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Sample records for emergency care settings

  1. Patient safety in the pediatric emergency care setting.

    PubMed

    Krug, Steven E; Frush, Karen

    2007-12-01

    Patient safety is a priority for all health care professionals, including those who work in emergency care. Unique aspects of pediatric care may increase the risk of medical error and harm to patients, especially in the emergency care setting. Although errors can happen despite the best human efforts, given the right set of circumstances, health care professionals must work proactively to improve safety in the pediatric emergency care system. Specific recommendations to improve pediatric patient safety in the emergency department are provided in this policy statement. PMID:18055687

  2. Paediatric emergency and acute care in resource poor settings.

    PubMed

    Duke, Trevor; Cheema, Baljit

    2016-02-01

    Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. Improvements require support and training for health workers and quality processes. Effective training is that which is ongoing, combining good technical training in under-graduate courses and continuing professional development. Quality processes combine evidence-based guidelines, essential medicines, appropriate technology, appropriate financing of services, standards and assessment tools and training resources. While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little. PMID:27062627

  3. How to protect incompetent clinical research subjects involved in critical care or emergency settings.

    PubMed

    Zamperetti, Nereo; Piccinni, Mariassunta; Bellomo, Rinaldo; Citerio, Giuseppe; Mistraletti, Giovanni; Gristina, Giuseppe; Giannini, Alberto

    2016-04-01

    Clinical research is an essential component of medical activity, and this is also true in intensive care. Adequate information and consent are universally considered necessary for the protection of research subjects. However, in emergency situations, the majority of critical patients are unable to consent and a valid legal representative is often unavailable. The situation is even more complex in Italy, where the relevant legislation fails to specify how investigators should manage research in emergency or critical care setting when it involves incompetent patients who do not have an appointed legal representative. While special measures for the protection of incompetent subjects during emergency research are necessary, not allowing such research at all dooms critically ill patients to receive non-evidence-based treatments without the prospect of improvement. The recently-issued EU Regulation n. 536/2014 will probably help shed light on this situation. Indeed, it specifically addresses the issue of "research in emergency situations" and introduces detailed rules aimed at protecting patients while allowing research. In this article, we argue that obtaining informed consent during emergency research on incompetent subjects in unrealistic, and that in most cases substituted judgment on the part of a proxy carries major flaws. Strict criteria in evaluating the risk-benefit ratio of proposed intervention and a careful evaluation of the trial by a local or national Research Ethics Committee are perhaps the most practicable solution. PMID:26154445

  4. Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting.

    PubMed Central

    Molyneux, Elizabeth; Ahmad, Shafique; Robertson, Ann

    2006-01-01

    PROBLEM: Early assessment, prioritization for treatment and management of sick children attending a health service are critical to achieving good outcomes. Many hospitals in developing countries see large numbers of patients and have few staff, so patients often have to wait before being assessed and treated. APPROACH: We present the example of a busy Under-Fives Clinic that provided outpatient services, immunizations and treatment for medical emergencies. The clinic was providing an inadequate service resulting in some inappropriate admissions and a high case-fatality rate. We assessed the deficiencies and sought resources to improve services. LOCAL SETTING: A busy paediatric outpatient clinic in a public tertiary care hospital in Blantyre, Malawi. RELEVANT CHANGES: The main changes we made were to train staff in emergency care and triage, improve patient flow through the department and to develop close cooperation between inpatient and outpatient services. Training coincided with a restructuring of the physical layout of the department. The changes were put in place when the department reopened in January 2001. LESSONS LEARNED: Improvements in the process and delivery of care and the ability to prioritize clinical management are essential to good practice. Making the changes described above has streamlined the delivery of care and led to a reduction in inpatient mortality from 10-18% before the changes were made (before 2001) to 6-8% after. PMID:16628305

  5. Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya

    PubMed Central

    Burke, Thomas F; Hines, Rosemary; Ahn, Roy; Walters, Michelle; Young, David; Anderson, Rachel Eleanor; Tom, Sabrina M; Clark, Rachel; Obita, Walter; Nelson, Brett D

    2014-01-01

    Objective Injuries, trauma and non-communicable diseases are responsible for a rising proportion of death and disability in low-income and middle-income countries. Delivering effective emergency and urgent healthcare for these and other conditions in resource-limited settings is challenging. In this study, we sought to examine and characterise emergency and urgent care capacity in a resource-limited setting. Methods We conducted an assessment within all 30 primary and secondary hospitals and within a stratified random sampling of 30 dispensaries and health centres in western Kenya. The key informants were the most senior facility healthcare provider and manager available. Emergency physician researchers utilised a semistructured assessment tool, and data were analysed using descriptive statistics and thematic coding. Results No lower level facilities and 30% of higher level facilities reported having a defined, organised approach to trauma. 43% of higher level facilities had access to an anaesthetist. The majority of lower level facilities had suture and wound care supplies and gloves but typically lacked other basic trauma supplies. For cardiac care, 50% of higher level facilities had morphine, but a minority had functioning ECG, sublingual nitroglycerine or a defibrillator. Only 20% of lower level facilities had glucometers, and only 33% of higher level facilities could care for diabetic emergencies. No facilities had sepsis clinical guidelines. Conclusions Large gaps in essential emergency care capabilities were identified at all facility levels in western Kenya. There are great opportunities for a universally deployed basic emergency care package, an advanced emergency care package and facility designation scheme, and a reliable prehospital care transportation and communications system in resource-limited settings. PMID:25260371

  6. Expanding the Application of Group Interventions: Emergence of Groups in Health Care Settings

    ERIC Educational Resources Information Center

    Drum, David; Becker, Martin Swanbrow; Hess, Elaine

    2011-01-01

    Changes in the health care arena and within the specialty of group work are contributing to the increased utilization of groups in health care settings. Psychoeducational, theme, and interpersonal therapy groups are highlighted for their contributions to treating challenging health conditions. An understanding of the evolution of these group…

  7. An assessment of priority setting process and its implication on availability of emergency obstetric care services in Malindi District, Kenya

    PubMed Central

    Nyandieka, Lilian Nyamusi; Kombe, Yeri; Ng'ang'a, Zipporah; Byskov, Jens; Njeru, Mercy Karimi

    2015-01-01

    Introduction In spite of the critical role of Emergency Obstetric Care in treating complications arising from pregnancy and childbirth, very few facilities are equipped in Kenya to offer this service. In Malindi, availability of EmOC services does not meet the UN recommended levels of at least one comprehensive and four basic EmOC facilities per 500,000 populations. This study was conducted to assess priority setting process and its implication on availability, access and use of EmOC services at the district level. Methods A qualitative study was conducted both at health facility and community levels. Triangulation of data sources and methods was employed, where document reviews, in-depth interviews and focus group discussions were conducted with health personnel, facility committee members, stakeholders who offer and/ or support maternal health services and programmes; and the community members as end users. Data was thematically analysed. Results Limitations in the extent to which priorities in regard to maternal health services can be set at the district level were observed. The priority setting process was greatly restricted by guidelines and limited resources from the national level. Relevant stakeholders including community members are not involved in the priority setting process, thereby denying them the opportunity to contribute in the process. Conclusion The findings illuminate that consideration of all local plans in national planning and budgeting as well as the involvement of all relevant stakeholders in the priority setting exercise is essential in order to achieve a consensus on the provision of emergency obstetric care services among other health service priorities. PMID:26889337

  8. Health care in a unique setting: applying emergency medicine at music festivals

    PubMed Central

    McQueen, Carl; Davies, Charlotte

    2012-01-01

    The last 25 years has seen an explosion in the popularity of outdoor music festivals, especially in the UK. Coupled with this has been the development of the trend for major sporting events that were once confined to stadia to be accompanied by mass gatherings of spectators and fans in “fan parks” and public places. The majority of music festivals and sporting events are considered to be mass gatherings, using the popular definition of more than 1000 people in one place.1 Despite the increasing popularity of music festivals and other mass gathering events, there is a lack of scientifically robust data concerning the provision of medical care in these circumstances. Published studies are almost exclusively retrospective reviews or case studies of the care provided at individual events. Prospective studies analyzing the role of medical professionals and the quality of care provided at mass gathering events are extremely rare. This literature review aims to summarize the current literature and provide an opportunity to identify new and exciting avenues for research into this unique field. PMID:27147863

  9. Tariffs in emergency care.

    PubMed

    Hughes, Thomas; Higginson, Ian; Mann, Clifford

    2014-11-01

    The crisis in emergency medicine in the UK was no surprise to staff in the specialty, but was not expected by the Department of Health. This article explains how chronic, systematic under-resourcing of emergency care has caused emergency departments to decompensate, and discusses actions that are necessary to prevent recurrence. PMID:25383433

  10. PAin SoluTions In the Emergency Setting (PASTIES)—patient controlled analgesia versus routine care in emergency department patients with pain from traumatic injuries: randomised trial

    PubMed Central

    Rockett, Mark; Squire, Rosalyn; Hayward, Chris; Ewings, Paul; Barton, Andy; Pritchard, Colin; Eyre, Victoria; Cocking, Laura; Benger, Jonathan

    2015-01-01

    Objective To determine whether patient controlled analgesia (PCA) is better than routine care in patients presenting to emergency departments with moderate to severe pain from traumatic injuries. Design Pragmatic, multicentre, parallel group, randomised controlled trial. Setting Five English hospitals. Participants 200 adults (71% (n=142) male), aged 18 to 75 years, who presented to the emergency department requiring intravenous opioid analgesia for the treatment of moderate to severe pain from traumatic injuries and were expected to be admitted to hospital for at least 12 hours. Interventions PCA (n=99) or nurse titrated analgesia (treatment as usual; n=101). Main outcome measures The primary outcome was total pain experienced over the 12 hour study period, derived by standardised area under the curve (scaled from 0 to 100) of each participant’s hourly pain scores, captured using a visual analogue scale. Pre-specified secondary outcomes included total morphine use, percentage of study period in moderate/severe pain, percentage of study period asleep, length of hospital stay, and satisfaction with pain management. Results 200 participants were included in the primary analyses. Mean total pain experienced was 47.2 (SD 21.9) for the treatment as usual group and 44.0 (24.0) for the PCA group. Adjusted analyses indicated slightly (but not statistically significantly) lower total pain experienced in the PCA group than in the routine care group (mean difference 2.7, 95% confidence interval −2.4 to 7.8). Participants allocated to PCA used more morphine in total than did participants in the treatment as usual group (mean 44.3 (23.2) v 27.2 (18.2) mg; mean difference 17.0, 11.3 to 22.7). PCA participants spent, on average, less time in moderate/severe pain (36.2% (31.0) v 44.1% (31.6)), but the difference was not statistically significant. A higher proportion of PCA participants reported being perfectly or very satisfied compared with the treatment as usual group (86

  11. Assessing School Emergency Care Preparedness.

    ERIC Educational Resources Information Center

    Hale, Charles; Varnes, Jill

    A study assessed the emergency health care preparedness of a north central Florida public school district in light of seven criteria: (1) school policies regarding delivery of emergency health care; (2) identification of school personnel responsible for rendering emergency care; (3) training levels of emergency health care providers (first aid and…

  12. SETTING UP TRIAGE SERVICES IN THE EMERGENCY DEPARTMENT: EXPERIENCE FROM A TERTIARY CARE INSTITUTE OF PAKISTAN. A JOURNEY TOWARD EXCELLENCE.

    PubMed

    Khursheed, Munawar; Fayyaz, Jabeen; Jamil, Ahsan

    2015-01-01

    The history of triage started from the French battle field for prioritizing patients. Emergency triage was started in early 1950's in USA in order to treat the sickest first. It has now become an integral component of all emergency departments (ED). The basic aim of triage is not only to sort out patients according to the criticality of their illness, but it also serves to streamline the patient flow. This will ultimately enable the ED physician to provide right management at the right time to the right patient in the available resources. In turn has a positive impact in reducing the ED overcrowding. The history of triage at AKUH-ED dated back in 2000. In the beginning physicians and nurse both were assigned to triage desk where they use to sort out the patient according to presenting complaints. At that time the documentation was manual with locally developed triage priorities. With the expansion of ED in 2008, responsibility of triage was shifted to nursing services. Triage policy was established and implemented. Specific triage protocols were developed for guidance and uniformity of care. Manual recording system was replaced by computerized triage data entry software. Enabling the department to monitor patient quality care indicators like total number of patients triaged, triage category, lag time reports and left without being seen by physicians. PMID:26721057

  13. Settings for Terminal Care.

    ERIC Educational Resources Information Center

    Corless, Inge B.

    1988-01-01

    Examines topics related to delivery of terminal care services: ability of various hospice programs to survive financially, contributions of various models of hospice care, impact of Medicare legislation on hospice movement, demonstration of unique hospice intervention, integration of spiritual care into hospice, and role of hospice in care of…

  14. Emergency time: caring in Congo.

    PubMed

    Reading, Claire

    2016-01-01

    Midwifery practice in rural central Africa is full of joys (an abundance of twins, births by candlelight and resilience and stoicism that would leave even the very experienced birth practitioner speechless), but also a lot of challenges (every obstetric emergency in your wildest nightmares and worse) that are compounded by a lack of access to a skilled birth attendant. Women here have a strong culture of traditional practices and remedies, and hospital is often not the first port of call. Caring for women who cannot, themselves, consent to emergency life-saving caesarean sections, is a cultural aspect that we accept and respect as medical professionals working in the Democratic Republic of Congo (DRC). In a busy maternity ward in a low-resource setting, in a hospital supported by emergency humanitarian medical organisation Médecins sans Frontières (MSF), just how are obstetric emergencies managed--and are the outcomes what you would expect? PMID:26975127

  15. SYMPTEK homemade foam models for client education and emergency obstetric care skills training in low-resource settings.

    PubMed

    Deganus, Sylvia A

    2009-10-01

    Clinical training for health care workers using anatomical models and simulation has become an established norm. A major requirement for this approach is the availability of lifelike training models or simulators for skills practice. Manufactured sophisticated human models such as the resuscitation neonatal dolls, the Zoë gynaecologic simulator, and other pelvic models are very expensive, and are beyond the budgets of many training programs or activities in low-resource countries. Clinical training programs in many low-resource countries suffer greatly because of this cost limitation. Yet it is also in these same poor countries that the need for skilled human resources in reproductive health is greatest. The SYMPTEK homemade models were developed in response to the need for cheaper, more readily available humanistic models for training in emergency obstetric skills and also for client education. With minimal training, a variety of cheap SYMPTEK models can easily be made, by both trainees and facilitators, from high-density latex foam material commonly used for furnishings. The models are reusable, durable, portable, and easily maintained. The uses, advantages, disadvantages, and development of the SYMPTEK foam models are described in this article. PMID:19941722

  16. Addressing Unmet Need for HIV Testing in Emergency Care Settings: A Role for Computer-facilitated Rapid HIV Testing?

    PubMed Central

    Kurth, Ann E.; Severynen, Anneleen; Spielberg, Freya

    2014-01-01

    HIV testing in emergency departments (EDs) remains underutilized. We evaluated a computer tool to facilitate rapid HIV testing in an urban ED. Randomly assigned non-acute adult ED patients to computer tool (‘CARE’) and rapid HIV testing before standard visit (n=258) or to standard visit (n=259) with chart access. Assessed intervention acceptability and compared noted HIV risks. Participants were 56% non-white, 58% male; median age 37 years. In the CARE arm nearly all (251/258) completed the session and received HIV results; 4 declined test consent. HIV risks were reported by 54% of users and there was one confirmed HIV-positive and 2 false-positives (seroprevalence 0.4%, 95% CI 0.01–2.2%). Half (55%) preferred computerized, over face-to-face, counseling for future HIV testing. In standard arm, one HIV test and 2 referrals for testing occurred. Computer-facilitated HIV testing appears acceptable to ED patients. Future research should assess cost-effectiveness compared with staff-delivered approaches. PMID:23837807

  17. Outbreaks in Health Care Settings.

    PubMed

    Sood, Geeta; Perl, Trish M

    2016-09-01

    Outbreaks and pseudo-outbreaks in health care settings can be complex and should be evaluated systematically using epidemiologic tools. Laboratory testing is an important part of an outbreak evaluation. Health care personnel, equipment, supplies, water, ventilation systems, and the hospital environment have been associated with health care outbreaks. Settings including the neonatal intensive care unit, endoscopy, oncology, and transplant units are areas that have specific issues which impact the approach to outbreak investigation and control. Certain organisms have a predilection for health care settings because of the illnesses of patients, the procedures performed, and the care provided. PMID:27515142

  18. Primary care and public emergency department overcrowding.

    PubMed Central

    Grumbach, K; Keane, D; Bindman, A

    1993-01-01

    OBJECTIVES. Our objective was to evaluate whether referral to primary care settings would be clinically appropriate for and acceptable to patients waiting for emergency department care for nonemergency conditions. METHODS. We studied 700 patients waiting for emergency department care at a public hospital. Access to alternative sources of medical care, clinical appropriateness of emergency department use, and patients' willingness to use nonemergency services were measured and compared between patients with and without a regular source of care. RESULTS. Nearly half (45%) of the patients cited access barriers to primary care as their reason for using the emergency department. Only 13% of the patients waiting for care had conditions that were clinically appropriate for emergency department services. Patients with a regular source of care used the emergency department more appropriately than did patients without a regular source of care. Thirty-eight percent of the patients expressed a willingness to trade their emergency department visit for an appointment with a physician within 3 days. CONCLUSIONS. Public emergency departments could refer large numbers of patients to appointments at primary care facilities. This alternative would be viable only if the availability and coordination of primary care services were enhanced for low-income populations. PMID:8438975

  19. [Non invasive ventilation in the emergency setting].

    PubMed

    Wilhelm, Laetitia; Della Santa, Vincent; Hanhart, Walter-Alexandre

    2015-08-12

    Before the development of non invasive ventilation (NIV), endotracheal intubation was the only ventilatory therapy available in case of severe respiratory distress and acute respiratory failure. NIV used to be employed in intensive care settings only. Nowadays, the use of NIV has been democratized to include the emergency room, and the pre-hospital care setting for treatment of acute respiratory failure. Cardiogenic pulmonary edema and acute exacerbation of COPD are indications of choice, since NIV improves mortality. The efficiency of the therapy depends on early treatment; however, endotracheal intubation should not be delayed when it becomes necessary. PMID:26449102

  20. Reptile Critical Care and Common Emergencies.

    PubMed

    Music, Meera Kumar; Strunk, Anneliese

    2016-05-01

    Reptile emergencies are an important part of exotic animal critical care, both true emergencies and those perceived as emergencies by owners. The most common presentations for reptile emergencies are addressed here, with information on differential diagnoses, helpful diagnostics, and approach to treatment. In many cases, reptile emergencies are actually acute presentations originating from a chronic problem, and the treatment plan must include both clinical treatment and addressing husbandry and dietary deficiencies at home. Accurate owner expectations must be set in order to have owner compliance to long-term treatment plans. PMID:27131163

  1. Doing challenging research studies in a patient-centred way: a qualitative study to inform a randomised controlled trial in the paediatric emergency care setting

    PubMed Central

    Woolfall, Kerry; Young, Bridget; Frith, Lucy; Appleton, Richard; Iyer, Anand; Messahel, Shrouk; Hickey, Helen; Gamble, Carrol

    2014-01-01

    Objective To inform the design of a randomised controlled trial (called EcLiPSE) to improve the treatment of children with convulsive status epilepticus (CSE). EcLiPSE requires the use of a controversial deferred consent process. Design Qualitative interview and focus group study. Setting 8 UK support groups for parents of children who have chronic or acute health conditions and experience of paediatric emergency care. Participants 17 parents, of whom 11 participated in telephone interviews (10 mothers, 1 father) and 6 in a focus group (5 mothers, 1 father). 6 parents (35%) were bereaved and 7 (41%) had children who had experienced seizures, including CSE. Results Most parents had not heard of deferred consent, yet they supported its use to enable the progress of emergency care research providing a child's safety was not compromised by the research. Parents were reassured by tailored explanation, which focused their attention on aspects of EcLiPSE that addressed their priorities and concerns. These aspects included the safety of the interventions under investigation and how both EcLiPSE interventions are used in routine clinical practice. Parents made recommendations about the appropriate timing of a recruitment discussion, the need to individualise approaches to recruiting bereaved parents and the use of clear written information. Conclusions Our study provided information to help ensure that a challenging trial was patient centred in its design. We will use our findings to help EcLiPSE practitioners to: discuss potentially threatening trial safety information with parents, use open-ended questions and prompts to identify their priorities and concerns and clarify related aspects of written trial information to assist understanding and decision-making. PMID:24833694

  2. [Severe infection in critical emergency care].

    PubMed

    Matsuda, Naoyuki; Takatani, Yudai; Higashi, Tomoko; Inaba, Masato; Ejima, Tadashi

    2016-02-01

    In the emergency and critical care medicine, infection is easy to merge to various basic conditions and diseases. In the social structure aging in critical care, the immune weakness was revealed as the result of severe infection and septic shock in the reduced function of neutrophils and lymphocytes. In the life-saving emergency care, cardiovascular diseases, diabetes, chronic renal failure and lever dysfunction are often observed, and the underlying diseases have the foundation of biological invasion after a first inflammatory attack of surgery, trauma, burn, and systemic injury. It will be placed into a susceptible situation such as artificial respiratory management. In this review, we discussed severe infection in emergency and critical care. It is necessary to pay attention to the drug resistance bacterias in own critical care setting by trends. PMID:26915247

  3. A cohort study of influences, health outcomes and costs of patients’ health-seeking behaviour for minor ailments from primary and emergency care settings

    PubMed Central

    Watson, M C; Ferguson, J; Barton, G R; Maskrey, V; Blyth, A; Paudyal, V; Bond, C M; Holland, R; Porteous, T; Sach, T H; Wright, D; Fielding, S

    2015-01-01

    Objectives To compare health-related and cost-related outcomes of consultations for symptoms suggestive of minor ailments in emergency departments (EDs), general practices and community pharmacies. Design Observational study; prospective cohort design. Setting EDs (n=2), general practices (n=6) and community pharmacies (n=10) in a mix of rural/urban and deprived/affluent areas across North East Scotland and East Anglia. Participants Adults (≥18 years) presenting between 09:00 and 18:00 (Monday–Friday) in general practices and 09:00–18:00 (Monday–Saturday) in pharmacies and EDs with ≥1 of the following: musculoskeletal pain; eye discomfort; gastrointestinal disturbance; or upper respiratory tract-related symptoms. Interventions Participants completed three questionnaires: baseline (prior to index consultation); satisfaction with index consultation and follow-up (2 weeks after index consultation). Main outcome measures Symptom resolution, quality of life, costs, satisfaction and influences on care-seeking behaviour. Results 377 patients participated, recruited from EDs (81), general practices (162) and community pharmacies (134). The 2-week response rate was 70% (264/377). Symptom resolution was similar across all three settings: ED (37.3%), general practice (35.7%) and pharmacy (44.3%). Mean overall costs per consultation were significantly lower for pharmacy (£29.30 (95% CI £21.60 to £37.00)) compared with general practice (£82.34 (95% CI £63.10 to £101.58)) and ED (£147.09 (95% CI £125.32 to £168.85)). Satisfaction varied across settings and by measure used. Compared with pharmacy and general practice use, ED use was significantly (p<0.001) associated with first episode and short duration of symptom(s), as well as higher levels of perceived seriousness and urgency for seeking care. Convenience of location was the most common reason for choice of consultation setting. Conclusions These results suggest similar health-related outcomes and

  4. Prehospital emergency trauma care and management.

    PubMed

    Kerby, Jeffrey D; Cusick, Marianne V

    2012-08-01

    Prehospital care of the trauma patient is continuing to evolve; however, the principles of airway maintenance, hemorrhage control, and appropriate resuscitative maneuvers remain central to the role of the emergency medical care provider. Recent changes in the regulations for research in emergency settings will allow randomized trials to proceed to test new devices, drugs, and resuscitative strategies in the prehospital environment. The creation of prehospital research networks will provide the appropriate infrastructure to greatly facilitate the development of new protocols and the execution of large-scale randomized trials with the potential to change current prehospital practice. PMID:22850149

  5. Emergent burn care.

    PubMed

    Harvey, J S; Watkins, G M; Sherman, R T

    1984-02-01

    The estimated 32,600,000 fires that occur annually in the United States produce over 300,000 injuries and 7,500 deaths. Ten percent of hospitalized burn victims die as a direct result of the burn. Initial evaluation and management of the burn patient are critical. The history should include the burn source, time of injury, burn environment, and combustible products. The burn size is best estimated by the Lund and Browder chart, and the burn depth is determined by clinical criteria. Pulmonary involvement and circumferential thoracic or extremity burns require detection and aggressive treatment to maintain organ viability. Hospitalization is usually necessary for adults with burns larger than 10% of the total body surface area (TBSA) or children with burns larger than 5% of TBSA. Major burns, those of 25% or more of TBSA or of 10% or more of full thickness, should be considered for treatment at a burn center, as well as children or elderly victims with burns of greater than 10% TBSA. Lactated Ringer's solution, infused at 4 ml/kg/% TBSA, is generally advocated for initial fluid restoration. After the acute phase (48 hours), replacement of evaporative and hypermetabolic fluid loss is necessary. These losses may constitute 3 to 5 liters per day for a 40% to 70% TBSA burn. Blood transfusion is often required because of persistent loss of red blood cells (8% per day for about ten days). Many electrolyte abnormalities may occur in the first two weeks. Pulmonary injury commonly is lethal. Circumoral burns, oropharyngeal burns, and carbonaceous sputum are indicative of inhalation injury, but arterial blood gas determinations, fiberoptic bronchoscopy, and xenon lung scans are useful for confirming the diagnosis. Humidified oxygen, intubation, positive-pressure ventilation, and pulmonary toilet are the mainstays of therapy for inhalation injury. Wound care is initially directed at preservation of vital function by escharotomy, if restrictive eschar impairs ventilatory or

  6. Measles in health-care settings.

    PubMed

    Maltezou, Helena C; Wicker, Sabine

    2013-07-01

    Despite the availability of an effective and safe vaccine for almost half a century, measles is re-emerging in several developed countries because of the insufficient vaccination coverage among specific subpopulations, the emerging anti-vaccination movement, and the increasing movement of humans across borders. In this context, health-care settings play a critical role in the transmission of infection and generation of numerous cases. Health-care-associated outbreaks may be associated with severe morbidity and mortality among specific groups of patients, disruption of health-care services, and considerable costs. Misdiagnosis or delayed diagnosis of a measles case and inadequate implementation of infection control measures are common in almost all events of nosocomial spread. Measles vaccination of health-care workers is an effective means of prevention of nosocomial measles outbreaks. Eliminating measles by 2010 has not been accomplished. Stronger recommendations and higher vaccination coverage against measles in health-care workers could contribute to eliminate measles in the general population. PMID:23352075

  7. Safety Hazards in Child Care Settings. CPSC Staff Study.

    ERIC Educational Resources Information Center

    Consumer Product Safety Commission, Washington, DC.

    Each year, thousands of children in child care settings are injured seriously enough to need emergency medical treatment. This national study identified potential safety hazards in 220 licensed child care settings in October and November 1998. Eight product areas were examined: cribs, soft bedding, playground surfacing, playground surface…

  8. [Obesity in prehospital emergency care].

    PubMed

    Kruska, Patricia; Kappus, Stefan; Kerner, Thoralf

    2012-09-01

    The prevalence of obesity has increased steadily in recent years. Obese people often suffer from diseases which acute decompensation requires a prompt prehospital therapy. The Emergency Medical Service will be confronted with difficulties in clinical diagnostic, therapy and especially with a delayed management of rescue and transport. It is most important to avoid prehospital depreciation in quality and time management. This article reviews the specific requirements of prehospital care of obese persons and discusses possible solutions to optimize the prehospital therapy. PMID:22968983

  9. Emergency Medical Care Training and Adolescents.

    ERIC Educational Resources Information Center

    Topham, Charles S.

    1982-01-01

    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)

  10. Health systems organization for emergency care.

    PubMed

    Pedroto, Isabel; Amaro, Pedro; Romãozinho, José Manuel

    2013-10-01

    The increasing number of acute and severe digestive diseases presenting to hospital emergency departments, mainly related with an ageing population, demands an appropriate answer from health systems organization, taking into account the escalating pressure on cost reduction. However, patients expect and deserve a response that is appropriate, effective, efficient and safe. The huge variety of variables which can influence the evolution of such cases warranting intensive monitoring, and the coordination and optimization of a range of human and technical resources involved in the care of these high-risk patients, requires their admission in hospital units with conveniently equipped facilities, as is done for heart attack and stroke patients. Little information of gastroenterology emergencies as a function of structure, processes and outcome is available at the organizational level. Surveys that have been conducted in different countries just assess local treatment outcome and question the organizational structure and existing resources but its impact on the outcome is not clear. Most studies address the problem of upper gastrointestinal bleeding and the out-of-hours endoscopy services in the hospital setting. The demands placed on emergency (part of the overall continuum of care) are obvious, as are the needs for the efficient use of resources and processes to improve the quality of care, meaning data must cover the full care cycle. Gastrointestinal emergencies, namely gastrointestinal bleeding, must be incorporated into the overall emergency response as is done for heart attack and stroke. This chapter aims to provide a review of current literature/evidence on organizational health system models towards a better management of gastroenterology emergencies and proposes a research agenda. PMID:24160936

  11. Hypoglycemia Revisited in the Acute Care Setting

    PubMed Central

    Tsai, Shih-Hung; Lin, Yen-Yue; Hsu, Chin-Wang; Cheng, Chien-Sheng

    2011-01-01

    Hypoglycemia is a common finding in both daily clinical practice and acute care settings. The causes of severe hypoglycemia (SH) are multi-factorial and the major etiologies are iatrogenic, infectious diseases with sepsis and tumor or autoimmune diseases. With the advent of aggressive lowering of HbA1c values to achieve optimal glycemic control, patients are at increased risk of hypoglycemic episodes. Iatrogenic hypoglycemia can cause recurrent morbidity, sometime irreversible neurologic complications and even death, and further preclude maintenance of euglycemia over a lifetime of diabetes. Recent studies have shown that hypoglycemia is associated with adverse outcomes in many acute illnesses. In addition, hypoglycemia is associated with increased mortality among elderly and non-diabetic hospitalized patients. Clinicians should have high clinical suspicion of subtle symptoms of hypoglycemia and provide prompt treatment. Clinicians should know that hypoglycemia is associated with considerable adverse outcomes in many acute critical illnesses. In order to reduce hypoglycemia-associated morbidity and mortality, timely health education programs and close monitoring should be applied to those diabetic patients presenting to the Emergency Department with SH. ED disposition strategies should be further validated and justified to achieve balance between the benefits of euglycemia and the risks of SH. We discuss relevant issues regarding hypoglycemia in emergency and critical care settings. PMID:22028152

  12. Characterizing emergency departments to improve understanding of emergency care systems

    PubMed Central

    2011-01-01

    International emergency medicine aims to understand different systems of emergency care across the globe. To date, however, international emergency medicine lacks common descriptors that can encompass the wide variety of emergency care systems in different countries. The frequent use of general, system-wide indicators (e.g. the status of emergency medicine as a medical specialty or the presence of emergency medicine training programs) does not account for the diverse methods that contribute to the delivery of emergency care both within and between countries. Such indicators suggest that a uniform approach to the development and structure of emergency care is both feasible and desirable. One solution to this complex problem is to shift the focus of international studies away from system-wide characteristics of emergency care. We propose such an alternative methodology, in which studies would examine emergency department-specific characteristics to inventory the various methods by which emergency care is delivered. Such characteristics include: emergency department location, layout, time period open to patients, and patient type served. There are many more ways to describe emergency departments, but these characteristics are particularly suited to describe with common terms a wide range of sites. When combined, these four characteristics give a concise but detailed picture of how emergency care is delivered at a specific emergency department. This approach embraces the diversity of emergency care as well as the variety of individual emergency departments that deliver it, while still allowing for the aggregation of broad similarities that might help characterize a system of emergency care. PMID:21756328

  13. The Affordable Care Act and emergency care.

    PubMed

    McClelland, Mark; Asplin, Brent; Epstein, Stephen K; Kocher, Keith Eric; Pilgrim, Randy; Pines, Jesse; Rabin, Elaine Judith; Rathlev, Niels Kumar

    2014-10-01

    The Affordable Care Act (ACA) will have far-reaching effects on the way health care is designed and delivered. Several elements of the ACA will directly affect both demand for ED care and expectations for its role in providing coordinated care. Hospitals will need to employ strategies to reduce ED crowding as the ACA expands insurance coverage. Discussions between EDs and primary care physicians about their respective roles providing acute unscheduled care would promote the goals of the ACA. PMID:25121814

  14. Emergency care for children in the United States.

    PubMed

    Chamberlain, James M; Krug, Steven; Shaw, Kathy N

    2013-12-01

    A formal emergency care system for children in the United States began in the 1980s with the establishment of specialized training programs in academic children's hospitals. The ensuing three decades have witnessed the establishment of informal regional networks for clinical care and a federally funded research consortium that allows for multisite research on evidence-based practices. However, pediatric emergency care suffers from problems common to emergency departments (EDs) in general, which include misaligned incentives for care, overcrowding, and wide variation in the quality of care. In pediatric emergency care specifically, there are problems with low-volume EDs that have neither the experience nor the equipment to treat children, poor adherence to clinical guidelines, lack of resources for mental health patients, and a lack of widely accepted performance metrics. We call for policies to address these issues, including providing after-hours care in other settings and restructuring payment and reimbursement policies to better address patients' needs. PMID:24301393

  15. [Relations with emergency medical care and primary care doctor, home health care].

    PubMed

    Azuma, Kazunari; Ohta, Shoichi

    2016-02-01

    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

  16. Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis.

    PubMed Central

    Westwood, Marie; Ramaekers, Bram; Whiting, Penny; Tomini, Florian; Joore, Manuela; Armstrong, Nigel; Ryder, Steve; Stirk, Lisa; Severens, Johan; Kleijnen, Jos

    2015-01-01

    BACKGROUND Determination of the presence or absence of bacterial infection is important to guide appropriate therapy and reduce antibiotic exposure. Procalcitonin (PCT) is an inflammatory marker that has been suggested as a marker for bacterial infection. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of adding PCT testing to the information used to guide antibiotic therapy in adults and children (1) with confirmed or highly suspected sepsis in intensive care and (2) presenting to the emergency department (ED) with suspected bacterial infection. METHODS Twelve databases were searched to June 2014. Randomised controlled trials were assessed for quality using the Cochrane Risk of Bias tool. Summary relative risks (RRs) and weighted mean differences (WMDs) were estimated using random-effects models. Heterogeneity was assessed visually using forest plots and statistically using the I (2) and Q statistics and investigated through subgroup analysis. The cost-effectiveness of PCT testing in addition to current clinical practice was compared with current clinical practice using a decision tree with a 6 months' time horizon. RESULTS Eighteen studies (36 reports) were included in the systematic review. PCT algorithms were associated with reduced antibiotic duration [WMD -3.19 days, 95% confidence interval (CI) -5.44 to -0.95 days, I (2) = 95.2%; four studies], hospital stay (WMD -3.85 days, 95% CI -6.78 to -0.92 days, I (2) = 75.2%; four studies) and a trend towards reduced intensive care unit (ICU) stay (WMD -2.03 days, 95% CI -4.19 to 0.13 days, I (2) = 81.0%; four studies). There were no differences for adverse clinical outcomes. PCT algorithms were associated with a reduction in the proportion of adults (RR 0.77, 95% CI 0.68 to 0.87; seven studies) and children (RR 0.86, 95% CI 0.80 to 0.93) receiving antibiotics, reduced antibiotic duration (two studies). There were no differences for adverse clinical outcomes. All but one of the

  17. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 11--Childbirth, Pediatric Emergencies. Revised.

    ERIC Educational Resources Information Center

    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 childbirth and pediatric emergencies. Objectives stated for the two chapters are for the students to be able to describe: emergency procedures for normal childbirth, unusual childbirth emergencies, emergency care for…

  18. MIDAS questionnaire in the emergency setting.

    PubMed

    Aliprandi, A; Frigerio, R; Santoro, P; Frigo, M; Iurlaro, S; Vaccaro, M; Tremolizzo, L; Beghi, E; Ferrarese, C; Agostoni, E

    2004-10-01

    Migraine is a common disorder and is a major cause of disability and loss of working performance in western countries. Therefore, many tools have been developed to assess migraine related disability. Among these, the Migraine Disability Assessment (MIDAS) questionnaire has been shown to be of particular interest, as it is valid, reliable and useful for therapeutic decisions. In this pilot study, we address the validity of the MIDAS questionnaire in an unselected population of migraine patients in the emergency setting. We found that the MIDAS scores in the emergency room were similar to those collected in a specialised headache centre. This result suggests that the MIDAS questionnaire could be reliably used in the emergency setting, hence avoiding unnecessary delays in the treatment of migraine patients. PMID:15549558

  19. Setting up terminal care units *

    PubMed Central

    Matthews, Bridget

    1980-01-01

    From my experience the main problems found by developing terminal care units have been: initial acceptance from existing medical disciplines; communication difficulties and misunderstandings because of them; mistakes in planning and design, possibly due to lack of experience or attention to detail; occasionally, the appointment of staff that have proved unsuitable; problems in the siting of a unit, usually due to shortage of available land. The ideal site is centrally placed in the community it serves and easily accessible to public transport. PMID:7452580

  20. Psychopharmacology in Primary Care Settings.

    PubMed

    Benich, Joseph J; Bragg, Scott W; Freedy, John R

    2016-06-01

    Psychopharmacology requires clinicians to stay current on the latest guidelines and to use dynamic treatment strategies. Psychiatric conditions are prevalent in the primary care population. Choice of treatment with psychopharmacology should be based on controlling the patient's predominant symptoms while taking into consideration patient age, treatment compliance, patient past response to treatments, dosing frequency, patient preference, medication side effects, potential medication interactions, drug precautions/warnings, and cost. Response to therapy, as well as side effects, needs to be evaluated at regular intervals. The goal is to minimize symptoms and return patients to their maximal level of functioning. PMID:27262011

  1. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 7--Medical Emergencies. Revised.

    ERIC Educational Resources Information Center

    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…

  2. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Emergency care. 460.100 Section 460.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  3. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Emergency care. 460.100 Section 460.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  4. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Emergency care. 460.100 Section 460.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  5. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Emergency care. 460.100 Section 460.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  6. EMERGENCY VICTIM CARE AND RESCUE, INSTRUCTOR'S MANUAL.

    ERIC Educational Resources Information Center

    MORANDO, ROCCO V.; STOVER, WILBUR F.

    DEVELOPED AT THE STATE LEVEL BY SQUADMEN AND TRADE AND INDUSTRIAL PERSONNEL, THIS MANUAL IS FOR USE BY A QUALIFIED SQUADMAN IN TEACHING FULL-TIME AND VOLUNTEER EMERGENCY AND RESCUE WORKERS IN AN EMERGENCY SQUAD STATION OR TRAINING CENTER. TEACHING GUIDES ARE PROVIDED FOR A 30-HOUR COURSE ON EMERGENCY VICTIM CARE AND A 20-HOUR COURSE ON VICTIM…

  7. Cardiac emergency simulation: drilling for success in the ambulatory setting.

    PubMed

    Kusler-Jensen, Jane A

    2014-03-01

    The "see one, do one, teach one" method of clinical teaching is no longer practical for preparing perioperative personnel to respond to emergency situations. Teaching with simulation trains team members to respond to unexpected events and enables them to provide care when an emergency situation arises. Simulation drills resemble clinical practice and allow personnel to apply and integrate skills, teamwork, and critical thinking. This article provides information and tools for performing cardiac simulation drills in the ambulatory setting. Tools included are a 10-step guide to simulation drills, a scenario, roles and duties to assign during a drill, and a drill evaluation form. PMID:24581645

  8. Harnessing the Affordable Care Act to Catalyze Delivery System Reform and Strengthen Emergency Care in America

    PubMed Central

    Maa, John

    2015-01-01

    As health care reform in the US evolves beyond insurance reform to encompass delivery system reform, the opportunity arises to harness the Affordable Care Act to strengthen patient care in America. One area for dedicated individuals to lead this effort is by improving transitions in patient care across the continuum of team members, specialties, settings, and systems. This article will describe innovations of the surgicalist and acute care surgeon that have emerged in response to the challenges facing surgery in specialization, geography, and the need to comply with health care reform mandates. Three ways will be described to integrate these innovations with pilot programs in the Affordable Care Act: to promote teamwork, to reduce readmissions, and to strengthen emergency care because the key location where the joint efforts intersect most acutely with patient need is in our nation’s Emergency Departments. PMID:25663212

  9. An update on emergency care and emergency medicine in Russia.

    PubMed

    Rodigin, Anthony

    2015-12-01

    Russia's national healthcare system is undergoing significant changes. Those changes which affect healthcare financing are particularly vital. As has often been the case in other nations, the emergency care field is at the forefront of such reforms. The ongoing challenges constitute the environment in which the hospital-based specialty of emergency medicine needs to develop as part of a larger system. Emergency care has to evolve in order to match true needs of the population existing today. New federal regulations recently adopted have recognized emergency departments as the new in-hospital component of emergency care, providing the long-needed legal foundation upon which the new specialty can advance. General knowledge of Western-style emergency departments in terms of their basic setup and function has been widespread among Russia's medical professionals for some time. Several emergency departments are functioning in select regions as pilots. Preliminary data stemming from their operation have supported a positive effect on efficiency of hospital bed utilization and on appropriate use of specialists and specialized hospital departments. In the pre-hospital domain, there has been a reduction of specialized ambulance types and of the number of physicians staffing all ambulances in favor of midlevel providers. Still, a debate continues at all levels of the medical hierarchy regarding the correct future path for emergency care in Russia with regard to adaptation and sustainability of any foreign models in the context of the country's unique national features. PMID:26608599

  10. Wildlife Emergency and Critical Care.

    PubMed

    Riley, Jennifer; Barron, Heather

    2016-05-01

    Wildlife patients often present as emergencies. For veterinarians who do not typically treat wildlife, it is important to be able to stabilize and determine the underlying cause of the animal's signs. This article discusses initial assessment, stabilization, and treatment of common emergency presentations in wild birds, reptiles, and mammals. PMID:26948268

  11. Treatment of Neurocritical Care Emergencies in Pregnancy.

    PubMed

    Sheth, Sangini S; Sheth, Kevin N

    2012-02-01

    OPINION STATEMENT: Neurologic emergencies are a major cause of morbidity and mortality in pregnant women. In part because the patient population is young, the nihilistic approach that often accompanies neurologically devastating disorders in other contexts is largely absent. A number of studies have demonstrated improved patient outcomes in the setting of aggressive care delivered by neurointensivists in a specialty-specific environment. It stands to reason that young, pregnant women who suffer from neurologically devastating disorders and who have a wide range of prognosis may also benefit from such specialized care. Close collaboration between obstetricians and neurointensivists is critical in this context. A number of unique considerations in diagnosis and management present dilemmas in the context of pregnancy, such as radiation dose from diagnostic neuroimaging, choice of pharmacotherapy for seizures, anticoagulation, and the method of delivery in the context of cerebral mass lesions and elevated intracranial pressure. Patients and their physicians are often faced with the additional challenge of balancing the relative risks and benefits of the impact of a management approach on both mother and fetus. In general, this balance tends to favor the interests of the mother, but the impact on the fetus becomes more relevant over the course of the pregnancy, especially in the third trimester. A low threshold for admission to an intensive care unit (ideally one that specializes in neurointensive care) should be used for pregnant patients. Because of the limited information regarding long-term outcomes in this population, rigid prognosis formation and early care limitations should be deferred in the immediate period. After the patient is stabilized and a plan has been charted for the remainder of the pregnancy, every effort should be made to engage patients in aggressive, urgent neurologic rehabilitation. PMID:22298283

  12. Eating Disorders in the Primary Care Setting.

    PubMed

    Sangvai, Devdutta

    2016-06-01

    Eating disorders are a complex set of illnesses most commonly affecting white adolescent girls and young women. The most common eating disorders seen in the primary care setting are anorexia nervosa, bulimia nervosa, and binge eating disorder. Treatment in the primary care environment ideally involves a physician, therapist, and nutritionist, although complex cases may require psychiatric and other specialist care. Early diagnosis and treatment are associated with improved outcomes, whereas the consequences of untreated eating disorders, particularly anorexia nervosa, can be devastating, including death. PMID:27262009

  13. [Renal colic: new care in emergency centers].

    PubMed

    Morandi, Eléonore; Kherad, Omar; Chollet, Yves; Dussoix, Philippe

    2016-02-01

    The prevalence of renal colic is increasing in industrialized countries, representing a frequent reason for consultation in emergencies. Most patients have simple renal colic that will require analgesia and ambulatory monitoring. Doctors working in emergency centers play a key role in the diagnosis, care and guidance of these patients. They must identify factors of gravity and request urological advice if necessary. This article summarizes the recent diagnostic and therapeutic innovations in the management and guidance of renal colic in emergency centers. PMID:26999995

  14. Living forensics: a natural evolution in emergency care.

    PubMed

    McCracken, L M

    1999-10-01

    'Throughout history, health care professionals have been called upon to assist the legal system in the prosecution of cases where patient care overlaps with the law and physiological realities collide' (Lynch 1995). Working for the last 21 years in the Accident & Emergency setting, the author is dedicated to increasing the awareness and assisting in the establishment of basic forensic evidence collection guidelines for the emergency care provider. Due to the nature of the clientele and setting, emergency personnel will inevitably care for 'victims of violence'. Domestic violence injuries, abuse and neglect in the elderly and young, the addictive client seeking emergency care, the sexual assault victim, and sufferers of occupational injuries, are but a few of the cases that would be classified in the forensic arena. Holistic care dictates looking after the patient as a whole. The nurse must meet the patient's physical and psychosocial needs. The forensic nurse ensures that the patient's civil and constitutional rights are also met. This forensic health care role can be achieved and strengthened by recognizing potential evidence and maintaining a 'chain of custody' of this evidence. PMID:10808761

  15. Priority setting for health in emerging markets.

    PubMed

    Glassman, Amanda; Giedion, Ursula; McQueston, Kate

    2013-05-01

    The use of health technology assessment research in emerging economies is becoming an increasingly important tool to determine the uses of health spending. As low- and middle-income countries' gross domestic product grows, the funding available for health has increased in tandem. There is growing evidence that comparative effectiveness research and cost-effectiveness can be used to improve health outcomes within a predefined financial space. The use of these evaluation tools, combined with a systematized process of priority setting, can help inform national and global health payers. This review of country institutions for health technology assessment illustrates two points: the efforts underway to use research to inform priorities are widespread and not confined to wealthier countries; and many countries' efforts to create evidence-based policy are incomplete and more country-specific research will be needed. Further evidence shows that there is scope to reduce these gaps and opportunity to support better incorporation of data through better-defined priority-setting processes. PMID:24236627

  16. Prevention Opportunities in Health Care Settings.

    ERIC Educational Resources Information Center

    Johnson, Suzanne Bennett; Millstein, Susan G.

    2003-01-01

    Reviews changing patterns of health and illness that have led to increased interest in the role of patient and provider behaviors, discussing the advantages of using health care settings as prevention sites. Presents examples of successful behaviorally-based prevention programs, offering evidence supporting their cost-effectiveness. Describes…

  17. Professionalism in Long-Term Care Settings

    ERIC Educational Resources Information Center

    Lubinski, Rosemary

    2006-01-01

    Speech-language pathologists who serve elders in a variety of long-term care settings have a variety of professional skills and responsibilities. Fundamental to quality service is knowledge of aging and communication changes and disorders associated with this process, institutional alternatives, and the changing nature of today's elders in…

  18. Dilemma in the emergency setting: hypomagnesemia mimicking acute stroke

    PubMed Central

    Rico, María; Martinez-Rodriguez, Laura; Larrosa-Campo, Davinia; Calleja, Sergio

    2016-01-01

    Background Stroke mimics may account for up to 30% of all acute stroke consultations. However, in the emergency setting, accurate diagnosis is not always possible. Methods Case report and review of the literature. Results A 73-year-old woman was admitted to the emergency department with acute aphasia and right hemiparesis. The National Institute of Health Stroke Score was 21, compatible with severe stroke, so she received thrombolysis. Laboratory testing demonstrated severe hypomagnesemia. She had been taking proton pump inhibitors for years and neuroimaging did not demonstrate signs of acute ischemic disease. After correcting the metabolic alterations with intravenous and oral supplemental magnesium, the patient was discharged asymptomatic. No further episodes have been registered to date. Conclusion Hypomagnesemia might cause acute neurological symptoms that could be confused with stroke. A careful history is essential for diagnosis but suspicion of stroke mimic should not prevent tPA administration. PMID:27354832

  19. Palliative Care in the Emergency Department.

    PubMed

    McEwan, Alyssia; Silverberg, Joshua Z

    2016-08-01

    As the geriatric population increases in the United States, there is an increase in number of visits to emergency departments for end-of-life and palliative care. This provides the emergency physician with a unique opportunity to alleviate and prevent further suffering in this vulnerable population. Competency in communication strategies that support shared decision making and familiarity with medicolegal terminology increase physician confidence about addressing complaints at the end of life. Familiarity with evidence-based recommendations for symptom management of pain at the end of life aids the emergency physician in creating a positive experience for the patient and their loved ones. PMID:27475020

  20. Emerging infections - implications for dental care.

    PubMed

    Monaghan, N P

    2016-07-01

    Over the last 20 years the majority of emerging infections which have spread rapidly across the globe have been respiratory infections that are spread via droplets, a trend which is likely to continue. Aerosol spray generation in the dental surgery has the potential to spread such infections to staff or other patients. Although the diseases may differ, some common approaches can reduce the risk of transmission. Dental professionals should be aware of areas affected by emerging infections, the incubation period and the recent travel history of patients. Elective dental care for those returning from areas affected by emerging infections should be delayed until the incubation period for the infection is over. PMID:27388077

  1. Involvement of Pharmacists in Medical Care in Emergency and Critical Care Centers.

    PubMed

    Imai, Toru; Yoshida, Yoshikazu

    2016-01-01

    Emergency and critical care centers provide multidisciplinary therapy for critically ill patients by centralizing the expertise and technology of many medical professionals. Because the patients' conditions vary, different drug treatments are administered along with surgery. Therefore, the role of pharmacists is important. Critically ill patients who receive high-level invasive treatment undergo physiological changes differing from their normal condition along with variable therapeutic effects and pharmacokinetics. Pharmacists are responsible for recommending the appropriate drug therapy using their knowledge of pharmacology and pharmacokinetics. Further, pharmacists need to determine the general condition of patients by understanding vital signs, blood gas analysis results, etc. It is therefore necessary to conduct consultations with physicians and nurses. The knowledge required for emergency medical treatment is not provided during systematic training in pharmaceutical education, meaning that pharmacists acquire it in the clinical setting through trial and error. To disseminate the knowledge of emergency medical care to pharmacy students, emergency care training has been started in a few facilities. I believe that medical facilities and universities need to conduct joint educational sessions on emergency medical care. Moreover, compared with other medical fields, there are fewer studies on emergency medical care. Research-oriented pharmacists must resolve this issue. This review introduces the work conducted by pharmacists for clinical student education and clinical research at the Emergency and Critical Care Center of Nihon University Itabashi Hospital and discusses future prospects. PMID:27374959

  2. Identifying and managing patients with delirium in acute care settings.

    PubMed

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium. PMID:26511424

  3. Emergency Care Skills for Occupational Health Nurses.

    ERIC Educational Resources Information Center

    North Carolina State Dept. of Community Colleges, Raleigh. Occupational Information Center.

    Designed for use in community colleges, technical colleges, and technical institutes, this manual contains a course for teaching emergency care skills to both licensed practical and registered nurses employed in occupational health. The manual consists of three sections. In section 1 the need for the course, its content, objectives, length,…

  4. Providing high-quality care in primary care settings

    PubMed Central

    Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, Éveline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William

    2014-01-01

    Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. PMID:24829023

  5. Palliative Care in the Emergency Department

    PubMed Central

    Mierendorf, Susanne M; Gidvani, Vinita

    2014-01-01

    The Emergency Department (ED) is the place where people most frequently seek urgent care. For patients living with chronic disease or malignancy who may be in a crisis, this visit may be pivotal in determining the patients’ trajectory. There is a large movement in education of emergency medicine physicians, hospitalists, and intensivists from acute aggressive interventions to patient-goal assessment, recognizing last stages of life and prioritizing symptom management. Although the ED is not considered an ideal place to begin palliative care, hospital-based physicians may assist in eliciting the patient’s goals of care and discussing prognosis and disease trajectory. This may help shift to noncurative treatment. This article will summarize the following: identification of patients who may need palliation, discussing prognosis, eliciting goals of care and directives, symptom management in the ED, and making plans for further care. These efforts have been shown to improve outcomes and to decrease length of stay and cost. The focus of this article is relieving “patient” symptoms and family distress, honoring the patient’s goals of care, and assisting in transition to a noncurative approach and placement where this may be accomplished. PMID:24694318

  6. [Quality improvement of health care services in Croatian emergency medicine].

    PubMed

    Predavec, Sanja; Sogorić, Selma; Jurković, Drazen

    2010-12-01

    Emergency medical services (EMS) in the Republic of Croatia are currently organized as part of the existing health care system and delivered in the form of pre-hospital and hospital EMS. The pre-hospital EMS are delivered by standalone EMS Centers, EMS units set up in community health centers, and by general practitioners working in shifts and on call in remote and scarcely populated areas. In hospitals, each ward usually has its own emergency reception area, and only in a couple of cases there is an integrated emergency admission unit for the entire hospital. The current EMS structure does not meet the basic requirements that would make an EMS system optimal, i.e. equal quality, equal access, effectiveness and appropriate equipment. The EMS Restructuring Project is part of the Croatian health care system reform and is addressed by the National Health Development Strategy 2006-2011. As part of restructuring efforts, the Croatian National Institute of Emergency Medicine, 21 County Institutes of Emergency Medicine and county-level call centers are going to be set up. In addition, the project will introduce the following: integrated emergency admission areas at hospitals; telemedicine as part of emergency medicine; emergency medicine specialty for physicians and additional specialized training for nurses/technicians; separation of emergency and non-emergency transport; standards for vehicles and equipment and guidelines/protocols/algorithms for care. The Croatian National Institute of Emergency Medicine is an umbrella EMS organization. It shapes the EMS in Croatia and proposes, plans, monitors and analyzes EMS actions in Croatia. In addition, it submits a proposal of the Emergency Medicine Network to the minister, sets standards for EMS transport, and coordinates, guides and supervises the work of County Institutes of Emergency Medicine. County Institutes organize and deliver pre-hospital EMS in their counties. Integrated hospital emergency admission units represent a

  7. Facilitating emergent change in a healthcare setting.

    PubMed

    Dickens, Peter M

    2013-01-01

    During my doctoral research, I identified new ways of thinking about complexity in organizations. This involved embracing the capacity of complex systems to find their own form of order and coherence, often referred to as self-organization, and then asking the question, "What can organizational leaders do to create the systems and structures that would facilitate emergent change?" Emergent change comes from within and through the active members of a system and not according to some external prompting or design. This results in the sort of change capacity that enables an organization to be agile and resilient through a high level of employee engagement. The question was answered by identifying and validating organizational-specific factors that facilitate emergent change. PMID:24409579

  8. Death anxiety among emergency care workers.

    PubMed

    Brady, Mike

    2015-07-01

    Death anxiety, or 'thanatophobia', is a state in which people experience negative emotional reactions in recognition of their own mortality. Emergency and unscheduled healthcare workers, such as emergency nurses and paramedics, are constantly reminded of death and therefore of their own mortality, and this makes them susceptible to death anxiety. This article introduces the concept of death anxiety, and highlights the need for staff, employers and universities to recognise its signs and symptoms. It also suggests some interventions that could prevent the debilitating effects of death anxiety, to improve staff's mental health and the care they provide to patients. PMID:26159347

  9. Computed radiography in an emergency department setting

    NASA Astrophysics Data System (ADS)

    Andriole, Katherine P.; Gould, Robert G.; Arenson, Ronald L.

    1997-05-01

    Evaluation of radiologist and non-radiologist physician acceptance of computed radiography (CR) as an alternative to film-based radiography in an emergency department (ED) is performed. All emergency department radiographs are performed using photostimulable phosphor plates and rad by a computed radiography laser reader placed in the former emergency department darkroom. Soft copy images are simultaneously transmitted to high- and medium-resolution dual-monitor display stations located in radiology and ED reading rooms respectively. The on-call radiologist is automatically paged by the Radiology Information System (RIS) upon exam completion, to read the new ED imaging study. Patient demographic information including relevant clinical history is conveyed to the radiologist via the RIS. A 'wet read' preliminary radiology report is immediately transmitted back to the ED. Radiology and ED physicians are surveyed to ascertain preferences for CR or traditional screen-film, based on system implementation, image viewing and clinical impact issues. Preliminary results indicate a preference for filmless CR among the ED physicians if digital reliability and speed issues are met. This preference appears to be independent of physician level of experience. Inexperienced radiologists-in-training appear to have less comfort with softcopy reading for primary diagnosis. However, additional training in softcopy reading techniques can improve confidences. Image quality issues are most important tot he radiologist, while speed and reliability are the major issues for ED physicians. Reasons for CR preference include immediate access to images on display stations, near-zero exam retake rates, and improved response time and communication between radiology and the emergency department clinician.

  10. Assessing the Assessment in Emergency Care Training

    PubMed Central

    Dankbaar, Mary E. W.; Stegers-Jager, Karen M.; Baarveld, Frank; van Merrienboer, Jeroen J. G.; Norman, Geoff R.; Rutten, Frans L.; van Saase, Jan L. C. M.; Schuit, Stephanie C. E.

    2014-01-01

    Objective Each year over 1.5 million health care professionals attend emergency care courses. Despite high stakes for patients and extensive resources involved, little evidence exists on the quality of assessment. The aim of this study was to evaluate the validity and reliability of commonly used formats in assessing emergency care skills. Methods Residents were assessed at the end of a 2-week emergency course; a subgroup was videotaped. Psychometric analyses were conducted to assess the validity and inter-rater reliability of the assessment instrument, which included a checklist, a 9-item competency scale and a global performance scale. Results A group of 144 residents and 12 raters participated in the study; 22 residents were videotaped and re-assessed by 8 raters. The checklists showed limited validity and poor inter-rater reliability for the dimensions “correct” and “timely” (ICC = .30 and.39 resp.). The competency scale had good construct validity, consisting of a clinical and a communication subscale. The internal consistency of the (sub)scales was high (α = .93/.91/.86). The inter-rater reliability was moderate for the clinical competency subscale (.49) and the global performance scale (.50), but poor for the communication subscale (.27). A generalizability study showed that for a reliable assessment 5–13 raters are needed when using checklists, and four when using the clinical competency scale or the global performance scale. Conclusions This study shows poor validity and reliability for assessing emergency skills with checklists but good validity and moderate reliability with clinical competency or global performance scales. Involving more raters can improve the reliability substantially. Recommendations are made to improve this high stakes skill assessment. PMID:25521702

  11. Management competencies required in ambulatory care settings.

    PubMed

    Brooke, P P; Hudak, R P; Finstuen, K; Trounson, J

    1998-01-01

    A study was conducted to identify the most important competencies physician executives in medical groups and other ambulatory settings will need to have in the next five years. The specific job skills, knowledge, and abilities (SKA) that physician executives will need to acquire these competencies were also explored. The Delphi techniques were used to analyze responses from two surveys from members of the American College of Medical Practice Executives. The most important competencies were grouped into 13 management domains, each with specific SKAs. "Managing health care resources to create quality and value" and "fundamentals of business and finance" were rated as the most important competencies. The most frequently rated SKA was the "ability to build and maintain credibility and trust." PMID:10185642

  12. 32 CFR 1656.20 - Expenses for emergency medical care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 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...

  13. 32 CFR 1656.20 - Expenses for emergency medical care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 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...

  14. 32 CFR 1656.20 - Expenses for emergency medical care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 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...

  15. 32 CFR 1656.20 - Expenses for emergency medical care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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...

  16. 32 CFR 1656.20 - Expenses for emergency medical care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 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...

  17. Infection Control in Alternative Health Care Settings: An Update.

    PubMed

    Flanagan, Elaine; Cassone, Marco; Montoya, Ana; Mody, Lona

    2016-09-01

    With changing health care delivery, patients receive care at various settings including acute care hospitals, nursing homes, outpatient primary care and specialty clinics, and at home, exposing them to pathogens in various settings. Various health care settings face unique challenges, requiring individualized infection control programs. Infection control programs in nursing homes should address surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs. PMID:27515148

  18. 32 CFR 732.16 - Emergency care requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... MEDICAL AND DENTAL CARE Medical and Dental Care From Nonnaval Sources § 732.16 Emergency care requirements. Only in a bona fide emergency will medical, maternity, or dental services be obtained under this part... dental care. A situation where the need or apparent need for medical or dental attention does not...

  19. Palliative Care Patients in the Emergency Department

    PubMed Central

    LAWSON, BEVERLEY J.; BURGE, FREDERICK I.; MCINTYRE, PAUL; FIELD, SIMON; MAXWELL, DAVID

    2016-01-01

    Although end-of-life care is not a primary function of the emergency department (ED), in reality, many access this department in the later stages of illness. In this study, ED use by patients registered with the Capital Health Integrated Palliative Care Service (CHIPCS) is examined and CHIPCS patient characteristics associated with ED use identified. Overall, 27% of patients made at least one ED visit while registered with CHIPCS; 54% of these resulted in a hospital admission. ED visiting was not associated with time of day or day of the week. Multivariate logistic regression results suggest older patients were significantly less likely to make an ED visit. Making an ED visit was associated with hospital death, rural residence (particularly for women), and having a parent or relative other than a spouse or child as the primary caregiver. Further research may suggest strategies to reduce unnecessary ED visits during the end of life. PMID:19227016

  20. Rivaroxaban and Hemostasis in Emergency Care

    PubMed Central

    Koscielny, Jürgen; Rutkauskaite, Edita

    2014-01-01

    Rivaroxaban is an oral, direct Factor Xa inhibitor, approved for the prevention and treatment of several thromboembolic disorders. Rivaroxaban does not require routine coagulation monitoring and has a short half-life. However, confirmation of rivaroxaban levels may be required in circumstances such as life-threatening bleeding or perioperative management. Here, we explore the management strategies in patients receiving rivaroxaban who have a bleeding emergency or require emergency surgery. Rivaroxaban plasma concentrations can be assessed quantitatively using anti-Factor Xa chromogenic assays, or qualitatively using prothrombin time assays (using rivaroxaban-sensitive reagents). In patients receiving long-term rivaroxaban therapy who require elective surgery, discontinuation of rivaroxaban 20–30 hours beforehand is normally sufficient to minimize bleeding risk. For emergency surgery, we advise against prophylactic use of hemostatic blood products, even with high rivaroxaban concentrations. Temporary rivaroxaban discontinuation is recommended if minor bleeding occurs; for severe bleeding, rivaroxaban withdrawal may be necessary, along with compression or appropriate surgical treatment. Supportive measures such as blood product administration might be beneficial. Life-threatening bleeding demands comprehensive hemostasis management, including potential use of agents such as prothrombin complex concentrate. Patients taking rivaroxaban who require emergency care for bleeding or surgery can be managed using established protocols and individualized assessment. PMID:24696784

  1. Assessment of suicidal intent in emergency care.

    PubMed

    Bethel, James

    The assessment of suicidal intent in first-contact settings, including the emergency department, can be challenging. Inaccurate assessment can lead to increased incidence of self-harm and completion of suicide. This article focuses on factors that may affect review of this patient group, including healthcare professionals' personal and professional standards and values. Strategies to aid assessment of people presenting with suicidal ideation are discussed. PMID:24063487

  2. Optimizing antibiotic therapy in the intensive care unit setting

    PubMed Central

    Kollef, Marin H

    2001-01-01

    Antibiotics are one of the most common therapies administered in the intensive care unit setting. In addition to treating infections, antibiotic use contributes to the emergence of resistance among pathogenic microorganisms. Therefore, avoiding unnecessary antibiotic use and optimizing the administration of antimicrobial agents will help to improve patient outcomes while minimizing further pressures for resistance. This review will present several strategies aimed at achieving optimal use of antimicrobial agents. It is important to note that each intensive care unit should have a program in place which monitors antibiotic utilization and its effectiveness. Only in this way can the impact of interventions aimed at improving antibiotic use (e.g. antibiotic rotation, de-escalation therapy) be evaluated at the local level. PMID:11511331

  3. Emergency care and health systems: consensus-based recommendations and future research priorities.

    PubMed

    Calvello, Emilie J B; Broccoli, Morgan; Risko, Nicholas; Theodosis, Christian; Totten, Vicken Y; Radeos, Michael S; Seidenberg, Phil; Wallis, Lee

    2013-12-01

    The theme of the 14th annual Academic Emergency Medicine consensus conference was "Global Health and Emergency Care: A Research Agenda." The goal of the conference was to create a robust and measurable research agenda for evaluating emergency health care delivery systems. The concept of health systems includes the organizations, institutions, and resources whose primary purpose is to promote, restore, and/or maintain health. This article further conceptualizes the vertical and horizontal delivery of acute and emergency care in low-resource settings by defining specific terminology for emergency care platforms and discussing how they fit into broader health systems models. This was accomplished through discussion surrounding four principal questions touching upon the interplay between health systems and acute and emergency care. This research agenda is intended to assist countries that are in the early stages of integrating emergency services into their health systems and are looking for guidance to maximize their development and health systems planning efforts. PMID:24341583

  4. Aligning payment reform and delivery innovation in emergency care.

    PubMed

    Pines, Jesse M; McStay, Frank; George, Meaghan; Wiler, Jennifer L; McClellan, Mark

    2016-08-01

    Current alternative payment models (APMs) that move away from traditional fee-for-service payment often have explicit goals to reduce utilization in episodic settings, such as emergency departments (ED). We apply the new HHS payment reform taxonomy to illustrate a pathway to success for EDs in APMs. Despite the unique challenges faced by EDs, a variety of category 2 and 3 APMs may be applicable to EDs in the short- and long term to improve efficiency and value. Full and partially capitated models create incentives for longitudinal and episodic ED providers and payers to unite to create interventions to reduce costs. However, prospective attribution remains a challenge for EDs because of exogenous demand, which makes it important for EDs to be one of the components of capitated payment along with longitudinal providers who can exert greater control on overall care demands. The goal of payment and delivery reforms in ED care is to improve population health across the continuum of acute and longitudinal care. In order to deliver cost-conscious care, ED providers will need additional resources, expanded information, and new processes and metrics to facilitate cost-conscious decisions. Improved availability of electronic information across settings, evidence generated from developing and testing acute care-specific payment models, and engaging acute care providers directly in reform efforts will help meet these goals. PMID:27541697

  5. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 6. Bleeding Control, Wounds and Bandaging, Shock. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This student manual, the sixth in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains three sections covering the following course content: control of bleeding, caring for wounds and bandaging various body parts, and caring for shock victims. Each section contains objectives, an introduction,…

  6. Mental Health in Long Term Care Settings.

    ERIC Educational Resources Information Center

    Shore, Herbert

    1978-01-01

    There are many ways in which long-term care facilities attempt to cope with the mental health problems of the elderly. The author reviews five factors crucial to effective care for the aged in these facilities. (Author/RK)

  7. Substance use disorder patient privacy and comprehensive care in integrated health care settings.

    PubMed

    Schaper, Elizabeth; Padwa, Howard; Urada, Darren; Shoptaw, Steven

    2016-02-01

    The Affordable Care Act (ACA) expands health insurance coverage for substance use disorder (SUD) treatment, underscoring the value of improving SUD service integration in primarily physical health care settings. It is not yet known to what degree specialized privacy regulations-Code of Federal Regulations Title 42, Part 2 (42 CFR Part 2), in particular-will affect access to or the utilization and delivery of SUD treatment in primary care. In addition to exploring the emerging benefits and barriers that specialized confidentiality regulations pose to treatment in early adopting integrated health care settings, this article introduces and explicates 42 CFR Part 2 to support provider and administrator implementation of SUD privacy regulations in integrated settings. The authors also argue that, although intended to protect patients with SUD, special SUD information protection may inadvertently reinforce stigma against patients by purporting the belief that SUD is different from other health problems and must be kept private. In turn, this stigma may inhibit the delivery of comprehensive integrated care. PMID:26845493

  8. Emergency medicine physician attitudes toward HPV vaccine uptake in an emergency department setting

    PubMed Central

    Hill, Mandy; Okugo, Glory

    2014-01-01

    A physician's recommendation is the most effective published method of motivating HPV vaccination initiation. The emergency department (ED) is the 'public health safety net', and often the only access to care for underserved populations. Recommendation of the HPV vaccine in the ED is a potential avenue to improve vaccination rates among sub-populations who do not have access to routine medical care. We assessed willingness of EM physicians to recommend the vaccine, target high-risk women, and disclose perceived barriers to vaccination in the ED. A cross sectional study using an 11-item survey, was used to assess physician attitudes toward recommending the HPV vaccine in an ED setting to age eligible patients. 67.4% stated they would recommend the vaccine, 23.9% were neutral, and 8.7% would not recommend the vaccine to age eligible patients in the ED. 41% noted lack of adequate reimbursement for vaccination as a barrier to vaccination in the ED (P < 0.05). Physicians were comfortable targeting women at high risk for cervical cancer for vaccination (P < 0.05). EM physicians are comfortable targeting high-risk women for HPV vaccination in an ED setting. Support of EM physicians in the national effort to improve HPV vaccine uptake is an important step in eradicating a largely preventable yet lethal cancer. PMID:25483493

  9. Android-based access to holistic emergency care record.

    PubMed

    Koufi, Vassiliki; Malamateniou, Flora; Prentza, Andriana; Vassilacopoulos, George

    2013-01-01

    This paper is concerned with the development of an Emergency Medical Services (EMS) system which interfaces with a Holistic Emergency Care Record (HECR) that aims at managing emergency care holistically by supporting EMS processes and is accessible by Android-enabled mobile devices. PMID:23823406

  10. Terrorism and the ethics of emergency medical care.

    PubMed

    Pesik, N; Keim, M E; Iserson, K V

    2001-06-01

    The threat of domestic and international terrorism involving weapons of mass destruction-terrorism (WMD-T) has become an increasing public health concern for US citizens. WMD-T events may have a major effect on many societal sectors but particularly on the health care delivery system. Anticipated medical problems might include the need for large quantities of medical equipment and supplies, as well as capable and unaffected health care providers. In the setting of WMD-T, triage may bear little resemblance to the standard approach to civilian triage. To address these issues to the maximum benefit of our patients, we must first develop collective forethought and a broad-based consensus that these decisions must reach beyond the hospital emergency department. Critical decisions like these should not be made on an individual case-by-case basis. Physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply. It is for this reason that emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision making before an acute bioterrorist event. PMID:11385335

  11. Perceptions of emergency care in Kenyan communities lacking access to formalised emergency medical systems: a qualitative study

    PubMed Central

    Broccoli, Morgan C; Calvello, Emilie J B; Skog, Alexander P; Wachira, Benjamin; Wallis, Lee A

    2015-01-01

    Objectives We undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members’ thoughts regarding high impact solutions to expand access to essential emergency services. Design We used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach. Setting Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation. Results Socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care—a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene. Conclusions Access to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These community-generated solutions likely have a wider applicability in the region. PMID:26586324

  12. Comparative Effectiveness Research: Alternatives to "Traditional" Computed Tomography Use in the Acute Care Setting.

    PubMed

    Moore, Christopher L; Broder, Joshua; Gunn, Martin L; Bhargavan-Chatfield, Mythreyi; Cody, Dianna; Cullison, Kevin; Daniels, Brock; Gans, Bradley; Kennedy Hall, M; Gaines, Barbara A; Goldman, Sarah; Heil, John; Liu, Rachel; Marin, Jennifer R; Melnick, Edward R; Novelline, Robert A; Pare, Joseph; Repplinger, Michael D; Taylor, Richard A; Sodickson, Aaron D

    2015-12-01

    Computed tomography (CT) scanning is an essential diagnostic tool and has revolutionized care of patients in the acute care setting. However, there is widespread agreement that overutilization of CT, where benefits do not exceed possible costs or harms, is occurring. The goal was to seek consensus in identifying and prioritizing research questions and themes that involve the comparative effectiveness of "traditional" CT use versus alternative diagnostic strategies in the acute care setting. A modified Delphi technique was used that included input from emergency physicians, emergency radiologists, medical physicists, and an industry expert to achieve this. PMID:26576033

  13. Primary Care in Secondary Settings: Inherent Strains

    ERIC Educational Resources Information Center

    Maier, Henry W.; Garfat, Thom

    2005-01-01

    There is an ever present struggle associated with reconciling "primary" care requirements for children and young people living in group care programs with "secondary" organizational demands imposed by external agency expectations and administrative requirements. That struggle finds its expression and potential balance in the daily work of staff.…

  14. Conflicts between managed care organizations and emergency departments in California.

    PubMed Central

    Johnson, L A; Derlet, R W

    1996-01-01

    To control costs, managed care organizations have begun to restrict the use of hospital emergency departments by their enrollees. They are doing this by educating enrollees, providing better access to 24-hour urgent care, denying preauthorizations for care for some patients who do present to emergency departments, and retrospectively denying payment for certain patients who use emergency services. Changing traditional use of emergency departments has resulted in conflicts between managed care organizations and these departments. Because federal law mandates access to emergency care for all persons, disagreements occur over the precise definition of an emergency medical condition. In addition, conflicts occur over the scope and payment for the medical screening examination required by federal law of persons presenting to an emergency department. Finally, issues arise related to the safety of patients who present to emergency departments and request care but are denied care because the managed care organization does not authorize the visit. Recent legislation in California has attempted to reconcile differences between managed care practices and federal and state laws; however, areas of continued conflict need to be resolved to prevent possible adverse consequences for patients actually needing emergency care. PMID:8775727

  15. Patient and public involvement in emergency care research.

    PubMed

    Hirst, Enid; Irving, Andy; Goodacre, Steve

    2016-09-01

    Patients participate in emergency care research and are the intended beneficiaries of research findings. The public provide substantial funding for research through taxation and charitable donations. If we do research to benefit patients and the public are funding the research, then patients and the public should be involved in the planning, prioritisation, design, conduct and oversight of research, yet patient and public involvement (or more simply, public involvement, since patients are also members of the public) has only recently developed in emergency care research. In this article, we describe what public involvement is and how it can help emergency care research. We use the development of a pioneering public involvement group in emergency care, the Sheffield Emergency Care Forum, to provide insights into the potential and challenges of public involvement in emergency care research. PMID:27044949

  16. [Position paper for a reform of medical emergency care in German emergency departments].

    PubMed

    Riessen, R; Gries, A; Seekamp, A; Dodt, C; Kumle, B; Busch, H-J

    2015-06-01

    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

  17. Suicide screening in schools, primary care and emergency departments

    PubMed Central

    Horowitz, Lisa M.; Ballard, Elizabeth D.; Pao, Maryland

    2010-01-01

    Purpose of review Every year, suicide claims the lives of tens of thousands of young people worldwide. Despite its high prevalence and known risk factors, suicidality is often undetected. Early identification of suicide risk may be an important method of mitigating this public health crisis. Screening youth for suicide may be a critical step in suicide prevention. This paper reviews suicide screening in three different settings: schools, primary care clinics and emergency departments (EDs). Recent findings Unrecognized and thus untreated suicidality leads to substantial morbidity and mortality. With the onus of detection falling on nonmental health professionals, brief screening tools can be used to initiate more in-depth evaluations. Nonetheless, there are serious complexities and implications of screening all children and adolescents for suicide. Recent studies show that managing positive screens is a monumental challenge, including the problem of false positives and the burden subsequently posed on systems of care. Furthermore, nearly 60% of youth in need of mental health services do not receive the care they need, even after suicide attempt. Schools, primary care clinics and EDs are logical settings where screening that leads to intervention can be initiated. Summary Valid, brief and easy-to-administer screening tools can be utilized to detect risk of suicide in children and adolescents. Targeted suicide screening in schools, and universal suicide screening in primary care clinics and EDs may be the most effective way to recognize and prevent self-harm. These settings must be equipped to manage youth who screen positive with effective and timely interventions. Most importantly, the impact of suicide screening in various settings needs to be further assessed. PMID:19617829

  18. Point of Care Cardiac Ultrasound Applications in the Emergency Department and Intensive Care Unit - A Review

    PubMed Central

    Arntfield, Robert T; Millington, Scott J

    2012-01-01

    The use of point of care echocardiography by non-cardiologist in acute care settings such as the emergency department (ED) or the intensive care unit (ICU) is very common. Unlike diagnostic echocardiography, the scope of such point of care exams is often restricted to address the clinical questions raised by the patient’s differential diagnosis or chief complaint in order to inform immediate management decisions. In this article, an overview of the most common applications of this focused echocardiography in the ED and ICU is provided. This includes but is not limited to the evaluation of patients experiencing hypotension, cardiac arrest, cardiac trauma, chest pain and patients after cardiac surgery. PMID:22894759

  19. Hazardous waste compliance in health care settings.

    PubMed

    Marcoux, Rita M; Vogenberg, F Randy

    2015-02-01

    Pharmaceutical waste has become an urgent public health and environmental protection issue in recent years, leading to a variety of sometimes-conflicting federal and state legislation and regulations that health care entities must take seriously. PMID:25673960

  20. The emerging role of cell phone technology in ambulatory care.

    PubMed

    Boland, Peter

    2007-01-01

    Three factors are coinciding to reshape the ambulatory care market: chronic disease prevalence, workforce shortages, and the availability of cell phone technology with very high consumer penetration. These factors will disproportionately drive the business strategies and practices of ambulatory care providers, payers, and delivery systems this decade. Market dynamics are driving the healthcare industry to adopt new strategies to deal with the swelling prevalence of chronic disease. Healthcare organizations are constrained by money and inadequate tools to systematically manage chronic care patients. As a result, traditional notions of ambulatory care are changing from being provider-centered to becoming more patient-centric. A host of new remote monitoring and communication technologies are available so that providers can now interact with patients "anywhere, anytime." The traditional care setting is shifting to where the patient is rather than where the physician is located. Patients are the most underutilized resource in healthcare, and patient engagement is the key to managing chronic illness. Cell phones are particularly suited for leveraging the time and expertise of providers while engaging patients in their own self-care. To demonstrate this concept, data are presented that illustrate how cell phone applications significantly reduced the cost of treating severely asthmatic children and teens in 2 ways: through more frequent communication between patients and their medical teams, and by motivating patients to become more engaged and knowledgeable about their care. The healthcare industry can support consumer choice by making available as many options as possible for engaging patients in their care. Consumers like having choices and patients are no different: they are not all one type. This suggests an emerging role for cell phone applications and platforms that enable both Internet and medical device connectivity where appropriate for managing chronic

  1. Point-of-care ultrasonography by pediatric emergency physicians. Policy statement.

    PubMed

    Marin, Jennifer R; Lewiss, Resa E

    2015-04-01

    Point-of-care ultrasonography is increasingly being used to facilitate accurate and timely diagnoses and to guide procedures. It is important for pediatric emergency physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. Pediatric emergency medicine fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital privileges will vary and will be specific to individual departments and hospitals. As more physicians are trained and more research is completed, there should be one national standard for credentialing and privileging in point-of-care ultrasonography for pediatric emergency physicians. PMID:25805037

  2. Emergency Victim Care. A Textbook for Emergency Medical Personnel.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Trade and Industrial Education Service.

    This textbook for emergency medical personnel should be useful to fire departments, private ambulance companies, industrial emergency and rescue units, police departments, and nurses. The 30 illustrated chapters cover topics such as: (1) Emergency Medical Service Vehicles, (2) Safe Driving Practices, (3) Anatomy and Physiology, (4) Closed Chest…

  3. [Latex allergy - an emerging health care problem.].

    PubMed

    Gislason, D; Bjornsdottir, U S

    1996-08-01

    Since immediate hypersensitivity reaction to natural rubber was described 17 years ago, the incidence of latex allergy has been increasing rapidly. This is in part due to a growing awareness of the problem along with improved diagnostic methods. Additionally, in accordance with universal health care plans and the HIV epidemic, more rubber products such as latex gloves and condoms are in general use. Changes in methods of rubber production may also contribute to the increasing prevalence in latex allergy. Individuals at greatest risk for developing latex allergy are patients who have undergone multiple operations. These include children with myelomeningocele (spina bifida) and congenital defects of the urinary tract. Another high risk group includes health care providers and individuals working in rubber production. Latex containing products are in general use in the hospital setting as well as in the home environment. They can therefore pose a great risk to sensitized patients if prophylactic measures are not undertaken. Defining high risk patients and subsequent diagnosis with appropriate skin tests are important. Patients with latex allergy must then be provided with self-administered adrenalin (Epi-pen) and instructed in avoidance measures. In this article we describe 23 individuals who have been diagnosed allergic to latex in Iceland. PMID:20065424

  4. Hospital emergency care teams: our solution to out of hours emergency care.

    PubMed

    Carberry, Martin

    2006-01-01

    The implementation of the European Working Time Directive and the compulsory reduction in junior doctors hours provided the main driver and background for this project. The project aim was to implement Hospital Emergency Care Teams (HECT) on three District General Hospitals (DGHs) to provide emergency out-of-hours care. The project strategy centred on the recruitment, training and preparation of critical care nurses to undertake advanced assessment roles. Methods used to monitor and evaluate activity include the use of innovative hand-held computers. Main outcomes include, the conclusion that a multidisciplinary HECT of five could manage the overnight workload and level of acuity in a DGH of 420-500 beds, and that critical care nursing staff can be prepared for advanced supporting roles. Experiences gained provide valuable learning that could be used to influence similar projects. Implications for practice include the development of a national framework to inform areas such as multidisciplinary competency-based education and training. Scientific evidence is required to evaluate the effect of HECT on hospital mortality and morbidity and quantify the staff, inpatient experiences. PMID:16869524

  5. On priority setting in preventive care resources.

    PubMed

    Courbage, Christophe

    2010-04-01

    Using an expected utility approach, we show that within a population that differs with respect to the probability of developing a disease, the allocation of preventive care resources should be prioritized based on the efficiency of prevention and not on whether individuals are at high or low risk of developing the disease. Should the efficiency of prevention be the same within the population, we show that the gravity of the disease, the presence of co-morbidities and the existence of uncertainty on health status can alternatively be considered so as to prioritize among preventive care resources. PMID:19353516

  6. Aesthetics in Asian Child Care Settings.

    ERIC Educational Resources Information Center

    Honig, Alice S.

    This speech presents observations, made on a trip in June 1976, of the aesthetic environments of children in China, Japan, and Hong Kong. Home, school and day care environments are compared in terms of living and play space, room decor, the presence of art and toys, dramatic play and performance, music, nature and outdoor appreciation, food and…

  7. Emerging organisms in a tertiary healthcare set up

    PubMed Central

    Khan, Inam Danish; Sahni, Ajay Kumar; Bharadwaj, Reena; Lall, Mahima; Jindal, A.K.; Sashindran, V.K.

    2013-01-01

    Background One-tenth of all infectious diseases are attributable to emerging organisms. As emerging organisms sporadically affect a relatively small percentage of population they are not studied at large. This study was aimed at studying the characteristics of emerging organisms encountered from various clinical samples in an apex tertiary care multispeciality teaching and research hospital. Methods 16,918 positive isolates obtained from 66,323 culture samples processed in the clinical microbiology lab of an apex multispeciality hospital during 2011–2012 were included after a pilot study. Both manual and automated systems were used for identification and antimicrobial susceptibility. The frequency of isolation, sources, referring centers, resistance and susceptibility profiles, phenotypic characteristics and number of reports in PubMed were studied. Results Out of 16,918 isolates, 13,498 (79.78%) were Gram negative bacteria, 3254 (19.23%) were Gram positive bacteria and 166 (0.98%) were yeasts. A total of 483 (2.85%, 95% CI 2.6%–3.1%) emerging organisms including 116 (0.69%, 95% CI 0.57%–0.81%) emerging species were identified comprising 54 genera. Conclusion Emerging organisms are likely to evade routine identification or be disregarded as non-contributory. Astute efforts directed at identification of emerging isolates, decisions by clinical microbiologists and treating physicians and containment of infection are required. PMID:24843199

  8. Managed dental care in the HMO setting.

    PubMed

    Gong, C C

    1995-01-01

    DHMOs are gaining in popularity, and are the fastest-growing dental managed-care product, primarily because of their ability to reduce premium and patient costs. Dentistry, because of the strong correlation between prevention and disease control, is more suited to a managed-care system than medicine. However, there remains a wide gulf between theory and practice, as the DHMO industry continues to evolve. Poorly designed programs will save money but create problems with patient satisfaction and unmet treatment needs. Well-designed programs use the principles of population management to bring large numbers of patients to maintenance oral health levels. In any event, the continuing growth and development of DHMOs will benefit patients, group purchasers, and the dentists who can understand and embrace the concepts of dentistry in the HMO environment. PMID:9161149

  9. Designing Groups to Meet Evolving Challenges in Health Care Settings

    ERIC Educational Resources Information Center

    McCarthy, Christopher J.; Hart, Sonia

    2011-01-01

    This article provides an overview of the special issue on groups in health care settings and describes how each contribution addresses challenges and opportunities in the health care field for group work. Fundamental criteria for evaluating groups in such settings are applied to each contribution. Finally, trends and opportunities about the future…

  10. What Should I Do? A Safety and Emergency Care Handbook.

    ERIC Educational Resources Information Center

    Crist, Mary Jo; And Others

    One of a series written especially for parents and other caregivers, this handbook offers an overview of emergency care and safety considerations. The discussion of emergency care focuses on supplies for the first aid kit and provides guidelines for dealing with bleeding, bites, burns, suffocation, eye injury, broken bones, head injuries, fevers,…

  11. Interactional aspects of care during hospitalization: perspectives of family caregivers of psychiatrically ill in a tertiary care setting in India.

    PubMed

    Dinakaran, P; Mehrotra, Seema; Bharath, Srikala

    2014-12-01

    There are very few studies on user-perspectives about mental health care services that explore perspectives of family caregivers in India. An exploratory study was undertaken to understand the perceived importance of various aspects of interactions with mental health service providers during hospitalization, from the perspectives of family caregivers. In addition, it also aimed at documenting their actual experience of interactional aspects of care during the hospitalization of their relatives. The study was conducted on fifty family caregivers of patients with varied psychiatric diagnoses hospitalized in a tertiary psychiatric care setting in South India. Measures of Interactional aspects of care were developed to assess perceived importance of six different interactional domains of care and the actual experience of care in these domains. Provision of informational inputs and addressing of concerns raised emerged as the domains of care given highest importance. The item pertaining to 'sharing with the caregiver about different alternatives for treatment' received negative ratings in terms of actual experience by maximum number of participants (18%). Significant differences on perceived importance of four domains of interactional aspects of care (dignity, confidentiality and fairness, addressing concerns raised, informational inputs and prompt attention and consistent care) emerged between caregiver subgroups based on educational level of the caregiver, socio-economic status, hospitalization history and broad diagnostic categories. In addition, the care givers of patients with psychoses assigned significantly more positive ratings on actual experience for all the domains of interactional aspects of care. The findings have implications for further research and practice. PMID:25440563

  12. Emerging Technologies for Pediatric and Adult Trauma Care

    PubMed Central

    Moulton, Steven L.; Haley-Andrews, Stephanie; Mulligan, Jane

    2010-01-01

    Purpose of the Review Current EMS protocols rely on provider directed care for evaluation, management and triage of injured patients from the field to a trauma center. New methods to quickly diagnose, support and coordinate the movement of trauma patients from the field to the most appropriate trauma center are in development. These methods will enhance trauma care and promote trauma system development. Recent Findings Recent advances in machine learning, statistical methods, device integration and wireless communication are giving rise to new methods for vital sign data analysis and a new generation of transport monitors. These monitors will collect and synchronize exponentially growing amounts of vital sign data with electronic patient care information. The application of advanced statistical methods to these complex clinical data sets has the potential to reveal many important physiological relationships and treatment effects. Summary Several emerging technologies are converging to yield a new generation of smart sensors and tightly integrated transport monitors. These technologies will assist pre-hospital providers in quickly identifying and triaging the most severely injured children and adults to the most appropriate trauma centers. They will enable the development of real-time clinical support systems of increasing complexity, able to provide timelier, more cost-effective, autonomous care. PMID:20407375

  13. 64. FORWARD EMERGENCY DIESEL GENERATOR SET STARBOARD LOOKING TO ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    64. FORWARD EMERGENCY DIESEL GENERATOR SET - STARBOARD LOOKING TO PORT SHOWING BOTTOM HALF OF FAIRBANKS MORSE 36D81/8 TEN CYLINDER DIESEL ENGINE SERIAL #951230 AND GENERAL ELECTRIC 1,000KW GENERATOR KVA 1250, RPM 720, SERIAL #6920274. - U.S.S. HORNET, Puget Sound Naval Shipyard, Sinclair Inlet, Bremerton, Kitsap County, WA

  14. 65. FORWARD EMERGENCY DIESEL GENERATOR SET AFT LOOKING FORWARD ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    65. FORWARD EMERGENCY DIESEL GENERATOR SET - AFT LOOKING FORWARD SHOWING TOP HALF OF FAIRBANKS MORSE 36D81/8 TEN CYLINDER DIESEL ENGINE SERIAL #951230 AND EXHAUST SYSTEM. - U.S.S. HORNET, Puget Sound Naval Shipyard, Sinclair Inlet, Bremerton, Kitsap County, WA

  15. Understanding Emerging Adulthood from a Goal-Setting Perspective

    ERIC Educational Resources Information Center

    Shulman, Shmuel; Nurmi, Jari-Erik

    2010-01-01

    The chapter first introduces the concept of emerging adulthood as a period of life that is characterized by instabilities and fluctuations. Then, the role of goal setting and aspirations in individual development during this stage of life is discussed. Following this, seven chapters of the present special issue are introduced, and the ways in…

  16. Quality Care and Patient Safety in the Pediatric Emergency Department.

    PubMed

    Rosen, Johanna R; Suresh, Srinivasan; Saladino, Richard A

    2016-04-01

    Over the past 15 years, with alarming and illustrative reports released from the Institute of Medicine, quality improvement and patient safety have come to the forefront of medical care. This article reviews quality improvement frameworks and methodology and the use of evidence-based guidelines for pediatric emergency medicine. Top performance measures in pediatric emergency care are described, with examples of ongoing process and quality improvement work in our pediatric emergency department. PMID:27017034

  17. Emerging Trends of Herbal Care in Dentistry

    PubMed Central

    Kumar, Gunjan; Jalaluddin, Md.; Rout, Purnendu; Mohanty, Rajat; Dileep, C.L.

    2013-01-01

    Herbs are staging a comeback and herbal ‘renaissance’ is happening all over the globe. The herbal products, today, symbolize safety, in contrast to the synthetics that are regarded as unsafe to humans and the environment. A herb, botanically speaking, is any plant that lacks the woody tissue which is characteristic of shrubs or trees. More specifically, herbs are plants which are used medicinally or for their flavour or scent. Herbs with medicinal properties are a useful and an effective source of treatment for various disease processes. Herbal extracts have been successfully used in dentistry as tooth cleaning and antimicrobial plaque agents. The use of herbal medicines continues to expand rapidly across the world. Many people take herbal medicines or herbal products now for their health care in different national healthcare settings. Herbal extracts have been used in dentistry for reducing inflammation, as antimicrobial plaque agents, for preventing release of histamine and as antiseptics, antioxidants, antimicrobials, antifungals, antibacterials, antivirals and analgesics. They also aid in healing and are effective in controlling microbial plaque in gingivitis and periodontitis, thereby improving immunity. PMID:24086929

  18. Emerging trends of herbal care in dentistry.

    PubMed

    Kumar, Gunjan; Jalaluddin, Md; Rout, Purnendu; Mohanty, Rajat; Dileep, C L

    2013-08-01

    Herbs are staging a comeback and herbal 'renaissance' is happening all over the globe. The herbal products, today, symbolize safety, in contrast to the synthetics that are regarded as unsafe to humans and the environment. A herb, botanically speaking, is any plant that lacks the woody tissue which is characteristic of shrubs or trees. More specifically, herbs are plants which are used medicinally or for their flavour or scent. Herbs with medicinal properties are a useful and an effective source of treatment for various disease processes. Herbal extracts have been successfully used in dentistry as tooth cleaning and antimicrobial plaque agents. The use of herbal medicines continues to expand rapidly across the world. Many people take herbal medicines or herbal products now for their health care in different national healthcare settings. Herbal extracts have been used in dentistry for reducing inflammation, as antimicrobial plaque agents, for preventing release of histamine and as antiseptics, antioxidants, antimicrobials, antifungals, antibacterials, antivirals and analgesics. They also aid in healing and are effective in controlling microbial plaque in gingivitis and periodontitis, thereby improving immunity. PMID:24086929

  19. Respiratory protection in the health care setting.

    PubMed

    Schaefer, J A

    1997-01-01

    Respiratory protection is of increased importance due to the resurgence of tuberculosis. This chapter examines protective devices and regulations and explains how a program can be designed to minimize workplace hazards. Of particular value is a table detailing 12 high-efficiency particulate air respirators that meet criteria set by the Centers for Disease Control and the National Institute of Occupational Safety and Health. PMID:9353814

  20. Building a transdisciplinary approach to palliative care in an acute care setting.

    PubMed

    Daly, Donnelle; Matzel, Stephen Chavez

    2013-01-01

    A transdisciplinary team is an essential component of palliative and end-of-life care. This article will demonstrate how to develop a transdisciplinary approach to palliative care, incorporating nursing, social work, spiritual care, and pharmacy in an acute care setting. Objectives included: identifying transdisciplinary roles contributing to care in the acute care setting; defining the palliative care model and mission; identifying patient/family and institutional needs; and developing palliative care tools. Methods included a needs assessment and the development of assessment tools, an education program, community resources, and a patient satisfaction survey. After 1 year of implementation, the transdisciplinary palliative care team consisted of seven palliative care physicians, two social workers, two chaplains, a pharmacist, and End-of-Life Nursing Consortium (ELNEC) trained nurses. Palomar Health now has a palliative care service with a consistent process for transdisciplinary communication and intervention for adult critical care patients with advanced, chronic illness. PMID:23977778

  1. Innovations to reduce demand and crowding in emergency care; a review study.

    PubMed

    Mason, Suzanne; Mountain, Gail; Turner, Janette; Arain, Mubashir; Revue, Eric; Weber, Ellen J

    2014-01-01

    Emergency Department demand continues to rise in almost all high-income countries, including those with universal coverage and a strong primary care network. Many of these countries have been experimenting with innovative methods to stem demand for acute care, while at the same time providing much needed services that can prevent Emergency Department attendance and later hospital admissions. A large proportion of patients comprise of those with minor illnesses that could potentially be seen by a health care provider in a primary care setting. The increasing number of visits to Emergency Departments not only causes delay in urgent care provision but also increases the overall cost. In the UK, the National Health Service (NHS) has made a number of efforts to strengthen primary healthcare services to increase accessibility to healthcare as well as address patients' needs by introducing new urgent care services. PMID:25212060

  2. Confronting Ethical and Regulatory Challenges of Emergency Care Research With Conscious Patients.

    PubMed

    Dickert, Neal W; Brown, Jeremy; Cairns, Charles B; Eaves-Leanos, Aaliyah; Goldkind, Sara F; Kim, Scott Y H; Nichol, Graham; O'Conor, Katie J; Scott, Jane D; Sinert, Richard; Wendler, David; Wright, David W; Silbergleit, Robert

    2016-04-01

    Barriers to informed consent are ubiquitous in the conduct of emergency care research across a wide range of conditions and clinical contexts. They are largely unavoidable; can be related to time constraints, physical symptoms, emotional stress, and cognitive impairment; and affect patients and surrogates. US regulations permit an exception from informed consent for certain clinical trials in emergency settings, but these regulations have generally been used to facilitate trials in which patients are unconscious and no surrogate is available. Most emergency care research, however, involves conscious patients, and surrogates are often available. Unfortunately, there is neither clear regulatory guidance nor established ethical standards in regard to consent in these settings. In this report-the result of a workshop convened by the National Institutes of Health Office of Emergency Care Research and Department of Bioethics to address ethical challenges in emergency care research-we clarify potential gaps in ethical understanding and federal regulations about research in emergency care in which limited involvement of patients or surrogates in enrollment decisions is possible. We propose a spectrum of approaches directed toward realistic ethical goals and a research and policy agenda for addressing these issues to facilitate clinical research necessary to improve emergency care. PMID:26707358

  3. Nosocomial infection control in healthcare settings: Protection against emerging infectious diseases.

    PubMed

    Fu, Chuanxi; Wang, Shengyong

    2016-01-01

    The Middle East respiratory syndrome (MERS) outbreak in Korea in 2015 may be attributable to poor nosocomial infection control procedures implemented. Strict infection control measures were taken in the hospital where an imported case with MERS was treated in southern China and 53 health care workers were confirmed to be MERS-CoV negative. Infection control in healthcare settings, in which patients with emerging infectious diseases such as MERS, Ebola virus disease, and the severe acute respiratory syndrome (SARS) are diagnosed and treated, are often imperfect. When it comes to emerging or unknown infectious diseases, before the imported case was finally identified or community transmission was reported, cases have often occurred in clusters in healthcare settings. Nosocomial infection control measures should be further strengthened among the workers and inpatients in designated healthcare settings that accommodate suspected cases suffering from emerging or unknown infectious diseases. PMID:27068809

  4. Asthma Care in Resource-Poor Settings

    PubMed Central

    2011-01-01

    Asthma prevalence in low-to middle-income countries is at least the same or higher than in rich countries, but with increased severity. Lack of control in these settings is due to various factors such as low accessibility to effective medications, multiple and uncoordinated weak infrastructures of medical services for the management of chronic diseases such as asthma, poor compliance with prescribed therapy, lack of asthma education, and social and cultural factors. There is an urgent requirement for the implementation of better ways to treat asthma in underserved populations, enhancing the access to preventive medications and educational approaches with modern technological methods. PMID:23282401

  5. Sedation in the intensive care setting

    PubMed Central

    Hughes, Christopher G; McGrane, Stuart; Pandharipande, Pratik P

    2012-01-01

    Critically ill patients are routinely provided analgesia and sedation to prevent pain and anxiety, permit invasive procedures, reduce stress and oxygen consumption, and improve synchrony with mechanical ventilation. Regional preferences, patient history, institutional bias, and individual patient and practitioner variability, however, create a wide discrepancy in the approach to sedation of critically ill patients. Untreated pain and agitation increase the sympathetic stress response, potentially leading to negative acute and long-term consequences. Oversedation, however, occurs commonly and is associated with worse clinical outcomes, including longer time on mechanical ventilation, prolonged stay in the intensive care unit, and increased brain dysfunction (delirium and coma). Modifying sedation delivery by incorporating analgesia and sedation protocols, targeted arousal goals, daily interruption of sedation, linked spontaneous awakening and breathing trials, and early mobilization of patients have all been associated with improvements in patient outcomes and should be incorporated into the clinical management of critically ill patients. To improve outcomes, including time on mechanical ventilation and development of acute brain dysfunction, conventional sedation paradigms should be altered by providing necessary analgesia, incorporating propofol or dexmedetomidine to reach arousal targets, and reducing benzodiazepine exposure. PMID:23204873

  6. Point-of-care ultrasonography by pediatric emergency medicine physicians.

    PubMed

    Marin, Jennifer R; Lewiss, Resa E

    2015-04-01

    Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews. PMID:25825532

  7. [Structure, organization and capacity problems in emergency medical services, emergency admission and intensive care units].

    PubMed

    Dick, W

    1994-01-01

    Emergency medicine is subjected worldwide to financial stringencies and organizational evaluations of cost-effectiveness. The various links in the chain of survival are affected differently. Bystander assistance or bystander CPR is available in only 30% of the emergencies, response intervals--if at all required by legislation--are observed to only a limited degree or are too extended for survival in cardiac arrest. A single emergency telephone number is lacking. Too many different phone numbers for emergency reporting result in confusion and delays. Organizational realities are not fully overcome and impair efficiency. The position of the emergency physician in the EMS System is inadequately defined, the qualification of too many emergency physicians are unsatisfactory. In spite of this, emergency physicians are frequently forced to answer out-of-hospital emergency calls. Conflicts between emergency physicians and EMTs may be overcome by providing both groups with comparable qualifications as well as by providing an explicit definition of emergency competence. A further source of conflict occurs at the juncture of prehospital and inhospital emergency care in the emergency department. Deficiencies on either side play a decisive role. At least in principle there are solutions to the deficiencies in the EMSS and in intensive care medicine. They are among others: Adequate financial compensation of emergency personnel, availability of sufficient numbers of highly qualified personnel, availability of a central receiving area with an adjacent emergency ward, constant information flow to the dispatch center on the number of available emergency beds, maintaining 5% of all beds as emergency beds, establishing intermediate care facilities. Efficiency of emergency physician activities can be demonstrated in polytraumatized patients or in patients with ventricular fibrillation or acute myocardial infarction, in patients with acute myocardial insufficiency and other emergency

  8. Noddings's caring ethics theory applied in a paediatric setting.

    PubMed

    Lundqvist, Anita; Nilstun, Tore

    2009-04-01

    Since the 1990s, numerous studies on the relationship between parents and their children have been reported on in the literature and implemented as a philosophy of care in most paediatric units. The purpose of this article is to understand the process of nurses' care for children in a paediatric setting by using Noddings's caring ethics theory. Noddings's theory is in part described from a theoretical perspective outlining the basic idea of the theory followed by a critique of her work. Important conceptions in her theory are natural caring (reception, relation, engrossment, motivational displacement, reciprocity) and ethical caring (physical self, ethical self, and ethical ideal). As a nurse one holds a duty of care to patients and, in exercising this duty, the nurse must be able to develop a relationship with the patient including giving the patient total authenticity in a 'feeling with' the patient. Noddings's theory is analysed and described in three examples from the paediatrics. In the first example, the nurse cared for the patient in natural caring while in the second situation, the nurse strived for the ethical caring of the patient. In the third example, the nurse rejected the impulse to care and deliberately turned her back to ethics and abandoned her ethical caring. According to the Noddings's theory, caring for the patient enables the nurse to obtain ethical insights from the specific type of nursing care which forms an important contribution to an overall increase of an ethical consciousness in the nurse. PMID:19291199

  9. [Setting up supportive care in oncology: reflexions and suggestions.].

    PubMed

    Colombat, P; Antoun, S; Aubry, R; Banterla-Dadon, I; Barruel, F; Bonel, J-M; Bonnin, J-C; Chassignol, L; Chollet, A; Chvetzoff, G; D'Hérouville, D; Drouart, M; Gaillet, H; Ganem, G; Krakowski, I; Morigault, M-O; Nallet, G; Rolland, J; Suc, A

    2009-09-01

    A group of 19 health professionals implicated in supportive care wanted to suggest some reflexions for organization, setting and evaluation of the supportive care in institutions and health territories. The suggested organization must be applicable to any cancer patient and the place of the care whatever the age, the stage of the disease; in the future, must be applicable to any patient with serious chronic illness. This organization must allow to optimize the accompaniment and the care of the patients and their close relations by 1) precise and regular analysis of their needs; 2) the respect of the continuity of the health care; 3) the setting of collaborative practice and transversality in the care. It is not a new medical speciality but a coordination of competences for patients and their families. PMID:19903599

  10. The current scenario of emergency care policies in Brazil

    PubMed Central

    2013-01-01

    Background The regulation of emergency care has featured prominently in Brazil’s federal health agenda since the 2000s. The aim of this study was to review up to the present day the implementation of the National Emergency Care Policy. Methods The methods employed were documental review, analysis of official data and 11 interviews conducted with federal, state and local managers. The results were analyzed using Giddens’ Structuration Theory, relating the cognitive abilities of the agents to their action strategies, in view of the structural dimensions, rules and resources provided by the federal administration. Results Federal policy for emergency care in Brazil can be divided into three stages: from 1998 to 2003, the initial regulation; from 2004 to 2008, the expansion of the Mobile Emergency Medical Services (SAMU, in Brazil); and from 2009 onwards, the implementation of stationary pre-hospital care facilities, known as Emergency Care Units (UPA). The structuration elements identified for the emergency care policy were the public health system guidelines, legislation, standards and federal financing. Significant restrictions were found such as lack of hospital beds and intensive care treatment, gaps in the information system for producing evidence for management, ineffective Management Committees, as well as a low degree of commitment among physicians to the services. Conclusion Considering the financial constraints imposed on the SUS (Brazilian Unified Health System), emergency care was identified as a political priority with financial support. The individual actions by emergency care workers and governmental agents typified the first period of the policy, structuring the basis and producing changes in the circumstances of action. Federal strategies can be equated to the rules and resources provided to support the implementation process of the policy. PMID:23425342

  11. Examination of Negative Peer Contagion in a Residential Care Setting

    ERIC Educational Resources Information Center

    Huefner, Jonathan C.; Ringle, Jay L.

    2012-01-01

    There has been ongoing concern about the negative impact of residential treatment on youth in care. Research examining the impact of negative peer influence in juvenile justice, education, and residential care settings is reviewed. A study was conducted to examine the impact of negative peer contagion on the level of problem behavior in a…

  12. Social Antecedents of Learned Helplessness in the Health Care Setting.

    ERIC Educational Resources Information Center

    Solomon, Kenneth

    1982-01-01

    Examines social factors that lead to the development of learned helplessness in elderly persons in the health care setting, including stereotyping elderly by health care professionals, effects of unequal interpersonal exchange, and behaviors associated with sick and healer roles. Discusses programatic and educational prophylaxis and solutions to…

  13. Management of Teenage Pregnancies in Three Different Health Care Settings.

    ERIC Educational Resources Information Center

    Tatelbaum, Robert

    1978-01-01

    This paper reports a retrospective study undertaken to determine if differences existed in obstetric outcome, contraceptive usage, and repeat pregnancy rates of teenage patients cared for in three different health care settings: the Rochester Adolescent Maternity Project (RAMP), a traditional obstetric clinic, and a neighborhood health center.…

  14. Assessing Health Literacy in Diverse Primary Care Settings

    ERIC Educational Resources Information Center

    McCune, Renee L.

    2010-01-01

    Patient health literacy skills are critical to effective healthcare communication and safe care delivery in primary care settings. Methods and strategies to identify patient health literacy (HL) capabilities and provider/staff knowledge, attitudes and beliefs (KAB) regarding HL must be known before addressing provider/staff communication skills.…

  15. The Role of Child Care Settings in Obesity Prevention

    ERIC Educational Resources Information Center

    Story, Mary; Kaphingst, Karen M.; French, Simone

    2006-01-01

    Mary Story, Karen Kaphingst, and Simone French argue that researchers and policymakers focused on childhood obesity have paid insufficient attention to child care. Although child care settings can be a major force in shaping children's dietary intake, physical activity, and energy balance--and thus in combating the childhood obesity…

  16. Emergency medical care in developing countries: is it worthwhile?

    PubMed Central

    Razzak, Junaid A.; Kellermann, Arthur L.

    2002-01-01

    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

  17. Providing adolescent sexual health care in the pediatric emergency department: views of health care providers

    PubMed Central

    Miller, Melissa K.; Mollen, Cynthia J.; O’Malley, Donna; Owens, Rhea L.; Maliszewski, Genevieve A.; Goggin, Kathy; Patricia, Kelly

    2014-01-01

    Objective The purpose of this study was to explore health care providers’ (HCPs) attitudes and beliefs about adolescent sexual health care provision in the emergency department (ED) and to identify barriers to a role of a health educator-based intervention. Methods We conducted focused, semi-structured interviews of HCPs from the ED and Adolescent Clinic of a children’s hospital. The interview guide was based on the Theory of Planned Behavior and its constructs: attitudes, subjective norms, perceived behavioral control, and intention to facilitate care. We used purposive sampling and enrollment continued until themes were saturated. Interviews were recorded and transcribed. Transcripts were analyzed using directed content analysis. Results Twenty-nine interviews were required for saturation. Participants were 12 physicians, 12 nurses, 3 nurse practitioners and 2 social workers; the majority (83%) were female. Intention to facilitate care was influenced by HCP perception of 1) their professional role, 2) the role of the ED (focused vs. expanded care), and 3) need for patient safety. HCPs identified three practice referents: patients/families, peers and administrators, and professional organizations. HCPs perceived limited behavioral control over care delivery because of time constraints, confidentiality issues, and comfort level. There was overall support for a health educator and many felt the educator could help overcome barriers to care. Conclusion Despite challenges unique to the ED, HCPs were supportive of the intervention and perceived the health educator as a resource to improve adolescent care and services. Future research should evaluate efficacy and costs of a health educator in this setting. PMID:24457494

  18. Emergency Wound Care After a Natural Disaster

    MedlinePlus

    ... page: About CDC.gov . Natural Disasters and Severe Weather Earthquakes Being Prepared Emergency Supplies Home Hazards Indoor ... Heat Prevention Guide (Part 3 of 3) Hot Weather Tips Heat Stress in Older Adults FAQs Extreme ...

  19. Emerging trends in health care finance.

    PubMed

    Sterns, J B

    1994-01-01

    Access to capital will become more difficult. Capital access is dependent on ability to repay debt, which, in turn, is dependent on internally generated cash flows. Under any health care reform proposal, revenue inflows will be slowed. The use of corporate finance techniques to limit financial risk and lower cost will be a permanent response to fundamental changes to the health care system. These changes will result in greater balance sheet management, centralized capital allocation, and alternative sources of capital. PMID:7614219

  20. The Influence of Setting on Care Coordination for Childhood Asthma

    PubMed Central

    Kelly, R. Patrick; Stoll, Shelley C.; Bryant-Stephens, Tyra; Janevic, Mary R.; Lara, Marielena; Ohadike, Yvonne U.; Persky, Victoria; Ramos-Valencia, Gilberto; Uyeda, Kimberly; Malveaux, Floyd J.

    2015-01-01

    Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings—school district, clinic or health care system, and community—and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team. PMID:26232778

  1. Use of the emergency department for nonurgent care during regular business hours.

    PubMed Central

    Burnett, M G; Grover, S A

    1996-01-01

    OBJECTIVE: To characterize the patient population seeking care for nonurgent medical problems at an emergency department during regular business hours and to determine why these patients chose the emergency department over alternative care sites. DESIGN: Patient survey (self-administered questionnaire). SETTING: Emergency department at a tertiary care hospital in Montreal. PATIENTS: All ambulatory patients presenting on weekdays between 8 am and 5 pm from Nov. 10 to Dec. 8, 1993, whose condition was determined to be nonurgent. Eligible patients had to be residents of Montreal, who did not have a pre-arranged consultation at the emergency department. Of 202 consecutive eligible patients, 200 agreed to participate. OUTCOME MEASURES: Description of events leading to the visit, including possible attempts by patients to contact their regular physician; patients' knowledge of alternative care options such as provincial CLSGs (centres locaux des services communautaires) and private walk-in clinics. RESULTS: Of the 200 patients 152 (76%) stated that they had not visited an emergency department within the previous month, and only 10 (5%) stated that they were in extreme pain. At least 70% were aware of alternative care options, however, 120 (60%) felt that the emergency department was the best place for them to receive care for their medical problem. In all, 81 patients (40%) were referred to the emergency department; 62 (77%) were referred by a health care professional, 46 (57%) by a physician. CONCLUSION: Most patients are aware of alternatives to the emergency department for care of nonurgent medical problems. Nevertheless, a large number are being referred to the emergency department during regular business hours by health care professionals. This inefficient use of expensive hospital resources requires further investigation. PMID:8616737

  2. Creating Discursive Order at the End of Life: The Role of Genres in Palliative Care Settings

    ERIC Educational Resources Information Center

    Schryer, Catherine; McDougall, Allan; Tait, Glendon R.; Lingard, Lorelei

    2012-01-01

    This article investigates an emerging practice in palliative care: dignity therapy. Dignity therapy is a psychotherapeutic intervention that its proponents assert has clinically significant positive impacts on dying patients. Dignity therapy consists of a physician asking a patient a set of questions about his or her life and returning to the…

  3. [Specific features of emergency dental care in pregnant women].

    PubMed

    Anisimova, E N; Axamit, L A; Manukhina, E I; Letunova, N Yu; Golikova, A M; Fedotova, T M

    2016-01-01

    The aim of the study was to evaluate the algorithm of safe emergency dental care in pregnant patients. Eighty-five pregnant women aged 20-35 were included in the study. The paper presents elaborated state-of-the-art guidelines for emergency dental care in pregnant patients. Articaine 4% with epinephrine 1:200,000 is recommended as a choice agent for local anesthesia in these patients. PMID:27239992

  4. Health reform: setting the agenda for long term care.

    PubMed

    Hatch, O G; Wofford, H; Willging, P R; Pomeroy, E

    1993-06-01

    The White House Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton, is expected to release its prescription for health care reform this month. From the outset, Clinton's mandate was clear: to provide universal coverage while reining in costs for delivering quality health care. Before President Clinton was even sworn into office, he had outlined the major principles that would shape the health reform debate. Global budgeting would establish limits on all health care expenditures, thereby containing health costs. Under a system of managed competition, employers would form health alliances for consumers to negotiate for cost-effective health care at the community level. So far, a basic approach to health care reform has emerged. A key element is universal coverage--with an emphasis on acute, preventive, and mental health care. Other likely pieces are employer-employee contributions to health care plans, laws that guarantee continued coverage if an individual changes jobs or becomes ill, and health insurance alliances that would help assure individual access to low-cost health care. What still is not clear is the extent to which long term care will be included in the basic benefits package. A confidential report circulated by the task force last month includes four options for long term care: incremental Medicaid reform; a new federal/state program to replace Medicaid; a social insurance program for home and community-based services; or full social insurance for long term care. Some work group members have identified an additional option: prefunded long term care insurance.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10126659

  5. Cognitive design of a digital desk for the emergency room setting

    PubMed Central

    Bang, Magnus; Prytz, Erik; Rybing, Jonas; Timpka, Toomas

    2014-01-01

    Digital desk technology has a still mainly unexplored potential to support the everyday work of collaborating clinicians. This paper presents ER Desk – a digital desk that was designed to specifically support a team of healthcare professionals working in an emergency room setting. The underlying design requirements were elicited in a comprehensive distributed cognition study of paper-based practices in an emergency room of a middle-sized Swedish hospital. We present the user interface and visualization requirements for digital desks for small clinical emergency room teams. Moreover, we discuss key design issues more generally with a focus on supporting team awareness, cognition, and collaborative routines of healthcare personnel working in clinical environments such as emergency rooms and intensive care units. PMID:25954329

  6. Evidence Based Order Sets as a Nursing Care Planning System

    PubMed Central

    LaCrosse, Lisa M.; Heermann, Judith; Azevedo, Karen; Sorrentino, Catherine; Straub, Dawn; O'Dowd, Gloria

    2002-01-01

    The process for developing the nursing care planning (NCP) function for integration into a clinical information system (CIS) will be described. This NCP system uses evidence based order sets or interventions that are specific to a problem with associated patient focused goals or outcomes. The problem, order set, goal framework will eventually be used by all disciplines in the patient focused record.

  7. Comparing Chronic Pain Treatment Seekers in Primary Care versus Tertiary Care Settings

    PubMed Central

    Fink-Miller, Erin L.; Long, Dustin M.; Gross, Richard T.

    2015-01-01

    Background Patients frequently seek treatment for chronic nonmalignant pain in primary care settings. Compared with physicians who have completed extensive specialization (eg, fellowships) in pain management, primary care physicians receive much less formal training in managing chronic pain. While chronic pain represents a complicated condition in its own right, the recent increase in opioid prescriptions further muddles treatment. It is unknown whether patients with chronic pain seeking treatment in primary care differ from those seeking treatment in tertiary care settings. This study sought to determine whether patients with chronic pain in primary care reported less pain, fewer psychological variables related to pain, and lower risk of medication misuse/abuse compared with those in tertiary care. Methods Data collected from patients with chronic pain in primary care settings and tertiary care settings were analyzed for significant differences using Wilcoxon rank sum tests, Fisher exact tests, and linear regression. A host of variables among populations, including demographics, self-reported pain severity, psychological variables related to pain, and risk for opioid misuse and abuse, were compared. Results Findings suggest that primary care patients with chronic pain were similar to those in tertiary care on a host of indices and reported more severe pain. There were no significant group differences for risk of medication misuse or abuse. Conclusion It seems that primary care physicians care for a complicated group of patients with chronic pain that rivals the complexity of those seen in specialized tertiary care pain management facilities. PMID:25201929

  8. Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments

    ERIC Educational Resources Information Center

    Bennett, Kevin J.; Moore, Charity G.; Probst, Janice C.

    2007-01-01

    Context: Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits. Purpose: To develop a national estimate of uncompensated care from patients…

  9. A patient classification system for emergency events in home care.

    PubMed

    Sienkiewicz, Josephine; Wilkinson, Ginny; Cubbage, Betsy

    2007-06-01

    The purpose of this article is to describe the development of a uniform classification system that provides a way for home care agencies to classify patient priority needs for evacuation, transport, supportive care, and use of staffing resources in an emergency/disaster situation/bioterroristic event. PMID:17556919

  10. Pediatric Mental Health Emergencies and Special Health Care Needs

    PubMed Central

    Chun, Thomas H.; Katz, Emily R.; Duffy, Susan J.

    2013-01-01

    SYNOPSIS Children with mental health problems are increasingly being evaluated and treated by both pediatric primary care and pediatric emergency physicians. This article focuses on the epidemiology, evaluation, and management of the two most common pediatric mental health emergencies, suicidal and homicidal/aggressive patients, as well as the equally challenging population of children with autism or other developmental disabilities. PMID:24093903

  11. Ethical matters in rural integrated primary care settings.

    PubMed

    Mullin, Daniel; Stenger, Joseph

    2013-03-01

    Integrated primary care is particularly valuable to rural communities. Behavioral health care is often in short supply, and small or close-knit communities can intensify the stigma of seeking specialty mental health in rural settings. These and other barriers result in reduced access to needed behavioral health care. Nonetheless, rural practice of integrated primary care presents unique challenges to practitioners of multiple disciplines, including issues of competence, confidentiality, and dual relationships. This article provides an illustrative vignette to describe ethical issues in the rural practice of integrated primary care. It will review discipline-specific guidance in approaching these challenges and will offer recommendations for addressing disparities in the approaches of various disciplines engaged in the practice of integrated primary care. PMID:23566130

  12. Emergent Subjectivity in Caring Institutions for Teenagers

    ERIC Educational Resources Information Center

    Severinsson, Susanne; Nord, Catharina

    2015-01-01

    We investigate how different mealtime situations help shape teenager and staff subjectivities in two Swedish residential care homes and a special school for girls and boys, 12-15 years old, with social, emotional and behavioural difficulties. Three mealtime networks are analysed using concepts from actor-network theory, treating architectural…

  13. Customer care. Patient satisfaction in the prehospital setting.

    PubMed

    Doering, G T

    1998-09-01

    The focus of the study was to prioritize six emergency medical service treatment factors in terms of their impact upon patient satisfaction in the prehospital setting. The six treatment areas analyzed were: EMS response time; medical care provided on scene; explanation of care by the provider; the provider's ability to reduce patient anxiety; the provider's ability to meet the patient's non-medical needs; and the level of courtesy/politeness shown by the EMS provider toward the patient. Telephone interviews were conducted with both patients and bystanders to obtain their perception of how well the system met their needs. The study analyzed how the six issues were rated and then evaluated the impact an individual's low score in a category had on that person's overall rating of the service provided. The overall satisfaction rating is not a calculated score, but an overall score specified by the respondent. The effect each issue had on the respondent's overall rating was determined by averaging the overall ratings for a category's low scorers, averaging the overall ratings for high scorers and then measuring the difference. Results of the study indicate that the factor with the greatest negative impact on patient satisfaction came from a perceived lack of crew courtesy and politeness. Respondents who indicated a fair to poor score in this category decreased their overall score by 60.2%. Ratings in other categories yielded the following results: When respondents rated the response time as fair to poor, their average overall rating showed an 18.4% decrease. When respondents rated the quality of medical care as fair to poor, their average overall rating showed a decrease of 22.6%. When the crew's ability to explain what was happening to the patient was rated as fair to poor, the average overall score dropped 33.6%. When the EMT's and medic's ability to reduce the patient's anxiety was rated fair to poor, average overall score declined by 32.6%. Finally, when the crew

  14. Skills required for maritime pre-hospital emergency care.

    PubMed

    Mellor, Adrian

    2012-01-01

    Pre-hospital emergency care (PHEC) in the military has undergone major changes during the last 10 years of warfighting in the land environment. Providing this care in the maritime environment presents several unique challenges. This paper examines the clinical capabilities required of a PHEC team in the maritime environment and how this role can be fulfilled as part of Role 2 Afloat. It applies to Pre-hospital emergency care projected from a hospital not to General Duties Medical Officers at Role 1. PMID:22558737

  15. Emergency neurological care of strokes and bleeds

    PubMed Central

    Birenbaum, Dale

    2010-01-01

    Ischemic stroke and brain hemorrhage are common and challenging problems faced by emergency physicians. In this article, important details in the diagnosis and clinical management of these neurological emergencies are presented with the following goals: 1) To provide a more comprehensive understanding of the approach to the identification and management of patients who have sustained ischemic and hemorrhagic strokes; 2) to explain the importance and application of commonly used national stroke scoring and outcome scales; 3) to improve the ability to recognize important aspects in the approach and comprehensive treatment of ruptured and unruptured intracranial aneurysms; and 4) to demonstrate the difficulties in the neurological, neurosurgical, and endovascular treatment of these catastrophic diseases. PMID:20165722

  16. Getting a charge out of emergency care.

    PubMed

    Barton, Stephen; Bieker, Michael

    2007-10-01

    To help emergency department (ED) nurses effectively capture charge information, hospitals should create a one-page form that contains a list of possible charges for selection. Hospitals should use and maintain a formal protocol for ED visit charges so they can be consistently assigned. Hospitals that use coders to enter ED charges should give them workspace in the department so they can answer questions for the clinical staff and provide documentation training as needs arise. PMID:17953182

  17. Trampoline injury in New Zealand: emergency care.

    PubMed Central

    Hume, P A; Chalmers, D J; Wilson, B D

    1996-01-01

    OBJECTIVE: To examine trampoline related injuries resulting in emergency department attendance. METHODS: Cases were identified by searching free text descriptions of the circumstances of injury contained in the records of the emergency department of a large city hospital. RESULTS: 114 cases were identified for a 12 month period, giving an incidence rate of 108 per 100,000 population per year (95% confidence interval = 89 to 129) compared with 9.3 hospital admissions per 100,000 population per year (95% confidence interval = 8.3 to 10.4) for a corresponding period reported in earlier research from New Zealand. This suggested that for every one hospital admission there are approximately 12 emergency department attendances. Of the cases, 95% were aged less than 20 years. As for the earlier research, falls from the trampoline to the surrounding surface were the commonest cause of injury. In the present study, sprains and strains were the commonest type of injury (40%), and the body site most frequently involved was the lower limb (46%). CONCLUSIONS: The findings support the conclusion from earlier research that although existing trampoline standards address many of the issues relating to trampoline safety, the need remains for measures to reduce the impact of falls from the trampoline to the ground surface and to prohibit the use of trampolines as unsupervised "play equipment". PMID:9015596

  18. Emergency cardiac care. Moral, legal, and ethical considerations.

    PubMed

    Peskin, R M; Siegelman, L I

    1995-07-01

    because the limited hours of training in conscious sedation provide less medical background than is acquired during training in deep sedation and general anesthesia. In addition, the dentist is ultimately responsible for the demeanor of his or her office and staff. In the prehospital dental office setting, the matter of converting a dental office team geared to efficient delivery of dental procedures, into a team primed to perform emergency cardiac care seems daunting. This is especially so if the dentist has little undergraduate or clinical preparation for managing life-threatening emergencies. Therefore, an emergency management plan (with oversight for its implementation by the dentist) is of paramount importance. PMID:7556798

  19. Research priorities for the influence of gender on diagnostic imaging choices in the emergency department setting.

    PubMed

    Ashurst, John V; Cherney, Alan R; Evans, Elizabeth M; Kennedy Hall, Michael; Hess, Erik P; Kline, Jeffrey A; Mitchell, Alice M; Mills, Angela M; Weigner, Michael B; Moore, Christopher L

    2014-12-01

    Diagnostic imaging is a cornerstone of patient evaluation in the acute care setting, but little effort has been devoted to understanding the appropriate influence of sex and gender on imaging choices. This article provides background on this issue and a description of the working group and consensus findings reached during the diagnostic imaging breakout session at the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes." Our goal was to determine research priorities for how sex and gender may (or should) affect imaging choices in the acute care setting. Prior to the conference, the working group identified five areas for discussion regarding the research agenda in sex- and gender-based imaging using literature review and expert consensus. The nominal group technique was used to identify areas for discussion for common presenting complaints to the emergency department where ionizing radiation is often used for diagnosis: suspected pulmonary embolism, suspected kidney stone, lower abdominal pain with a concern for appendicitis, and chest pain concerning for coronary artery disease. The role of sex- and gender-based shared decision-making in diagnostic imaging decisions is also raised. PMID:25420885

  20. The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

    PubMed Central

    Stellefson, Michael; Stopka, Christine

    2013-01-01

    Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. PMID:23428085

  1. Care of spinal cord injury in non-specialist settings.

    PubMed

    Rodger, Sian

    Patient with spinal cord injuries have individualised care routines to help prevent complications. Disruption to these routines following admission to non-specialist settings can have long-term consequences. This article focuses on the key long-term problems of pressure ulcers, bladder and bowel dysfunction, and autonomic dysreflexia. Nurses working on general wards need to consider how to manage these problems when caring for patients with spinal cord injury. PMID:27544957

  2. Methodology for developing quality indicators for the care of older people in the Emergency Department

    PubMed Central

    2013-01-01

    Background Compared with younger people, older people have a higher risk of adverse health outcomes when presenting to emergency departments. As the population ages, older people will make up an increasing proportion of the emergency department population. Therefore it is timely that consideration be given to the quality of care received by older persons in emergency departments, and to consideration of those older people with special needs. Particular attention will be focused on important groups of older people, such as patients with cognitive impairment, residents of long term care and patients with palliative care needs. This project will develop a suite of quality indicators focused on the care of older persons in the emergency department. Methods/design Following input from an expert panel, an initial set of structural, process, and outcome indicators will be developed based on thorough systematic search in the scientific literature. All initial indicators will be tested in eight emergency departments for their validity and feasibility. Results of the data from the field studies will be presented to the expert panel at a second meeting. A suite of Quality Indicators for the older emergency department population will be finalised following a formal voting process. Discussion The predicted burgeoning in the number of older persons presenting to emergency departments combined with the recognised quality deficiencies in emergency department care delivery to this population, highlight the need for a quality framework for the care of older persons in emergency departments. Additionally, high quality of care is associated with improved survival & health outcomes of elderly patients. The development of well-selected, validated and economical quality indicators will allow appropriate targeting of resources (financial, education or quality management) to improve quality in areas with maximum potential for improvement. PMID:24314126

  3. Computerized databases for emergency care: what impact on patient care?

    PubMed

    Pugh, G E; Tan, J K

    1994-12-01

    A field-based evaluation is conducted of a Clinical Computerized Information System (CCIS). Following training, the use of the CCIS database, word processing and other programs by thirteen full-time practicing emergency physicians in two urban emergency departments of a University-associated teaching hospital was studied over a one-year period. A tracking program automatically logged frequency and duration of use by the physicians, and user satisfaction was assessed by a reliable and validated questionnaire instrument. Based on utilization data and verbal reports of these physicians, CCIS database searching was not only found to be easy-to-learn but was readily accessible during emergency shifts. Individual physicians were found to perform an average of 3.5 searches per month lasting a mean search time of 8 min. Positive notes about the CCIS system included ease-of-use, accuracy of data, accessibility of system, and value of output while negative perceptions included a lack of integration with other systems, a lack of system completeness, and a high subscription cost. It was suggested that a less costly telephone link to a high-volume Centre would be desirable in actual implementation of the system. PMID:7869949

  4. Considerations for emergencies & disasters in the neonatal intensive care unit.

    PubMed

    Schultz, Ronni; Pouletsos, Cheryl; Combs, Adriann

    2008-01-01

    This article outlines outside principles of emergency and disaster planning for neonatal intensive care units and includes resources available to organizations to support planning and education, and considerations for nurses developing hospital-specific neonatal intensive care unit disaster plans. Hospital disaster preparedness programs and unit-specific policies and procedures are essential in facilitating an effective response to major incidents or disasters, whether they are man-made or natural. All disasters place extraordinary stress on existing resources, systems, and personnel. If nurses in neonatal intensive care units work collaboratively to identify essential services in disasters, the result could be safer care for vulnerable patients. PMID:18664900

  5. Dependence on Emergency Care among Young Adults in the United States

    PubMed Central

    Robbins, Brett W.; Mani, Nandini; Halterman, Jill S.

    2010-01-01

    ABSTRACT BACKGROUND Young adults have a high prevalence of many preventable diseases and frequently lack a usual source of ambulatory care, yet little is known about their use of the emergency department. OBJECTIVE To characterize care provided to young adults in the emergency department. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of visits from young adults age 20 to 29 presenting to emergency departments (N = 17,048) and outpatient departments (N = 14,443) in the National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey. MAIN MEASURES Visits to the emergency department compared to ambulatory offices. RESULTS Emergency department care accounts for 21.6% of all health care visits from young adults, more than children/adolescents (12.6%; P < 0.001) or patients 30 years and over (8.3%; P < 0.001). Visits from young adults were considerably more likely to occur in the emergency department for both injury-related and non-injury-related reasons compared to children/adolescents (P < 0.001) or older adults (P < 0.001). Visits from black young adults were more likely than whites to occur in the emergency department (36.2% vs.19.2%; P < 0.001) rather than outpatient offices. The proportion of care delivered to black young adults in the emergency department increased between 1996 and 2006 (25.9% to 38.5%; P = 0.001 for trend). In 2006, nearly half (48.5%) of all health care provided to young black men was delivered through emergency departments. The urgency of young adult emergency visits was less than other age groups and few (4.7%) resulted in hospital admission. CONCLUSIONS A considerable amount of care provided to young adults is delivered through emergency departments. Trends suggest that young adults are increasingly relying on emergency departments for health care, while being seen for less urgent indications. PMID:20306149

  6. Variation in Readmission Rates by Emergency Departments and Emergency Department Providers Caring for Patients After Discharge

    PubMed Central

    Singh, Siddhartha; Lin, Yu-Li; Nattinger, Ann B.; Kuo, Yong-Fang; Goodwin, James S.

    2016-01-01

    BACKGROUND The role of the emergency department (ED) provider and ED facility in readmissions of recently discharged patients who visit the ED has not been studied. OBJECTIVE To determine the variation in readmission rates by ED facility and ED providers caring for patients after discharge. DESIGN Retrospective cohort study using multilevel, multi-variable models of 100% Texas Medicare claims data from the years 2007 to 2011. SETTING Texas acute-care hospitals and ED facilities. PATIENTS Medicare beneficiaries who visited an ED within 30 days of discharge from a hospital. INTERVENTION None. MEASUREMENT Readmission after an ED visit within 30 days of discharge from an initial hospitalization defined as a hospitalization starting the day of or the day following the ED visit. RESULTS The mean readmission rate following an ED visit was 52.67%. In 2-level models, 14.2% of ED providers readmitted significantly more patients (mean readmission rate of 67.2%) than the mean; 14.7% of ED providers readmitted significantly fewer patients (mean readmission rate of 36.8%) than the mean. After accounting for the ED facility in 3-level models, the variance for the ED providers decreased 65% from 0.2532 to 0.0893. CONCLUSIONS The risk of readmission varies by ED provider caring for patients after discharge. A large part of this variation is explained by the ED facility in which the ED providers practice. Thus, ED provider practices patterns and ED facility systems of care may be a target for interventions to reduce readmissions. PMID:26130443

  7. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol

    PubMed Central

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-01-01

    Introduction The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. Methods and analysis This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-built online platform. Two investigators will independently extract methodological variables and outcomes related to patient-level morbidity and mortality and community-level effects on resilience or emergency care capacity. Two investigators will independently assess external validity, selection bias, performance bias, measurement bias, attrition bias and confounding. We will summarise the findings using a narrative approach to highlight similarities and differences between the gathered studies. Ethics and dissemination Formal ethical approval is not required. Results The results will be disseminated through a peer-reviewed publication and knowledge translation strategy. Review registration number CRD42014009685. PMID:27194315

  8. CURVES: a mnemonic for determining medical decision-making capacity and providing emergency treatment in the acute setting.

    PubMed

    Chow, Grant V; Czarny, Matthew J; Hughes, Mark T; Carrese, Joseph A

    2010-02-01

    The evaluation of medical decision-making capacity and provision of emergency treatment in the acute care setting may present a significant challenge for both physicians-in-training and attending physicians. Although absolutely essential to the proper care of patients, recalling criteria for decision-making capacity may prove cumbersome during a medical emergency. Likewise, the requirements for providing emergency treatment must be fulfilled. This article presents a mnemonic (CURVES: Choose and Communicate, Understand, Reason, Value, Emergency, Surrogate) that addresses the abilities a patient must possess in order to have decision-making capacity, as well as the essentials of emergency treatment. It may be used in conjunction with, or in place of, lengthier capacity-assessment tools, particularly when time is of the essence. In addition, the proposed tool assists the practitioner in deciding whether emergency treatment may be administered, and in documenting medical decisions made during an acute event. PMID:20133288

  9. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 13--Extrication from Automobiles. Revised.

    ERIC Educational Resources Information Center

    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 extrication of victims from automobiles. Objectives stated for the chapter are for the student to be able to describe how to use extrication equipment properly and the correct use of the long and short backboards to…

  10. Primary health care vs. emergency medical assistance: a conceptual framework.

    PubMed

    Van Damme, W I M; Van Lerberghe, W I M; Boelaert, Marleen

    2002-03-01

    Primary health care (PHC) and emergency medical assistance (EMA) are discussed as two fundamentally different strategies of delivering health care. PHC is conceptualized as part of overall development, while EMA is delivered in disaster or emergency situations. The article contrasts the underlying paradigms, and the characteristics of care in PHC and EMA. It then analyzes the characteristics of PHC and EMA health services, their structure, management and support systems. In strategic aspects, it contrasts how managerial and financial sustainability are fundamentally different, and how the term accountability is used differently in development and disaster situations. However, while PHC and EMA, development and disaster, are clear opposite poles, many field situations in the developing world are today somewhere in-between. In such non-development, non-emergency situations, the objectives and approach will have to vary and an adapted strategy combining characteristics from PHC and EMA will have to be developed. PMID:11861586

  11. Suicide Prevention: An Emerging Priority For Health Care.

    PubMed

    Hogan, Michael F; Grumet, Julie Goldstein

    2016-06-01

    Suicide is a significant public health problem. It is the tenth leading cause of death in the United States, and the rate has risen in recent years. Many suicide deaths are among people recently seen or currently under care in clinical settings, but suicide prevention has not been a core priority in health care. In recent years, new treatment and management strategies have been developed, tested, and implemented in some organizations, but they are not yet widely used. This article examines the feasibility of improving suicide prevention in health care settings. In particular, we consider Zero Suicide, a model for better identification and treatment of patients at risk for suicide. The approach incorporates new tools for screening, treatment, and support; it has been deployed with promising results in behavioral health programs and primary care settings. Broader adoption of improved suicide prevention care may be an effective strategy for reducing deaths by suicide. PMID:27269026

  12. [Problems in the development of the emergency health care system].

    PubMed

    Hasić, Z; Sisić, I

    2000-01-01

    Since February 1994, during and after 4-years supervision of American specialists, Emergency department of Zenica hospital has been trying to implement Anglo-American working system within the hospital framework (video). Principles of quality functioning of Emergency Medical Service (EMS) are based on: Population that depends on different demographic factors and prevention programme (education of population, quality functioning of health legislation). Pre-hospital treatment depends on good quality communication and transport. Hospital treatment based on good functioning of Emergency department and Intensive care unit as well as proper coordination with other specialties. Proper implementation of items stated above depends on top-class teaching and compulsory periodical screening of attained knowledge and skills, properly organized communication, transport and technical equipment. Emergency medicine is not only a sum of urgencies from the existing conditions but a special medical discipline and it has special and unique approach to diagnosis and therapy of acute health disorders. Therefore, a main weakness in the development of emergency medicine is: no recognition of emergency medicine as a unique specialty in the most European countries, non-existing departments of emergency medicine at medical faculties, no unification of BiH emergency medicine system, undeveloped monitoring and development evaluation of emergency medicine etc. The World Association of Emergency Medicine should have an important role for emergency medicine recognition, and in its future development through links with health legislation and educational associations (ACLS, ATLS, APLS). PMID:11117025

  13. Identification of the development needs for the emergency care nursing workforce.

    PubMed

    Nixon, Val

    2008-01-01

    In 2000, the government launched their agenda to modernise the National Health Service to deliver high quality care. Within this agenda, Emergency Care provision was seen as a priority. Primarily national targets were set to reduce waiting times in Accident and Emergency (A&E) departments to no more than 4h from arrival to admission, transfer or discharge. National targets to improve access were further expanded into other facets of Emergency Care which together has resulted in major changes in the provision and delivery of emergency care. These changes have resulted in new ways of working across traditional professional and organisational boundaries resulting in the development of new professional roles; new services such as nurse led minor injury units, walk in centres, nurse practitioners and telephone triage in Out of Hours services. Locally, emergency care was a key priority in Shropshire and Staffordshire Strategic Health Authority. As a result the Workforce Development Directorate commissioned this project to scope the nursing workforce to identify nursing staff numbers; roles and titles; and educational preparation. Variations of new nursing roles and titles: educational preparation for all nursing staff; nursing staff establishments compared to national recommendations in particular Emergency Nurse Practitioners, Registered Children's Nurses and Healthcare Assistants and Out of Hours provision are key themes that have been presented together with recommendations. PMID:18519049

  14. Assessing the Physical and Architectural Features of Sheltered Care Settings.

    ERIC Educational Resources Information Center

    Moos, Rudolf H.; Lemke, Sonne

    1980-01-01

    The Physical and Architectural Features Checklist (PAF) measures physical resources of sheltered care settings in terms of nine derived dimensions. Data show that facilities which have more physical resources are seen as attractive by outside observers and pleasant by residents. Cost is not related to any PAF dimension. (Author)

  15. Filipino Arts among Elders in Institutionalized Care Settings

    ERIC Educational Resources Information Center

    de Guzman, Allan B.; Satuito, James Cyril B.; Satumba, Miko Anne E.; Segui, Diego Rey A.; Serquina, Faith Evelyn C.; Serrano, Lawrence Jan P.; Sevilla, Madelyn D.

    2011-01-01

    The use of traditional art in recreational therapies is unexplored. This paper, thus, attempts to surface the unique power of traditional Filipino arts (TFA) as synergizing lens in capturing the individual and the collective experiences of a select group of Filipino elderly in an institutionalized care setting relative to their feelings of…

  16. A Setting for Growth. Caring for Children No. 6.

    ERIC Educational Resources Information Center

    Murphy, Lois B.; Leeper, Ethel M.

    Discussed are issues in the development of a physical setting for child care facilities to encourage the physical and psychological growth of preschool children. Questions to be considered in selecting a location are given to include available space and nearness to the neighborhood being served. Encouraged is consideration of mental stimulation,…

  17. Doctoral Clinical Geropsychology Training in a Primary Care Setting

    ERIC Educational Resources Information Center

    Zweig, Richard A.; Siegel, Lawrence; Hahn, Steven; Kuslansky, Gail; Byrne, Kathy; Fyffe, Denise; Passman, Vicki; Stewart, Douglas; Hinrichsen, Gregory

    2005-01-01

    Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica,…

  18. Improving Quality of Emergency Care Through Integration of Mental Health.

    PubMed

    Okafor, Martha; Wrenn, Glenda; Ede, Victor; Wilson, Nana; Custer, William; Risby, Emile; Claeys, Michael; Shelp, Frank E; Atallah, Hany; Mattox, Gail; Satcher, David

    2016-04-01

    The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput. PMID:26711094

  19. Emergencies and Critical Care of Commonly Kept Fowl.

    PubMed

    Sabater González, Mikel; Calvo Carrasco, Daniel

    2016-05-01

    Fowl are birds belonging to one of the 2 biological orders, the game fowl or land fowl (Galliformes) and the waterfowl (Anseriformes). Studies of anatomic and molecular similarities suggest these two groups are close evolutionary relatives. Multiple fowl species have a long history of domestication. Fowl are considered food-producing animals in most countries and clinicians should follow legislation regarding reportable diseases and antibiotic use, even if they are pets. This article reviews aspects of emergency care for most commonly kept fowl, including triage, patient assessment, diagnostic procedures, supportive care, short-term hospitalization, and common emergency presentations. PMID:26948266

  20. Caring for the injured child in settings of limited resource.

    PubMed

    Stephenson, Jacob

    2016-02-01

    Children represent the most vulnerable members of our global society, a truth that is magnified when they are physically wounded. In much of the developed world, society has responded by offering protection in the form of law, injury prevention guidelines, and effective trauma systems to provide care for the injured child. Much of our world, though, remains afflicted by poverty and a lack of protective measures. As the globe becomes smaller by way of ease of travel and technology, surgeons are increasingly able to meet these children where they live and in doing so offer their hands and voices to care and protect these young ones. This article is intended as an overview of current issues in pediatric trauma care in the developing world as well as to offer some tips for the volunteer surgeon who may be involved in the care of the injured child in a setting of limited resource availability. PMID:26831134

  1. Medication administration in the domiciliary care setting: whose role?

    PubMed

    Bradford, Jennie

    2012-11-01

    Unqualified social care workers are increasingly delegated the responsibility of both assisting with and administering medication in the domiciliary care setting. This article discusses the considerations required before the delegation of these roles by both commissioners and nurses. In particular, variations in training, policies and provision are explored with reference to the Care Quality Commission guidance and Nursing and Midwifery Council standards. The levels of support and their definitions are clarified for use in policy documents, and the effectiveness of devices used to support self-care are critiqued within a legal framework. The importance of joint working to provide a seamless medication management service are highlighted using reflections on examples from practice. PMID:23124424

  2. Healing Environments: Integrative Medicine and Palliative Care in Acute Care Settings.

    PubMed

    Estores, Irene M; Frye, Joyce

    2015-09-01

    Conventional medicine is excellent at saving lives; however, it has little to offer to address the physical, mental, and emotional distress associated with life-threatening or life-limiting disease. An integrative approach to palliative care in acute care settings can meet this need by creating healing environments that support patients, families, and health care professionals. Mindful use of language enhances the innate healing response, improves communication, and invites patients and families to participate in their care. Staff should be offered access to skills training to cultivate compassion and mindful practice to enhance both patient and self-care. PMID:26333757

  3. Architecture of a prehospital emergency patient care report system (PEPRS).

    PubMed

    Majeed, Raphael W; Stöhr, Mark R; Röhrig, Rainer

    2013-01-01

    In recent years, prehospital emergency care adapted to the technology shift towards tablet computers and mobile computing. In particular, electronic patient care report (e-PCR) systems gained considerable attention and adoption in prehospital emergency medicine [1]. On the other hand, hospital information systems are already widely adopted. Yet, there is no universal solution for integrating prehospital emergency reports into electronic medical records of hospital information systems. Previous projects either relied on proprietary viewing workstations or examined and transferred only data for specific diseases (e.g. stroke patients[2]). Using requirements engineering and a three step software engineering approach, this project presents a generic architecture for integrating prehospital emergency care reports into hospital information systems. Aim of this project is to describe a generic architecture which can be used to implement data transfer and integration of pre hospital emergency care reports to hospital information systems. In summary, the prototype was able to integrate data in a standardized manner. The devised methods can be used design generic software for prehospital to hospital data integration. PMID:23920925

  4. Assuring Quality Health Care in the Emergency Department

    PubMed Central

    Letvak, Susan; Rhew, Denise

    2015-01-01

    The provision of quality healthcare is an international mandate. The provision of quality healthcare for mental health patients poses unique challenges. Nowhere is this challenge greater than in the emergency department. The purpose of this manuscript is to describe evidence-based initiatives for improving the quality of care of mental health patients in the emergency department. Specifically, the use of telepsychiatry and reducing provider biases will be presented.

  5. [Collaboration with specialists and regional primary care physicians in emergency care at acute hospitals provided by generalists].

    PubMed

    Imura, Hiroshi

    2016-02-01

    A role of acute hospitals providing emergency care is becoming important more and more in regional comprehensive care system led by the Ministry of Health, Labour and Welfare. Given few number of emergent care specialists in Japan, generalists specializing in both general internal medicine and family practice need to take part in the emergency care. In the way collaboration with specialists and regional primary care physicians is a key role in improving the quality of emergency care at acute hospitals. A pattern of collaborating function by generalists taking part in emergency care is categorized into four types. PMID:26915241

  6. Patient satisfaction with emergency oral health care in rural Tanzania.

    PubMed

    Ntabaye, M K; Scheutz, F; Poulsen, S

    1998-10-01

    Emergency oral health care, as conceived in Tanzania, is an on-demand service provided at a rural health center or dispensary by a Rural Medical Aide. The service includes: simple tooth extraction under local anesthesia, draining of abscesses, control of acute oral infection with appropriate drug therapy, first aid for maxillo-facial trauma, and recognition of oral conditions requiring patient referral for further care at the district or regional hospital dental clinic. The objective of the present study was to describe patient satisfaction with emergency oral health care services in rural Tanzania and determine the relative importance of factors influencing patient satisfaction. The study was carried out as a cross-sectional interview survey between April 1993 and May 1994 using a patient satisfaction questionnaire in rural villages in the Rungwe district of Tanzania. It included 206 patients aged 18 years or more who had received emergency oral health care between April 1993 and March 1994. Overall, 92.7% of the respondents reported that they were satisfied with the service. Patients who were married, had no formal education and lived more than 3 km from the dispensary were more likely to be satisfied with treatment. In a logistic regression model, a good working atmosphere at the dispensary, a good relationship between care provider and patients (art of care) and absence of post-treatment complications significantly influenced patient satisfaction with odds ratios of 10.3, 17.4 and 6.2, respectively. PMID:9792119

  7. Report on the International Conference on Emergency Health Care Development.

    PubMed Central

    Dines, G B

    1990-01-01

    Emergency medical services (EMS) provide rescue, field stabilization, transportation to medical facilities, and definitive care for persons experiencing medical emergencies. In order to advance worldwide development and refinement of EMS systems, and their integration with emergency preparedness and response programs, the International Conference on Emergency Health Care Development was held in Crystal City, Arlington, VA, August 15-19, 1989. The conference was supported by the Department of Health and Human Services and its Health Resources and Services Administration; the Department of Transportation and its National Highway Traffic and Safety Administration; and the Pan American Health Organization. Objectives of the conference were to clarify linkages between various levels of emergency response, to present methods for developing or improving EMS systems within societies with different resources, to demonstrate processes by which EMS systems have been developed, and to propose international emergency health care development goals. Topics included development of services in developing nations, case studies of underdeveloped countries' responses to natural disasters, and a method for updating disaster response through use of available medical resources. PMID:1968669

  8. [Essential data set's archetypes for nursing care of endometriosis patients].

    PubMed

    Spigolon, Dandara Novakowski; Moro, Claudia Maria Cabral

    2012-12-01

    This study aimed to develop an Essential Data Set for Nursing Care of Patients with Endometriosis (CDEEPE), represented by archetypes. An exploratory applied research with specialists' participation that was carried out at Heath Informatics Laboratory of PUCPR, between February and November of 2010. It was divided in two stages: CDEEPE construction and evaluation including Nursing Process phases and Basic Human Needs, and archetypes development based on this data set. CDEEPE was evaluated by doctors and nurses with 95.9% of consensus and containing 51 data items. The archetype "Perception of Organs and Senses" was created to represents this data set. This study allowed identifying important information for nursing practices contributing to computerization and application of nursing process during care. The CDEEPE was the basis for archetype creation, that will make possible structured, organized, efficient, interoperable, and semantics records. PMID:23596913

  9. Setting up and functioning of an Emergency Medicine Department: Lessons learned from a preliminary study

    PubMed Central

    Asish, K; Suresh, Varun

    2016-01-01

    Background and Aims: Tertiary care teaching hospitals remain referral centres for victims of trauma and mass casualty. Often specialists from various disciplines manage these crowded casualty areas. These age old casualty areas are being replaced, throughout the country by Emergency Medicine Departments (EMDs), presumed to be better planned to confront a crisis. We aimed to gather basic data contributive in setting up of an EMD at a tertiary care teaching hospital from the lessons learned from functioning existent systems. Methods: This is primarily a questionnaire-based descriptive study at tertiary care referral centres across the country, which was purposively selected. The study models included one from a hospital without designated EMD and the other four from hospitals with established EMDs. Direct observation and focus group meetings with experienced informants at these hospitals contributed to the data. In the absence of a validated hospital preparedness assessment scale, comparison was done with regard to quantitative, qualitative and corroborative parameters using descriptive analysis. Results: The EMDs at best practice models were headed by specialist in Emergency Medicine assisted by organised staff, had protocols for managing mass casualty incident (MCI), separate trauma teams, ergonomic use of infrastructure and public education programmes. In this regard, these hospitals seemed well organised to manage MCIs and disasters. Conclusion: The observation may provide a preliminary data useful in setting up an EMD. In the absence of published Indian literature, this may facilitate further research in this direction. Anaesthesiologists, presently an approved Faculty in Emergency Medicine training can provide creative input with regard to its initial organisation and functioning, thus widening our horizons in a country where there is a severe dearth of trained emergency physicians. PMID:27013749

  10. Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept.

    PubMed

    Choi, Bryan Y; Blumberg, Charles; Williams, Kenneth

    2016-03-01

    Mobile integrated health care and community paramedicine are models of health care delivery that use emergency medical services (EMS) personnel to fill gaps in local health care infrastructure. Community paramedics may perform in an expanded role and require additional training in the management of chronic disease, communication skills, and cultural sensitivity, whereas other models use all levels of EMS personnel without additional training. Currently, there are few studies of the efficacy, safety, and cost-effectiveness of mobile integrated health care and community paramedicine programs. Observations from existing program data suggest that these systems may prevent congestive heart failure readmissions, reduce EMS frequent-user transports, and reduce emergency department visits. Additional studies are needed to support the clinical and economic benefit of mobile integrated health care and community paramedicine. PMID:26169927

  11. Implementation of newly adopted technology in acute care settings: a qualitative analysis of clinical staff

    PubMed Central

    Langhan, Melissa L.; Riera, Antonio; Kurtz, Jordan C.; Schaeffer, Paula; Asnes, Andrea G.

    2015-01-01

    Objective Technologies are not always successfully implemented into practise. We elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. Methods A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within ten emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Results Five major categories emerged: decision-making factors, the impact on practise, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use, and access difficulties. A positive outlook, sufficient training, support staff, and user friendliness were facilitators. Conclusions This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology. PMID:25367721

  12. Implementation of newly adopted technology in acute care settings: a qualitative analysis of clinical staff.

    PubMed

    Langhan, Melissa L; Riera, Antonio; Kurtz, Jordan C; Schaeffer, Paula; Asnes, Andrea G

    2015-01-01

    Technologies are not always successfully implemented into practice. This study elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within 10 emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Five major categories emerged: decision-making factors, the impact on practice, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use and access difficulties. A positive outlook, sufficient training, support staff and user friendliness were facilitators. This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology. PMID:25367721

  13. A national survey of board-certified emergency physicians: quality of care and practice structure issues.

    PubMed

    Plantz, S H; Kreplick, L W; Panacek, E A; Mehta, T; Adler, J; McNamara, R M

    1998-01-01

    The opinions and experiences of board-certified emergency physicians regarding employment structure and finances, professional society policies, and quality of patient care have never been formally studied. A survey questionnaire was sent to a random sample of 1,050 emergency physicians certified by the American Board of Emergency Medicine. The survey contained 29 multiple choice questions. Of the 1,050, 465 (44.3%) of the surveys were returned. Respondents averaged 13.5 years of emergency medicine practice, 83% were members of the American College of Emergency Physicians, and 44% were emergency medicine residency trained. Seventy-five percent felt they had been financially exploited by the emergency department contract holder and 49% considered leaving their employer because of unfair business practices. Fifteen percent have been terminated without due process/peer review, and 11% have been forced to leave a position, move, or pay compensation because of noncompete clauses. The majority reported encountering instances of substandard emergency medical care, most commonly in settings with multihospital contract company coverage. The majority also believe their specialty societies should address issues of employment structure and quality of patient care standards. PMID:9451304

  14. Incentivizing health care behaviors in emerging adults: a systematic review

    PubMed Central

    Yu, Catherine H; Guarna, Giuliana; Tsao, Pamela; Jesuthasan, Jude R; Lau, Adrian NC; Siddiqi, Ferhan S; Gilmour, Julie Anne; Ladha, Danyal; Halapy, Henry; Advani, Andrew

    2016-01-01

    Purpose For emerging adults with chronic medical diseases, the transition from pediatric to adult health care is often a time of great upheaval, commonly associated with unhealthy self-management choices, loss to follow-up, and adverse outcomes. We conducted a systematic review to examine the use of incentive strategies to promote positive health-related behaviors in young adults with chronic medical diseases. Methods The Medline, CINAHL, Embase, PsycInfo, and Cochrane databases were searched through June 2014. Studies of any design where an incentive was used to achieve a target behavior or outcome in a pediatric or emerging adult population (age <30 years) with chronic medical conditions including addictions, were included. Results A total of 26 studies comprising 10,880 patients met our inclusion criteria after screening 10,305 abstracts and 301 full-text articles. Of these studies, 20 examined the effects of behavioral incentives on cigarette smoking or substance abuse, including alcohol; four studies explored behavioral incentives in the setting of HIV or sexual health; and two articles studied individuals with other chronic medical conditions. Seventeen articles reported a statistically significant benefit of the behavioral incentive on one or more outcomes, although only half reported follow-up after the incentive period was terminated. Conclusion While the majority of studies reported positive outcomes, these studies focused on promoting the cessation of adverse behaviors rather than promoting positive behaviors. In addition, conclusions were limited by the high risk of bias present in the majority of studies, as well as lack of follow-up after the incentive period. Whether behavioral incentives facilitate the adoption of positive health choices in this population remains to be determined. PMID:27069356

  15. An Expanded Theoretical Framework of Care Coordination Across Transitions in Care Settings.

    PubMed

    Radwin, Laurel E; Castonguay, Denise; Keenan, Carolyn B; Hermann, Cherice

    2016-01-01

    For many patients, high-quality, patient-centered, and cost-effective health care requires coordination among multiple clinicians and settings. Ensuring optimal care coordination requires a clear understanding of how clinician activities and continuity during transitions affect patient-centeredness and quality outcomes. This article describes an expanded theoretical framework to better understand care coordination. The framework provides clear articulation of concepts. Examples are provided of ways to measure the concepts. PMID:26595361

  16. Dissociative Spectrum Disorders in the Primary Care Setting.

    PubMed

    Elmore, James L.

    2000-04-01

    Dissociative disorders have a lifetime prevalence of about 10%. Dissociative symptoms may occur in acute stress disorder, posttraumatic stress disorder, somatization disorder, substance abuse, trance and possession trance, Ganser's syndrome, and dissociative identity disorder, as well as in mood disorders, psychoses, and personality disorders. Dissociative symptoms and disorders are observed frequently among patients attending our rural South Carolina community mental health center. Given the prevalence of mental illness in primary care settings and the diagnostic difficulties encountered with dissociative disorders, such illness may be undiagnosed or misdiagnosed in primary care settings. We developed an intervention model that may be applicable to primary care settings or helpful to primary care physicians. Key points of the intervention are identification of dissociative symptoms, patient and family education, review of the origin of the symptoms as a method of coping with trauma, and supportive reinforcement of cognitive and relaxation skills during follow-up visits. Symptom recognition, Education of the family, Learning new skills, and Follow-up may be remembered by the mnemonic device SELF. We present several cases to illustrate dissociative symptoms and our intervention. Physicians and other professionals using the 4 steps and behavioral approaches will be able to better recognize and triage patients with dissociative symptoms. Behaviors previously thought to be secondary to psychosis or personality disorders may be seen in a new frame of reference, strengthening the therapeutic alliance while reducing distress and acting-out behaviors. PMID:15014580

  17. Dissociative Spectrum Disorders in the Primary Care Setting

    PubMed Central

    Elmore, James L.

    2000-01-01

    Dissociative disorders have a lifetime prevalence of about 10%. Dissociative symptoms may occur in acute stress disorder, posttraumatic stress disorder, somatization disorder, substance abuse, trance and possession trance, Ganser's syndrome, and dissociative identity disorder, as well as in mood disorders, psychoses, and personality disorders. Dissociative symptoms and disorders are observed frequently among patients attending our rural South Carolina community mental health center. Given the prevalence of mental illness in primary care settings and the diagnostic difficulties encountered with dissociative disorders, such illness may be undiagnosed or misdiagnosed in primary care settings. We developed an intervention model that may be applicable to primary care settings or helpful to primary care physicians. Key points of the intervention are identification of dissociative symptoms, patient and family education, review of the origin of the symptoms as a method of coping with trauma, and supportive reinforcement of cognitive and relaxation skills during follow-up visits. Symptom recognition, Education of the family, Learning new skills, and Follow-up may be remembered by the mnemonic device SELF. We present several cases to illustrate dissociative symptoms and our intervention. Physicians and other professionals using the 4 steps and behavioral approaches will be able to better recognize and triage patients with dissociative symptoms. Behaviors previously thought to be secondary to psychosis or personality disorders may be seen in a new frame of reference, strengthening the therapeutic alliance while reducing distress and acting-out behaviors. PMID:15014580

  18. Health Care Aides' Struggle to Build and Maintain Relationships with Families in Complex Continuing Care Settings

    ERIC Educational Resources Information Center

    McGilton, Katherine S.; Guruge, Sepali; Librado, Ruby; Bloch, Lois; Boscart, Veronique

    2008-01-01

    Research on the relationships between health care aides (HCAs) and families of clients has been situated mainly in long-term care settings and includes scant findings about the perceptions of HCAs. Based on the findings of a larger qualitative study using a grounded theory approach, this paper addresses the topic of HCA-family relationships in…

  19. A Profile of Child Care Settings: Early Education and Care in 1990.

    ERIC Educational Resources Information Center

    Kisker, Ellen Eliason; And Others

    This volume combines an executive summary, a report, and appendixes, all of which comprise the findings of the Profile of Child Care Settings Study. The study collected information on the supply of formal early education and care programs by means of telephone interviews with a national sample of center directors and home-based providers of early…

  20. Managing insomnia in the primary care setting: raising the issues.

    PubMed

    Richardson, G S

    2000-02-01

    The optimal management of insomnia in the primary care setting should be viewed as a public health problem that will require specific attention. Important recent strides in the understanding of insomnia, its consequences, and its treatment do not always provide a basis for management strategies in a setting with distinct practical limitations. A somewhat different research focus will be needed if the scientific advances are to be translated into practical improvements in therapy. In primary care today, multiple agendas compete for the physician's time. Therefore, it is necessary to view diagnosis and management in terms of both what is efficient and what is optimally effective. Much can be learned from experience with medical risk factors of broad prevalence, such as hypercholesterolemia and hypertension. Large outcome trials demonstrating the benefits of drug therapy were required before pharmacologic management became standard care in the primary care setting. For insomnia, specific issues that must be addressed include the components of diagnosis that will guide therapy and affect prognosis. How can the 10% of adults with insomnia in the primary care practice be subdivided to identify those most in need of therapy? Stated another way, what are the features of insomnia that predict risk? Is duration important? Severity? Frequency? Which treatments are most effective? Which are most efficient in terms of the time required of patient and practitioner? Do treatments for insomnia produce patient satisfaction? Do they prevent adverse outcomes, such as depression and automobile accidents? Studies are now addressing many of these questions. In selecting research priorities, however, the practical application of this information in the clinical setting is important if the ultimate goal is to reduce the number of patients suffering from insomnia and its consequences. PMID:10755803

  1. Provider workload and quality of care in primary care settings: moderating role of relational climate.

    PubMed

    Mohr, David C; Benzer, Justin K; Young, Gary J

    2013-01-01

    Primary care providers are increasingly under pressure to do more with fewer resources. We examined the effect of workload on patients' experiences of quality of care, measured through approximately 44,000 patient experience surveys in a sample of 222 primary care clinics in the Veterans Health Administration. We tested the extent to which relational climate, a measure of teamwork, moderated the relationship between workload and patient ratings of quality of care. Our outcome measures included patient complaints, time spent with provider, and overall visit quality. Workload was negatively associated with patients' quality of care ratings and relational climate moderated the relation between workload and quality of care ratings. Patients seen in clinics with higher workload and greater relational climate reported better care compared with patients in clinics with higher workload but lower relational climate. Findings highlight the importance of relational climate as an important teamwork factor when managing and developing clinic policies, practices, and procedures in resource-constrained settings. PMID:23222471

  2. EMERGENCY VICTIM CARE AND RESCUE, TEXTBOOK FOR SQUADMEN.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Trade and Industrial Education Service.

    DESIGNED FOR TRAINING EMERGENCY SQUAD PERSONNEL IN RESCUE PROCEDURES AND VICTIM CARE BEYOND BASIC FIRST AID, THIS TEXTBOOK WAS DEVELOPED BY A COMMITTEE OF SQUADMEN, DOCTORS, NURSES, FIREMEN, AND STATE TRADE AND INDUSTRIAL PERSONNEL TO BE USED IN ADULT TRAINING CLASSES OF FULL-TIME OR VOLUNTEER SQUADMEN. THE INSTRUCTIONAL MATERIAL INCLUDES 26…

  3. [Reflections concerning the care process in the emergency medical services].

    PubMed

    Castañón-González, Jorge Alberto; Barrientos-Fortes, Tomás; Polanco-González, Carlos

    2016-01-01

    In this paper we share some reflections regarding the care process in the emergency medical services, as well as some of the challenges with which these fundamental services deal. We highlight the increasing amount of patients and the complexity of some of the clinical cases, which are some of the causes that lead to the overcrowding of these services. PMID:27100984

  4. Maternal Care and Attachment Security in Ordinary and Emergency Contexts.

    ERIC Educational Resources Information Center

    Posada, German; Jacobs, Amanda; Carbonell, Olga A.; Alzate, Gloria; Bustamante, Maria R.; Arenas, Angela

    1999-01-01

    Two studies examined the relationship between maternal sensitivity and infant security of attachment in home and hospital contexts. Results are discussed in terms of links between methodology and effect sizes, the generality of links between maternal care and child security, need for research on caregiving in ordinary and emergency situations, and…

  5. Availability of ambulance patient care reports in the emergency department.

    PubMed

    Shelton, Dominick; Sinclair, Paul

    2016-01-01

    Clinical handovers of patient care among healthcare professionals is vulnerable to the loss of important clinical information. A verbal report is typically provided by paramedics and documented by emergency department (ED) triage nurses. Paramedics subsequently complete a patient care report which is submitted electronically. This emergency medical system (EMS) patient care report often contains details of paramedic assessment and management that is not all captured in the nursing triage note. EMS patient care reports are often unavailable for review by emergency physicians and nurses. Two processes occur in the distribution of EMS patient care reports. The first is an external process to the ED that is influenced by the prehospital emergency medical system and results in the report being faxed to the ED. The second process is internal to the ED that requires clerical staff to distribute the fax report to accompany patient charts. A baseline audit measured the percentage of EMS patient care reports that were available to emergency physicians at the time of initial patient assessments and showed a wide variation in the availability of EMS reports. Also measured were the time intervals from patient transfer from EMS to ED stretcher until the EMS report was received by fax (external process measure) and the time from receiving the EMS fax report until distribution to patient chart (internal process measure). These baseline measures showed a wide variation in the time it takes to receive the EMS reports by fax and to distribute reports. Improvement strategies consisted of: 1. Educating ED clerical staff about the importance of EMS reports 2. Implementing a new process to minimize ED clerical staff handling of EMS reports for nonactive ED patients 3. Elimination of the automatic retrieval of old hospital charts and their distribution for ED patients 4. Introduction of an electronic dashboard for patients arriving by ambulance to facilitate more efficient distribution of

  6. Availability of ambulance patient care reports in the emergency department

    PubMed Central

    Shelton, Dominick; Sinclair, Paul

    2016-01-01

    Clinical handovers of patient care among healthcare professionals is vulnerable to the loss of important clinical information. A verbal report is typically provided by paramedics and documented by emergency department (ED) triage nurses. Paramedics subsequently complete a patient care report which is submitted electronically. This emergency medical system (EMS) patient care report often contains details of paramedic assessment and management that is not all captured in the nursing triage note. EMS patient care reports are often unavailable for review by emergency physicians and nurses. Two processes occur in the distribution of EMS patient care reports. The first is an external process to the ED that is influenced by the prehospital emergency medical system and results in the report being faxed to the ED. The second process is internal to the ED that requires clerical staff to distribute the fax report to accompany patient charts. A baseline audit measured the percentage of EMS patient care reports that were available to emergency physicians at the time of initial patient assessments and showed a wide variation in the availability of EMS reports. Also measured were the time intervals from patient transfer from EMS to ED stretcher until the EMS report was received by fax (external process measure) and the time from receiving the EMS fax report until distribution to patient chart (internal process measure). These baseline measures showed a wide variation in the time it takes to receive the EMS reports by fax and to distribute reports. Improvement strategies consisted of: 1. Educating ED clerical staff about the importance of EMS reports 2. Implementing a new process to minimize ED clerical staff handling of EMS reports for nonactive ED patients 3. Elimination of the automatic retrieval of old hospital charts and their distribution for ED patients 4. Introduction of an electronic dashboard for patients arriving by ambulance to facilitate more efficient distribution of

  7. Prevalence of Respiratory Protective Devices in U.S. Health Care Facilities: Implications for Emergency Preparedness.

    PubMed

    Wizner, Kerri; Stradtman, Lindsay; Novak, Debra; Shaffer, Ronald

    2016-08-01

    An online questionnaire was developed to explore respiratory protective device (RPD) prevalence in U.S. health care facilities. The survey was distributed to professional nursing society members in 2014 and again in 2015 receiving 322 and 232 participant responses, respectively. The purpose of this study was to explore if the emergency preparedness climate associated with Ebola virus disease changed the landscape of RPD use and awareness. Comparing response percentages from the two sampling time frames using bivariate analysis, no significant changes were found in types of RPDs used in health care settings. N95 filtering facepiece respirators continue to be the most prevalent RPD used in health care facilities, but powered air-purifying respirators are also popular, with regional use highest in the West and Midwest. Understanding RPD use prevalence could ensure that health care workers receive appropriate device trainings as well as improve supply matching for emergency RPD stockpiling. PMID:27462029

  8. Radiologist, obstetric patient, and emergency department provider survey: radiologist-patient interaction in the emergency department setting.

    PubMed

    Erlichman, David B; Stein, Marjorie W; Weiss, Amanda; Mazzariol, Fernanda

    2016-06-01

    The aim of this study was to evaluate the feasibility and acceptance of a model of direct interaction between radiologist and patients in the emergency department (ED) setting. The study population was comprised of pregnant patients accrued in a non-consecutive prospective manner from June 2014 to September 2015, who had an obstetrical ultrasound performed in the radiology department of an inner-city tertiary care hospital at the request of the ED. The feasibility and approval of direct communication between radiologist and patient were evaluated by means of a questionnaire presented by an independent observer to the ED provider, patient, and radiologist. The exam enrolled 54 patients. Ultrasound (US) exam results were divided into (31) normal live intrauterine gestation (group 1), (7) abnormal failed intrauterine gestation or ectopic pregnancy (group 2), and (16) indeterminate pregnancies that could not be placed in the former categories and may require a follow-up exam (group 3). Forty-five (83 %) ED providers approved of the radiologist's direct communication with patients. Fifty (93 %) patients stated a better understanding of the radiologist's role in their care after than before the interaction. The radiologists found the interaction with patients to be positive in 52 (96 %) cases. Direct communication between radiologist and patient yielded a good acceptance by the radiologist, ED provider, and patient. More importantly, after the encounter, the vast majority of patients reported a better understanding of the radiologist's role in their care. PMID:26965006

  9. Supporting the Integration of HIV Testing Into Primary Care Settings

    PubMed Central

    Bradley-Springer, Lucy; Kang Dufour, Mi-Suk; Koester, Kimberly A.; Beane, Stephanie; Warren, Nancy; Beal, Jeffrey; Frank, Linda Rose

    2012-01-01

    Objectives. We examined the efforts of the US network of AIDS Education and Training Centers (AETCs) to increase HIV testing capacity across a variety of clinical settings. Methods. We used quantitative process data from 8 regional AETCs for July 1, 2008, to June 30, 2009, and qualitative program descriptions to demonstrate how AETC education helped providers integrate HIV testing into routine clinical care with the goals of early diagnosis and treatment. Results. Compared with other AETC training, HIV testing training was longer and used a broader variety of strategies to educate more providers per training. During education, providers were able to understand their primary care responsibility to address public health concerns through HIV testing. Conclusions. AETC efforts illustrate how integration of the principles of primary care and public health can be promoted through professional training. PMID:22515867

  10. Introducing herbal medicine into conventional health care settings.

    PubMed

    Lee, L

    1999-01-01

    Herbal therapy is one of several holistic therapies gaining recognition within the health care community in the United States. As a discipline, herbal medicine is in its infancy regarding educational standards for credentialling, standardization, and regulation of products and clinical applications within this health care system. This article discusses professional considerations for midwives who are interested in integrating herbal healing into their clinical practices, and offers examples of how to incorporate herbal medicine into midwifery care. Resources for practitioners including books, newsletters, journals, courses, computer sites, and databases are presented. The author offers guidance for creating an herbal practice manual for the midwifery office as well as the hospital setting and for documenting herbal healing in the medical record. Collegial support, barriers to practice, liability, and insurance issues are discussed. A clinical applications section includes specific herbal formulas for preconception health, pregnancy-induced hypertension, gestational diabetes, and postdates pregnancy. PMID:10380444

  11. Implementing culture change in long-term dementia care settings.

    PubMed

    McGreevy, Jessica

    2016-01-01

    The approach to nursing in long-term care settings for people living with dementia continues to evolve from a traditional, task-oriented culture to one that is person-centred. Such change can be difficult to manage and may encounter considerable opposition; having an understanding of change management and leadership styles may help to make this transition easier. This article discusses the differences between task-oriented and person-centred care, theories of management, motivation and leadership styles, and focuses on those that are most appropriate for this type of change. An improved understanding of these theories will enable nurses to support others in the delivery of person-centred care. PMID:26938420

  12. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives

    PubMed Central

    Lim, Ching Jou; Kong, David CM; Stuart, Rhonda L

    2014-01-01

    Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of particular concern is the recent emergence of multidrug-resistant organisms among this vulnerable population. Accordingly, antimicrobial stewardship (AMS) programs have started to be introduced into the residential aged care facilities setting to promote judicious antimicrobial use. However, to successfully implement AMS programs, there are unique challenges pertaining to this resource-limited setting that need to be addressed. In this review, we summarize the epidemiology of infections in this population and review studies that explore antibiotic use and prescribing patterns. Specific attention is paid to issues relating to inappropriate or suboptimal antibiotic prescribing to guide future AMS interventions. PMID:24477218

  13. Reforming emergency care: Experts put focus on value, better alignment.

    PubMed

    2015-07-01

    While most healthcare reforms have thus far been focused outside of the ED, they nonetheless have big implications for emergency providers, according to a panel of experts who discussed the future of emergency care at a conference sponsored by the Brookings Institution in Washington, DC. Going forward, the experts noted that emergency providers need to engage on how to most-effectively deliver higher value while also achieving better alignment with primary care providers. And they highlighted reforms that are already delivering results in pioneering EDs. Through the use of high-risk care plans, a specialized protocol for chest pain, and other reforms, the ED at the University of Maryland Upper Chesapeake Health System, based in Bel Air, MD, has been able to prevent more than 500 hospital admissions in the past year. Working with partners, emergency physicians in Washington state have managed to save the state more than $32 million while also slashing narcotic prescribing to Medicaid recipients by 24%. Their interventions include a prescription drug monitoring program, a mechanism for information sharing on key data points, and the development of care plans for frequent ED utilizers. A program called Bridges to Care in Denver, CO, has thus far been able to reduce ED and hospital utilization among frequent utilizers by 40%, generating $2 million in cost-savings to the health care system. The program focuses on identifying the key drivers of utilization, and then addressing these drivers with interventions. Program developers say connecting with patients while they are still in the ED, as opposed to making follow-up phone calls, is key to the program's success. PMID:26131537

  14. Emergency Protocol and Violence Prevention in a University Setting

    ERIC Educational Resources Information Center

    Rust, Dylan

    2012-01-01

    This study analyzed the emergency protocol and violence prevention methods utilized at an American university. The four research questions were: (1) What are the sources of violence at the university? a. How has the university addressed these sources? (2) What constitutes an emergency in the eyes of the university? (3) How do emergency protocols…

  15. Intimate Partner Violence in an Outpatient Palliative Care Setting

    PubMed Central

    Wygant, Carmella; Bruera, Eduardo; Hui, David

    2013-01-01

    Although a few studies have evaluated intimate partner violence (IPV) in the oncology setting, to our knowledge no studies exist of IPV among palliative care patients. IPV may be exacerbated at the end of life because patients and their caregivers often experience significant stressors associated with physical, emotional, social, and financial burdens. We discuss IPV in the palliative care setting using the example of a patient with advanced cancer who experienced IPV. A better understanding and awareness of IPV at the end of life could help clinicians support and counsel patients and ameliorate the suffering caused by this “unspoken” trauma. We further discuss 1) the prevalence and indicators of IPV, 2) how to initiate conversations about IPV, 3) the resources available to clinicians, and 4) various management strategies. PMID:23948161

  16. The Development of Sustainable Emergency Care in Ghana: Physician, Nursing and Prehospital Care Training Initiatives

    PubMed Central

    Martel, John; Oteng, Rockefeller; Mould-Millman, Nee-Kofi; Bell, Sue Anne; Zakariah, Ahmed; Oduro, George; Kowalenko, Terry; Donkor, Peter

    2014-01-01

    Background Ghana’s first Emergency Medicine residency and nursing training programs were initiated in 2009 and 2010, respectively, at Komfo Anokye Teaching Hospital in the city of Kumasi in association with Kwame Nkrumah University of Science and Technology and the Universities of Michigan and Utah. In addition, the National Ambulance Service was commissioned initially in 2004 and has developed to include both prehospital transport services in all regions of the country and Emergency Medical Technician training. Over a decade of domestic and international partnership has focused on making improvements in emergency care at a variety of institutional levels, culminating in the establishment of comprehensive emergency care training programs. Objective We describe the history and status of novel post-graduate emergency physician, nurse and prehospital provider training programs as well as the prospect of creating a board certification process and formal continuing education program for practicing emergency physicians. Discussion Significant strides have been made in the development of emergency care and training in Ghana over the last decade, resulting in the first group of Specialist level EM physicians as of late 2012, as well as development of accredited emergency nursing curricula and continued expansion of a national EMS. Conclusion This work represents a significant move toward in-country development of sustainable, interdisciplinary, team-based emergency provider training programs designed to retain skilled healthcare workers in Ghana and may serve as a model for similar developing nations. PMID:25066956

  17. [Blood transfusion in emergency settings: French military health service experience].

    PubMed

    Sailliol, A; Ausset, S; Peytel, E

    2010-12-01

    Blood transfusion is required in a number of emergency settings and the French military health service (FMHS) has issued specific guidelines for the treatment of war casualties. These guidelines take into account European standards and laws, NATO standards, and also public sentiment regarding transfusion. These guidelines reflect a determination to control the process and to avoid the improvisation frequently associated with wartime transfusion. The evolution in warfare (terrorism and bombing more frequent than gunshot) and the wide use of body armor have deeply changed the clinical presentation of war injuries. These now involve the extremities in 80% of cases, with extensive tissue damage and heavy blood loss. The FMHS recommends that war casualties with hemorrhagic shock be brought quickly to a medical treatment facility (MTF) after first-line treatment applied through buddy aid or by medics. In the MTF, before an early Medevac, a damage control surgery will be performed, with resuscitation using freeze-dried plasma, red blood cells and fresh whole blood. The French military blood bank is responsible for blood product supply, training and medical advice regarding transfusion therapy during wartime, as well as hemovigilance. All transfusion therapy practices are periodically assessed but research on whole blood pathogen reduction is being conducted in order to reduce the residual infectious risk associated with this product. PMID:21051268

  18. Qualitative research: Observational methods in health care settings.

    PubMed Central

    Mays, N.; Pope, C.

    1995-01-01

    Clinicians used to observing individual patients, and epidemiologists trained to observe the course of disease, may be forgiven for misunderstanding the term observational method as used in qualitative research. In contrast to the clinician or epidemiologist, the qualitative researcher systematically watches people and events to find out about behaviours and interactions in natural settings. Observation, in this sense, epitomises the idea of the researcher as the research instrument. It involves "going into the field"--describing and analysing what has been seen. In health care settings this method has been insightful and illuminating, but it is not without pitfalls for the unprepared researcher. Images p183-a PMID:7613435

  19. Fluoride use in caries prevention in the primary care setting.

    PubMed

    Clark, Melinda B; Slayton, Rebecca L

    2014-09-01

    Dental caries remains the most common chronic disease of childhood in the United States. Caries is a largely preventable condition, and fluoride has proven effectiveness in the prevention of caries. The goals of this clinical report are to clarify the use of available fluoride modalities for caries prevention in the primary care setting and to assist pediatricians in using fluoride to achieve maximum protection against dental caries while minimizing the likelihood of enamel fluorosis. PMID:25157014

  20. Cloud based emergency health care information service in India.

    PubMed

    Karthikeyan, N; Sukanesh, R

    2012-12-01

    A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the

  1. Chart Card: Feasibility of a Tool for Improving Emergency Department Care in Sickle Cell Disease

    PubMed Central

    Neumayr, Lynne; Pringle, Steven; Giles, Stephen; Quirolo, Keith C.; Paulukonis, Susan; Vichinsky, Elliott P.; Treadwell, Marsha J.

    2016-01-01

    Background Patients with sickle cell disease (SCD) are concerned with emergency department care, including time to treatment and staff attitudes and knowledge. Providers are concerned about rapid access to patient information and SCD treatment protocols. A software application that stores and retrieves encrypted personal medical information on a plastic credit card–sized Chart Card was designed. Objective To determine the applicability and feasibility of the Chart Card on patient satisfaction with emergency department care and provider accessibility to patient information and care protocols. Methods One-half of 44 adults (aged ~18 years) and 50 children with SCD were randomized to either the Chart Card or usual care. Patient satisfaction was surveyed pre and post implementation of the Chart Card program, and emergency department staff was surveyed about familiarity with SCD treatment protocols. Results Fifty-two percent of patients were female (mean age, 18.8 ± 15.6); 61% had SCD SS. Adults visited an emergency department 4.2 ± 4.0 times in the year prior to enrollment vs 2.7 ± 3.7 (p = .06) visits for children, most commonly for pain. Patient emergency department care ratings of very good or excellent increased from 47% to 66% (p < .05), and ratings of staff knowledge improved. Qualitative data reflected positive comments about patient and staff experiences with the Chart Card. Conclusion Patient satisfaction with emergency department care and efficacy in health care increased post Chart Card implementation. Providers valued immediate access to patient information and SCD treatment guidelines. The technology has potential for application in the treatment of other illnesses in other settings. PMID:21141289

  2. Quality of emergency rooms and urgent care services: user satisfaction

    PubMed Central

    Lima, Cássio de Almeida; dos Santos, Bruna Tatiane Prates; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; da Costa, Fernanda Marques; Carneiro, Jair Almeida

    2015-01-01

    Objective To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. Methods A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Results Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Conclusion Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself. PMID:26313440

  3. Measuring situation awareness in emergency settings: a systematic review of tools and outcomes

    PubMed Central

    Cooper, Simon; Porter, Joanne; Peach, Linda

    2014-01-01

    Background Nontechnical skills have an impact on health care outcomes and improve patient safety. Situation awareness is core with the view that an understanding of the environment will influence decision-making and performance. This paper reviews and describes indirect and direct measures of situation awareness applicable for emergency settings. Methods Electronic databases and search engines were searched from 1980 to 2010, including CINAHL, Ovid Medline, Pro-Quest, Cochrane, and the search engine, Google Scholar. Access strategies included keyword, author, and journal searches. Publications identified were assessed for relevance, and analyzed and synthesized using Oxford evidence levels and the Critical Appraisal Skills Programme guidelines in order to assess their quality and rigor. Results One hundred and thirteen papers were initially identified, and reduced to 55 following title and abstract review. The final selection included 14 papers drawn from the fields of emergency medicine, intensive care, anesthetics, and surgery. Ten of these discussed four general nontechnical skill measures (including situation awareness) and four incorporated the Situation Awareness Global Assessment Technique. Conclusion A range of direct and indirect techniques for measuring situation awareness is available. In the medical literature, indirect approaches are the most common, with situation awareness measured as part of a nontechnical skills assessment. In simulation-based studies, situation awareness in emergencies tends to be suboptimal, indicating the need for improved training techniques to enhance awareness and improve decision-making. PMID:27147872

  4. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 12. Water Accidents, Electrical Emergencies, Hazardous Materials and Radiation Accidents. Revised.

    ERIC Educational Resources Information Center

    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 water accidents, electrical emergencies, and hazardous materials and radiation accidents. Objectives stated for the three chapters are for the students to be able to describe: emergency care for specified water…

  5. 75 FR 49507 - Recovery Policy, RP9525.4, Emergency Medical Care and Medical Evacuations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-13

    ... 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...

  6. The aspects of safety in future care settings.

    PubMed

    Pharow, Peter; Blobel, Bernd G M E; Savastano, Mario

    2007-01-01

    Communication and cooperation processes in the growing healthcare and welfare domain require a well-defined set of security services provided by a standards-based interoperable security infrastructure. Any communication and collaboration procedures require a verifiable purpose. Without such a purpose for communicating with each other, there's no need to communicate at all. But security is not the only aspect that needs to carefully be investigated. More and more, aspects of safety, privacy, and quality get importance while discussing about future-proof health information systems and health networks--regardless whether local, regional and national ones or even pan-European networks. The patient needs to be moved into the center of each care process. During the course of the current paradigm change from an organization centered via a process-related to a person-centered healthcare and welfare system approach, different new technologies need to be applied in order to meet the new challenges arising from both legal and technical circumstances. International organizations like WHO, UNESCO and the European Parliament increasingly aim at enhancing the safety aspect in future care settings, and so do many projects and studies. Beside typical information and communication devices, extended use of modern IT technology in healthcare and welfare includes large medical devices like, e.g., CT, X-ray and MR but also very tiny devices like sensors worn or implemented in a person's clothing. Safety gets on top of the nations priority list for several reasons. The paper aims at identifying some of these reasons along with possible solutions on how to increase patient's awareness, confidence, and acceptance in future care settings. PMID:17901619

  7. Does audit improve diabetes care in a primary care setting? A management tool to address health system gaps

    PubMed Central

    Pruthu, T. K.; Majella, Marie Gilbert; Nair, Divya; Ramaswamy, Gomathi; Palanivel, C.; Subitha, L.; Kumar, S. Ganesh; Kar, Sitanshu Sekhar

    2015-01-01

    Introduction: Diabetes mellitus is one of the emerging epidemics. Regular clinical and biochemical monitoring of patients, adherence to treatment and counseling are cornerstones for prevention of complications. Clinical audits as a process of improving quality of patient care and outcomes by reviewing care against specific criteria and then reviewing the change can help in optimizing care. Objective: We aimed to audit the process of diabetes care using patient records and also to assess the effect of audit on process of care indicators among patients availing diabetes care from a rural health and training center in Puducherry, South India. Materials and Methods: A record based study was conducted to audit diabetes care among patients attending noncommunicable disease clinic in a rural health center of South India. Monitoring of blood pressure (BP), blood glucose, lipid profile and renal function test were considered for auditing in accordance with standard guidelines. Clinical audit cycle (CAC), a simple management tool was applied and re-audit was done after 1-year. Results: We reviewed 156 and 180 patients records during year-1 and year-2, respectively. In the audit year-1, out of 156 patients, 78 (50%), 70 (44.9%), 49 (31.4%) and 19 (12.2%) had got their BP, blood glucose, lipid profile and renal function tests done. Monitoring of blood glucose, BP, lipid profile and renal function improved significantly by 35%, 20.7%, 36.4% and 56.1% over 1-year. Conclusion: CAC improves process of diabetes care in a primary care setting with existing resources. PMID:26604621

  8. Improving the governance of patient safety in emergency care: a systematic review of interventions

    PubMed Central

    Hesselink, Gijs; Berben, Sivera; Beune, Thimpe

    2016-01-01

    Objectives To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. Design A systematic review of the literature. Methods PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. Results Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. Conclusions Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an

  9. Tuberculosis diagnosis: primary health care or emergency medical services?

    PubMed Central

    Andrade, Rubia Laine de Paula; Scatolin, Beatriz Estuque; Wysocki, Anneliese Domingues; Beraldo, Aline Ale; Monroe, Aline Aparecida; Scatena, Lúcia Marina; Villa, Tereza Cristina Scatena

    2013-01-01

    OBJECTIVE To assess primary health care and emergency medical services performance for tuberculosis diagnosis. METHODS Cross-sectional study were conducted with 90 health professionals from primary health care and 68 from emergency medical services, in Ribeirao Preto, SP, Southeastern Brazil, in 2009. A structured questionnaire based on an instrument of tuberculosis care assessment was used. The association between health service and the variables of structure and process for tuberculosis diagnosis was assessed by Chi-square test, Fisher's exact test (both with 5% of statistical significance) and multiple correspondence analysis. RESULTS Primary health care was associated with the adequate provision of inputs and human resources, as well as with the sputum test request. Emergencial medical services were associated with the availability of X-ray equipment, work overload, human resources turnover, insufficient availability of health professionals, unavailability of sputum collection pots and do not request sputum test. In both services, tuberculosis diagnosis remained as a physician's responsibility. CONCLUSIONS Emergencial medical services presented weaknesses in its structure to identify tuberculosis suspects. Gaps on the process were identified in both primary health care and emergencial medical services. This situation highlights the need for qualification of health services that are the main gateway to health system to meet sector reforms that prioritize the timely diagnosis of tuberculosis and its control. PMID:24626553

  10. Using Electronic Health Record Systems in Diabetes Care: Emerging Practices.

    PubMed

    Veinot, Tiffany C; Zheng, Kai; Lowery, Julie C; Souden, Maria; Keith, Rosalind

    2010-01-01

    While there has been considerable attention devoted to the deployment of electronic health record (EHR) systems, there has been far less attention given to their appropriation for use in clinical encounters - particularly in the context of complex, chronic illness. The Department of Veterans' Affairs (VA) has been at the forefront of EHR adoption and, as such, provides a unique opportunity to examine a mature EHR system in widespread use. Moreover, with a high prevalence of diabetes in its patient population, the VA provides a useful platform for examining EHR use in the context of chronic disease care. We conducted a sequential, exploratory qualitative study at two VA Medical Centers in the Midwest. First, we conducted observations of 64 clinical consultations with diabetes patients. These observations involved 31 different health care providers. Second, using insights from these observations, we conducted in-depth, semi-structured interviews with 39 health care providers focusing on their use of information in diabetes patient care. Field notes and interview transcripts were analyzed using a grounded theory approach. Our analysis generated several categories of EHR use in clinical encounters: priming, structuring, assessing, informing, and continuing. We also outline some mismatches between EHR system design and VA diabetes care practices. We conclude by discussing implications of these emergent system uses for improving the software design of EHRs to better support chronic disease care, as well as for our understanding of the integration of technologies in health care. PMID:25264545

  11. [Intraosseous access for in-hospital emergencies. Intensive medical care case study].

    PubMed

    Werner, M; Daniel, H-P; Hoitz, J

    2010-07-01

    Since the release of the 2005 resuscitation guidelines intraosseous infusion has been recognized as the favorite alternative vascular access in emergency patients. It is no longer restricted to paediatric emergencies but is also considered the vascular access of choice for adult patients with difficult venous access. Intraosseous access has been used in an increasing proportion of patients especially in an out-of-hospital emergency care setting while only limited experience exists for in-hospital usage of this technique. This article reports on a case of intraosseous access performed in a critically ill patient directly after admission to the intensive care unit (ICU) due to difficult peripheral venous access. Despite the extensive medical resources available in the ICU (i.e. central venous catheterization) less invasive means were used to render appropriate care. Based on this case different strategies of critical care and possible improvements will be discussed. Intraosseous infusion should be regarded as an infrequently needed but potentially life-saving procedure that is still too often considered as an option at later stages during in-hospital emergency care. PMID:20628712

  12. Nitrous oxide/oxygen analgesia in emergency care.

    PubMed

    McKinnon, K D; Culver, D; Prno, J M

    1980-01-01

    A method of analgesia relatively new to North American emergency care involves the use of a homogeneous gas composed of 50% nitrous oxide and 50% oxygen (Entonox). The gas is administered by the patient, who holds the Entonox apparatus mask to his face and triggers gas flow by exerting negative inspiratory pressure (-1 cm. H(2)O). Worthwhile analgesia (i.e. marked or partial pain relief) was achieved in 95% of 110 emergency department patients experiencing significant pain from various sources. PMID:21297843

  13. Nitrous Oxide/Oxygen Analgesia In Emergency Care

    PubMed Central

    McKinnon, Kent D. L.; Culver, Denis; Prno, John M.

    1980-01-01

    A method of analgesia relatively new to North American emergency care involves the use of a homogeneous gas composed of 50% nitrous oxide and 50% oxygen (Entonox). The gas is administered by the patient, who holds the Entonox apparatus mask to his face and triggers gas flow by exerting negative inspiratory pressure (−1 cm. H2O). Worthwhile analgesia (i.e. marked or partial pain relief) was achieved in 95% of 110 emergency department patients experiencing significant pain from various sources. ImagesFig. 3 PMID:21297843

  14. Nurses' Comfort Level with Emergency Interventions in the Rural Hospital Setting

    ERIC Educational Resources Information Center

    Ross, Erin L.; Bell, Sue E.

    2009-01-01

    Context: One quarter of the persons living in the United States receive their emergency care in a rural hospital. Nurses employed in these hospitals see few emergencies but must be prepared to provide expert and efficient care when they do occur. Purpose: The purpose of this study was to determine the influence of registered nurses' certifications…

  15. The occupational history in the primary care setting

    SciTech Connect

    Schwartz, D.A.; Wakefield, D.S.; Fieselmann, J.F.; Berger-Wesley, M.; Zeitler, R. )

    1991-03-01

    The purpose of this study is to assess the need for services in occupational medicine, we determined the prevalence of reported occupational exposures in patients seen in the primary care setting. In addition, we evaluated the validity of our survey instrument. All patients (n = 1,112) seen over a 3-month period of time in the Primary Care Clinic at the Iowa City Veterans Affairs Medical Center were considered eligible for this study. A survey instrument was developed to obtain specific information regarding occupational exposures. The questionnaire was administered to 534 or 48% of all eligible patients. The validity of the survey instrument was evaluated by comparing chest radiographs in subjects with a history of exposure to asbestos, coal dust, or silica to those in patients who were not exposed to any of these agents. We found that almost 75% of the patients reported prior occupational exposure to at least one potentially toxic agent, and over 30% claimed exposure to at least four potentially toxic agents. The validation study indicated that the reported exposure history for asbestos, coal dust, and silica is significantly associated with anticipated changes on chest radiographs. These findings suggest that this easily administered survey instrument is valid for pneumoconiotic dust exposures and may also be valid for other potentially toxic exposures. Data from our study indicate that patients seen in the ambulatory care setting may have clinically significant occupational exposures that are relevant to their medical condition.

  16. Toward integrating a common nursing data set in home care to facilitate monitoring outcomes across settings.

    PubMed

    Keenan, Gail; Stocker, Julia; Barkauskas, Violet; Treder, Marcy; Heath, Crystal

    2003-01-01

    The purpose of our research is to identify a realistic subset of North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC), and Nursing Interventions Classification (NIC) terms specific to the home care (HC) setting. A subset of 89 NOC outcomes were identified for study in HC through a baseline survey. Three research assistants then observed the care of 258 patients to whom the 89 NOC outcomes applied and recorded the associated NANDA and NIC terms. Follow-up surveys and focus groups were conducted with the nurses and research assistants. There were 81 different NANDA and 226 NIC labels used to describe study patients' care. Only 36 of the 89 NOC labels studied were deemed clinically useful for HC. We found that expert opinion about terminology usage before actual experience under practice conditions is unreliable. PMID:15274523

  17. Emergency care in 59 low- and middle-income countries: a systematic review

    PubMed Central

    Abujaber, Samer; Makar, Maggie; Stoll, Samantha; Kayden, Stephanie R; Wallis, Lee A; Reynolds, Teri A

    2015-01-01

    Abstract Objective To conduct a systematic review of emergency care in low- and middle-income countries (LMICs). Methods We searched PubMed, CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers. We screened articles for inclusion based on their titles and abstracts in English or French. We extracted data on patient outcomes and demographics as well as facility and provider characteristics. Analyses were restricted to reports published from 1990 onwards. Findings We identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. The median mortality within emergency departments was 1.8% (interquartile range, IQR: 0.2–5.1%). Mortality was relatively high in paediatric facilities (median: 4.8%; IQR: 2.3–8.4%) and in sub-Saharan Africa (median: 3.4%; IQR: 0.5–6.3%). The median number of patients was 30 000 per year (IQR: 10 296–60 000), most of whom were young (median age: 35 years; IQR: 6.9–41.0) and male (median: 55.7%; IQR: 50.0–59.2%). Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care. Conclusion Available data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings. PMID:26478615

  18. [Ethics in pediatric emergencies: Care access, communication, and confidentiality].

    PubMed

    Benoit, J; Berdah, L; Carlier-Gonod, A; Guillou, T; Kouche, C; Patte, M; Schneider, M; Talcone, S; Chappuy, H

    2015-05-01

    Children suffer most from today's increasing precariousness. In France, access to care is available for all children through various structures and existing measures. The support for foreign children is overseen by specific legislation often unfamiliar to caregivers. Pediatric emergencies, their location, organization, actors, and patient flow are a particular environment that is not always suitable to communication and may lead to situations of abuse. Communication should not be forgotten because of the urgency of the situation. The place of the child in the dialogue is often forgotten. Considering the triangular relationship, listening to the child and involving the parents in care are the basis for a good therapeutic alliance. Privacy and medical confidentiality in pediatric emergencies are governed by law. However, changes in treatments and medical practices along with the variety of actors involved imply both individual and collective limitations, to the detriment of medical confidentiality. PMID:25840466

  19. Mental health-related stigma in health care and mental health-care settings.

    PubMed

    Henderson, Claire; Noblett, Jo; Parke, Hannah; Clement, Sarah; Caffrey, Alison; Gale-Grant, Oliver; Schulze, Beate; Druss, Benjamin; Thornicroft, Graham

    2014-11-01

    This Review considers the evidence for mental-health-related stigma in health-care and mental-health-care settings. Do mental-health-care and other health-care professionals stigmatise people using their services? If so, what are the effects on quality of mental and physical health care? How can stigma and discrimination in the context of health care be reduced? We show that the contact mental-health-care professionals have with people with mental illness is associated with positive attitudes about civil rights, but does not reduce stigma as does social contact such as with friends or family members with mental illness. Some evidence suggests educational interventions are effective in decreasing stigma especially for general health-care professionals with little or no formal mental health training. Intervention studies are needed to underpin policy; for instance, to decrease disparity in mortality associated with poor access to physical health care for people with mental illness compared with people without mental illness. PMID:26361202

  20. Comparison of Two Clinical Teaching Models for Veterinary Emergency and Critical Care Instruction.

    PubMed

    Conner, Bobbi J; Behar-Horenstein, Linda S; Su, Yu

    2016-01-01

    Standards to oversee the implementation and assessment of clinical teaching of emergency and critical care for veterinary students do not exist. The purpose of this study was to assess differences in the learning environment between two veterinary emergency and critical care clinical rotations (one required, one elective) with respect to caseload, technical/procedural opportunities, direct faculty contact time, client communication opportunities, and students' perception of practice readiness. The authors designed a 22-item survey to assess differences in the learning environment between the two rotations. It was sent electronically to 35 third- and fourth-year veterinary medicine students. Bivariate analysis, including the Wilcoxon signed-rank test and the t-test, were used to compare differences between pre-test and post-test scores among students. Twenty-six students' responses were included from the required rotation and nine from the elective rotation. Findings showed that students preferred the elective community emergency department setting to the required academic setting and that there were statistically significantly more positive experiences related to the variables of interest. Students saw significantly more cases at the community emergency department setting. Findings from this study offer guidance to assess students' emergency department rotations, suggest how teaching interactions can be modified for optimal learning experiences, and ensure that students receive maximal opportunities to treat patients that are representative of what they would encounter in practice. PMID:26751912

  1. Micro-skills of group formulations in care settings.

    PubMed

    Jackman, Louisa J; Wood-Mitchell, Amy; James, Ian A

    2014-01-01

    This study examines some of the micro-skills associated with the moment-to-moment decisions and actions involved in delivering group formulation sessions in dementia care settings. We discuss the therapeutic framework used by therapists from a number of Challenging Behaviour Services in the UK (Newcastle, Northumberland, South Tyneside, Teesside, Sutton and Merton, Northern Ireland) which is frequently referred to as the Newcastle or Colombo approach. Through a theoretical review and practice illustration, the study pays particular attention to the role of therapists' questions and questioning styles in group formulation sessions, providing a framework which aims to facilitate care staffs' understanding, reflection and empathy regarding their residents who are displaying 'challenging behaviours'. The study also provides a potential guide to the training of therapists working in this area and thereby attempts to benefit clinical practices in an area where pharmacological approaches are usually the treatment of choice. PMID:24381037

  2. Diabetes medication incidents in the care home setting.

    PubMed

    Milligan, Frank

    This article analyses data received from a Freedom of Information Act 2000 request made to the National Patient Safety Agency in June 2010. Information was requested about adverse drug event reports in relation to insulin therapy and oral glucose-lowering agents in the care home setting. Data identified were reported to the National Patient Safety Agency between January 12005 and December 312009 and were processed through the National Reporting and Learning Service. There were 684 reports related to insulin and 84 incidents related to oral glucose-lowering agents. The most common error involved wrong or unclear dose: 173 reports for insulin, including one death, and 20 reports for oral glucose-lowering agents. Evidence shows that residents with diabetes in care homes are at risk of harm from adverse drug events involving insulin and oral glucose-lowering agents. PMID:22662553

  3. Pain management in the acute care setting: Update and debates.

    PubMed

    Palmer, Greta M

    2016-02-01

    Pain management in the paediatric acute care setting is underutilised and can be improved. An awareness of the analgesic options available and their limitations is an important starting point. This article describes the evolving understanding of relevant pharmacogenomics and safety data of the various analgesic agents with a focus on agents available in Australia and New Zealand. It highlights the concerns with the use of codeine in children and discusses alternative oral opioids. Key features of oral, parenteral, inhaled and intranasal analgesic agents are discussed, as well as evidence supported use of sweet tasting solutions and non-pharmacological interventions. One of the biggest changes in acute care pain management has been the advent of intranasal fentanyl providing reliable potent analgesia without the need for intravenous access. The article will also address the issue of multimodal analgesia where a single agent is insufficient. PMID:27062626

  4. Management of hypertensive emergencies: implications for the critical care nurse.

    PubMed

    Schulenburg, Margaret

    2007-01-01

    Hypertensive emergencies are characterized by acute blood pressure elevations and potential for end organ damage. The critical care nurse must understand the pathophysiology to appreciate the therapeutic management and complications associated with the devastating clinical event. Stroke, renal damage and failure, retinopathy, aortic dissection, and encephalopathy are among the sequelae of severe hypertensive episodes. Intravenous medications are the treatment of choice to lower the blood pressure without risking hypoperfusion of the brain and other vital organs. PMID:17356350

  5. A strategy to improve priority setting in health care institutions.

    PubMed

    Martin, Doug; Singer, Peter

    2003-03-01

    Priority setting (also known as resource allocation or rationing) occurs at every level of every health system and is one of the most significant health care policy questions of the 21st century. Because it is so prevalent and context specific, improving priority setting in a health system entails improving it in the institutions that constitute the system. But, how should this be done? Normative approaches are necessary because they help identify key values that clarify policy choices, but insufficient because different approaches lead to different conclusions and there is no consensus about which ones are correct, and they are too abstract to be directly used in actual decision making. Empirical approaches are necessary because they help to identify what is being done and what can be done, but are insufficient because they cannot identify what should be done. Moreover, to be really helpful, an improvement strategy must utilize rigorous research methods that are able to analyze and capture experience so that past problems are corrected and lessons can be shared with others. Therefore, a constructive, practical and accessible improvement strategy must be research-based and combine both normative and empirical methods. In this paper we propose a research-based improvement strategy that involves combining three linked methods: case study research to describe priority setting; interdisciplinary research to evaluate the description using an ethical framework; and action research to improve priority setting. This describe-evaluate-improve strategy is a generalizable method that can be used in different health care institutions to improve priority setting in that context. PMID:14510309

  6. Neurohospitalists: an emerging model for inpatient neurological care.

    PubMed

    Josephson, S Andrew; Engstrom, John W; Wachter, Robert M

    2008-02-01

    Over the past decade, the hospitalist model has become a dominant system for the delivery of general adult and pediatric inpatient care. Similar forces, including national mandates to improve safety and quality and intense pressure to safely reduce length of hospital stays, that led to the remarkable growth of hospitalist medicine are now exerting pressure on neurologists. A neurohospitalist model, in which inpatient neurology specialists deliver high-quality and efficient care to neurology patients, is emerging to meet these challenges. Benefits of this system may include more frequent, timely neurology consultations in the hospital and emergency department, as well as improved quality of inpatient neurological education for residents and medical students. Challenges will involve defining the relationship of neurohospitalists with primary stroke centers, the economic feasibility of such neurohospitalist systems, and how to train members of this new field. A neurohospitalist model of care is an emerging idea in neurology that would overcome many regulatory, educational, and economic challenges facing neurologists; further research is needed to gauge the effects of this innovative approach. PMID:18306369

  7. Recognizing/accepting futility: prehospital, emergency center, operating room, and intensive care unit.

    PubMed

    Coimbra, Raul; Lee, Jeanne; Bansal, Vishal; Hollingsworth-Fridlund, Peggy

    2007-01-01

    Trauma has been perceived by the public as occurring as an isolated event, always resulting in favorable outcomes. There has therefore been a lack of discussion of futility of care and termination of care when dealing with the sick trauma patient. Several stages exist where issues of futility and early termination of care must be considered. These include the prehospital setting and involve the emergency medical service system in recognizing those patients who are nonsurvivors. Next is in the emergency room, where heroic measures may not benefit the very sick patient. In the operating room, the surgeon must always reassess and recognize when massive resuscitation will not benefit a particular trauma patient. Lastly, the intensivist must recognize those patients who may or may not benefit from continued efforts to sustain life. PMID:17579324

  8. New care model targets high-utilizing, complex patients, frees up emergency providers to focus on acute care concerns.

    PubMed

    2013-11-01

    Hennepin County Medical Center in Minneapolis, MN, has developed a new model of care, designed to meet the needs of high-utilizing hospital and ED patients with complex medical, social, and behavioral needs.The Coordinated Care Center (CCC) provides easy access to patients with a history of high utilization, and delivers multidisciplinary care in a one-stop-shop format. In one year, the approach has slashed ED visits by 37%, freeing up emergency providers to focus on patients with acute needs. In-patient care stays are down by 25%. The CCC focuses on patients with diagnoses that are primarily medical, such as CHF [congestive heart failure], COPD [chronic obstructive pulmonary disease], or diabetes. ED-based clinical coordinators keep an eye out for patients who world be good candidates for the CCC, and facilitate quick transitions when their needs would be better served in that setting. Administrators describe CCC as an ambulatory intensive care unit, with an on-site pharmacist, social worker, psychologist, and chemical health counselor as well as physicians, nurse practitioners, LPNs, and patient navigators--enough personnel to comprise two full care teams. While the model does not pay for itself under current payment models, administrators anticipate that the approach will work well under future payment reforms that focus on total cost of care. PMID:24195142

  9. 48 CFR 52.219-20 - Notice of Emerging Small Business Set-Aside.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Clauses 52.219-20 Notice of Emerging Small Business Set-Aside. As prescribed in 19.1008(b), insert the following provision: Notice of Emerging Small Business Set-Aside (JAN 1991) Offers or quotations under this acquisition are solicited from emerging small business concerns only. Offers that are not from an...

  10. Seeing the invisible: painless aortic dissection in the emergency setting.

    PubMed

    Ayrik, C; Cece, H; Aslan, O; Karcioglu, O; Yilmaz, E

    2006-03-01

    Acute dissection of the aorta can be one of the most dramatic cardiovascular emergencies. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterised as ripping or tearing in nature. However, a timely diagnosis can be elusive in the event of an atypical presentation. In this report, the authors present two patients with painless aortic dissection who were misdiagnosed during their initial evaluation in the emergency department. PMID:16498148

  11. Seeing the invisible: painless aortic dissection in the emergency setting

    PubMed Central

    Ayrik, C; Cece, H; Aslan, O; Karcioglu, O; Yilmaz, E

    2006-01-01

    Acute dissection of the aorta can be one of the most dramatic cardiovascular emergencies. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterised as ripping or tearing in nature. However, a timely diagnosis can be elusive in the event of an atypical presentation. In this report, the authors present two patients with painless aortic dissection who were misdiagnosed during their initial evaluation in the emergency department. PMID:16498148

  12. Barriers to formal emergency obstetric care services' utilization.

    PubMed

    Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

    2011-06-01

    Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be

  13. Emergency care of older people who fall: a missed opportunity

    PubMed Central

    Snooks, Helen A; Halter, Mary; Close, Jacqueline C T; Cheung, Wai‐Yee; Moore, Fionna; Roberts, Stephen E

    2006-01-01

    Introduction A high number of emergency (999) calls are made for older people who fall, with many patients not subsequently conveyed to hospital. Ambulance crews do not generally have protocols or training to leave people at home, and systems for referral are rare. The quality and safety of current practice is explored in this study, in which for the first time, the short‐term outcomes of older people left at home by emergency ambulance crews after a fall are described. Results will inform the development of care for this population. Methods Emergency ambulance data in London were analysed for patterns of attendance and call outcomes in 2003–4. All older people who were attended by emergency ambulance staff after a fall in September and October 2003, within three London areas, were identified. Those who were not conveyed to hospital were followed up; healthcare contacts and deaths within the following 2 weeks were identified. Results During 2003–4, 8% of all 999 calls in London were for older people who had fallen (n = 60 064), with 40% not then conveyed to hospital. Of 2151 emergency calls attended in the study areas during September and October 2003, 534 were for people aged ⩾65 who had fallen. Of these, 194 (36.3%) were left at home. 86 (49%) people made healthcare contacts within the 2‐week follow‐up period, with 83 (47%) people calling 999 again at least once. There was an increased risk of death (standard mortality ratio 5.4) and of hospital admission (4.7) compared with the general population of the same age in London. Comment The rate of subsequent emergency healthcare contacts and increased risk of death and hospitalisation for older people who fall and who are left at home after a 999 call are alarming. Further research is needed to explore appropriate models for delivery of care for this vulnerable group. PMID:17142584

  14. Management of orthodontic emergencies in primary care - self-reported confidence of general dental practitioners.

    PubMed

    Popat, H; Thomas, K; Farnell, D J J

    2016-07-01

    Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations. PMID:27388086

  15. Measuring quality of care in psychiatric emergencies: construction and evaluation of a Bayesian index.

    PubMed Central

    Gustafson, D H; Sainfort, F; Johnson, S W; Sateia, M

    1993-01-01

    OBJECTIVE. This study was conducted to determine whether an index for measuring quality of care for psychiatric emergencies is reliable and valid. DATA SOURCES/STUDY SETTING. The study used primary data collected over a 12-month period from two urban hospitals in the Northeast. One had 700 inpatient beds, an inpatient psychiatric unit, and community mental health personnel located in the emergency department. The other had 300 beds but none of the other hospital's features. STUDY DESIGN. The index was developed by a panel of experts in emergency psychiatry using a subjective Bayesian statistical methodology and was evaluated in terms of its ability to: (1) predict a second panel's judgments of quality; (2) predict a specific quality-related patient outcome, i.e., compliance with follow-up recommendations; (3) provide a reliable measurement procedure; and (4) detect variations in patterns of emergency department practices. DATA COLLECTION/EXTRACTION METHODS. Data were collected on 2,231 randomly selected emergency psychiatric patients (psychiatric diagnosis, alcohol abuse, nonverbal patients experiencing a psychiatric emergency, and patients with somatic complaints such as life crisis) treated in the emergency departments of the two hospitals. PRINCIPAL FINDINGS. The index predicted physician judgments of quality, was reliable, exhibited sufficient variation in scores, and was strongly associated with patient compliance. CONCLUSIONS. The study demonstrated that a subjective Bayesian model can be used to develop a reliable and valid index for measuring quality of care, with potential for practical application in management of health services. PMID:8514497

  16. Transfusion transmitted diseases in perioperative and intensive care settings.

    PubMed

    Das, Rekha; Hansda, Upendra

    2014-09-01

    Patients in the perioperative period and intensive care unit are commonly exposed to blood transfusion (BT). They are at increased risk of transfusion transmitted bacterial, viral and protozoal diseases. The risk of viral transmission has decreased steadily, but the risk of bacterial transmission remains same. Bacterial contamination is more in platelet concentrates than in red cells and least in plasma. The chances of sepsis, morbidity and mortality depend on the number of transfusions and underlying condition of the patient. Challenges to safe BT continue due to new emerging pathogens and various management problems. Strategies to restrict BT, optimal surgical and anaesthetic techniques to reduce blood loss and efforts to develop transfusion alternatives should be made. Literature search was performed using search words/phrases blood transfusion, transfusion, transfusion transmitted diseases, transfusion transmitted bacterial diseases, transfusion transmitted viral diseases, transfusion transmitted protozoal diseases or combinations, on PubMed and Google Scholar from 1990 to 2014. PMID:25535416

  17. Infection in home health care: Results from national Outcome and Assessment Information Set data

    PubMed Central

    Shang, Jingjing; Larson, Elaine; Liu, Jianfang; Stone, Patricia

    2015-01-01

    Background Patients in home health care (HHC), the fastest growing health care sector, are at risk for infection. The existing research on infection in HHC is often limited by small sample sizes, local scope of inquiry, and a lack of current data. There is no national study examining agency-level infection rates. Methods This secondary data analysis used a 20% random sample of the 2010 national Outcome and Assessment Information Set (OASIS) data. An infection case was identified when the HHC patient was hospitalized or received emergency care for respiratory infection, urinary tract infection, intravenous catheter-related infection, wound infection, or deterioration. Proportions of infection cases out of the total number of patients were calculated for the whole sample and for each HHC agency. Results The final analysis included 199,462 patients from 8,255 HHC agencies. Approximately 3.5% of patients developed infections during their HHC stay, leading to emergency care treatment or hospitalization. Seventeen percent of unplanned hospitalizations among HHC patients were caused by infections. The agency-level infection rate ranged from 0%–34%, with an average of 3.5%. Conclusion To our knowledge, this is the first study to examine the proportion of hospitalizations or emergency care treatment caused by infection in HHC and the agency-level infection rate at a national level by using OASIS data. These data demonstrate that infection is a serious problem in HHC, and infection rates varied between agencies. The variance in agency level rates may be caused by differences in infection control policies and practices. Better infection surveillance system in HHC is needed to benchmark quality of care. PMID:25681302

  18. Advances in addressing technical challenges of point-of-care diagnostics in resource-limited settings

    PubMed Central

    Wang, ShuQi; Lifson, Mark A.; Inci, Fatih; Liang, Li-Guo; Sheng, Ye-Feng; Demirci, Utkan

    2016-01-01

    The striking prevalence of HIV, TB and malaria, as well as outbreaks of emerging infectious diseases, such as influenza A (H7N9), Ebola and MERS, poses great challenges for patient care in resource-limited settings (RLS). However, advanced diagnostic technologies cannot be implemented in RLS largely due to economic constraints. Simple and inexpensive point-of-care (POC) diagnostics, which rely less on environmental context and operator training, have thus been extensively studied to achieve early diagnosis and treatment monitoring in non-laboratory settings. Despite great input from material science, biomedical engineering and nanotechnology for developing POC diagnostics, significant technical challenges are yet to be overcome. Summarized here are the technical challenges associated with POC diagnostics from a RLS perspective and the latest advances in addressing these challenges are reviewed. PMID:26777725

  19. Advances in addressing technical challenges of point-of-care diagnostics in resource-limited settings.

    PubMed

    Wang, ShuQi; Lifson, Mark A; Inci, Fatih; Liang, Li-Guo; Sheng, Ye-Feng; Demirci, Utkan

    2016-04-01

    The striking prevalence of HIV, TB and malaria, as well as outbreaks of emerging infectious diseases, such as influenza A (H7N9), Ebola and MERS, poses great challenges for patient care in resource-limited settings (RLS). However, advanced diagnostic technologies cannot be implemented in RLS largely due to economic constraints. Simple and inexpensive point-of-care (POC) diagnostics, which rely less on environmental context and operator training, have thus been extensively studied to achieve early diagnosis and treatment monitoring in non-laboratory settings. Despite great input from material science, biomedical engineering and nanotechnology for developing POC diagnostics, significant technical challenges are yet to be overcome. Summarized here are the technical challenges associated with POC diagnostics from a RLS perspective and the latest advances in addressing these challenges are reviewed. PMID:26777725

  20. Maternal mortality in resource-poor settings: policy barriers to care.

    PubMed

    Mavalankar, Dileep V; Rosenfield, Allan

    2005-02-01

    Maternal mortality remains one of the most daunting public health problems in resource-poor settings, and reductions in maternal mortality have been identified as a prominent component of the United Nations Millennium Development Goals. The World Health Organization estimates that 515000 women die each year from pregnancy-related causes, and almost all of these deaths occur in developing countries. Evidence has shown that access to and utilization of high-quality emergency obstetric care (EmOC) is central to efforts aimed at reducing maternal mortality. We analyzed health care policies that restrict access to life-saving EmOC in most resource-poor settings, focusing on examples from rural India, a country of more than 1 billion people that contributes approximately 20% to 24% of the world's maternal deaths. PMID:15671450

  1. In California, Primary Care Continuity Was Associated With Reduced Emergency Department Use And Fewer Hospitalizations

    PubMed Central

    Pourat, Nadereh; Davis, Anna C.; Chen, Xiao; Vrungos, Shelley; Kominski, Gerald F.

    2015-01-01

    The expansion of health insurance coverage to millions of Americans through the Affordable Care Act has given rise to concerns over increased use of emergency department (ED) and hospital services by previously uninsured populations. Prior research has also demonstrated that continuity with a regular source of primary care is associated with lower utilization of ED and inpatient services and with better patient satisfaction. We assessed the impact of a policy to increase patient adherence with an individual primary care provider or clinic and subsequent use of ED and hospital services in a California coverage program for previously uninsured adults called the Health Care Coverage Initiative. We found that the policy was associated with increased probability of primary care provider adherence (change in probability = 42%). Furthermore, patients who were always adherent had a higher probability of having no ED visits (change in probability = 2.0%) and no hospitalizations (change in probability = 1.7%) compared to those who were never adherent. Primary care provider adherence can reduce utilization of costly care because it allows patients’ health care needs to be managed within the less-expensive primary care setting. PMID:26153305

  2. The Role of eHealth in Optimizing Preventive Care in the Primary Care Setting.

    PubMed

    Carey, Mariko; Noble, Natasha; Mansfield, Elise; Waller, Amy; Henskens, Frans; Sanson-Fisher, Rob

    2015-01-01

    Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion of the world's morbidity and mortality burden. General practitioners (GPs) play a key role in identifying and managing modifiable health risk behaviors. However, these are often underdetected and undermanaged in the primary care setting. We describe the potential of eHealth to help patients and GPs to overcome some of the barriers to managing health risk behaviors. In particular, we discuss (1) the role of eHealth in facilitating routine collection of patient-reported data on lifestyle risk factors, and (2) the role of eHealth in improving clinical management of identified risk factors through provision of tailored feedback, point-of-care reminders, tailored educational materials, and referral to online self-management programs. Strategies to harness the capacity of the eHealth medium, including the use of dynamic features and tailoring to help end users engage with, understand, and apply information need to be considered and maximized. Finally, the potential challenges in implementing eHealth solutions in the primary care setting are discussed. In conclusion, there is significant potential for innovative eHealth solutions to make a contribution to improving preventive care in the primary care setting. However, attention to issues such as data security and designing eHealth interfaces that maximize engagement from end users will be important to moving this field forward. PMID:26001983

  3. The emerging primary care workforce: preliminary observations from the primary care team: learning from effective ambulatory practices project.

    PubMed

    Ladden, Maryjoan D; Bodenheimer, Thomas; Fishman, Nancy W; Flinter, Margaret; Hsu, Clarissa; Parchman, Michael; Wagner, Edward H

    2013-12-01

    Many primary care practices are changing the roles played by the members of their health care teams. The purpose of this article is to describe some of these new roles, using the authors' preliminary observations from 25 site visits to high-performing primary care practices across the United States in 2012-2013. These sites visits, to practices using their workforce creatively, were part of the Robert Wood Johnson Foundation-funded initiative, The Primary Care Team: Learning From Effective Ambulatory Practices.Examples of these new roles that the authors observed on their site visits include medical assistants reviewing patient records before visits to identify care gaps, ordering and administering immunizations using protocols, making outreach calls to patients, leading team huddles, and coaching patients to set self-management goals. The registered nurse role has evolved from an emphasis on triage to a focus on uncomplicated acute care, chronic care management, and hospital-to-home transitions. Behavioral health providers (licensed clinical social workers, psychologists, or licensed counselors) were colocated and integrated within practices and were readily available for immediate consults and brief interventions. Physicians have shifted from lone to shared responsibility for patient panels, with other team members empowered to provide significant portions of chronic and preventive care.An innovative team-based primary care workforce is emerging. Spreading and sustaining these changes will require training both health professionals and nonprofessionals in new ways. Without clinical experiences that model this new team-based care and role models who practice it, trainees will not be prepared to practice as a team. PMID:24128622

  4. Late-life depression in the primary care setting: Challenges, collaborative care, and prevention

    PubMed Central

    Hall, Charles A.; Reynolds, Charles F.

    2014-01-01

    Late-life depression is highly prevalent worldwide. In addition to being a debilitating illness, it is a risk factor for excess morbidity and mortality. Older adults with depression are at risk for dementia, coronary heart disease, stroke, cancer and suicide. Individuals with late-life depression often have significant medical comorbidity and, poor treatment adherence. Furthermore, psychosocial considerations such as gender, ethnicity, stigma and bereavement are necessary to understand the full context of late-life depression. The fact that most older adults seek treatment for depression in primary care settings led to the development of collaborative care interventions for depression. These interventions have consistently demonstrated clinically meaningful effectiveness in the treatment of late-life depression. We describe three pivotal studies detailing the management of depression in primary care settings in both high and low-income countries. Beyond effectively treating depression, collaborative care models address additional challenges associated with late-life depression. Although depression treatment interventions are effective compared to usual care, they exhibit relatively low remission rates and small to medium effect sizes. Several studies have demonstrated that depression prevention is possible and most effective in at-risk older adults. Given the relatively modest effects of treatment in averting years lived with disability, preventing late-life depression at the primary care level should be highly prioritized as a matter of health policy. PMID:24996484

  5. Noise Pollution in Intensive Care Units and Emergency Wards

    PubMed Central

    Khademi, Gholamreza; Roudi, Masoumeh; Shah Farhat, Ahmad; Shahabian, Masoud

    2011-01-01

    Introduction: The improvement of technology has increased noise levels in hospital Wards to higher than international standard levels (35-45 dB). Higher noise levels than the maximum level result in patient’s instability and dissatisfaction. Moreover, it will have serious negative effects on the staff’s health and the quality of their services. The purpose of this survey is to analyze the level of noise in intensive care units and emergency wards of the Imam Reza Teaching Hospital, Mashhad. Procedure: This research was carried out in November 2009 during morning shifts between 7:30 to 12:00. Noise levels were measured 10 times at 30-minute intervals in the nursing stations of 10 wards of the emergency, the intensive care units, and the Nephrology and Kidney Transplant Departments of Imam Reza University Hospital, Mashhad. The noise level in the nursing stations was tested for both the maximum level (Lmax) and the equalizing level (Leq). The research was based on the comparison of equalizing levels (Leq) because maximum levels were unstable. Results: In our survey the average level (Leq) in all wards was much higher than the standard level. The maximum level (Lmax) in most wards was 85-86 dB and just in one measurement in the Internal ICU reached 94 dB. The average level of Leq in all wards was 60.2 dB. In emergency units, it was 62.2 dB, but it was not time related. The highest average level (Leq) was measured at 11:30 AM and the peak was measured in the Nephrology nursing station. Conclusion: The average levels of noise in intensive care units and also emergency wards were more than the standard levels and as it is known these wards have vital roles in treatment procedures, so more attention is needed in this area. PMID:24303374

  6. Qualitative methodologies in health-care priority setting research.

    PubMed

    Smith, Neale; Mitton, Craig; Peacock, Stuart

    2009-10-01

    Priority setting research in health economics has traditionally employed quantitative methodologies and been informed by post-positivist philosophical assumptions about the world and the nature of knowledge. These approaches have been rewarded with well-developed and validated tools. However, it is now commonly noted that there has been limited uptake of economic analysis into actual priority setting and resource allocation decisions made by health-care systems. There seem to be substantial organizational and political barriers. The authors argue in this paper that understanding and addressing these barriers will depend upon the application of qualitative research methodologies. Some efforts in this direction have been attempted; however these are theoretically under-developed and seldom rooted in any of the established qualitative research traditions. Two such approaches - narrative inquiry and discourse analysis - are highlighted here. These are illustrated with examples drawn from a real-world priority setting study. The examples demonstrate how such conceptually powerful qualitative traditions produce distinctive findings that offer unique insight into organizational contexts and decision-maker behavior. We argue that such investigations offer untapped benefits for the study of organizational priority setting and thus should be pursued more frequently by the health economics research community. PMID:18972324

  7. Solving the Emergency Care Crisis in America: The Power of the Law and Storytelling

    PubMed Central

    Maa, John

    2012-01-01

    An Emergency Department visit that ended tragically prompted my yearlong journey to Washington, DC, and emergency rooms across the country to search for solutions to the national crisis in emergency care. I reached the conclusion that the crisis is entirely solvable, and I developed a three-part solution that includes 1) nationally standardizing and coordinating care, 2) prioritizing resources and incentives in the delivery of emergency care, and 3) inspiring young clinicians to careers in emergency care. Physicians across America should now harness the power of storytelling to strengthen both the delivery of patient care and health care reform efforts on Capitol Hill. PMID:23012606

  8. Emergency access authorization for personally controlled online health care data.

    PubMed

    Chen, Tingting; Zhong, Sheng

    2012-02-01

    Personally controlled health records (PCHR) systems have emerged to allow patients to control their own medical data. In a PCHR system, all the access privileges to a patient's data are granted by the patient. However, in many emergency cases, it is impossible for the patient to participate in access authorization on site when immediate medical treatment is needed. To solve the emergency access authorization problem in the absence of patients, we consider two cases: a) the requester is already in the PCHR system but has not obtained the access privilege of the patient's health records, and b) the requester does not even have an account in the PCHR system to submit its request. For each of the two cases, we present a method for emergency access authorization, utilizing the weighted voting and source authentication cryptographic techniques. Our methods provide an effective, secure and private solution for emergency access authorization, that makes the existing PCHR system frameworks more practical and thus improves the patients' experiences of health care when using PCHR systems. We have implemented a prototype system as a proof of concept. PMID:20703719

  9. HIV-Related discrimination in European health care settings.

    PubMed

    Nöstlinger, Christiana; Rojas Castro, Daniela; Platteau, Tom; Dias, Sonia; Le Gall, Jean

    2014-03-01

    This cross-sectional European study assessed self-reported HIV-related discrimination and its associated factors in health care settings. Socio-demographics, health status, support needs relating to sexual and reproductive health (SRH), and self-reported HIV-related discrimination were measured using an anonymous survey in a sample of 1549 people living with HIV from 14 countries. Thirty-two per cent of the participants had experienced HIV-related discrimination during the previous 3 years; almost half of them felt discriminated against by health care providers. For this type of discrimination, logistic regression analysis revealed significant associations with not being a migrant (OR: 2.0; IC 1.0-3.7; p<0.05), having been forced into sexual activities (OR: 1.6; IC 1.2-2.2; p<0.001), reporting lack of time to discuss SRH during service provision (OR: 1.7; IC 1.0-2.7; p<0.05), and insufficient openness among service providers to discuss SRH (OR: 2.0; IC 1.1-3.4; p<0.05). Other significant associations related to unmet support needs on safer sex practices (OR: 1.8; IC 1.0-3.2; p<0.05), partner communication about sexuality (OR: 2.0; IC 1.1-3.4; p<0.05), and prevention of sexually transmitted infections (OR: 1.7; IC 1.0-3.0; p<0.05). Female gender had a protective effect (OR: 0.2; IC 0.0-0.9; p<0.05). Being denied the opportunity to discuss SRH may translate in feelings of discrimination. Improving health care providers' communication skills, and fostering openness about SRH topics in HIV care could contribute to destigmatization of PLHIV. PMID:24568694

  10. Pharmacotherapeutic Management of Dementia Across Settings of Care

    PubMed Central

    Rattinger, Gail B.; Burcu, Mehmet; Dutcher, Sarah K.; Chhabra, Pankdeep T.; Rosenberg, Paul B.; Simoni-Wastila, Linda; Franey, Christine S.; Walker, Loreen D.; Zuckerman, Ilene H.

    2013-01-01

    Objectives To describe population-based use of cognitive-enhancing and psychopharmacological medications across care settings among Medicare beneficiaries with dementia. Design One-year (2008) cross-sectional study Setting Medicare administrative claims froma 5% random sample Participants 52,754 Medicare beneficiaries with dementia aged ≥65 years with continuous Medicare Parts A, B, and D coverage and alive throughout 2008. To ascertain dementia, ≥1 medical claim with a dementia ICD-9-CM code was required prior to 2008 and an additional claim was required in 2008 to confirm active disease. Measurements Use of medications commonly prescribed in managing dementia (cognitive enhancers, antidepressants, antipsychotics, and mood stabilizers) was assessed using three separate measures: 1) Annual prevalence of use; 2) Consistency of use; 3) Count of psychopharmacological medication classes. Care setting was determined using the number of months of nursing home (NH) residency: no-NH (zero months), partial-NH (1–11 months), and full-NH (12 months). Results Community-dwellers represented 41.3% of the cohort, while 42.4% and 16.3% resided partially and fully in a NH, respectively. Annual prevalence of use was 57.1% for cognitive enhancers, 56.4% for antidepressants, 34.0% for antipsychotics, and 8.8% for mood stabilizers. Cognitive enhancer use was significantly lower among those with any NH-stay [adjusted-prevalence-ratio (99% CI) partial-NH vs. no-NH 0.84 (0.83–0.86); full-NH versus no-NH0.83 (0.81–0.85)]. In contrast, those with any NH residence had significantly higher use for all psychopharmacological medication classes compared with community-dwellers. Over half the cohort had consistent medication regimens during 2008 (64.8%). The number of psychopharmacological medication classes used increased with increasing NH-stay duration. Conclusion This population-based study documents significant differences in medication use for managing dementia across care

  11. A Review of Pediatric Critical Care in Resource-Limited Settings: A Look at Past, Present, and Future Directions.

    PubMed

    Turner, Erin L; Nielsen, Katie R; Jamal, Shelina M; von Saint André-von Arnim, Amelie; Musa, Ndidiamaka L

    2016-01-01

    Fifteen years ago, United Nations world leaders defined millenium development goal 4 (MDG 4): to reduce under-5-year mortality rates by two-thirds by the year 2015. Unfortunately, only 27 of 138 developing countries are expected to achieve MDG 4. The majority of childhood deaths in these settings result from reversible causes, and developing effective pediatric emergency and critical care services could substantially reduce this mortality. The Ebola outbreak highlighted the fragility of health care systems in resource-limited settings and emphasized the urgent need for a paradigm shift in the global approach to healthcare delivery related to critical illness. This review provides an overview of pediatric critical care in resource-limited settings and outlines strategies to address challenges specific to these areas. Implementation of these tools has the potential to move us toward delivery of an adequate standard of critical care for all children globally, and ultimately decrease global child mortality in resource-limited settings. PMID:26925393

  12. A Review of Pediatric Critical Care in Resource-Limited Settings: A Look at Past, Present, and Future Directions

    PubMed Central

    Turner, Erin L.; Nielsen, Katie R.; Jamal, Shelina M.; von Saint André-von Arnim, Amelie; Musa, Ndidiamaka L.

    2016-01-01

    Fifteen years ago, United Nations world leaders defined millenium development goal 4 (MDG 4): to reduce under-5-year mortality rates by two-thirds by the year 2015. Unfortunately, only 27 of 138 developing countries are expected to achieve MDG 4. The majority of childhood deaths in these settings result from reversible causes, and developing effective pediatric emergency and critical care services could substantially reduce this mortality. The Ebola outbreak highlighted the fragility of health care systems in resource-limited settings and emphasized the urgent need for a paradigm shift in the global approach to healthcare delivery related to critical illness. This review provides an overview of pediatric critical care in resource-limited settings and outlines strategies to address challenges specific to these areas. Implementation of these tools has the potential to move us toward delivery of an adequate standard of critical care for all children globally, and ultimately decrease global child mortality in resource-limited settings. PMID:26925393

  13. Integrating palliative care in oncologic emergency departments: Challenges and opportunities

    PubMed Central

    Elsayem, Ahmed F; Elzubeir, Hiba E; Brock, Patricia A; Todd, Knox H

    2016-01-01

    Although visiting the emergency departments (EDs) is considered poor quality of cancer care, there are indications these visits are increasing. Similarly, there is growing interest in providing palliative care (PC) to cancer patients in EDs. However, this integration is not without major challenges. In this article, we review the literature on why cancer patients visit EDs, the rates of hospitalization and mortality for these patients, and the models for integrating PC in EDs. We discuss opportunities such integration will bring to the quality of cancer care, and resource utilization of resources. We also discuss barriers faced by this integration. We found that the most common reasons for ED visits by cancer patients are pain, fever, shortness of breath, and gastrointestinal symptoms. The majority of the patients are admitted to hospitals, about 13% of the admitted patients die during hospitalization, and some patients die in ED. Patients who receive PC at an ED have shorter hospitalization and lower resource utilization. Models based solely on increasing PC provision in EDs by PC specialists have had modest success, while very limited ED-based PC provision has had slightly higher impact. However, details of these programs are lacking, and coordination between ED based PC and hospital-wide PC is not clear. In some studies, the objectives were to improve care in the communities and reduce ED visits and hospitalizations. We conclude that as more patients receive cancer therapy late in their disease trajectory, more cancer patients will visit EDs. Integration of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer patients. PC specialist should play an active role in educating ED physicians about PC, and provide timely consultations. The impact of integrating PC in EDs on quality and cost of cancer care should be studied. PMID:27081645

  14. Integrating palliative care in oncologic emergency departments: Challenges and opportunities.

    PubMed

    Elsayem, Ahmed F; Elzubeir, Hiba E; Brock, Patricia A; Todd, Knox H

    2016-04-10

    Although visiting the emergency departments (EDs) is considered poor quality of cancer care, there are indications these visits are increasing. Similarly, there is growing interest in providing palliative care (PC) to cancer patients in EDs. However, this integration is not without major challenges. In this article, we review the literature on why cancer patients visit EDs, the rates of hospitalization and mortality for these patients, and the models for integrating PC in EDs. We discuss opportunities such integration will bring to the quality of cancer care, and resource utilization of resources. We also discuss barriers faced by this integration. We found that the most common reasons for ED visits by cancer patients are pain, fever, shortness of breath, and gastrointestinal symptoms. The majority of the patients are admitted to hospitals, about 13% of the admitted patients die during hospitalization, and some patients die in ED. Patients who receive PC at an ED have shorter hospitalization and lower resource utilization. Models based solely on increasing PC provision in EDs by PC specialists have had modest success, while very limited ED-based PC provision has had slightly higher impact. However, details of these programs are lacking, and coordination between ED based PC and hospital-wide PC is not clear. In some studies, the objectives were to improve care in the communities and reduce ED visits and hospitalizations. We conclude that as more patients receive cancer therapy late in their disease trajectory, more cancer patients will visit EDs. Integration of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer patients. PC specialist should play an active role in educating ED physicians about PC, and provide timely consultations. The impact of integrating PC in EDs on quality and cost of cancer care should be studied. PMID:27081645

  15. Application of a Proactive Risk Analysis to Emergency Department Sickle Cell Care

    PubMed Central

    Thornton, Victoria L.; Holl, Jane L.; Cline, David M.; Freiermuth, Caroline E.; Sullivan, Dori T.; Tanabe, Paula

    2014-01-01

    Introduction Patients with sickle cell disease (SCD) often seek care in emergency departments (EDs) for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1) explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA) in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made) for patients with SCD, and 2) report the failures of these care processes in each ED. Methods A FMECA was conducted of ED SCD patient care at two hospitals. A multidisciplinary group examined each step of four processes. Providers identified failures in each step, and then characterized the frequency, impact, and safeguards, resulting in risk categorization. Results Many “high risk” failures existed in both institutions, including a lack of recognition of high-risk or high-user patients and a lack of emphasis on psychosocial referrals. Specific to SCD analgesic management, one setting inconsistently used existing analgesic policies, while the other setting did not have such policies. Conclusion FMECA facilitated the identification of failures of ED SCD care and has guided quality improvement activities. Interventions can focus on improvements in these specific areas targeting improvements in the delivery and organization of ED SCD care. Improvements should correspond with the forthcoming National Heart, Lung and Blood-sponsored guidelines for treatment of patients with sickle cell disease. PMID:25035751

  16. Nursing Care as Perceived by Nurses Working in Disability Community Settings in Greece

    PubMed Central

    Fotiadou, Elpida; Malliarou, Maria; Zetta, Stella; Gouva, Mary; Kotrotsiou, Evaggelia

    2016-01-01

    Introduction-Aim: The concept of nursing care in learning disability community settings has not been investigated in Greece. The aim of this paper is to investigate how nurses working in learning disability community settings perceive the meaning of nursing care. Material and Methods: The sample consisted of 100 nurses and nursing assistants working in a social care hospice. Participants were asked to answer questions about socio- demographic characteristics of the sample and fill in a questionnaire of care (GR-NDI-24), the “Job-Communication-Satisfaction-Importance” (JCSI) questionnaire and the altruism scale of Ahmed and Jackson. The data analysis was realized with statistical methods of descriptive and inductive statistics. The analysis was made with the use of SPSS (version 19). Results: The majority of the sample was women (78%). The majority of participants were married (66 %), DE graduates (66%) without postgraduate studies (96.7%). The mean age of respondents was 36.98±6.70 years. On the scales of caring and altruism, the mean values were 40.89±15.87 and 28.12±4.16 respectively. Very or fully satisfied with his work was 72% of the sample. The scope of work emerges as the most important factor influencing job satisfaction. The wages and working conditions (73% and 40% respectively) are the parameters of work which gathers the most dissatisfaction, while the salary is emerging as the most important parameter, the improvement of which would provide the highest satisfaction. Marginally statistically significant difference was observed in the range between TE graduates (d=40) and those of the DE grade (d=37), p=0.053. No statistically significant differences were observed in relation to other working and demographic characteristics (p>0.05). Greater care importance was associated with greater job satisfaction (p<0.01), while the latter was associated with high levels of altruism (p<0.05). Conclusion: The scope of work provides high satisfaction to nurses

  17. 21 CFR 203.11 - Applications for reimportation to provide emergency medical care.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... emergency medical care. 203.11 Section 203.11 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Applications for reimportation to provide emergency medical care. (a) Applications for reimportation for emergency medical care shall be submitted to the director of the FDA District Office in the district...

  18. 20 CFR 10.300 - What are the basic rules for authorizing emergency medical care?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... emergency medical care? 10.300 Section 10.300 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS...' COMPENSATION ACT, AS AMENDED Medical and Related Benefits Emergency Medical Care § 10.300 What are the basic rules for authorizing emergency medical care? (a) When an employee sustains a work-related...

  19. 21 CFR 203.11 - Applications for reimportation to provide emergency medical care.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... emergency medical care. 203.11 Section 203.11 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Applications for reimportation to provide emergency medical care. (a) Applications for reimportation for emergency medical care shall be submitted to the director of the FDA District Office in the district...

  20. 20 CFR 10.300 - What are the basic rules for authorizing emergency medical care?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... emergency medical care? 10.300 Section 10.300 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS...' COMPENSATION ACT, AS AMENDED Medical and Related Benefits Emergency Medical Care § 10.300 What are the basic rules for authorizing emergency medical care? (a) When an employee sustains a work-related...

  1. 20 CFR 10.300 - What are the basic rules for authorizing emergency medical care?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... emergency medical care? 10.300 Section 10.300 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS...' COMPENSATION ACT, AS AMENDED Medical and Related Benefits Emergency Medical Care § 10.300 What are the basic rules for authorizing emergency medical care? (a) When an employee sustains a work-related...

  2. 21 CFR 203.11 - Applications for reimportation to provide emergency medical care.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... emergency medical care. 203.11 Section 203.11 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Applications for reimportation to provide emergency medical care. (a) Applications for reimportation for emergency medical care shall be submitted to the director of the FDA District Office in the district...

  3. 20 CFR 10.300 - What are the basic rules for authorizing emergency medical care?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... emergency medical care? 10.300 Section 10.300 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS...' COMPENSATION ACT, AS AMENDED Medical and Related Benefits Emergency Medical Care § 10.300 What are the basic rules for authorizing emergency medical care? (a) When an employee sustains a work-related...

  4. 20 CFR 10.300 - What are the basic rules for authorizing emergency medical care?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... emergency medical care? 10.300 Section 10.300 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS...' COMPENSATION ACT, AS AMENDED Medical and Related Benefits Emergency Medical Care § 10.300 What are the basic rules for authorizing emergency medical care? (a) When an employee sustains a work-related...

  5. Emergency planning and management in health care: priority research topics

    PubMed Central

    Boyd, Alan; Chambers, Naomi; French, Simon; Shaw, Duncan; King, Russell; Whitehead, Alison

    2014-01-01

    Many major incidents have significant impacts on people's health, placing additional demands on health-care organisations. The main aim of this paper is to suggest a prioritised agenda for organisational and management research on emergency planning and management relevant to U.K. health care, based on a scoping study. A secondary aim is to enhance knowledge and understanding of health-care emergency planning among the wider research community, by highlighting key issues and perspectives on the subject and presenting a conceptual model. The study findings have much in common with those of previous U.S.-focused scoping reviews, and with a recent U.K.-based review, confirming the relative paucity of U.K.-based research. No individual research topic scored highly on all of the key measures identified, with communities and organisations appearing to differ about which topics are the most important. Four broad research priorities are suggested: the affected public; inter- and intra-organisational collaboration; preparing responders and their organisations; and prioritisation and decision making. PMID:25013721

  6. Technology Compatibility Standard Setting & Its Applicability to Emerging American Media.

    ERIC Educational Resources Information Center

    Jassem, Harvey C.

    This paper examines the role that standard-setting plays in the adoption and growth of new technologies, particularly in the development of electronic media. Background on technological standardization is provided in the first section, including discussions of the costs and benefits of standardization and the timing of standards setting. The…

  7. Learning from Japan: strengthening US emergency care and disaster response.

    PubMed

    Parmar, Parveen; Arii, Maya; Kayden, Stephanie

    2013-12-01

    As Hurricane Katrina demonstrated in 2005, US health response systems for disasters-typically designed to handle only short-term mass-casualty events-are inadequately prepared for disasters that result in large-scale population displacements. Similarly, after the 2011 Great East Japan Earthquake, Japan found that many of its disaster shelters failed to meet international standards for long-term provision of basic needs and health care for the vulnerable populations that sought refuge in the shelters. Hospital disaster plans had not been tested and turned out to be inadequate, and emergency communication equipment did not function. We make policy recommendations that aim to improve US responses to mass-displacement disasters based on Japan's 2011 experience. First, response systems must provide for the extended care of large populations of chronically ill and vulnerable people. Second, policies should ensure that shelters meet or exceed international standards for the provision of food, water, sanitation, and privacy. Third, hospital disaster plans should include redundant communication systems and sufficient emergency provisions for both staff and patients. Finally, there must be routine drills for responses to mass-displacement disasters so that areas needing improvement can be uncovered before an emergency occurs. PMID:24301402

  8. Future Connectivity for Disaster and Emergency Point of Care

    PubMed Central

    Yu, Jimmy N.; Brock, Terry Keith; Mecozzi, Daniel M.; Tran, Nam K.; Kost, Gerald J.

    2011-01-01

    Objective The goal of this paper is to identify strategies for connectivity that will optimize point-of-care testing (POCT) organized as small-world networks in disaster settings. Methods We evaluated connectivity failures during the 2010 Haiti Earthquake, applied small-world network concepts, and reviewed literature for point-of-care (POC) connectivity systems. Results Medical teams responding to the Haiti Earthquake faced connectivity failures that affected patient outcomes. Deploying robust wireless connectivity systems can enhance the efficiency of the disaster response by improving health care delivery, medical documentation, logistics, response coordination, communication, and telemedicine. Virtual POC connectivity education and training programs can enhance readiness of disaster responders. Conclusions The admirable humanitarian efforts of more than 4000 organizations substantially impacted the lives of earthquake victims in Haiti. However, the lack of connectivity and small-world network strategies, combined with communication failures, during early stages of the relief effort must be addressed for future disaster preparedness. PMID:21547239

  9. Future Connectivity for Disaster and Emergency Point of Care.

    PubMed

    Yu, Jimmy N; Brock, Terry Keith; Mecozzi, Daniel M; Tran, Nam K; Kost, Gerald J

    2010-12-01

    OBJECTIVE: The goal of this paper is to identify strategies for connectivity that will optimize point-of-care testing (POCT) organized as small-world networks in disaster settings. METHODS: We evaluated connectivity failures during the 2010 Haiti Earthquake, applied small-world network concepts, and reviewed literature for point-of-care (POC) connectivity systems. RESULTS: Medical teams responding to the Haiti Earthquake faced connectivity failures that affected patient outcomes. Deploying robust wireless connectivity systems can enhance the efficiency of the disaster response by improving health care delivery, medical documentation, logistics, response coordination, communication, and telemedicine. Virtual POC connectivity education and training programs can enhance readiness of disaster responders. CONCLUSIONS: The admirable humanitarian efforts of more than 4000 organizations substantially impacted the lives of earthquake victims in Haiti. However, the lack of connectivity and small-world network strategies, combined with communication failures, during early stages of the relief effort must be addressed for future disaster preparedness. PMID:21547239

  10. A survey of dental school's emergency departments in Ireland and the UK: provision of undergraduate teaching and emergency care

    PubMed Central

    Anderson, S.; Nunn, J.; Stassen, L. F. A.; McLoughlin, J.

    2015-01-01

    Aim Emergency dental care is a vital service that new graduates should be prepared to offer. There are few published data relating to emergency dental care education. To assess this, and to gain a profile of accident and emergency departments (A&E) in dental schools, an online survey was sent to all of the dental schools in the Republic of Ireland and the UK. Setting The survey addressed the school's A&E curriculum, teaching methods, undergraduate exposure and departmental details. Results The majority of A&E departments operated during normal working hours with a minority offering an out-of-hours service. Teaching of A&E topics, and undergraduate experience, vary significantly between schools. A&E departments were diversely named and exhibited significant regional variation. Approximately half employed a triage system. It is unclear what represents an adequate level of undergraduate exposure, and more research is required in this area. Conclusions Assessment of undergraduates following time in clinic is an important component of any A&E module. We consider a reflective portfolio to represent a suitable form of assessment, and would recommend their introduction. In addition, we recommend that dental hospitals consider a nurse-led triage system. PMID:26067892

  11. Optimizing Patient-centered Communication and Multidisciplinary Care Coordination in Emergency Diagnostic Imaging: A Research Agenda.

    PubMed

    Sabbatini, Amber K; Merck, Lisa H; Froemming, Adam T; Vaughan, William; Brown, Michael D; Hess, Erik P; Applegate, Kimberly E; Comfere, Nneka I

    2015-12-01

    Patient-centered emergency diagnostic imaging relies on efficient communication and multispecialty care coordination to ensure optimal imaging utilization. The construct of the emergency diagnostic imaging care coordination cycle with three main phases (pretest, test, and posttest) provides a useful framework to evaluate care coordination in patient-centered emergency diagnostic imaging. This article summarizes findings reached during the patient-centered outcomes session of the 2015 Academic Emergency Medicine consensus conference "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The primary objective was to develop a research agenda focused on 1) defining component parts of the emergency diagnostic imaging care coordination process, 2) identifying gaps in communication that affect emergency diagnostic imaging, and 3) defining optimal methods of communication and multidisciplinary care coordination that ensure patient-centered emergency diagnostic imaging. Prioritized research questions provided the framework to define a research agenda for multidisciplinary care coordination in emergency diagnostic imaging. PMID:26575785

  12. Identification of myocardial injury in the emergency setting

    PubMed Central

    Kavsak, Peter A.; Worster, Andrew; You, John J.; Oremus, Mark; Elsharif, Adell; Hill, Stephen A.; Devereaux, P.J.; MacRae, Andrew R.; Jaffe, Allan S.

    2013-01-01

    Within the past decade, the use of biomarkers to detect myocardial injury in the emergency department (ED) has been given increasing prominence as evident by the numerous studies and guidelines documenting their use. This review details the scope of the clinical problem, the history of changes in the definition of myocardial infarction (MI) and the new approaches, as well as suggestions for using laboratory biomarkers in the early detection of MI in the ED. PMID:20026097

  13. Identification of myocardial injury in the emergency setting.

    PubMed

    Kavsak, Peter A; Worster, Andrew; You, John J; Oremus, Mark; Elsharif, Adell; Hill, Stephen A; Devereaux, P J; MacRae, Andrew R; Jaffe, Allan S

    2010-04-01

    Within the past decade, the use of biomarkers to detect myocardial injury in the emergency department (ED) has been given increasing prominence as evident by the numerous studies and guidelines documenting their use. This review details the scope of the clinical problem, the history of changes in the definition of myocardial infarction (MI) and the new approaches, as well as suggestions for using laboratory biomarkers in the early detection of MI in the ED. PMID:20026097

  14. The Integration of Palliative Care into the Emergency Department.

    PubMed

    Basol, Nursah

    2015-06-01

    Palliative care (PC) is a new and developing area. It aims to provide the best possible quality of life for patients with life-limiting diseases. It does not primarily include life-extending therapies, but rather tries to help patients spend the rest of their lives in the best way. PC patients often are admitted to emergency departments during the course of a disease. The approach and management of PC include differences with emergency medicine. Thus, there are some problems while providing PC in the ED. With this article, the definition, main features, benefits, and problems of providing PC are presented, with the primary aim of emphasizing the importance of PC integration into the ED. PMID:27336074

  15. Glycemic Targets in Diabetes Care: Emerging Clarity after Accord

    PubMed Central

    Buse, John B.

    2015-01-01

    Through the 1990s convincing evidence emerged from studies involving relatively recent onset diabetes that glycemic control achieving glycated hemoglobin A1c levels of approximately 7% was associated with improved microvascular outcomes. Based on advocacy groups' statements encouraging lower targets and recognition of cardiovascular disease as the leading cause of death in diabetes, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was funded in 1999 to explore more intensive targets and techniques in the treatment of type 2 diabetes. Most surprisingly, intensive management targeting normal levels of glycemia was associated with increased mortality and the ACCORD trial was terminated early in 2008. Post hoc analyses have allowed the emergence of some clarity around the role of glycemic management and targets in diabetes care and are the subject of this review. PMID:26330660

  16. Emergence and spread of antibiotic resistance: setting a parameter space

    PubMed Central

    Baquero, Fernando

    2014-01-01

    The emergence and spread of antibiotic resistance among human pathogens is a relevant problem for human health and one of the few evolution processes amenable to experimental studies. In the present review, we discuss some basic aspects of antibiotic resistance, including mechanisms of resistance, origin of resistance genes, and bottlenecks that modulate the acquisition and spread of antibiotic resistance among human pathogens. In addition, we analyse several parameters that modulate the evolution landscape of antibiotic resistance. Learning why some resistance mechanisms emerge but do not evolve after a first burst, whereas others can spread over the entire world very rapidly, mimicking a chain reaction, is important for predicting the evolution, and relevance for human health, of a given mechanism of resistance. Because of this, we propose that the emergence and spread of antibiotic resistance can only be understood in a multi-parameter space. Measuring the effect on antibiotic resistance of parameters such as contact rates, transfer rates, integration rates, replication rates, diversification rates, and selection rates, for different genes and organisms, growing under different conditions in distinct ecosystems, will allow for a better prediction of antibiotic resistance and possibilities of focused interventions. PMID:24678768

  17. Tracking emergency department overcrowding in a tertiary care academic institution.

    PubMed

    Bullard, Michael J; Villa-Roel, Cristina; Bond, Kenneth; Vester, Michael; Holroyd, Brian R; Rowe, Brian H

    2009-01-01

    Despite the release of a national report describing key markers of emergency department (ED) overcrowding, limited linear data using these markers have been published. We sought to report the degree and trends of ED overcrowding in a typical academic hospital and to highlight some of the key markers of ED patient flow and care. We conducted a prospective study in a large Canadian urban tertiary care teaching hospital that receives approximately 55,000 annual adult ED visits. A database captured demographic and real-time process of care data for each patient from 2000 to 2007. Descriptive data are reported using Canadian Triage and Acuity Scale (CTAS) scores. Over the study period, the ED patient visit volume and presentation times remained predictable. Emergent cases (CTAS levels 1-2) doubled from 8 to 16.6%, and urgent cases (CTAS level 3) increased from 40.2 to 50.3%. Moreover, semi-urgent presentations (CTAS level 4) decreased from 42.4 to 28.8%, and non-urgent cases (CTAS level 5) dropped from 9.4 to 4.3%. The median wait time from triage to bed location increased from two minutes (inter-quartile range [IQR] 1, 46) in 2000 to 27 minutes (IQR 2, 110) in 2007, while the median time from bed location to physician remained constant (29 minutes in 2001 versus 28 minutes in 2007). Overall, admissions increased from 20.4 to 23%. Semi-urgent and non-urgent admissions dropped from 11.5 to 7.4% and 3.2 to 1.8%, respectively. Admitted patients "boarding" in the ED increased from 70,955 hours in 2002 to 118,741 hours in 2007, while the number of emergent and urgent patients leaving without being seen increased by more than 400%. ED overcrowding in a tertiary care hospital is primarily a result of access block due to boarding admitted patients, a situation that poses serious risks to the majority of patients who have emergent or urgent conditions that cannot be managed appropriately in the waiting room. PMID:19553772

  18. Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework.

    PubMed

    Maluka, Stephen; Kamuzora, Peter; San Sebastiån, Miguel; Byskov, Jens; Olsen, Øystein E; Shayo, Elizabeth; Ndawi, Benedict; Hurtig, Anna-Karin

    2010-08-01

    Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level in the contexts of low-income countries. Second, it provides guidance to decision-makers on how to improve fairness, legitimacy, and sustainability of the priority-setting process. PMID

  19. Two methods for setting child-focused tuberculosis care targets

    PubMed Central

    Jenkins, H. E.; Chang, R.; Mpunga, J.; Becerra, M. C.

    2016-01-01

    Objective: To allocate resources for household contact investigations, tuberculosis (TB) programs need estimates of the numbers of child contacts requiring care. Design: We developed two methods to estimate annual numbers of child contacts aged 0–14 years requiring evaluation and treatment. Method 1 combines local data using simple formulas. Using publicly available data, Method 2 uses a linear regression model based on Demographic and Health Survey and World Bank data to estimate the number of children per household, then combines these results with case notifications and risk estimates of disease and infection. Results: Applying Method 1 to data from Malawi indicated that every year ~21 000 child contacts require evaluation and ~1900 should be diagnosed with TB. Applying Method 2 to all countries suggested that, globally, 2.41 million (95% uncertainty interval [UI] 2.36–2.46) children aged <5 years, and 5.07 million (95%UI 4.81–5.34) children aged 5–14 years live in households of adult patients with known TB. Of these, 239 014 (95%UI 118 649–478581) and 419 816 (95%UI 140600–1 268805), respectively, will have TB. An additional 848 453 (95%UI 705838–1 017551) and 2660 885 (95%UI 2080517–3 413 189), respectively, will be infected. Conclusion: It is feasible to use available data to set programmatic evaluation and treatment targets to improve care for child contacts of patients with TB. PMID:27358801

  20. Rethinking chronic pain in a primary care setting.

    PubMed

    Stanos, Steven; Brodsky, Marina; Argoff, Charles; Clauw, Daniel J; D'Arcy, Yvonne; Donevan, Sean; Gebke, Kevin B; Jensen, Mark P; Lewis Clark, Evelyn; McCarberg, Bill; Park, Peter W; Turk, Dennis C; Watt, Stephen

    2016-06-01

    Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings. PMID:27166559

  1. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 5. CPR, Oxygen Therapy. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This student manual, the fifth in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains two sections covering the following course content; cardiopulmonary resuscitation (CPR) (including artificial ventilation, foreign body obstructions, adjunctive equipment and special techniques, artificial…

  2. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 3--Anatomy and Physiology. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This student manual, the third in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains one section covering the following topics: general anatomical terms, the body cavities and contents, the integumentary system, the skeletal system, the muscular system, the nervous system, the respiratory…

  3. Developing a Policy for Delegation of Nursing Care in the School Setting

    ERIC Educational Resources Information Center

    Spriggle, Melinda

    2009-01-01

    School nurses are in a unique position to provide care for students with special health care needs in the school setting. The incidence of chronic conditions and improved technology necessitate care of complex health care needs that had formerly been managed in inpatient settings. Delegation is a tool that may be used by registered nurses to allow…

  4. Education in the Wake of Healthcare Reform: Increasing Primary Care Usage by Individuals Currently Reliant upon Emergency Departments for Care

    ERIC Educational Resources Information Center

    Tannebaum, Michael; Wilkin, Holley A.; Keys, Jobia

    2014-01-01

    Background: The Affordable Care Act (ACA) was introduced, in part, to increase access to primary care, which has been shown to provide patients with myriad health benefits. Objective: To increase primary care usage by understanding the beliefs about primary and emergency care most salient to those whose healthcare-seeking practices may be impacted…

  5. Prince Edward Island: building capacity--the implementation of a critical care/emergency program.

    PubMed

    Cotton, Judith

    2012-03-01

    Like other Canadian provinces, Prince Edward Island has a shortage of experienced nurses, especially in critical and emergency care. To increase the numbers of competent nurses, a PEI-based nursing course in these areas was identified as key to building capacity. This Research to Action pilot program successfully involved nurses in PEI-based emergency and critical care courses developed by the Nova Scotia Registered Nurses Professional Development Centre and funded by Human Resources and Skills Development Canada. The programs were offered on a full-time basis, lasted 14 weeks and included classroom and simulation laboratory time, along with a strong clinical component.Sixteen RNs graduated from the courses and became Advanced Cardiovascular Life Support (ACLS) certified. An additional 12 RNs were trained as preceptors. Feedback from participants indicates greater job satisfaction and increased confidence in providing patient assessments and care. Based on the program's success, the RTA partners proposed the establishment of an ongoing, PEI-based critical care and emergency nursing program utilizing 80/20 staffing models and mentorship. Their proposal was approved, with courses set to resume in January, 2012. PMID:22398483

  6. Predictors of physical restraint in a psychiatric emergency setting

    PubMed Central

    Hadi, Fatemeh; Khosravi, Termeh; Shariat, Seyed Vahid; Jalali Nadoushan, Amir Hossein

    2015-01-01

    Background: Considering the negative consequences of using physical restraints, we conducted this study to identify patients who are more frequently restrained in a psychiatric emergency ward as an initial step to limit the use of restraint to the minimum possible. Methods: This was a retrospective case control study conducted in Iran Psychiatric Hospital in Tehran, Iran. We reviewed the files of 607 patients who were admitted during a one year period using convenience sampling; of them, 186 were in the restrained group and 421 in the unrestrained group. Results: Surprisingly, no significant difference was found between the restrained and unrestrained groups in demographic characteristics. The patients who were referred because of violence were diagnosed as having methamphetamine induced psychotic disorder or bipolar I disorder in manic 1episode and had a higher odds of being restrained (OR=2.51, OR=1.61, and OR=1.57 respectively). Being restrained was also associated with a longer duration of hospitalization and duration of staying in the emergency ward. Moreover, patients in their first admission were more frequently restrained. Conclusion: Medical and nursing staff should consider special measures for the patients who are at a higher risk for being restrained. More frequent visits and education for both patients and staff may be effective in reducing the number of physical restraints for these groups of patients. PMID:26913259

  7. Emergency Management of Seizures in the School Setting

    ERIC Educational Resources Information Center

    O'Dell, Christine; O'Hara, Kathryn; Kiel, Sarah; McCullough, Kathleen

    2007-01-01

    Effective seizure management in the school setting is a critical issue for students with seizures, as well as their parents, classmates, and school personnel. The unpredictable nature of seizures and the potential outcomes of experiencing a seizure in school are sources of anxiety for students with seizures. The ability to respond appropriately to…

  8. Emergency care research funding in the global health context: trends, priorities, and future directions.

    PubMed

    Vu, Alexander; Duber, Herbert C; Sasser, Scott M; Hansoti, Bhakti; Lynch, Catherine; Khan, Ayesha; Johnson, Tara; Modi, Payal; Clattenburg, Eben J; Hargarten, Stephen

    2013-12-01

    Over the past few decades there has been a steady growth in funding for global health, yet generally little is known about funding for global health research. As part of the 2013 Academic Emergency Medicine consensus conference, a session was convened to discuss emergency care research funding in the global health context. Overall, the authors found a lack of evidence available to determine funding priorities or quantify current funding for acute care research in global health. This article summarizes the initial preparatory research and reports on the results of the consensus conference focused on identifying challenges and strategies to improve funding for global emergency care research. The consensus conference meeting led to the creation of near- and long-term goals to strengthen global emergency care research funding and the development of important research questions. The research questions represent a consensus view of important outstanding questions that will assist emergency care researchers to better understand the current funding landscape and bring evidence to the debate on funding priorities of global health and emergency care. The four key areas of focus for researchers are: 1) quantifying funding for global health and emergency care research, 2) understanding current research funding priorities, 3) identifying barriers to emergency care research funding, and 4) using existing data to quantify the need for emergency services and acute care research. This research agenda will enable emergency health care scientists to use evidence when advocating for more funding for emergency care research. PMID:24341581

  9. Existing and Emerging Technologies for Point-of-Care Testing

    PubMed Central

    St John, Andrew; Price, Christopher P

    2014-01-01

    The volume of point-of-care testing (PoCT) has steadily increased over the 40 or so years since its widespread introduction. That growth is likely to continue, driven by changes in healthcare delivery which are aimed at delivering less costly care closer to the patient’s home. In the developing world there is the challenge of more effective care for infectious diseases and PoCT may play a much greater role here in the future. PoCT technologies can be split into two categories, but in both, testing is generally performed by technologies first devised more than two decades ago. These technologies have undoubtedly been refined and improved to deliver easier-to-use devices with incremental improvements in analytical performance. Of the two major categories the first is small handheld devices, providing qualitative or quantitative determination of an increasing range of analytes. The dominant technologies here are glucose biosensor strips and lateral flow strips using immobilised antibodies to determine a range of parameters including cardiac markers and infectious pathogens. The second category of devices are larger, often bench-top devices which are essentially laboratory instruments which have been reduced in both size and complexity. These include critical care analysers and, more recently, small haematology and immunology analysers. New emerging devices include those that are utilising molecular techniques such as PCR to provide infectious disease testing in a sufficiently small device to be used at the point of care. This area is likely to grow with many devices being developed and likely to reach the commercial market in the next few years. PMID:25336761

  10. Risks associated with obese patient handling in emergency prehospital care.

    PubMed

    Réminiac, François; Jouan, Youenn; Cazals, Xavier; Bodin, Jean-François; Dequin, Pierre-François; Guillon, Antoine

    2014-01-01

    The number of ambulance crewmembers may affect the quality of cardiopulmonary resuscitation in particular situations. However, few studies have investigated how the number of emergency care providers affects the quality of CPR. Nonetheless, problems in the initial handling of patients due to small ambulance crew sizes may have significant consequences. These difficulties may be more frequent in an obese population than in a non-obese population. Hence such problems may be frequently encountered because obesity is epidemic in developed countries. In this report, we illustrate the fatal consequences of initial problems in patient handling due to a small ambulance crew size in an obese patient who suffered an out-of-hospital cardiac arrest. Following successful resuscitation, this patient presented humeral fractures that may have promoted a disorder of hemostasis. The patient eventually died. This case highlights the requirement for specific instructions for paramedics to manage obese patients in these emergency conditions. This case also highlights the need to take into account body mass index when deciding on appropriate pre-hospital care, especially regarding the number of ambulance crewmembers. PMID:24830962

  11. Brief report: Assessing youth well-being in global emergency settings: Early results from the Emergency Developmental Assets Profile.

    PubMed

    Scales, Peter C; Roehlkepartain, Eugene C; Wallace, Teresa; Inselman, Ashley; Stephenson, Paul; Rodriguez, Michael

    2015-12-01

    The 13-item Emergency Developmental Assets Profile measures the well-being of children and youth in emergency settings such as refugee camps and armed conflict zones, assessing whether young people are experiencing adequate positive relationships and opportunities, and developing positive values, skills, and self-perceptions, despite being in crisis circumstances. The instrument was found to have acceptable and nearly identical internal consistency reliability in 22 administrations in non-emergency samples in 15 countries (.75), and in 4 samples of youth ages 10-18 (n = 1550) in the emergency settings (war refugees and typhoon victims, .74) that are the measure's focus, and evidence of convergent validity. Confirmatory Factor Analysis showed acceptable model fit among those youth in emergency settings. Measures of model fit showed that the Em-DAP has configural and metric invariance across all emergency contexts and scalar invariance across some. The Em-DAP is a promising brief cross-cultural tool for assessing the developmental quality of life as reported by samples of youth in a current humanitarian crisis situation. The results can help to inform international relief program decisions about services and activities to be provided for children, youth, and families in emergency settings. PMID:26426457

  12. The adoption of the Reference Framework for diabetes care among primary care physicians in primary care settings

    PubMed Central

    Wong, Martin C.S.; Wang, Harry H.X.; Kwan, Mandy W.M.; Chan, Wai Man; Fan, Carmen K.M.; Liang, Miaoyin; Li, Shannon TS; Fung, Franklin D.H.; Yeung, Ming Sze; Chan, David K.L.; Griffiths, Sian M.

    2016-01-01

    Abstract The prevalence of diabetes mellitus has been increasing both globally and locally. Primary care physicians (PCPs) are in a privileged position to provide first contact and continuing care for diabetic patients. A territory-wide Reference Framework for Diabetes Care for Adults has been released by the Hong Kong Primary Care Office in 2010, with the aim to further enhance evidence-based and high quality care for diabetes in the primary care setting through wide adoption of the Reference Framework. A valid questionnaire survey was conducted among PCPs to evaluate the levels of, and the factors associated with, their adoption of the Reference Framework. A total of 414 completed surveys were received with the response rate of 13.0%. The average adoption score was 3.29 (SD 0.51) out of 4. Approximately 70% of PCPs highly adopted the Reference Framework in their routine practice. Binary logistic regression analysis showed that the PCPs perceptions on the inclusion of sufficient local information (adjusted odds ratio [aOR] = 4.748, 95%CI 1.597–14.115, P = 0.005) and reduction of professional autonomy of PCPs (aOR = 1.859, 95%CI 1.013–3.411, P = 0.045) were more likely to influence their adoption level of the Reference Framework for diabetes care in daily practices. The overall level of guideline adoption was found to be relatively high among PCPs for adult diabetes in primary care settings. The adoption barriers identified in this study should be addressed in the continuous updating of the Reference Framework. Strategies need to be considered to enhance the guideline adoption and implementation capacity. PMID:27495018

  13. The lived experience of new graduate nurses working in an acute care setting.

    PubMed

    McCalla-Graham, James A; De Gagne, Jennie C

    2015-03-01

    The high attrition rate of graduate nurses will exacerbate the current nursing shortage as Baby Boomer nurses (born between 1946 and 1964) retire, negatively affecting the quality of patient care and increasing employer costs. The purpose of this phenomenological study was to explore the lived experiences of new graduate nurses employed in an acute care setting in southwest Florida. This information provides further guidance to nurse educators as they develop curricula, support graduate nurses to transition into professional practice, and create strategies to increase retention. Ten participants who were traditional students in generic baccalaureate nursing programs, selected through purposeful and snowball sampling, were interviewed via open-ended questions. Using Colaizzi's classic phenomenological method of data analysis and NVivo 10 software, three over-arching themes emerged-knowledge, skills, and environment-which were interpreted in relation to graduates' lived experience. Recommendations include implementation of innovative initiatives that address new graduates' experience and increase retention. PMID:25723333

  14. Implementing emergency manuals: can cognitive aids help translate best practices for patient care during acute events?

    PubMed

    Goldhaber-Fiebert, Sara N; Howard, Steven K

    2013-11-01

    In this article, we address whether emergency manuals are an effective means of helping anesthesiologists and perioperative teams apply known best practices for critical events. We review the relevant history of such cognitive aids in health care, as well as examples from other high stakes industries, and describe why emergency manuals have a role in improving patient care during certain events. We propose 4 vital elements: create, familiarize, use, and integrate, necessary for the widespread, successful development, and implementation of medical emergency manuals, using the specific example of the perioperative setting. The details of each element are presented, drawing from the medical literature as well as from our combined experience of more than 30 years of observing teams of anesthesiologists managing simulated and real critical events. We emphasize the importance of training clinicians in the use of emergency manuals for education on content, format, and location. Finally, we discuss cultural readiness for change, present a system example of successful integration, and highlight the importance of further research on the implementation of emergency manuals. PMID:24108251

  15. Exploring the mealtime experience in residential care settings for older people: an observational study.

    PubMed

    Barnes, Sarah; Wasielewska, Anna; Raiswell, Christine; Drummond, Barbara

    2013-07-01

    Improving the mealtime experience in residential care can be a major facilitator in improving care, well-being and QoL. Evidence suggests that, despite guidance on the subject of food, nutrition and hydration, there are still concerns. Although there is a range of methods to research and assess the quality of food provision, there is a challenge in capturing the experiences of those residents who are unable or unwilling to describe their feelings and experiences because of frailty, impaired communication or other vulnerability. The aim of this exploratory study was to capture and describe individual residents' mealtime experience. In spring 2011, a small-scale, observational study was carried out in seven dining settings in four residential care homes in Manchester. An adapted dementia care mapping tool was used alongside field notes. Observations showed two major differences in the way the mealtimes were organised: 'pre-plated' and 'family-style' (where either bowls of food are placed in the centre of the table or food is served directly from a hotplate by a chef). These two styles of service are discussed in relation to the emerging themes of 'task versus resident-centred mealtimes', 'fostering resident independence' and 'levels of interaction'. Although improving mealtimes alone is not enough to improve quality of life in care homes, findings showed that relatively small changes to mealtime delivery can potentially have an impact on resident well-being in these homes. Observation is a useful method of engaging residents in care settings for older people who may not otherwise be able to take part in research. PMID:23638872

  16. The Demand and Supply of Child Care in 1990: Joint Findings from the National Child Care Survey 1990 and a Profile of Child Care Settings.

    ERIC Educational Resources Information Center

    Willer, Barbara; And Others

    This document reports the results of two coordinated studies of early education and care in the United States. Information on child care demand was provided through the National Child Care Survey 1990 (NCCS), which involved interviews with 4,392 parents. Information on child care supply was provided by A Profile of Child Care Settings (PCS), which…

  17. An experience of emergency ultrasonography in children in a sub‐Saharan setting

    PubMed Central

    Ahmad, S; Kampondeni, S; Molyneux, E

    2006-01-01

    Emergency ultrasonography is an appealing imaging modality in paediatric emergencies, given its non‐invasive nature and potential as an adjunct to physical examination in a setting where rapid decisions need to be made. This review of a case series describes the applications, versatility, and limitations of emergency physician led ultrasonography in a paediatric resuscitation room in a sub‐Saharan African setting. PMID:16627831

  18. Using electronic communication safely in health care settings.

    PubMed

    Broussard, Brenda S; Broussard, Anne B

    2013-01-01

    Nurses are increasingly using mobile and other devices, such as cell phones, smartphones, tablets, bar-coding scanners, monitoring equipment and bedside computers, to communicate with members of the health care team and with patients. Communication accomplished with such devices includes direct verbal communication, text-messaging, emailing, obtaining patient care information and accessing medical records for order entry and for documenting nursing care. Problems that could occur with such communication methods include distraction, errors, de-personalized care, violation of confidentiality and transmission of nosocomial pathogens. Policies are needed to prevent inappropriate use of technological devices in patient care and to promote patient safety and quality care with their use. PMID:23399014

  19. Current and Emerging Treatment Options in Diabetes Care.

    PubMed

    Clemmensen, Christoffer; Müller, Timo D; Finan, Brian; Tschöp, Matthias H; DiMarchi, Richard

    2016-01-01

    Diabetes constitutes an increasing threat to human health, particularly in newly industrialized and densely populated countries. Type 1 and type 2 diabetes arise from different etiologies but lead to similar metabolic derangements constituted by an absolute or relative lack of insulin that results in elevated plasma glucose. In the last three decades, a set of new medicines built upon a deeper understanding of physiology and diabetic pathology have emerged to enhance the clinical management of the disease and related disorders. Recent insights into insulin-dependent and insulin-independent molecular events have accelerated the generation of a series of novel medicinal agents, which hold the promise for further advances in the management of diabetes. In this chapter, we provide a historical context for what has been accomplished to provide perspective for future research and novel emerging treatment options. PMID:25903416

  20. Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner—qualitative and summative findings

    PubMed Central

    Cooper, Simon; O'Carroll, Judith; Jenkin, Annie; Badger, Beryl

    2007-01-01

    Objective To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods A 12‐month (2005–2006) mixed methods clinical case study was carried out in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multi‐professional emergency care practitioners (ECPs), interviews with 45 ECPs and stakeholders, and an audit of 611 patients Results Using a generic qualitative approach, observational records and interviews showed that ECPs' numerous links with other professions were influenced by three major themes as follows. (i) The ECP role: for example, “restricted transport codes” of communication, focus on reducing admissions, frustrations about patient tasking and conflicting views about leadership and team work. (ii) Education and training: drivers for multi‐professional clinically focussed graduate level education, requirements for skill development in minor injury units (MIUs) and general practice, and the need for clinical supervision/mentorship. (iii) Cultural perspectives: a “crew room” blue collar view of inter‐professional working versus emerging professional white collar views, power and communication conflicts, and a lack of understanding of the ECPs' role. The quantitative findings are reported elsewhere. Conclusions The final model of collaborative practice suggests that ECPs are having an impact on patient care, but that improvements can be made. We recommend the appointment of ECP clinical leads, degree level clinically focussed multi‐professional education, communication skills training, clinical supervision and multi‐professional ECP appointments. PMID:17711937

  1. Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner—quantitative findings

    PubMed Central

    Cooper, Simon; O'Carroll, Judith; Jenkin, Annie; Badger, Beryl

    2007-01-01

    Objective To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods A 12 month (2005–6) mixed methods clinical case study in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multiprofessional emergency care practitioners (ECPs); interviews with 45 ECPs and stakeholders; and an audit of 611 patients. Results Quantitative observational ratings indicated that the higher the leadership rating the greater the communication ability (p⩽0.001) and teamwork (p⩽0.001), and the higher grade ECPs were rated more highly on their leadership performance. From the patient audit, influences and outputs of collaborative practice are revealed: mean time on scene was 47 mins; 62% were not conveyed; 38% were referred, mainly to accident and emergency; ECPs claimed to make the referral decision in 87% of cases with a successful referral in 96% of cases; and in 66% of cases ECPs claimed that their intervention prevented an acute trust admission. The qualitative interview findings, final collaborative model and recommendations are reported in another paper. Conclusions The collaborative performance of ECPs varies, but the ECPs' role does appear to have an impact on collaborative practices and patient care. Final recommendations are reported with the qualitative results elsewhere. PMID:17711938

  2. Fit for purpose? Introducing a rational priority setting approach into a community care setting.

    PubMed

    Cornelissen, Evelyn; Mitton, Craig; Davidson, Alan; Reid, Colin; Hole, Rachelle; Visockas, Anne-Marie; Smith, Neale

    2016-06-20

    Purpose - Program budgeting and marginal analysis (PBMA) is a priority setting approach that assists decision makers with allocating resources. Previous PBMA work establishes its efficacy and indicates that contextual factors complicate priority setting, which can hamper PBMA effectiveness. The purpose of this paper is to gain qualitative insight into PBMA effectiveness. Design/methodology/approach - A Canadian case study of PBMA implementation. Data consist of decision-maker interviews pre (n=20), post year-1 (n=12) and post year-2 (n=9) of PBMA to examine perceptions of baseline priority setting practice vis-à-vis desired practice, and perceptions of PBMA usability and acceptability. Findings - Fit emerged as a key theme in determining PBMA effectiveness. Fit herein refers to being of suitable quality and form to meet the intended purposes and needs of the end-users, and includes desirability, acceptability, and usability dimensions. Results confirm decision-maker desire for rational approaches like PBMA. However, most participants indicated that the timing of the exercise and the form in which PBMA was applied were not well-suited for this case study. Participant acceptance of and buy-in to PBMA changed during the study: a leadership change, limited organizational commitment, and concerns with organizational capacity were key barriers to PBMA adoption and thereby effectiveness. Practical implications - These findings suggest that a potential way-forward includes adding a contextual readiness/capacity assessment stage to PBMA, recognizing organizational complexity, and considering incremental adoption of PBMA's approach. Originality/value - These insights help us to better understand and work with priority setting conditions to advance evidence-informed decision making. PMID:27296887

  3. Essential basic and emergency obstetric and newborn care: from education and training to service delivery and quality of care.

    PubMed

    Otolorin, Emmanuel; Gomez, Patricia; Currie, Sheena; Thapa, Kusum; Dao, Blami

    2015-06-01

    Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings. PMID:26115858

  4. Making It Happen: Training health-care providers in emergency obstetric and newborn care.

    PubMed

    Ameh, Charles A; van den Broek, Nynke

    2015-11-01

    An estimated 289,000 maternal deaths, 2.6 million stillbirths and 2.4 million newborn deaths occur globally each year, with the majority occurring around the time of childbirth. The medical and surgical interventions to prevent this loss of life are known, and most maternal and newborn deaths are in principle preventable. There is a need to build the capacity of health-care providers to recognize and manage complications during pregnancy, childbirth and the post-partum period. Skills-and-drills competency-based training in skilled birth attendance, emergency obstetric care and early newborn care (EmONC) is an approach that is successful in improving knowledge and skills. There is emerging evidence of this resulting in improved availability and quality of care. To evaluate the effectiveness of EmONC training, operational research using an adapted Kirkpatrick framework and a theory of change approach is needed. The Making It Happen programme is an example of this. PMID:25911056

  5. "The anticipation alone could kill you": past and potential clients' perspectives on HIV testing in non-health care settings.

    PubMed

    Joseph, Heather A; Fasula, Amy M; Morgan, Rebecca L; Stuckey, Amy; Alvarez, Maria E; Margolis, Andrew; Stratford, Dale; Dooley, Samuel W

    2011-12-01

    HIV testing in non-health care settings is an effective strategy for increasing the proportion of persons aware of their infection. We conducted 21 focus groups with 186 past and potential clients in five U.S. cities to explore attitudes and experiences related to HIV counseling and testing in non-health care settings. Qualitative analysis yielded several key themes. HIV-related stigma and fear emerged as a main theme throughout the discussions. Knowing one's HIV status quickly and accurately was of primary importance; HIV prevention counseling was secondary. Participants prioritized a supportive, nonjudgmental environment with adequate privacy and confidentiality. Provision of immediate emotional support, medical information, and linkage services to HIV-infected clients were considered essential. Staff with HIV-specific skills to address clients' emotional and informational needs was considered a strength of non-health care testing programs. Frequently, however, participants compared non-health care settings unfavorably to health care settings regarding privacy, competency, confidentiality, and test accuracy. Recommendations for enhancing counseling and testing services in non-health care settings are discussed. PMID:22201240

  6. Emergent interfacility evacuation of critical care patients in combat.

    PubMed

    Franco, Yvonne E; De Lorenzo, Robert A; Salyer, Steven W

    2012-01-01

    During the Second Iraq War (Operation Iraqi Freedom), high-intensity, low-utilization medical and surgical services, such as neurosurgical care, were consolidated into a centralized location within the combat zone. This arrangement necessitated intra-theater air medical evacuation of critically ill or injured patients from outlying combat support hospitals (CSH) to another combat zone facility having the needed services. A case series is presented of intratheater transfer of neurosurgical patients in Iraq during 2005-06. Ninety-eight patients are included in the series, with typical transfer distances of 40 miles (approximately 20-25 minutes of flight time). All patients were transported with a CSH nurse in addition to the standard Army EMT-B flight medic. Seventy-six percent of cases were battle injury, 17% were non-battle injuries, and the balance were classified as non-injury mechanisms. Seventy-six percent of cases were head injuries, with the balance involving burns, stroke, and other injuries. At 30 days, 12% of the patients had died, and 9% remained hospitalized in a critical care setting. None of the patients died during evacuation. Intratheater and interfacility transfer of critical care patients in the combat theater often involves severely head-injured and other neurosurgical cases. Current Army staffing for helicopter transport in these case requires a nurse or other advanced personnel to supplement the standard EMT-B flight medic. PMID:22748416

  7. The emergence of a global right to health norm – the unresolved case of universal access to quality emergency obstetric care

    PubMed Central

    2014-01-01

    Background The global response to HIV suggests the potential of an emergent global right to health norm, embracing shared global responsibility for health, to assist policy communities in framing the obligations of the domestic state and the international community. Our research explores the extent to which this global right to health norm has influenced the global policy process around maternal health rights, with a focus on universal access to emergency obstetric care. Methods In examining the extent to which arguments stemming from a global right to health norm have been successful in advancing international policy on universal access to emergency obstetric care, we looked at the period from 1985 to 2013 period. We adopted a qualitative case study approach applying a process-tracing methodology using multiple data sources, including an extensive literature review and limited key informant interviews to analyse the international policy agenda setting process surrounding maternal health rights, focusing on emergency obstetric care. We applied John Kingdon's public policy agenda setting streams model to analyse our data. Results Kingdon’s model suggests that to succeed as a mobilising norm, the right to health could work if it can help bring the problem, policy and political streams together, as it did with access to AIDS treatment. Our analysis suggests that despite a normative grounding in the right to health, prioritisation of the specific maternal health entitlements remains fragmented. Conclusions Despite United Nations recognition of maternal mortality as a human rights issue, the relevant policy communities have not yet managed to shift the policy agenda to prioritise the global right to health norm of shared responsibility for realising access to emergency obstetric care. The experience of HIV advocates in pushing for global solutions based on right to health principles, including participation, solidarity and accountability; suggest potential avenues for

  8. The spectrum of emergency care of agricultural trauma in central Wisconsin.

    PubMed

    Stueland, D; Zoch, T; Stamas, P; Krieg, G; Boulet, W

    1990-11-01

    Agriculture is among the most dangerous occupations in the United States. When injuries do occur, the emergency department (ED) is the primary source of care. Over a 2-year period, the emergency medicine section of the Marshfield Clinic/St Joseph's Hospital, cared for 913 victims of agricultural trauma. Although 11% were initially admitted and 4% were later treated, the remainder received their care solely in the ED. Unlike most occupational injuries, people of any age may be involved in agricultural injuries; 27% in this series were less than 18 years of age and 5% were 65 years or older. Just over half of all injuries were from mechanical devices, including tractor and farm machinery. The remainder were from animals, falls, or exposure. Although several different types of injuries occurred, the most common diagnoses were soft tissue injuries and fractures and the most common procedure was diagnostic radiography followed by wound and fracture care. An ED in a rural setting should be prepared to deal with agricultural trauma. PMID:2222598

  9. Integration of Tactical Emergency Casualty Care Into the National Tactical Emergency Medical Support Competency Domains.

    PubMed

    Pennardt, Andre; Kamin, Rich; Llewellyn, Craig; Shapiro, Geoff; Carmona, Philip A; Schwartz, Richard B

    2016-01-01

    Tactical emergency medical support (TEMS) is a critical component of the out-of-hospital response to domestic high-threat incidents such as hostage scenarios, warrant service, active shooter or violent incidents, terrorist attacks, and other intentional mass casualty-producing acts. From its grass-roots inception in the form of medical support of select law enforcement special weapons and tactics (SWAT) units in the 1980s, the TEMS subspecialty of prehospital care has rapidly grown and evolved over the past 40 years. The National TEMS Initiative and Council (NTIC) competencies and training objectives are the only published recommendations of their kind and offer the opportunity for national standardization of TEMS training programs and a future accreditation process. Building on the previous work of the NTIC and the creation of acknowledged competency domains for TEMS and the acknowledged civilian translation of TCCC by the Committee for Tactical Emergency Casualty Care (C-TECC), the Joint Review Committee (JRC) has created an opportunity to bring forward the work in a form that could be operationally useful in an all-hazards and whole of community format. PMID:27450605

  10. A top-five list for emergency medicine: a pilot project to improve the value of emergency care.

    PubMed

    Schuur, Jeremiah D; Carney, Dylan P; Lyn, Everett T; Raja, Ali S; Michael, John A; Ross, Nicholas G; Venkatesh, Arjun K

    2014-04-01

    IMPORTANCE The mean cost of medical care in the United States is growing at an unsustainable rate; from 2003 through 2011, the cost for an emergency department (ED) visit rose 240%, from $560 to $1354. The diagnostic tests, treatments, and hospitalizations that emergency clinicians order result in significant costs. OBJECTIVE To create a "top-five" list of tests, treatments, and disposition decisions that are of little value, are amenable to standardization, and are actionable by emergency medicine clinicians. DESIGN, SETTING, AND PARTICIPANTS Modified Delphi consensus process and survey of 283 emergency medicine clinicians (physicians, physician assistants, and nurse practitioners) from 6 EDs. INTERVENTION We assembled a technical expert panel (TEP) and conducted a modified Delphi process to identify a top-five list using a 4-step process. In phase 1, we generated a list of low-value clinical decisions from TEP brainstorming and e-mail solicitation of clinicians. In phase 2, the TEP ranked items on contribution to cost, benefit to patients, and actionability by clinicians. In phase 3, we surveyed all ordering clinicians from the 6 EDs regarding distinct aspects of each item. In phase 4, the TEP voted for a final top-five list based on survey results and discussion. MAIN OUTCOMES AND MEASURES A top-five list for emergency medicine. The TEP ranked items on contribution to cost, benefit to patients, and actionability by clinicians. The survey asked clinicians to score items on the potential benefit or harm to patients and the provider actionability of each item. Voting and surveys used 5-point Likert scales. A Pearson interdomain correlation was used. RESULTS Phase 1 identified 64 low-value items. Phase 2 narrowed this list to 7 laboratory tests, 3 medications, 4 imaging studies, and 3 disposition decisions included in the phase 3 survey (71.0% response rate). All 17 items showed a significant positive correlation between benefit and actionability (r, 0.19-0.37 [P

  11. Characteristics of Youth Seeking Emergency Care for Assault Injuries

    PubMed Central

    Ranney, Megan; Newton, Manya; Woodhull, Whitney; Zimmerman, Marc; Walton, Maureen A.

    2014-01-01

    OBJECTIVE: To characterize youth seeking care for assault injuries, the context of violence, and previous emergency department (ED) service utilization to inform ED-based injury prevention. METHODS: A consecutive sample of youth (14–24) presenting to an urban ED with an assault injury completed a survey of partner violence, gun/knife victimization, gang membership, and context of the fight. RESULTS: A total of 925 youth entered the ED with an assault injury; 718 completed the survey (15.4% refused); 730 comparison youth were sampled. The fights leading to the ED visit occurred at home (37.6%) or on streets (30.4%), and were commonly with a known person (68.3%). Fights were caused by issues of territory (23.3%) and retaliation (8.9%); 20.8% of youth reported substance use before the fight. The assault-injured group reported more peer/partner violence and more gun experiences. Assault-injured youth reported higher past ED utilization for assault (odds ratio [OR]: 2.16) or mental health reasons (OR: 7.98). Regression analysis found the assault-injured youth had more frequent weapon use (OR: 1.25) and substance misuse (OR: 1.41). CONCLUSIONS: Assault-injured youth seeking ED care report higher levels of previous violence, weapon experience, and substance use compared with a comparison group seeking care for other complaints. Almost 10% of assault-injured youth had another fight-related ED visit in the previous year, and ∼5% had an ED visit for mental health. Most fights were with people known to them and for well-defined reasons, and were therefore likely preventable. The ED is a critical time to interact with youth to prevent future morbidity. PMID:24323994

  12. 48 CFR 5119.1070-2 - Emerging small business set-aside.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... set-aside. 5119.1070-2 Section 5119.1070-2 Federal Acquisition Regulations System DEPARTMENT OF THE... Competitiveness Demonstration Program 5119.1070-2 Emerging small business set-aside. (a)(S-90) Solicitations for dredging shall be set-aside for exclusive competition among ESBs when the estimated award value is equal...

  13. A Profile Approach to Child Care Quality, Quantity, and Type of Setting: Parent Selection of Infant Child Care Arrangements

    ERIC Educational Resources Information Center

    Sosinsky, Laura Stout; Kim, Se-Kang

    2013-01-01

    Building on prior variable-oriented research which demonstrates the independence of the associations of child care quality, quantity, and type of setting with family factors and child outcomes, the current study identifies four profiles of child care dimensions from the NICHD Study of Early Child Care and Youth Development. Profiles accounted for…

  14. RYAN WHITE COMPREHENSIVE AIDS RESOURCES EMERGENCY (CARE) ACT OF 1990 OR CARE ACT DATA REPORT (CADR) SYSTEM

    EPA Science Inventory

    The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is Federal legislation that addresses the unmet health needs of persons living with HIV disease (PLWH) by funding primary health care and support services that enhance access to and retention in care.

  15. Toward collecting a standardized nursing data set across the continuum: case of adult care nurse practitioner setting.

    PubMed

    Keenan, Gail; Stocker, Julia; Barkauskas, Violet; Treder, Marcy; Heath, Crystal

    2003-01-01

    Viable strategies are needed to move toward collection of a standardized nursing data set across settings for eventual use in examining nursing effectiveness. One strategy is to introduce potential nurse adopters to subsets of valid setting-specific standardized terms and measures to support adoption and initial implementation. The present study was designed to identify the "most clinically useful" NANDA (North American Nursing Diagnoses Association) diagnoses, NOC (Nursing Outcomes Classifications) outcomes, and NIC (Nursing Intervention Classifications) interventions pertinent to the adult care nurse practitioner setting. Ultimately, clinicians must recognize, however, that they will need to use additional terms and measures outside the subsets to more fully describe the nursing care provided. PMID:12881972

  16. The Australian public's preferences for emergency care alternatives and the influence of the presenting context: a discrete choice experiment

    PubMed Central

    Harris, Paul; Whitty, Jennifer A; Kendall, Elizabeth; Ratcliffe, Julie; Wilson, Andrew; Littlejohns, Peter; Scuffham, Paul A

    2015-01-01

    Objectives The current study seeks to quantify the Australian public's preferences for emergency care alternatives and determine if preferences differ depending on presenting circumstances. Setting Increasing presentations to emergency departments have led to overcrowding, long waiting times and suboptimal health system performance. Accordingly, new service models involving the provision of care in alternative settings and delivered by other practitioners continue to be developed. Participants A stratified sample of Australian adults (n=1838), 1382 from Queensland and 456 from South Australia, completed the survey. This included 951 females and 887 males from the 2045 people who met the screening criteria out of the 4354 people who accepted the survey invitation. Interventions A discrete choice experiment was used to elicit preferences in the context of one of four hypothetical scenarios: a possible concussion, a rash/asthma-related problem involving oneself or one's child and an anxiety-related presentation. Mixed logit regression was used to analyse the dependent variable choice and identify the relative importance of care attributes and the propensity to access care in each context. Results Results indicated a preference for treatment by an emergency physician in hospital for possible concussion and treatment by a doctor in ambulatory settings for rash/asthma-related and anxiety-related problems. Participants were consistently willing to wait longer before making trade-offs in the context of the rash/asthma-related scenario compared with when the same problem affected their child. Results suggest a clear preference for lower costs, shorter wait times and strong emphasis on quality care; however, significant preference heterogeneity was observed. Conclusions This study has increased awareness that the public's emergency care choices will differ depending on the presenting context. It has further demonstrated the importance of service quality as a determinant of

  17. Improving interunit transitions of care between emergency physicians and hospital medicine physicians: a conceptual approach.

    PubMed

    Beach, Christopher; Cheung, Dickson S; Apker, Julie; Horwitz, Leora I; Howell, Eric E; O'Leary, Kevin J; Patterson, Emily S; Schuur, Jeremiah D; Wears, Robert; Williams, Mark

    2012-10-01

    Patient care transitions across specialties involve more complexity than those within the same specialty, yet the unique social and technical features remain underexplored. Further, little consensus exists among researchers and practitioners about strategies to improve interspecialty communication. This concept article addresses these gaps by focusing on the hand-off process between emergency and hospital medicine physicians. Sensitivity to cultural and operational differences and a common set of expectations pertaining to hand-off content will more effectively prepare the next provider to act safely and efficiently when caring for the patient. Through a consensus decision-making process of experienced and published authorities in health care transitions, including physicians in both specialties as well as in communication studies, the authors propose content and style principles clinicians may use to improve transition communication. With representation from both community and academic settings, similarities and differences between emergency medicine and internal medicine are highlighted to heighten appreciation of the values, attitudes, and goals of each specialty, particularly pertaining to communication. The authors also examine different communication media, social and cultural behaviors, and tools that practitioners use to share patient care information. Quality measures are proposed within the structure, process, and outcome framework for institutions seeking to evaluate and monitor improvement strategies in hand-off performance. Validation studies to determine if these suggested improvements in transition communication will result in improved patient outcomes will be necessary. By exploring the dynamics of transition communication between specialties and suggesting best practices, the authors hope to strengthen hand-off skills and contribute to improved continuity of care. PMID:23035952

  18. Places to Live: Important Dimensions in Child Care Settings

    ERIC Educational Resources Information Center

    Greenman, Jim

    2007-01-01

    Child care centers can be great institutions of learning and caring, if everyone pays attention to some important dimensions that also make them reasonable places to live. Children need a place where they have full use of their bodies and senses and enough freedom to take advantage of the variety of life, where they can find or invent the spaces…

  19. Improving Services for Women with Depression in Primary Care Settings

    ERIC Educational Resources Information Center

    Katon, Wayne J.; Ludman, Evette J.

    2003-01-01

    Women have a higher prevalence of depressive disorders compared to men. The current system of care for women with depressive disorders provides significant financial barriers for patients with lower incomes to access mental health services. Primary care systems are used extensively by women and have the potential to diagnose patients at early…

  20. Indicators of Home Care Use in Urban and Rural Settings

    ERIC Educational Resources Information Center

    Mitchell, Lori A.; Strain, Laurel A.; Blandford, Audrey A.

    2007-01-01

    This study employs a longitudinal design to examine rural-urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba (n = 855) were…

  1. The Future of Family Engagement in Residential Care Settings

    ERIC Educational Resources Information Center

    Affronti, Melissa L.; Levison-Johnson, Jody

    2009-01-01

    Residential programs for children and youth are increasingly implementing engagement strategies to promote family-centered and family-driven models of care (Leichtman, 2008). The practice of engagement is a fairly new area of research, especially in residential care. Driven by their goal to increase the use of state-of-the-art family engagement…

  2. Quality specifications and standard-setting for stoma care patients.

    PubMed

    Primer, M A

    1995-12-01

    Quality specifications can be used as an information resource by purchasers of health care. The nature of service provision and nursing care can be positively influenced by the formalisation of standards and quality specifications. Auditing is essential in the ongoing evaluation of a quality system. PMID:8552696

  3. Identification of Violence in Turkish Health Care Settings

    ERIC Educational Resources Information Center

    Ayranci, Unal; Yenilmez, Cinar; Balci, Yasemin; Kaptanoglu, Cem

    2006-01-01

    This study sought to investigate the contributing factors to and frequency of violence against health care workers (HCWs) working in western Turkey. The population is composed of a random sample of 1,209 HCWs from 34 health care workplaces. Written questionnaires were given to HCWs at all sites, where staff were instructed to register all types of…

  4. A multi-organisation aged care emergency service for acute care management of older residents in aged care facilities.

    PubMed

    Conway, Jane; Dilworth, Sophie; Hullick, Carolyn; Hewitt, Jacqueline; Turner, Catherine; Higgins, Isabel

    2015-11-01

    This case study describes a multi-organisation aged care emergency (ACE) service. The service was designed to enable point-of-care assessment and management for older people in residential aged care facilities (RACFs). Design of the ACE service involved consultation and engagement of multiple key stakeholders. The ACE service was implemented in a large geographical region of a single Medicare Local (ML) in New South Wales, Australia. The service was developed over several phases. A case control pilot evaluation of one emergency department (ED) and four RACFs revealed a 16% reduction in presentations to the ED as well as reductions in admission to the hospital following ED presentation. Following initial pilot work, the ACE service transitioned across another five EDs and 85 RACFs in the local health district. The service has now been implemented in a further 10 sites (six metropolitan and four rural EDs) across New South Wales. Ongoing evaluation of the implementation continues to show positive outcomes. The ACE service offers a model shown to reduce ED presentations and admissions from RACFs, and provide quality care with a focus on the needs of the older person. PMID:25981903

  5. Management of alcoholism in the primary care setting.

    PubMed Central

    Bradley, K. A.

    1992-01-01

    Primary care physicians can play an important role in managing alcoholic patients. Identifying and treating alcoholism early, before it has interfered with patients' relationships and work, may increase the likelihood of prolonged recovery. Simple office interventions can help motivate patients to abstain and seek treatment. People who abuse alcohol and are unwilling to abstain can benefit from a recommendation to reduce their intake of alcohol. For alcohol-dependent patients who decide to stop drinking, primary care physicians often can manage withdrawal on an outpatient basis. Selecting an appropriate treatment program for each alcoholic patient is important, and referral to a specialist to assist in matching patients to treatments is often necessary. Primary care physicians also can help prevent relapse. Although disulfiram is of limited value, primary care physicians can support recovery by identifying coexistent psychosocial problems, helping patients to restructure their lives, and ensuring continuity of care. PMID:1595243

  6. Nonurgent Use of the Emergency Department by Pediatric Patients: A Theory-Guided Approach for Primary and Acute Care Pediatric Nurse Practitioners.

    PubMed

    Ohns, Mary Jean; Oliver-McNeil, Sandra; Nantais-Smith, Leanne M; George, Nancy M

    2016-01-01

    Providing quality, cost-effective care to children and their families in the appropriate setting is the goal of nurse practitioners in primary and acute care. However, increased utilization of the emergency department (ED) for nonurgent care threatens cost-effective quality care, interrupts continuity of care, and contributes to ED overcrowding. To date, descriptive research has identified demographics of those using the ED for nonurgent care, the chief complaints of children seeking nonurgent care, the cost to the health care system of pediatric nonurgent care, and characteristics of associated primary care settings. Using Donabedian's Model of Quality of Healthcare and a Theory of Dependent Care by Taylor and colleagues, acute and primary care pediatric nurse practitioners can incorporate interventions that will channel care to the appropriate setting and educate caregivers regarding common childhood illnesses and the value of continuity of care. By using a theoretical framework as a guide, this article will help both acute and primary care pediatric nurse practitioners understand why parents seek nonurgent care for their children in the ED and actions they can take to ensure that care is provided in an optimal setting. PMID:26489793

  7. Patients' experiences of psychiatric care in emergency departments: A secondary analysis.

    PubMed

    Harris, Barbara; Beurmann, Ross; Fagien, Samantha; Shattell, Mona M

    2016-05-01

    The number of psychiatric emergencies presenting to EDs in the United States continues to rise. Evidence suggests that psychiatric ED care encounters can have less than optimal outcomes, and result in stress for providers. The primary aim of this study is to describe the perceptions of ED visits by persons experiencing emotional distress, identifying themes among these that may guide nursing interventions that minimize stress and optimize outcomes in the treatment of psychiatric emergency. This secondary analysis used a qualitative, phenomenological method to analyze a de-identified data set originally collected in a study of experiences of psychiatric emergency in a community based crisis management setting. Findings consist of three major themes: "Emergency rooms are cold and clinical", "They talk to you like you're a crazy person", and "You get put away against your will". An overarching theme through all three is the influence of RN communication, both positive and negative, on patient perceptions of their ED encounters. While nurse-patient communication is basic to all areas of practice, it may be a low priority in the urgent and chaotic context of the ED. However, our findings suggest that increased attention to timely, empathic and validating communication and openness to the patient's reality may decrease severity of symptoms, optimize outcomes, and decrease provider stress. PMID:26459607

  8. Needles and Other Sharps (Safe Disposal Outside of Health Care Settings)

    MedlinePlus

    ... are generally available through pharmacies, medical supply companies, health care providers and online. These containers are made of ... proper disposal methods for sharps used outside of health care settings visit this website or call (800) 643- ...

  9. A qualitative study on hypertensive care behavior in primary health care settings in Malaysia

    PubMed Central

    Shima, Razatul; Farizah, Mohd Hairi; Majid, Hazreen Abdul

    2014-01-01

    Purpose The aim of this study was to explore patients’ experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes) in primary health clinic settings. Patients and methods A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang) in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis. Results There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients’ attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups. Conclusion Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their inhibition of asking questions and to accept the recommendations. A self-management approach must be responsive to the needs of individuals, ethnicities, and communities. PMID:25484577

  10. Setting the Equation: Establishing Value in Spine Care

    PubMed Central

    Resnick, Daniel K.; Tosteson, Anna N. A.; Groman, Rachel F.; Ghogawala, Zoher

    2014-01-01

    Study Design Topic review Objective Describe value measurement in spine care and discuss the motivation for, methods for, and limitations of such measurement. Summary of Background Data Spinal disorders are common and are an important cause of pain and disability. Numerous complimentary and competing treatment strategies are used to treat spinal disorders and the costs of these treatments is substantial and continues to rise despite clear evidence of improved health status as a result of these expenditures. Methods The authors present the economic and legislative imperatives forcing the assessment of value in spine care. The definition of value in health care and methods to measure value specifically in spine care are presented. Limitations to the utility of value judgements and caveats to their use are presented. Results Examples of value calculations in spine care are presented and critiqued. Methods to improve and broaden the measurement of value across spine care are suggested and the role of prospective registries in measuring value is discussed. Conclusions Value can be measured in spine care through the use of appropriate economic measures and patient reported outcomes measures. Value must be interpreted in light of the perspective of the assessor, the duration of the assessment period, the degree of appropriate risk stratification, and the relative value of treatment alternatives. PMID:25299258

  11. 48 CFR 5119.1070-2 - Emerging small business set-aside.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... participation by small businesses and emerging small businesses: (1) Specifying of contract requirements and... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Emerging small business set... ACQUISITION REGULATIONS SMALL BUSINESS AND SMALL DISADVANTAGED BUSINESS CONCERNS Small...

  12. The Emergence of Student Creativity in Classroom Settings: A Case Study of Elementary Schools in Korea

    ERIC Educational Resources Information Center

    Cho, Younsoon; Chung, Hye Young; Choi, Kyoulee; Seo, Choyoung; Baek, Eunjoo

    2013-01-01

    This research explores the emergence of student creativity in classroom settings, specifically within two content areas: science and social studies. Fourteen classrooms in three elementary schools in Korea were observed, and the teachers and students were interviewed. The three types of student creativity emerging in the teaching and learning…

  13. 48 CFR 5119.1070-2 - Emerging small business set-aside.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 7 2011-10-01 2011-10-01 false Emerging small business... ARMY ACQUISITION REGULATIONS SMALL BUSINESS AND SMALL DISADVANTAGED BUSINESS CONCERNS Small Business Competitiveness Demonstration Program 5119.1070-2 Emerging small business set-aside. (a)(S-90) Solicitations...

  14. Emergency ultrasound in the prehospital setting: the impact of environment on examination outcomes.

    PubMed

    Snaith, B; Hardy, M; Walker, A

    2011-12-01

    This study aimed to compare ultrasound examinations performed within a land ambulance (stationary and moving) with those completed in a simulated emergency department (ED) to determine the feasibility of undertaking ultrasound examinations within the UK prehospital care environment. The findings suggest that abdominal aortic aneurysm and extended focused assessment with sonography in trauma emergency ultrasound examinations can be performed in the stationary or moving land ambulance environment to a standard consistent with those performed in the hospital ED. PMID:21450758

  15. System facilitators and barriers to discussing older driver safety in primary care settings

    PubMed Central

    Betz, Marian E.; Jones, Jacqueline; Carr, David B.

    2015-01-01

    Background Primary care physicians play a leading role in counseling older drivers, but discussions often do not occur until safety concerns arise. Prior work suggests that routine questioning about driving might facilitate these difficult conversations. Objective To explore system-level factors affecting driving discussions in primary care settings, in order to inform the design and implementation of a program supporting routine conversations. Methods This qualitative descriptive study used iterative interviews with providers (physicians, nurses, medical assistants, social workers, and administrative staff) working at two clinics (one geriatric, one general internal medicine) at a tertiary-care teaching hospital. General inductive techniques in transcript analysis were used to identify stakeholder-perceived system-level barriers and facilitators to routine conversations with older drivers. Results From fifteen interviews, four themes emerged: (1) complexity of defined provider roles within primary care setting (which can both support team work and hamper efficiency); (2) inadequate resources to support providers (including clinical prompts, local guides, and access to social workers and driving specialists); (3) gaps in education of providers and patients about discussing driving; and (4) suggested models to enhance provider conversations with older drivers (including following successful examples and using defined pathways integrated into the electronic medical record). A fifth theme was that participants characterized their experiences in terms of current and ideal states. Conclusions Physicians have been tasked with assessing older driver safety and guiding older patients through the process of “driving retirement.” Attention to system-level factors such as provider roles, resources, and training can support them in this process. PMID:25617342

  16. Unnecessary Antibiotics for Acute Respiratory Tract Infections: Association With Care Setting and Patient Demographics

    PubMed Central

    Barlam, Tamar F.; Soria-Saucedo, Rene; Cabral, Howard J.; Kazis, Lewis E.

    2016-01-01

    Background. Up to 40% of antibiotics are prescribed unnecessarily for acute respiratory tract infections (ARTIs). We sought to define factors associated with antibiotic overprescribing of ARTIs to inform efforts to improve practice. Methods. We conducted a retrospective analysis of ARTI visits between 2006 and 2010 from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Those surveys provide a representative sample of US visits to community-based physicians and to hospital-based emergency departments (EDs) and outpatient practices. Patient factors (age, sex, race, underlying lung disease, tobacco use, insurance), physician specialty, practice demographics (percentage poverty, median household income, percentage with a Bachelor's Degree, urban-rural status, geographic region), and care setting (ED, hospital, or community-based practice) were evaluated as predictors of antibiotic overprescribing for ARTIs. Results. Hospital and community-practice visits had more antibiotic overprescribing than ED visits (odds ratio [OR] = 1.64 and 95% confidence interval [CI], 1.27–2.12 and OR = 1.59 and 95% CI, 1.26–2.01, respectively). Care setting had significant interactions with geographic region and urban and rural location. The quartile with the lowest percentage of college-educated residents had significantly greater overprescribing (adjusted OR = 1.41; 95% CI, 1.07–1.86) than the highest quartile. Current tobacco users were overprescribed more often than nonsmokers (OR = 1.71; 95% CI, 1.38–2.12). Patient age, insurance, and provider specialty were other significant predictors. Conclusions. Tobacco use and a lower grouped rate of college education were associated with overprescribing and may reflect poor health literacy. A focus on educating the patient may be an effective approach to stewardship. PMID:27006968

  17. Point-of-care D-dimer testing in emergency departments.

    PubMed

    Marquardt, Udo; Apau, Daniel

    2015-09-01

    Overcrowding and prolonged patient stays in emergency departments (EDs) affect patients' experiences and outcomes, and increase healthcare costs. One way of addressing these problems is through using point-of-care blood tests, laboratory testing undertaken near patient locations with rapidly available results. D-dimer tests are used to exclude venous thromboembolism (VTE), a common presentation in EDs, in low-risk patients. However, data on the effects of point-of-care D-dimer testing in EDs and other urgent care settings are scarce. This article reports the results of a literature review that examined the benefits to patients of point-of-care D-dimer testing in terms of reduced turnaround times (time to results), and time to diagnosis, discharge or referral. It also considers the benefits to organisations in relation to reduced ED crowding and increased cost effectiveness. The review concludes that undertaking point-of-care D-dimer tests, combined with pre-test probability scores, can be a quick and safe way of ruling out VTE and improving patients' experience. PMID:26344541

  18. [Compassionate care, emergence of a notion in the light and shade of the care environment].

    PubMed

    Casagrande, Alice

    2016-05-01

    Compassionate care is a recent notion. It is based on a shared culture which focuses on promoting the rights of vulnerable people, integral to the quality of professionals' life at work. Tangible and part of day-to-day practice, it requires room to be set aside for discussion and ethical considerations, essential for ensuring the long-lasting creativity of caregivers, at the source of their mobilisation. PMID:27157555

  19. Emergency care capacity in Africa: A clinical and educational initiative in Tanzania

    PubMed Central

    Reynolds, Teri A; Mfinanga, Juma A; Sawe, Hendry R; Runyon, Michael S; Mwafongo, Victor

    2012-01-01

    Even though sub-Saharan Africa faces a disproportionate burden of acute injury and illness, few clinical facilities are configured to take an integrated approach to resuscitation and stabilization. Emergency care is a high-impact and cost-effective form of secondary prevention; disease surveillance at facilities delivering acute and emergency care is essential to guide primary prevention. Barriers to emergency care implementation in the region include limited documentation of the acute disease burden, a lack of consensus on regionally appropriate metrics to facilitate impact evaluation, and the lack of coordinated advocacy for acute disease prevention and emergency care. Despite these challenges, interest in creating dedicated acute care facilities and emergency training programs is rapidly expanding in Africa. We describe one such initiative at Muhimbili National Hospital in Dar es Salaam, with a focus on the development of the emergency medicine residency program. PMID:23254838

  20. Streamlining Pediatric Emergency Medicine at a Tertiary-care Hospital of a Low- to Middle-income Country.

    PubMed

    Bhimani, Salima Ahmed; Brown, Nick; Mian, Asad I

    2015-12-01

    The factors of integral importance to run any pediatric emergency department efficiently are the ability to process a high volume of patients quickly and a sensitive triage system that identifies the sickest children. Achieving these aims in a low- to middle-income country setting is more complex as a result of scarce resources and data on which to base systems. In this article, we discuss existing models of streamlining pediatric emergency department services that are most applicable to resource-limited countries, and present suggestions for streamlining pediatric emergency care in such countries. PMID:26713983

  1. Evaluation of child maltreatment in the emergency department setting: an overview for behavioral health providers.

    PubMed

    Leetch, Aaron N; Leipsic, John; Woolridge, Dale P

    2015-01-01

    Emergency providers are confronted with medical, social, and legal dilemmas with each case of possible child maltreatment. Keeping a high clinical suspicion is key to diagnosing latent abuse. Child abuse, especially sexual abuse, is best handled by a multidisciplinary team including emergency providers, nurses, social workers, and law enforcement trained in caring for victims and handling forensic evidence. The role of the emergency provider in such cases is to identify abuse, facilitate a thorough investigation, treat medical needs, protect the patient, provide an unbiased medical consultation to law enforcement, and provide an ethical testimony if called to court. PMID:25455575

  2. The Effectiveness of Emergency Obstetric Referral Interventions in Developing Country Settings: A Systematic Review

    PubMed Central

    Hussein, Julia; Kanguru, Lovney; Astin, Margaret; Munjanja, Stephen

    2012-01-01

    Background Pregnancy complications can be unpredictable and many women in developing countries cannot access health facilities where life-saving care is available. This study assesses the effects of referral interventions that enable pregnant women to reach health facilities during an emergency, after the decision to seek care is made. Methods and findings Selected bibliographic databases were searched with no date or language restrictions. Randomised controlled trials and quasi experimental study designs with a comparison group were included. Outcomes of interest included maternal and neonatal mortality and other intermediate measures such as service utilisation. Two reviewers independently selected, appraised, and extracted articles using predefined fields. Forest plots, tables, and qualitative summaries of study quality, size, and direction of effect were used for analysis. Nineteen studies were included. In South Asian settings, four studies of organisational interventions in communities that generated funds for transport reduced neonatal deaths, with the largest effect seen in India (odds ratio 0·48 95% CI 0·34–0·68). Three quasi experimental studies from sub-Saharan Africa reported reductions in stillbirths with maternity waiting home interventions, with one statistically significant result (OR 0.56 95% CI 0.32–0.96). Effects of interventions on maternal mortality were unclear. Referral interventions usually improved utilisation of health services but the opposite effect was also documented. The effects of multiple interventions in the studies could not be disentangled. Explanatory mechanisms through which the interventions worked could not be ascertained. Conclusions Community mobilisation interventions may reduce neonatal mortality but the contribution of referral components cannot be ascertained. The reduction in stillbirth rates resulting from maternity waiting homes needs further study. Referral interventions can have unexpected adverse effects

  3. Contamination of equipment in emergency settings: An exploratory study with a targeted automated intervention

    PubMed Central

    Obasi, Chidi; Agwu, Allison; Akinpelu, Wale; Hammons, Roger; Clark, Clyde; Etienne-cummings, Ralph; Hill, Peter; Rothman, Richard; Babalola, Stella; Ross, Tracy; Carroll, Karen; Asiyanbola, Bolanle

    2009-01-01

    Background Despite standard manual decontamination, hospital equipment remains contaminated with microorganisms, contributing to nosocomial transmission and hospital acquired infections. This has the potential to negate the effects of healthcare workers' hand-washing protocols. In order to decrease the likihood of equipment contamination, there has been a rise in the use of disposable pieces of equipment, especially non-critical disposables. However, these carry a significant cost, both a direct financial cost (running into billions of dollars), as well as a cost to the environment. This is important because we hope to contain the cost of healthcare, one way to do that, is to look to the hospitals themselves, for innovative solutions that maintain the standard of care. Objective To develop and evaluate the effectiveness of an simple decontamination device for use with portable hospital equipment, by comparing rates of residual contamination after use of the novel device versus those seen with standard manual decontamination methods. Methods The Self-cleaning Unit for the Decontamination of Small instruments (SUDS) is a user-friendly, automated instrument developed via multi-disciplinary collaboration for decontamination in the clinical area. Pre- and post- utilization of portable medical equipment in an emergency department (ED) setting were cultured. To evaluate durability of the decrease in antimicrobial contamination, objects were re-cultured 48 hours after SUDS cleaning and following re-introduction into the clinical setting. Results After manual decontamination, 25% (23/91) of the tested objects in the ED were found to be culture positive with clinically significant microorganisms(CSO). Fifteen percent (ED) of non-critical equipment tested had multiple organisms. Following the use of SUDS, the colonization rate decreased to 0%. Following SUDS treatment and re-introduction into the clinical settings, after 48 hours the contamination rates as reflected by the

  4. Public Private Partnerships for Emergency Obstetric Care: Lessons from Maharashtra

    PubMed Central

    Chaturvedi, Sarika; Randive, Bharat

    2011-01-01

    Background: The National Rural Health Mission of India advocates public private partnerships (PPPs) to meet its “service guarantee” of Emergency obstetric care (EmOC) provision. The Janani Suraksha Yojana (JSY) has a provision of Rs. 1500 for contracting in obstetric specialists. Objectives: The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. Materials and Methods: A cross-sectional study using the rapid assessment approach was conducted in Ahmednagar district of Maharashtra spanning 1-year duration ending in June 2009. Primary data were obtained through interviews with women, providers, and administrators at various levels. Data were analyzed thematically. Results: The PPP scheme for EmOC is restricted to deliveries by Caesarean section.The administrators prefer subsidization of costs for services in private facilities to contracting in. There are no PPPs executed in the study district. This study identifies barriers to women in accessing the benefit and the difficulties faced by administrators in implementing the scheme. Conclusion: The PPPs for EmOC under the JSY have minimally influenced the out-of-pocket payments for EmOC. Infrastructural inadequacies and passive support of the implementers are major barriers to the implementation of contracting-in model of PPPs. Capacities in the public health system are inadequate to design and manage PPPs. PMID:21687376

  5. Fluid as a Drug: Balancing Resuscitation and Fluid Overload in the Intensive Care Setting.

    PubMed

    McGuire, Matthew D; Heung, Michael

    2016-05-01

    Intravenous fluid resuscitation is ubiquitous throughout medicine and is often considered a benign procedure. Yet, there is now clear recognition of the potential harms of fluid overload after initial resuscitation. In recent years, there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks. Studies have examined colloids, such as albumin and starches, against the clinical standard of crystalloids. In addition, evidence has emerged to suggest that outcomes may be different between resuscitation with chloride-rich vs balanced crystalloid solutions. In this article, we review the current literature regarding choice of intravenous fluids for resuscitation in the intensive care setting and describe the dangers associated with fluid overload in critically ill patients. PMID:27113691

  6. Brief Intervention for Problem Drug Use in Safety-Net Primary Care Settings

    PubMed Central

    Roy-Byrne, Peter; Bumgardner, Kristin; Krupski, Antoinette; Dunn, Chris; Ries, Richard; Donovan, Dennis; West, Imara I.; Maynard, Charles; Atkins, David C.; Graves, Meredith C.; Joesch, Jutta M.; Zarkin, Gary A.

    2015-01-01

    IMPORTANCE Although brief intervention is effective for reducing problem alcohol use, few data exist on its effectiveness for reducing problem drug use, a common issue in disadvantaged populations seeking care in safety-net medical settings (hospitals and community health clinics serving low-income patients with limited or no insurance). OBJECTIVE To determine whether brief intervention improves drug use outcomes compared with enhanced care as usual. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial with blinded assessments at baseline and at 3, 6, 9, and 12 months conducted in 7 safety-net primary care clinics in Washington State. Of 1621 eligible patients reporting any problem drug use in the past 90 days, 868 consented and were randomized between April 2009 and September 2012. Follow-up participation was more than 87% at all points. INTERVENTIONS Participants received a single brief intervention using motivational interviewing, a handout and list of substance abuse resources, and an attempted 10-minute telephone booster within 2 weeks (n = 435) or enhanced care as usual, which included a handout and list of substance abuse resources (n = 433). MAIN OUTCOMES AND MEASURES The primary outcomes were self-reported days of problem drug use in the past 30 days and Addiction Severity Index–Lite (ASI) Drug Use composite score. Secondary outcomes were admission to substance abuse treatment; ASI composite scores for medical, psychiatric, social, and legal domains; emergency department and inpatient hospital admissions, arrests, mortality, and human immunodeficiency virus risk behavior. RESULTS Mean days used of the most common problem drug at baseline were 14.40 (SD, 11.29) (brief intervention) and 13.25 (SD, 10.69) (enhanced care as usual); at 3 months postintervention, means were 11.87 (SD, 12.13) (brief intervention) and 9.84 (SD, 10.64) (enhanced care as usual) and not significantly different (difference in differences, β = 0.89 [95% CI, –0.49 to 2

  7. Hospital Epidemiology and Infection Control in Acute-Care Settings

    PubMed Central

    Sydnor, Emily R. M.; Perl, Trish M.

    2011-01-01

    Summary: Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs. The role for infection control programs has grown and continues to grow as rates of antimicrobial resistance rise and HAIs lead to increasing risks to patients and expanding health care costs. In this review, we summarize the history of the development of hospital epidemiology and infection control, common HAIs and the pathogens causing them, and the structure and role of a hospital epidemiology and infection control program. PMID:21233510

  8. Mental health care utilization and costs in a corporate setting.

    PubMed

    Tsai, S P; Bernacki, E J; Reedy, S M

    1987-10-01

    This article presents the mental health care utilization and costs among 14,162 employees and their families, covered under a major medical policy of a large multinational corporation for the 1984 policy year. Mental health care costs comprise a substantial portion of the total health care dollars expended (8.1%) for a relatively small fraction of the total number of claims (2.8%). The average hospital stay for mental disorders (20 days for employees; 15 days for spouses; 43 days for dependents) was significantly longer than for other illnesses (6.1 days for employees; 6.2 days for spouses; 4.4 days for dependents). Although the average daily hospital cost for mental disorders was less than that for non-mental conditions, total expenditures per admission were approximately three times higher due to the long lengths of stay. Case management, peer utilization review, and day treatment are recommended to reduce these costs. PMID:3681492

  9. Social anxiety disorder in the primary care setting.

    PubMed

    Culpepper, Larry

    2006-01-01

    Generalized social anxiety disorder (SAD) is a disabling yet unrecognized condition for many individuals visiting primary care physicians. Social anxiety disorder carries a high risk of developing additional anxiety and mood disorders, including those with suicidal behaviors, as comorbidities, leading to a severe course. Screening and case-finding tools are available and can lead to the recognition of affected individuals. Once symptoms are recognized, an initial assessment will help to differentiate from other anxiety disorders and conditions that can be misdiagnosed as SAD. The primary care physician can manage treatment of SAD, which might require involving mental health professionals. Both pharmacotherapy, involving selective serotonin reuptake inhibitors, and psychotherapy, preferably with cognitive-behavioral therapy, can be effective. Long-term support strategies to monitor relapses or the development of additional psychiatric disorders or to provide anticipatory guidance at times of significant life transitions are additional primary care-based activities that can be helpful to the patient with SAD. PMID:17092194

  10. Opening School-Based Health Centers in a Rural Setting: Effects on Emergency Department Use

    ERIC Educational Resources Information Center

    Schwartz, Katherine E.; Monie, Daphne; Scribani, Melissa B.; Krupa, Nicole L.; Jenkins, Paul; Leinhart, August; Kjolhede, Chris L.

    2016-01-01

    Background: Previous studies of urban school-based health centers (SBHCs) have shown that SBHCs decrease emergency department (ED) utilization. This study seeks to evaluate the effect of SBHCs on ED utilization in a rural setting. Methods: This retrospective, controlled, quasi-experimental study used an ED patient data set from the Bassett…

  11. Management of Acute Myeloid Leukemia in the Intensive Care Setting.

    PubMed

    Cowan, Andrew J; Altemeier, William A; Johnston, Christine; Gernsheimer, Terry; Becker, Pamela S

    2015-10-01

    Patients with acute myeloid leukemia (AML) who are newly diagnosed or relapsed and those who are receiving cytotoxic chemotherapy are predisposed to conditions such as sepsis due to bacterial and fungal infections, coagulopathies, hemorrhage, metabolic abnormalities, and respiratory and renal failure. These conditions are common reasons for patients with AML to be managed in the intensive care unit (ICU). For patients with AML in the ICU, providers need to be aware of common problems and how to manage them. Understanding the pathophysiology of complications and the recent advances in risk stratification as well as newer therapy for AML are relevant to the critical care provider. PMID:24756309

  12. The costs of nonbeneficial treatment in the intensive care setting.

    PubMed

    Gilmer, Todd; Schneiderman, Lawrence J; Teetzel, Holly; Blustein, Jeffrey; Briggs, Kathleen; Cohn, Felicia; Cranford, Ronald; Dugan, Daniel; Kamatsu, Glen; Young, Ernlé

    2005-01-01

    Ethics consultations have been shown to reduce the use of "nonbeneficial treatments," defined as life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, when treatment conflicts occurred in the adult intensive care unit (ICU). In this paper we estimated the costs of nonbeneficial treatment using the results from a randomized trial of ethics consultations. We found that ethics consultations were associated with reductions in hospital days and treatment costs among patients who did not survive to hospital discharge. We conclude that consultations resolved conflicts that would have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU instead of focusing on more appropriate comfort care. PMID:16136635

  13. [Do not resuscitate orders in the intensive care setting].

    PubMed

    Kleiren, P; Sohawon, S; Noordally, S O

    2010-01-01

    Even if Belgium (2002), The Netherlands (2002) and Luxemburg (2009) are the first three countries in the world to have legalized active euthanasia, there still is not a law on the do not resuscitate concept (NTBR or DNR). Nevertheless, numerous royal decrees and some consensus as well as advice given by the Belgian Medical Council, hold as jurisprudence. These rules remain amenable to change so as to suite the daily practice in intensive care units. This article describes the actual Belgian legal environment surrounding the intensive care specialist when he has to take such decisions. PMID:20687449

  14. [A.S. Puchkov as an organizer of the Moscow station of emergency medical care].

    PubMed

    Blokhina, N N

    2013-01-01

    The article is devoted to the 125th anniversary of outstanding Russian physician, health administrator, honored physician Aleksander Sergeyevitch Putchkov (1887-1952). During thirty years, from 1923, he continuously headed the Moscow station of emergency medical care based at the Sheremetoyevskiy hospital, nowadays the N.V. Sklifosofskiy research institute of emergency care. PMID:24175393

  15. 21 CFR 203.11 - Applications for reimportation to provide emergency medical care.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Applications for reimportation to provide emergency medical care. 203.11 Section 203.11 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Applications for reimportation to provide emergency medical care. (a) Applications for reimportation...

  16. 21 CFR 203.11 - Applications for reimportation to provide emergency medical care.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Applications for reimportation to provide emergency medical care. 203.11 Section 203.11 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Applications for reimportation to provide emergency medical care. (a) Applications for reimportation...

  17. A Survey of Autism Knowledge in a Health Care Setting

    ERIC Educational Resources Information Center

    Heidgerken, Amanda, D.; Geffken, Gary; Modi, Avani; Frakey, Laura

    2005-01-01

    The current study extends research by Stone [Cross-disciplinary perspectives on autism? "Journal of Pediatric Psychology, 12", (1988) 615; A comparison of teacher and parent views of autism. "Journal of Autism and Development Disorders, 18", (1988) 403] exploring the knowledge and beliefs about autism across multiple health care professions. One…

  18. Communication Supports in Congregate Residential Care Settings in Ohio

    ERIC Educational Resources Information Center

    Mitchell, Pamela R.

    2009-01-01

    Background: Communication skills are important to the pursuit of increased self-determination in individuals with disabilities. The aim of this investigation was to gather information about communication supports in state-run residential care facilities in Ohio, and to compare findings with a previous investigation on this topic examining such…

  19. How Do Physicians Teach Empathy in the Primary Care Setting?

    ERIC Educational Resources Information Center

    Shapiro, Johanna

    2002-01-01

    Explored how primary care clinician-teachers actually attempt to convey empathy to medical students and residents. Found that they stress the centrality of role modeling in teaching, and most used debriefing strategies as well as both learner- and patient-centered approaches in instructing learners about empathy. (EV)

  20. The Burn-Out Syndrome in the Day Care Setting

    ERIC Educational Resources Information Center

    Maslach, Christina; Pines, Ayala

    1977-01-01

    Results of a study of personal job-stress factors among day care center personnel focus on impact of staff-child ratio, working hours, time out, staff meetings and program structure. Recommended institutional changes for prevention of staff "burn-out" involve reduction in amount of direct staff-child contact, development of social-professional…

  1. Creating optimal healing environments in a health care setting.

    PubMed

    Zborowsky, Terri; Kreitzer, Mary Jo

    2008-03-01

    As evidence about the benefits of healing environments accumulates, health care organizations are starting to incorporate features into hospital design that reduce stress and promote healing. This article discusses some of the research supporting healing design and provides examples of how it is being used in new construction and renovations. PMID:18438085

  2. A Guide to Health Education in Ambulatory Care Settings.

    ERIC Educational Resources Information Center

    Health Services Administration (DHEW/PHS), Rockville, MD. Bureau of Community Health Services.

    This report outlines ways in which health education strategies can be developed within an ambulatory care center and how they can be implemented to optimize their effectiveness and efficiency. Section 1 describes a program planning model for use in the development of health education programs. Sections 2 through 5 trace the consumer through four…

  3. An unusual cause of vomiting in a palliative care setting.

    PubMed

    Railsback, Linda

    2011-09-01

    Control of symptoms, including nausea and vomiting, is central to palliative care. Self-induced vomiting in a middle-aged male patient with a life-limiting abdominal malignancy provided a challenge in diagnosis and management. This case report discusses diagnostic and therapeutic considerations. PMID:21838953

  4. Pediatric Hearing Healthcare in Kentucky's Appalachian Primary Care Setting.

    PubMed

    Bush, Matthew L; Alexander, David; Noblitt, Bryce; Lester, Cathy; Shinn, Jennifer B

    2015-08-01

    Diagnosis and intervention for infant hearing loss is often delayed in areas of healthcare disparity, such as rural Appalachia. Primary care providers play a key role in timely hearing healthcare. The purpose of this study was to assess the practice patterns of rural primary care providers (PCPs) regarding newborn hearing screening (NHS) and experiences with rural early hearing diagnosis and intervention programs in an area of known hearing healthcare disparity. Cross sectional questionnaire study. Appalachian PCP's in Kentucky were surveyed regarding practice patterns and experiences regarding the diagnosis and treatment of congenital hearing loss. 93 Appalachian primary care practitioners responded and 85% reported that NHS is valuable for pediatric health. Family practitioners were less likely to receive infant NHS results than pediatricians (54.5 versus 95.2%, p < 0.01). A knowledge gap was identified in the goal ages for diagnosis and treatment of congenital hearing loss. Pediatrician providers were more likely to utilize diagnostic testing compared with family practice providers (p < 0.001). Very rural practices (Beale code 7-9) were less likely to perform hearing evaluations in their practices compared with rural practices (Beale code 4-6) (p < 0.001). Family practitioners reported less confidence than pediatricians in counseling and directing care of children who fail newborn hearing screening. 46% felt inadequately prepared or completely unprepared to manage children who fail the NHS. Rural primary care providers face challenges in receiving communication regarding infant hearing screening and may lack confidence in directing and providing rural hearing healthcare for children. PMID:25672888

  5. Handbook on Quality Child Care for Young Children: Settings Standards and Resources.

    ERIC Educational Resources Information Center

    Baglin, Carol Ann, Ed.; Bender, Michael, Ed.

    Intended primarily for professionals teaching early childhood and infant intervention courses, this handbook presents an overview of child care as both a support to families and an economic necessity, meeting changing and dynamic needs. Child care settings and types of care are discussed, along with quality indicators, licensing, and provider…

  6. A Secure Cloud-Assisted Wireless Body Area Network in Mobile Emergency Medical Care System.

    PubMed

    Li, Chun-Ta; Lee, Cheng-Chi; Weng, Chi-Yao

    2016-05-01

    Recent advances in medical treatment and emergency applications, the need of integrating wireless body area network (WBAN) with cloud computing can be motivated by providing useful and real time information about patients' health state to the doctors and emergency staffs. WBAN is a set of body sensors carried by the patient to collect and transmit numerous health items to medical clouds via wireless and public communication channels. Therefore, a cloud-assisted WBAN facilitates response in case of emergency which can save patients' lives. Since the patient's data is sensitive and private, it is important to provide strong security and protection on the patient's medical data over public and insecure communication channels. In this paper, we address the challenge of participant authentication in mobile emergency medical care systems for patients supervision and propose a secure cloud-assisted architecture for accessing and monitoring health items collected by WBAN. For ensuring a high level of security and providing a mutual authentication property, chaotic maps based authentication and key agreement mechanisms are designed according to the concept of Diffie-Hellman key exchange, which depends on the CMBDLP and CMBDHP problems. Security and performance analyses show how the proposed system guaranteed the patient privacy and the system confidentiality of sensitive medical data while preserving the low computation property in medical treatment and remote medical monitoring. PMID:27000778

  7. Automated patient care documentation: what's in it for us? An expert system emergency drug card printout.

    PubMed Central

    Bjornstad, G. C.; Farr, F.; Vernon, P.; Welkie, K.; Witte, M.

    1995-01-01

    This article summarizes experiences to date for a collaborative approach, utilizing systems analysis and decision support methods, to design, develop, and implement automated patient centered documentation. Current manual methods for retrieving patient centered data for treatment activities and evaluation of practice are laborious, frustrating and often uneventful. Accessing specific patient information in an arrest or emergent situation, in the hospital and out patient clinical setting, is fraught with difficulties of data and information availability, reliability, legibility, integrity, security, and obsolescence. Treatment decisions made during an arrest or emergent situation, whether for an in-patient or clinical out patient, utilize Advanced Life Support guidelines and also may vary based on the heuristics of the lead practitioner on duty at the time. Walking the informatics talk of "managing and processing data to information to knowledge" lead to standardization for best practice of emergency drug calculations and treatments (1). An expedient and reliable method for retrieving patient specific data to calculate 26 medications, 3 treatments, and upwards of 40 criteria to consider during an arrest or emergent situation was achieved and implemented, as a by product of height and weight charting, across most all patient care areas at Primary Children's Medical Center in Salt Lake City Utah. PMID:8563260

  8. Computer networking in an ambulatory health care setting.

    PubMed

    Alger, R; Berkowitz, L L; Bergeron, B; Buskett, D

    1999-01-01

    Computers are a ubiquitous part of the ambulatory health care environment. Although stand-alone computers may be adequate for a small practice, networked computers can create much more powerful and cost-effective computerized systems. Local area networks allow groups of computers to share peripheral devices and computerized information within an office or cluster of offices. Wide area networks allow computers to securely share devices and information across a large geographical area. Either singly or in combination, these networks can be used to create robust systems to help physicians automate their practices and improve their access to important clinical information. In this article, we will examine common network configurations, explain how they function, and provide examples of real-world implementations of networking technology in health care. PMID:10662271

  9. Distraction: an assessment of smartphone usage in health care work settings

    PubMed Central

    Gill, Preetinder S; Kamath, Ashwini; Gill, Tejkaran S

    2012-01-01

    Smartphone use in health care work settings presents both opportunities and challenges. The benefits could be severely undermined if abuse and overuse are not kept in check. This practice-focused research paper examines the current panorama of health software applications. Findings from existing research are consolidated to elucidate the level and effects of distraction in health care work settings due to smartphone use. A conceptual framework for crafting guidelines to regulate the use of smartphones in health care work settings is then presented. Finally, specific guidelines are delineated to assist in creating policies for the use of smartphones in a health care workplace. PMID:22969308

  10. Extending the HL7/LOINC Document Ontology Settings of Care.

    PubMed

    Rajamani, Sripriya; Chen, Elizabeth S; Wang, Yan; Melton, Genevieve B

    2014-01-01

    Given federal mandates recommending document standards, increasing numbers of electronic clinical documents being created, and local initiatives/projects using clinical documents, there is a growing need to better represent clinical document metadata. The HL7/LOINC Document Ontology (DO) was developed to provide a standard representation of clinical document attributes with a multi-axis structure. Prior studies have demonstrated the need for extension of DO axes values and proposed new values for some axes, but significant gaps remain for representing the DO "Setting" axis. This study aimed to extend the "Setting" axis by combining the current values in the DO with values from 5 other sources. Evaluation and refinement by subject matter experts over a series of four iterative sessions resulted in a reorganized hierarchy with 254 additional values from a baseline of 20. Incorporating a comprehensive set of "Settings" in DO provides better representation of clinical information across the healthcare ecosystem. PMID:25954408

  11. Is Higher Education Following the Path Set by Health Care in the U.S.?

    ERIC Educational Resources Information Center

    Castiglia, Beth

    2012-01-01

    The recent emergence of higher education into political and economic debate is reminiscent of the ongoing arguments about the appropriate provision of health care in the United States. Health care reform has been a political battle cry in the United States for years, and there are similar calls for reforms of higher education. These two industries…

  12. Recognizing and managing insomnia in primary care and specialty settings.

    PubMed

    Krystal, Andrew D; Sorscher, Adam J

    2016-04-01

    Insomnia is a common feature of both medical and psychiatric disorders. Whether as a symptom of an illness or as a comorbid disorder, insomnia worsens patient outcomes related to quality of life, functioning, workplace productivity, and health care expenditures. This CME webcast covers how to screen for insomnia in patients with both medical and mental illnesses and how to develop a comprehensive treatment plan. The authors also review evidence-based therapies for insomnia, including psychological/behavioral interventions and medications. PMID:27137433

  13. Parenting enhancement among Egyptian mothers in a tertiary care setting.

    PubMed

    Porter, L S; Youssef, M; Shaaban, I; Ibrahim, W

    1992-01-01

    This study tested the efficacy and effectiveness of systematically planned parenting enhancement program aimed toward breaking the cycle of high-risk mothers producing high-risk babies in Egypt. The assumption is that self-esteem and self-care are requisites to effective parenting, which can be enhanced or impeded by human and environmental forces. Given that parenting is a learned behavior, it can be repatterned by modifying human-environmental processes. PMID:1518669

  14. Embracing the Insulin Revolution in the Ambulatory Care Setting.

    PubMed

    Bzowyckyj, Andrew S

    2016-08-01

    IN BRIEF Recent additions of various new formulations of insulin to the U.S. marketplace have increased the number of treatment options available to people living with diabetes. However, it is important to take into consideration the implications of these new insulins in terms of patient safety and medication errors, integration with electronic medical records, and financial considerations. This review outlines several considerations for practitioners regarding the implications of these new insulin products for ambulatory care practice. PMID:27574367

  15. Involving patients in health care: explanation in the clinical setting.

    PubMed Central

    Buchanan, B. G.; Moore, J.; Forsythe, D.; Banks, G.; Ohlsson, S.

    1992-01-01

    The long-term goal of our research is to improve the overall effectiveness of physicians' time, by improving the information exchange between physicians and chronic-care patients, initially migraine patients. The computer system we are constructing has a partial knowledge base about migraines, common therapies, and common side effects of those therapies. The system consists of two main programs: data collection and explanation. The design of our system is based on empirical data concerning patients' information needs. PMID:1482927

  16. Implementation of a Program of Outcomes Research in Residential Care Settings: Outcomes for Children and Youth

    ERIC Educational Resources Information Center

    Portwood, Sharon G.; Boyd, A. Suzanne; Murdock, Tamera B.

    2016-01-01

    Background: There is a need to examine behavioral and mental health outcomes for children in out-of-home care across settings. Objective: Using a participatory research approach, researchers and agency personnel aimed to implement a program of scientific outcomes research in residential care settings. Data were used to examine children's…

  17. Antibiotic Misuse in Hospital, Outpatient, and Long-Term Care Settings.

    PubMed

    Ashraf, Muhammad Salman; Cook, Paul P

    2016-01-01

    Antibiotic misuse is common in the United States, but the causes of antibiotic misuse may differ from one health care setting to another. In this commentary, we describe the factors associated with inappropriate antibiotic prescriptions in hospital, outpatient, and long-term care settings, along with specific measures that can help prevent antibiotic misuse. PMID:27621347

  18. Day Care for All Children: Integrating Children with Special Needs into Community Child Care Settings. A Resource and Consultation Manual.

    ERIC Educational Resources Information Center

    Gaumer, Nancy; And Others

    This manual provides guidance on using the consultation method to help meet the needs of families of children with disabilities in integrated community-based day care settings. The introductory section provides an overview, a statement of philosophy, the history of the day care consultation program in Illinois, and instructions for using the…

  19. Neurologic aspects of palliative care: the end of life setting.

    PubMed

    Sizoo, Eefje M; Grisold, Wolfgang; Taphoorn, Martin J B

    2014-01-01

    As there are, to date, few curative treatment options for many neurologic diseases, end of life (EOL) care is an important aspect of the treatment of neurologic patients. In the EOL phase, treatment should be aimed at relieving symptoms, maintaining quality of life, and facilitating a peaceful and dignified way of dying. Common signs and symptoms in the EOL phase of neurologic patients are raised intracranial pressure, seizures, confusion, cognitive deficits, and impaired motor function. Supportive treatment of these symptoms (such as analgesic drugs, dexamethasone, antiepileptic and neuroleptic drugs) is of major importance to maintain quality of life as long as possible. Another key aspect of EOL care is EOL decision making, such as withholding or withdrawing life-sustaining treatment, and palliative sedation. The main goal of EOL decision making is the prevention and relief of suffering, even if this might hasten death. Especially in advanced stages of many neurologic diseases, confusion, cognitive deficits, communication deficits, and decreasing levels of consciousness may impair the competence of patients to participate in EOL decision making. Given that patient autonomy is increasingly essential, advance care planning (ACP) at an early stage of the disease should be considered. PMID:24365413

  20. Primary Care Physicians Practicing Preventive Medicine in the Outpatient Setting

    PubMed Central

    Snipelisky, David; Carter, Kimberly; Sundsted, Karna; Burton, M. Caroline

    2016-01-01

    Background: Preventive care is an important part of primary care medicine, yet much variation in its practice exists. The aim of this study is to assess physicians’ perspectives of practicing preventive medicine and evaluate which topics are deemed most important. Methods: All primary care medicine providers at two separate academic medical centers (Mayo Clinic, MN and Mayo Clinic, FL) were surveyed via an E-mail questionnaire assessing physicians’ perception of the role of preventive medicine during both acute/routine and yearly visits, physicians’ perception of patients’ response to preventive medicine topics, and which preventive medicine topics are commonly practiced. Results: Of 445 providers meeting inclusion criteria, a total of 183 (41.1%) responded. Providers were more likely to engage patients in preventive medicine during yearly visits more so than acute visits (3.82 vs. 4.72, range 1–5 Likert Scale), yet providers were very likely to partake in such practices during both visits. Providers perceived that patients received the practice of preventive medicine very well (4.13 on 1–5 Likert Scale). No significant difference between provider practice and patient perception was noted between the two sites, although there was some variation based on clinical experience of the provider. Providers were found to most commonly practice topics recommended by the United States Preventive Services Task Force. Conclusions: Our study found a high predisposition to practicing preventive medicine. Providers seem to practice according to published evidence-based medicine recommendations. PMID:26941906

  1. Perspectives of Health Care Providers Regarding Emergency Department Care of Children and Youth with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Zwaigenbaum, Lonnie; Nicholas, David B.; Muskat, Barbara; Kilmer, Christopher; Newton, Amanda S.; Craig, William R.; Ratnapalan, Savithiri; Cohen-Silver, Justine; Greenblatt, Andrea; Roberts, Wendy; Sharon, Raphael

    2016-01-01

    This study aimed to characterize the perspectives of health professionals who care for children with autism spectrum disorder (ASD) in the emergency department (ED) and to determine what strategies could optimize care. Ten physicians and twelve nurses were interviewed individually. Questions related to experiences, processes, clinical…

  2. An Easy Guide to Developing an Emergency Child Care System (Free Child Care in the Aftermath of Major Disasters).

    ERIC Educational Resources Information Center

    Bozeman, Karl

    A program and related materials for providing child care free of charge in the aftermath of widespread disaster to children ranging in age from infancy through second grade are described in this guidebook. In Section I, the Temporary Emergency Child Care (TECC) program is discussed. In particular, the nature of TECC services is indicated, the…

  3. Operationalising emergency care delivery in sub-Saharan Africa: consensus-based recommendations for healthcare facilities.

    PubMed

    Calvello, Emilie J B; Tenner, Andrea G; Broccoli, Morgan C; Skog, Alexander P; Muck, Andrew E; Tupesis, Janis P; Brysiewicz, Petra; Teklu, Sisay; Wallis, Lee; Reynolds, Teri

    2016-08-01

    A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery. PMID:26202673

  4. High Yield Research Opportunities in Geriatric Emergency Medicine: Prehospital Care, Delirium, Adverse Drug Events, and Falls

    PubMed Central

    Carpenter, Christopher R.; Shah, Manish N.; Hustey, Fredric M.; Heard, Kennon; Gerson, Lowell W.

    2011-01-01

    Emergency services constitute crucial and frequently used safety nets for older persons, an emergency visit by a senior very often indicates high vulnerability for functional decline and death, and interventions via the emergency system have significant opportunities to change the clinical course of older patients who require its services. However, the evidence base for widespread employment of emergency system-based interventions is lacking. In this article, we review the evidence and offer crucial research questions to capitalize on the opportunity to optimize health trajectories of older persons seeking emergency care in four areas: prehospital care, delirium, adverse drug events, and falls. PMID:21498881

  5. A bite in the playroom: Managing human bites in child care settings

    PubMed Central

    2008-01-01

    Young children bite each other frequently in child care settings, but the bites rarely break the skin and the risk of infection is minimal. Nevertheless, parents and child care personnel may be concerned about infection, especially with blood-borne viruses. The present document reviews the literature concerning infections following bites in child care settings, and provides recommendations for prevention and management of such incidents. PMID:19436423

  6. Women's Health Care Minimum Data Set: pilot test and validation for use in clinical practice.

    PubMed

    Farley, Cindy L; Tharpe, Nell; Miller, Liane; Ruxer, Debbie Jenkins

    2006-01-01

    Basic elements of the structure, process, and outcomes of midwifery practice have not been fully determined, particularly in the areas of women's gynecologic and primary health care. The American College of Nurse-Midwives (ACNM) supported the development of clinical data sets to describe structure, process, and outcomes of midwifery practice for use by clinical practitioners. The Woman's Health Care Minimum Data Set was developed using a panel of expert midwives and other women's health care professionals, as well as literature resources. Students of the Graduate Midwifery Program at Philadelphia University performed pilot testing of the Woman's Health Care Minimum Data Set as a service to the profession of midwifery while applying concepts learned in their research methods courses. Each student (n = 19) recruited a midwifery practice in which she had a clinical affiliation, and gathered data sets on the previous 30 consecutive women's health care encounters by CNMs or CMs (n = 569). Item analysis and refinement were done. Criterion-related validity and construct-related validity of the Woman's Health Care Minimum Data Set were explored through comparison with the medical record and through the testing of plausible hypotheses. The Woman's Health Care Minimum Data Set has the potential to be an important instrument in documenting and understanding the evolving nature of the practice of primary women's health care by midwives and other women's health care providers. PMID:17081941

  7. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings

    PubMed Central

    Sen, Sanchita; Bowen, Jane F.; Ganetsky, Valerie S.; Hadley, Diane; Melody, Karleen; Otsuka, Shelley; Vanmali, Radha; Thomas, Tyan

    2014-01-01

    Objective To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC) models in the inpatient, ambulatory, and community practice settings. Methods TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist’s TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optimization of medications. Additionally, a checklist has been created to assist other pharmacists in developing the pharmacist’s TOC roles in a practice environment or incorporating more TOC elements in their practice setting. Conclusion Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care. PMID:25035721

  8. The meaning of quality of care in home care settings: older lesbian and bisexual women's perspectives.

    PubMed

    Grigorovich, Alisa

    2016-03-01

    Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55-72 from Ontario, Canada, participated in semi-structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers' comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy. PMID:25919504

  9. Emergency shelter care utilization in child welfare: Who goes to shelter care? How long do they stay?

    PubMed

    Leon, Scott C; Jhe Bai, Grace; Fuller, Anne K; Busching, Michelle

    2016-01-01

    Emergency shelter care for children entering foster care is widely used as a temporary first placement, despite its contraindications. However, little research has examined predictors of utilization (e.g., entry into care, length of stay in care). A sample of 123 children (ages 6-13) entering foster care was studied to explore the variables associated with an initial placement in shelter care versus kinship care and variables associated with children staying less than 30 days in the shelter versus 30 days or longer. After applying a classification tree analysis (CTA via Optimal Data Analysis), results indicated that variables across the child's ecology--specifically the microsystem, mesosystem, and exosystem--were associated with increased emergency shelter utilization, including older age, entering as a dependency case, more relatives and fictive kin with barriers to involvement in the child's life, and the child welfare agency serving the child. These results suggest that although emergency shelter care utilization may be determined by a complex interaction of variables across the child's ecology, policy and programmatic attention to some of these risk factors might be effective in limiting utilization so that children can enter care with a more long-term, family-based placement. PMID:26569355

  10. Screening older Latinos for dementia in the primary care setting.

    PubMed

    Grober, Ellen; Ehrlich, Amy R; Troche, Yaritza; Hahn, Steven; Lipton, Richard B

    2014-09-01

    The purpose was to compare the Spanish language picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR) and the Mini Mental State Exam (MMSE) in identifying very mild dementia among Spanish speaking Latino patients. The tests and an independent diagnostic assessment were administered to 112 Latino patients free of medically diagnosed dementia from an urban primary care clinic. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to examine differences in the operating characteristics of the pFCSRT+IR and the MMSE. Cut scores were manipulated to equate sensitivities (specificities) at clinically relevant values to compare differences in specificities (sensitivities) using the Pearson Chi Square test. Youden's index was used to select the optimal cut scores. Twenty-four of the 112 primary care patients (21%) received a research dementia diagnosis, indicating a substantial burden of unrecognized dementia. MMSE scores but not free recall scores were associated with years of education in patients free of dementia. AUC was significantly higher for free recall than for MMSE. Free recall performed significantly better than the MMSE in sensitivity and in specificity. Using optimal cut scores, patients with impaired free recall were 10 times more likely to have dementia than patients with intact recall, and patients with impaired MMSE scores were 4.5 times more likely to have dementia than patients with intact scores. These results suggest that the Spanish language pFCSRT+IR may be an effective tool for dementia screening in educationally diverse Latino primary care populations. PMID:25120108

  11. Cystic fibrosis carrier population screening in the primary care setting.

    PubMed Central

    Loader, S.; Caldwell, P.; Kozyra, A.; Levenkron, J. C.; Boehm, C. D.; Kazazian, H. H.; Rowley, P. T.

    1996-01-01

    To determine the receptivity of prenatal care providers and their patients to carrier testing for cystic fibrosis (CF), we offered free carrier screening, followed by genetic counseling of carriers, to all prenatal care providers in Rochester, NY, for all their female patients of reproductive age, pregnant or not. Of 124 prenatal care providers, only 37 elected to participate, but many of these offered screening only to pregnant women. The acceptance rate among pregnant women was approximately 57%. The most common reasons for accepting screening were to obtain reassurance (50.7%) and to avoid having a child with CF (27.8 %). The most common reasons for declining screening were not intending to terminate a pregnancy for CF (32.4%) and believing that the chance of having a CF child was very low (32.2%). Compared with decliners, acceptors were more likely to have no children, regarded having a child with CF as more serious, believed themselves more susceptible to having such a child, knew more about CF, would be more likely to terminate a pregnancy if the fetus were shown to have CF, and more strongly supported offering CF screening to women of reproductive age. Of 4,879 women on whom results were obtained, 124 were found to be carriers. Of these 124 carriers, the partners of 106 were tested. Of the five at-risk couples, four requested prenatal diagnosis and one requested neonatal diagnosis. No woman found to be a carrier whose partner tested negative requested prenatal diagnosis. Except for the imperfect knowledge of those testing negative, none of the adverse outcomes predicted for CF carrier testing in the general population were observed in this study. Images p236-a p236-b p236-c PMID:8659530

  12. Does community emergency care initiative improve the knowledge and skill of healthcare workers and laypersons in basic emergency care in India?

    PubMed Central

    Bhoi, Sanjeev; Thakur, Nirmal; Verma, Pankaj; Sawhney, Chhavi; Vankar, Sameer; Agrawal, Deepak; Sinha, Tejprakash

    2016-01-01

    Background: Due to lack of training in emergency care, basic emergency care in India is still in its infancy. We designed All India Institute of Medical Sciences basic emergency care course (AIIMS BECC) to address the issue. Aim: To improve the knowledge and skill of healthcare workers and laypersons in basic emergency care and to identify impact of the course. Materials and Methods: Prospective study conducted over a period of 4 years. The target groups were medical and nonmedical personnel. Provider AIIMS BECC is of 1 day duration including lectures on cardio-pulmonary resuscitation, choking, and special scenarios. Course was disseminated via lectures, audio-visual aids, and mannequin training. For analysis, the participants were categorized on the basis of their education and profession. A pre- and a post-course evaluation were done and individual scores were given out of 20 and compared among all the groups and P value was calculated. Results: A total of 1283 subjects were trained. 99.81% became providers and 2.0% were trained as instructors. There was a significant improvement in knowledge among all the participants irrespective of their education level including medicos/nonmedicos. However, participants who had higher education (graduates and postgraduates) and/or belonged to medical field had better knowledge gain as compared to those who had low level of education (≤12th standard) and were nonmedicos. Conclusion: BECC is an excellent community initiative to improve knowledge and skill of healthcare and laypersons in providing basic emergency care. PMID:26957820

  13. Working with advanced dementia patients in a day care setting.

    PubMed

    Abramowitz, Leah

    2008-01-01

    Alzheimer's disease and most other causes of dementia are regressive by nature. As such one can expect patients with such types of mental impairment to gradually decline in function and ability to participate in day care activities. This paper attempts to show that with the right kind of orientation, staff can "tune into" the more advanced dementia patients, find the key to their personal needs, desires and remaining abilities and design a program that allows them not only to continue to participate in a social and therapeutic framework, but also to gain some meaningful human contact and quality of life despite their cognitive deterioration. PMID:18510188

  14. Enhancing linkage and retention in HIV care: a review of interventions for highly resourced and resource-poor settings.

    PubMed

    Okeke, N Lance; Ostermann, Jan; Thielman, Nathan M

    2014-12-01

    Given the widespread availability of effective antiretroviral therapy, engagement of HIV-infected persons in care is a global priority. We reviewed 51 studies, published in the past decade, assessing strategies for improving linkage to and retention in HIV care. The review included studies from highly resourced settings (HRS) and resource-poor settings (RPS), specifically the USA and sub-Saharan Africa. In HRS, strength-based case management was best supported for improving linkage and retention in care; peer navigation and clinic-based health promotion were supported for improving retention. In RPS, point of care CD4 testing was best supported for improving linkage to care; decentralization, and task-shifting for improving retention. Novel interventions continue to emerge in HRS and RPS, yet many strategies have not been adequately evaluated. Further consideration should be given to analyses that identify which interventions, or combinations of interventions, are most effective, cost-effective, scalable, and aligned with patient preferences for HIV care. PMID:25323298

  15. An emergency medical bag set for long-range aeromedical transportation.

    PubMed

    Barillo, David J; Renz, Evan; Broger, Kristine; Moak, Brandon; Wright, Gabriel; Holcomb, John B

    2008-01-01

    The global war on terror has created the need for urgent long-range aeromedical transport of severely wounded service members over distances of several thousand miles from Afghanistan or Iraq to the United States. This need is met by specialized medical transport teams such as US Air Force Critical Care Air Transport Teams (CCATT) or by the US Army Burn Flight Team (BFT). Both teams travel with multiple bags or cases of emergency equipment, which are comprehensive but cumbersome. To avoid the need to search multiple bags for equipment or drugs when an in-flight emergency occurs, many CCATT and BFT physicians also carry a personal bag of emergency supplies for rapid access. Over the last year, we have evolved and standardized an emergency equipment bag designed to provide the supplies necessary for initial management of emergencies that occur during flight and ground transport. This or a similar emergency kit would be useful for inter or intrahospital transport of critically ill or injured civilian patients, or for physicians who respond to civil emergencies, such as members of Disaster Medical Assistance Teams. PMID:18522249

  16. Occupational exposure to antineoplastic drugs in four Italian health care settings.

    PubMed

    Sottani, Cristina; Porro, Benedetta; Imbriani, Marcello; Minoia, Claudio

    2012-08-13

    Exposure assessment of health care workers to antineoplastic drugs (ADs) is still an open issue since new, critical, and emerging factors may put pharmacists who prepare hazardous drugs or nurses who administer anti cancer agents to an increased risk of developing adverse health effects. Overall, eight pharmacies and nine patient areas have been surveyed in this study. Wipe and pad samples were experienced during the surveillance program in four Italian health care settings. Urine samples were collected from workers handling ADs. Cyclophosphamide (CP), ifosfamide (IF), and gemcitabine (GEM) were detected in all the work environments by using a LC-MS/MS method-based capable of analysing all the three drugs simultaneously. In total, 54% of wipe samples were positive for at least one drug and 19% of pad samples were shown to be contaminated by cyclophosphamide. Pharmacies were generally more contaminated than patient areas with the exception of one site where a nurse had an acute exposure during the cleaning-up of an hazardous drug solution spill. In total, 22 urine samples collected from pharmacists and 78 urine samples from nurses had no detectable concentrations of any antineoplastic drugs. Despite the adherence to the recommended safety practices residue contamination on surfaces and floors has continued to be assessed in all the investigated sites. PMID:21477641

  17. Differences in HIV risk behavior of injection drug users in New York City by health care setting.

    PubMed

    Turner, A K; Harripersaud, K; Crawford, N D; Rivera, A V; Fuller, C M

    2013-01-01

    The purpose of this study is to examine the HIV risk behaviors and demographic characteristics of injection drug users (IDUs) by type of health care setting, which can inform development of tailored structural interventions to increase access to HIV prevention and medical treatment services. IDU syringe customers were recruited from pharmacies as part of the "Pharmacist As Resources Making Links to Community Services" (PHARM-Link) study, a randomized community-based intervention in New York City (NYC) aimed at connecting IDUs to HIV prevention, medical, and social services. An ACASI survey ascertained demographics, risk behavior, health-care utilization, and location where health care services were received in the past year. Data were analyzed using logistic regression. Of 602 participants, 34% reported receiving health care at a community clinic, 46% a private medical office, 15% a mobile medical unit, and 59% an emergency room (ER). After adjustment, participants who attended a community clinic were significantly more likely to have health insurance, report syringe sharing, and be HIV positive. Whites, nondaily injectors, insured, and higher income IDUs were more likely to attend a private medical office. Participants who recently used a case manager and had multiple sexual partners were more likely to use a mobile medical unit. ER attendees were more likely to be homeless and report recent drug treatment use. These findings show that IDU demographics and risk behaviors differ by health care setting, suggesting that risk reduction interventions should be tailored to health care settings. Specifically, these data suggest that community clinics and mobile medical units serve high-risk IDUs, highlighting the need for more research to develop and test innovative prevention and care programs within these settings. PMID:23451991

  18. Joint policy statement--guidelines for care of children in the emergency department.

    PubMed

    2009-10-01

    Children who require emergency care have unique needs, especially when emergencies are serious or life-threatening. The majority of ill and injured children are brought to community hospital emergency departments (EDs) by virtue of their geography within communities. Similarly, emergency medical services (EMS) agencies provide the bulk of out-of-hospital emergency care to children. It is imperative, therefore, that all hospital EDs have the appropriate resources (medications, equipment, policies, and education) and staff to provide effective emergency care for children. This statement outlines resources necessary to ensure that hospital EDs stand ready to care for children of all ages, from neonates to adolescents. These guidelines are consistent with the recommendations of the Institute of Medicine's report on the future of emergency care in the United States health system. Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that hospital ED staff and administrators and EMS systems' administrators and medical directors seek to meet or exceed these guidelines in efforts to optimize the emergency care of children they serve. This statement has been endorsed by the Academic Pediatric Association, American Academy of Family Physicians, American Academy of Physician Assistants, American College of Osteopathic Emergency Physicians, American College of Surgeons, American Heart Association, American Medical Association, American Pediatric Surgical Association, Brain Injury Association of America, Child Health Corporation of America, Children's National Medical Center, Family Voices, National Association of Children's Hospitals and Related Institutions, National Association of EMS Physicians, National Association of Emergency Medical Technicians, National Association of State EMS Officials, National Committee for Quality Assurance, National PTA, Safe Kids USA, Society of Trauma Nurses, Society for Academic

  19. Joint policy statement--guidelines for care of children in the emergency department.

    PubMed

    2013-03-01

    Children who require emergency care have unique needs, especially when emergencies are serious or life-threatening. The majority of ill and injured children are brought to community hospital emergency departments (EDs) by virtue of their geography within communities. Similarly, emergency medical services (EMS) agencies provide the bulk of out-of-hospital emergency care to children. It is imperative, therefore, that all hospital EDs have the appropriate resources (medications, equipment, policies, and education) and staff to provide effective emergency care for children. This statement outlines resources necessary to ensure that hospital EDs stand ready to care for children of all ages, from neonates to adolescents. These guidelines are consistent with the recommendations of the Institute of Medicine's report on the future of emergency care in the United States health system. Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that hospital ED staff and administrators and EMS systems' administrators and medical directors seek to meet or exceed these guidelines in efforts to optimize the emergency care of children they serve. This statement has been endorsed by the Academic Pediatric Association, American Academy of Family Physicians, American Academy of Physician Assistants, American College of Osteopathic Emergency Physicians, American College of Surgeons, American Heart Association, American Medical Association, American Pediatric Surgical Association, Brain Injury Association of America, Child Health Corporation of America, Children's National Medical Center, Family Voices, National Association of Children's Hospitals and Related Institutions, National Association of EMS Physicians, National Association of Emergency Medical Technicians, National Association of State EMS Officials, National Committee for Quality Assurance, National PTA, Safe Kids USA, Society of Trauma Nurses, Society for Academic

  20. Joint policy statement--guidelines for care of children in the emergency department.

    PubMed

    2009-10-01

    Children who require emergency care have unique needs, especially when emergencies are serious or life threatening. The majority of ill and injured children are brought to community hospital emergency departments (EDs) by virtue of their geography within communities. Similarly, emergency medical services (EMS) agencies provide the bulk of out-of-hospital emergency care to children. It is imperative, therefore, that all hospital EDs have the appropriate resources (medications, equipment, policies, and education) and staff to provide effective emergency care for children. This statement outlines resources necessary to ensure that hospital EDs stand ready to care for children of all ages, from neonates to adolescents. These guidelines are consistent with the recommendations of the Institute of Medicine's report on the future of emergency care in the United States health system. Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that hospital ED staff and administrators and EMS systems' administrators and medical directors seek to meet or exceed these guidelines in efforts to optimize the emergency care of children they serve. This statement has been endorsed by the American Pediatric Association, the American Academy of Family Physicians, American Academy of Physician Assistants, American College of Osteopathic Emergency Physicians, American College of Surgeons, American Heart Association, American Medical Association, Brain Injury Association of America, Child Health Corporation of America, Children's National Medical Center, Family Voices, National Association of Children's Hospitals and Related Institutions, National Association of EMS Physicians, National Association of Emergency Medical Technicians, National Association of State EMS Officials, National Committee for Quality Assurance, National PTA, Safe Kids USA, Society of Trauma Nurses, The Joint Commission, American Pediatric Surgical

  1. POINT-OF-CARE HEMATOLOGY AND COAGULATION TESTING IN PRIMARY, RURAL EMERGENCY, AND DISASTER CARE SCENARIOS

    PubMed Central

    Curtis, Corbin M.; Kost, Gerald J.; Louie, Richard F.; Sonu, Rebecca J.; Ammirati, Erika B.; Sumner, Stephanie

    2012-01-01

    The purpose of this article is to review current principles and criteria for obtaining Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88) waiver, identify existing point-of-care (POC) coagulation and hematology technologies, and analyze regulatory challenges regarding CLIA-waiver for those and future devices. CLIA ’88 documentation requires tests performed by laboratories with a Certificate of Waiver to be so simple that the likelihood of erroneous results by the user is negligible, or poses no unreasonable risk of harm to the patient if performed incorrectly as determined by the Secretary of Health and Human Services. “Simple” means that the test uses unprocessed samples, has a direct read-out of test results, does not have specifications for user training, and includes instructions for confirmatory testing when advisable. Currently the CLIA-waived hematology and coagulation POC devices only test for hemoglobin (Hb), hematocrit (Hct), and prothrombin time/international normalized ratio (PT/INR). The problem with these devices is the lack of multiplexing. POC coagulation and hematology devices face challenges for obtaining a waiver. These challenges include the lack of clinical needs assessment, miniturized assays that correct for interfering substances, and assays simple enough to be combined in a multiplex platform. Several scenarios demonstrate how POC coagulation or hematology devices can improve crisis care. Industry should perform needs assessment on clinicians and emergency responders to determine which analytes to incorporate on multiplex POC coagulation and hematology devices, and produce devices that address confounding factors. PMID:23843728

  2. WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting.

    PubMed

    Sartelli, Massimo; Catena, Fausto; Ansaloni, Luca; Coccolini, Federico; Griffiths, Ewen A; Abu-Zidan, Fikri M; Di Saverio, Salomone; Ulrych, Jan; Kluger, Yoram; Ben-Ishay, Ofir; Moore, Frederick A; Ivatury, Rao R; Coimbra, Raul; Peitzman, Andrew B; Leppaniemi, Ari; Fraga, Gustavo P; Maier, Ronald V; Chiara, Osvaldo; Kashuk, Jeffry; Sakakushev, Boris; Weber, Dieter G; Latifi, Rifat; Biffl, Walter; Bala, Miklosh; Karamarkovic, Aleksandar; Inaba, Kenji; Ordonez, Carlos A; Hecker, Andreas; Augustin, Goran; Demetrashvili, Zaza; Melo, Renato Bessa; Marwah, Sanjay; Zachariah, Sanoop K; Shelat, Vishal G; McFarlane, Michael; Rems, Miran; Gomes, Carlos Augusto; Faro, Mario Paulo; Júnior, Gerson Alves Pereira; Negoi, Ionut; Cui, Yunfeng; Sato, Norio; Vereczkei, Andras; Bellanova, Giovanni; Birindelli, Arianna; Di Carlo, Isidoro; Kok, Kenneth Y; Gachabayov, Mahir; Gkiokas, Georgios; Bouliaris, Konstantinos; Çolak, Elif; Isik, Arda; Rios-Cruz, Daniel; Soto, Rodolfo; Moore, Ernest E

    2016-01-01

    Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference. PMID:27478494

  3. Internet Applications for Screening and Brief Interventions for Alcohol in Primary Care Settings – Implementation and Sustainability

    PubMed Central

    Wallace, Paul; Bendtsen, Preben

    2014-01-01

    Screening and brief interventions head the list of effective evidence-based interventions for the prevention and treatment of alcohol use disorders in healthcare settings. However, healthcare professionals have been reluctant to engage with this kind of activity both because of the sensitive nature of the subject and because delivery is potentially time-consuming. Digital technologies for behavioral change are becoming increasingly widespread and their low delivery costs make them highly attractive. Internet and mobile technologies have been shown to be effective for the treatment of depression, anxiety, and smoking cessation in healthcare settings, and have the potential to add substantial value to the delivery of brief intervention for alcohol. Online alcohol questionnaires have been shown to elicit reliable responses on alcohol consumption and compared with conventional prevention techniques, digital alcohol interventions delivered in various settings have been found to be as effective in preventing alcohol-related harms. The last decade has seen the emergence of a range of approaches to the implementation in health care settings of referral to Internet-based applications for screening and brief interventions (eSBI) for alcohol. Research in this area is in its infancy, but there is a small body of evidence providing early indications about implementation and sustainability, and a number of studies are currently underway. This paper examines some of the evidence emerging from these and other studies and assesses the implications for the future of eSBI delivery in primary care settings. PMID:25400593

  4. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 4. Vital Signs, Patient Assessment. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This student manual, the fourth in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains two sections covering the following course content: vital signs (temperature, pulse, respirations, and blood pressure) and patient assessment at the scene of an emergency. Each section contains objectives,…

  5. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings [UPDATED

    PubMed Central

    Sen, Sanchita; Bowen, Jane F.; Ganetsky, Valerie S.; Hadley, Diane; Melody, Karleen; Otsuka, Shelley; Vanmali, Radha; Thomas, Tyan

    Objective To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC) models in the inpatient, ambulatory, and community practice settings. Methods TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist’s TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optimization of medications.[a sentence was deleted] Conclusion Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care.

  6. Primary Palliative Care for the General Internist: Integrating Goals of Care Discussions into the Outpatient Setting

    PubMed Central

    Ahia, Chad L.; Blais, Christopher M.

    2014-01-01

    Background Primary palliative care consists of the palliative care competencies required of all primary care clinicians. Included in these competencies is the ability to assist patients and their families in establishing appropriate goals of care. Goals of care help patients and their families understand the patient's illness and its trajectory and facilitate medical care decisions consistent with the patient's values and goals. General internists and family medicine physicians in primary care are central to getting patients to articulate their goals of care and to have these documented in the medical record. Case Report Here we present the case of a 71-year-old male patient with chronic obstructive pulmonary disorder, congestive heart failure, and newly diagnosed Alzheimer dementia to model pertinent end-of-life care communication and discuss practical tips on how to incorporate it into practice. Conclusion General internists and family medicine practitioners in primary care are central to eliciting patients' goals of care and achieving optimal end-of-life outcomes for their patients. PMID:25598737

  7. The subjective experience of personhood in dementia care settings.

    PubMed

    Nowell, Zoe C; Thornton, Amanda; Simpson, Jane

    2013-07-01

    Within the social psychological understanding of dementia, individuals' personhood is central. A respect for personhood has been linked to successful person-centred care, yet research exploring subjective personhood in dementia is scarce. This study aimed to understand personhood by exploring the subjective experiences of those with dementia. Seven individuals with dementia were interviewed and interpretative phenomenological analysis was used to identify themes across accounts. Themes identified were: (1) working out the system and adapting in order to survive it--the 'peoplehood' of the system; (2) using past and future roles and experiences to manage the present--the transient nature of personhood; (3) being both an individual and a member of a group--the conflict of a dual role. The themes highlighted showed that individuals with dementia supported their personhood by drawing on their own, others' and the system's resources. The findings are discussed and links with existing literature and clinical implications are considered. PMID:24336951

  8. Dimensions and Determinants of Trust in Health Care in Resource Poor Settings – A Qualitative Exploration

    PubMed Central

    Gopichandran, Vijayaprasad; Chetlapalli, Satish Kumar

    2013-01-01

    Background Trust in health care has been intensely researched in resource rich settings. Some studies in resource poor settings suggest that the dimensions and determinants of trust are likely to be different. Objectives This study was done as a qualitative exploration of the dimensions and determinants of trust in health care in Tamil Nadu, a state in south India to assess the differences from dimensions and determinants in resource rich settings. Methodology The participants included people belonging to marginalized communities with poor access to health care services and living in conditions of resource deprivation. A total of thirty five in depth interviews were conducted. The interviews were summarized and transcribed and data were analyzed following thematic analysis and grounded theory approach. Results The key dimensions of trust in health care identified during the interviews were perceived competence, assurance of treatment irrespective of ability to pay or at any time of the day, patients’ willingness to accept drawbacks in health care, loyalty to the physician and respect for the physician. Comfort with the physician and health facility, personal involvement of the doctor with the patient, behavior and approach of doctor, economic factors, and health awareness were identified as factors determining the levels of trust in health care. Conclusions The dimensions and determinants of trust in health care in resource poor settings are different from that in resource rich settings. There is a need to develop scales to measure trust in health care in resource poor settings using these specific dimensions and determinants. PMID:23874904

  9. The Sheffield experiment: the effects of centralising accident and emergency services in a large urban setting

    PubMed Central

    Simpson, A; Wardrope, J; Burke, D

    2001-01-01

    Objectives—To assess the effects of centralisation of accident and emergency (A&E) services in a large urban setting. The end points were the quality of patient care judged by time to see a doctor or nurse practitioner, time to admission and the cost of the A&E service as a whole. Methods—Sheffield is a large industrial city with a population of 471 000. In 1994 Sheffield health authority took a decision to centralise a number of services including the A&E services. This study presents data collected over a three year period before, during and after the centralisation of adult A&E services from two sites to one site and the centralisation of children's A&E services to a separate site. A minor injury unit was also established along with an emergency admissions unit. The study used information from the A&E departments' computer system and routinely available financial data. Results—There has been a small decrease in the number of new patient attendances using the Sheffield A&E system. Most patients go to the correct department. The numbers of acute admissions through the adult A&E have doubled. Measures of process efficiency show some improvement in times to admission. There has been measurable deterioration in the time to be seen for minor injuries in the A&E departments. This is partly offset by the very good waiting time to be seen in the minor injuries unit. The costs of providing the service within Sheffield have increased. Conclusion—Centralisation of A&E services in Sheffield has led to concentration of the most ill patients in a single adult department and separate paediatric A&E department. Despite a greatly increased number of admissions at the adult site this change has not resulted in increased waiting times for admission because of the transfer of adequate beds to support the changes. There has however been a deterioration in the time to see a clinician, especially in the A&E departments. The waiting times at the minor injury unit are very short

  10. Experiences from development of home health care applications based on emerging Java technology.

    PubMed

    Lind, L; Sundvall, E; Ahlfeldt, H

    2001-01-01

    Home health care is an expanding area within the health care system. The idea of moving parts of the health care process from expensive specialised hospital care to primary health care and home health care might be attractive in a cost perspective. The introduction of home health care applications must be based on a rigorous analysis of necessary requirements to secure a safe and reliable health care. This article reports early experiences from the development of a home health care application based on emerging Java technologies such as the OSGi platform. A pilot application for follow-up of diabetes patients is presented and discussed in relation to a list of general requirements on home health care applications. PMID:11604851

  11. Translating evidence into practice: Hong Kong Reference Framework for Preventive Care for Children in Primary Care Settings.

    PubMed

    Siu, Natalie P Y; Too, L C; Tsang, Caroline S H; Young, Betty W Y

    2015-06-01

    There is increasing evidence that supports the close relationship between childhood and adult health. Fostering healthy growth and development of children deserves attention and effort. The Reference Framework for Preventive Care for Children in Primary Care Settings has been published by the Task Force on Conceptual Model and Preventive Protocols under the direction of the Working Group on Primary Care. It aims to promote health and prevent disease in children and is based on the latest research, and contributions of the Clinical Advisory Group that comprises primary care physicians, paediatricians, allied health professionals, and patient groups. This article highlights the comprehensive, continuing, and patient-centred preventive care for children and discusses how primary care physicians can incorporate the evidence-based recommendations into clinical practice. It is anticipated that the adoption of this framework will contribute to improved health and wellbeing of children. PMID:25999033

  12. Primary care professionals providing non-urgent care in hospital emergency departments

    PubMed Central

    Khangura, Jaspreet K; Flodgren, Gerd; Perera, Rafael; Rowe, Brian H; Shepperd, Sasha

    2014-01-01

    Background In many countries emergency departments (EDs) are facing an increase in demand for services, long-waits and severe crowding. One response to mitigate overcrowding has been to provide primary care services alongside or within hospital EDs for patients with non-urgent problems. It is not known, however, how this impacts the quality of patient care, the utilisation of hospital resources, or if it is cost-effective. Objectives To assess the effects of locating primary care professionals in the hospital ED to provide care for patients with non-urgent health problems, compared with care provided by regular Emergency Physicians (EPs), Search methods We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialized register; Cochrane Central Register of Controlled Trials (The Cochrane library, 2011, Issue 4), MEDLINE (1950 to March 21 2012); EMBASE (1980 to April 28 2011); CINAHL (1980 to April 28 2011); PsychINFO (1967 to April 28 2011); Sociological Abstracts (1952 to April 28 2011); ASSIA (1987 to April 28 2011); SSSCI (1945 to April 28 2011); HMIC (1979 to April 28 2011), sources of unpublished literature, reference lists of included papers and relevant systematic reviews. We contacted experts in the field for any published or unpublished studies, and hand searched ED conference abstracts from the last three years. Selection criteria Randomised controlled trials, non-randomised studies, controlled before and after studies and interrupted time series studies that evaluated the effectiveness of introducing primary care professionals to hospital EDs to attend to non-urgent patients, as compared to the care provided by regular EPs. Data collection and analysis Two reviewers independently extracted data and assessed the risk of bias for each included study. We contacted authors of included studies to obtain additional data. Dichotomous outcomes are presented as risk ratios (RR) with 95% confidence intervals (CIs) and continuous

  13. Emerging roles for telemedicine and smart technologies in dementia care

    PubMed Central

    Bossen, Ann L; Kim, Heejung; Williams, Kristine N; Steinhoff, Andreanna E; Strieker, Molly

    2015-01-01

    Demographic aging of the world population contributes to an increase in the number of persons diagnosed with dementia (PWD), with corresponding increases in health care expenditures. In addition, fewer family members are available to care for these individuals. Most care for PWD occurs in the home, and family members caring for PWD frequently suffer negative outcomes related to the stress and burden of observing their loved one’s progressive memory and functional decline. Decreases in cognition and self-care also necessitate that the caregiver takes on new roles and responsibilities in care provision. Smart technologies are being developed to support family caregivers of PWD in a variety of ways, including provision of information and support resources online, wayfinding technology to support independent mobility of the PWD, monitoring systems to alert caregivers to changes in the PWD and their environment, navigation devices to track PWD experiencing wandering, and telemedicine and e-health services linking caregivers and PWD with health care providers. This paper will review current uses of these advancing technologies to support care of PWD. Challenges unique to widespread acceptance of technology will be addressed and future directions explored. PMID:26636049

  14. Introduction: priority setting, equitable access and public involvement in health care.

    PubMed

    Weale, Albert; Kieslich, Katharina; Littlejohns, Peter; Tugendhaft, Aviva; Tumilty, Emma; Weerasuriya, Krisantha; Whitty, Jennifer A

    2016-08-15

    Purpose - The purpose of this paper is to introduce the special issue on improving equitable access to health care through increased public and patient involvement (PPI) in prioritization decisions by discussing the conceptualization, scope and rationales of PPI in priority setting that inform the special issue. Design/methodology/approach - The paper employs a mixed-methods approach in that it provides a literature review and a conceptual discussion of the common themes emerging in the field of PPI and health priority setting. Findings - The special issue focuses on public participation that is collective in character, in the sense that the participation relates to a social, not personal, decision and is relevant to whole groups of people and not single individuals. It is aimed at influencing a decision on public policy or legal rules. The rationales for public participation can be found in democratic theory, especially as they relate to the social and political values of legitimacy and representation. Originality/value - The paper builds on previous definitions of public participation by underlining its collective character. In doing so, it develops the work by Parry, Moyser and Day by arguing that, in light of the empirical evidence presented in this issue, public participatory activities such as protests and demonstrations should no longer be labelled unconventional, but should instead be labelled as "contestatory participation". This is to better reflect a situation in which these modes of participation have become more conventional in many parts of the world. PMID:27468772

  15. Biopsychosocial Health Care Needs at the Emergency Room: Challenge of Complexity

    PubMed Central

    Matzer, Franziska; Wisiak, Ursula V.; Graninger, Monika; Söllner, Wolfgang; Stilling, Hans Peter; Glawischnig-Goschnik, Monika; Lueger, Andreas; Fazekas, Christian

    2012-01-01

    Background In an emergency room of internal medicine, triage and treatment of patients deserve first priority. However, biopsychosocial case complexity may also affect patient health outcome but has not yet been explored in this setting. Therefore, the aims of the study are (1) to estimate prevalence rates of complex patients in the emergency room (ER), (2) to describe biopsychosocial complexity in this population and (3) to evaluate possible correlations between patient profiles regarding case complexity and further clinical treatment. Methods During a study period of one week, all patients of an emergency room of internal medicine who were triaged to Manchester levels three to five were invited to participate in the study. Biopsychosocial case complexity was assessed by the INTERMED method. Psychosocial interventions were evaluated based on all documented interventions and recommendations given at the emergency room and during inpatient treatment. Results Study participants consisted of 167 patients with a subgroup of 19% (n = 32) receiving subsequent inpatient-treatment at the department. High biopsychosocial case complexity was found in 12% (n = 20) of the total sample (INTERMED score >20). This finding was paralleled by a cluster analysis suggesting three clusters with one highly complex patient group of 14%. These highly complex patients differed significantly from the other clusters as they had visited the emergency room more often within the last year and lived alone more frequently. In addition, admission rates were highest in this group. During ER treatment and subsequent inpatient treatment, 21% of highly complex patients received interventions addressing psychosocial factors as compared to 6% and 7%, respectively, in the other clusters. Conclusions A standardized screening of biopsychosocial case complexity among ‘frequent utilizers’ of the ER would be helpful to detect specific multidisciplinary health care needs among this particularly

  16. Exposure of medical students to pharmaceutical marketing in primary care settings: frequent and influential.

    PubMed

    Sarikaya, Ozlem; Civaner, Murat; Vatansever, Kevser

    2009-12-01

    It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient-physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts. Considering the move toward early clinical encounters and community-based education, which expose students early to pharmaceutical representatives, the influence of those gifts is becoming a matter of concern. This study examines the frequency and influence of student exposure to drug marketing in primary care settings, as well as student perceptions of physician-pharmaceutical company relationships. This was a two-phase study consisting of qualitative research followed by a cross-sectional survey. Clinical experience logbooks of 280 second-year students in one school were analysed, and the themes that emerged were used to develop a survey that was administered to 308 third-year students from two medical schools. Survey results showed a 91.2% exposure to any type of marketing, and 56.8% of students were exposed to all classes of marketing methods studied. Deliberate targeting of students by pharmaceutical representatives, in particular, was correlated with being less sensitive to the negative effects of and having positive opinions about interactions with pharmaceutical companies. The vast majority of students are exposed to drug marketing in primary care settings, and may become more vulnerable to that strategy. Considering that medical students are vulnerable and are targeted deliberately by pharmaceutical companies, interventions aimed at developing skills in the rational use of medicines and in strategies for coping with drug marketing should be devised. PMID:19184498

  17. Individual versus Significant Other-Enhanced Brief Motivational Intervention for Alcohol in Emergency Care

    PubMed Central

    Monti, Peter M.; Colby, Suzanne M.; Mastroleo, Nadine R.; Barnett, Nancy P.; Gwaltney, Chad J.; Apodaca, Timothy R.; Rohsenow, Damaris J.; Magill, Molly; Gogineni, Aruna; Mello, Michael J.; Biffl, Walter L.; Cioffi, William G.

    2014-01-01

    Objective Effects of brief motivational interventions (BMIs) for heavy drinkers identified by alcohol-related emergency department (ED) visits are mixed. The successes of including significant others (SOs) in behavioral treatment suggest that involving SOs in ED-delivered BMI might prove beneficial. This study investigated the relative efficacy of an SO-enhanced Motivational Intervention (SOMI) compared to an Individual Motivational Intervention (IMI) to address heavy drinking in emergency care settings. Method ED (n = 317) or trauma unit (n = 89) patients were randomly assigned to receive either an IMI or an SOMI and were re-assessed at 6 and 12 months for alcohol consumption, alcohol-related consequences, and perceived alcohol-specific SO support. Results GEE analyses showed consistent reductions over time for both alcohol consumption and consequences. At one-year follow up, the average reduction in total drinks consumed per week was greater for patients in the SOMI condition than the IMI condition. In SOMI, 9.4% more patients moved to within the national guidelines for weekly drinking than did IMI patients. Frequency of heavy drinking and negative alcohol consequences showed no differential effects of intervention. Conclusions Emergence of a modest treatment effect at 12 months suggests that SO involvement in the SOMI condition may have led to more sustained positive influence on patient drinking than in the IMI condition. Implications and limitations regarding SO involvement in brief treatment are discussed. PMID:25111430

  18. Provider and clinic cultural competence in a primary care setting.

    PubMed

    Paez, Kathryn A; Allen, Jerilyn K; Carson, Kathryn A; Cooper, Lisa A

    2008-03-01

    A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary care providers and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA completed an on-line survey which included items assessing provider and clinic cultural competence. Using simple linear regression, it was found that providers with attitudes reflecting greater cultural motivation to learn were more likely to work in clinics with a higher percent of nonwhite staff, and those offering cultural diversity training and culturally adapted patient education materials. More culturally appropriate provider behavior was associated with a higher percent of nonwhite staff in the clinic, and culturally adapted patient education materials. Enhancing provider and clinic cultural competence may be synergistic strategies for reducing healthcare disparities. PMID:18164114

  19. Benign prostatic hyperplasia (BPH) management in the primary care setting.

    PubMed

    Kapoor, Anil

    2012-10-01

    Benign prostate hyperplasia (BPH) occurs in up to 50% of men by age 50, and the incidence increases with age. This common clinical problem is diagnosed by history, including the International Prostate Symptom Score (IPSS) questionnaire, and physical examination by digital rectal examination (DRE). Initial management for BPH includes lifestyle modification, and smooth muscle relaxant alpha blocker therapy. Alpha blockers usually take effect quickly within 3-5 days, and have minimal side effects. Current commonly used alpha blockers include the selective alpha blockers tamsulosin (Flomax), alfusosin (Xatral), and silodosin (Rapaflo). For patients with larger prostates, the 5-alpha reductase inhibitor class (finasteride (Proscar) and dutasteride (Avodart)) work effectively to shrink prostate stroma resulting in improved voiding. The 5-ARI class of drugs, in addition to reducing prostate size, also reduce the need for future BPH-related surgery, and reduce the risk of future urinary retention. Drugs from the phosphodiesterase-5 (PDE-5) inhibitor class may now be considered for treating BPH. Once daily 5 mg tadalafil has been shown to improve BPH-related symptoms and is currently approved to treat patients with BPH. Referral to a urologist can be considered for patients with a rising prostate-specific antigen (PSA), especially while on 5-ARI, failure of urinary symptom control despite maximal medical therapy, suspicion of prostate cancer, hematuria, recurrent urinary infections, urinary retention, or renal failure. Currently the primary care physician is armed with multiple treatment options to effectively treat men with symptomatic BPH. PMID:23089343

  20. Provider and Clinic Cultural Competence in a Primary Care Setting

    PubMed Central

    Paez, Kathryn A; Allen, Jerilyn K; Carson, Kathryn A; Cooper, Lisa A

    2008-01-01

    A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary care providers and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA. completed an on-line survey which included items assessing provider and clinic cultural competence. Using simple linear regression, it was found that providers with attitudes reflecting greater cultural motivation to learn were more likely to work in clinics with a higher percent of nonwhite staff, and those offering cultural diversity training and culturally adapted patient education materials. More culturally appropriate provider behavior was associated with a higher percent of nonwhite staff in the clinic, and culturally adapted patient education materials. Enhancing provider and clinic cultural competence may be synergistic strategies for reducing healthcare disparities. PMID:18164114

  1. Patients in acute care settings. Which health-care services are provided?

    PubMed

    Dugan, J; Mosel, L

    1992-07-01

    Studies have shown that early discharge planning, multidisciplinary care, and a focus on functional abilities for older adults do reduce acute care hospital readmissions. Of the 101 records reviewed of acute care admissions 75 years of age and older, 36 had no multidisciplinary service documented and 75 had no discharge planning documented within 48 hours of admission. Eleven functional activities were assessed and documented in one record with a range of 4 to 11 activities assessed in the remaining 100 documents. Identifying and filling gaps in care provided to this age group might provide substantial cost savings, improve care, and decrease complications. Advocacy, coordination of care, and greater knowledge may be keys to narrowing these service gaps. PMID:1629531

  2. Information Provision in Emergency Settings: The Experience of Refugee Communities in Zambia

    ERIC Educational Resources Information Center

    Kanyengo, Brendah Kakulwa; Kanyengo, Christine Wamunyima

    2011-01-01

    This article identifies information provision services in emergency settings using Zambia as a case study by identifying innovative ways of providing library and information services. The thrust of the article is to analyze information management practices of organizations that work within refugee camps and how they take specific cognizance of the…

  3. Mother-Child Joint Writing in an Environmental Print Setting: Relations with Emergent Literacy

    ERIC Educational Resources Information Center

    Neumann, Michelle M.; Hood, Michelle; Ford, Ruth M.

    2012-01-01

    Mother-child dyads (N = 35) were videoed as they wrote a shopping list in an environmental print-rich grocery shop play setting. The children (M age = 4.3 years) were assessed on emergent literacy skills (letter name and sound knowledge, print concepts, phonological awareness, and letter and name writing). Mothers' general level of print and…

  4. 48 CFR 52.226-4 - Notice of Disaster or Emergency Area Set-Aside.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Notice of Disaster or Emergency Area Set-Aside. 52.226-4 Section 52.226-4 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION (CONTINUED) CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 52.226-4 Notice...

  5. Teacher Retention in Refugee and Emergency Settings: The State of the Literature

    ERIC Educational Resources Information Center

    Ring, Hannah Reeves; West, Amy R.

    2015-01-01

    Teacher quality is recognised as a primary driver of variation in student learning outcomes, particularly in refugee and emergency settings, but few studies have examined the factors that motivate or demotivate teachers in these contexts. In this article we use secondary source materials from academic experts and grey literature from United…

  6. [The organizational technologies of quality support of emergency and acute medical care in megalopolis: Moscow case].

    PubMed

    2011-01-01

    The article deals with the issues of emergency medical care in conditions of megalopolis on the example of the Moscow A.S. Putchkov emergency and acute medical care station. The analysis is applied to such new organizational technologies as the automatic navigational dispatcher system of field brigades 'management, the zoning of transport mains according accessibility of emergency medical are stations, the organization of emergency medical posts on the most conducive to accident areas of megalopolis, the integrated municipal inter-warning system in case of road accidents. PMID:22279806

  7. A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency Care

    PubMed Central

    Wallis, Lee A.; Fleming, Julian; Hasselberg, Marie; Laflamme, Lucie; Lundin, Johan

    2016-01-01

    Background Each year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back. Methods and Results The application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s) through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care. Conclusions In this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on

  8. Development and Validation of the Standard Chinese Version of the CARE Item Set (CARE-C) for Stroke Patients

    PubMed Central

    Chang, Ke-Vin; Hung, Chen-Yu; Kao, Chien-Wei; Tan, Fuk-Tang; Gage, Barbara; Hsieh, Ching-Lin; Wang, Tyng-Guey; Han, Der-Sheng

    2015-01-01

    Abstract The Continuity Assessment Record and Evaluation (CARE) item set is a standardized, integrative scale for evaluation of functional status across acute and postacute care (PAC) providers. The aim of this study was to develop a Chinese version of the CARE (CARE-C) item set and to examine its reliability and validity for assessment of functional outcomes among stroke patients. The CARE-C was administered in two samples. Sample 1 included 30 stroke patients in the outpatient clinic setting for the purpose of examining interrater and test–retest reliabilities and internal consistency. Sample 2 included 138 stroke patients admitted to rehabilitation units for the purpose of investigating criterion-related validity with the Barthel index, Lawton Instrumental Activities of Daily Living (IADL) scale, EuroQOL five dimensions questionnaire (EQ-5D), and Mini-Mental State Examination (MMSE). The CARE-C was categorized into 11 subscales, 52 items of which were analyzed. At the subscale level, the interrater reliability and test–retest reliability expressed by intraclass correlation coefficient (ICC) ranged from 0.72 to 0.99 and 0.60 to 1.00, respectively. Six of the 11 subscales met acceptable levels of internal consistency (Cronbach alpha > 0.7). The criterion-related validity of the CARE-C showed moderate to high correlations of its subscales of cognition and basic and instrumental activities of daily living with the Barthel index, IADL scale, and MMSE. The CARE-C is a useful instrument for evaluating functional quality metrics in the Chinese stroke population. The development of the CARE-C also facilitates the assessment of the PAC program in Taiwan and future research is warranted for validating the capability of CARE-C to identify patients’ functional change over time and its generalizability for nonstroke populations. PMID:26496322

  9. Migrants' and professionals' views on culturally sensitive pre-hospital emergency care.

    PubMed

    Kietzmann, Diana; Hannig, Christian; Schmidt, Silke

    2015-08-01

    This study was designed to explore the views of migrants and professionals on culturally sensitive pre-hospital emergency care in order to adapt such care to migrants' needs. Interviews were conducted with 41 migrants who had received direct (as a patient) or indirect (as a significant other) pre-hospital emergency care. Furthermore, 20 professionals in the field of pre-hospital emergency care were interviewed. The content analysis showed five distinguishable categories based on the statements by the migrants and six categories based on the statements by the professionals. While migrants gave priority to basic proficiencies of first responders such as 'social/emotional competencies' and 'communication skills', the professionals considered '(basic) cultural knowledge', 'awareness' and 'attitude' the most important. Furthermore, migrants provided practical indications, e.g. regarding areas of cultural knowledge, whereas professionals seemed to view the issue of culturally pre-hospital emergency care from a more theoretical perspective. The issues of the culturally sensitive pre-hospital emergency care itself, as well as the varying points of view of the two groups interviewed, resulted in eight recommendations for culturally sensitive pre-hospital emergency care. PMID:26123882

  10. Differences in HIV risk behavior of injection drug users in New York City by health care setting

    PubMed Central

    Turner, AT; Harripersaud, K; Crawford, ND; Rivera, AV; Fuller, CM

    2013-01-01

    The purpose of this study is to examine the HIV risk behaviors and demographic characteristics of injection drug users (IDUs) by type of health care setting, which can inform development of tailored structural interventions to increase access to HIV prevention and medical treatment services. IDU syringe customers were recruited from pharmacies as part of the “Pharmacist As Resources Making Links to Community Services” (PHARM-Link) study, a randomized community-based intervention in New York City (NYC) aimed at connecting IDUs to HIV prevention, medical, and social services. An ACASI survey ascertained demographics, risk behavior, healthcare utilization, and location where health care services were received in the past year. Data were analyzed using logistic regression. Of 602 participants, 34% reported receiving health care at a community clinic, 46% a private medical office, 15% a mobile medical unit, and 59% an emergency room (ER). After adjustment, participants who attended a community clinic were significantly more likely to have health insurance, report syringe sharing, and be HIV positive. Whites, non-daily injectors, insured and higher income IDUs were more likely to attend a private medical office. Participants who recently used a case manager and had multiple sexual partners were more likely to use a mobile medical unit. ER attendees were more likely to be homeless and report recent drug treatment use. These findings show that IDU demographics and risk behaviors differ by health care setting suggesting that risk reduction interventions should be tailored to health care settings. Specifically, these data suggest that community clinics and mobile medical units serve high risk IDUs, highlighting the need for more research to develop and test innovative prevention and care programs within these settings. PMID:23451991

  11. [Intensive care for emerging infectious diseases--Ebola and Dengue].

    PubMed

    Ohmagari, Norio

    2016-02-01

    Although significant effort has been made for the development of treatment and prevention of Ebola hemorrhagic fever, one has to keep in mind that basic supportive therapy, including sufficient hydration to the patients, would be a standard of care for Ebola hemorrhagic fever and other antiviral therapy would be an adjunct to this standard of care. Also, effective antiviral drug to dengue virus is not known, and a basic supportive therapy, including fluid therapy, would be a standard of care and prevent serious type of dengue virus infections. Aspirin and other non-steroidal anti-inflammatory drug must not be used, because they promote bleeding and acidosis. PMID:26915248

  12. Extending the HL7/LOINC Document Ontology Settings of Care

    PubMed Central

    Rajamani, Sripriya; Chen, Elizabeth S.; Wang, Yan; Melton, Genevieve B.

    2014-01-01

    Given federal mandates recommending document standards, increasing numbers of electronic clinical documents being created, and local initiatives/projects using clinical documents, there is a growing need to better represent clinical document metadata. The HL7/LOINC Document Ontology (DO) was developed to provide a standard representation of clinical document attributes with a multi-axis structure. Prior studies have demonstrated the need for extension of DO axes values and proposed new values for some axes, but significant gaps remain for representing the DO “Setting” axis. This study aimed to extend the “Setting” axis by combining the current values in the DO with values from 5 other sources. Evaluation and refinement by subject matter experts over a series of four iterative sessions resulted in a reorganized hierarchy with 254 additional values from a baseline of 20. Incorporating a comprehensive set of “Settings” in DO provides better representation of clinical information across the healthcare ecosystem. PMID:25954408

  13. Integrating quantitative and qualitative methodologies for the assessment of health care systems: emergency medicine in post-conflict Serbia

    PubMed Central

    Nelson, Brett D; Dierberg, Kerry; Šćepanović, Milena; Mitrović, Mihajlo; Vuksanović, Miloš; Milić, Ljiljana; VanRooyen, Michael J

    2005-01-01

    Background Due to the complexity of health system reform in the post-conflict, post-disaster, and development settings, attempts to restructure health services are fraught with pitfalls that are often unanticipated because of inadequate preliminary assessments. Our proposed Integrated Multimodal Assessment – combining quantitative and qualitative methodologies – may provide a more robust mechanism for identifying programmatic priorities and critical barriers for appropriate and sustainable health system interventions. The purpose of this study is to describe this novel multimodal assessment using emergency medicine in post-conflict Serbia as a model. Methods Integrated quantitative and qualitative methodologies – system characterization and observation, focus group discussions, free-response questionnaires, and by-person factor analysis – were used to identify needs, problems, and potential barriers to the development of emergency medicine in Serbia. Participants included emergency and pre-hospital personnel from all emergency medical institutions in Belgrade. Results Demographic data indicate a loosely ordered network of part-time emergency departments supported by 24-hour pre-hospital services and an academic emergency center. Focus groups and questionnaires reveal significant impediments to delivery of care and suggest development priorities. By-person factor analysis subsequently divides respondents into distinctive attitudinal types, compares participant opinions, and identifies programmatic priorities. Conclusions By combining quantitative and qualitative methodologies, our Integrated Multimodal Assessment identified critical needs and barriers to emergency medicine development in Serbia and may serve as a model for future health system assessments in post-conflict, post-disaster, and development settings. PMID:15715917

  14. Role of public transport in accessibility to emergency dental care in Melbourne, Australia.

    PubMed

    Rocha, Carla M; Kruger, Estie; McGuire, Shane; Tennant, Marc

    2015-01-01

    The aim of this study was to develop a method for the analysis of the influence of public transport supply in a large city (Melbourne) on the access to emergency dental treatment. Geographic Information Systems (GIS) tools were used to associate the geographical distribution of patients (and their socioeconomic status) with accessibility (through public transport supply, i.e. bus, tram and/or train) to emergency dental care. The methodology used allowed analysis of the socioeconomic status of patient residential areas and both spatial location and supply frequency of public transport by using existing data from patient records, census and transport departments. In metropolitan Melbourne, a total of 13 784 patients met the inclusion criteria for the study sample, of which 95% (n = 13 077) were living within a 50 km radius of the Royal Dental Hospital of Melbourne. Low socioeconomic areas had a higher demand for dental emergency care in the Royal Dental Hospital of Melbourne. Public transport supply was similar across the various socioeconomic strata in the population, with 80% of patients having good access to public transport. However, when considering only high-frequency bus stops, the percentage of patients living within 400 m from a bus stop dropped to 65%. Despite this, the number of patients (adjusted to the population) coming from areas not supplied by public transport, and from areas with good or poor public transport supply, was similar. The methodology applied in the present study highlights the importance of evaluating not only the spatial distribution but also the frequency of public transport supply when studying access to services. This methodology can be extrapolated to other settings to identity transport/access patterns for a variety of services. PMID:26509207

  15. Time-critical neurological emergencies: the unfulfilled role for point-of-care testing

    PubMed Central

    Knight, William A.; Clark, Joseph F.; Beyette, Fred R.; Pancioli, Arthur

    2010-01-01

    Background Neurological emergencies are common and frequently devastating. Every year, millions of Americans suffer an acute stroke, severe traumatic brain injury, subarachnoid hemorrhage, status epilepticus, or spinal cord injury severe enough to require medical intervention. Aims Full evaluation of the diseases in the acute setting often requires advanced diagnostics, and treatment frequently necessitates transfer to specialized centers. Delays in diagnosis and/or treatment may result in worsened outcomes; therefore, optimization of diagnostics is critical. Methods Point-of-care (POC) testing brings advanced diagnostics to the patient’s bedside in an effort to assist medical providers with real-time decisions based on real-time information. POC testing is usually associated with blood tests (blood glucose, troponin, etc.), but can involve imaging, medical devices, or adapting existing technologies for use outside of the hospital. Noticeably missing from the list of current point-of-care technologies are real-time bedside capabilities that address neurological emergencies. Results Unfortunately, the lack of these technologies may result in delayed identification of patients of these devastating conditions and contribute to less aggressive therapies than is seen with other disease processes. Development of time-dependent technologies appropriate for use with the neurologically ill patient are needed to improve therapies and outcomes. Conclusion POC-CENT is designed to support the development of novel ideas focused on improving diagnostic or prognostic capabilities for acute neurological emergencies. Eligible examples include biomarkers of traumatic brain injury, non-invasive measurements of intracranial pressure or cerebral vasospasm, and improved detection of pathological bacteria in suspected meningitis. PMID:20606822

  16. Child Care Teachers' Perspectives on Including Children with Challenging Behavior in Child Care Settings

    ERIC Educational Resources Information Center

    Quesenberry, Amanda C.; Hemmeter, Mary Louise; Ostrosky, Michaelene M.; Hamann, Kira

    2014-01-01

    In this study, 9 teachers from 5 child care centers were interviewed to examine their perceptions on including children with challenging behavior in their classrooms. The findings provide a firsthand view into how child care teachers support children's social and emotional development and address challenging behavior. Results confirm previous…

  17. Emergency Care of Patients with Pacemakers and Defibrillators.

    PubMed

    Allison, Michael G; Mallemat, Haney A

    2015-08-01

    Devices such as pacemakers and implantable cardioverter-defibrillators (ICDs) are commonly inserted to treat unstable cardiac rhythm disturbances. Despite the benefits of these devices on mortality and morbidity rates, patients often present to the emergency department with complaints related to device insertion or malfunction. Emergency physicians must be able to rapidly identify potential life threats caused by pacemaker malfunction, ICD firing, and complications associated with implantation of the devices. PMID:26226872

  18. Capability of Using Clinical Care Classification System to Represent Nursing Practice in Acute Setting in Taiwan

    PubMed Central

    Feng, Rung-Chuang; Tseng, Kuan-Jui; Yan, Hsiu-Fang; Huang, Hsiu-Ya; Chang, Polun

    2012-01-01

    This study examines the capability of the Clinical Care Classification (CCC) system to represent nursing record data in a medical center in Taiwan. Nursing care records were analyzed using the process of knowledge discovery in data sets. The study data set included all the nursing care plan records from December 1998 to October 2008, totaling 2,060,214 care plan documentation entries. Results show that 75.42% of the documented diagnosis terms could be mapped using the CCC system. A total of 21 established nursing diagnoses were recommended to be added into the CCC system. Results show that one-third of the assessment and care tasks were provided by nursing professionals. This study shows that the CCC system is useful for identifying patterns in nursing practices and can be used to construct a nursing database in the acute setting. PMID:24199066

  19. The economic role of the Emergency Department in the health care continuum: applying Michael Porter's five forces model to Emergency Medicine.

    PubMed

    Pines, Jesse M

    2006-05-01

    Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players. PMID:16740464

  20. Maternal mortality and its relationship to emergency obstetric care (EmOC) in a tertiary care hospital in South India

    PubMed Central

    2015-01-01

    Objective: To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. Methods: A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Results: Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. Conclusion: The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care. PMID:27512460

  1. Rising pressure: hospital emergency departments as barometers of the health care system.

    PubMed

    O'Malley, Ann S; Gerland, Anneliese M; Pham, Hoangmai H; Berenson, Robert A

    2005-11-01

    Pressures--ranging from persuading specialists to provide on-call coverage to dealing with growing numbers of patients with serious mental illness--are building in already-crowded hospital emergency departments (EDs) across the country, according to findings from the Center for Studying Health System Change's (HSC) 2005 site visits to 12 nationally representative communities. As the number of ED visits rises significantly faster than population growth, many hospitals are expanding emergency department capacity. At the same time, hospitals face an ongoing nursing shortage, contributing to tight inpatient capacity that in turn hinders admitting ED patients. In their role as hospitals' "front door" for attracting insured inpatient admissions, emergency departments also increasingly are expected to help hospitals compete for insured patients while still meeting obligations to provide emergency care to all-comers under federal law. Failure to address these growing pressures may compromise access to emergency care for patients and spur already rapidly rising health care costs. PMID:16299951

  2. Maritime pre-hospital emergency care primary retrieval team--operational considerations.

    PubMed

    Newman, Darryl A

    2012-01-01

    This article examines the non clinical skills and training required for effective maritime pre-hospital emergency care provision within a Role Two Afloat facility, allowing for a Primary Retrieval Team to be deployed in support of boarding operations. The provision of pre-hospital emergency care and sending a retrieval team forward has been trialled in various forms. In 2010 and 2011 a R2A team was deployed aboard RFA FORT VICTORIA. This included a Primary Retrieval Team consisting of an Emergency Nurse Specialist, a Medical Assistant which can be enhanced when required by an Emergency Care or Anaesthetic Consultant. This differs from the land operations support provided by the airborne Medical Emergency Response Team (MERT) as the maritime environment requires a bespoke solution for casualty retrieval as the method of deployment and the type of casualties and their locations may be more varied, requiring greater flexibility of approach. PMID:22558736

  3. Staff "Burnout" in Child Care Settings. ERIC/EECE Short Report-4.

    ERIC Educational Resources Information Center

    ERIC Clearinghouse on Elementary and Early Childhood Education, Urbana, IL.

    Derived from a study by Whitebook and others (1982), this ERIC Short Report presents findings, recommendations, and other information on staff burnout in child care settings. Child care staff were found to be underpaid and overworked. Differences in working conditions among centers and job satisfaction among staff appeared to be related to such…

  4. Evaluation of the Get Set Day Care Program, 1978-1979.

    ERIC Educational Resources Information Center

    Figgures, Cleo

    This study reports results of an evaluation of the developmental, parent involvement, staff development, and supportive services components of the Get Set Day Care Program in Philadelphia. During 1978-1979, the program provided day care and educational services to approximately 4,100 children in 70 sites. Developmental Behavior Checklist (DBC)…

  5. Palliative and Curative Care Nurses' Attitudes Toward Dying and Death in the Hospital Setting.

    ERIC Educational Resources Information Center

    Thompson, Edward H.

    1986-01-01

    Examined sociodemographic background, nursing unit, amount of experience caring for dying patients, death anxiety, and attitudes toward working with dying patients among 56 nurses in palliative, surgical, and pediatric services. Work setting was found to be a more significant force in shaping attitudes toward caring for the dying than was…

  6. Unit Manager's Role with Family Members of Clients in Complex Continuing Care Settings: An Untold Story

    ERIC Educational Resources Information Center

    Guruge, Sepali; McGilton, Katherine; Yetman, Linda; Campbell, Heather; Librado, Ruby; Bloch, Lois; Ladak, Salima

    2005-01-01

    Most literature on staff-family relationships has come from studies of long-term care settings, has focused mainly on the families' perspectives on factors affecting their relationships with staff, and has included scant findings from the staff's perspective. No studies that examined staff-family relationships in complex continuing care (CCC)…

  7. Learning and Language: Educarer-Child Interactions in Singapore Infant-Care Settings

    ERIC Educational Resources Information Center

    Lim, Cynthia; Lim, Sirene May-Yin

    2013-01-01

    While there has been extensive research exploring the quality of caregiver-child interactions in programmes for preschool children, comparatively less international research has explored the nature of caregiver-child interactions in centre-based infant-care programmes. Nine caregivers in six Singapore infant-care settings were observed and…

  8. Clinical Instructor Characteristics, Behaviors and Skills in Allied Health Care Settings: A Literature Review

    ERIC Educational Resources Information Center

    Levy, Linda S.; Sexton, Patrick; Willeford, K. Sean; Barnum, Mary G.; Guyer, M. Susan; Gardner, Greg; Fincher, A. Louise

    2009-01-01

    The purpose of this literature review is to compare both clinical instructor and student perceptions of helpful and hindering clinical instructor characteristics, behaviors and skills in athletic training and allied health care settings. Clinical education in athletic training is similar to that of other allied health care professions. Clinical…

  9. Guiding Principles for Providing High-Quality Education in Juvenile Justice Secure Care Settings

    ERIC Educational Resources Information Center

    US Department of Education, 2014

    2014-01-01

    Providing high-quality education in juvenile justice secure care settings presents unique challenges for the administrators, teachers, and staff who are responsible for the education, rehabilitation, and welfare of youths committed to their care. The United States departments of Education (ED) and Justice (DOJ) recognize that while these…

  10. Contextualizing an Expanded Definition of Health Literacy among Adolescents in the Health Care Setting

    ERIC Educational Resources Information Center

    Massey, Philip M.; Prelip, Michael; Calimlim, Brian M.; Quiter, Elaine S.; Glik, Deborah C.

    2012-01-01

    The current emphasis on preventive health care and wellness services suggests that measures of skills and competencies needed to effectively navigate the health care system need to be better defined. We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and…

  11. Nurses in Action: A Response to Cultural Care Challenges in a Pediatric Acute Care Setting.

    PubMed

    Mixer, Sandra J; Carson, Emily; McArthur, Polly M; Abraham, Cynthia; Silva, Krystle; Davidson, Rebecca; Sharp, Debra; Chadwick, Jessica

    2015-01-01

    Culturally congruent care is satisfying, meaningful, fits with people's daily lives, and promotes their health and wellbeing. A group of staff nurses identified specific clinical challenges they faced in providing such care for Hispanic and underserved Caucasian children and families in the pediatric medical-surgical unit of an urban regional children's hospital in the southeastern U.S. To address these challenges, an academic-practice partnership was formed between a group of nurse managers and staff nurses at the children's hospital and nursing faculty and graduate students at a local, research-intensive public university. Using the culture care theory, the partners collaborated on a research study to discover knowledge that would help the nursing staff resolve the identified clinical challenges. Twelve families and 12 healthcare providers participated. Data analysis revealed five care factors that participants identified as most valuable: family, faith, communication, care integration, and meeting basic needs. These themes were used to formulate nursing actions that, when applied in daily practice, could facilitate the provision of culturally congruent care for these children and their families. The knowledge generated by this study also has implications for healthcare organizations, nursing educators, and academic-practice partnerships that seek to ensure the delivery of equitable care for all patients. PMID:26072213

  12. Prevalence of intimate partner violence across medical and surgical health care settings: a systematic review.

    PubMed

    Sprague, Sheila; Goslings, J Carel; Hogentoren, Celine; de Milliano, Simone; Simunovic, Nicole; Madden, Kim; Bhandari, Mohit

    2014-01-01

    Intimate partner violence (IPV) is a serious health problem and a leading cause of nonfatal injury in North American females. Prevalence of IPV has ranged from less than 20% to more than 50% across primary care, emergency medicine, and family medicine. We conducted a systematic review and meta-analysis of the literature to examine best estimates of IPV prevalence as opportunities for targeted interventions in health care specialties. We included 37 articles in this study. Based on our pooled data, best estimates of the lifetime prevalence of any type of IPV were 38% in family medicine and 40% in emergency medicine. PMID:24476759

  13. Clinical Practice Guidelines as Instruments for Sound Health Care Priority Setting.

    PubMed

    Lawler, Patrick R; Norheim, Ole F

    2015-11-01

    This editorial discusses the potential role that physician-authored clinical practice guidelines could play in health care priority setting decisions in the United States. We briefly review the challenges associated with increasingly obligate health care priority setting in the United States and discuss accountability for these decisions. We then propose a potential role for clinical practice guidelines in addressing these challenges, while considering the ethical foundations of such a proposal. PMID:26342516

  14. The Potential Use of Health Care Financing Administration Data Sets for Health Care Services Research

    PubMed Central

    Lave, Judith; Dobson, Allen; Walton, Carol

    1983-01-01

    Administrative Record Systems may be an overlooked source of data for health services researchers. Through its administration of the Medicare and Medicaid Programs, the Health Care Financing Administration (HCFA) routinely receives data on items such as its beneficiary population, providers certified to deliver care to its beneficiary population, providers certified to deliver care to the beneficiaries, the use of services and reimbursements to providers. This article introduces the reader to the HCFA data, it describes the most important data bases that are useful for research, their relative strengths and weaknesses and the extent to which they are available to outside users. PMID:10310280

  15. Effectively using communication to enhance the provision of pediatric palliative care in an acute care setting

    PubMed Central

    Hubble, Rosemary; Trowbridge, Kelly; Hubbard, Claudia; Ahsens, Leslie; Ward-Smith, Peggy

    2008-01-01

    The capability of effectively communicating is crucial when providing palliative care, especially when the patient is a child. Communication among healthcare professionals with the child and family members must be clear, concise, and consistent. Use of a communication tool provides documentation for conversations, treatment plans, and specific desires related to care. This paper describes communication theory, portrays the use of this theory to develop a communication tool, and illustrates the use of this tool by multidisciplinary members of a healthcare team to provide pediatric palliative care. PMID:21197332

  16. Measuring non-technical skills in medical emergency care: a review of assessment measures

    PubMed Central

    Cooper, Simon; Endacott, Ruth; Cant, Robyn

    2010-01-01

    Aim To review the literature on non-technical skills and assessment methods relevant to emergency care. Background Non-technical skills (NTS) include leadership, teamwork, decision making and situation awareness, all of which have an impact on healthcare outcomes. Significant concerns have been raised about the rates of adverse medical events, many of which are attributed to NTS failures. Methods Ovid, Medline, ProQUEST, PsycINFO and specialty websites were searched for NTS measures using applicable access strategies, inclusion and exclusion criteria. Publications identified were assessed for relevance. Results A range of non-technical skill measures relevant to emergency care was identified: leadership (n = 5), teamwork (n = 7), personality/behavior (n = 3) and situation awareness tools (n = 1). Of these, 9 have been used with emergency care populations/clinicians. All had varying degrees of reliability and validity. In the last decade there has been some development of teamwork measures specific to emergency care with a predominantly global and collective rating of broad skills. Conclusion A variety of non-technical skill measures are available; only a few have been used in the emergency care arena. There is a need for an increase in the focused assessment of teamwork skills for a greater understanding of team performance to enhance patient safety in medical emergency care. PMID:27147832

  17. YACHIYO HOSPITAL; Center of SUPER CARE MIX--Comprehensive Care from Emergency to Home for the community.

    PubMed

    Matsumoto, Takatoshi; Iyomasa, Shinsuke; Fukatsu, Atsushi

    2016-01-01

    Anjo City has two general hospitals. Kosei Hospital, a central medical center for advanced care, and our Yachiyo Hospital for regional care. Recently, Kosei Hospital faced over-capacity problem because of overflow in emergency visits and congested wards due to shortage of post-acute beds. We planned a project to ease the congestion of the central hospital and manage post-acute patients. PMID:27180467

  18. Informed consent procedure for clinical trials in emergency settings: the Polish perspective.

    PubMed

    Iwanowski, Piotr S

    2007-09-01

    Setting reasonable and fair limits of emergency research acceptability in ethical norms and legal regulations must still adhere to the premise of well-being of the research subject over the interests of science and society. Informed consent of emergency patients to be enrolled in clinical trials is a particularly difficult issue due to impaired competencies of patients' to give consent, short diagnostic and therapeutic windows, as well as the requirement to provide detailed information to participants. Whereas the Declaration of Helsinki, Good Clinical Practice guideline, Additional Protocol to the European Bioethical Convention concerning Biomedical Research, as well as appropriate regulations adopted by the Food and Drugs Administration (USA) allow waivers from participants' consent or deferred consent for emergency research, the regulations of most European Community countries following the Clinical Trial Directive (2001/20/EC) do not give space for a deferred consent or a waiver from consent for adult patients (unless surrogate consent is made use of). This is even more confusing in case of Poland, where conflicting regulations on a waiver from a participant's consent in emergency research exist and the regulations on surrogate consent of temporarily incompetent adults are too restrictive and authorise only the guardianship courts to consent, which is not or hardly feasible in practice. European Community regulations need to be amended to allow for implementation of the deferred consent or waivers from consent for emergency research in order to enable ethical research of emergency conditions that should become a large part of important public health priorities. PMID:18210227

  19. Latex allergy: an emerging problem in health care.

    PubMed

    Kinnaird, S W; McClure, N; Wilham, S

    1995-10-01

    Allergy to latex has been increasing as the use of latex products has grown. The increase is disproportionately occurring in those people with myelodysplasias, those who have undergone multiple surgical procedures, and health care providers. Within those groups, the most susceptible to latex allergy are people with other allergies. Early identification of high-risk individuals and their avoidance of products containing latex can minimize the occurrence of this allergic response. Heightened awareness among health care providers is needed because latex is very common in hospitals and clinics. Inadvertent exposure places latex-sensitive individuals in danger of anaphylaxis. Nurses caring for infants and children are able to modify the environment of those at risk for latex allergy, reducing exposure to this potentially dangerous substance. Teaching families of children at risk will help them avoid latex in the home; many common household substances contain latex and are likely to trigger allergic responses. PMID:7565525

  20. Care coordination for patients with complex health profiles in inpatient and outpatient settings.

    PubMed

    Berry, Leonard L; Rock, Beth L; Smith Houskamp, Beth; Brueggeman, Joan; Tucker, Lois

    2013-02-01

    Patients with the most complex health profiles consume a disproportionate percentage of health care expenditures, yet often receive fragmented, suboptimal care. Since 2003, Wisconsin-based Gundersen Health has improved the quality of life and reduced the cost burden of patients with complex health profiles with an integrated care coordination program. Those results are consistent with data from the most successful care coordination demonstration projects funded by the Centers for Medicare and Medicaid Services. Specifically, Gundersen's program has been associated with reduced hospital stays, lower costs for inpatients, less use of inpatient services, and increased patient satisfaction. Gundersen's success is rooted in its team-based approach to coordinated care. Teams, led by a subspecialty-trained nurse, have regular, face-to-face contact with patients and their physicians in both inpatient and outpatient settings; involve patients deeply in care-related decisions; access a system-wide electronic medical record database that tracks patients' care; and take a macrolevel view of care-related factors and costs. Gundersen's model offers specific take-home lessons for institutions interested in coordinated care as they design programs aimed at improving quality and lowering costs. This institutional case study provides a window into well-executed care coordination at a large health care system in an era when major changes in health care provision and reimbursement mechanisms are on the horizon. PMID:23290738

  1. Palliative Care Psychiatry: Update on an Emerging Dimension of Psychiatric Practice

    PubMed Central

    Fairman, Nathan

    2013-01-01

    Palliative care psychiatry is an emerging subspecialty field at the intersection of Palliative Medicine and Psychiatry. The discipline brings expertise in understanding the psychosocial dimensions of human experience to the care of dying patients and support of their families. The goals of this review are (1) to briefly define palliative care and summarize the evidence for its benefits, (2) to describe the roles for psychiatry within palliative care, (3) to review recent advances in the research and practice of palliative care psychiatry, and (4) to delineate some steps ahead as this sub-field continues to develop, in terms of research, education, and systems-based practice. PMID:23794027

  2. Prehospital Electronic Patient Care Report Systems: Early Experiences from Emergency Medical Services Agency Leaders

    PubMed Central

    Landman, Adam B.; Lee, Christopher H.; Sasson, Comilla; Van Gelder, Carin M.; Curry, Leslie A.

    2012-01-01

    Background As the United States embraces electronic health records (EHRs), improved emergency medical services (EMS) information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement electronic patient care report (e-PCR) systems. We sought to characterize motivations for adoption of e-PCR systems, challenges associated with adoption and implementation, and emerging implementation strategies. Methods We conducted a qualitative study using semi-structured in-depth interviews with EMS agency leaders. Participants were recruited through a web-based survey of National Association of EMS Physicians (NAEMSP) members, a didactic session at the 2010 NAEMSP Annual Meeting, and snowball sampling. Interviews lasted approximately 30 minutes, were recorded and professionally transcribed. Analysis was conducted by a five-person team, employing the constant comparative method to identify recurrent themes. Results Twenty-three interviewees represented 20 EMS agencies from the United States and Canada; 14 EMS agencies were currently using e-PCR systems. The primary reason for adoption was the potential for e-PCR systems to support quality assurance efforts. Challenges to e-PCR system adoption included those common to any health information technology project, as well as challenges unique to the prehospital setting, including: fear of increased ambulance run times leading to decreased ambulance availability, difficulty integrating with existing hospital information systems, and unfunded mandates requiring adoption of e-PCR systems. Three recurring strategies emerged to improve e-PCR system adoption and implementation: 1) identify creative funding sources; 2) leverage regional health information organizations; and 3) build internal information technology capacity. Conclusion EMS agencies are highly motivated to adopt e-PCR systems to support quality assurance efforts; however, adoption and implementation of e

  3. Access to and Use of Point-of-Care Ultrasound in the Emergency Department

    PubMed Central

    Sanders, Jason L.; Noble, Vicki E.; Raja, Ali S.; Sullivan, Ashley F.; Camargo, Carlos A.

    2015-01-01

    Introduction Growing evidence supports emergency physician (EP)-performed point-of-care ultrasound (PoC US). However, there is a utilization gap between academic emergency departments (ED) and other emergency settings. We elucidated barriers to PoC US use in a multistate sample of predominantly non-academic EDs to inform future strategies to increase PoC US utilization, particularly in non-academic centers. Methods In 2010, we surveyed ED directors in five states (Arkansas, Hawaii, Minnesota, Vermont, and Wyoming; n=242 EDs) about general ED characteristics. In four states we determined barriers to PoC US use, proportion of EPs using PoC US, use privileges, and whether EPs can bill for PoC US. Results Response rates were >80% in each state. Overall, 47% of EDs reported PoC US availability. Availability varied by state, from 34% of EDs in Arkansas to 85% in Vermont. Availability was associated with higher ED visit volume, and percent of EPs who were board certified/board eligible in emergency medicine. The greatest barriers to use were limited training (70%), expense (39%), and limited need (perceived or real) (32%). When PoC US was used by EPs, 50% used it daily, 44% had privileges not requiring radiology confirmation, and 34% could bill separately for PoC US. Only 12% of EPs used it ≥80% of the time when placing central venous lines. Conclusion Only 47% of EDs in our five-state sample of predominantly non-academic EDs had PoC US immediately available. When available, the greatest barriers to use were limited training, expense, and limited need. Recent educational and technical advancements may help overcome these barriers. PMID:26587101

  4. Reducing health care costs by rationalizing staffing in primary care settings.

    PubMed

    Mawajdeh, S; Khoury, S A; Yoder, R; Qtaishat, M

    2004-05-01

    Jordan spends around 9% of its GDP on health care services, a high figure compared with similar developing countries. This study assessed staffing patterns in relation to Ministry of Health expenditures in a nationally representative sample of 97 primary care facilities. The economic costs of primary care facilities amounted to Jordanian dinar (JD) 42.3 million. Personnel costs consumed 53.8% of recurrent costs and in monetary terms the amount of down time (time not being used effectively) amounted to JD 9.7 million (about US$ 13.7 million). The Ministry should consider changing the functioning of its primary care facilities to obtain a more cost-effective use of staff time. PMID:16212216

  5. The Con Edison Emergency Child Care Plan for Management Employees: Summary Plan Description.

    ERIC Educational Resources Information Center

    Consolidated Edison Co., Brooklyn, NY.

    This summary plan description offers guidelines for participation in a pilot program that provides short-term emergency care for children of Con Edison managers who are under 13 years old. The plan offers professional, in-home child care that can be used when usual arrangements have collapsed. The summary plan description addresses the following…

  6. Evaluation of Access, a Primary Care Program for Indigent Patients: Inpatient and Emergency Room Utilization.

    ERIC Educational Resources Information Center

    Davidson, Richard A.; Giancola, Angela; Gast, Andrea; Ho, Janice; Waddell, Rhondda

    2003-01-01

    Evaluated the impact of Accessing Community Care through Eastside Social Services (ACCESS), a program that provided indigent patients with free primary care, on inpatient admissions, emergency room (ER) visits, and subsequent charges. Data on 19 people before and after program enrollment showed significant decreases in ER visits following…

  7. Outpatient Care of Young People after Emergency Treatment of Deliberate Self-Harm

    ERIC Educational Resources Information Center

    Bridge, Jeffrey A.; Marcus, Steven C.; Olfson, Mark

    2012-01-01

    Objective: Little is known about the mental health care received by young people after an episode of deliberate self-harm. This study examined predictors of emergency department (ED) discharge, mental health assessments in the ED, and follow-up outpatient mental health care for Medicaid-covered youth with deliberate self-harm. Method: A…

  8. [Emergency care in the autonomous regions of Spain. Improvement in pre-hospital emergency care and welfare coordination. SESPAS Report 2012].

    PubMed

    Miguel García, Félix; Fernández Quintana, Ana Isabel; Díaz Prats, Amadeo

    2012-03-01

    The present article describes the general organization of pre-hospital emergency care in the autonomous regions and provides data on activity corresponding to 2010, drawn from the information available in the Primary Care Information System of the Ministry of Health, Social Policy and Equality. Emergency care is provided through various organizational structures covering 24-hour periods. Family medicine attended 17.8 million emergency consultations and nursing attended 10.2 million (year 2010, 14 autonomous communities, 79.7% of the National Health System population). Emergency department utilization ranged between 0.11 and 0.83 urgent family physician consultations per inhabitant/year and between 0.05 and 0.57 nursing consultations per inhabitant/year. Any reform in the management of pre-hospital emergency care will involve organizational changes and aims to produce measurable improvements in healthcare coordination. In the new organizational designs, most of the responsibility lies with human resources in order to achieve the new goals for the future aims to be presented in an operational teamwork structure. Undoubtedly, the main challenge is to achieve optimal coordination with other welfare levels, including the police, social services, nursing homes, etc. If optimal care of the population needs to count on the efforts of all these groups, mobility, individual differences, consistent achievement of high standards, and -most of all- the use of these services by citizens will determine the final result. The results can be quantified in various ways, but evaluation should concentrate on the resources used, the degree of satisfaction among all the parties involved and optimal management of demand, which will help to disseminate the need for a rational resource use. PMID:22321943

  9. World society of emergency surgery study group initiative on Timing of Acute Care Surgery classification (TACS)

    PubMed Central

    2013-01-01

    Timing of surgical intervention is critical for outcomes of patients diagnosed with surgical emergencies. Facing the challenge of multiple patients requiring emergency surgery, or of limited resource availability, the acute care surgeon must triage patients according to their disease process and physiological state. Emergency operations from all surgical disciplines should be scheduled by an agreed time frame that is based on accumulated data of outcomes related to time elapsed from diagnosis to surgery. Although literature exists regarding the optimal timing of various surgical interventions, implementation of protocols for triage of surgical emergencies is lacking. For institutions of a repetitive triage mechanism, further discussion on optimal timing of surgery in diverse surgical emergencies should be encouraged. Standardizing timing of interventions in surgical emergencies will promote clinical investigation as well as a commitment by administrative authorities to proper operating theater provision for acute care surgery. PMID:23634784

  10. The emergence of the vertical birth in Ecuador: an analysis of agenda setting and policy windows for intercultural health.

    PubMed

    Llamas, Ana; Mayhew, Susannah

    2016-07-01

    Maternal mortality continues to claim the lives of thousands of women in Latin America despite the availability of effective treatments to avert maternal death. In the past, efforts to acknowledge cultural diversity in birth practices had not been clearly integrated into policy. However, in Otavalo (Ecuador) a local hospital pioneered the implementation of the 'Vertical Birth'-a practical manifestation of an intercultural health policy aimed at increasing indigenous women's access to maternity care. Drawing on agenda-setting theory, this qualitative research explores how the vertical birth practice made it onto the local policy agenda and the processes that allowed actors to seize a window of opportunity allowing the vertical birth practice to emerge. Our results show that the processes that brought about the vertical birth practice took place over a prolonged period of time and resulted from the interplay between various factors. Firstly, a maternal health policy community involving indigenous actors played a key role in identifying maternal mortality as a policy problem, defining its causes and framing it as an indigenous rights issue. Secondly, previous initiatives to address maternal mortality provided a wealth of experience that gave these actors the knowledge and experience to formulate a feasible policy solution and consolidate support from powerful actors. Thirdly, the election of a new government that had incorporated the demands of the indigenous movement opened up a window of opportunity to push intercultural health policies such as the vertical birth. We conclude that the socioeconomic and political changes at both national and local level allowed the meaningful participation of indigenous actors that made a critical contribution to the emergence of the vertical birth practice. These findings can help us advance our knowledge of strategies to set the agenda for intercultural maternal health policy and inform future policy in similar settings. Our

  11. A systematic review of contemporary models of shared HIV care and HIV in primary care in high-income settings.

    PubMed

    Mapp, Fiona; Hutchinson, Jane; Estcourt, Claudia

    2015-12-01

    HIV shared care is uncommon in the UK although shared care could be a beneficial model of care. We review the literature on HIV shared care to determine current practice and clinical, economic and patient satisfaction outcomes. We searched MEDLINE, EMBASE, NICE Evidence, Cochrane collaboration, Google and websites of the British HIV Association, Aidsmap, Public Health England, World Health Organization and Terrence Higgins Trust using relevant search terms in August 2014. Studies published after 2000, from healthcare settings comparable to the UK that described links between primary care and specialised HIV services were included and compared using principles of the Critical Appraisal Skills Programme and Authority, Accuracy, Coverage, Objectivity, Date, Significance frameworks. Three of the nine included models reported clinical or patient satisfaction outcomes but data collection and analyses were inadequate. None reported economic outcomes although some provided financial costings. Facilitators of shared care included robust clinical protocols, training and timely communication. Few published examples of HIV shared care exist and quality of evidence is poor. There is no consistent association with improved clinical outcomes, cost effectiveness or acceptability. Models are context specific, driven by local need, although some generalisable features could inform novel service delivery. Further evaluative research is needed to determine optimal components of shared HIV care. PMID:25804421

  12. Methylisothiazolinone: An Emergent Allergen in Common Pediatric Skin Care Products

    PubMed Central

    Schlichte, Megan J.

    2014-01-01

    Recalcitrant dermatitis, such as that of the hands, face, or genitals, may be due to allergic contact dermatitis (ACD) from ingredients in seemingly innocuous personal care products. Rising rates of allergy have been noted due to the preservative methylisothiazolinone (MI). This preservative is commonly found in skin and hair care products, especially wipes. This study evaluated the use of MI in products specifically marketed for babies and children and examined the associated marketing terms of such products. Ingredients of skin care products specifically marketed for babies and children were surveyed at two major retailers. Of 152 products surveyed, 30 products contained MI. Categories of products surveyed included facial or body wipes, antibacterial hand wipes, hair products, soaps, bubble baths, moisturizers, and sunscreens. Facial or body wipes and hair products were the categories with the greatest number of MI-containing products. MI-containing products were manufactured by a number of popular brands. Of note, products marketed as “gentle,” “sensitive,” “organic,” or “hypoallergenic” often contained MI, thus emphasizing the importance of consumer scrutiny of product choices. These findings reinforce the importance of educating parents and providing consumer decision-making advice regarding common skin care products, in order to help prevent ACD in children. PMID:25342949

  13. Update on prehospital emergency care of severe trauma patients.

    PubMed

    Tazarourte, K; Cesaréo, E; Sapir, D; Atchabahian, A; Tourtier, J-P; Briole, N; Vigué, B

    2013-01-01

    The prognosis of severe trauma patients is determined by the ability of a healthcare system to provide high intensity therapeutic treatment on the field and to transport patients as quickly as possible to the structure best suited to their condition. Direct admission to a specialized center ("trauma center") reduces the mortality of the most severe trauma at 30 days and one year. Triage in a non-specialized hospital is a major risk of loss of chance and should be avoided whenever possible. Medical dispatching plays a major role in determining patient care. The establishment of a hospital care network is an important issue that is not formalized enough in France. The initial triage of severe trauma patients must be improved to avoid taking patients to hospitals that are not equipped to take care of them. For this purpose, the MGAP score can predict severity and help decide where to transport the patient. However, it does not help predict the need for urgent resuscitation procedures. Hemodynamic management is central to the care of hemorrhagic shock and severe head trauma. Transport helicopter with a physician on board has an important role to allow direct admission to a specialized center in geographical areas that are difficult to access. PMID:23916517

  14. Methylisothiazolinone: an emergent allergen in common pediatric skin care products.

    PubMed

    Schlichte, Megan J; Katta, Rajani

    2014-01-01

    Recalcitrant dermatitis, such as that of the hands, face, or genitals, may be due to allergic contact dermatitis (ACD) from ingredients in seemingly innocuous personal care products. Rising rates of allergy have been noted due to the preservative methylisothiazolinone (MI). This preservative is commonly found in skin and hair care products, especially wipes. This study evaluated the use of MI in products specifically marketed for babies and children and examined the associated marketing terms of such products. Ingredients of skin care products specifically marketed for babies and children were surveyed at two major retailers. Of 152 products surveyed, 30 products contained MI. Categories of products surveyed included facial or body wipes, antibacterial hand wipes, hair products, soaps, bubble baths, moisturizers, and sunscreens. Facial or body wipes and hair products were the categories with the greatest number of MI-containing products. MI-containing products were manufactured by a number of popular brands. Of note, products marketed as "gentle," "sensitive," "organic," or "hypoallergenic" often contained MI, thus emphasizing the importance of consumer scrutiny of product choices. These findings reinforce the importance of educating parents and providing consumer decision-making advice regarding common skin care products, in order to help prevent ACD in children. PMID:25342949

  15. 42 CFR 405.440 - Emergency and urgent care services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... a private contract, he or she: (1) Must submit a claim to Medicare in accordance with both 42 CFR part 424 and Medicare instructions (including but not limited to complying with proper coding of... previously entered into a private contract (that is, entered into before the onset of the emergency...

  16. 42 CFR 405.440 - Emergency and urgent care services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... a private contract, he or she: (1) Must submit a claim to Medicare in accordance with both 42 CFR part 424 and Medicare instructions (including but not limited to complying with proper coding of... previously entered into a private contract (that is, entered into before the onset of the emergency...

  17. 42 CFR 405.440 - Emergency and urgent care services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... a private contract, he or she: (1) Must submit a claim to Medicare in accordance with both 42 CFR part 424 and Medicare instructions (including but not limited to complying with proper coding of... previously entered into a private contract (that is, entered into before the onset of the emergency...

  18. Critical care in the emergency department: acute kidney injury.

    PubMed

    Nee, Patrick A; Bailey, David J; Todd, Victoria; Lewington, Andrew J; Wootten, Andrea E; Sim, Kevin J

    2016-05-01

    Acute kidney injury (AKI) is common among emergency department patients admitted to hospital. There is evidence of inadequate management of the condition leading to adverse outcomes. We present an illustrative case of AKI complicating a gastrointestinal disorder in an older adult. We discuss the clinical presentation, assessment and management of AKI with reference to recent consensus guidelines on classification and treatment. PMID:25969433

  19. [Palliative care at home, transferring information to emergency medical teams].

    PubMed

    Ribeaucoup, Luc; Roche, Blandine

    2015-11-01

    Many people wish to die at home. However, the end-of-life period can be marked by the occurrence of numerous symptoms causing situations of crisis. Emergency medical teams are therefore frequently called upon. In order to be able to make the right decisions in a short space of time, they must have quick access to all the relevant information. PMID:26567076

  20. 42 CFR 405.440 - Emergency and urgent care services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... a private contract, he or she: (1) Must submit a claim to Medicare in accordance with both 42 CFR... contract, provided the physician or practitioner complies with the billing requirements specified in... previously entered into a private contract (that is, entered into before the onset of the emergency...