Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.
This curriculum guide is designed to help teachers to provide advanced-level training for care providers who want to work with individuals who are chronically or terminally ill and require specialized care. The curriculum contains seven units. Each of the instructional units includes some or all of these basic components: performance objectives,…
Levi, Benjamin H.
Discussing end-of-life decisions with cancer patients is a crucial skill for physicians. This article reports findings from a pilot study evaluating the effectiveness of a computer-based decision aid for teaching medical students about advance care planning. Second-year medical students at a single medical school were randomized to use a standard advance directive or a computer-based decision aid to help patients with advance care planning. Students' knowledge, skills, and satisfaction were measured by self-report; their performance was rated by patients. 121/133 (91%) of students participated. The Decision-Aid Group (n=60) outperformed the Standard Group (n=61) in terms of students´ knowledge (p<0.01), confidence in helping patients with advance care planning (p<0.01), knowledge of what matters to patients (p=0.05), and satisfaction with their learning experience (p<0.01). Likewise, patients in the Decision Aid Group were more satisfied with the advance care planning method (p<0.01) and with several aspects of student performance. Use of a computer-based decision aid may be an effective way to teach medical students how to discuss advance care planning with cancer patients. PMID:20632222
Gillick, Muriel R
Developing a reasonable approach to the medical care of older people with dementia will be essential in the coming decades. Physicians are the locus of decision making for persons with dementia. It is the responsibility of the physician to assure that the surrogate understands the nature and trajectory of the disease and then to elicit the desired goal of care. Physicians need to ascertain whether any advance directives are available, and if so, whether they apply to the situation of advanced dementia. Finally, physicians should help surrogates understand how the goals of care are best translated into practice. When the goal is comfort, this is achieved by assuring dignity, minimizing suffering, and promoting caring. In general, comfort should be the default goal of care, best implemented through palliative care or hospice. PMID:22458462
Head, Barbara A; Schapmire, Tara J; Earnshaw, Lori; Chenault, John; Pfeifer, Mark; Sawning, Susan; Shaw, Monica A
The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients. PMID:26955298
Stallworthy, Elizabeth J
Advance care planning should be available to all patients with chronic kidney disease, including end-stage kidney disease on renal replacement therapy. Advance care planning is a process of patient-centred discussion, ideally involving family/significant others, to assist the patient to understand how their illness might affect them, identify their goals and establish how medical treatment might help them to achieve these. An Advance Care Plan is only one useful outcome from the Advance Care Planning process, the education of patient and family around prognosis and treatment options is likely to be beneficial whether or not a plan is written or the individual loses decision making capacity at the end of life. Facilitating Advance Care Planning discussions requires an understanding of their purpose and communication skills which need to be taught. Advance Care Planning needs to be supported by effective systems to enable the discussions and any resulting Plans to be used to aid subsequent decision making. PMID:23586906
... 5 Things to Know About Zika & Pregnancy Medical Care During Pregnancy KidsHealth > For Parents > Medical Care During ... médica durante el embarazo The Importance of Prenatal Care Millions of American women give birth every year, ...
Bowen, Judith L; Hirsh, David; Aagaard, Eva; Kaminetzky, Catherine P; Smith, Marie; Hardman, Joseph; Chheda, Shobhina G
Continuity of care is a core value of patients and primary care physicians, yet in graduate medical education (GME), creating effective clinical teaching environments that emphasize continuity poses challenges. In this Perspective, the authors review three dimensions of continuity for patient care-informational, longitudinal, and interpersonal-and propose analogous dimensions describing continuity for learning that address both residents learning from patient care and supervisors and interprofessional team members supporting residents' competency development. The authors review primary care GME reform efforts through the lens of continuity, including the growing body of evidence that highlights the importance of longitudinal continuity between learners and supervisors for making competency judgments. The authors consider the challenges that primary care residency programs face in the wake of practice transformation to patient-centered medical home models and make recommendations to maximize the opportunity that these practice models provide. First, educators, researchers, and policy makers must be more precise with terms describing various dimensions of continuity. Second, research should prioritize developing assessments that enable the study of the impact of interpersonal continuity on clinical outcomes for patients and learning outcomes for residents. Third, residency programs should establish program structures that provide informational and longitudinal continuity to enable the development of interpersonal continuity for care and learning. Fourth, these educational models and continuity assessments should extend to the level of the interprofessional team. Fifth, policy leaders should develop a meaningful recognition process that rewards academic practices for training the primary care workforce. PMID:25470307
Edlich, Richard F; Wish, John R; Britt, L D
One of the goals of this manuscript is to celebrate the influential and productive careers of three leaders in Emergency Medical Systems: Drs. James Mills, R Adams Cowley, and David Boyd. Through his courageous efforts, Dr. James Mills established the specialty of emergency medicine, with its own educational training programs, credentialing process, as well as a recognized society, the American College of Emergency Physicians. Dr. R Adams Cowley was the preeminent leader in developing an organized approach in trauma care in the State of Maryland, with the creation of the R Adams Cowley Shock Trauma Center. Many of the components of his comprehensive trauma program in the State of Maryland have been replicated in every state in our nation. Dr. David Boyd championed the development of emergency medical systems throughout our nation as he served as Director of the Office of Emergency Medical Service Systems in the Department of Health, Education, and Welfare. Under the guidance of Drs. Mills, Cowley, and Boyd, Dr. Edlich was a leader in developing emergency medical systems in the Commonwealth of Virginia. Unlike the comprehensive trauma system in the State of Maryland, the Commonwealth of Virginia, as well as other states in our nation, still lack statewide helicopter aviation services that bring critically ill patients throughout the state from the scene of injury to separate and distinct trauma facilities in which life saving trauma care can be initiated without admission to an emergency department. PMID:15479153
... Division of Geriatrics and Clinical Gerontology Division of Neuroscience FAQs Funding Opportunities Intramural Research Program Office of ... Is Advance Care Planning? Advance care planning involves learning about the types of decisions that might need ...
Lyon, Maureen E.; Garvie, Patricia A.; Kao, Ellin; Briggs, Linda; He, Jianping; Malow, Robert; D’Angelo, Lawrence J.; McCarter, Robert
Purpose To explore the impact of spirituality and religious beliefs on FAmily CEntered (FACE) Advance Care Planning and medication adherence in HIV+ adolescents and their surrogate decision-makers. Methods A sample of HIV+ adolescents (n=40) and their surrogates, age 21 or older, (n=40) was randomized to an active Healthy Living Control group or the FACE Advance Care Planning intervention, guided by transactional stress and coping theory. Adolescents’ spirituality was assessed at baseline and 3 months post-intervention, using the FACIT-SP-4-EX, as was the belief that HIV is a punishment from God. Results Control adolescents increased faith and meaning/purpose more so than FACE adolescents (p=0.02). At baseline more behaviorally (16%) vs. perinatally (8%) infected adolescents believed HIV was a punishment from God, but not at 3-months post-intervention. Adolescents endorsing HIV was a punishment scored lower on spirituality (p=.05) and adherence to HAART (p= .04). Surrogates were more spiritual than adolescents (p=<.0001). Conclusion Providing family support in a friendly, facilitated, environment enhanced adolescents’ spirituality. Facilitated family conversations had an especially positive effect on behaviorally infected adolescents’ medication adherence and spiritual beliefs. PMID:21575826
A patient's rights to autonomy and to participate in the decision making process is a fundamental ethical principle. However, for the non-competent patient, participation in decision-making is more problematic. A survey carried out in Israel found that less than half of the offspring of terminally ill elderly patients knew the request of their parents regarding life-supporting measures. A solution to this problem is the use of medical advance directives (MADs). In the U.S.A (in 1991) it was required by a federal law to inform every hospitalized patient of his right to use MADs. The experience from the use of MADs in the USA during the last 10 years show that: 1) Most lay persons as well as medical staff support the use of MADs 2) The rate of the use of MADs is about 20%, and among long term care hospitalized patients it is even higher. 3) Sex, age, level of education, morbidity and income were found to be significant factors. 4) Education on the use of the MADs raised the rate of use. 5) Most of the patients who had MADs did not discuss the issue of life supporting treatment with their physicians. 6) Patients who had MADs received less aggressive treatment with reduced medical cost. 7) There is a preference to write generic MADs. Arguments supporting the use of MADs state that they: extend patient autonomy; relieve patient anxiety regarding unwanted treatment; relieve physicians' anxiety concerning legal liability; reduce interfamily conflicts, and they also lower health care costs. Arguments opposing the use claim that they: violate sanctity of life; promote an adversarial physician-patient relationship; may lead to euthanasia; fail to express the patient's current wishes and may even counteract physicians' values. On the basis of experience in the USA and the positive attitude regarding MADs, it appears that MADs can also be applicable in Israel. PMID:11905092
Winkler, Eva C; Heußner, Pia
Decisions to limit treatment are important in order to avoid overtreatment at the end of life. They proceed more than half of expected deaths in Europe and the US, but are not always communicated with the patient in advance. One reason for non-involvement is that conversations that prepare patients for end-of-life decisions and work out their preferences do not take place on a regular basis. At the same time there is growing evidence that such communication improves patients' quality of life, reduces anxiety and depression and allows patients to develop a realistic understanding of their situation - which in turn is a prerequisite for shared decision making about limiting treatment. In this paper we define "treatment limitation" and explain the medical ethics perspective. The main focus, however, is on the causes that hinder advanced care planning and conversations about limiting treatment in the care of patients with advanced disease. Finally the evidence for approaches to improve the situation is presented with concrete suggestions for solutions. PMID:26983109
Maurana, Cheryl A; Lucey, Paula A; Ahmed, Syed M; Kerschner, Joseph E; Bolton, G Allen; Raymond, John R
Health care conversion foundations, such as the Advancing a Healthier Wisconsin Endowment (the endowment) at the Medical College of Wisconsin (MCW), result from the conversion of nonprofit health organizations to for-profit corporations. Over the past several decades, nearly 200 of these foundations have been created, and they have had a substantial impact on the field of health philanthropy. The MCW was a recipient of funds resulting from Blue Cross & Blue Shield United of Wisconsin's conversion from a nonprofit to a for-profit status in 1999. Established in 2004, the endowment has invested approximately $185 million in 337 research, education, and public and community health initiatives that benefit Wisconsin residents. However, the transformative potential of the health care conversion foundation has extended well beyond the opportunities provided through the endowment's financial resources. As the endowment celebrates its 10th anniversary, the authors describe the transformative nature of the endowment, as well as significant accomplishments and lessons learned, in the following areas: shared power, community partnerships, translational research, and integration of medicine and public health. It is the authors' hope that these lessons will be valuable to other medical schools and the communities they serve, as they invest in improving the health of their communities, irrespective of the funding source. PMID:26445084
Kizawa, Yoshiyuki; Yamaguchi, Takashi; Yotani, Nobuyuki
Advance care planning (ACP) is one of the most important issues to consider in providing quality end of life care for cancer patients. ACP has been described as a process whereby a patient, in consultation with health care providers, family members, and important others, makes decisions about his or her future health care, in the event he or she becomes incapable of participating in medical treatment decisions. ACP improves rates of following end of life wishes, increases patient and family satisfaction, and reduces family stress, anxiety, and depression. This article clarifies the differences among ACP, advance directives, and living wills. Additionally, we describe, based on clinical experience, how to introduce ACP most effectively for all stages of cancer care. PMID:27067841
Brown, Margaret; Fisher, John W; Brumley, David J; Ashby, Michael A; Milliken, Jan
In order to explore the usefulness and acceptability of the provisions of the Medical Treatment Act 1988 (Vic) for palliative care patients in a rural region in Victoria, Australia, between July and December 2004 patients were given information explaining the Act and the opportunity to discuss it with the research officer. Grounded theory methodology was used to evaluate client responses. Findings suggested that palliative care patients are willing to engage in advance care planning but they have to be well enough and need skilled, practical, face-to-face assistance to complete the required legal forms. Written materials alone are not adequate, but provide the opportunity for medical staff to have conversations about death and dying. Doctors and nurses should understand the provisions of the Act to assist patients and families. It is recommended that advance care planning, appropriate to the jurisdiction, be an integral part of the palliative care assessment process. PMID:16304759
Klaiman, Tamar; Pracilio, Valerie; Kimberly, Laura; Cecil, Kate; Legnini, Mark
Policy makers, payers, and the general public are increasingly focused on health care quality improvement. Measuring quality requires robust data systems that collect data over time, can be integrated with other systems, and can be analyzed easily for trends. The goal of this project was to study effective tools and strategies in the design and use of clinical registries with the potential to facilitate quality improvement, value-based purchasing, and public reporting on the quality of care. The research team worked with an expert panel to define characteristics of effectiveness, and studied examples of effective registries in cancer, cardiovascular care, maternity, and joint replacement. The research team found that effective registries were successful in 1 or more of 6 key areas: data standardization, transparency, accuracy/completeness of data, participation by providers, financial sustainability, and/or providing feedback to providers. The findings from this work can assist registry designers, sponsors, and researchers in implementing strategies to increase the use of clinical registries to improve patient care and outcomes. PMID:24152057
McKenas, D K
Primum non nocere-First, do no harm. How often have we as physicians and health care providers heard those words? We at American Airlines did not wish to put even one person in harm's way by not having care available to save a life in a remote commercial aviation environment. The decision was purely a business decision of the AMR corporation, who always keeps the welfare of the customer at the fore. It may not be the right choice for the entire commercial aviation industry under an FAA mandate. We know that we will save lives of persons traveling on American Airlines with this program. If the 'ripple' that we have started expands to affect the practices of other commercial air carriers in the domestic United States, American's reward will be a great one-to know that the lives of many people will be saved because one air carrier has taken the first step. PMID:9143743
Labek, Gerold; Schöffl, Harald; Stoica, Christian Ioan
A series of events relating to inferior medical devices has brought about changes in the legal requirements regarding quality control on the part of regulators. Apart from clinical studies, register and routine data will play an essential role in this context. To ensure adequate use of these data, adapted methodologies are required as register data in fact represent a new scientific entity. For the interpretation of register and routine data several limitations of published data should be taken into account. In many cases essential parameters of study cohorts - such as age, comorbidities, the patients’ risk profiles or the hospital profile - are not presented. Required data and evaluation procedures differ significantly, for example, between hip and spine implants. A “one fits for all” methodology is quite unlikely to exist and vigorous efforts will be required to develop suitable standards in the next future. The new legislation will affect all high-risk products, besides joint implants also contact lenses, cardiac pacemakers or stents, for example, the new regulations can markedly enhance product quality monitoring. Register data and clinical studies should not be considered as competitors, they complement each other when used responsibly. In the future follow-up studies should increasingly focus on specific questions, while global follow-up investigations regarding product complication rates and surgical methods will increasingly be covered by registers. PMID:27004163
For the last nine years of his life Adolf Hitler, a lifelong hypochondriac had as his physician Dr Theodor Morell. Hitler's mood swings, Parkinson's disease, gastro-intestinal symptoms, skin problems and steady decline until his suicide in 1945 are documented by reliable observers and historians, and in Morell's diaries. The bizarre and unorthodox medications given to Hitler, often for undisclosed reasons, include topical cocaine, injected amphetamines, glucose, testosterone, estradiol, and corticosteroids. In addition, he was given a preparation made from a gun cleaner, a compound of strychnine and atropine, an extract of seminal vesicles, and numerous vitamins and 'tonics'. It seems possible that some of Hitler's behaviour, illnesses and suffering can be attributed to his medical care. Whether he blindly accepted such unorthodox medications or demanded them is unclear. PMID:15825245
The authors consider acute problems in the quality and management of medical services challenging health care systems worldwide. This actuality has motivated the representatives of the European Association for Predictive, Preventive and Personalised Medicine and European Federation of Clinical Chemistry and Laboratory Medicine to consider the efforts in promoting an integrative approach based on multidisciplinary expertise to advance health care. The current paper provides a global overview of the problems related to medical services: pandemic scenario in the progression of common chronic diseases, delayed interventional approaches of reactive medicine, poor economy of health care systems, lack of specialised educational programmes, problematic ethical aspects of treatments as well as inadequate communication among professional groups and policymakers. Further, in the form of individual paragraphs, the article presents a consolidated position of the represented European organisations. This position is focused on the patients' needs, expert recommendations for the relevant medical fields and plausible solutions which have a potential to advance health care services if the long-term strategies were to be effectively implemented as proposed here. PMID:23663422
Lum, Hillary D; Sudore, Rebecca L; Bekelman, David B
Key components of advance care planning (ACP) for the elderly include choosing a surrogate decision maker, identifying personal values, communicating with surrogates and clinicians, documenting wishes in advance directives, and translating values and preferences for future medical care into medical orders. ACP often involves multiple brief discussions over time. This article outlines common benefits and barriers to ACP in primary care, and provides practical approaches to integrating key ACP components into primary care for older adults. Opportunities for multidisciplinary teams to incorporate ACP into brief clinic visits are highlighted. PMID:25700590
Pool, S. L.
Details of medical research and development programs, particularly an integrated medical laboratory, as derived from space technology are given. The program covers digital biotelemetry systems, automatic visual field mapping equipment, sponge electrode caps for clinical electroencephalograms, and advanced respiratory analysis equipment. The possibility of using the medical laboratory in ground based remote areas and regional health care facilities, as well as long duration space missions is discussed.
The thirteenth module of the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study: Cultural Considerations When Caring for African Americans explores the attitudes and practices of African Americans related to completion of advance directives, and recommends effective strategies to improve decision-making in the setting of serious, life-threatening illness, in ways that augment patient autonomy and support patient-centered goal-setting and decision-making among African American patients and their families.
Stewart, Don F.
Consideration is given to the delivery of medical care in space. The history of aviation medicine is reviewed. Medical support for the early space programs is discussed, including the Mercury, Gemini, Apollo, and Skylab programs. The process of training crew members for basic medical procedures for the Space Shuttle program is briefly described and medical problems during the Shuttle program are noted. Plans for inflight medical care on the Space Station are examined, including the equipment planned for the Health Maintenance Facility, the use of exercise to help prevent medical problems.
... 32 National Defense 3 2014-07-01 2014-07-01 false Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care... medical care is obtained are enumerated in AR 40-3. (b) Elective care. Elective care in civilian...
... 32 National Defense 3 2011-07-01 2009-07-01 true Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care... medical care is obtained are enumerated in AR 40-3. (b) Elective care. Elective care in civilian...
... 32 National Defense 3 2010-07-01 2010-07-01 true Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care... medical care is obtained are enumerated in AR 40-3. (b) Elective care. Elective care in civilian...
... 32 National Defense 3 2012-07-01 2009-07-01 true Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care... medical care is obtained are enumerated in AR 40-3. (b) Elective care. Elective care in civilian...
... 32 National Defense 3 2013-07-01 2013-07-01 false Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care... medical care is obtained are enumerated in AR 40-3. (b) Elective care. Elective care in civilian...
Kalousova, Lucie; Burgard, Sarah A
Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and ratios of debt to income and debt to assets were positively associated with foregoing medical or dental care in the past 12 months, even after adjusting for the poorer socioeconomic and health characteristics of those foregoing care and for respondents' household incomes and net worth. These overall associations were driven largely by credit card and medical debt, while housing debt and automobile and student loans were not associated with foregoing care. These results suggest that debt is an understudied aspect of health stratification. PMID:23620501
Kalousova, Lucie; Burgard, Sarah A.
Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and…
Some patients of advanced age with heart failure (HF) require repeated hospital care. In an aging society, the importance of medical and social care support systems for patients with HF further increases. In Onomichi-city, a comprehensive community care system has been in place since its introduction in 1997. The system is called "Onomichi Type". This is an interprofessional care system in which a variety of healthcare professionals, with common basic knowledge of disease prevention, treatment and welfare, collaborate with other care professionals. These professionals gain shared knowledge in regard to care management, and fulfill their respective roles at Care Conferences held during a patient's hospital stay. Elderly patients also often have multiple comorbidities and take a lot of medicines. Some patients might forget to take their medicine, whereas others might take an overdose. Thus, sharing a patient's complete medical information with pharmacists is also necessary. We began to collaborate with pharmacists in hospitals and at pharmacies in 2014. The pharmacist plays a great role in providing comprehensive community medical care. PMID:27477730
Medverd, Jonathan R; Cross, Nathan M; Font, Frank; Casertano, Andrew
Radiologists routinely make decisions with only limited information when assigning protocol instructions for the performance of advanced medical imaging examinations. Opportunity exists to simultaneously improve the safety, quality and efficiency of this workflow through the application of an electronic solution leveraging health system resources to provide concise, tailored information and decision support in real-time. Such a system has been developed using an open source, open standards design for use within the Veterans Health Administration. The Radiology Protocol Tool Recorder (RAPTOR) project identified key process attributes as well as inherent weaknesses of paper processes and electronic emulators of paper processes to guide the development of its optimized electronic solution. The design provides a kernel that can be expanded to create an integrated radiology environment. RAPTOR has implications relevant to the greater health care community, and serves as a case model for modernization of legacy government health information systems. PMID:23288437
Johnson-Throop, Kathy A.; Polk, J. D.; Hines, John W.; Nall, Marsha M.
The goal of Autonomous Medical Care (AMC) is to ensure a healthy, well-performing crew which is a primary need for exploration. The end result of this effort will be the requirements and design for medical systems for the CEV, lunar operations, and Martian operations as well as a ground-based crew health optimization plan. Without such systems, we increase the risk of medical events occurring during a mission and we risk being unable to deal with contingencies of illness and injury, potentially threatening mission success. AMC has two major components: 1) pre-flight crew health optimization and 2) in-flight medical care. The goal of pre-flight crew health optimization is to reduce the risk of illness occurring during a mission by primary prevention and prophylactic measures. In-flight autonomous medical care is the capability to provide medical care during a mission with little or no real-time support from Earth. Crew medical officers or other crew members provide routine medical care as well as medical care to ill or injured crew members using resources available in their location. Ground support becomes telemedical consultation on-board systems/people collect relevant data for ground support to review. The AMC system provides capabilities to incorporate new procedures and training and advice as required. The on-board resources in an autonomous system should be as intelligent and integrated as is feasible, but autonomous does not mean that no human will be involved. The medical field is changing rapidly, and so a challenge is to determine which items to pursue now, which to leverage other efforts (e.g. military), and which to wait for commercial forces to mature. Given that what is used for the CEV or the Moon will likely be updated before going to Mars, a critical piece of the system design will be an architecture that provides for easy incorporation of new technologies into the system. Another challenge is to determine the level of care to provide for each
Governor's Committee on Community Health Assistance, Raleigh, NC.
Technological, social, economic, and political changes have increased the rapidity of changes in the pattern of living in small towns and rural areas. As a result, a large percentage of rural Americans who live at or below the poverty level are not provided adequate medical care. After realizing the shortage of physicians in North Carolina and…
Rayman, Russell B; Zanick, David; Korsgard, Trina
With the anticipated growth of air travel, inflight illness and injury are expected to increase as well. This is because more elderly people and people with preexisting disease are taking to the air. Although inflight medical events and deaths are uncommon, physician passengers are occasionally called upon to render care. Resources for the physician may include emergency medical kits, automatic external defibrillators (AEDs), ECG monitors, portable oxygen bottles, and first-aid kits. Most airlines provide around-the-clock air-to-ground radio consultation either with their own medical department personnel or contracted medical consultants. Furthermore, some flight attendants are trained in cardiopulmonary resuscitation, first-aid, and operation of AEDs. This paper describes those inflight resources available to a physician who is called upon to treat an ill or injured passenger. In a broader sense, it is also providing advice to physicians who administer inflight medical care. The Aviation Medical Assistance Act of 1998 ("Good Samaritan act") is also discussed. PMID:15018298
... order on your medical chart. Fill out an organ donation card and carry it in your wallet. Keep ... your important papers. You can find out about organ donation from your doctor. You can also have this ...
Davidson, Ehud; Sheiner, Eyal
Soroka University Medical Center is a tertiary hospital, and the sole medical center in the Negev, the southern part of Israel. Soroka has invested in quality, service and research. The region has developed joint programs in order to advance the quality of medical care whilst optimizing the utilization of available resources. In this editorial we describe the path to leadership in quality of medical care, service and research. PMID:27215117
Azuma, Kazunari; Ohta, Shoichi
Medical care for an ultra-aging society has been shifted from hospital-centered to local community-based. This shift has yielded the so-called Integrated Community Care System. In the system, emergency medical care is considered important, as primary care doctors and home health care providers play a crucial role in coordinating with the department of emergency medicine. Since the patients move depending on their physical condition, a hospital and a community should collaborate in providing a circulating service. The revision of the medical payment system in 2014 clearly states the importance of "functional differentiation and strengthen and coordination of medical institutions, improvement of home health care". As part of the revision, the subacute care unit has been integrated into the community care unit, which is expected to have more than one role in community coordination. The medical fee has been set for the purpose of promoting the home medical care visit, and enhancing the capability of family doctors. In the section of end-of-life care for the elderly, there have been many issues such as reduction of the readmission rate and endorsement of a patient's decision-making, and judgment for active emergency medical care for patient admission. The concept of frailty as an indicator of prognosis has been introduced, which might be applied to the future of emergency medicine. As described above, the importance of a primary doctor and a family doctor should be identified more in the future; thereby it becomes essential for doctors to closely work with the hospital. Advancing the cooperation between a hospital and a community for seamless patient-centered care, the emergency medicine as an integrated community care will further develop by adapting to an ultra-aging society. PMID:26915240
Williamson, Kelvin; Ramesh, Ramaiah; Grabinsky, Andreas
Prehospital trauma care developed over the last decades parallel in many countries. Most of the prehospital emergency medical systems relied on input or experiences from military medicine and were often modeled after the existing military procedures. Some systems were initially developed with the trauma patient in mind, while other systems were tailored for medical, especially cardiovascular, emergencies. The key components to successful prehospital trauma care are the well-known ABCs of trauma care: Airway, Breathing, Circulation. Establishing and securing the airway, ventilation, fluid resuscitation, and in addition, the quick transport to the best-suited trauma center represent the pillars of trauma care in the field. While ABC in trauma care has neither been challenged nor changed, new techniques, tools and procedures have been developed to make it easier for the prehospital provider to achieve these goals in the prehospital setting and thus improve the outcome of trauma patients. PMID:22096773
Merel, Susan E; Merel, Susan; DeMers, Shaune; Vig, Elizabeth
Because neurodegenerative dementias are progressive and ultimately fatal, a palliative approach focusing on comfort, quality of life, and family support can have benefits for patients, families, and the health system. Elements of a palliative approach include discussion of prognosis and goals of care, completion of advance directives, and a thoughtful approach to common complications of advanced dementia. Physicians caring for patients with dementia should formulate a plan for end-of-life care in partnership with patients, families, and caregivers, and be prepared to manage common symptoms at the end of life in dementia, including pain and delirium. PMID:25037291
Green, Michael J.; Levi, Benjamin H.
Objective To describe the development of an innovative, multimedia decision aid for advance care planning. Background Advance care planning is an important way for people to articulate their wishes for medical care when they are not able to speak for themselves. Living wills and other types of advance directives are the most commonly used tools for advance care planning, but have been criticized for being vague, difficult to interpret, and inconsistent with individuals’ core beliefs and values. Results We developed a multimedia, computer-based decision aid for advance care planning (‘Making Your Wishes Known: Planning Your Medical Future’) to overcome many of the limitations of standard advance directive forms. This computer program guides individuals through the process of advance care planning, and unlike standard advance directives, provides tailored education, values clarification exercises, and a decision-making tool that translates an individual’s values and preferences into a specific medical plan that can be implemented by a health-care team. Pilot testing with 50 adult volunteers recruited from an outpatient primary care clinic showed high levels of satisfaction with the program. Further pilot testing with 34 cancer patients indicated that the program was perceived to be highly accurate at representing patients’ wishes. Conclusions This paper describes the development of an innovative decision aid for advance care planning that was designed to overcome common problems with standard advance directives. Preliminary testing suggests that it is acceptable to users and is accurate. PMID:18823445
Norri-Sederholm, Teija; Saranto, Kaija; Paakkonen, Heikki
Critical success factors in medication care involve communication and information sharing. Knowing the information needs of each actor in medication process in home care, is the first step to ensure that the right type of information is available, when needed. The aim of the study was to describe the needed and delivered information in home care in order to perform medication care successfully. A total of 15 nurses from primary home care participated a workshop focusing on medication treatment. The qualitative data was collected by focus group technique. Data was analyzed according to content analysis. Three medication information themes were formulated: Client-related information, medication, and medication error. The critical medication information were generic drug information, validity of the list of medication and client's clinical status. As a conclusion findings, show the diversity of the medication information in home care. PMID:27332222
Blaisdell, F W
The contributions to medical care that developed during the Civil War have not been fully appreciated, probably because the quality of care administered was compared against modern standards rather than the standards of the time. The specific accomplishments that constituted major advances were as follows. 1. Accumulation of adequate records and detailed reports for the first time permitted a complete military medical history. This led to the publication of the Medical and Surgical History of the War of the Rebellion, which was identified in Europe as the first major academic accomplishment by US medicine. 2. Development of a system of managing mass casualties, including aid stations, field hospitals, and general hospitals, set the pattern for management of the wounded in World War I, World War II, and the Korean War. 3. The pavilion-style general hospitals, which were well ventilated and clean, were copied in the design of large civilian hospitals over the next 75 years. 4. The importance of immediate, definitive treatment of wounds and fractures was demonstrated and it was shown that major operative procedures, such as amputation, were optimally carried out in the first 24 hours after wounding. 5. The importance of sanitation and hygiene in preventing infection, disease, and death among the troops in the field was demonstrated. 6. Female nurses were introduced to hospital care and Catholic orders entered the hospital business. 7. The experience and training of thousands of physicians were upgraded and they were introduced to new ideas and standards of care. These included familiarity with prevention and treatment of infectious disease, with anesthetic agents, and with surgical principles that rapidly advanced the overall quality of American medical practice. 8. The Sanitary Commission was formed, a civilian-organized soldier's relief society that set the pattern for the development of the American Red Cross. PMID:3046560
Fried, Terri R.; Redding, Colleen A.; Robbins, Mark L.; Paiva, Andrea; O'Leary, John R.; Iannone, Lynne
Objectives To develop measures representing key constructs of the Transtheoretical Model (TTM) of behavior change as applied to advance care planning (ACP) and to examine whether associations between these measures replicate the relationships posited by the TTM. Methods Sequential scale development techniques were used to develop measures for Decisional Balance (Pros and Cons of behavior change), ACP Values/Beliefs (religious beliefs and medical misconceptions serving as barriers to participation), Processes of Change (behavioral and cognitive processes used to foster participation) based on responses of 304 persons age ≥ 65 years. Results Items for each scale/subscale demonstrated high factor loading (> .5) and good to excellent internal consistency (Cronbach α .76–.93). Results of MANOVA examining scores on the Pros, Cons, ACP Values/Beliefs, and POC subscales by stage of change for each of the six behaviors were significant, Wilks' λ= .555–.809, η2=.068–.178, p ≤ .001 for all models. Conclusion Core constructs of the TTM as applied to ACP can be measured with high reliability and validity. Practice Implications Cross-sectional relationships between these constructs and stage of behavior change support the use of TTM-tailored interventions to change perceptions of the pros and cons of participation in ACP and promote the use of certain processes of change in order to promote older persons' engagement in ACP. PMID:21741194
Olmari-Ebbing, M; Zumbach, C N; Forest, M I; Rapin, C H
The relationship between the patient and a medical care giver is complex specially as it implies to the human, juridical and practical points of view. It depends on legal and deontological considerations, but also on professional habits. Today, we are confronted to a fundamental modification of this relationship. Professional guidelines exist, but are rarely applied and rarely taught in universities. However, patients are eager to move from a paternalistic relationship to a true partnership, more harmonious and more respectful of individual values ("value based medicine"). Advance directives give us an opportunity to improve our practices and to provide care consistent with the needs and wishes of each patient. PMID:10967645
Advances in technology a nd medical knowledge have dramatically altered our ability to sustain life in the Intensive Care Unit (ICU). Many things come into play for the nurse when establishing patient goals, respecting patient's wishes, and valuing spiritual and cultural beliefs in end-of-life care. A veteran ICU nurse shares the challenges of caring and how, she copes when medical interventions seem futile. PMID:25898443
Peacock, Jennifer J
Improvements in the care of the premature infant and advancements in technology are increasing life expectancy of infants with medical conditions once considered lethal; these infants are at risk of becoming a medically complex infant. Complex infants have a significant existing problem list, are on several medications, and receive medical care by several specialists. Deficits in communication and information transfer at the time of discharge remain problematic for this population. A questionnaire was developed for primary care providers (PCPs) to explore the effectiveness of the current discharge summary because it is related to effective communication when assuming the care of a new patient with medical complexity. PCPs assuming the care of these infants agree that an evidence-based tool, in the form of a specialized summary for this population, would be of value. PMID:24985113
Kassler, William J.; And Others
A study of factors influencing medical students to choose primary care careers, in contrast with high-technology careers, found students attracted by opportunity to provide direct care, ambulatory care, continuity of care, and involvement in psychosocial aspects of care. Age, race, gender, marital status, and some attitudes were not influential.…
Delichatsios, Helen; Callahan, Mark; Charlson, Mary
OBJECTIVES To document the outcomes of a telephone coverage system and identify patient characteristics that may predict these outcomes. DESIGN Telephone survey. SETTING An academic outpatient medical practice that has a physician telephone coverage service. PATIENTS All patients (483) who called during the 3-week study period to speak to a physician were evaluated, and for the 180 patients with symptoms, attempts were made to survey them by telephone 1 week after their initial telephone call. MEASUREMENTS AND MAIN RESULTS The mean age of the 180 patients was 41 years, 71% were female, and 56% belonged to commercial managed care plans. In the week after the initial telephone call, the following outcomes were reported: 27% of the patients had no further contact with the practice; 9% filled a prescription medication; 19% called the practice again; 48% kept an earlier appointment in the practice; 3% saw an internist elsewhere; 8% saw a specialist; 8% went to an emergency department; 4% were admitted to a hospital. Of the 180 patients who called with symptoms, 160 (89%) were successfully contacted for survey. Eighty-seven percent of these 160 patients rated their satisfaction with the care they received over the telephone as excellent, very good, or good. In multivariate analysis, patients' own health perception identified those most likely to have symptom relief (p = .002), and symptom relief, in turn, was a strong predictor of high patient satisfaction (p = .006). Thirty-three percent of the 160 patients reported that they would have gone to an emergency department if a physician were not available by telephone. CONCLUSIONS In the present study, younger patients, female patients, and patients in commercial managed care plans used the telephone most frequently. Also, the telephone provided a viable alternative to emergency department and walk-in visits. Overall satisfaction with telephone medicine was high, and the strongest predictors of high patient satisfaction
Johannigman, Suzanne; Eschiti, Valerie
Marijuana has been documented to provide relief to patients in palliative care. However, healthcare providers should use caution when discussing medical marijuana use with patients. This article features a case study that reveals the complexity of medical marijuana use. For oncology nurses to offer high-quality care, examining the pros and cons of medical marijuana use in the palliative care setting is important. PMID:23899972
Bhatnagar, Rahul; Corcoran, John P; Maldonado, Fabien; Feller-Kopman, David; Janssen, Julius; Astoul, Philippe; Rahman, Najib M
The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease. PMID:27246597
Topham, Charles S.
Describes an 11-week emergency medical care training program for adolescents focusing on: pretest results; factual emergency instruction and first aid; practical experience training; and assessment. (RC)
Moyen, Eric; Camiré, Eric; Stelfox, Henry Thomas
Medication errors in critical care are frequent, serious, and predictable. Critically ill patients are prescribed twice as many medications as patients outside of the intensive care unit (ICU) and nearly all will suffer a potentially life-threatening error at some point during their stay. The aim of this article is to provide a basic review of medication errors in the ICU, identify risk factors for medication errors, and suggest strategies to prevent errors and manage their consequences. PMID:18373883
Kwon, Sung Ae; Kolomer, Stacey
As ethical issues arise concerning the continuation of futile medical treatment for dying patients in Korean society, advance directive planning initiatives have been put into place to guide practice. This article describes the awareness and attitudes of social workers in Korea regarding advance care planning and related factors. A total of 246 gerontological/geriatric social workers completed a mailed or in-person survey regarding awareness and attitudes toward advance care planning. Seventy-three percent (n = 180) of the participants reported no knowledge of advance directives. Social workers who emphasized self-determination as a professional value, professed a preference for hospice care, and who were comfortable discussing death were more likely to have a positive attitudes toward advance care planning. This study reinforces the need for the infusion of advance care planning and end-of-life training in social work education in Korea. PMID:27428654
Berry, C. A.
Treatment and prevention of the physiologic problems of spacecrews are discussed. Preflight procedures, inflight monitoring and medication, and postflight examination are described. Specific factors covered include: medical screening and astronaut selection; health stabilization and exposure prevention; preflight medical examinations and training; biomedical data; medical kits; diagnosis and treatment; and implications of postflight findings.
... conversations Caring Connections National Hospice and Palliative Care Organization Links to every state’s advance care directive forms http: / / www. caringinfo. org/ i4a/ pages/ index. cfm? ...
Tjia, Jennifer; Briesacher, Becky A.; Peterson, Daniel; Liu, Qin; Andrade, Susan E.; Mitchell, Susan L.
IMPORTANCE Advanced dementia is characterized by severe cognitive impairment and complete functional dependence. Patients’ goals of care should guide the prescribing of medication during such terminal illness. Medications that do not promote the primary goal of care should be minimized. OBJECTIVES To estimate the prevalence of medications with questionable benefit used by nursing home residents with advanced dementia, identify resident- and facility-level characteristics associated with such use, and estimate associated medication expenditures. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of medication use by nursing home residents with advanced dementia using a nationwide long-term care pharmacy database linked to the Minimum Data Set (460 facilities) between October 1, 2009, and September 30, 2010. MAIN OUTCOMES AND MEASURES Use of medication deemed of questionable benefit in advanced dementia based on previously published criteria and mean 90-day expenditures attributable to these medications per resident. Generalized estimating equations using the logit link function were used to identify resident- and facility-related factors independently associated with the likelihood of receiving medications of questionable benefit after accounting for clustering within nursing homes. RESULTS Of 5406 nursing home residents with advanced dementia, 2911 (53.9%) received at least 1 medication with questionable benefit (range, 44.7% in the Mid-Atlantic census region to 65.0% in the West South Central census region). Cholinesterase inhibitors (36.4%), memantine hydrochloride (25.2%), and lipid-lowering agents (22.4%) were the most commonly prescribed. In adjusted analyses, having eating problems (adjusted odds ratio [AOR], 0.68; 95% CI, 0.59–0.78), a feeding tube (AOR, 0.58; 95% CI, 0.48–0.70), or a do-not-resuscitate order (AOR, 0.65; 95% CI, 0.57–0.75), and enrolling in hospice (AOR, 0.69; 95% CI, 0.58–0.82) lowered the likelihood of receiving these
Jecker, N S
In this article, I address ethical concerns related to forgoing futile medical treatment in terminally ill and dying patients. Any discussion of medical futility should emphasize that health professionals and health care institutions have ethical responsibilities regarding medical futility. Among the topics I address are communicating with patients and families, resolving possible conflicts, and developing professional standards. Finally, I explore why acknowledging the futility of life-prolonging medical interventions can be so difficult for patients, families, and health professionals. PMID:7571593
Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J
People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population. PMID:27053406
The medical care system is undergoing widespread and significant changes. Individual hospitals may be disappearing as mergers, acquisitions, and a variety of multi-institutional arrangements become the dominant form and as a host of free-standing medical enterprises spread out into the community. (MLW)
Ruchlin, Hirsch S.; Morris, Shirley; Morris, John N.
This article presents the findings of an evaluation of medical care service utilization by two elderly cohorts one living in continuing care retirement communities (CCRCs) and the other living in traditional community settings. CCRC residents' overall use of Medicare-covered medical services did not differ significantly from that of the traditional community-residing elders. Both groups incurred annual per capita expenditures of approximately $2,000. In their last year of life, however, CCRC residents displayed significantly lower expenditures for hospital care ($3,854 versus $7,268) but higher expenditures for Medicare or non-Medicare-covered nursing home care ($5,565 versus $3,533). PMID:10133107
Advance care planning is crucial for patients confronting incurable, debilitating, or terminal disease. Discussing end-of-life issues can reduce overtreatment and undertreatment as defined by the patient, and improve satisfaction with care. PMID:23805592
Schlaeper, Christian; Diaz-Buxo, Jose A
The Fresenius Medical Care home dialysis system consists of a newly designed machine, a central monitoring system, a state-of-the-art reverse osmosis module, ultrapure water, and all the services associated with a successful implementation. The 2008K@home hemodialysis machine has the flexibility to accommodate the changing needs of the home hemodialysis patient and is well suited to deliver short daily or prolonged nocturnal dialysis using a broad range of dialysate flows and concentrates. The intuitive design, large graphic illustrations, and step-by-step tutorial make this equipment very user friendly. Patient safety is assured by the use of hydraulic systems with a long history of reliability, smart alarm algorithms, and advanced electronic monitoring. To further patient comfort with their safety at home, the 2008K@home is enabled to communicate with the newly designed iCare remote monitoring system. The Aquaboss Smart reverse osmosis (RO) system is compact, quiet, highly efficient, and offers an improved hygienic design. The RO module reduces water consumption by monitoring the water flow of the dialysis system and adjusting water production accordingly. The Diasafe Plus filter provides ultrapure water, known for its long-term benefits. This comprehensive approach includes planning, installation, technical and clinical support, and customer service. PMID:15043622
Yung, Victoria Y.; Walling, Anne M.; Min, Lillian; Wenger, Neil S.
Abstract Background Advance planning for end-of-life care has gained acceptance, but actual end-of-life care is often incongruent with patients' previously stated goals. We assessed the flow of advance care planning information from patients to medical records in a community sample of older adults to better understand why advance care planning is not more successful. Methods Our study used structured interview and medical record data from community-dwelling older patients in two previous studies: Assessing Care of Vulnerable Elders (ACOVE)-1 (245 patients age ≥65 years and screened for high risk of death/functional decline in 1998–1999) and ACOVE-2 (566 patients age ≥75 who screened positive for falls/mobility disorders, incontinence, and/or dementia in 2002–2003). We compared interview data on patients' preferences, advance directives, and surrogate decision-makers with findings from the medical record. Results In ACOVE-1, 38% of surveyed patients had thought about limiting the aggressiveness of medical care; 24% of surveyed patients stated that they had spoken to their doctor about this. The vast majority of patients (88%–93%) preferred to die rather than remain permanently in a coma, on a ventilator, or tube fed. Regardless of patients' specific preferences, 15%–22% of patients had preference information in their medical record. Among patients who reported that they had completed an advance directive and had given it to their health-care provider, 15% (ACOVE-1) and 47% (ACOVE-2) had advance directive information in the medical record. Among patients who had not completed an advance directive but had given surrogate decision-maker information to their provider, 0% (ACOVE-1) and 16% (ACOVE-2) had documentation of a surrogate decision-maker in the medical record. Conclusions Community-dwelling elders' preferences for end-of-life care are not consistent with documentation in their medical records. Electronic health records and standardized data
Sherman, Deborah Witt
Describes the role and responsibilities of advanced-practice nurses in palliative care and nursing's initiative in promoting high-quality care through the educational preparation of these nurses. (JOW)
Jox, Ralf J; Borasio, Gian Domenico; Führer, Monika
Background: Pediatric advance care planning differs from the adult setting in several aspects, including patients’ diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals’ perspective. Aim: We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. Design: This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. Setting/participants: We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. Results: Perceived problems with pediatric advance care planning relate to professionals’ discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor’s advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. Conclusion: Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers. PMID:25389347
... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Medical care defined. 702.401 Section 702.401... WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.401 Medical care defined. (a) Medical care shall include medical, surgical, and other...
... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Medical care defined. 702.401 Section 702.401... WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.401 Medical care defined. (a) Medical care shall include medical, surgical, and other...
... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Medical care defined. 702.401 Section 702.401... WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.401 Medical care defined. (a) Medical care shall include medical, surgical, and other...
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Medical care defined. 702.401 Section 702.401... WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.401 Medical care defined. (a) Medical care shall include medical, surgical, and other...
... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Medical care defined. 702.401 Section 702.401... WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.401 Medical care defined. (a) Medical care shall include medical, surgical, and other...
Cannon, Jeremy W; Chung, Kevin K; King, David R
Care of critically injured patients has evolved over the 50 years since Shoemaker established one of the first trauma units at Cook County Hospital in 1962. Modern trauma intensive care units offer a high nurse-to-patient ratio, physicians and midlevel providers who manage the patients, and technologically advanced monitors and therapeutic devices designed to optimize the care of patients. This article describes advances that have transformed trauma critical care, including bedside ultrasonography, novel patient monitoring techniques, extracorporeal support, and negative pressure dressings. It also discusses how to evaluate the safety and efficacy of future advances in trauma critical care. PMID:22850154
Pope, Thaddeus Mason
This issue's "Legal Briefing" column covers the recent decision by the Centers for Medicare and Medicaid Services (CMS) to expand Medicare coverage of advance care planning, beginning 1 January 2016. Since 2009, most "Legal Briefings" in this journal have covered a wide gamut of judicial, legislative, and regulatory developments concerning a particular topic in clinical ethics. In contrast, this "Legal Briefing" is more narrowly focused on one single legal development. This concentration on Medicare coverage of advance care planning seems warranted. Advance care planning is a frequent subject of articles in JCE. After all, it has long been seen as an important, albeit only partial, solution to a significant range of big problems in clinical ethics. These problems range from medical futility disputes to decision making for incapacitated patients who have no available legally authorized surrogate. Consequently, expanded Medicare coverage of advance care planning is a potentially seismic development. It may materially reduce both the frequency and severity of key problems in clinical ethics. Since the sociological, medical, and ethical literature on advance care planning is voluminous, I will not even summarize it here. Instead, I focus on Medicare coverage. I proceed, chronologically, in six stages: 1. Prior Medicare Coverage of Advance Care Planning 2. Proposed Expanded Medicare Coverage in 2015 3. Proposed Expanded Medicare Coverage in 2016 4. The Final Rule Expanding Medicare Coverage in 2016 5. Remaining Issues for CMS to Address in 2017 6. Pending Federal Legislation. PMID:26752396
Silvester, William; Parslow, Ruth A; Lewis, Virginia J; Fullam, Rachael S; Sjanta, Rebekah; Jackson, Lynne; White, Vanessa; Hudson, Rosalie
Objectives To report on the quality of advance care planning (ACP) documents in use in residential aged care facilities (RACF) in areas of Victoria Australia prior to a systematic intervention; to report on the development and performance of an aged care specific Advance Care Plan template used during the intervention. Design An audit of the quality of pre-existing documentation used to record resident treatment preferences and end-of-life wishes at participating RACFs; development and pilot of an aged care specific Advance Care Plan template; an audit of the completeness and quality of Advance Care Plans completed on the new template during a systematic ACP intervention. Participants and setting 19 selected RACFs (managed by 12 aged care organisations) in metropolitan and regional areas of Victoria. Results Documentation in use at facilities prior to the ACP intervention most commonly recorded preferences regarding hospital transfer, life prolonging treatment and personal/cultural/religious wishes. However, 7 of 12 document sets failed to adequately and clearly specify the resident's preferences as regards life prolonging medical treatment. The newly developed aged care specific Advance Care Plan template was met with approval by participating RACFs. Of 203 Advance Care Plans completed on the template throughout the project period, 49% included the appointment of a Medical Enduring Power of Attorney. Requests concerning medical treatment were specified in almost all completed documents (97%), with 73% nominating the option of refusal of life-prolonging treatment. Over 90% of plans included information concerning residents’ values and beliefs, and future health situations that the resident would find to be unacceptable were specified in 78% of completed plans. Conclusions Standardised procedures and documentation are needed to improve the quality of processes, documents and outcomes of ACP in the residential aged care sector. PMID:23626906
Leininger, Lindsey; Levy, Helen
It might seem strange to ask whether increasing access to medical care can improve children's health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children's health.…
The American Medical Association's Board of Trustees recently issued a report on advance medical directives, Living Wills, Durable Powers of Attorney, and Durable Powers of Attorney for Health Care (AMA; 1989). Here Orentlicher, writing under the auspices of the AMA's Office of the General Counsel, offers an expanded version of that report. Orentlicher's article discusses the advantages and drawbacks of living wills, the appointment of a proxy decision maker through a living will, a durable power of attorney, or a durable power of attorney for health care, and the physician's role in implementing treatment preferences. PMID:2325236
Doukas, Charalampos N; Maglogiannis, Ilias; Pliakas, Thomas
The aim of this paper is to present a framework for advanced medical video delivery services, through network and patient-state awareness. Under this scope a context-aware medical networking platform is described. The developed platform enables proper medical video data coding and transmission according to both a) network availability and/or quality and b) patient status, optimizing thus network performance and telediagnosis. An evaluation platform has been developed based on scalable H.264 coding of medical videos. Corresponding results of video transmission over a WiMax network have proved the effectiveness and efficiency of the platform providing proper video content delivery. PMID:18002643
Medical care applies to the individual, and public health to the community. One is the concentrated application of diagnosis and treatment for the life, the comfort of a patient, and includes guidance in health as for motherhood, infancy, childhood and old age. Public health services, provided by the community through its local government and the local department of health, are concerned with the prevention of diseases of all kinds. Some are controlled by sanitary authority, but the majority of preventable diseases are dealt with by public health education. It is not the function of the health department to treat the sick. The family physicians, the hospitals and dispensaries provide for medical care. Medical care of the sick and public health protection are two parallel activities to make use of medical science, one for treatment, the other for prevention of disease. PMID:13009462
Pool, S. L.
NASA-sponsored medical R & D programs for space applications are reviewed with particular attention to the benefits of these programs to earthbound medical services and to the general public. Notable among the results of these NASA programs is an integrated medical laboratory equipped with numerous advanced systems such as digital biotelemetry and automatic visual field mapping systems, sponge electrode caps for electroencephalograms, and sophisticated respiratory analysis equipment.
Bromham, D R
The role of the family doctor in the management of endometriosis is considered in three phases. With the exception of a small minority of cases in which there are superficial endometriotic lesions, it will be difficult for the general practitioner to confirm the diagnosis without referral for laparoscopy or similar gynaecological investigation. In the majority of patients, clinical diagnosis based on symptomatology and physical findings on pelvic examination is not reliable enough to be a sound basis on which to initiate medical therapy. However, the early referral of patients with a suspicious history allows prompter confirmation of endometriosis, if present, and the establishment of a treatment regime, if required. Where medical therapy is instigated, this is usually by the gynaecological team, but, for the convenience of the patient, her surveillance during treatment is conducted jointly with the referring doctor. Compliance with and continuation of therapy will largely depend on the knowledge and skill of the general practitioner in assessing the significance of side-effects of medication. A significant proportion of endometriosis sufferers experience recurrence of their symptoms, and it may be possible for the general practitioner to initiate re-treatment, with the same or alternative medication, prior to a re-evaluation by the gynaecological team. PMID:1807362
Heron, Christopher R; Simmons, B Brent
In the next 30 years, the average age of the population will continue to increase, as will the prevalence of dementia. The management of advanced dementia requires the careful orchestration of communication, prognostication, patient care, and caregiver education. Understanding the specific tools available to establish prognosis and guide medical management in these complicated medical patients greatly improves patient and caregiver satisfaction at the end of the patient's life. In caring for patients with advanced-stage dementia, providers should be knowledgeable regarding the terminal nature of the condition and its common comorbid diseases, and should be prepared to educate the patients' caregivers, building a structure of support for the patient's benefit and navigating the complexities of end-of-life care. PMID:25414940
Rostami, Somayeh; Jafari, Hedayat
The increasing progress in medical and health sciences has enhanced patient survival over the years. However, increased longevity without quality of life in terminally ill patients has been a challenging issue for care providers, especially nurses, since they are required to determine the futility or effectiveness of treatments. Futile care refers to the provision of medical care with futile therapeutic outcomes for the patient. Interest in this phenomenon has grown rapidly over the years. In this study, we aimed to review and identify nurses’ perceptions of futile care, based on available scientific resources. In total, 135 articles were retrieved through searching scientific databases (with no time restrictions), using relevant English and Farsi keywords. Finally, 16 articles, which were aligned with the study objectives, were selected and evaluated in this study. Overlapping studies were excluded or integrated, based on the research team’s opinion. According to the literature, futile care cannot be easily defined in medical sciences, and ethical dilemmas surrounding this phenomenon are very complex. Considering the key role of nurses in patient care and end-of-life decision-making and their great influence on the attitudes of patients and their families, support and counseling services on medical futility and the surrounding ethical issues are necessary for these members of healthcare teams. PMID:27147925
Rostami, Somayeh; Jafari, Hedayat
The increasing progress in medical and health sciences has enhanced patient survival over the years. However, increased longevity without quality of life in terminally ill patients has been a challenging issue for care providers, especially nurses, since they are required to determine the futility or effectiveness of treatments. Futile care refers to the provision of medical care with futile therapeutic outcomes for the patient. Interest in this phenomenon has grown rapidly over the years. In this study, we aimed to review and identify nurses' perceptions of futile care, based on available scientific resources. In total, 135 articles were retrieved through searching scientific databases (with no time restrictions), using relevant English and Farsi keywords. Finally, 16 articles, which were aligned with the study objectives, were selected and evaluated in this study. Overlapping studies were excluded or integrated, based on the research team's opinion. According to the literature, futile care cannot be easily defined in medical sciences, and ethical dilemmas surrounding this phenomenon are very complex. Considering the key role of nurses in patient care and end-of-life decision-making and their great influence on the attitudes of patients and their families, support and counseling services on medical futility and the surrounding ethical issues are necessary for these members of healthcare teams. PMID:27147925
Leininger, Lindsey; Levy, Helen
It might seem strange to ask whether increasing access to medical care can improve children’s health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children’s health. Nonetheless, they find that, on the whole, policies to improve access indeed improve children’s health, with the caveat that context plays a big role—medical care “matters more at some times, or for some children, than others.” Focusing on studies that can plausibly show a causal effect between policies to increase access and better health for children, and starting from an economic framework, they consider both the demand for and the supply of health care. On the demand side, they examine what happens when the government expands public insurance programs (such as Medicaid), or when parents are offered financial incentives to take their children to preventive appointments. On the supply side, they look at what happens when public insurance programs increase the payments that they offer to health-care providers, or when health-care providers are placed directly in schools where children spend their days. They also examine how the Affordable Care Act is likely to affect children’s access to medical care. Leininger and Levy reach three main conclusions. First, despite tremendous progress in recent decades, not all children have insurance coverage, and immigrant children are especially vulnerable. Second, insurance coverage alone doesn’t guarantee access to care, and insured children may still face barriers to getting the care they need. Finally, as this issue of Future of Children demonstrates, access to care is only one of the factors that policy makers should consider as they seek to make the nation’s children healthier. PMID:27516723
... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Arrangements for medical care. 725.705... Arrangements for medical care. (a) Operator liability. If an operator has been determined liable for the... arrangements to provide medical care to the miner, notify the miner and medical care facility selected of...
... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Arrangements for medical care. 725.705... Arrangements for medical care. (a) Operator liability. If an operator has been determined liable for the... arrangements to provide medical care to the miner, notify the miner and medical care facility selected of...
Wagemans, Annemieke M A; van Wijmen, Frans C B
Difficult medical decisions regularly need to be made for people with intellectual disability. They are often unable to play a meaningful role in this and the decisions fall to the family or guardians. A useful aid to proactive medical management is advance care planning. This is a long-term care plan which is centred on the well-being of patients and their quality of life. Ideally it should be a matter for patients and those closest to them, the responsible medical practitioner and those tasked with the day-to-day care of patients. It is important to draw up this plan carefully and to regularly review it in the light of current circumstances. PMID:25424633
Rein, A J; Harshman, D L; Frick, T; Phillips, J M; Lewis, S; Nolan, M T
Per the Patient Self-Determination Act of 1991, hospitals are required to ascertain whether patients have an advance directive (AD). At this point, factors prompting patients to issue ADs have not been studied. The purpose of this study was to describe patients' understanding of ADs as well as the process patients used to arrive at their decisions to implement an AD. A stratified random sample of 26 patients from two intensive care units, one general medical unit, one general cardiac unit, and one acquired immunodeficiency unit were selected for participation. Patients were asked a series of open-ended questions to determine their knowledge and understanding of ADs. The constant comparative method was used to review the transcripts. It was found that only 31 per cent of patients had issued an AD, and 20% had learned of ADs for the first time during their hospitalization. Response analysis showed four phases of AD decision making: evaluation of illness, establishment of priorities, consideration of implications of the directives, and selection or rejection of directives. In conclusion, patients continue to have limited understanding of ADs and their implications. Continued investigation will elucidate the best strategies to educate patients about this topic. PMID:8583031
... SECURITY Federal Emergency Management Agency Recovery Policy, RP9525.4, Emergency Medical Care and Medical..., Emergency Medical Care and Medical Evacuations. This is an existing policy that is scheduled for review to... policy identifies the extraordinary emergency medical care and medical evacuation expenses that...
As heart failure progresses to the end stage, it becomes more difficult to maintain the same level of quality of life using the established therapy for the heart failure patients. We believe that an innovative home medical care for heart failure therapy that focuses on the individual's quality of daily living and early intervention is necessary. The roles of home medical care include: early discharge to home as opposed to long hospitalization; the prevention of re-hospitalization; the provision of good care; treatment of any exacerbations; and options available at the end of the patient's life at home. Being able to provide all of the above will allow heart failure patients to live at their home. Home medical care for heart failure requires collaborative teamwork among multiple institutions and medical professionals. Among this collaborative group, the role of pharmacists is critical. Since many of the elderly with heart failure are taking multiple medications, it is important to evaluate the compliance and to intervene for improvement. Pharmacists visiting the patient's home will be able to check the patient's living environment, to evaluate medication compliance, to reconsider the necessary medications for the specific patient, and to consult physicians. Pharmacists can also explain clearly to patients and their family members any changes in medical therapy, as the conditions for an end-stage heart failure patient may change drastically in a short time. By achieving all of the above, it may be possible to prevent re-hospitalization and to help maintain the quality of life for heart failure patients. PMID:27477731
Sabatino, Charles P
Context: The legal tools of health care advance planning have substantially changed since their emergence in the mid-1970s. Thirty years of policy development, primarily at the state legislative level addressing surrogate decision making and advance directives, have resulted in a disjointed policy landscape, yet with important points of convergence evolving over time. An understanding of the evolution of advance care planning policy has important implications for policy at both the state and federal levels. Methods: This article is a longitudinal statutory and literature review of health care advance planning from its origins to the present. Findings: While considerable variability across the states still remains, changes in law and policy over time suggest a gradual paradigm shift from what is described as a “legal transactional approach” to a “communications approach,” the most recent extension of which is the emergence of Physician Orders for Life-Sustaining Treatment, or POLST. The communications approach helps translate patients’ goals into visible and portable medical orders. Conclusions: States are likely to continue gradually moving away from a legal transactional mode of advance planning toward a communications model, albeit with challenges to authentic and reliable communication that accurately translates patients’ wishes into the care they receive. In the meantime, the states and their health care institutions will continue to serve as the primary laboratory for advance care planning policy and practice. PMID:20579283
van Brussel, G H
The Dutch Association for Addiction Medicine and the umbrella organisation GGZ Nederland (sector organisation for mental health and addiction care) have compiled a report entitled 'Strengthening medical care in the addiction care sector'. The report argues why medical care needs to be strengthened and provides guidance as to how the present shortcomings in quality and quantity can be dealt with. Addiction is now considered to be a medical condition with patients instead of clients. This means that the care, including the financial aspects, needs to be organised in the same way as all other forms of regular health care. Furthermore, the training in addiction medicine needs to be given a clearer status in the form of departments, professorships, training institutes and certification. Within the context of this report the responsibility of addiction centres needs to be emphasised. Vacancies in the many forms of social work could be exchanged for well-trained nurses and physicians, without the need for extra financial assistance. PMID:12966626
Vogel, Wendy H
Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring. PMID:27249776
Boucher, Nathan A; Mcmillen, Marvin A; Gould, James S
Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization's quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts. PMID:25663213
Shortell, S M
Continuity of medical care is conceived as the extent to which services are received as part of a coordinated and uninterrupted succession of events consistent with the medical care needs of patients. Two operational measures are proposed, based on the Gini and CON indices of concentration. Examples of their application are provided using the 1970 CHAS-NORC national study of health services utilization. The validity of the proposed measures is assessed in a preliminary fashion, and some commonly held assumptions about the relationship between access, quality, and continuity of care are challenged. Advantages of the proposed measures include their ability to summarize a distribution, the availability of data for construction, the relative ease of computation and interpretation, and their sensitivity to organizational changes in the delivery of health services. PMID:1271879
... 32 National Defense 3 2010-07-01 2010-07-01 true Medical care benefits. 564.39 Section 564.39... REGULATIONS Medical Attendance and Burial § 564.39 Medical care benefits. (a) A member of the ARNG who incurs a disease or injury under the conditions enumerated herein is entitled to medical care, in...
... 32 National Defense 3 2013-07-01 2013-07-01 false Medical care benefits. 564.39 Section 564.39... REGULATIONS Medical Attendance and Burial § 564.39 Medical care benefits. (a) A member of the ARNG who incurs a disease or injury under the conditions enumerated herein is entitled to medical care, in...
... 32 National Defense 3 2011-07-01 2009-07-01 true Medical care benefits. 564.39 Section 564.39... REGULATIONS Medical Attendance and Burial § 564.39 Medical care benefits. (a) A member of the ARNG who incurs a disease or injury under the conditions enumerated herein is entitled to medical care, in...
... 32 National Defense 3 2014-07-01 2014-07-01 false Medical care benefits. 564.39 Section 564.39... REGULATIONS Medical Attendance and Burial § 564.39 Medical care benefits. (a) A member of the ARNG who incurs a disease or injury under the conditions enumerated herein is entitled to medical care, in...
... 32 National Defense 3 2012-07-01 2009-07-01 true Medical care benefits. 564.39 Section 564.39... REGULATIONS Medical Attendance and Burial § 564.39 Medical care benefits. (a) A member of the ARNG who incurs a disease or injury under the conditions enumerated herein is entitled to medical care, in...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Medical treatment, care... Certain New Pension Recipients Medical and Related Services § 21.6240 Medical treatment, care and services... be furnished medical treatment, care and services which VA determines are necessary to develop,...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Medical treatment, care... Certain New Pension Recipients Medical and Related Services § 21.6240 Medical treatment, care and services... be furnished medical treatment, care and services which VA determines are necessary to develop,...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Medical treatment, care... 38 U.S.C. Chapter 31 Medical and Related Services § 21.240 Medical treatment, care and services. (a) General. A Chapter 31 participant shall be furnished medical treatment, care and services which...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Medical treatment, care... 38 U.S.C. Chapter 31 Medical and Related Services § 21.240 Medical treatment, care and services. (a) General. A Chapter 31 participant shall be furnished medical treatment, care and services which...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Medical treatment, care... 38 U.S.C. Chapter 31 Medical and Related Services § 21.240 Medical treatment, care and services. (a) General. A Chapter 31 participant shall be furnished medical treatment, care and services which...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Medical treatment, care... 38 U.S.C. Chapter 31 Medical and Related Services § 21.240 Medical treatment, care and services. (a) General. A Chapter 31 participant shall be furnished medical treatment, care and services which...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Medical treatment, care... Certain New Pension Recipients Medical and Related Services § 21.6240 Medical treatment, care and services... be furnished medical treatment, care and services which VA determines are necessary to develop,...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Medical treatment, care... Certain New Pension Recipients Medical and Related Services § 21.6240 Medical treatment, care and services... be furnished medical treatment, care and services which VA determines are necessary to develop,...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Medical treatment, care... 38 U.S.C. Chapter 31 Medical and Related Services § 21.240 Medical treatment, care and services. (a) General. A Chapter 31 participant shall be furnished medical treatment, care and services which...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Medical treatment, care... Certain New Pension Recipients Medical and Related Services § 21.6240 Medical treatment, care and services... be furnished medical treatment, care and services which VA determines are necessary to develop,...
... 32 National Defense 3 2014-07-01 2014-07-01 false Procedures for obtaining medical care. 564.40... benefits. (b) Authorization for care in civilian facility. (1) An individual who desires medical or dental care in civilian medical treatment facilities at Federal expense is not authorized such care...
... 32 National Defense 3 2011-07-01 2009-07-01 true Procedures for obtaining medical care. 564.40... benefits. (b) Authorization for care in civilian facility. (1) An individual who desires medical or dental care in civilian medical treatment facilities at Federal expense is not authorized such care...
... 32 National Defense 3 2012-07-01 2009-07-01 true Procedures for obtaining medical care. 564.40... benefits. (b) Authorization for care in civilian facility. (1) An individual who desires medical or dental care in civilian medical treatment facilities at Federal expense is not authorized such care...
... 32 National Defense 3 2013-07-01 2013-07-01 false Procedures for obtaining medical care. 564.40... benefits. (b) Authorization for care in civilian facility. (1) An individual who desires medical or dental care in civilian medical treatment facilities at Federal expense is not authorized such care...
... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Supervision of medical care. 702.407 Section... Care and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the district directors and their designees, shall actively supervise the medical care of an injured employee covered...
Doarn, C. R.; Lloyd, C. W.
As a result of Congressional mandate Space Station Freedom (SSF) was restructured. This restructuring activity has affected the capabilities for providing medical care on board the station. This presentation addresses the health care facility to be built and used on the orbiting space station. This unit, named the Health Maintenance Facility (HMF) is based on and modeled after remote, terrestrial medical facilities. It will provide a phased approach to health care for the crews of SSF. Beginning with a stabilization and transport phase, HMF will expand to provide the most advanced state of the art therapeutic and diagnostic capabilities. This presentation details the capabilities of such a phased HMF. As Freedom takes form over the next decade there will be ever-increasing engineering and scientific developmental activities. The HMF will evolve with this process until it eventually reaches a mature, complete stand-alone health care facility that provides a foundation to support interplanetary travel. As man's experience in space continues to grow so will the ability to provide advanced health care for Earth-orbital and exploratory missions as well.
Scully, Christopher G; Forrest, Shawn; Galeotti, Loriano; Schwartz, Suzanne B; Strauss, David G
The Food and Drug Administration (FDA) performs regulatory science to provide science-based medical product regulatory decisions. This article describes the types of scientific research the FDA's Center for Devices and Radiological Health performs and highlights specific projects related to medical devices for emergency medicine. In addition, this article discusses how results from regulatory science are used by the FDA to support the regulatory process as well as how the results are communicated to the public. Regulatory science supports the FDA's mission to assure safe, effective, and high-quality medical products are available to patients. PMID:25128009
Koutkias, Vassilis G; Chouvarda, Ioanna; Triantafyllidis, Andreas; Malousi, Andigoni; Giaglis, Georgios D; Maglaveras, Nicos
The ongoing efforts toward continuity of care and the recent advances in information and communication technologies have led to a number of successful personal health systems for the management of chronic care. These systems are mostly focused on monitoring efficiently the patient's medical status at home. This paper aims at extending home care services delivery by introducing a novel framework for monitoring the patient's condition and safety with respect to the medication treatment administered. For this purpose, considering a body area network (BAN) with advanced sensors and a mobile base unit as the central communication hub from the one side, and the clinical environment from the other side, an architecture was developed, offering monitoring patterns definition for the detection of possible adverse drug events and the assessment of medication response, supported by mechanisms enabling bidirectional communication between the BAN and the clinical site. Particular emphasis was given on communication and information flow aspects that have been addressed by defining/adopting appropriate formal information structures as well as the service-oriented architecture paradigm. The proposed framework is illustrated via an application scenario concerning hypertension management. PMID:20007042
Holden, F M
A dialogue between upper management and operational elements over an organization's informatics policies and procedures could take place in an environment in which both parties could succeed. Excellent patient care practices can exist in organizational settings where upper management is not concerned with the specifics of the medical care process. But as the medical care process itself becomes costly, complex, and part of the purview of upper management, solutions to ambiguous informatics policies and practices need to be found. As the discussion of cost determination suggests, a comprehensive "top-down" solution may not be feasible. Allowing patient care expertise to drive the design and implementation of clinical computing modules without unduly restrictive specifications from above is probably the best way to proceed. But if the organization needs to know the specifics of a treatment episode, then the informatics definitions specific to treatment episodes need to be unambiguous and consistently applied. As the discussion of Social Security numbers suggests, communication of information across various parts of the organization not only requires unambiguous data structure definitions, but also suggests that the communication process not be dependent on the content of the messages. Both ideas--consistent data structure definitions for essential data and open system communication architectures--are current in the medical informatician's vocabulary. The same ideas are relevant to the management and operation of large and diffuse health care enterprises. The lessons we are learning about informatics policy and practice controls in clinical computing need to be applied to the enterprise as a whole. PMID:1921663
Wiesmüller, G A; Dötsch, J; Weiß, M; Wiater, A; Fätkenheuer, G; Nitschke, H; Bunte, A
The Cologne statement resulted from both regional and nationwide controversial discussions about meaning and purpose of an initial examination for infectious diseases of refugees with respect to limited time, personnel and financial resources. Refugees per se are no increased infection risk factors for the general population as well as aiders, when the aiders comply with general hygiene rules and are vaccinated according to the recommendations of the German Standing Committee on Vaccination (STIKO). This is supported by our own data. Based on individual medical history, refugees need medical care, which is offered purposeful, economic, humanitarian and ethical. In addition to medical confidentiality, the reporting obligation according § 34 Infection Protection Act (IPA) and the examination concerning infectious pulmonary tuberculosis according to § 36 (4) IPA must be considered. PMID:27078831
Marxist studies of medical care emphasize political power and economic dominance in capitalist society. Although historically the Marxist paradigm went into eclipse during the early twentieth century, the field has developed rapidly during recent years. The health system mirrors the society's class structure through control over health institutions, stratification of health workers, and limited occupational mobility into health professions. Monopoly capital is manifest in the growth of medical centers, financial penetration by large corporations, and the "medical-industrial complex." Health policy recommendations reflect different interest groups' political and economic goals. The state's intervention in health care generally protects the capitalist economic system and the private sector. Medical ideology helps maintain class structure and patterns of domination. Comparative international research analyzes the effects of imperialism, changes under socialism, and contradictions of health reform in capitalist societies. Historical materialist epidemiology focuses on economic cycles, social stress, illness-generating conditions of work, and sexism. Health praxis, the disciplined uniting of study and action, involves advocacy of "nonreformist reforms" and concrete types of political struggle. PMID:354452
Casalino, Lawrence P.; Chen, Melinda A.; Staub, C. Todd; Press, Matthew J.; Mendelsohn, Jayme L.; Lynch, John T.; Miranda, Yesenia
PURPOSE In the turbulent US health care environment, many primary care physicians seek hospital employment. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. We wanted to describe these groups, their advantages, and their challenges. METHODS We identified 21 groups and studied 5 that varied in size and location. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers—leaders of a health plan, hospital, and specialty medical group that shared patients with the group. We triangulated responses from group leaders, group physicians, and external observers to identify key themes. RESULTS The groups’ physicians work in small practices, with the group providing economies of scale necessary to develop laboratory and imaging services, health information technology, and quality improvement infrastructure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Unlike hospital-employed and multispecialty groups, independent primary care groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Each group was positively regarded by external observers. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale. CONCLUSIONS Large, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting. PMID:26755779
... 32 National Defense 6 2013-07-01 2013-07-01 false Expenses for emergency medical care. 1656.20... ALTERNATIVE SERVICE § 1656.20 Expenses for emergency medical care. (a) Claims for payment of actual and reasonable expenses for emergency medical care, including hospitalization, of ASWs who suffer illness...
... 32 National Defense 6 2011-07-01 2011-07-01 false Expenses for emergency medical care. 1656.20... ALTERNATIVE SERVICE § 1656.20 Expenses for emergency medical care. (a) Claims for payment of actual and reasonable expenses for emergency medical care, including hospitalization, of ASWs who suffer illness...
... 32 National Defense 6 2012-07-01 2012-07-01 false Expenses for emergency medical care. 1656.20... ALTERNATIVE SERVICE § 1656.20 Expenses for emergency medical care. (a) Claims for payment of actual and reasonable expenses for emergency medical care, including hospitalization, of ASWs who suffer illness...
... 32 National Defense 6 2014-07-01 2014-07-01 false Expenses for emergency medical care. 1656.20... ALTERNATIVE SERVICE § 1656.20 Expenses for emergency medical care. (a) Claims for payment of actual and reasonable expenses for emergency medical care, including hospitalization, of ASWs who suffer illness...
... 32 National Defense 6 2010-07-01 2010-07-01 false Expenses for emergency medical care. 1656.20... ALTERNATIVE SERVICE § 1656.20 Expenses for emergency medical care. (a) Claims for payment of actual and reasonable expenses for emergency medical care, including hospitalization, of ASWs who suffer illness...
... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Supervision of medical care. 702.407 Section...'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the...
... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Supervision of medical care. 702.407 Section...'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the...
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Supervision of medical care. 702.407 Section... AND HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the...
The present situation in health care From the perspective of regional society, there are many public facilities which support the health, medication and welfare for the residents, and they operate their own service without an appropriate linkage or organized method of sharing information with each other. It is important to provide health care based on a principle with a concept of health information management by life stage. As present, such information is divided among several government agencies, namely the Ministries of Health and Welfare, Education and Labor. Infant, school medical exam, and adult or geriatric annual check-ups are under the control of the respective Ministries. As a result, we lack in communication between regional facilities and sharing information. Recent advancement in medical information systems and instruments have been remarkable. Especially after the electronic medical card will be in officially used, the medical check supporting system will gradually come into wide-spread use with easy operation. To swim with the current of the times, it is important to cooperate with organizations in other fields for practical use of personal health data. We must make an effort to establish an effective method of using computer and individual information to collect significant data. PMID:11051797
Gilliland, Jill; Donnellan, Amy; Justice, Lindsey; Moake, Lindy; Mauney, Jennifer; Steadman, Page; Drajpuch, David; Tucker, Dawn; Storey, Jean; Roth, Stephen J; Koch, Josh; Checchia, Paul; Cooper, David S; Staveski, Sandra L
The addition of advanced practice providers (APPs; nurse practitioners and physician assistants) to a pediatric cardiac intensive care unit (PCICU) team is a health care innovation that addresses medical provider shortages while allowing PCICUs to deliver high-quality, cost-effective patient care. APPs, through their consistent clinical presence, effective communication, and facilitation of interdisciplinary collaboration, provide a sustainable solution for the highly specialized needs of PCICU patients. In addition, APPs provide leadership, patient and staff education, facilitate implementation of evidence-based practice and quality improvement initiatives, and the performance of clinical research in the PCICU. This article reviews mechanisms for developing, implementing, and sustaining advance practice services in PCICUs. PMID:26714997
Dellasega, Cheryl; Whitehead, Megan; Green, Michael J.
Background Advance care planning (ACP) is an under-utilized process that involves thinking about what kind of life-prolonging medical care one would want should the need arise, identifying a spokesperson, and then communicating these wishes. Objective To better understand what influences individuals to engage in ACP. Design Three focus groups using semi-structured interactive interviews were conducted with 23 older individuals from three diverse populations in central Pennsylvania. Results Four categories of influences for engaging in ACP were identified: 1) Concern for Self; 2) Concern for Others; 3) Expectations About the Impact of Advance Care Planning; and 4) Anecdotes, Stories, & Experiences. Conclusions The motivations for undertaking ACP that we have identified offer healthcare providers insight into effective strategies for facilitating the process of ACP with their patients. PMID:20103783
Jaudes, Paula Kienberger; Champagne, Vince; Harden, Allen; Masterson, James; Bilaver, Lucy A.
The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates. These…
Advance care planning (ACP) provides a framework for discussing and documenting care preferences in preparation for situations in which a person loses the cognitive capacity to make decisions. It can be particularly valuable in assisting people in the early stages of living with a dementia, supported by their families, to document their preferences for care at the later stages of their illness. While the potential benefits of ACP are widely acknowledged, there remain gaps in the research evidence on ACP and challenges in implementing ACP in practice. The three recently-published studies described below address these issues. PMID:27231079
Ritom, M H
Human Rights traditionally refer to rights and freedom that are inherent to every human being. They are based on Human Rights Law and concern the respect for dignity and worth of a person. These rights are universal, inalienable, indivisible, inter-related and interdependent. Members of Societies are detained for varied reasons and are made up of different age groups and gender. The United Nations through its numerous agencies, associated Conventions, Treaties and Resolutions have laid down guidelines that govern the rights of those under detention. Article 5 of General Assembly Resolution 45/111 clearly stipulates that except for those limitations that are demonstrably necessitated by the fact of incarceration, all prisoners shall retain the human rights and fundamental freedom set out in the Universal Declaration of Human Rights. As such, the Medical and Health Care of People under Detention should not be any different from the other members of societies. The Right to Health and Medical Care is stipulated under various Articles contained in the UN Bill of Human Rights (UDHR, ICCPCR and ICESCR) as well as other Conventions, e.g. Convention against Torture (CAT), Convention on Rights of the Child (CRC) and Convention for the Extinction of all Forms of Discrimination against Women (CEDAW). The United Nations have also developed specific guidelines and instruments for Treatment of People under Detention. These include the General Assembly Resolution 45/111 December 1990 elucidating the Basic Principles for Treatment of Prisoners, ECOSOG resolution 663C and 2076 regarding the Standard Minimum Rules for the Treatment of Prisoners which covers rules pertaining to accommodation and Medical Services, General Assembly Resolution 37/194 on Principles of Medical Ethics relevant to the role of health personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. PMID:14556353
Mahoney, L E; Reutershan, T P
The National Disaster Medical System (NDMS) is aimed at medical care needs resulting from catastrophic earthquakes, which may cause thousands of deaths and injuries. Other geophysical events may cause great mortality, but leave few injured survivors. Weather incidents, technological disasters, and common mass casualty incidents cause much less mortality and morbidity. Catastrophic disasters overwhelm the local medical care system. Supplemental care is provided by disaster relief forces; this care should be adapted to prevalent types of injuries. Most care should be provided at the disaster scene through supplemental medical facilities, while some can be provided by evacuating patients to distant hospitals. Medical response teams capable of stabilizing, sorting, and holding victims should staff supplemental medical facilities. The NDMS program includes hospital facilities, evacuation assets, and medical response teams. The structure and capabilities of these elements are determined by the medical care needs of the catastrophic disaster situation. PMID:3631673
Parker, Thomas F; Aronoff, George R
Integrated clinical care models, like Accountable Care Organizations and ESRD Seamless Care Organizations, present new opportunities for dialysis facility medical directors to affect changes in care that result in improved patient outcomes. Currently, there is little scholarly information on what role the medical director should play. In this opinion-based review, it is predicted that dialysis providers, the hospitals in which the medical director and staff physicians practice, and the payers with which they contract are going to insist that, as care becomes more integrated, dialysis facility medical directors participate in new ways to improve quality and decrease the costs of care. Six broad areas are proposed where dialysis unit medical directors can have the greatest effect on shifting the quality-care paradigm where integrated care models are used. The medical director will need to develop an awareness of the regional medical care delivery system, collect and analyze actionable data, determine patient outcomes to be targeted that are mutually agreed on by participating physicians and institutions, develop processes of care that result in improved patient outcomes, and lead and inform the medical staff. Three practical examples of patient-centered, quality-focused programs developed and implemented by dialysis unit medical directors and their practice partners that targeted dialysis access, modality choice, and fluid volume management are presented. Medical directors are encouraged to move beyond traditional roles and embrace responsibilities associated with integrated care. PMID:25352380
As a patient approaches the end of life, he or she faces a number of very difficult medical decisions. Allied health care professionals, including speech-language pathologists (SLPs) and occupational therapists (OTs), can be instrumental in assisting their patients to make advance care plans, although their traditional job descriptions do not…
Current medical care is subdivided according to medical advances, and sophistication and new techniques are necessary. In this setting, doctors and nurses have been explaining to and consulting patients about their medical examinations; however, in recent years, medical technologists have performed these duties at the start of the team's medical care. Therefore, we think it is possible for patients to receive clear and convincing explanations. Most patients cannot understand their examination data, which are written using numbers and charts, etc. Recently, the Nagano Medical Technologist Society has been developing technologists who could explain examination results to patients. This development training included hospitality and communication. The certificate of completion will be issued in March when the program starts. PMID:23855193
Bhatt, R V
In 1965, Baroda Medical College initiated a process of medical audit of maternal and perinatal deaths occurring at this institution, and consultation in peripheral medical facilities providing antenatal and obstetric care. By 1984 maternal and perinatal mortality had declined and clinical judgment in maternity care had improved. PMID:2572472
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Arrangements for medical care. 725.705... FEDERAL MINE SAFETY AND HEALTH ACT, AS AMENDED Medical Benefits and Vocational Rehabilitation § 725.705 Arrangements for medical care. (a) Operator liability. If an operator has been determined liable for...
Spellman, Douglas F.; Griffith, Annette K.; Huefner, Jonathan C.; Wise, Neil, III; McElderry, Ellen; Leslie, Laurel K.
This article presents a psychotropic medication management approach that is used within a residential care program. The approach is used to assess medications at youths' times of entry and to facilitate decision making during care. Data from a typical case study have indicated that by making medication management decisions slowly, systematically,…
Golnik, Allison; Scal, Peter; Wey, Andrew; Gaillard, Philippe
Forty-six subjects received primary medical care within an autism-specific medical home intervention (www.autismmedicalhome.com) and 157 controls received standard primary medical care. Subjects and controls had autism spectrum disorder diagnoses. Thirty-four subjects (74%) and 62 controls (40%) completed pre and post surveys. Controlling for…
... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Arrangements for medical care. 725.705... FEDERAL MINE SAFETY AND HEALTH ACT, AS AMENDED Medical Benefits and Vocational Rehabilitation § 725.705 Arrangements for medical care. (a) Operator liability. If an operator has been determined liable for...
... 42 Public Health 4 2013-10-01 2013-10-01 false Medical care advisory committee. 431.12 Section 431... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Single State Agency § 431.12 Medical care advisory committee. (a) Basis and purpose. This section, based on section...
... 42 Public Health 4 2012-10-01 2012-10-01 false Medical care advisory committee. 431.12 Section 431... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Single State Agency § 431.12 Medical care advisory committee. (a) Basis and purpose. This section, based on section...
... 42 Public Health 4 2014-10-01 2014-10-01 false Medical care advisory committee. 431.12 Section 431... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Single State Agency § 431.12 Medical care advisory committee. (a) Basis and purpose. This section, based on section...
... 42 Public Health 4 2011-10-01 2011-10-01 false Medical care advisory committee. 431.12 Section 431... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Single State Agency § 431.12 Medical care advisory committee. (a) Basis and purpose. This section, based on section...
... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Arrangements for medical care. 725.705... FEDERAL MINE SAFETY AND HEALTH ACT, AS AMENDED Medical Benefits and Vocational Rehabilitation § 725.705 Arrangements for medical care. (a) Operator liability. If an operator has been determined liable for...
... AFFAIRS 38 CFR Part 17 RIN 2900-AN55 Reimbursement Offsets for Medical Care or Services AGENCY: Department... to amend its regulations concerning the reimbursement of medical care and services delivered to... payers are required to reimburse VA for costs related to care provided by VA to a veteran covered...
How, Choon How; Koh, Lip Hoe
Advance Care Planning (ACP) is a process of discussion of healthcare decisions with regard to a patient’s future health and personal care, should they become unable to make or communicate their own decisions in the future. ACP can be as simple as a chat about the patient’s end-of-life wishes with their trusted loved ones, and may involve their doctors, organisations and trained facilitators. The process can be documented with available online resources, such as structured tools. Family physicians, with whom patients share unique therapeutic relationships, are in the best position to introduce and start the ACP conversation with their patients. PMID:25640095
Paes, B; Mitchell, A; Hunsberger, M; Blatz, S; Watts, J; Dent, P; Sinclair, J; Southwell, D
Advances in technology have improved the survival rates of infants of low birth weight. Increasing service commitments together with cutbacks in Canadian training positions have caused concerns about medical staffing in neonatal intensive care units (NICUs) in Ontario. To determine whether an imbalance exists between the supply of medical personnel and the demand for health care services, in July 1985 we surveyed the medical directors, head nurses and staff physicians of nine tertiary level NICUs and the directors of five postgraduate pediatric residency programs. On the basis of current guidelines recommending an ideal neonatologist:patient ratio of 1:6 (assuming an adequate number of support personnel) most of the NICUs were understaffed. Concern about the heavy work pattern and resulting lifestyle implications has made Canadian graduates reluctant to enter this subspecialty. We propose strategies to correct staffing shortages in the context of rapidly increasing workloads resulting from a continuing cutback of pediatric residency positions and restrictions on immigration of foreign trainees. PMID:2720515
Awosogba, Temitope; Betancourt, Joseph R.; Conyers, F. Garrett; Estapé, Estela S.; Francois, Fritz; Gard, Sabrina J.; Kaufman, Arthur; Lunn, Mitchell R.; Nivet, Marc A.; Oppenheim, Joel D.; Pomeroy, Claire; Yeung, Howa
Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. PMID:23659676
Awosogba, Temitope; Betancourt, Joseph R; Conyers, F Garrett; Estapé, Estela S; Francois, Fritz; Gard, Sabrina J; Kaufman, Arthur; Lunn, Mitchell R; Nivet, Marc A; Oppenheim, Joel D; Pomeroy, Claire; Yeung, Howa
Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. PMID:23659676
... 42 Public Health 1 2010-10-01 2010-10-01 false Medical and other care; death. 34.7 Section 34.7... EXAMINATIONS MEDICAL EXAMINATION OF ALIENS § 34.7 Medical and other care; death. (a) An alien detained by or in... further care. (b) In case of the death of an alien, the body shall be delivered to the consular...
... 42 Public Health 1 2014-10-01 2014-10-01 false Medical and other care; death. 34.7 Section 34.7... EXAMINATIONS MEDICAL EXAMINATION OF ALIENS § 34.7 Medical and other care; death. (a) An alien detained by or in... further care. (b) In case of the death of an alien, the body shall be delivered to the consular...
... 42 Public Health 1 2011-10-01 2011-10-01 false Medical and other care; death. 34.7 Section 34.7... EXAMINATIONS MEDICAL EXAMINATION OF ALIENS § 34.7 Medical and other care; death. (a) An alien detained by or in... further care. (b) In case of the death of an alien, the body shall be delivered to the consular...
... 42 Public Health 1 2012-10-01 2012-10-01 false Medical and other care; death. 34.7 Section 34.7... EXAMINATIONS MEDICAL EXAMINATION OF ALIENS § 34.7 Medical and other care; death. (a) An alien detained by or in... further care. (b) In case of the death of an alien, the body shall be delivered to the consular...
... 42 Public Health 1 2013-10-01 2013-10-01 false Medical and other care; death. 34.7 Section 34.7... EXAMINATIONS MEDICAL EXAMINATION OF ALIENS § 34.7 Medical and other care; death. (a) An alien detained by or in... further care. (b) In case of the death of an alien, the body shall be delivered to the consular...
Zenaty, D; Laurent, M; Carel, J C; Léger, J
Turner syndrome is a rare genetic disorder, affecting approximately one in 2500 live-born female, due to total or partial absence of the X chromosome. Typical clinical features are short stature and premature ovarian failure and less constantly phenotypic particularities such as congenital malformations, acquired cardiovascular, otological (hearing impairment), autoimmune and metabolic pathologies. The phenotype is highly variable with slight or even normal phenotype. Several studies have shown that growth hormone treatment improves adult height. The possibility of pregnancies after oocyte donation highlights the high risk of these pregnancies requiring a careful follow-up, especially in terms of cardiovascular issues. Although the quality of life seems similar to the normal population, the presence of cardiovascular and otological diseases, and delayed feminisation are associated with an impaired quality of life. Early diagnosis and regular screening for potentials associated complications are essential in the medical follow-up of these patients. The recent publication of recommendations should lead to an optimization and harmonisation of the medical practices and follow-up from paediatric age to adulthood, a lowering morbidity and self-esteem improvement. The interest of ovarian cryopreservation at an early age in these patients is under investigation. PMID:22041596
... can be forced into the stomach, causing distress. Dialysis What does it entail? If a person develops ... kidneys and build up in the body. A dialysis machine filters the toxins out of the blood. ...
Booth, Adam T; Lehna, Carlee
The purposes of this study were to assess healthcare professionals' need for information on advanced directives and to implement and evaluate an educational plan for change in knowledge and behaviors related to advanced directives. End-of-life (EOL) care is an important topic for patients to discuss with their families and healthcare professionals (HP). Needs assessment data were collected from healthcare providers at an urban trauma intensive care unit (ICU) in Louisville, Kentucky on concepts related to end-of-life. Next, healthcare professionals participated in an educational intervention focused on: knowledge about advanced directives; communication techniques for healthcare professionals to use with patients and their families; awareness of the patient's level of illness in advanced care planning; and specifics about living wills in Kentucky and how to complete one. Pre- and post-test data were collected to evaluate change in knowledge, capability an average of 8.7 years (SD = 9.1; range = 1.9-35 years) in healthcare and worked an average of 8.4 years (SD = 9.3; range = 4 months to 35 years) in their respective ICUs. Eighty-seven percent did not have an AD in place even though their perceived knowledge about AD remained moderate throughout pre- and post-test scores (3.3 to 3.8 on a 5 point scale, respectively). Total post-test scores revealed a 2% improvement in correct responses. These findings point to the need for education of healthcare providers in the ICU to increase early AD and ACP discussions with patients and their families. PMID:27183766
Chauhan, Bindiya; Coffin, Janis
On April 1, 2013, sequestration cuts went into effect impacting Medicare physician payments, graduate medical education, and many other healthcare agencies. The cuts range from 2% to 5%, affecting various departments and organizations. There is already a shortage of primary care physicians in general, not including rural or underserved areas, with limited grants for advanced training. The sequestration cuts negatively impact the future of many primary care physicians and hinder the care many Americans will receive over time. PMID:24044191
Elliott, Barbara A.; Gessert, Charles E.
Purpose: Recent nephrology literature focuses on the need for discussions regarding advance care planning (ACP) for people living with dialysis (PWD). PWD and their family members’ attitudes toward ACP and other aspects of late-life decision making were assessed in this qualitative study. Methodology: Thirty-one interviews were completed with 20 PWD over the age of 70 (mean dialysis 34 months) and 11 family members, related to life experiences, making medical decisions, and planning for the future. Interviews were recorded, transcribed and analyzed. Findings: Four themes regarding ACP emerged from this secondary analysis of the interviews: how completing ACP, advance directives (AD), and identifying an agent fit into PWD experiences; PWD understanding of their prognosis; what gives PWD lives meaning and worth; and PWD care preferences when their defined meaning and worth are not part of their experience. These PWD and family members revealed that ACP is ongoing and common among them. They did not seem to think their medical providers needed to be part of these discussions, since family members were well informed. Practical implications: These results suggest that if health care providers and institutions need AD forms completed, it will important to work with both PWD and their family members to assure personal wishes are documented and honored. PMID:27417605
Hodes, R M; Kloos, H
Ethiopia is a country of 45 million people in northeast Africa. With a stagnant, agriculture-based economy and a per capita gross national product of $110 in 1984, it is one of the world's poorest nations. 70% of the children are mildly to severely malnourished, and 25.7% of children born alive die before the age of 5. Life expectancy is 41 years. The population is growing at the rate of 2.9%/year, but only 2% of the people use birth control. After the 1974 revolution, the socialist government nationalized land and created 20,000 peasant associations and kebeles (urban dwellers' associations), which are the units of local government. The government has set ambitious goals for development in all sectors, including health, but famine, near famine, forced resettlement programs, and civil war have prevented any real progress from being made. The government's approach to health care is based on an emphasis on primary health care and expansion of rural health services, but the Ministry of Health is allocated only 3.5% of the national budget. Ethiopia has 3 medical schools -- at Addis Ababa, Gondar, and the Jimma Institute of Health Sciences. Physicians are government employees but also engage in private practice. A major problem is that a large proportion of medical graduates emigrate. Ethiopia has 87 hospitals with 11,296 beds, which comes to 1 bed per 3734 people. There are 1949 health stations and 141 health centers, but many have no physician, and attrition among health workers is high due to lack of ministerial support. Health care is often dispensed legally or illegally by pharmacists. Overall, there is 1 physician for 57,876 people, but in the southwest and west central Ethiopia 1 physician serves between 200,000 and 300,000 people. In rural areas, where 90% of the population lives, 85% live at least 3 days by foot from a rural health unit. Immunization of 1-year olds against tuberculosis, diphtheria-pertussis-tetanus, poliomyelitis, and measles is 11, 6, 6, and
Baughman, Kristin R; Burke, Ryan C; Hewit, Michael S; Sudano, Joseph J; Meeker, James; Hull, Sharon K
Problems paying medical bills have been reported to be associated with increased stress, bankruptcy, and forgone medical care. Using the Behavioral Model for Vulnerable Populations developed by Gelberg et al as a framework, as well as data from the 2010 Ohio Family Health Survey, this study examined the relationships between difficulty paying medical bills and forgone medical and prescription drug care. Logistic regression was used to examine associations between difficulty paying medical bills and predisposing, enabling, need (health status), and health behaviors (forgoing medical care). Difficulty paying medical bills increased the effect of lack of health insurance in predicting forgone medical care and had a conditional effect on the association between education and forgone prescription drug care. Those who had less than a bachelor's degree were more likely to forgo prescription drug care than those with a bachelor's degree, but only if they had difficulty paying medical bills. Difficulty paying medical bills also accounted for the relationships between several population characteristics (eg, age, income, home ownership, health status) in predicting forgone medical and prescription drug care. Policies to cap out-of-pocket medical expenses may mitigate health disparities by addressing the impact of difficulty paying medical bills on forgone care. PMID:25856468
Lum, Hillary D; Sudore, Rebecca L
This article provides an approach to advance care planning (ACP) and goals of care communication in older adults with cardiovascular disease and multi-morbidity. The goal of ACP is to ensure that the medical care patients receive is aligned with their values and preferences. In this article, the authors outline common benefits and challenges to ACP for older adults with cardiovascular disease and multimorbidity. Recognizing that these patients experience diverse disease trajectories and receive care in multiple health care settings, the authors provide practical steps for multidisciplinary teams to integrate ACP into brief clinic encounters. PMID:27113144
Washington, Karla; Bowland, Sharon; Mueggenburg, Kay; Pederson, Margaret; Otten, Sheila; Renn, Tanya
Professional leaders have identified clear roles for social workers involved in advance care planning (ACP), a facilitated process whereby individuals identify their preferences for future medical care; yet information about effective teaching practices in this area is scant. This study reports on the experiences of 14 social workers who…
Ohio State Dept. of Education, Columbus. Div. of Vocational Education.
This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers medical emergencies. The objectives for the chapter are for students to be able to describe the causes, signs, and symptoms for specified medical emergencies and to describe emergency care for them. Informative…
As managed care becomes more and more dominant in U.S. health care, it is coming into conflict with medical education. There are historical reasons for this: medical education traditionally excluded physicians who chose to work in health plans, and for profit managed care has tended to avoid subsidizing medical education. In order to improve the climate, three changes are necessary: medical education must understand the tense history of discord between the two; distinctions must be made between responsible and irresponsible managed care plans; and medical educators should not assume they own the moral high ground. Arrogance, a gross oversupply of physicians and especially specialists, scandals and fraud, an often callous attitude toward the poor, and other sins can be laid at medical education's door. The worse threat for both sides is that the public and payers could simply abandon both, leading to underfunding for health professions education, a society that does not trust its health care system, and the loss of superb teaching organizations. To prevent this, managed care and medical education should work together to solve several difficult problems: how to shrink the medical education infrastructure; how to report honestly the uses to which medical education funds are put; and how to identify and end irresponsible behavior on the part of health plans and medical education entities alike. If the two sides can exercise leadership in these areas, they will be able to protect and enhance the singular place of honor that medical education holds in this society. PMID:9159575
Seltzer, Rebecca R; Henderson, Carrie M; Boss, Renee D
Medical interventions for life-threatening pediatric conditions often oblige ongoing and complex medical care for survivors. For some children with medical complexity, their caretaking needs outstrip their parents' resources and abilities. When this occurs, the medical foster care system can provide the necessary health care and supervision to permit these children to live outside of hospitals. However, foster children with medical complexity experience extremes of social and medical risk, confounding their prognosis and quality of life beyond that of similar children living with biologic parents. Medical foster parents report inadequate training and preparation, perpetuating these health risks. Further, critical decisions that weigh the benefits and burdens of medical interventions for these children must accommodate complicated relationships involving foster families, caseworkers, biologic families, legal consultants, and clinicians. These variables can delay and undermine coordinated and comprehensive care. To rectify these issues, medical homes and written care plans can promote collaboration between providers, families, and agencies. Pediatricians should receive specialized training to meet the unique needs of this population. National policy and research agendas could target medical and social interventions to reduce the need for medical foster care for children with medical complexity, and to improve its quality for those children who do. PMID:26460524
Chapman, Dennis G.; Toseland, Ronald W.
This study evaluated the effectiveness of advanced illness care teams (AICTs) for nursing home residents with advanced dementia. The AICTs used a holistic approach that focused on four domains: (1) medical, (2) meaningful activities, (3) psychological, and (4) behavioral. The authors recruited 118 residents in two nursing homes for this study and…
Florida State Dept. of Education, Tallahassee. Div. of Elementary and Secondary Education.
Secondary level students learn about medical care in this learning activity package, which is one in a series. The developers believe that consumer education in the health field would ensure better patient care and help eliminate incompetent medical practices and practitioners. The learning package includes instructions for the teacher,…
Bates, Richard D.; Nahata, Milap C.
Noting the lack of reference sources available on the use of medications in schools and day care centers, this book was created to help school and day care center personnel become more aware of the medicine being given to children at home and at school. Using detailed medication charts, the book answers questions about how to administer medicines…
... Zika & Pregnancy Medical Care and Your 1- to 2-Year-Old KidsHealth > For Parents > Medical Care and Your 1- to 2-Year-Old Print A A A Text Size ... Following simple instructions? Saying a few words? Combining two words by age 2? The doctor may ask ...
van Loon, Jos; Knibbe, Jeroen; Van Hove, Geert
Background: Concerns have been raised about the quality of medical care available for people with intellectual disabilities in community-based services. The aims of this study were to evaluate a model of medical care developed during a programme of deinstitutionalization, based on a specialist physician supporting general practitioners (GPs).…
O'Neil, Edward H.; Seifer, Sarena D.
Health care reforms will dramatically change the culture of medical schools in areas of patient care, research, and education programs. Academic medical centers must construct mutually beneficial partnerships that will position them to take advantage of the opportunities rather than leave them without the diversity of resources needed to make…
... Pregnancy Medical Care and Your 1- to 3-Month-Old KidsHealth > For Parents > Medical Care and Your 1- to 3-Month-Old Print A A A Text Size What's ... When to Call the Doctor During these early months, you may have many questions about your baby's ...
... Pregnancy Medical Care and Your 8- to 12-Month-Old KidsHealth > For Parents > Medical Care and Your 8- to 12-Month-Old Print A A A Text Size What's ... baby visits during this period, once at 9 months and again at 12 months . If you have ...
... Pregnancy Medical Care and Your 4- to 7-Month-Old KidsHealth > For Parents > Medical Care and Your 4- to 7-Month-Old Print A A A Text Size What's ... really begin to show their personality during these months. So you might find yourself talking to your ...
War, said Carl von Clausewitz, is a cameleon. In this century, each armed conflict has proved to be unique, particularly in its medical aspects, with its own features and teaching its won lessons. As recent events show, no conflict is a fact of the past. Medical care delivered to war casualties depend on the circumstances of the war, on the medical resources available, but also on the price that cultures or circumstances place on it. Everything separates these two paradigms; on the one hand the "precious" casualty of western armies whose medical support is organized in a concept (forward medical and surgical care, ultra-rapid medical evacuation) tailored to each case, and as close as possible to the medical care of a civilian trauma patient whose models remains the North-American ballistic wound managed in trauma centers; on the other hand, civilian victims, in large numbers, in poor and disorganized countries, often abandoned to their own fate or sorted by "epidemiological" triage, which guarantees a distribution, as efficient as possible, of limited medical care. In war, advanced medical care and precarious medicine may work side by side according to two logics which do not exclude one another and constantly improve. PMID:9297902
Ahlner-Elmqvist, Marianne; Jordhøy, Marit S; Jannert, Magnus; Fayers, Peter; Kaasa, Stein
The purpose of this prospective nonrandomized study was to evaluate time spent at home, place of death and differences in sociodemographic and medical characteristics of patients, with cancer in palliative stage, receiving either hospital-based advanced home care (AHC), including 24-hour service by a multidisciplinary palliative care team or conventional hospital care (CC). Recruitment to the AHC group and to the study was a two-step procedure. The patients were assigned to either hospital-based AHC or CC according to their preferences. Following this, the patients were asked to participate in the study. Patients were eligible for the study if they had malignant disease, were older than 18 years and had a survival expectancy of 2-12 months. A total of 297 patients entered the study and 280 died during the study period of two and a half years, 117 in the AHC group and 163 in the CC group. Significantly more patients died at home in the AHC group (45%) compared with the CC group (10%). Preference for and referral to hospital-based AHC were not related to sociodemographic or medical characteristics. However, death at home was associated with living together with someone. Advanced hospital-based home care targeting seriously ill cancer patients with a wish to remain at home enable a substantial number of patients to die in the place they desire. PMID:15540666
Jennings, D L; White-Means, S I
As Medicaid moves toward a system of managed care, Aid for Families with Dependent Children (AFDC) recipients often are assigned to an organization that assumes responsibility for managing their annual receipt of health care. This study reports the results of an investigation into the patterns of medical care utilization by AFDC recipients and their children under reformed Medicaid. The issues explored include whether or not medical care utilization patterns vary by race, and if there are identifiable factors that determine the utilization patterns of AFDC recipients and their children. We conclude that racial differences in medical care utilization do exist for AFDC recipients, but not for their children. Policy makers involved in reforming Medicaid should recognize that certain cohorts continue to exhibit undesirable medical care utilization patterns, and implement measures to rectify this situation. PMID:11190655
Moss, Jacqueline; Berner, Eta; Bothe, Olaf; Rymarchuk, Irina
Medication administration errors have been shown to be frequent and serious. Error is particularly prevalent in highly technical specialties such as critical care. The purpose of this study was to describe the characteristics of intravenous medication administration in five intensive care units. These data were used within the context of a larger study to design information system decision support to decrease medication administration errors in these settings. Nurses were observed during the course of their work and their intravenous medication administration process, medication order source, references used, calculation method, number of medications prepared simultaneously, and any interruptions occurring during the preparation and delivery phases of the administration event were recorded. In addition, chart reviews of medication administration records were completed and nurses were asked to complete an anonymous drop-box questionnaire regarding their experiences with medication administration error. The results of this study are discussed in terms of potential informatics solutions for reducing medication administration error. PMID:18998790
"Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers. PMID:22216474
Thacker, Holly L; Maxwell, Richard; Saporito, Jennifer; Bronson, David
Shared medical appointments (SMAs) are a new way to deliver woman-focused interdisciplinary care for midlife women. SMAs are a series of one physician to one patient encounters with other patient observers. The women's health physician addresses each woman's unique medical needs individually but in the context of a shared setting. The major focus is on delivering individual medical care with the benefits of additional time spent educating women patients and answering questions. PMID:16313217
Spatz, Christin; Bricker, Patricia; Gabbay, Robert
The growing need for coordinated care of those with medically complex diseases is becoming more important in today's health care system, wherein reimbursement changes are driving methods to improve quality and cost. This article discusses the 6 key processes that, according to the American College of Physicians, define an effective medical neighborhood; the evidence supporting the need for this coordinated system; and pilot medical neighborhood strategies being implemented. PMID:23966551
... that failure to promptly report the occurrence of a disease or injury may result in the loss of medical... 32 National Defense 3 2010-07-01 2010-07-01 true Procedures for obtaining medical care. 564.40... RESERVES NATIONAL GUARD REGULATIONS Medical Attendance and Burial § 564.40 Procedures for obtaining...
van der Lee, Arnold; de Haan, Lieuwe; Beekman, Aartjan
Background Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment. Methods Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008–2011 in the Netherlands. Included were 7,392 patients under 70 years of age with schizophrenia in 2008, insured during the whole period. We assessed the relationship between continuous elective psychiatric care and the outcome measures: acute treatment events, psychiatric hospitalization, somatic care and health care costs. Results Continuous elective psychiatric care was accessed by 73% of the patients during the entire three year follow-up period. These patients received mostly outpatient care and accessed more somatic care, at a total cost of €36,485 in three years, than those without continuous care. In the groups accessing fewer or no years of elective care 34%-68% had inpatient care and acute treatment events, while accessing less somatic care at average total costs of medical care from €33,284 to €64,509. Conclusions Continuous elective mental and somatic care for 73% of the patients with schizophrenia showed better quality of care at lower costs. Providing continuous elective care to the remaining patients may improve health while reducing acute illness episodes. PMID:27275609
Conrey, Elizabeth J; Seidu, Dazar; Ryan, Norma J; Chapman, Dj Sam
Medical homes deliver primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. Children with special health care needs (CSHCN) require a wide range of support to maintain health, making medical home access particularly important. We sought to understand independent risk factors for lacking access. We analyzed Ohio, USA data from the National Survey of Children with Special Health Care Needs (2005-2006). Among CSHCN, 55.6% had medical home access. The proportion achieving each medical home component was highest for having a personal doctor/nurse and lowest for receiving coordinated care, family-centered care and referrals. Specific subsets of CSHCN were significantly and independently more likely to lack medical home access: Hispanic (AOR=3.08), moderate/high severity of difficulty (AOR=2.84), and any public insurance (AOR=1.60). Efforts to advance medical home access must give special attention to these CSHCN populations and improvements must be made to referral access, family-centered care, and care coordination. PMID:23242811
Pugsley, Lesley; McCrorie, Peter
Is medical education unique among all other educational disciplines? Why does it not seem to conform to the rules laid down by universities for every other faculty? We explore the ways in which particular elements pertaining to medical education have been perceived historically and consider the ways in which medical educators and students have…
Herold, Thomas J S
There is great focus within the military medical community regarding the ever growing cost of medical care overall and dependent care specifically. A great deal of discussion relates to the delivery of care through a growing military-civilian partnership, where an increased amount of health care will be referred to an ever growing network of civilian providers. The U.S. military establishment now stands at an important crossroad leading into the future of dependent care. However, the special concerns, which arise from the responsibility of caring for military dependents, are not a solely recent phenomenon. Ever since the establishment of a permanent standing U.S. Army in the late 1700s, there have been families in need of medical treatment. Although changes occurred continuously, the development and evolution of policies regulating the delivery of medical care to dependants can be divided into three periods. The first is the longest and ranges from the establishment of the Army until the year 1900. The second period spans from 1900 to the post-Korean War year of 1956. The third and final period is from 1956 to 1975. Special changes and advances in each of these periods have served to shape the face of dependent care in today's Army Medical Department. PMID:22128648
Garcia, Theresa J; Harrison, Tracie C; Goodwin, James S
Demand by nursing home residents for involvement in their medical care, or, patient-centered care, is expected to increase as baby boomers begin seeking long-term care for their chronic illnesses. To explore the needs in meeting this proposed demand, we used a qualitative descriptive method with content analysis to obtain the joint perspective of key stakeholders on the current state of person-centered medical care in the nursing home. We interviewed 31 nursing home stakeholders: 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Our findings revealed constraints placed by the long-term care system limited medical involvement opportunities and created conflicting goals for patient-centered medical care. Resident participation in medical care was perceived as low, but important. The creation of supportive educational programs for all stakeholders to facilitate a common goal for nursing home admission and to provide assistance through the long-term care system was encouraged. PMID:25721717
Carpenter, Janet S; Rosenman, Marc B; Knisely, Mitchell R; Decker, Brian S; Levy, Kenneth D; Flockhart, David A
Objective: Prior to implementing a trial to evaluate the economic costs and clinical outcomes of pharmacogenetic testing in a large safety net health care system, we determined the number of patients taking targeted medications and their clinical care encounter sites. Methods: Using 1-year electronic medical record data, we evaluated the number of patients who had started one or more of 30 known pharmacogenomically actionable medications and the number of care encounter sites the patients had visited. Results: Results showed 7039 unique patients who started one or more of the target medications within a 12-month period with visits to 73 care sites within the system. Conclusion: Findings suggest that the type of large-scale, multi-drug, multi-gene approach to pharmacogenetic testing we are planning is widely relevant, and successful implementation will require wide-scale education of prescribers and other personnel involved in medication dispensing and handling. PMID:26835014
Tripodoro, Vilma A; Rynkiewicz, María C; Llanos, Victoria; Padova, Susana; De Lellis, Silvina; De Simone, Gustavo
About 75% of population will die from one or more chronic progressive diseases. From this projection WHO urged countries to devise strategies for strengthening palliative treatment as part of comprehensive care. In Catalonia, Spain, direct measurement of the prevalence of these patients with NECPAL CCOMS-ICO© tool was 1.5% of the population. This tool is an indicative, not dichotomous, quali-quantitative multifactorial evaluation to be completed by the treating physician. In Argentina there is no information on these patients. Our goal was to explore and characterize the proportion of chronically ill patients in palliative care needs, by NECPAL CCOMS-ICO© tool, in an accessible population of the City of Buenos Aires. General hospitals of the Health Region 2 (Piñero, álvarez and Santojanni) and its program areas were surveyed. In Health Region 1, we surveyed the Udaondo gastroenterology hospital. A total of 53 physicians (704 patients) were interviewed. It was identified that 29.5% of these patients were affected by advanced chronic diseases; 72.1% of them were NECPAL positive, younger (median 64) than in others studies, and more than 98% presented high levels of comorbidity. Palliative care demand (31.4%) and needs (52.7%) were recorded. Specific indicators of fragility, progression, severity and kind of chronic disease were described. The main finding was to identify, with an instrument not based on mortality that, in Buenos Aires City, 1 in 3 patients with chronic diseases could die in the next year and had palliative care needs. PMID:27295702
Kruer, Rachel M; Jarrell, Andrew S; Latif, Asad
The Institute of Medicine has reported that medication errors are the single most common type of error in health care, representing 19% of all adverse events, while accounting for over 7,000 deaths annually. The frequency of medication errors in adult intensive care units can be as high as 947 per 1,000 patient-days, with a median of 105.9 per 1,000 patient-days. The formulation of drugs is a potential contributor to medication errors. Challenges related to drug formulation are specific to the various routes of medication administration, though errors associated with medication appearance and labeling occur among all drug formulations and routes of administration. Addressing these multifaceted challenges requires a multimodal approach. Changes in technology, training, systems, and safety culture are all strategies to potentially reduce medication errors related to drug formulation in the intensive care unit. PMID:25210478
Hoang, G N; Erickson, R V
Almost 500,000 Southeast Asian refugees have arrived in the United States since 1975. While these refugees have not presented substantial public health problems, they have important personal health problems frequently requiring medical attention. Medical care providers in this country need to be aware of disease patterns and prevalence among these refugees. As well, they need to be aware of the cultural and religious backgrounds and previous medical practices of this refugee population, particularly as these practice influence the refugees' ability to obtain and maintain medical services provided in this country. Historical, cultural, religious, ethical, and medical information is provided to help US health care facilities develop culturally appropriate medical care services for Southeast Asian refugees. PMID:7097923
Brown, J V; Rusinova, N L
This article examines medical utilization patterns and attitudes toward the medical care system among the citizens of Russia's second largest city, St. Petersburg. It focuses upon the extent to which both attitudes towards and usage of medical care institutions have changed in the immediate post-Soviet period. A particular concern has been to determine the degree to which utilization and perceptions vary across the socioeconomic status hierarchy. The data were collected in two stages: a mass survey (N = 1500) conducted in mid 1992 and intensive follow-up interviews (N = 44) conducted in late 1994. The findings indicate that urban Russians were very critical of their medical care system at the end of the Soviet period. Most feel that the system has deteriorated even further since the end of 1991, and they are particularly worried about the emergency care system and about hospital conditions. Although people believe that the system now includes more alternatives, very few have changed their medical utilization patterns to take advantage of these new possibilities. This is more a product of their perceived high cost than of principled opposition to "pay" medicine. The analysis also demonstrates the extent to which medical utilization differs by socioeconomic status. lower status individuals tend to utilize the formal medical care system. High status individuals seek help from a variety of sources and, in particular, rely much more heavily on informal connections to the medical care system. The medical help-seeking strategies of higher status groups have proven to be reasonably adaptable to the post-Soviet medical marketplace, while for others finding good quality medical care remains more problematic. PMID:9381239
The current paradigm of medical care depends heavily on the autonomous and highly trained doctor to collect and process information necessary to care for each patient. This paradigm is challenged by the increasing requirements for knowledge by both patients and doctors; by the need to evaluate populations of patients inside and outside one’s practice; by consistently unmet quality of care expectations; by the costliness of redundant, fragmented, and suboptimal care; and by a seemingly insurmountable demand for chronic disease care. Medical care refinements within the old paradigm may not solve these challenges, suggesting a shift to a new paradigm is needed. A new paradigm could be considerably more reliant on health information technology because that offers the best option for addressing our challenges and creating a foundation for future medical progress, although this process will be disruptive. PMID:18373152
Petersdorf, R G
Title VII funding to medical schools has not succeeded in correcting the shortage of primary care physicians. Although it is generally true that there is an inverse relationship between the amount of research funds awarded to a school and its success in producing primary care physicians, there are many exceptions. Neither Title VII, the amount of research funding, or Medicare's Direct Medical Education payments has had a substantial effect on the production of primary care physicians. These factors are comparatively insignificant when considered in the light of strong external incentives to specialize. Medical education cannot remedy the specialty imbalance unless the external environment becomes more friendly to generalists. PMID:8438967
Kelly, Edward K.; And Others
It is argued that higher education institutions can play a major role in health care reform by providing campus cultures that foster healthy lifestyle choices and in turn reduce medical costs. Specific issues discussed include elimination of unnecessary tests, focus on special high-risk populations, and use of advance directives. (MSE)
Mitchell, Jonathan I; Owen, Marie M; Colquhoun, Margaret H; Lawand, Christina
Four national healthcare organizations - Accreditation Canada, the Canadian Institute for Health Information, the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada - recently collaborated to better understand and share comprehensive information about medication reconciliation in Canada. This article summarizes the key findings of their joint report titled Medication Reconciliation in Canada: Raising the Bar and profiles innovative approaches and tools for healthcare organizations across Canada. PMID:24485236
Latkin, Carl A.; Davey-Rothwell, Melissa A.; Knowlton, Amy R.; Alexander, Kamila A.; Williams, Chyvette T.; Boodram, Basmattee
This article reviews current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates and treatment access and outcomes. Social network analysis is a value tool to link social structural factors to individual behaviors. Social networks provide an avenue for low cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, and optimizing HIV medical care and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics. PMID:23673888
Demiris, George; Marek, Karen D.
Introduction Older adults with multiple chronic conditions face the complex task of medication management involving multiple medications of varying doses at different times. Advances in telehealth technologies have resulted in home-based devices for medication management and health monitoring of older adults. We examined older adults’ perceptions of a telehealth medication dispensing device as part of a clinical trial involving home health care clients, nurse coordination and use of the medication dispensing device. Methods Ninety-six frail older adult participants who used the medication dispensing device for 12 months completed a satisfaction survey related to perceived usefulness and reliability. Results were analyzed and grouped by themes in the following areas: Ease of Use, Reliability, Medication Management Assistance, Routine Task Performance and Acceptability. Results Nearly all participants perceived the medication dispensing device as very easy to use, very reliable and helpful in management of their medications. Eighty-four percent of participants expressed a desire to use the machine in the future. Conclusion The technology-enhanced medication management device in this study is an acceptable tool for older adults to manage medication in collaboration with home care nurses. Improved usability and cost models for medication dispensers are areas for future research. Trial Registration clinicaltrials.gov identifier: NCT01321853 PMID:23323721
Burd, Andrew; Huang, Lin
Advanced wound care centres are now a well established response to the growing epidemic of chronic wounds in the adult population. Is the concept transferable to children? Whilst there is not the same prevalence of chronic wounds in children there are conditions affecting the integumentary system that do have a profound effect on the quality of life of both children and their families. We have identified conditions involving the skin, scars and wounds which contribute to a critical number of potential patients that can justify the setting up of an advanced skin, scar and wound care centre for children. The management of conditions such as giant naevi, extensive scarring and epidermolysis bullosa challenge medical professionals and lead to new and novel treatments to be developed. The variation between and within such conditions calls for a customizing of individual patient care that involves a close relationship between research scientists and clinicians. This is translational medicine of its best and we predict that this is the future of wound care particularly and specifically in children. PMID:23162215
Alexander, Randell A.
This volume is the first of a two-part special issue detailing state of the art practice in medical issues around child sexual abuse. The six articles in this issue explore methods for medical history evaluation, the rationale for when sexual examinations should take place, specific hymenal findings that suggest a child has been sexually abused,…
Shi, Hanyuan; Lee, Kevin C.
The Association of American Medical Colleges reports an impending shortage of over 90,000 primary care physicians by the year 2025. An aging and increasingly insured population demands a larger provider workforce. Unfortunately, the supply of US-trained medical students entering primary care residencies is also dwindling, and without a redesign in this country's undergraduate and graduate medical education structure, there will be significant problems in the coming decades. As an institution producing fewer and fewer trainees in primary care for one of the poorest states in the United States, we propose this curriculum to tackle the issue of the national primary care physician shortage. The aim is to promote more recruitment of medical students into family medicine through an integrated 3-year medical school education and a direct entry into a local or state primary care residency without compromising clinical experience. Using the national primary care deficit figures, we calculated that each state medical school should reserve 20–30 primary care (family medicine) residency spots, allowing students to bypass the traditional match after successfully completing a series of rigorous externships, pre-internships, core clerkships, and board exams. Robust support, advising, and personal mentoring are also incorporated to ensure adequate preparation of students. The nation's health is at risk. With full implementation in allopathic medical schools in 50 states, we propose a long-term solution that will serve to provide more than 1,000–2,700 new primary care providers annually. Ultimately, we will produce happy, experienced, and empathetic doctors to advance our nation's primary care system. PMID:27389607
... to medical care, National Health Interview Survey Does health insurance coverage differ by race and ethnicity for young ... having health insurance coverage. Definitions Terms related to health insurance Health insurance coverage: Health insurance is broadly defined ...
The Division of Research within KP-MCP conducts, publishes, and disseminates high-quality epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large.
Vogt, T M
A household interview survey of 2,582 adult members of the Kaiser-Permanente Medical Care Program of Oregon conducted in 1970-71 contained detailed questions about cigarette smoking patterns. Detailed, computerized medical records were maintained for all inpatient and outpatient care rendered between 1967 and 1974 to the 1,761 children of the interviewed sample. Adjusted for age, family size, socioeconomic status, and duration of Health Plan membership, children in non-smoking households used significantly more outpatient services than did children in smoking households, a relationship largely accounted for by their use of more preventive medical services than by children in smoking households. There were no significant differences in inpatient medical care use and outpatient care use for respiratory illness by children of smoking and non-smoking households. PMID:6689838
Baker, Michael S
Throughout the recorded history of civilization, there has been armed conflict. Warfare has been associated with advances in care for the wounded. Many of these advances when shown effective on the battlefield become incorporated into civilian health care. It is a laboratory where there is unfortunately much clinical material and presents opportunity for the creative, curious, and innovative. This article reviews the medical advances that resulted from the Korean War. There were notable advances in neurosurgery, vascular surgery, and plastic surgery. Tools from prior wars were rediscovered, dusted off, and used to stop combat losses from psychiatric trauma. A treatment was developed for cleft lip by a plastic surgeon, thus giving hope to young lives. War is a disruptive, destructive, and harrowing experience--but can lead to improvements in care for the wounded and these developments can improve the lives of people everywhere. PMID:22594134
Riessen, R; Gries, A; Seekamp, A; Dodt, C; Kumle, B; Busch, H-J
The hospital emergency departments play a central role for the in- and outpatient care of patients with medical emergencies in Germany. In this position paper we point out some general financial and organizational problems of German emergency departments and urge for a higher significance of emergency care in the German health system as an element of public services. The corresponding reform proposals include a change in hospital financing towards a more budget-based system for the emergency departments, an improved structural planning for regional and transregional emergency care, an intensified cooperation with the emergency services of the ambulatory care physicians, a better organizational representation of emergency care within the hospitals and an advancement of emergency medicine in postgraduate medical education. PMID:26024948
Gamertsfelder, Elise M; Seaman, Jennifer Burgher; Tate, Judith; Buddadhumaruk, Praewpannarai; Happ, Mary Beth
Because older adults are at high risk for hospitalization and potential decisional incapacity, advance directives are important components of pre-hospital advanced care planning, as they document individual preferences for future medical care. The prevalence of pre-hospital advance directive completion in 450 critically ill older adults requiring mechanical ventilation from two Mid-Atlantic hospitals is described, and demographic and clinical predictors of pre-hospital advance directive completion are explored. The overall advance directive completion rate was 42.4%, with those in older age groups (75 to 84 years and 85 and older) having approximately two times the odds of completion. No significant differences in the likelihood of advance directive completion were noted by sex, race, or admitting diagnosis. The relatively low prevalence of advance directive completion among older adults with critical illness and high mortality rate (24%) suggest a need for greater awareness and education. [Journal of Gerontological Nursing, 42(4), 34-41.]. PMID:26651862
Stewart, Donald F.
The stated goal of this meeting is to examine the use of telemedicine in disaster management, public health, and remote health care. NASA has a vested interest in providing health care to crews in remote environments. NASA has unique requirements for telemedicine support, in that our flight crews conduct their job in the most remote of all work environments. Compounding the degree of remoteness are other environmental concerns, including confinement, lack of atmosphere, spaceflight physiological deconditioning, and radiation exposure, to name a few. In-flight medical care is a key component in the overall support for missions, which also includes extensive medical screening during selection, preventive medical programs for astronauts, and in-flight medical monitoring and consultation. This latter element constitutes the telemedicine aspect of crew health care. The level of in-flight resources dedicated to medical care is determined by the perceived risk of a given mission, which in turn is related to mission duration, planned crew activities, and length of time required for return to definitive medical care facilities.
Kirchhoff, Karin T.; Hammes, Bernard J.; Kehl, Karen A.; Briggs, Linda A.; Brown, Roger L.
Background/Objectives Advance Care Planning (ACP) allows patients to state preferences for their end of life care but these preferences are frequently ignored. Following a Patient-Centered ACP interview (PC-ACP), patients’ preferences were compared to care received at end of life. Design A randomized controlled trial was conducted with patients with Congestive Heart Failure or End-stage Renal Disease and their surrogates who were randomized to receive either PC-ACP or usual care. Setting Two centers in Wisconsin with associated clinics/dialysis units provided patients. Participants Of the 313 patients and their surrogates who completed entry data, 110 died. Intervention During PC-ACP the trained facilitator assessed the patient and surrogate understanding of and experiences with the illness, provided information about disease-specific treatment options and their benefits and burden, assisted in documentation of patient treatment preferences, and assisted the surrogates in understanding the patient’s preferences and their role. Measurements Preferences were documented and then compared to the care received at end of life determined by surrogate interviews or medical charts. Results Patients (74%) frequently continued to make their own decisions about care to the end. The experimental group had fewer (1/62) but not significantly so cases where the patients could not get their wishes met about CPR than control (6/48). Significantly more experimental patients withdrew from dialysis than control. Conclusions Patients and their surrogates were generally willing to discuss preferences with a trained facilitator. Most patients received the care they desired at end of life or altered their preferences to be in accord with the care they could receive. A larger sample with surrogate decision makers is needed to detect significance. PMID:22458336
Chicherin, L P; Nagaev, R Ia
The model of the subject of the Russian Federation is used to consider means of development of health protection and health promotion in adolescents including implementation of the National strategy of activities in interest of children for 2012-2017 approved by decree No761 of the President of Russia in June 1 2012. The analysis is carried out concerning organization of medical social care to this group of population in medical institutions and organizations of different type in the Republic of Bashkortostan. Nowadays, in 29 territories medical social departments and rooms, 5 specialized health centers for children, 6 clinics friendly to youth are organized. The analysis of manpower support demonstrates that in spite of increasing of number of rooms and departments of medical social care for children and adolescents decreasing of staff jobs both of medical personnel and psychologists and social workers occurs. The differences in priorities of functioning of departments and rooms of medical social care under children polyclinics, health centers for children and clinics friendly to youth are established. The questionnaire survey of pediatricians and adolescents concerning perspectives of development of adolescent service established significant need in development of specialized complex center. At the basis of such center problems of medical, pedagogical, social, psychological, legal profile related to specific characteristics of development and medical social needs of adolescents can be resolved. The article demonstrates organizational form of unification on the functional basis of the department of medical social care of children polyclinic and clinic friendly to youth. During three years, number of visits of adolescents to specialists of the center increases and this testifies awareness of adolescents and youth about activities of department of medical social care. The most percentage of visits of adolescents to specialists was made with prevention purpose. Among
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Effect of failure to report on medical care... ADMINISTRATION AND PROCEDURE Medical Care and Supervision Medical Procedures § 702.422 Effect of failure to report on medical care after initial authorization. (a) Notwithstanding that medical care is...
... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Effect of failure to report on medical care... ADMINISTRATION AND PROCEDURE Medical Care and Supervision Medical Procedures § 702.422 Effect of failure to report on medical care after initial authorization. (a) Notwithstanding that medical care is...
... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Effect of failure to report on medical care... ADMINISTRATION AND PROCEDURE Medical Care and Supervision Medical Procedures § 702.422 Effect of failure to report on medical care after initial authorization. (a) Notwithstanding that medical care is...
... 42 Public Health 4 2012-10-01 2012-10-01 false Content of medical care evaluation studies. 456.243... Ur Plan: Medical Care Evaluation Studies § 456.243 Content of medical care evaluation studies. Each medical care evaluation study must— (a) Identify and analyze medical or administrative factors related...
... 42 Public Health 4 2013-10-01 2013-10-01 false Content of medical care evaluation studies. 456.243... Ur Plan: Medical Care Evaluation Studies § 456.243 Content of medical care evaluation studies. Each medical care evaluation study must— (a) Identify and analyze medical or administrative factors related...
... 42 Public Health 4 2011-10-01 2011-10-01 false Content of medical care evaluation studies. 456.243... Ur Plan: Medical Care Evaluation Studies § 456.243 Content of medical care evaluation studies. Each medical care evaluation study must— (a) Identify and analyze medical or administrative factors related...
... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Effect of failure to report on medical care... ADMINISTRATION AND PROCEDURE Medical Care and Supervision Medical Procedures § 702.422 Effect of failure to report on medical care after initial authorization. (a) Notwithstanding that medical care is...
... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.243... Ur Plan: Medical Care Evaluation Studies § 456.243 Content of medical care evaluation studies. Each medical care evaluation study must— (a) Identify and analyze medical or administrative factors related...
... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Effect of failure to report on medical care... ADMINISTRATION AND PROCEDURE Medical Care and Supervision Medical Procedures § 702.422 Effect of failure to report on medical care after initial authorization. (a) Notwithstanding that medical care is...
... 42 Public Health 4 2014-10-01 2014-10-01 false Content of medical care evaluation studies. 456.243... Ur Plan: Medical Care Evaluation Studies § 456.243 Content of medical care evaluation studies. Each medical care evaluation study must— (a) Identify and analyze medical or administrative factors related...
... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.143...: Medical Care Evaluation Studies § 456.143 Content of medical care evaluation studies. Each medical care evaluation study must— (a) Identify and analyze medical or administrative factors related to the...
Alexander, Randell A
This volume is the first of a two-part special issue detailing state of the art practice in medical issues around child sexual abuse. The six articles in this issue explore methods for medical history evaluation, the rationale for when sexual examinations should take place, specific hymenal findings that suggest a child has been sexually abused, the healing of genital injuries, approaches to interpretation of medical findings, and the neurological harm of sexual abuse. From the initial history to the process of the medical examination, the mechanics of what a genital examination might show, and the neurobiological consequences, it is demonstrated that the harm of sexual abuse is has more effect on the brain than the genital area. PMID:21970641
... costs and insurance requirements before you get care. Free and Low-Cost Clinics and Health Centers If ... in school), you may be able to find free or low-cost health clinics in your neighborhood. ...
Lassen, Karin O; Olsen, Jens; Grinderslev, Edvin; Kruse, Filip; Bjerrum, Merete
Background The inspiration for the present assessment of the nutritional care of medical patients is puzzlement about the divide that exists between the theoretical knowledge about the importance of the diet for ill persons, and the common failure to incorporate nutritional aspects in the treatment and care of the patients. The purpose is to clarify existing problems in the nutritional care of Danish medical inpatients, to elucidate how the nutritional care for these inpatients can be improved, and to analyse the costs of this improvement. Methods Qualitative and quantitative methods are deployed to outline how nutritional care of medical inpatients is performed at three Danish hospitals. The practices observed are compared with official recommendations for nutritional care of inpatients. Factors extraneous and counterproductive to optimal nutritional care are identified from the perspectives of patients and professional staff. A review of the literature illustrates the potential for optimal nutritional care. A health economic analysis is performed to elucidate the savings potential of improved nutritional care. Results The prospects for improvements in nutritional care are ameliorated if hospital management clearly identifies nutritional care as a priority area, and enjoys access to management tools for quality assurance. The prospects are also improved if a committed professional at the ward has the necessary time resources to perform nutritional care in practice, and if the care staff can requisition patient meals rich in nutrients 24 hours a day. At the kitchen production level prospects benefit from a facilitator contact between care and kitchen staff, and if the kitchen staff controls the whole food path from the kitchen to the patient. At the patient level, prospects are improved if patients receive information about the choice of food and drink, and have a better nutrition dialogue with the care staff. Better nutritional care of medical patients in Denmark
Akubue, B. N.; Anikweze, G. U.
The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…
This paper considers the multiple discourses that influence medical education with a focus on the discourses of competence and caring. Discourses of competence are largely constituted through, and related to, biomedical and clinical issues whereas discourses of caring generally focus on social concerns. These discourses are not necessarily equal…
In the wake of health care reform, a large health system developed a new model of medical-surgical nursing care delivery. To facilitate the subsequent culture change, a non-traditional educational approach was used to provide a dynamic experiential venue that included real-time feedback to facilitate nurses' behavioral transformation. PMID:22475230
Re', Richard N.
The cost of medical care in the United States is deemed to be excessive by government and business. The causes for this high cost of care are multiple, but the argument that technology is the leading cause has been made. It is argued here that technology, properly employed, can actually be a major component of the solution to rising to health care costs. Because the National Laboratories are a repository for many of the technologies needed to lower health care costs while improving health care quality, a national effort linking these laboratories with university and other academic medical centers, industry, and the National Institutes of Health should be undertaken. The development of a technology roadmap for health care technologies is an important part of this effort.
Nakanishi, Miharu; Miyamoto, Yuki
This study examined factors contributing to the knowledge and attitudes of nursing home staff regarding palliative care for advanced dementia in Japan. A cross-sectional survey of 275 nurses and other care workers from 74 long-term care facilities was conducted across three prefectures in August 2014. The Japanese versions of the Questionnaire on Palliative Care for Advanced Dementia (qPAD) and Frommelt Attitudes Toward Care of the Dying scale, Form B (FATCOD-B-J) were used. Greater knowledge was exhibited among nursing home staff in facilities that established a manual for end-of-life care. Higher levels of positive attitudes were observed among nursing home staff in facilities that had established a manual and those in facilities with a physician's written opinions on end-of-life care. An organisational effort should be explored to establish end-of-life care policies among nursing home staff for advanced dementia. PMID:26878406
Recent research in both the biology of cancer and the treatment of patients has increased the life expectancy of cancer patients with recurrence and who have a longer survival rate. Cancer is no longer considered a lethal but a chronic disease. More patients survive, but above all there are more patients with recurrences thus increasing the need for physical or psychological treatment of patients with longer lives. The American Cancer Society reported in 1992 that in the U.S. more than 8 million people survived between 4 and 5 years. This produces both an ethical and medical challenge for treatment of cancer patients. This paper reviews the actual criteria for palliative care: treatment for pain and the ethical and psychological treatment of advanced cancer patients and their families. PMID:16454965
Barazangi, Nobl; Hemphill, J Claude
New cerebral monitoring techniques allow direct measurement of brain oxygenation and metabolism. Investigation using these new tools has provided additional insight into the understanding of the pathophysiology of acute brain injury and suggested new ways to guide management of secondary brain injury. Studies of focal brain tissue oxygen monitoring have suggested ischemic thresholds in focal regions of brain injury and demonstrated the interrelationship between brain tissue oxygen tension (P bt O 2 ) and other cerebral physiologic and metabolic parameters. Jugular venous oxygen saturation (SjVO 2 ) monitoring may evaluate global brain oxygen delivery and consumption, providing thresholds for detecting brain hypoperfusion and hyperperfusion. Furthermore, critically low values of P bt O 2 and SjVO 2 have also been predictive of mortality and worsened functional outcome, especially after head trauma. Cerebral microdialysis measures the concentrations of extracellular metabolites which may be relevant to cerebral metabolism or ischemia in focal areas of injury. Cerebral blood flow may be measured in the neurointensive care unit using continuous methods such as thermal diffusion and laser Doppler flowmetry. Initial studies have also attempted to correlate findings from advanced neuromonitoring with neuroimaging using dynamic perfusion computed tomography, positron emission tomography, and Xenon computed tomography. Additionally, new methods of data acquisition, storage, and analysis are being developed to address the increasing burden of patient data from neuromonitoring. Advanced informatics techniques such as hierarchical data clustering, generalized linear models, and heat map dendrograms are now being applied to multivariable patient data in order to better develop physiologic patient profiles to improve diagnosis and treatment. PMID:19127034
Hamilton, Douglas; Smart, Kieran; Melton, Shannon; Polk, James D; Johnson-Throop, Kathy
The US-based health care system of the International Space Station contains several subsystems, the Health Maintenance System, Environmental Health System and the Countermeasure System. These systems are designed to provide primary, secondary and tertiary medical prevention strategies. The medical system deployed in low Earth orbit for the International Space Station is designed to support a "stabilize and transport" concept of operations. In this paradigm, an ill or injured crewmember would be rapidly evacuated to a definitive medical care facility (DMCF) on Earth, rather than being treated for a protracted period on orbit. The medical requirements of the short (7 day) and long duration (up to 6 months) exploration class missions to the moon are similar to low Earth orbit class missions but also include an additional 4 to 5 days needed to transport an ill or injured crewmember to a DMCF on Earth. Mars exploration class missions are quite different in that they will significantly delay or prevent the return of an ill or injured crewmember to a DMCF. In addition the limited mass, power and volume afforded to medical care will prevent the mission designers from manifesting the entire capability of terrestrial care. National Aeronautics and Space Administration has identified five levels of care as part of its approach to medical support of future missions including the Constellation program. To implement an effective medical risk mitigation strategy for exploration class missions, modifications to the current suite of space medical systems may be needed, including new crew medical officer training methods, treatment guidelines, diagnostic and therapeutic resources, and improved medical informatics. PMID:18385587
Hamilton, Douglas; Smart, Kieran; Melton, Shannon; Polk, James D.; Johnson-Throop, Kathy
The US-based health care system of the International Space Station (ISS) contains several subsystems, the Health Maintenance System, Environmental Health System and the Countermeasure System. These systems are designed to provide primary, secondary and tertiary medical prevention strategies. The medical system deployed in Low Earth Orbit (LEO) for the ISS is designed to enable a "stabilize and transport" concept of operations. In this paradigm, an ill or injured crewmember would be rapidly evacuated to a definitive medical care facility (DMCF) on Earth, rather than being treated for a protracted period on orbit. The medical requirements of the short (7 day) and long duration (up to 6 months) exploration class missions to the Moon are similar to LEO class missions with the additional 4 to 5 days needed to transport an ill or injured crewmember to a DCMF on Earth. Mars exploration class missions are quite different in that they will significantly delay or prevent the return of an ill or injured crewmember to a DMCF. In addition the limited mass, power and volume afforded to medical care will prevent the mission designers from manifesting the entire capability of terrestrial care. NASA has identified five Levels of Care as part of its approach to medical support of future missions including the Constellation program. In order to implement an effective medical risk mitigation strategy for exploration class missions, modifications to the current suite of space medical systems may be needed, including new Crew Medical Officer training methods, treatment guidelines, diagnostic and therapeutic resources, and improved medical informatics.
Aita, Virginia A; Lydiatt, William M; Gilbert, Mark A
The Portraits of Care study used portraiture to investigate ideas about care and care giving at the intersection of art and medicine. The study employed mixed methods involving both qualitative and quantitative research techniques. All aspects of the study were approved by the Institutional Review Board. The study included 26 patient and 20 caregiver subjects. Patient subjects were drawn from across the lifespan and included healthy and ill patients. Caregiver subjects included professional and familial caregivers. All subjects gave their informed consent for the study and the subsequent exhibition of artwork. The artist drew or painted 100 portraits during the 2-year study. A multi-disciplinary analysis team carried out the initial analysis of portraits and subject data. Findings from their qualitative analysis were used to develop a quantitative survey and qualitative journal tool that the public used to give feedback at the subsequent exhibition. Exhibition data confirmed the initial findings. Study results showed the introspection of subjects that revealed their sense of identity and psychological status. Patients appear as 'whole people', not fragmented by diagnosis. Caregivers' portraits reveal their commitment to care. There is also a sense of mutuality and fluidity in the background stories of subjects. Many patient subjects have been caregivers and, at times, caregivers are also patients. Public data emphasised the identity transformation of subjects, the centrality of the idea of mortality, the presence of hope despite adversity, and the importance of empathy and compassion in care. PMID:21393267
Bischoff, Kara E.; Sudore, Rebecca; Miao, Yinghui; Boscardin, W. John; Smith, Alexander K.
Background Advance care planning is increasingly common, but whether it influences end-of-life quality of care remains controversial. Design Medicare data and survey data from the Health and Retirement Study were combined to determine whether advance care planning was associated with quality metrics. Setting The nationally representative Health and Retirement Study. Participants 4394 decedent subjects (mean age 82.6 years at death, 55% women). Measurements Advance care planning was defined as having an advance directive, durable power of attorney or having discussed preferences for end-of-life care with a next-of-kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ≤3 days). Results Seventy-six percent of subjects engaged in advance care planning. Ninety-two percent of advance directives stated a preference to prioritize comfort. After adjustment, subjects who engaged in advance care planning were less likely to die in a hospital (adjusted RR 0.87, 95% CI 0.80-0.94), more likely to be enrolled in hospice (aRR 1.68, 1.43-1.97), and less likely to receive hospice for ≤3 days before death (aRR 0.88, 0.85-0.91). Having an advance directive, a durable-power-of-attorney or an advance care planning discussion were each independently associated with a significant increase in hospice use (p<0.01 for all). Conclusion Advance care planning was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an advance directive, assigning a durable power of attorney and conducting advance care planning discussions are all important elements of advance care planning. PMID:23350921
Cargill, V; Cohen, D; Kroenke, K; Neuhauser, D
Hospitals often have rotational assignment of patients to one of several similar provider care teams. The research potential of these arrangements has gone unnoticed. By changing to random assignment of patients and physicians to provider care teams (firms) this kind of organization can be used for sequential, randomized clinical trials which are ethical and efficient. The paper describes such arrangements at three different hospitals: Cleveland Metropolitan General Hospital, Brooke Army Medical Center, and University Hospitals of Cleveland. Associated methodologic issues are discussed. This is a new, more widely applicable method for medical care research. PMID:3546202
Allen, Rebecca S.; DeLaine, Shermetra R.; Chaplin, William F.; Marson, Daniel C.; Bourgeois, Michelle S.; Dijkstra, Katinka; Burgio, Louis D.
Purpose: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. Design…
Nichols, Andrew W
Competitive swimmers are affected by several musculoskeletal and medical complaints that are unique to the sport. 'Swimmer's shoulder,' the most common overuse injury, is usually caused by some combination of impingement, rotator cuff tendinopathy, scapular dyskinesis, and instability. The condition may be treated with training modifications, stroke error correction, and strengthening exercises targeting the rotator cuff, scapular stabilizers, and core. Implementation of prevention programs to reduce the prevalence of shoulder pathology is crucial. Knee pain usually results from the breaststroke kick in swimmers, and the 'egg beater' kick in water polo players and synchronized swimmers. Lumbar back pain also is common in aquatics athletes. Among the medical conditions of particular importance in swimmers are exercise-induced bronchoconstriction, respiratory illnesses, and ear problems. Participants in other aquatics sports (water polo, diving, synchronized swimming, and open water swimming) may experience medical ailments specific to the sport. PMID:26359841
Hatcher, Irene; Sullivan, Mark; Hutchinson, James; Thurman, Susan; Gaffney, F Andrew
Improving medication safety at the point of care--particularly for high-risk drugs--is a major concern of nursing administrators. The medication errors most likely to cause harm are administration errors related to infusion of high-risk medications. An intravenous medication safety system is designed to prevent high-risk infusion medication errors and to capture continuous quality improvement data for best practice improvement. Initial testing with 50 systems in 2 units at Vanderbilt University Medical Center revealed that, even in the presence of a fully mature computerized prescriber order-entry system, the new safety system averted 99 potential infusion errors in 8 months. PMID:15577664
Razzak, Junaid A.; Kellermann, Arthur L.
Prevention is a core value of any health system. Nonetheless, many health problems will continue to occur despite preventive services. A significant burden of diseases in developing countries is caused by time-sensitive illnesses and injuries, such as severe infections, hypoxia caused by respiratory infections, dehydration caused by diarrhoea, intentional and unintentional injuries, postpartum bleeding, and acute myocardial infarction. The provision of timely treatment during life-threatening emergencies is not a priority for many health systems in developing countries. This paper reviews evidence indicating the need to develop and/or strengthen emergency medical care systems in these countries. An argument is made for the role of emergency medical care in improving the health of populations and meeting expectations for access to emergency care. We consider emergency medical care in the community, during transportation, and at first-contact and regional referral facilities. Obstacles to developing effective emergency medical care include a lack of structural models, inappropriate training foci, concerns about cost, and sustainability in the face of a high demand for services. A basic but effective level of emergency medical care responds to perceived and actual community needs and improves the health of populations. PMID:12481213
Irizarry, Dan; Tate, Charmaine; Wey, Pierre-Francois; Batjom, Emmanuel; Nicholas, Thomas A; Boedeker, Ben H
Background The Medical Civic Assistance Program (MEDCAP) is a military commander?s tool developed during the Vietnam War to gain access to and positively influence an indigenous population through the provision of direct medical care provided by military medical personnel, particularly in Counter Insurgency Operations (COIN). An alternative to MEDCAPs is the medical seminar (MEDSEM). The MEDSEM uses a Commander?s military medical assets to share culturally appropriate medical information with a defined indigenous population in order to create a sustainable training resource for the local population?s health system. At the heart of the MEDSEM is the ?train the trainer? concept whereby medical information is passed to indigenous trainers who then pass that information to an indigenous population. The MEDSEM achieves the Commander?s objectives of increasing access and influence with the population through a medical training venue rather than direct patient care. Previous MEDSEMS conducted in Afghanistan by military forces focused on improvement of rural healthcare through creation of Village Health Care Workers. This model can also be used to engage host nation (HN) medical personnel and improve medical treatment capabilities in population centers. The authors describe a modification of the MEDSEM, a Medical Mentorship (MM), conducted in November 2010 in Kabul, Afghanistan, at the Afghan National Army (ANA) National Medical Hospital. This training was designed to improve intubation skills in Afghan National Army Hospitals by ANA medical providers, leave residual training capability, and build relationships within the institution that not only assist the institution, but can also be leveraged to foster Commanders? objectives, such as health and reconstruction initiatives and medical partnering for indigenous corps and medical forces described below. Methods We, the authors, developed a culturally appropriate endotracheal intubation training package including a Dari and