cross-sectional study, including 405 patients, was performed in outpatient cardiology clinics of three hospitals in Beirut. Blood pressure was measured, a questionnaire filled, and sodium intake estimated by a urine test. Logistic regression defined predictors of hypertension control and adherence. Results. 54.9% had controlled hypertension. 82.4% were adherent by the new scale, which showed good internal consistency, adequate questions (KMO coefficient = 0.743, and four factors. It predicted hypertension control (OR = 1.217; p value = 0.003, unlike MMAS-8, but the scores were correlated (ICC average measure = 0.651; p value < 0.001. Stress and smoking predicted nonadherence. Conclusion. This study elaborated a validated, practical, and useful tool measuring adherence to medications in Lebanese hypertensive patients.

Medical student quality-of-life in the clerkships: a scale validation study.

Science.gov (United States)

Brannick, Michael T; Horn, Gregory T; Schnaus, Michael J; Wahi, Monika M; Goldin, Steven B

2015-04-01

Many aspects of medical school are stressful for students. To empirically assess student reactions to clerkship programs, or to assess efforts to improve such programs, educators must measure the overall well-being of the students reliably and validly. The purpose of the study was to develop and validate a measure designed to achieve these goals. The authors developed a measure of quality of life for medical students by sampling (public domain) items tapping general happiness, fatigue, and anxiety. A quality-of-life scale was developed by factor analyzing responses to the items from students in two different clerkships from 2005 to 2008. Reliability was assessed using Cronbach's alpha. Validity was assessed by factor analysis, convergence with additional theoretically relevant scales, and sensitivity to change over time. The refined nine-item measure is a Likert scaled survey of quality-of-life items comprised of two domains: exhaustion and general happiness. The resulting scale demonstrated good reliability and factorial validity at two time points for each of the two samples. The quality-of-life measure also correlated with measures of depression and the amount of sleep reported during the clerkships. The quality-of-life measure appeared more sensitive to changes over time than did the depression measure. The measure is short and can be easily administered in a survey. The scale appears useful for program evaluation and more generally as an outcome variable in medical educational research.

[Reliability and validity of assessment of educational outcomes obtained by students of Medical Rescue at Medical University of Warsaw].

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Panczyk, Mariusz; Stachacz, Grzegorz; Gałązkowski, Robert; Gotlib, Joanna

2016-01-01

In the interest of preservation of high degree of objectivity of information about students' educational outcomes, a system of assessment needs to meet criteria of appropriate reliability and validity. Analysis of reliability and validity of the system of assessment of students' educational outcomes for courses followed by an examination and covered by a curriculum in Medical Rescue at Medical University of Warsaw (MU W). A retrospective study enrolling a group of 421 students of eight subsequent full education cycles. Detailed data concerning grades for fourteen courses followed by an examination in the entire course of studies were collected. Reliability (Cronbach's alpha coefficient) and criteria validity (Spearman's rank correlation) were assessed. Internal consistency was estimated using a multiple regression model. The levels of assessment reliability for the general university, pre-clinical, and clinical scopes amounted to alpha: 0.42, 0.53, and 0.70, respectively. The strongest positive correlations between the results of pre-clinical and clinical trainings were found for the Anatomy course (r ≈ 0.30). Only in the case of the Pharmacology course it was found that students' achievements in this field were significantly correlated with all other courses of clinical training. The influence of educational outcomes in particular areas of clinical training on the final grade for the entire course of studies was diverse (β regression between 0.04 and 0.11). While the Pharmacology course had the strongest impact on final results, the Surgery course had the least influence on students' final grades (β = 0.04). 1. Sufficient reliability of the system of assessment of educational outcomes in Medical Rescue showed good precision and repeatability of assessment. 2. A low level of validity was caused by a failure to keep the appropriateness of the assessment of educational outcomes in several clinical courses. 3. Prognostic and diagnostic validity of methods used for

[Application of supply chain integration management of medical consumables].

Science.gov (United States)

Zhang, Jian

2013-07-01

This paper introduces the background, the content, the information management system of material supply chain integration management and the consumables management process. The system helps to expand the selection of hospital supplies varieties, to reduce consumables management costs, to improve the efficiency of supplies, to ensure supplies safety, reliability and traceability.

Patient Care Physician Supply and Requirements: Testing COGME Recommendations. Council on Graduate Medical Education, Eighth Report.

Science.gov (United States)

Council on Graduate Medical Education.

This report reassesses recommendations made by the Council on Graduate Medical Education in earlier reports which had, beginning in 1992, addressed the problems of physician oversupply. In this report physician supply and requirements are examined in the context of a health care system increasingly dominated by managed care. Patterns of physician…

Applying the International Medical Graduate Program Model to Alleviate the Supply Shortage of Accounting Doctoral Faculty

Science.gov (United States)

HassabElnaby, Hassan R.; Dobrzykowski, David D.; Tran, Oanh Thikie

2012-01-01

Accounting has been faced with a severe shortage in the supply of qualified doctoral faculty. Drawing upon the international mobility of foreign scholars and the spirit of the international medical graduate program, this article suggests a model to fill the demand in accounting doctoral faculty. The underlying assumption of the suggested model is…

An extended protocol for usability validation of medical devices : Research design and reference model

NARCIS (Netherlands)

Schmettow, M.; Schnittker, R.; Schraagen, J.M.

2017-01-01

This paper proposes and demonstrates an extended protocol for usability validation testing of medical devices. A review of currently used methods for the usability evaluation of medical devices revealed two main shortcomings. Firstly, the lack of methods to closely trace the interaction sequences

On the validity of language: speaking, knowing and understanding in medical geography.

Science.gov (United States)

Scarpaci, J L

1993-09-01

This essay examines methodological problems concerning the conceptualization and operationalization of phenomena central to medical geography. Its main argument is that qualitative research can be strengthened if the differences between instrumental and apparent validity are better understood than the current research in medical geography suggests. Its premise is that our definitions of key terms and concepts must be reinforced throughout the design of research should our knowledge and understanding be enhanced. In doing so, the paper aims to move the methodological debate beyond the simple dichotomies of quantitative vs qualitative approaches and logical positivism vs phenomenology. Instead, the argument is couched in a postmodernist hermeneutic sense which questions the validity of one discourse of investigation over another. The paper begins by discussing methods used in conceptualizing and operationalizing variables in quantitative and qualitative research design. Examples derive from concepts central to a geography of health-care behavior and well-being. The latter half of the essay shows the uses and misuses of validity studies in selected health services research and the current debate on national health insurance.

An extended protocol for usability validation of medical devices: Research design and reference model.

Science.gov (United States)

Schmettow, Martin; Schnittker, Raphaela; Schraagen, Jan Maarten

2017-05-01

This paper proposes and demonstrates an extended protocol for usability validation testing of medical devices. A review of currently used methods for the usability evaluation of medical devices revealed two main shortcomings. Firstly, the lack of methods to closely trace the interaction sequences and derive performance measures. Secondly, a prevailing focus on cross-sectional validation studies, ignoring the issues of learnability and training. The U.S. Federal Drug and Food Administration's recent proposal for a validation testing protocol for medical devices is then extended to address these shortcomings: (1) a novel process measure 'normative path deviations' is introduced that is useful for both quantitative and qualitative usability studies and (2) a longitudinal, completely within-subject study design is presented that assesses learnability, training effects and allows analysis of diversity of users. A reference regression model is introduced to analyze data from this and similar studies, drawing upon generalized linear mixed-effects models and a Bayesian estimation approach. The extended protocol is implemented and demonstrated in a study comparing a novel syringe infusion pump prototype to an existing design with a sample of 25 healthcare professionals. Strong performance differences between designs were observed with a variety of usability measures, as well as varying training-on-the-job effects. We discuss our findings with regard to validation testing guidelines, reflect on the extensions and discuss the perspectives they add to the validation process. Copyright © 2017 Elsevier Inc. All rights reserved.

Creation and preliminary validation of the screening for self-medication safety post-stroke scale (S-5).

Science.gov (United States)

Kaizer, Franceen; Kim, Angela; Van, My Tram; Korner-Bitensky, Nicol

2010-03-01

Patients with stroke should be screened for safety prior to starting a self-medication regime. An extensive literature review revealed no standardized self-medication tool tailored to the multi-faceted needs of the stroke population. The aim of this study was to create and validate a condition-specific tool to be used in screening for self-medication safety in individuals with stroke. Items were generated using expert consultation and review of the existing tools. The draft tool was pilot-tested on expert stroke clinicians to receive feedback on content, clarity, optimal cueing and domain omissions. The final version was piloted on patients with stroke using a structured interviewer-administered interview. The tool was progressively refined and validated according to feedback from the 11 expert reviewers. The subsequent version was piloted on patients with stroke. The final version includes 16 questions designed to elicit information on 5 domains: cognition, communication, motor, visual-perception and, judgement/executive function/self-efficacy. The Screening for Safe Self-medication post-Stroke Scale (S-5) has been created and validated for use by health professionals to screen self-medication safety readiness of patients after stroke. Its use should also help to guide clinicians' recommendations and interventions aimed at enhancing self-medication post-stroke.

Elaboration and Validation of the Medication Prescription Safety Checklist.

Science.gov (United States)

Pires, Aline de Oliveira Meireles; Ferreira, Maria Beatriz Guimarães; Nascimento, Kleiton Gonçalves do; Felix, Márcia Marques Dos Santos; Pires, Patrícia da Silva; Barbosa, Maria Helena

2017-08-03

to elaborate and validate a checklist to identify compliance with the recommendations for the structure of medication prescriptions, based on the Protocol of the Ministry of Health and the Brazilian Health Surveillance Agency. methodological research, conducted through the validation and reliability analysis process, using a sample of 27 electronic prescriptions. the analyses confirmed the content validity and reliability of the tool. The content validity, obtained by expert assessment, was considered satisfactory as it covered items that represent the compliance with the recommendations regarding the structure of the medication prescriptions. The reliability, assessed through interrater agreement, was excellent (ICC=1.00) and showed perfect agreement (K=1.00). the Medication Prescription Safety Checklist showed to be a valid and reliable tool for the group studied. We hope that this study can contribute to the prevention of adverse events, as well as to the improvement of care quality and safety in medication use. elaborar e validar um instrumento tipo checklist para identificar a adesão às recomendações na estrutura das prescrições de medicamentos, a partir do Protocolo do Ministério da Saúde e Agência Nacional de Vigilância Sanitária. pesquisa metodológica, conduzida por meio do processo de validade e análise de confiabilidade, com amostra de 27 prescrições eletrônicas. análises realizadas confirmaram a validade de conteúdo e a confiabilidade da versão do instrumento. A validade de conteúdo, obtida por meio da avaliação de juízes, foi considerada satisfatória por contemplar itens que representam a adesão às recomendações na estrutura das prescrições de medicamentos. A confiabilidade, avaliada por interobservadores, apresentou-se excelente (ICC=1,00) e de concordância perfeita (K=1,00). o instrumento Lista de Verificação de Segurança na Prescrição de Medicamentos demonstrou-se válido e confiável para o grupo estudado. Espera

Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students

OpenAIRE

Eun-Jung Shim; Hong Jin Jeon; Hana Kim; Kwang-Min Lee; Dooyoung Jung; Hae-Lim Noh; Myoung-Sun Roh; Bong-Jin Hahm

2016-01-01

Abstract Background Medical students face a variety of stressors associated with their education; if not promptly identified and adequately dealt with, it may bring about several negative consequences in terms of mental health and academic performance. This study examined psychometric properties of the Korean version of the Higher Education Stress Inventory (K-HESI). Methods The reliability and validity of the K-HESI were examined in a large scale multi-site survey involving 7110 medical stud...

Development and validation of an instrument to assess the prescribing readiness of medical students in Malaysia.

Science.gov (United States)

Lai, Pauline Siew Mei; Sim, Si Mui; Chua, Siew Siang; Tan, Choo Hock; Ng, Chirk Jenn; Achike, Francis Ifejika; Teng, Cheong Lieng

2015-09-21

Prescribing incompetence is an important factor that contributes to prescribing error, and this is often due to inadequate training during medical schools. We therefore aimed to develop and validate an instrument to assess the prescribing readiness of medical students (PROMS) in Malaysia. The PROMS comprised of 26 items with four domains: undergraduate learning opportunities; hands-on clinical skills practice; information gathering behaviour; and factors affecting the learning of prescribing skills. The first three domains were adapted from an existing questionnaire, while items from the last domain were formulated based on findings from a nominal group discussion. Face and content validity was determined by an expert panel, pilot tested in a class of final year (Year 5) medical students, and assessed using the Flesch reading ease. To assess the reliability of the PROMS, the internal consistency and test-retest (at baseline and 2 weeks later) were assessed using the Wilcoxon Signed Ranks test and Spearman's rho. The discriminative validity of the PROMS was assessed using the Mann-Whitney U-test (to assess if the PROMS could discriminate between final year medical students from a public and a private university). A total of 119 medical students were recruited. Flesch reading ease was 46.9, indicating that the instrument was suitable for use in participants undergoing tertiary education. The overall Cronbach alpha value of the PROMS was 0.695, which was satisfactory. Test-retest showed no difference for 25/26 items, indicating that our instrument was reliable. Responses from the public and private university final year medical students were significantly different in 10/26 items, indicating that the PROMS was able to discriminate between these two groups. Medical students from the private university reported fewer learning opportunities and hands-on practice compared to those from the public university. On the other hand, medical students from the private university

[The status quo and future prospects of emergency medical service systems in Japan in view of the tight supply-demand situation for medical resources].

Science.gov (United States)

Aruga, Tohru

2016-02-01

Considering the tight supply-demand situation for medical resources contributing to emergency medical service(EMS) systems at present and in the future in Japan, the author has explained the present states and future prospects of EMS systems in our country. EMS in remote places in this country is now consisting of the concentration of limited human resources, and is therefore suggestive of the EMS systems in the future, because we will have to deal with the possible exhaustion of EMS in our superannuated society progressing now and in the future. And also EMS systems will have to be maintained in the future with concerted efforts of all the medical staffs. The transferring the medical doctors' tasks to those of nurses and other staffs, that is to say the task shifting has just authorized by recent laws, and so the task shifting will be useful in the future EMS systems performed by all kinds of medical workers, in whom general physicians will be included as they are to be distributed throughout this country in the future.

A Validation of the Group-Based Medical Mistrust Scale in Formerly Incarcerated Black and Latino Men.

Science.gov (United States)

Valera, Pamela; Boyas, Javier F; Bernal, Camila; Chiongbian, Victoria Briones; Chang, Yvonne; Shelton, Rachel C

2016-05-04

While there is a growing body of literature on medical mistrust and its relevance to public health, research on formerly incarcerated Black and Latino men and their perception of mistrust toward medical providers and medical institutions remains scant. Very little is known about whether formerly incarcerated Black and Latino men mistrust medical and clinical providers given their previous experiences with the criminal justice system. It is important to determine whether medical mistrust play a key role in the health and health behaviors of released Black and Latino men. The purpose of this study is to validate and assess the psychometric properties of the Group-Based Medical Mistrust Scale for use among formerly incarcerated Black and Latino men in New York City. The findings of the exploratory and confirmatory factor analyses state that a two-factor structure fit the data best. Two dimensions emerged as important subscales: discrimination and suspicion. The current findings suggest the two-factor Group-Based Medical Mistrust Scale is a valid and reliable assessment tool to discern medical mistrust levels among formerly incarcerated Black and Latino men. © The Author(s) 2016.

[Formal sample size calculation and its limited validity in animal studies of medical basic research].

Science.gov (United States)

Mayer, B; Muche, R

2013-01-01

Animal studies are highly relevant for basic medical research, although their usage is discussed controversially in public. Thus, an optimal sample size for these projects should be aimed at from a biometrical point of view. Statistical sample size calculation is usually the appropriate methodology in planning medical research projects. However, required information is often not valid or only available during the course of an animal experiment. This article critically discusses the validity of formal sample size calculation for animal studies. Within the discussion, some requirements are formulated to fundamentally regulate the process of sample size determination for animal experiments.

Supply Chain Management Practices in Toy Supply Chains

DEFF Research Database (Denmark)

Arlbjørn, Jan Stentoft; Johansen, J.; Wong, C. Y.

2005-01-01

Purpose - Innovative products usually experience highly unpredictable and variable demand. This is especially valid for the volatile and seasonal toy industry, which produces high obsolete inventory, lost sales and markdown. In such a volatile industry, what supply chain management (SCM) practices...... (traditional mass-production or push-models). These low-responsive practices in the toy supply chain are not caused only by slow knowledge diffusion. SCM know-how is not yet capable of managing such levels of volatility and seasonality. Therefore, explanations of these theoretical gaps and what new theories...... are required for such extreme volatility and seasonality are proposed. Originality/value - It reveals actual SCM practices in a volatile and seasonal supply chain, such that theoretical and practical gaps are identified. Also, it proposes a model to match manufacturing SCM-practices with retailer SCM-practices....

Using the Estimating Supplies Program to Develop Material Solutions for the U.S. Air Force Medical Gynecological Treatment Team (FFGYN)

National Research Council Canada - National Science Library

Hopkins, Curt; Nix, Ralph; Konoske, Paula; Pang, Gerry; Onofrio, Kathleen

2007-01-01

...) conduct a proof of concept study to assess the validity and feasibility of using NHRC's medical modeling tool for the development and management of Air Force medical Allowance Standards as a baseline...

Industrial sterilization of medical supplies. Turkey. Terminal report. Project findings and recommendations. Report prepared for the Government of Turkey

International Nuclear Information System (INIS)

1995-08-01

The document contains the terminal report on the implementation of the project IAEA/UNDP-TUR/88/040 'Industrial Sterilization of Medical Supplies' (1988-1995). The objective of the project was to set up a Radiation Sterilization Centre in Ankara for health care products indigenously manufactured

Validation of a Teaching Effectiveness Assessment in Psychiatry Continuing Medical Education.

Science.gov (United States)

Palmer, Brian A; Frye, Mark A; Vickers Douglas, Kristin S; Staab, Jeffrey P; Bright, Robert P; Schleck, Cathy D; Mandrekar, Jayawant N; Mahapatra, Saswati; Beckman, Thomas J; Wittich, Christopher M

2017-07-06

Little is known about factors associated with effective continuing medical education (CME) in psychiatry. The authors aimed to validate a method to assess psychiatry CME teaching effectiveness and to determine associations between teaching effectiveness scores and characteristics of presentations, presenters, and participants. This cross-sectional study was conducted at the Mayo Clinic Psychiatry Clinical Reviews and Psychiatry in Medical Settings. Presentations were evaluated using an eight-item CME teaching effectiveness instrument, its content based on previously published instruments. Factor analysis, internal consistency and interrater reliabilities, and temporal stability reliability were calculated. Associations were determined between teaching effectiveness scores and characteristics of presentations, presenters, and participants. In total, 364 participants returned 246 completed surveys (response rate, 67.6%). Factor analysis revealed a unidimensional model of psychiatry CME teaching effectiveness. Cronbach α for the instrument was excellent at 0.94. Item mean score (SD) ranged from 4.33 (0.92) to 4.71 (0.59) on a 5-point scale. Overall interrater reliability was 0.84 (95% CI, 0.75-0.91), and temporal stability was 0.89 (95% CI, 0.77-0.97). No associations were found between teaching effectiveness scores and characteristics of presentations, presenters, and participants. This study provides a new, validated measure of CME teaching effectiveness that could be used to improve psychiatry CME. In contrast to prior research in other medical specialties, CME teaching effectiveness scores were not associated with use of case-based or interactive presentations. This outcome suggests the need for distinctive considerations regarding psychiatry CME; a singular approach to CME teaching may not apply to all medical specialties.

Predictive validity of the comprehensive basic science examination mean score for assessment of medical students' performance

Directory of Open Access Journals (Sweden)

Firouz Behboudi

2002-04-01

Full Text Available Background Medical education curriculum improvements can be achieved bye valuating students performance. Medical students have to pass two undergraduate comprehensive examinations, basic science and preinternship, in Iran. Purpose To measure validity of the students' mean score in comprehensive basic science exam (CBSE for predicting their performance in later curriculum phases. Methods This descriptive cross-sectional study was conducted on 95 (38 women and 55 men Guilan medical university students. Their admission to the university was 81% by regional quota and 12% by shaheed and other organizations' share. They first enrolled in 1994 and were able to pass CBS£ at first try. Data on gender, regional quota, and average grades of CBS£, PC, and CPIE were collected by a questionnaire. The calculations were done by SPSS package. Results The correlation coefficient between CBS£ and CPIE mean scores (0.65 was higher than correlation coefficient between CBS£ and PC mean scores (0.49. The predictive validity of CBS£ average grade was significant for students' performance in CPIE; however, the predictive validity of CBSE mean scores for students I pe1jormance in PC was lower. Conclusion he students' mean score in CBSE can be a good denominator for their further admission. We recommend further research to assess the predictive validity for each one of the basic courses. Keywords predictive validity, comprehensive basic exam

The Supply of Medical Radioisotopes. Policy Options for Ensuring Long-term Supply Security of Molybdenum-99 and/or Technetium-99m Produced Without Highly Enriched Uranium Targets

International Nuclear Information System (INIS)

Westmacott, Chad; Cameron, Ron

2012-01-01

Following the shortages of the key medical radioisotopes, molybdenum-99 ( 99 Mo) and its daughter technetium-99m (' 99m Tc), the OECD-Nuclear Energy Agency (NEA) created the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR). Since 2009, this group has identified the reasons for the isotope shortages and developed a policy approach to address the challenges to a long-term secure supply of these important medical isotopes. On top of the ongoing concerns related to long-term reliability, all current long-term major 99 Mo-producing nations have agreed to convert to using low-enriched uranium (LEU) targets for the production of 99 Mo. This decision was made based on important nonproliferation reasons; however, the conversion will have potential impacts on the global supply chain - both in terms of costs and available capacity. Recognising that conversion is important and will occur, and also recognising the need to ensure a long-term secure supply of 99 Mo/' 99m Tc, the NEA, along with stakeholders, examined potential policy options that could be used by to ensure a reliable supply of 99 Mo and/or ' 99m Tc produced without highly enriched uranium (HEU), consistent with the time frames and policies of the HLG-MR. This discussion paper provides the various policy options available to governments to encourage a reliable supply of 99 Mo and/or ' 99m Tc produced without HEU. The examination of these options was done through the lens of ensuring a reliable supply, consistent with the time frames and policies of the HLG-MR. The options described in this document are meant to meet this objective by taking one of three general actions: - Making the option of purchasing or producing non-HEU-based 99 Mo and/or ' 99m Tc more attractive. - Making the option of purchasing or producing HEU-based 99 Mo and/or ' 99m Tc less attractive. - Limiting access to HEU-based 99 Mo and/or ' 99m Tc. This paper presents the options in each category and provides some views

Supply Chain Risk Management: A Conceptual Framework and Empirical Validation

OpenAIRE

Sumeet Gupta; Mark Goh; Robert De-Souza; Fanwen Meng; Miti Garg

2014-01-01

Increasing globalization of the supply chains is making them increasingly vulnerable to various supply chain risks. Effective management of these risks is essential to prevent minor as well as major risks that may occur in day-to-day operations of the firm. In this paper an attempt is made to bring out a schema for analyzing supply chain risks faced by the firm and develop a risk management action framework that would serve as a guide for practitioners to identify the level at which their fir...

Validation of a Malay Version of the Smartphone Addiction Scale among Medical Students in Malaysia.

Science.gov (United States)

Ching, Siew Mooi; Yee, Anne; Ramachandran, Vasudevan; Sazlly Lim, Sazlyna Mohd; Wan Sulaiman, Wan Aliaa; Foo, Yoke Loong; Hoo, Fan Kee

2015-01-01

This study was initiated to determine the psychometric properties of the Smart Phone Addiction Scale (SAS) by translating and validating this scale into the Malay language (SAS-M), which is the main language spoken in Malaysia. This study can distinguish smart phone and internet addiction among multi-ethnic Malaysian medical students. In addition, the reliability and validity of the SAS was also demonstrated. A total of 228 participants were selected between August 2014 and September 2014 to complete a set of questionnaires, including the SAS and the modified Kimberly Young Internet addiction test (IAT) in the Malay language. There were 99 males and 129 females with ages ranging from 19 to 22 years old (21.7±1.1) included in this study. Descriptive and factor analyses, intra-class coefficients, t-tests and correlation analyses were conducted to verify the reliability and validity of the SAS. Bartlett's test of sphericity was significant (p addiction scale among medical students. This scale was shown to be reliable and valid in the Malay language.

Predicting medical complications after spine surgery: a validated model using a prospective surgical registry.

Science.gov (United States)

Lee, Michael J; Cizik, Amy M; Hamilton, Deven; Chapman, Jens R

2014-02-01

The possibility and likelihood of a postoperative medical complication after spine surgery undoubtedly play a major role in the decision making of the surgeon and patient alike. Although prior study has determined relative risk and odds ratio values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of medical complication, rather than relative risk or odds ratio values, would greatly enhance the discussion of safety of spine surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. The purpose of this study was to create and validate a predictive model for the risk of medical complication during and after spine surgery. Statistical analysis using a prospective surgical spine registry that recorded extensive demographic, surgical, and complication data. Outcomes examined are medical complications that were specifically defined a priori. This analysis is a continuation of statistical analysis of our previously published report. Using a prospectively collected surgical registry of more than 1,476 patients with extensive demographic, comorbidity, surgical, and complication detail recorded for 2 years after surgery, we previously identified several risk factor for medical complications. Using the beta coefficients from those log binomial regression analyses, we created a model to predict the occurrence of medical complication after spine surgery. We split our data into two subsets for internal and cross-validation of our model. We created two predictive models: one predicting the occurrence of any medical complication and the other predicting the occurrence of a major medical complication. The final predictive model for any medical complications had a receiver operator curve characteristic of 0.76, considered to be a fair measure. The final predictive model for any major medical complications had

Development of a questionnaire to assess medical competencies: Reliability and validity of the Questionnaire

Science.gov (United States)

Giesler, Marianne; Forster, Johannes; Biller, Silke; Fabry, Götz

2011-01-01

Introduction: While preparing a graduate survey for medical education in 2008 we realized that no instrument existed that would be suitable to evaluate whether the learning outcomes outlined in the Medical Licensure Act (ÄAppO) would be met. Therefore we developed the Freiburg Questionnaire to Assess Competencies in Medicine (Freiburger Fragebogen zur Erfassung von Kompetenzen in der Medizin, FKM)1 which has been revised and extended several times since then. Currently the FKM includes 45 items which are assigned to nine domains that correspond to the CanMEDS roles: medical expertise, communication, team-work, health and prevention, management, professionalism, learning, scholarship, and personal competencies. Methods: In order to test the reliability and validity of the questionnaire we have repeatedly surveyed medical students and residents since May 2008. In this article we report on the results of a cross-sectional study with 698 medical students from the preclinical and clinical years. In addition, we report the results of a survey of 514 residents who were up to two years into their residency. Results and conclusions: In summary, results show that the scales of the FKM are reliable (Cronbach’s α between .68 and .97). Significant differences in means between selected groups of students support the measure’s construct validity. Furthermore, there is evidence that the FKM might be used as a screening tool e.g. in graduate surveys to identify weaknesses in the medical education curriculum. PMID:21818241

Examining assumptions regarding valid electronic monitoring of medication therapy: development of a validation framework and its application on a European sample of kidney transplant patients

Directory of Open Access Journals (Sweden)

Steiger Jürg

2008-02-01

Full Text Available Abstract Background Electronic monitoring (EM is used increasingly to measure medication non-adherence. Unbiased EM assessment requires fulfillment of assumptions. The purpose of this study was to determine assumptions needed for internal and external validity of EM measurement. To test internal validity, we examined if (1 EM equipment functioned correctly, (2 if all EM bottle openings corresponded to actual drug intake, and (3 if EM did not influence a patient's normal adherence behavior. To assess external validity, we examined if there were indications that using EM affected the sample representativeness. Methods We used data from the Supporting Medication Adherence in Renal Transplantation (SMART study, which included 250 adult renal transplant patients whose adherence to immunosuppressive drugs was measured during 3 months with the Medication Event Monitoring System (MEMS. Internal validity was determined by assessing the prevalence of nonfunctioning EM systems, the prevalence of patient-reported discrepancies between cap openings and actual intakes (using contemporaneous notes and interview at the end of the study, and by exploring whether adherence was initially uncharacteristically high and decreased over time (an indication of a possible EM intervention effect. Sample representativeness was examined by screening for differences between participants and non-participants or drop outs on non-adherence. Results Our analysis revealed that some assumptions were not fulfilled: 1 one cap malfunctioned (0.4%, 2 self-reported mismatches between bottle openings and actual drug intake occurred in 62% of the patients (n = 155, and 3 adherence decreased over the first 5 weeks of the monitoring, indicating that EM had a waning intervention effect. Conclusion The validity assumptions presented in this article should be checked in future studies using EM as a measure of medication non-adherence.

Construct Validity of Medical Clinical Competence Measures: A Multitrait-Multimethod Matrix Study Using Confirmatory Factor Analysis.

Science.gov (United States)

Forsythe, George B.; And Others

1986-01-01

Construct validity was investigated for three tests of clinical competence in medicine: National Board of Medical Examiners examination (NBME), California Psychological Inventory (CPI), and Resident Evaluation Form (REF). Scores from 166 residents were analyzed. Results suggested low construct validity for CPI and REF scales, and moderate…

The Supply of Medical Radioisotopes. Implementation of the HLG-MR Policy Approach: Results from a Self-assessment by the Global 99Mo/'99mTc Supply Chain

International Nuclear Information System (INIS)

Peykov, Pavel; Cameron, Ron

2013-03-01

At the request of its member countries, OECD/NEA became involved in global efforts to ensure a secure supply of 99 Mo and ' 99m Tc. Since June 2009, the NEA and its High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) examined the causes of supply shortages and developed a policy approach, including principles and supporting recommendations to address those causes. The 'Economic Study' of the molybdenum-99 ( 99 Mo) and technetium-99m (' 99m Tc) supply chain published by the NEA clearly demonstrated that the pricing structure at nuclear research reactors prior to the most recent supply shortage in 2009-10 was not economically sustainable. Host nations traditionally subsidised the cost of irradiation services for 99 Mo production, along with experimental research at reactors. With a move away from subsidising 99 Mo production that often benefits foreign nations or foreign companies, pricing must recover the full cost of production to ensure economic sustainability and a long-term secure supply of medical isotopes. Appropriate pricing would also encourage an efficient use of the product, reducing wasted 99 Mo/' 99m Tc and thus reducing excess production and the associated radioactive waste. A key principle adopted by the HLG-MR was that all producers should move towards full-cost recovery and should implement the other principles adopted by the group. In February 2012, the NEA web-published a guidance document with a methodology for full- cost recovery and an associated Excel spreadsheet. This costing methodology identifies the essential elements that should be included when determining the full cost of 99 Mo irradiation services and how these elements should be allocated between various missions in the case of multipurpose facilities. The application of the costing methodology at all 99 Mo/' 99m Tc-producing research reactors and other production technology facilities within the global supply chain will ensure a common approach to full

Validation of battery-alternator model against experimental data - a first step towards developing a future power supply system

Energy Technology Data Exchange (ETDEWEB)

Boulos, A.M.; Burnham, K.J.; Mahtani, J.L. [Coventry University (United Kingdom). Control Theory and Applications Centre; Pacaud, C. [Jaguar Cars Ltd., Coventry (United Kingdom). Engineering Centre

2004-01-01

The electric power system of a modern vehicle has to supply enough electrical energy to drive numerous electrical and electronic systems and components. The electric power system of a vehicle consists of two major components: an alternator and a battery. A detailed understanding of the characteristics of the electric power system, electrical load demands and the operating environment, such as road conditions and vehicle laden weight, is required when the capacities of the generator and the battery are to be determined for a vehicle. In this study, a battery-alternator system has been developed and simulated in MATLAB/Simulink, and data obtained from vehicle tests have been used as a basis for validating the models. This is considered to be a necessary first step in the design and development of a new 42 V power supply system. (author)

Patient need at the heart of workforce planning: the use of supply and demand analysis in a large teaching hospital's acute medical unit.

Science.gov (United States)

Le Jeune, I R; Simmonds, M J R; Poole, L

2012-08-01

Timely medical assessment is integral to the safety and quality of healthcare delivery in acute medicine. Medical staff are an expensive resource. This study aimed to develop a modelling system that facilitated efficient workforce planning according to patient need on the acute medical unit. A realistic 24-hour 'supply' of junior doctors was calculated by adjusting the theoretical numbers on the rota for leave allowances, natural breaks and other ward duties by a combination of direct observation of working practice and junior doctor interviews. 'Demand' was analysed using detailed admission data. Supply and demand were then integrated with data from a survey of the time spent on the process of clerking and assessment of medical admissions. A robust modelling system that predicted the number of unclerked patients was developed. The utility of the model was assessed by demonstrating the impact of a regulation-compliant redesign of the rota using existing staff and by predicting the most efficient use of an additional shift. This simple modelling system has the potential to enhance quality of care and efficiency by linking workforce planning to patient need.

Impact of pharmacists assisting with prescribing and undertaking medication review on oxycodone prescribing and supply for patients discharged from surgical wards.

Science.gov (United States)

Tran, T; Taylor, S E; Hardidge, A; Findakly, D; Aminian, P; Elliott, R A

2017-10-01

Overprescribing of oxycodone is a contributor to the epidemic of prescription opioid misuse and deaths. Practice models to optimize oxycodone prescribing and supply need to be evaluated. We explored the impact of pharmacist-assisted discharge prescribing and medication review on oxycodone prescribing and supply for patients discharged from surgical wards. A retrospective audit was conducted on two surgical inpatient wards following a 16-week prospective pre- and post-intervention study. During the pre-intervention period, discharge prescriptions were prepared by hospital doctors and then reviewed by a ward pharmacist (WP) before being dispensed. Post-intervention, prescriptions were prepared by a project pharmacist in consultation with hospital doctors and then reviewed by a WP and dispensed. Proportion of patients who were prescribed, and proportion supplied, oxycodone on discharge; Median amount (milligrams) of oxycodone prescribed and supplied, for patients who were prescribed and supplied at least one oxycodone-containing preparation, respectively. A total of 320 and 341 patients were evaluated pre- and post-intervention, respectively. Pre-intervention, 75.6% of patients were prescribed oxycodone; after WP review, 60.3% were supplied oxycodone (Psupplied was 100 milligrams/patient. Post-intervention, 68.6% of patients were prescribed oxycodone; after WP review, 57.8% were supplied oxycodone (Psupplied was 50 milligrams/patient (difference in amount prescribed and supplied: 50 milligrams, Psupplied oxycodone but not the amount supplied/patient. Having a pharmacist assist with prescribing reduced the amount of oxycodone supplied. © 2017 John Wiley & Sons Ltd.

The Malaysian Medication Adherence Scale (MALMAS: Concurrent Validity Using a Clinical Measure among People with Type 2 Diabetes in Malaysia.

Directory of Open Access Journals (Sweden)

Wen Wei Chung

Full Text Available Medication non-adherence is a prevalent problem worldwide but up to today, no gold standard is available to assess such behavior. This study was to evaluate the psychometric properties, particularly the concurrent validity of the English version of the Malaysian Medication Adherence Scale (MALMAS among people with type 2 diabetes in Malaysia. Individuals with type 2 diabetes, aged 21 years and above, using at least one anti-diabetes agent and could communicate in English were recruited. The MALMAS was compared with the 8-item Morisky Medication Adherence Scale (MMAS-8 to assess its convergent validity while concurrent validity was evaluated based on the levels of glycated hemoglobin (HbA1C. Participants answered the MALMAS twice: at baseline and 4 weeks later. The study involved 136 participants. The MALMAS achieved acceptable internal consistency (Cronbach's alpha=0.565 and stable reliability as the test-retest scores showed fair correlation (Spearman's rho=0.412. The MALMAS has good correlation with the MMAS-8 (Spearman's rho=0.715. Participants who were adherent to their anti-diabetes medications had significantly lower median HbA1C values than those who were non-adherence (7.90 versus 8.55%, p=0.032. The odds of participants who were adherent to their medications achieving good glycemic control was 3.36 times (95% confidence interval: 1.09-10.37 of those who were non-adherence. This confirms the concurrent validity of the MALMAS. The sensitivity of the MALMAS was 88.9% while its specificity was 29.6%. The findings of this study further substantiates the reliability and validity of the MALMAS, in particular its concurrent validity and sensitivity for assessing medication adherence of people with type 2 diabetes in Malaysia.

A Supply and Demand Update of the Molybdenum-99 Market

International Nuclear Information System (INIS)

2012-08-01

Medical diagnostic imaging techniques using technetium-99m account for roughly 80% of all nuclear medicine procedures, representing over 30 million examinations worldwide every year. Disruptions in the supply chain of these medical isotopes - which have half-lives of 66 hours for molybdenum-99 ( 99 Mo) and 6 hours for its daughter isotope, technetium-99m (' 99m Tc), and thus must be produced continually - can lead to cancellations or delays in important medical testing services. Unfortunately, supply reliability has declined over the past decade due to unexpected or extended shutdowns at the few ageing 99 Mo-producing research reactor and processing facilities. These shutdowns have created global supply shortages. In 2011, the OECD Nuclear Energy Agency (NEA), along with its High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR), released a report that presents the reasons behind the lack of infrastructure that led to global supply shortages and a policy approach to encourage long-term medical isotope supply security. In that report, The Supply of Medical Radioisotopes: The Path to Reliability, the NEA also provides potential futures of supply and demand out to 2030. Since the release of The Path there have been a number of changes in the market and therefore this document provides an update on the 2011 supply and demand situation. This update is based on information provided to the NEA by members of the HLG-MR and other key stakeholders. This presentation of supply and demand future scenarios for the 99 Mo market revises previous NEA future scenarios based on new data and target conversion commitments from the supply chain. The update, unfortunately, does not present a more optimistic future scenario than previous presentations - the concern around the uneconomic situation of the supply chain continues to dominate the potential for new projects. This results in the potential for long-term shortages within the decade. However, there are a

Validity of helicopter emergency medical services dispatch criteria for traumatic injuries: A systematic review

NARCIS (Netherlands)

A.N. Ringburg (Akkie); G. de Ronde (Gijs); S. Thomas (Siep); E.M.M. van Lieshout (Esther); P. Patka (Peter); I.B. Schipper (Inger)

2009-01-01

textabstractObjective. This review provides an overview of the validity of Helicopter Emergency Medical Services (HEMS) dispatch criteria for severely injured patients. Methods. A systematic literature search was performed. English written and peer-reviewed publications on HEMS dispatch criteria

COCOA: A New Validated Instrument to Assess Medical Students' Attitudes towards Older Adults

Science.gov (United States)

Hollar, David; Roberts, Ellen; Busby-Whitehead, Jan

2011-01-01

This study tested the reliability and validity of the Carolina Opinions on Care of Older Adults (COCOA) survey compared with the Geriatric Assessment Survey (GAS). Participants were first year medical students (n = 160). A Linear Structural Relations (LISREL) measurement model for COCOA had a moderately strong fit that was significantly better…

Factor analysis methods and validity evidence: A systematic review of instrument development across the continuum of medical education

Science.gov (United States)

Wetzel, Angela Payne

Previous systematic reviews indicate a lack of reporting of reliability and validity evidence in subsets of the medical education literature. Psychology and general education reviews of factor analysis also indicate gaps between current and best practices; yet, a comprehensive review of exploratory factor analysis in instrument development across the continuum of medical education had not been previously identified. Therefore, the purpose for this study was critical review of instrument development articles employing exploratory factor or principal component analysis published in medical education (2006--2010) to describe and assess the reporting of methods and validity evidence based on the Standards for Educational and Psychological Testing and factor analysis best practices. Data extraction of 64 articles measuring a variety of constructs that have been published throughout the peer-reviewed medical education literature indicate significant errors in the translation of exploratory factor analysis best practices to current practice. Further, techniques for establishing validity evidence tend to derive from a limited scope of methods including reliability statistics to support internal structure and support for test content. Instruments reviewed for this study lacked supporting evidence based on relationships with other variables and response process, and evidence based on consequences of testing was not evident. Findings suggest a need for further professional development within the medical education researcher community related to (1) appropriate factor analysis methodology and reporting and (2) the importance of pursuing multiple sources of reliability and validity evidence to construct a well-supported argument for the inferences made from the instrument. Medical education researchers and educators should be cautious in adopting instruments from the literature and carefully review available evidence. Finally, editors and reviewers are encouraged to recognize

Validating the Modified Drug Adherence Work-Up (M-DRAW Tool to Identify and Address Barriers to Medication Adherence

Directory of Open Access Journals (Sweden)

Sun Lee

2017-09-01

Full Text Available Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often. The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity in patients taking one or more prescription medication(s for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 “adherers” (65.4%, and into the intervention group of nine “unintentional and intentional non-adherers” (34.6%. Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74 for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p < 0.05. The current study did not investigate construct validity due to small sample size and challenges on follow-up with patients. Future testing of the tool will include construct validation.

Present status of 99Mo/99mTc supply in Japan

International Nuclear Information System (INIS)

Yamashita, Takashi; Nakamura, Yoshihide

2017-01-01

The use of medical radioisotopes is an important part of modern medical practice. Disruptions in the radioisotope supply chain can disturb the availability of medical testing for millions of patients around the world. The NEA established the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) in 2009. During the 2009-2010 period, there were substantial shortages, but in the period since 2011 there have been only a limited number of minor supply shortages of the most widely used medical radioisotope. Japan does not have a reactor for 99 Mo production or a processing facility, and has been considering a number of alternative technology approaches to produce material domestically. (author)

Validation of a Delirium Risk Assessment Using Electronic Medical Record Information.

Science.gov (United States)

Rudolph, James L; Doherty, Kelly; Kelly, Brittany; Driver, Jane A; Archambault, Elizabeth

2016-03-01

Identifying patients at risk for delirium allows prompt application of prevention, diagnostic, and treatment strategies; but is rarely done. Once delirium develops, patients are more likely to need posthospitalization skilled care. This study developed an a priori electronic prediction rule using independent risk factors identified in a National Center of Clinical Excellence meta-analysis and validated the ability to predict delirium in 2 cohorts. Retrospective analysis followed by prospective validation. Tertiary VA Hospital in New England. A total of 27,625 medical records of hospitalized patients and 246 prospectively enrolled patients admitted to the hospital. The electronic delirium risk prediction rule was created using data obtained from the patient electronic medical record (EMR). The primary outcome, delirium, was identified 2 ways: (1) from the EMR (retrospective cohort) and (2) clinical assessment on enrollment and daily thereafter (prospective participants). We assessed discrimination of the delirium prediction rule with the C-statistic. Secondary outcomes were length of stay and discharge to rehabilitation. Retrospectively, delirium was identified in 8% of medical records (n = 2343); prospectively, delirium during hospitalization was present in 26% of participants (n = 64). In the retrospective cohort, medical record delirium was identified in 2%, 3%, 11%, and 38% of the low, intermediate, high, and very high-risk groups, respectively (C-statistic = 0.81; 95% confidence interval 0.80-0.82). Prospectively, the electronic prediction rule identified delirium in 15%, 18%, 31%, and 55% of these groups (C-statistic = 0.69; 95% confidence interval 0.61-0.77). Compared with low-risk patients, those at high- or very high delirium risk had increased length of stay (5.7 ± 5.6 vs 3.7 ± 2.7 days; P = .001) and higher rates of discharge to rehabilitation (8.9% vs 20.8%; P = .02). Automatic calculation of delirium risk using an EMR algorithm identifies patients at

The future of medical isotope supply - 2017 status update

International Nuclear Information System (INIS)

Charlton, Kevin; )

2017-01-01

In April 2014, the NEA analysed likely future market demand and projected production capacity for "9"9Mo. This research identified a period beyond 2016 of increased risk when further supply disruption could result from a number of ageing supply chain participants ending their activities. The analysis also examined the likely deployment of potential new capacity and confirmed that the introduction of new capacity would be vital to ensure security of supply. Concerns were expressed at the time about the possibility of potential new facilities experiencing project delays. The overall conclusion was that 2017 would represent the start of a period of particular risk, with a likely nadir in production capacity as a result of planned facility closures and project delays. In 2017, the NEA is pleased to report that market participants have reacted positively to the concerns identified in 2014

Validation of the Chinese version of the Modified Caregivers Strain Index among Hong Kong caregivers: an initiative of medical social workers.

Science.gov (United States)

Chan, Wallace Chi Ho; Chan, Christopher L F; Suen, Margaret

2013-11-01

Family caregivers may often experience caregiving stress and burden. To systematically assess this issue, medical social workers may need to use a brief and valid measurement in their practice. In the Hong Kong Chinese context, one additional challenge is to examine whether a measurement developed in the West is valid for Hong Kong Chinese caregivers. Thus, medical social workers in Hong Kong initiated this research study to validate the Chinese version of the Modified Caregiver Strain Index (C-M-CSI). A total of 223 Chinese caregivers of patients with various chronic illnesses were recruited for this validation study. C-M-CSI demonstrated good reliability (Cronbach's alpha coefficient = .91), concurrent validity with the Chinese version of the Caregiver Burden Inventory, and discriminant validity with the Chinese version of the Meaning in Life Questionnaire. Factor analysis yielded a single factor as the original M-CSI, which explained 49 percent of variance. Construct validity was shown by differentiating spousal and nonspousal caregivers, as well as caregivers of patients with and without behavioral problems. C-M-CSI is recommended as a brief and valid measurement that can be used by medical social workers in assessing the caregiving strain of Chinese caregivers of patients in Hong Kong.

The MMPI-2 Symptom Validity Scale (FBS) Not Influenced by Medical Impairment: A Large Sleep Center Investigation

Science.gov (United States)

Greiffenstein, Manfred F.

2010-01-01

The Symptom Validity Scale (Minnesota Multiphasic Personality Inventory-2-FBS [MMPI-2-FBS]) is a standard MMPI-2 validity scale measuring overstatement of somatic distress and subjective disability. Some critics assert the MMPI-2-FBS misclassifies too many medically impaired persons as malingering symptoms. This study tests the assertion of…

Forecasting Ontario's blood supply and demand.

Science.gov (United States)

Drackley, Adam; Newbold, K Bruce; Paez, Antonio; Heddle, Nancy

2012-02-01

Given an aging population that requires increased medical care, an increasing number of deferrals from the donor pool, and a growing immigrant population that typically has lower donation rates, the purpose of this article is to forecast Ontario's blood supply and demand. We calculate age- and sex-specific donation and demand rates for blood supply based on 2008 data and project demand between 2008 and 2036 based on these rates and using population data from the Ontario Ministry of Finance. Results indicate that blood demand will outpace supply as early as 2012. For instance, while the total number of donations made by older cohorts is expected to increase in the coming years, the number of red blood cell (RBC) transfusions in the 70+ age group is forecasted grow from approximately 53% of all RBC transfusions in 2008 (209,515) in 2008 to 68% (546,996) by 2036. A series of alternate scenarios, including projections based on a 2% increase in supply per year and increased use of apheresis technology, delays supply shortfalls, but does not eliminate them without active management and/or multiple methods to increase supply and decrease demand. Predictions show that demand for blood products will outpace supply in the near future given current age- and sex-specific supply and demand rates. However, we note that the careful management of the blood supply by Canadian Blood Services, along with new medical techniques and the recruitment of new donors to the system, will remove future concerns. © 2012 American Association of Blood Banks.

Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs.

Science.gov (United States)

McCoy, A B; Wright, A; Krousel-Wood, M; Thomas, E J; McCoy, J A; Sittig, D F

2015-01-01

Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging. We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record. We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision. The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%. We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across healthcare settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes.

Same admissions tools, different outcomes: a critical perspective on predictive validity in three undergraduate medical schools.

Science.gov (United States)

Edwards, Daniel; Friedman, Tim; Pearce, Jacob

2013-12-27

Admission to medical school is one of the most highly competitive entry points in higher education. Considerable investment is made by universities to develop selection processes that aim to identify the most appropriate candidates for their medical programs. This paper explores data from three undergraduate medical schools to offer a critical perspective of predictive validity in medical admissions. This study examined 650 undergraduate medical students from three Australian universities as they progressed through the initial years of medical school (accounting for approximately 25 per cent of all commencing undergraduate medical students in Australia in 2006 and 2007). Admissions criteria (aptitude test score based on UMAT, school result and interview score) were correlated with GPA over four years of study. Standard regression of each of the three admissions variables on GPA, for each institution at each year level was also conducted. Overall, the data found positive correlations between performance in medical school, school achievement and UMAT, but not interview. However, there were substantial differences between schools, across year levels, and within sections of UMAT exposed. Despite this, each admission variable was shown to add towards explaining course performance, net of other variables. The findings suggest the strength of multiple admissions tools in predicting outcomes of medical students. However, they also highlight the large differences in outcomes achieved by different schools, thus emphasising the pitfalls of generalising results from predictive validity studies without recognising the diverse ways in which they are designed and the variation in the institutional contexts in which they are administered. The assumption that high-positive correlations are desirable (or even expected) in these studies is also problematised.

Validation of a Malay Version of the Smartphone Addiction Scale among Medical Students in Malaysia.

Directory of Open Access Journals (Sweden)

Siew Mooi Ching

Full Text Available This study was initiated to determine the psychometric properties of the Smart Phone Addiction Scale (SAS by translating and validating this scale into the Malay language (SAS-M, which is the main language spoken in Malaysia. This study can distinguish smart phone and internet addiction among multi-ethnic Malaysian medical students. In addition, the reliability and validity of the SAS was also demonstrated.A total of 228 participants were selected between August 2014 and September 2014 to complete a set of questionnaires, including the SAS and the modified Kimberly Young Internet addiction test (IAT in the Malay language.There were 99 males and 129 females with ages ranging from 19 to 22 years old (21.7±1.1 included in this study. Descriptive and factor analyses, intra-class coefficients, t-tests and correlation analyses were conducted to verify the reliability and validity of the SAS. Bartlett's test of sphericity was significant (p <0.01, and the Kaiser-Mayer-Olkin measure of sampling adequacy for the SAS-M was 0.92, indicating meritoriously that the factor analysis was appropriate. The internal consistency and concurrent validity of the SAS-M were verified (Cronbach's alpha = 0.94. All of the subscales of the SAS-M, except for positive anticipation, were significantly related to the Malay version of the IAT.This study developed the first smart phone addiction scale among medical students. This scale was shown to be reliable and valid in the Malay language.

Tying supply chain costs to patient care.

Science.gov (United States)

Parkinson, Rosalind C

2014-05-01

In September 2014, the FDA will establish a unique device identification (UDI) system to aid hospitals in better tracking and managing medical devices and analyzing their effectiveness. When these identifiers become part of patient medical records, the UDI system will provide a much-needed link between supply cost and patient outcomes. Hospitals should invest in technology and processes that can enable them to trace supply usage patterns directly to patients and analyze how these usage patterns affect cost and quality.

The gender composition of the medical profession in Mexico: implications for employment patterns and physician labor supply.

Science.gov (United States)

Knaul, F; Frenk, J; Aguilar, A M

2000-01-01

The gender composition of the medical profession is changing rapidly in many parts of the world, including Mexico. We analyze cross-sectional and longitudinal data on sex differences in physician employment from household employment surveys. The results suggest that Mexico is a particularly interesting example of the feminization of physician employment. Female enrollment in medical school increased from 11% in 1970 to about 50% in 1998. The increased participation of women in medicine seems to be accompanied by differences in employment patterns that could generate significant reductions in the total supply of physician hours of service. Women physicians are unemployed at a much higher rate than men and hence account for half of underused physician human capital. The results suggest that improved educational opportunities do not translate automatically into equal employment opportunities.

The balance of supply and demand

International Nuclear Information System (INIS)

Darmayan, P.

1981-01-01

The Supply and Demand Committee of the Uranium Institute was established to monitor continuously information and developments bearing on the uranium market and to publish from time to time reports giving its views on the supply and demand outlook. The last Uranium Institute supply and demand report was compiled at the beginning of 1979. Its main conclusions were that from 1979 to 1990 the flexibilities of the market were such as to offer adequate scope to producers and consumers of uranium to ensure a balance between supply and demand. Is that conclusion still valid one and a half years later. Some of the Supply and Demand Committee's more recent estimates are reported under the headings: reactor orders and cancellations; revised Institute forecasts of nuclear capacity; uranium supply; main implications of the new forecasts. (U.K.)

A medical school's organizational readiness for curriculum change (MORC): development and validation of a questionnaire.

Science.gov (United States)

Jippes, Mariëlle; Driessen, Erik W; Broers, Nick J; Majoor, Gerard D; Gijselaers, Wim H; van der Vleuten, Cees P M

2013-09-01

Because successful change implementation depends on organizational readiness for change, the authors developed and assessed the validity of a questionnaire, based on a theoretical model of organizational readiness for change, designed to measure, specifically, a medical school's organizational readiness for curriculum change (MORC). In 2012, a panel of medical education experts judged and adapted a preliminary MORC questionnaire through a modified Delphi procedure. The authors administered the resulting questionnaire to medical school faculty involved in curriculum change and tested the psychometric properties using exploratory and confirmatory factor analysis, and generalizability analysis. The mean relevance score of the Delphi panel (n = 19) reached 4.2 on a five-point Likert-type scale (1 = not relevant and 5 = highly relevant) in the second round, meeting predefined criteria for completing the Delphi procedure. Faculty (n = 991) from 131 medical schools in 56 countries completed MORC. Exploratory factor analysis yielded three underlying factors-motivation, capability, and external pressure-in 12 subscales with 53 items. The scale structure suggested by exploratory factor analysis was confirmed by confirmatory factor analysis. Cronbach alpha ranged from 0.67 to 0.92 for the subscales. Generalizability analysis showed that the MORC results of 5 to 16 faculty members can reliably evaluate a school's organizational readiness for change. MORC is a valid, reliable questionnaire for measuring organizational readiness for curriculum change in medical schools. It can identify which elements in a change process require special attention so as to increase the chance of successful implementation.

Validating the Modified Drug Adherence Work-Up (M-DRAW) Tool to Identify and Address Barriers to Medication Adherence.

Science.gov (United States)

Lee, Sun; Bae, Yuna H; Worley, Marcia; Law, Anandi

2017-09-08

Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW) was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often). The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity) in patients taking one or more prescription medication(s) for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 "adherers" (65.4%), and into the intervention group of nine "unintentional and intentional non-adherers" (34.6%). Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74) for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p tool will include construct validation.

A Medical School's Organizational Readiness for Curriculum Change (MORC): Development and Validation of a Questionnaire

NARCIS (Netherlands)

Jippes, M.; Driessen, E.W.; Broers, N.J.; Majoor, G.D.; Gijselaers, W.H.; Vleuten, C.P.M. van der

2013-01-01

PURPOSE: Because successful change implementation depends on organizational readiness for change, the authors developed and assessed the validity of a questionnaire, based on a theoretical model of organizational readiness for change, designed to measure, specifically, a medical school's

Aggregate Timber Supply: From the Forest to the Market

Science.gov (United States)

David N. Wear; Subhrendu K. Pattanayak

2003-01-01

Timber supply modeling is a means of formalizing the production behavior of heterogeneous landowners managing a wide variety of forest types and vintages within a region. The critical challenge of timber supply modeling is constructing theoretically valid and empirically practical aggregate descriptions of harvest behavior. Understanding timber supply is essential for...

Predictive validity of the personal qualities assessment for selection of medical students in Scotland.

Science.gov (United States)

Dowell, Jon; Lumsden, Mary Ann; Powis, David; Munro, Don; Bore, Miles; Makubate, Boikanyo; Kumwenda, Ben

2011-01-01

The Personal Qualities Assessment (PQA) was developed to enhance medical student selection by measuring a range of non-cognitive attributes in the applicants to medical school. Applicants to the five Scottish medical schools were invited to pilot the test in 2001 and 2002. To evaluate the predictive validity of PQA for selecting medical students. A longitudinal cohort study was conducted in which PQA scores were compared with senior year medical school performance. Consent to access performance markers was obtained from 626 students (61.6% of 1017 entrants in 2002-2003). Linkable Foundation Year (4th) rankings were available for 411 (66%) students and objective structured clinical examination (OSCE) rankings for 335 (54%) of those consenting. Both samples were representative of the original cohort. No significant correlations were detected between separate elements of the PQA assessment and student performance. However, using the algorithm advocated by Powis et al. those defined as 'non-extreme' (libertarian-communitarian moral orientation scales were ranked higher in OSCEs (average of 7.5% or 25 out of 335, p = 0.049). This study was limited by high attrition and basic outcome markers which are insensitive to relevant non-cognitive characteristics. However, it is the largest currently available study of predictive validity for the PQA assessment. There was one finding of significance: that those students who were identified by PQA as 'not extreme' on the two personal characteristics scales performed better in an OSCE measure of professionalism. Futures studies are required since psychometric testing for both cognitive and non-cognitive attributes are increasingly used in admission process and these should include more and better measures of professionalism against which to correlate non-cognitive traits.

Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs

Science.gov (United States)

Wright, A.; Krousel-Wood, M.; Thomas, E. J.; McCoy, J. A.; Sittig, D. F.

2015-01-01

Summary Background Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging. Objective We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record. Methods We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision. Results The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%. Conclusions We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across healthcare settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes. PMID:26171079

[Development and validation of a questionnaire on perception of portfolio by undergraduate medical students].

Science.gov (United States)

Riquelme, Arnoldo; Méndez, Benjamín; de la Fuente, Paloma; Padilla, Oslando; Benaglio, Carla; Sirhan, Marisol; Labarca, Jaime

2011-01-01

Portfolio is an innovative instrument that promotes reflection, creativity and professionalism among students. To describe the development and validation process of a questionnaire to evaluate the use of portfolio in undergraduate medical students. Focus groups with students and teachers were employed to identify aspects related with portfolio in undergraduate teaching. The Delphi technique was used to prioritize relevant aspects and construct the questionnaire. The validated questionnaire, consisting of 43 items and 6 factors, was applied to 97 students (response rote of 99.9%) in 2007 and 100 students (99.2%) in 2008. Each question had to be answered using a Likert scale, from 0 (completely disagree) to 4 (completely agree) The validity and reliability of the questionnaire was evaluated. The questionnaire showed a high reliability (Cronbach alpha = 0.9). The mean total scores obtained in 2007 and 2008 were 106.2 ± 21.2 (61.7% of the maximal obtainable score) and 104.6 ± 34.0 (60.8% of the maximal obtainable score), respectively No significant differences were seen in the analysis by factors. Changes in portfolio during 2008 showed differences in items related with organization, evaluation and regulation. The questionnaire is a valid and highly reliable instrument, measuring perceptions about the portfolio by undergraduate medical students. The students perceived an improvement in their creativity and professionalism as one of the strengths of portfolio. The weaknesses identified during the implementation process helped us to focus changes in organization and evaluation to improve the portfolio as a dynamic process.

Predictive validity of pre-admission assessments on medical student performance.

Science.gov (United States)

Dabaliz, Al-Awwab; Kaadan, Samy; Dabbagh, M Marwan; Barakat, Abdulaziz; Shareef, Mohammad Abrar; Al-Tannir, Mohamad; Obeidat, Akef; Mohamed, Ayman

2017-11-24

To examine the predictive validity of pre-admission variables on students' performance in a medical school in Saudi Arabia. In this retrospective study, we collected admission and college performance data for 737 students in preclinical and clinical years. Data included high school scores and other standardized test scores, such as those of the National Achievement Test and the General Aptitude Test. Additionally, we included the scores of the Test of English as a Foreign Language (TOEFL) and the International English Language Testing System (IELTS) exams. Those datasets were then compared with college performance indicators, namely the cumulative Grade Point Average (cGPA) and progress test, using multivariate linear regression analysis. In preclinical years, both the National Achievement Test (p=0.04, B=0.08) and TOEFL (p=0.017, B=0.01) scores were positive predictors of cGPA, whereas the General Aptitude Test (p=0.048, B=-0.05) negatively predicted cGPA. Moreover, none of the pre-admission variables were predictive of progress test performance in the same group. On the other hand, none of the pre-admission variables were predictive of cGPA in clinical years. Overall, cGPA strongly predict-ed students' progress test performance (p<0.001 and B=19.02). Only the National Achievement Test and TOEFL significantly predicted performance in preclinical years. However, these variables do not predict progress test performance, meaning that they do not predict the functional knowledge reflected in the progress test. We report various strengths and deficiencies in the current medical college admission criteria, and call for employing more sensitive and valid ones that predict student performance and functional knowledge, especially in the clinical years.

AN EXPLORATORY APPROACH TO INTEGRATION OF BUSINESS PRACTICES IN SUPPLY CHAIN MANAGEMENT

Directory of Open Access Journals (Sweden)

Constangioara Alexandru

2014-07-01

After reviewing the literature on supply chain integration, present paper proposes an exploratory analysis of the measurement model corresponding to logistics integration. A Romanian dataset of 21 firms from various industries, covering all levels of a supply chain, from production to commerce is used to conduct a principal factor analysis to test for (a content validity, (b substantive validity, (c uni-dimensionality and (d reliability of scales used to measure integration in supply chains. Also the principal component analysis is used to forecast both dependent and independent variables subsequently used in an OLS estimation of the relationship between supply chain integration and performances in Romanian supply chains. Results support the conclusion that Romanian supply chains focus on a strategy of operational excellence.

Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam.

Science.gov (United States)

Tran, Hong Thi; Nguyen, Hoa Phuong; Walker, Sue M; Hill, Peter S; Rao, Chalapati

2018-05-18

Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death

Supply and distribution for γ-ray sources

International Nuclear Information System (INIS)

Yamamoto, Takeo

1997-01-01

Japan Atomic energy Research Institute (JAERI) is the only facility to supply and distribute radioisotopes (RI) in Japan. The γ-ray sources for medical use are 192 Ir and 169 Yb for non-destructive examination and 192 Ir, 198 Au and 153 Gd for clinical use. All of these demands in Japan are supplied with domestic products at present. Meanwhile, γ-ray sources imported are 60 Co sources for medical and industrial uses including sterilization of medical instruments, 137 Cs for irradiation to blood and 241 Am for industrial measurements. The major overseas suppliers are Nordion International Inc. and Amersham International plc. RI products on the market are divided into two groups; one is the primary products which are supplied in liquid or solid after chemical or physical treatments of radioactive materials obtained from reactor and the other is the secondary product which is a final product after various processing. Generally these secondary products are used in practice. In Japan, both of the domestic and imported products are supplied to the users via JRIA (Japan Radioisotope Association). The association participates in the sales and the distributions of the secondary products and also in the processings of the primary ones to their sealed sources. Furthermore, stable supplying systems for these products are almost established according to the half life of each nuclide only if there is no accident in the reactor. (M.N.)

Challenges to validation of a complex nonsterile medical device tray.

Science.gov (United States)

Prince, Daniel; Mastej, Jozef; Hoverman, Isabel; Chatterjee, Raja; Easton, Diana; Behzad, Daniela

2014-01-01

Validation by steam sterilization of reusable medical devices requires careful attention to many parameters that directly influence whether or not complete sterilization occurs. Complex implant/instrument tray systems have a variety of configurations and components. Geobacillus stearothermophilus biological indicators (BIs) are used in overkill cycles to to simulate worst case conditions and are intended to provide substantial sterilization assurance. Survival of G. stearothermophilus spores was linked to steam access and size of load in the chamber. By a small and reproducible margin, it was determined that placement of the trays in a rigid container into minimally loaded chambers were more difficult to completely sterilize than maximally loaded chambers.

The validation of the Utrecht work engagement scale for emergency medical technicians in Gauteng

Directory of Open Access Journals (Sweden)

JLP Naudé

2004-04-01

Full Text Available The objectives of this study were to validate the Utrecht Work Engagement Scale (UWES for emergency medical technicians in the Gauteng Province of South Africa and to determine its construct equivalence and bias for different language groups. A cross-sectional survey design was used with a convenient sample (N = 318 of emergency medical technicians in Gauteng. The UWES and a biographical questionnaire were administered. A two-factor model of work engagement, consisting of Vigour/Dedication and Absorption was found. Exploratory factor analysis with target rotations confirmed the construct equivalence of the work engagement construct for white and black employees.

Supply chain strategy: empirical case study in Europe and Asia:

OpenAIRE

Sillanpää, Ilkka; Sillanpää, Sebastian

2014-01-01

The purpose of this case study research is to present a literature review of supply chain strategy approaches, develop supply chain strategy framework and to validate a framework in empirical case study. Literature review and case study research are the research methods for this research. This study presents the supply chain strategy framework which merges together business environment, corporate strategy, supply chain demand and supply chain strategy. Research argues that all the different c...

The Danish version of the Medication Adherence Report Scale: preliminary validation in cancer pain patients

DEFF Research Database (Denmark)

Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona Louring

2009-01-01

into Danish following the repeated back-translation procedure. Cancer patients for the study were recruited from specialized pain management facilities. Thirty-three patients responded to the DMARS-4, the Danish Barriers Questionnaire II, The Danish version of Patient Perceived Involvement in Care Scale......OBJECTIVE: To examine the psychometric properties of the Danish version of the Medication Adherence Report Scale (DMARS-4) adapted to measure adherence to analgesic regimen among cancer patients. METHODS: The validated English version of the Medication Adherence Report Scale was translated...

Validation of questionnaire-reported hearing with medical records: A report from the Swiss Childhood Cancer Survivor Study.

Directory of Open Access Journals (Sweden)

Annette Weiss

Full Text Available Hearing loss is a potential late effect after childhood cancer. Questionnaires are often used to assess hearing in large cohorts of childhood cancer survivors and it is important to know if they can provide valid measures of hearing loss. We therefore assessed agreement and validity of questionnaire-reported hearing in childhood cancer survivors using medical records as reference.In this validation study, we studied 361 survivors of childhood cancer from the Swiss Childhood Cancer Survivor Study (SCCSS who had been diagnosed after 1989 and had been exposed to ototoxic cancer treatment. Questionnaire-reported hearing was compared to the information in medical records. Hearing loss was defined as ≥ grade 1 according to the SIOP Boston Ototoxicity Scale. We assessed agreement and validity of questionnaire-reported hearing overall and stratified by questionnaire respondents (survivor or parent, sociodemographic characteristics, time between follow-up and questionnaire and severity of hearing loss.Questionnaire reports agreed with medical records in 85% of respondents (kappa 0.62, normal hearing was correctly assessed in 92% of those with normal hearing (n = 249, and hearing loss was correctly assessed in 69% of those with hearing loss (n = 112. Sensitivity of the questionnaires was 92%, 74%, and 39% for assessment of severe, moderate and mild bilateral hearing loss; and 50%, 33% and 10% for severe, moderate and mild unilateral hearing loss, respectively. Results did not differ by sociodemographic characteristics of the respondents, and survivor- and parent-reports were equally valid.Questionnaires are a useful tool to assess hearing in large cohorts of childhood cancer survivors, but underestimate mild and unilateral hearing loss. Further research should investigate whether the addition of questions with higher sensitivity for mild degrees of hearing loss could improve the results.

Validation of questionnaire-reported hearing with medical records: A report from the Swiss Childhood Cancer Survivor Study

Science.gov (United States)

Scheinemann, Katrin; Grotzer, Michael; Kompis, Martin; Kuehni, Claudia E.

2017-01-01

Background Hearing loss is a potential late effect after childhood cancer. Questionnaires are often used to assess hearing in large cohorts of childhood cancer survivors and it is important to know if they can provide valid measures of hearing loss. We therefore assessed agreement and validity of questionnaire-reported hearing in childhood cancer survivors using medical records as reference. Procedure In this validation study, we studied 361 survivors of childhood cancer from the Swiss Childhood Cancer Survivor Study (SCCSS) who had been diagnosed after 1989 and had been exposed to ototoxic cancer treatment. Questionnaire-reported hearing was compared to the information in medical records. Hearing loss was defined as ≥ grade 1 according to the SIOP Boston Ototoxicity Scale. We assessed agreement and validity of questionnaire-reported hearing overall and stratified by questionnaire respondents (survivor or parent), sociodemographic characteristics, time between follow-up and questionnaire and severity of hearing loss. Results Questionnaire reports agreed with medical records in 85% of respondents (kappa 0.62), normal hearing was correctly assessed in 92% of those with normal hearing (n = 249), and hearing loss was correctly assessed in 69% of those with hearing loss (n = 112). Sensitivity of the questionnaires was 92%, 74%, and 39% for assessment of severe, moderate and mild bilateral hearing loss; and 50%, 33% and 10% for severe, moderate and mild unilateral hearing loss, respectively. Results did not differ by sociodemographic characteristics of the respondents, and survivor- and parent-reports were equally valid. Conclusions Questionnaires are a useful tool to assess hearing in large cohorts of childhood cancer survivors, but underestimate mild and unilateral hearing loss. Further research should investigate whether the addition of questions with higher sensitivity for mild degrees of hearing loss could improve the results. PMID:28333999

Mapping medical marijuana: state laws regulating patients, product safety, supply chains and dispensaries, 2017.

Science.gov (United States)

Klieger, Sarah B; Gutman, Abraham; Allen, Leslie; Pacula, Rosalie Liccardo; Ibrahim, Jennifer K; Burris, Scott

2017-12-01

(1) To describe open source legal data sets, created for research use, that capture the key provisions of US state medical marijuana laws. The data document how state lawmakers have regulated a medicine that remains, under federal law, a Schedule I illegal drug with no legitimate medical use. (2) To demonstrate the variability that exists across states in rules governing patient access, product safety and dispensary practice. Two legal researchers collected and coded state laws governing marijuana patients, product safety and dispensaries in effect on 1 February 2017, creating three empirical legal data sets. We used summary tables to identify the variation in specific statutory provisions specified in each state's medical marijuana law as it existed on 1 February 2017. We compared aspects of these laws to the traditional Federal approach to regulating medicine. Full data sets, codebooks and protocols are available through the Prescription Drug Abuse Policy System (http://www.pdaps.org/; Archived at http://www.webcitation.org/6qv5CZNaZ on 2 June 2017). Twenty-eight states (including the District of Columbia) have authorized medical marijuana. Twenty-seven specify qualifying diseases, which differ across states. All states protect patient privacy; only 14 protect patients against discrimination. Eighteen states have mandatory product safety testing before any sale. While the majority have package/label regulations, states have a wide range of specific requirements. Most regulate dispensaries (25 states), with considerable variation in specific provisions such as permitted product supply sources number of dispensaries per state and restricting proximity to various types of location. The federal ban in the United States on marijuana has resulted in a patchwork of regulatory strategies that are not uniformly consistent with the approach usually taken by the Federal government and whose effectiveness remains unknown. © 2017 Society for the Study of Addiction.

Construct validation of supply chain management in cooperative

OpenAIRE

Idris, Nurjihan; Arshad, Fatimah Mohamed; Radam, Alias; Ali, Noor Azman

2009-01-01

This study attempts to analyze construct in supply chain and to determine which construct contribute to performance of agricultural cooperatives in Malaysia. The primary data is collected via questionnaire from top level management of agricultural cooperatives using 5-item Likert scale. Factor analysis and structural equations modeling were used to analyze the data. Findings show that cooperatives places importance on quality and technology, logistic, supplier and governance. As a whole, supp...

Sterilization of health care products - Radiation. Part 1: Requirements for development, validation and routine control of a sterilization process for medical devices

International Nuclear Information System (INIS)

2006-01-01

A sterile medical device is one that is free of viable microorganisms. International Standards, which specify requirements for validation and routine control of sterilization processes, require, when it is necessary to supply a sterile medical device, that adventitious microbiological contamination of a medical device prior to sterilization be minimized. Even so, medical devices produced under standard manufacturing conditions in accordance with the requirements for quality management systems (see, for example, ISO 13485) may, prior to sterilization, have microorganisms on them, albeit in low numbers. Such medical devices are non-sterile. The purpose of sterilization is to inactivate the microbiological contaminants and thereby transform the nonsterile medical devices into sterile ones. The kinetics of inactivation of a pure culture of microorganisms by physical and/or chemical agents used to sterilize medical devices can generally best be described by an exponential relationship between the numbers of microorganisms surviving and the extent of treatment with the sterilizing agent; inevitably this means that there is always a finite probability that a microorganism may survive regardless of the extent of treatment applied. For a given treatment, the probability of survival is determined by the number and resistance of microorganisms and by the environment in which the organisms exist during treatment. It follows that the sterility of any one medical device in a population subjected to sterilization processing cannot be guaranteed and the sterility of a processed population is defined in terms of the probability of there being a viable microorganism present on a medical device. This part of ISO 11137 describes requirements that, if met, will provide a radiation sterilization process intended to sterilize medical devices, that has appropriate microbicidal activity. Furthermore, compliance with the requirements ensures that this activity is both reliable and

U.S. healthcare fix: leveraging the lessons from the food supply chain.

Science.gov (United States)

Kumar, Sameer; Blair, John T

2013-01-01

U.S. healthcare costs consistently outpace inflation, causing growing problems of affordability. This trend cannot be sustained indefinitely. The purpose of this study is to use supply-chain tools for macro-level examination of the U.S. healthcare as a business system and identify options and best use practices. We compare the important and successful U.S. food industry to the essential but problematic U.S. healthcare industry. Supply chain strategies leading to food business operations success are examined and healthcare applications suggested. We emphasize "total cost of ownership" which includes all costs incurred by all stakeholders of U.S. healthcare, including maintenance and cleanup, not just the initial purchase price. U.S. hospitals and clinics can use supply chain strategies in a total cost of ownership framework to reduce healthcare costs while maintaining patient care quality. Supply chain strategies of resource pooling, mass customization, centralized logistics, specialization, postponement and continuous improvement that have been successfully used in the U.S. food industry should be more widely applied to the U.S. healthcare industry. New and growing areas of telemedicine and medical tourism should be included in the supply chain analysis of U.S. healthcare. Valid statistical analysis of results in all areas of U.S. healthcare is an important part of the process. U.S. healthcare industry problems are systematic operational and supply chain problems rather than problems with workforce or technology. Examination of the U.S. healthcare industry through a supply chain framework should lead to significant operational improvement in both prevention and treatment of acute and chronic ailments. A rational and unemotional reorganization of the U.S. healthcare system operations, using supply chain strategies, should help reduce healthcare costs while maintaining quality and increasing accessibility.

Utilization of never-medicated bipolar disorder patients towards development and validation of a peripheral biomarker profile.

Directory of Open Access Journals (Sweden)

Catherine L Clelland

Full Text Available There are currently no biological tests that differentiate patients with bipolar disorder (BPD from healthy controls. While there is evidence that peripheral gene expression differences between patients and controls can be utilized as biomarkers for psychiatric illness, it is unclear whether current use or residual effects of antipsychotic and mood stabilizer medication drives much of the differential transcription. We therefore tested whether expression changes in first-episode, never-medicated BPD patients, can contribute to a biological classifier that is less influenced by medication and could potentially form a practicable biomarker assay for BPD. We employed microarray technology to measure global leukocyte gene expression in first-episode (n=3 and currently medicated BPD patients (n=26, and matched healthy controls (n=25. Following an initial feature selection of the microarray data, we developed a cross-validated 10-gene model that was able to correctly predict the diagnostic group of the training sample (26 medicated patients and 12 controls, with 89% sensitivity and 75% specificity (p<0.001. The 10-gene predictor was further explored via testing on an independent cohort consisting of three pairs of monozygotic twins discordant for BPD, plus the original enrichment sample cohort (the three never-medicated BPD patients and 13 matched control subjects, and a sample of experimental replicates (n=34. 83% of the independent test sample was correctly predicted, with a sensitivity of 67% and specificity of 100% (although this result did not reach statistical significance. Additionally, 88% of sample diagnostic classes were classified correctly for both the enrichment (p=0.015 and the replicate samples (p<0.001. We have developed a peripheral gene expression biomarker profile, that can classify healthy controls from patients with BPD receiving antipsychotic or mood stabilizing medication, which has both high sensitivity and specificity

Ireland's medical brain drain: migration intentions of Irish medical students.

LENUS (Irish Health Repository)

Gouda, Pishoy

2015-12-01

To provide the optimum level of healthcare, it is important that the supply of well-trained doctors meets the demand. However, despite many initiatives, Ireland continues to have a shortfall of physicians, which has been projected to persist. Our study aimed to investigate the migration intentions of Irish medical students and identify the factors that influence their decisions in order to design appropriate interventions to sustain the supply of trained doctors in order to maintain a viable medical system.

Estimating Supplies Program (ESP), Version 1.00, User's Guide

National Research Council Canada - National Science Library

Tropeano, Anne

2000-01-01

The Estimating Supplies Program (ESP) is an easy to use Windows(TM)-based software program for military medical providers, planners, and trainers that calculates the amount of supplies and equipment required to treat a patient stream...

Validation of the self-assessment teamwork tool (SATT) in a cohort of nursing and medical students.

Science.gov (United States)

Roper, Lucinda; Shulruf, Boaz; Jorm, Christine; Currie, Jane; Gordon, Christopher J

2018-02-09

Poor teamwork has been implicated in medical error and teamwork training has been shown to improve patient care. Simulation is an effective educational method for teamwork training. Post-simulation reflection aims to promote learning and we have previously developed a self-assessment teamwork tool (SATT) for health students to measure teamwork performance. This study aimed to evaluate the psychometric properties of a revised self-assessment teamwork tool. The tool was tested in 257 medical and nursing students after their participation in one of several mass casualty simulations. Using exploratory and confirmatory factor analysis, the revised self-assessment teamwork tool was shown to have strong construct validity, high reliability, and the construct demonstrated invariance across groups (Medicine & Nursing). The modified SATT was shown to be a reliable and valid student self-assessment tool. The SATT is a quick and practical method of guiding students' reflection on important teamwork skills.

Evaluation of tumor registry validity in Samsung medical center radiation oncology department

International Nuclear Information System (INIS)

Park, Won; Huh, Seung Jae; Kim, Dae Yong; Shin, Seong Soo; Ahn, Yong Chan; Lim, Do Hoon; Kim, Seon Woo

2004-01-01

A tumor registry system for the patients treated by radiotherapy at Samsung Medical Center since the opening of a hospital at 1994 was employed. In this study, the tumor registry system was introduced and the validity of the tumor registration was analyzed. The tumor registry system was composed of three parts: patient demographic, diagnostic, and treatment information. All data were input in a screen using a mouse only. Among the 10,000 registered cases in the tumor registry system until Aug, 2002, 199 were randomly selected and their registration data were compared with the patients' medical records. Total input errors were detected in 15 cases (7.5%). There were 8 error items in the part relating to diagnostic information: tumor site 3, pathology 2, AJCC staging 2 and performance status 1. In the part relating to treatment information there were 9 mistaken items: combination treatment 4, the date of initial treatment 3 and radiation completeness 2. According to the assignment doctor, the error ratio was consequently variable. The doctors who did no double-checks showed higher errors than those that did (15.6%: 3.7%). Our tumor registry had errors within 2% for each item. Although the overall data quality was high, further improvement might be achieved through promoting sincerity, continuing training periodic validity tests and keeping double-checks. Also, some items associated with the hospital information system will be input automatically in the next step

Reliability and known-group validity of the Arabic version of the 8-item Morisky Medication Adherence Scale among type 2 diabetes mellitus patients.

Science.gov (United States)

Ashur, S T; Shamsuddin, K; Shah, S A; Bosseri, S; Morisky, D E

2015-12-13

No validation study has previously been made for the Arabic version of the 8-item Morisky Medication Adherence Scale (MMAS-8(©)) as a measure for medication adherence in diabetes. This study in 2013 tested the reliability and validity of the Arabic MMAS-8 for type 2 diabetes mellitus patients attending a referral centre in Tripoli, Libya. A convenience sample of 103 patients self-completed the questionnaire. Reliability was tested using Cronbach alpha, average inter-item correlation and Spearman-Brown coefficient. Known-group validity was tested by comparing MMAS-8 scores of patients grouped by glycaemic control. The Arabic version showed adequate internal consistency (α = 0.70) and moderate split-half reliability (r = 0.65). Known-group validity was supported as a significant association was found between medication adherence and glycaemic control, with a moderate effect size (ϕc = 0.34). The Arabic version displayed good psychometric properties and could support diabetes research and practice in Arab countries.

Medication reconciliation is a prerequisite for obtaining a valid medication review

DEFF Research Database (Denmark)

Bjeldbak-Olesen, Mette; Danielsen, Anja Gadsbølle; Tomsen, Dorthe Vilstrup

2013-01-01

The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-related problems (DRPs), denoted errors.......The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-related problems (DRPs), denoted errors....

Medical students' attitudes to complementary and alternative medicine: further validation of the IMAQ and findings from an international longitudinal study.

Science.gov (United States)

Rees, Charlotte E; Wearn, Andy M; Dennis, Ian; Amri, Hakima; Greenfield, Sheila M

2009-02-01

Current research mainly employs cross-sectional designs to examine changes in medical students' attitudes towards complementary and alternative medicine (CAM). This paper reports the findings of a longitudinal study to further validate the Integrative Medicine Attitude Questionnaire (IMAQ) and examine changes in medical students' attitudes over 3 years. A total of 154 medical students from four schools in three countries completed a modified version of the IMAQ during their first (T1) and fourth year (T2). We established the validity of a three-factor model for the IMAQ: (1) attitudes towards holism; (2) attitudes towards the effectiveness of CAM therapies, and (3) attitudes towards introspection and the doctor-patient relationship. We found that IMAQ factor scores did not differ significantly from T1 to T2, emphasizing the relative stability in attitudes across time. Various student characteristics were significantly associated with IMAQ factor scores at T2: age, gender, CAM use, CAM education and school; and two variables (gender and CAM use) predicted changes in medical students' attitudes between T1 and T2. We urge medical educators to continue exploring medical students' attitude changes towards CAM and we provide examples of what further research is needed.

Validation of the complex of measures of medical rehabilitation of children victims of Chernobyl accident

International Nuclear Information System (INIS)

Paramonov, Z.M.

1999-01-01

Special complex program including social medical, organizational and hygienic aspects of studying state of health of children and the characteristics of the system of medical service have been worked out. The peculiarities of changes in the state of health in children and its correlation with the level of the internal irradiation as well as the ways to form the latter in the chain 'soil-water complex - food stuffs - organism' have been determined. Special rehabilitation measures and their application in the network of therapeutic sanatorium centers for radiation protection are validated. The expediency and necessity of medico-hygienic protection of children was established

Design and validation of a questionnaire on nursing competence in the notification of medication incidents.

Science.gov (United States)

Salcedo-Diego, Isabel; de Andrés-Gimeno, Begoña; Ruiz-Antorán, Belén; Layunta, Rocío; Serrano-Gallardo, Pilar

To design and perform a face and content validation of a questionnaire to measure the competence of hospital RN to report medication incidents. Content and face questionnaire validation descriptive study. A review of the literature was performed for the creation of ítems. A panel of six experts assessed the relevance of the inclusion of each ítem in the questionnaire by calculating the position index; ítems with position index >0.70 were selected. The questionnaire was piloted by 59 RN. Finally, a meeting was convened with experts, in order to reduce the length of the piloted questionnaire through review, discussion and decision by consensus on each item. From the literature review, a battery of 151 ítems grouped into three elements of competence: attitudes, knowledge and skills was created. 52.9% (n=80) of the ítems received a position index > 0.70. The response rate in the pilot study was 40.65%. The median time to complete the questionnaire was 23:35minutes. After reduction by the experts, the final questionnaire comprised 45 ítems grouped into 32 questions. The NORMA questionnaire, designed to explore the competence of hospital RN to report medication incidents, has adequate face and content validity and is easy to administer, enabling its institutional implementation. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Reducing Conductor Usage in Superconducting Machines by Multiple Power Supplies

DEFF Research Database (Denmark)

Jensen, Bogi Bech; Mijatovic, Nenad; Abrahamsen, Asger Bech

2013-01-01

This paper presents and applies a method of reducing the needed amount of superconductor in a superconducting machine by supplying the superconductor from multiple power supplies. The method is presented and validated experimentally in a constructed prototype. Thereafter, a superconducting tape...

Assessment of the rates and characteristics of the short-term supply of medication (Tider from an integrated healthcare delivery system in the United States

Directory of Open Access Journals (Sweden)

Delate T

2017-06-01

Full Text Available Objectives: The purpose of this study was to describe the rate of medication short-term supply dispensings (tider, patient and medication characteristics associated with a tider, and costs for tider dispensings in an integrated healthcare delivery system in Colorado, United States. Methods: This was a retrospective study conducted in an integrated healthcare delivery system’s outpatient clinics. All patients who had a prescription dispensed for a study medication at any of the system’s 28 outpatient pharmacies during the first quarter of 2016 were included. A tider was identified as a 3-day supply of a prescription medication that was dispensed at no charge to a patient. The quarterly tider rate and the per member per month (PMPM cost of tiders were estimated. Patient and medication characteristics associated with a tider were assessed. Results: A total of 444,225 study medications were dispensed for 135,907 patients during the study period. There were 3,430 (0.77%, 95%CI 0.75%:0.80% medications dispensed as a tider. The PMPM cost of tider medications and their dispensing fees was USD 0.03. There were 1,092 (0.8% and 134,815 (99.2% patients who did and did not, respectively, have at least one tider dispensed during the study period. Patient characteristics strongly associated with having had a tider dispensed included being older, male, and a Medicare beneficiary. Cardiovascular and neuromuscular medications had the highest rates of tider dispensing. Conclusions: The rate of tider dispensing was relatively low; however, approximately one out of 125 patients had at least one tider. Patients who had a tider were more likely to be older, female, a Medicare beneficiary, and having had a previous tider dispensing and a higher burden of chronic disease. The tider medication was more likely to be a cardiovascular or neuromuscular medication class and more likely to be dispensed on a weekend. The total cost of dispensing a tider appears reasonable

Adaptation and validation of the instrument Clinical Learning Environment and Supervision for medical students in primary health care

Directory of Open Access Journals (Sweden)

Eva Öhman

2016-12-01

Full Text Available Abstract Background Clinical learning takes place in complex socio-cultural environments that are workplaces for the staff and learning places for the students. In the clinical context, the students learn by active participation and in interaction with the rest of the community at the workplace. Clinical learning occurs outside the university, therefore is it important for both the university and the student that the student is given opportunities to evaluate the clinical placements with an instrument that allows evaluation from many perspectives. The instrument Clinical Learning Environment and Supervision (CLES was originally developed for evaluation of nursing students’ clinical learning environment. The aim of this study was to adapt and validate the CLES instrument to measure medical students’ perceptions of their learning environment in primary health care. Methods In the adaptation process the face validity was tested by an expert panel of primary care physicians, who were also active clinical supervisors. The adapted CLES instrument with 25 items and six background questions was sent electronically to 1,256 medical students from one university. Answers from 394 students were eligible for inclusion. Exploratory factor analysis based on principal component methods followed by oblique rotation was used to confirm the adequate number of factors in the data. Construct validity was assessed by factor analysis. Confirmatory factor analysis was used to confirm the dimensions of CLES instrument. Results The construct validity showed a clearly indicated four-factor model. The cumulative variance explanation was 0.65, and the overall Cronbach’s alpha was 0.95. All items loaded similarly with the dimensions in the non-adapted CLES except for one item that loaded to another dimension. The CLES instrument in its adapted form had high construct validity and high reliability and internal consistency. Conclusion CLES, in its adapted form, appears

Hospital employment of physicians and supply chain performance: An empirical investigation.

Science.gov (United States)

Young, Gary J; Nyaga, Gilbert N; Zepeda, E David

2016-01-01

As hospital employment of physicians becomes increasingly common in the United States, much speculation exists as to whether this type of arrangement will promote hospital operating efficiency in such areas as supply chain management. Little empirical research has been conducted to address this question. The aim of this study was to provide an exploratory assessment of whether hospital employment of physicians is associated with better supply chain performance. Drawing from both agency and stewardship theories, we examined whether hospitals with a higher proportion of employed medical staff members have relatively better supply chain performance based on two performance measures, supply chain expenses and inventory costs. We conducted the study using a pooled, cross-sectional sample of hospitals located in California between 2007 and 2009. Key data sources were hospital annual financial reports from California's Office of Statewide Health Policy and Development and the American Hospital Association annual survey of hospitals. To examine the relationship between physician employment and supply chain performance, we specified physician employment as the proportion of total employed medical staff members as well as the proportion of employed medical staff members within key physician subgroups. We analyzed the data using generalized estimating equations. Study results generally supported our hypothesis that hospital employment of physicians is associated with better supply chain performance. Although the results of our study should be viewed as preliminary, the trend in the United States toward hospital employment of physicians may be a positive development for improved hospital operating efficiency. Hospital managers should also be attentive to training and educational resources that medical staff members may need to strengthen their role in supply chain activities.

Effects of Technological Innovation in Relationship between Green Supply Chain Management Practices and Green Performance

OpenAIRE

Umar, Mohammed Sangiru; Danjuma, Ibrahim; Hammawa, Dahiru Dauda; Habibu, Sherif Ahmed

2016-01-01

Although scholars have conceptualised on green supply chain management practices and green performance, evidence to validate the conceptualisation was lacking, albeit in the context of small and medium enterprises. In addition, effect of technological innovation on supply chain practices and green performance was largely unexplored by researchers. Therefore this study validates and provides empirical evidence on the relationship between green supply chain management practices, technological i...

Integrated Medical Model (IMM) Project Verification, Validation, and Credibility (VVandC)

Science.gov (United States)

Walton, M.; Boley, L.; Keenan, L.; Kerstman, E.; Shah, R.; Young, M.; Saile, L.; Garcia, Y.; Meyers, J.; Reyes, D.

2015-01-01

The Integrated Medical Model (IMM) Project supports end user requests by employing the Integrated Medical Evidence Database (iMED) and IMM tools as well as subject matter expertise within the Project. The iMED houses data used by the IMM. The IMM is designed to forecast relative changes for a specified set of crew health and mission success risk metrics by using a probabilistic model based on historical data, cohort data, and subject matter expert opinion. A stochastic approach is taken because deterministic results would not appropriately reflect the uncertainty in the IMM inputs. Once the IMM was conceptualized, a plan was needed to rigorously assess input information, framework and code, and output results of the IMM, and ensure that end user requests and requirements were considered during all stages of model development and implementation, as well as lay the foundation for external review and application. METHODS: In 2008, the Project team developed a comprehensive verification and validation (VV) plan, which specified internal and external review criteria encompassing 1) verification of data and IMM structure to ensure proper implementation of the IMM, 2) several validation techniques to confirm that the simulation capability of the IMM appropriately represents occurrences and consequences of medical conditions during space missions, and 3) credibility processes to develop user confidence in the information derived from the IMM. When the NASA-STD-7009 (7009) [1] was published, the Project team updated their verification, validation, and credibility (VVC) project plan to meet 7009 requirements and include 7009 tools in reporting VVC status of the IMM. Construction of these tools included meeting documentation and evidence requirements sufficient to meet external review success criteria. RESULTS: IMM Project VVC updates are compiled recurrently and include updates to the 7009 Compliance and Credibility matrices. Reporting tools have evolved over the lifetime of

The validity of student tutors' judgments in early detection of struggling in medical school. A prospective cohort study.

Science.gov (United States)

O'Neill, Lotte Dyhrberg; Morcke, Anne Mette; Eika, Berit

2016-12-01

Early identification and support of strugglers in medical education is generally recommended in the research literature, though very little evidence of the diagnostic qualities of early teacher judgments in medical education currently exists. The aim of this study was to examine the validity of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical students for signs of struggling. By week six, the student tutors were able to detect approximately 1/4-1/3 of the students who eventually failed or dropped out, and for ¾ of the strugglers they identified, they were correct in their judgments. Informal student tutor's judgements showed incremental validity for both outcomes when controlling for grades obtained in preceeding exams. Lack of participation, lack of commitment, poor academic performance, poor social interactions and general signs of distress were the main indicators of struggling identified. Teachers' informal judgements of in-class behavior may be an untapped source of information in the early identification of struggling medical students with added value above and beyond formal testing.

Differences in the validity of a visual estimation method for determining patients' meal intake between various meal types and supplied food items.

Science.gov (United States)

Kawasaki, Yui; Akamatsu, Rie; Tamaura, Yuki; Sakai, Masashi; Fujiwara, Keiko; Tsutsuura, Satomi

2018-02-12

The aim of this study was to examine differences in the validity of a visual estimation method for determining patients' meal intake between various meal types and supplied food items in hospitals and to find factors influencing the validity of a visual estimation method. There are two procedures by which we obtained the information on dietary intake of the patients in these hospitals. These are both by visual assessment from the meal trays at the time of their clearing, by the attending nursing staff and by weighing conducted by researchers. The following criteria are set for the target trays: A) standard or therapeutic meals, which are monitored by a doctor, for energy and/or protein and/or sodium; B) regular, bite-sized, minced and pureed meal texture, and C) half-portion meals. Visual assessment results were tested for their validity by comparing with the corresponding results of weighing. Differences between these two methods indicated the estimated and absolute values of nutrient intake. A total of 255 (76.1%) trays were included in the analysis out of the 335 possible trays and the results indicated that the energy consumption estimates by visual or weighing procedures are not significantly different (412 ± 173 kcal, p = 0.15). However, the mean protein consumption was significantly different (16.3 ± 6.7 g/tray, p food items were significantly misestimated for energy intake (66 ± 58 kcal/tray) compared to trays with no additions (32 ± 39 kcal/tray, p food items were significantly associated with increased odds of a difference between the two methods (OR: 3.84; 95% confidence interval [CI]: 1.07-13.85). There were high correlations between the visual estimation method and the weighing method measuring patients' dietary intake for various meal types and textures, except for meals with added supplied food items. Nursing staff need to be attentive to supplied food items. Copyright © 2018 Elsevier Ltd and European Society for Clinical

The Supply of Medical Radioisotopes. Medical Isotope Supply in the Future: Production Capacity and Demand. Forecast for the 99Mo/99mTc Market, 2015-2020

International Nuclear Information System (INIS)

Peykov, Pavel; Cameron, Ron

2014-04-01

This document presents a forecast of 99 Mo/ 99m Tc production capacity and demand in 2015-2020, when two major irradiators - the OSIRIS and NRU reactors in France and Canada - are expected to exit the global supply chain and new alternative technology projects may be commissioned. The forecast does not attempt to predict shortages, but identify periods when there is an increased risk of disrupted supply, to inform policy makers and other stakeholders. (authors)

Drug supply strategies, constraints and prospects in Nigeria.

Science.gov (United States)

Yusuff, K B; Tayo, F

2004-12-01

The study set out to identify the strategies for public drug supply in Nigeria, assess its functionality, and recommend appropriate means to ensure regular availability of safe, efficacious, good quality and affordable essential drugs at public health facilities. The investigation was carried out at the Directorate of Pharmaceutical services, Federal Ministry of Health (F.M.O.H) Abuja and Federal Medical Stores, Oshodi, Lagos. Semi-structured interview was conducted with key informants at the Department of Food & Drugs, Drug procurement unit and Central Medical store using structured questionnaires and direct informants answers. Our study shows that public drug supply in Nigeria is governed by a National Drug Policy (NDP) which was introduced in 1990 and it is yet to be reviewed after ten years. We also identified the Central Medical Store (CMS) system as the current public drug supply strategy in Nigeria. Public drug supply is mainly financed by governments and this is inadequate to ensure sustained availability of essential drugs. The major procurement methods in use are open tender and direct procurement. These methods as presently operated suffer from late order placement, delay in payment and poor supplier lead-time mainly attributable to lateness in payment for previous drug supplies. These have contributed to stock out of essential drugs at public health facilities. Major losses due to expiration and spoilage are recorded at both central and peripheral storage points despite adequacy of storage facilities and personnel. Road transportation was the major mode of drug distribution from central to peripheral storage points and shortage of vehicle was a key factor affecting drug distribution. There was an apparent lack of a functioning drug management information system to effectively coordinate public drug supply and there are no definite systems that monitor and evaluate staff performance. The CMS strategy currently used for public drug supply in Nigeria has

Requirements for a commercial-scale domestic Mo-99 supply

International Nuclear Information System (INIS)

Coats, R.

2009-01-01

This presentation describes the requirements for commercial-scale domestic Molybdenum-99 supply for the United States. It outlines the USA demand for Molybdenum-99 and the supply situation in the USA. Domestic supply ceased in the late 80s. The basic supply issues for USA are quantity, product quality, process control and logistics. It is proposed that the most viable solution to the chronic radionuclide supply problem faced by the USA medical community is the development of a domestic and dedicated single-purpose LEU- based reactor, collocated with a separation processing facility, and capable supplying 100-200% of U.S. demand for the principle clinical radionuclide, Molybdenum-99.

Development and validation of a generic questionnaire for the implementation of complex medical interventions

Directory of Open Access Journals (Sweden)

Kramer, Lena

2014-04-01

Full Text Available [english] Introduction: The implementation of complex medical interventions in daily practice is often fraught with difficulties. According to the iterative phase model proposed by the British Medical Research Council (MRC, the development, implementation and evaluation of complex interventions should be theory-driven. A conceptual model that seems to be a promising framework is the Theory of planned behaviour (TPB. In our study we aimed to develop and validate a generic and multifaceted questionnaire based on the TPB to detect physicians’ willingness to implement complex medical interventions and the factors influencing this willingness.Methods: The questionnaire was developed according to the literature and was informed by previous qualitative research of our department. It was validated on the example of an electronic library of decision aids, arriba-lib. The sample consisted of 181 General Practitioners (GPs who received a training regarding arriba-lib and subsequently filled in the questionnaire, assessing the TPB variables attitude, subjective norm, perceived behaviour control and intention. Follow-up assessments were conducted after two (assessing retest reliability and eight weeks (assessing target behaviour. We performed a confirmatory factor analysis investigating the factorial structure of our questionnaire according to the TPB. Beside the calculation of the questionnaire’s psychometric properties we conducted a structural equation model and an ordinal regression to predict actual behaviour regarding the installation and application of arriba-lib.Results: The postulated three factorial model (attitude, subjective norm, perceived behaviour control of our questionnaire based on the TPB was rejected. A two factorial model with a combined factor subjective norm/perceived behaviour control was accepted. The explained variance in the ordinal regression was low (Nagelkerke’s R=.12. Neither attitude nor intention were able to predict

Role and liabilities of the medical physicist in the validation of oncologic treatments in internal vectorized radiation therapy. S.F.P.M. report nr 31, June 2015

International Nuclear Information System (INIS)

Farman, Bardia; Defez, Didier; Martineau, Antoine; Vrigneaud, Jean-Marc; Dieudonne, Arnaud; Giraud, Fabienne; Divry, Guillaume; Bardies, Manuel; Laffont, Sophie; Santoro, Lore; Ferrer, Ludovic; Guilhem, Marie-Therese; Meyer, Philippe; Simon, Luc

2015-06-01

According to legal arrangements and decrees, the medical physicist must validate the preparation of each treatment based on the use of radio-elements in non-sealed sources. As the medical physicist is therefore liable of this validation, this report addresses the approach to be followed to comply with the law. The authors first outline that this report only concerns oncologic internal vectorized radiation therapy, and does not address the dosimetric aspect of these treatments. After having recalled the principles of internal vectorized radiography, they describe the role of the different actors: nuclear physician, medical physicist, radio-pharmacist, radio-pharmacy dispenser, medical electro-radiology operator, state nurse. They address the various aspects of the process of validation of a treatment preparation: technical prerequisites, organisational prerequisite, validation process, traceability, dosimetry. Several examples are proposed in appendix regarding traceability, dosimetry software, examples of PRM files

Dependence and power in healthcare equipment supply chains.

Science.gov (United States)

de Jong, Jurriaan L; Benton, W C

2018-03-05

Most healthcare organizations (HCOs) engage Group Purchasing Organizations (GPOs) as an outsourcing strategy to secure their supplies and materials. When an HCO outsources the procurement function to a GPO, this GPO will directly interact with the HCO's supplier on the HCO's behalf. This study investigates how an HCO's dependence on a GPO affects supply chain relationships and power in the healthcare medical equipment supply chain. Hypotheses are tested through factor analysis and structural equation modeling, using primary survey data from HCO procurement managers. An HCO's dependence on a GPO is found to be positively associated with a GPO's reliance on mediated power, but, surprisingly, negatively associated with a GPO's mediated power. Furthermore, analysis indicates that an HCO's dependence on a GPO is positively associated with an HCO's dependence on a GPO-contracted Original Equipment Manufacturer (OEM). HCO reliance on GPOs may lead to a buyer's dependence trap, where HCOs are increasingly dependent on GPOs and OEMs. Implications for HCO procurement managers and recommended steps for mitigation are offered. Power-dependence relationships in the medical equipment supply chain are not consistent with relationships in other, more traditional, supply chains. While dependence in a supply chain relationship typically leads to an increase in reliance on mediated power, GPO-dependent HCOs instead perceive a decrease in GPO mediated power. Furthermore, HCOs that rely on procurement service from GPOs are increasingly dependent on the OEMs.

The validity of student tutors’ judgments in early detection of struggling in medical school. A prospective cohort study

DEFF Research Database (Denmark)

O'Neill, Lotte; Mørcke, Anne Mette; Eika, Berit

2016-01-01

Early identification and support of strugglers in medical education is generally recommended in the research literature, though very little evidence of the diagnostic qualities of early teacher judgments in medical education currently exists. The aim of this study was to examine the validity...... of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted...... to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical...

Practical aspects during sterilization validation for medical devices at IRASM Microbiological Laboratory

International Nuclear Information System (INIS)

Trandafir, L.; Ene, M.; Alexandru, M.; Constantin, M.; Ionita, A.; Zorila, F.; Moise, I.V.

2011-01-01

Complete text of publication follows. The state of being free of living microorganisms is called sterility. The sterility state can be achieved by different means of sterilization. In practice the results of the process cannot be fully verified by tests, so the efficacy of the sterilization process must be validated. ISO 11137 established regulations for setting or substantiating the dose for achieving the desired sterility assurance level. The validation studies can be designed in particular for different types of product. Each product needs distinct protocol for bioburden determination and sterility testing. During time, the Microbiological Laboratories from Multipurpose Irradiation Center deals with different types of products, mainly for VD max 25 method. When it comes to microbiological evaluation the most challenging was cotton gauze. Special situation for establishing the sterilization validation method appears in cases of cotton, packed in large quantities. VD max 25 method can not be applied for items with average bioburden more than 1000 CFU / pack, no matter which is the weight of the package. This is a method limitation and implies increased costs for manufacturer, when choosing other method. For microbiological tests, culture condition should be selected in both cases the bioburden and sterility testing. These are time and money consuming. The costs can be reduced if taking into account some aspects. Reason for performing the bacteriostasis-fungistasis just for sterility testing will be given. The present study puts forward aspects during the validation studies for medical devices (cotton wool, cotton gauze, surgical sutures, dental screws), at IRASM Microbiological Laboratory.

The Transgenic RNAi Project at Harvard Medical School: Resources and Validation.

Science.gov (United States)

Perkins, Lizabeth A; Holderbaum, Laura; Tao, Rong; Hu, Yanhui; Sopko, Richelle; McCall, Kim; Yang-Zhou, Donghui; Flockhart, Ian; Binari, Richard; Shim, Hye-Seok; Miller, Audrey; Housden, Amy; Foos, Marianna; Randkelv, Sakara; Kelley, Colleen; Namgyal, Pema; Villalta, Christians; Liu, Lu-Ping; Jiang, Xia; Huan-Huan, Qiao; Wang, Xia; Fujiyama, Asao; Toyoda, Atsushi; Ayers, Kathleen; Blum, Allison; Czech, Benjamin; Neumuller, Ralph; Yan, Dong; Cavallaro, Amanda; Hibbard, Karen; Hall, Don; Cooley, Lynn; Hannon, Gregory J; Lehmann, Ruth; Parks, Annette; Mohr, Stephanie E; Ueda, Ryu; Kondo, Shu; Ni, Jian-Quan; Perrimon, Norbert

2015-11-01

To facilitate large-scale functional studies in Drosophila, the Drosophila Transgenic RNAi Project (TRiP) at Harvard Medical School (HMS) was established along with several goals: developing efficient vectors for RNAi that work in all tissues, generating a genome-scale collection of RNAi stocks with input from the community, distributing the lines as they are generated through existing stock centers, validating as many lines as possible using RT-qPCR and phenotypic analyses, and developing tools and web resources for identifying RNAi lines and retrieving existing information on their quality. With these goals in mind, here we describe in detail the various tools we developed and the status of the collection, which is currently composed of 11,491 lines and covering 71% of Drosophila genes. Data on the characterization of the lines either by RT-qPCR or phenotype is available on a dedicated website, the RNAi Stock Validation and Phenotypes Project (RSVP, http://www.flyrnai.org/RSVP.html), and stocks are available from three stock centers, the Bloomington Drosophila Stock Center (United States), National Institute of Genetics (Japan), and TsingHua Fly Center (China). Copyright © 2015 by the Genetics Society of America.

The Transgenic RNAi Project at Harvard Medical School: Resources and Validation

Science.gov (United States)

Perkins, Lizabeth A.; Holderbaum, Laura; Tao, Rong; Hu, Yanhui; Sopko, Richelle; McCall, Kim; Yang-Zhou, Donghui; Flockhart, Ian; Binari, Richard; Shim, Hye-Seok; Miller, Audrey; Housden, Amy; Foos, Marianna; Randkelv, Sakara; Kelley, Colleen; Namgyal, Pema; Villalta, Christians; Liu, Lu-Ping; Jiang, Xia; Huan-Huan, Qiao; Wang, Xia; Fujiyama, Asao; Toyoda, Atsushi; Ayers, Kathleen; Blum, Allison; Czech, Benjamin; Neumuller, Ralph; Yan, Dong; Cavallaro, Amanda; Hibbard, Karen; Hall, Don; Cooley, Lynn; Hannon, Gregory J.; Lehmann, Ruth; Parks, Annette; Mohr, Stephanie E.; Ueda, Ryu; Kondo, Shu; Ni, Jian-Quan; Perrimon, Norbert

2015-01-01

To facilitate large-scale functional studies in Drosophila, the Drosophila Transgenic RNAi Project (TRiP) at Harvard Medical School (HMS) was established along with several goals: developing efficient vectors for RNAi that work in all tissues, generating a genome-scale collection of RNAi stocks with input from the community, distributing the lines as they are generated through existing stock centers, validating as many lines as possible using RT–qPCR and phenotypic analyses, and developing tools and web resources for identifying RNAi lines and retrieving existing information on their quality. With these goals in mind, here we describe in detail the various tools we developed and the status of the collection, which is currently composed of 11,491 lines and covering 71% of Drosophila genes. Data on the characterization of the lines either by RT–qPCR or phenotype is available on a dedicated website, the RNAi Stock Validation and Phenotypes Project (RSVP, http://www.flyrnai.org/RSVP.html), and stocks are available from three stock centers, the Bloomington Drosophila Stock Center (United States), National Institute of Genetics (Japan), and TsingHua Fly Center (China). PMID:26320097

Validity of the Medication-based Disease Burden Index compared with the Charlson Comorbidity Index and the Cumulative Illness Rating Scale for geriatrics: a cohort study.

Science.gov (United States)

Beloosesky, Yichayaou; Weiss, Avraham; Mansur, Nariman

2011-12-01

Co-morbidity is common in older people. A co-morbidity index reduces coexisting illnesses and their severity to a single numerical score, allowing comparison with scores from other patients. Recently, the Medication-Based Disease Burden Index (MDBI) was developed. The aim of the study was to assess the MDBI's validity in hospitalized elderly patients. Clinical and demographic data and data on patients' medications on admission were obtained prospectively. Retrospectively, we applied the MDBI to the patients' medication regimens, determining their co-morbidity using the Charlson Comorbidity Index and Cumulative Illness Rating Scale for Geriatrics (CIRS-G). The MDBI's criterion validity was assessed against the Charlson and CIRS-G indices. Convergent and discriminant validities were also assessed. The MDBI's predictive validity was assessed by its ability to predict 3-month post-discharge readmissions or mortality compared with the Charlson and CIRS-G indices. MDBI scores were correlated with the Charlson and CIRS-G indices' scores (r = 0.44 and r = 0.37, respectively [p indices had good predictive ability for mortality (OR 1.50 [95% CI 1.22, 1.84; p failed to differentiate between cognitive and functional patient groups. The MDBI should be investigated in larger studies to determine its validity in settings where medication data rather than diagnostic data are more readily available. In clinical practice with elderly patients, we recommend employing co-morbidity indices that are based on medical records, such as the Charlson Comorbidity Index and CIRS-G.

Investigating the Supply Chain Strategies and Information System Strategies Alignment and its Effects on Supply Chain Management Performance (Case Study: Manufacturing Firms in Khuzestan Province, Iran

Directory of Open Access Journals (Sweden)

Belghis Bavarsad

2016-12-01

Full Text Available The purpose of the present study is to investigate the supply chain strategies and information system strategies alignment and the impact of these two strategies on supply chain management performance of manufacturing firms in Khuzestan province. The population of this applied research consisted of 1716 manufacturing firms and with using Cochran's formula for limited society, 231 firms were selected. Statistical unit of society were the purchasing / logistic managers of said firms and research questionnaire was distributed to them for each firm. The data collection instrument is Qrunfleh (2010 questionnaire, which its content validity was evaluated through experts and academics and its construct validity was confirmed through confirmatory factor analysis. Structural equation models and SPSS 22 have been used in order to analysis the data. The results showed that, all components of supply chain strategies (lean, agile and hybrid have a positive and significant impact on supply chain management performance and the moderate role of Information system strategies (efficient, flexible and comprehensive on supply chain management Performance also conformed.

Implementation of an integrated pharmacy supply management strategy.

Science.gov (United States)

Amerine, Lindsey B; Calvert, Daniel R; Pappas, Ashley L; Lee, Sarah M; Valgus, John M; Savage, Scott W

2017-12-15

Implementation of an integrated pharmacy supply management strategy is described. In 2011, the formulary approval process and supply management for oncology medications were independent of each other at an oncology infusion center. Numerous nonformulary medications were kept on hand and reordered based on inventory levels that were established with inadequate usage information, while some formulary agents did not have on-hand inventory levels and had to be reordered on a patient-specific basis, which required paperwork and then a review by drug information staff per institutional policy. Because there was no true distinction in the ordering of formulary versus nonformulary oncology agents, the medical staff prescribed both in the same manner, leaving the pharmacy staff responsible for ensuring that enough quantities were on hand for many drugs, regardless of formulary status. Using supply chain management principles, a formal analysis of the on-hand inventory was performed. In addition, the formulary process for oncology drugs was restructured to align with how oncology drugs are managed for on-hand inventory levels. The alignment of these processes allowed the operation to have 1 supply strategy for the ambulatory oncology infusion center. As a result, inventory exhaustion rates were reduced by 70% and inventory turn rates improved by 78%. There was also significant time savings in the operational process streamlining, eliminating the rework and inefficiencies caused by an unclear process that was not fully captured in this assessment. Alignment of the formulary review process with inventory analyses that support supply management principles reduced inventory exhaustion while improving inventory turn rates. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Community resiliency through recovery resource supply chain planning.

Science.gov (United States)

Franklin, Charlotte; Todt, Kiersten

2014-01-01

Information in this paper is the result of recommendations and remedies developed at 'Local Supply Chain Capacity in a Crisis Summit Exercise' held in Arlington, VA on 30th-31st January,2013. At the event, which was funded through the Regional Catastrophic Preparedness Grant Program, national private sector and not-for-profit essential resource provider experts in sectors such as transportation, communication systems, energy/power, financial resources, medical supplies and other vital supplies, together with emergency managers, discussed best practices, major challenges and exchanged remedy recommendations.

DME Prosthetics Orthotics, and Supplies Fee Schedule

Data.gov (United States)

U.S. Department of Health & Human Services — Durable Medical Equipment, Prosthetics-Orthotics, and Supplies Fee Schedule. The list contains the fee schedule amounts, floors, and ceilings for all procedure codes...

Provision of medical supply kits to improve quality of antenatal care in Mozambique: a stepped-wedge cluster randomised trial.

Science.gov (United States)

Betrán, Ana Pilar; Bergel, Eduardo; Griffin, Sally; Melo, Armando; Nguyen, My Huong; Carbonell, Alicia; Mondlane, Santos; Merialdi, Mario; Temmerman, Marleen; Gülmezoglu, A Metin

2018-01-01

High levels of maternal and newborn mortality and morbidity remain a daunting reality in many low-income countries. Several interventions delivered during antenatal care have been shown to improve maternal and newborn outcomes, but stockouts of medical supplies at point of care can prevent implementation of these services. We aimed to evaluate whether a supply chain strategy based on the provision of kits could improve quality of care. We did a pragmatic, stepped-wedge, cluster-randomised controlled trial at ten antenatal care clinics in Mozambique. Clinics were eligible if they were not already implementing the proposed antenatal care package; they served at least 200 new pregnant women per year; they had Maternal and Child Health (MCH) nurses; and they were willing to participate. All women attending antenatal care visits at the participating clinics were included in the trial. Participating clinics were randomly assigned to shift from control to intervention on prespecified start dates. The intervention involved four components (kits with medical supplies, a cupboard to store these supplies, a tracking sheet to monitor stocks, and a one-day training session). The primary outcomes were the proportion of women screened for anaemia and proteinuria, and the proportion of women who received mebendazole in the first antenatal care visit. The intervention was delivered under routine care conditions, and analyses were done according to the intention-to-treat principle. This trial is registered with the Pan African Clinical Trial Registry, number PACTR201306000550192. Between March, 2014, and January, 2016, 218 277 antenatal care visits were registered, with 68 598 first and 149 679 follow-up visits. We found significant improvements in all three primary outcomes. In first visits, 5519 (14·6%) of 37 826 women were screened for anaemia in the control period, compared with 30 057 (97·7%) of 30 772 in the intervention period (adjusted odds ratio 832·40; 99

Cross-cultural adaptation and validation of a European Portuguese version of the 8-item Morisky medication adherence scale.

Science.gov (United States)

Cabral, Ana C; Moura-Ramos, Mariana; Castel-Branco, Margarida; Fernandez-Llimos, Fernando; Figueiredo, Isabel V

2018-04-01

The 8-Item Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used instruments to assess medication adherence, but a validated European Portuguese version of MMAS-8 does not exist. Our aim was to develop and validate a European Portuguese version of the MMAS-8. A process of translation and back-translation of the original MMAS-8 was performed. The questionnaire was administered in nine community pharmacies and one public hospital between March 2014 and September 2015. Adult patients taking at least one antihypertensive drug were invited to participate. A confirmatory factor analysis was performed and internal consistency, convergent validity and concurrent validity were examined. A total of 472 patients were enrolled in the study. The mean MMAS-8 score obtained was 6.74±1.39. One hundred and thirty-two patients were classified as low adherers (28%), 181 (38.3%) as medium adherers and 159 (33.7%) as high adherers. For the factorial structure of the Portuguese version of the MMAS-8, the fit indices of the final model (chi-square [18] 48.465, pPortuguese version of the MMAS-8 was created that maintained a similar structure to the original MMAS-8 and good psychometric properties. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Using Healthcare Failure Mode and Effect Analysis to reduce medication errors in the process of drug prescription, validation and dispensing in hospitalised patients.

Science.gov (United States)

Vélez-Díaz-Pallarés, Manuel; Delgado-Silveira, Eva; Carretero-Accame, María Emilia; Bermejo-Vicedo, Teresa

2013-01-01

To identify actions to reduce medication errors in the process of drug prescription, validation and dispensing, and to evaluate the impact of their implementation. A Health Care Failure Mode and Effect Analysis (HFMEA) was supported by a before-and-after medication error study to measure the actual impact on error rate after the implementation of corrective actions in the process of drug prescription, validation and dispensing in wards equipped with computerised physician order entry (CPOE) and unit-dose distribution system (788 beds out of 1080) in a Spanish university hospital. The error study was carried out by two observers who reviewed medication orders on a daily basis to register prescription errors by physicians and validation errors by pharmacists. Drugs dispensed in the unit-dose trolleys were reviewed for dispensing errors. Error rates were expressed as the number of errors for each process divided by the total opportunities for error in that process times 100. A reduction in prescription errors was achieved by providing training for prescribers on CPOE, updating prescription procedures, improving clinical decision support and automating the software connection to the hospital census (relative risk reduction (RRR), 22.0%; 95% CI 12.1% to 31.8%). Validation errors were reduced after optimising time spent in educating pharmacy residents on patient safety, developing standardised validation procedures and improving aspects of the software's database (RRR, 19.4%; 95% CI 2.3% to 36.5%). Two actions reduced dispensing errors: reorganising the process of filling trolleys and drawing up a protocol for drug pharmacy checking before delivery (RRR, 38.5%; 95% CI 14.1% to 62.9%). HFMEA facilitated the identification of actions aimed at reducing medication errors in a healthcare setting, as the implementation of several of these led to a reduction in errors in the process of drug prescription, validation and dispensing.

[A medical consumable material management information system].

Science.gov (United States)

Tang, Guoping; Hu, Liang

2014-05-01

Medical consumables material is essential supplies to carry out medical work, which has a wide range of varieties and a large amount of usage. How to manage it feasibly and efficiently that has been a topic of concern to everyone. This article discussed about how to design a medical consumable material management information system that has a set of standardized processes, bring together medical supplies administrator, suppliers and clinical departments. Advanced management mode, enterprise resource planning (ERP) applied to the whole system design process.

Physician Brain Drain from Sub-Saharan Africa: Exploring the Utility of an Eco-psychopolitical Validity Framework for Medical Migration Research

Directory of Open Access Journals (Sweden)

Benjamin Siankam

2011-11-01

Full Text Available In-depth understanding of any critical social issue requires investigators to use analytical tools that reflect the complexity of the social issue of interest. Toward this aim, I examine the medical brain drain from Sub-Saharan Africa to the United States through the lens of the eco-psychopolitical validity model (see, Christen and Perkins, 2008; Prilleltensky, 2008, an integrative approach that stresses the combined influences of structural factors, individual agency, and power at play in human dynamics and social systems. By adapting the eco-psychopolitical validity model to the study of medical skilled migration, I construe migration as a liberating venture articulated around the triadic process of oppression, empowerment, and wellness. If migrants yearn to breathe free, then émigré physicians are essentially in pursuit of liberation and wellbeing. However, in a world of profound health disparities, where the increasing emigration of medical doctors from resource-constrained countries ultimately leads to loss of lives in the communities left behind, migrant doctors´ individual agency and the multilevel contexts that enable or constrain them to emigrate require critical reflection. Some emerging themes and variations of an ongoing qualitative study are examined using the eco-psychopolitical validity paradigm.

Medical chart validation of an algorithm for identifying multiple sclerosis relapse in healthcare claims.

Science.gov (United States)

Chastek, Benjamin J; Oleen-Burkey, Merrikay; Lopez-Bresnahan, Maria V

2010-01-01

Relapse is a common measure of disease activity in relapsing-remitting multiple sclerosis (MS). The objective of this study was to test the content validity of an operational algorithm for detecting relapse in claims data. A claims-based relapse detection algorithm was tested by comparing its detection rate over a 1-year period with relapses identified based on medical chart review. According to the algorithm, MS patients in a US healthcare claims database who had either (1) a primary claim for MS during hospitalization or (2) a corticosteroid claim following a MS-related outpatient visit were designated as having a relapse. Patient charts were examined for explicit indication of relapse or care suggestive of relapse. Positive and negative predictive values were calculated. Medical charts were reviewed for 300 MS patients, half of whom had a relapse according to the algorithm. The claims-based criteria correctly classified 67.3% of patients with relapses (positive predictive value) and 70.0% of patients without relapses (negative predictive value; kappa 0.373: p value of the operational algorithm. Limitations of the algorithm include lack of differentiation between relapsing-remitting MS and other types, and that it does not incorporate measures of function and disability. The claims-based algorithm appeared to successfully detect moderate-to-severe MS relapse. This validated definition can be applied to future claims-based MS studies.

Relationship Between Attention-Deficit/Hyperactivity Disorder Care and Medication Continuity.

Science.gov (United States)

Brinkman, William B; Baum, Rebecca; Kelleher, Kelly J; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua; Epstein, Jeffery N

2016-04-01

To describe the relationships between attention-deficit/hyperactivity disorder (ADHD) care practices and subsequent medication use. A retrospective cohort from a random sample of medical records in 50 pediatric practices with 188 providers, including 1,352 children who started ADHD medication, was studied. Independent variables included physician behaviors related to medication titration and monitoring of treatment response. Primary outcomes were number of days covered with ADHD medication during the first year of treatment and time from starting medicine to the first 30-day gap in medication supply. Multilevel modeling and Cox proportional hazards regression models were conducted. Children had an average medication supply of 217 days in the first year. Half experienced a 30-day gap in medication supply in the first 3 months. Nearly three-fourths had a medication adjustment in the first year with the first adjustment usually being a dosage change. The average time to the first medication adjustment was over 3 months. Physician's first contact with parents occurred in the first month of treatment for less than half, with the average time being over 2 months. Little variation related to ADHD care quality was accounted for at the physician level. Early titration and early contact were related to greater medication supply and continuity of treatment. Earlier physician-delivered ADHD care (e.g., contact with parent after starting medication and medication adjustment) is related to greater medication supply and continuity. It remains to be determined whether interventions that improve the quality of titration and monitoring practices for children with ADHD would also improve medication continuity. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

[Ethic review on clinical experiments of medical devices in medical institutions].

Science.gov (United States)

Shuai, Wanjun; Chao, Yong; Wang, Ning; Xu, Shining

2011-07-01

Clinical experiments are always used to evaluate the safety and validity of medical devices. The experiments have two types of clinical trying and testing. Ethic review must be done by the ethics committee of the medical department with the qualification of clinical research, and the approval must be made before the experiments. In order to ensure the safety and validity of clinical experiments of medical devices in medical institutions, the contents, process and approval criterions of the ethic review were analyzed and discussed.

Validation of metabolic syndrome using medical records in the SUN cohort

Directory of Open Access Journals (Sweden)

Barrio-Lopez Maria

2011-11-01

Full Text Available Abstract Background The objective of this study was to evaluate the validity of self reported criteria of Metabolic Syndrome (MS in the SUN (Seguimiento Universidad de Navarra cohort using their medical records as the gold standard. Methods We selected 336 participants and we obtained MS related data according to Adult Treatment Panel III (ATP III and International Diabetes Federation (IDF. Then we compared information on the self reported diagnosis of MS and MS diagnosed in their medical records. We calculated the proportion of confirmed MS, the proportion of confirmed non-MS and the intraclass correlation coefficients for each component of the MS. Results From those 336 selected participants, we obtained sufficient data in 172 participants to confirm or reject MS using ATP III criteria. The proportion of confirmed MS was 91.2% (95% CI: 80.7- 97.1 and the proportion of confirmed non-MS was 92.2% (95% CI: 85.7-96.4 using ATP III criteria. The proportion of confirmed MS using IDF criteria was 100% (95% CI: 87.2-100 and the proportion of confirmed non-MS was 97.1% (95% CI: 85.1-99.9. Kappa Index was 0.82 in the group diagnosed by ATP III criteria and 0.97 in the group diagnosed by IDF criteria. Intraclass correlation coefficients for the different component of MS were: 0.93 (IC 95%:0.91- 0.95 for BMI; 0.96 (IC 95%: 0.93-0.98 for waist circumference; 0.75 (IC 95%: 0.66-0.82 for fasting glucose; 0.50 (IC 95%:0.35-0.639 for HDL cholesterol; 0.78 (IC 95%: 0.70-0.84 for triglycerides; 0.49 (IC 95%:0.34-0.61 for systolic blood pressure and 0.55 (IC 95%: 0.41-0.65 for diastolic blood pressure. Conclusions Self-reported MS based on self reported components of the SM in a Spanish cohort of university graduates was sufficiently valid as to be used in epidemiological studies.

Planning the bioterrorism response supply chain: learn and live.

Science.gov (United States)

Brandeau, Margaret L; Hutton, David W; Owens, Douglas K; Bravata, Dena M

2007-01-01

Responses to bioterrorism require rapid procurement and distribution of medical and pharmaceutical supplies, trained personnel, and information. Thus, they present significant logistical challenges. On the basis of a review of the manufacturing and service supply chain literature, the authors identified five supply chain strategies that can potentially increase the speed of response to a bioterrorism attack, reduce inventories, and save money: effective supply chain network design; effective inventory management; postponement of product customization and modularization of component parts; coordination of supply chain stakeholders and appropriate use of incentives; and effective information management. The authors describe how concepts learned from published evaluations of manufacturing and service supply chains, as well as lessons learned from responses to natural disasters, naturally occurring outbreaks, and the 2001 US anthrax attacks, can be applied to design, evaluate, and improve the bioterrorism response supply chain. Such lessons could also be applied to the response supply chains for disease outbreaks and natural and manmade disasters.

European Union's efforts to sustain the supply of 99Mo

International Nuclear Information System (INIS)

Remigiusz Baranczyk; Stamatios Tsalas; Turquet de Beauregard, G.Y.

2015-01-01

The Molybdenum-99/Technetium-99m ( 99 Mo/ 99m Tc) supply disruptions occurred in the recent years prompted the European Commission and industry to establish in 2012 a European Observatory on the Supply of Medical Radioisotopes, aimed at bringing together all relevant information to the decision makers in the European Union (EU) institutions and national governments in order to assist them in defining strategies as well as policies for their implementation. The Observatory follows the Organisation for Economic Co-operation and Development/Nuclear Energy Agency-OECD/NEA principles established by the High Level Group on the Security of Supply of Medical Radioisotopes (HLG-MR), of which the European Commission is a Member, and focuses on the specificities of their implementation in the EU, recognizing at the same time that the supply is of a global nature and requires broader international cooperation. The Observatory has four general strategic objectives: to support a secure 99 Mo/ 99m Tc supply across the European Union, ensure that the issue of 99 Mo/ 99m Tc supply is given high political visibility, encourage the creation of a sustainable economic structure of the supply chain and establish periodic reviews of the supply capacities and demand. (author)

Risk management in technovigilance: construction and validation of a medical-hospital product evaluation instrument.

Science.gov (United States)

Kuwabara, Cleuza Catsue Takeda; Evora, Yolanda Dora Martinez; de Oliveira, Márcio Mattos Borges

2010-01-01

With the continuous incorporation of health technologies, hospital risk management should be implemented to systemize the monitoring of adverse effects, performing actions to control and eliminate their damage. As part of these actions, Technovigilance is active in the procedures of acquisition, use and quality control of health products and equipment. This study aimed to construct and validate an instrument to evaluate medical-hospital products. This is a quantitative, exploratory, longitudinal and methodological development study, based on the Six Sigma quality management model, which has as its principle basis the component stages of the DMAIC Cycle. For data collection and content validation, the Delphi technique was used with professionals from the Brazilian Sentinel Hospital Network. It was concluded that the instrument developed permitted the evaluation of the product, differentiating between the results of the tested brands, in line with the initial study goal of qualifying the evaluations performed.

Validity of self-reported periodontal measures, demographic characteristics and systemic medical conditions.

Science.gov (United States)

Chatzopoulos, Georgios S; Cisneros, Alejandro; Sanchez, Miguel; Lunos, Scott; Wolff, Larry F

2018-04-06

The objective of the present study was to assess self-reported periodontal screening questions, demographic characteristics, systemic medical conditions and tobacco use for predicting periodontal disease among individuals seeking dental therapy in a university dental clinic. In this retrospective study, a total of 4,890 randomly selected dental charts were evaluated from among patients who had attended the University of Minnesota School of Dentistry clinics for treatment. Radiographic bone loss measurements were utilized to assess the severity of periodontal disease. Demographic characteristics as well as medical history of the patients were also recorded. Five self-reported periodontal screening questions were included with the range of answers limited to Yes/No. Generalized logit models were used to assess the association between bone loss and the predictors. The sample mean age was 54.1 years and included 52.6% males and 14.9% smokers with a mean number of missing teeth of 3.5. Self-reported tooth mobility, history of "gum treatment" and the importance to keep the teeth as well as age, tobacco use and cancer were statistically significant (p brushing", gender, diabetes, anxiety and arthritis. Self-reported periodontal screening questions as well as demographic characteristics, smoking and systemic medical conditions were significant predictors of periodontal disease and they could be used as valid, economical and practical measures. This article is protected by copyright. All rights reserved. © 2018 American Academy of Periodontology.

Validation of Autoclave Protocols for Successful Decontamination of Category A Medical Waste Generated from Care of Patients with Serious Communicable Diseases.

Science.gov (United States)

Garibaldi, Brian T; Reimers, Mallory; Ernst, Neysa; Bova, Gregory; Nowakowski, Elaine; Bukowski, James; Ellis, Brandon C; Smith, Chris; Sauer, Lauren; Dionne, Kim; Carroll, Karen C; Maragakis, Lisa L; Parrish, Nicole M

2017-02-01

In response to the Ebola outbreak in 2014, many hospitals designated specific areas to care for patients with Ebola and other highly infectious diseases. The safe handling of category A infectious substances is a unique challenge in this environment. One solution is on-site waste treatment with a steam sterilizer or autoclave. The Johns Hopkins Hospital (JHH) installed two pass-through autoclaves in its biocontainment unit (BCU). The JHH BCU and The Johns Hopkins biosafety level 3 (BSL-3) clinical microbiology laboratory designed and validated waste-handling protocols with simulated patient trash to ensure adequate sterilization. The results of the validation process revealed that autoclave factory default settings are potentially ineffective for certain types of medical waste and highlighted the critical role of waste packaging in successful sterilization. The lessons learned from the JHH validation process can inform the design of waste management protocols to ensure effective treatment of highly infectious medical waste. Copyright © 2017 American Society for Microbiology.

Research on Effective Supply Mode of Rural Public Goods

Institute of Scientific and Technical Information of China (English)

2011-01-01

On the basis of definition and classification of rural public goods, this paper analyses the status quo of public goods supply in vast rural areas of China, and it indicates that the electricity and communication facility in rural areas have not yet been popularized; the culture and education facility is critically backward; the medical care and social warfare institutions are short. It points out the rational supply model of public goods as follows: the government plays dominant role in the public goods supply with a large amount of investments, related to the quality of living and production of multitudinous farmers; small wieldy quasi-public goods that can be easily supplied and marginalized public goods can introduce multiplex supply main body under the framework of government guidance. According to this model, corresponding policy suggestions are put forward as follows: increase financial inputs, and perfect local financial system; actively encourage the majority of farmers in rural areas to participate in public goods supply mechanism, so that the supply has pertinence; vigorously develop multiplex supply system of rural public goods, to ensure effective supply.

Medical impact analysis for the space station.

Science.gov (United States)

Nelson, B D; Gardner, R M; Ostler, D V; Schulz, J M; Logan, J S

1990-02-01

Since the Space Station Health Maintenance Facility can house only a relatively limited quantity of supplies and equipment, the decisions about what should be included must be based on documented research. In this study, Space Station medical care priorities were determined by a medical impact analysis of two analog populations, U.S. Army and U.S. Navy personnel. Diseases and injuries in the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) were ranked, using a Medical Impact Score (MIS) combining modified incidence rate and a function of disease outcome. The validity of the analysis method was tested by measuring rank order correlation between the two analog populations. Despite virtually identical age and sex distributions, Army and Navy incidence rates differed significantly for half of the ICD-9-CM categories, p less than 0.05. Disability rates differed for 76%, p less than 0.05. Nevertheless, Army and Navy MIS rank orders for categories and sections were not significantly different, p less than 0.001. In critical ways, the Space Station will be a safer environment than Earth. Cardiac events, musculoskeletal injuries, affective psychoses, and renal calculi were among the highest scoring categories.

Highly-stabilized power supply for synchrotron accelerators. High speed, low ripple power supply

Energy Technology Data Exchange (ETDEWEB)

Sato, Kenji [Osaka Univ., Ibaraki (Japan). Research Center for Nuclear Physics; Kumada, Masayuki; Fukami, Kenji; Koseki, Shoichiro; Kubo, Hiroshi; Kanazawa, Toru

1997-02-01

In synchrotron accelerators, in order to utilize high energy beam effectively, those are operated by repeating acceleration and taking-out at short period. In order to accelerate by maintaining beam track stable, the tracking performance with the error less than 10{sup -3} in the follow-up of current is required for the power supply. Further, in order to maintain the intensity and uniformity of beam when it is taken out, very low ripple is required for output current. The power supply having such characteristics has been developed, and applied to the HIMAC and the SPring-8. As the examples of the application of synchrotrons, the accelerators for medical treatment and the generation of synchrotron radiation are described. As to the power supply for the deflection magnets and quadrupole magnets of synchrotron accelerators, the specifications of the main power supply, the method of reducing ripple, the method of improving tracking, and active filter control are reported. As to the test results, the measurement of current ripple and tracking error is shown. The lowering of ripple was enabled by common mode filter and the symmetrical connection of electromagnets, and high speed response was realized by the compensation for delay with active filter. (K.I.)

Reliability and Validity of Survey Instruments to Measure Work-Related Fatigue in the Emergency Medical Services Setting: A Systematic Review

Science.gov (United States)

2018-01-11

Background: This study sought to systematically search the literature to identify reliable and valid survey instruments for fatigue measurement in the Emergency Medical Services (EMS) occupational setting. Methods: A systematic review study design wa...

Supply/Demand in Radiology: A Historical Perspective and Comparison to other Labor Markets.

Science.gov (United States)

Sharafinski, Mark E; Nussbaum, David; Jha, Saurabh

2016-02-01

There has been attention on the job market recently and on radiology's supply/demand calculus. Supply is influenced by the number of trained radiologists, while demand is driven by demographics and technological innovation. We analyze the supply of radiologists historically and compare to other labor markets-medical and non-medical, domestic and foreign. We review National Resident Matching Program data in radiology and several other specialties from 1991 to 2015. We also review surveys, physician recruitment data, and peer-reviewed commentaries on medical specialty job markets. Trends are compared across specialties. The regulation of American medical training is compared to that in the United Kingdom and to a nonmedical labor market, unionized theatrical stage employees. Radiology residency positions have increased since 1998 despite a downturn in the job market. This expansion coincides with a decreasing percentage of positions filled by domestic graduates. A similar trend has been seen in pathology, a notoriously oversupplied specialty. Conversely, other specialties have maintained their proportion of domestic graduates by way of limited supply or implicit demand. The radiology job market is currently oversupplied, primarily a result of increasing residency positions despite indicators of decreasing demand. The percentage of residency positions filled by domestic graduates has decreased during the same period, suggesting that medical student interest is responsive to the market. Other specialties, particularly pathology, demonstrate the dangers of chronic oversupply. We advocate a reduction of radiology residency positions such that supply closely approximates demand without exceeding it. Additional measures may be taken, if necessary, to restore market equilibrium in the event of a mild undersupply. Copyright © 2015 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Air Force Supply Management Analysis of Activity Groups Financial Reports, Prices, and Cash Management

National Research Council Canada - National Science Library

1998-01-01

The Air Force supply management activity group provides about two million types of inventory items, including weapon system spare parts, fuels, and medical-dental supplies, to customers which consist...

How valid are commercially available medical simulators?

NARCIS (Netherlands)

Stunt, J.J.; Wulms, P.H.; Kerkhoffs, G.M.; Dankelman, J.; Van Dijk, C.N.; Tuijthof, G.J.M.

2014-01-01

Background: Since simulators offer important advantages, they are increasingly used in medical education and medical skills training that require physical actions. A wide variety of simulators have become commercially available. It is of high importance that evidence is provided that training on

Specificity of the tomography implementation in electric arc domain - Validity in medical imaging

International Nuclear Information System (INIS)

Benech, Julie

2008-01-01

The aim of these works was to implement a new experimental method to characterize 3D thermal plasmas by emission spectroscopy. The method used is based on tomographic technique which is widely used in medical imaging nowadays. However, tomography that we have developed and applied to electric arc is specific as the number of accessible projections angles is strongly limited: 4 projections our case against basically 64 in medical imaging. The particularity of our experimental tomographic system is that measurements are resolved both spectrally and spatially. The spectral resolution is necessary to determine the temperature values from method based on atomic line intensity. The spatial resolution is needed to simultaneously acquire the whole width of the plasma and so to reconstruct a whole cross-section in only one acquisition. One of the principal objective was to realize the experimental system of four-view tomography for thermal plasmas. Thanks to this device, we showed that the characterization of non-axisymmetric plasma is possible and that it enables to reconstruct 3D temperature maps. Finally, our tomographic method is applied with medical imaging data acquired in SPECT (Single Photon Emission Computed Tomography). These tests allowed validating the use of our tomographic reconstruction technique in SPECT, particularly the used iterative algebraic algorithm and the limited-view configuration. (author) [fr

Medical-isotope supply hit by production problems

Science.gov (United States)

Gould, Paula

2008-10-01

A shortfall in the production of medical isotopes in Europe has forced hospitals to delay patient scans or offer alternative diagnostic tests. The problems began in August when all three nuclear reactors used to generate molybdenum-99, which then decays to form the key nuclear-imaging agent technetium-99, had to be unexpectedly shut down at the same time.

Petroleum and Health Care: Evaluating and Managing Health Care's Vulnerability to Petroleum Supply Shifts

Science.gov (United States)

Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica

2011-01-01

Petroleum is used widely in health care—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services. PMID:21778473

Evaluation of performance metrics of leagile supply chain through fuzzy MCDM

Directory of Open Access Journals (Sweden)

D. Venkata Ramana

2013-07-01

Full Text Available Leagile supply chain management has emerged as a proactive approach for improving business value of companies. The companies that face volatile and unpredictable market demand of their products must pioneer in leagile supply chain strategy for competition and various demands of customers. There are literally many approaches for performance metrics of supply chain in general, yet little investigation has identified the reliability and validity of such approaches particularly in leagile supply chains. This study examines the consistency approaches by confirmatory factor analysis that determines the adoption of performance dimensions. The prioritization of performance enablers under these dimensions of leagile supply chain in small and medium enterprises are determined through fuzzy logarithmic least square method (LLSM. The study developed a generic hierarchy model for decision-makers who can prioritize the supply chain metrics under performance dimensions of leagile supply chain.

Validity of Simulation-Based Assessment for Accreditation Council for Graduate Medical Education Milestone Achievement.

Science.gov (United States)

Isaak, Robert S; Chen, Fei; Martinelli, Susan M; Arora, Harendra; Zvara, David A; Hobbs, Gene; Stiegler, Marjorie P

2018-01-25

The Accreditation Council for Graduate Medical Education requires biannual evaluation of anesthesiology residents on 25 subcompetency milestones. Some milestone domains are particularly challenging to repeatedly and reliably observe during clinical care. Simulation-Based Milestones Assessment (SBMA) may help overcome these challenges. However, few studies have examined the external validation of simulation assessment scores (ie, the relationships between simulation-based assessment scores and other standard measures of ability) for milestones. This study analyzed whether SBMA scores (1) discriminate by postgraduate year, (2) improve over time, and (3) correlate with traditional measures of performance. This is a retrospective analysis of 55 residents' SBMA data from 30 scenarios for two academic years. Each scenario was evaluated for time-in-training discrimination. Scenarios were then analyzed for SBMA scoring trends over time, and SBMA scores were compared with residents' clinical evaluations. Twenty-four SBMA scenarios discriminated by postgraduate year. Repeated measure analysis of variance showed statistically significant between-session score improvements (F (3, 54) = 17.79, P Medical Education milestone competencies.

Aeromedical Hazard Comparison of FAA Medically Certified Third-Class and Medically Uncertified Pilots.

Science.gov (United States)

Ricaurte, Eduard M; Mills, William D; DeJohn, Charles A; Laverde-Lopez, Maria C; Porras-Sanchez, Daniel F

2016-07-01

Since 2004, in the United States, light sport aircraft (LSA) and some aircraft with standard airworthiness certificates can be operated for recreational purposes with a valid state driver's license rather than a Federal Aviation Administration (FAA)-issued aeromedical certificate. There have been recent efforts to allow operation of much larger, heavier, faster, and more complex aircraft without requiring a medical certificate. The primary objective of this research was to compare hazards to flight safety identified in fatally injured pilots required to possess a valid FAA third-class medical certificate to hazards in fatally injured pilots who were not required to possess a valid medical certificate. A search of all fatal U.S. aircraft accidents in the FAA Medical ANalysis and TRAcking (MANTRA) registry between January 1, 2011, and April 30, 2014, identified 1084 individuals. A review of accident pilots' medical, autopsy, and toxicological data was conducted. After applying exclusion criteria, 467 pilots remained, including 403 medically certified and 64 medically uncertified pilots. A significant difference was found in a surrogate measure for risk between medically certified and uncertified pilots (25% vs. 59%). This difference remained significant after adjustment for age. No significant difference was found in the proportions of hazards identified on toxicological review. The results of this study suggest that the risk of an adverse medical event is reduced in pilots required to possess a valid medical certificate. Ricaurte EM, Mills WD, DeJohn CA, Laverde-Lopez MC, Porras-Sanchez DF. Aeromedical hazard comparison of FAA medically certified third-class and medically uncertified pilots. Aerosp Med Hum Perform. 2016; 87(7):618-621.

The Malaysian Medication Adherence Scale (MALMAS): Concurrent Validity Using a Clinical Measure among People with Type 2 Diabetes in Malaysia

OpenAIRE

Chung, Wen Wei; Chua, Siew Siang; Lai, Pauline Siew Mei; Morisky, Donald E.

2015-01-01

Medication non-adherence is a prevalent problem worldwide but up to today, no gold standard is available to assess such behavior. This study was to evaluate the psychometric properties, particularly the concurrent validity of the English version of the Malaysian Medication Adherence Scale (MALMAS) among people with type 2 diabetes in Malaysia. Individuals with type 2 diabetes, aged 21 years and above, using at least one anti-diabetes agent and could communicate in English were recruited. The ...

Validation of an improved abnormality insertion method for medical image perception investigations

Science.gov (United States)

Madsen, Mark T.; Durst, Gregory R.; Caldwell, Robert T.; Schartz, Kevin M.; Thompson, Brad H.; Berbaum, Kevin S.

2009-02-01

The ability to insert abnormalities in clinical tomographic images makes image perception studies with medical images practical. We describe a new insertion technique and its experimental validation that uses complementary image masks to select an abnormality from a library and place it at a desired location. The method was validated using a 4-alternative forced-choice experiment. For each case, four quadrants were simultaneously displayed consisting of 5 consecutive frames of a chest CT with a pulmonary nodule. One quadrant was unaltered, while the other 3 had the nodule from the unaltered quadrant artificially inserted. 26 different sets were generated and repeated with order scrambling for a total of 52 cases. The cases were viewed by radiology staff and residents who ranked each quadrant by realistic appearance. On average, the observers were able to correctly identify the unaltered quadrant in 42% of cases, and identify the unaltered quadrant both times it appeared in 25% of cases. Consensus, defined by a majority of readers, correctly identified the unaltered quadrant in only 29% of 52 cases. For repeats, the consensus observer successfully identified the unaltered quadrant only once. We conclude that the insertion method can be used to reliably place abnormalities in perception experiments.

Low fertility awareness in United States reproductive-aged women and medical trainees: creation and validation of the Fertility & Infertility Treatment Knowledge Score (FIT-KS).

Science.gov (United States)

Kudesia, Rashmi; Chernyak, Elizabeth; McAvey, Beth

2017-10-01

To create, validate, and use a fertility awareness survey based on current U.S. Cross-sectional study. Not applicable. Phase 1 included U.S. women ages 18-45; phase 2 included female medical students and obstetrics and gynecology trainees at two urban academic programs. Survey including demographics, the Fertility & Infertility Treatment Knowledge Score (FIT-KS) instrument, and General Nutrition Knowledge Questionnaire. Knowledge of natural fertility and infertility treatments. The FIT-KS was validated through detailed item and validity analyses. In phase 1, 127 women participated; their median age was 31 years, and 43.7% had children. Their mean FIT-KS score was 16.2 ± 3.5 (55.9% correct). In phase 2, 118 medical trainees participated; their median age was 25 years, and 12.4% had children. Their mean FIT-KS score was 18.8 ± 2.1 (64.9% correct), with year of training correlating to a higher score (r=0.40). Participant awareness regarding lifestyle factors varied, but it was particularly low regarding the effects of lubricants. The majority underestimated the spontaneous miscarriage rate and overestimated the fecundability of 40-year-old women. There was general overestimation of success rates for assisted reproductive technologies, particularly among medical trainees. The FIT-KS is validated to current U.S. data for use in both general and medical populations as a quick assessment of fertility knowledge. The knowledge gaps demonstrated in this study correlate with national trends in delayed childbearing and time to initiate treatment. For medical trainees, these results raise concerns about the quality of fertility counseling they may be able to offer patients. Greater educational outreach must be undertaken to enhance fertility awareness. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Factorial Invariance and Convergent Validity of the Group-Based Medical Mistrust Scale across Gender and Ethnoracial Identity.

Science.gov (United States)

Wheldon, Christopher W; Kolar, Stephanie K; Hernandez, Natalie D; Daley, Ellen M

2017-01-01

The objective of this study was to assess the factorial invariance and convergent validity of the Group-Based Medical Mistrust Scale (GBMMS) across gender (male and female) and ethnoracial identity (Latino and Black). Minority students (N = 686) attending a southeastern university were surveyed in the fall of 2011. Psychometric analysis of the GBMMS was performed. A three-factor solution fit the data after the omission of two problematic items. This revised version of the GBMMS exhibited sufficient configural, metric, and scalar invariance. Convergence of the GBMMS with conceptually related measures provided further evidence of validity; however, there was variation across ethnoracial identity. The GBMMS has viable psychometric properties across gender and ethnoracial identity in Black and Latino populations.

Tax revenue and innovations in natural gas supply: New Mexico

International Nuclear Information System (INIS)

Ulibarri, C.A.; Marsh, T.L.

1994-10-01

This paper develops an econometric model of natural gas supply at the state-level using New Mexico as a case study. The supply model is estimated using annual time series observations on production levels, delivered prices, proved reserves, existing wells, and extraction costs. The authors validate the model against historical data and then use it to consider the fiscal impacts on state tax revenue from innovations in extraction technologies

Development and Validation of a Short-Form Safety Net Medical Home Scale.

Science.gov (United States)

Nocon, Robert S; Gunter, Kathryn E; Gao, Yue; Lee, Sang Mee; Chin, Marshall H

2017-12-01

To develop a short-form Safety Net Medical Home Scale (SNMHS) for assessing patient-centered medical home (PCMH) capability in safety net clinics. National surveys of federally qualified health centers (FQHCs). Interviews with FQHC directors. We constructed three short-form SNMHS versions and examined correlations with full SNMHS and related primary care assessments. We tested usability with FQHC directors and reviewed scale development with an advisory group. Federally qualified health center surveys were administered in 2009 and 2013, by mail and online. Usability testing was conducted through telephone interviews with FQHC directors in 2013. Six-, 12-, and 18-question short-form SNMHS versions had Pearson correlations with full scale of 0.84, 0.92, and 0.96, respectively. All versions showed a level of convergent validity with other primary care assessment scales comparable to the full SNMHS. User testers found short forms to be low-burden, though missing some PCMH concepts. Advisory group members expressed caution over missing concepts and appropriate use of short-form self-assessments. Short-form versions of SNMHS showed strong correlations with full scale and may be useful for brief assessment of safety net PCMH capability. Each short-form SNMHS version may be appropriate for different research, quality improvement, and assessment purposes. © Health Research and Educational Trust.

Problems in clinical practice of domestic supply of 99Mo/99mTc. Current status and action plans on domestic production of 99Mo raw materials for medical use

International Nuclear Information System (INIS)

Nakamura, Yoshihide

2012-01-01

NRU in Canada and HFR in the Netherlands which had been producing the most important medical isotope, 99 Mo, were shut down in 2009-2010. As the production of more than 95% of global 99 Mo supply were performed in only five research reactors in the world including the two reactors mentioned above, these shutdowns resulted in global supply shortage of 99 Mo. Although the medical isotope crisis were alleviated after the two reactors returning to service, all of these five 99 Mo producing reactors are approximately 50 years old. Because the remaining life time of these reactors is not so long, the construction of new reactors or the development of new technologies to produce bulk 99 Mo, such as the neutron activation of 98 Mo in a reactor or charged particle reaction by accelerator, are proposed for the long-term security of supply of 99 Mo. The methods using the molybdenum target lead to much lower specific activity of 99 Mo compared to the production with fission method. The new chemical processing technologies, such as manufacturing 99m Tc-labeled radiopharmaceuticals from such low specific activity 99 Mo, are required for the development of domestic practical production of 99 Mo. (author)

Dimensionality and predictive validity of the HAM-Nat, a test of natural sciences for medical school admission.

Science.gov (United States)

Hissbach, Johanna C; Klusmann, Dietrich; Hampe, Wolfgang

2011-10-14

Knowledge in natural sciences generally predicts study performance in the first two years of the medical curriculum. In order to reduce delay and dropout in the preclinical years, Hamburg Medical School decided to develop a natural science test (HAM-Nat) for student selection. In the present study, two different approaches to scale construction are presented: a unidimensional scale and a scale composed of three subject specific dimensions. Their psychometric properties and relations to academic success are compared. 334 first year medical students of the 2006 cohort responded to 52 multiple choice items from biology, physics, and chemistry. For the construction of scales we generated two random subsamples, one for development and one for validation. In the development sample, unidimensional item sets were extracted from the item pool by means of weighted least squares (WLS) factor analysis, and subsequently fitted to the Rasch model. In the validation sample, the scales were subjected to confirmatory factor analysis and, again, Rasch modelling. The outcome measure was academic success after two years. Although the correlational structure within the item set is weak, a unidimensional scale could be fitted to the Rasch model. However, psychometric properties of this scale deteriorated in the validation sample. A model with three highly correlated subject specific factors performed better. All summary scales predicted academic success with an odds ratio of about 2.0. Prediction was independent of high school grades and there was a slight tendency for prediction to be better in females than in males. A model separating biology, physics, and chemistry into different Rasch scales seems to be more suitable for item bank development than a unidimensional model, even when these scales are highly correlated and enter into a global score. When such a combination scale is used to select the upper quartile of applicants, the proportion of successful completion of the curriculum

Dimensionality and predictive validity of the HAM-Nat, a test of natural sciences for medical school admission

Directory of Open Access Journals (Sweden)

Hissbach Johanna C

2011-10-01

Full Text Available Abstract Background Knowledge in natural sciences generally predicts study performance in the first two years of the medical curriculum. In order to reduce delay and dropout in the preclinical years, Hamburg Medical School decided to develop a natural science test (HAM-Nat for student selection. In the present study, two different approaches to scale construction are presented: a unidimensional scale and a scale composed of three subject specific dimensions. Their psychometric properties and relations to academic success are compared. Methods 334 first year medical students of the 2006 cohort responded to 52 multiple choice items from biology, physics, and chemistry. For the construction of scales we generated two random subsamples, one for development and one for validation. In the development sample, unidimensional item sets were extracted from the item pool by means of weighted least squares (WLS factor analysis, and subsequently fitted to the Rasch model. In the validation sample, the scales were subjected to confirmatory factor analysis and, again, Rasch modelling. The outcome measure was academic success after two years. Results Although the correlational structure within the item set is weak, a unidimensional scale could be fitted to the Rasch model. However, psychometric properties of this scale deteriorated in the validation sample. A model with three highly correlated subject specific factors performed better. All summary scales predicted academic success with an odds ratio of about 2.0. Prediction was independent of high school grades and there was a slight tendency for prediction to be better in females than in males. Conclusions A model separating biology, physics, and chemistry into different Rasch scales seems to be more suitable for item bank development than a unidimensional model, even when these scales are highly correlated and enter into a global score. When such a combination scale is used to select the upper quartile of

From patient care to research: a validation study examining the factors contributing to data quality in a primary care electronic medical record database.

Science.gov (United States)

Coleman, Nathan; Halas, Gayle; Peeler, William; Casaclang, Natalie; Williamson, Tyler; Katz, Alan

2015-02-05

Electronic Medical Records (EMRs) are increasingly used in the provision of primary care and have been compiled into databases which can be utilized for surveillance, research and informing practice. The primary purpose of these records is for the provision of individual patient care; validation and examination of underlying limitations is crucial for use for research and data quality improvement. This study examines and describes the validity of chronic disease case definition algorithms and factors affecting data quality in a primary care EMR database. A retrospective chart audit of an age stratified random sample was used to validate and examine diagnostic algorithms applied to EMR data from the Manitoba Primary Care Research Network (MaPCReN), part of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). The presence of diabetes, hypertension, depression, osteoarthritis and chronic obstructive pulmonary disease (COPD) was determined by review of the medical record and compared to algorithm identified cases to identify discrepancies and describe the underlying contributing factors. The algorithm for diabetes had high sensitivity, specificity and positive predictive value (PPV) with all scores being over 90%. Specificities of the algorithms were greater than 90% for all conditions except for hypertension at 79.2%. The largest deficits in algorithm performance included poor PPV for COPD at 36.7% and limited sensitivity for COPD, depression and osteoarthritis at 72.0%, 73.3% and 63.2% respectively. Main sources of discrepancy included missing coding, alternative coding, inappropriate diagnosis detection based on medications used for alternate indications, inappropriate exclusion due to comorbidity and loss of data. Comparison to medical chart review shows that at MaPCReN the CPCSSN case finding algorithms are valid with a few limitations. This study provides the basis for the validated data to be utilized for research and informs users of its

Tradução e validação para o português do Medication Regimen Complexity Index Translation and validation into portuguese Language of the Medication Regimen Complexity Index

Directory of Open Access Journals (Sweden)

Ana Carolina Melchiors

2007-10-01

Full Text Available FUNDAMENTO: A complexidade da farmacoterapia consiste de múltiplas características do regime prescrito, incluindo o número de diferentes medicações no esquema, o número de unidades de dosagem por dose, o número total de doses por dia e os cuidados na administração dos medicamentos. O Medication Regimen Complexity Index (MRCI é um instrumento específico, validado e utilizado para medir a complexidade da farmacoterapia, desenvolvido originalmente em língua inglesa. OBJETIVO: Tradução transcultural e validação desse instrumento para o português do Brasil. MÉTODOS: Foi desenvolvido um estudo transversal envolvendo 95 pacientes com diabete do tipo 2 utilizando múltiplas medicações. O processo de validação teve início pela tradução, retrotradução e pré-teste do instrumento, gerando uma versão adaptada chamada Índice de Complexidade da Farmacoterapia (ICFT. Em seguida foram analisados parâmetros psicométricos, incluindo validade convergente, validade divergente, confiabilidade entre avaliadores e teste-reteste. RESULTADOS: A complexidade da farmacoterapia medida pelo ICFT obteve média de 15,7 pontos (desvio padrão = 8,36. O ICFT mostrou correlação significativa com o número de medicamentos em uso (r = 0,86; p BACKGROUND: The complexity of pharmacotherapy is a result of a multiplicity of prescribed regimen factors, including the number of different drugs in the regimen, the number of dosage units per dose, the total number of prescribed doses per day and administration instructions. The Medication Regimen Complexity Index (MRCI is a specific, reliable and valid tool used to measure the complexity of pharmacotherapy, originally developed in English language. OBJECTIVE: Transcultural translation and validation of this tool into Brazilian Portuguese. METHODS: A cross-sectional study was developed with 95 type-2 diabetes patients, receiving multiple medications. The validation process included translation into

Amphenicols stability in medicated feed – development and validation of liquid chromatography method

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Pietro Wojciech Jerzy

2014-12-01

Full Text Available A liquid chromatography-ultraviolet detection method for the determination of florfenicol (FF and thiamphenicol (TAP in feeds is presented. The method comprises the extraction of analytes from the matrix with a mixture of methanol and acetonitrile, drying of the extract, and its dissolution in phosphate buffer. The analysis was performed with a gradient programme of the mobile phase composed of acetonitrile and buffer (pH = 7.3 on a Zorbax Eclipse Plus C18 (150 × 4.6 mm, 5 μm analytical column with UV (λ = 220 nm detection. The analytical procedure has been successfully adopted and validated for quantitative determination of florfenicol and thiamphenicol in feed samples. Sensitivity, specificity, linearity, repeatability, and intralaboratory reproducibility were included in the validation. The mean recovery of amphenicols was 93.5% within the working range of 50-4000 mg/kg. Simultaneous determination of chloramphenicol, which is banned in the feed, was also included within the same procedure of FF and TAP stability studies. Storing the medicated feed at room temperature for up to one month decreased concentration in the investigated drugs even by 45%. These findings are relevant to successful provision of therapy to animals.

Validation of a scenario-based assessment of critical thinking using an externally validated tool.

Science.gov (United States)

Buur, Jennifer L; Schmidt, Peggy; Smylie, Dean; Irizarry, Kris; Crocker, Carlos; Tyler, John; Barr, Margaret

2012-01-01

With medical education transitioning from knowledge-based curricula to competency-based curricula, critical thinking skills have emerged as a major competency. While there are validated external instruments for assessing critical thinking, many educators have created their own custom assessments of critical thinking. However, the face validity of these assessments has not been challenged. The purpose of this study was to compare results from a custom assessment of critical thinking with the results from a validated external instrument of critical thinking. Students from the College of Veterinary Medicine at Western University of Health Sciences were administered a custom assessment of critical thinking (ACT) examination and the externally validated instrument, California Critical Thinking Skills Test (CCTST), in the spring of 2011. Total scores and sub-scores from each exam were analyzed for significant correlations using Pearson correlation coefficients. Significant correlations between ACT Blooms 2 and deductive reasoning and total ACT score and deductive reasoning were demonstrated with correlation coefficients of 0.24 and 0.22, respectively. No other statistically significant correlations were found. The lack of significant correlation between the two examinations illustrates the need in medical education to externally validate internal custom assessments. Ultimately, the development and validation of custom assessments of non-knowledge-based competencies will produce higher quality medical professionals.

Tracking and Monitoring of Radioactive Materials in the Commercial Hazardous Materials Supply Chain

International Nuclear Information System (INIS)

Walker, Randy M.; Kopsick, Deborah A; Warren, Tracy A; Abercrombie, Robert K.; Sheldon, Frederick T; Hill, David E.; Gross, Ian G; Smith, Cyrus M.

2007-01-01

One of the main components of the Environmental Protection Agency's (EPA) Clean Materials Program is to prevent the loss of radioactive materials through the use of tracking technologies. If a source is inadvertently lost or purposely abandoned or stolen, it is critical that the source be recovered before harm to the public or the environment occurs. Radio frequency identification (RFID) tagging on radioactive sources is a technology that can be operated in the active or passive mode, has a variety of frequencies available allowing for flexibility in use, is able to transmit detailed data and is discreet. The purpose of the joint DOE and EPA Radiological Source Tracking and Monitoring (RadSTraM) project is to evaluate the viability, effectiveness and scalability of RFID technology under a variety of transportation scenarios. The goal of the Phase II was to continue testing integrated RFID tag systems from various vendors for feasibility in tracking radioactive sealed sources which included the following performance objectives: 1. Validate the performance of RFID intelligent systems to monitor express air shipments of medical radioisotopes in the nationwide supply chain, 2. Quantify the reliability of these tracking systems with regards to probability of tag detection and operational reliability, 3. Determine if the implementation of these systems improves manpower effectiveness, and 4. Demonstrate that RFID tracking and monitoring of radioactive materials is ready for large scale deployment at the National level. For purposes of analysis, the test scenario employed in this study utilized the real world commerce supply chain process for radioactive medical isotopes to validate the performance of intelligent RFID tags. Three different RFID systems were assessed from a shipping and packaging perspective, included varied environmental conditions, varied commodities on board vehicles, temporary staging in shipping terminals using various commodities and normal

Increasing Medical Trainees’ Empathy Through Volunteerism and Mentorship

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Kathleen Bronson Dussán

2017-11-01

Full Text Available Background: Within medical education, there have been recent calls for increased understanding and exposure to poverty to increase trainees’ empathy toward the underserved. Students participating in Michigan Cardiovascular Outcomes Research and Reporting Program research program volunteered at World Medical Relief (WMR in Detroit, Michigan, a nonprofit organization which recycles medical equipment for developing countries and within greater Detroit. Participants’ perceptions of the underserved were measured before and after the experience. Methods: Preliminary questionnaires were given to participants prior to and after exposures at WMR. Questionnaires examined participants’ attitudes toward the underserved, knowledge of medical supply reuse, and their perceived ability to impact change. P values of 4× more likely than previously to have knowledge of the variety of recycled medical supplies at WMR. Prior to volunteering, 48.7% of participants gave little thought to how excess medical supplies could be collected versus 0% after exposure. Participants were 1.5× more likely to agree that the experience was enhanced working with their peers and 2.7× more likely to consider starting their own organization/intervention for medical supply donations. Those participants that never previously volunteered were 1.3× more likely to do so with encouragement from a mentor. Conclusions: Encouraging exposure to such service programs resulted in enhanced knowledge of community resources and increased motivation to participate in outreach and belief of individual responsibility to care for the underserved. Incorporating volunteerism into traditional education programs offers the opportunity to build awareness and interest in students reaching out to the underserved.

Transient Wave Scattering and Its Influence on Transient Analysis and Leak Detection in Urban Water Supply Systems: Theoretical Analysis and Numerical Validation

Directory of Open Access Journals (Sweden)

Huan-Feng Duan

2017-10-01

Full Text Available This paper investigates the impacts of non-uniformities of pipe diameter (i.e., an inhomogeneous cross-sectional area along pipelines on transient wave behavior and propagation in water supply pipelines. The multi-scale wave perturbation method is firstly used to derive analytical solutions for the amplitude evolution of transient pressure wave propagation in pipelines, considering regular and random variations of cross-sectional area, respectively. The analytical analysis is based on the one-dimensional (1D transient wave equation for pipe flow. Both derived results show that transient waves can be attenuated and scattered significantly along the longitudinal direction of the pipeline due to the regular and random non-uniformities of pipe diameter. The obtained analytical results are then validated by extensive 1D numerical simulations under different incident wave and non-uniform pipe conditions. The comparative results indicate that the derived analytical solutions are applicable and useful to describe the wave scattering effect in complex pipeline systems. Finally, the practical implications and influence of wave scattering effects on transient flow analysis and transient-based leak detection in urban water supply systems are discussed in the paper.

The economics of improving medication adherence in osteoporosis: validation and application of a simulation model.

Science.gov (United States)

Patrick, Amanda R; Schousboe, John T; Losina, Elena; Solomon, Daniel H

2011-09-01

Adherence to osteoporosis treatment is low. Although new therapies and behavioral interventions may improve medication adherence, questions are likely to arise regarding their cost-effectiveness. Our objectives were to develop and validate a model to simulate the clinical outcomes and costs arising from various osteoporosis medication adherence patterns among women initiating bisphosphonate treatment and to estimate the cost-effectiveness of a hypothetical intervention to improve medication adherence. We constructed a computer simulation using estimates of fracture rates, bisphosphonate treatment effects, costs, and utilities for health states drawn from the published literature. Probabilities of transitioning on and off treatment were estimated from administrative claims data. Patients were women initiating bisphosphonate therapy from the general community. We evaluated a hypothetical behavioral intervention to improve medication adherence. Changes in 10-yr fracture rates and incremental cost-effectiveness ratios were evaluated. A hypothetical intervention with a one-time cost of $250 and reducing bisphosphonate discontinuation by 30% had an incremental cost-effectiveness ratio (ICER) of $29,571 per quality-adjusted life year in 65-yr-old women initiating bisphosphonates. Although the ICER depended on patient age, intervention effectiveness, and intervention cost, the ICERs were less than $50,000 per quality-adjusted life year for the majority of intervention cost and effectiveness scenarios evaluated. Results were sensitive to bisphosphonate cost and effectiveness and assumptions about the rate at which intervention and treatment effects decline over time. Our results suggests that behavioral interventions to improve osteoporosis medication adherence will likely have favorable ICERs if their efficacy can be sustained.

Recent trends in the dispensing of 90-day-supply prescriptions at retail pharmacies: implications for improved convenience and access.

Science.gov (United States)

Liberman, Joshua N; Girdish, Charmaine

2011-03-01

Mail-service pharmacies offer consumers the convenience of prescriptions filled with a 90-day supply of medication. Unlike mail-service pharmacies, retail pharmacies traditionally dispensed maintenance medication prescriptions with a 30-day supply. However, the retail landscape changed in May 2008 with Walmart's announcement of an extension of its $4 Prescription Program to include 90-day-supply prescriptions. To evaluate recent changes in access to and use of 90-day-supply maintenance medications dispensed via retail pharmacy. As of the first quarter of 2007, the proportion of retail-dispensed maintenance medications with a 90-day supply (compared with all maintenance prescriptions dispensed) among Medicare Part D plans, self-insured employers, and private health plans was 5.1%, 5.1%, and 5.0%, respectively. As of December 2009, this ratio had risen to 8.0% for Medicare plans and 8.1% for commercial health plans; the ratio among employers had risen more modestly to 6.1%. Of particular interest and importance, the proportion increased similarly for brand and for generic medications. There has been substantial growth in 90-day prescriptions dispensed via retail pharmacy, a trend that is likely to continue as more insurance providers adopt compatible benefit designs. It is important to continue monitoring these trends and to identify opportunities to rigorously evaluate their impact on medication adherence and healthcare costs.

Influence of Japan's 2004 postgraduate training on ophthalmologist location choice, supply and distribution.

Science.gov (United States)

Sakai-Bizmark, Rie; Goto, Rei; Hiragi, Shusuke; Tamura, Hiroshi

2018-03-27

Highly-competent patient care is paramount to medicine. Quality training and patient accessibility to physicians with a wide range of specializations is essential. Yet, poor quality of life for physicians cannot be ignored, being detrimental to patient care and leading to personnel leaving the medical profession. In 2004, the Japanese government reformed postgraduate training for medical graduates, adding a 2-year, hands-on rotation through different specialties before the specialization residency was begun. Residents could now choose practice location, but it sparked concerns that physician distribution disparities had been created. Japanese media reported that residents were choosing specialties deemed to offer a higher quality of life, like Ophthalmology or Dermatology, over underserved areas like Obstetrics or Cardiology. To explore the consequences of Japan's policy efforts, through the residency reform in 2004, to improve physician training, analyzing ophthalmologist supply and distribution in the context of providing the best possible patient care and access while maintaining physician quality of life. Using secondary data, we analyzed changes in ophthalmologist supply at the secondary tier of medical care (STM). We applied ordinary least-squares regression models to ophthalmologist density to reflect community factors such as residential quality and access to further professional development, to serve as predictors of ophthalmologist supply. Coefficient equality tests examined predictor differences before and after 2004. Similar analyses were conducted for all physicians excluding ophthalmologists (other physicians). Ophthalmologist coverage in top and bottom 10% of STMs revealed supply inequalities. Change in ophthalmologist supply was inversely associated with baseline ophthalmologist density before (P supply were not associated with baseline other physician density before 2004 (P = 0.5), but positively associated after 2004 (P supply in STMs were

Development of the microbiological control aspects of radiation sterilization of medical supplies. Part of a coordinated programme on radiation sterilization of medical and biological products

International Nuclear Information System (INIS)

Horakova, V.

1978-06-01

The variability and extent of microbial contamination of such medical supplies as hydrophilic gauze swabs and dermo-epidermal grafts were investigated. Gross bacterial contamination was observed in the swabs, with a relative absence of water. It was concluded that medical disposable products under dried aerobic conditions can be sterilized by a minimum dose of 25 kJ/kg/2.5 Mrad if the mean value of pre-sterilization bacterial counts does not exceed 100. Products contaminated by 10,000 or more bacteria prior to sterilization must be considered ''decontaminated'' after irradiation but as rather than ''sterile'', as accepted pharmaceutically. The author recommends that the efficacy of the sterilization dose used be evaluated, assuming the decrease in contaminated items to follow the exponential law, with constants estimated as n=1.98 and k=0.44, and that the sterilization process to be controlled dosimetrically. In general, sub-process doses should be used before actual sterilization by ionizing radiation, in order to estimate the constants characterizing the decrease in contamination under given conditions. In skin grafts a dose of 25 kJ/kg was found to give a high guarantee of sterility. A minimum sterilizing dose of 20 kJ/kg was recommended, provided the mean value of microorganisms on 1 cm 2 of the disinfected and freeze-dried skin grafts from human cadavres was 100, without exceeding an upper limit of 130

Coordinating Supply Chain Distribution in the Presence of Production Disruption Risks

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Xuanguo Xu

2010-09-01

Full Text Available With the impacts of unexpected events, production processes of supply chain system may be forced to interrupt in a certain period, which may decrease the supply capacity of manufacturer to its retailers. This paper discusses methods to distribute the limited stock in case the production disruptions occur. To ascertain a reasonable replenish sequence and quantity after the production disruption, a production disruption-oriented supply chain distribution model is offered, which can be used to minimize the negative impact of production disruption to supply chain system. And then a constraint satisfaction optimization method is established to resolve the model. Finally, validity of the model is verified with an actual application in an air-conditioner factory in China.

The Impact of Money Supply Volatility on the Fisher Effect –A Botswana Empirical Perspective

OpenAIRE

Bosupeng, Mpho; Biza-Khupe, Simangaliso

2015-01-01

To the extent that these authors have been able to determine, existing literature on the Fisher Effect has only attempted to vary methodological approaches to test for the existence and validity of the Fisher hypothesis. It is the objective of this paper to expand on the literature by determining the degree of influence of money supply changes on the validity and existence of the Fisher Effect. The study examines interest rates and money supply quantities in Botswana from 1989 to 2013 and use...

Evaluation of the Cardiac Depression Visual Analogue Scale in a medical and non-medical sample.

Science.gov (United States)

Di Benedetto, Mirella; Sheehan, Matthew

2014-01-01

Comorbid depression and medical illness is associated with a number of adverse health outcomes such as lower medication adherence and higher rates of subsequent mortality. Reliable and valid psychological measures capable of detecting a range of depressive symptoms found in medical settings are needed. The Cardiac Depression Visual Analogue Scale (CDVAS) is a recently developed, brief six-item measure originally designed to assess the range and severity of depressive symptoms within a cardiac population. The current study aimed to further investigate the psychometric properties of the CDVAS in a general and medical sample. The sample consisted of 117 participants, whose mean age was 40.0 years (SD = 19.0, range 18-84). Participants completed the CDVAS, the Cardiac Depression Scale (CDS), the Depression Anxiety Stress Scales (DASS) and a demographic and health questionnaire. The CDVAS was found to have adequate internal reliability (α = .76), strong concurrent validity with the CDS (r = .89) and the depression sub-scale of the DASS (r = .70), strong discriminant validity and strong predictive validity. The principal components analysis revealed that the CDVAS measured only one component, providing further support for the construct validity of the scale. Results of the current study indicate that the CDVAS is a short, simple, valid and reliable measure of depressive symptoms suitable for use in a general and medical sample.

Demand and supply of doctors and dentists in Bahrain, 1998-2005.

Science.gov (United States)

Ahmed, A A; Fateha, B; Benjamin, S

2000-01-01

We examined the supply and demand of medical doctors and dentists in Bahrain. Demand for physicians and dentists was based on the objective of having a physician-to-population ratio of 1:650, and a dentist-to-population ratio of 1:5000. Analysis of the current workforce and projected graduates in the period 1998-2005 indicated that the supply of Bahraini medical doctors and dentists until the year 2005 will not be sufficient to meet the projected demand in these categories. By the year 2005, Bahraini doctors and dentists will provide 82.5% and 75.9% of medical and dental demands respectively. The remaining 17.2% of physicians and 24.1% of dentists will have to be recruited from abroad. Thus, the prospect of oversupply of Bahrainis among these categories until the year 2005 is highly unlikely.

22 CFR 71.10 - Emergency medical assistance.

Science.gov (United States)

2010-04-01

...) Preventive or protective medications and medical supplies and equipment (vaccinations, inoculations, etc... effort to contact the ill or injured prisoner as soon as possible; (2) Take steps to obtain a...

[Research of regional medical consumables reagent logistics system in the modern hospital].

Science.gov (United States)

Wu, Jingjiong; Zhang, Yanwen; Luo, Xiaochen; Zhang, Qing; Zhu, Jianxin

2013-09-01

To explore the modern hospital and regional medical consumable reagents logistics system management. The characteristics of regional logistics, through cooperation between medical institutions within the region, and organize a wide range of special logistics activities, to make reasonable of the regional medical consumable reagents logistics. To set the regional management system, dynamic management systems, supply chain information management system, after-sales service system and assessment system. By the research of existing medical market and medical resources, to establish the regional medical supplies reagents directory and the initial data. The emphasis is centralized dispatch of medical supplies reagents, to introduce qualified logistics company for dispatching, to improve the modern hospital management efficiency, to costs down. Regional medical center and regional community health service centers constitute a regional logistics network, the introduction of medical consumable reagents logistics services, fully embodies integrity level, relevance, purpose, environmental adaptability of characteristics by the medical consumable reagents regional logistics distribution. Modern logistics distribution systems can increase the area of medical consumables reagent management efficiency and reduce costs.

Network evolution model for supply chain with manufactures as the core

Science.gov (United States)

Jiang, Dali; Fang, Ling; Yang, Jian; Li, Wu; Zhao, Jing

2018-01-01

Building evolution model of supply chain networks could be helpful to understand its development law. However, specific characteristics and attributes of real supply chains are often neglected in existing evolution models. This work proposes a new evolution model of supply chain with manufactures as the core, based on external market demand and internal competition-cooperation. The evolution model assumes the external market environment is relatively stable, considers several factors, including specific topology of supply chain, external market demand, ecological growth and flow conservation. The simulation results suggest that the networks evolved by our model have similar structures as real supply chains. Meanwhile, the influences of external market demand and internal competition-cooperation to network evolution are analyzed. Additionally, 38 benchmark data sets are applied to validate the rationality of our evolution model, in which, nine manufacturing supply chains match the features of the networks constructed by our model. PMID:29370201

Network evolution model for supply chain with manufactures as the core.

Science.gov (United States)

Fang, Haiyang; Jiang, Dali; Yang, Tinghong; Fang, Ling; Yang, Jian; Li, Wu; Zhao, Jing

2018-01-01

Building evolution model of supply chain networks could be helpful to understand its development law. However, specific characteristics and attributes of real supply chains are often neglected in existing evolution models. This work proposes a new evolution model of supply chain with manufactures as the core, based on external market demand and internal competition-cooperation. The evolution model assumes the external market environment is relatively stable, considers several factors, including specific topology of supply chain, external market demand, ecological growth and flow conservation. The simulation results suggest that the networks evolved by our model have similar structures as real supply chains. Meanwhile, the influences of external market demand and internal competition-cooperation to network evolution are analyzed. Additionally, 38 benchmark data sets are applied to validate the rationality of our evolution model, in which, nine manufacturing supply chains match the features of the networks constructed by our model.

Network evolution model for supply chain with manufactures as the core.

Directory of Open Access Journals (Sweden)

Haiyang Fang

Full Text Available Building evolution model of supply chain networks could be helpful to understand its development law. However, specific characteristics and attributes of real supply chains are often neglected in existing evolution models. This work proposes a new evolution model of supply chain with manufactures as the core, based on external market demand and internal competition-cooperation. The evolution model assumes the external market environment is relatively stable, considers several factors, including specific topology of supply chain, external market demand, ecological growth and flow conservation. The simulation results suggest that the networks evolved by our model have similar structures as real supply chains. Meanwhile, the influences of external market demand and internal competition-cooperation to network evolution are analyzed. Additionally, 38 benchmark data sets are applied to validate the rationality of our evolution model, in which, nine manufacturing supply chains match the features of the networks constructed by our model.

New tools for systematic evaluation of teaching qualities of medical faculty: results of an ongoing multi-center survey.

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Onyebuchi A Arah

Full Text Available Tools for the evaluation, improvement and promotion of the teaching excellence of faculty remain elusive in residency settings. This study investigates (i the reliability and validity of the data yielded by using two new instruments for evaluating the teaching qualities of medical faculty, (ii the instruments' potential for differentiating between faculty, and (iii the number of residents' evaluations needed per faculty to reliably use the instruments.Multicenter cross-sectional survey among 546 residents and 629 medical faculty representing 29 medical (non-surgical specialty training programs in The Netherlands. Two instruments--one completed by residents and one by faculty--for measuring teaching qualities of faculty were developed. Statistical analyses included factor analysis, reliability and validity exploration using standard psychometric methods, calculation of the numbers of residents' evaluations needed per faculty to achieve reliable assessments and variance components and threshold analyses.A total of 403 (73.8% residents completed 3575 evaluations of 570 medical faculty while 494 (78.5% faculty self-evaluated. In both instruments five composite-scales of faculty teaching qualities were detected with high internal consistency and reliability: learning climate (Cronbach's alpha of 0.85 for residents' instrument, 0.71 for self-evaluation instrument, professional attitude and behavior (0.84/0.75, communication of goals (0.90/0.84, evaluation of residents (0.91/0.81, and feedback (0.91/0.85. Faculty tended to evaluate themselves higher than did the residents. Up to a third of the total variance in various teaching qualities can be attributed to between-faculty differences. Some seven residents' evaluations per faculty are needed for assessments to attain a reliability level of 0.90.The instruments for evaluating teaching qualities of medical faculty appear to yield reliable and valid data. They are feasible for use in medical residencies

New tools for systematic evaluation of teaching qualities of medical faculty: results of an ongoing multi-center survey.

Science.gov (United States)

Arah, Onyebuchi A; Hoekstra, Joost B L; Bos, Albert P; Lombarts, Kiki M J M H

2011-01-01

Tools for the evaluation, improvement and promotion of the teaching excellence of faculty remain elusive in residency settings. This study investigates (i) the reliability and validity of the data yielded by using two new instruments for evaluating the teaching qualities of medical faculty, (ii) the instruments' potential for differentiating between faculty, and (iii) the number of residents' evaluations needed per faculty to reliably use the instruments. Multicenter cross-sectional survey among 546 residents and 629 medical faculty representing 29 medical (non-surgical) specialty training programs in The Netherlands. Two instruments--one completed by residents and one by faculty--for measuring teaching qualities of faculty were developed. Statistical analyses included factor analysis, reliability and validity exploration using standard psychometric methods, calculation of the numbers of residents' evaluations needed per faculty to achieve reliable assessments and variance components and threshold analyses. A total of 403 (73.8%) residents completed 3575 evaluations of 570 medical faculty while 494 (78.5%) faculty self-evaluated. In both instruments five composite-scales of faculty teaching qualities were detected with high internal consistency and reliability: learning climate (Cronbach's alpha of 0.85 for residents' instrument, 0.71 for self-evaluation instrument, professional attitude and behavior (0.84/0.75), communication of goals (0.90/0.84), evaluation of residents (0.91/0.81), and feedback (0.91/0.85). Faculty tended to evaluate themselves higher than did the residents. Up to a third of the total variance in various teaching qualities can be attributed to between-faculty differences. Some seven residents' evaluations per faculty are needed for assessments to attain a reliability level of 0.90. The instruments for evaluating teaching qualities of medical faculty appear to yield reliable and valid data. They are feasible for use in medical residencies, can

Comparison of Three Supply Distribution Systems for Medical and Surgical Supplies in the Veterans Administration Sierra Pacific Network

Science.gov (United States)

2011-12-01

supplies are checked for expiration dates and inspected to ensure the packaging is not damaged, wet, or soiled . The type and quantity of items is...creating value in a global business enviroment . (9th ed.). New York, NY: McGraw-Hill/Irwin. Nathan, J., & Trinkaus, J. (1996). Improving health care

Cytogenetics in medical practice | Nelson | South African Medical ...

African Journals Online (AJOL)

A cytogenetics and tissue culture laboratory is an essential component of a medical genetics department. Chromosome analysis provides a definite answer in many cases where clinical diagnosis is in doubt, and supplies information on which counselling may be based. Cultured cells from different body tissues may be the ...

Manufacturers’ Closed-Loop Orientation for Green Supply Chain Management

Directory of Open Access Journals (Sweden)

Shumin Liu

2017-02-01

Full Text Available The concept of green supply chain management (GSCM is still in its infancy and has been implemented only to a limited extent. Strategic orientation is an important factor affecting its implementation. No reliable and valid strategic orientation construct has been developed for greening a supply chain. This study proposes closed-loop orientation (CLO as the appropriate strategic orientation to implement GSCM practices successfully and develops a valid measurement of CLO. Data collected from 296 Chinese manufacturers were analyzed using the structural equation modeling method to examine the relationships among CLO, GSCM practice and environmental and economic performance. The results show that both CLO and GSCM have positive effects on the environmental performance and economic performance and that CLO positively impacts the level of implementation of GSCM. The results also show that GSCM completely mediates the relationships between CLO and environmental and economic performance.

Global public health impact of recovered supplies from operating rooms: a critical analysis with national implications.

Science.gov (United States)

Wan, Eric L; Xie, Li; Barrett, Miceile; Baltodano, Pablo A; Rivadeneira, Andres F; Noboa, Jonathan; Silver, Maya; Zhou, Richard; Cho, Suzy; Tam, Tammie; Yurter, Alp; Gentry, Carol; Palacios, Jorge; Rosson, Gedge D; Redett, Richard J

2015-01-01

In modern operating rooms, clean and unused medical supplies are routinely discarded and can be effectively recovered and redistributed abroad to alleviate the environmental burden of donor hospitals and to generate substantial health benefits at resource-poor recipient institutions. We established a recovery and donation program to collect clean and unused supplies for healthcare institutions in developing nations. We analyzed items donated over a 3-year period (September 2010-November 2013) by quantity and weight, and estimated the projected value of the program under potential nationwide participation. To capture the health benefits attributable to the donated supplies at recipient institutions, we partnered with two tertiary-care centers in Guayaquil, Ecuador and conducted a pilot study on the utility of the donated supplies at the recipient institutions (October 2013). We determined the disability-adjusted life years (DALY) averted for all patients undergoing procedures involving donated items and estimated the annual attributable DALY as well as the cost per DALY averted both by supply and by procedure. Approximately, 2 million lbs (907,185 kg) per year of medical supplies are recoverable from large non-rural US academic medical centers. Of these supplies, 19 common categories represent a potential for donation worth US $15 million per year, at a cost-utility of US $2.14 per DALY averted. Hospital operating rooms continue to represent a large source of recoverable surgical supplies that have demonstrable health benefits in the recipient communities. Cost-effective recovery and need-based donation programs can significantly alleviate the global burden of surgical diseases.

Estimating spatially specific demand and supply of dental services: a longitudinal comparison in Northern Germany.

Science.gov (United States)

Schwendicke, Falk; Jäger, Ralf; Hoffmann, Wolfgang; Jordan, Rainer A; van den Berg, Neeltje

2016-09-01

Assessing the spatial distribution of oral morbidity-related demand and the workforce-related supply is relevant for planning dental services. We aimed to establish and validate a model for estimating the spatially specific demand and supply. This model was then applied to compare demand-supply ratios in 2001 and 2011 in the federal state of Mecklenburg-Vorpommern (Northern Germany). The spatial units were zip code areas. Demand per area was estimated by linking population-specific oral morbidities to working times via insurance claim data. Estimated demand was validated against the provided demand in 2001 and 2011. Supply was calculated for both years using cohort data from the dentist register. The ratio of demand and supply was geographically mapped and its distribution between areas assessed using the Gini coefficient. Between 2001 and 2011, a significant decrease of the general population (-7.0 percent), the annual demand (-13.1 percent), and the annual supply (-12.9 percent) was recorded. The estimated demands were nearly (2001: -4 percent) and completely (2011: ±0 percent) congruent with provided demands. The average demand-supply-ratio did not change significantly between 2001 and 2011 (P > 0.05), but was increasingly unequally distributed. In both years, few areas were over-serviced, while many were under-serviced. The established model can be used to estimate spatially specific demand and supply. © 2016 American Association of Public Health Dentistry.

Business Case Analysis of the Walter Reed Army Medical Center Medical/Surgical Prime Vendor Generation III Service Level Electron Program

National Research Council Canada - National Science Library

Markot, Peter B

2007-01-01

...) staffing and medical/surgical services offered under the Prime Vendor (PV) Generation III contract would provide the best supply chain management solution for Walter Reed Army Medical Center (WRAMC...

Global Expanded Nutrient Supply (GENuS Model: A New Method for Estimating the Global Dietary Supply of Nutrients.

Directory of Open Access Journals (Sweden)

Matthew R Smith

Full Text Available Insufficient data exist for accurate estimation of global nutrient supplies. Commonly used global datasets contain key weaknesses: 1 data with global coverage, such as the FAO food balance sheets, lack specific information about many individual foods and no information on micronutrient supplies nor heterogeneity among subnational populations, while 2 household surveys provide a closer approximation of consumption, but are often not nationally representative, do not commonly capture many foods consumed outside of the home, and only provide adequate information for a few select populations. Here, we attempt to improve upon these datasets by constructing a new model--the Global Expanded Nutrient Supply (GENuS model--to estimate nutrient availabilities for 23 individual nutrients across 225 food categories for thirty-four age-sex groups in nearly all countries. Furthermore, the model provides historical trends in dietary nutritional supplies at the national level using data from 1961-2011. We determine supplies of edible food by expanding the food balance sheet data using FAO production and trade data to increase food supply estimates from 98 to 221 food groups, and then estimate the proportion of major cereals being processed to flours to increase to 225. Next, we estimate intake among twenty-six demographic groups (ages 20+, both sexes in each country by using data taken from the Global Dietary Database, which uses nationally representative surveys to relate national averages of food consumption to individual age and sex-groups; for children and adolescents where GDD data does not yet exist, average calorie-adjusted amounts are assumed. Finally, we match food supplies with nutrient densities from regional food composition tables to estimate nutrient supplies, running Monte Carlo simulations to find the range of potential nutrient supplies provided by the diet. To validate our new method, we compare the GENuS estimates of nutrient supplies against

Pulling Drugs Along the Supply Chain: Centralization of Hospitals’ Inventory

OpenAIRE

Iannone, Raffaele; Lambiase, Alfredo; Miranda, Salvatore; Riemma, Stefano; Sarno, Debora

2014-01-01

Due to the economic crisis and the predominance of drug expenditure in healthcare costs, the cooperation of groups of hospitals to negotiate with suppliers and centralize warehouses has been a recent trend in the pharmaceutical supply chain. This paper shows the economic convenience of centralizing the hospitals’ inventory decisions (how much/when to order) based on the sharing of medical prescriptions of patients along the supply chain. The logistic network under investigation (TO BE model) ...

IDENTIFICATION OF MEASUREMENT ITEMS OF DESIGN REQUIREMENTS FOR LEAN AND AGILE SUPPLY CHAIN-CONFIRMATORY FACTOR ANALYSIS

Directory of Open Access Journals (Sweden)

D.Venkata Ramana

2013-06-01

Full Text Available This study examines the consistency approaches by confirmatory factor analysis that determines the construct validity, convergent validity, construct reliability and internal consistency of the items of strategic design requirements. The design requirements includes use of information technology, sourcing procedures, new product development, flexible manufacturing functions and demand management supply chain net work design, management, commitment and inventory management policies among manufacturers of volatile and unforeseeable products in Andhraadesh, India. This study suggested that the seven factor model with 20 items of the leagile supply chain design requirements had a good fit. Further, the study showed a val id and reliable measurement to identify critical items among the design requirements of leagile supply chains.

Voluntary medical male circumcision: matching demand and supply with quality and efficiency in a high-volume campaign in Iringa Region, Tanzania.

Science.gov (United States)

Mahler, Hally R; Kileo, Baldwin; Curran, Kelly; Plotkin, Marya; Adamu, Tigistu; Hellar, Augustino; Koshuma, Sifuni; Nyabenda, Simeon; Machaku, Michael; Lukobo-Durrell, Mainza; Castor, Delivette; Njeuhmeli, Emmanuel; Fimbo, Bennett

2011-11-01

The government of Tanzania has adopted voluntary medical male circumcision (VMMC) as an important component of its national HIV prevention strategy and is scaling up VMMC in eight regions nationwide, with the goal of reaching 2.8 million uncircumcised men by 2015. In a 2010 campaign lasting six weeks, five health facilities in Tanzania's Iringa Region performed 10,352 VMMCs, which exceeded the campaign's target by 72%, with an adverse event (AE) rate of 1%. HIV testing was almost universal during the campaign. Through the adoption of approaches designed to improve clinical efficiency-including the use of the forceps-guided surgical method, the use of multiple beds in an assembly line by surgical teams, and task shifting and task sharing-the campaign matched the supply of VMMC services with demand. Community mobilization and bringing client preparation tasks (such as counseling, testing, and client scheduling) out of the facility and into the community helped to generate demand. This case study suggests that a campaign approach can be used to provide high-volume quality VMMC services without compromising client safety, and provides a model for matching supply and demand for VMMC services in other settings.

Barriers to green supply chain management in the automotive industry

Directory of Open Access Journals (Sweden)

Flávia Cristina da Silva

2018-04-01

Full Text Available This study identified the barriers to and analyzed their degree of influence on Green Supply Chain Management (GSCM from the perspective of a first tier supplier in the Brazilian automotive industry. There are 43 barriers in the literature of which 13 were validated: support and involvement (five, operational performance (three, economic performance (two, environmental performance (two, and knowledge and information (one. The validation occurred through the perception of technical and academic specialists familiar with environmental management and supply chains in several sectors. The hierarchy of barriers priorities was obtained through the application of the Analytic Hierarchy Process (AHP, with decision makers representing an industry in the automotive sector. The research showed that the cost implications represent the most influential barrier to GCSV, from the perspective of a first tier supplier in the sector.

Cosmonauts and astronauts during medical operations training

Science.gov (United States)

1994-01-01

Cosmonaut Alexandr F. Poleshchuk (right) inventories medical supplies with Ezra D. Kucharz, medical operations trainer for Krug Life Sciences, Incorporated. Poleshchuk, a Mir reserve crew member, and a number of other cosmonauts and astronauts participati

Validity of Medical Student Questionnaire Data in Prediction of Rural Practice Choice and Its Association With Service Orientation.

Science.gov (United States)

Shannon, C Ken; Jackson, Jodie

2015-01-01

The validity of medical student projection of, and predictors for, rural practice and the association of a measure of service orientation, projected practice accessibility to the indigent, were investigated. West Virginia (WV) medical student online pre- and postrural rotation questionnaire data were collected during the time period 2001-2009. Of the 1,517 respondent students, submissions by 1,271 met the time interval criterion for inclusion in analyses. Subsequent WV licensing data were available for 461 in 2013. These 2 databases were used to assess for validity of projection of rural practice, for predictors of rural practice, and for student projected accessibility of the future practice to indigent patients. There were statistically significant associations between both pre- and postrotation projections of rural practice and subsequent rural practice. The most significant independent predictors of rural practice were student rural background, reported primary care intent, prediction of rural practice and projection of greater accessibility of the future practice to indigent patients. For scoring of practice access, there were trends for higher scoring by rural students and rural practitioners, with greater pre-post increases for those with urban hometowns. This study demonstrates the utility of medical student questionnaires for projections of numbers of future rural physicians. It suggests that students with a rural background, rural practice intent, or greater service orientation are more likely to enter rural practice. It also suggests that students, particularly those with urban hometowns, are influenced by rural rotation experiences in forecasting greater practice accessibility and in entering rural practice. © 2015 National Rural Health Association.

38 CFR 17.240 - Sharing specialized medical resources.

Science.gov (United States)

2010-07-01

..., agreements may be entered into for sharing medical resources with other hospitals, including State or local, public or private hospitals or other medical installations having hospital facilities or organ banks... medical resources, incidental hospital care or other needed services, supplies used, and normal...

Validity of the Malay version of the Internet Addiction Test: a study on a group of medical students in Malaysia.

Science.gov (United States)

Guan, Ng Chong; Isa, Saramah Mohammed; Hashim, Aili Hanim; Pillai, Subash Kumar; Harbajan Singh, Manveen Kaur

2015-03-01

The use of the Internet has been increasing dramatically over the decade in Malaysia. Excessive usage of the Internet has lead to a phenomenon called Internet addiction. There is a need for a reliable, valid, and simple-to-use scale to measure Internet addiction in the Malaysian population for clinical practice and research purposes. The aim of this study was to validate the Malay version of the Internet Addiction Test, using a sample of 162 medical students. The instrument displayed good internal consistency (Cronbach's α = .91), parallel reliability (intraclass coefficient = .88, P students with and without Internet dependence. Principal component analysis with varimax rotation identified a 5-factor model. The Malay version of the Internet Addiction Test appeared to be a valid instrument for assessing Internet addiction in Malaysian university students. © 2012 APJPH.

Modeling of shallot supply decisions: the case of Indonesia

Science.gov (United States)

Prabawati, N. F.; Pujawan, I. N.; Widodo, E.

2018-04-01

To optimize supply chain role, the players of supply chain need to integrate its function. One of the general problems in supply chain was the unbalanced quantity of sales and quantity of supply. This paper focused on modelling a simple method to manage the gap between the demand and the supply. The gap might cause an overstock or a loss. This paper propose a buffer quantity in order to handle the gap by using import decision. The case study was about shallot supply - demand in Indonesia. In this study we model the supply decisions of shallot in Indonesia. While the demand was quite stable over time, the supply was heavily affected by the yield from the farms. The shortage could result in the government importing shallot from other countries. Hence, the government also needed to have a proper buffering mechanism in order to ensure the supply was sufficient and the price was quite stable. The initial model of this research was built by stochastic parameters and the extended model to gain pricing mechanism was built by Shapley value principal with modification. The primary variables were supply quantity, demand quantity, buffer and purchased quantity (stock needed), actual consumption, and price for three players. The validation proved that the result of price at each player presented a significant difference. Therefore, the model could be applied to decide the stock quantity needed and to keep the price stable at each player especially at the end player which would influence the market price.

Mass Medication Clinic (MMC) Patient Medical Assistant (PMA) System Training Initiative

Science.gov (United States)

2007-06-01

AD_________________ Award Number: W81XWH-06-2-0045 TITLE: Mass Medication Clinic (MMC) Patient ...SUBTITLE 5a. CONTRACT NUMBER Mass Medication Clinic (MMC) Patient Medical Assistant (PMA) System Training Initiative 5b. GRANT NUMBER W81XWH-06-2...sections will describe the events, results, and accomplishments of this study. With validation through this project the Patient Medical Assistant

Reliability and Validity of the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2) in Adults with Non-Cancer Pain

Science.gov (United States)

Hayes, Corey J.; Bhandari, Naleen Raj; Kathe, Niranjan; Payakachat, Nalin

2017-01-01

Limited evidence exists on how non-cancer pain (NCP) affects an individual’s health-related quality of life (HRQoL). This study aimed to validate the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2), a generic measure of HRQoL, in a NCP cohort using the Medical Expenditure Panel Survey Longitudinal Files. The SF Mental Component Summary (MCS12) and SF Physical Component Summary (PCS12) were tested for reliability (internal consistency and test-retest reliability) and validity (construct: convergent and discriminant; criterion: concurrent and predictive). A total of 15,716 patients with NCP were included in the final analysis. The MCS12 and PCS12 demonstrated high internal consistency (Cronbach’s alpha and Mosier’s alpha > 0.8), and moderate and high test-retest reliability, respectively (MCS12 intraclass correlation coefficient (ICC): 0.64; PCS12 ICC: 0.73). Both scales were significantly associated with a number of chronic conditions (p reliable and valid measure of HRQoL for patients with NCP. PMID:28445438

Imaging and embolization of hepatocellular carcinoma supplied by gonadal artery

International Nuclear Information System (INIS)

Wu Hongping; Wang Junjie; Lu Yang; You Kaizhi

2010-01-01

Objective: To evaluate radiology and embolization for hepatocellular carcinoma supplied by gonadal artery. Methods: The medical records of 3 patients with hepatocellular carcinoma supplied by gonadal artery from August 2002 to September 2008 were reviewed. The demography, gonadal artery location, modus operandi, imaging features of liver cancer and prognosis were retrospectively analyzed. Results: Anatomic variation of gonadal artery occurred with the gonadal artery arising from the upper abdominal aorta in 1 patient and from the middle suprarenal artery in 2 patients. The blood supply of the hepatocellular carcinoma derived from the gonadal artery in all 3 patients. No complications occurred in the 6-month follow-up after embolization. Conclusion: Hepatocellular carcinoma may be supplied by gonadal artery with anomalous origin. This anatomic variant can be readily demonstrated by imaging to guide embolization. (authors)

A Low-Power Medical Oxygen Generator, Phase II

Data.gov (United States)

National Aeronautics and Space Administration — An on-board oxygen concentrator is required during long duration manned space missions to supply medical oxygen. The commercial medical oxygen generators based on...

A Low-Power Medical Oxygen Generator, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — An on-board oxygen concentrator is required during long duration manned space missions to supply medical oxygen. The commercial medical oxygen generators based on...

Research on Supply Chain Coordination of Fresh Agricultural Products under Agricultural Insurance

Directory of Open Access Journals (Sweden)

Zhang Pei

2017-01-01

Full Text Available Based on the fact that the current fresh agricultural products are susceptible to natural risks and the coordination of supply chain is poor, This paper constructs the supply chain profit model under the two models of natural risk and agricultural insurance, Firstly, studying the coordination function of the supply chain system under Two-part Tariff; Then discussing the setting and claiming mechanism of agricultural insurance, compares the influence of agricultural insurance on supply chain profit and supply chain coordination; Finally, giving an example to validate the model results and give decision - making opinions. Research shows that the supply chain of fresh agricultural products can coordinated under Two-part Tariff, but the supply chain cooperation is poor in the natural risk , need to further stabilize and optimize the supply chain; When the risk factor is less than the non-participation insurance coefficient, not to participate in agricultural insurance is conducive to maintaining the coordination of the supply chain system; When the risk coefficient exceeds the non-participation insurance coefficient, the introduction of agricultural insurance can not only effectively manage the natural risks, but also help to improve the coordination of the supply chain system.

Validation of the MedUseQ: A Self-Administered Screener for Older Adults to Assess Medication Use Problems.

Science.gov (United States)

Berman, Rebecca L; Iris, Madelyn; Conrad, Kendon J; Robinson, Carrie

2018-01-01

Older adults taking multiple prescription and nonprescription drugs are at risk for medication use problems, yet there are few brief, self-administered screening tools designed specifically for them. The study objective was to develop and validate a patient-centered screener for community-dwelling older adults. In phase 1, a convenience sample of 57 stakeholders (older adults, pharmacists, nurses, and physicians) participated in concept mapping, using Concept System® Global MAX TM , to identify items for a questionnaire. In phase 2, a 40-item questionnaire was tested with a convenience sample of 377 adults and a 24-item version was tested with 306 older adults, aged 55 and older, using Rasch methodology. In phase 3, stakeholder focus groups provided feedback on the format of questionnaire materials and recommended strategies for addressing problems. The concept map contained 72 statements organized into 6 conceptual clusters or domains. The 24-item screener was unidimensional. Cronbach's alpha was .87, person reliability was acceptable (.74), and item reliability was high (.96). The MedUseQ is a validated, patient-centered tool targeting older adults that can be used to assess a wide range of medication use problems in clinical and community settings and to identify areas for education, intervention, or further assessment.

Extent of Supply of Biology Teachers Demanded in Secondary ...

African Journals Online (AJOL)

A questionnaire titled “Demand and Supply of Biology Teachers (DSBT)” was used as the instrument for data collection which was validated and the internal consistency established using Cronbach alpha (8) reliability test method. One research question and one null hypothesis were formulated to guide the study.

Medical application and clinical validation for reliable and trustworthy physiological monitoring using functional textiles: experience from the HeartCycle and MyHeart project.

Science.gov (United States)

Reiter, Harald; Muehlsteff, Jens; Sipilä, Auli

2011-01-01

Functional textiles are seen as promising technology to enable healthcare services and medical care outside hospitals due to their ability to integrate textile-based sensing and monitoring technologies into the daily life. In the past much effort has been spent onto basic functional textile research already showing that reliable monitoring solutions can be realized. The challenge remains to find and develop suited medical application and to fulfil the boundary conditions for medical endorsement and exploitation. The HeartCycle vest described in this abstract will serve as an example for a functional textile carefully developed according to the requirements of a specific medical application, its clinical validation, the related certification aspects and the next improvement steps towards exploitation.

Cultures of Death and Politics of Corpse Supply

Science.gov (United States)

Buklijas, Tatjana

2008-01-01

Summary Nineteenth-century Vienna is well known to medical historians as a leading centre of medical research and education, offering easy access to patients and corpses to students from all over the world. This article seeks to explain how this enviable supply with cadavers was achieved, why it provoked so little opposition at a time when Britain and the United States saw widespread protests against dissection, and how it was threatened from mid-century. To understand permissive Viennese attitudes we need to place them in a longue durée history of death and dissection, and to pay close attention to the city’s political geography as it was transformed into a major imperial capital. The tolerant stance of the Roman Catholic Church, strong links to Southern Europe and the weak position of individuals in the absolutist state all contributed to an idiosyncratic anatomical culture. But as the fame of the Vienna medical school peaked in the later 1800s, the increased demand created by rising student numbers combined with intensified interdisciplinary competition to produce a shortfall that professors found increasingly difficult to meet. Around 1900, new religious groups and mass political parties challenged the long-standing anatomical practice by refusing to supply cadavers and making dissection into an instrument of political struggle. This study of the material preconditions for anatomy at one of Europe’s most influential medical schools provides a contrast to the dominant Anglo-American histories of death and dissection. PMID:18791297

Turn-key supply for the power supplies of the control coils of wendelstein 7-X experiment

International Nuclear Information System (INIS)

Jauregi, E.; Ganuza, D.; Garcia, I.; Rio, J.M. del; Rummel, T.; Fuellenbach, F.

2003-01-01

In the Max-Planck Institute for Plasma Physics, IPP, in Greifswald, a new stellerator is being built for fusion research experiments, the so called Wendelstein 7-X Experiment. JEMA Company has designed, manufacture and supply the turnkey system which energises the ten control coils in the stellerator. The system comprises ten independent Switch-mode power supplies, and the central distribution stations for power, cooling and control facilities. Each power supply must provide a controlled current compounded of direct current and 0-20 Hz bandwidth ac current in a range of almost 3 kA at low voltage, 30 V, in four quadrants. Positive and negative voltage and sinusoidal current with low harmonic distortion is required by load. The selected design is based on Switch-mode-power supply technology (SMPS) providing the system with a very high regulation response (very low current and voltage ripple) and excellent input power factor, keeping the grid total harmonic distortion (THD) under minimum values. The sources can be operated locally as independent systems or they can be co-ordinated from a main control keeping current synchronisation requirements. The system in its entirety requires a high efficiency due to thermal considerations and reduced space. The system presented here introduces a decisive solution for the future power supplies to superconducting or regular coils, where the regulation, precision and ripple are the basic requirements for the design. During year 2000 the design stage was covered and in 2001 a first prototype for the power supplies was manufactured and successfully tested at factory. The entire system has been installed over this year after the series fabrication and it is currently working at IPP facilities, waiting for the acceptance tests scheduled before end of the year. This paper aims to explain the different stages the company went through in order to get validation of the power supply system and make it running at its last location

The Doctrinal Basis for Medical Stability Operations

Science.gov (United States)

2010-01-01

lead actor, preferably a HN agency, but sometimes the military must take the lead in medical stability operations when overwhelming violence prevents...34 Assessment Tasks Administration of hospital Communications Obstetrics , Pediatrics, Emergency room. Operating room Nursing procedures Medical supply

Resonance power supplies for large accelerator

International Nuclear Information System (INIS)

Karady, G.; Schneider, E.J.

1993-01-01

The resonance power supply has been proposed as an efficient power supply for a future 6 GB, keon producing accelerator. This report presents a detailed analysis of the circuit operation. Based on these analyses each component is designed, one line diagram is developed, component requirements are determined and a detailed cost estimate is prepared. The major components of the system are: the magnet power supply, high voltage by-pass thyristor switch, with l0kA repetitive interruption capability, capacitor banks, capacitor bank thyristor switch, and an energy make up device. The most important components are the bypass thyristor switch and the energy injection device. The bypass thyristor switch is designed to turn on and interrupt to 10 kA dc current with a recovery voltage of 20kV and repetition frequency of 3 Hz. The switch consists of a large array of series and parallel connected thyristors and gate turn off (GTO) devices. The make up energy device is designed to replace the circuit energy losses. A capacitor bank is charged with constant current and discharged during the acceleration period. One of the advantages of the developed circuit is that it can be supplied directly from the local power network. In order to prove the validity of the assumptions, a scaled down model circuit was thoroughly tested. These tests proved that the engineering design of critical components is correct and this resonant power supply can be properly controlled by an inventer/rectifier connected in series with the magnet and by the make up energy device. This finding reduces the system cost

A national medical cyclotron facility: report to the Minister of Health by the Medical Cyclotron Committee

International Nuclear Information System (INIS)

1985-01-01

Research and training in nuclear medicine in Australia are both limited by the lack of a medical cyclotron facility. The Committee recommends the establishment of a national medical cyclotron to provide a supply of short-lived radioisotopes for research in relevant fields of medicine, and for diagnostic use in nuclear medicine

Experimental validation of neutron activation simulation of a varian medical linear accelerator.

Science.gov (United States)

Morato, S; Juste, B; Miro, R; Verdu, G; Diez, S

2016-08-01

This work presents a Monte Carlo simulation using the last version of MCNP, v. 6.1.1, of a Varian CLinAc emitting a 15MeV photon beam. The main objective of the work is to estimate the photoneutron production and activated products inside the medical linear accelerator head. To that, the Varian LinAc head was modelled in detail using the manufacturer information, and the model was generated with a CAD software and exported as a mesh to be included in the particle transport simulation. The model includes the transport of photoneutrons generated by primary photons and the (n, γ) reactions which can result in activation products. The validation of this study was done using experimental measures. Activation products have been identified by in situ gamma spectroscopy placed at the jaws exit of the LinAc shortly after termination of a high energy photon beam irradiation. Comparison between experimental and simulation results shows good agreement.

Hospital Supply Expenses: An Important Ingredient in Health Services Research.

Science.gov (United States)

Abdulsalam, Yousef; Schneller, Eugene

2017-07-01

The purpose of this article is to shed light on hospital supply expenses, which form the second largest expense category after payroll and hold more promise for improving cost-efficiency compared to payroll. However, limited research has rigorously scrutinized this cost category, and it is rarely given specific consideration across cost-focused studies in health services publications. After reviewing previously cited estimates, we examine and independently validate supply expense data (collected by the American Hospital Association) for over 3,500 U.S. hospitals. We find supply expenses to make up 15% of total hospital expenses, on average, but as high as 30% or 40% in hospitals with a high case-mix index, such as surgery-intensive hospitals. Future research can use supply expense data to better understand hospital strategies that aim to manage costs, such as systemization, physician-hospital arrangements, and value-based purchasing.

Medical device development.

Science.gov (United States)

Panescu, Dorin

2009-01-01

The development of a successful medical product requires not only engineering design efforts, but also clinical, regulatory, marketing and business expertise. This paper reviews items related to the process of designing medical devices. It discusses the steps required to take a medical product idea from concept, through development, verification and validation, regulatory approvals and market release.

Impact of Supply Chain Alignment on Construction Performance: A developed model for Vietnam

Directory of Open Access Journals (Sweden)

Huy Troung Quang

2017-12-01

Full Text Available There are many articles mentioning the advantages and benefits of supply chain alignment none, however, describe how to model such alignment in the supply chain. This paper offers a framework for examining and understanding the impact supply chain alignment has on performance. Based on supply chain mapping approach, a model describing alignment between processes/ flows in the supply chain network is developed. The model is then validated using a dataset of 316 enterprises operating in the Vietnam construction sector. Evidence indicates that the supply chain processes and flows were aligned. According to the results, the proposed supply chain alignment model is able to explain a 59.9% variance in operational performance, 58.9% in customer satisfaction, 34.5% in operating costs and 67.4% in business performance. To successfully align the supply chain network, companies can use the proposed model as a “road-map” to reduce high costs, to avoid the loss of control, management difficulties and/or vulnerability to opportunistic action, all of which may hinder efforts to align the supply chains.

SPECIFICITY OF MANIFACTURING PROCESS VALIDATION FOR DIAGNOSTIC SEROLOGICAL DEVICES

Directory of Open Access Journals (Sweden)

O. Yu. Galkin

2018-02-01

Full Text Available The aim of this research was to analyze recent scientific literature, as well as national and international legislature on manifacturing process validation of biopharmaceutical production, in particular devices for serological diagnostics. Technology validation in the field of medical devices for serological diagnostics is most influenced by the Technical Regulation for Medical Devices for in vitro Diagnostics State Standards of Ukraine – SSU EN ISO 13485:2015 “Medical devices. Quality management system. Requirements for regulation”, SSU EN ISO 14971:2015 “Medical devices. Instructions for risk management”, Instruction ST-N of the Ministry of Healthcare of Ukraine 42-4.0:2014 “Medications. Suitable industrial practice”, State Pharmacopoeia of Ukraine and Instruction ICH Q9 on risk management. Current recommendations for validations of drugs manufacturing process, including biotechnological manufacturing, can not be directly applied to medical devices for in vitro diagnostics. It was shown that the specifics of application and raw materials require individual validation parameters and process validations for serological diagnostics devices. Critical parameters to consider in validation plans were provided for every typical stage of production of in vitro diagnostics devices on the example of immunoassay kits, such as obtaining protein antigens, including recombinant ones, preparations of mono- and polyclonal antibodies, immunoenzyme conjugates and immunosorbents, chemical reagents etc. The bottlenecks of technologies for in vitro diagnostics devices were analyzed from the bioethical and biosafety points of view.

Medical education in Ecuador.

Science.gov (United States)

Joffre, Carrillo P; Delgado, Belgica; Kosik, Russell Olive; Huang, Lei; Zhao, Xudong; Su, Tung-Ping; Wang, Shuu-Jiun; Chen, Qi; Fan, Angela Pei-Chen

2013-12-01

Ecuador, the smallest of the Andean countries, is located in the northwest portion of South America. The nation's 14.5 million people have a tremendous need for high quality primary care. To describe the profound advances as well as the persistent needs in medical education in Ecuador that have occurred with globalization and with the modernization of the country. Through an extensive search of the literature; medical school data; reports from the Ecuador Ministry of Public Health and Ministry of Education; and information from the National Secretary of Higher Education, Science, and Innovation (SENESCYT), the medical education system in Ecuador has been thoroughly examined. The National System of Higher Education in Ecuador has experienced significant growth over the last 20 years. As of 2009 the system boasts 19 medical schools, all of which offer the required education needed to obtain the title of Physician, but only 12 of which offer postgraduate clinical training. Of these 19 universities, nine are public, five are private and self-financed, and five are private and co-financed. Post-graduate options for medical students include: (1) Clinical specialization, (2) Higher diploma, (3) Course specialization, (4) Master's degree, and (5) PhD degree. The rapid growth of Ecuador's system of medical education has led to inevitable gaps that threaten its ability to sustain itself. Chief among these is the lack of well-trained faculty to supply its medical schools. To ensure an adequate supply of faculty exists, the creation of sufficient postgraduate, sub-specialization, and PhD training positions must be created and maintained.

Andragogy and medical education: are medical students internally motivated to learn?

Science.gov (United States)

Misch, Donald A

2002-01-01

Andragogy - the study of adult education - has been endorsed by many medical educators throughout North America. There remains, however, considerable controversy as to the validity and utility of adult education principles as espoused by the field's founder, Malcolm Knowles. Whatever the utility of andragogic doctrine in general education settings, there is reason to doubt its wholesale applicability to the training of medical professionals. Malcolm Knowles' last tenet of andragogy holds that adult learners are more motivated by internal than by external factors. The validity of this hypothesis in medical education is examined, and it is demonstrated that medical students' internal and external motivation are context-dependent, not easily distinguishable, and interrelate with one another in complex ways. Furthermore, the psychological motivation for medical student learning is determined by a variety of factors that range from internal to external, unconscious to conscious, and individual to societal. The andragogic hypothesis of increased internal motivation to learn on the part of adults in general, and medical trainees in particular, is rejected as simplistic, misleading, and counterproductive to developing a greater understanding of the forces that drive medical students to learn.

A Compact Medical Oxygen Generator for Spacecraft, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — An on-board oxygen concentrator is required during long duration manned space missions to supply medical oxygen. Commercial medical oxygen generators are pressure...

Psychometric validation of a new measurement instrument for time-oriented patient information in electronic medical records: A questionnaire survey of physicians.

Science.gov (United States)

Shibuya, Akiko; Misawa, Jimpei; Maeda, Yukihiro; Ichikawa, Rie; Kamata, Michiyo; Inoue, Ryusuke; Morimoto, Tetsuji; Nakayama, Masaharu; Hishiki, Teruyoshi; Kondo, Yoshiaki

2017-12-01

Time is an important element in medical data. Physicians record and store information about patients' disease progress and treatment response in electronic medical records (EMRs). Because EMRs use timestamps, physicians can identify patterns over time regarding a patient's disease and treatment (eg, laboratory values and medications). However, analyses of physicians' use and satisfaction with EMRs have focused on functionality, storage, and system operation rather than the use of time-oriented information. This study aimed to understand physicians' needs regarding time-oriented patient information in EMRs in clinical practice. The reliability and validity of the items in the questionnaire were evaluated in 87 physicians at a national university hospital. Internal consistency was satisfactory (Cronbach alpha coefficient, 0.87). Four dimensions were identified in exploratory factor analysis. Correlations between the 4 dimensions supported the construct validity of the items. Scores of time-oriented patients' medical history in the 4 dimensions showed a significant association with physician age. Based on confirmatory factor analysis, associations were significant and positive (P information in EMRs, both time-oriented treatment results followed by time-oriented team information had significant positive associations. Our study suggests that 4 specific time-oriented patient information factors in EMRs are needed by physicians. Exploring physicians' needs regarding patient-specific time-oriented information may provide a better understanding of the barriers facing the adoption and use of EMRs (eg, decision-making and practice safety concerns) and lead to better acceptance of EMRs in physicians' clinical practices. © 2017 John Wiley & Sons, Ltd.

Intelligent Medical Systems for Aerospace Emergency Medical Services

Science.gov (United States)

Epler, John; Zimmer, Gary

2004-01-01

The purpose of this project is to develop a portable, hands free device for emergency medical decision support to be used in remote or confined settings by non-physician providers. Phase I of the project will entail the development of a voice-activated device that will utilize an intelligent algorithm to provide guidance in establishing an airway in an emergency situation. The interactive, hands free software will process requests for assistance based on verbal prompts and algorithmic decision-making. The device will allow the CMO to attend to the patient while receiving verbal instruction. The software will also feature graphic representations where it is felt helpful in aiding in procedures. We will also develop a training program to orient users to the algorithmic approach, the use of the hardware and specific procedural considerations. We will validate the efficacy of this mode of technology application by testing in the Johns Hopkins Department of Emergency Medicine. Phase I of the project will focus on the validation of the proposed algorithm, testing and validation of the decision making tool and modifications of medical equipment. In Phase 11, we will produce the first generation software for hands-free, interactive medical decision making for use in acute care environments.

A triple helix model of medical innovation: Supply, demand, and technological capabilities in terms of Medical Subject Headings

NARCIS (Netherlands)

Petersen, A.M.; Rotolo, D.; Leydesdorff, L.

We develop a model of innovation that enables us to trace the interplay among three key dimensions of the innovation process: (i) demand of and (ii) supply for innovation, and (iii) technological capabilities available to generate innovation in the forms of products, processes, and services.

Problems of pharmacological supply of disaster medicine

International Nuclear Information System (INIS)

Sabaev, V.V.; Il'ina, S.L.

1995-01-01

The paper reviews a number of pharmacological problems, being important for the disaster medicine, of theoretical and practical nature, the settlement of which would promote more efficient rendering emergency medical aid to the injured persons in the conditions of emergency situations and further expert medical care. On the example of radiation accidents there are studied methodical approaches to organization of drug prophylaxis and therapy of the injured persons in emergency situations. The authors have proved the necessity of arranging proper pharmacological supply of disaster medicine which is to settle the whole complex of scientific-applied and organizational questions relating to the competence of pharmacology and pharmacy. 17 refs

Projecting surgeon supply using a dynamic model.

Science.gov (United States)

Fraher, Erin P; Knapton, Andy; Sheldon, George F; Meyer, Anthony; Ricketts, Thomas C

2013-05-01

To develop a projection model to forecast the head count and full-time equivalent supply of surgeons by age, sex, and specialty in the United States from 2009 to 2028. The search for the optimal number and specialty mix of surgeons to care for the United States population has taken on increased urgency under health care reform. Expanded insurance coverage and an aging population will increase demand for surgical and other medical services. Accurate forecasts of surgical service capacity are crucial to inform the federal government, training institutions, professional associations, and others charged with improving access to health care. The study uses a dynamic stock and flow model that simulates future changes in numbers and specialty type by factoring in changes in surgeon demographics and policy factors. : Forecasts show that overall surgeon supply will decrease 18% during the period form 2009 to 2028 with declines in all specialties except colorectal, pediatric, neurological surgery, and vascular surgery. Model simulations suggest that none of the proposed changes to increase graduate medical education currently under consideration will be sufficient to offset declines. The length of time it takes to train surgeons, the anticipated decrease in hours worked by surgeons in younger generations, and the potential decreases in graduate medical education funding suggest that there may be an insufficient surgeon workforce to meet population needs. Existing maldistribution patterns are likely to be exacerbated, leading to delayed or lost access to time-sensitive surgical procedures, particularly in rural areas.

Physician and nurse supply in Serbia using time-series data.

Science.gov (United States)

Santric-Milicevic, Milena; Vasic, Vladimir; Marinkovic, Jelena

2013-06-17

Unemployment among health professionals in Serbia has risen in the recent past and continues to increase. This highlights the need to understand how to change policies to meet real and projected needs. This study identified variables that were significantly related to physician and nurse employment rates in the public healthcare sector in Serbia from 1961 to 2008 and used these to develop parameters to model physician and nurse supply in the public healthcare sector through to 2015. The relationships among six variables used for planning physician and nurse employment in public healthcare sector in Serbia were identified for two periods: 1961 to 1982 and 1983 to 2008. Those variables included: the annual total national population; gross domestic product adjusted to 1994 prices; inpatient care discharges; outpatient care visits; students enrolled in the first year of medical studies at public universities; and the annual number of graduated physicians. Based on historic trends, physician supply and nurse supply in the public healthcare sector by 2015 (with corresponding 95% confidence level) have been modeled using Autoregressive Integrated Moving Average (ARIMA) / Transfer function (TF) models. The ARIMA/TF modeling yielded stable and significant forecasts of physician supply (stationary R2 squared = 0.71) and nurse supply (stationary R2 squared = 0.92) in the public healthcare sector in Serbia through to 2015. The most significant predictors for physician employment were the population and GDP. The supply of nursing staff was, in turn, related to the number of physicians. Physician and nurse rates per 100,000 population increased by 13%. The model predicts a seven-year mismatch between the supply of graduates and vacancies in the public healthcare sector is forecasted at 8,698 physicians - a net surplus. The ARIMA model can be used to project trends, especially those that identify significant mismatches between forecasted supply of physicians and vacancies and can

Application of lean tools in the supply chain of a maintenance environment

Directory of Open Access Journals (Sweden)

Fourie, C. J.

2017-05-01

Full Text Available Historically, Lean thinking has limited applications in the maintenance environment (that is, a non-manufacturing environment. This article reports on the Lean tools that can be implemented in the maintenance environment. To achieve this, a typical supply chain management of a rolling stock service organisation was used for analysis and validation. The approach was initially to map the current supply chain process through a standard method of value stream mapping so as to identify non-Lean activities. After mapping the current state, other suitable Lean tools for the current supply chain management were applied. Finally, performance Indicators were formulated for continuous review and assessment.

Experience of medical service of the Armed Forces during elimination of consequences of Chernobyl's disaster

International Nuclear Information System (INIS)

Chizh, I.M.

1996-01-01

The article analyzes ten-years experience (1986-1996) of the Armed Forces medical service participation in elimination of consequences of Chernobyl's accidents. The system of medical supply created soon after accidents (management and interaction, forces and means, peculiarities of sanitary-hygienic, antiepidemic, treatment-and-prophylactic supply) has been described in breaf, its positive sides and main deficiencies and also the ways of there elimination, the place of military-medical service in modern sate system of disaster medical supply have been discussed. The results of prolonged dynamic observation of rescuers by the All-Army medical-and-dosimetric register materials, the main directions, results and prospects of scientific study about problems of radiative disaster have been analyzed. 32 refs., 4 figs., 1 tab

The Impact of the Expanding Supply of Physicians on Continuing Medical Education.

Science.gov (United States)

Bowman, Marjorie A.

1985-01-01

The expanding supply of physicians could result in threatened or actual loss of physician income; longer, more convenient physician office hours but fewer patients seen per hour; more physicians available for vacancies; increased quality assurance activities; increased variety of practice organizational arrangements and reimbursement types; and an…

Reliability and Validity of Objective Structured Clinical Examination for Residents of Obstetrics and Gynecology at Kermanshah University of Medical Sciences

Directory of Open Access Journals (Sweden)

Nasrin Jalilian

2012-11-01

Full Text Available Introduction: Objective structured clinical examination (OSCE is used for the evaluation of the clinical competence in medicine for which it is essential to measure validity and reliability. This study aimed to investigate the validity and reliability of OSCE for residents of obstetrics and gynecology at Kermanshah University of Medical Sciences in 2011.Methods: A descriptive-correlation study was designed and the data of OSCE for obstetrics and gynecology were collected via learning behavior checklists in method stations and multiple choice questions in question stations. The data were analyzed through Pearson correlation coefficient and Cronbach's alpha, using SPSS software (version 16. To determine the criterion validity, correlation of OSCE scores with scores of resident promotion test, direct observation of procedural skills, and theoretical knowledge was determined; for reliability, however, Cronbach's alpha was used. Total sample consisted of 25 participants taking part in 14 stations. P value of less than 0.05 was considered as significant.Results: The mean OSCE scores was 22.66 (±6.85. Criterion validity of the stations with resident promotion theoretical test, first theoretical knowledge test, second theoretical knowledge, and direct observation of procedural skills (DOPS was 0.97, 0.74, 0.49, and 0.79, respectively. In question stations, criterion validity was 0.15, and total validity of OSCE was 0.77.Conclusion: Findings of the present study indicated acceptable validity and reliability of OSCE for residents of obstetrics and gynecology.

The Security of Energy Supply and the Contribution of Nuclear Energy

International Nuclear Information System (INIS)

2011-01-01

What contribution can nuclear energy make to improve the security of energy supply? This study, which examines a selection of OECD member countries, qualitatively and quantitatively validates the often intuitive assumption that, as a largely domestic source of electricity with stable costs and no greenhouse gas emissions during production, nuclear energy can make a positive contribution. Following an analysis of the meaning and context of security of supply, the study uses transparent and policy-relevant indicators to show that, together with improvements in energy efficiency, nuclear energy has indeed contributed significantly to enhanced energy supply security in OECD countries over the past 40 years. Content: Foreword; Executive Summary; 1. The Security of Energy Supply and the Contribution of Nuclear Energy - Concepts and Issues: - Energy supply security: An introduction, - Why security of energy supply remains a policy issue in OECD countries, - The external dimension: import dependence, resource exhaustion and carbon policy, - The internal dimension: economic, financial and technical considerations for energy supply security - Orientations for government policies to enhance the security of energy supply, - Conclusions; 2. Indicators and Models for Measuring Security of Energy Supply Risks: - Introduction, - Different approaches towards designing the Supply/Demand Index, - A detailed review of selected security of supply indicators, - Comprehensive models for assessing the security of energy supply, - The Supply/Demand Index, - Concluding observations; 3. Evolution of the Security of Energy Supply in OECD Countries: - Time-dependent quantification of the security of energy supply, - Changes in security of supply in selected OECD countries, - Electricity generation and the security of energy supply, - The contribution of nuclear energy and energy intensity to the security of energy supply, - The geographical distribution of SSDI values, - Conclusions; 4. Public

[Production chain supply management for public hospitals: a logistical approach to healthcare].

Science.gov (United States)

Infante, Maria; dos Santos, Maria Angélica Borges

2007-01-01

Despite their importance for hospital operations, discussions of healthcare organization logistics and supply and materials management are notably lacking in Brazilian literature. This paper describes a methodology for organizing the supply of medical materials in public hospitals, based on an action-research approach. Interventions were based on the assumption that a significant portion of problems in Brazil's National Health System (SUS) facilities derive from the fact that their clinical and administrative departments do not see themselves as belonging to the same production chain - neither the hospital nor the supply department is aware of what the other produces. The development of the methodology and its main steps are presented and discussed, against a background of recent literature and total quality and supply chain management concepts.

Department of the Army Supply Bulletin, Army Medical Department Supply Information, SB8-75-S7

National Research Council Canada - National Science Library

2002-01-01

.... Army Medical Materiel Agency (USAMMA), Fort Detrick, Maryland This edition focuses on the mission and functions of the SCMD and its capability to support the "Warfighter" during a full range of contingency operations While all of...

Translation, adaptation and validation the contents of the Diabetes Medical Management Plan for the Brazilian context.

Science.gov (United States)

Torres, Heloísa de Carvalho; Chaves, Fernanda Figueredo; Silva, Daniel Dutra Romualdo da; Bosco, Adriana Aparecida; Gabriel, Beatriz Diniz; Reis, Ilka Afonso; Rodrigues, Júlia Santos Nunes; Pagano, Adriana Silvina

2016-08-08

to translate, adapt and validate the contents of the Diabetes Medical Management Plan for the Brazilian context. This protocol was developed by the American Diabetes Association and guides the procedure of educators for the care of children and adolescents with diabetes in schools. this methodological study was conducted in four stages: initial translation, synthesis of initial translation, back translation and content validation by an expert committee, composed of 94 specialists (29 applied linguists and 65 health professionals), for evaluation of the translated version through an online questionnaire. The concordance level of the judges was calculated based on the Content Validity Index. Data were exported into the R program for statistical analysis. the evaluation of the instrument showed good concordance between the judges of the Health and Applied Linguistics areas, with a mean content validity index of 0.9 and 0.89, respectively, and slight variability of the index between groups (difference of less than 0.01). The items in the translated version, evaluated as unsatisfactory by the judges, were reformulated based on the considerations of the professionals of each group. a Brazilian version of Diabetes Medical Management Plan was constructed, called the Plano de Manejo do Diabetes na Escola. traduzir, adaptar e validar o conteúdo do Diabetes Medical Management Plan para o contexto brasileiro, protocolo elaborado pela Associação Americana de Diabetes, que orienta a conduta dos educadores para o cuidado das crianças e adolescentes com diabetes mellitus nas escolas. trata-se de estudo metodológico, realizado em quatro etapas: tradução inicial, síntese da tradução inicial, retrotradução e validação de conteúdo por um Comitê de Juízes, composto por 94 especialistas (29 linguistas aplicados e 65 profissionais da área da Saúde), para avaliação da versão traduzida por meio de um questionário online. O nível de concordância dos juízes foi

Maturity models in supply chain sustainability

DEFF Research Database (Denmark)

Correia, Elisabete; Carvalho, Helena; Azevedo, Susana G.

2017-01-01

A systematic literature review of supply chain maturity models with sustainability concerns is presented. The objective is to give insights into methodological issues related to maturity models, namely the research objectives; the research methods used to develop, validate and test them; the scope...... of maturity levels. The comprehensive review, analysis, and synthesis of the maturity model literature represent an important contribution to the organization of this research area, making possible to clarify some confusion that exists about concepts, approaches and components of maturity models...

The control system based on PXI technology for high voltage power supply

International Nuclear Information System (INIS)

Chen Dehong; Zhang Ming; Ma Shaoxiang; Xia Linglong; Zeng Zhen; Zhang Xueliang; Wang Chuliang; Yu Kexun

2014-01-01

A 100 kV/60 A high voltage power supply (HVPS) is being developed to carry some auxiliary heating research on J-TEXT and supply the auxiliary heating system. The power supply which consists of 144 switch modules is based on PSM technology. For the requirement of isolation, control and protection, a control system based on the PCI extensions for instrumentation (PXI) which meets up with the CODAC standards is designed with developed PSM technology for the high voltage power supply. The compact structure of hardware in the control system is presented too. And the control strategy which is based on shift phase pulse width modulation is discussed Some tests are performed on the control system to validate the control strategy, the experimental results show that the system has a good control performance and fast response, which meets the control requirement of 100 kV/60 A high voltage power supply. (authors)

Qualitative Validation of the IMM Model for ISS and STS Programs

Science.gov (United States)

Kerstman, E.; Walton, M.; Reyes, D.; Boley, L.; Saile, L.; Young, M.; Arellano, J.; Garcia, Y.; Myers, J. G.

2016-01-01

To validate and further improve the Integrated Medical Model (IMM), medical event data were obtained from 32 ISS and 122 STS person-missions. Using the crew characteristics from these observed missions, IMM v4.0 was used to forecast medical events and medical resource utilization. The IMM medical condition incidence values were compared to the actual observed medical event incidence values, and the IMM forecasted medical resource utilization was compared to actual observed medical resource utilization. Qualitative comparisons of these parameters were conducted for both the ISS and STS programs. The results of these analyses will provide validation of IMM v4.0 and reveal areas of the model requiring adjustments to improve the overall accuracy of IMM outputs. This validation effort should result in enhanced credibility of the IMM and improved confidence in the use of IMM as a decision support tool for human space flight.

Sustainable Public Procurement of Medical Technology and Green Logistics

DEFF Research Database (Denmark)

Vettorato, Giovanna; Hsuan, Juliana

This paper investigates design for remanufacture in terms of both detailed new product design and the environmental performance in which modularization and reversed production may operate. We examine the medical equipment industry and their potential contributions to the implementation of green...... supply chain in the healthcare sector. An exploratory case study of medical equipment supply chain is presented when considering the life cycle of the product can be managed through the modularization strategies. Preliminary findings indicate that design-for-disassembly of modules make equipment easier...

Readmissions of medical patients

DEFF Research Database (Denmark)

Cooksley, T.; Nanayakkara, P. W. B.; Nickel, C. H.

2016-01-01

of readmission but have not been validated in international populations. AIM: To perform an external independent validation of the HOSPITAL and LACE scores. DESIGN: An unplanned secondary cohort study. METHODS: Patients admitted to the medical admission unit at the Hospital of South West Jutland (10...... power of both scores decreased with increasing age. CONCLUSION: Readmissions are a complex phenomenon with not only medical conditions contributing but also system, cultural and environmental factors exerting a significant influence. It is possible that the heterogeneity of the population and health...

Validation of core medical knowledge by postgraduates and specialists.

NARCIS (Netherlands)

Koens, F.; Rademakers, J.J.; Cate, O.T.J. ten

2005-01-01

BACKGROUND: Curriculum constructors and teachers must decide on the content and level of objectives and materials included in the medical curriculum. At University Medical Centre Utrecht it was decided to test relatively detailed knowledge at a regular level in study blocks and to design a progress

Projections of Demand for Cardiovascular Surgery and Supply of Surgeons.

Science.gov (United States)

Lee, Jung Jeung; Park, Nam Hee; Lee, Kun Sei; Chee, Hyun Keun; Sim, Sung Bo; Kim, Myo Jeong; Choi, Ji Suk; Kim, Myunghwa; Park, Choon Seon

2016-12-01

While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040-an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309-an increase of -24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time, effort, and resources; therefore, by analyzing the various factors

What are validated self-report adherence scales really measuring?: a systematic review.

Science.gov (United States)

Nguyen, Thi-My-Uyen; La Caze, Adam; Cottrell, Neil

2014-03-01

Medication non-adherence is a significant health problem. There are numerous methods for measuring adherence, but no single method performs well on all criteria. The purpose of this systematic review is to (i) identify self-report medication adherence scales that have been correlated with comparison measures of medication-taking behaviour, (ii) assess how these scales measure adherence and (iii) explore how these adherence scales have been validated. Cinahl and PubMed databases were used to search articles written in English on the development or validation of medication adherence scales dating to August 2012. The search terms used were medication adherence, medication non-adherence, medication compliance and names of each scale. Data such as barriers identified and validation comparison measures were extracted and compared. Sixty articles were included in the review, which consisted of 43 adherence scales. Adherence scales include items that either elicit information regarding the patient's medication-taking behaviour and/or attempts to identify barriers to good medication-taking behaviour or beliefs associated with adherence. The validation strategies employed depended on whether the focus of the scale was to measure medication-taking behaviour or identify barriers or beliefs. Supporting patients to be adherent requires information on their medication-taking behaviour, barriers to adherence and beliefs about medicines. Adherence scales have the potential to explore these aspects of adherence, but currently there has been a greater focus on measuring medication-taking behaviour. Selecting the 'right' adherence scale(s) requires consideration of what needs to be measured and how (and in whom) the scale has been validated. © 2013 The British Pharmacological Society.

Medical tourism and organ trafficking

Directory of Open Access Journals (Sweden)

Athena Smith

2012-01-01

Full Text Available The growth of medical tourism in developing nations has not only helped the local economies but also has assisted patients from the developed world to seek treatment at a lower cost. However, the expansion of the sector has been stigmatized by the growth of organ trafficking that facilitates organ transplantation to those who can afford it. Although developing countries have been taking measures to prohibit the sale of organs, the large gap between demand and supply has fuelled a black market that involves the "brokers", the medical personnel and the poor whose abuse and exploitation is fuelled by the expansion of the sector and the illegitimate opportunities it creates on the side. The problem is exacerbated by the low supply in developed countries, where living potential donors appear to be misinformed about the process and hesitate to register as donors. The need for a nationwide campaign of awareness is urgently needed as the expansion of medical tourism has the potential of encouraging a further rise in organ trafficking.

Anti-Candida activity assessment of Pelargonium graveolens oil free and nanoemulsion in biofilm formation in hospital medical supplies.

Science.gov (United States)

Giongo, Janice Luehring; de Almeida Vaucher, Rodrigo; Fausto, Viviane Pedroso; Quatrin, Priscilla Maciel; Lopes, Leonardo Quintana Soares; Santos, Roberto Christ Vianna; Gündel, André; Gomes, Patrícia; Steppe, Martin

2016-11-01

Infections due to microbial biofilm formation on the surface of catheters and other medical devices are constantly reported as a major cause of morbidity and mortality in patients admitted to hospitals. Furthermore, sessile cells are more resistant to phagocytosis and most antimicrobial, which complicates the treatment of such infections. Researches aimed at new antimicrobial originating mainly from plants have increased in recent years and the development of new strategies for their release is critical in combating the formation of biofilms. Geranium oil (GO) has proven antimicrobial activity. Because of this, the aim of this study was to develop nanoemulsions containing this oil (NEG) and evaluate its activity after the biofilm formation of Candida albicans, Candida tropicalis, Candida glabrata, and Candida krusei in hospital medical supplies. For quantification of the biofilm, crystal violet, total protein, and ATP-bioluminescence assays were used. The results revealed that GO and NEG showed lower MIC for C. albicans and C. tropicalis. The biofilms formed by different species of Candida on the surfaces of polyethylene and polyurethane were quantified. GO and NEG significantly inhibited the formation of biofilms in all species tested on the surfaces of polyethylene. However, NEG antibiofilm has had better activity than GO for C. albicans, C. tropicalis and C. glabrata, according to the surface potential analysis by atomic force microscopy (AFM). The analysis of the biofilm formation on the polyethylene surface by ATP-bioluminescence and CFU showed similar results. In both methods the formation of biofilm in the catheter occurred in greater quantity for C. albicans and C. tropicalis. GO did not significantly inhibit the formation of biofilms only in C. krusei, although NEG significantly increased this activity GO in all species tested when compared to the control training biofilm. The following study shows that the development of NEG may become an effective

Validity Evidence and Scoring Guidelines for Standardized Patient Encounters and Patient Notes From a Multisite Study of Clinical Performance Examinations in Seven Medical Schools.

Science.gov (United States)

Park, Yoon Soo; Hyderi, Abbas; Heine, Nancy; May, Win; Nevins, Andrew; Lee, Ming; Bordage, Georges; Yudkowsky, Rachel

2017-11-01

To examine validity evidence of local graduation competency examination scores from seven medical schools using shared cases and to provide rater training protocols and guidelines for scoring patient notes (PNs). Between May and August 2016, clinical cases were developed, shared, and administered across seven medical schools (990 students participated). Raters were calibrated using training protocols, and guidelines were developed collaboratively across sites to standardize scoring. Data included scores from standardized patient encounters for history taking, physical examination, and PNs. Descriptive statistics were used to examine scores from the different assessment components. Generalizability studies (G-studies) using variance components were conducted to estimate reliability for composite scores. Validity evidence was collected for response process (rater perception), internal structure (variance components, reliability), relations to other variables (interassessment correlations), and consequences (composite score). Student performance varied by case and task. In the PNs, justification of differential diagnosis was the most discriminating task. G-studies showed that schools accounted for less than 1% of total variance; however, for the PNs, there were differences in scores for varying cases and tasks across schools, indicating a school effect. Composite score reliability was maximized when the PN was weighted between 30% and 40%. Raters preferred using case-specific scoring guidelines with clear point-scoring systems. This multisite study presents validity evidence for PN scores based on scoring rubric and case-specific scoring guidelines that offer rigor and feedback for learners. Variability in PN scores across participating sites may signal different approaches to teaching clinical reasoning among medical schools.

Supply-demand balance in outward-directed networks and Kleiber's law.

Science.gov (United States)

Painter, Page R

2005-11-10

Recent theories have attempted to derive the value of the exponent alpha in the allometric formula for scaling of basal metabolic rate from the properties of distribution network models for arteries and capillaries. It has recently been stated that a basic theorem relating the sum of nutrient currents to the specific nutrient uptake rate, together with a relationship claimed to be required in order to match nutrient supply to nutrient demand in 3-dimensional outward-directed networks, leads to Kleiber's law (b = 3/4). The validity of the supply-demand matching principle and the assumptions required to prove the basic theorem are assessed. The supply-demand principle is evaluated by examining the supply term and the demand term in outward-directed lattice models of nutrient and water distribution systems and by applying the principle to fractal-like models of mammalian arterial systems. Application of the supply-demand principle to bifurcating fractal-like networks that are outward-directed does not predict 3/4-power scaling, and evaluation of water distribution system models shows that the matching principle does not match supply to demand in such systems. Furthermore, proof of the basic theorem is shown to require that the covariance of nutrient uptake and current path length is 0, an assumption unlikely to be true in mammalian arterial systems. The supply-demand matching principle does not lead to a satisfactory explanation for the approximately 3/4-power scaling of mammalian basal metabolic rate.

Validation of an Improved Computer-Assisted Technique for Mining Free-Text Electronic Medical Records.

Science.gov (United States)

Duz, Marco; Marshall, John F; Parkin, Tim

2017-06-29

The use of electronic medical records (EMRs) offers opportunity for clinical epidemiological research. With large EMR databases, automated analysis processes are necessary but require thorough validation before they can be routinely used. The aim of this study was to validate a computer-assisted technique using commercially available content analysis software (SimStat-WordStat v.6 (SS/WS), Provalis Research) for mining free-text EMRs. The dataset used for the validation process included life-long EMRs from 335 patients (17,563 rows of data), selected at random from a larger dataset (141,543 patients, ~2.6 million rows of data) and obtained from 10 equine veterinary practices in the United Kingdom. The ability of the computer-assisted technique to detect rows of data (cases) of colic, renal failure, right dorsal colitis, and non-steroidal anti-inflammatory drug (NSAID) use in the population was compared with manual classification. The first step of the computer-assisted analysis process was the definition of inclusion dictionaries to identify cases, including terms identifying a condition of interest. Words in inclusion dictionaries were selected from the list of all words in the dataset obtained in SS/WS. The second step consisted of defining an exclusion dictionary, including combinations of words to remove cases erroneously classified by the inclusion dictionary alone. The third step was the definition of a reinclusion dictionary to reinclude cases that had been erroneously classified by the exclusion dictionary. Finally, cases obtained by the exclusion dictionary were removed from cases obtained by the inclusion dictionary, and cases from the reinclusion dictionary were subsequently reincluded using Rv3.0.2 (R Foundation for Statistical Computing, Vienna, Austria). Manual analysis was performed as a separate process by a single experienced clinician reading through the dataset once and classifying each row of data based on the interpretation of the free

Self-medication practice among undergraduate medical students in a tertiary care medical college, West Bengal.

Science.gov (United States)

Banerjee, I; Bhadury, T

2012-01-01

Self-medication is a widely prevalent practice in India. It assumes a special significance among medical students as they are the future medical practitioners. To assess the pattern of self-medication practice among undergraduate medical students. Tertiary care medical college in West Bengal, India. A cross-sectional questionnaire-based study was conducted among the undergraduate medical students. Out of 500 students of the institute, 482 consented for the study and filled in the supplied questionnaire. Fourteen incomplete questionnaires were excluded and the remaining 468 analyzed. It was found that 267 (57.05%) respondents practiced self-medication. The principal morbidities for seeking self-medication included cough and common cold as reported by 94 students (35.21%) followed by diarrhea (68 students) (25.47%), fever (42 students) (15.73%), headache (40 students) (14.98%) and pain abdomen due to heartburn/ peptic ulcer (23 students) (8.61%). Drugs/ drug groups commonly used for self-medication included antibiotics (31.09%) followed by analgesics (23.21%), antipyretics (17.98%), antiulcer agents (8.99%), cough suppressant (7.87%), multivitamins (6.37%) and antihelminthics (4.49%). Among reasons for seeking self-medication, 126 students (47.19%) felt that their illness was mild while 76 (28.46%) preferred as it is time-saving. About 42 students (15.73%) cited cost-effectiveness as the primary reason while 23 (8.62%) preferred because of urgency. Our study shows that self-medication is widely practiced among students of the institute. In this situation, faculties should create awareness and educate their students regarding advantages and disadvantages of self-medication.

Decision-Making for Supply Chain Integration Supply Chain Integration

CERN Document Server

Lettice, Fiona; Durowoju, Olatunde

2012-01-01

Effective supply chain integration, and the tight co-ordination it creates, is an essential pre-requisite for successful supply chain management.  Decision-Making for Supply Chain Integration is a practical reference on recent research in the area of supply chain integration focusing on distributed decision-making problems. Recent applications of various decision-making tools for integrating supply chains are covered including chapters focusing on: •Supplier selection, pricing strategy and inventory decisions in multi-level supply chains, •RFID-enabled distributed decision-making, •Operational risk issues and time-critical decision-making for sensitive logistics nodes, Modelling end to end processes to improve supply chain integration, and •Integrated systems to improve service delivery and optimize resource use. Decision-Making for Supply Chain Integration provides an insight into the tools and methodologies of this field with support from real-life case studies demonstrating successful application ...

Evaluating the validity of an integrity-based situational judgement test for medical school admissions.

Science.gov (United States)

Husbands, Adrian; Rodgerson, Mark J; Dowell, Jon; Patterson, Fiona

2015-09-02

While the construct of integrity has emerged as a front-runner amongst the desirable attributes to select for in medical school admissions, it is less clear how best to assess this characteristic. A potential solution lies in the use of Situational Judgement Tests (SJTs) which have gained popularity due to robust psychometric evidence and potential for large-scale administration. This study aims to explore the psychometric properties of an SJT designed to measure the construct of integrity. Ten SJT scenarios, each with five response stems were developed from critical incident interviews with academic and clinical staff. 200 of 520 (38.5 %) Multiple Mini Interview candidates at Dundee Medical School participated in the study during the 2012-2013 admissions cycle. Participants were asked to rate the appropriateness of each SJT response on a 4-point likert scale as well as complete the HEXACO personality inventory and a face validity questionnaire. Pearson's correlations and descriptive statistics were used to examine the associations between SJT score, HEXACO personality traits, pre-admissions measures namely academic and United Kingdom Clinical Aptitude Test (UKCAT) scores, as well as acceptability. Cronbach's alpha reliability for the SJT was .64. Statistically significant correlations ranging from .16 to .36 (.22 to .53 disattenuated) were observed between SJT score and the honesty-humility (integrity), conscientiousness, extraversion and agreeableness dimensions of the HEXACO inventory. A significant correlation of .32 (.47 disattenuated) was observed between SJT and MMI scores and no significant relationship with the UKCAT. Participant reactions to the SJTs were generally positive. Initial findings are encouraging regarding the psychometric robustness of an integrity-based SJT for medical student selection, with significant associations found between the SJTs, integrity, other desirable personality traits and the MMI. The SJTs showed little or no redundancy with

Perceptions and practices of self-medication among medical students in coastal South India.

Directory of Open Access Journals (Sweden)

Nithin Kumar

Full Text Available Self-medication is a common practice worldwide and the irrational use of drugs is a cause of concern. This study assessed the prevalence of self-medication among the medical students in South India. The data was analysed using SPSS version 11.5. A total of 440 students were included in the study. The prevalence of self-medication was 78.6%. A larger number of females were self-medicating (81.2% than males (75.3%. The majority of the students self-medicated because of the illness being too trivial for consultation (70.5%. Antipyretics were most commonly self-medicated by the participants (74.8%. Only 47% of the participants opined that self-medication was a part of self-care and it needs to be encouraged. 39.3% of the participants perceived that the supply of medicine without prescription by the pharmacist can prevent the growing trend of self-medication. Easy availability and accessibility to health care facilities remains the cornerstone for reducing the practice of self-medication.

Direct medical costs and medication compliance among fibromyalgia patients: duloxetine initiators vs. pregabalin initiators.

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Sun, Peter; Peng, Xiaomei; Sun, Steve; Novick, Diego; Faries, Douglas E; Andrews, Jeffrey S; Wohlreich, Madelaine M; Wu, Andrew

2014-01-01

To assess and compare direct medical costs and medication compliance between patients with fibromyalgia who initiated duloxetine and patients with fibromyalgia who initiated pregabalin in 2008. A retrospective cohort study design was used based on a large US national commercial claims database (2006 to 2009). Patients with fibromyalgia aged 18 to 64 who initiated duloxetine or pregabalin in 2008 and who had continuous health insurance 1 year preceding and 1 year following the initiation were selected into duloxetine cohort or pregabalin cohort based on their initiated agent. Medication compliance was measured by total supply days, medication possession ratio (MPR), and proportion of patients with MPR ≥ 0.8. Direct medical costs were measured by annual costs per patient and compared between the cohorts in the year following the initiation. Propensity score stratification and bootstrapping methods were used to adjust for distribution bias, as well as cross-cohort differences in demographic, clinical and economic characteristics, and medication history prior to the initiation. Both the duloxetine (n = 3,033) and pregabalin (n = 4,838) cohorts had a mean initiation age around 49 years, 89% were women. During the postindex year, compared to the pregabalin cohort, the duloxetine cohort had higher totally annual supply days (273.5 vs. 176.6, P costs ($2,994.9 vs. $4,949.6, P costs ($8,259.6 vs. $10,312.2, P costs ($5,214.6 vs. $5,290.8, P > 0.05), and lower total medical costs ($16,469.1 vs. $20,552.6, P compliance and consumed less inpatient, outpatient, and total medical costs than those who initiated pregabalin. © 2013 The Authors Pain Practice © 2013 World Institute of Pain.

HOW A SUPPLY CHAIN PROCESS MATTERS IN FIRMS’ PERFORMANCE-AN EMPIRICAL EVIDENCE OF PAKISTAN

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Muhammad Ziaullah

2017-12-01

Full Text Available In recent years, supply chain processes (i.e. demand management, customer relationship management, and new product development have gained a great importance from academicians and practitioners. Yet, research into the subject of supply chain processes’ effects on performance is nascent. The purpose of this study is to examine the process dimensions’ effects on supply chain (SC partners’ trust and firms’ performance as supply chain processes are essential for firms’ competitiveness. The research framework consists of seven hypotheses. An empirical study was conducted in Pakistan, and the data were collected from 164 supply chain firms. The reliability and validity of the model were examined through the exploratory factor analysis (EFA and Confirmatory factor analysis (CFA. The results delineate that supply chain processes have a significant relationship with SC partners’ trust and performance. Thus, all hypotheses were supported. This study presents interesting theoretical contributions and managerial implications. At last, limitations regarding future research directions are discussed.

The research on optimization of auto supply chain network robust model under macroeconomic fluctuations

International Nuclear Information System (INIS)

Guo, Chunxiang; Liu, Xiaoli; Jin, Maozhu; Lv, Zhihan

2016-01-01

Considering the uncertainty of the macroeconomic environment, the robust optimization method is studied for constructing and designing the automotive supply chain network, and based on the definition of robust solution a robust optimization model is built for integrated supply chain network design that consists of supplier selection problem and facility location–distribution problem. The tabu search algorithm is proposed for supply chain node configuration, analyzing the influence of the level of uncertainty on robust results, and by comparing the performance of supply chain network design through the stochastic programming model and robustness optimize model, on this basis, determining the rational layout of supply chain network under macroeconomic fluctuations. At last the contrastive test result validates that the performance of tabu search algorithm is outstanding on convergence and computational time. Meanwhile it is indicated that the robust optimization model can reduce investment risks effectively when it is applied to supply chain network design.

Awareness of family medicine discipline among clinical medical ...

African Journals Online (AJOL)

Introduction: Undergraduate medical education requires the studying of a wide range of medical specialties to produce the future workforce of the healthcare system. Family medicine (FM), a relatively new specialty in Nigeria, aims at supplying doctors capable of providing comprehensive healthcare for the majority of the ...

Construct validity of the pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT) in children with medical complexity.

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Dumas, Helene M; Fragala-Pinkham, Maria A; Rosen, Elaine L; O'Brien, Jane E

2017-11-01

To assess construct (convergent and divergent) validity of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) in a sample of children with complex medical conditions. Demographics, clinical information, PEDI-CAT normative score, and the Post-Acute Acuity Rating for Children (PAARC) level were collected for all post-acute hospital admissions (n = 110) from 1 April 2015 to 1 March 2016. Correlations between the PEDI-CAT Daily Activities, Mobility, and Social/Cognitive domain scores for the total sample and across three age groups (infant, preschool, and school-age) were calculated. Differences in mean PEDI-CAT scores for each domain across two groups, children with "Less Complexity," or "More Complexity" based on PAARC level were examined. All correlations for the total sample and age subgroups were statistically significant and trends across age groups were evident with the stronger associations between domains for the infant group. Significant differences were found between mean PEDI-CAT Daily Activities, Mobility, and Social/Cognitive normative scores across the two complexity groups with children in the "Less Complex" group having higher PEDI-CAT scores for all domains. This study provides evidence indicating the PEDI-CAT can be used with confidence in capturing and differentiating children's level of function in a post-acute care setting. Implications for Rehabilitation The PEDI-CAT is measure of function for children with a variety of conditions and can be used in any clinical setting. Convergent validity of the PEDI-CAT's Daily Activities, Mobility, and Social/Cognitive domains was significant and particularly strong for infants and young children with medical complexity. The PEDI-CAT was able to discriminate groups of children with differing levels of medical complexity admitted to a pediatric post-acute care hospital.

On Production and Green Transportation Coordination in a Sustainable Global Supply Chain

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Feng Guo

2017-11-01

Full Text Available This paper addresses a coordination problem of production and green transportation and the effects of production and transportation coordination on supply chain sustainability in a global supply chain environment with the consideration of important realistic characteristics, including parallel machines, different order processing complexities, fixed delivery departure times, green transportation and multiple transportation modes. We formulate the measurements for carbon emissions of different transportation modes, including air, sea and land transportation. A hybrid genetic algorithm-based optimization approach is developed to handle this problem, in which a hybrid genetic algorithm and heuristic procedures are combined. The effectiveness of the proposed approach is validated by means of various problem instances. We observe that the coordination of production and green transportation has a large effect on the overall supply chain sustainability, which can reduce the total supply chain cost by 9.60% to 21.90%.

Vaccine supply, demand, and policy: a primer.

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Muzumdar, Jagannath M; Cline, Richard R

2009-01-01

To provide an overview of supply and demand issues in the vaccine industry and the policy options that have been implemented to resolve these issues. Medline, Policy File, and International Pharmaceutical Abstracts were searched to locate academic journal articles. Other sources reviewed included texts on the topics of vaccine history and policy, government agency reports, and reports from independent think tanks. Keywords included vaccines, immunizations, supply, demand, and policy. Search criteria were limited to English language and human studies. Articles pertaining to vaccine demand, supply, and public policy were selected and reviewed for inclusion. By the authors. Vaccines are biologic medications, therefore making their development and production more difficult and costly compared with "small-molecule" drugs. Research and development costs for vaccines can exceed $800 million, and development may require 10 years or more. Strict manufacturing regulations and facility upgrades add to these costs. Policy options to increase and stabilize the supply of vaccines include those aimed at increasing supply, such as government subsidies for basic vaccine research, liability protection for manufacturers, and fast-track approval for new vaccines. Options to increase vaccine demand include advance purchase commitments, government stockpiles, and government financing for select populations. High development costs and multiple barriers to entry have led to a decline in the number of vaccine manufacturers. Although a number of vaccine policies have met with mixed success in increasing the supply of and demand for vaccines, a variety of concerns remain, including developing vaccines for complex pathogens and increasing immunization rates with available vaccines. New policy innovations such as advance market commitments and Medicare Part D vaccine coverage have been implemented and may aid in resolving some of the problems in the vaccine industry.

Construct-level predictive validity of educational attainment and intellectual aptitude tests in medical student selection: meta-regression of six UK longitudinal studies

Science.gov (United States)

2013-01-01

Background Measures used for medical student selection should predict future performance during training. A problem for any selection study is that predictor-outcome correlations are known only in those who have been selected, whereas selectors need to know how measures would predict in the entire pool of applicants. That problem of interpretation can be solved by calculating construct-level predictive validity, an estimate of true predictor-outcome correlation across the range of applicant abilities. Methods Construct-level predictive validities were calculated in six cohort studies of medical student selection and training (student entry, 1972 to 2009) for a range of predictors, including A-levels, General Certificates of Secondary Education (GCSEs)/O-levels, and aptitude tests (AH5 and UK Clinical Aptitude Test (UKCAT)). Outcomes included undergraduate basic medical science and finals assessments, as well as postgraduate measures of Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) performance and entry in the Specialist Register. Construct-level predictive validity was calculated with the method of Hunter, Schmidt and Le (2006), adapted to correct for right-censorship of examination results due to grade inflation. Results Meta-regression analyzed 57 separate predictor-outcome correlations (POCs) and construct-level predictive validities (CLPVs). Mean CLPVs are substantially higher (.450) than mean POCs (.171). Mean CLPVs for first-year examinations, were high for A-levels (.809; CI: .501 to .935), and lower for GCSEs/O-levels (.332; CI: .024 to .583) and UKCAT (mean = .245; CI: .207 to .276). A-levels had higher CLPVs for all undergraduate and postgraduate assessments than did GCSEs/O-levels and intellectual aptitude tests. CLPVs of educational attainment measures decline somewhat during training, but continue to predict postgraduate performance. Intellectual aptitude tests have lower CLPVs than A-levels or GCSEs

Analysis on the cost structure of product recall for reverse supply chain

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Yanhua, Feng; Xuhui, Xia; Zheng, Yang

2017-12-01

The research on the reverse supply chain of product recall mainly focused on the recall network structure, logistics mode and so on. In this paper, when product recall and supply channel are fixed, the specific structure and function expression of cost are analyzed according to the peak season and off-season of recall activities, and whether the assembly manufacturer, supplier and recyclers are cooperated situation, respectively, to build the total cost structure of the function model. Finally, the model is validated correctly through the automotive industry and the electromechanical industry.

Assessing the Learning Environment for Medical Students: An Evaluation of a Novel Survey Instrument in Four Medical Schools.

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Pololi, Linda H; Evans, Arthur T; Nickell, Leslie; Reboli, Annette C; Coplit, Lisa D; Stuber, Margaret L; Vasiliou, Vasilia; Civian, Janet T; Brennan, Robert T

2017-06-01

A practical, reliable, and valid instrument is needed to measure the impact of the learning environment on medical students' well-being and educational experience and to meet medical school accreditation requirements. From 2012 to 2015, medical students were surveyed at the end of their first, second, and third year of studies at four medical schools. The survey assessed students' perceptions of the following nine dimensions of the school culture: vitality, self-efficacy, institutional support, relationships/inclusion, values alignment, ethical/moral distress, work-life integration, gender equity, and ethnic minority equity. The internal reliability of each of the nine dimensions was measured. Construct validity was evaluated by assessing relationships predicted by our conceptual model and prior research. Assessment was made of whether the measurements were sensitive to differences over time and across institutions. Six hundred and eighty-six students completed the survey (49 % women; 9 % underrepresented minorities), with a response rate of 89 % (range over the student cohorts 72-100 %). Internal consistency of each dimension was high (Cronbach's α 0.71-0.86). The instrument was able to detect significant differences in the learning environment across institutions and over time. Construct validity was supported by demonstrating several relationships predicted by our conceptual model. The C-Change Medical Student Survey is a practical, reliable, and valid instrument for assessing the learning environment of medical students. Because it is sensitive to changes over time and differences across institution, results could potentially be used to facilitate and monitor improvements in the learning environment of medical students.

Manual versus automated coding of free-text self-reported medication data in the 45 and Up Study: a validation study.

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Gnjidic, Danijela; Pearson, Sallie-Anne; Hilmer, Sarah N; Basilakis, Jim; Schaffer, Andrea L; Blyth, Fiona M; Banks, Emily

2015-03-30

Increasingly, automated methods are being used to code free-text medication data, but evidence on the validity of these methods is limited. To examine the accuracy of automated coding of previously keyed in free-text medication data compared with manual coding of original handwritten free-text responses (the 'gold standard'). A random sample of 500 participants (475 with and 25 without medication data in the free-text box) enrolled in the 45 and Up Study was selected. Manual coding involved medication experts keying in free-text responses and coding using Anatomical Therapeutic Chemical (ATC) codes (i.e. chemical substance 7-digit level; chemical subgroup 5-digit; pharmacological subgroup 4-digit; therapeutic subgroup 3-digit). Using keyed-in free-text responses entered by non-experts, the automated approach coded entries using the Australian Medicines Terminology database and assigned corresponding ATC codes. Based on manual coding, 1377 free-text entries were recorded and, of these, 1282 medications were coded to ATCs manually. The sensitivity of automated coding compared with manual coding was 79% (n = 1014) for entries coded at the exact ATC level, and 81.6% (n = 1046), 83.0% (n = 1064) and 83.8% (n = 1074) at the 5, 4 and 3-digit ATC levels, respectively. The sensitivity of automated coding for blank responses was 100% compared with manual coding. Sensitivity of automated coding was highest for prescription medications and lowest for vitamins and supplements, compared with the manual approach. Positive predictive values for automated coding were above 95% for 34 of the 38 individual prescription medications examined. Automated coding for free-text prescription medication data shows very high to excellent sensitivity and positive predictive values, indicating that automated methods can potentially be useful for large-scale, medication-related research.

Port supply chain integration : analyzing biofuel supply chains

NARCIS (Netherlands)

Stevens, Leonie C. E.; Vis, Iris F. A.

2016-01-01

This paper focuses on port supply chain integration to strengthen operational and business performance. We provide a structured and comprehensive method to enable port supply chain integration and demonstrate its applicability to the biofuel supply chain. We define the value proposition, role,

Managing Food Quality Risk in Global Supply Chain: A Risk Management Framework

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Pablo Jose Arevalo Chavez

2012-04-01

Full Text Available Today, the food sector is one of the sectors most vulnerable to intentional contamination by debilitating agents [1]. Some cases of contaminated food have indicated that product quality risk is one of the vulnerabilities in the global supply chain. A series of company scandals, affecting reputation and causing the recall of products and increasing costs have hit the food industry. The obvious problem is that even a minor incident in one part of the chain can have disastrous effects on other parts of the supply chain. Thus, risks are transmitted through the chain. Even though the dangers from members in the supply chain are small, the cumulative effect becomes significant. The aim of this study is to propose an integrated supply chain risk management framework for practitioners that can provide directions for how to evaluate food quality risk in the global supply chain. For validating the proposed model in‐depth, a case study is conducted on a food SME distributor in Central America. The case study investigates how product quality risks are handled according to the proposed framework.

Sustainable Construction Supply Chains through Synchronized Production Planning and Control in Engineer-to-Order Enterprises

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Patrick Dallasega

2017-10-01

Full Text Available Sustainability in the supply chain is becoming more and more important for industrial enterprises in different sectors. This research article focuses on construction supply chains (CSCs in the Engineer-to-Order (ETO industry, where every product is almost unique based on specific customer needs and requirements. The development of methods and approaches for more sustainable supply chain management in construction is becoming even more important. Engineering, fabrication of parts and their installation on-site are not always well synchronized in ETO supply chains. The results of such supply chains are long lead times, inefficient material transport and high and uncontrolled levels of work-in-progress (WIP. This article describes a conceptual approach to synchronize demand on-site with supply in manufacturing using the CONstant Work In Progress (ConWIP concept from Lean Management to achieve Just-in-Time (JIT supply. As a result, sustainable supply chains in ETO enterprises, with optimizations from an economic, ecological and social point of view, can be designed. The approach has been validated in an industrial case study.

Communication behaviours of skilled and less skilled oncologists: a validation study of the Medical Interaction Process System (MIPS).

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Ford, Sarah; Hall, Angela

2004-09-01

The Medical Interaction Process System (MIPS) was originally developed in order to create a reliable observation tool for analysing doctor-patient encounters in the oncology setting. This paper reports a series of analyses carried out to establish whether the behaviour categories of the MIPS can discriminate between skilled and less skilled communicators. This involved the use of MIPS coded cancer consultations to compare the MIPS indices of 10 clinicians evaluated by an independent professional as skilled communicators with 10 who were considered less skilled. Eleven out of the 15 MIPS variables tested were able to distinguish the skilled from the less skilled group. Although limitations to the study are discussed, the results indicate that the MIPS has satisfactory discriminatory power and the results provide validity data that meet key objectives for developing the system. There is an ever-increasing need for reliable methods of assessing doctors' communication skills and evaluating medical interview teaching programmes. Copyright 2004 Elsevier Ireland Ltd.

Future trends in the supply and demand for radiation oncology physicists.

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Mills, Michael D; Thornewill, Judah; Esterhay, Robert J

2010-04-12

Significant controversy surrounds the 2012 / 2014 decision announced by the Trustees of the American Board of Radiology (ABR) in October of 2007. According to the ABR, only medical physicists who are graduates of a Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP) accredited academic or residency program will be admitted for examination in the years 2012 and 2013. Only graduates of a CAMPEP accredited residency program will be admitted for examination beginning in the year 2014. An essential question facing the radiation oncology physics community is an estimation of supply and demand for medical physicists through the year 2020. To that end, a Demand & Supply dynamic model was created using STELLA software. Inputs into the model include: a) projected new cancer incidence and prevalence 1990-2020; b) AAPM member ages and retirement projections 1990-2020; c) number of ABR physics diplomates 1990-2009; d) number of patients per Qualified Medical Physicist from Abt Reports I (1995), II (2002) and III (2008); e) non-CAMPEP physicists trained 1990-2009 and projected through 2014; f) CAMPEP physicists trained 1993-2008 and projected through 2014; and g) working Qualified Medical Physicists in radiation oncology in the United States (1990-2007). The model indicates that the number of qualified medical physicists working in radiation oncology required to meet demand in 2020 will be 150-175 per year. Because there is some elasticity in the workforce, a portion of the work effort might be assumed by practicing medical physicists. However, the minimum number of new radiation oncology physicists (ROPs) required for the health of the profession is estimated to be 125 per year in 2020. The radiation oncology physics community should plan to build residency programs to support these numbers for the future of the profession.

Dealing with large-scale supply lines when introducing new regimens.

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Malati, Christine; Rosenfeld, Joshua; Mowafy, Sherif; Rittmiller, Trevor; Kuritsky, Joel; Crowley, John

2017-07-01

As programs plan the introduction of a new antiretroviral as part of a regimen for HIV treatment, supply chain considerations need to be taken into account. The key to success is balancing the introduction of a new regimen with the phasing out of an old regimen in a manner that does not result in either a shortage or an excess supply of either product while ensuring that patients continue receiving their medications. This necessitates that country programs, donors, and procurement entities possess an appreciation of the global antiretroviral market and understand the dynamics that the manufacturing of new antiretrovirals will have on the transition. Supply, demand, and financial considerations affect the capacity of the supply chain to facilitate a successful antiretroviral transition. Although this commentary draws on United States Agency for International Development experiences under the President's Emergency Plan for AIDS Relief from earlier antiretroviral treatment shifts, the approaches are applicable to other institutions and to future transitions. Three approaches were employed: ensuring the engagement of all key stakeholders in transition planning and execution, including clinicians, advocacy groups, supply chain professionals, ministry, and donors; conducting and updating regularly the national quantification and supply plans for all regimens; and introducing antiretroviral products into programs from regional warehouses based on firm orders. Extensive planning and accounting for supply chain factors is essential to ensuring a smooth transition to a new regimen and to enable the global antiretroviral market to respond adequately.

Canadian inquiry assesses blame for tainted blood supply.

Science.gov (United States)

1997-12-26

A commission of inquiry, headed by Justice Horace Krever of the Ontario Court of Appeal, found that hundreds of hemophiliacs and blood transfusion recipients could have avoided HIV if the government regulators and medical suppliers had taken precautions in the early 1980s to protect Canada's blood supply. The report documents an inventory of errors and misjudgments that resulted in the infection of more than 1,200 people with HIV and roughly 60,000 with hepatitis C. The report noted that one U.S. blood fractionator, Armour Pharmaceutical, violated Canadian law by not informing government regulators in 1985 that its products might be tainted with HIV. Other findings conclude that the Red Cross, the agency with principal responsibility for protecting Canada's blood supply, put forth a halfhearted and ineffective response, and little effort was made to promote the use of safer blood clotting agents for hemophiliacs. Canada only began testing its blood supply for HIV eight months after the U.S. initiated ELISA testing. The commission recommends compensating all past and future recipients of contaminated blood and blood products.

Developing measures for the evaluation of information flow efficiency in supply chains

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Johanna A. Badenhorst

2013-05-01

Full Text Available Member organisations in a supply chain are dependent on each other to provide material, services and information to perform optimally in the supply chain. Efficient, unrestricted information flow is needed in supply chains to function properly. Information flow is thus an element of supply chain management that needs to be managed. Yet, no indication could be found in supply chain management literature of the measurement of information flow efficiency. Hence, the aim of this article is to explore the measurement of information flow efficiency in supply chain management (SCM and exploratively develop possible measures (indicators and associated metrics to measure the efficiency of information flow.In this research the theory of information and related concepts, the basic notions of information systems and the models of business performance measurement were explored. Based on information flow theory and information flow characteristics a research instrument was developed. It was used in a survey to seek inputs from supply chain managers as to the usefulness of characteristics as indicators and metrics for the measurement of information flow efficiency in a supply chain. The main contribution of the study is the development of a conceptual framework of indicators and metrics that may be used to evaluate the efficiency of information flows in supply chains. The results of this study can be used as a basis for further studies to validate the instrument for measuring information flow efficiency and to develop scales to actually measure information flow efficiency.

NF EN ISO 11137-1, July 2006. Sterilization of health care products - Irradiation - Part 1: Requirements for development, validation and routine control of a sterilization process for medical devices

International Nuclear Information System (INIS)

2006-01-01

This part of the ISO 11137 standard specifies requirements for the development, validation and routine control of a radiation sterilization process for medical devices. Although the scope of this part of the ISO 11137 standard is limited to medical devices, it specifies requirements and provides guidance that may be applicable to other products and equipment. This part of the international standard covers radiation processes employing irradiators using the radionuclide 60 Co or 137 Cs, a beam from an electron generator or a beam from an X-ray generator. This part of the international standard does not: - specify requirements for development, validation and routine control of a process for inactivating the causative agents of spongiform encephalopathies such as scrapie, bovine spongiform encephalopathy and Creutzfeldt-Jakob disease; - detail specified requirements for designating a medical device as sterile; - specify a quality management system for the control of all stages of production of medical devices; - specify requirements for occupational safety associated with the design and operation of irradiation facilities; - specify requirements for the sterilization of used or reprocessed devices

Self-medication practice among undergraduate medical students in a tertiary care medical college, West Bengal

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I Banerjee

2012-01-01

Full Text Available Background: Self-medication is a widely prevalent practice in India. It assumes a special significance among medical students as they are the future medical practitioners. Aim: To assess the pattern of self-medication practice among undergraduate medical students. Settings and Design: Tertiary care medical college in West Bengal, India. Material and Methods: A cross-sectional questionnaire-based study was conducted among the undergraduate medical students. Results: Out of 500 students of the institute, 482 consented for the study and filled in the supplied questionnaire. Fourteen incomplete questionnaires were excluded and the remaining 468 analyzed. It was found that 267 (57.05% respondents practiced self-medication. The principal morbidities for seeking self-medication included cough and common cold as reported by 94 students (35.21% followed by diarrhea (68 students (25.47%, fever (42 students (15.73%, headache (40 students (14.98% and pain abdomen due to heartburn/ peptic ulcer (23 students (8.61%. Drugs/ drug groups commonly used for self-medication included antibiotics (31.09% followed by analgesics (23.21%, antipyretics (17.98%, antiulcer agents (8.99%, cough suppressant (7.87%, multivitamins (6.37% and antihelminthics (4.49%. Among reasons for seeking self-medication, 126 students (47.19% felt that their illness was mild while 76 (28.46% preferred as it is time-saving. About 42 students (15.73% cited cost-effectiveness as the primary reason while 23 (8.62% preferred because of urgency. Conclusion: Our study shows that self-medication is widely practiced among students of the institute. In this situation, faculties should create awareness and educate their students regarding advantages and disadvantages of self-medication.

Coordination of Supply Chain with a Dominant Retailer under Demand Disruptions

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Jian Li

2014-01-01

Full Text Available We develop a coordination model of a one-manufacturer multi-retailers supply chain with a dominant retailer. We consider the impact of a dominant retailer on the market retail price and his sales promotion opportunity and examine how the manufacturer can coordinate such a supply chain by revenue-sharing contract after demand disruptions. We address the following important research questions in this paper. (i How do we design an appropriate revenue-sharing contract to coordinate the supply chain with a dominant retailer without demand disruptions? (ii When demand is disrupted with variations in market scale and price sensitive coefficient, can the original contract still be valid? (iii How do the demand disruptions affect the coordination mechanism under different disruption scenarios and how should the new contract change? Finally, we generate important insights by both analytical and numerical examples.

Supply-demand balance in outward-directed networks and Kleiber's law

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Painter Page R

2005-11-01

Full Text Available Abstract Background Recent theories have attempted to derive the value of the exponent α in the allometric formula for scaling of basal metabolic rate from the properties of distribution network models for arteries and capillaries. It has recently been stated that a basic theorem relating the sum of nutrient currents to the specific nutrient uptake rate, together with a relationship claimed to be required in order to match nutrient supply to nutrient demand in 3-dimensional outward-directed networks, leads to Kleiber's law (b = 3/4. Methods The validity of the supply-demand matching principle and the assumptions required to prove the basic theorem are assessed. The supply-demand principle is evaluated by examining the supply term and the demand term in outward-directed lattice models of nutrient and water distribution systems and by applying the principle to fractal-like models of mammalian arterial systems. Results Application of the supply-demand principle to bifurcating fractal-like networks that are outward-directed does not predict 3/4-power scaling, and evaluation of water distribution system models shows that the matching principle does not match supply to demand in such systems. Furthermore, proof of the basic theorem is shown to require that the covariance of nutrient uptake and current path length is 0, an assumption unlikely to be true in mammalian arterial systems. Conclusion The supply-demand matching principle does not lead to a satisfactory explanation for the approximately 3/4-power scaling of mammalian basal metabolic rate.

[Appliancation of logistics in resources management of medical asset].

Science.gov (United States)

Miroshnichenko, Iu V; Goriachev, A B; Bunin, S A

2011-06-01

The usage of basic regulations of logistics in practical activity for providing joints and military units with medical asset is theoretically justified. The role of logistics in organizing, building and functioning of military (armed forces) medical supply system is found out. The methods of solving urgent problems of improvement the resources management of medical asset on the basis of logistics are presented.

Development and validation of an LC-MS/MS method for the quantification of tiamulin, trimethoprim, tylosin, sulfadiazine and sulfamethazine in medicated feed.

Science.gov (United States)

Patyra, Ewelina; Nebot, Carolina; Gavilán, Rosa Elvira; Cepeda, Alberto; Kwiatek, Krzysztof

2018-01-22

A new multi-compound method for the analysis of veterinary drugs, namely tiamulin, trimethoprim, tylosin, sulfadiazine and sulfamethazine was developed and validated in medicated feeds. After extraction, the samples were centrifuged, diluted in Milli-Q water, filtered and analysed by high performance liquid chromatography coupled to tandem mass spectrometry. The separation of the analytes was performed on a biphenyl column with a gradient of 0.1% formic acid in acetonitrile and 0.1% formic acid in Milli-Q water. Quantitative validation was done in accordance with the guidelines laid down in European Commission Decision 2002/657/EC. Method performances were evaluated by the following parameters: linearity (R 2  tiamulin, tylosin and sulfamethazine were detected at the concentration levels declared by the manufacturers. The developed method can therefore be successfully used to routinely control the content and homogeneity of these antibacterial substances in medicated feed. Abbreviations AAFCO - Association of American Feed Control Officials; TYL - tylosin; TIAM - tiamulin fumarate; TRIM - trimethoprim; SDZ - sulfadiazine; SMZ - sulfamethazine; UV - ultraviolet detector; FLD - fluorescence detector; HPLC - high performance liquid chromatography; MS/MS - tandem mass spectrometry; LOD - limit of detection; LOQ - limit of quantification; CV - coefficient of variation; SD - standard deviation; U - uncertainty.

Projections of Demand for Cardiovascular Surgery and Supply of Surgeons

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Jung Jeung Lee

2016-12-01

Full Text Available Background: While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. Methods: After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. Results: The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040—an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309—an increase of -24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. Conclusion: Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time

Low-technology cooling box for storage of malaria RDTs and other medical supplies in remote areas.

Science.gov (United States)

Chanthap, Lon; Ariey, Frédéric; Socheat, Duong; Tsuyuoka, Reiko; Bell, David

2010-01-23

With the increase in use of point-of-care diagnostic tests for malaria and other diseases comes the necessity of storing the diagnostic kits and the drugs required for subsequent management, in remote areas, where temperatures are high and electricity supply is unreliable or unavailable. To address the lack of temperature-controlled storage during the introduction of community-based malaria management in Cambodia, the Cambodian National Centre for Parasitology, Entomology and Malaria Control (CNM) developed prototype evaporative cooling boxes (Cambodian Cooler Boxes - CCBs) for storage of perishable medical commodities in remote clinics. The performance of these CCBs for maintaining suitable storage temperatures was evaluated over two phases in 2005 and 2006-7, comparing conditions in CCBs using water as designed, CCBs with no water for evaporation, and ambient storage room temperatures. Temperature and humidity was monitored, together with the capacity of the RDTs recommended for storage between 2 to 30 degree Celsius to detect low-density malaria parasite samples after storage under these conditions. Significant differences were recorded between the proportion of temperatures within the recommended RDT storage conditions in the CCBs with water and the temperatures in the storage room (p concept of evaporative cooling has potential to greatly enhance access to perishable diagnostics and medicines in remote communities, as it allows prolonged storage at low cost using locally-available materials, in the absence of electricity.

[The adaptation and validation to Spanish of the questionnaire Aid to Capacity Evaluation (ACE), for the assessment of the ability of patients in medical decision-making].

Science.gov (United States)

Moraleda Barba, Sandra; Ballesta Rodríguez, M Isabel; Delgado Quero, Antonio Luis; Lietor Villajos, Norberto; Moreno Corredor, Andrés; Delgado Rodríguez, Miguel

2015-03-01

To adapt and validate the Spanish version of the Aid to Capacity Evaluation scale, designed to assess the capacity of the adult in medical decision-making, both in diagnosis and treatment processes. Observational study of prospective validation. Primary and hospital care of the basic health area of Jaen. One hundred twenty-nine patients. Questionnaire which included sociodemographic variables, concerning the decision (scope, type of decision, the need for written informed consent), assessment of the capacity to the Aid to Capacity Evaluation scale and other related comorbidity (hearing loss, alcoholism, cognitive level variables with the Mini-Mental State Examination and depression by Goldberg or Yesavage test). The tool is considered viable. The conclusions of the expert panel were favorable. The result of the criteria' validity, comparing the results with the assessment of the experts (forensic and psychiatrist) was very satisfying (P<.001). The intra-observer reliability was low (kappa=0,135). Interobserver reliability remained high (kappa=0.74). The internal consistency was awarded an alpha of Cronbach's 0,645 for the reduced model of 6 items. The Aid to Capacity Evaluation scale was adapted to Spanish, demonstrating adequate internal consistency and construct validity. Its use in clinical practice could contribute to the identification of patients unable to make a particular medical decision and/or to give an informed consent. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

A Medical Research and Evaluation Facility (MREF) and Studies Supporting the Medical Chemical Defense Program: Task 95-39: Methods Development and Validation of Two Mouse Bioassays for Use in Quantifying Botulinum Toxins (A, B, C, D and E) and Toxin Antibody Titers

National Research Council Canada - National Science Library

Olson, Carl

1997-01-01

Ths task was conducted for the U.S. Army Medical Materiel Development Activity (USAMMDA) to validate two mouse bioassays for quantify botulinum toxin potency and neutralizing antibodies to botulimun toxins...

Sustainable Rent-Based Closed-Loop Supply Chain for Fashion Products

Directory of Open Access Journals (Sweden)

Zhi-Hua Hu

2014-10-01

Full Text Available The textile and clothing industry generates much pollution and consumes a large amount of resources. Improper uses and disposal of clothing products make the problems much more severe. Fast fashion products shorten the valid lifecycle and generate more waste than regular clothing products. Considering the features of fashion products, a system of a rent-based closed-loop supply chain is developed to improve the sustainability of fashion products. The supply chain processes (fashion design and manufacturing, laundry, logistics and disposal, the operations management issues (inventory management, closed-loop logistics, human-clothing matching, booking system and the rental pricing and the sustainability promotion aspects (customization, responsive system, culture and policy aspects are investigated by devising sustainable strategies. The rationalities of the developed system and strategies are reviewed and elucidated in detail. The results may contribute to building sustainable closed-loop fashion supply chains, the related information systems and operational and managerial mechanisms.

Evaluation and feedback for effective clinical teaching in postgraduate medical education: validation of an assessment instrument incorporating the CanMEDS roles.

Science.gov (United States)

Fluit, Cornelia; Bolhuis, Sanneke; Grol, Richard; Ham, Marieke; Feskens, Remco; Laan, Roland; Wensing, Michel

2012-01-01

Providing clinical teachers in postgraduate medical education with feedback about their teaching skills is a powerful tool to improve clinical teaching. A systematic review showed that available instruments do not comprehensively cover all domains of clinical teaching. We developed and empirically test a comprehensive instrument for assessing clinical teachers in the setting of workplace learning and linked to the CanMEDS roles. In a Delphi study, the content validity of a preliminary instrument with 88 items was studied, leading to the construction of the EFFECT (evaluation and feedback for effective clinical teaching) instrument. The response process was explored in a pilot test and focus group research with 18 residents of 6 different disciplines. A confirmatory factor analyses (CFA) and reliability analyses were performed on 407 evaluations of 117 supervisors, collected in 3 medical disciplines (paediatrics, pulmonary diseases and surgery) of 6 departments in 4 different hospitals. CFA yielded an 11 factor model with a good to excellent fit and internal consistencies ranged from 0.740 to 0.940 per domain; 7 items could be deleted. The model of workplace learning showed to be a useful framework for developing EFFECT, which incorporates the CanMEDS competencies and proved to be valid and reliable.

21 CFR 864.2240 - Cell and tissue culture supplies and equipment.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cell and tissue culture supplies and equipment. 864.2240 Section 864.2240 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Cell And Tissue Culture Products...

Profiling medical school learning environments in Malaysia: a validation study of the Johns Hopkins Learning Environment Scale

Directory of Open Access Journals (Sweden)

Sean Tackett

2015-07-01

Full Text Available Purpose: While a strong learning environment is critical to medical student education, the assessment of medical school learning environments has confounded researchers. Our goal was to assess the validity and utility of the Johns Hopkins Learning Environment Scale (JHLES for preclinical students at three Malaysian medical schools with distinct educational and institutional models. Two schools were new international partnerships, and the third was school leaver program established without international partnership. Methods: First- and second-year students responded anonymously to surveys at the end of the academic year. The surveys included the JHLES, a 28-item survey using five-point Likert scale response options, the Dundee Ready Educational Environment Measure (DREEM, the most widely used method to assess learning environments internationally, a personal growth scale, and single-item global learning environment assessment variables. Results: The overall response rate was 369/429 (86%. After adjusting for the medical school year, gender, and ethnicity of the respondents, the JHLES detected differences across institutions in four out of seven domains (57%, with each school having a unique domain profile. The DREEM detected differences in one out of five categories (20%. The JHLES was more strongly correlated than the DREEM to two thirds of the single-item variables and the personal growth scale. The JHLES showed high internal reliability for the total score (α=0.92 and the seven domains (α, 0.56-0.85. Conclusion: The JHLES detected variation between learning environment domains across three educational settings, thereby creating unique learning environment profiles. Interpretation of these profiles may allow schools to understand how they are currently supporting trainees and identify areas needing attention.

Radiation sterilization of medical supplies: conceptions, regulations, present status and further developments

International Nuclear Information System (INIS)

Peteu, Gh.

1994-01-01

A general view on the present stage and tendencies in the development of radiation sterilization of biomedical supplies is presented. Specific concepts in correlation with some regulations of the World Health Organization and of the National Public Health Authorities concerning the present state, the possibilities and criteria of development in our country, are discussed. Finally the present status of the design and execution of the project of two mobile and multipurpose irradiators is presented. (Author)

Validation of cardiovascular diagnoses in the Greenlandic Hospital Discharge Register for epidemiological use

DEFF Research Database (Denmark)

Tvermosegaard, Maria; Ronn, Pernille Falberg; Pedersen, Michael Lynge

2018-01-01

not previously been validated specifically. The objective of the study was to validate diagnoses of CVD in GHDR. The study was conducted as a validation study with primary investigator comparing information in GHDR with information in medical records. Diagnoses in GHDR were considered correct and thus valid......Cardiovascular disease (CVD) is one of the leading causes of death worldwide. In Greenland, valid estimates of prevalence and incidence of CVD do not exist and can only be calculated if diagnoses of CVD in the Greenlandic Hospital Discharge Register (GHDR) are correct. Diagnoses of CVD in GHDR have...... if they matched the diagnoses or the medical information in the medical records. A total of 432 online accessible medical records with a cardiovascular diagnosis according to GHDR from Queen Ingrid's Hospital from 2001 to 2013 (n=291) and from local health care centres from 2007 to 2013 (n=141) were reviewed...

Using the Estimating Supplies Program to Develop Materiel Solutions for the U.S. Air Force Aeromedical Evacuation In-Flight Kit (FFQDM)

National Research Council Canada - National Science Library

Hopkins, Curtis; Nix, Ralph; Pang, Gerry; Konoske, Paula

2008-01-01

... NHRC's medical modeling tool the Estimating Supplies Program (ESP) for the development and management of Air Force medical Allowance Standards as a baseline for standardization throughout the services...

Closed-Loop Supply Chain Planning Model of Rare Metals

Directory of Open Access Journals (Sweden)

Dongmin Son

2018-04-01

Full Text Available Rare metals (RMs are becoming increasingly important in high-tech industries associated with the Fourth Industrial Revolution, such as the electric vehicle (EV and 3D printer industries. As the growth of these industries accelerates in the near future, manufacturers will also face greater RM supply risks. For this reason, many countries are putting considerable effort into securing the RM supply. For example, countries including Japan, Korea, and the USA have adopted two major policies: the stockpile system and Extended Producer Responsibility (EPR. Therefore, it is necessary for the manufacturers with RMs to establish a suitable supply chain plan that reflects this situation. In this study, the RM classification matrix is created based on the stockpile and recycling level in Korea. Accordingly, three different types of supply chain are designed in order to develop the closed-loop supply chain (CLSC planning model of RM, and the CLSC planning models of RM are validated through experimental analysis. The results show that the stockpiling and the EPR recycling obligation increase the amount of recycled flow and reduce the total cost of the part manufacturing, which means that these two factors are significant for obtaining sustainability of the RMs’ CLSC. In addition, the government needs to set an appropriate sharing cost for promoting the manufacturer’s recycling. Also, from the manufacturer’s perspective, it is better to increase the return rate by making a contract with the collectors to guarantee the collection of used products.

GPM Ground Validation Navigation Data ER-2 OLYMPEX V1

Data.gov (United States)

National Aeronautics and Space Administration — The GPM Ground Validation NASA ER-2 Navigation Data OLYMPEX dataset supplies navigation data collected by the NASA ER-2 aircraft for flights that occurred during...

Reliability and Validity of Survey Instruments to Measure Work-Related Fatigue in the Emergency Medical Services Setting: A Systematic Review.

Science.gov (United States)

Patterson, P Daniel; Weaver, Matthew D; Fabio, Anthony; Teasley, Ellen M; Renn, Megan L; Curtis, Brett R; Matthews, Margaret E; Kroemer, Andrew J; Xun, Xiaoshuang; Bizhanova, Zhadyra; Weiss, Patricia M; Sequeira, Denisse J; Coppler, Patrick J; Lang, Eddy S; Higgins, J Stephen

2018-02-15

This study sought to systematically search the literature to identify reliable and valid survey instruments for fatigue measurement in the Emergency Medical Services (EMS) occupational setting. A systematic review study design was used and searched six databases, including one website. The research question guiding the search was developed a priori and registered with the PROSPERO database of systematic reviews: "Are there reliable and valid instruments for measuring fatigue among EMS personnel?" (2016:CRD42016040097). The primary outcome of interest was criterion-related validity. Important outcomes of interest included reliability (e.g., internal consistency), and indicators of sensitivity and specificity. Members of the research team independently screened records from the databases. Full-text articles were evaluated by adapting the Bolster and Rourke system for categorizing findings of systematic reviews, and the rated data abstracted from the body of literature as favorable, unfavorable, mixed/inconclusive, or no impact. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was used to evaluate the quality of evidence. The search strategy yielded 1,257 unique records. Thirty-four unique experimental and non-experimental studies were determined relevant following full-text review. Nineteen studies reported on the reliability and/or validity of ten different fatigue survey instruments. Eighteen different studies evaluated the reliability and/or validity of four different sleepiness survey instruments. None of the retained studies reported sensitivity or specificity. Evidence quality was rated as very low across all outcomes. In this systematic review, limited evidence of the reliability and validity of 14 different survey instruments to assess the fatigue and/or sleepiness status of EMS personnel and related shift worker groups was identified.

Multi-channel programmable power supply with temperature compensation for silicon sensors

International Nuclear Information System (INIS)

Shukla, R. A.; Achanta, V. G.; Dugad, S. R.; Kurup, A. M.; Lokhandwala, S. S.; Prabhu, S. S.; Freeman, J.; Los, S.; Garde, C. S.; Khandekar, P. D.; Gupta, S. K.; Rakshe, P. S.

2016-01-01

Silicon Photo-Multipliers (SiPMs) are increasingly becoming popular for discrete photon counting applications due to the wealth of advantages they offer over conventional photo-detectors such as photo-multiplier tubes and hybrid photo-diodes. SiPMs are used in variety of applications ranging from high energy physics and nuclear physics experiments to medical diagnostics. The gain of a SiPM is directly proportional to the difference between applied and breakdown voltage of the device. However, the breakdown voltage depends critically on the ambient temperature and has a large temperature co-efficient in the range of 40-60 mV/°C resulting in a typical gain variation of 3%-5%/°C [Dinu et al., in IEEE Nuclear Science Symposium, Medical Imaging Conference and 17th Room Temperature Semiconductor Detector Workshop (IEEE, 2010), p. 215]. We plan to use the SiPM as a replacement for PMT in the cosmic ray experiment (GRAPES-3) at Ooty [Gupta et al., Nucl. Instrum. Methods Phys. Res., Sect. A 540, 311 (2005)]. There the SiPMs will be operated in an outdoor environment subjected to temperature variation of about 15 °C over a day. A gain variation of more than 50% was observed for such large variations in the temperature. To stabilize the gain of the SiPM under such operating conditions, a low-cost, multi-channel programmable power supply (0-90 V) was designed that simultaneously provides the bias voltage to 16 SiPMs. The programmable power supply (PPS) was designed to automatically adjust the operating voltage for each channel with a built-in closed loop temperature feedback mechanism. The PPS provides bias voltage with a precision of 6 mV and measures the load current with a precision of 1 nA. Using this PPS, a gain stability of 0.5% for SiPM (Hamamatsu, S10931-050P) has been demonstrated over a wide temperature range of 15 °C. The design methodology of the PPS system, its validation, and the results of the tests carried out on the SiPM is presented in this

Multi-channel programmable power supply with temperature compensation for silicon sensors

Energy Technology Data Exchange (ETDEWEB)

Shukla, R. A.; Achanta, V. G.; Dugad, S. R., E-mail: dugad@cern.ch; Kurup, A. M.; Lokhandwala, S. S.; Prabhu, S. S. [Tata Institute of Fundamental Research, Mumbai 400005 (India); Freeman, J.; Los, S. [Fermi National Accelerator Laboratory, Batavia, Illinois 60510 (United States); Garde, C. S.; Khandekar, P. D. [Vishwakarma Institute of Information Technology, Pune 411048 (India); Gupta, S. K. [Tata Institute of Fundamental Research, Mumbai 400005 (India); GRAPES-3 Experiment, Cosmic Ray Laboratory, Raj Bhavan, Ooty 643001 (India); Rakshe, P. S. [Vishwakarma Institute of Information Technology, Pune 411048 (India); GRAPES-3 Experiment, Cosmic Ray Laboratory, Raj Bhavan, Ooty 643001 (India)

2016-01-15

Silicon Photo-Multipliers (SiPMs) are increasingly becoming popular for discrete photon counting applications due to the wealth of advantages they offer over conventional photo-detectors such as photo-multiplier tubes and hybrid photo-diodes. SiPMs are used in variety of applications ranging from high energy physics and nuclear physics experiments to medical diagnostics. The gain of a SiPM is directly proportional to the difference between applied and breakdown voltage of the device. However, the breakdown voltage depends critically on the ambient temperature and has a large temperature co-efficient in the range of 40-60 mV/°C resulting in a typical gain variation of 3%-5%/°C [Dinu et al., in IEEE Nuclear Science Symposium, Medical Imaging Conference and 17th Room Temperature Semiconductor Detector Workshop (IEEE, 2010), p. 215]. We plan to use the SiPM as a replacement for PMT in the cosmic ray experiment (GRAPES-3) at Ooty [Gupta et al., Nucl. Instrum. Methods Phys. Res., Sect. A 540, 311 (2005)]. There the SiPMs will be operated in an outdoor environment subjected to temperature variation of about 15 °C over a day. A gain variation of more than 50% was observed for such large variations in the temperature. To stabilize the gain of the SiPM under such operating conditions, a low-cost, multi-channel programmable power supply (0-90 V) was designed that simultaneously provides the bias voltage to 16 SiPMs. The programmable power supply (PPS) was designed to automatically adjust the operating voltage for each channel with a built-in closed loop temperature feedback mechanism. The PPS provides bias voltage with a precision of 6 mV and measures the load current with a precision of 1 nA. Using this PPS, a gain stability of 0.5% for SiPM (Hamamatsu, S10931-050P) has been demonstrated over a wide temperature range of 15 °C. The design methodology of the PPS system, its validation, and the results of the tests carried out on the SiPM is presented in this

An ant colony based resilience approach to cascading failures in cluster supply network

Science.gov (United States)

Wang, Yingcong; Xiao, Renbin

2016-11-01

Cluster supply chain network is a typical complex network and easily suffers cascading failures under disruption events, which is caused by the under-load of enterprises. Improving network resilience can increase the ability of recovery from cascading failures. Social resilience is found in ant colony and comes from ant's spatial fidelity zones (SFZ). Starting from the under-load failures, this paper proposes a resilience method to cascading failures in cluster supply chain network by leveraging on social resilience of ant colony. First, the mapping between ant colony SFZ and cluster supply chain network SFZ is presented. Second, a new cascading model for cluster supply chain network is constructed based on under-load failures. Then, the SFZ-based resilience method and index to cascading failures are developed according to ant colony's social resilience. Finally, a numerical simulation and a case study are used to verify the validity of the cascading model and the resilience method. Experimental results show that, the cluster supply chain network becomes resilient to cascading failures under the SFZ-based resilience method, and the cluster supply chain network resilience can be enhanced by improving the ability of enterprises to recover and adjust.

41 CFR 50-204.6 - Medical services and first aid.

Science.gov (United States)

2010-07-01

... first aid. 50-204.6 Section 50-204.6 Public Contracts and Property Management Other Provisions Relating... SUPPLY CONTRACTS General Safety and Health Standards § 50-204.6 Medical services and first aid. (a) The... trained to render first aid. First aid supplies approved by the consulting physician shall be readily...

[Validation of the Portuguese version of an instrument to measure the degree of patient knowledge about their medication].

Science.gov (United States)

Rubio, Joaquín Salmerón; García-Delgado, Pilar; Ferreira, Paula Iglésias; Santos, Henrique Mateus; Martínez-Martínez, Fernando

2014-04-01

The scope of this study was the validation of a cross-culturally adapted questionnaire into Portuguese in five community pharmacies in Portugal. The discriminatory power of items, content and construct validity and factor analysis of the main components and their reliability and stability were determined. A high degree of semantic equivalence between the original questionnaire and the cross-culturally adapted questionnaire into Portuguese was observed. A Kaiser-Meyer-Olkin index of 0.550 was obtained and the Bartlett sphericity test confirmed the adequacy of the data for the application of factor analysis (p <0.0001). Three factors which accounted for 52.6% of the total variability were considered. With respect to reliability the following results were obtained: 0.519 for Cronbach's alpha test; 0.89 for Cohen's kappa coefficient; and 0.756 (IC=0.598-0.963) for the CCI exam. In this work, the first adaptation for the Portuguese culture of a specific questionnaire was produced to measure the degree of knowledge patients have about their medication.

Framework for Knowledge Management Processes in Supply Chain

OpenAIRE

Mohsen Shafiei Nikabadi

2014-01-01

The main goal of this study is to provide a framework for knowledge management processes in supply chain of automotive industry in iran. This is an applied research and has done as a survey in Iran Khodro and Saipa Company as the largest companies in automotive industry of Iran. In this study 206 experts participated. Reliability methods were cronbach's Alfa and validity tests were content construction and discriminant analysis. To response to 1 main question and 5 sub questions in this resea...

ClinicalCodes: an online clinical codes repository to improve the validity and reproducibility of research using electronic medical records.

Science.gov (United States)

Springate, David A; Kontopantelis, Evangelos; Ashcroft, Darren M; Olier, Ivan; Parisi, Rosa; Chamapiwa, Edmore; Reeves, David

2014-01-01

Lists of clinical codes are the foundation for research undertaken using electronic medical records (EMRs). If clinical code lists are not available, reviewers are unable to determine the validity of research, full study replication is impossible, researchers are unable to make effective comparisons between studies, and the construction of new code lists is subject to much duplication of effort. Despite this, the publication of clinical codes is rarely if ever a requirement for obtaining grants, validating protocols, or publishing research. In a representative sample of 450 EMR primary research articles indexed on PubMed, we found that only 19 (5.1%) were accompanied by a full set of published clinical codes and 32 (8.6%) stated that code lists were available on request. To help address these problems, we have built an online repository where researchers using EMRs can upload and download lists of clinical codes. The repository will enable clinical researchers to better validate EMR studies, build on previous code lists and compare disease definitions across studies. It will also assist health informaticians in replicating database studies, tracking changes in disease definitions or clinical coding practice through time and sharing clinical code information across platforms and data sources as research objects.

A model of user engagement in medical device development.

Science.gov (United States)

Grocott, Patricia; Weir, Heather; Ram, Mala Bridgelal

2007-01-01

The purpose of this paper is to address three topical themes: user involvement in health services research; determining the value of new medical technologies in patient care pathways, furthering knowledge related to quality in health and social care; and knowledge exchange between manufacturers, health service supply chain networks and device users. The model is being validated in a case study in progress. The latter is a "proving ground" study for a translational research company. Medical devices play a pivotal role in the management of chronic diseases, across all care settings. Failure to engage users in device development inevitably affects the quality of clinical outcomes. A model of user engagement is presented, turning unmet needs for medical devices into viable commercial propositions. A case study investigating the perceptions of individuals with Epidermolysis Bullosa (EB), their lay and professional carers into unmet needs. EB is an inherited condition affecting the skin and mucosal linings that leads to blistering and wounds. Qualitative data are being collected to generate understanding of unmet needs and wound care products. These needs are being translated into new design concepts and prototypes. Prototypes will be evaluated in an n = 1 experimental design, generating quantitative outcomes data. There are generalisations from the case study, and the model outlined. New products for managing EB wounds can logically benefit other groups. The model is transferable to other clinical problems, which can benefit from research and technological advances that are integral to clinical needs and care.

Numerical study on oil supply system of a rotary compressor

International Nuclear Information System (INIS)

Wu, Jianhua; Wang, Gang

2013-01-01

The oil supply system is a crucial reliability issue for rotary compressors. This paper provides a general method for analyzing the oil supply system of a rotary compressor by using computational fluid dynamics (CFD). The process includes establishing the physical model, dividing computational grid, setting boundary conditions, calculating leakage rates through the roller end clearances, translating the dynamic issue into the static issue and so on. Validation of the rationality of the oil supply system model has been made by the measurement of the main bearing oil flow rates. The effects of operating conditions of the compressor, the oil level height of the oil sump and the main design parameters of the oil supply system on the oil supply characteristics are analyzed by numerical simulation. It is found that the main bearing oil flow rate varies circularly along with the rotation of the shaft. The shape and inclination angle of the spiral groove also influence the main bearing oil flow rate. The oil leakage rates through the roller end clearances depend largely on the operating conditions. In addition, the oil level height of the oil sump has a huge effect on the total oil flow rate. -- Highlights: • A CFD method for analyzing the oil supply system of rotary compressor is presented. • Leakage through the roller end clearances depends on the operating condition. • Groove shape and inclination angle are the main design parameters of spiral grooves. • A parabolic interface of oil and gas can be formed in the gallery of the shaft. • Single-flow model and steady solver can be applied to the oil supply system

Developing a global health diplomacy supply chain--a viable option for the United States to curb extremism.

Science.gov (United States)

Kumar, Sameer; Honkanen, Erik J; Karl, Chad C

2009-01-01

This study examines the idea of developing a global health diplomacy supply chain as an important foreign policy approach with the aim of improving the lives of vulnerable populations and serving the best interests of the United States. The study was based on the review of academic literature, news events, and military communiques, and historical writings were studied to determine the feasibility of the idea and the extent of costs and benefits of such an endeavor. An integrated strategic business model, supported by a medical care delivery process, was developed to create a framework for a feasible global health diplomacy supply chain. The findings indicate that extremism can be contained by creating and efficiently executing an effective supply chain to get medical care units to those that need them. The limitations are the potential exit strategies required, the tactical abilities, and diplomatic techniques needed in order to create positive diplomatic change in aid distribution. Managers must consider how supply chains will affect other organizations giving aid and the potential public response. Moreover, determining the level of care necessary to achieve the greatest positive health diplomacy continues to require vigilant scrutiny over the potential cost/benefit analysis. The analysis is valuable to policymakers considering the impacts of health diplomacy by utilizing supply chain management.

Planning Mechanisms for Regional Electric Power Supply System Development

Directory of Open Access Journals (Sweden)

Evgeniy Anatolyevich Malyshev

2015-12-01

power supply infrastructure development have been validated. The PPP mechanism application can help to solve the problem of regional and interregional power supply infrastructure development, as it is of vital importance for the regions of Siberia and the Far East.

Supply Chain Connectivity: Enhancing Participation in the Global Supply Chain

OpenAIRE

Patalinghug, Epictetus E.

2015-01-01

Supply chain connectivity is vital for the efficient flow of trade among APEC economies. This paper reviews the literature and supply chain management, describes the barriers to enhancing participation in global supply chain, analyzes the various measures of supply chain performance, and suggests steps for the Philippines to fully reap the benefits of the global value chain.

World medical schools: The sum also rises.

Science.gov (United States)

Rigby, Perry G; Gururaja, Ramnarayan P

2017-06-01

There is a worldwide shortage of doctors, which is true in most countries and on most continents. To enumerate the number of medical schools in the world at two different times, showing the trends and relating this to population is a beginning. The number is actually going up and has done so for some time; this has increased the supply of physicians and broadened healthcare delivery. The number to count for geographic and regional information about the medical schools relates directly to the supply of doctors. Regions were chosen from WHO and Foundation for the Advancement of International Medical Education and Research data to illustrate geographic distributions, physicians per patient and kinetics. The number of medical schools has consistently been rising around the world. However, world order is reverting to disorder, considering wars, disease and beleaguered stand-offs. None. Eight countries contain 40% of medical schools; however, several locations are rising faster than the rest. Some regions are stable, but sub-Saharan Africa, the Caribbean, South Asia and South America have increased the most in percentage recently, but not uniformly. Medical schools are related not only by geography, political boundaries and population but are concentrated in some regions. Graduate Medical Education positions appear to be short on a worldwide basis, as well as in some regions and countries. The number of medical schools is increasing worldwide and the identification of rapidly rising geographic areas is useful in exploring, planning and comparing regions. Controversy continues in a variety of locations, especially concerning Graduate Medical Education. In addition to funding, faculty candidates and accreditation, new schools are confronting a variety of choices in standards and quality, sizing and regional concerns.

Study on the Coordination of Supply Chain Based on Carbon Emissions Trading Considering the Retailers’ Competition

Directory of Open Access Journals (Sweden)

Wang Daoping

2017-01-01

Full Text Available This paper studies the coordination of supply chain in the context of carbon emissions trading mechanism, which considering the competition between retailers. Centralized and decentralized supply chain models were constructed to discuss the price of product, to avoid the losses of profit from the decentralized decision-making, the revenue-sharing contract was introduced to coordinate the supply chain. Research shows that the carbon emissions trading reduce emissions effectively, but the higher price of carbon emissions trading cut down the total profit of supply chain; The competition between retailers upgrades the supply chain members’ profit; Coordination was achieved by introducing the revenue-sharing contract. Finally, numerical example was given to illustrate the validity of the revenue-sharing contract, and the sensitivity analysis of parameters such as the price of the emissions trading and the retailers’ competition were presented.

Awareness of academic use of smartphones and medical apps among medical students in a private medical college?

Science.gov (United States)

Shah, Jehanzaib; Haq, Usman; Bashir, Ali; Shah, Syed Aslam

2016-02-01

To assess the awareness of medical apps and academic use of smartphones among medical students. The questionnaire-based descriptive cross-sectional study was conducted in January 2015 and comprised medical students of the Rawal Institute of Health Sciences, Islamabad, Pakistan. The self-designed questionnaire was reviewed by a panel of expert for content reliability and validity. Questionnaires were distributed in the classrooms and were filled by the students anonymously. SPSS 16 was used for statistical analysis. Among the 569 medical students in the study, 545 (95.8%) had smartphones and 24(4.2%) were using simple cell phones. Overall, 226(41.46%) of the smart phone users were using some medical apps. Besides, 137(24.08%) were aware of the medical apps but were not using them. Also, 391(71.7%) students were not using any type of medical text eBooks through their phone, and only 154(28.3%) had relevant text eBooks in their phones. Medical college students were using smartphones mostly as a means of telecommunication rather than a gadget for improving medical knowledge.

Alignment of global supply networks based on strategic groups of supply chains

Directory of Open Access Journals (Sweden)

Nikos G. Moraitakis

2017-09-01

Full Text Available Background: From a supply chain perspective, often big differences exist between global raw material suppliers’ approaches to supply their respective local markets. The progressing complexity of large centrally managed global supply networks and their often-unknown upstream ramifications increase the likelihood of undetected bottlenecks and inefficiencies. It is therefore necessary to develop an approach to strategically master the upstream complexity of such networks from a holistic supply chain perspective in order to align regional competitive priorities and supply chain structures. The objective of this research is hence to develop an approach for the supply-chain-based alignment of complex global supply networks. Method: We review existing literature from the fields of supply chain and network management, strategic sourcing, and strategic management. Based on the literature review and theoretical and practical considerations we deduce a conceptual approach to consider upstream supply chain structures in supply network alignment initiatives. Results: On the basis of these considerations and current empirical literature we transfer strategic group theory to the supply network management context. The proposed approach introduces strategic groups of supply chains as a segmentation criterion for complex global supply networks which enables the network-wide alignment of competitive priorities. Conclusion: Supply-chain-based segmentation of global supply network structures can effectively reduce the complexity, firms face when aiming to strategically align their supply chains on a holistic level. The results of this research are applicable for certain types of global supply networks and can be used for network alignment and strategy development. The approach can furthermore generate insights useable for negotiation support with suppliers.

A hybrid approach based on ANP, ELECTRE and SIMANP metaheuristic method for outsourcing manufacturing procedures according to supply chain risks - Case study: A medical equipment manufacturer company in Iran

Directory of Open Access Journals (Sweden)

Hiwa Farughi

2017-01-01

Full Text Available Nowadays enterprises should consider seeking to reduce the supply chain risks as a crucial part of their activities in order to improve their competitiveness in the international context. Choosing the suitable strategy in connection with assigning some parts of the production process to outside the organization is a complex multi-criteria decision making problem and it gets more complicated when supply chain risk factors as the factors to select the strategy as well as dependence and the close ties between these criteria also be considered. In this paper, after the identification of risks in the supply chain of a medical equipment manufacturer company, dependence and ties between criteria in line with choosing the best strategy among existing alternatives has been examined in the form of a combined ANP-ELECTRE method. This combined model is of high performance to give a solution to the problem considered in this paper. But given the complex and time consuming nature of the AHP and ELECTRE, in this study a meta-heuristic algorithm is developed called SIMANP that despite the simplicity of computing and high-speed, is good in the terms of precision and efficiency. The results of comparing SIMANP algorithm and the proposed ANP - ELECTRE method are presented at the end.

Scientometric Analysis of Scientific Validity of Medical Archives Regarding Other Medical Journals in Bosnia and Herzegovina.

Science.gov (United States)

Masic, Izet; Begic, Edin; Zunic, Lejla

2016-02-01

Medical Archives is the oldest medical journal in Bosnia and Herzegovina (B&H) (founded in 1947.). A total of 104 articles were published in Medical Archives during 2015. Analyzing the type of articles, original articles are present in majority during 2015-80.7% (in last seven years, 561 (76%) were original out of 738). In last seven years, 651 (88.2%) articles were from the field of clinical medicine (preclinical disciplines, in the last three years are more represented than in previous years). Collaboration rate in 2015 was 0,92. Articles written in collaboration of five authors (21.1 %) are found to be predominant. From year to year, most often required time for a decision on acceptance or on the revision prior acceptance is between 50 and 60 days (30% of cases in 2015). During 2015, 47.1% of articles were originally from B&H (eleven countries were represented). H index of Medical Archive for 2014 was 12, and does not vary during the last decade. In 2015 in B&H about twenty-five journals are issued in the field of biomedical and life sciences in general (six are indexed on Medline/PubMed, one is indexed in the Science Citation Index Expanded (SCIE)/Web of Science base). According to GoogleScholar the biggest h5 index has Bosnian Journal of Basic Medical Sciences (BJBMS) and Medical Archives, while the biggest h5 median has BJBMS i Acta Informatica Medica. The highest H-index (13) in B&H has Izet Masic MD, PhD, Enver Zerem MD, PhD and Semir Vranic MD, PhD, while highest g-index (22) has Enver Zerem MD, PhD (analyzed by software package "Publish or Perish"). By comparing the state of medical publishing in B&H with neighboring countries (Croatia, Serbia, Montenegro), we have concluded that B&H is behind Croatia and Serbia by following parameters: Total Documents, Total Cites and H index but in front of Montenegro.

Transcultural adaptation and initial validation of Brazilian-Portuguese version of the Basel assessment of adherence to immunosuppressive medications scale (BAASIS) in kidney transplants.

Science.gov (United States)

Marsicano, Elisa de Oliveira; Fernandes, Neimar da Silva; Colugnati, Fernando; Grincenkov, Fabiane Rossi dos Santos; Fernandes, Natalia Maria da Silva; De Geest, Sabina; Sanders-Pinheiro, Helady

2013-05-21

Transplant recipients are expected to adhere to a lifelong immunosuppressant therapeutic regimen. However, nonadherence to treatment is an underestimated problem for which no properly validated measurement tool is available for Portuguese-speaking patients. We aimed to initially validate the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS®) to accurately estimate immunosuppressant nonadherence in Brazilian transplant patients. The BAASIS® (English version) was transculturally adapted and its psychometric properties were assessed. The transcultural adaptation was performed using the Guillemin protocol. Psychometric testing included reliability (intraobserver and interobserver reproducibility, agreement, Kappa coefficient, and the Cronbach's alpha) and validity (content, criterion, and construct validities). The final version of the transculturally adapted BAASIS® was pretested, and no difficulties in understanding its content were found. The intraobserver and interobserver reproducibility variances (0.007 and 0.003, respectively), the Cronbach's alpha (0.7), Kappa coefficient (0.88) and the agreement (95.2%) suggest accuracy, preciseness and reliability. For construct validity, exploratory factorial analysis demonstrated unidimensionality of the first three questions (r = 0.76, r = 0.80, and r = 0.68). For criterion validity, the adapted BAASIS® was correlated with another self-report instrument, the Measure of Adherence to Treatment, and showed good congruence (r = 0.65). The BAASIS® has adequate psychometric properties and may be employed in advance to measure adherence to posttransplant immunosuppressant treatments. This instrument will be the first one validated to use in this specific transplant population and in the Portuguese language.

Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims.

Science.gov (United States)

Ratanawongsa, Neda; Quan, Judy; Handley, Margaret A; Sarkar, Urmimala; Schillinger, Dean

2018-04-06

Clinicians have difficulty accurately assessing medication non-adherence within chronic disease care settings. Health information technology (HIT) could offer novel tools to assess medication adherence in diverse populations outside of usual health care settings. In a multilingual urban safety net population, we examined the validity of assessing adherence using automated telephone self-management (ATSM) queries, when compared with non-adherence using continuous medication gap (CMG) on pharmacy claims. We hypothesized that patients reporting greater days of missed pills to ATSM queries would have higher rates of non-adherence as measured by CMG, and that ATSM adherence assessments would perform as well as structured interview assessments. As part of an ATSM-facilitated diabetes self-management program, low-income health plan members typed numeric responses to rotating weekly ATSM queries: "In the last 7 days, how many days did you MISS taking your …" diabetes, blood pressure, or cholesterol pill. Research assistants asked similar questions in computer-assisted structured telephone interviews. We measured continuous medication gap (CMG) by claims over 12 preceding months. To evaluate convergent validity, we compared rates of optimal adherence (CMG ≤ 20%) across respondents reporting 0, 1, and ≥ 2 missed pill days on ATSM and on structured interview. Among 210 participants, 46% had limited health literacy, 57% spoke Cantonese, and 19% Spanish. ATSM respondents reported ≥1 missed day for diabetes (33%), blood pressure (19%), and cholesterol (36%) pills. Interview respondents reported ≥1 missed day for diabetes (28%), blood pressure (21%), and cholesterol (26%) pills. Optimal adherence rates by CMG were lower among ATSM respondents reporting more missed days for blood pressure (p = 0.02) and cholesterol (p < 0.01); by interview, differences were significant for cholesterol (p = 0.01). Language-concordant ATSM demonstrated modest potential

Water supply

International Nuclear Information System (INIS)

Peterson, F.L.

1986-01-01

Options and methodologies for the development of fresh water supplies on Bikini Atoll are much the same as those practiced in the rest of the Marshall Islands and for that matter, most atolls in the central Pacific Ocean Basin. That is, rainfall distribution on Bikini produces a distinct wet season, lasting from about May through November, with the remaining months being generally dry. As a result, fresh water from surface catchments tends to be plentiful during the wet season? but is usually scarce during the dry months, and alternative sources such as groundwater must be utilized during this time. On Bikini the problems of fresh water supply are somewhat more difficult than for most Marshall Island atolls because rainfall is only about half the Marshall Island's average. Tus water supply is a critical factor limiting the carrying capacity of Bikini Atoll. To address this problem BARC has undertaken a study of the Bikini Atoll water supply. Te primary objectives of this work are to determine: (1) alternatives available for fresh water supply, 2 the amounts, location and quality of available supplies and 3 optimal development methods. The study planned for one's year duration, has been underway only since the summer of 1985 and is thus not yet fully completed. However, work done to date, which is presented in this report of preliminary findings, provides a reasonably accurate picture of Bikini's fresh water supplies and the various options available for their development. The work remaining to be completed will mainly add refinements to the water supply picture presented in the sections to follow

Medical writing, revising and editing

DEFF Research Database (Denmark)

Pilegaard, Morten

2006-01-01

The globalization of science makes medical writing, editing and revision a rapidly growing field of linguistic study and practice. Medical science texts are written according to uniform, general guidelines and medical genres have become highly conventionalized in terms of structure and linguistic...... form. Medical editing often takes the form of peer review and mainly addresses issues of contents and overall validity. Medical revision incorporates the checking of the macrostructure and the microstructure of the text, its language and style and its suitability for the target reader or client...

An Investigation of Justice in Supply Chain Trust and Relationship Commitment - An Empirical Study of Pakistan

Directory of Open Access Journals (Sweden)

Ziaullah Muhammad

2015-03-01

Full Text Available In recent years supply chain integration (SCI has received increasing attention from scholars and practitioners. However, our knowledge of what influences the supply chain integration practice of relationship commitment is still very limited. The objective of this study is to investigate the relationship among supply chain justices (procedural, distributive and interactional, trust and inter-firms relationship commitment in mainland Pakistan. The research variables have considerable importance in the literature of supply chain management (SCM. The conceptual model comprises five hypotheses. Then hypotheses are tested via an empirical study in which data are collected from 170 manufacturers, distributors, suppliers and retailers of main stream spectrum industries in Pakistan. We used exploratory factor analysis (EFA, confirmatory factor analysis (CFA to examine the validity and reliability of the measurement model, and structural equation modeling (SEM to test the hypotheses. The findings delineate that supply chain justices can develop relationship commitment (affective and continuance via establishing trust among supply chain partners. Moreover, this study reveals interesting and useful implications of supply chain justices, trust and relationship commitment for practitioners.

Promise and problems with supply chain management approaches to health care purchasing.

Science.gov (United States)

Ford, Eric W; Scanlon, Dennis P

2007-01-01

Double-digit health care inflation, coupled with widespread reports of poor care quality and deadly medical errors, has caused private sector employers to reevaluate their health benefits purchasing strategies, with a focus on supply chain management approaches. In other industries, this strategy has proven to be an effective method for simultaneously reducing costs and increasing quality. This article describes four current applications of supply chain management network methodologies to health care systems and identifies potential ways to improve purchasers' return on investment. In particular, information exchanges, purchase decision, and payment agreement components of integrated supply chains are described. First, visual depictions of the health care supply chain are developed from a purchaser's perspective. Next, five nationwide programs designed to realign incentives and rewards across the health care supply chain are described. Although several nationwide efforts are gaining traction in the marketplace, at this time, no cost reduction and quality improvement program initiative appears to systematically align the entire health care supply chain from providers to purchasers, raising doubt about the ability of supply chain management network techniques to significantly impact the health care marketplace in the short run. Current individual efforts to coordinate the health care supply chain do not act on all of the actors necessary to improve outcomes, promote safety, and control costs. Nevertheless, there are indications that several of the individual efforts are coming together. If national efforts touching on all critical elements can coordinate with purchasers, then the health care supply chain's performance may improve significantly.

Methodology for Computational Fluid Dynamic Validation for Medical Use: Application to Intracranial Aneurysm.

Science.gov (United States)

Paliwal, Nikhil; Damiano, Robert J; Varble, Nicole A; Tutino, Vincent M; Dou, Zhongwang; Siddiqui, Adnan H; Meng, Hui

2017-12-01

Computational fluid dynamics (CFD) is a promising tool to aid in clinical diagnoses of cardiovascular diseases. However, it uses assumptions that simplify the complexities of the real cardiovascular flow. Due to high-stakes in the clinical setting, it is critical to calculate the effect of these assumptions in the CFD simulation results. However, existing CFD validation approaches do not quantify error in the simulation results due to the CFD solver's modeling assumptions. Instead, they directly compare CFD simulation results against validation data. Thus, to quantify the accuracy of a CFD solver, we developed a validation methodology that calculates the CFD model error (arising from modeling assumptions). Our methodology identifies independent error sources in CFD and validation experiments, and calculates the model error by parsing out other sources of error inherent in simulation and experiments. To demonstrate the method, we simulated the flow field of a patient-specific intracranial aneurysm (IA) in the commercial CFD software star-ccm+. Particle image velocimetry (PIV) provided validation datasets for the flow field on two orthogonal planes. The average model error in the star-ccm+ solver was 5.63 ± 5.49% along the intersecting validation line of the orthogonal planes. Furthermore, we demonstrated that our validation method is superior to existing validation approaches by applying three representative existing validation techniques to our CFD and experimental dataset, and comparing the validation results. Our validation methodology offers a streamlined workflow to extract the "true" accuracy of a CFD solver.

What Can Healthcare Supply Chains Learn from Consumer-Product Supply Chains?

OpenAIRE

Schwarz, Leroy B.

2008-01-01

A Framework for Thinking About Supply-Chain Management: “The IDIB Portfolio” (Information, Decision-making, Implementation, Buffer system) Describe Supply-Chains for Consumer Products Before “Wal-Mart” Describe Supply-Chains for Consumer Products After “Wal-Mart” Describe Stylized Supply Chain for Healthcare Products

Two-Stage Multiobjective Optimization for Emergency Supplies Allocation Problem under Integrated Uncertainty

Directory of Open Access Journals (Sweden)

Xuejie Bai

2016-01-01

Full Text Available This paper proposes a new two-stage optimization method for emergency supplies allocation problem with multisupplier, multiaffected area, multirelief, and multivehicle. The triplet of supply, demand, and the availability of path is unknown prior to the extraordinary event and is descriptive with fuzzy random variable. Considering the fairness, timeliness, and economical efficiency, a multiobjective expected value model is built for facility location, vehicle routing, and supply allocation decisions. The goals of proposed model aim to minimize the proportion of demand nonsatisfied and response time of emergency reliefs and the total cost of the whole process. When the demand and the availability of path are discrete, the expected values in the objective functions are converted into their equivalent forms. When the supply amount is continuous, the equilibrium chance in the constraint is transformed to its equivalent one. To overcome the computational difficulty caused by multiple objectives, a goal programming model is formulated to obtain a compromise solution. Finally, an example is presented to illustrate the validity of the proposed model and the effectiveness of the solution method.

A Location-Inventory Problem in a Closed-Loop Supply Chain with Secondary Market Consideration

Directory of Open Access Journals (Sweden)

Hao Guo

2018-06-01

Full Text Available To design sustainable supply chain systems in today’s business environment, this paper studies a location-inventory problem in a closed-loop supply chain by considering the sales of new and used products in the primary and secondary markets, respectively. This problem is formulated as a mixed-integer nonlinear program to optimize facility location and inventory management decisions jointly, and the logistics flows between the two markets are modeled dynamically. To solve this problem efficiently, a new heuristic approach is also developed by introducing an effective adaptive mechanism into differential evolution. Finally, numerical experiments are presented to validate the solution approach and provide valuable managerial insight. This paper makes a meaningful contribution to the literature by incorporating the secondary market into the study of closed-loop supply chains, and practically, it is also greatly beneficial to improve the sustainability and efficiency of modern supply chains.

Two-Bin Kanban: Ordering Impact at Navy Medical Center San Diego

Science.gov (United States)

2016-06-01

cost of healthcare . This is done by “focusing on quality, eliminating waste , reducing unwarranted variation, and considering not just the cost of...of the two-bin inventory management system was the supermarket. Food waste is a very high expense for many supermarkets. To mitigate food waste , the...stockpiled medical supplies. Stockpiling supplies is called the “bull whip effect” and it is a wasteful impact of a poorly managed supply system. The

The role of supply chain collaboration in supply chain risk mitigation

OpenAIRE

Chen, Jie

2017-01-01

In the last two decades, supply chain operations have changed drastically. Globalization of the market, shortened product life cycle, global outsourcing and offshoring, and increasing complexity of the supply base has resulted in modern supply chains becoming more vulnerable than ever. There are also more frequent natural or man-made disasters which disrupt the supply chain operations. All these have led to higher exposure of risks of supply chains and the failure to manage the...

Supply chain strategies in an era of natural resource scarcity

OpenAIRE

Kalaitzi, Dimitra; Matopoulos, Aristides; Bourlakis, Michael; Tate, Wendy

2018-01-01

Purpose – The primary objective of this research is to explore the implications of natural resource scarcity for companies’ supply chain strategies. Design/methodology/approach – Drawing on resource dependence theory, a conceptual model is developed and validated through the means of exploratory research. The empirical work includes the assessment of qualitative data collected via 22 interviews representing 6 large multinational companies from the manufacturing sector. Findings – When the res...

Design of Supply Chain Networks with Supply Disruptions using Genetic Algorithm

OpenAIRE

Taha, Raghda; Abdallah, Khaled; Sadek, Yomma; El-Kharbotly, Amin; Afia, Nahid

2014-01-01

The design of supply chain networks subject to disruptions is tackled. A genetic algorithm with the objective of minimizing the design cost and regret cost is developed to achieve a reliable supply chain network. The improvement of supply chain network reliability is measured against the supply chain cost.

Electronic unit for fotovoltaic solar panelling validation

International Nuclear Information System (INIS)

Vazquez, J.; Valverde, J.; Garcia, J.M.

1988-01-01

A low cost and easy to use electronic system for photovoltaic solar panelling validation is described. It measures, with a certain periodicity, voltage and current given by the panel, determines the supplied power, and every so often, its maximum valves. The unit is fitted with a data storage system which allows data recording for later analysis. (Author)

What is a medical physicist?

International Nuclear Information System (INIS)

Endo, Masahiro

2011-01-01

The modern radiotherapy requires a medical physicist who optimizes treatment plans, assures delivered dose equal to prescription, and performs QA (quality assurance) of radiotherapy equipments. However, medical physicist has not been established as a medical profession in Japan mainly because importance of radiotherapy was not sufficiently recognized until recently. Between 2000 and 2004, several accidents of radiotherapy including hundreds of patients were found and these accidents were mainly caused by lack of QA. The necessity and importance of medical physicist were recognized by these accidents as well as by the advent of high-precision radiotherapy such as IMRT (intensity modulation radiation therapy). JRS (Japan Radiological Society) that certified medical physicists with the help of JSMP (Japan Society of Medical Physics), decided to extend eligibility in order to increase certified medical physicists rapidly in 2003. After the decision certified medical physicists were rapidly increased in number. The government supports this tendency to enact that certified medical physicists is necessary to reimbursement for high-precision therapy. It also started to supply grants for medical physics training in physical and health science graduate schools. In this program several universities have started medical physics course in their graduate schools. If these movements continue, medical physicist will be established as a medical profession in the near future. (author)

Design and implementation of improved LsCpLp resonant circuit for power supply for high-power electromagnetic acoustic transducer excitation

Science.gov (United States)

Zao, Yongming; Ouyang, Qi; Chen, Jiawei; Zhang, Xinglan; Hou, Shuaicheng

2017-08-01

This paper investigates the design and implementation of an improved series-parallel inductor-capacitor-inductor (LsCpLp) resonant circuit power supply for excitation of electromagnetic acoustic transducers (EMATs). The main advantage of the proposed resonant circuit is the absence of a high-permeability dynamic transformer. A high-frequency pulsating voltage gain can be achieved through a double resonance phenomenon. Both resonant tailing behavior and higher harmonics are suppressed by the improved resonant circuit, which also contributes to the generation of ultrasonic waves. Additionally, the proposed circuit can realize impedance matching and can also optimize the transduction efficiency. The complete design and implementation procedure for the power supply is described and has been validated by implementation of the proposed power supply to drive a portable EMAT. The circuit simulation results show close agreement with the experimental results and thus confirm the validity of the proposed topology. The proposed circuit is suitable for use as a portable EMAT excitation power supply that is fed by a low-voltage source.

Design and implementation of improved LsCpLp resonant circuit for power supply for high-power electromagnetic acoustic transducer excitation.

Science.gov (United States)

Zao, Yongming; Ouyang, Qi; Chen, Jiawei; Zhang, Xinglan; Hou, Shuaicheng

2017-08-01

This paper investigates the design and implementation of an improved series-parallel inductor-capacitor-inductor (L s C p L p ) resonant circuit power supply for excitation of electromagnetic acoustic transducers (EMATs). The main advantage of the proposed resonant circuit is the absence of a high-permeability dynamic transformer. A high-frequency pulsating voltage gain can be achieved through a double resonance phenomenon. Both resonant tailing behavior and higher harmonics are suppressed by the improved resonant circuit, which also contributes to the generation of ultrasonic waves. Additionally, the proposed circuit can realize impedance matching and can also optimize the transduction efficiency. The complete design and implementation procedure for the power supply is described and has been validated by implementation of the proposed power supply to drive a portable EMAT. The circuit simulation results show close agreement with the experimental results and thus confirm the validity of the proposed topology. The proposed circuit is suitable for use as a portable EMAT excitation power supply that is fed by a low-voltage source.

Energy supply between state, local government, and economy. Energieversorgung zwischen Staat, Gemeinde und Wirtschaft

Energy Technology Data Exchange (ETDEWEB)

Loewer, W.

1989-01-01

The central theme in the current discussion about the decentralization of the structures of energy supply in the Federal Republic of Germany and about the possibilities for implementing the reform on the basis of the valid law is a competency of the local government for energy provision by virtue of its 'general responsibility' or its 'tasks as a caterer for basic needs' (Daseinsvorsorge). The question raised thereby in relation to constitutional law, municipal economy law and energy law are thoroughly studied and answered in the book. It deals with the complexes 'catering for basic needs', 'public task', and 'decentralization' in the energy-political discussion, giving selected examples; with basic traits of the development of electric power supply as a many-sided system of energy provision; with the competency of the national or local government for ensuring electric power supply based on its being a 'caterer for basic needs', or electric power supply, being a public task; and with electric power supply as a municipal task. (orig.).

SPD-based Logistics Management Model of Medical Consumables in Hospitals

Science.gov (United States)

LIU, Tongzhu; SHEN, Aizong; HU, Xiaojian; TONG, Guixian; GU, Wei; YANG, Shanlin

2016-01-01

Background: With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. Methods: We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. Results: We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. Conclusion: The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China. PMID:27957435

SPD-based Logistics Management Model of Medical Consumables in Hospitals.

Science.gov (United States)

Liu, Tongzhu; Shen, Aizong; Hu, Xiaojian; Tong, Guixian; Gu, Wei; Yang, Shanlin

2016-10-01

With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China.

Contract Coordination in Dual Sourcing Supply Chain under Supply Disruption Risk

Directory of Open Access Journals (Sweden)

Tong Shu

2015-01-01

Full Text Available This paper explores a coordination model for a three-echelon supply chain including two different manufacturers, one distributer and one retailer via the combined option and back contracts. And one manufacturer provides the high wholesale price with low supply disruption risk and the other is completely the opposite. This differs from the previous supply chain coordination model. Firstly, supply disruption is added to the three-echelon supply chain. Secondly, considering the coordination of the supply chain, we deploy the combined option and back contracts which are seldom used in the previous study. Furthermore, it is interesting that supply disruption risk and buyback factor do not affect the distributor’s order quantity from the manufacturer who has low product price and unreliable operating ability, while the order quantity increases with the rise of option premium and option strike price. The distributor’s order quantity from the manufacturer, which has high product price and reliable operating ability, increases with the rise of supply disruption risk but decreases when the buyback factor, option premium, and option strike price decrease.

Developing competencies for medical librarians in Pakistan.

Science.gov (United States)

Ullah, Midrar; Anwar, Mumtaz A

2013-03-01

To identify competencies for medical librarians and get these validated from head librarians and employers. The survey method was used. A structured questionnaire, listing 84 competency statements, covering eight areas, prepared after extensive literature review, expert scrutiny and pilot testing, using a 5-point Likert scale was distributed among the head librarians and chairpersons of library committees (CLC) in 115 medical libraries. Sixty seven (58%) useable responses were received from head librarians and 63 (55%) from CLC. Of the 84 competency statements 83 were validated by the head librarians, 44 receiving four or higher mean score while the other 39 statements getting mean scores in the range of 3.97 and 3.06. The CLC validated 80 statements. Only 27 statements received four or higher mean score from CLC while the other 53 got mean scores in the range of 3.97 and 3.22. Medical librarians are required to be well versed with all those competencies which are needed for general librarianship. In addition, they are expected to have adequate knowledge of health sciences environment including medical terminologies and concepts. Sound knowledge of some competencies specific for medical libraries is an additional requirement for library personnel. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

Clinical validation of a medical grade color monitor for chest radiology

Science.gov (United States)

Jacobs, J.; Zanca, F.; Verschakelen, J.; Marchal, G.; Bosmans, H.

2009-02-01

Until recently, the specifications of medical grade monochrome LCD monitors outperformed those of color LCD monitors. New generations of color LCD monitors, however, show specifications that are in many respects similar to those of monochrome monitors typically used in diagnostic workstations. The aim of present study was to evaluate the impact of different medical grade monitors in terms of detection of simulated lung nodules in chest x-ray images. Specifically, we wanted to compare a new medical grade color monitor (Barco Coronis 6MP color) to a medical grade grayscale monitor (Barco Coronis 3MP monochrome) and a consumer color monitor (Philips 200VW 1.7MP color) by means of an observer performance experiment. Using the free-response acquisition data paradigm, seven radiologists were asked to detect and locate lung nodules (170 in total), simulated in half of the 200 chest X-ray images used in the experiment. The jackknife free-response receiver operating characteristic (JAFROC) analysis of the data showed a statistically significant difference between at least two monitors, F-value=3.77 and p-value =0.0481. The different Figure of Merit values were 0.727, 0.723 and 0.697 for the new color LCD monitor, the medical grade monitor and the consumer color monitor respectively. There was no difference between the needed reading times but there was a difference between the mean calculated Euclidian distances between the position marked by the observers and the center of the simulated nodule, indicating a better accuracy with both medical grade monitors. Present data suggests that the new generation of medical grade color monitors could be used as diagnostic workstations.

Computer model of the MFTF-B neutral beam Accel dc power supply

International Nuclear Information System (INIS)

Wilson, J.H.

1983-01-01

Using the SCEPTRE circuit modeling code, a computer model was developed for the MFTF Neutral Beam Power Supply System (NBPSS) Accel dc Power Supply (ADCPS). The ADCPS provides 90 kV, 88 A, to the Accel Modulator. Because of the complex behavior of the power supply, use of the computer model is necessary to adequately understand the power supply's behavior over a wide range of load conditions and faults. The model developed includes all the circuit components and parameters, and some of the stray values. The model has been well validated for transients with times on the order of milliseconds, and with one exception, for steady-state operation. When using a circuit modeling code for a system with a wide range of time constants, it can become impossible to obtain good solutions for all time ranges at once. The present model concentrates on the millisecond-range transients because the compensating capacitor bank tends to isolate the power supply from the load for faster transients. Attempts to include stray circuit elements with time constants in the microsecond and shorter range have had little success because of huge increases in computing time that result. The model has been successfully extended to include the accel modulator

Developing a measure of medication-related quality of life for people with polypharmacy.

Science.gov (United States)

Tseng, Hsu-Min; Lee, Chia-Hui; Chen, Yin-Jen; Hsu, Hsiang-Hao; Huang, Li-Yueh; Huang, Jing-Long

2016-05-01

To develop a measure of medication-related quality of life (MRQoL) and to validate the measure in a hospital-based population of patients with polypharmacy. The Medication-Related Quality of Life Scale version 1.0 (MRQoLS-v1.0) included 14 items developed on the basis of interviews with elderly patients with polypharmacy, defined as taking five or more medications simultaneously. This scale was tested in 219 outpatients (99 with polypharmacy and 120 without polypharmacy). Two measures were used to establish construct validity the Psychological Distress Checklist, for convergent validity, and the Medication Adherence Behavior Scale (MABS), for discriminant validity. The 14-item scale was found to be both reliable and valid. Internal consistency reliability evaluated using Cronbach's alpha for this scale was 0.91. Scores on the MRQoLS-v1.0 correlated statistically significantly and negatively with those on the Psychological Distress Checklist. Discriminant validity was demonstrated by low correlation with MABS, indicating that the MRQoLS-v1.0 measured concepts different from medication adherence. Significant differences in the MRQoLS-v1.0 between patients with polypharmacy and those without polypharmacy provided evidence for known-group validity. The study presents a psychometric evaluation of a measure used to assess MRQoL of patients with polypharmacy. The instrument is practical to administer in clinics and provides a valuable adjunct to the outcome measurement for patients with polypharmacy. Further research on the sensitivity of this instrument to medication change in multi-medicated patients is warranted.

Burnout Syndrome Among Medical Students at One University in Serbia: Validity and Reliability of the Maslach Burnout Inventory-Student Survey.

Science.gov (United States)

Ilic, Milena; Todorovic, Zeljko; Jovanovic, Milena; Ilic, Irena

2017-01-01

The Maslach Burnout Inventory-Student Survey (MBI-SS) contains 15 items that evaluate the following burnout dimensions: Emotional Exhaustion, Cynicism, and Academic Efficacy. The purpose of this study was to evaluate the dimensionality of the MBI-SS on a sample of Serbian medical students (N = 760). The overall Cronbach's α coefficient of the MBI-SS questionnaire was 0.757, while the Cronbach's α coefficients for Emotional Exhaustion, Cynicism, and Academic Efficacy were 0.869, 0.856, and 0.852, respectively. Principal Component Analysis with Oblimin rotation indicated 3 main components that explained 64.9% variance. The confirmatory factor analysis revealed good fit indices (χ 2 /df = 575.74/87, RMSEA = 0.086 (90% Confidence Interval for RMSEA = 0.079 to 0.092), CFI = 0.949, NNFI = 0.939, IFI = 0.949, GFI = 0.904) of the MBI-SS scale. The Serbian version of MBI-SS represents a valid and reliable instrument in the Serbian sample of medical students.

[Evidence-based management of medical disposable materials].

Science.gov (United States)

Yang, Hai

2009-03-01

Evidence-based management of medical disposable materials pays attention to collect evidence comprehensively and systematically, accumulate and create evidence through its own work and also evaluate evidence strictly. This can be used as a function to guide out job. Medical disposable materials evidence system contains product register qualification, product quality certification, supplier's behavior, internal and external communication evidence. Managers can find different ways in creating and using evidence referring to specific inside and outside condition. Evidence-based management can help accelerating the development of management of medical disposable materials from traditional experience pattern to a systematic and scientific pattern. It also has the very important meaning to improve medical quality, control the unreasonable growth of medical expense and make purchase and supply chain be more efficient.

Supply Chain Management og Supply Chain costing

DEFF Research Database (Denmark)

Nielsen, Steen; Mortensen, Ole

2002-01-01

Formålet med denne artikel er at belyse de muligheder som ligger i at integrere virksomhedens økonomiske styring med begrebet Supply Chain Management (SCM). Dette søges belyst ved først at beskrive den teoretiske ramme, hvori SCM indgår. Herefter analyseres begrebet Supply Chain Costing (SCC) som...... Århus. Et resultat er, at via begrebet Supply Chain Costing skabes der mulighed for at måle logistikkædens aktiviteter i kr./øre. Anvendelsen af denne information har også strategisk betydning for at kunne vælge kunde og leverandør. Ved hjælp af integrationen skabes der også helt nye mulighed...

Studying Hospitalizations and Mortality in the Netherlands: Feasible and Valid Using Two-Step Medical Record Linkage with Nationwide Registers.

Directory of Open Access Journals (Sweden)

Elske Sieswerda

Full Text Available In the Netherlands, the postal code is needed to study hospitalizations of individuals in the nationwide hospitalization register. Studying hospitalizations longitudinally becomes troublesome if individuals change address. We aimed to report on the feasibility and validity of a two-step medical record linkage approach to examine longitudinal trends in hospitalizations and mortality in a study cohort. First, we linked a study cohort of 1564 survivors of childhood cancer with the Municipal Personal Records Database (GBA which has postal code history and mortality data available. Within GBA, we sampled a reference population matched on year of birth, gender and calendar year. Second, we extracted hospitalizations from the Hospital Discharge Register (LMR with a date of discharge during unique follow-up (based on date of birth, gender and postal code in GBA. We calculated the agreement of death and being hospitalized in survivors according to the registers and to available cohort data. We retrieved 1477 (94% survivors from GBA. Median percentages of unique/potential follow-up were 87% (survivors and 83% (reference persons. Characteristics of survivors and reference persons contributing to unique follow-up were comparable. Agreement of hospitalization during unique follow-up was 94% and agreement of death was 98%. In absence of unique identifiers in the Dutch hospitalization register, it is feasible and valid to study hospitalizations and mortality of individuals longitudinally using a two-step medical record linkage approach. Cohort studies in the Netherlands have the opportunity to study mortality and hospitalization rates over time. These outcomes provide insight into the burden of clinical events and healthcare use in studies on patients at risk of long-term morbidities.

Validation of the MARS (Medical Admission Risk System): A combined physiological and laboratory risk prediction tool for 5- to 7-day in-hospital mortality.

Science.gov (United States)

Ohman, Malin Charlotta; Atkins, Tara E Holm; Cooksley, Tim; Brabrand, Mikkel

2018-03-10

The MARS (Medical Admission Risk System) uses 11 physiological and laboratory data and had promising results in its derivation study for predicting 5 and 7 day mortality. To perform an external independent validation of the MARS score. An unplanned secondary cohort study. Patients admitted to the medical admission unit (MAU) at The Hospital of South West Jutland were included from 2 October 2008 until 19 February 2009 and 23 February 2010 until 26 May 2010 were analysed. Validation of the MARS score using 5 and 7 day mortality was the primary endpoint. 5858 patients were included in the study. 2923 (49.9%) patients were women with a median age of 65 years (15-107). The MARS score had an AUROC of 0.858 (95% CI: 0.831-0.884) for 5-day mortality and 0.844 (0.818-0.870) for 7 day mortality with poor calibration for both outcomes. The MARS score had excellent discriminatory power but poor calibration in predicting both 5 and 7-day mortality. The development of accurate combination physiological/laboratory data risk scores has the potential to improve the recognition of at risk patients.

Impact of radio-frequency identification (RFID) technologies on the hospital supply chain: a literature review.

Science.gov (United States)

Coustasse, Alberto; Tomblin, Shane; Slack, Chelsea

2013-01-01

Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce costs, improve patient safety, and improve supply chain management effectiveness by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Despite ongoing RFID implementation in the hospital supply chain, barriers to widespread and rapid adoption include significant total expenditures, unclear return on investment, and competition with other strategic imperatives.

Impact of Radio-Frequency Identification (RFID) Technologies on the Hospital Supply Chain: A Literature Review

Science.gov (United States)

Coustasse, Alberto; Tomblin, Shane; Slack, Chelsea

2013-01-01

Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce costs, improve patient safety, and improve supply chain management effectiveness by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Despite ongoing RFID implementation in the hospital supply chain, barriers to widespread and rapid adoption include significant total expenditures, unclear return on investment, and competition with other strategic imperatives. PMID:24159272

A hybrid particle swarm optimization and genetic algorithm for closed-loop supply chain network design in large-scale networks

DEFF Research Database (Denmark)

Soleimani, Hamed; Kannan, Govindan

2015-01-01

Today, tracking the growing interest in closed-loop supply chain shown by both practitioners and academia is easily possible. There are many factors, which transform closed-loop supply chain issues into a unique and vital subject in supply chain management, such as environmental legislation...... is proposed and a complete validation process is undertaken using CPLEX and MATLAB software. In small instances, the global optimum points of CPLEX for the proposed hybrid algorithm are compared to genetic algorithm, and particle swarm optimization. Then, in small, mid, and large-size instances, performances...

An Innovative Interactive Modeling Tool to Analyze Scenario-Based Physician Workforce Supply and Demand

Science.gov (United States)

Gupta, Saurabh; Black-Schaffer, W. Stephen; Crawford, James M.; Gross, David; Karcher, Donald S.; Kaufman, Jill; Knapman, Doug; Prystowsky, Michael B.; Wheeler, Thomas M.; Bean, Sarah; Kumar, Paramhans; Sharma, Raghav; Chamoli, Vaibhav; Ghai, Vikrant; Gogia, Vineet; Weintraub, Sally; Cohen, Michael B.

2015-01-01

Effective physician workforce management requires that the various organizations comprising the House of Medicine be able to assess their current and future workforce supply. This information has direct relevance to funding of graduate medical education. We describe a dynamic modeling tool that examines how individual factors and practice variables can be used to measure and forecast the supply and demand for existing and new physician services. The system we describe, while built to analyze the pathologist workforce, is sufficiently broad and robust for use in any medical specialty. Our design provides a computer-based software model populated with data from surveys and best estimates by specialty experts about current and new activities in the scope of practice. The model describes the steps needed and data required for analysis of supply and demand. Our modeling tool allows educators and policy makers, in addition to physician specialty organizations, to assess how various factors may affect demand (and supply) of current and emerging services. Examples of factors evaluated include types of professional services (3 categories with 16 subcategories), service locations, elements related to the Patient Protection and Affordable Care Act, new technologies, aging population, and changing roles in capitated, value-based, and team-based systems of care. The model also helps identify where physicians in a given specialty will likely need to assume new roles, develop new expertise, and become more efficient in practice to accommodate new value-based payment models. PMID:28725751