Sample records for ensure adequate care

  1. ENSURING ADEQUATE SAFETY WHEN USING HYDROGEN AS A FUEL

    SciTech Connect

    Coutts, D

    2007-01-22

    Demonstration projects using hydrogen as a fuel are becoming very common. Often these projects rely on project-specific risk evaluations to support project safety decisions. This is necessary because regulations, codes, and standards (hereafter referred to as standards) are just being developed. This paper will review some of the approaches being used in these evolving standards, and techniques which demonstration projects can implement to bridge the gap between current requirements and stakeholder desires. Many of the evolving standards for hydrogen-fuel use performance-based language, which establishes minimum performance and safety objectives, as compared with prescriptive-based language that prescribes specific design solutions. This is being done for several reasons including: (1) concern that establishing specific design solutions too early will stifle invention, (2) sparse performance data necessary to support selection of design approaches, and (3) a risk-adverse public which is unwilling to accept losses that were incurred in developing previous prescriptive design standards. The evolving standards often contain words such as: ''The manufacturer shall implement the measures and provide the information necessary to minimize the risk of endangering a person's safety or health''. This typically implies that the manufacturer or project manager must produce and document an acceptable level of risk. If accomplished using comprehensive and systematic process the demonstration project risk assessment can ease the transition to widespread commercialization. An approach to adequately evaluate and document the safety risk will be presented.

  2. |reportingchecklistforlifesciencesarticles 1. How was the sample size chosen to ensure adequate power

    E-print Network

    Cai, Long

    |reportingchecklistforlifesciencesarticles May 2013 i 1. How was the sample size chosen to ensure they are relevant: · the exact sample size (n) for each experimental group/condition, given as a number, not a range adequate power to detect a pre-specified effect size? For animal studies, include a statement about sample

  3. Barriers to adequate prenatal care utilization in American Samoa

    PubMed Central

    Hawley, Nicola L; Brown, Carolyn; Nu’usolia, Ofeira; Ah-Ching, John; Muasau-Howard, Bethel; McGarvey, Stephen T

    2013-01-01

    Objective To describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Methods Using data from prenatal clinic records, women (n=692) were categorized according to the Adequacy of Prenatal Care Utilization Index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way Analysis of Variance (ANOVA) and independent samples t-tests. Results Between 2001 and 2008 85.4% of women received inadequate prenatal care. Parity (P=0.02), maternal unemployment (P=0.03), and both parents being unemployed (P=0.03) were negatively associated with the timing of prenatal care initation. Giving birth in 2007–2008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 versus 25.12 weeks; P<0.01) and improved adequacy of received services (95.04% versus 83.8%; P=0.02). Conclusion The poor prenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 2007–2008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population. PMID:24045912

  4. Barriers to adequate prenatal care utilization in American Samoa.

    PubMed

    Hawley, Nicola L; Brown, Carolyn; Nu'usolia, Ofeira; Ah-Ching, John; Muasau-Howard, Bethel; McGarvey, Stephen T

    2014-12-01

    The objective of this study is to describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Using data from prenatal clinic records, women (n = 692) were categorized according to the adequacy of prenatal care utilization index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way analysis of variance and independent samples t tests. Between 2001 and 2008 85.4 % of women received inadequate prenatal care. Parity (P = 0.02), maternal unemployment (P = 0.03), and both parents being unemployed (P = 0.03) were negatively associated with the timing of prenatal care initiation. Giving birth in 2007-2008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 vs. 25.12 weeks; P < 0.01) and improved adequacy of received services (95.04 vs. 83.8 %; P = 0.02). The poor prenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 2007-2008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population. PMID:24045912

  5. The role of Taiwan's National Health Insurance program in influencing adequate prenatal care.

    PubMed

    Liu, Tsai-Ching; Chen, Chin-Shyan

    2004-01-01

    This paper reviews achievements in the utilization of prenatal care by pregnant women in Taiwan by analysing the 1989 and 1996 National Maternal and Infant Health Survey data. More precisely, it identifies and examines the programmatic and non-programmatic factors that influence prenatal care utilization, thus determining the areas that require further attention from the programe. Logistic regression results show that the adequacy of prenatal care use was significantly associated with the implementation of the National Health Insurance (NHI). A higher likelihood of adequate care utilization was found among women who were married or employed, had a higher level of education, had more experience with regard to pregnancy and were at higher risk in terms of obstetrics. The effect of facility choice showed variations after the implementation of the NHI programme. Prior to NHI, no differences were noted between the use of clinics and hospitals. After the implementation of NHI, on the other hand, women who received most of their care from clinics had a higher likelihood of receiving more adequate prenatal care than those who received care from hospitals. Regional differences in seeking adequate prenatal care were also evident. Mothers who were living in southern areas were less likely to receive adequate prenatal care despite the implementation of NHI. The Bureau of NHI, therefore, still needs to work on mechanisms to ensure that more attention is given to the distribution of its medical resources and that additional health care accessibility is provided to pregnant women in these areas. PMID:15239208

  6. Factors affecting adequate prenatal care and the prenatal care visits of immigrant women to Taiwan.

    PubMed

    Liang, Yia-Wun; Chang, Hua-Pin; Lin, Yu-Hsiu; Lin, Long-Yau; Chen, Wen-Yi

    2014-02-01

    This paper investigates prenatal care utilization, identifies factors affecting the adequacy of prenatal care, and explores the effect of adequate initial timing of prenatal care on total prenatal care visits among Taiwan new immigrant females. Data was obtained from the 2008 Prenatal Care Utilization among Taiwan New Immigrant Females Survey on women who either had at least one preschool-aged child or had delivered their infants but were still hospitalized (N = 476). The Adequacy of Prenatal Care Utilization Index was applied to rate the prenatal care adequacy. The logistic regression model was used to investigate factors associated with the adequacy of prenatal care utilization, and the linear regression model was estimated to identify the impact of influential factors on the prenatal care usage. Females' nationality, employment, and transportation convenience increased the likelihood of receiving adequate prenatal care. Having adequate initial timing of prenatal care was found to be positively related to the frequency of prenatal care visits. Prenatal care utilization can be affected by factors within the health care system and by characteristics of the population; therefore, a measure of prenatal care utilization cannot distinguish these factors but reflects the result of all of them in varying combinations. PMID:23065308

  7. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...veterinarian; (4) Adequate guidance to personnel involved in the care and use of animals regarding handling, immobilization, anesthesia, analgesia, tranquilization, and euthanasia; and (5) Adequate pre-procedural and post-procedural care in...

  8. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...to principal investigators and other personnel involved in the care and use of animals regarding handling, immobilization, anesthesia, analgesia, tranquilization, and euthanasia; and (5) Adequate pre-procedural and post-procedural care in...

  9. Caring for an Ageing Population: Are Physiotherapy Graduates Adequately Prepared?

    ERIC Educational Resources Information Center

    Ramklass, Serela S.; Butau, Anne; Ntinga, Nomusa; Cele, Nozipho

    2010-01-01

    In view of South African policy developments related to the care of older persons, it was necessary to examine the nature of the geriatrics content within physiotherapy curricula. A survey was conducted amongst final-year student physiotherapists at South African universities, together with content analysis of physiotherapy curricula. Very little…

  10. Adequate self-care of dialysed patients: a review of the literature

    Microsoft Academic Search

    Regula Ricka; Yves Vanrenterghem; Georges C. M. Evers

    2002-01-01

    The purpose of this article is to clarify the concept: ‘adequate self-care of patients treated with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD)’. This was done by the specification of Orem's general definition of self-care and a review of the literature. Adequate self-care behaviours for preventing and regulating pathological processes and related disabilities e.g. following dialysis and medication prescriptions

  11. Is mental heal care in women's prisons adequate?

    PubMed

    Sims, Joyce

    Some individuals and groups, find it difficult to seek healthcare, including prisoners. This group is recognised as needing input but are often difficult to engage, yet failure to meet their needs can be devastating for the health of individuals and have wider implications on society. This qualitative study explored the perceptions of female prisoners who had not yet consulted the mental health team. I aimed to find out what support these women seek out while in prison, what difficulties they encountered in getting psychological help and whether they avoided statutory mental health services. Participants revealed during semistructured interviews that continuing to have a caring role for their families encouraged them to feel more positive and supported. Support from family members, specialist prison officers and the multi-faith centre staff team was also highly regarded. Some of the participants reported experiencing problems self-referring to prison mental health services, for example when transferred to a new prison. They identified the prison application system and inreach administrative failings as weaknesses, alongside other variables. I found that prisoners did not avoid mental health services and often once settled in the prison, they reconsidered their need for statutory support. PMID:24383307

  12. Systems and processes that ensure high quality care.

    PubMed

    Bassett, Sally; Westmore, Kathryn

    2012-10-01

    This is the second in a series of articles examining the components of good corporate governance. It considers how the structures and processes for quality governance can affect an organisation's ability to be assured about the quality of care. Complex information systems and procedures can lead to poor quality care, but sound structures and processes alone are insufficient to ensure good governance, and behavioural factors play a significant part in making sure that staff are enabled to provide good quality care. The next article in this series looks at how the information reporting of an organisation can affect its governance. PMID:23252087

  13. Blue Shield ensures uninterrupted access to quality medical care after Palm Drive Hospital ceases operations

    E-print Network

    Ravikumar, B.

    Blue Shield ensures uninterrupted access to quality medical care after Palm Drive Hospital ceases emergency care and in-patient care at Palm Drive. We are working with our members to ensure a smooth of California member in the Sonoma County area seeking emergency medical services or inpatient care, please

  14. Interchangeability of low-dose oral contraceptives. Are current bioequivalent testing measures adequate to ensure therapeutic equivalency?

    PubMed

    Ansbacher, R

    1991-02-01

    Current Food and Drug Administration guidelines for assessing the differences in bioavailability between generic oral contraceptives and brand-name products are inadequate to ensure therapeutic equivalence. The guidelines do not take into account those women who may have blood levels of active ingredients well outside the range of acceptability. Due to the narrow therapeutic range of steroids, these women may become pregnant or experience an increased incidence of breakthrough bleeding. Furthermore, oral contraceptive packaging is unique to each manufacturer, and any change in brands (and therefore packaging) can easily negate the sequential administration of the appropriate tablet. These are among the reasons proposed for placing oral contraceptives in the critical drug category, in which generic substitution and interchangeability of products should not be allowed. PMID:2040168

  15. Unbearable Pain: India's Obligation to Ensure Palliative Care

    NSDL National Science Digital Library

    The Human Rights Watch organization has written this report, which talks about the difficulties faced by patients in major cancer hospitals across India. Released in October 2009, this 102-page report takes an investigative look into the pain treatment situation in these hospitals. The report identifies three key obstacles to improving the availability of pain treatment and palliative care, including restrictive drug regulations and the failure to train doctors about pain treatment methods. Visitors will find that the report is divided into several major sections including "Palliative Care and Pain Treatment in India" and "The Plight of Patients". Additionally, interested parties can also view the appendices attached to the report. An online slide show and a video feature round out the site.

  16. Actions Needed to Ensure Scientific and Technical Information is Adequately Reviewed at Goddard Space Flight Center, Johnson Space Center, Langley Research Center, and Marshall Space Flight Center

    NASA Technical Reports Server (NTRS)

    2008-01-01

    This audit was initiated in response to a hotline complaint regarding the review, approval, and release of scientific and technical information (STI) at Johnson Space Center. The complainant alleged that Johnson personnel conducting export control reviews of STI were not fully qualified to conduct those reviews and that the reviews often did not occur until after the STI had been publicly released. NASA guidance requires that STI, defined as the results of basic and applied scientific, technical, and related engineering research and development, undergo certain reviews prior to being released outside of NASA or to audiences that include foreign nationals. The process includes technical, national security, export control, copyright, and trade secret (e.g., proprietary data) reviews. The review process was designed to preclude the inappropriate dissemination of sensitive information while ensuring that NASA complies with a requirement of the National Aeronautics and Space Act of 1958 (the Space Act)1 to provide for the widest practicable and appropriate dissemination of information resulting from NASA research activities. We focused our audit on evaluating the STI review process: specifically, determining whether the roles and responsibilities for the review, approval, and release of STI were adequately defined and documented in NASA and Center-level guidance and whether that guidance was effectively implemented at Goddard Space Flight Center, Johnson Space Center, Langley Research Center, and Marshall Space Flight Center. Johnson was included in the review because it was the source of the initial complaint, and Goddard, Langley, and Marshall were included because those Centers consistently produce significant amounts of STI.

  17. Hepatitis and the Need for Adequate Standards in Federally Supported Day Care.

    ERIC Educational Resources Information Center

    Silva, Richard J.

    1980-01-01

    This article examines findings in three epidemiological studies of day care centers and concludes that higher standards of care can reduce the incidence of hepatitis among parents and staff. (Author/DB)

  18. Canada's Compassionate Care Benefit: Is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

    Microsoft Academic Search

    Allison M Williams; Jeanette A Eby; Valorie A Crooks; Kelli Stajduhar; Melissa Giesbrecht; Mirjana Vuksan; S Robin Cohen; Kevin Brazil; Diane Allan

    2011-01-01

    Background  An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision\\u000a of adequate palliative\\/end-of-life (P\\/EOL) care. Informal caregivers who take on the responsibility of providing P\\/EOL care\\u000a often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically\\u000a examine how Canada's Compassionate Care Benefit (CCB) - a contributory benefits

  19. Ensuring Patient Safety in Care Transitions: An Empirical Evaluation of a Handoff Intervention Tool

    PubMed Central

    Abraham, Joanna; Kannampallil, Thomas; Patel, Bela; Almoosa, Khalid; Patel, Vimla L.

    2012-01-01

    Successful handoffs ensure smooth, efficient and safe patient care transitions. Tools and systems designed for standardization of clinician handoffs often focuses on ensuring the communication activity during transitions, with limited support for preparatory activities such as information seeking and organization. We designed and evaluated a Handoff Intervention Tool (HAND-IT) based on a checklist-inspired, body system format allowing structured information organization, and a problem-case narrative format allowing temporal description of patient care events. Based on a pre-post prospective study using a multi-method analysis we evaluated the effectiveness of HAND-IT as a documentation tool. We found that the use of HAND-IT led to fewer transition breakdowns, greater tool resilience, and likely led to better learning outcomes for less-experienced clinicians when compared to the current tool. We discuss the implications of our results for improving patient safety with a continuity of care-based approach. PMID:23304268

  20. Ensuring patient safety in care transitions: an empirical evaluation of a Handoff Intervention Tool.

    PubMed

    Abraham, Joanna; Kannampallil, Thomas; Patel, Bela; Almoosa, Khalid; Patel, Vimla L

    2012-01-01

    Successful handoffs ensure smooth, efficient and safe patient care transitions. Tools and systems designed for standardization of clinician handoffs often focuses on ensuring the communication activity during transitions, with limited support for preparatory activities such as information seeking and organization. We designed and evaluated a Handoff Intervention Tool (HAND-IT) based on a checklist-inspired, body system format allowing structured information organization, and a problem-case narrative format allowing temporal description of patient care events. Based on a pre-post prospective study using a multi-method analysis we evaluated the effectiveness of HAND-IT as a documentation tool. We found that the use of HAND-IT led to fewer transition breakdowns, greater tool resilience, and likely led to better learning outcomes for less-experienced clinicians when compared to the current tool. We discuss the implications of our results for improving patient safety with a continuity of care-based approach. PMID:23304268

  1. Do older patients receive adequate stroke care? An experience of a neurovascular clinic

    Microsoft Academic Search

    Y-Y K Kee; W Brooks; A Bhalla

    2009-01-01

    Background:National guidelines and government directives have adopted policies for urgent assessment of patients with a transient ischaemic attack or minor stroke not admitted to hospital. The risk of recurrent stroke increases substantially with age, as does the potential benefit of secondary prevention. In order to develop effective strategies for older patients, it is important to identify how stroke care is

  2. Public Health Implications for Adequate Transitional Care for HIV-Infected Prisoners: Five Essential Components

    PubMed Central

    Spaulding, Anne C.; Meyer, Jaimie P.; Altice, Frederick L.

    2011-01-01

    In the United States, 10 million inmates are released every year, and human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) prevalence is several-fold greater in criminal justice populations than in the community. Few effective linkage-to-the-community programs are currently available for prisoners infected with HIV. As a result, combination antiretroviral therapy (cART) is seldom continued after release, and virological and immunological outcomes worsen. Poor HIV treatment outcomes result from a myriad of obstacles that released prisoners face upon reentering the community, including homelessness, lack of medical insurance, relapse to drug and alcohol use, and mental illness. This article will focus on 5 distinct factors that contribute significantly to treatment outcomes for released prisoners infected with HIV and have profound individual and public health implications: (1) adaptation of case management services to facilitate linkage to care; (2) continuity of cART; (3) treatment of substance use disorders; (4) continuity of mental illness treatment; and (5) reducing HIV-associated risk-taking behaviors as part of secondary prevention. PMID:21844030

  3. Vigorous cleaning and adequate ventilation are necessary to control an outbreak in a neonatal intensive care unit.

    PubMed

    Shimono, Nobuyuki; Hayashi, Jun; Matsumoto, Hiroko; Miyake, Noriko; Uchida, Yujiro; Shimoda, Shinji; Furusyo, Norihiro; Akashi, Koichi

    2012-06-01

    An outbreak of Bacillus cereus (B. cereus) bacteremia occurred in our neonatal intensive care unit (NICU) in July 2005. Many strains of B. cereus were cultured from patient specimens, as well as from environmental samples such as the surfaces of instruments and air in the NICU. Some of these strains were analyzed by pulsed field gel electrophoresis, and several were confirmed to be identical. We speculated that the bacterial load in the environment had initially increased and then possibly spread throughout the NICU facility via the airflow of the ventilation system. For this reason, besides maintaining standard precautions, we performed a vigorous clean of the NICU, and covered the vents to prevent dust falling from them. These protective measures ended the outbreak. In the hospital environment, adequate ventilation is important, especially in single-occupancy isolation rooms and operating theaters. However, the criteria for the adequate ventilation of multioccupancy rooms for acute care environments such as the NICU have not yet been defined. We need to pay more attention to these environmental factors in order to avoid cross contamination and infectious outbreaks. PMID:22038125

  4. Ensuring Timely Clinical Lab Test Result Management: A Generative XML Process Model to Support Medical Care

    E-print Network

    Golbeck, Jennifer

    Ensuring Timely Clinical Lab Test Result Management: A Generative XML Process Model to Support4,5 1 Department of Computer Science & 2 Human-Computer Interaction Lab University of Maryland (Multi-Step Task Alerting, Reminding, and Tracking), which uses XML specifications of a workflow model

  5. Staffing in postnatal units: is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia

    Microsoft Academic Search

    Della A Forster; Helen L McLachlan; Jane Yelland; Jo Rayner; Judith Lumley; Mary-Ann Davey

    2006-01-01

    BACKGROUND: State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in

  6. An Android-enabled mobile framework for ensuring quality of life through patient-centric care.

    PubMed

    Koufi, Vassiliki; Malamateniou, Flora; Vassilacopoulos, George

    2012-01-01

    The drive to achieve excellence in healthcare delivery while containing costs, underlies the need for a new generation of applications which facilitate the realization of a patient-centric care model. Under this emerging care model healthcare delivery can be integrated across the continuum of services, from prevention to follow up, and care can be coordinated across all settings. With care moving out into the community, health systems require real-time information to deliver coordinated care to patients. The integration of leading-edge technologies, such as mobile technology, with Personal Health Records (PHRs) can meet this requirement by making comprehensive and unified health information available to authorized users at any point of care or decision making through familiar environments such as Google's Android. This paper presents a framework that provides ubiquitous access to patients' PHRs via Android-enabled mobile devices. Where possible health information access and management is performed in a transparent way, thus enabling healthcare professionals to devote more time on practicing medicine and patients to manage their own health with the least possible intervention. This depends heavily on the context, which is collected by both Android-specific core system services and special purpose software agents with the latter being also responsible for preserving PHR data privacy. PMID:22874352

  7. Mentoring and social skills training: ensuring better outcomes for youth in foster care.

    PubMed

    Williams, Charles A

    2011-01-01

    Youth in foster care face significant life challenges that make it more likely that they will face negative outcomes (i.e., school failure, homelessness, and incarceration). While the reason(s) for out-of-home placement (i.e., family violence, abuse, neglect and/or abandonment) provide some context for negative outcomes, such negative outcomes need not be a foregone conclusion. In fact, interventions created to serve at-risk youth could ostensibly address the needs of youth in foster care as well, given that they often face similar social, emotional, and other challenges. Specifically, the author posits that supporting foster care youth through the use ofmentoring and social skills training could reduce the negative outcomes far too common for many of these youth. PMID:21950175

  8. Early Care and Education: Policy Considerations for Ensuring High-Quality Pre-K Programs

    ERIC Educational Resources Information Center

    Best, Jane; Cohen, Courtney

    2013-01-01

    Interest in early care and education (ECE), also referred to as an early childhood education, has escalated in recent years. The interest is bipartisan, as evidenced by the multiple ECE-related bills already introduced by the 113th Congress. Further, 39 states have implemented prekindergarten (pre-K) programs. In 2013, 27 governors mentioned ECE…

  9. Mentoring and Social Skills Training: Ensuring Better Outcomes for Youth in Foster Care

    ERIC Educational Resources Information Center

    Williams, Charles A.

    2011-01-01

    Youth in foster care face significant life challenges that make it more likely that they will face negative outcomes (i.e., school failure, homelessness, and incarceration). While the reason(s) for out-of-home placement (i.e., family violence, abuse, neglect and/or abandonment) provide some context for negative outcomes, such negative outcomes…

  10. Loss of parent in childhood and adult psychiatric disorder: the role of lack of adequate parental care.

    PubMed

    Harris, T; Brown, G W; Bifulco, A

    1986-08-01

    The inconclusiveness of the literature on the role of loss of parent in influencing psychiatric disorder in adulthood is well known. A number of reasons involving sampling, location and other methodological features, are given to account for these contradictory findings. A study specially designed to cope with these features is then described and basic results are reported. These indicate that, in a sample of women aged 18-65, loss of mother before the age of 17, either by death or by separation of one year or more, was associated with clinical depression in the year of interview. Loss of father by death was in no way associated with current depression, but separation from father showed a trend which, however, did not reach statistical significance. Control for other possible confounding factors did not change this patterning of results; these were further supported when psychiatric episodes earlier in adulthood were examined. Examination of the caregiving arrangements in childhood suggests that it is 'lack of care', defined in terms of neglect rather than simply hostile parental behaviour, which accounts for the raised rate of depression. Such 'lack of care' is more frequent after loss of mother than after loss of father. PMID:3763778

  11. Staffing in postnatal units: is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia

    PubMed Central

    Forster, Della A; McLachlan, Helen L; Yelland, Jane; Rayner, Jo; Lumley, Judith; Davey, Mary-Ann

    2006-01-01

    Background State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding) and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers. Methods A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73), exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning). Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives) and a medical practitioner from eachselected hospital. Results Staffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives) providing postnatal care. Staffing issues impact on hospitals' ability to provide continuity of care. Recruitment and retention of midwives are significant issues, particularly in rural areas. Conclusion Staffing in postnatal wards is a challenging issue, and varies with hospital locality and model of care. Staff/patient ratios and recruitment of midwives in rural areas are the two areas that appear to have the greatest negative impact on staffing adequacy and provision of quality care. Future research on postnatal care provision should include consideration of any impact on staff and staffing. PMID:16817974

  12. Ensuring Appropriate Care for LGBT Veterans in the Veterans Health Administration.

    PubMed

    Sharpe, Virginia Ashby; Uchendu, Uchenna S

    2014-09-01

    Within health care systems, negative perceptions of lesbian, gay, bisexual, and transgender persons have often translated into denial of services, denial of visitation rights to same-sex partners, reluctance on the part of LGBT patients to share personal information, and failure of workers to assess and recognize the unique health care needs of these patients. Other bureaucratic forms of exclusion have included documents, forms, and policies that fail to acknowledge a patient's valued relationships because of, for example, a narrow definition of "spouse," "parent," or "family." Bureaucratic exclusion has taken a particularly prominent form in the U.S. military. Until its repeal and termination in 2011, the "Don't Ask, Don't Tell" policy had for eighteen years barred openly gay men and lesbians from serving in the military. Among the effects of DADT is a dearth of information about the number and needs of LGBT service members who transition to the Veterans Health Administration for health care at the end of their military service. The long-standing social stigma against LGBT persons, the silence mandated by DADT, and the often unrecognized bias built into the fabric of bureaucratic systems make the task of creating a welcoming culture in the VHA urgent and challenging. The VHA has accepted a commitment to that task. Its Strategic Plan for fiscal years 2013 through 2018 stipulates that "[v]eterans will receive timely, high quality, personalized, safe, effective and equitable health care irrespective of geography, gender, race, age, culture or sexual orientation." To achieve this goal, the VHA undertook a number of coordinated initiatives to create an environment and culture that is informed, welcoming, positive, and empowering for the LGBT veterans and families whom the agency serves. PMID:25231789

  13. Determining unmet, adequately met, and overly met needs for health care and services for persons living with HIV/AIDS in Mississippi.

    PubMed

    Krause, Denise D; May, Warren L; Butler, Kenneth R

    2013-08-01

    A statewide needs assessment of persons living with HIV/AIDS (PLWHA) was conducted to determine what is known about access to care, utilization of services, and perceived barriers to receiving care and services. Our objective was to determine which needs were being met or unmet among PLWHA in Mississippi to provide a better understanding of how effectively to allocate funding to provide for the needs of that group. In this cross-sectional study, a true random sample of PLWHA in Mississippi was interviewed in 2005-2006. Questions were asked to identify opinions about respondents' experiences with 23 health care services and 30 public or private assistance services. The kappa statistic was used to measure agreement between level of services needed and level of services provided. Services with the lowest kappa scores revealed which services were being either mostly unmet, or even overly met. Greatest service needs were HIV viral load test, Pap smear, CD4/T-cell count test, and medication for HIV/AIDS, which were reasonably well met. The most significantly unmet needs were dental care and dental exams, eye care and eye exams, help paying for housing, subsidized housing assistance, mental health therapy or counseling, access to emotional support groups, and job placement or employment. Overly met services included medical care at a physician's office or clinic and free condoms. This study identified needs perceived to be significantly unmet by PLWHA, as well as areas that were perceived to be adequately or overly met. This information may be used to target areas with the greatest impact for improvement and provide insight into how to effectively allocate health care resources and public/private assistance. PMID:23252519

  14. Automated medical resident rotation and shift scheduling to ensure quality resident education and patient care.

    PubMed

    Smalley, Hannah K; Keskinocak, Pinar

    2014-08-30

    At academic teaching hospitals around the country, the majority of clinical care is provided by resident physicians. During their training, medical residents often rotate through various hospitals and/or medical services to maximize their education. Depending on the size of the training program, manually constructing such a rotation schedule can be cumbersome and time consuming. Further, rules governing allowable duty hours for residents have grown more restrictive in recent years (ACGME 2011), making day-to-day shift scheduling of residents more difficult (Connors et al., J Thorac Cardiovasc Surg 137:710-713, 2009; McCoy et al., May Clin Proc 86(3):192, 2011; Willis et al., J Surg Edu 66(4):216-221, 2009). These rules limit lengths of duty periods, allowable duty hours in a week, and rest periods, to name a few. In this paper, we present two integer programming models (IPs) with the goals of (1) creating feasible assignments of residents to rotations over a one-year period, and (2) constructing night and weekend call-shift schedules for the individual rotations. These models capture various duty-hour rules and constraints, provide the ability to test multiple what-if scenarios, and largely automate the process of schedule generation, solving these scheduling problems more effectively and efficiently compared to manual methods. Applying our models on data from a surgical residency program, we highlight the infeasibilities created by increased duty-hour restrictions placed on residents in conjunction with current scheduling paradigms. PMID:25171938

  15. UNIVERSITY OF STRATHCLYDE APPLICATION FORM: NOTES FOR GUIDANCE Before completing the form, PLEASE ENSURE THAT YOU READ THESE NOTES FOR GUIDANCE CAREFULLY. You should

    E-print Network

    Mottram, Nigel

    are deaf or hard of hearing. 4 You use a wheelchair or have mobility difficulties. 6 You have mental health, PLEASE ENSURE THAT YOU READ THESE NOTES FOR GUIDANCE CAREFULLY. You should also read the current for the examining bodies listed below. a) Scottish Qualifications Authority (Standard Grades, Higher, Advanced

  16. Maintaining adequate hydration and nutrition in adult enteral tube feeding.

    PubMed

    Dunn, Sasha

    2015-07-01

    Predicting the nutritional and fluid requirements of enterally-fed patients can be challenging and the practicalities of ensuring adequate delivery must be taken into consideration. Patients who are enterally fed can be more reliant on clinicians, family members and carers to meet their nutrition and hydration needs and identify any deficiencies, excesses or problems with delivery. Estimating a patient's requirements can be challenging due to the limitations of using predictive equations in the clinical setting. Close monitoring by all those involved in the patient's care, as well as regular review by a dietitian, is therefore required to balance the delivery of adequate feed and fluids to meet each patient's individual needs and prevent the complications of malnutrition and dehydration. Increasing the awareness of the signs of malnutrition and dehydration in patients receiving enteral tube feeding among those involved in a patient's care will help any deficiencies to be detected early on and rectified before complications occur. PMID:26087203

  17. Right care, right place, right time. Regional systems of care are the best way to ensure patients with emergent conditions have the best outcomes.

    PubMed

    Hick, John L

    2015-05-01

    A bystander calls 911 after witnessing an auto accident in rural Minnesota in which a passenger has been seriously injured. The dispatcher provides the caller with instructions on how to care for the person until the ambulance arrives. When emergency medical services personnel get to the scene, they find that the patient meets the criteria for trauma and activate a "trauma code" at the local hospital. Upon receiving that radio notification, the hospital calls in additional staff and also calls for a helicopter to transfer the patient to a tertiary care trauma center. Staff at the receiving hospital do an initial assessment and stabilize the patient. Helicopter personnel provide additional medications and interventions en route to the trauma center, where a specialty team is ready to deliver definitive care. PMID:26065186

  18. Sustaining a "culture of silence" in the neonatal intensive care unit during nonemergency situations: a grounded theory on ensuring adherence to behavioral modification to reduce noise levels.

    PubMed

    Swathi, S; Ramesh, A; Nagapoornima, M; Fernandes, Lavina M; Jisina, C; Rao, P N Suman; Swarnarekha, A

    2014-01-01

    The aim of this study was to generate a substantive theory explaining how the staff in a resource-limited neonatal intensive care unit (NICU) of a developing nation manage to ensure adherence to behavioral modification components of a noise reduction protocol (NsRP) during nonemergency situations. The study was conducted after implementation of an NsRP in a level III NICU of south India. The normal routine of the NICU is highly dynamic because of various categories of staff conducting clinical rounds followed by care-giving activities. This is unpredictably interspersed with very noisy emergency management of neonates who suddenly fall sick. In-depth interviews were conducted with 36 staff members of the NICU (20 staff nurses, six nursing aides, and 10 physicians). Group discussions were conducted with 20 staff nurses and six nursing aides. Data analysis was done in line with the reformulated grounded theory approach, which was based on inductive examination of textual information. The results of the analysis showed that the main concern was to ensure adherence to behavioral modification components of the NsRP. This was addressed by using strategies to "sustain a culture of silence in NICU during nonemergency situations" (core category). The main strategies employed were building awareness momentum, causing awareness percolation, developing a sense of ownership, expansion of caring practices, evolution of adherence, and displaying performance indicators. The "culture of silence" reconditions the existing staff and conditions new staff members joining the NICU. During emergency situations, a "noisy culture" prevailed because of pragmatic neglect of behavioral modification when life support overrode all other concerns. In addition to this, the process of operant conditioning should be formally conducted once every 18 months. The results of this study may be adapted to create similar strategies and establish context specific NsRPs in NICUs with resource constraints. PMID:24646472

  19. Sustaining a “culture of silence” in the neonatal intensive care unit during nonemergency situations: A grounded theory on ensuring adherence to behavioral modification to reduce noise levels

    PubMed Central

    Swathi, S.; Ramesh, A.; Nagapoornima, M.; Fernandes, Lavina M.; Jisina, C.; Suman Rao, P. N.

    2014-01-01

    The aim of this study was to generate a substantive theory explaining how the staff in a resource-limited neonatal intensive care unit (NICU) of a developing nation manage to ensure adherence to behavioral modification components of a noise reduction protocol (NsRP) during nonemergency situations. The study was conducted after implementation of an NsRP in a level III NICU of south India. The normal routine of the NICU is highly dynamic because of various categories of staff conducting clinical rounds followed by care-giving activities. This is unpredictably interspersed with very noisy emergency management of neonates who suddenly fall sick. In-depth interviews were conducted with 36 staff members of the NICU (20 staff nurses, six nursing aides, and 10 physicians). Group discussions were conducted with 20 staff nurses and six nursing aides. Data analysis was done in line with the reformulated grounded theory approach, which was based on inductive examination of textual information. The results of the analysis showed that the main concern was to ensure adherence to behavioral modification components of the NsRP. This was addressed by using strategies to “sustain a culture of silence in NICU during nonemergency situations” (core category). The main strategies employed were building awareness momentum, causing awareness percolation, developing a sense of ownership, expansion of caring practices, evolution of adherence, and displaying performance indicators. The “culture of silence” reconditions the existing staff and conditions new staff members joining the NICU. During emergency situations, a “noisy culture” prevailed because of pragmatic neglect of behavioral modification when life support overrode all other concerns. In addition to this, the process of operant conditioning should be formally conducted once every 18 months. The results of this study may be adapted to create similar strategies and establish context specific NsRPs in NICUs with resource constraints. PMID:24646472

  20. Adequate supervision for children and adolescents.

    PubMed

    Anderst, James; Moffatt, Mary

    2014-11-01

    Primary care providers (PCPs) have the opportunity to improve child health and well-being by addressing supervision issues before an injury or exposure has occurred and/or after an injury or exposure has occurred. Appropriate anticipatory guidance on supervision at well-child visits can improve supervision of children, and may prevent future harm. Adequate supervision varies based on the child's development and maturity, and the risks in the child's environment. Consideration should be given to issues as wide ranging as swimming pools, falls, dating violence, and social media. By considering the likelihood of harm and the severity of the potential harm, caregivers may provide adequate supervision by minimizing risks to the child while still allowing the child to take "small" risks as needed for healthy development. Caregivers should initially focus on direct (visual, auditory, and proximity) supervision of the young child. Gradually, supervision needs to be adjusted as the child develops, emphasizing a safe environment and safe social interactions, with graduated independence. PCPs may foster adequate supervision by providing concrete guidance to caregivers. In addition to preventing injury, supervision includes fostering a safe, stable, and nurturing relationship with every child. PCPs should be familiar with age/developmentally based supervision risks, adequate supervision based on those risks, characteristics of neglectful supervision based on age/development, and ways to encourage appropriate supervision throughout childhood. PMID:25369578

  1. Recommendations for ensuring early thrombolytic therapy for acute myocardial infarction. The Heart and Stroke Foundation of Canada, the Canadian Cardiovascular Society and the Canadian Association of Emergency Physicians for the Emergency Cardiac Care Coalition.

    PubMed Central

    1996-01-01

    OBJECTIVE: To recommend practical steps to ensure early thrombolytic therapy and thereby reduce mortality and morbidity associated with acute myocardial infarction (AMI). OPTIONS: Various factors were considered that influence time to thrombolysis related to patients, independent practitioners and health care systems. OUTCOMES: Reduction in morbidity and mortality associated with AMI. EVIDENCE: Early initiation of thrombolytic therapy reduces morbidity and mortality associated with AMI. The ECC Coalition analysed the factors that might impede early implementation of thrombolytic therapy. VALUES: Published data were reviewed, and recommendations were based on consensus opinion of the Emergency Cardiac Care (ECC) Coalition. The ECC Coalition comprises 20 professional, nongovernment and government organizations and has a mandate to improve emergency cardiac care services through collaboration. BENEFITS, HARMS AND COSTS: Early thrombolytic therapy reduces morbidity and mortality associated with AMI. Implementation of the recommendations will result in reduced time to thrombolytic therapy, streamlining of current practices and enhanced cooperation among health care professionals to expedite care. Depending on existing practices, implementation may require protocol development, and public and professional education. Although costs are associated with educating the public and health care professionals, they are outweighed by the financial and social benefits of reduced morbidity and mortality. RECOMMENDATIONS: Early recognition of AMI symptoms by the public and health care professionals, early access to the emergency medical services system and early action by emergency care providers in administering thrombolytic therapy (within 30 minutes after the patient's arrival at the emergency department). VALIDATION: No similar consensus statements or practice guidelines for thrombolytic therapy in Canada are available for comparison. PMID:8630837

  2. Ensuring pain relief for children at the end of life.

    PubMed

    Grégoire, Marie-Claude; Frager, Gerri

    2006-01-01

    Pain management in the context of pediatric palliative care can be challenging. The present article reviews, through a case-based presentation, the nonpharmacological and pharmacological methods used to ensure adequate pain control in children facing end of life. Details on the impressive range of opioid dosages required and routes of administration are highlighted from published literature and clinical experience. Where available, evidence-based recommendations are provided. Potential side effects of pain medication and barriers to good pain control are discussed. Novel analgesics and innovative delivery methods are presented as future tools enhancing pain relief at the end of life. Some challenges to ethically grounded research in this important context of care are reviewed. PMID:16960633

  3. Minimum Standards for Tribal Child Care Centers.

    ERIC Educational Resources Information Center

    Administration on Children, Youth, and Families (DHHS), Washington, DC. Child Care Bureau.

    These minimum standards for tribal child care centers are being issued as guidance. An interim period of at least 1 year will allow tribal agencies to identify implementation issues, ensure that the standards reflect tribal needs, and guarantee that the standards provide adequate protection for children. The standards will be issued as regulations…

  4. Ensuring condensate recovery efficiency.

    PubMed

    Mayoh, Paul

    2012-09-01

    According to steam system specialist, Spirax Sarco, 'condensate contains about a quarter of the energy of the steam from which it came--a significant amount of heat available to an energy centre'. Ensuring that existing condensate recovery systems are as efficient as possible is therefore 'key' to reducing energy centre costs, the company says. Paul Mayoh, product manager, Spirax Sarco, considers ways to ensure that as much condensate as possible is re-used. PMID:23009016

  5. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...services. (4) Resource provider has personnel with documented training certification and degree experience (Naval Architecture, Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and...

  6. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...services. (4) Resource provider has personnel with documented training certification and degree experience (Naval Architecture, Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and...

  7. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...services. (4) Resource provider has personnel with documented training certification and degree experience (Naval Architecture, Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and...

  8. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...services. (4) Resource provider has personnel with documented training certification and degree experience (Naval Architecture, Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and...

  9. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...experience to work in the specific regional geographic environment(s) that the vessel operates in (e.g., bottom type, water turbidity, water depth, sea state and temperature extremes). (13) Resource provider has the logistical and...

  10. Ensuring Students' Success

    ERIC Educational Resources Information Center

    Oblinger, James L.

    2006-01-01

    James L. Oblinger, Chancellor of North Carolina State University, argues that higher education must continually evolve new methods of teaching and learning to support students' lifelong skills and impending careers. Part of ensuring students' success lies in finding alternative learning models, such as the Student-Centered Activities for Large…

  11. Ensuring Academic Standards in US Higher Education

    ERIC Educational Resources Information Center

    Dill, David D.

    2014-01-01

    The most recent research on college-student learning in the US by respected scholars such as Richard Arum, Josipa Roksa, and Ernest Pascarella suggests that the nation's means of ensuring academic standards in US colleges and universities are not working effectively. Like US K-12 education and health care, the US higher education system is…

  12. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...to demonstrate that it complies with the following requirements: (1) Offers an appropriate range of preventive, primary care, and specialty services that is adequate for the anticipated number of enrollees for the service area. (2)...

  13. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...to demonstrate that it complies with the following requirements: (1) Offers an appropriate range of preventive, primary care, and specialty services that is adequate for the anticipated number of enrollees for the service area. (2)...

  14. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...to demonstrate that it complies with the following requirements: (1) Offers an appropriate range of preventive, primary care, and specialty services that is adequate for the anticipated number of enrollees for the service area. (2)...

  15. Ensure Program Correctness Programming Languages

    E-print Network

    Chen, Sheng-Wei

    Ensure Program Correctness Programming Languages and Formal Methods Research Group Lab Coordinator Bow-Yaw Wang The Programming Languages and Formal Methods Research Group develops techniques to help ensure program correctness. Our research in programming languages focuses on syntactic, semantic

  16. Developing a service model that integrates palliative care throughout cancer care: the time is now.

    PubMed

    Partridge, Ann H; Seah, Davinia S E; King, Tari; Leighl, Natasha B; Hauke, Ralph; Wollins, Dana S; Von Roenn, Jamie Hayden

    2014-10-10

    Palliative care is a fundamental component of cancer care. As part of the 2011 to 2012 Leadership Development Program (LDP) of the American Society of Clinical Oncology (ASCO), a group of participants was charged with advising ASCO on how to develop a service model integrating palliative care throughout the continuum of cancer care. This article presents the findings of the LDP group. The group focused on the process of palliative care delivery in the oncology setting. We identified key elements for models of palliative care in various settings to be potentially equitable, sustainable, feasible, and acceptable, and here we describe a dynamic model for the integrated, simultaneous implementation of palliative care into oncology practice. We also discuss critical considerations to better integrate palliative care into oncology, including raising consciousness and educating both providers and the public about the importance of palliative care; coordinating palliative care efforts through strengthening affiliations and/or developing new partnerships; prospectively evaluating the impact of palliative care on patient and provider satisfaction, quality improvement, and cost savings; and ensuring sustainability through adequate reimbursement and incentives, including linkage of performance data to quality indicators, and coordination with training efforts and maintenance of certification requirements for providers. In light of these findings, we believe the confluence of increasing importance of incorporation of palliative care education in oncology education, emphasis on value-based care, growing use of technology, and potential cost savings makes developing and incorporating palliative care into current service models a meaningful goal. PMID:25199756

  17. Funding the Formula Adequately in Oklahoma

    ERIC Educational Resources Information Center

    Hancock, Kenneth

    2015-01-01

    This report is a longevity, simulational study that looks at how the ratio of state support to local support effects the number of school districts that breaks the common school's funding formula which in turns effects the equity of distribution to the common schools. After nearly two decades of adequately supporting the funding formula, Oklahoma…

  18. Adequate Yearly Progress: Results, Not Process.

    ERIC Educational Resources Information Center

    Keegan, Lisa Graham; Orr, Billie J.; Jones, Brian J.

    The No Child Left Behind Act of 2001 (NCLB) demands from the American public school system that all students, regardless of race or socioeconomic status, must be held to the same academic expectations, and that their academic progress must be measured using a newly refined concept of adequate yearly progress (AYP). Success in complying with the…

  19. ON THE ADEQUATENESS OF AISYSTEMS ---Extended Abstract ---

    E-print Network

    Hoelldobler, Steffen

    unknown environment if we do not understand how the human nervous system perceives, processes, and acts in a similar scenario? Can we expect to fully understand the human nervous system if we cannot build a machineON THE ADEQUATENESS OF AI­SYSTEMS --- Extended Abstract --- STEFFEN H ¨ OLLDOBLER Fachgebiet

  20. Toward More Adequate Quantitative Instructional Research.

    ERIC Educational Resources Information Center

    VanSickle, Ronald L.

    1986-01-01

    Sets an agenda for improving instructional research conducted with classical quantitative experimental or quasi-experimental methodology. Includes guidelines regarding the role of a social perspective, adequate conceptual and operational definition, quality instrumentation, control of threats to internal and external validity, and the use of…

  1. Improving children's access to health care: the role of decategorization.

    PubMed Central

    Hughes, D. C.; Halfon, N.; Brindis, C. D.; Newacheck, P. W.

    1996-01-01

    Far too many children in this country are unable to obtain the health care they need because of barriers that prohibit easy access. Among the most significant obstacles are financial barriers, including lack of adequate health insurance and inadequate funding of programs for low-income children and those with special health-care needs. Another set of "non-financial" barriers are related to the categorical nature of addressing children's health-care needs, which impedes access by increasing the complexity and burden of seeking care and discourages providers from providing care. Decategorization represents an appealing partial remedy to these problems because it can lead to fundamental and lasting changes in financing and delivering health services. The greatest appeal of decategorization is its potential to improve access to care with the expenditure of little or no new funds. Decategorization also holds considerable risk. Depending on how it is designed and implemented, decategorization may lead to diminished access to care by serving as a foil for budget cuts or by undermining essential standards of care. However, these risks do not negate the value of exploring decategorization as an approach that can be taken today to better organize services and ensure that existing resources adequately meet children's needs. In this report we examine the role of decategorization as a mechanism for removing the barriers to care that are created by categorical funding of health programs. PMID:8982519

  2. Are women with psychosis receiving adequate cervical cancer screening?

    PubMed Central

    Tilbrook, Devon; Polsky, Jane; Lofters, Aisha

    2010-01-01

    ABSTRACT OBJECTIVE To investigate the rates of cervical cancer screening among female patients with psychosis compared with similar patients without psychosis, as an indicator of the quality of primary preventive health care. DESIGN A retrospective cohort study using medical records between November 1, 2004, and November 1, 2007. SETTING Two urban family medicine clinics associated with an academic hospital in Toronto, Ont. PARTICIPANTS A random sample of female patients with and without psychosis between the ages of 20 and 69 years. MAIN OUTCOME MEASURES Number of Papanicolaou tests in a 3-year period. RESULTS Charts for 51 female patients with psychosis and 118 female patients without psychosis were reviewed. Of those women with psychosis, 62.7% were diagnosed with schizophrenia, 19.6% with bipolar disorder, 17.6% with schizoaffective disorder, and 29.4% with other psychotic disorders. Women in both groups were similar in age, rate of comorbidities, and number of full physical examinations. Women with psychosis were significantly more likely to smoke (P < .0001), to have more primary care appointments (P = .035), and to miss appointments (P = .0002) than women without psychosis. After adjustment for age, other psychiatric illnesses, number of physical examinations, number of missed appointments, and having a gynecologist, women with psychosis were significantly less likely to have had a Pap test in the previous 3 years compared with women without psychosis (47.1% vs 73.7%, respectively; odds ratio 0.19, 95% confidence interval 0.06 to 0.58). CONCLUSION Women with psychosis are more than 5 times less likely to receive adequate Pap screening compared with the general population despite their increased rates of smoking and increased number of primary care visits. PMID:20393098

  3. Institutional predictors of developmental outcomes among racially diverse foster care alumni.

    PubMed

    Garcia, Antonio R; Pecora, Peter J; Harachi, Tracy; Aisenberg, Eugene

    2012-10-01

    Child welfare practitioners are confronted with the responsibility of relying on best practice to ensure children in foster care transition successfully into adulthood after leaving the foster care system. Yet, despite recent reforms and efforts to address their needs, research clearly shows that foster care alumni are still more likely to experience negative developmental outcomes compared to adults in the general population. The purpose of this study was to better understand how child-serving systems of care adequately prepare racially diverse foster care alumni to thrive. Controlling for gender, age, placement instability, and circumstances of exit from foster care, study findings highlighted salient racial and ethnic differences relative to which factors predicted the odds of mental health, education, and employment outcomes. Implications for developing and implementing culturally sensitive, evidence-based prevention and intervention programs to promote positive developmental outcomes among racially diverse foster care alumni are discussed. PMID:23039355

  4. Ensuring the Health of Refugees: Taking a Broader Vision.

    ERIC Educational Resources Information Center

    Kuntz, Diane; And Others

    Refugee assistance policies and programs should be reoriented to ensure both short- and long-term physical, social, and mental well-being. This approach must fully encompass primary health care and embrace a wide range of activities and programs that are not traditionally viewed as health-related. The refugee assistance community is sometimes…

  5. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...Environment 2 2014-07-01 2014-07-01 false Adequate tools and resources. 51.354 Section 51.354 Protection of...Inspection/Maintenance Program Requirements § 51.354 Adequate tools and resources. (a) Administrative...

  6. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...Environment 2 2010-07-01 2010-07-01 false Adequate tools and resources. 51.354 Section 51.354 Protection of...Inspection/Maintenance Program Requirements § 51.354 Adequate tools and resources. (a) Administrative...

  7. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...Environment 2 2011-07-01 2011-07-01 false Adequate tools and resources. 51.354 Section 51.354 Protection of...Inspection/Maintenance Program Requirements § 51.354 Adequate tools and resources. (a) Administrative...

  8. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...Environment 2 2012-07-01 2012-07-01 false Adequate tools and resources. 51.354 Section 51.354 Protection of...Inspection/Maintenance Program Requirements § 51.354 Adequate tools and resources. (a) Administrative...

  9. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...Environment 2 2013-07-01 2013-07-01 false Adequate tools and resources. 51.354 Section 51.354 Protection of...Inspection/Maintenance Program Requirements § 51.354 Adequate tools and resources. (a) Administrative...

  10. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...2010-01-01 2010-01-01 false Sanitation and adequate facilities. 305... Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT...REPORTS OF VIOLATION § 305.3 Sanitation and adequate facilities....

  11. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...2011-01-01 false Adequate exploration plan. 970.404 Section 970...DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may...

  12. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...2012-01-01 false Adequate exploration plan. 970.404 Section 970...DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may...

  13. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...2010-01-01 false Adequate exploration plan. 970.404 Section 970...DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may...

  14. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...2014-01-01 false Adequate exploration plan. 970.404 Section 970...DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may...

  15. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...2013-01-01 false Adequate exploration plan. 970.404 Section 970...DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may...

  16. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 2013-07-01 false Adequate file search. 716.25 Section 716.25 Protection...General Provisions § 716.25 Adequate file search. The scope of a person's responsibility to search records is limited to records in...

  17. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 2012-07-01 false Adequate file search. 716.25 Section 716.25 Protection...General Provisions § 716.25 Adequate file search. The scope of a person's responsibility to search records is limited to records in...

  18. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 2014-07-01 false Adequate file search. 716.25 Section 716.25 Protection...General Provisions § 716.25 Adequate file search. The scope of a person's responsibility to search records is limited to records in...

  19. Ensuring equal opportunity sprinkler irrigation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Equal opportunity for plants to sprinkler irrigation water must be carefully considered by crop producers, irrigation consultants, and the industry that supplies the irrigation equipment. Equal opportunity can be negated by improper marketing, design, and installation, as well as through improper f...

  20. Fundamentals of randomized clinical trials in wound care: design and conduct.

    PubMed

    Eskes, Anne M; Brölmann, Fleur E; Sumpio, Bauer E; Mayer, Dieter; Moore, Zena; Agren, Magnus S; Hermans, Michel; Cutting, Keith; Legemate, Dink A; Ubbink, Dirk T; Vermeulen, Hester

    2012-01-01

    The care for chronic and acute wounds is a substantial problem around the world. This has led to a plethora of products to accelerate healing. Unfortunately, the quality of studies evaluating the efficacy of such wound care products is frequently low. Randomized clinical trials are universally acknowledged as the study design of choice for comparing treatment effects, as they eliminate several sources of bias. We propose a framework for the design and conduct of future randomized clinical trials that will offer strong scientific evidence for the effectiveness of wound care interventions. While randomization is a necessary feature of a robust comparative study, it is not sufficient to ensure a study at low risk of bias. Randomized clinical trials should also ensure adequate allocation concealment and blinding of outcome assessors, apply intention-to-treat analysis, and use patient-oriented outcomes. This article proposes strategies for improving the evidence base for wound care decision making. PMID:22642397

  1. Comprehensive care.

    PubMed

    Pioli, G; Davoli, M L; Pellicciotti, F; Pignedoli, P; Ferrari, A

    2011-06-01

    Comprehensive care (CC) represents the basic approach of orthogeriatric comanaged care with the overall objectives of improving results regarding physical and psychological functions and reducing hospitalization, long-term care placement and mortality. It is a two-stage process that includes the Comprehensive Geriatric Assessment (CGA) and the development and implementation of an interdisciplinary treatment plan based on priority interventions and unmet needs. In older hip fracture patients CC has to face crucial issues such as treatment choice and surgical options, clinical stabilization of patients before surgery and the prevention and treatment of complication in the postoperative phase. The main aim are to avoid inappropriate surgical delays and reduce the overall number of days of immobility endorsing an early ambulation with full weight bearing as tolerated. Multiprofessional CC must also ensure uninterrupted care for transition between the different care levels that patients need after fracture before returning home. Therefore another important issue is a structured discharge plan tailored to the individual patient identifying subjects that could benefit from a skilled or more intensive rehabilitation, identifying patients and family that will probably need a higher level of care even after rehabilitation, determining timing of discharge, defining the continuing care that needs to be provided and finally ensuring the patient has access to available services and resources. However, the implementation of a comprehensive and multidisciplinary co-care model in an orthopedic unit is a difficult task because it is necessary a great effort to change cultural attitudes related to traditional model of care. PMID:21597436

  2. Self-reported segregation experience throughout the life course and its association with adequate health literacy.

    PubMed

    Goodman, Melody S; Gaskin, Darrell J; Si, Xuemei; Stafford, Jewel D; Lachance, Christina; Kaphingst, Kimberly A

    2012-09-01

    Residential segregation has been shown to be associated with health outcomes and health care utilization. We examined the association between racial composition of five physical environments throughout the life course and adequate health literacy among 836 community health center patients in Suffolk County, NY. Respondents who attended a mostly White junior high school or currently lived in a mostly White neighborhood were more likely to have adequate health literacy compared to those educated or living in predominantly minority or diverse environments. This association was independent of the respondent's race, ethnicity, age, education, and country of birth. PMID:22658579

  3. Self-reported segregation experience throughout the life course and its association with adequate health literacy

    PubMed Central

    Gaskin, Darrell J.; Si, Xuemei; Stafford, Jewel D.; Lachance, Christina; Kaphingst, Kimberly A.

    2012-01-01

    Residential segregation has been shown to be associated with health outcomes and health care utilization. We examined the association between racial composition of five physical environments throughout the life course and adequate health literacy among 836 community health center patients in Suffolk County, NY. Respondents who attended a mostly White junior high school or currently lived in a mostly White neighborhood were more likely to have adequate health literacy compared to those educated or living in predominantly minority or diverse environments. This association was independent of the respondent’s race, ethnicity, age, education, and country of birth. PMID:22658579

  4. Humanitarian and civic assistance health care training and cultural awareness promoting health care pluralism.

    PubMed

    Facchini, Rose E

    2013-05-01

    Integration between traditional and contemporary health care in a host nation can be beneficial to nation- and capacity-building and, subsequently, to the overall health of the society. "Traditional" health care in this sense refers to the indigenous health care system in the host nation, which includes characteristic religious or cultural practices, whereas "contemporary" health care is also known as "conventional" or "Westernized"; integration is a synchronization of these two health care forms. However, the choice of integration depends on the political and cultural situation of the nation in which the Department of Defense health care personnel are intervening. Thus, cultural awareness training is essential to ensure the success of missions related to global health and in promoting a health care system that is most beneficial to the society. The present study attempts to show the benefits of both cultural training and health care integration, and how adequately evaluating their efficacy has been problematic. The author proposes that determinants of this efficacy are better documentation collection, extensive predeployment cultural awareness and sensitivity training, and extensive after-action reports for future development. PMID:23756013

  5. Major Difficulties the US Nephrologist Faces in Providing Adequate Dialysis

    Microsoft Academic Search

    Jose A. Diaz-Buxo; Terri L. Crawford-Bonadio

    2007-01-01

    Aim: To identify the major difficulties nephrologists in the US face in providing adequate dialysis. Methods: To identify the perceived obstacles to achieving adequate dialysis in the US, 30 clinical support specialists responsible for nursing education and training were polled. Their responses together with those found in the recent literature were summarized and analyzed. Results: The obstacles identified fell into

  6. "Something Adequate"? In Memoriam Seamus Heaney, Sister Quinlan, Nirbhaya

    ERIC Educational Resources Information Center

    Parker, Jan

    2014-01-01

    Seamus Heaney talked of poetry's responsibility to represent the "bloody miracle", the "terrible beauty" of atrocity; to create "something adequate". This article asks, what is adequate to the burning and eating of a nun and the murderous gang rape and evisceration of a medical student? It considers Njabulo…

  7. Quality of Care

    Cancer.gov

    The Institute of Medicine (IOM) defines quality of care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." In 1999, the IOM issued Ensuring Quality Cancer Care, a report that documented significant gaps in the quality of cancer care in the United States.

  8. Child Health USA 2013: Barriers to Prenatal Care

    MedlinePLUS

    ... Utilization > Barriers to Prenatal Care Barriers to Prenatal Care Narrative Early and adequate prenatal care is important ... Data Mothers Who Experienced Barriers to Receiving Prenatal Care as Early as Desired, by Maternal Age, 2009– ...

  9. Providing care to children in times of war.

    PubMed

    Cole, Will; Edwards, Mary J; Burnett, Mark W

    2015-06-01

    The Geneva Conventions stipulate that an occupying power must ensure adequate health care delivery to noncombatants. Special emphasis is given to children, who are among the most vulnerable in a conflict zone. Whether short-term pediatric care should be provided by Military Treatment Facilities to local nationals for conditions other than combat-related injury is controversial. A review of 1,197 children without traumatic injury cared for during 10 years in Iraq and Afghanistan was conducted. Mortality rates were less than 1% among patients with surgical conditions and resource utilization was not excessive. In view of international humanitarian law and these outcomes, children with nontraumatic conditions can and should be considered for treatment at Military Treatment Facilities. The ability to correct the condition and availability of resources necessary to do so should be taken into account. PMID:26032375

  10. Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

    PubMed Central

    2014-01-01

    Background Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used. Methods We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics. Results The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate. Conclusions Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge. PMID:24555812

  11. The quality of health care in prison: results of a year's programme of semistructured inspections.

    PubMed Central

    Reed, J.; Lyne, M.

    1997-01-01

    OBJECTIVES: To assess, as part of wider inspections by HM Inspectorate of Prisons, the extent and quality of health care in prisons in England and Wales. DESIGN: Inspections based on a set of "expectations" derived mainly from existing healthcare quality standards published by the prison service and existing ethical guidelines; questionnaire survey of prisoners. SUBJECTS: 19 prisons in England and Wales, 1996-7. MAIN OUTCOME MEASURES: Appraisals of needs assessment and the commissioning and delivery of health care against the inspectorate's expectations. RESULTS: The quality of health care varied greatly. A few prisons provided health care broadly equivalent to NHS care, but in many the health care was of low quality, some doctors were not adequately trained to do the work they faced, and some care failed to meet proper ethical standards. Little professional support was available to healthcare staff. CONCLUSIONS: The current policy for improving health care in prisons is not likely to achieve its objectives and is potentially wasteful. The prison service needs to recognise that expertise in the commissioning and delivery of health care is overwhelming based in the NHS. The current review of the provision of health care in prisons offers an opportunity to ensure that prisoners are not excluded from high quality health care. PMID:9418090

  12. Do Beginning Teachers Receive Adequate Support from Their Headteachers?

    ERIC Educational Resources Information Center

    Menon, Maria Eliophotou

    2012-01-01

    The article examines the problems faced by beginning teachers in Cyprus and the extent to which headteachers are considered to provide adequate guidance and support to them. Data were collected through interviews with 25 school teachers in Cyprus, who had recently entered teaching (within 1-5 years) in public primary schools. According to the…

  13. Honoring those who have served: how can health professionals provide optimal care for members of the military, veterans, and their families?

    PubMed

    Lee, Jennifer; Sanders, Karen M; Cox, Malcolm

    2014-09-01

    With over one million service members separating from the military over the next several years, it seems prudent to ask whether U.S. health care professionals and systems of care are prepared to evaluate and treat the obvious and more subtle injuries ascribed to military deployment and combat. The authors suggest that several systemic interventions-adding military health history sections to electronic health records, history and physical diagnosis textbooks, and licensing exams while also ensuring that this content is adequately covered in undergraduate and graduate health professional training-will enable all health care professionals to provide service members and veterans with the high-quality care that they deserve. The authors also highlight the U.S. Department of Veterans Affairs' recent innovations in education and care delivery, which are enhancing the education of thousands of students and residents, who will be better prepared to care for veterans after receiving this training. PMID:24979290

  14. Mature care in professional relationships and health care prioritizations.

    PubMed

    Nordhaug, Marita; Nortvedt, Per

    2011-03-01

    This article addresses some ambiguities and normative problems with the concept of mature care in professional relationships and in health care priorities. Mature care has recently been introduced in the literature on care ethics as an alternative to prevailing altruistic conceptions of care. The essence of mature care is an emphasis on reciprocity, where the mature agent has the ability to balance the concerns of self with those of others and act from a principle of not causing harm. Our basic claim is that the prevailing concept of mature care does not capture the real nature of professional relationships and role obligations in health care. As the focus of attention in professional care is and must be the patient's particular medical and care needs, such care must principally be altruistic. Furthermore, we argue that mature care cannot adequately address moral conflict in health care without accepting some more principle-based approaches and a richer notion of partiality. PMID:21372234

  15. Ensuring Safe Use of Contact Lens Solution

    MedlinePLUS

    ... Consumer Updates RSS Feed Ensuring Safe Use of Contact Lens Solution Search the Consumer Updates Section Printer- ... About Eye Infections Dos and Don'ts for Contact Lens Wearers Not emptying the solution out of ...

  16. A plan to overcome resistance to managed care.

    PubMed

    Silverstein, J L

    1993-01-01

    A managed-care plan is attempting to reverse New Yorkers' negativity toward managed care. The focus is on giving consumers adequate information and access to allow them to make prudent health care choices. PMID:10130044

  17. Child Care Providers' Experiences Caring for Sick Children: Implications for Public Policy.

    ERIC Educational Resources Information Center

    Heymann, S. Jody; Vo, Phuong Hong; Bergstrom, Cara A.

    2002-01-01

    Examined the experiences of preschool and school-age child care providers regarding sick child care. Found that providers repeatedly described sick children whose health problems made it impossible to provide adequate care for sick and well children in their care. Findings pose international public health policy implications for child care and…

  18. Do national drug control laws ensure the availability of opioids for medical and scientific purposes?

    PubMed Central

    Brown, Marty Skemp; Maurer, Martha A

    2014-01-01

    Abstract Objective To determine whether national drug control laws ensure that opioid drugs are available for medical and scientific purposes, as intended by the 1972 Protocol amendment to the 1961 Single Convention on Narcotic Drugs. Methods The authors examined whether the text of a convenience sample of drug laws from 15 countries: (i) acknowledged that opioid drugs are indispensable for the relief of pain and suffering; (ii) recognized that government was responsible for ensuring the adequate provision of such drugs for medical and scientific purposes; (iii) designated an administrative body for implementing international drug control conventions; and (iv) acknowledged a government’s intention to implement international conventions, including the Single Convention. Findings Most national laws were found not to contain measures that ensured adequate provision of opioid drugs for medical and scientific purposes. Moreover, the model legislation provided by the United Nations Office on Drugs and Crime did not establish an obligation on national governments to ensure the availability of these drugs for medical use. Conclusion To achieve consistency with the Single Convention, as well as with associated resolutions and recommendations of international bodies, national drug control laws and model policies should be updated to include measures that ensure drug availability to balance the restrictions imposed by the existing drug control measures needed to prevent the diversion and nonmedical use of such drugs. PMID:24623904

  19. Abstract--Unilateral export controls in United States policy have not been adequately modified during the last decade to keep up with

    E-print Network

    Wang, Hai

    foreign policy, and economic objectives by ensuring an effective export control and treaty compliance1 Abstract-- Unilateral export controls in United States policy have not been adequately modified TABLE OF CONTENTS I. INTRODUCTION 1 II. POLICY PROBLEMS 3 III. POLICY GOALS 6 IV. POLICY OPTIONS 6 V

  20. Regulating electricity to ensure efficient competition

    Microsoft Academic Search

    David M Newbery

    2001-01-01

    The European Commission's attempt to update the Electricity and Gas Directives to underwrite unbundling and full liberalisation coincides with the California electricity crisis. The paper argues that compared to the US, much of the EU lacks the necessary legislative and regulatory power to mitigate generator market power. Unless markets are made more contestable, transmission capacity expanded and adequate generation capacity

  1. Outsourcing your medical practice call center: how to choose a vendor to ensure regulatory compliance.

    PubMed

    Johnson, Bill

    2014-01-01

    Medical practices receive hundreds if not thousands of calls every week from patients, payers, pharmacies, and others. Outsourcing call centers can be a smart move to improve efficiency, lower costs, improve customer care, ensure proper payer management, and ensure regulatory compliance. This article discusses how to know when it's time to move to an outsourced call center, the benefits of making the move, how to choose the right call center, and how to make the transition. It also provides tips on how to manage the call center to ensure the objectives are being met. PMID:25807604

  2. Autonomy and paternalism: an ethical dilemma in caring for the elderly.

    PubMed

    Everett, I

    1993-01-01

    As care providers, nurses must be on a never-ending search for opportunities to promote self-worth, self-dignity, and meaning for elderly clients. Nurses must focus on ending the process whereby the system drives the care given and get back to where the individual care needs drive the system. This advocacy role can be enhanced by ensuring that nurses have an adequate knowledge base and the integrity to assess whose values are determining the care being given to the elderly. The dignity and autonomy of individuals is promoted through informed consent and the opportunity for choice (Philips, 1987). When there is respect for the personhood of others, it becomes clear that a client is not a problem but a person with a problem (Gunter, 1979). Personhood, to this author, requires having a quality of life that possesses the ability for free choice and opportunities for responsible behaviour. Nurses have the unique opportunity to act as patient advocates by the very fact that they are in the only discipline within the multi-disciplinary team that is in 24-hour per day contact with the institutionalized individual. It is the responsibility of the nurse to ensure that no harm is done, not by removing the right to decide or the right to take a risk or the right to say no, but rather by ensuring the individual's right to autonomy and personhood are preserved.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8116316

  3. Control Measures: Proper control measures ensure that

    E-print Network

    Jia, Songtao

    Control Measures: Proper control measures ensure that exposure to the eyes & skin are minimal Amplification by Stimulated Emission of Radiation. This is a description of the process that creates laser light the electrical hazards associated with high voltages within the laser and its power supply. While

  4. Ensuring Interoperability with Automated Interoperability Testing

    E-print Network

    Grabowski, Jens

    in standardization and industry to ensure delivery of services across products from different vendors. Today significant cost reductions in industrial and standardization case studies. We explain here why automation interoperability of all products part of such systems, efforts in the telecommunication domain relied mainly

  5. Heater Ensures Strain-Gage Bond Reliability

    NASA Technical Reports Server (NTRS)

    Brown, J. K.; Davenport, M. L.

    1984-01-01

    Aluminum block with embedded heating element provides concentrated and controllable heat for curing strain-gage adhesives. Device replaces heat lamps and hot-air guns; provides higher temperatures, allows shorter curing times, and ensures more reliable bond. Low temperatures and wind do not significantly affect operation of heater, therefore suited to outdoor use.

  6. DATABASE MANAGEMENT TECHNIQUES TO ENSURE PROJECT INTEGRITY

    EPA Science Inventory

    The Drinking Water Research Division of the Risk Reduction Engineering Laboratory in Cincinnati, Ohio is responsible for conducting field scale research projects on the cost and performance of drinking water treatment technology in support of the Safe Drinking Water Act. o ensure...

  7. Subcutaneous immunoglobulin replacement therapy: ensuring success.

    PubMed

    Younger, M Elizabeth M; Blouin, William; Duff, Carla; Epland, Kristin Buehler; Murphy, Elyse; Sedlak, Debra

    2015-01-01

    Subcutaneous immunoglobulin (SCIg) infusions are an option for patients requiring immunoglobulin therapy. Nurses are uniquely positioned to advocate for patients and to teach them how to successfully manage their infusions. The purpose of this review is to describe SCIg therapy and to provide teaching instructions as well as creative tips to ensure treatment success. PMID:25545976

  8. Ensuring message embedding in wet paper steganography

    E-print Network

    Paris-Sud XI, Université de

    Ensuring message embedding in wet paper steganography Daniel Augot1, Morgan Barbier1, and Caroline of this new scheme in the case of perfect codes. Keywords: steganography, syndrome coding problem, wet paper codes. 1 Introduction Hiding messages in innocuous-looking cover-media in a stealthy way, steganography

  9. USGS Laboratory Review Program Ensures Analytical Quality

    USGS Publications Warehouse

    Erdmann, David E.

    1995-01-01

    The USGS operates a review program for laboratories that analyze samples for USGS environmental investigations. This program has been effective in providing QA feedback to laboratories while ensuring that analytical data are consistent, of satisfactory quality, and meet the data objectives of the investigation.

  10. Surgical excision alone is adequate treatment for primary colorectal cancer.

    PubMed Central

    Hind, R.; Rew, D. R.; Johnson, C. D.

    1992-01-01

    This debate examines the arguments for and against the proposal that surgical excision alone is adequate treatment for primary colorectal cancer. The arguments in favour are that the results from curative surgery are excellent and that despite many trials of adjuvant chemotherapy, radiotherapy and immunotherapy, the proposed benefits remain unproven. Recent improvements in surgical technique, particularly for dissection of rectal tumours, have shown the way towards further improvement using surgery alone, and it is clear from a national survey that technical factors related to individual surgeons play a large part in determining recurrence rates. With optimum primary treatment, surgical excision alone is indeed adequate therapy. The arguments against this motion are that although a considerable number of patients do survive with surgery, the 5-year survival rate is poor when there is extensive local invasion or lymphatic metastases. Surgery starts therapy by reducing the tumour load, but other modalities are required to destroy the cells which might subsequently develop into metastases. Trial results with adjuvant therapy are encouraging, although many contain too few patients. We cannot be content with the results of treatment of Dukes' Stage B and C tumours; more trials are needed to determine the best treatment for these patients. PMID:1736798

  11. Ensuring system security through formal software evaluation

    SciTech Connect

    Howell, J A; Fuyat, C [Los Alamos National Lab., NM (United States)] [Los Alamos National Lab., NM (United States); Elvy, M [Marble Associates, Boston, MA (United States)] [Marble Associates, Boston, MA (United States)

    1992-01-01

    With the increasing use of computer systems and networks to process safeguards information in nuclear facilities, the issue of system and data integrity is receiving worldwide attention. Among the many considerations are validation that the software performs as intended and that the information is adequately protected. Such validations are often requested of the Safeguards Systems Group of the Los Alamos National Laboratory. This paper describes our methodology for performing these software evaluations.

  12. Drinking Water in Schools and Child Care Facilities

    MedlinePLUS

    ... Drinking Water in Schools & Child Care Facilities Drinking Water in Schools & Child Care Facilities This one-stop EPA site provides information about drinking water quality in schools and child care facilities. Ensuring ...

  13. Do low standing biomass and leaf area index of sub-tropical coastal dunes ensure that plants have an adequate supply of water?

    Microsoft Academic Search

    Brad S. Ripley; Norman W. Pammenter

    2004-01-01

    Water status in relation to standing biomass and leaf area indices (LAI) of the subtropical foredune species Arctotheca populifolia, Ipomoea pes-caprae and Scaevola plumieri were studied in the Eastern Cape, South Africa. The plants showed little evidence of water stress, never developing leaf water potentials more negative than -1.55 MPa, a value which is typical of mesophytes rather than xerophytes. The

  14. World oil supply adequate for 93's healthy demand

    SciTech Connect

    Beck, R.J.

    1993-01-25

    This paper reports that world oil supply and demand fundamentals have changed little in the past year, bringing some stability to the market. That could change in 1993 as demand resumes a more healthy growth rate, and production declines continue in the U.S. and the C.I.S. Though there's little chance average prices will increase significantly, crude markets could be more volatile this year. Offsetting upward pressures on oil prices resulting from accelerated demand are plans by Persian Gulf producers to expand productive capacity, the possibility that Iraq will reenter the international oil market, and continued economic decline in eastern Europe and the former republics of the Soviet Union. When it's all added up, world oil supply looks more than adequate for 1993. If events occur in a particular combination, prices could weaken.

  15. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...Adequate financial records, statistical data, and cost finding. 417...Adequate financial records, statistical data, and cost finding. (a...sufficient financial records and statistical data for proper...

  16. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...Adequate financial records, statistical data, and cost finding. 417...Adequate financial records, statistical data, and cost finding. (a...sufficient financial records and statistical data for proper...

  17. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...Adequate financial records, statistical data, and cost finding. 417...Adequate financial records, statistical data, and cost finding. (a...sufficient financial records and statistical data for proper...

  18. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...Adequate financial records, statistical data, and cost finding. 417...Adequate financial records, statistical data, and cost finding. (a...sufficient financial records and statistical data for proper...

  19. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...Adequate financial records, statistical data, and cost finding. 417...Adequate financial records, statistical data, and cost finding. (a...sufficient financial records and statistical data for proper...

  20. Perceived Access to General Medical and Psychiatric Care Among Veterans With Bipolar Disorder

    PubMed Central

    Copeland, Laurel A.; McCarthy, John F.; Bauer, Mark S.; Kilbourne, Amy M.

    2009-01-01

    Objectives. We examined associations between patient characteristics and self-reported difficulties in accessing mental health and general medical care services. Methods. Patients were recruited from the Continuous Improvement for Veterans in Care–Mood Disorders study. We used multivariable logistic regression analyses to assess whether predisposing (demographic characteristics), enabling (e.g., homelessness), or need (bipolar symptoms, substance abuse) factors were associated with difficulties in obtaining care, difficulties in locating specialty providers, and forgoing care because of cost. Results. Patients reported greater difficulty in accessing general medical services than in accessing psychiatric care. Individuals experiencing bipolar symptoms more frequently avoided psychiatric care because of cost (odds ratio [OR] = 2.43) and perceived greater difficulties in accessing medical specialists (OR = 2.06). Homeless individuals were more likely to report hospitalization barriers, whereas older and minority patients generally encountered fewer problems accessing treatment. Conclusions. Need and enabling factors were most influential in predicting self-reported difficulties in accessing care, subsequently interfering with treatment dynamics and jeopardizing clinical outcomes. Efforts in the Department of Veterans Affairs to expand mental health care access should be coupled with efforts to ensure adequate access to general medical services among patients with chronic mental illnesses. PMID:19150912

  1. Do British travel agents provide adequate health advice for travellers?

    PubMed Central

    Lawlor, D A; Burke, J; Bouskill, E; Conn, G; Edwards, P; Gillespie, D

    2000-01-01

    Travel-related illness is a burden for primary care, with more than two million travellers consulting a general practitioner each year. The annual cost of travel-related illness in the United Kingdom is 11 million Pounds. Travel agents are in a unique position to influence this burden as the most common and most serious problems are preventable with simple advice and/or immunisation. This study, using covert researchers, suggests this potential is not being fully utilised. PMID:10954940

  2. Literacy in the World of the Aged Care Worker.

    ERIC Educational Resources Information Center

    Wyse, Linda; Casarotto, Nadia

    Australia's Aged Care Act of 1997 mandates a number of key reforms aimed at ensuring consistency in the quality of care and well-being for all residents of aged care facilities. The law required residential aged care facilities to provide high-quality care within a framework of continuous improvement which requires aged care workers to perform the…

  3. Prenatal Care

    MedlinePLUS

    ... Our ePublications > Prenatal care fact sheet ePublications Prenatal care fact sheet Print this fact sheet Prenatal care ... More information on prenatal care What is prenatal care? Prenatal care is the health care you get ...

  4. Driving through: postpartum care during World War II.

    PubMed Central

    Temkin, E

    1999-01-01

    In 1996, public outcry over shortened hospital stays for new mothers and their infants led to the passage of a federal law banning "drive-through deliveries." This recent round of brief postpartum stays is not unprecedented. During World War II, a baby boom overwhelmed maternity facilities in American hospitals. Hospital births became more popular and accessible as the Emergency Maternal and Infant Care program subsidized obstetric care for servicemen's wives. Although protocols before the war had called for prolonged bed rest in the puerperium, medical theory was quickly revised as crowded hospitals were forced to discharge mothers after 24 hours. To compensate for short inpatient stays, community-based services such as visiting nursing care, postnatal homes, and prenatal classes evolved to support new mothers. Fueled by rhetoric that identified maternal-child health as a critical factor in military morale, postpartum care during the war years remained comprehensive despite short hospital stays. The wartime experience offers a model of alternatives to legislation for ensuring adequate care of postpartum women. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 PMID:10191809

  5. Access to primary health care for immigrants: results of a patient survey conducted in 137 primary care practices in Ontario, Canada

    PubMed Central

    2012-01-01

    Background Immigrants make up one fifth of the Canadian population and this number continues to grow. Adequate access to primary health care is important for this population but it is not clear if this is being achieved. This study explored patient reported access to primary health care of a population of immigrants in Ontario, Canada who were users of the primary care system and compared this with Canadian-born individuals; and by model of primary care practice. Methods This study uses data from the Comparison of Models of Primary Care Study (COMP-PC), a mixed-methods, practice-based, cross-sectional study that collected information from patients and providers in 137 primary care practices across Ontario, Canada in 2005-2006. The practices were randomly sampled to ensure an equal number of practices in each of the four dominant primary care models at that time: Fee-For-Service, Community Health Centres, and the two main capitation models (Health Service Organization and Family Health Networks). Adult patients of participating practices were identified when they presented for an appointment and completed a survey in the waiting room. Three measures of access were used, all derived from the patient survey: First Contact Access, First Contact Utilization (both based on the Primary Care Assessment Tool) and number of self-reported visits to the practice in the past year. Results Of the 5,269 patients who reported country of birth 1,099 (20.8%) were born outside of Canada. In adjusted analysis, recent immigrants (arrival in Canada within the past five years) and immigrants in Canada for more than 20 years were less likely to report good health compared to Canadian-born (Odds ratio 0.58, 95% CI 0.36,0.92 and 0.81, 95% CI 0.67,0.99). Overall, immigrants reported equal access to primary care services compared with Canadian-born. Within immigrant groups recently arrived immigrants had similar access scores to Canadian-born but reported 5.3 more primary care visits after adjusting for health status. Looking across models, recent immigrants in Fee-For-Service practices reported poorer access and fewer primary care visits compared to Canadian-born. Conclusions Overall, immigrants who were users of the primary care system reported a similar level of access as Canadian-born individuals. While recent immigrants are in poorer health compared with Canadian-born they report adequate access to primary care. The differences in access for recently arrived immigrants, across primary care models suggests that organizational features of primary care may lead to inequity in access. PMID:23272805

  6. Care and Consent.

    ERIC Educational Resources Information Center

    Gottesman, Roberta

    1981-01-01

    Discusses the legal ramifications of informed consent for medical treatment of schoolchildren, including the problems posed by parents unwilling to give adequate medical protection to their children because of religious or other reasons. Covers the types of medical care that minors can receive without parental consent. (WD)

  7. DARHT - an `adequate` EIS: A NEPA case study

    SciTech Connect

    Webb, M.D.

    1997-08-01

    The Dual Axis Radiographic Hydrodynamic Test (DARHT) Facility Environmental Impact Statement (EIS) provides a case study that is interesting for many reasons. The EIS was prepared quickly, in the face of a lawsuit, for a project with unforeseen environmental impacts, for a facility that was deemed urgently essential to national security. Following judicial review the EIS was deemed to be {open_quotes}adequate.{close_quotes} DARHT is a facility now being built at Los Alamos National Laboratory (LANL) as part of the Department of Energy (DOE) nuclear weapons stockpile stewardship program. DARHT will be used to evaluate the safety and reliability of nuclear weapons, evaluate conventional munitions and study high-velocity impact phenomena. DARHT will be equipped with two accelerator-driven, high-intensity X-ray machines to record images of materials driven by high explosives. DARHT will be used for a variety of hydrodynamic tests, and DOE plans to conduct some dynamic experiments using plutonium at DARHT as well.

  8. Can surface EMG be adequately described by digital sampling?

    PubMed

    Min, Lei; Sarkar, Nilanjan; Guang, Meng; Yudong, Gu; Kaili, Zhang; Dong, Tian

    2014-07-01

    Surface electromyography (SEMG) is a common tool to evaluate muscle function in kinesiological studies, musculoskeletal rehabilitation, prosthetics, clinical research and neurological disease diagnosis. The acquisition of SEMG is a crucially basic issue to gain an insight into musculoskeletal system function. The aim of this study is to investigate if the sampled surface EMG signals can reflect adequately the neural activity of the underlying musculature. The surface EMG signals of four muscles (abductor pollicis muscles and abductor digiti minimi muscles of right hand and left hand) are studied on the amplitude, frequency and nonlinear measure based on symplectic geometry. There are obvious differences in nonlinear measures of the different sampled signals, although there are little significant changes in their amplitude and frequency measures. Meanwhile, surface EMG signals obviously differ from their surrogate data at higher sampling frequencies. The results indicate that surface EMG signals contain nonlinear components. To gather the sufficient information of surface EMG signal, the data acquisition should be required at the higher sampling frequency. Furthermore, the nonlinear measure based on symplectic geometry can be used as a sensitive index for evaluation of the activity of the human muscles. PMID:24894263

  9. Dose Limits for Man do not Adequately Protect the Ecosystem

    SciTech Connect

    Higley, Kathryn A.; Alexakhin, Rudolf M.; McDonald, Joseph C.

    2004-08-01

    It has been known for quite some time that different organisms display differing degrees of sensitivity to the effects of ionizing radiations. Some microorganisms such as the bacterium Micrococcus radiodurans, along with many species of invertebrates, are extremely radio-resistant. Humans might be categorized as being relatively sensitive to radiation, and are a bit more resistant than some pine trees. Therefore, it could be argued that maintaining the dose limits necessary to protect humans will also result in the protection of most other species of flora and fauna. This concept is usually referred to as the anthropocentric approach. In other words, if man is protected then the environment is also adequately protected. The ecocentric approach might be stated as; the health of humans is effectively protected only when the environment is not unduly exposed to radiation. The ICRP is working on new recommendations dealing with the protection of the environment, and this debate should help to highlight a number of relevant issues concerning that topic.

  10. COHERENT ADEQUATE FORCING AND PRESERVING CH JOHN KRUEGER AND MIGUEL ANGEL MOTA

    E-print Network

    Krueger, John

    COHERENT ADEQUATE FORCING AND PRESERVING CH JOHN KRUEGER AND MIGUEL ANGEL MOTA Abstract. We develop, adequate sets, coherent adequate sets. 1 #12;2 JOHN KRUEGER AND MIGUEL ANGEL MOTA can be factored in many which adds a club to a fat stationary set and falls in the class of coherent adequate type forcings

  11. Ensuring the strength of rolled metal

    SciTech Connect

    Belen`kii, D.M.; Beskopyl`nyi, A.N. [State Academy of Construction, Rostov-on-Don (Russian Federation)

    1995-02-01

    A new approach to ensuring the strength of a material is considered. Strength is considered as the unity of the stress-strain state resulting from external factors and the material resistance to this state. The material resistance is characterized by the random vector of mechanical properties determined by tensile impact toughness, fatigue, crack resistance, etc. testings. The method of impact indentation of a conical indenter in the material and recording of the parameters of the impact indentation curve is proposed to determine this vector. This principle is used to develop equipment allowing the determination of the mechanical properties of steels.

  12. Universal health insurance in India: ensuring equity, efficiency, and quality.

    PubMed

    Prinja, Shankar; Kaur, Manmeet; Kumar, Rajesh

    2012-07-01

    Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India's workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete. PMID:23112438

  13. Self-care: a foundational science.

    PubMed

    Denyes, M J; Orem, D E; Bekel, G; SozWiss

    2001-01-01

    Further development of conceptual elements of the theory of self-care, one of the three constituent theories of Orem's self-care deficit theory of nursing, is reported. Five content areas of a practical science of self-care are identified; one content area, self-care requisites, is refined and developed. The nature of self-care requisites is reformulated; guides and standards for the expression of self-care requisites, examples of expressed self-care requisites, and a self-care practice guide are described. These developments are illustrated using the example of the requisite to maintain an adequate fluid intake. PMID:11873354

  14. The role of corporations in ensuring biodiversity

    NASA Astrophysics Data System (ADS)

    Kelly, Joyce M.; Hodge, Michael R.

    1996-11-01

    Corporations own approximately 25% of all private land in the United States and, therefore, play an essential role in protecting biodiversity and maintaining natural habitats. The Wildlife Habitat Council (WHC) is a unique joint venture between conservation organizations and corporations to utilize corporate lands for ensuring biodiversity. The following case studies demonstrate how corporations have helped ensure healthy ecosystems and provided critical leadership in regional efforts. Amoco Chemical Company's Cooper River Plant has been instrumental in developing a cooperative project that involves numerous corporations, plantation owners, private citizens, nonprofit organizations, government agencies, and community groups to develop a comprehensive, ecosystem-based management plan for part of the Cooper River in Charleston, South Carolina, USA. The second case focuses on the Morie Company, a national sand quarry operator headquartered in southern New Jersey, USA. Morie Company is working with WHC, community groups, the Pinelands Commission, and other state regulatory agencies to explore sustainable development opportunities for companies within the Pinelands regulations. The third case takes us to DuPont Company's Asturias, Spain, site. A win—win success story of improved habitat and cost savings is the result of DuPont's concern for the environment, ability to work with a variety of groups, and willingness to consider innovative restoration techniques. The fourth case discusses Consumers Power Company's Campbell Plant in West Olive, Michigan, USA. In addition to implementing projects that contribute to biodiversity, Consumers Power has developed an environmental education field station to teach others about the importance of natural habitats. The final case highlights Baltimore Gas & Electric Company's efforts to maintain habitat for endangered species at their Calvert Cliffs site in Maryland.

  15. The Role of Corporations in Ensuring Biodiversity

    PubMed

    KELLY; HODGE

    1996-11-01

    / Corporations own approximately 25% of all private land in the United States and, therefore, play an essential role in protecting biodiversity and maintaining natural habitats. The Wildlife Habitat Council (WHC) is a unique joint venture between conservation organizations and corporations to utilize corporate lands for ensuring biodiversity. The following case studies demonstrate how corporations have helped ensure healthy ecosystems and provided critical leadership in regional efforts. Amoco Chemical Company's Cooper River Plant has been instrumental in developing a cooperative project that involves numerous corporations, plantation owners, private citizens, nonprofit organizations, government agencies, and community groups to develop a comprehensive, ecosystem-based management plan for part of the Cooper River in Charleston, South Carolina, USA. The second case focuses on the Morie Company, a national sand quarry operator headquartered in southern New Jersey, USA. Morie Company is working with WHC, community groups, the Pinelands Commission, and other state regulatory agencies to explore sustainable development opportunities for companies within the Pinelands regulations. The third case takes us to DuPont Company's Asturias, Spain, site. A win-win success story of improved habitat and cost savings is the result of DuPont's concern for the environment, ability to work with a variety of groups, and willingness to consider innovative restoration techniques. The fourth case discusses Consumers Power Company's Campbell Plant in West Olive, Michigan, USA. In addition to implementing projects that contribute to biodiversity, Consumers Power has developed an environmental education field station to teach others about the importance of natural habitats. The final case highlights Baltimore Gas & Electric Company's efforts to maintain habitat for endangered species at their Calvert Cliffs site in Maryland.KEY WORDS: Partnerships; Stewardship; International; Habitats; Biodiversity PMID:8895418

  16. Managing pain medications in long-term care: nurses' views.

    PubMed

    Kaasalainen, Sharon; Agarwal, Gina; Dolovich, Lisa; Brazil, Kevin; Papaioannou, Alexandra

    2015-05-14

    The purpose of this study was to explore nurses' perceptions of their current practices related to administering pain medications to long-term care (LTC) residents. A cross-sectional survey design was used, including both quantitative and open-ended questions. Data were collected from 165 nurses (59% response rate) at nine LTC homes in southern Ontario, Canada. The majority (85%) felt that the medication administration system was adequate to help them manage residents' pain and 98% felt comfortable administering narcotics. In deciding to administer a narcotic, nurses were influenced by pain assessments, physician orders, diagnosis, past history, effectiveness of non-narcotics and fear of making dosage miscalculations or developing addictions. Finally, most nurses stated that they trusted the physicians and pharmacists to ensure orders were safe. These findings highlight nurses' perceptions of managing pain medications in LTC and related areas where continuing education initiatives for nurses are needed. PMID:25978282

  17. When systems fail: improving care through technology can create risk.

    PubMed

    Bagalio, Sharon A

    2007-01-01

    Emerging medical technology is transforming the care of the modern-day patient. Hospital performance and patient safety is improving, lowering professional liability and medical malpractice costs. This advanced technology affects not only diagnosis and treatment but also hospital productivity and revenue. However, it also exposes hospitals and medical personnel to a number of unforeseeable risks. This article examines ongoing efforts to improve patient safety through the use of technology, automation and complex systems operations. It discusses the importance of skilled negotiation when vying for technology contracts and the value of maintaining a reliable data center to support it. Technology risk exposure is now a reality. A hospital needs to know how to protect itself from cyber liability, business interruption, and data loss and theft by ensuring that there is adequate coverage. PMID:20200890

  18. Effective nursing care of children and young people outside hospital.

    PubMed

    Whiting, Lisa; Caldwell, Chris; Donnelly, Mary; Martin, Debbie; Whiting, Mark

    2015-06-10

    Aim To assess the preparation required to ensure a workforce of nurses who can provide high quality out-of-hospital services for children and young people. Methods Using mixed methods, questionnaires were sent to young people and community children's nursing teams, interviews were conducted with academic staff and clinical nurses, and focus groups were undertaken with pre-registration children's nursing students. Findings Nurses' communication skills and clinical abilities were most important to young people. There is a range of opinions about optimum out-of-hospital clinical experience. Pre- and post-qualification education and recruitment in this area, therefore, need attention. Conclusion Out-of-hospital care presents problems, but is developing rapidly. Adequate, updated training, supervision and resources are needed. PMID:26059588

  19. 76 FR 51041 - Hemoglobin Standards and Maintaining Adequate Iron Stores in Blood Donors; Public Workshop

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-17

    ...and Maintaining Adequate Iron Stores in Blood Donors; Public Workshop AGENCY: Food...and Maintaining Adequate Iron Stores in Blood Donors.'' The purpose of this public workshop is to discuss blood donor hemoglobin and hematocrit...

  20. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 2011-04-01 false Medical devices; adequate directions for use...HUMAN SERVICES (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for...

  1. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...2014-04-01 2014-04-01 false Medical devices; adequate directions for use...HUMAN SERVICES (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for...

  2. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...2012-04-01 2012-04-01 false Medical devices; adequate directions for use...HUMAN SERVICES (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for...

  3. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...2013-04-01 2013-04-01 false Medical devices; adequate directions for use...HUMAN SERVICES (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for...

  4. 72 FR 44560 - Guidance for Industry: Adequate and Appropriate Donor Screening Tests for Hepatitis B; Hepatitis...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2007-08-08

    ...Adequate and Appropriate Donor Screening Tests for Hepatitis B; Hepatitis B Surface Antigen Assays Used to Test Donors of Whole...Adequate and Appropriate Donor Screening Tests for Hepatitis B; Hepatitis B Surface Antigen (HBsAg)...

  5. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 2010-04-01 false Medical devices; adequate directions for use...HUMAN SERVICES (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for...

  6. Challenges of implementing depression care management in the primary care setting.

    PubMed

    Belnap, Bea Herbeck; Kuebler, Julie; Upshur, Carole; Kerber, Kevin; Mockrin, Deborah Ruth; Kilbourne, Amy M; Rollman, Bruce L

    2006-01-01

    Empirical evidence shows that care management is an effective tool for improving depression treatment in primary care patients. However, several conceptual and practical issues have not been sufficiently addressed. This article explores questions concerning the scope of care management services within the chronic illness care model; optimal ways to identify depressed patients in the primary care setting; responsibilities and desirable qualifications of depression care managers; the location and manner in which care managers interact with patients; costs of services provided by care managers; and the level of supervision by mental health specialists that is necessary to ensure quality care. PMID:16215660

  7. Home Care

    MedlinePLUS

    Home Care Basic Facts & Information Role of Health Care Professionals in Home Care Your physician is the leader of an interdisciplinary ... travel to see the healthcare team. Is Home Care Right for You? Home care is especially useful ...

  8. Hospice care

    MedlinePLUS

    ... person in charge of care is called the primary care giver. This may be a spouse, life partner, ... some settings the hospice team will teach the primary care giver how to care for the patient. Caring ...

  9. Workers' compensation in the United States and the role of the primary care physician.

    PubMed

    Pye, H; Orris, P

    2000-12-01

    The workers' compensation system was designed as a no-fault system in the early years of the last century. The system is organized on a state level. There are three differing models in current use: the single public fund, the single private fund, and an open market. States range as well in the amount of choice available to the injured workers in their selection of health care providers. In each state though, the physician plays an integral role in ensuring that the injured worker obtains adequate medical care in a prompt and efficient manner. The physician's function is either as treating physician, or as one who provides an independent medical evaluation for either the employee's lawyer, the employer, the insurer or their counsel or the state. Many obvious improvements in the system have not been made because political agreement on the state level is often lacking. PMID:11072289

  10. End of life care.

    PubMed

    2015-01-28

    NHS England is working with statutory and voluntary organisations to develop a five-year plan for end of life care. In the meantime, it has published a framework titled Actions for End of Life Care 2014-2016. This has four interdependent components aimed at ensuring that: individuals and carers are engaged and informed, by providing information and seeking feedback; health and care professionals are committed to partnership working by developing capability and communities of practice; processes provide more consistent, co-ordinated care; and resources and commissioning approaches that improve end of life care are developed. Specific actions to identify and address inequalities are included in each component. To read the document, go to tinyurl.com/p3dv4ce. PMID:25629343

  11. Environmental education: Ensuring a sustainable future

    SciTech Connect

    Rogers, D.P. [Environmental Protection Agency, Research Triangle Park, NC (United States); Lee, J.C. [SAIC, Durham, NC (United States)

    1997-12-31

    It is important to remember that personal actions and decisions have a significant impact on the environment. Although they may sometimes forget, today`s school children are the policy and decision makers of tomorrow. Today`s students must be exposed to factual information about the environment so they will be able to make responsible and informed ecological decisions. Since the National Environmental Education Act was signed into law in 1990, the Environmental Protection Agency (EPA) has taken an active role in ensuring a sustainable future through environmental education. Through its education programs, the EPA strives to increase environmental literacy throughout the country and encourages young people to pursue careers in math, science, engineering, communications, and other fields essential to a sustainable environment. The US Environmental Protection Agency`s Office of Air Quality Planning and Standards (OAQPS), located in Research Triangle Park, North Carolina, is an international center for air quality research and information. One of the ways OAQPS invests in the environmental preservation of the Nation is through unique environmental education programs that target teachers and students of all ages. To be sure that environmental education programs incorporate a complete look at the environment, including issues associated with air quality, the EPA works with North Carolina teachers and students through the Education and Outreach Group`s Environmental Education Program. The EPA recognizes that the key to a sustainable future is engaging teachers and others in significant environmental education experiences. They will in turn instill a sense of environmental stewardship in America`s young people. There is hope that by the year 2000, every citizen will be fluent in the principles of ecology.

  12. Rethinking parent involvement in child care programs

    Microsoft Academic Search

    Rena Shimoni; Barbara Ferguson

    1992-01-01

    The feasibility of parent involvement in child care programs is examined in terms of goals such as parent influence and control, educating parents, ensuring continuity of care, and empowerment. Studies relating to parent involvement are reviewed and their implications for child care discussed.

  13. Parent Handbook for Family Child Care Homes.

    ERIC Educational Resources Information Center

    Nebraska State Dept. of Health and Human Services, Lincoln.

    Published by Nebraska's Department of Health and Human Services, this guide provides information that will help parents and providers ensure that their child receives the best possible care from a licensed child care home provider. The guide also serves as a basis for discussion between parents and their child care providers to make a child's…

  14. Key safety issues of bowel preparations for colonoscopy and importance of adequate hydration.

    PubMed

    Dykes, Cathy; Cash, Brooks D

    2008-01-01

    Although screening colonoscopy is effective for early detection of colorectal cancer, screening rates remain low. Multiple factors are thought to be responsible for the low rates of screening colonoscopy, but bowel preparation appears to be a key deterrent. Tolerability issues with bowel preparations may lead to poor patient compliance, inadequate colon cleansing, and reduced detection of colonic polyps. Successful colon cleansing requires careful selection of the appropriate bowel purgative regimen, as well as patient acceptance of and compliance with the chosen regimen. The two major classes of bowel preparations include polyethylene glycol solutions and sodium phosphate preparations. Patient preference for tablet versus liquid formulations and medical history (e.g., renal impairment) should be considered when choosing the appropriate bowel preparation. Regardless of the bowel preparation administered, adequate hydration is important before, during, and after bowel preparation. Appropriate patient education regarding hydration and individualized patient instructions may increase compliance, reduce adverse events, promote successful bowel preparation for colonoscopy, and enhance the probability of a quality exam. PMID:18300822

  15. Heat transfer in food processing: ensuring product quality and safety

    Microsoft Academic Search

    Peter J. Fryer; Phillip T. Robbins

    2005-01-01

    Heat transfer to foods is commonplace but critical; heating develops flavour and texture and ensures product safety. The food industry must ensure that all parts of the product have all been processed sufficiently, without unacceptable loss of quality. Conventionally, food is significantly over-processed to ensure safety. This paper reviews some problems which heat-transfer engineers face in the food industry, and

  16. Ensuring Safety, Security, and Sustainability of Mission-Critical Cyber–Physical Systems

    Microsoft Academic Search

    Ayan Banerjee; Krishna K. Venkatasubramanian; Tridib Mukherjee; Sandeep Kumar S. Gupta

    2012-01-01

    Cyber–physical systems (CPSs) couple their cyber and physical parts to provide mission-critical services, including automated pervasive health care, smart electricity grid, green cloud computing, and surveillance with unmanned aerial vehicles (UAVs). CPSs can use the information available from the physical environment to provide such ubiquitous, energy-efficient and low-cost functionalities. Their operation needs to ensure three key properties, collectively referred to

  17. Treatment of Depression in a Low-Income Primary Care Setting With Colocated Mental Health Care

    Microsoft Academic Search

    Lisa A. Uebelacker; Marcia Smith; Angelique W. Lewis; Ryan Sasaki; Ivan W. Miller

    2009-01-01

    In order to characterize depression treatment-as-usual in a large primary care practice in the United States with colocated mental health care, and to examine predictors of receiving any treatment and receiving adequate treatment, primary care patients were systematically approached in waiting rooms. Those with a minimum level of depression symptoms (n = 91) were asked to participate in a study

  18. Ensuring Students Come to Class Well To ensure that your students come to class well prepared, consider

    E-print Network

    Biasutti, Michela

    of us ask our students to write response papers, reacting critically to an assigned reading, prior of evidence, and conclusions. Each of these papers will ensure that students have read and thought criticallyEnsuring Students Come to Class Well Prepared To ensure that your students come to class well

  19. Adolescents and access to health care.

    PubMed

    Klein, J D; Slap, G B; Elster, A B; Cohn, S E

    1993-01-01

    The developmental characteristics and health behaviors of adolescents make the availability of certain services--including reproductive health services, diagnosis and treatment of sexually transmitted disease, mental health and substance abuse counseling and treatment--critically important. Furthermore, to serve adolescents appropriately, services must be available in a wide range of health care settings, including community-based adolescent health, family planning and public health clinics, school-based and school-linked health clinics, physicians' offices, HMOs, and hospitals. National, authoritative content standards (for example, the American Medical Association's Guidelines for Adolescent Preventive Services (GAPS), a multispecialty, interdisciplinary guideline for a package of clinical preventive services for adolescents may increase the possibility that insurers will cover adolescent preventive services, and that these services will become part of health professionals' curricula and thus part of routine practice. However, additional and specific guidelines mandating specific services that must be available to adolescents in clinical settings (whether in schools or in communities) are also needed. Although local government, parents, providers, and schools must assume responsibility for ensuring that health services are available and accessible to adolescents, federal and state financing mandates are also needed to assist communities and providers in achieving these goals. The limitations in what even comprehensive programs currently are able to provide, and the dismally low rates of preventive service delivery to adolescents, suggests that adolescents require multiple points of access to comprehensive, coordinated services, and that preventive health interventions must be actively and increasingly integrated across health care, school, and community settings. Unless access issues are dealt with in a rational, coordinated fashion, America's adolescents will not have access to appropriate health services. Current efforts to minimize current health care expenditures through managed care programs inevitably conflict with efforts to deliver comprehensive preventive services to all adolescents. Use of multiple sites may not represent inadequate access to care. However, as managed care reimbursement continues to expand, school-based clinics and free-standing adolescent health programs increasingly report decreases in reimbursement without a change in demand for services. The Office of Technology Assessment study called for explicit funding and expansion of services for America's youth; since then, a federal Office of Adolescent Health has been authorized, and, by the time this reaches print, should have received appropriations and been staffed. Dryfoos has called for expansion to nearly 5000 comprehensive programs in the coming years. 76 Additionally, The Robert Wood Johnson Foundation has just announced a $23.2 million state-community partnership grant program to increase availability of school-based health services for children and youth with unmet health needs.77 As health care reform efforts move forward,both careful definition of the services adolescents need and adequate financing for these services are essential to ensure access to care for all adolescents. PMID:8148842

  20. Residential Care

    MedlinePLUS

    ... will not sell or share your name. Residential Care Tweet Bookmark this page | Email | Print If the ... setting Care facility checklist Costs Types of residential care A good long-term care facility should feel ...

  1. Hospice Care

    MedlinePLUS

    ... Page Resize Text Printer Friendly Online Chat Hospice Care What is Hospice Care? When is Hospice Care ... Family Counseling and Support Services What is Hospice Care? Hospice programs are available to help terminally ill ...

  2. Preconception Care

    MedlinePLUS

    ... should speak with your healthcare provider about preconception care. Preconception care is care you receive before you get pregnant. It involves finding and taking care of any problems that might affect you and ...

  3. [The "Bolsa Família" family grant scheme: the interface between professional practice and the human right to adequate food and nutrition].

    PubMed

    Ramos, Camila Irigonhé; Cuervo, Maria Rita Macedo

    2012-08-01

    The Human Right to Adequate Nutrition must be ensured through the public policies included in SAN, namely the Food and Nutritional Security campaign. Besides the income transfer geared to ensuring access to basic social rights, the "Bolsa Família" Program (PBF) is included in this context. This study seeks to analyze the operational aspects of the PBF and also ascertain whether or not the health professionals see the program as a core element of the SAN public policy. With this in mind, semi-structured interviews were conducted with primary healthcare workers involved directly both with the PBF and with the families who receive this benefit. By the end of the study, it was possible to perceive the importance of training health professionals who work in this area, because when one dissociates the social reality in which the beneficiaries live from the program objectives, this can lead to the simple mechanization of these practices. In this respect, it should be stressed that health professionals need to understand the proposals of the program as political and social strategies which, in addition to providing immediate relief, strive to overcome the problems related to poverty and hunger. PMID:22899156

  4. 32 CFR 199.16 - Supplemental Health Care Program for active duty members.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...adequate to provide the needed primary care services to the active duty service...adequate to provide the needed primary care services to the active duty service...member will select or be assigned a primary care manager. In the absence of a...

  5. 32 CFR 199.16 - Supplemental Health Care Program for active duty members.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...adequate to provide the needed primary care services to the active duty service...adequate to provide the needed primary care services to the active duty service...member will select or be assigned a primary care manager. In the absence of a...

  6. 32 CFR 199.16 - Supplemental Health Care Program for active duty members.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...adequate to provide the needed primary care services to the active duty service...adequate to provide the needed primary care services to the active duty service...member will select or be assigned a primary care manager. In the absence of a...

  7. 32 CFR 199.16 - Supplemental Health Care Program for active duty members.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...adequate to provide the needed primary care services to the active duty service...adequate to provide the needed primary care services to the active duty service...member will select or be assigned a primary care manager. In the absence of a...

  8. 32 CFR 199.16 - Supplemental Health Care Program for active duty members.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...adequate to provide the needed primary care services to the active duty service...adequate to provide the needed primary care services to the active duty service...member will select or be assigned a primary care manager. In the absence of a...

  9. Skin care for the newborn

    Microsoft Academic Search

    Rashmi Sarkar; Srikanta Basu; R. K. Agrawal; Piyush Gupta

    2010-01-01

    Skin of the newborn differs from that of an adult in several ways. It is more susceptible to trauma and infection and requires\\u000a special care. Certain principles of skin care have to be emphasized to the mother or caregiver such as gentle cleansing, adequate\\u000a hydration and moisturization of the skin, preventing friction and maceration in body folds, and protection from

  10. Improving Palliative Cancer Care

    PubMed Central

    Del Ferraro, Catherine; Ferrell, Betty; Van Zyl, Carin; Freeman, Bonnie; Klein, Linda

    2014-01-01

    Over a decade ago, the Institute of Medicine (IOM) presented Ensuring Quality Cancer Care in the United States, with recommendations for change (IOM, 1999). However, barriers to integrating palliative care (PC) to achieve high-quality care in cancer still remain. As novel therapeutic agents evolve, patients are living longer, and advanced cancer is now considered a chronic illness. In addition to complex symptom concerns, patients and family caregivers are burdened with psychological, social, and spiritual distress. Furthermore, data show that PC continues to be underutilized and inaccessible, and current innovative models of integrating PC into standard cancer care lack uniformity. The aim of this article is to address the existing barriers in implementing PC into our cancer care delivery system and discuss how the oncology advanced practice nurse plays an essential role in providing high-quality cancer care. We also review the IOM recommendations; highlight the work done by the National Consensus Project in promoting quality PC; and discuss a National Cancer Institute–funded program project currently conducted at a National Comprehensive Cancer Center, "Palliative Care for Quality of Life and Symptoms Concerns in Lung Cancer," which serves as a model to promote high-quality care for patients and their families.

  11. Daily Care

    MedlinePLUS

    ... Music & Art Personal Care Incontinence Bathing Dressing & Grooming Dental Care Medical Care Working with the Doctor Treatments Clinical Trials ... Get Tips on Personal Care Bathing Incontinence Dressing Dental Care Get Educated on Medical Care Working with the Doctor Treatments Medication Safety ...

  12. Parental participation in pediatric surgical care.

    PubMed

    Kristensson-Hallström, I

    2000-05-01

    Hospitalization and surgery are stressful experiences for children and their parents. In recent years, pediatric health care has shifted toward family-centered care that is based on close and continuous involvement of the child's family members. To shape and improve how pediatric care is delivered, health care providers need to know what children and parents need, expect, and experience. Such knowledge would enable the development of appropriate, systematic, and effective routines to optimize care for all children. Parental participation is beneficial to children, parents, and health care facilities, but it is dependent on the existence of effective routines to facilitate adequate communication among all parties. PMID:10820630

  13. [Care for dementia patients by their families and home care].

    PubMed

    Nakajima, K

    1990-05-01

    Present problems concerning home care for the aged including the following three points: 1. The extent of the period during which care is needed has been prolonged as the aged live longer than in previous times. 2. The range of need for home care has increased. 3. As a result of the increase of the individual-dependent "life support infrastructure" due to the decreased role of the family-dependent "life support infrastructure", the aged, who were more self-supporting in past, have become more dependent on care both in quality and quantity. In particular, dementia patients gradually worsen, therefore care for them becomes increasing by difficult with time. This reports attempts to clarify the actual conditions of care for dementia patients by long term stay, short term stay and day care. At present it is difficult to ensure sufficient human terminal care. To overcome this problem, some families caring for dementia patients have formed "self-help groups" and give mutual support while attempting to approach to professional aid groups. While the family is the core of the home care system, it is not necessarily home care per se. Medical and nursing systems should improve home care by creating a system by which professionals are able to approach to families caring for dementia patients through two ways of "waiting" and "visiting" community programs, and by building closer connections with the welfare service. PMID:2214310

  14. Expanded Medical Home Model Works for Children in Foster Care

    ERIC Educational Resources Information Center

    Jaudes, Paula Kienberger; Champagne, Vince; Harden, Allen; Masterson, James; Bilaver, Lucy A.

    2012-01-01

    The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates. These…

  15. DETENTION CARE IN RURAL AREAS.

    ERIC Educational Resources Information Center

    DOWNEY, JOHN J.

    DETENTION IS DEFINED AS THE TEMPORARY CARE OF CHILDREN WHO REQUIRE SECURE CUSTODY FOR THEIR OWN OR THE COMMUNITY'S PROTECTION, PENDING COURT DISPOSITION. THE DOCUMENT STATES THAT JAIL DETENTION OF CHILDREN, THE PREVALENT RECOURSE, IS DEMORALIZING, UNFIT, AND OFTEN UNNECESSARY. NEEDS ARE STATED TO INCLUDE (1) ADEQUATE PROBATION SERVICES, (2)…

  16. Distributional Learning of some Context-free Languages with a Minimally Adequate Teacher

    E-print Network

    Clark, Alexander

    Distributional Learning of some Context-free Languages with a Minimally Adequate Teacher Alexander. Angluin showed that the class of regular languages could be learned from a Minimally Adequate Teacher (mat). This approach has two parts; first basing the states of the learned automata on the residual languages or right

  17. Ensure Portability and Transferability of Credits and Skills Attained

    ERIC Educational Resources Information Center

    Hyslop, Alisha

    2008-01-01

    The fourth recommendation in ACTE's postsecondary reform position statement is to ensure portability and transferability of credits and skills attained. All postsecondary learning has value that should be recognized. Students' progress toward completion of postsecondary credentials can be improved with clear, consistent policies that ensure full…

  18. Beyond Care?

    ERIC Educational Resources Information Center

    Hedge, Nicki; Mackenzie, Alison

    2012-01-01

    Care is a feature of all of our lives, all of the time. An analysis of Scotland's Curriculum for Excellence reveals that care and caring permeate complex dimensions of life in and after school and we ask here, if, on some accounts, care can do the work required of it. Acknowledging the significance of her contribution to care, we focus on the work…

  19. Bovine hemoglobin as the sole source of dietary iron does not support adequate iron status in copper-adequate or copper-deficient rats

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This experiment was designed to determine whether hemoglobin as the sole source of dietary iron (Fe) could sustain normal Fe status in growing rats. Because adequate copper (Cu) status is required for efficient Fe absorption in the rat, we also determined the effects of Cu deficiency on Fe status of...

  20. Palliative Care

    MedlinePLUS

    ... Patients and Families Take the Quiz What Is Palliative Care? Palliative care (pronounced pal-lee-uh-tiv) is specialized medical ... life for both the patient and the family. Palliative care is provided by a specially-trained team of ...

  1. Respite Care

    MedlinePLUS

    ... Page Resize Text Printer Friendly Online Chat Respite Care What is Respite Care? How Do You Pay ... Learn More About Respite Services? What is Respite Care? Millions of Americans provide unpaid assistance each year ...

  2. Critical Care

    MedlinePLUS

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  3. Palliative Care

    MedlinePLUS

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  4. English Proficiency and Access to Health Insurance in Hispanics Who Are Elderly: Implications for Adequate Health Care

    ERIC Educational Resources Information Center

    Caesar, Lena G.

    2006-01-01

    Medicare, as a publicly funded insurance program, has produced significant improvement in the overall health of America's elderly populations. However, health disparities still persist between Hispanic and non-Hispanic White populations in terms of overall access to health services. This study utilized data from the Hispanic Established Population…

  5. Health Care Reform Act is Constitutional and Necessary

    Microsoft Academic Search

    Ian C. Bartrum

    2011-01-01

    It has been nearly a year since President Obama signed into law the most important piece of civil and social rights legislation since the 1960s. The Patient Protection and Affordable Care Act not only offers responsible solutions to our impending national health care crisis, it also protects the right to adequate health care for our most physically, financially and politically

  6. Access to Health Care in a Black Urban Elderly Population.

    ERIC Educational Resources Information Center

    Petchers, Marcia K.; Milligan, Sharon E.

    1988-01-01

    Conducted community survey (N=396) which revealed that adequate financial coverage for health care for low-income urban Black elderly has been prevented by out-of-pocket medical expenses. Found that, although health care facilities were regularly available, the lack of regular physicians' services at the health care location was a major cause of…

  7. Mobile advanced simulation for primary care pediatricians: Spanish Experience

    E-print Network

    Manstein, Dietmar J.

    Mobile advanced simulation for primary care pediatricians: Spanish Experience Purpose of the study: Advanced simulation uses to be focused on hospital and emergencies personnel. Primary care pediatricians and initiate the adequate treatment. We report the results of the Spanish Society of Primary Care Pediatrics

  8. Effective Marketing of Quality Child Care.

    ERIC Educational Resources Information Center

    Caldwell, Bettye M.; Boyd, Harper W., Jr.

    1984-01-01

    Identifies negative public and professional attitudes that lie beneath the contemporary negative image of quality child care. Argues that concepts and principles of marketing are appropriate for influencing parents to choose high quality services and helping ensure that supplementary care is of sufficient quality to enhance, not inhibit, the…

  9. Setting priorities for mental health care in Nepal: a formative study

    PubMed Central

    2013-01-01

    Background There is an urgent need to address the massive treatment gap for mental health problems, especially in low income settings. Packages of care integrated in routine primary health care are posited as a strategy to scale-up mental health care, yet more needs to be known about the most feasible and effective way to go about this. Methods The study follows a combined methods design that includes engaging an expert panel in a priority setting exercise, running workshops to develop a Theory of Change and conducting in-depth qualitative interviews and focus group discussions with key stakeholders. The results of each research step were taken forward to inform the subsequent one. Results There was strong endorsement for a system of care that encompasses both the perspectives of health facility and the community. Issues related to increasing access and demand, guaranteeing a sustainable supply of psychotropic medicine, adequate human resourcing, and ensuring positive family involvement came up as priority areas of attention. Conclusion The study underlines many of the known barriers in developing mental health services. At the same time it provides a distinct pathway and concrete recommendations for overcoming these challenges in Nepal. PMID:24305432

  10. Service Users and Providers Expectations of Mental Health Care in Iran: A Qualitative Study

    PubMed Central

    Setareh Forouzan, Ameneh; Ghazinour, Mehdi; Dejman, Masoumeh; Rafeiey, Hassan; Baradaran Eftekhari, Monir; San Sebastian, Miguel

    2013-01-01

    Abstract Background Mental disorders are known to be an important cause of disabilities worldwide. Despite their importance, about two thirds of mentally ill people do not seek treatment, probably because of the mental health system’s inability to decrease the negative side effects of the interaction with the mental health services. The World Health Organization has suggested the concept of responsiveness as a way to better understand the active interaction between the health system and the population. This study aimed to explore the expectations of mental health service users and providers. Methods Six focus group discussions were carried in Tehran, the capital of Iran. In total, seventy-four participants comprising twenty-one health providers and fifty-three users of mental health system were interviewed. Interviews were analyzed through content analysis. The coding was synchronized between the researchers through two discussion sessions to ensure the credibility of the findings. The results were then discussed with two senior researchers to strengthen plausibility. Results Five common domains among all groups were identified: accessibility, quality of interpersonal relationships, adequate infrastructure, participation in decisions, and continuity of care. The importance of cultural appropriateness of care was only raised by service users as an expectation of an ideal mental health service. Conclusions Both users and providers identified the most relevant expectations from the mental health care system in Iran. More flexible community mental health services which are responsive to users’ experiences may contribute to improving the process of care for mental health patients.

  11. Confronting the care penalty: the case for extending reasonable adjustment rights along the disability\\/care continuum

    Microsoft Academic Search

    Charlotte OBrien

    2012-01-01

    Informal caring for adults with disabilities is a source of unacceptable disadvantage in employment, finances, social inclusion, and health; here termed the ‘care penalty’. This penalty can be appropriately tackled through equality law, making care a ground for unlawful discrimination. Carers are not adequately protected from indirectly discriminatory disadvantages by other grounds such as sex and disability. Nor are carers

  12. Regulatory Considerations to Ensure Clean and Safe Drinking Water

    EPA Science Inventory

    Federal drinking water regulations are based on risk assessment of human health effects and research conducted on source water, treatment technologies, residuals, and distribution systems. The book chapter summarizes the role that EPA research plays in ensuring pure drinking wat...

  13. COMPRESSION INDEPENDENT OBJECT ENCRYPTION FOR ENSURING PRIVACY IN VIDEO SURVEILLANCE

    E-print Network

    Kalva, Hari

    COMPRESSION INDEPENDENT OBJECT ENCRYPTION FOR ENSURING PRIVACY IN VIDEO SURVEILLANCE Paula Carrillo of video surveillance is the loss of individual privacy. Individuals who are not suspects need solution that provides privacy in video surveillance applications. The proposed approach is based

  14. Acoustical and noise redesign considerations when trying to increase patient privacy while ensuring comfort

    NASA Astrophysics Data System (ADS)

    Klavetter, Eric

    2005-09-01

    An internal assessment was undertaken to understand the flow of patients to ensure comfort and privacy during their health care experience at Mayo Clinic. A number of different prototypes, work flows, and methodologies were utilized and assessed to determine the ``best experience for our patients.'' A number of prototypes ranging from self-check in to personal pagers were assessed along with creating environments that introduced ``passive distractions'' for acoustical and noise management, which can range from fireplaces, to coffee shops to playgrounds to ``tech corridors.'' While a number of these designs are currently being piloted, the over-reaching goal is to make the patient experience ``like no other'' when receiving their care at Mayo Clinic.

  15. A public-sector HMO in a competitive market: ensuring equity for the poor.

    PubMed

    Bluford, J W

    1994-01-01

    While managed care is still a new concept in much of the country, it has been a reality in the Minneapolis-St. Paul area for more than three decades. Metropolitan Health Plan (MHP), a public-sector, county-owned health maintenance organization (HMO), was developed 10 years ago as a mechanism to ensure retention of the county hospital's historical patient base if the state of Minnesota were to mandate managed care for public-assistance patients (which occurred in 1985). Because MHP's chief provider organization was Hennepin County Medical Center, which has a long history of serving the poor, it had an advantage over its more established competitors. MHP's greater knowledge of the population and sensitivity to ethnic and cultural diversity has enabled it to develop programs and systems to streamline access to services, many of which are unique to MHP. PMID:7918887

  16. Clinical guidelines for postpartum women and infants in primary care–a systematic review

    PubMed Central

    2014-01-01

    Background While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care. Methods PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument. Results Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest. Conclusions Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines. PMID:24475888

  17. LIABILITY FOR INDEPENDENT CONTRACTORS IN CONTRACT AND TORT: DUTIES TO ENSURE THAT CARE IS TAKEN

    E-print Network

    Morgan, Jonathan

    2015-03-26

    , they cannot be taken to approve the arguments that follow. 1 [2013] UKSC 66; [2014] A.C. 537 (Woodland). 2 Cf. R. Dworkin, Justice in Robes (Cambridge, Mass. 2006), 69: “Is abortion more like infanticide or appendectomy? We cannot even begin to answer...

  18. [Medical consult before taking a plane: assessment and advice by the primary care physician].

    PubMed

    Butty, Anne-Virginie; Pala, Christophe; Dao, Melissa Dominicé

    2014-09-24

    Many of our patients travel by air. During the flight, they are exposed to specific physical conditions: decrease of the PaO2, increase of body gas volume and decrease in humidity. Depending on their illness, their tolerance to these conditions may vary. The primary care physician's role is to adequately counsel patients in order to ensure their security during and after the flight, as well as to prescribe additional therapies, when needed. Patients with a hypoxemic medical condition or patients that were recently operated deserve particular attention. Complications of common ear, nose and throat diseases should not be underestimated. Preventive recommendations for thromboembolic disease need to be addressed, while drug prophylaxis is not systematically recommended any more for patients with major thromboembolic risk factors. PMID:25369695

  19. Ensuring safe water in post-chemical, biological, radiological and nuclear emergencies.

    PubMed

    Amar, Praveen Kumar

    2010-07-01

    Disaster scenarios are dismal and often result in mass displacement and migration of people. In eventuality of emergency situations, people need to be rehabilitated and provided with an adequate supply of drinking water, the most essential natural resource needed for survival, which is often not easily available even during non-disaster periods. In the aftermath of a natural or human-made disaster affecting mankind and livestock, the prime aim is to ensure supply of safe water to reduce the occurrence and spread of water borne disease due to interrupted, poor and polluted water supply. Chemical, biological, radiological and nuclear (CBRN) emergencies augment the dilemma as an additional risk of "contamination" is added. The associated risks posed to health and life should be reduced to as low as reasonably achievable. Maintaining a high level of preparedness is the crux of quick relief and efficient response to ensure continuous supply of safe water, enabling survival and sustenance. The underlying objective would be to educate and train the persons concerned to lay down the procedures for the detection, cleaning, and treatment, purification including desalination, disinfection, and decontamination of water. The basic information to influence the organization of preparedness and execution of relief measures at all levels while maintaining minimum standards in water management at the place of disaster, are discussed in this article. PMID:21829321

  20. Ensuring safe water in post-chemical, biological, radiological and nuclear emergencies

    PubMed Central

    Amar, Praveen Kumar

    2010-01-01

    Disaster scenarios are dismal and often result in mass displacement and migration of people. In eventuality of emergency situations, people need to be rehabilitated and provided with an adequate supply of drinking water, the most essential natural resource needed for survival, which is often not easily available even during non-disaster periods. In the aftermath of a natural or human-made disaster affecting mankind and livestock, the prime aim is to ensure supply of safe water to reduce the occurrence and spread of water borne disease due to interrupted, poor and polluted water supply. Chemical, biological, radiological and nuclear (CBRN) emergencies augment the dilemma as an additional risk of “contamination” is added. The associated risks posed to health and life should be reduced to as low as reasonably achievable. Maintaining a high level of preparedness is the crux of quick relief and efficient response to ensure continuous supply of safe water, enabling survival and sustenance. The underlying objective would be to educate and train the persons concerned to lay down the procedures for the detection, cleaning, and treatment, purification including desalination, disinfection, and decontamination of water. The basic information to influence the organization of preparedness and execution of relief measures at all levels while maintaining minimum standards in water management at the place of disaster, are discussed in this article. PMID:21829321

  1. Patient acceptance of adequately filled breast implants using the tilt test.

    PubMed

    Tebbetts, J B

    2000-07-01

    Adequate fill of any breast implant, regardless of shell characteristics, shape, or filler material, is important to prevent implant shell wrinkling, folding, or collapse that could potentially decrease the life of the implant. Implant shell life is a major factor that affects reoperation rates. The greater the necessity of reoperations, regardless of implant type, the greater the rate of local complications, necessitating additional surgery with additional risks and costs to patients. Palpable shell folding, visible wrinkling or rippling, palpable shifts of filler material, sloshing, and compromised aesthetic results can result from an under-filled implant. Any of these complications can necessitate reoperations with increased risks and costs to patients. This is a study of 609 consecutive patients from January of 1993 to December of 1998 who were given detailed preoperative informed consent and a choice of implant shape and type and who chose the increased firmness associated with an implant that is adequately filled to pass the tilt test. This study addresses two questions: (1) Will patients accept the increased firmness of an implant that is filled to pass the tilt test? and (2) Is adequate fill by the tilt test useful clinically to help reduce the incidence of postoperative rippling, wrinkling, and spontaneous deflation in saline implants? Patients were followed by postoperative examinations and questionnaires. No patient requested implant replacement to a softer implant postoperatively, and no reoperations were performed for visible rippling or wrinkling. The spontaneous deflation rate over this 6-year period was 9 of 1218 implants, or 0.739 percent. If patients will accept more firmness with an adequately filled implant, regardless of the filler material, surgeons might worry less about recommending an adequately filled implant to patients, and manufacturers might feel more comfortable producing adequately filled implants and redefining fill volumes for underfilled implants. More adequately filled implants could potentially reduce risks of reoperations by reducing premature shell failure and shell wrinkling complications. PMID:10883627

  2. Managed care challenges and opportunities for cardiovascular advanced practice nurses.

    PubMed

    Urban, N

    1997-02-01

    The aggressive changes in the health-care system are mandating revolutionary new approaches in patient-care delivery. Cardiovascular care, in particular, is under scrutiny due to its high cost and wide variation in outcome. The need to comprehensively coordinate cardiac surgical care and aggressively manage complex cases has resulted in growing interest in using cardiovascular advanced practice nurses (APNs) to ensure high-quality, yet cost-effective patient care. The unique skills of the cardiovascular APN as practitioner, consultant, educator, researcher, and change agent ensure optimal outcomes for patients and their families as well the staff, physicians, and the hospital's bottom line. PMID:9086921

  3. The Impact of Day Care

    PubMed Central

    Alexander, Jean

    1983-01-01

    Children who attend day care centres have different behavioral characteristics than children cared for at home by parents. Several studies report that children who have attended day care are more aggressive, more physically active, less cooperative, interact more with their peers, and are slower in acquiring adults' cultural values than children cared for at home. While children from low risk families appear to gain no cognitive advantage from day care, those from high risk families or with developmental problems do. Problems with hearing, vision, development or behavior, and child abuse may be identified in a well organized centre. Early recognition of developmental problems may help ensure the child does not lack self-worth later on. Imagesp1880-ap1881-a PMID:21283426

  4. HACCP approach to ensure the safety and quality of food packaging.

    PubMed

    Bovee, E H; de Kruijf, N; Jetten, J; Barendsz, A W

    1997-01-01

    EC Directive 93/43/EEC of 14 June 1993 on the hygiene of foodstuffs has been implemented in the Netherlands through the Food and Commodity Act (Warenwet) of 14 December 1995. This Directive requires food companies to identify steps in their activities that are critical to ensuring food safety, and to ensure that adequate safety procedures are identified, implemented, maintained and reviewed based on the principles of the Hazard Analysis Critical Control Point (HACCP) system. HACCP is a tool used to assess hazards, estimate risks and establish specific control measures that emphasize prevention and control rather than reliance on end-product testing. Increasing public awareness of food safety, together with the introduction of this new legislation, has led producers and retailers of food to demand higher standards from their suppliers. Suppliers of raw materials, ingredients and also food packaging will be expected to bring their standards of hygiene in line with the expectations of the food industry. Food producers will need to obtain the guarantee from their suppliers that the packaging does not negatively influence their products. HACCP is a method that can also be applied to ensure the safety and other quality aspects of all kinds of food packaging materials such as films, foils, trays, cups, boxes and tubs made of paper, cardboard, polymers, metal and other materials (single use or disposable packagings as well as re-usable and recycled packagings). At the Netherlands Organization for Applied Scientific Research (TNO), the quality and safety aspects of re-use of food packaging, and refillable bottles in particular, have been the subject of extensive investigations in the project 'Quality monitoring of synthetic refillable bottles'. In this paper the set-up of the project and the Codes of Practice for refillable bottles are described. Moreover, the applicability of HACCP to food packagings and an example of a HACCP study for refillable PET bottles will be discussed. PMID:9373535

  5. How did formative research inform the development of a home-based neonatal care intervention in rural Ghana?

    PubMed

    Hill, Z; Manu, A; Tawiah-Agyemang, C; Gyan, T; Turner, K; Weobong, B; Ten Asbroek, A H A; Kirkwood, B R

    2008-12-01

    Formative research is often used to inform intervention design, but the design process is rarely reported. This study describes how an integrated home visit intervention for newborns in Ghana was designed. As a first step in the design process, the known intervention parameters were listed, information required to refine the intervention was then identified and a formative research strategy designed. The strategy included synthesizing available data, collecting data on newborn care practices in homes and facilities, on barriers and facilitators to adopting desired behaviors and on practical issues such as whom to include in the intervention. The data were used to develop an intervention plan through workshops with national and international stakeholders and experts. The intervention plan was operationalized by district level committees. This included developing work plans, a creative brief for the materials and completing a community volunteer inventory. The intervention was then piloted and the intervention materials were finalized. The design process took over a year and was iterative. Throughout the process, literature was reviewed to identify the best practice. The intervention focuses on birth preparedness, using treated bednets in pregnancy, early and exclusive breastfeeding, thermal care, special care for small babies and prompt care seeking for newborns with danger signs. The need for a problem-solving approach was identified to help ensure behavior change. A subset of behaviors were already being performed adequately, or were the focus of other interventions, but were important to reinforce in the visits. These include attending antenatal care and care seeking for danger signs in pregnancy. On the basis of the intervention content, the timing of newborn deaths and the acceptability of visits, two antenatal and three visits in the first week of life (days 1, 3 and 7) were planned. Several household members were identified to include in the visits as they were involved in newborn care or they made financial decisions. Birth attendants and health workers were often the locus of control for immediate newborn care, and sensitization activities were designed to improve their practices and to help ensure that families received consistent messages. An existing cadre of community volunteers was identified to deliver the intervention-these volunteers were already trusted and accepted by the community, already visited pregnant women at home and had the time and commitment to deliver the intervention. A supervision and remuneration system was developed through discussions with the volunteers and at the planning workshops. The need for community entry activities was identified to garner community support for the intervention, to encourage self-identification of pregnant and delivered women and to motivate the volunteer through community recognition. Formative research is an essential step in helping to ensure the development of an effective, appropriate and sustainable intervention. PMID:19057567

  6. Investing in Our Future: A Guide to Child Care Financing.

    ERIC Educational Resources Information Center

    Stoney, Louise; Groginsky, Scott; Poppe, Julie

    This book investigates the innovative ways being used to ensure and finance high quality care for children. Chapter 1, "Introduction," discusses the government's role in helping to structure, build, and finance the system, as well as financing strategies. Chapter 2, "Financing Child Care Supply," addresses center-based child care, supports for…

  7. Animal and Range Sciences Department Agricultural Animal Care Training Program

    E-print Network

    Maxwell, Bruce D.

    Animal and Range Sciences Department Agricultural Animal Care Training Program Approved by AACUC May 2003 Goals The goals of the Agricultural Animal Care Training Program are to ensure animal well-being, the validity and effectiveness of research and teaching activities, and the health and safety of animal care

  8. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care

    PubMed Central

    Valentijn, Pim P.; Schepman, Sanneke M.; Opheij, Wilfrid; Bruijnzeels, Marc A.

    2013-01-01

    Introduction Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care. Methods The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method) and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework. Results The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration), meso (professional and organisational integration) and macro (system integration) level. Functional and normative integration ensure connectivity between the levels. Discussion The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective. PMID:23687482

  9. Palliative Care in Children With Cancer: Which Child and When?

    Microsoft Academic Search

    Michael B. Harris

    2004-01-01

    At a time of increasing interest in palliative care in pediat- rics, pediatric oncology programs may be failing to deliver adequate palliation to children with cancer. In a recent study, parents of children who died on a pediatric oncology service reported that despite treatment at the end of life, their children's suffering was not adequately relieved and that parents were

  10. Representing Critical Care Data Using the Clinical Care Classification

    PubMed Central

    Moss, Jacqueline; Damrongsak, Mantana; Gallichio, Kathleen

    2005-01-01

    Concept-oriented terminologies require the user to combine terms, making them awkward for their direct use as a documentation tool. Therefore, classification systems are needed to serve as interface terminologies between the user and the reference terminology used to organize the computer database system. Whether nursing classification systems provide sufficient granularity to adequately capture nursing practice is controversial. In addition, no nursing classification systems have been designed specifically for or evaluated in the critical care setting. The purpose of this study was to evaluate the ability of the Clinical Care Classification (CCC) to represent data in an intensive care setting and to provide recommendations for the expansion of this classification for its use in critical care documentation. PMID:16779099

  11. Navigating an Educational Program through the Treacherous 90s: Dynamics of the Health Care System.

    ERIC Educational Resources Information Center

    Van Ostenburg, Paul

    1991-01-01

    Health care system changes since 1965 are reviewed. Areas in which hospital dental care can contribute to improved dental services are discussed, including the promotion of dentistry as primary care, progress in obtaining adequate reimbursement for oral health care, integration with other health professions, and improvement of credentialing and…

  12. An approach for representing and managing medical exceptions in care pathways based on

    E-print Network

    Fernández Olivares, Juan

    An approach for representing and managing medical exceptions in care pathways based on temporal of a patient- centered care pathway. Personalized care pathways are generated auto- matically by means is evaluated with oncology care plans, seems to be an adequate exception recovery mechanism maintaining

  13. December 2011 EA Report Brown Bagger 1 EAPs and Primary Care Physicians

    E-print Network

    Kim, Duck O.

    December 2011 EA Report Brown Bagger 1 Brown Bagger EAPs and Primary Care Physicians By Harry to visit their primary care physicians, who often are not equipped to provide adequate treatment for depression (Wojcik, 2004). Primary Care Physicians Primary care physicians are more likely than mental health

  14. Hospice Care

    MedlinePLUS

    ... comfort as possible. Is hospice care available to nursing home residents? Yes. The services of hospice care programs ... home, a family member's home, a hospital, a nursing home or a hospice facility. The members of the ...

  15. Palliative Care

    MedlinePLUS

    ... are consistent with your personal values and beliefs. Palliative Care Basics Palliative means relieving or soothing symptoms without ... what is best for you and your child. Palliative Care Considerations Before you make a choice regarding palliative ...

  16. CARES Foundation

    MedlinePLUS

    ... much they do for you every day! WHO CARES FOR YOU? POST your pics/videos/messages on ... LIKE DONATE SHARE! Children’s Hospital Los Angeles Comprehensive Care Center Ribbon-Cutting Ceremony, Los Angeles, CA – June ...

  17. Self Care

    MedlinePLUS

    The Center for Health & Healing Mount Sinai Beth Israel Heart Disease Diabetes Chronic Pain New Approaches to Chronic Disease Self Assessment Self Care Connections Experiences Research Learning Evaluation Print Email Self Care If you are living with a chronic health ...

  18. Cancer Care in the United States: What's Right, What's Wrong? - September 16, 1999

    Cancer.gov

    CANCER CARE IN THE UNITED STATES: WHAT'S RIGHT, WHAT'S WRONG? ENSURING THE QUALITY OF CANCER CARE Robert Hiatt, M.D., Ph.D., Deputy Director of the Division of Cancer Control and Population Sciences National Cancer Institute National Institutes

  19. Prenatal Care.

    ERIC Educational Resources Information Center

    Office of Child Development (DHEW), Washington, DC.

    Initially published by the Children's Bureau in 1913, this pamphlet has been revised frequently. Its purpose is to point out the importance of medical care during pregnancy. Comfortable pregnancies, easy labor, and better care for their new infants are the usual concerns of prospective mothers. Consequently, this 1962 edition of "Prenatal Care"…

  20. To Ensure the Learning of Every Child with a Disability.

    ERIC Educational Resources Information Center

    Mainzer, Richard W.; Deshler, Donald; Coleman, Mary Ruth; Kozleski, Elizabeth; Rodriguez-Walling, Matty

    2003-01-01

    This paper reviews progress made since a Council for Exceptional Children Commission in 2000 identified three outcomes fundamental to ensuring learning results for every exceptional learner. It concludes that the special education field will continue to lose its workforce without the active engagement of state and local policymakers, educators,…

  1. Ensuring Successful Development of Multimedia Computer-Based Training (CBT)

    Microsoft Academic Search

    Carolyn Stein; Mark N. Frolick

    2001-01-01

    Error-free multimedia computer-based training must be produced quickly to respond to market demand. This presents a challenge to project managers who are under pressure to keep production costs low. Testing is the key to limiting risk and ensuring quality. This article describes how testing multimedia differs from standard application testing and shows how project managers can set up an effective

  2. Ensuring Good Character and Civic Education: Connecting through Service Learning

    ERIC Educational Resources Information Center

    Shumer, Robert; Lam, Carolina; Laabs, Bonnie

    2012-01-01

    Character and citizenship education are part of the vision of many countries, including Singapore. Ensuring they are implemented in academic environments, service learning has been shown to be a natural bridge between the two. Research has shown that service learning, when done well, produces outcomes related to character development and…

  3. INTERIOR VIEW WITH ANNEALING OVEN AND OPERATOR ENSURING THAT ALL ...

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

    INTERIOR VIEW WITH ANNEALING OVEN AND OPERATOR ENSURING THAT ALL ENTERING PIPE IS STRAIGHT AND THAT THE CORE HAS BEEN REMOVED FROM THE BELL END OF EACH PIPE - McWane Cast Iron Pipe Company, Pipe Casting Area, 1201 Vanderbilt Road, Birmingham, Jefferson County, AL

  4. Operations Manager Vince ensures the timely and cost-

    E-print Network

    Narasayya, Vivek

    sources the right quality product from the right supplier at the right price. She understands supplier to Alicia. Ricardo · Quality Controller Ricardo maintains traceability support documentation and ensures product quality by inspecting received and shipped products. LOGISTICS Oscar · Process Engineer Oscar

  5. Strategies for Ensuring Trustworthiness in Qualitative Research Projects

    ERIC Educational Resources Information Center

    Shenton, Andrew K.

    2004-01-01

    Although many critics are reluctant to accept the trustworthiness of qualitative research, frameworks for ensuring rigour in this form of work have been in existence for many years. Guba's constructs, in particular, have won considerable favour and form the focus of this paper. Here researchers seek to satisfy four criteria. In addressing…

  6. Ensuring Equal Access to High-Quality Education. Revised

    ERIC Educational Resources Information Center

    Office for Civil Rights, US Department of Education, 2011

    2011-01-01

    The Office for Civil Rights (OCR) in the U.S. Department of Education (Department) is a law enforcement agency charged with enforcing federal civil rights laws to ensure that educational institutions receiving federal financial assistance do not engage in discriminatory conduct. OCR enforces the federal civil rights laws that prohibit…

  7. Ensuring system and software reliability in safety-critical systems

    Microsoft Academic Search

    W. T. Tsai; R. Mojdehbakhsh; F. Zhu

    1998-01-01

    Reliability growth models, formal specifications, testing, safety analysis have been proposed to address system and software reliability. This paper presents a technique, called ripple effect analysis, which is well known in software maintenance, for system and software reliability. This technique is useful to ensure that all the changes that need to be done are indeed changed after a software modification.

  8. Building strategies to ensure language coexistence in presence of bilingualism

    E-print Network

    Paris-Sud XI, Université de

    Building strategies to ensure language coexistence in presence of bilingualism C. Bernard, S- tition. Some models involve two different languages, others include also a bilingual population coexistence in presence of a bilingual population. Among this set, we empha- sise slow viable evolutions

  9. Ensuring the Validity of the Micro Foundation in DSGE Models

    Microsoft Academic Search

    Martin Møller Andreasen

    2008-01-01

    The presence of i) stochastic trends, ii) deterministic trends, and\\/or iii) stochastic volatil- ity in DSGE models may imply that the agents' objective functions attain infinite values. We say that such models do not have a valid micro foundation. The paper derives sufficient condi- tions which ensure that the objective functions of the households and the firms are finite even

  10. Inspection criteria ensure quality control of parallel gap soldering

    NASA Technical Reports Server (NTRS)

    Burka, J. A.

    1968-01-01

    Investigation of parallel gap soldering of electrical leads resulted in recommendation on material preparation, equipment, process control, and visual inspection criteria to ensure reliable solder joints. The recommendations will minimize problems in heat-dwell time, amount of solder, bridging conductors, and damage of circuitry.

  11. Making the Grade: How Boards Can Ensure Academic Quality

    ERIC Educational Resources Information Center

    Ewell, Peter

    2006-01-01

    "Making the Grade: How Boards Can Ensure Academic Quality" fills a significant void in today's boardroom discussions with its clear, realistic advice and its "perfect pitch" balancing act with respect to board involvement with the heart of the academic enterprise: teaching and learning. NCHEMS vice president Peter Ewell clarifies the grey areas of…

  12. Specially Designed Assessment and Instruction for Children Who Have Not Responded Adequately to Reading Intervention

    ERIC Educational Resources Information Center

    Knutson, Jennifer S.; Simmons, Deborah C.; Good, Roland, III; McDonagh, Sarah H.

    2004-01-01

    Dimensions of instruction and assessment were manipulated within a tertiary prevention to examine their effects on word and text reading development. In this article case studies of two children who demonstrated significant and sustained lack of adequate response to treatment are profiled. Results indicated that reducing group size, using…

  13. Perceptions of Teachers in Their First Year of School Restructuring: Failure to Make Adequate Yearly Progress

    ERIC Educational Resources Information Center

    Moser, Sharon

    2010-01-01

    The 2007-2008 school year marked the first year Florida's Title I schools that did not made Adequate Yearly Progress (AYP) for five consecutive years entered into restructuring as mandated by the "No Child Left Behind Act" of 2001. My study examines the perceptions of teacher entering into their first year of school restructuring due to failure to…

  14. Adequate Motion Simulation and Collision Detection for Soccer Playing Humanoid Robots

    E-print Network

    Stryk, Oskar von

    Adequate Motion Simulation and Collision Detection for Soccer Playing Humanoid Robots Martin Friedmann, Karen Petersen, Oskar von Stryk Simulation, Systems Optimization and Robotics Group Technische.tu-darmstadt.de Abstract-- In this paper a humanoid robot simulator built with the Multi-Robot-Simulation-Framework (Mu

  15. Characteristics of Adequate and Inadequate Responders in a Multi-Tiered Model

    ERIC Educational Resources Information Center

    Greulich, Luana L.

    2012-01-01

    This study is a secondary analysis on a larger study that was conducted by Al Otaiba and colleagues (2011). The participants include 170 students that participated in Tier 2 and 3 intervention during a school year. The primary purpose of this mixed methods study was to determine accuracy for group membership for adequate and inadequate responders…

  16. ARE RADON GAS MEASUREMENTS ADEQUATE FOR EPIDEMIOLOGICAL STUDIES AND CASE CONTROL

    E-print Network

    Yu, K.N.

    ARE RADON GAS MEASUREMENTS ADEQUATE FOR EPIDEMIOLOGICAL STUDIES AND CASE CONTROL STUDIES OF RADON 2004 The lung dose derived from radon is not attributed to the radon gas itself, but instead to its of the radon risk, the excess number of cancers are related to the radon gas exposure, and not to the radon

  17. The Unequal Effect of Adequate Yearly Progress: Evidence from School Visits

    ERIC Educational Resources Information Center

    Brown, Abigail B.; Clift, Jack W.

    2010-01-01

    The authors report insights, based on annual site visits to elementary and middle schools in three states from 2004 to 2006, into the incentive effect of the No Child Left Behind Act's requirement that increasing percentages of students make Adequate Yearly Progress (AYP) in every public school. They develop a framework, drawing on the physics…

  18. The Relationship between Parental Involvement and Adequate Yearly Progress among Urban, Suburban, and Rural Schools

    ERIC Educational Resources Information Center

    Ma, Xin; Shen, Jianping; Krenn, Huilan Y.

    2014-01-01

    Using national data from the 2007-08 School and Staffing Survey, we compared the relationships between parental involvement and school outcomes related to adequate yearly progress (AYP) in urban, suburban, and rural schools. Parent-initiated parental involvement demonstrated significantly positive relationships with both making AYP and staying off…

  19. How to Modify Grade Point Average (GPA) to Make It More Adequate

    E-print Network

    Kreinovich, Vladik

    How to Modify Grade Point Average (GPA) to Make It More Adequate Joe Lorkowski1 , Olga Kosheleva2 by comparing their Grade Point Average (GPA). A GPA is simply an arithmetic average of all the grades: for ex- ample, if, after completing all required classes with the highest grade of "excellent" (A

  20. Criteria for Rating Audit Opinions and Risks Reasonable to Strong Improvement Opportunity Not adequate

    E-print Network

    Maxwell, Bruce D.

    Criteria for Rating Audit Opinions and Risks Reasonable to Strong Improvement Opportunity a campus or the institution Risk Ratings IMPACT Opinions are only issued when sufficient audit Not adequate Only low risk observations with low likelihood and/or significance of negative impacts noted

  1. Leadership Style and Adequate Yearly Progress: A Correlational Study of Effective Principal Leadership

    ERIC Educational Resources Information Center

    Leapley-Portscheller, Claudia Iris

    2008-01-01

    Principals are responsible for leading efforts to reach increasingly higher levels of student academic proficiency in schools associated with adequate yearly progress (AYP) requirements. The purpose of this quantitative, correlational study was to identify the degree to which perceptions of principal transformational, transactional, and…

  2. Inferential Processing among Adequate and Struggling Adolescent Comprehenders and Relations to Reading Comprehension

    ERIC Educational Resources Information Center

    Barth, Amy E.; Barnes, Marcia; Francis, David; Vaughn, Sharon; York, Mary

    2015-01-01

    Separate mixed model analyses of variance were conducted to examine the effect of textual distance on the accuracy and speed of text consistency judgments among adequate and struggling comprehenders across grades 6-12 (n = 1,203). Multiple regressions examined whether accuracy in text consistency judgments uniquely accounted for variance in…

  3. Conducting Tests of Hypotheses: The Need for an Adequate Sample Size

    ERIC Educational Resources Information Center

    Asraf, Ratnawati Mohd; Brewer, James K.

    2004-01-01

    This article addresses the importance of obtaining a sample of an adequate size for the purpose of testing hypotheses. The logic underlying the requirement for a minimum sample size for hypothesis testing is discussed, as well as the criteria for determining it. Implications for researchers working with convenient samples of a fixed size are also…

  4. Human milk feeding supports adequate growth in infants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Despite current nutritional strategies, premature infants remain at high risk for extrauterine growth restriction. The use of an exclusive human milk-based diet is associated with decreased incidence of necrotizing enterocolitis (NEC), but concerns exist about infants achieving adequate growth. The ...

  5. Abstract --The need to determine adequate regulations in the transmission activity in deregulated environments does not

    E-print Network

    Dixon, Juan

    that are adapted to local market conditions. Relevant issues are transmission tariff schemes and transmission expansion methods, both intimately linked. The Chilean 1982 regulation defines a user based tariff scheme, including costs sub additivities [1]. The challenge is to determine an adequate tariff scheme for electrical

  6. Facilitating Adequate Prioritization of Safety Goals in Distributed Teams at the Norwegian Continental Shelf

    Microsoft Academic Search

    A. B. Skjerve; G. Rindahl; H. O. Randem; S. Sarshar

    Petroleum installation employees have to balance safety goals versus other types of goals as a part of their daily work activities. To reduce the risk for incidents and accidents, it is critical to obtain a better understanding of how to facilitate adequate prioritization of safety goals, i.e., prioritizations in accordance with the standards set by the company in charge. The

  7. Performance Effects of Failure to Make Adequate Yearly Progress (AYP): Evidence from a Regression Discontinuity Framework

    ERIC Educational Resources Information Center

    Hemelt, Steven W.

    2011-01-01

    As the No Child Left Behind (NCLB) law moves through the reauthorization process, it is important to understand the basic performance impacts of its central structure of accountability. In this paper, I examine the effects of failure to make Adequate Yearly Progress (AYP) under NCLB on subsequent student math and reading performance at the school…

  8. Spirituality, religion and palliative care.

    PubMed

    Richardson, Patrice

    2014-07-01

    As medical science has evolved, many conditions that once were thought to be "death sentences" have become chronic illness. In some ways, this makes death and dying more complicated, fraught with decisions about what care is appropriate and when to withhold or withdraw care. Studies have shown that most patients faced with life-threatening illness have spiritual needs that are not adequately addressed by their health care providers. The philosophy and practice of palliative care operates upon an understanding of whole person care, reflected in the muli-dimensional approach of the biopsychosocial model. One cannot provide whole-person care without giving consideration to the relevant spiritual needs held by patients with serious illness. As palliative care clinicians, we are uniquely positioned to work with teams/patients/families to explore the many variables that individuals and their families use as the guiding principles when making difficult decisions around end of life. While we are often consulted to manage physical symptoms, that is only part of our work. As we work on building relationships, both with our patients and their care team, we are often able to help facilitate communication that allows for mutually satisfactory goal setting. We are equipped to work with patients within their cultural contexts of which spirituality is a part. It is important to recognize the barriers to providing adequate spiritual care. The National Consensus Project has created clinical practice guidelines to provide a road map for the provision of quality palliative care. These guidelines delineate eight domains that are addressed through the provision of palliative care; the fifth domain gives attention to spiritual, religious and existential aspects of care. Guidelines recommend the use of standardized tools wherever possible to assess spiritual needs; referral to members of the interdisciplinary team who have specialized skills in addressing existential and spiritual concerns, and initiating contact and communication with community spiritual providers as requested by patients and their families. Palliative care providers are also called to be advocates for the spiritual and religious rituals of patients and families, especially at the time of death. PMID:25841692

  9. Coercion and compulsion in community mental health care.

    PubMed

    Molodynski, Andrew; Rugkåsa, Jorun; Burns, Tom

    2010-01-01

    There is ongoing debate in the UK as to the place of coercion and compulsion in community mental health care. Recent changes in service provision and amendments to the Mental Health Act in England and Wales have increased the scope for compulsion in the community. This has intensified the debate revealing fault lines in the psychiatric and legal professions. Despite powerful arguments from all sides there is little empirical evidence to inform this debate at a clinical or a theoretical level. This review utilizes evidence from articles in peer reviewed journals. Papers were identified from electronic databases, the authors' databases of relevant literature and personal correspondence with experts in the field. The evidence base is relatively small but is expanding. It has been demonstrated that informal coercion is common in USA mental health services and can be experienced negatively by patients. There is evidence that powers of compulsion in community mental health care are used frequently when available and their availability is generally seen as positive by clinicians when practice becomes embedded. The evidence for the effectiveness of compulsion in community mental health care is patchy and conflicting, with randomized or other trials failing to show significant benefits overall even if secondary analyses may suggest positive outcomes in some subgroups. There are widespread regional and international differences in the use of community compulsion. Research examining treatment pressures (or 'leverage') and the subjective patient experience of them appears to be expanding and is increasing our awareness and understanding of these complex issues. There is an urgent need for evidence regarding the usefulness and acceptability of compulsion in the community now that powers have been made available. Trials of the effectiveness of compulsion are needed as is qualitative work examining the experiences of those involved in the use of such orders. These are needed to help clinicians utilize the powers available to them in an informed and judicious fashion and to ensure adequate training. PMID:20501486

  10. The ethics of nursing care and 'the ethic of care'.

    PubMed

    Bowden, P L

    1995-03-01

    Recent discussions concerning the ethics of nursing care have gained added impetus from articulations of the so-called 'ethic of care' in moral philosophy. This paper addresses the question of recognizing and elaborating the ethics of nursing care by exploring the problems and the possibilities of these intersecting discourses. In the first part of the paper it is argued that appropriation of 'the ethic of care' by nursing theorists as the central value of nursing, in contradistinction to other moral values such as beneficence or justice, runs the risk of reinforcing the conventional approaches to ethics that 'the ethic of care' seeks to overturn. Central to 'the ethic of care' is the recognition that caring entails a focus on the particularities and context of the relationships in which it is expressed. Accordingly the application of a unitary concept of care to the context of nursing relations may seriously distort their diverse and complex-specific ethical possibilities. The dynamic complexity of nursing ethics may be more adequately understood by working through an array of specific examples of nursing practice highlighting the differences and similarities between them and other ethical practices of care. Experience of a set of examples in this way will draw attention to the multiplicity, ambiguity, and particularity of the ethics of nursing care. In the second part of the paper a beginning is made on this project by addressing the work of several different theorists of care who have examined different practices of nursing from the overlapping perspectives of nurses, patients and the socio-historical construction of their relationships. PMID:7728589

  11. End-of-Life Care in the Intensive Care Unit

    PubMed Central

    Engelberg, Ruth A.; Bensink, Mark E.; Ramsey, Scott D.

    2012-01-01

    The incidence and costs of critical illness are increasing in the United States at a time when there is a focus both on limiting the rising costs of healthcare and improving the quality of end-of-life care. More than 25% of healthcare costs are spent in the last year of life, and approximately 20% of deaths occur in the intensive care unit (ICU). Consequently, there has been speculation that end-of-life care in the ICU represents an important target for cost savings. It is unclear whether efforts to improve end-of-life care in the ICU could significantly reduce healthcare costs. Here, we summarize recent studies suggesting that important opportunities may exist to improve quality and reduce costs through two mechanisms: advance care planning for patients with life-limiting illness and use of time-limited trials of ICU care for critically ill patients. The goal of these approaches is to ensure patients receive the intensity of care that they would choose at the end of life, given the opportunity to make an informed decision. Although these mechanisms hold promise for increasing quality and reducing costs, there are few clearly described, effective methods to implement these mechanisms in routine clinical practice. We believe basic science in communication and decision making, implementation research, and demonstration projects are critically important if we are to translate these approaches into practice and, in so doing, provide high-quality and patient-centered care while limiting rising healthcare costs. PMID:22859524

  12. Overview of the Medicare Catastrophic Coverage Act of 1988 and its impact on health-care delivery.

    PubMed

    Grealy, M R

    1989-07-01

    The Medicare Catastrophic Coverage Act of 1988 is described, and its impact on health-care delivery is discussed. The act will expand Medicare coverage of inpatient hospital care and will also provide payment for outpatient prescription drugs and home i.v. therapy. For the prescription drug benefit, deductible and coinsurance payments will be phased in, and Medicare will establish payment limits. A per diem fee schedule will be established to pay for the supplies and services used in home i.v. therapy. Providers of home therapy must have qualifications specified by the act. Pharmacists will have an important role in ensuring that patients understand and comply with their drug therapy once they leave the hospital. As members of the home health-care team, pharmacists will be involved in identifying candidates for home care, instructing patients in the use of sophisticated medical equipment, and monitoring the safety and efficacy of therapy. Medicare beneficiaries will help finance the new coverage by paying a flat premium; in addition, all individuals eligible for Medicare will pay supplemental premiums based on their federal income tax liability. Congress, however, will come under pressure to lower or freeze these premiums. Hospitals and pharmacists should cooperate in urging Congress to provide adequate funding for services specified by the catastrophic coverage act. PMID:2672805

  13. Ensuring animal welfare is at the heart of research.

    PubMed

    Bradbury, Guen

    2015-06-27

    Guen Bradbury is an anaesthetist in a critical care facility that provides anaesthetic and technical support for medical research on large animals in studies that aim to help critically ill human patients. PMID:26113343

  14. [Patient safety can be ensured in clinical microsystems].

    PubMed

    von Plessen, Christian; Gäre, Boel Andersson

    2012-11-01

    Patients, health-care professionals and the public expect safe health care. The system, however, is not safe and patients are being harmed. Workplace and organizational conditions and human factors contribute to these harms and a system approach is needed to avoid them. In clinical microsystems (CMS), the frontline units of health care, staff and patients can make care safer by learning about their system, its processes, members and purposes. Approaches from patient safety should be integrated in the daily work of every member of the CMS to reduce risk, implement safe practices and learn from errors. We summarize methods for use in CMS and offer ideas for fostering a proactive culture of patient safety. PMID:23137384

  15. Leveraging resources improves care for seniors.

    PubMed

    2013-10-01

    Wishard-Eskenazi Health in Indianapolis has developed the Geriatric Resources for Assessment and Care of Elders (GRACE) program in which hospital geriatricians collaborate with primary care providers to ensure that the elderly get the care they need. Patients in the program are evaluated in the home by a nurse practitioner and social worker who report back to a multidisciplinary geriatric team and develop a treatment plan. They share the plan with the patient's primary care provider, who can make changes and ultimately has final approval. They spend time with the patient and family members to discuss the plan and goals and go over the patient's medication regimen. PMID:24195137

  16. Integrated transitional care: patient, informal caregiver and health care provider perspectives on care transitions for older persons with hip fracture

    PubMed Central

    Toscan, Justine; Mairs, Katie; Hinton, Stephanie; Stolee, Paul

    2012-01-01

    Introduction Complex older adults, such as those with hip fracture, frequently require care from multiple professionals across a variety of settings. Integrated care both between providers and across settings is important to ensure care quality and patient safety. The purpose of this study was to determine the core factors related to poorly integrated care when hip fracture patients transition between care settings. Methods A qualitative, focused ethnographic approach was used to guide data collection and analysis. Patients, their informal caregivers and health care providers were interviewed and observed at each care transition. A total of 45 individual interviews were conducted. Interview transcripts and field notes were coded and analysed to uncover emerging themes in the data. Results Four factors related to poorly integrated transitional care were identified: confusion with communication about care, unclear roles and responsibilities, diluted personal ownership over care, and role strain due to system constraints. Conclusions Our research supports a broader notion of collaborative practice that extends beyond specific care settings and includes an appropriate, informed role for patients and informal caregivers. This research can help guide system-level and setting-specific interventions designed to promote high-quality, patient-centred care during care transitions. PMID:22977426

  17. 9 CFR 3.17 - Care in transit.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...Care, Treatment, and Transportation of Dogs and Cats 1 Transportation Standards...Animal Welfare regulations transporting dogs or cats in commerce must ensure that...accompanying the operator, observes the dogs or cats as often as...

  18. 9 CFR 3.17 - Care in transit.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...Care, Treatment, and Transportation of Dogs and Cats 1 Transportation Standards...Animal Welfare regulations transporting dogs or cats in commerce must ensure that...accompanying the operator, observes the dogs or cats as often as...

  19. 9 CFR 3.17 - Care in transit.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...Care, Treatment, and Transportation of Dogs and Cats 1 Transportation Standards...Animal Welfare regulations transporting dogs or cats in commerce must ensure that...accompanying the operator, observes the dogs or cats as often as...

  20. End-of-life care issues in advanced dementia

    PubMed Central

    2013-01-01

    Appropriate management of advanced dementia requires it to be recognised as a terminal condition that needs palliative care. Interventions during this stage should be carefully chosen to ensure the improvement or maintenance of the quality of life of the person with dementia. Advanced care planning is an important aspect of dementia care. Carers and relatives should be educated and encouraged to actively participate in discussions related to artificial nutrition, cardiopulmonary resuscitation (CPR) and other medical interventions. PMID:24427179

  1. Are currently GFR estimating equations and standard Kt/V value adequate for advanced chronic kidney disease (CKD) frail elderly patients?

    PubMed

    Musso, Carlos G; Alvarez-Gregori, Joaquin; Jauregui, Jose; Núñez, Juan F Macías

    2015-07-01

    Chronic kidney disease (CKD) elderly patients have a reduced glomerular filtration rate (GFR) due to the combination of ageing and chronic nephropathy damage. This situation is very important to be taken into account in order to prescribe an adequate medication and dialysis dose in this aged group. Besides, cognitive and urinary incontinence problems make difficult to obtain an adequate 24-h urine collection in order to evaluate creatinine clearance in this group. Thus, a reliable GFR estimating equation would be very useful for assisting elderly CKD patients. Additionally, Kt/V is the main parameter currently used for dosing dialysis in stage V CKD young and elderly patients. However, frailty and sarcopenia are prevalent disorders usually suffered by old people, who also present many physiological changes that could make GFR estimating equations and standard Kt/V value to become unreliable in this particular group. In conclusion, based on all these facts, it seems crucial for clinical geriatric nephrology to carefully evaluate how reliable current GFR estimating equations are, as well as which would be an adequate Kt/V value in CKD frail elderly patients. PMID:25993909

  2. FINANCE COMMITTEE REPORTS ON BUDGET 2008 CONSULTATIONS VICTORIA - After hearing the budgetary priorities of 5,800-plus British Columbians, the Select Standing Committee on Finance and Government Services has concluded its Budget 2008 consultation process. In response to this year's budget consultation questionnaire, the committee's report contains 55 recommendations - including 17 recommendations for addressing climate change; nine suggestions for ensuring the sustainability of B.C.'s health-care system; and four recommendations on enhancing housing supports

    Microsoft Academic Search

    Bill Bennett; Bruce Ralston; Harry Bloy; Randy Hawes; Dave S. Hayer; John Horgan; Jenny Wai; Ching Kwan; Richard T. Lee; Bob Simpson

    The Finance Committee also received hundreds of submissions on other budgetary priorities. The committee's report includes recommendations on topics such as arts funding, wildlife conservation, child care accessibility, post-secondary education costs, and funding for restorative justice programs. With respect to enhancing economic growth, the Finance Committee makes recommendations to bolster B.C.'s mining and forestry sectors, review personal and corporate income

  3. Immediate prosthetic breast reconstruction: the ensured subpectoral pocket (ESP).

    PubMed

    Loustau, Hugo D; Mayer, Horacio F; Sarrabayrouse, Manuel

    2007-01-01

    Implant exposure due to cutaneous necrosis is one of the most feared complications of mastectomy with immediate prosthetic reconstruction. A key issue is to ensure good blood supply to the skin and complete integrity of the submuscular pocket. The latter is created with the pectoralis major and supplemented with the serratus anterior, the rectus abdominis sheat, the obliquus mayor and the pectoralis minor. The main drawback is that those muscles, when sutured to create a complete pocket, only allow the setting of small-sized implants. The authors present the application of polyglycolic mesh in an original fashion, mimicking the anatomy of the muscles usually employed in pocket creation. The proposed technique has been denominated Ensured Subpectoral Pocket and has proved to be a valid strategy in immediate single stage prosthetic breast reconstruction. It allows the setting of bigger implants without previous tissue expansion while preventing implant displacement. In addition, it reduces emotional trauma on patients and lowers surgical costs. PMID:17889630

  4. Smart Grid Embedded Cyber Security: Ensuring Security While Promoting Interoperability 

    E-print Network

    Ragsdale, G.

    2010-01-01

    Smart Grid Embedded Cyber Security: Ensuring Security While Promoting Interoperability Communications and Embedded Systems Department Southwest Research Institute Gary Ragsdale, Ph.D., P.E. August 24 ? 25, 2010 ESL-HH-10-08-09 Proceedings of the 17... via physical attacks on hardware ? Firmware extraction through debug interfaces and monitoring of system state with In-Circuit Emulators (ICE) ? Firmware Analysis, Reverse Engineering, and Modification ? Physical Bus Snooping and Traffic...

  5. Defining Mental Retardation and Ensuring Access to the General Curriculum

    E-print Network

    Wehmeyer, Michael L.

    2003-01-01

    Defining Mental Retardation and Ensuring Access to the General Curriculum Michael L. Wehmeyer University of Kansas Abstract: Release of the most recent edition (2002) of the American Association on Mental Retardation’s terminology and classification... manual provides a point in time to consider ways in which mental retardation is understood and how that understanding contributes to educational practices to promote positive outcomes for students with mental retardation. Since release of the previous...

  6. The concept of adequate causation and Max Weber's comparative sociology of religion.

    PubMed

    Buss, A

    1999-06-01

    Max Weber's The Protestant Ethic and the Spirit of Capitalism, studied in isolation, shows mainly an elective affinity or an adequacy on the level of meaning between the Protestant ethic and the 'spirit' of capitalism. Here it is suggested that Weber's subsequent essays on 'The Economic Ethics of World Religions' are the result of his opinion that adequacy on the level of meaning needs and can be verified by causal adequacy. After some introductory remarks, particularly on elective affinity, the paper tries to develop the concept of adequate causation and the related concept of objective possibility on the basis of the work of v. Kries on whom Weber heavily relied. In the second part, this concept is used to show how the study of the economic ethics of India, China, Rome and orthodox Russia can support the thesis that the 'spirit' of capitalism, although it may not have been caused by the Protestant ethic, was perhaps adequately caused by it. PMID:15260028

  7. Problems and conception of ensuring radiation safety during Mars missions

    NASA Astrophysics Data System (ADS)

    Petrov, V. M.

    2004-01-01

    The Mars mission differs from near-Earth manned space flights by radiation environment and duration. The importance of effective using the weight of the spacecraft increases greatly because all the necessary things for the mission must be included in its starting weight. For this reason the development of optimal systems of radiation safety ensuring (RSES) acquires especial importance. It is the result of sharp change of radiation environment in the interplanetary space as compared to the one in the near-Earth orbits and significant increase of the interplanetary flight duration. The demand of a harder limitation of unfavorable factors effects should lead to radiation safety (RS) standards hardening. The main principles of ensuring the RS of the Mars mission (optimizing, radiation risk, ALARA) and the conception of RSES, developed on the basis of the described approach and the experience obtained during orbital flights are presented in the report. The problems that can impede the ensuring of the crew members' RS are also given here.

  8. Cep63 and Cep152 Cooperate to Ensure Centriole Duplication

    PubMed Central

    Brown, Nicola J.; Marjanovi?, Marko; Lüders, Jens; Stracker, Travis H.; Costanzo, Vincenzo

    2013-01-01

    Centrosomes consist of two centrioles embedded in pericentriolar material and function as the main microtubule organising centres in dividing animal cells. They ensure proper formation and orientation of the mitotic spindle and are therefore essential for the maintenance of genome stability. Centrosome function is crucial during embryonic development, highlighted by the discovery of mutations in genes encoding centrosome or spindle pole proteins that cause autosomal recessive primary microcephaly, including Cep63 and Cep152. In this study we show that Cep63 functions to ensure that centriole duplication occurs reliably in dividing mammalian cells. We show that the interaction between Cep63 and Cep152 can occur independently of centrosome localisation and that the two proteins are dependent on one another for centrosomal localisation. Further, both mouse and human Cep63 and Cep152 cooperate to ensure efficient centriole duplication by promoting the accumulation of essential centriole duplication factors upstream of SAS-6 recruitment and procentriole formation. These observations describe the requirement for Cep63 in maintaining centriole number in dividing mammalian cells and further establish the order of events in centriole formation. PMID:23936128

  9. Staffing for Adequate Fire and Emergency Response: The SAFER Grant Program

    Microsoft Academic Search

    Lennard G Kruger

    2009-01-01

    [Excerpt] In response to concerns over the adequacy of firefighter staffing, the Staffing for Adequate Fire and Emergency Response Act—popularly called the “SAFER Act”—was enacted by the 108th Congress as Section 1057 of the FY2004 National Defense Authorization Act (P.L. 108-136). The SAFER Act authorizes grants to career, volunteer, and combination local fire departments for the purpose of increasing the

  10. Adequate Nutrition Followed by Revisional Bariatric Surgery to Optimize Homeostatic Eating Control

    Microsoft Academic Search

    Dave H. Schweitzer

    2008-01-01

    Terms as treatment failure or ineffective treatment after bariatric surgery are not clearly defined and difficult to handle.\\u000a About one third of all persons who were formerly treated with a Lapband have either mechanical problems or do not lose enough\\u000a weight. The current review argues in favor of adequate nutrition to suppress hunger and optimize satiety together with effective\\u000a but

  11. Oil & gas in the 1990`s and beyond: Adequate supplies, growing demand, flat prices

    SciTech Connect

    Kennedy, J.L. [Oil & Gas Journal, Houston, TX (United States)

    1995-06-01

    Long term petroleum market fundamentals are clear: supplies are adequate and world demand will continue to grow steadily. Adequate supplies insure that prices will not increase significantly, on average, till the end of the 1990`s, probably much beyond. Despite plentiful supply and modest price increases, there will be peaks and valleys in the price graph as productive capacity is used up, then expanded. Tens of billions of dollars will be needed over the next decade to expand producing capacity. World oil consumption will increase at about 1.5% per year, at least for the next decade. Demand in Asia and Latin America will grow several times faster than this average world rate. World natural gas demand will grow at more then 2% per year well past 2000. Oil and gas companies around the world have changed the way they operate to survive the market realities of the 1990`s. restructuring, outsourcing, and partnering will continue as increasing costs and flat prices squeeze profits. Energy use patterns will change. Fuel and other product specifications will change. Market shares of oil and gas will shift. But opportunities abound in this new market environment. Growing markets always provide opportunities. Technology has helped operators dramatically lower finding, developing, and producing costs. The petroleum age is far from being over. Growing markets, adequate supply, affordable products, and a 60% market share. Those are the signs of an industry with a bright future.

  12. Global Risk Assessment of Aflatoxins in Maize and Peanuts: Are Regulatory Standards Adequately Protective?

    PubMed Central

    Wu, Felicia

    2013-01-01

    The aflatoxins are a group of fungal metabolites that contaminate a variety of staple crops, including maize and peanuts, and cause an array of acute and chronic human health effects. Aflatoxin B1 in particular is a potent liver carcinogen, and hepatocellular carcinoma (HCC) risk is multiplicatively higher for individuals exposed to both aflatoxin and chronic infection with hepatitis B virus (HBV). In this work, we sought to answer the question: do current aflatoxin regulatory standards around the world adequately protect human health? Depending upon the level of protection desired, the answer to this question varies. Currently, most nations have a maximum tolerable level of total aflatoxins in maize and peanuts ranging from 4 to 20ng/g. If the level of protection desired is that aflatoxin exposures would not increase lifetime HCC risk by more than 1 in 100,000 cases in the population, then most current regulatory standards are not adequately protective even if enforced, especially in low-income countries where large amounts of maize and peanuts are consumed and HBV prevalence is high. At the protection level of 1 in 10,000 lifetime HCC cases in the population, however, almost all aflatoxin regulations worldwide are adequately protective, with the exception of several nations in Africa and Latin America. PMID:23761295

  13. Current strategies for the restoration of adequate lordosis during lumbar fusion

    PubMed Central

    Barrey, Cédric; Darnis, Alice

    2015-01-01

    Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

  14. A test for adequate wastewater treatment based on glutathione S transferase isoenzyme profile.

    PubMed

    Grammou, A; Samaras, P; Papadimitriou, C; Papadopoulos, A I

    2013-04-01

    Discharge to the environment of treated or non-treated municipal wastewater imposes several threats to coastal and estuarine ecosystems which are difficult to assess. In our study we evaluate the use of the isoenzyme profile of glutathione S transferase (GST) in combination with the kinetic characteristics of the whole enzyme and of heme peroxidase, as a test of adequate treatment of municipal wastewater. For this reason, Artemia nauplii were incubated in artificial seawater prepared by wastewater samples, such as secondary municipal effluents produced by a conventional activated sludge unit and advanced treated effluents produced by the employment of coagulation, activated carbon adsorption and chlorination as single processes or as combined ones. Characteristic changes of the isoenzyme pattern and the enzymes' kinetic properties were caused by chlorinated secondary municipal effluent or by secondary non-chlorinated effluent. Advanced treatment by combination of coagulation and/or carbon adsorption resulted to less prominent changes, suggesting more adequate treatment. Our results suggest that GST isoenzyme profile in combination with the kinetic properties of the total enzyme family is a sensitive test for the evaluation of the adequateness of the treatment of reclaimed wastewater and the reduction of potentially harmful compounds. Potentially, it may offer a 'fingerprint' characteristic of a particular effluent and probably of the treatment level it has been subjected. PMID:23313117

  15. Current strategies for the restoration of adequate lordosis during lumbar fusion.

    PubMed

    Barrey, Cédric; Darnis, Alice

    2015-01-18

    Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

  16. Performance of new alternative providers of primary care services in England: an observational study

    PubMed Central

    Greaves, Felix; Laverty, Anthony A; Pape, Utz; Ratneswaren, Anenta; Majeed, Azeem

    2015-01-01

    Summary Objectives Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants – including private companies – have been allowed into the primary care market under ‘alternative provider of medical services’ contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice. Design Open cohort study of English general practices. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics, to compare quality in practices using alternative provider contracts to traditional practices. We created regression models using practice fixed effects to estimate the impact of practices changing to the new contract type. Setting The English National Health Service. Participants All general practices open from 2008/2009 to 2012/2013. Main outcome measures Seventeen established quality indicators – covering clinical effectiveness, efficiency, access and patient experience. Results In total, 4.1% (347 of 8300) of general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjusting for practice and population characteristics (p?care services in England has not led to improvements in quality and may have resulted in worse care. Regulators should ensure that new entrants to clinical provider markets are performing to adequate standards and at least as well as traditional providers. PMID:25908312

  17. Equity versus adequacy of managed care contracts.

    PubMed

    Cleverley, William O; Cleverley, James O

    2012-11-01

    Healthcare finance leaders can use a methodology and metrics to compare managed care payments against those of their local and regional peers. Depending on payment levels, they should adopt one of the following negotiation stances with payers: If payment levels are both equitable and adequate, they should view a continuation of the present structure as desirable. If payment levels are adequate but not equitable (e.g., payments are lower than payments peers are receiving for similar services), they should seek increases in payment to level the payment structure among providers. If payment levels are neither adequate nor equitable, they should demand correction in the near future to avoid the need to cease operations. If payment levels are equitable but not adequate, however, they should question the viability of the delivery system. PMID:23173370

  18. Differences in outcome with subspecialty care: Pyloromyotomy in North Carolina

    Microsoft Academic Search

    Thomas Pranikoff; Brendan T. Campbell; Jeffrey Travis; Ronald B. Hirschl

    2002-01-01

    Background\\/Purpose: Proponents of subspecialization in surgery claim that fellowship training improves the quality of care. Others claim that general training is adequate for most routine surgical procedures. The authors questioned whether there were differences in outcomes when general surgeons (GEN) operate on children and infants with common surgical conditions compared with the care of their pediatric surgical (PED) colleagues. Methods:

  19. Assessing Child-Care Quality with a Telephone Interview.

    ERIC Educational Resources Information Center

    Holloway, Susan D.; Kagan, Sharon L.; Fuller, Bruce; Tsou, Lynna; Carroll, Jude

    2001-01-01

    Examined whether data on child care quality obtained from a telephone interview with the provider could serve as an adequate proxy for data obtained from direct observation of 89 child care homes and 92 centers. Found that a 25-item interview predicted accurately the quality classification of 92 percent of homes and 89 percent of centers.…

  20. Space medicine innovation and telehealth concept implementation for medical care during exploration-class missions

    NASA Astrophysics Data System (ADS)

    Martin, Annie; Sullivan, Patrick; Beaudry, Catherine; Kuyumjian, Raffi; Comtois, Jean-Marc

    2012-12-01

    Medical care on the International Space Station (ISS) is provided using real-time communication with limited medical data transmission. In the occurrence of an off-nominal medical event, the medical care paradigm employed is 'stabilization and transportation', involving real-time management from ground and immediate return to Earth in the event that the medical contingency could not be resolved in due time in space. In preparation for future missions beyond Low-Earth orbit (LEO), medical concepts of operations are being developed to ensure adequate support for the new mission profiles: increased distance, duration and communication delays, as well as impossibility of emergency returns and limitations in terms of medical equipment availability. The current ISS paradigm of medical care would no longer be adequate due to these new constraints. The Operational Space Medicine group at the Canadian Space Agency (CSA) is looking towards synergies between terrestrial and space medicine concepts for the delivery of medical care to deal with the new challenges of human space exploration as well as to provide benefits to the Canadian population. Remote and rural communities on Earth are, in fact, facing similar problems such as isolation, remoteness to tertiary care centers, resource scarcity, difficult (and expensive) emergency transfers, limited access to physicians and specialists and limited training of medical and nursing staff. There are a number of researchers and organizations, outside the space communities, working in the area of telehealth. They are designing and implementing terrestrial telehealth programs using real-time and store-and-forward techniques to provide isolated populations access to medical care. The cross-fertilization of space-Earth research could provide support for increased spin-off and spin-in effects and stimulate telehealth and space medicine innovations to engage in the new era of human space exploration. This paper will discuss the benefits of space-Earth research projects for the advancement of both terrestrial and space medicine and will use examples of operational space medicine projects conducted at the CSA in areas such as remote training, tele-mentoring and remote control of an ultrasound.

  1. Oral Care

    Microsoft Academic Search

    Irène Hitz Lindenmüller; J. Thomas Lambrecht

    2011-01-01

    Adequate dental and oral hygiene may become a challenge for all users and especially for elderly people and young children because of their limited motor skills. The same holds true for patients undergoing\\/recovering from chemo-\\/radiotherapy with accompanying sensitive mucosal conditions. Poor dental hygiene can result in tooth decay, gingivitis, periodontitis, tooth loss, bad breath (halitosis), fungal infection and gum diseases.

  2. Extending Care

    Microsoft Academic Search

    Kristin E Borgwald

    2011-01-01

    In recent years, sentimentalist care ethics has been developed and defended as a normative ethical theory alongside and in opposition to Kantian liberalism. Carol Gilligan introduced the idea of a woman’s moral perspective that emphasizes maintaining relationships and responding to need, and saw it as a different way of framing moral issues. Care ethics is no longer associated only with

  3. Caring Reflexivity

    ERIC Educational Resources Information Center

    Rallis, Sharon F.; Rossman, Gretchen B.

    2010-01-01

    This article provides a brief summary of the seven articles in this special issue through the lens of the concept of "caring reflexivity". In joining "caring" and "reflexivity", we deepen the conversation about what constitutes reflexivity, encouraging an explicit focus on the relational. Revisiting the first article, we argue that…

  4. Compassionate care.

    PubMed

    Moore, Alison

    While working as a healthcare assistant caring for patients with dementia, as well as on placements as a nursing student, I have seen how important it is to listen to what a patient is saying and to watch their body language. By taking time to do this, nurses can develop therapeutic relationships with patients, promoting compassionate care. PMID:24617406

  5. Universal health care in India: Panacea for whom?

    PubMed

    Qadeer, Imrana

    2013-01-01

    This paper examines the current notion of universal health care (UHC) in key legal and policy documents and argues that the recommendations for UHC in these entail further abdication of the State's responsibility in health care with the emphasis shifting from public provisioning of services to merely ensuring universal access to services. Acts of commission (recommendations for public private partnership [PPPs], definition and provision of an essential health package to vulnerable populations to ensure universal access to care) and omission (silence maintained on tertiary care) will eventually strengthen the private and corporate sector at the cost of the public health care services and access to care for the marginalized. Thus, the current UHC strategy uses equity as a tool for promoting the private sector in medical care rather than health for all. PMID:24351383

  6. The Challenges in Building an Adequate and Comprehensive Fund-Ensuring System for Rural Compulsory Education in China: Empirical Evidence from the Implementation of "Two Exemptions and One Subsidy" (TEOS)

    ERIC Educational Resources Information Center

    Yanqing, Ding

    2008-01-01

    Beginning in 2006, the "two exemptions and one subsidy" (TEOS) policy was integrated into the New Mechanism for Assured Funding for Rural Compulsory Education (hereafter the "New Mechanism"). The New Mechanism includes TEOS, raising the standard of public expenditure guarantees for rural compulsory education stage schools, creating a permanent…

  7. Good research practices: a commonsense approach to ensuring quality in research facilities.

    PubMed

    Herman, D R; Usher, R W

    1994-12-01

    This guideline can be a useful tool for assisting and assessing "non-GLP" laboratories in academic and contract settings. This guideline has proven useful in assessing academic and/or contract labs where a final product is needed which would meet FDA expectations for preclinical or clinical research. Because of differing research settings and study types, we apply the standards in a flexible manner. For example, in some settings, the study plan is simply documented in a research notebook as the study unfolds, whereas in other settings a written protocol (which is signed by the principal investigator) is in place prior to study initiation. Additionally, all criteria may not be applicable to every research facility. The focus of this guideline is to ensure that sufficient documentation exists which will allow for study reconstruction and to provide adequate evidence that the raw data generated by the facility are accurate. This guideline is a useful tool for Quality Assurance personnel and can also be used by research personnel in the development of appropriate quality systems for their research environment. PMID:7613744

  8. Smart Grid Embedded Cyber Security: Ensuring Security While Promoting Interoperability

    E-print Network

    Ragsdale, G.

    Smart Grid Embedded Cyber Security: Ensuring Security While Promoting Interoperability Communications and Embedded Systems Department Southwest Research Institute Gary Ragsdale, Ph.D., P.E. August 24 ? 25, 2010 ESL-HH-10-08-09 Proceedings of the 17... of Smart Grid devices ? Describe progress made in Smart Grid security ? Propose a more robust approach to SG security ? Describe needs for further research and development ESL-HH-10-08-09 Proceedings of the 17th Symposium for Improving Building Systems...

  9. The health literacy, self-care, and medication hassles of patients with heart failure and their caregivers

    Microsoft Academic Search

    Aleda M Hess

    2009-01-01

    Nearly 90 million Americans lack the necessary health literacy skills to adequately care for themselves in the face of a complex healthcare system and self-care regimens. Patients with heart failure are particularly challenged by meeting with multiple healthcare providers, who may emphasize different self-care strategies, which can be difficult for patients to interpret. Understanding how to effectively care for one's

  10. Ensuring Patient Safety in Wireless Medical Device Networks

    Microsoft Academic Search

    Vijay Gehlot; Elliot B. Sloane

    2006-01-01

    WMDNs provide many alarms and related clinical data that are life-critical. To avoid exposing patients to serious injuries or death, these systems must be protected from data delays, distortions, loss, or other erratic delivery problems. Despite the careful planning, procurement, installation, and management that goes into selecting and deploying WMDN systems, by nature many intentional and unintentional ad hoc changes

  11. Supporting middle-cadre health care workers in Malawi: lessons learned during implementation of the PALM PLUS package

    PubMed Central

    2014-01-01

    Background The government of Malawi is committed to the broad rollout of antiretroviral treatment in Malawi in the public health sector; however one of the primary challenges has been the shortage of trained health care workers. The Practical Approach to Lung Health Plus HIV/AIDS in Malawi (PALM PLUS) package is an innovative guideline and training intervention that supports primary care middle-cadre health care workers to provide front-line integrated primary care. The purpose of this paper is to describe the lessons learned in implementing the PALM PLUS package. Methods A clinical tool, based on algorithm- and symptom-based guidelines was adapted to the Malawian context. An accompanying training program based on educational outreach principles was developed and a cascade training approach was used for implementation of the PALM PLUS package in 30 health centres, targeting clinical officers, medical assistants, and nurses. Lessons learned were identified during program implementation through engagement with collaborating partners and program participants and review of program evaluation findings. Results Key lessons learned for successful program implementation of the PALM PLUS package include the importance of building networks for peer-based support, ensuring adequate training capacity, making linkages with continuing professional development accreditation and providing modest in-service training budgets. The main limiting factors to implementation were turnover of staff and desire for financial training allowances. Conclusions The PALM PLUS approach is a potential model for supporting mid-level health care workers to provide front-line integrated primary care in low and middle income countries, and may be useful for future task-shifting initiatives. PMID:25080192

  12. Measuring organizational readiness for knowledge translation in chronic care

    Microsoft Academic Search

    Marie-Pierre Gagnon; Jenni Labarthe; Mathieu Ouimet; Carole A Estabrooks; Geneviève Roch; El Kebir Ghandour; Jeremy Grimshaw

    2011-01-01

    Background  Knowledge translation (KT) is an imperative in order to implement research-based and contextualized practices that can answer\\u000a the numerous challenges of complex health problems. The Chronic Care Model (CCM) provides a conceptual framework to guide\\u000a the implementation process in chronic care. Yet, organizations aiming to improve chronic care require an adequate level of\\u000a organizational readiness (OR) for KT. Available instruments

  13. Early adequate mycophenolic acid exposure is associated with less rejection in kidney transplantation.

    PubMed

    Kiberd, Bryce A; Lawen, Joseph; Fraser, Albert D; Keough-Ryan, Tammy; Belitsky, Philip

    2004-07-01

    This study examines the importance of early mycophenolic acid (MPA) exposure in the cyclosporine- and mycophenolate mofetil (MMF)-treated kidney transplant population. We prospectively evaluated 94 first solitary kidney transplant patients treated with cyclosporine (Neoral), MMF, and prednisone. Basiliximab was also given to 72 recipients. MPA exposure was measured by HPLC using a limited sampling estimate of 12 h area under the curve (AUC [0-12]) within the first week. Efficacy was determined by the occurrence of acute rejection and toxicity by the need to reduce MMF doses within the first 3 months post-transplantation. Acute rejection was observed in 14 (15%) and MMF toxicity in 27 (29%). Receiver operator curve analysis shows that MPA AUC [0-12] on day 3 was predictive of efficacy (c = 0.72, p = 0.007) but not toxicity (c = 0.57, p = 0.285). A separate analysis of only patients on basiliximab shows that the MPA AUC [0-12] on day 3 was also predictive of efficacy (c = 0.80, p = 0.01). Therefore early adequate exposure to MPA by day 3 is associated with low acute rejection but cannot predict toxicity. Adequate MPA exposure is also important with basiliximab induction therapy. PMID:15196064

  14. Involving Parents in Their Children's Dental Care.

    ERIC Educational Resources Information Center

    Becker, Donna

    1998-01-01

    Asserts that parent education is vital to good dental hygiene for the whole family. Discusses what Head Start staffers can do to ensure that children's dental needs are being met, particularly in assisting parents with taking responsibility for children's dental hygiene. Covers dental care tips for parents, questions and answers about dental…

  15. Treating depression in primary care: An innovative role for mental health nurses

    Microsoft Academic Search

    Carol D. Saur; Linda H. Harpole; David C. Steffens; Caryl D. Fulcher; Yvonne Porterfield; Rita Haverkamp; Dena Kivett; Jürgen Unützer

    2002-01-01

    Late-life depression is common in primary care. However, because of barriers such as stigma and the assumption that depression in older adults is a normal part of aging, it is often underrecognized and undertreated. Further, most primary care providers do not have the time or resources to provide adequate follow-up depression care. By integrating a depression clinical specialist into the

  16. Medical Savings Accounts in Publicly Financed Health Care Systems: What Do We Know?

    Microsoft Academic Search

    Jeremiah Hurley

    2001-01-01

    Medical Savings Accounts (MSAs) are a method of financing health care that includes two essential features: an individual (or household)-specific account whose balances are earmarked for health care expenses; a high-deductible, catastrophic insurance plan that covers expenses above the deductible. An individual uses MSA funds, and personal resources if the MSA funds are not adequate, to pay for health care

  17. Prenatal Care

    MedlinePLUS

    ... Health Treatment & Care Blood Glucose Testing Medication Doctors, Nurses & More Oral Health & Hygiene Women A1C Insulin Pregnancy ... needs change during and after pregnancy A diabetes educator who can help you manage your diabetes during ...

  18. Maintaining technical quality of care in the introduction of Cyclofem in a national family planning program: findings from Indonesia.

    PubMed

    Lubis, F; Fajans, P; Simmons, R

    1994-05-01

    This paper discusses the technical dimensions of "quality of care" in contraceptive service delivery in both the Cyclofem Introductory Trial, as well as in routine service delivery of other injectables in Indonesia. Although the quality of care in the Cyclofem trial was generally acceptable, substantial weaknesses in screening, clinical technique, the management of side-effects, and knowledge concerning re-injection time frames were identified in the provision of injectable contraceptives in routine service delivery. The findings suggest that in order for Cyclofem and other injectables to be delivered in the routine program with an adequate standard of care, considerable managerial adaptation and strengthening of providers' technical capabilities would be necessary prior to actual introduction. This would include providing training and updated technical guidelines concerning both Cyclofem and other contraceptives to providers, with an emphasis on technical issues including contraceptive indications and contraindications, re-injection time frames, maintenance of asepsis and the management of side-effects. Strengthening the existing management information system and logistics systems to facilitate differentiation between injectable contraceptives provided by the program so as to ensure sufficient supplies of both contraceptives and associated materials such as needles and syringes will also be necessary. PMID:8045136

  19. Do US Emergency Medicine Residency Programs Provide Adequate Training for Bioterrorism?

    Microsoft Academic Search

    Nicki Pesik; Mark Keim; Tomoko Rie Sampson

    1999-01-01

    Currently, there is no standardized curriculum for training of emergency physicians about the health hazards related to weapons of mass destruction. Opportunities for the widespread teaching of this material have remained limited, and the range of knowledge regarding even general disaster medical care is also variable among most residency training programs in the United States. We developed a survey to

  20. Clinical knowledge management using computerized patient record systems: is the current infrastructure adequate?

    Microsoft Academic Search

    Daniel P. Lorence; Richard Churchill

    2005-01-01

    The proliferation of technology in health care, spurred by environmental factors encouraging the adoption of computerized patient records (CPRs), has led to a widely held perception of fully computerized patient information systems as the industry norm. To test the validity of this assumption, using data from a national survey of certified health information managers, we examined the CPR technology adoption

  1. Self-care behaviors among patients with heart failure

    Microsoft Academic Search

    Nancy T. Artinian; Morris Magnan; Michelle Sloan; M. Patricia Lange

    2002-01-01

    Background: One way to prevent frequent hospitalizations and promote positive health outcomes among patients with heart failure (HF) is to ensure that the amount and quality of self-care used is appropriate to the patient's situation. Objectives: The following are the purposes of this study: (a) examine the frequency of performance of self-care behaviors, (b) describe personal and environmental factors (basic

  2. UNIVERSITY ANIMAL CARE COMMITTEE UACC Approved: November 2012

    E-print Network

    Abolmaesumi, Purang

    UNIVERSITY ANIMAL CARE COMMITTEE UACC Approved: November 2012 Policy on Pedagogical Merit of Teaching Protocols It is the responsibility of the University Animal Care Committee (UACC) to ensure that no teaching program (including field studies) involving vertebrate animals be commenced and that no animals

  3. Drugs Requiring Application to PharmaCare Special Authority

    E-print Network

    OVER Drugs Requiring Application to PharmaCare Special Authority Program Drugs listed may cost and ensures the long-term sustainability of your PBC drug plan. When prescribed a drug below, you.* Regardless of PharmaCare's decision to cover the drug, a copy of the decision must be submitted to PBC

  4. Hospital discharge planning and continuity of care for aged people in an Italian local health unit: does the care-home model reduce hospital readmission and mortality rates?

    Microsoft Academic Search

    Gianfranco Damiani; Bruno Federico; Antonella Venditti; Lorella Sicuro; Silvia Rinaldi; Franco Cirio; Cristiana Pregno; Walter Ricciardi

    2009-01-01

    BACKGROUND: Hospital discharge planning is aimed to decrease length of stay in hospitals as well as to ensure continuity of health care after being discharged. Hospitalized patients in Turin, Italy, who are in need of medical, social and rehabilitative care are proposed as candidates to either discharge planning relying on a care-home model (DPCH) for a period of about 30

  5. Pediatric advance care planning from the perspective of health care professionals: A qualitative interview study

    PubMed Central

    Jox, Ralf J; Borasio, Gian Domenico; Führer, Monika

    2015-01-01

    Background: Pediatric advance care planning differs from the adult setting in several aspects, including patients’ diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals’ perspective. Aim: We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. Design: This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. Setting/participants: We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. Results: Perceived problems with pediatric advance care planning relate to professionals’ discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor’s advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. Conclusion: Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers. PMID:25389347

  6. [Shared care in BPH. First national experience].

    PubMed

    Padilla León, M; Marchal Escalona, C; Caballero Alcántara, J; Padilla León, F; Lucas de Vega, I M

    1998-06-01

    The high prevalence of Benign Prostate Hyperplasia and the increased demand for care of this condition, should compel us to plan for shared care models in parallel to Primary Care, in the way it has happened with entities such as HBP and Diabetes. The set of measurements to be adopted when sharing services with primary care is known as "shared care". This paper presents the first national experience of "shared care" with primary care in BPH. The project has consisted in a series of steps to increase awareness, train and make available for family physicians, a clinical practice guide defining the criteria for initial evaluation, medical treatment and referral of patients to Urology surgeries, including with the referral document the appropriate diagnostic tests. A Quality Commission has been created to study the level of compliance of the documentation used for referral to the specialist and the clinical histories of patients treated in primary care. The results obtained are significant and most studies carried out fulfill the requirements in 60% cases, which has allowed to reduce overcrowding in the Urology outpatient offices (4200 surgery visits saved/year in our environment), has provided easy access of patients to adequate diagnosis and treatment, as well as significant financial savings (30 million pesetas/year). In short "shared care" is a reality in our environment that allows a more effective, fast medical assistance and improved access to specialist care by reducing the demand of specialized surgery hours. PMID:9734123

  7. Ensuring data consistency over CMS distributed computing system

    SciTech Connect

    Rossman, Paul; /Fermilab

    2009-05-01

    CMS utilizes a distributed infrastructure of computing centers to custodially store data, to provide organized processing resources, and to provide analysis computing resources for users. Integrated over the whole system, even in the first year of data taking, the available disk storage approaches 10 petabytes of space. Maintaining consistency between the data bookkeeping, the data transfer system, and physical storage is an interesting technical and operations challenge. In this paper we will discuss the CMS effort to ensure that data is consistently available at all computing centers. We will discuss the technical tools that monitor the consistency of the catalogs and the physical storage as well as the operations model used to find and solve inconsistencies.

  8. Biodiversity ensures plant-pollinator phenological synchrony against climate change.

    PubMed

    Bartomeus, Ignasi; Park, Mia G; Gibbs, Jason; Danforth, Bryan N; Lakso, Alan N; Winfree, Rachael

    2013-11-01

    Climate change has the potential to alter the phenological synchrony between interacting mutualists, such as plants and their pollinators. However, high levels of biodiversity might buffer the negative effects of species-specific phenological shifts and maintain synchrony at the community level, as predicted by the biodiversity insurance hypothesis. Here, we explore how biodiversity might enhance and stabilise phenological synchrony between a valuable crop, apple and its native pollinators. We combine 46 years of data on apple flowering phenology with historical records of bee pollinators over the same period. When the key apple pollinators are considered altogether, we found extensive synchrony between bee activity and apple peak bloom due to complementarity among bee species' activity periods, and also a stable trend over time due to differential responses to warming climate among bee species. A simulation model confirms that high biodiversity levels can ensure plant-pollinator phenological synchrony and thus pollination function. PMID:23968538

  9. Neuronal Oscillations Enhance Stimulus Discrimination by Ensuring Action Potential Precision

    PubMed Central

    Schaefer, Andreas T; Angelo, Kamilla; Spors, Hartwig

    2006-01-01

    Although oscillations in membrane potential are a prominent feature of sensory, motor, and cognitive function, their precise role in signal processing remains elusive. Here we show, using a combination of in vivo, in vitro, and theoretical approaches, that both synaptically and intrinsically generated membrane potential oscillations dramatically improve action potential (AP) precision by removing the membrane potential variance associated with jitter-accumulating trains of APs. This increased AP precision occurred irrespective of cell type and—at oscillation frequencies ranging from 3 to 65 Hz—permitted accurate discernment of up to 1,000 different stimuli. At low oscillation frequencies, stimulus discrimination showed a clear phase dependence whereby inputs arriving during the trough and the early rising phase of an oscillation cycle were most robustly discriminated. Thus, by ensuring AP precision, membrane potential oscillations dramatically enhance the discriminatory capabilities of individual neurons and networks of cells and provide one attractive explanation for their abundance in neurophysiological systems. PMID:16689623

  10. Managed care: survival skills for the future.

    PubMed

    Braveman, B H; Fisher, G S

    1997-01-01

    The last two decades have been a time of dramatic and consistent change in the way health care is delivered. The use of managed care strategies by health care providers impacts occupational therapy practitioners directly, yet they are often ill-prepared to respond to changes constructively. With adequate preparation, occupational therapy practitioners may not only respond to organizational change, but play a major role in helping to shape their organization's future. This article presents and defines the major managed care strategies being utilized by health care providers and their impacts on occupational therapy practitioners. The skills and strategies occupational therapy practitioners can use to effectively respond are presented and discussed. Suggested methods for gaining these skills are included. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworth.com]. PMID:23947950

  11. Collaborative Drug Therapy Management: Case Studies of Three Community-Based Models of Care

    PubMed Central

    Snyder, Margie E.; Earl, Tara R.; Greenberg, Michael; Heisler, Holly; Revels, Michelle; Matson-Koffman, Dyann

    2015-01-01

    Collaborative drug therapy management agreements are a strategy for expanding the role of pharmacists in team-based care with other providers. However, these agreements have not been widely implemented. This study describes the features of existing provider–pharmacist collaborative drug therapy management practices and identifies the facilitators and barriers to implementing such services in community settings. We conducted in-depth, qualitative interviews in 2012 in a federally qualified health center, an independent pharmacy, and a retail pharmacy chain. Facilitators included 1) ensuring pharmacists were adequately trained; 2) obtaining stakeholder (eg, physician) buy-in; and 3) leveraging academic partners. Barriers included 1) lack of pharmacist compensation; 2) hesitation among providers to trust pharmacists; 3) lack of time and resources; and 4) existing informal collaborations that resulted in reduced interest in formal agreements. The models described in this study could be used to strengthen clinical–community linkages through team-based care, particularly for chronic disease prevention and management. PMID:25811494

  12. Technical Basis for the Determination that Current Characterization Data and Processes are Sufficient to Ensure Safe Storage and to Design Waste Disposal

    SciTech Connect

    SIMPSON, B.C.

    1999-08-12

    This document presents the technical basis for closure of Defense Nuclear Facilities Safety Board (DNFSB) Recommendation 93-5 Implementation Plan milestone 5.6.3.13, ''Core sample all tanks by 2002'' (DOE-RL 1996). The milestone was based on the need for characterization data to ensure safe storage of the waste, to operate the tanks safely, and to plan and implement retrieval and processing of the waste. Sufficient tank characterization data have been obtained to ensure that existing controls are adequate for safe storage of the waste in the 177 waste tanks at the Hanford Site. In addition, a process has been developed, executed, and institutionalized to systemically identify information needs, to integrate and prioritize the needs, and to reliably obtain and analyze the associated samples. This document provides a technical case that the remaining 45 incompletely sampled tanks no longer require sampling to support the intent of the Implementation Plan milestone. Sufficient data have been obtained to close the Unreviewed Safety Questions (USQs), and to ensure that existing hazard controls are adequate and appropriately applied. However, in the future, additional characterization of tanks at the site will be required to support identified information needs. Closure of this milestone allows sampling and analytical data to be obtained in a manner that is consistent with the integrated priority process.

  13. Active therapy and models of care for adolescents and young adults with cancer.

    PubMed

    Ramphal, Raveena; Meyer, Ralph; Schacter, Brent; Rogers, Paul; Pinkerton, Ross

    2011-05-15

    The reduction in the cancer mortality rate in adolescents and young adults (AYA) with cancer has lagged behind the reduction noted in children and older adults. Studies investigating reasons for this are limited but causes appear to be multifactorial. Host factors such as developmental stage, compliance, and tolerance to therapy; provider factors such as lack of awareness of cancer in AYA and referral patterns; differences in disease biology and treatment strategies; low accrual onto clinical trials; and lack of psychosocial support and education programs for AYA all likely play a role. Recommendations for change from a recent international workshop include education of physicians and patients concerning AYA cancer, improved cooperation between pediatric and adult centers, age-appropriate psychosocial support services, programs to help AYA with issues relevant to them, dedicated AYA hospital space, improved accrual to clinical trials, the use of technology to educate patients and enhance communication between patients and the health care team, and ensuring that resident and fellowship training programs provide adequate education in AYA oncology. The longer term goal is to develop AYA oncology into a distinct subspecialist discipline within oncology. The ideal model of care would incorporate medical care, psychosocial support services, and a physical environment that are age-appropriate. When this is not feasible, the development of "virtual units" connecting patients to the health care team or a combination of physical and virtual models are alternative options. The assessment of outcome measures is necessary to determine whether the interventions implemented result in improved survival and better quality of life, and are cost-effective. PMID:21523752

  14. Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care

    PubMed Central

    Zielinski, Andrzej; Kronogård, Maria; Lenhoff, Håkan; Halling, Anders

    2009-01-01

    Background Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC) has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Methods Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000) listed with public PHC (approx. 120,000) for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB) using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender) and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Results Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. Conclusion The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system. PMID:19765286

  15. Informed use of patients' records on trusted health care services.

    PubMed

    Sahama, Tony; Miller, Evonne

    2011-01-01

    Health care is an information-intensive business. Sharing information in health care processes is a smart use of data enabling informed decision-making whilst ensuring. the privacy and security of patient information. To achieve this, we propose data encryption techniques embedded Information Accountability Framework (IAF) that establishes transitions of the technological concept, thus enabling understanding of shared responsibility, accessibility, and efficient cost effective informed decisions between health care professionals and patients. The IAF results reveal possibilities of efficient informed medical decision making and minimisation of medical errors. Of achieving this will require significant cultural changes and research synergies to ensure the sustainability, acceptability and durability of the IAF. PMID:21335699

  16. A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems

    PubMed Central

    Taylor, Tatiana L; Killaspy, Helen; Wright, Christine; Turton, Penny; White, Sarah; Kallert, Thomas W; Schuster, Mirjam; Cervilla, Jorge A; Brangier, Paulette; Raboch, Jiri; Kališová, Lucie; Onchev, Georgi; Dimitrov, Hristo; Mezzina, Roberto; Wolf, Kinou; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitri; Gonidakis, Fragiskos; Caldas-de-Almeida, José; Cardoso, Graça; King, Michael B

    2009-01-01

    Background A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. Methods We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. Results We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). Conclusion Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening. PMID:19735562

  17. Measuring the quality of patient-centered care: why patient-reported measures are critical to reliable assessment

    PubMed Central

    Tzelepis, Flora; Sanson-Fisher, Robert W; Zucca, Alison C; Fradgley, Elizabeth A

    2015-01-01

    Purpose The Institute of Medicine (IOM) identified patient-centeredness as crucial to quality health care. The IOM endorsed six patient-centeredness dimensions that stipulated that care must be: respectful to patients’ values, preferences, and expressed needs; coordinated and integrated; provide information, communication, and education; ensure physical comfort; provide emotional support; and involve family and friends. Patient-reported measures examine the patient’s perspective and are essential to the accurate assessment of patient-centered care. This article’s objectives are to: 1) use the six IOM-endorsed patient-centeredness dimensions as a framework to outline why patient-reported measures are crucial to the reliable measurement of patient-centered care; and 2) to identify existing patient-reported measures that assess each patient-centered care dimension. Methods For each IOM-endorsed patient-centeredness dimension, the published literature was searched to highlight the essential role of patients in assessing patient-centered care and informing quality improvement efforts. Existing literature was also searched to identify examples of patient-reported measures that assess each patient-centeredness dimension. Conclusion Patient-reported measures are arguably the best way to measure patient-centeredness. For instance, patients are best positioned to determine whether care aligns with patient values, preferences, and needs and the Measure of Patient Preferences is an example of a patient-reported measure that does so. Furthermore, only the patient knows whether they received the level of information desired, and if information was understood and can be recalled. Patient-reported measures that examine information provision include the Lung Information Needs Questionnaire and the EORTC QLQ-INFO25. In relation to physical comfort, only patients can report the severity of physical symptoms and whether medications provide adequate relief. Patient-reported measures that investigate physical comfort include the Pain Care Quality Survey and the Brief Pain Inventory. Using patient-reported measures to regularly measure patient-centered care is critical to identifying areas of health care where improvements are needed. PMID:26150703

  18. Foster Care and Medicaid Managed Care.

    ERIC Educational Resources Information Center

    Leslie, Laurel K.; Kelleher, Kelly J.; Burns, Barbara J.; Landsverk, John; Rolls, Jennifer A.

    2003-01-01

    Reviews issues surrounding the delivery of managed health care services to children in foster care. Details the unique characteristics of children in foster care, including limited medical histories upon entry into foster care, multiple health care needs, lack of a clearly identified medical care coordinator, and frequent placement changes.…

  19. Overcome of Carbon Catabolite Repression of Bioinsecticides Production by Sporeless Bacillus thuringiensis through Adequate Fermentation Technology

    PubMed Central

    Ben Khedher, Saoussen; Jaoua, Samir; Zouari, Nabil

    2014-01-01

    The overcoming of catabolite repression, in bioinsecticides production by sporeless Bacillus thuringiensis strain S22 was investigated into fully controlled 3?L fermenter, using glucose based medium. When applying adequate oxygen profile throughout the fermentation period (75% oxygen saturation), it was possible to partially overcome the catabolite repression, normally occurring at high initial glucose concentrations (30 and 40?g/L glucose). Moreover, toxin production yield by sporeless strain S22 was markedly improved by the adoption of the fed-batch intermittent cultures technology. With 22.5?g/L glucose used into culture medium, toxin production was improved by about 36% when applying fed-batch culture compared to one batch. Consequently, the proposed fed-batch strategy was efficient for the overcome of the carbon catabolite repression. So, it was possible to overproduce insecticidal crystal proteins into highly concentrated medium. PMID:25309756

  20. Overcome of Carbon Catabolite Repression of Bioinsecticides Production by Sporeless Bacillus thuringiensis through Adequate Fermentation Technology.

    PubMed

    Ben Khedher, Saoussen; Jaoua, Samir; Zouari, Nabil

    2014-01-01

    The overcoming of catabolite repression, in bioinsecticides production by sporeless Bacillus thuringiensis strain S22 was investigated into fully controlled 3?L fermenter, using glucose based medium. When applying adequate oxygen profile throughout the fermentation period (75% oxygen saturation), it was possible to partially overcome the catabolite repression, normally occurring at high initial glucose concentrations (30 and 40?g/L glucose). Moreover, toxin production yield by sporeless strain S22 was markedly improved by the adoption of the fed-batch intermittent cultures technology. With 22.5?g/L glucose used into culture medium, toxin production was improved by about 36% when applying fed-batch culture compared to one batch. Consequently, the proposed fed-batch strategy was efficient for the overcome of the carbon catabolite repression. So, it was possible to overproduce insecticidal crystal proteins into highly concentrated medium. PMID:25309756

  1. Do measures commonly used in body image research perform adequately with African American college women?

    PubMed

    Kashubeck-West, Susan; Coker, Angela D; Awad, Germine H; Stinson, Rebecca D; Bledman, Rashanta; Mintz, Laurie

    2013-07-01

    This study examines reliability and validity estimates for 3 widely used measures in body image research in a sample of African American college women (N = 278). Internal consistency estimates were adequate (? coefficients above .70) for all measures, and evidence of convergent and discriminant validity was found. Confirmatory factor analyses failed to replicate the hypothesized factor structures of these measures. Exploratory factor analyses indicated that 4 factors found for the Sociocultural Attitudes Toward Appearance Questionnaire were similar to the hypothesized subscales, with fewer items. The factors found for the Multidimensional Body-Self Relations Questionnaire-Appearance Scales and the Body Dissatisfaction subscale of the Eating Disorders Inventory-3 were not similar to the subscales developed by the scale authors. Validity and reliability evidence is discussed for the new factors. PMID:23731233

  2. When one is not enough: prevalence and characteristics of homes not adequately protected by smoke alarms

    PubMed Central

    Peek-Asa, C; Allareddy, V; Yang, J; Taylor, C; Lundell, J; Zwerling, C

    2005-01-01

    Objective: The National Fire Protection Association (NFPA) has specific recommendations about the number, location, and type of smoke alarms that are needed to provide maximum protection for a household. No previous studies have examined whether or not homes are completely protected according to these guidelines. The authors describe the prevalence and home characteristics associated with compliance to recommendations for smoke alarm installation by the NFPA. Design, setting, and subjects: Data are from the baseline on-site survey of a randomized trial to measure smoke alarm effectiveness. The trial was housed in a longitudinal cohort study in a rural Iowa county. Of 1005 homes invited, 691 (68.8%) participated. Main outcome measures: Information about smoke alarm type, placement, and function, as well as home and occupant characteristics, was collected through an on-site household survey. Results: Although 86.0% of homes had at least one smoke alarm, only 22.3% of homes (approximately one in five) were adequately protected according to NFPA guidelines. Fourteen percent of homes had no functioning smoke alarms. More than half of the homes with smoke alarms did not have enough of them or had installed them incorrectly, and 42.4% of homes with alarms had at least one alarm that did not operate. Homes with at least one high school graduate were nearly four times more likely to be fully protected. Homes that had multiple levels, a basement, or were cluttered or poorly cleaned were significantly less likely to be fully protected. Conclusion: These findings indicate that consumers may not be knowledgeable about the number of alarms they need or how to properly install them. Occupants are also not adequately maintaining the alarms that are installed. PMID:16326772

  3. Are the Psychological Needs of Adolescent Survivors of Pediatric Cancer Adequately Identified and Treated?

    PubMed Central

    Kahalley, Lisa S.; Wilson, Stephanie J.; Tyc, Vida L.; Conklin, Heather M.; Hudson, Melissa M.; Wu, Shengjie; Xiong, Xiaoping; Stancel, Heather H.; Hinds, Pamela S.

    2012-01-01

    Objectives To describe the psychological needs of adolescent survivors of acute lymphoblastic leukemia (ALL) or brain tumor (BT), we examined: (a) the occurrence of cognitive, behavioral, and emotional concerns identified during a comprehensive psychological evaluation, and (b) the frequency of referrals for psychological follow-up services to address identified concerns. Methods Psychological concerns were identified on measures according to predetermined criteria for 100 adolescent survivors. Referrals for psychological follow-up services were made for concerns previously unidentified in formal assessment or not adequately addressed by current services. Results Most survivors (82%) exhibited at least one concern across domains: behavioral (76%), cognitive (47%), and emotional (19%). Behavioral concerns emerged most often on scales associated with executive dysfunction, inattention, learning, and peer difficulties. CRT was associated with cognitive concerns, ?2(1,N=100)=5.63, p<0.05. Lower income was associated with more cognitive concerns for ALL survivors, t(47)=3.28, p<0.01, and more behavioral concerns for BT survivors, t(48)=2.93, p<0.01. Of survivors with concerns, 38% were referred for psychological follow-up services. Lower-income ALL survivors received more referrals for follow-up, ?2(1,N=41)=8.05, p<0.01. Referred survivors had more concerns across domains than non-referred survivors, ALL: t(39)=2.96, p<0.01, BT: t(39)=3.52, p<0.01. Trends suggest ALL survivors may be at risk for experiencing unaddressed cognitive needs. Conclusions Many adolescent survivors of cancer experience psychological difficulties that are not adequately managed by current services, underscoring the need for long-term surveillance. In addition to prescribing regular psychological evaluations, clinicians should closely monitor whether current support services appropriately meet survivors’ needs, particularly for lower-income survivors and those treated with CRT. PMID:22278930

  4. 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:20554365

  5. Effect of an emergency department-based electronic system for musculoskeletal consultation on facilitating care for common injuries.

    PubMed

    Mears, Simon C; Pantle, Hardin A; Bessman, Edward S; Lifchez, Scott D

    2015-05-01

    Access to musculoskeletal consultation in the emergency department (ED) is a nationwide problem. In addition, consultation from a subspecialist may be delayed or may not be available, which can slow down the ED flow and reduce patient satisfaction. The purpose of this study was to review the 1-year results of a change in the authors' institutional practice to reduce subspecialty consultation for select musculoskeletal problems while still ensuring adequate patient follow-up in orthopedic or plastic surgery clinics for patients not seen by these services in the ED. The authors hypothesized that select injuries could be safely managed in the ED by using an electronic system to ensure appropriate follow-up care. Using Kaizen methodology, a multidisciplinary group (including ED staff, orthopedics, plastic surgery, pediatrics, nursing, radiology, therapy, and administration) met to improve care for select musculoskeletal injuries. A system was agreed on in which ED providers managed select musculoskeletal injuries without subspecialist consultation. Follow-up was organized using an electronic system, which facilitated communication between the ED staff and the secretarial staff of the subspecialist departments. Over a 1-year period, 150 patients were treated using this system. Charts and radiographs were reviewed for missed injuries. Radiographic review revealed 2 missed injuries. One patient had additional back pain and a lumbar spine fracture was found during the subspecialist follow-up visit; it was treated nonoperatively. Another patient appeared to have scapholunate widening on the injury radiograph that was not appreciated in the ED. Of the 150 patients, 51 were seen in follow-up by a subspecialist at the authors' institution. An electronic system to organize follow-up with a subspecialist allowed the ED providers to deliver safe and effective care for simple musculoskeletal injuries. [Orthopedics. 2015; 38(5):e407-e410.]. PMID:25970368

  6. How to create awareness and ensure broad dissemination of health informatics standards.

    PubMed

    Williams, P

    1998-02-01

    There is a range of organisations with responsibility for information standards development within Australia. These include Standards Australia, which is formally linked to the International Organisation for Standards (ISO), the National Health Information Management Group, which deals with the government sector and several statutory organisations such as the Australian Institute of Health and Welfare and the National Centre for Classification in Health. The different constituencies involved with each of these organisations, the scope of healthcare informatics and the rate of organisational and technological change in the industry present a significant challenge in ensuring that the standard setting process is highly visible, responsive and capable of demonstrating its value through effective implementation. Creating awareness and ensuring broad dissemination of healthcare informatics standards is a key component in meeting this challenge. This can operate at a number of levels from strategic to operational. At the strategic level, it requires active engagement and commitment of the key decision-makers, both political and professional. This may require directly lobbying and promoting the benefits of standardisation to those decision-makers but can be achieved even more effectively by creating industry awareness and demand through carefully targeted presentations on the impact of standards to broader health industry forums. At the tactical level, the standards development medium itself can be used to engage and gain commitment from government, professionals, vendors and the health industry by operating as an inclusive, open and effective process. At the operational level, there is the opportunity for much more efficient use of technology to create awareness of both these processes and their outcomes. The establishment in Australia of a web enabled National Health Information Knowledge base built around ISO standards is one example of the type of development which will assist in the acceleration of awareness of standards and standardisation, which is needed to cope with the increasing demand. PMID:9600403

  7. Kids Get Care: Integrating Preventive Dental and Medical Care Using a Public Health Case Management Model

    Microsoft Academic Search

    Tracy E. Garland; Susan M. Johnson

    Kids Get Care is a public health-based program in the Seattle area designed to ensure that low-income children, regardless of insurance status, receive early integrated preventive medical, dental, and developmental health services through attachment to medical and dental homes (the usual sources of medical or dental care). The oral health component of the program focuses on cross-training medical and dental

  8. Ensuring privacy in the study of pathogen genetics.

    PubMed

    Mehta, Sanjay R; Vinterbo, Staal A; Little, Susan J

    2014-08-01

    Rapid growth in the genetic sequencing of pathogens in recent years has led to the creation of large sequence databases. This aggregated sequence data can be very useful for tracking and predicting epidemics of infectious diseases. However, the balance between the potential public health benefit and the risk to personal privacy for individuals whose genetic data (personal or pathogen) are included in such work has been difficult to delineate, because neither the true benefit nor the actual risk to participants has been adequately defined. Existing approaches to minimise the risk of privacy loss to participants are based on de-identification of data by removal of a predefined set of identifiers. These approaches neither guarantee privacy nor protect the usefulness of the data. We propose a new approach to privacy protection that will quantify the risk to participants, while still maximising the usefulness of the data to researchers. This emerging standard in privacy protection and disclosure control, which is known as differential privacy, uses a process-driven rather than data-centred approach to protecting privacy. PMID:24721230

  9. Models for Designing Long-Term Care Service Plans and Care Programs for Older People

    PubMed Central

    Tsuru, Satoko; Iizuka, Yoshinori

    2013-01-01

    The establishment of a system for providing appropriate long-term care services for older people is a national issue in Japan, and it will likely become a worldwide issue in the years to come. Under Japanese Long-term Care Insurance System, long-term care is provided based on long-term care programs, which were designed by care providers on the basis of long-term care service plans, which were designed by care managers. However, defined methodology for designing long-term care service plans and care programs has not been established yet. In this paper, we propose models for designing long-term care service plans and care programs for older people, both by incorporating the technical issues from previous studies and by redesigning the total methodology according to these studies. Our implementation model consists of “Function,” “Knowledge Structure,” and “Action Flow.” In addition, we developed the concrete knowledgebases based on the Knowledge Structure by visualizing, summarizing, and structuring the inherent knowledge of healthcare/welfare professionals. As the results of the workshop and retrospective verification, the adequacy of the models was suggested, while some further issues were pointed. Our models, knowledgebases, and application make it possible to ensure the quality of long-term care for older people. PMID:23589773

  10. Dementia - home care

    MedlinePLUS

    ... include in-home care, nursing homes, or adult day care. LONG-TERM CARE A person with dementia may ... or in an institution. Possible options include: Adult day care Boarding homes Convalescent homes In-home care Many ...

  11. Home Health Care

    MedlinePLUS

    ... Page Resize Text Printer Friendly Online Chat Home Health Care What is Home Health Care? How Do I ... More About Home Health Care? What is Home Health Care? Home health care helps seniors live independently for ...

  12. Women Veterans Health Care

    MedlinePLUS

    ... Health Care » Women Veterans Health Care Women Veterans Health Care Menu Menu Womens Health Women Veterans Health Care ... more » MyHealtheVet LGBT Awareness Role Models Women Veterans Health Care Did you know that women are the fastest ...

  13. Respiratory Home Health Care

    MedlinePLUS

    Respiratory Home Health Care Respiratory care at home can contribute to improved quality of life and significant cost savings. Your respiratory care ... your family and home situation to help your health care provider plan for your care after you are ...

  14. Models of care and delivery.

    PubMed

    Lundgren, Jens

    2014-01-01

    Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach with community clinics for injecting drug-dependent persons is also being implemented. Shared care models require oversight to ensure that primary responsibility is defined for the persons overall health situation, for screening of co-morbidities, defining indication to treat comorbidities, prescription of non-HIV medicines, etc. Intelligent bioinformatics platforms (i.e. generation of alerts if course of care deviates from a prior defined normality) are being developed to assist in providing this oversight and to provide measure of quality. Although consensus exists to assess basic quality indicators of care, a comprehensive set of harmonized indicators are urgently needed to define best practise standards via benchmarking. Such a tool will be central to guide ongoing discussions on restructuring of models, as quality of care should not be compromised in this process. PMID:25394003

  15. Ensuring Wire Alignment for the New COMPASS Drift Chamber

    NASA Astrophysics Data System (ADS)

    Cromis, Megan; Compass Dc5 Team

    2014-09-01

    COMPASS is a fixed-target experiment at CERN investigating the internal structure of the proton. Polarized Drell-Yan measurements at COMPASS will explore how the quark orbital angular momentum contributes to the spin of the proton. To enable this measurement, several straw tube chambers need to be replaced due to long term wear. One of the replacement chambers, drift chamber DC5, is being built at Old Dominion University based on a prototype from UIUC and existing COMPASS drift chambers. DC5 consists of 4 wire planes with 513 wires (256 [20 ?m] sense wires and 257 [100 ?m] field wires alternating) and 4 wire planes at a 10 degree offset with 641 wires each. Each of these 4616 wires need to be aligned within either 100 ?m (sense wire) or 200 ?m (field wire) of the center of the solder pad to ensure the accuracy of the drift chamber. Problems that arose during stringing include initial alignment of the wire and efficient soldering techniques. Also, because the field wires charged at -1750 volts will be 4 mm from the sense wires, there should be no gaps or points in the solder to prevent arcing. This poster will discuss the alignment techniques, soldering methods, testing, and repair process for the wires. COMPASS is a fixed-target experiment at CERN investigating the internal structure of the proton. Polarized Drell-Yan measurements at COMPASS will explore how the quark orbital angular momentum contributes to the spin of the proton. To enable this measurement, several straw tube chambers need to be replaced due to long term wear. One of the replacement chambers, drift chamber DC5, is being built at Old Dominion University based on a prototype from UIUC and existing COMPASS drift chambers. DC5 consists of 4 wire planes with 513 wires (256 [20 ?m] sense wires and 257 [100 ?m] field wires alternating) and 4 wire planes at a 10 degree offset with 641 wires each. Each of these 4616 wires need to be aligned within either 100 ?m (sense wire) or 200 ?m (field wire) of the center of the solder pad to ensure the accuracy of the drift chamber. Problems that arose during stringing include initial alignment of the wire and efficient soldering techniques. Also, because the field wires charged at -1750 volts will be 4 mm from the sense wires, there should be no gaps or points in the solder to prevent arcing. This poster will discuss the alignment techniques, soldering methods, testing, and repair process for the wires. This research was supported in part by the DOE under Grant Number DE-FG03-94ER40860.

  16. Toward Improving the Quality of Cancer Care: Addressing the Interfaces of Primary & Oncology-Related Subspecialty Care

    Cancer.gov

    A number of reports in the last decade, including the classic Institute of Medicine reports on the quality chasm, have identified key elements and deconstructed processes of care that must be addressed to ensure quality of care. This supplement moves beyond that important initial work in distinguishing between the steps in care that are the usual focus of guidelines to focusing on the connections between these steps that have seldom been examined in research or addressed in practice.

  17. Transitional Care Strategies From Hospital to Home

    PubMed Central

    Ranji, Sumant R.

    2015-01-01

    Hospitals are challenged with reevaluating their hospital’s transitional care practices, to reduce 30-day readmission rates, prevent adverse events, and ensure a safe transition of patients from hospital to home. Despite the increasing attention to transitional care, there are few published studies that have shown significant reductions in readmission rates, particularly for patients with stroke and other neurologic diagnoses. Successful hospital-initiated transitional care programs include a “bridging” strategy with both predischarge and postdischarge interventions and dedicated transitions provider involved at multiple points in time. Although multicomponent strategies including patient engagement, use of a dedicated transition provider, and facilitation of communication with outpatient providers require time and resources, there is evidence that neurohospitalists can implement a transitional care program with the aim of improving patient safety across the continuum of care. PMID:25553228

  18. New Pathways for Primary Care: An Update on Primary Care Programs From the Innovation Center at CMS

    PubMed Central

    Baron, Richard J.

    2012-01-01

    Those in practice find that the fee-for-service system does not adequately value the contributions made by primary care. The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. All programs coming out of the Innovation Center are tests of new payment and service delivery models. By changing both payment and delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, we may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide. PMID:22412007

  19. XDS-I outsourcing proxy: ensuring confidentiality while preserving interoperability.

    PubMed

    Ribeiro, Luís S; Viana-Ferreira, Carlos; Oliveira, José Luís; Costa, Carlos

    2014-07-01

    The interoperability of services and the sharing of health data have been a continuous goal for health professionals, patients, institutions, and policy makers. However, several issues have been hindering this goal, such as incompatible implementations of standards (e.g., HL7, DICOM), multiple ontologies, and security constraints. Cross-enterprise document sharing (XDS) workflows were proposed by Integrating the Healthcare Enterprise (IHE) to address current limitations in exchanging clinical data among organizations. To ensure data protection, XDS actors must be placed in trustworthy domains, which are normally inside such institutions. However, due to rapidly growing IT requirements, the outsourcing of resources in the Cloud is becoming very appealing. This paper presents a software proxy that enables the outsourcing of XDS architectural parts while preserving the interoperability, confidentiality, and searchability of clinical information. A key component in our architecture is a new searchable encryption (SE) scheme-Posterior Playfair Searchable Encryption (PPSE)-which, besides keeping the same confidentiality levels of the stored data, hides the search patterns to the adversary, bringing improvements when compared to the remaining practical state-of-the-art SE schemes. PMID:25014941

  20. Failure assessment techniques to ensure shipping container integrity

    SciTech Connect

    McConnell, P.

    1986-02-01

    This report discusses several methodologies which may be used to ensure the structural integrity of containment systems to be used for the transport and storage of high-level radioactive substances. For economic reasons, shipping containers constructed of ferritic materials are being considered for manufacture by vendors in the US and Europe. Ferritic show an inherent transition from a ductile, high energy failure mode to a brittle, low energy fracture mode with decreasing temperature. Therefore, formal consideration of means by which to avoid unstable brittle fracture is necessary prior to the licensing of ferritic casks. It is suggested that failure of a shipping container wall be defined as occurring when a flaw extends through the outer wall of the containment system. Crack initiation which may lead to unstable brittle crack growth should therefore be prevented. It is suggested that a fundamental linear elastic fracture mechanics (lefm) approach be adopted on a case-by-case basis, applied perhaps by means of appropriate modifications to ASMA Section III or Section XI. A lefm analysis requires information concerning service temperatures, loading rates, flaw sizes, and applied stresses. Tentative judgments regarding these parameters for typical shipping containers have been made.

  1. Procuring small hydro equipment: Ways to ensure satisfactory performance

    SciTech Connect

    Koseatac, A.S. (Northeast Engineering Associates, Fairfield, CT (United States))

    1993-12-01

    Ensuring satisfactory performance of a new hydro plant's generating equipment is essential, but for small hydro developers, the cost of a full performance test can be prohibitive. Certain contract provisions can help protect against substandard equipment performance, using a full performance test only as a last resort. These provisions have proven useful in protecting the project developer against substandard equipment performance. They are: (1) Request detailed information from the equipment supplier on how the guaranteed performance figures were determined; (2) Require the equipment supplier to submit a model test report; (3) Require the equipment supplier to submit quality control and inspection procedures, operation and maintenance manuals, and start-up and testing procedures, with delivery of these items tied to liquidated damages; (4) Require the equipment supplier to perform an index test for the installed turbine(s); (5) Specify, as an option to the owner, full performance tests for the equipment to be used as a last resort; and (6) Establish liquidated damages for deficient equipment performance.

  2. Maximizing Health Care Enrollment through Seamless Coverage for Families in Transition

    E-print Network

    Kammen, Daniel M.

    policymakers on how best to ensure seamless health coverage under the Affordable Care Act for individuals of recommendations will follow in a policy brief to be released in the summer. Introduction The Affordable Care Act of coverage. Background Under the recently enacted federal health law, the Affordable Care Act, Americans

  3. Transforming Data into Practical Information: Using Consumer Input to Improve Home-Care Services

    ERIC Educational Resources Information Center

    Applebaum, Robert; Kunkel, Suzanne; Wilson, Ken

    2007-01-01

    Purpose: As funds have increased for the provision of in-home care, so too have concerns about the quality of services. In response, care management agencies and home-care providers have developed an array of monitoring activities designed to ensure the quality of services. In this article, we show how an area agency on aging both collected and…

  4. 78 FR 38594 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-27

    ...Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services AGENCY...requirements will ensure that long-term care (LTC) facilities (that is, SNFs and...to arrange for the provision of hospice care through an agreement with one or more...

  5. 75 FR 65282 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-22

    ...Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services AGENCY...requirements to ensure that long-term care (LTC) facilities (that is, SNFs and...to arrange for the provision of hospice care through an agreement with one or more...

  6. Can the ASAR Global Monitoring Mode Product Adequately Capture Spatial Soil Moisture Variability?

    NASA Astrophysics Data System (ADS)

    Mladenova, I.; Lakshmi, V.; Walker, J.; Panciera, R.; Wagner, W.; Doubkova, M.

    2008-12-01

    Global soil moisture (SM) monitoring in the past several decades has been undertaken mainly at coarse spatial resolution, which is not adequate for addressing small-scale phenomena and processes. The currently operational Advanced Microwave Scanning Radiometer (NASA) and future planned missions such as the Soil Moisture and Ocean Salinity (ESA) and the Soil Moisture Active Passive (NASA) will remain resolution limited. Finer scale soil moisture estimates can be achieved either by down-scaling the available coarse resolution radiometer and scatterometer (i.e. ERS1/2, ASCAT) observations or by using high resolution active microwave SAR type systems (typical resolution is in the order of meters). Considering the complex land surface - backscatter signal interaction, soil moisture inversion utilizing active microwave observations is difficult and generally needs supplementary data. Algorithms based on temporal change detection offer an alternative less complex approach for deriving (and disaggregating coarse) soil moisture estimates. Frequent monitoring and low frequency range along with a high pixel resolution are essential preconditions when characterizing spatial and temporal soil moisture variability. An alternative active system that meets these requirements is the Advance Synthetic Aperture Radar (ASAR) on ENVISAT [C-band, global, 1 km in Global Monitoring (GM) Mode]. The Vienna University of Technology (TU Wien) has developed a 1 km soil moisture product using the temporal change detection approach and the ASAR GM. The TU Wien SM product sensitivity was evaluated at two scales: point (using in situ data from permanent soil moisture stations) and regional [using ground measured data and aircraft estimates derived from the Polarimetric L-band Microwave Radiometer (PLMR)] over the National Airborne Field Experiment (NAFE'05) area located in the Goulburn catchment, SE Australia. The month long (November 2005) campaign was undertaken in a region predominantly covered by grasslands and partly by forests and croplands. Point scale analysis revealed high ASAR sensitivity and adequate response to changes in moisture conditions (R = 0.69 and RMSE = 0.08 v/v). Regional analysis was performed at several different spatial resolutions (1 km to 25 km). ASAR exhibited high noise level and significant wet bias. Increase in pixel size resulted in improving R and RMSE from R = 0.59 and RMSE = 0.14 to R = 0.91 and RMSE = 0.05 at 1 km and 25 km respectively; however, despite the reasonable statistical agreement at 1 km, the soil moisture spatial patterns clearly visible in the PLMR images, the later were verified with ground data, were lacking in the ASAR product.

  7. Comprehensive Care

    MedlinePLUS

    ... part — but not all — of a person’s overall health management strategies . Like the general population, people with MS are subject to medical problems that have nothing to do with their MS — which means that regular visits with a primary care physician and ... Share Smaller ...

  8. Infant Care.

    ERIC Educational Resources Information Center

    North, A. Frederick

    This new addition of a government pamphlet is a guide offering advice and information to new parents. Sections include: You and Your New Baby (handling the baby, care of the mother, feeding, etc.); First Weeks at Home (equipment, formula preparation, bathing, sleeping, crying, colic, etc.); After the First Weeks (temperament, "difficult" babies,…

  9. Prenatal Care.

    ERIC Educational Resources Information Center

    Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Office for Maternal and Child Health Services.

    This booklet is the first in a series of publications designed to provide parents with useful information about childrearing. Contents are organized into three parts. Part I focuses on the pregnancy, prenatal care, development of the baby, pregnant lifestyles, nutrition, common discomforts, and problems of pregnancy. Part II provides information…

  10. Choosing Your Prenatal Care Provider

    MedlinePLUS

    ... Prenatal care > Choosing your prenatal care provider Prenatal care Prenatal care is the care you get while ... been added to your dashboard . Choosing your prenatal care provider Prenatal care is medical care you get ...

  11. Adequate early cyclosporin exposure is critical to prevent renal allograft rejection: patients monitored by absorption profiling.

    PubMed

    Clase, C M; Mahalati, K; Kiberd, B A; Lawen, J G; West, K A; Fraser, A D; Belitsky, P

    2002-09-01

    This study used receiver operating characteristic analysis to investigate the properties of area under the concentration-time curve during the first 4h after cyclosporin-microemulsion dosing (AUC0-4) and cyclosporin (CyA) levels immediately before and at 2 and 3h after dosing (C0, C2 and C3) to predict the risk of biopsy-proven acute rejection (AR) at 6 months. Ninety-eight kidney transplant recipients treated with CyA-microemulsion-based triple therapy immunosuppression were studied on post-transplant days 3, 5, and 7, and at increasing intervals thereafter. The most sensitive and specific predictor of AR was AUC0-4. Of the single time-point measurements, the measurement properties of C2 were closest to those of AUC0-4, and superior to those of C3. The relationship between C0 and subsequent AR was weak and did not reach statistical significance. On day 3, CyA AUC0-4 > or = 4,400 ng.h/mL and C2 > or = 1,700 ng/mL were each associated with a 92% negative predictive value for rejection in the first 6months. Pharmacokinetic measurements on or after day 5, and measurements on day 3 in patients with delayed graft function, were not predictive of AR. Adequate exposure within the first 3days post transplantation may be critically important in preventing subsequent rejection. PMID:12243501

  12. The placental pursuit for an adequate oxidant balance between the mother and the fetus.

    PubMed

    Herrera, Emilio A; Krause, Bernardo; Ebensperger, German; Reyes, Roberto V; Casanello, Paola; Parra-Cordero, Mauro; Llanos, Anibal J

    2014-01-01

    The placenta is the exchange organ that regulates metabolic processes between the mother and her developing fetus. The adequate function of this organ is clearly vital for a physiologic gestational process and a healthy baby as final outcome. The umbilico-placental vasculature has the capacity to respond to variations in the materno-fetal milieu. Depending on the intensity and the extensity of the insult, these responses may be immediate-, mediate-, and long-lasting, deriving in potential morphostructural and functional changes later in life. These adjustments usually compensate the initial insults, but occasionally may switch to long-lasting remodeling and dysfunctional processes, arising maladaptation. One of the most challenging conditions in modern perinatology is hypoxia and oxidative stress during development, both disorders occurring in high-altitude and in low-altitude placental insufficiency. Hypoxia and oxidative stress may induce endothelial dysfunction and thus, reduction in the perfusion of the placenta and restriction in the fetal growth and development. This Review will focus on placental responses to hypoxic conditions, usually related with high-altitude and placental insufficiency, deriving in oxidative stress and vascular disorders, altering fetal and maternal health. Although day-to-day clinical practice, basic and clinical research are clearly providing evidence of the severe impact of oxygen deficiency and oxidative stress establishment during pregnancy, further research on umbilical and placental vascular function under these conditions is badly needed to clarify the myriad of questions still unsettled. PMID:25009498

  13. Gaussian membership functions are most adequate in representing uncertainty in measurements

    NASA Technical Reports Server (NTRS)

    Kreinovich, V.; Quintana, C.; Reznik, L.

    1992-01-01

    In rare situations, like fundamental physics, we perform experiments without knowing what their results will be. In the majority of real-life measurement situations, we more or less know beforehand what kind of results we will get. Of course, this is not the precise knowledge of the type 'the result will be between alpha - beta and alpha + beta,' because in this case, we would not need any measurements at all. This is usually a knowledge that is best represented in uncertain terms, like 'perhaps (or 'most likely', etc.) the measured value x is between alpha - beta and alpha + beta.' Traditional statistical methods neglect this additional knowledge and process only the measurement results. So it is desirable to be able to process this uncertain knowledge as well. A natural way to process it is by using fuzzy logic. But, there is a problem; we can use different membership functions to represent the same uncertain statements, and different functions lead to different results. What membership function do we choose? In the present paper, we show that under some reasonable assumptions, Gaussian functions mu(x) = exp(-beta(x(exp 2))) are the most adequate choice of the membership functions for representing uncertainty in measurements. This representation was efficiently used in testing jet engines to airplanes and spaceships.

  14. Splenic autotransplantation and the immune system. Adequate testing required for evaluation of effect.

    PubMed Central

    Timens, W; Leemans, R

    1992-01-01

    The risk of severe infections after splenectomy, even after many years, is now well established. In attempts to prevent these infections, spleen-saving techniques, including autotransplantation of spleen fragments, have been performed, when possible in combination with vaccination. The problem in autotransplantation is the evaluation of functional activity. The results of the tests used until now often do not seem to correlate very well with the risk of developing an overwhelming postsplenectomy infection (OPSI). This may be related to the fact that the tests used evaluate general functions, and not specific spleen-related functions, such as the capacity to mount a primary response to certain polysaccharide antigens present in the capsule of bacteria known to cause OPSI. In this review, the significance of the spleen in the human immune system is discussed and the effects of splenectomy are described, including the precautions that can be taken to diminish the risk of postsplenectomy infections and sepsis. It appears that postsplenectomy vaccination is more successful when recently developed protein-conjugated polysaccharide vaccines are used. Because the present testing of the function of spleen autotransplants is not adequate, we suggest that new tests should be developed, employing appropriate polysaccharide antigens. PMID:1543398

  15. Social care informatics as an essential part of holistic health care: A call for action

    Microsoft Academic Search

    Michael Rigby; Penny Hill; Sabine Koch; Debbie Keeling

    2011-01-01

    PurposeThe authors identified the need for a cross-disciplinary research view of issues to ensure an integrated citizen-centric support to achieve optimal health of individual citizens and, in particular, the role of informatics to inform and coordinate support towards integrated and holistic care.

  16. 45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...trained to protect the security and privacy of such records...promulgated by the General Services Administration. ...adequately trained in the security and privacy of personal data...proposed by the General Services Administration or...

  17. 45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...trained to protect the security and privacy of such records...promulgated by the General Services Administration. ...adequately trained in the security and privacy of personal data...proposed by the General Services Administration or...

  18. 45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...trained to protect the security and privacy of such records...promulgated by the General Services Administration. ...adequately trained in the security and privacy of personal data...proposed by the General Services Administration or...

  19. 45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...trained to protect the security and privacy of such records...promulgated by the General Services Administration. ...adequately trained in the security and privacy of personal data...proposed by the General Services Administration or...

  20. 45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...trained to protect the security and privacy of such records...promulgated by the General Services Administration. ...adequately trained in the security and privacy of personal data...proposed by the General Services Administration or...

  1. 21 CFR 740.10 - Labeling of cosmetic products for which adequate substantiation of safety has not been obtained.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 2010-04-01 true Labeling of cosmetic products for which adequate substantiation of safety...DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS Warning Statements...

  2. Heightened Scrutiny of the Fourth Branch: Separation of Powers and the Requirement Of Adequate Reasons for Agency Decisions

    E-print Network

    Levy, Richard E.; Shapiro, Sidney A.

    1987-01-01

    In recent years, the requirement that administrative agencies provide adequate reasons for their decisions has come to play a central role in judicial review of agency decisions. While the increasing importance of this ...

  3. Ensuring Credibility of NASA's Earth Science Data (Invited)

    NASA Astrophysics Data System (ADS)

    Maiden, M. E.; Ramapriyan, H. K.; Mitchell, A. E.; Berrick, S. W.; Walter, J.; Murphy, K. J.

    2013-12-01

    The summary description of the Fall 2013 AGU session on 'Data Curation, Credibility, Preservation Implementation, and Data Rescue to Enable Multi-Source Science' identifies four attributes needed to ensure credibility in Earth science data records. NASA's Earth Science Data Systems Program has been working on all four of these attributes: transparency, completeness, permanence, and ease of access and use, by focusing on them and upon improving our practices of them, over many years. As far as transparency or openness, NASA was in the forefront of free and open sharing of data and associated information for Earth observations. The US data policy requires such openness, but allows for the recoup of the marginal cost of distribution of government data and information - but making the data available with no such charge greatly increases their usage in scientific studies and the resultant analyses hasten our collective understanding of the Earth system. NASA's currently available Earth observations comprise primarily those obtained from satellite-borne instruments, suborbital campaigns, and field investigations. These data are complex and must be accompanied by rich metadata and documentation to be understandable. To enable completeness, NASA utilizes standards for data format, metadata content, and required documentation for any data that are ingested into our distributed Earth Observing System Data and Information System, or EOSDIS. NASA is moving to a new metadata paradigm, primarily to enable a fuller description of data quality and fit-for-purpose attributes. This paradigm offers structured approaches for storing quality measures in metadata that include elements such as Positional Accuracy, Lineage and Cloud Cover. NASA exercises validation processes for the Earth Science Data Systems Program to ensure users of EOSDIS have a predictable level of confidence in data as well as assessing the data viability for usage and application. The Earth Science Data Systems Program has been improving its data management practices for over twenty years to assure permanence of data utility through reliable preservation of bits, readability, understandability, usability and reproducibility of results. While NASA has focused on the Earth System Science research community as the primary data user community, broad interest in the data due to climate change and how it is affecting people everywhere (e.g. sea level rise) by environmental managers, public policymakers and citizen scientists has led the Program to respond with new tools and ways to improve ease of access and use of the data. NASA's standard Earth observation data will soon be buttressed with the long tail of federally-funded research data created or analyzed by grantees, in response to John Holdren's OSTP Memorandum to federal departments and agencies entitled 'Increasing Access to the Results of Federally-Funded Scientific Research'. We fully expect that NASA's Earth Science Data Systems Program will be able to work with our grantees to comply early, and flexibly improve the openness of this source of scientific data to a best practice for NASA and the grantees

  4. Palliative care in adolescents and young adults with cancer.

    PubMed

    Pritchard, Sheila; Cuvelier, Geoff; Harlos, Mike; Barr, Ronald

    2011-05-15

    Adolescents and young adults (AYA) with advanced or terminal cancer have distinctive medical and psychosocial needs that may not have been adequately provided by either pediatric or adult palliative care services. A discussion group, as part of a larger workshop on AYA with cancer, was held in Toronto on March 11-13, 2010;117:-. Recommendations were as follows: Develop a specific AYA screening tool designed to detect increased anxiety or new symptoms and to initiate discussion about palliative or symptom care; Set Canadian standards for palliative care in AYA patients. These standards should be included in hospital accreditation; Involve the palliative/symptom care team early in the disease trajectory to help manage clinically important symptoms that may not be associated with imminent death; Establish specific AYA multidisciplinary palliative care teams throughout Canada that are flexible and can work in both pediatric and adult facilities, and are able to work in a "virtual" environment to support patients being cared for at home; Improve physical facilities in hospices and hospitals to meet the distinctive needs of terminally ill AYA patients; Enhance support for palliative care at home by: changing legislation to improve Compassionate Care Benefits and developing "virtual palliative care support teams". Adequate provision of AYA palliative care and symptom management services will likely confer notable benefits to AYA patients and their families, and is likely to be cost saving to the tax payer by avoiding prolonged hospitalization and promoting easier return to work for the families and caregivers. PMID:21523753

  5. 34 CFR 602.18 - Ensuring consistency in decision-making.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Ensuring consistency in decision-making. 602.18 Section 602... Ensuring consistency in decision-making. The agency must...information the agency relies on for making accrediting decisions is accurate; and...

  6. 34 CFR 602.18 - Ensuring consistency in decision-making.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Ensuring consistency in decision-making. 602.18 Section 602... Ensuring consistency in decision-making. The agency must...information the agency relies on for making accrediting decisions is accurate; and...

  7. 34 CFR 602.18 - Ensuring consistency in decision-making.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Ensuring consistency in decision-making. 602.18 Section 602... Ensuring consistency in decision-making. The agency must...information the agency relies on for making accrediting decisions is accurate; and...

  8. 34 CFR 602.18 - Ensuring consistency in decision-making.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Ensuring consistency in decision-making. 602.18 Section 602... Ensuring consistency in decision-making. The agency must...information the agency relies on for making accrediting decisions is accurate; and...

  9. Which way around does this go? A simple method for ensuring the correct glenosphere offset.

    PubMed

    Javed, Saqib; Heasley, Richard; Ravenscroft, Matt

    2013-12-01

    The correct glenosphere offset in a reverse total shoulder replacement ensures prosthetic stability, longevity and avoids scapula notching. We present a simple technique for ensuring the correct glenosphere offset when the prosthesis is implanted. PMID:24426680

  10. 34 CFR 200.66 - Requirements to ensure that funds do not benefit a private school.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...ensure that funds do not benefit a private school. 200.66 Section 200...Participation of Eligible Children in Private Schools § 200.66 Requirements to ensure that funds do not benefit a private school. (a) An LEA must...

  11. Linking research and policy to ensure children's environmental health.

    PubMed

    Goldman, L R

    1998-06-01

    The U.S. Environmental Protection Agency (U.S. EPA) has made protecting children's environmental health its highest priority. Data on how and when children may be at risk are vital for accomplishing this goal. Recent examples of the link between research and policy include U.S. EPA actions to carry out the recommendations of the National Academy of Sciences on pesticides in children's food, reduce and prevent childhood lead poisoning, and revise national ambient air quality standards for ozone and particulate matter. Today, the Food Quality Protection Act (FQPA), which makes protecting children from pesticide residues in food a national priority, is contributing to the growing need for data for decision making. Further impetus comes from provisions in the FQPA and 1996 Safe Drinking Water Act Amendments for establishing a screening and testing program for potential risks from endocrine disruptors. Another factor is the analysis that will be required under President William J. Clinton's executive order directing all federal agencies, for the first time, to reduce environmental health and safety risks to children. Success of the U.S. international commitment to protect children is directly tied to the strength and availability of environmental data. To meet such challenges, the U.S. EPA is revising key science policies, expanding research opportunities, and adding to the public's right-to-know tools. In this dynamic climate, there are growing opportunities for the research community to play a greater role in helping ensure the well-being of children living today and in generations to come. PMID:9646049

  12. Mechanism to ensure safety of fission system during launch

    NASA Astrophysics Data System (ADS)

    Godfroy, Thomas; Ring, Peter; Patton, Bruce; Houts, Mike; Pedersen, Kevin

    2001-02-01

    The potential for fission-based propulsion systems in opening the solar system to extensive exploration, development, and settlement has been recognized for decades. Work toward a first-generation flight demonstrator is underway at MSFC. Safety is one of the main concerns in the planning, development, and design of the system. The purpose of this research is to design, fabricate, and test a mechanism that will (1) enable complete separation of high reactivity worth nuclear fuel elements from the reactor core during launch and (2) enable reliable insertion of these elements into the core immediately prior to reactor startup. The mechanism will preclude any potential for inadvertent reactor startup during a launch accident. The mechanism thus represents one option for ensuring that the launch of space fission systems is fully safe. Early in the concept phase it became clear that there were many different ways to accomplish fuel separation followed by in-space insertion. The benefits of each method ultimately depended on the overall system (spacecraft or otherwise) design and the mission requirements or uses for the reactor. It became evident that since this information was not yet available the best solution would be to provide multiple designs and let the mission and spacecraft requirements dictate which design to use. With this in mind, two different in-space fueling methods were pursued with the available funding. The first method involves placing the nuclear fuel off axis and external to the fuel. The second method involves replacing some of the fuel with a neutron absorber until the reactor is ready to be fueled. Each method has its benefits and constraints that should be balanced with system and mission requirements. .

  13. An approach to ensuring quality in environmental software

    SciTech Connect

    Gelston, G.M.; Lundgren, R.E.; McDonald, J.P.; Hoopes, B.L.

    1998-05-01

    Environmental software is often used to determine impacts to the public, workers, and the environment from environmental contamination. It is vital, therefore, that the modeling results, and the software that provides them, be scientifically defensible and capable of withstanding the most rigorous of technical reviews. The control and assurance of quality is a critical factor for the project team that develops environmental software at the Pacific Northwest National Laboratory. This document describes the philosophy, process, and activities that ensure a quality product throughout the life cycle of requirements analysis, design, programming, modification, testing, and implementation of environmental software. Environmental software developed by the project team is designed using an object-oriented approach. This software offers increased benefits, such as ease of maintenance and retention of the development and testing legacy of individual components, over traditional hard wired software. These benefits allow the design and testing of the models and future additions to be faster and less costly. This software is developed using a modular framework concept that allows a variety of models to work within a single construct. This software has two parts: an overall system framework and a set of modules. Each module has up to three components: a user interface, a scientific model, and pre/post-processors. Each of these pieces has a different set of quality criteria associated with it. However, whatever form this software might take for a particular client, standard processes apply to protect the information from inappropriate use. The information contained within this document can be applied to most environmental software to analyze risk in multiple environmental media.

  14. Ensuring accurate testing for human immunodeficiency virus in Myanmar

    PubMed Central

    Kyaw, Latt Latt; Wada, Koji; Oo, Khin Yi; Tin, Htay Htay; Yoshihara, Namiko

    2015-01-01

    Abstract Problem Until 2005, the quality of rapid diagnostic human immunodeficiency virus (HIV) testing was not monitored and no regular technical support was provided to hospital laboratories in Myanmar. Approach The national reference laboratory introduced a national external quality assessment scheme. The scheme involved (i) training laboratory technicians in HIV testing and in the requirements of the quality assessment system; (ii) implementing a biannual proficiency panel testing programme; (iii) on-site assessments of poorly-performing laboratories to improve testing procedures; and (iv) development of national guidelines. Local setting In 2011, a total of 422 public hospitals in Myanmar had laboratories providing HIV tests. In addition, private laboratories supported by nongovernmental organizations (NGOs) conducted HIV testing. Relevant changes The scheme was started in 65 public laboratories in 2005. In 2012, it had expanded nationwide to 347 laboratories, including 33 NGO laboratories. During the expansion of the scheme, laboratory response rates were greater than 90% and the proportion of laboratories reporting at least one aberrant result improved from 9.2% (6/65) in 2005 to 5.4% (17/316) in 2012. Lessons learnt National testing guidelines and a reference laboratory are needed to successfully implement quality assurance of HIV testing services. On-site assessments are crucial for all participating laboratories and the only source for insight on the causes of aberrant results; lessons that the reference laboratory can share nationally. Proficiency testing helps laboratory technicians to maintain HIV testing skills by ensuring that they regularly encountered HIV-positive samples. PMID:25558106

  15. Dementia Home Care Resources: How Are We Managing?

    PubMed Central

    Ward-Griffin, Catherine; Hall, Jodi; DeForge, Ryan; St-Amant, Oona; McWilliam, Carol; Oudshoorn, Abram; Forbes, Dorothy; Klosek, Marita

    2012-01-01

    With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future. PMID:22132332

  16. Ensuring confidence in radionuclide-based sediment chronologies and bioturbation rates

    USGS Publications Warehouse

    Crusius, John; Kenna, Timothy C.

    2007-01-01

    Sedimentary records of naturally occurring and fallout-derived radionuclides are widely used as tools for estimating both the ages of recent sediments and rates of sedimentation and bioturbation. Developing these records to the point of data interpretation requires careful sample collection, processing, analysis and data modeling. In this work, we document a number of potential pitfalls that can impact sediment core records and their interpretation. This paper is not intended as an exhaustive treatment of these potential problems. Rather, the emphasis is on potential problems that are not well documented in the literature, as follows: (1) the mere sampling of sediment cores at a resolution that is too coarse can result in an apparent diffusive mixing of the sedimentary record at rates comparable to diffusive bioturbation rates observed in many locations; (2) 210Pb profiles in slowly accumulating sediments can easily be misinterpreted to be driven by sedimentation, when in fact bioturbation is the dominant control. Multiple isotopes of different half lives and/or origin may help to distinguish between these two possible interpretations; (3) apparent mixing can occur due simply to numerical artifacts inherent in the finite difference approximations of the advection diffusion equation used to model sedimentation and bioturbation. Model users need to be aware of this potential problem. Solutions to each of these potential pitfalls are offered to ensure the best possible sediment age estimates and/or sedimentation and bioturbation rates can be obtained.

  17. Primary care in nursing homes revisited: survey of the experiences of primary care physicians.

    PubMed

    Gleeson, L E; Jennings, S; Gavin, R; McConaghy, D; Collins, D R

    2014-09-01

    The Irish Health Information and Quality Authority (HIQA) published National Quality Standards for Residential Care Settings for Older People in 2009. We reported on experiences of general practitioners (GPs) in Dublin caring for nursing home patients (NHPs) in 2006. We revisit these experiences following publication of HIQA's standards. 400 GPs received an anonymous postal survey. Of 204 respondents, 145 (71%) felt NHPs required more contact time and 124 (61%) reported more complex consultations compared to other patients. Only 131 (64%) felt adequately trained in gerontology. 143 (70%) reported access to specialist advice, but only 6 (3%) reported a change in this following HIOA standards. 65 (32%) had witnessed substandard care in a NH, of which 16 (25%) made no report, similar figures to 2006. There remains similar levels of concern regarding patient complexity, substandard care, access to specialist support and training in the care of NHPs. Many GPs expressed uncertainty regarding their role in implementing HIQA standards. PMID:25282960

  18. 45 CFR 261.15 - Can a family be penalized if a parent refuses to work because he or she cannot find child care?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...because he or she cannot find child care? 261.15 Section...PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES ENSURING...because he or she cannot find child care? (a) No, the...

  19. Reflections on curative health care in Nicaragua.

    PubMed Central

    Slater, R G

    1989-01-01

    Improved health care in Nicaragua is a major priority of the Sandinista revolution; it has been pursued by major reforms of the national health care system, something few developing countries have attempted. In addition to its internationally recognized advances in public health, considerable progress has been made in health care delivery by expanding curative medical services through training more personnel and building more facilities to fulfill a commitment to free universal health coverage. The very uneven quality of medical care is the leading problem facing curative medicine now. Underlying factors include the difficulty of adequately training the greatly increased number of new physicians. Misdiagnosis and mismanagement continue to be major problems. The curative medical system is not well coordinated with the preventive sector. Recent innovations include initiation of a "medicina integral" residency, similar to family practice. Despite its inadequacies and the handicaps of war and poverty, the Nicaraguan curative medical system has made important progress. PMID:2705603

  20. Survivorship care in breast cancer

    PubMed Central

    Smith, Sally L.; Murchison, Sonja; Singh-Carlson, Savitri; Alexander, Cheryl; Wai, Elaine S.

    2015-01-01

    Abstract Objective To compare the perceptions of breast cancer survivors and primary care physicians (PCPs) about PCPs’ ability to deliver survivorship care in breast cancer. Design Mailed survey. Setting British Columbia. Participants A total of 1065 breast cancer survivors who had completed treatment of nonmetastatic breast cancer within the previous year, and 587 PCPs who had patients with nonmetastatic breast cancer discharged to their care within the preceding 18 months. Main outcome measures Breast cancer survivors’ and PCPs’ confidence ratings of PCPs’ ability to deliver the following aspects of care: screening for recurrence; managing osteoporosis, lymphedema, endocrine therapy, menopausal symptoms, and anxiety about or fear of recurrence; and providing nutrition and exercise counseling, sex and body image counseling, and family counseling. Response options for each question included low, adequate, or good. Responses were summarized as frequencies and compared using ?2 tests. Results Response rates for breast cancer survivors and PCPs were 47% and 59%, respectively. Responses were statistically different in all categories (P < .05). Both groups were most confident in the ability of PCPs to screen for recurrence, but breast cancer survivors were 10 times as likely to indicate low confidence (10% of breast cancer survivors vs 1% of PCPs) in this aspect of care. More breast cancer survivors (23%) expressed low confidence in PCPs’ ability to provide counseling about fear of recurrence compared with PCPs (3%). Aspects of care in which both breast cancer survivors and PCPs were most likely to express low confidence included sex and body image counseling (35% of breast cancer survivors vs 26% of PCPs) and family counseling (33% of breast cancer survivors vs 24% of PCPs). Primary care physicians (24%) described low confidence in their ability to manage lymphedema. Conclusion Breast cancer survivors and PCPs are reasonably confident in a PCP-based model of survivorship care. Primary care physicians are confident in their ability to manage physical effects related to breast cancer, with the exception of lymphedema. Low confidence ratings among both groups in psychosocial aspects of care suggest an area for improvement.

  1. Elderly and long-term care trends and policy in Taiwan: challenges and opportunities for health care professionals.

    PubMed

    Wang, Hsiu-Hung; Tsay, Shwn-Feng

    2012-09-01

    The purpose of this article is to address the trends and policy of elderly and long-term care in Taiwan. In response to the increasing demand of an aging society, healthcare professionals play crucial roles in elderly and long-term care and quality assurance of services. This article focuses on the current situation of elderly health care, demands of long-term care, long-term care policy in Taiwan, draft of the Long-term Care Services Act, and draft of the Long-term Care Insurance Act. After the 10-year long-term care project was proposed by the Taiwan government, the supply of health care services and demand for long-term care have created many challenges and opportunities for innovative health professional development. Challenges consist of low old dependency ratio caused by low birth rate, lack of elderly and long-term care related manpower, services and education reform related to long-term care for the future society, and interprofessional collaboration and team work of long-term care. Opportunities include expanding the roles and the career pathways of healthcare professionals, promoting the concepts of active aging and good quality of life, and developing industrial cooperation related to long-term care services. Under these circumstances, healthcare professonals are actively involved in practice, education and research of long-term care services that ensure elderly and disabled people can live a healthier and better life. PMID:22974664

  2. A Better Diet Quality is Attributable to Adequate Energy Intake in Hemodialysis Patients.

    PubMed

    Kim, Hyerang; Lim, Hyunjung; Choue, Ryowon

    2015-01-01

    Poor diet quality is one of strong predictors of subsequent increased mortality in hemodialysis patients. To determine diet quality and to define major problems contributing to poor diet quality in hemodialysis patients, a cross-sectional study was conducted between June 2009 and October 2010. Sixty-three hemodialysis patients (31 men, 32 women; aged 55.3 ± 11.9 years) in stable condition were recruited from the Artificial Kidney Center in Kyung Hee University, Seoul, Korea. Three-day diet records were obtained for dietary assessment. Mean adequacy ratio (MAR) is the average of the ratio of intakes to Dietary Reference Intakes (DRI) for 12 nutrients. Index of nutritional quality (INQ) was determined as the nutritional density per 1,000 kcal of calories. Overall diet quality was evaluated using the Diet Quality Index-International (DQI-I). Statistics were used to determine diet quality, comparing dietary intake to DRI. Dietary calories (21.9 ± 6.7 kcal/kg/day) and protein (0.9 ± 0.3 g/kg/day) were found insufficient in the participants. The overall intake of 12 nutrients appeared to be also inadequate (0.66 ± 0.15), but INQs of overall nutrients, except for folate (0.6) and calcium (0.8), were found relatively adequate (INQ ? 1). As a result of diet quality assessment using DQI-I, dietary imbalance and inadequacy were found to be the most problematic in hemodialysis patients. This study suggests that the main reason for insufficient intake of essential nutrients is insufficient calorie intake. Hemodialysis patients should be encouraged to use various food sources to meet their energy requirements as well as satisfy overall balance and nutrient adequacy. PMID:25713792

  3. The adequate stimulus for avian short latency vestibular responses to linear translation

    NASA Technical Reports Server (NTRS)

    Jones, T. A.; Jones, S. M.; Colbert, S.

    1998-01-01

    Transient linear acceleration stimuli have been shown to elicit eighth nerve vestibular compound action potentials in birds and mammals. The present study was undertaken to better define the nature of the adequate stimulus for neurons generating the response in the chicken (Gallus domesticus). In particular, the study evaluated the question of whether the neurons studied are most sensitive to the maximum level of linear acceleration achieved or to the rate of change in acceleration (da/dt, or jerk). To do this, vestibular response thresholds were measured as a function of stimulus onset slope. Traditional computer signal averaging was used to record responses to pulsed linear acceleration stimuli. Stimulus onset slope was systematically varied. Acceleration thresholds decreased with increasing stimulus onset slope (decreasing stimulus rise time). When stimuli were expressed in units of jerk (g/ms), thresholds were virtually constant for all stimulus rise times. Moreover, stimuli having identical jerk magnitudes but widely varying peak acceleration levels produced virtually identical responses. Vestibular response thresholds, latencies and amplitudes appear to be determined strictly by stimulus jerk magnitudes. Stimulus attributes such as peak acceleration or rise time alone do not provide sufficient information to predict response parameter quantities. Indeed, the major response parameters were shown to be virtually independent of peak acceleration levels or rise time when these stimulus features were isolated and considered separately. It is concluded that the neurons generating short latency vestibular evoked potentials do so as "jerk encoders" in the chicken. Primary afferents classified as "irregular", and which traditionally fall into the broad category of "dynamic" or "phasic" neurons, would seem to be the most likely candidates for the neural generators of short latency vestibular compound action potentials.

  4. [Critical involvement of the specific neuroendocrine profile for an adequate T-dependent immune response].

    PubMed

    Pérez Castro, C; Páez Pereda, M; Keller, E A; Arzt, E

    1998-01-01

    A functional relationship between the neuroendocrine and immune systems has been clearly established. We examined the role of neuroendocrine changes, particularly thyrotropin-releasing hormone (TRH) and prolactin (PRL), during the T cell-dependent immune response. After immunization of rats with sheep red blood cells (SRBC, a T cell-dependent antigen) we observed: a) an increase of hypothalamic TRH mRNA at 4 to 24 h post-immunization (i.e.: SRBC vs saline: 4 h, 2.8x), in contrast to the decrease of TRH mRNA observed following treatment with LPS, a T-independent antigen (LPS vs saline: 4 h, 1.6x); b) an increase in pituitary TRH receptor mRNA and plasma PRL levels but no changes in thyroid-stimulating hormone and growth hormone plasma levels. Intracerebroventricular (icv) injection in conscious freely-moving rats of antisense oligonucleotide complementary to rat TRH mRNA resulted in: a) a significant inhibition of specific antibody production [ELISA 7 days: Ig(M/G): TRH sense vs TRH-antisense: 384 +/- 27 (n = 11) vs 193 +/- 22 (n = 11); p < 0.001]b) an inability to produce the peak in plasma PRL levels in rats immunized with SRBC [(12h post-immunization, TRH-sense vs TRH-antisense: 8.3 +/- 1.4 (n = 6) vs 2.2 +/- 0.5 (n = 6); p < 0.01]; c) a decrease in hypothalamic TRH mRNA (TRH-sense vs TRH-antisense: 12h, 1.7x). These studies demonstrate that the T-cell antigen needs an early activation of TRH and PRL for an adequate immune response, in contrast to the inhibition induced by a T-cell independent antigen. PMID:9706254

  5. Defining an adequate sample of earlywood vessels for retrospective injury detection in diffuse-porous species.

    PubMed

    Arbellay, Estelle; Corona, Christophe; Stoffel, Markus; Fonti, Patrick; Decaulne, Armelle

    2012-01-01

    Vessels of broad-leaved trees have been analyzed to study how trees deal with various environmental factors. Cambial injury, in particular, has been reported to induce the formation of narrower conduits. Yet, little or no effort has been devoted to the elaboration of vessel sampling strategies for retrospective injury detection based on vessel lumen size reduction. To fill this methodological gap, four wounded individuals each of grey alder (Alnus incana (L.) Moench) and downy birch (Betula pubescens Ehrh.) were harvested in an avalanche path. Earlywood vessel lumina were measured and compared for each tree between the injury ring built during the growing season following wounding and the control ring laid down the previous year. Measurements were performed along a 10 mm wide radial strip, located directly next to the injury. Specifically, this study aimed at (i) investigating the intra-annual duration and local extension of vessel narrowing close to the wound margin and (ii) identifying an adequate sample of earlywood vessels (number and intra-ring location of cells) attesting to cambial injury. Based on the results of this study, we recommend analyzing at least 30 vessels in each ring. Within the 10 mm wide segment of the injury ring, wound-induced reduction in vessel lumen size did not fade with increasing radial and tangential distances, but we nevertheless advise favoring early earlywood vessels located closest to the injury. These findings, derived from two species widespread across subarctic, mountainous, and temperate regions, will assist retrospective injury detection in Alnus, Betula, and other diffuse-porous species as well as future related research on hydraulic implications after wounding. PMID:22761707

  6. Preventive Care for Children (Affordable Care Act)

    MedlinePLUS

    ... Myspace Close Text Size: A A A Preventive Care for Children Many insurers are now required to ... Services Task Force Recommendations . Fact Sheet: The Affordable Care Act and Immunization Fact Sheet: The Affordable Care ...

  7. Detection of alloimmunization to ensure safer transfusion practice

    PubMed Central

    Sood, Rashmi; Makroo, R. N.; Riana, Vimarsh; Rosamma, N. L.

    2013-01-01

    Background: Serological safety is an integral part of overall safety for blood banks. Emphasis is on the use of routinue Red Blood Cell (RBC) antibody screen test, at set time intervals, to reduce risks related to alloantibodies. Also emphasis is on importance of issuing antigen negative blood to alloantibody positive patients. Effect of using leucodepleted blood on the rate of alloimmunization is highlighted. The concept of provision of phenotypically matched blood is suggested. Materials and Methods: Antibody screen test is important to select appropriate blood for transfusion. Repeat antibody screen testing, except if time interval between the earlier and subsequent transfusion was less than 72 hours, followed by antibody identification, if required, was performed in patients being treated with repeat multiple blood transfusions. Between February 2008 and June 2009, repeat samples of 306 multi-transfused patients were analyzed. Search for irregular antibodies and reading of results was conducted using RBC panels (three-cell panel of Column Agglutination Technology (CAT) and two cell panel of the Solid Phase Red Cell Adherence Technology (SPRCAT). Specificities of antibodies were investigated using appropriate panels, 11 cell panel of CAT and 16 cell panel of SPRCA. These technologies, detecting agglutination in columns and reactions in solid phase, evaluate the attachment of irregular incomplete antibody to antigen in the first phase of immunological reaction more directly and hence improve the reading of agglutination. Three to four log leuco reduced red blood cells were transfused to patients in the study using blood collection bags with integral filters. Results: Alloimmunization rate of 4.24% was detected from 306 multiply transfused patients tested and followed up. The Transfusion therapy may become significantly complicated. Conclusion: Red cell antibody screening and identification and subsequent issue of antigen negative blood have a significant role in improving blood safety. Centers that have incorporated antibody screen test and identification have ensured safe transfusion. Identified patients should be flagged in a database and information shared. Such patients can be given carry-on cards and educated about the names of the identified antibodies. Full red cell phenotyping of individuals, patients and donors, can be feasibility. PMID:24014944

  8. Are community-level financial data adequate to assess population health investments?

    PubMed

    Casper, Tim; Kindig, David A

    2012-01-01

    The variation in health outcomes among communities results largely from different levels of financial and nonfinancial policy investments over time; these natural experiments should offer investment and policy guidance for a business model on population health. However, little such guidance exists. We examined the availability of data in a sample of Wisconsin counties for expenditures in selected categories of health care, public health, human services, income support, job development, and education. We found, as predicted by the National Committee on Vital and Health Statistics in 2002, that availability is often limited by the challenges of difficulty in locating useable data, a lack of resources among public agencies to upgrade information technology systems for making data more usable and accessible to the public, and a lack of enterprise-wide coordination and geographic detail in data collection efforts. These challenges must be overcome to provide policy-relevant information for optimal population health resource allocation. PMID:22877572

  9. Are Community-Level Financial Data Adequate to Assess Population Health Investments?

    PubMed Central

    Casper, Tim

    2012-01-01

    The variation in health outcomes among communities results largely from different levels of financial and nonfinancial policy investments over time; these natural experiments should offer investment and policy guidance for a business model on population health. However, little such guidance exists. We examined the availability of data in a sample of Wisconsin counties for expenditures in selected categories of health care, public health, human services, income support, job development, and education. We found, as predicted by the National Committee on Vital and Health Statistics in 2002, that availability is often limited by the challenges of difficulty in locating useable data, a lack of resources among public agencies to upgrade information technology systems for making data more usable and accessible to the public, and a lack of enterprise-wide coordination and geographic detail in data collection efforts. These challenges must be overcome to provide policy-relevant information for optimal population health resource allocation. PMID:22877572

  10. Incorporating palliative care into primary care education

    Microsoft Academic Search

    Susan D. Block; George M. Bernier; LaVera M. Crawley; Stuart Farber; David Kuhl; William Nelson; Joseph O’Donnell; Lewis Sandy; Wayne Ury

    1998-01-01

    Summary  The confluence of enhanced attention to primary care and palliative care education presents educators with an opportunity\\u000a to improve both (as well as patient care) through integrated teaching. Improvements in palliative care education will have\\u000a benefits for dying patients and their families, but will also extend to the care of many other primary care patients, including\\u000a geriatric patients and those

  11. The Prevention and Reactivation Care Program: intervention fidelity matters

    PubMed Central

    2013-01-01

    Background The Prevention and Reactivation Care Program (PReCaP) entails an innovative multidisciplinary, integrated and goal oriented approach aimed at reducing hospital related functional decline among elderly patients. Despite calls for process evaluation as an essential component of clinical trials in the geriatric care field, studies assessing fidelity lag behind the number of effect studies. The threefold purpose of this study was (1) to systematically assess intervention fidelity of the hospital phase of the PReCaP in the first year of the intervention delivery; (2) to improve our understanding of the moderating factors and modifications affecting intervention fidelity; and (3) to explore the feasibility of the PReCaP fidelity assessment in view of the modifications. Methods Based on the PReCaP description we developed a fidelity instrument incorporating nineteen (n=19) intervention components. A combination of data collection methods was utilized, i.e. data collection from patient records and individual Goal Attainment Scaling care plans, in-depth interviews with stakeholders, and non-participant observations. Descriptive analysis was performed to obtain levels of fidelity of each of the nineteen PReCaP components. Moderating factors were identified by using the Conceptual Framework for Implementation Fidelity. Results Ten of the nineteen intervention components were always or often delivered to the group of twenty elderly patients. Moderating factors, such as facilitating strategies and context were useful in explaining the non- or low-adherence of particular intervention components. Conclusions Fidelity assessment was carried out to evaluate the adherence to the PReCaP in the Vlietland Ziekenhuis in the Netherlands. Given that the fidelity was assessed in the first year of PReCaP implementation it was commendable that ten of the nineteen intervention components were performed always or often. The adequate delivery of the intervention components strongly depended on various moderating factors. Since the intervention is still developing and undergoing continuous modifications, it has been concluded that the fidelity criteria should evolve with the modified intervention. Furthermore, repeated intervention fidelity assessments will be necessary to ensure a valid and reliable fidelity assessment of the PReCaP. Trial registration The Netherlands National Trial Register: NTR2317 PMID:23351355

  12. Sharing patient data: competing demands of privacy, trust and research in primary care

    PubMed Central

    Stone, Margaret A; Redsell, Sarah A; Ling, Jennifer T; Hay, Alastair D

    2005-01-01

    Background Patient privacy may conflict with the advancement of knowledge through data sharing. The data contained in primary care records are uniquely comprehensive. Aim To explore the knowledge and attitudes of patients and members of the primary healthcare team regarding the sharing of data held in primary care records, with particular reference to data sharing for research and the impact that this may have on trust between patients and health professionals. Design of study Qualitative study using quota sampled, semi-structured interviews. Setting Five general practices in Leicestershire, UK. Method Grounded theory and framework methodology were used. Interviews were transcribed and analysed thematically. Results Twenty patients and 15 healthcare professionals and managers were interviewed. Patients had limited knowledge of the type of information held in their general practice records and the ways in which these data are shared, but appeared ready to form preliminary views on issues such as data sharing for audit and disease registration. In this climate of limited awareness, there was no suggestion that concern about data sharing for research adversely affects patient trust or leads patients to withhold relevant information from health professionals in primary care. Interviews carried out with staff suggested a lack of clear practice policies regarding data sharing. Conclusions General practices may need to develop policies on data sharing, bring these to the attention of their patient population and improve patient awareness about the nature of the data contained in their records. Researchers should ensure that patients are adequately informed about the nature of data contained in patient records when seeking consent for data extraction. PMID:16212854

  13. Development and implementation of a quality improvement program for Ryan White Title I care services using a stakeholder-based model.

    PubMed

    Linsk, Nathan L; Bruce, Douglas; Schechtman, Barbara; Warnecke, Richard; Tunney, Kathleen; Bass, Michael

    2005-03-01

    Both medical and community support services for people living with HIV and/or AIDS have been implemented on a widespread basis since the implementation of the 1990 Ryan White CARE Act. However, many services are provided without adequate evaluation or quality assurance, in spite of federal directions to both evaluate and ensure quality. This report details the development and implementation of a quality improvement project to evaluate Ryan White CARE services using a community stakeholder-based effort. The evaluation was consumer rather than administratively driven, including both consumers and providers to define, measure, and improve services. Project phases included: (1) developing service standards for 14 areas of service provided under Title I of the Ryan White CARE Act; (2) creating and implementing a provider/consumer peer site visit instrument to assess agencies' activities in meeting the service standards; and (3) developing a mechanism to improve quality by linking agencies to technical assistance resources in the metropolitan provider community. By involving providers and consumers in evaluation roles, recommendations by peers could serve as the basis for ongoing quality improvement. PMID:15798385

  14. Community-Based Care

    MedlinePLUS

    ... providing important healthcare or personal care support. Adult Day Care Adult day care is a community-based option that has become ... support services in a group setting. Most adult day care centers are either in churches or community centers. ...

  15. Health Care Team

    MedlinePLUS

    ... NKF Newsroom Contact Us You are here Home » Health Care Team Good health care is always a team effort - especially for people ... chronic kidney failure. Since each member of the health care staff contributes to your care, it is important ...

  16. Adult Day Care

    MedlinePLUS

    ... Resize Text Printer Friendly Online Chat Adult Day Care What is Adult Day Care? How Do Adult ... More About Local Services? What is Adult Day Care? Adult Day Care Centers are designed to provide ...

  17. Home Care Services

    MedlinePLUS

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with ...

  18. Human milk feeding supports adequate growth in infants ? 1250 grams birth weight

    PubMed Central

    2013-01-01

    Background Despite current nutritional strategies, premature infants remain at high risk for extrauterine growth restriction. The use of an exclusive human milk-based diet is associated with decreased incidence of necrotizing enterocolitis (NEC), but concerns exist about infants achieving adequate growth. The objective of this study was to evaluate growth velocities and incidence of extrauterine growth restriction in infants ? 1250 grams (g) birth weight (BW) receiving an exclusive human milk-based diet with early and rapid advancement of fortification using a donor human milk derived fortifier. Methods In a single center, prospective observational cohort study, preterm infants weighing ? 1250 g BW were fed an exclusive human milk-based diet until 34 weeks postmenstrual age. Human milk fortification with donor human milk derived fortifier was started at 60 mL/kg/d and advanced to provide 6 to 8 additional kilocalories per ounce (or 0.21 to 0.28 kilocalories per gram). Data for growth were compared to historical growth standards and previous human milk-fed cohorts. Results We consecutively evaluated 104 infants with mean gestational age of 27.6 ± 2.0 weeks and BW of 913 ± 181 g (mean ± standard deviation). Weight gain was 24.8 ± 5.4 g/kg/day with length 0.99 ± 0.23 cm/week and head circumference 0.72 ± 0.14 cm/week. There were 3 medical NEC cases and 1 surgical NEC case. 22 infants (21%) were small for gestational age at birth. Overall, 45 infants (43%) had extrauterine growth restriction. Weight velocity was affected by day of fortification (p = 0.005) and day of full feeds (p = 0.02). Our cohort had significantly greater growth in weight and length compared to previous entirely human milk-fed cohorts. Conclusions A feeding protocol for infants ? 1250 g BW providing an exclusive human milk-based diet with early and rapid advancement of fortification leads to growth meeting targeted standards with a low rate of extrauterine growth restriction. Consistent nutritional policies using this approach may be considered for this population. PMID:24220185

  19. Trauma care systems in France.

    PubMed

    Masmejean, Emmanuel H; Faye, Alain; Alnot, Jean Yves; Mignon, Alexandre F

    2003-09-01

    The French Republic includes approximatively 60 millions inhabitants for almost 550,000 km(2). Prehospital management is organised at department level (96). This management involves a regulatory system initiated from a unique phone number (15 national). The medical regulator sends either first-aid providers or a medical team. On-site care is highly developed and prehospital medically assisted care is really the first phase of the treatment of the injured. The team ensures that the victim is in the best condition for transport and participates in monitoring. Intra-hospital care begins either in an emergency room, with a physician qualified in Emergency Medicine, or in a recovery room, with a surgical intensive-care team. There is no specialisation in trauma in France. All specialist surgeons treat those aspects of trauma pathology that concern them. All surgeons operate on trauma patients and with regard to the organ concerned: digestive, orthopaedic, em leader. The challenge nevertheless remains that of maintaining facilities at a sufficient level to deal with everyday pathology, known for the seriousness of its consequences in both human and financial terms, within an increasingly sparse hospital infrastructure. Suggestions are emerging in response to these preoccupations. Organisation at the European level of hand emergency units (FESUM) is a targeted example. PMID:12951291

  20. The teamlet model of primary care.

    PubMed

    Bodenheimer, Thomas; Laing, Brian Yoshio

    2007-01-01

    The 15-minute visit does not allow the physician sufficient time to provide the variety of services expected of primary care. A teamlet (little team) model of care is proposed to extend the 15-minute physician visit. The teamlet consists of 1 clinician and 2 health coaches. A clinical encounter includes 4 parts: a previsit by the coach, a visit by the clinician together with the coach, a postvisit by the coach, and between-visit care by the coach. Medical assistants or other practice personnel would require retraining to assume the health coach role. Some organizations have instituted aspects of the teamlet model. Primary care practices interested in trying out the teamlet concept need to train 2 health coaches for each full-time equivalent clinician to ensure smooth patient flow. PMID:17893389

  1. Basics of quality improvement in health care.

    PubMed

    Varkey, Prathibha; Reller, M Katherine; Resar, Roger K

    2007-06-01

    With the rapid expansion of knowledge and technology and a health care system that performs far below acceptable levels for ensuring patient safety and needs, front-line health care professionals must understand the basics of quality improvement methodologies and terminology. The goals of this review are to provide clinicians with sufficient information to understand the fundamentals of quality improvement, provide a starting point for improvement projects, and stimulate further inquiry into the quality improvement methodologies currently being used in health care. Key quality improvement concepts and methodologies, including plan-do-study-act, six-sigma, and lean strategies, are discussed, and the differences between quality improvement and quality-of-care research are explored. PMID:17550754

  2. The Medicaid program: The low-income health care subsidy

    Microsoft Academic Search

    Bernadette P. Chachere

    1980-01-01

    Conclusions  While these data are inadequate to empirically test the foregoing three hypotheses, they are sufficient to caste doubt on\\u000a the validity of the assumption upon which the design of the low-income medical care subsidy is based; i.e., that the private\\u000a medical care market is efficient and therefore adequate to meet the health needs of all low-income groups. Further, analysis\\u000a of

  3. Skin Care.

    PubMed

    Clark, Amelia; Hessler, Jill L

    2015-08-01

    Aging skin is among the most common patient concerns in a facial plastic surgery practice. Ultraviolet (UV)-induced damage expedites the pace of intrinsic aging, resulting in many of the visible signs of aging, such as rough skin texture, pigmentation irregularities, fine and deep wrinkling, and inelasticity. Primary prevention of UV and environmental damage with proper skin care and the use of sunscreen are critical. There is great interest in topically applied products to reverse or delay the visible signs of photoaging. We discuss the most common topically applied agents for photoaging, reviewing their mechanisms and supporting evidence. PMID:26208767

  4. Current Strategies for Identification of Glioma Stem Cells: Adequate or Unsatisfactory?

    PubMed Central

    Brescia, Paola; Richichi, Cristina; Pelicci, Giuliana

    2012-01-01

    Cancer stem cells (CSCs) were isolated in multiple tumor types, including human glioblastomas, and although the presence of surface markers selectively expressed on CSCs can be used to isolate them, no marker/pattern of markers are sufficiently robust to definitively identify stem cells in tumors. Several markers were evaluated for their prognostic value with promising early results, however none of them was proven to be clinically useful in large-scale studies, leading to outstanding efforts to identify new markers. Given the heterogeneity of human glioblastomas further investigations are necessary to identify both cancer stem cell-specific markers and the molecular mechanisms sustaining the tumorigenic potential of these cells to develop tailored treatments. Markers for glioblastoma stem cells such as CD133, CD15, integrin-?6, L1CAM might be informative to identify these cells but cannot be conclusively linked to a stem cell phenotype. Overlap of expression, functional state and morphology of different subpopulations lead to carefully consider the techniques employed so far to isolate these cells. Due to a dearth of methods and markers reliably identifying the candidate cancer stem cells, the isolation/enrichment of cancer stem cells to be therapeutically targeted remains a major challenge. PMID:22685459

  5. Allopurinol dosing in renal impairment: walking the tightrope between adequate urate lowering and adverse events.

    PubMed

    Dalbeth, Nicola; Stamp, Lisa

    2007-01-01

    Allopurinol is the mainstay of urate-lowering therapy for patients with gout and impaired renal function. Although rare, a life-threatening hypersensitivity syndrome may occur with this drug. The risk of this allopurinol hypersensitivity syndrome (AHS) is increased in renal impairment. The recognition that AHS may be because of delayed-type hypersensitivity to oxypurinol, the main metabolite of allopurinol, and that oxypurinol concentrations are frequently elevated in patients with renal impairment prescribed standard doses of allopurinol has led to the widespread adoption of allopurinol-dosing guidelines. These guidelines advocate allopurinol dose reduction according to creatinine clearance in patients with renal impairment. However, recent studies have challenged the role of these guidelines, suggesting that AHS may occur even at low doses of allopurinol, and that these guidelines lead to under-treatment of hyperuricemia, a key therapeutic target in gout. Based on current data, we advocate gradual introduction of allopurinol according to current treatment guidelines, with close monitoring of serum uric acid concentrations. In patients with severe disease and persistent hyperuricemia, allopurinol dose escalation above those recommended by the guidelines should be considered, with careful evaluation of the benefits and risks of therapy. Further work is needed to clarify the safety and efficacy of allopurinol dose escalation, particularly in patients with renal impairment. PMID:17897242

  6. Physician reimbursement for critical care services integrating palliative care for patients who are critically ill.

    PubMed

    Lustbader, Dana R; Nelson, Judith E; Weissman, David E; Hays, Ross M; Mosenthal, Anne C; Mulkerin, Colleen; Puntillo, Kathleen A; Ray, Daniel E; Bassett, Rick; Boss, Renee D; Brasel, Karen J; Campbell, Margaret L; Cortez, Therese B; Curtis, J Randall

    2012-03-01

    Patients with advanced illness often spend time in an ICU, while nearly one-third of patients with advanced cancer who receive Medicare die in hospitals, often with failed ICU care. For most, death occurs following the withdrawal or withholding of life-sustaining treatments. The integration of palliative care is essential for high-quality critical care. Although palliative care specialists are becoming increasingly available, intensivists and other physicians are also expected to provide basic palliative care, including symptom treatment and communication about goals of care. Patients who are critically ill are often unable to make decisions about their care. In these situations, physicians must meet with family members or other surrogates to determine appropriate medical treatments. These meetings require clinical expertise to ensure that patient values are explored for medical decision making about therapeutic options, including palliative care. Meetings with families take time. Issues related to the disease process, prognosis, and treatment plan are complex, and decisions about the use or limitation of intensive care therapies have life-or-death implications. Inadequate reimbursement for physician services may be a barrier to the optimal delivery of high-quality palliative care, including effective communication. Appropriate documentation of time spent integrating palliative and critical care for patients who are critically ill can be consistent with the Current Procedural Terminology codes (99291 and 99292) for critical care services. The purpose of this article is to help intensivists and other providers understand the circumstances in which integration of palliative and critical care meets the definition of critical care services for billing purposes. PMID:22396564

  7. 42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...in accordance with the patient's needs if any of them so desire. The hospice must ensure that each patient and the primary care giver(s) receive education and training provided by the hospice as appropriate to their responsibilities for...

  8. 42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...in accordance with the patient's needs if any of them so desire. The hospice must ensure that each patient and the primary care giver(s) receive education and training provided by the hospice as appropriate to their responsibilities for...

  9. 42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...in accordance with the patient's needs if any of them so desire. The hospice must ensure that each patient and the primary care giver(s) receive education and training provided by the hospice as appropriate to their responsibilities for...

  10. Developing the Liverpool Care Pathway for the dying child.

    PubMed

    Matthews, Kate; Gambles, Maureen; Ellershaw, John E; Brook, Lynda; Williams, Michelle; Hodgson, Aruna; Barber, Muriel

    2006-02-01

    In most western societies the death of a child is a rare occurrence. When it does occur, it typically takes place after a period of intensive and often prolonged treatment. In light of the relative infrequency of these events in clinical practice, ensuring that all dying children and their families receive consistent and appropriate care remains a challenge. A retrospective audit of documentation of care for dying children in two paediatric units in the north-west of England illustrated that the care provided was not always documented consistently. This paper highlights work currently underway to develop an integrated care pathway for the care of the dying child based on the Liverpool Care Pathway (LCP). The aim of this work is to facilitate the delivery and recording of optimum care for all dying children and their families. PMID:16518947

  11. Nurse collaboration in community and psychiatric care: a Swedish study.

    PubMed

    Brändström, Linnéa; Mazaz, Nader; Berggren, Ingela

    2015-06-01

    Aim The aim of the study was to examine registered nurses' (RNs) experiences of collaboration in the community health care and psychiatric inpatient care systems. Background RNs in one area in the west of Sweden have indicated the need for collaborative routines between the community health care and psychiatric inpatient care systems. Method Qualitative content analysis of focus group interviews. Results RNs felt the web-based health-care communication programme was a major obstacle to the development of a collaboration plan. The poor collaboration between RNs was due to the absence of knowledge about the duties of each nursing team. Conclusion The findings contribute to the understanding of the barriers to collaboration between RNs in community health care and psychiatric inpatient care, and highlight the need for nurse managers to ensure well-functioning routines. PMID:26043016

  12. Next steps for federal child care policy.

    PubMed

    Greenberg, Mark

    2007-01-01

    In Mark Greenberg's view, a national child care strategy should pursue four goals. Every parent who needs child care to get or keep work should be able to afford care without having to leave children in unhealthy or dangerous environments; all families should be able to place their children in settings that foster education and healthy development; parental choice should be respected; and a set of good choices should be available. Attaining these goals, says Greenberg, requires revamping both federal child care subsidy programs and federal tax policy related to child care. Today subsidies are principally provided through a block grant structure in which states must restrict eligibility, access, or the extent of assistance because both federal and state funds are limited. Tax policy principally involves a modest nonrefundable credit that provides little or no assistance to poor and low-income families. Greenberg would replace the block grant with a federal guarantee of assistance for all families with incomes under 200 percent of poverty that need child care to enter or sustain employment. States would administer the federal assistance program under a federal-state matching formula with the federal government paying most of the cost. States would develop and implement plans to improve the quality of child care, coordinate child care with other early education programs, and ensure that child care payment rates are sufficient to allow families to obtain care that fosters healthy child development. Greenberg would also make the federal dependent care tax credit refundable, with the credit set at 50 percent of covered child care costs for the lowest-income families and gradually phasing down to 20 percent as family income increases. The combined subsidy and tax changes would lead to a better-coordinated system of child care subsidies that would assure substantial financial help to families below 200 percent of poverty, while tax-based help would ensure continued, albeit significantly reduced, assistance for families with higher incomes. Greenberg indicates that the tax credit expansions are estimated to cost about $5 billion a year, and the subsidy and quality expansions would cost about $18 billion a year. PMID:17902261

  13. Reaching the poor with adequately iodized salt through the Supplementary Nutrition Programme and Midday Meal Scheme in Madhya Pradesh, India

    PubMed Central

    Garg, Aashima; Naidu, Brij RG; Agrawal, Dwarka D; Pandey, Richa S; Aguayo, Victor M

    2013-01-01

    Abstract Problem In India, adequately iodized salt needs to be made accessible to the most marginalized. Approach In an effort to provide adequately iodized salt to the most vulnerable, in 2009 Madhya Pradesh launched a state-wide initiative through two national flagship nutrition programmes: the Supplementary Nutrition Programme of the Integrated Child Development Services and the Midday Meal Scheme. Programme staff members were taught how to correctly store salt and monitor its iodine content. Field monitors assessed the iodine content of the salt in the common kitchens of participating schools and anganwadi centres monthly. Local setting Madhya Pradesh, a state in central India, is home to a substantial proportion of India’s poor. In 2009, household coverage of adequately iodized salt in the state was nearly 90% among the richest but only about 50% among the poorest. Relevant changes Two hot meals prepared with adequately iodized salt were served daily for more than 21 days per month to approximately 89% of the 12?113?584 children aged 3 to 6 years enrolled in anganwadi centres (June 2011 to March 2012). One meal on school days was served to 78% of 5?751?979 primary-school children and to 79% of 2?704?692 secondary-school children (April 2011 to March 2012). Most of the kitchens visited in 2010 (79%) and 2011 (83%) were consistently using adequately iodized salt to prepare hot meals. Lessons learnt India has large-scale social safety net programmes for the poorest. Both national and state policies should mainstream the use of adequately iodized salt in these programmes. PMID:23825882

  14. Care with Cryogenics. 02 Care with Cryogenics

    E-print Network

    Bearhop, Stuart

    Care with Cryogenics. #12;02 Care with Cryogenics This document is designed to be used.eiga.org. Care with Cryogenics. #12;03Care with Cryogenics There are a number of potential hazards when using gases that are liquefied by cooling them to low temperatures. These may be referred to as "CRYOGENIC

  15. Optimization of pharmacotherapy in chronic heart failure: is heart rate adequately addressed?

    PubMed

    Franke, Jennifer; Wolter, Jan Sebastian; Meme, Lillian; Keppler, Jeannette; Tschierschke, Ramon; Katus, Hugo A; Zugck, Christian

    2013-01-01

    The aim of the study is to evaluate the use of beta-blockers in chronic heart failure (CHF) and the extent of heart rate reduction achieved in clinical practice and to determine differences in outcome of patients who fulfilled select inclusion criteria of the SHIFT study according to resting heart rate modulated by beta-blocker therapy. We evaluated an all-comer population of our dedicated CHF outpatient clinic between 2006 and 2010. For inclusion, individually optimized doses of guideline-recommended pharmacotherapy including beta-blockers had to be maintained for at least 3 months and routine follow-up performed at our outpatient CHF-clinic thereafter. Treatment dosages of beta-blockers, and demographic and clinical profiles including resting heart rate were assessed. The outcome of patients who fulfilled select inclusion criteria of the SHIFT study (left-ventricular ejection fraction (LVEF) ?35 %, sinus rhythm, NYHA II-IV) and were followed-up for at least 1 year was stratified according to resting heart rates: ?75 versus <75 bpm and ?70 versus <70 bpm. The composite primary endpoint was defined as all-cause death or hospital admission for worsening heart failure during 12-month follow-up. In total, 3,181 patients were assessed in regard to treatment dosages of beta-blockers, and demographic and clinical profiles including resting heart rate. Of the overall studied population, 443 patients fulfilled all inclusion criteria and entered outcome analysis. Median observation time of survivors was 27.5 months with 1,039.7 observation-years in total. Up-titration to at least half the evidence-based target dose of beta-blockers was achieved in 69 % and full up-titration in 29 % of these patients. Patients with increased heart rates were younger, more often male, exhibited a higher NYHA functional class and lower LVEF. The primary endpoint occurred in 21 % of patients in the ?70 bpm group versus 9 % of patients in the group with heart rates <70 bpm (p <0.01). Likewise, comparing the groups ?75 and <75 bpm, the primary endpoint was significantly increased in the group of patients with heart rates ?75 bpm 27 vs. 12.2 %; p < 0.01). 5-year event-free survival was significantly lower among patients with heart rates ?70 bpm as compared to those with <70 bpm (log-rank test p < 0.05) and among patients in the ?75 bpm group versus <75 bpm group (log-rank test p < 0.01). In conclusion, in clinical practice, 53 % of CHF patients have inadequate heart rate control (heart rates ?75 bpm) despite concomitant beta-blocker therapy. In this non-randomized cohort, adequate heart rate control under individually optimized beta-blocker therapy was associated with improved mid- and long-term clinical outcome up to 5 years. As further up titration of beta-blockers is not achievable in many patients, the administration of a selective heart rate lowering agent, such as ivabradine adjuvant to beta-blockers may pose an opportunity to further modulate outcome. PMID:22760479

  16. Caring for bereaved family caregivers: analyzing the context of care.

    PubMed

    Holtslander, Lorraine F

    2008-06-01

    Deaths from cancer will continue to rise with an increasing and aging population. Family caregivers of patients with cancer will face loss, grief, and bereavement as a result. As mandated by cancer and palliative care clinical practice guidelines, support for family caregivers continues through the processes of grief and bereavement to facilitate a positive transition through loss. To provide evidence-based nursing with this population, an analysis of their context of care was undertaken. Key health policies, characteristics of the healthcare delivery system, and the results of research with bereaved palliative caregivers are described. A model of effectiveness, efficiency, and equity is used to examine the situation of bereaved caregivers and to suggest research questions to fill the gaps in what is known about their needs and experience. Bereaved caregivers are at high risk for many distressing symptoms, including depression and sleeplessness, related to a range of complex variables, such as age, gender, social support, resources, and their experiences during caregiving. Current systems of support have not been adequate to meet the needs of this population and very little is known about the caregivers' quality of life, well-being, and health outcomes or how best to provide compassionate and effective nursing care. PMID:18515249

  17. Pediatric treatment 2.0: ensuring a holistic response to caring for HIV-exposed and infected children.

    PubMed

    Essajee, Shaffiq M; Arpadi, Stephen M; Dziuban, Eric J; Gonzalez-Montero, Raul; Heidari, Shirin; Jamieson, David G; Kellerman, Scott E; Koumans, Emilia; Ojoo, Atieno; Rivadeneira, Emilia; Spector, Stephen A; Walkowiak, Helena

    2013-11-01

    Treatment 2.0 is an initiative launched by UNAIDS and WHO in 2011 to catalyze the next phase of treatment scale-up for HIV. The initiative defines strategic activities in 5 key areas, drugs, diagnostics, commodity costs, service delivery and community engagement in an effort to simplify treatment, expand access and maximize program efficiency. For adults, many of these activities have already been turned into treatment policies. The recent WHO recommendation to use a universal first line regimen regardless of gender, pregnancy and TB status is a treatment simplification very much in line with Treatment 2.0. But despite that fact that Treatment 2.0 encompasses all people living with HIV, we have not seen the same evolution in policy development for children. In this paper we discuss how Treatment 2.0 principles can be adapted for the pediatric population. There are several intrinsic challenges. The need for distinct treatment regimens in children of different ages makes it hard to define a one size fits all approach. In addition, the fact that many providers are reluctant to treat children without the advice of specialists can hamper decentralization of service delivery. But at the same time, there are opportunities that can be availed now and in the future to scale up pediatric treatment along the lines of Treatment 2.0. We examine each of the five pillars of Treatment 2.0 from a pediatric perspective and present eight specific action points that would result in simplification of pediatric treatment and scale up of HIV services for children. PMID:24361631

  18. Indoor air quality in Montréal area day-care centres, Canada.

    PubMed

    St-Jean, Mélissa; St-Amand, Annie; Gilbert, Nicolas L; Soto, Julio C; Guay, Mireille; Davis, Karelyn; Gyorkos, Theresa W

    2012-10-01

    Indoor air quality (IAQ) has been understudied in day-care centres (DCCs), even though it can affect the respiratory health of children. This study was undertaken to assess IAQ in a randomly selected sample of 21 DCCs having space for at least 40 children in Montréal, Canada, and to determine associations between building characteristics and IAQ. Questionnaires on building characteristics and operation of the DCC were administered to managers. Temperature, relative humidity, and concentrations of carbon dioxide (CO(2)), formaldehyde and volatile organic compounds were measured in January and February 2008 in rooms attended by children aged between 18 and 60 months. Most DCCs (81%) had a mechanical ventilation system. Over 85% of the DCCs had a mean CO(2) concentration higher than 1000 ppm, the value generally targeted for comfort in buildings. Mean CO(2) concentrations were significantly lower in DCCs having a floor space meeting the provincial standards. The mean (standard deviation-SD) formaldehyde concentration was 22.9 (8.2) ?g/m(3), with all participating DCCs being within Health Canada's Residential IAQ Guideline of 50 ?g/m(3). The presence of a mechanical ventilation system and a large surface of play area per child were significantly associated with lower CO(2) levels, explaining 44% of the variance in indoor CO(2) concentrations. The presence of a mechanical ventilation system was also associated with significantly lower formaldehyde and acetaldehyde levels. Moreover, 68% of the variance in indoor acetaldehyde concentrations was explained by CO(2) levels, indicating that CO(2) was a better proxy of ventilation than the presence of a ventilation system, as this latter variable did not imply that the ventilation system was running or functioning adequately. These results demonstrate the need for on-going efforts to ensure sufficient floor space and adequate ventilation in DCCs to maintain good IAQ. PMID:22857914

  19. Helping clients with HIV disease navigate managed care.

    PubMed

    Halkitis, P N; Mayne, T

    1997-11-01

    The transition of medical care from fee-for-service to managed care is having an impact on health and mental health practitioners who provide care to people with HIV and AIDS. Evidence suggests that the quality of managed care is not adequate for older patients and patients with chronic diseases. Satisfaction with a managed care plan is often linked to perception of the plan's convenience, the relationship with one's primary health care provider, and the limits on out-of-pocket expenses. Dissatisfaction is linked to inefficient service, limits on choice of provider, and substandard care. The experiences of mental health care providers and recipients in the managed care system are discussed. Advocates note enhanced communication among health care providers and opponents voice concerns about regulation. The greatest concern is that treatment decisions will be based on factors other than the client's needs and best interests. Managed care has the potential to constrain psychotherapeutic treatment, however, understanding managed care plans can result in creative treatment approaches and strategies. PMID:11364939

  20. Ensuring Vitamin D Supplementation in Nursing Home Patients—A Quality Improvement Project

    Microsoft Academic Search

    Mamata Yanamadala; Mitchell T. Heflin; Heidi K. White; Gwendolen T. Buhr

    2012-01-01

    Randomized controlled trials have shown that adequate vitamin D supplementation in nursing home (NH) residents reduces the rates of falls and fractures. In our NH, review of medication administration records of all patients (n = 101) revealed that only 34.6% of the patients were currently prescribed adequate doses of vitamin D, revealing a need for intervention. We designed a Quality Improvement (QI)

  1. Rectal cancer delivery of radiotherapy in adequate time and with adequate dose is influenced by treatment center, treatment schedule, and gender and is prognostic parameter for local control: Results of study CAO/ARO/AIO-94

    SciTech Connect

    Fietkau, Rainer [Department of Radiation Therapy, University of Rostock, Rostock (Germany)]. E-mail: rainer.fietkau@med.uni-rostock.de; Roedel, Claus [Departments of Radiation Therapy and Surgery, University of Erlangen, Erlangen (Germany); Hohenberger, Werner [Departments of Radiation Therapy and Surgery, University of Erlangen, Erlangen (Germany); Raab, Rudolf [Department of Surgery, Klinikum Oldenburg, Oldenburg (Germany); Hess, Clemens [Departments of Radiation Therapy and General Surgery, University of Goettingen, Goettingen (Germany); Liersch, Torsten [Departments of Radiation Therapy and General Surgery, University of Goettingen, Goettingen (Germany); Becker, Heinz [Departments of Radiation Therapy and General Surgery, University of Goettingen, Goettingen (Germany); Wittekind, Christian [Institute of Pathology, University of Leipzig, Leipzig (Germany); Hutter, Matthias [Department of Radiation Therapy, Krankenhaus Nordwest Frankfurt, Frankfurt (Germany); Hager, Eva [Department of Radiation Therapy, Krankenhaus Klagenfurt, Klagenfurt (Austria); Karstens, Johann [Department of Radiation Therapy, University of Hannover, Hannover (Germany); Ewald, Hermann [Department of Radiation Therapy, University of Schleswig-Holstein, Campus Kiel, Kiel (Germany); Christen, Norbert [Department of Radiation Therapy, Krankenhaus Dresden-Friedrichstadt, Dresden (Germany); Jagoditsch, Michael [Department of Surgery, Klinikum St. Veit, St. Veit (Austria); Martus, Peter [Institute of Biostatistics and Clinical Epidemiology, Charite Universitary Medicine Berlin, Berlin (Germany); Sauer, Rolf [Departments of Radiation Therapy and Surgery, University of Erlangen, Erlangen (Germany)

    2007-03-15

    Purpose: The impact of the delivery of radiotherapy (RT) on treatment results in rectal cancer patients is unknown. Methods and Materials: The data from 788 patients with rectal cancer treated within the German CAO/AIO/ARO-94 phase III trial were analyzed concerning the impact of the delivery of RT (adequate RT: minimal radiation RT dose delivered, 4300 cGy for neoadjuvant RT or 4700 cGy for adjuvant RT; completion of RT in <44 days for neoadjuvant RT or <49 days for adjuvant RT) in different centers on the locoregional recurrence rate (LRR) and disease-free survival (DFS) at 5 years. The LRR, DFS, and delivery of RT were analyzed as endpoints in multivariate analysis. Results: A significant difference was found between the centers and the delivery of RT. The overall delivery of RT was a prognostic factor for the LRR (no RT, 29.6% {+-} 7.8%; inadequate RT, 21.2% {+-} 5.6%; adequate RT, 6.8% {+-} 1.4%; p = 0.0001) and DFS (no RT, 55.1% {+-} 9.1%; inadequate RT, 57.4% {+-} 6.3%; adequate RT, 69.1% {+-} 2.3%; p = 0.02). Postoperatively, delivery of RT was a prognostic factor for LRR on multivariate analysis (together with pathologic stage) but not for DFS (independent parameters, pathologic stage and age). Preoperatively, on multivariate analysis, pathologic stage, but not delivery of RT, was an independent prognostic parameter for LRR and DFS (together with adequate chemotherapy). On multivariate analysis, the treatment center, treatment schedule (neoadjuvant vs. adjuvant RT), and gender were prognostic parameters for adequate RT. Conclusion: Delivery of RT should be regarded as a prognostic factor for LRR in rectal cancer and is influenced by the treatment center, treatment schedule, and patient gender.

  2. Control of Drug Administration During Monitored Anesthesia Care

    Microsoft Academic Search

    Antonello L. G. Caruso; Thomas W. Bouillon; Peter M. Schumacher; Eleonora Zanderigo; Manfred Morari

    2009-01-01

    Monitored anesthesia care (MAC) is increasingly used to provide patient comfort for diagnostic and minor surgical procedures. The drugs used in this setting can cause profound respiratory depression even in the therapeutic concentration range. Titration to effect suffers from the difficulty to predict adequate analgesia prior to application of a stimulus, making titration to a continuously measurable side effect an

  3. Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care

    PubMed Central

    Berenson, Robert A.; Schoenbaum, Stephen C.; Gardner, Laurence B.

    2007-01-01

    Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed. PMID:17356977

  4. Monitoring in the Intensive Care

    PubMed Central

    Kipnis, Eric; Ramsingh, Davinder; Bhargava, Maneesh; Dincer, Erhan; Cannesson, Maxime; Broccard, Alain; Vallet, Benoit; Bendjelid, Karim; Thibault, Ronan

    2012-01-01

    In critical care, the monitoring is essential to the daily care of ICU patients, as the optimization of patient's hemodynamic, ventilation, temperature, nutrition, and metabolism is the key to improve patients' survival. Indeed, the decisive endpoint is the supply of oxygen to tissues according to their metabolic needs in order to fuel mitochondrial respiration and, therefore, life. In this sense, both oxygenation and perfusion must be monitored in the implementation of any resuscitation strategy. The emerging concept has been the enhancement of macrocirculation through sequential optimization of heart function and then judging the adequacy of perfusion/oxygenation on specific parameters in a strategy which was aptly coined “goal directed therapy.” On the other hand, the maintenance of normal temperature is critical and should be regularly monitored. Regarding respiratory monitoring of ventilated ICU patients, it includes serial assessment of gas exchange, of respiratory system mechanics, and of patients' readiness for liberation from invasive positive pressure ventilation. Also, the monitoring of nutritional and metabolic care should allow controlling nutrients delivery, adequation between energy needs and delivery, and blood glucose. The present paper will describe the physiological basis, interpretation of, and clinical use of the major endpoints of perfusion/oxygenation adequacy and of temperature, respiratory, nutritional, and metabolic monitorings. PMID:22970356

  5. Designing a Household Survey to Address Seasonality in Child Care Arrangements

    ERIC Educational Resources Information Center

    Schmidt, Stefanie R.; Wang, Kevin H.; Sonenstein, Freya L.

    2008-01-01

    In household telephone surveys, a long field period may be required to maximize the response rate and achieve adequate sample sizes. However, long field periods can be problematic when measures of seasonally affected behavior are sought. Surveys of child care use are one example because child care arrangements vary by season. Options include…

  6. Nursing Workload and the Changing Health Care Environment: A Review of the Literature

    ERIC Educational Resources Information Center

    Neill, Denise

    2011-01-01

    Changes in the health care environment have impacted nursing workload, quality of care, and patient safety. Traditional nursing workload measures do not guarantee efficiency, nor do they adequately capture the complexity of nursing workload. Review of the literature indicates nurses perceive the quality of their work has diminished. Research has…

  7. 532 D. Doro ef al. . ---itiOi:ifiiiliients is chliiieiigiiigililclshould prompt adequate neuro-irnaging, focusing on

    E-print Network

    Arizona, University of

    532 D. Doro ef al. . -·--itiOi:ifiiiliients is chliiieiigiiigililcl·should prompt adequate neuro. Charteris D, Cullen JF: Binasal field defects in primary empty sella syndrome. J Neuro-Ophthalmol 16 dysfunction. Neuro-Ophthalmol 9:259-265, 1989 6. Gu Xl , Tsai JC, Wurdeman A, Wall M, Foote T, Sadun AA

  8. graft morphology and function have not been adequately addressed. A systematic understanding of the effects of in

    E-print Network

    Gao, Jinming

    to human cells for the develop- ment of autologous human vascular grafts that have acceptable long628 graft morphology and function have not been adequately addressed. A systematic understanding- ture period, the vascular cells that are seeded onto the scaf- fold replicate and produce extracellular

  9. Does the asymmetry multiplier in the 1991 NIOSH lifting equation adequately control the biomechanical loading of the spine?

    Microsoft Academic Search

    S. A. Lavender; Y. C. Li; R. N. Natarajan; G. B. J. Andersson

    2009-01-01

    The aim of this research was to evaluate whether the asymmetry multiplier incorporated in the 1991 National Institute for Occupational Safety and Health lifting equation adequately controls the biomechanical spine loads during asymmetric lifting. Sixteen male subjects lifted a box from four initial locations varying in terms of the angular deviation from the mid-sagittal plane (0, 30, 60 and 90°).

  10. Freshwater Reserves in Australia: Directions and Challenges for the Development of a Comprehensive, Adequate and Representative System of Protected Areas

    Microsoft Academic Search

    James A. Fitzsimons; Hugh A. Robertson

    2005-01-01

    The establishment of a system of protected areas that samples all ecosystems, including freshwater environments, in a comprehensive, adequate and representative (CAR) manner is regarded as a cornerstone for the conservation of biodiversity. There have been few quantitative assessments of the comprehensiveness, adequacy and representativeness of freshwater reserves in Australia. This paper reviews and quantifies the effect of classification of

  11. 21 CFR 1.283 - What happens to food that is imported or offered for import without adequate prior notice?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    21 Food and Drugs 1 2012-04-01 2012-04-01 false What happens to food that is imported or offered for import without adequate prior notice? 1.283 Section 1.283 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  12. 21 CFR 1.283 - What happens to food that is imported or offered for import without adequate prior notice?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    21 Food and Drugs 1 2011-04-01 2011-04-01 false What happens to food that is imported or offered for import without adequate prior notice? 1.283 Section 1.283 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  13. 21 CFR 1.283 - What happens to food that is imported or offered for import without adequate prior notice?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    21 Food and Drugs 1 2014-04-01 2014-04-01 false What happens to food that is imported or offered for import without adequate prior notice? 1.283 Section 1.283 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  14. 21 CFR 1.283 - What happens to food that is imported or offered for import without adequate prior notice?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    21 Food and Drugs 1 2013-04-01 2013-04-01 false What happens to food that is imported or offered for import without adequate prior notice? 1.283 Section 1.283 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  15. 21 CFR 1.283 - What happens to food that is imported or offered for import without adequate prior notice?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    21 Food and Drugs 1 2010-04-01 2010-04-01 false What happens to food that is imported or offered for import without adequate prior notice? 1.283 Section 1.283 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  16. Are Substance Use Prevention Programs More Effective in Schools Making Adequate Yearly Progress? A Study of Project ALERT

    ERIC Educational Resources Information Center

    Clark, Heddy Kovach; Ringwalt, Chris L.; Shamblen, Stephen R.; Hanley, Sean M.; Flewelling, Robert L.

    2011-01-01

    This exploratory study sought to determine if a popular school-based drug prevention program might be effective in schools that are making adequate yearly progress (AYP). Thirty-four schools with grades 6 through 8 in 11 states were randomly assigned either to receive Project ALERT (n = 17) or to a control group (n = 17); of these, 10 intervention…

  17. Meeting the Challenge of Adequate Yearly Progress: How One School Is Learning to Leave No Child Behind

    ERIC Educational Resources Information Center

    Richardson, Jacqueline S.; Soltez, Jeff

    2003-01-01

    This article describes the step-by-step process Ross Elementary in Topeka, Kan., used to achieve Adequate Yearly Progress (AYP) in accordance with the No Child Left Behind Act of 2001. A simple process of using teamwork, setting specific measurable goals, and frequent monitoring of student progress toward these goals allowed Ross to significantly…

  18. Understanding Unresponsiveness to Tier 2 Reading Intervention: Exploring the Classification and Profiles of Adequate and Inadequate Responders in First Grade

    ERIC Educational Resources Information Center

    Toste, Jessica R.; Compton, Donald L.; Fuchs, Douglas; Fuchs, Lynn S.; Gilbert, Jennifer K.; Cho, Eunsoo; Barquero, Laura A.; Bouton, Bobette D.

    2014-01-01

    The purpose of the current study was to examine academic and cognitive profiles of first graders who responded adequately and inadequately to intensive small-group reading intervention (Tier 2), as well as assess how these profiles differ based on the criteria used for classification of unresponsiveness. Nonresponders were identified using two…

  19. Update with 2009-10 Data and Five-Year Trends: How Many Schools Have Not Made Adequate Yearly Progress?

    ERIC Educational Resources Information Center

    Usher, Alexandra

    2011-01-01

    Recently, much attention has focused on the number of schools in the nation failing to make adequate yearly progress (AYP) in raising student achievement under the No Child Left Behind Act (NCLB). The Obama Administration has projected a dramatic increase in this number as 2014--the year when 100% of students are expected to score proficient on…

  20. How Many Schools Have Not Made Adequate Yearly Progress under the No Child Left Behind Act? August 2010 Update

    ERIC Educational Resources Information Center

    Dietz, Shelby

    2010-01-01

    Drawing on data from state departments of education and other public sources, this report estimates the number and percentage of public schools that did not make adequate yearly progress. The report finds that approximately one-third of the nation's public schools did not make AYP in school year 2008-09, although the number varied greatly by…

  1. Increased fluid intake and adequate dietary modification may be enough for the successful treatment of uric acid stone.

    PubMed

    Chae, Ji Yun; Kim, Jong Wook; Kim, Jin Wook; Yoon, Cheol Yong; Park, Hong Seok; Moon, Du Geon; Oh, Mi Mi

    2013-04-01

    Uric acid stones are the most readily dissolvable of all types of urinary stones. The present paper describes two patients with uric acid stones in kidney and ureter, whom we have treated successfully only by a combination of increased fluid intake and adequate dietary modification. PMID:23503881

  2. Effect of Infection on Skeletal Muscle Ribosomes in Rats Fed Adequate or Low Protein1'2

    Microsoft Academic Search

    VERNON R. YOUNG; SHUI C. CHEN; ANDPAUL M. NEWBERNE

    2010-01-01

    The effect of Salmonella typhimurium infection on protein metabo lism in the skeletal muscle of the hind leg was studied in rats in 2 experiments. In experiment 1 rats were fed an adequate-protein diet and killed at zero, 1, 2, 3, and 5 days after infection. In vivo uptake of \\

  3. > http://eprint.iacr.org/2013/246.pdf Lever Function to a New Codomain with Adequate Indeterminacy*

    E-print Network

    > http://eprint.iacr.org/2013/246.pdf Lever Function to a New Codomain with Adequate is Ci (Ai W(i) ) (% M) with (i) = {5, 7, ..., 2n + 3} for i = 1, ..., n, where (i) is called a lever attack and indeterministic intersection attack most efficient now, and a relation between a lever

  4. 25 CFR 1000.256 - Must the Secretary retain project funds to ensure proper health and safety standards in...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction...

  5. 25 CFR 1000.256 - Must the Secretary retain project funds to ensure proper health and safety standards in...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction...

  6. 25 CFR 1000.256 - Must the Secretary retain project funds to ensure proper health and safety standards in...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction...

  7. 25 CFR 1000.256 - Must the Secretary retain project funds to ensure proper health and safety standards in...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction...

  8. Policy options to improve leadership of middle managers in the Australian residential aged care setting: a narrative synthesis

    Microsoft Academic Search

    Yun-Hee Jeon; Nicholas J Glasgow; Teri Merlyn; Emily Sansoni

    2010-01-01

    BACKGROUND: The prevalence of both chronic diseases and multi-morbidity increases with longer life spans. As Australia's population ages, the aged care sector is under increasing pressure to ensure that quality aged care is available. Key to responding to this pressure is leadership and management capability within the aged care workforce. A systematic literature review was conducted to inform the policy

  9. 78 FR 16795 - Medicare and Medicaid Programs; Requirements for Long-Term Care (LTC) Facilities; Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-19

    ...Programs; Requirements for Long-Term Care (LTC) Facilities; Notice of Facility...revised the requirements that a long-term care (LTC) facility must meet in order to...of the Patient Protection and Affordable Care Act to ensure that, among other...

  10. 76 FR 9503 - Medicare and Medicaid Programs; Requirements for Long-Term Care (LTC) Facilities; Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-18

    ...Programs; Requirements for Long-Term Care (LTC) Facilities; Notice of Facility...amends the requirements that a long- term care (LTC) facility must meet in order to...implement section 6113 of the Affordable Care Act to ensure that, among other...

  11. Selecting effective incentive structures in health care: A decision framework to support health care purchasers in finding the right incentives to drive performance

    Microsoft Academic Search

    Thomas Custers; Jeremiah Hurley; Niek S Klazinga; Adalsteinn D Brown

    2008-01-01

    BACKGROUND: The Ontario health care system is devolving planning and funding authority to community based organizations and moving from steering through rules and regulations to steering on performance. As part of this transformation, the Ontario Ministry of Health and Long-Term Care (MOHLTC) are interested in using incentives as a strategy to ensure alignment – that is, health service providers' goals

  12. Nurses' perceptions of leadership in an adult intensive care unit: a phenomenology study.

    PubMed

    Linton, Jenelle; Farrell, Maureen J

    2009-04-01

    The purpose of this research was to explore ICU nurses' perceptions of nursing leadership in the adult intensive care unit (ICU). The nursing profession needs leaders at all levels; ward, administration and executive and in an era in which there is a shortage of ICU nurses, nursing leadership is important, as positive leadership skills correlate with enhanced recruitment and retention of these specialist nurses. Six ICU nurses with at least 5 years experience in ICU nursing were recruited from a metropolitan hospital in Australia. Qualitative phenomenological methodology was used to depict the lived experiences of nurses' leadership in the adult ICU. Data were collected through individual semi-structured interviews using open-ended questions and analysed using Giorgi's [Giorgi A. Toward phenomenologically based research in psychology. J Phenomenol Psychol 1970;1:75-98] descriptive method for data analysis. Five themes emerged and these were all inter-related: leading by example, communication, ability to think outside the management square, knowing your staff and stepping up in times of crisis. These findings highlight the importance of nursing leadership in the adult ICU and the need to ensure that all current and future nursing ICU leaders are adequately prepared and educated for this role. This information may also be used to assist in the development of leadership skills in ICU nurses. PMID:19131249

  13. Community health workers in primary care practice: redesigning health care delivery systems to extend and improve diabetes care in underserved populations.

    PubMed

    Collinsworth, Ashley; Vulimiri, Madhulika; Snead, Christine; Walton, James

    2014-11-01

    New, comprehensive, approaches for chronic disease management are needed to ensure that patients, particularly those more likely to experience health disparities, have access to the clinical care, self-management resources, and support necessary for the prevention and control of diabetes. Community health workers (CHWs) have worked in community settings to reduce health care disparities and are currently being deployed in some clinical settings as a means of improving access to and quality of care. Guided by the chronic care model, Baylor Health Care System embedded CHWs within clinical teams in community clinics with the goal of reducing observed disparities in diabetes care and outcomes. This study examines findings from interviews with patients, CHWs, and primary care providers (PCPs) to understand how health care delivery systems can be redesigned to effectively incorporate CHWs and how embedding CHWs in primary care teams can produce informed, activated patients and prepared, proactive practice teams who can work together to achieve improved patient outcomes. Respondents indicated that the PCPs continued to provide clinical exams and manage patient care, but the roles of diabetes education, nutritional counseling, and patient activation were shifted to the CHWs. CHWs also provided patients with social support and connection to community resources. Integration of CHWs into clinical care teams improved patient knowledge and activation levels, the ability of PCPs to identify and proactively address specific patient needs, and patient outcomes. PMID:25359249

  14. Managing the care of patients who have visual impairment.

    PubMed

    Watkinson, Sue; Scott, Eileen

    An ageing population means that the incidence of people who are visually impaired will increase. However, extending the role of ophthalmic nurses will promote delivery of a more effective health service for these patients. Using Maslow's hierarchy of needs as a basis for addressing the care of patients with visual impairment is a means of ensuring that they receive high quality, appropriate care at the right time. PMID:14735633

  15. [Characteristics of Health-Care Provision for Patients in Out-of-Hours Care and Regular Care.

    PubMed

    Leutgeb, R; Szecsenyi, J; Kuehlein, T; Laux, G

    2014-11-01

    Background: Little is known of the primary care characteristics in out of hours care centres (OOHC) as compared to regular care in Germany. Obviously the provision of patients in OOHC exhibits special characteristics concerning supply requirements, occupation and physician services, that require a first approximation. Methods: The data retrieval is managed within the CONTENT (CONTinous morbidity registration Epidemiologic NeTwork) research network. The used software allows for classifying reasons for encounter (RFE), health-problems (diagnoses) and processes of care (prescriptions, referrals, hospitalisations) with the International Classification of Primary Care (ICPC). Furthermore the software allows for pseudonymised data export. One OOHC Centre in South Hessen is part of the network. Therefore, this allows the comparison of this OOHC centre with the regular care of the included 5 physicians in 4 practices of the same region. Results: A 3-year period (01 April 2010-31 March 2013) with 192?827 patient contacts of 13?394 patients (58.1% female) in regular care and 14?354 patient contacts with 9?208 patients (64.1% female) in OOHC was described. Medium age of the patients of the regular provision was 59.6 vs. 45.7 years in the OOHC centre based on the contacts (p<0.0001). The most frequent RFE in the OOHC centre were fever and pain predominantly caused by acute infections, injuries or acute pain of the musculoskeletal system. In regular care there could be documented predominantly chronic health issues and vaccinations. The prevalent prescriptions in OOHC were therefore antibiotics and analgesics in regular care blood pressure medication and antidiabetic drugs. The rate of referrals was obviously lower than in regular care (7.1 vs. 22.7; p<0.0001), whereas the rate of hospitalisations was obviously higher in OOHC than in regular care (5.6 vs. 1.1; p<0.0001). Conclusion: With the help of the data, requirements, occupation, resulting diagnoses and care processes in regular and out of hours care can be compared and described in detail. We could document major differences between the provision in OOHC and regular care. The results encourage initiating further studies to ensure the supply of primary care in OOHC. PMID:25372654

  16. Health care interactional suffering in palliative care.

    PubMed

    Beng, Tan Seng; Guan, Ng Chong; Jane, Lim Ee; Chin, Loh Ee

    2014-05-01

    A secondary analysis of 2 qualitative studies was conducted to explore the experiences of suffering caused by interactions with health care providers in the hospital setting. Interview transcripts from 20 palliative care patients and 15 palliative care informal caregivers in University Malaya Medical Centre were thematically analyzed. The results of health care interactional suffering were associated with themes of attention, understanding, communication, competence, and limitation. These 5 themes may serve as a framework for the improvement in interaction skills of health care providers in palliative care. PMID:23689367

  17. Willingness to Pay for Annual Health Care Services in Small Ruminants: The Case of South India

    NASA Astrophysics Data System (ADS)

    Kathiravan, G.; Thirunavukkarasu, M.; Michealraj, P.

    A study was undertaken in southern peninsular State of India, the Tamil Nadu State, to assess the farmers Willingness To Pay` (WTP) for annual health care services in small ruminants. The districts of the State were categorized as Livestock Developed (LD) and Livestock Under Developed (LUD) based on initial base line developed. Contingent Valuation (CV) approach was used to study the farmers maximum WTP value for two types of health care services: (a) providing animal health care services at government veterinary centres, (b) extending animal health care services at farmers door steps. A Payment Card (PC) format was used to assess the farmers` maximum WTP for ensuring health care services to sheep and goat. The Maximum Likelihood technique was used on interval midpoints. The study revealed that the farmers were willing to pay a maximum of INR 56.34 and INR 61.61 for availing health services to their sheep and goat, respectively, by in-centre services, while they were ready to offer INR 87.49 and INR 95.27 for the animal health services delivered at doorsteps. The mean maximum WTP value was found to be more for goats than sheep, postulated both in-centre and home services. Of the factors incorporated in the in-centre service model for sheep, age of respondent, livelihood share of livestock, number of sheep and VLU owned and distance from nearest public veterinary centre were found to significantly influence the WTP values. Unlike sheep, age of respondent, VLU possession, distance of the public veterinary centre and district versatility had a significant role in determining WTP values for goats. WTP values in sheep for home service were found to be significantly predisposed by all the significant factors of in-centre services model, except number of sheep owned. Similarly, in goat, the age of respondent turned to be insignificant in home services model. The results indicated that the people were willing to pay more for getting their small ruminants adequately protected from diseases and treated at once with quality services.

  18. Best practice eye care models

    PubMed Central

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

    2012-01-01

    Since the launching of Global Initiative, VISION 2020 “the Right to Sight” many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor. PMID:22944741

  19. The ventilator-dependent infant requiring palliative care in the neonatal intensive care unit: A literature review

    Microsoft Academic Search

    Christine Foster; Leanne Monterosso

    2012-01-01

    Aim: To review the literature relevant to palliative care of the ventilated infant and their family.\\u000aBackground: Impeccable symptom assessment and management is necessary to ensure the optimal quality of life for the ventilated palliative infant and their family. There is a plethora of literature regarding symptom assessment and care when a decision has been made to withdraw ventilatory support.

  20. Types of health care providers

    MedlinePLUS

    This article describes health care providers involved in primary care, nursing care, and specialty care. This is just ... PRIMARY CARE A primary care provider (PCP) is a person you may see first for checkups and health ...

  1. Use of GAC (granular activated carbon) filtration to ensure quality in drinking water from surface sources

    Microsoft Academic Search

    Schalekamp

    1979-01-01

    The use of GAC (Granular Activated Carbon) filtration to ensure quality in drinking water from surface sources in Switzerland shows that the use of GAC, which has a cost one-eighth of the total treatment cost, is economically feasible and will ensure that the quality of surface water is not inferior to that from wells or groundwater abstractions. In spite of

  2. 20 CFR 670.993 - How does Job Corps ensure that contract disputes will be resolved?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...2013-04-01 2013-04-01 false How does Job Corps ensure that contract disputes will...DEPARTMENT OF LABOR (CONTINUED) THE JOB CORPS UNDER TITLE I OF THE WORKFORCE INVESTMENT...Management Provisions § 670.993 How does Job Corps ensure that contract disputes...

  3. 20 CFR 670.993 - How does Job Corps ensure that contract disputes will be resolved?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...2012-04-01 2012-04-01 false How does Job Corps ensure that contract disputes will...DEPARTMENT OF LABOR (CONTINUED) THE JOB CORPS UNDER TITLE I OF THE WORKFORCE INVESTMENT...Management Provisions § 670.993 How does Job Corps ensure that contract disputes...

  4. 20 CFR 670.993 - How does Job Corps ensure that contract disputes will be resolved?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...2014-04-01 2014-04-01 false How does Job Corps ensure that contract disputes will...DEPARTMENT OF LABOR (CONTINUED) THE JOB CORPS UNDER TITLE I OF THE WORKFORCE INVESTMENT...Management Provisions § 670.993 How does Job Corps ensure that contract disputes...

  5. 20 CFR 670.993 - How does Job Corps ensure that contract disputes will be resolved?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 2011-04-01 false How does Job Corps ensure that contract disputes will...ADMINISTRATION, DEPARTMENT OF LABOR THE JOB CORPS UNDER TITLE I OF THE WORKFORCE INVESTMENT...Management Provisions § 670.993 How does Job Corps ensure that contract disputes...

  6. 20 CFR 670.993 - How does Job Corps ensure that contract disputes will be resolved?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 2010-04-01 false How does Job Corps ensure that contract disputes will...ADMINISTRATION, DEPARTMENT OF LABOR THE JOB CORPS UNDER TITLE I OF THE WORKFORCE INVESTMENT...Management Provisions § 670.993 How does Job Corps ensure that contract disputes...

  7. Strategic Plan To Ensure Racial and Ethnic Diversity in Connecticut Public Higher Education. Annual Report 2004

    ERIC Educational Resources Information Center

    Connecticut Department of Higher Education (NJ1), 2004

    2004-01-01

    Creation of a Strategic Plan to Ensure Racial and Ethnic Diversity in Connecticut Public Higher Education was among the original statutory mandates assigned to the Board of Governors of Higher Education by its 1982 enabling legislation. The purpose of the plan is to "ensure that students, faculty, administrators and staff at each public…

  8. New Techniques for Ensuring the Long Term Integrity of Digital Archives

    E-print Network

    JaJa, Joseph F.

    New Techniques for Ensuring the Long Term Integrity of Digital Archives Sangchul Song Department today needs to be archived and preserved for future use of periods ranging from a few years to decades and sometimes centuries. A fundamental requirement of a long term archive is to ensure the integrity of its

  9. Ensuring code safety without runtime checks for real-time control systems

    Microsoft Academic Search

    Sumant Kowshik; Dinakar Dhurjati; Vikram S. Adve

    2002-01-01

    This paper considers the problem of providing safe programming support and enabling secure online software upgrades for control software in real-time control systems. In such systems, offline techniques for ensuring code safety are greatly preferable to online techniques. We propose a language called Control-C that is essentially a subset of C, but with key restrictions designed to ensure that memory

  10. 24 CFR 903.25 - How does HUD ensure PHA compliance with its plan?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 2012-04-01 false How does HUD ensure PHA compliance with its plan? 903.25 Section...URBAN DEVELOPMENT PUBLIC HOUSING AGENCY PLANS PHA Plans § 903.25 How does HUD ensure PHA compliance with its plan? A PHA must...

  11. 24 CFR 903.25 - How does HUD ensure PHA compliance with its plan?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 2011-04-01 false How does HUD ensure PHA compliance with its plan? 903.25 Section...URBAN DEVELOPMENT PUBLIC HOUSING AGENCY PLANS PHA Plans § 903.25 How does HUD ensure PHA compliance with its plan? A PHA must...

  12. 24 CFR 903.25 - How does HUD ensure PHA compliance with its plan?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 2010-04-01 false How does HUD ensure PHA compliance with its plan? 903.25 Section...URBAN DEVELOPMENT PUBLIC HOUSING AGENCY PLANS PHA Plans § 903.25 How does HUD ensure PHA compliance with its plan? A PHA must...

  13. 24 CFR 903.25 - How does HUD ensure PHA compliance with its plan?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 2013-04-01 false How does HUD ensure PHA compliance with its plan? 903.25 Section...URBAN DEVELOPMENT PUBLIC HOUSING AGENCY PLANS PHA Plans § 903.25 How does HUD ensure PHA compliance with its plan? A PHA must...

  14. 24 CFR 903.25 - How does HUD ensure PHA compliance with its plan?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 2014-04-01 false How does HUD ensure PHA compliance with its plan? 903.25 Section...URBAN DEVELOPMENT PUBLIC HOUSING AGENCY PLANS PHA Plans § 903.25 How does HUD ensure PHA compliance with its plan? A PHA must...

  15. Preventive Care Benefits (Affordable Care Act)

    MedlinePLUS

    ... health coverage is important Marketplace coverage & taxes Preventive care benefits Rights and protections Appeal a Marketplace decision ... Tax Questions? Fees & exemptions Site Search Search Preventive care benefits Preventive health services for adults Select an ...

  16. The Role of EMS in Regionalized Systems of Care.

    PubMed

    Drennan, Ian R; Verbeek, P Richard

    2015-07-01

    The parallel advancement of prehospital and in-hospital patient care has provided impetus for the development and implementation of regionalized systems of health care for patients suffering from acute, life-threatening injury and illness. Regardless of the patient's clinical condition, regionalized systems of care revolve around the premise of providing the right care to the right patient at the right time. Current regionalization strategies have shown improvements in the time to patient treatment and in patient outcome, with the incorporation of emergency medical services (EMS) bypass as a key component of the system of care. This article discusses the emerging role of EMS as a critical component of regionalized systems essential to ensure effective and efficient use of resources to improve patient outcome. We also examine some of the benefits and barriers to implementation of regionalized systems of care and avenues for future research. PMID:26073708

  17. VA integrated post-combat care: a systemic approach to caring for returning combat veterans.

    PubMed

    Amdur, Deborah; Batres, Alfonso; Belisle, Janet; Brown, John H; Cornis-Pop, Micaela; Mathewson-Chapman, Marianne; Harms, Gregory; Hunt, Stephen C; Kennedy, Peggy; Mahoney-Gleason, Heather; Perez, Jennifer; Sheets, Carol; Washam, Terry

    2011-01-01

    The Department of Veterans Affairs (VA's) mission is to care for those who have borne the battle. As medical technology has advanced, more and more of our returning combat Veterans survive what would have been fatal wounds in previous conflicts ( Gawande, 2004 ). But survival is only the immediate goal-our job is to restore Veterans to the greatest level of health, independence, and quality of life that is medically possible. The VA is achieving this goal through close collaboration with the Department of Defense (DoD) to facilitate a smooth transition and continuum of care that ensures Veterans and Service Members receive the care they deserve. This article describes VA's system of Veteran-centered, post-combat care programs that rely on significant involvement of social workers to support Service Members, Veterans and their families through recovery, rehabilitation, and re-integration into their home communities. PMID:21846255

  18. Profiles of choice: Parents’ patterns of priority in child care decision-making

    Microsoft Academic Search

    Jinseok Kim; Maryah Stella Fram

    2009-01-01

    Responding adequately to parental priorities for child care is important for shaping children’s early experiences and development, and for facilitating parenting at the nexus of work and caregiving roles. Although much research on child care choice has relied on variable-centered approaches that treat parental priorities as distinct and isolated, this article aims to understand parents’ care choices from a person-centered,

  19. Child Care Aware

    MedlinePLUS

    ... learn about high-quality child care. Welcome to Child Care Aware® E-Mail Print Share Tweet Military Child ... 2246 Call TTY#: 1-866-278-9428 Free Child Care Search Please enter your zip code. Your local ...

  20. National Health Care Survey

    Cancer.gov

    The National Health Care Survey (NHCS) encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.

  1. Home health care

    MedlinePLUS

    ... and exercises, wound care, and daily living. Home health care nurses can help manage problems with your wound, ... Centers for Medicare and Medicaid Services. Home health care: what it is and what to expect. ... ...

  2. Palliative Care in Cancer

    MedlinePLUS

    ... is receiving palliative care. Hospice care is a form of palliative care that is given to a ... technical language and specific details of laws and forms are hard to understand. To ease the burden, ...

  3. Advance Care Planning

    MedlinePLUS

    ... burden off family and friends. What Is Advance Care Planning? Advance care planning involves learning about the ... change in your health. Medical Research and Advance Care Planning Medical research plays an important role in ...

  4. Your Dialysis Care Team

    MedlinePLUS

    ... Contact Us You are here Home » Your Dialysis Care Team Good health care is always a team ... your family improve your quality of life. Patient Care Technician and Biomedical Technician There are two kinds ...

  5. Skin care and incontinence

    MedlinePLUS

    Incontinence - skin care ... in a wheelchair, regular chair, or bed TAKING CARE OF THE SKIN Using diapers and other products ... skin. Over time, the skin breaks down. Special care must be taken to keep the skin clean ...

  6. Family as the primary caregiver: palliative care in the Golan Heights.

    PubMed

    Richman, Elon; Ringel, Amit; Kreniske, Jonah Susser; Safadi, Wajdi

    2015-01-01

    Palliative care is recognised by the WHO as an essential component of care for the seriously ill. Geographically isolated and historically underserved communities, particularly from ethnic minority groups, face obstacles in obtaining adequate palliative care. This case involves the care of a 26-year-old Druze man suffering from a terminal cancer in his Golan Heights village. Local physicians were able to train the patient's father in a palliative care capacity. In the effort of capacity building, the physician and palliative care team also aided the aggrieved family in the process of coping. Robust support networks, both at state and community levels, facilitated the care provided. In showcasing the role of the national and local safety net in activating and building community resources to address a dearth of palliative care services in disadvantaged regions, this case models a potentially effective community-based approach to palliative care for patients from underserved populations. PMID:25858919

  7. Autonomous Medical Care for Exploration

    NASA Technical Reports Server (NTRS)

    Johnson-Throop, Kathy A.; Polk, J. D.; Hines, John W.; Nall, Marsha M.

    2005-01-01

    The goal of Autonomous Medical Care (AMC) is to ensure a healthy, well-performing crew which is a primary need for exploration. The end result of this effort will be the requirements and design for medical systems for the CEV, lunar operations, and Martian operations as well as a ground-based crew health optimization plan. Without such systems, we increase the risk of medical events occurring during a mission and we risk being unable to deal with contingencies of illness and injury, potentially threatening mission success. AMC has two major components: 1) pre-flight crew health optimization and 2) in-flight medical care. The goal of pre-flight crew health optimization is to reduce the risk of illness occurring during a mission by primary prevention and prophylactic measures. In-flight autonomous medical care is the capability to provide medical care during a mission with little or no real-time support from Earth. Crew medical officers or other crew members provide routine medical care as well as medical care to ill or injured crew members using resources available in their location. Ground support becomes telemedical consultation on-board systems/people collect relevant data for ground support to review. The AMC system provides capabilities to incorporate new procedures and training and advice as required. The on-board resources in an autonomous system should be as intelligent and integrated as is feasible, but autonomous does not mean that no human will be involved. The medical field is changing rapidly, and so a challenge is to determine which items to pursue now, which to leverage other efforts (e.g. military), and which to wait for commercial forces to mature. Given that what is used for the CEV or the Moon will likely be updated before going to Mars, a critical piece of the system design will be an architecture that provides for easy incorporation of new technologies into the system. Another challenge is to determine the level of care to provide for each mission type. The level of care refers to the amount and type of care one will render based on perceived need and ability. This is in contrast to the standard of care which is the benchmark by which that care is provided. There are certainly some devices and procedures that have unique microgravity or partial gravity requirements such that terrestrial methods will not work. For example, performing CPR on Mars cannot be done in exactly the same way as on Earth because the reduced gravity causes too large a reduction in the forces available for effective compression of the chest. Likewise, fluid behavior in microgravity may require a specialized water filtration and mixing system for the creation of intravenous fluids. This paper will outline the drivers for the design of the medical care systems, prioritization and planning techniques, key system components, and long term goals.

  8. Defining the adequate arterial pressure target during septic shock: not a 'micro' issue but the microcirculation can help

    PubMed Central

    2011-01-01

    The Surviving Sepsis Campaign guidelines suggest targeting a mean arterial pressure of at least 65 mm Hg to maintain organ perfusion pressure during septic shock. However, the optimal mean arterial pressure can be higher in patients with a history of hypertension or other vascular comorbidities or in those with increased abdominal pressure. In a given individual, the adequate mean arterial pressure target can be difficult to define with the routine hemodynamic parameters (for example, cardiac output, central or mixed venous blood oxygen saturation, and urine output). Near-infrared spectroscopy and sidestream dark field imaging have emerged as promising technologies for monitoring the microcirculation at the bedside. These new methods could provide additional clues to help define the adequate blood pressure to target during the resuscitation phase of septic shock. PMID:22047945

  9. Limiting care: is CPR for everyone?

    PubMed

    Brown, C

    1990-05-01

    Current research on the efficacy of CPR in specific patient groups may lead to the withholding of CPR in groups that statistically show minimal success. Prognosticative factors that indicate minimal-at-best success with CPR include age greater than 70, dysrhythmias such as asystole and electromechanical dissociation, sepsis, metastatic cancer, GI hemorrhage, and acute stroke. Although physicians are under no legal or ethical obligation to provide futile treatments, how one defines a treatment as "futile" is unclear. As a patient advocate, the nurse acts to ensure the autonomous patient is fully informed, freely consenting, and actively directing his/her own health care. End-of-life decisions regarding health care must be based on the patient's goals, which will be revealed through the moral discourse among health care professionals, patients, and their loved ones. PMID:2357436

  10. Application of database systems in diabetes care.

    PubMed

    Kopelman, P G; Sanderson, A J

    1996-01-01

    The St Vincent Declaration includes a commitment to continuous quality improvement in diabetes care. This necessitates the collection of appropriate information to ensure that diabetes services are efficient, effective and equitable. The quantity of information, and the need for rapid access, means that this must be computer-based. The choice of architecture and the design of a database for diabetes care must take into account available equipment and operational requirements. Hardware topology may be determined by the operating system and/or netware software. An effective database system will include: user-friendliness, rapid but secure access to data, a facility for multiple selections for analysis and audit, the ability to be used as part of the patient consultation process, the ability to interface or integrate with other applications, and cost efficiency. An example of a clinical information database for diabetes care, Diamond, is described. PMID:9244825

  11. Effect of microbial phytase on apparent ileal amino acid digestibility of phosphorus-adequate diets in growing pigs

    Microsoft Academic Search

    So?a Nitrayová; Peter Patráš; Alexander Sommer; Jaroslav Heger

    2006-01-01

    Six ileally cannulated pigs (mean initial body weight 34.8 kg) were used to study the effect of microbial phytase on apparent ileal digestibility of P, total N and amino acids. Three P-adequate diets (digestible P concentration 2.3 g · kg ) containing barley (B), soyabean meal (S) or a mixture of the two (BS) with or without phytase supplement (1000 FTU · kg ) were fed

  12. Transition from Long Day Care to Kindergarten: Continuity or Not?

    ERIC Educational Resources Information Center

    Barblett, Lennie; Barratt-Pugh, Caroline; Kilgallon, Pam; Maloney, Carmel

    2011-01-01

    Transition practices that ensure continuity between early childhood settings have been shown to be important in assisting children's short-term and long-term growth and development (Vogler, Cravello & Woodhead, 2008). In Western Australia many young children move from and between long day care (LDC) settings to kindergarten. In that state,…

  13. Risk Based Post Closure Care Analysis for Florida Landfills

    Microsoft Academic Search

    Banu Sizirici Yildiz

    2009-01-01

    Subtitle D of the Resource Conservation and Recovery Act (RCRA) requires a post closure period of 30 years for non hazardous wastes in landfills. Post closure care (PCC) activities under Subtitle D include leachate collection and treatment, groundwater monitoring, inspection and maintenance of the final cover, and monitoring to ensure that landfill gas does not migrate off site or into

  14. Risk based post closure care analysis for Florida landfills

    Microsoft Academic Search

    Banu Sizirici Yildiz

    2009-01-01

    Subtitle D of the Resource Conservation and Recovery Act (RCRA) requires a post closure period of 30 years for non hazardous wastes in landfills. Post closure care (PCC) activities under Subtitle D include leachate collection and treatment, groundwater monitoring, inspection and maintenance of the final cover, and monitoring to ensure that landfill gas does not migrate off site or into

  15. Email consultations in health care: 2--acceptability and safe application

    Microsoft Academic Search

    Josip Car; Aziz Sheikh

    2004-01-01

    Email may have an important role in augmenting and facilitating communication between patients and healthcare professionals. 1 In this article we summarise the evidence describing public and professional attitudes to using email in routine clinical care and explore issues relating to ensuring such use is safe. Specifically, we aim to answer three questions: x How acceptable is email consulting to

  16. The impact of the carer support needs assessment tool (CSNAT) in community palliative care using a stepped wedge cluster trial.

    PubMed

    Aoun, Samar M; Grande, Gunn; Howting, Denise; Deas, Kathleen; Toye, Chris; Troeung, Lakkhina; Stajduhar, Kelli; Ewing, Gail

    2015-01-01

    Family caregiving towards the end-of-life entails considerable emotional, social, financial and physical costs for caregivers. Evidence suggests that good support can improve caregiver psychological outcomes. The primary aim of this study was to investigate the impact of using the carer support needs assessment tool (CSNAT), as an intervention to identify and address support needs in end of life home care, on family caregiver outcomes. A stepped wedge design was used to trial the CSNAT intervention in three bases of Silver Chain Hospice Care in Western Australia, 2012-14. The intervention consisted of at least two visits from nurses (2-3 weeks apart) to identify, review and address caregivers' needs. The outcome measures for the intervention and control groups were caregiver strain and distress as measured by the Family Appraisal of Caregiving Questionnaire (FACQ-PC), caregiver mental and physical health as measured by SF-12v2, and caregiver workload as measured by extent of caregiver assistance with activities of daily living, at baseline and follow up. Total recruitment was 620. There was 45% attrition for each group between baseline and follow-up mainly due to patient deaths resulting in 322 caregivers completing the study (233 in the intervention group and 89 in the control group). At follow-up, the intervention group showed significant reduction in caregiver strain relative to controls, p=0.018, d=0.348 (95% CI 0.25 to 0.41). Priority support needs identified by caregivers included knowing what to expect in the future, having time for yourself in the day and dealing with your feelings and worries. Despite the challenges at the clinician, organisational and trial levels, the CSNAT intervention led to an improvement in caregiver strain. Effective implementation of an evidence-informed and caregiver-led tool represents a necessary step towards helping palliative care providers better assess and address caregiver needs, ensuring adequate family caregiver support and reduction in caregiver strain. PMID:25849348

  17. The Impact of the Carer Support Needs Assessment Tool (CSNAT) in Community Palliative Care Using a Stepped Wedge Cluster Trial

    PubMed Central

    Aoun, Samar M.; Grande, Gunn; Howting, Denise; Deas, Kathleen; Toye, Chris; Troeung, Lakkhina; Stajduhar, Kelli; Ewing, Gail

    2015-01-01

    Family caregiving towards the end-of-life entails considerable emotional, social, financial and physical costs for caregivers. Evidence suggests that good support can improve caregiver psychological outcomes. The primary aim of this study was to investigate the impact of using the carer support needs assessment tool (CSNAT), as an intervention to identify and address support needs in end of life home care, on family caregiver outcomes. A stepped wedge design was used to trial the CSNAT intervention in three bases of Silver Chain Hospice Care in Western Australia, 2012-14. The intervention consisted of at least two visits from nurses (2-3 weeks apart) to identify, review and address caregivers’ needs. The outcome measures for the intervention and control groups were caregiver strain and distress as measured by the Family Appraisal of Caregiving Questionnaire (FACQ-PC), caregiver mental and physical health as measured by SF-12v2, and caregiver workload as measured by extent of caregiver assistance with activities of daily living, at baseline and follow up. Total recruitment was 620. There was 45% attrition for each group between baseline and follow-up mainly due to patient deaths resulting in 322 caregivers completing the study (233 in the intervention group and 89 in the control group). At follow-up, the intervention group showed significant reduction in caregiver strain relative to controls, p=0.018, d=0.348 (95% CI 0.25 to 0.41). Priority support needs identified by caregivers included knowing what to expect in the future, having time for yourself in the day and dealing with your feelings and worries. Despite the challenges at the clinician, organisational and trial levels, the CSNAT intervention led to an improvement in caregiver strain. Effective implementation of an evidence-informed and caregiver-led tool represents a necessary step towards helping palliative care providers better assess and address caregiver needs, ensuring adequate family caregiver support and reduction in caregiver strain. PMID:25849348

  18. Study Shows Importance of Early End-of-Life Care Discussions

    Cancer.gov

    Discussions about palliative and end-of-life care are often delayed until late in a patient's life, if they take place at all. Earlier discussions may help to ensure that the care delivered at the end of life is consistent with a patient's preferences.

  19. Learning and Growing Together: Head Start and Child Care Professional Development Partnerships.

    ERIC Educational Resources Information Center

    Elliott, Kimberly; Vestal, Anita

    High quality training is necessary to ensure that early childhood and child care practitioners are equipped to meet the diverse needs of the children and families they serve. This book presents the professional development partnership model of The Center for Career Development in Early Care and Education, a strategy to build a comprehensive career…

  20. DNA Fingerprinting Reveals Female Preference for Male Parental Care in Savannah Sparrows

    Microsoft Academic Search

    Corey R. Freeman-Gallant

    1996-01-01

    According to sexual selection theory, females choose mates to ensure access to high quality resources, male parental care, or good genes. This last hypothesis has been hotly debated on both theoretical and empirical grounds. In contrast, female preference for male parental care has received less attention, primarily because the potential benefits of paternal effort seem obvious. The fitness relations are