Science.gov

Sample records for review project patients

  1. Malignant melanoma slide review project: Patients from non-Kaiser hospitals in the San Francisco Bay Area. Final report

    SciTech Connect

    Reynolds, P.

    1993-01-05

    This project was initiated, in response to concerns that the observed excess of malignant melanoma among employees of Lawrence Livermore National Laboratory (LLNL) might reflect the incidence of disease diagnostically different than that observed in the general population. LLNL sponsored a slide review project, inviting leading dermatopathology experts to independently evaluate pathology slides from LLNL employees diagnosed with melanoma and those from a matched sample of Bay Area melanoma patients who did not work at the LLNL. The study objectives were to: Identify all 1969--1984 newly diagnosed cases of malignant melanoma among LLNL employees resident in the San Francisco-Oakland Metropolitan Statistical Area, and diagnosed at facilities other than Kaiser Permanente; identify a comparison series of melanoma cases also diagnosed between 1969--1984 in non-Kaiser facilities, and matched as closely as possible to the LLNL case series by gender, race, age at diagnosis, year of diagnosis, and hospital of diagnosis; obtain pathology slides for the identified (LLNL) case and (non-LLNL) comparison patients for review by the LLNL-invited panel of dermatopathology experts; and to compare the pathologic characteristics of the case and comparison melanoma patients, as recorded by the dermatopathology panel.

  2. Polypharmacy Reviews Among Elderly Populations Project: Assessing Needs in Patient-Provider Communication

    PubMed Central

    Balignasay, Mia-Danica; Nigg, Claudio R

    2013-01-01

    Adults sixty-five years of age and older are a growing population, and are the largest consumers of prescription and nonprescription medications in the United States with potentially increased medication interaction risks. Therefore, an investigation to determine if elderly populations at two minority serving, independent housing sites perceived any issues regarding their medication use, including any communication challenges with their providers. The data were collected using a survey in which participants had to recall information about their medication use and past provider interaction. Participants (N=21; 90.5% female; using 5.1 ± 2.6 medications) completed a needs assessment. Results indicated that patients felt comfortable talking to their doctors. However, the communication that occurs may not have included education on polypharmacy. Many participants did not believe that they could describe details about their medications, such as the purpose (47.6%), instructions (42.9%), side effects (66.7%), and the possible risk of addiction (42.9%). This assessment indicates a need for an intervention that is focused on communication about polypharmacy and medication review education. PMID:23386990

  3. Perinatal Patient Safety Project

    PubMed Central

    Nunes, Julie; McFerran, Sharon

    2005-01-01

    The Perinatal Patient Safety Project (PPSP) was created as a systemic strategy for creating high-reliability perinatal units by preventing identified causes of perinatal events in the clinical setting. With developmental funding from a Garfield grant, implementation of the PPSP has been completed at four pilot sites in the Kaiser Permanente Northern California (KPNC) Region. Its success has resulted in implementation at all perinatal units in the KPNC Region as well as being promoted by National Risk Management for nationwide implementation. PPSP emphasizes structured communication, multidisciplinary rounds, a definition of fetal well-being, and practicing for emergencies. Steps taken to create high reliability perinatal care include improved communication, patient safety focus, and satisfaction among perinatal patients, providers, and staff. PMID:21660157

  4. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Project review. 801.4... POLICIES § 801.4 Project review. (a) The Compact provides generally that no project affecting the water... project review authority regarding proposed projects in the basin coming under the review of...

  5. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Project review. 801.4... POLICIES § 801.4 Project review. (a) The Compact provides generally that no project affecting the water... project review authority regarding proposed projects in the basin coming under the review of...

  6. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Project review. 801.4... POLICIES § 801.4 Project review. (a) The Compact provides generally that no project affecting the water... project review authority regarding proposed projects in the basin coming under the review of...

  7. Group Projects and Peer Review.

    ERIC Educational Resources Information Center

    Dyrud, Marilyn A.

    2001-01-01

    Describes problems the author experienced with disfunctionality in student group projects. Describes how she implemented informal and formal peer reviews throughout the term in these groups, which has helped short-circuit disfunctionality, improve student productivity, and help the instructor form a fairer overall assessment. (SR)

  8. Improving adequacy of hemodialysis in Northern California ESRD patients: a final project report. Provider Participants and Medical Review Board of the TransPacific Renal Network.

    PubMed

    Brown, J; Josephson, M

    2000-10-01

    The National Core Indicators Project, initiated in 1994, has brought progressive changes in adequacy of dialysis for end-stage renal disease (ESRD) patients in the TransPacific Renal Network and across the United States. The 1998 Core Indicator Project showed each Network's standing for percentage of patients with urea reduction ratio (URR) > or = 0.65 and average URR. The TransPacific Renal Network ranked 12(th) among the 18 Networks for this adequacy measure. The goals of this project were to improve the Network standing in the United States for the percent of patients with URR > or = 0.65, eliminate or reduce the barriers to achieving adequate dialysis, and evaluate URR versus KT/V data and the variances occurring with these measures. In January 1999, data were collected from all 113 Northern California hemodialysis facilities for quarter 4, 1998, to evaluate adequacy. Each facility provided patient population (N) for KT/V and URR samples, facility averages for KT/V and URR, number of patients with KT/V > or = 1.2 and URR > or = 0.65, and data on post-blood-urea-nitrogen (BUN) sampling methods. A random selection of 10% (12) providers with data below the US and Network standards was selected for an intensive assessment. Using baseline measurements, on-site data were collected from a random selection of the patient population. Chart data were reviewed, analyzed, and discussed in an exit interview with the facility management. On-site visits were performed in July/June 1999. The primary focus included adequacy data and process of care that affect adequacy outcomes, concurrent review of patients receiving treatment at the time of the site visit, and general medical record review. In Phase I, only 12 facilities showed an average URR below 0.65. All facilities reported an average KT/V greater than the DOQI target of 1.2. Forty-two facilities had their percentage of patients with a URR below the national benchmark; only 18 facilities had their percentage of patients

  9. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Section 801.4 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION GENERAL... resources of the basin shall be undertaken by any person, governmental authority, or other entity prior to... project review authority regarding proposed projects in the basin coming under the review of...

  10. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Section 801.4 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION GENERAL... resources of the basin shall be undertaken by any person, governmental authority, or other entity prior to... project review authority regarding proposed projects in the basin coming under the review of...

  11. FIP Interim Review Project. Final Report.

    ERIC Educational Resources Information Center

    Whitbeck, John K.

    The Family Independence Project (FIP) Interim Review Project in Washington was mounted in order to give preliminary information on the progress of the FIP program compared to Assistance for Families with Dependent Children (AFDC) site activity, for management planning, and to document short-term outcomes and trends for policy considerations. A…

  12. Review of Projective Personality Assessment Techniques.

    ERIC Educational Resources Information Center

    Obrzut, John E.

    This paper reviews the literatuare on projective techniques of personality assessment and their use by school psychologists. Following a brief survey of the development of projective techniques, several of the most widely used techniques are briefly discussed, i.e., the Thematic Apperception Test (TAT), the Childrens Apperception Test (CAT), the…

  13. Applied Economics. Curriculum Review Project.

    ERIC Educational Resources Information Center

    Butler, Judy D.

    This paper provides a review of "Applied Economics," a curriculum package developed by Junior Achievement, Inc. (Colorado Springs, Colorado). The materials are used in high schools across the nation and provide students an opportunity to study economics, learn about the U.S. free enterprise system, and explore their roles as citizens, producers,…

  14. The life project book review - A correction.

    PubMed

    Tallo, Donato

    2016-05-01

    I was pleased to see your review of The Life Project by Helen Pearson (reviews, April 16). However, it contained one serious error. The original cohort study started in 1946 - not 1958 as stated. I was present at the book launch and have met the author - my grandmother is one of the 1946 original cohort members. That error apart, a great review and a good book. PMID:27154115

  15. M-6 steam drive project review report

    SciTech Connect

    Cerrada, R.; Puig, F.

    1982-01-01

    A review of the status and experiences gained in the M-6 steam drive project after 3 yr of steam injection is presented. The M-6 project is being conducted in a fully depleted heavy oil reservoir of Venezuela Bolivar Coast field, and comprises 151 wells of which 19 are injectors. The review is based on the overall project performance and describes operational problems, steam plant performance, production forecast and special data acquisition. After a total of ca 7.8 x 106 metric tons of steam injected, steam breakthrough has been observed in some hexagons. Remedial shut off in oil production wells have performed successfully. The M-6 project continues to provide useful experience and information which will be used in planning future steam drive projects in the heavy oil reservoirs of the Bolivar Coast.

  16. Portable Common Execution Environment (PCEE) project review: Peer review

    NASA Technical Reports Server (NTRS)

    Locke, C. Douglass

    1991-01-01

    The purpose of the review was to conduct an independent, in-depth analysis of the PCEE project and to provide the results of said review. The review team was tasked with evaluating the potential contribution of the PCEE project to the improvement of the life cycle support of mission and safety critical (MASC) computing components for large, complex, non-stop, distributed systems similar to those planned for such NASA programs as the space station, lunar outpost, and manned missions to Mars. Some conclusions of the review team are as follow: The PCEE project was given high marks for its breath of vision on the overall problem with MASC software; Correlated with the sweeping vision, the Review Team is very skeptical that any research project can successfully attack such a broad range of problems; and several recommendations are made such as to identify the components of the broad solution envisioned, prioritizing them with respect to their impact and the likely ability of the PCEE or others to attack them successfully, and to rewrite its Concept Document differentiating the problem description, objectives, approach, and results so that the project vision becomes assessible to others.

  17. Methods for the drug effectiveness review project.

    PubMed

    McDonagh, Marian S; Jonas, Daniel E; Gartlehner, Gerald; Little, Alison; Peterson, Kim; Carson, Susan; Gibson, Mark; Helfand, Mark

    2012-01-01

    The Drug Effectiveness Review Project was initiated in 2003 in response to dramatic increases in the cost of pharmaceuticals, which lessened the purchasing power of state Medicaid budgets. A collaborative group of state Medicaid agencies and other organizations formed to commission high-quality comparative effectiveness reviews to inform evidence-based decisions about drugs that would be available to Medicaid recipients. The Project is coordinated by the Center for Evidence-based Policy (CEbP) at Oregon Health & Science University (OHSU), and the systematic reviews are undertaken by the Evidence-based Practice Centers (EPCs) at OHSU and at the University of North Carolina. The reviews adhere to high standards for comparative effectiveness reviews. Because the investigators have direct, regular communication with policy-makers, the reports have direct impact on policy and decision-making, unlike many systematic reviews. The Project was an innovator of methods to involve stakeholders and continues to develop its methods in conducting reviews that are highly relevant to policy-makers. The methods used for selecting topics, developing key questions, searching, determining eligibility of studies, assessing study quality, conducting qualitative and quantitative syntheses, rating the strength of evidence, and summarizing findings are described. In addition, our on-going interactions with the policy-makers that use the reports are described. PMID:22970848

  18. LLNL oil shale project review

    SciTech Connect

    Cena, R.J.

    1990-04-01

    Livermore's oil shale project is funded by two budget authorities, two thirds from base technology development and one third from environmental science. Our base technology development combines fundamental chemistry research with operation of pilot retorts and mathematical modeling. We've studied mechanisms for oil coking and cracking and have developed a detailed model of this chemistry. We combine the detailed chemistry and physics into oil shale process models (OSP) to study scale-up of generic second generation Hot-Recycled-Solid (HRS) retorting systems and compare with results from our 4 tonne-per-day continuous-loop HRS pilot retorting facility. Our environmental science program focuses on identification of gas, solid and liquid effluents from oil shale processes and development of abatement strategies where necessary. We've developed on-line instruments to quantitatively measure trace sulfur and nitrogen compounds released during shale pyrolysis and combustion. We've studied shale mineralogy, inorganic and organic reactions which generate and consume environmentally sensitive species. Figures, references, and tables are included with each discussion.

  19. Preliminary Design Reviews Project: SAPHIRE 8

    SciTech Connect

    Kurt G. Vedros; Curtis L. Smith

    2011-09-01

    The Preliminary Design Review (PDR) is intended to be performed at the conceptual phase of a design request. The design request is initiated with a Design Specification document which includes a problem statement, design details, a design checklist and supporting documentation and/or projected sample output. In addition to this, the design specification has a chapter devoted to the completion of the Preliminary Design Review. This document describes the process of documentation of the PDR in the Design Specification.

  20. Quality Assurance: Patient Chart Reviews

    SciTech Connect

    Oginni, B. M.; Odero, D. O.

    2009-07-06

    Recent developments in radiation therapy have immensely impacted the way the radiation dose is delivered to patients undergoing radiation treatments. However, the fundamental quality assurance (QA) issues underlying the radiation therapy still remain the accuracy of the radiation dose and the radiation safety. One of the major duties of clinical medical physicists in the radiation therapy departments still revolves around ensuring the accuracy of dose delivery to the planning target volume (PTV), the reduction of unintended radiation to normal organs and minimization of the radiation exposure to the medical personnel based on ALARA (as low as reasonably achievable) principle. Many of the errors in radiation therapy can be minimized through a comprehensive program of periodic checks. One of the QA procedures on the patient comes in the form of chart reviews which could be in either electronic or paper-based format. We present the quality assurance procedures that have to be performed on the patient records from the beginning and periodically to the end of the treatment, based on the guidelines from the American Association of Physicists in Medicine (AAPM) and American College of Physicians (ACP)

  1. Drawing on Experience. REPLAN Projects Review.

    ERIC Educational Resources Information Center

    Smith, Vernon; And Others

    This document reports good practice as learned in Britain's FEU (Further Education Unit) and NIACE (National Institute of Adult Continuing Education) programs aimed at providing educational opportunities for unemployed adults. Section 1 describes the review of projects that resulted in the document; mentions specific issues and problems relating…

  2. CADD/M project review: January 1981

    SciTech Connect

    Crowe, R.A.

    1981-01-30

    The Computer-aided Design, Drafting/Manufacturing (CADD/M) Project and its current status are reviewed. The Project's history is reviewed and its present programmatic impact is discussed. The investment to date (including FY 1981) is reported along with maintenance costs. Some user activities are also reviewed. The Programs receiving the majority of the benefits are Nuclear Design (ND), Military Applications (MA), and Nuclear Test Programs. In general the benefits include increased design/drafting personnel productivity, reductions in design turn-around time, and improved design quality and documentation. Each Division does, however, receive slightly different benefits because of different missions and operations. State-of-the-art technology that may impact planning is noted and the status of the research and development efforts is presented. The report concludes with the latest plan for further implementation of CAD/CAM technology.

  3. Dynamic infrared scene projection: a review

    NASA Astrophysics Data System (ADS)

    Williams, Owen M.

    1998-12-01

    Since the early 1990s, there has been major progress in the developing field of dynamic infrared scene projection, driven principally by the need for hardware-in-the-loop simulation of the oncoming generation of imaging infrared missile seekers and more recently by the needs for realistic simulation of the new generation of thermal imagers and forward-looking infrared systems. In this paper the current status of the dynamic infrared projection field is reviewed, commencing with an outline of its history. The requirements for dynamic infrared scene projection are examined, allowing a set of validity criteria to be developed. Each class of infrared projector that has been investigated—emissive, transmissive, reflective, laser scanner and phosphor—together with the specific technology initiatives within the class is described and examined against the validity criteria. In this way the leading dynamic infrared scene projection technologies are identified.

  4. NASA's Hypersonic Research Engine Project: A review

    NASA Technical Reports Server (NTRS)

    Andrews, Earl H.; Mackley, Ernest A.

    1994-01-01

    The goals of the NASA Hypersonic Research Engine (HRE) Project, which began in 1964, were to design, develop, and construct a high-performance hypersonic research ramjet/scramjet engine for flight tests of the developed concept over the speed range of Mach 4 to 8. The project was planned to be accomplished in three phases: project definition, research engine development, and flight test using the X-15A-2 research airplane, which was modified to carry hydrogen fuel for the research engine. The project goal of an engine flight test was eliminated when the X-15 program was canceled in 1968. Ground tests of full-scale engine models then became the focus of the project. Two axisymmetric full-scale engine models, having 18-inch-diameter cowls, were fabricated and tested: a structural model and combustion/propulsion model. A brief historical review of the project, with salient features, typical data results, and lessons learned, is presented. An extensive number of documents were generated during the HRE Project and are listed.

  5. Critical Design Reviews Project: SAPHIRE 8

    SciTech Connect

    Kurt G. Vedros; Curtis L. Smith

    2011-09-01

    The Critical Design Review (CDR) is intended to be performed at the phase of the design request immediately before proceeding to implementation of the design request. The design request is initiated with a Design Specification document which includes a problem statement, design details, a design checklist and supporting documentation and/or projected sample output. The document then records the process through the Preliminary Design Review (PDR) and on to the finalized design specification. In addition to this, the design specification has a chapter devoted to the completion of the CDR. This document describes the process of documentation of the CDR in the Design Specification.

  6. Peterborough projects put patients first.

    PubMed

    Baillie, Jonathan

    2009-09-01

    In one of the architectural practice's largest ever contracts of its kind, Nightingale Associates is playing a major part in a pound 335 million local health reconfiguration project (the Greater Peterborough Health Investment Plan) which should see primary and acute care provision transformed in Peterborough and its surrounds. Jonathan Baillie reports on the completion of two impressive new Nightingale-designed buildings constructed as key scheme elements. PMID:19795674

  7. 77 FR 75915 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-26

    ... COMMISSION 18 CFR Part 806 Review and Approval of Projects AGENCY: Susquehanna River Basin Commission. ACTION... would amend the project review regulations of the Susquehanna River Basin Commission (Commission) to... is to make further modifications to the Commission's project review regulations relating to...

  8. Review by a local medical research ethics committee of the conduct of approved research projects, by examination of patients' case notes, consent forms, and research records and by interview.

    PubMed Central

    Smith, T.; Moore, E. J.; Tunstall-Pedoe, H.

    1997-01-01

    OBJECTIVE: To monitor the conduct of medical research projects that have already been approved by the local medical research ethics committee. DESIGN: Follow up study of ethically approved studies (randomly selected from all the studies approved in the previous year) by examination of patients' case notes, consent forms, and research records and by interview of the researchers at their workplace. SETTING: Tayside, Scotland (mixed rural and urban population). SUBJECTS: 30 research projects approved by Tayside local medical research ethics committee. MAIN OUTCOME MEASURES: Adherence to the agreed protocol, particularly for recruitment (obtaining and recording informed consent) and for specific requirements of the ethics committee, including notification of changes to the protocol and of adverse events. RESULTS: In one project only oral consent had been obtained, and in a quarter of the studies one or more consent forms were incorrectly completed. Inadequate filing of case notes in five studies and of consent forms in six made them unavailable for scrutiny. Adverse events were reported, but there was a general failure to report the abandoning or non-starting of projects in two studies the investigators failed to notify a change in the responsible researcher. CONCLUSIONS: Monitoring of medical research by local medical research ethics committees promotes and preserves ethical standards, protects subjects and researchers, discourages fraud, and has the support of investigators. We recommend that 10% of projects should undergo on-site review, with all others monitored by questionnaire. This would require about six person hours of time and a salary bill of 120 pounds per study monitored. PMID:9169403

  9. 75 FR 60617 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-01

    ... COMMISSION 18 CFR Parts 806 and 808 Review and Approval of Projects AGENCY: Susquehanna River Basin Commission. ACTION: Final rule. SUMMARY: This document contains final rules that amend the project review... procedures for all project applications; clarify requirements for grandfathered projects increasing...

  10. Review of BODO Fireflood Pilot Project

    SciTech Connect

    Nazarko, T.W.

    1983-01-01

    This work reviews the past, present, and projected future operations of the Bodo Fireflood Pilot Project in the Provost Upper Mannville B Pool of E.-central Alberta. This single pattern project was initiated in 1975 to evaluate the potential of tar sand oil recovery by the in situ combustion process. The pool is comprised of a high porosity McLaren Waseca channel sand deposit that attains a maximum thickness of 30 m and contains heavy oil with a density of 979 kg/cu m and in situ viscosity of 2,300 mpa/sec. Primary oil recovery is expected to reach 5%. The project operated as a dry combustion scheme until early in 1982 when wet combustion was initiated. During the dry combustion phase operation, 38,300,000 cu m of air was injected while 97,500 cu m of oil was produced. This amounts to an air/oil ratio of 395 cu m/cu m and an estimated oil recovery of ca 18% of the pilot drainage area oil in place. This favorable performance led to a decision to expand the pilot operation to 7, 6-ha 7-spots to demonstrate the satisfactory performance of a multi-pattern scheme.

  11. 75 FR 36301 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-25

    ... final at 71 FR 78570, December 29, 2006, updating and expanding the range of projects subject to... COMMISSION 18 CFR Parts 806 and 808 Review and Approval of Projects AGENCY: Susquehanna River Basin... proposed rules that would amend the project review regulations of the Susquehanna River Basin...

  12. 76 FR 41154 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-13

    ... COMMISSION 18 CFR Part 806 Review and Approval of Projects AGENCY: Susquehanna River Basin Commission. ACTION... would amend the project review regulations of the Susquehanna River Basin Commission (Commission) to... flowback or produced fluids from a Commission approved hydrocarbon development project to an...

  13. Auditory hallucinations: A review of the ERC "VOICE" project.

    PubMed

    Hugdahl, Kenneth

    2015-06-22

    In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the "VOICE" ERC Advanced Grant Project, funded by the European Research Council, but I also review and discuss the literature in general. Auditory hallucinations are suggested to be perceptual phenomena, with a neuronal origin in the speech perception areas in the temporal lobe. The phenomenology of auditory hallucinations is conceptualized along three domains, or dimensions; a perceptual dimension, experienced as someone speaking to the patient; a cognitive dimension, experienced as an inability to inhibit, or ignore the voices, and an emotional dimension, experienced as the "voices" having primarily a negative, or sinister, emotional tone. I will review cognitive, imaging, and neurochemistry data related to these dimensions, primarily the first two. The reviewed data are summarized in a model that sees auditory hallucinations as initiated from temporal lobe neuronal hyper-activation that draws attentional focus inward, and which is not inhibited due to frontal lobe hypo-activation. It is further suggested that this is maintained through abnormal glutamate and possibly gamma-amino-butyric-acid transmitter mediation, which could point towards new pathways for pharmacological treatment. A final section discusses new methods of acquiring quantitative data on the phenomenology and subjective experience of auditory hallucination that goes beyond standard interview questionnaires, by suggesting an iPhone/iPod app. PMID:26110121

  14. A Compilation and Review of Alaska Energy Projects

    SciTech Connect

    Arlon Tussing; Steve Colt

    2008-12-31

    There have been many energy projects proposed in Alaska over the past several decades, from large scale hydro projects that have never been built to small scale village power projects to use local alternative energy sources, many of which have also not been built. This project was initially intended to review these rejected projects to evaluate the economic feasibility of these ideas in the light of current economics. This review included contacting the agencies responsible for reviewing and funding these projects in Alaska, including the Alaska Energy Authority, the Denali Commission, and the Arctic Energy Technology Development Laboratory, obtaining available information about these projects, and analyzing the economic data. Unfortunately, the most apparent result of this effort was that the data associated with these projects was not collected in a systematic way that allowed this information to be analyzed.

  15. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A Designated Sole Source Aquifer in the San Antonio, Texas Area § 149.102 Project review authority. (a) Once an area... which the Administrator determines may contaminate the aquifer so as to create a significant hazard...

  16. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A Designated Sole Source Aquifer in the San Antonio, Texas Area § 149.102 Project review authority. (a) Once an area... which the Administrator determines may contaminate the aquifer so as to create a significant hazard...

  17. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A Designated Sole Source Aquifer in the San Antonio, Texas Area § 149.102 Project review authority. (a) Once an area... which the Administrator determines may contaminate the aquifer so as to create a significant hazard...

  18. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A Designated Sole Source Aquifer in the San Antonio, Texas Area § 149.102 Project review authority. (a) Once an area... which the Administrator determines may contaminate the aquifer so as to create a significant hazard...

  19. Field Review of Fish Habitat Improvement Projects in Central Idaho.

    SciTech Connect

    Beschta, Robert L.; Griffith, Jack; Wesche, Thomas A.

    1993-05-01

    The goal of this field review was to provide information to the Bonneville Power Administration (BPA) regarding previous and ongoing fish habitat improvement projects in central Idaho. On July 14, 1992, the review team met at the Sawtooth National Recreation Area office near Ketchum, Idaho, for a slide presentation illustrating several habitat projects during their construction phases. Following the slide presentation, the review team inspected fish habitat projects that have been implemented in the last several years in the Stanley Basin and adjacent valleys. At each site the habitat project was described to the field team and a brief period for project inspection followed. The review team visited approximately a dozen sites on the Challis, Sawtooth, and Boise National Forests over a period of approximately two and a half days. There are two objectives of this review namely to summarize observations for specific field sites and to provide overview commentary regarding the BPA habitat improvement program in central Idaho.

  20. Determinants of patient adherence: a review of systematic reviews

    PubMed Central

    Kardas, Przemyslaw; Lewek, Pawel; Matyjaszczyk, Michal

    2013-01-01

    Purpose: A number of potential determinants of medication non-adherence have been described so far. However, the heterogenic quality of existing publications poses the need for the use of a rigorous methodology in building a list of such determinants. The purpose of this study was a systematic review of current research on determinants of patient adherence on the basis of a recently agreed European consensus taxonomy and terminology. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Library, IPA, and PsycINFO were systematically searched for systematic reviews published between 2000/01/01 and 2009/12/31 that provided determinants on non-adherence to medication. The searches were limited to reviews having adherence to medication prescribed by health professionals for outpatient as a major topic. Results: Fifty-one reviews were included in this review, covering 19 different disease categories. In these reviews, exclusively assessing non-adherence to chronic therapies, 771 individual factor items were identified, of which most were determinants of implementation, and only 47—determinants of persistence with medication. Factors with an unambiguous effect on adherence were further grouped into 8 clusters of socio-economic-related factors, 6 of healthcare team- and system-related factors, 6 of condition-related factors, 6 of therapy-related factors, and 14 of patient-related factors. The lack of standardized definitions and use of poor measurement methods resulted in many inconsistencies. Conclusions: This study provides clear evidence that medication non-adherence is affected by multiple determinants. Therefore, the prediction of non-adherence of individual patients is difficult, and suitable measurement and multifaceted interventions may be the most effective answer toward unsatisfactory adherence. The limited number of publications assessing determinants of persistence with medication, and lack of those providing determinants of adherence to short-term treatment identify

  1. Using clinical audit in practice: a pilot peer review project.

    PubMed

    Holt, V P; Earp, D P

    1996-09-01

    A well-established study group undertook a pilot peer review project testing the use of clinical audit in members' practices. Two peer review groups were formed involving a total of 16 practices. Practice visits were undertaken and a series of meetings were held to prepare and discuss the various projects. The progress of the groups was monitored by questionnaires. All practitioners reported benefits from the project (specifically, from the practice visits) and made changes in areas of their practice other than those specifically chosen for their project. The benefits of carrying out audit projects in a peer review setting are stressed as are the benefits of reciprocal practice visits. The importance of prior establishment of mutual trust and confidence in the peer review group is emphasised. PMID:10332335

  2. Renal failure in burn patients: a review

    PubMed Central

    Emara, S.S.; Alzaylai, A.A.

    2013-01-01

    Summary Burn care providers are usually challenged by multiple complications during the management of acute burns. One of the most common complications worldwide is renal failure. This article reviews the various aspects of renal failure management in burn patients. Two different types of renal failures develop in these patients. The different aetiological factors, incidence, suspected prognosis, ways of diagnosing, as well as prevention methods, and the most accepted treatment modalities are all discussed. A good understanding and an effective assessment of the problem help to reduce both morbidity and mortality in burn management. PMID:23966893

  3. Followup review of major system aquisitions and major projects

    SciTech Connect

    Not Available

    1990-11-21

    In 1985, we reviewed the Department's procedures and practices for managing and controlling its major acquisition program, both for major systems and major projects. The 1985 review resulted in the identification of significant deficiencies. We found, for example, deficiencies relating to documentation and reporting requirements for major acquisitions. The purpose of this review was to determine if this condition had been corrected. The review included an examination of applicable laws, Executive Orders, Office of Management and Budget (OMB) Circulars, and Department policies. We examined key documents prepared for major acquisitions and reviewed reports used by senior Departmental officials to monitor these projects. Our audit was based primarily on a limited review of documentation available at Department of Energy (DOE) Headquarters. We did not extend our review of the issues raised in this report because we concluded that the management of major acquisitions was of such importance to the Department at this time that expedited reporting was needed.

  4. Review of JPL Automotive Technology Status and Projections (ATSP) project

    NASA Technical Reports Server (NTRS)

    Dowdy, M. W.

    1978-01-01

    The general objective was to make a continuing assessment of current automotive technology development programs and of the prospects for new concepts. The study embraced alternative engines, advanced powertrain components, and related energy conserving vehicle modifications which could be implemented by the end of this century. Vehicle level projections of the fuel economy and emissions potential of alternative power systems were key elements of this assessment.

  5. Patient engagement in research: a systematic review

    PubMed Central

    2014-01-01

    Background A compelling ethical rationale supports patient engagement in healthcare research. It is also assumed that patient engagement will lead to research findings that are more pertinent to patients’ concerns and dilemmas. However; it is unclear how to best conduct this process. In this systematic review we aimed to answer 4 key questions: what are the best ways to identify patient representatives? How to engage them in designing and conducting research? What are the observed benefits of patient engagement? What are the harms and barriers of patient engagement? Methods We searched MEDLINE, EMBASE, PsycInfo, Cochrane, EBSCO, CINAHL, SCOPUS, Web of Science, Business Search Premier, Academic Search Premier and Google Scholar. Included studies were published in English, of any size or design that described engaging patients or their surrogates in research design. We conducted an environmental scan of the grey literature and consulted with experts and patients. Data were analyzed using a non-quantitative, meta-narrative approach. Results We included 142 studies that described a spectrum of engagement. In general, engagement was feasible in most settings and most commonly done in the beginning of research (agenda setting and protocol development) and less commonly during the execution and translation of research. We found no comparative analytic studies to recommend a particular method. Patient engagement increased study enrollment rates and aided researchers in securing funding, designing study protocols and choosing relevant outcomes. The most commonly cited challenges were related to logistics (extra time and funding needed for engagement) and to an overarching worry of a tokenistic engagement. Conclusions Patient engagement in healthcare research is likely feasible in many settings. However, this engagement comes at a cost and can become tokenistic. Research dedicated to identifying the best methods to achieve engagement is lacking and clearly needed. PMID

  6. Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs

    PubMed Central

    Cruz-Correia, Ricardo J; Vieira-Marques, Pedro M; Ferreira, Ana M; Almeida, Filipa C; Wyatt, Jeremy C; Costa-Pereira, Altamiro M

    2007-01-01

    Background The integration of Information Systems (IS) is essential to support shared care and to provide consistent care to individuals – patient-centred care. This paper identifies, appraises and summarises studies examining different approaches to integrate patient data from heterogeneous IS. Methods The literature was systematically reviewed between 1995–2005 to identify articles mentioning patient records, computers and data integration or sharing. Results Of 3124 articles, 84 were included describing 56 distinct projects. Most of the projects were on a regional scale. Integration was most commonly accomplished by messaging with pre-defined templates and middleware solutions. HL7 was the most widely used messaging standard. Direct database access and web services were the most common communication methods. The user interface for most systems was a Web browser. Regarding the type of medical data shared, 77% of projects integrated diagnosis and problems, 67% medical images and 65% lab results. More recently significantly more IS are extending to primary care and integrating referral letters. Conclusion It is clear that Information Systems are evolving to meet people's needs by implementing regional networks, allowing patient access and integration of ever more items of patient data. Many distinct technological solutions coexist to integrate patient data, using differing standards and data architectures which may difficult further interoperability. PMID:17565667

  7. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... which the Administrator determines may contaminate the aquifer so as to create a significant hazard to... the Act, except the final determination that a project may contaminate the aquifer through its... review any project which he considers may potentially contaminate the aquifer through its recharge...

  8. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. (i) Any project... determined by the commissioners or Executive Director pursuant to § 806.5 or 18 CFR part 801. Such project...) Transfer of land used primarily for the raising of food, fiber or forage crops, trees, flowers,...

  9. SANTA MONICA BAY RESTORATION PROJECT IMPLEMENTATION REVIEW 2002

    EPA Science Inventory

    The Santa Monica Bay Restoration Project Implementation Review (IR) summarizes the progress and challenges ahead for the Project through examination of it activities in relation to the CCMP. Contents of the IR include: implementation progress with a financing for plan implementat...

  10. BOOK REVIEW: Science Fair Projects: Physics

    NASA Astrophysics Data System (ADS)

    Reynolds, Helen

    2000-11-01

    I have often thought that the notion of a Science Fair is intrinsically a good one but have never set one up. With this book such an undertaking is possible, with 47 projects from which you can choose. Each project has a clearly stated purpose with an overview that contains the physics you need to get started. A hypothesis, or sometimes two, and a procedure detailing what the student should do follow this. The materials to be used are those you should be able to find at home, and safety guidelines as well as places the student needs adult help are clearly marked. Every project asks the student to write down the results of their experiment and decide whether or not their hypothesis was correct. There are also suggestions for taking each project further. Some of these projects are standard experiments that you may already do with students in class, for example, making plasticine boats, string telephones and levers. Most are interesting twists on standard experiments such as using a wedge as a simple machine, home-made spinning toys and the experiments with light bulbs. The latter are the only real cause for concern if students were to do these things at home as adult supervision would be essential. This is obviously an American book, though. Teachers in British classrooms would need to work out how to deal with the references to temperature in Fahrenheit and mass in ounces. Length is usually given in centimetres as well as inches. Translations of soda bottles and bobby pins would also be needed. This book is designed to be full of ideas and to give structure to projects students can do at home, not to provide ideas that you can transport into the classroom. It does this very well and I would recommend it to anyone thinking of starting up a Science Fair. Alternatively, this is an excellent resource for more interesting homework assignments that would put more responsibility on the student and give them something fun to do.

  11. Patient safety stories: a project utilizing narratives in resident training.

    PubMed

    Cox, LeeAnn M; Logio, Lia S

    2011-11-01

    Incident reports have traditionally been the vehicle for identifying, assessing, and responding to quality gaps in hospitals. Yet because of a variety of barriers, residents often fail to participate in this formal process. The authors created a project to engage residents in incident reporting through the use of an online, anonymous narrative format, faculty-facilitated discussion groups, and involvement of patient safety officers in the educational process. During three months, 36 residents submitted a total of 79 stories about patient care that did not "go as intended." The authors reviewed and scored each story for contributing factors and outcomes. The residents met monthly in small groups with trained faculty facilitators to analyze the stories, which were also shared with the patient safety officers. The stories, narratives of both personal involvement and observed events, ranged from near-misses to sentinel events. Key contributing factors included lapses of professionalism, decision errors, communication/information mishaps, transition mix-ups, and workload difficulties. The narrative format proved a feasible tool for collecting significant, previously unrecognized patient safety issues. Internal medicine residents were willing to discuss gaps in care when given the tools and opportunity for anonymous storytelling and blame-free dialogue. PMID:21952066

  12. Project Management of Randomized Clinical Trials: A Narrative Review

    PubMed Central

    Goodarzynejad, Hamidreza; Babamahmoodi, Abdolreza

    2015-01-01

    Context: A well-structured protocol for a clinical trial may be able to answer clinical questions, but it cannot be deemed enough to ensure success in the face of incompetent management of time as well as human and economic resources. To address this problem, in this article, we present our literature review on evidence as to how a good knowledge of proper management among researchers can enhance the likelihood of the success of clinical trial projects. Evidence Acquisition: Using multiple search strategies, we conducted a literature review on published studies in the English language from 2002 to 2012 by searching the Cochrane Database of Systematic Reviews, MEDLINE, Google Scholar, and EMBASE. Results: Our review suggests that a successful trial requires a work plan or work scope as well as a timeline. The trial manager should subsequently manage the study in accordance with the plan and the timeline. Many research units have called for a clinical project manager with scientific background and regulatory skills to effect coordination among various aspects of a clinical trial. Conclusions: Project management may benefit both the managerial and scientific aspects of medical projects and reduce fund waste. However, little has been written to date on project management in the context of clinical research. The suggestions represent the views of the individual authors. To provide a high level of evidence in this regard, we recommend that a randomized controlled trial be performed to compare trial projects progressed with and without the use of project management. PMID:26430517

  13. Emerging lessons from the drug effectiveness review project.

    PubMed

    Neumann, Peter J

    2006-01-01

    The Drug Effectiveness Review Project (DERP) is an alliance of fifteen states and two private organizations, which have pooled resources to synthesize and judge clinical evidence for drug-class reviews. The experience shines a bright light on challenges involved in implementing an evidence-based medicine process to inform drug formulary decisions: When should evidence reviewers accept surrogate markers and assume therapeutic class effects? How open and participatory should review procedures be? Should reviewers consider cost-effectiveness information? What is the appropriate role of the public sector in judging evidence? The DERP illustrates that attempts to undertake evidence-based reviews, apart from the methods themselves, which continue to evolve, involve questions of organization, process, and leadership. PMID:16757486

  14. Congressional hearing reviews NSF major research and facilities projects

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    2012-03-01

    An 8 March congressional hearing about the U.S. National Science Foundation's Major Research Equipment and Facilities Construction (NSF MREFC) account focused on fiscal management and accountability of projects in that account and reviewed concerns raised by NSF's Office of Inspector General (OIG). NSF established the MREFC account in 1995 to better plan and manage investments in major equipment and facilities projects, which can cost from tens of millions to hundreds of millions of dollars, and the foundation has funded 17 MREFC projects since then. The Obama administration's proposed fiscal year (FY) 2013 budget includes funding for four MREFC projects: Advanced Laser Gravitational-Wave Observatory (AdvLIGO), Advanced Technology Solar Telescope (ATST), National Ecological Observatory (NEON), and Ocean Observatories Initiative (OOI). The hearing, held by a subcommittee of the House of Representatives' Committee on Science, Space, and Technology, reviewed management oversight throughout the life cycles of MREFC projects and concerns raised in recent OIG reports about the use of budget contingency funds. NSF's February 2012 manual called "Risk management guide for large facilities" states that cost contingency is "that portion of the project budget required to cover `known unknowns,'" such as planning and estimating errors and omissions, minor labor or material price fluctuations, and design developments and changes within the project scope. Committee members acknowledged measures that NSF has made to improve the MREFC oversight process, but they also urged the agency to continue to take steps to ensure better project management.

  15. The drug effectiveness review project: an important step forward.

    PubMed

    Gibson, Mark; Santa, John

    2006-01-01

    Peter Neumann's paper on the Drug Effectiveness Review Project (DERP) is a constructive if incomplete point of departure for discussing the work done by the project and the use of that work by decision-makers in states and elsewhere. This Perspective attempts to establish the proper context for judging the DERP by comparing its product and processes with those commonly produced and used by industry and other parties. It also provides a direct response to the criticisms of the project noted by Neumann. PMID:16757487

  16. Telemedical Support in Patients with Chronic Heart Failure: Experience from Different Projects in Germany

    PubMed Central

    Müller, Axel; Schweizer, Johannes; Helms, Thomas M.; Oeff, Micheal; Sprenger, Claudia; Zugck, Christian

    2010-01-01

    The great epidemiological significance and costs associated with chronic heart failure pose a challenge to health systems in Western industrial countries. In the past few years, controlled randomised studies have shown that patients with chronic heart failure benefit from telemedical monitoring; specifically, telemonitoring of various vital parameters combined with a review of the symptoms, drug compliance and patient education. In Germany, various telemedical monitoring projects for patients with chronic heart failure have been initiated in the past few years; seven of them are presented here. Currently 7220 patients are being monitored in the seven selected projects. Most patients (51.1%) are in NYHA stage II, 26.3% in NYHA stage III, 14.5% in NYHA stage I and only 6.6% in NYHA stage IV respectively. Most projects are primarily regional. Their structure of telemedical monitoring tends to be modular and uses stratification according to the NYHA stages. All projects include medical or health economics assessments. The future of telemedical monitoring projects for patients with chronic heart failure will depend on the outcome of these assessments. Only of there is statistical evidence for medical benefit to the individual patient as well as cost savings will these projects continue. PMID:20814594

  17. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support such... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IDENTIFICATION AND MAPPING OF SPECIAL HAZARD AREAS § 65.8 Review of proposed projects. A community, or an...

  18. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support such... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IDENTIFICATION AND MAPPING OF SPECIAL HAZARD AREAS § 65.8 Review of proposed projects. A community, or an...

  19. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support such... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IDENTIFICATION AND MAPPING OF SPECIAL HAZARD AREAS § 65.8 Review of proposed projects. A community, or an...

  20. The Virtual Factory Teaching System (VFTS): Project Review and Results.

    ERIC Educational Resources Information Center

    Kazlauskas, E. J.; Boyd, E. F., III; Dessouky, M. M.

    This paper presents a review of the Virtual Factory Teaching (VFTS) project, a Web-based, multimedia collaborative learning network. The system allows students, working alone or in teams, to build factories, forecast demand for products, plan production, establish release rules for new work into the factory, and set scheduling rules for…

  1. 77 FR 14272 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-09

    ... From the Federal Register Online via the Government Publishing Office SUSQUEHANNA RIVER BASIN COMMISSION 18 CFR Part 806 Review and Approval of Projects CFR Correction In Title 18 of the Code of Federal Regulations, Part 400 to End, revised as of April 1, 2011, on page 118, in Sec. 806.6, (b)(1)(i) and (ii)...

  2. 76 FR 60774 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ..., 2011 (76 FR 41154) may be submitted to the Commission on or before November 10, 2011. ADDRESSES... 10, 2011, the written comment deadline for proposed rules that appeared in 76 FR 41154-41157 July 13... COMMISSION 18 CFR Part 806 Review and Approval of Projects AGENCY: Susquehanna River Basin Commission....

  3. A Review of Research on Project STAR and Path Ahead

    ERIC Educational Resources Information Center

    Sohn, Kitae

    2016-01-01

    Understanding the effects of class size reduction (CSR) has been an enduring issue in education. For the past 3 decades, Project STAR has stimulated research and policy discussions regarding the effects of CSR on a variety of outcomes. Schanzenbach (2007) reviewed STAR studies and concluded that small classes improved student academic outcomes.…

  4. 78 FR 18481 - Project-Level Predecisional Administrative Review Process

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-27

    ... Forest Service 36 CFR Part 218 RIN 0596-AD07 Project-Level Predecisional Administrative Review Process... (the Department) is issuing this final rule to establish the ] sole process by which the public may... process. Section 428 further directs the Secretary to apply these procedures in lieu of the...

  5. Videotex Project Reviews II. Research Report Prepared for OCLC.

    ERIC Educational Resources Information Center

    Widing, Robert E., II; Talarzyk, W. Wayne

    Designed to provide an overview of the nature and focus of activity in the fledgling videotex industry in the United States and Canada, this updated and extended report presents in-depth reviews of 26 projects which reflect the involvement of such industries as publishing, retailing, agriculture, banking, other financial intermediaries,…

  6. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... § 806.5 or 18 CFR part 801. Such project sponsors shall be notified in writing by the Executive Director... forage crops, trees, flowers, shrubs, turf products, livestock, or poultry, or for aquaculture, to...

  7. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... § 806.5 or 18 CFR part 801. Such project sponsors shall be notified in writing by the Executive Director... forage crops, trees, flowers, shrubs, turf products, livestock, or poultry, or for aquaculture, to...

  8. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... determined by the commissioners or Executive Director pursuant to § 806.5 or 18 CFR part 801. Such project...) Transfer of land used primarily for the raising of food, fiber or forage crops, trees, flowers,...

  9. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... § 806.5 or 18 CFR part 801. Such project sponsors shall be notified in writing by the Executive Director... forage crops, trees, flowers, shrubs, turf products, livestock, or poultry, or for aquaculture, to...

  10. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.5 Projects that may require review and approval. (a) The following projects, if not otherwise requiring review and...

  11. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.5 Projects that may require review and approval. (a) The following projects, if not otherwise requiring review and...

  12. 1990 DOE/SANDIA crystalline photovoltaic technology project review meeting

    SciTech Connect

    Ruby, D.S.

    1990-07-01

    This document serves as the proceedings for the annual project review meeting held by Sandia's Photovoltaic Cell Research Division and Photovoltaic Technology Division. It contains information supplied by each organization making a presentation at the meeting, which was held August 7 through 9, 1990 at the Sheraton Hotel in Albuquerque, New Mexico. Sessions were held to discuss national photovoltaic programs, one-sun crystalline silicon cell research, concentrator silicon cell research, concentrator 3-5 cell research, and concentrating collector development.

  13. Patient Involvement in Health Care Decision Making: A Review

    PubMed Central

    Vahdat, Shaghayegh; Hamzehgardeshi, Leila; Hessam, Somayeh; Hamzehgardeshi, Zeinab

    2014-01-01

    Background: Patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions. Objectives: Given the importance of patient participation in healthcare decision making which empowers patients and improves services and health outcomes, this study was performed to review previous studies on patient participation in healthcare decision making. Materials and Methods: To prepare this narrative review article, researchers used general and specific search engines, as well as textbooks addressing this subject for an in-depth study of patient involvement in healthcare decision-making. As a result, 35 (out of 100 relevant) articles and also two books were selected for writing this review article. Results: Based on the review of articles and books, topics were divided into six general categories: definition of participation, importance of patient participation, factors influencing participation of patients in healthcare decisions, method of patient participation, tools for evaluating participation, and benefits and consequences of patient participation in health care decision-making. Conclusions: In most studies, factors influencing patient participation consisted of: factors associated with health care professionals such as doctor-patient relationship, recognition of patient’s knowledge, allocation of sufficient time for participation, and also factors related to patients such as having knowledge, physical and cognitive ability, and emotional connections, beliefs, values and their experiences in relation to health services. PMID:24719703

  14. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Projects that may require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.5 Projects that may require review and approval. (a) The...

  15. Determinants of patient choice of healthcare providers: a scoping review

    PubMed Central

    2012-01-01

    Background In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice. Methods We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information. Results Our review shows that patients’ choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics. Conclusions There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several

  16. [Nuclear energy and environment: review of the IAEA environmental projects].

    PubMed

    Fesenko, S; Fogt, G

    2012-01-01

    The review of the environmental projects of the International Atomic Energy Agency is presented. Basic IAEA documents intended to protect humans and the Environment are considered and their main features are discussed. Some challenging issues in the area of protection of the Environment and man, including the impact of nuclear facilities on the environment, radioactive waste management, and remediation of the areas affected by radiological accidents, nuclear testing and sites of nuclear facilities are also discussed. The need to maintain the existing knowledge in radioecology and protection of the environment is emphasised. PMID:23516895

  17. Preoperative patient assessment: a review of the literature and recommendations.

    PubMed Central

    Barnard, N. A.; Williams, R. W.; Spencer, E. M.

    1994-01-01

    The aims of preoperative assessment of patients are outlined, and the role of clinical and laboratory testing is defined. Following a review of the literature, guidelines for requesting such investigations are suggested. PMID:7979066

  18. The Blue Button Project: Engaging Patients in Healthcare by a Click of a Button

    PubMed Central

    Mohsen, Mona Omar; Aziz, Hassan A.

    2015-01-01

    The Blue Button project has become a way for many Americans to download their health records by just a click in any way that suits them, such as in print, on a thumb drive, or on their mobile devices and smartphones. Several organizations have developed and applied Blue Buttons on their websites to allow beneficiaries to securely access and view personal medical information and claims. The purpose of this literature review is to highlight the significance of the Blue Button project in the field of health information management. Findings suggest that the project could empower and engage consumers and patients in a healthcare system by allowing access to medical records, thereby promoting better management and overall improvement of their healthcare. To date, the project has gained wide support from insurers, technology companies, and health providers despite the challenges of standardization and interoperability. PMID:26755898

  19. The Blue Button Project: Engaging Patients in Healthcare by a Click of a Button.

    PubMed

    Mohsen, Mona Omar; Aziz, Hassan A

    2015-01-01

    The Blue Button project has become a way for many Americans to download their health records by just a click in any way that suits them, such as in print, on a thumb drive, or on their mobile devices and smartphones. Several organizations have developed and applied Blue Buttons on their websites to allow beneficiaries to securely access and view personal medical information and claims. The purpose of this literature review is to highlight the significance of the Blue Button project in the field of health information management. Findings suggest that the project could empower and engage consumers and patients in a healthcare system by allowing access to medical records, thereby promoting better management and overall improvement of their healthcare. To date, the project has gained wide support from insurers, technology companies, and health providers despite the challenges of standardization and interoperability. PMID:26755898

  20. Estimating software development costs for a patient multimedia education project.

    PubMed

    Caban, A; Cimino, C; Swencionis, C; Ginsberg, M; Wylie-Rosett, J

    2001-01-01

    The authors compare alternative methods of cost estimation for a patient multimedia education (PME) program, using a computerized weight-reduction PME project as an example. Data from the project planning and budgeting process and actual costs of the completed project are analyzed retrospectively to calculate three different estimates-pre-work, post-work, and actual work. Three traditional methods of estimating the cost of computer programs (the lines-of-code, function point, and task ratio analyses) underestimate costs in this example. A commercial program (Cost Xpert) that calculates the cost of developing a graphical user interface provided a better estimate, as did a tally reflecting the complexity and quality of media material in the project. PMID:11230386

  1. Fertility Preservation for Cancer Patients: A Review

    PubMed Central

    Ajala, Tosin; Rafi, Junaid; Larsen-Disney, Peter; Howell, Richard

    2010-01-01

    Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the fore-front the potential for fertility preservation in patients being treated for cancer. Oncologists must be aware of situations where their treatment will affect fertility in patients who are being treated for cancer and they must also be aware of the pathways available for procedures such as cryopreservation of gametes and/or embryos. Improved cancer care associated with increased cure rates and long term survival, coupled with advances in fertility treatment means that it is now imperative that fertility preservation is considered as part of the care offered to these patients. This can only be approached within a multidisciplinary setting. There are obvious challenges that still remain to be resolved, especially in the area of fertility preservation in prepubertal patients. These include ethical issues, such as valid consent and research in the area of tissue retrieval, cryopreservation, and transplantation. PMID:20379357

  2. Scoping review of patient-centered care approaches in healthcare

    PubMed Central

    2014-01-01

    Background The purpose of this scoping review was to describe how three tenants of patient-centered care provision: communication, partnership, and health promotion are addressed in patient-centered care models/frameworks across the literature. Methods A scoping review of literature published in English since 1990 was conducted using Medline, CINAHL, and EMBASE. A key term search strategy was employed using “patient-centered care”, “client-centered care”, “framework” and “model” to identify relevant studies. Results Application of the search strategy resulted in a hit total of 101 articles. Nineteen articles met inclusion criteria, of which 12 were review articles; 5 were qualitative research papers; one was a randomized control trial; and one was a prospective study. From these articles, 25 different patient-centered care frameworks/models were identified. Conclusions The fact that all identified approaches to patient-centered care incorporated strategies to achieve effective communication, partnership, and health promotion indicates that clinicians can select a patient-centered approach from the literature that best suits their patient’s needs, and be confident that it will satisfy the three core elements of patient-centered care provision. While empirical literature on specific patient-centric frameworks and models was limited, much empiric evidence was sourced for the most consistently defined component of patient-centered care, communication. PMID:24947822

  3. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  4. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  5. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  6. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  7. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  8. Engaging patients and stakeholders in research proposal review: the patient-centered outcomes research institute.

    PubMed

    Fleurence, Rachael L; Forsythe, Laura P; Lauer, Michael; Rotter, Jason; Ioannidis, John P A; Beal, Anne; Frank, Lori; Selby, Joseph V

    2014-07-15

    The inaugural round of merit review for the Patient-Centered Outcomes Research Institute (PCORI) in November 2012 included patients and other stakeholders, as well as scientists. This article examines relationships among scores of the 3 reviewer types, changes in scoring after in-person discussion, and the effect of inclusion of patient and stakeholder reviewers on the review process. In the first phase, 363 scientists scored 480 applications. In the second phase, 59 scientists, 21 patients, and 31 stakeholders provided a "prediscussion" score and a final "postdiscussion" score after an in-person meeting for applications. Bland-Altman plots were used to characterize levels of agreement among and within reviewer types before and after discussion. Before discussion, there was little agreement among average scores given by the 4 lead scientific reviewers and patient and stakeholder reviewers. After discussion, the 4 primary reviewers showed mild convergence in their scores, and the 21-member panel came to a much stronger agreement. Of the 25 awards with the best (and lowest) scores after phase 2, only 13 had ranked in the top 25 after the phase 1 review by scientists. Five percent of the 480 proposals submitted were funded. The authors conclude that patient and stakeholder reviewers brought different perspectives to the review process but that in-person discussion led to closer agreement among reviewer types. It is not yet known whether these conclusions are generalizable to future rounds of peer review. Future work would benefit from additional data collection for evaluation purposes and from long-term evaluation of the effect on the funded research. PMID:25023251

  9. Treating Insomnia: A Review of Patient Perceptions Toward Treatment.

    PubMed

    Cheung, Janet M Y; Bartlett, Delwyn J; Armour, Carol L; Saini, Bandana

    2016-01-01

    Patient views about their treatment for insomnia often dictate outcome. This review explores the literature relating to the patients' global perceptions toward treatment for insomnia. A strategic literature search was conducted using five databases (PubMed, CINAHL, Medline, PsycINFO, and Embase). The 57 research articles included for this review were mapped out chronologically across three key stages of treatment-seeking (pretreatment appraisal, actual treatment experiences, and posttreatment evaluation). Patient perceptions played an important role across these three key stages and influenced subsequent health behaviors such as the initiation of help-seeking, treatment uptake, treatment adherence, and treatment adjustment. Patients' perceptions toward treatment were heavily grounded by their psychosocial contexts. Clinical implications and future directions for including patient-centered metrics in mainstream practice and research are discussed. PMID:26240937

  10. 1992 DOE/Sandia crystalline photovoltaic technology project review meeting

    SciTech Connect

    Maish, A.

    1992-07-01

    This document serves as the proceedings for the annual project review meeting held by Sandia National Laboratories` Photovoltaic Technology and Photovoltaic Evaluation Departments. It contains information supplied by organizations making presentations at the meeting, which was held July 14--15, 1992 at the Sheraton Old Town Hotel in Albuquerque, New Mexico. Overview sessions covered the Department of Energy (DOE) program, including those at Sandia and the National Renewable Energy Laboratory (NREL), and non-DOE programs, including the EPRI concentrator collector program, The Japanese crystalline silicon program, and some concentrating photovoltaic activities in Europe. Additional sessions included papers on Sandia`s Photovoltaic Device Fabrication Laboratory`s collaborative research, cell processing research, the activities of the participants in the Concentrator Initiative Program, and photovoltaic technology evaluation at Sandia and NREL.

  11. eHealth for Patient Engagement: A Systematic Review

    PubMed Central

    Barello, Serena; Triberti, Stefano; Graffigna, Guendalina; Libreri, Chiara; Serino, Silvia; Hibbard, Judith; Riva, Giuseppe

    2016-01-01

    eHealth interventions are recognized to have a tremendous potential to promote patient engagement. To date, the majority of studies examine the efficacy of eHealth in enhancing clinical outcomes without focusing on patient engagement in its specificity. This paper aimed at reviewing findings from the literature about the use of eHealth in engaging patients in their own care process. We undertook a comprehensive literature search within the peer-reviewed international literature. Eleven studies met the inclusion criteria. eHealth interventions reviewed were mainly devoted to foster only partial dimensions of patient engagement (i.e., alternatively cognitive, emotional or behavioral domains related to healthcare management), thus failing to consider the complexity of such an experience. This also led to a great heterogeneity of technologies, assessed variables and achieved outcomes. This systematic review underlines the need for a more holistic view of patient needs to actually engage them in eHealth interventions and obtaining positive outcomes. In this sense, patient engagement constitute a new frontiers for healthcare models where eHealth could maximize its potentialities. PMID:26779108

  12. Review of PV Inverter Technology Cost and Performance Projections

    SciTech Connect

    Navigant Consulting Inc.

    2006-01-01

    The National Renewable Energy Laboratory (NREL) has a major responsibility in the implementation of the U.S. Department of Energy's (DOE's) Solar Energy Technologies Program. Sandia National Laboratories (SNL) has a major role in supporting inverter development, characterization, standards, certifications, and verifications. The Solar Energy Technologies Program recently published a Multiyear Technical Plan, which establishes a goal of reducing the Levelized Energy Cost (LEC) for photovoltaic (PV) systems to $0.06/kWh by 2020. The Multiyear Technical Plan estimates that, in order to meet the PV system goal, PV inverter prices will need to decline to $0.25-0.30 Wp by 2020. DOE determined the need to conduct a rigorous review of the PV Program's technical and economic targets, including the target set for PV inverters. NREL requested that Navigant Consulting Inc.(NCI) conduct a review of historical and projected cost and performance improvements for PV inverters, including identification of critical barriers identified and the approaches government might use to address them.

  13. An Open Library of CT Patient Projection Data

    PubMed Central

    Chen, Baiyu; Leng, Shuai; Yu, Lifeng; Holmes, David; Fletcher, Joel; McCollough, Cynthia

    2016-01-01

    Lack of access to projection data from patient CT scans is a major limitation for development and validation of new reconstruction algorithms. To meet this critical need, we are building a library of CT patient projection data in an open and vendor-neutral format, DICOM-CT-PD, which is an extended DICOM format that contains sinogram data, acquisition geometry, patient information, and pathology identification. The library consists of scans of various types, including head scans, chest scans, abdomen scans, electrocardiogram (ECG)-gated scans, and dual-energy scans. For each scan, three types of data are provided, including DICOM-CT-PD projection data at various dose levels, reconstructed CT images, and a free-form text file. Several instructional documents are provided to help the users extract information from DICOM-CT-PD files, including a dictionary file for the DICOM-CT-PD format, a DICOM-CT-PD reader, and a user manual. Radiologist detection performance based on the reconstructed CT images is also provided. So far 328 head cases, 228 chest cases, and 228 abdomen cases have been collected for potential inclusion. The final library will include a selection of 50 head, chest, and abdomen scans each from at least two different manufacturers, and a few ECG-gated scans and dual-source, dual-energy scans. It will be freely available to academic researchers, and is expected to greatly facilitate the development and validation of CT reconstruction algorithms. PMID:27239087

  14. An open library of CT patient projection data

    NASA Astrophysics Data System (ADS)

    Chen, Baiyu; Leng, Shuai; Yu, Lifeng; Holmes, David; Fletcher, Joel; McCollough, Cynthia

    2016-03-01

    Lack of access to projection data from patient CT scans is a major limitation for development and validation of new reconstruction algorithms. To meet this critical need, we are building a library of CT patient projection data in an open and vendor-neutral format, DICOM-CT-PD, which is an extended DICOM format that contains sinogram data, acquisition geometry, patient information, and pathology identification. The library consists of scans of various types, including head scans, chest scans, abdomen scans, electrocardiogram (ECG)-gated scans, and dual-energy scans. For each scan, three types of data are provided, including DICOM-CT-PD projection data at various dose levels, reconstructed CT images, and a free-form text file. Several instructional documents are provided to help the users extract information from DICOM-CT-PD files, including a dictionary file for the DICOM-CT-PD format, a DICOM-CT-PD reader, and a user manual. Radiologist detection performance based on the reconstructed CT images is also provided. So far 328 head cases, 228 chest cases, and 228 abdomen cases have been collected for potential inclusion. The final library will include a selection of 50 head, chest, and abdomen scans each from at least two different manufacturers, and a few ECG-gated scans and dual-source, dual-energy scans. It will be freely available to academic researchers, and is expected to greatly facilitate the development and validation of CT reconstruction algorithms.

  15. Implants in disabled patients: a review and update.

    PubMed

    Romero-Pérez, María-Jesús; Mang-de la Rosa, María del Rocio; López-Jimenez, Julián; Fernández-Feijoo, Javier; Cutando-Soriano, Antonio

    2014-09-01

    The range of indications for dental implants has broadened enormously owing to their predictability and the improvement of patient satisfaction in terms of stability, comfort, aesthetics and functionality. The aim of this article is to review those indications in patients with mental or physical disabilities as the difficulty to cope with oral hygiene often leads to teeth extraction, adding edentulousness to the impairments already present. Following that goal, available literature in Pubmed database, Scopus, Web of Knowledge and The Cochrane Library database about dental implants placement in these patients has been reviewed, assessing the variables of each study: number of patients, sex, average age, oral hygiene, parafunctional habits, impairment, bone quality, protocol of implant surgery, necessity of deep intravenous sedation or general anesthesia, follow-up period and number of failures. The comparison with studies involving other patient populations without mental or physical impediments did not show statistically significant differences in terms of the failure rate recorded. Although there is not much literature available, the results of this review seem to suggest that osseointegrated oral implants could be a therapeutic option in patients who suffer from any physical or psychological impairment. The success of an oral rehabilitation depends mainly on an adequate selection of the patients. PMID:24608221

  16. Implants in disabled patients: A review and update

    PubMed Central

    Romero-Pérez, María J.; Mang-de la Rosa, María R.; López-Jimenez, Julián; Fernández-Feijoo, Javier

    2014-01-01

    The range of indications for dental implants has broadened enormously owing to their predictability and the improvement of patient satisfaction in terms of stability, comfort, aesthetics and functionality. The aim of this article is to review those indications in patients with mental or physical disabilities as the difficulty to cope with oral hygiene often leads to teeth extraction, adding edentulousness to the impairments already present. Following that goal, available literature in Pubmed database, Scopus, Web of Knowledge and The Cochrane Library database about dental implants placement in these patients has been reviewed, assessing the variables of each study: number of patients, sex, average age, oral hygiene, parafunctional habits, impairment, bone quality, protocol of implant surgery, necessity of deep intravenous sedation or general anesthesia, follow-up period and number of failures. The comparison with studies involving other patient populations without mental or physical impediments did not show statistically significant differences in terms of the failure rate recorded. Although there is not much literature available, the results of this review seem to suggest that osseointegrated oral implants could be a therapeutic option in patients who suffer from any physical or psychological impairment. The success of an oral rehabilitation depends mainly on an adequate selection of the patients. Key words:Implants, disabled, sedation. PMID:24608221

  17. Patient engagement in the inpatient setting: a systematic review

    PubMed Central

    Prey, Jennifer E; Woollen, Janet; Wilcox, Lauren; Sackeim, Alexander D; Hripcsak, George; Bakken, Suzanne; Restaino, Susan; Feiner, Steven; Vawdrey, David K

    2014-01-01

    Objective To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. Methods PubMed, Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, and Cochrane databases were searched for studies that discussed patient engagement (‘self-efficacy’, ‘patient empowerment’, ‘patient activation’, or ‘patient engagement’), (2) involved health information technology (‘technology’, ‘games’, ‘electronic health record’, ‘electronic medical record’, or ‘personal health record’), and (3) took place in the inpatient setting (‘inpatient’ or ‘hospital’). Only English language studies were reviewed. Results 17 articles were identified describing the topic of inpatient patient engagement. A few articles identified design requirements for inpatient engagement technology. The remainder described interventions, which we grouped into five categories: entertainment, generic health information delivery, patient-specific information delivery, advanced communication tools, and personalized decision support. Conclusions Examination of the current literature shows there are considerable gaps in knowledge regarding patient engagement in the hospital setting and inconsistent use of terminology regarding patient engagement overall. Research on inpatient engagement technologies has been limited, especially concerning the impact on health outcomes and cost-effectiveness. PMID:24272163

  18. How patients' review sites will change health care.

    PubMed

    Hotopf, Max

    2013-10-01

    TripAdvisor has changed how the travel industry treats customers. Is the same likely to happen to health services? Review sites are growing fast across Europe, propelled by expansions in patient choice. What impact will they have on the medical profession and on providers, both public and private? How will they change the nature of health care? To address these questions, those at the forefront of developing review sites in Europe were interviewed. PMID:23904237

  19. Auditory hallucinations: A review of the ERC “VOICE” project

    PubMed Central

    Hugdahl, Kenneth

    2015-01-01

    In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the “VOICE” ERC Advanced Grant Project, funded by the European Research Council, but I also review and discuss the literature in general. Auditory hallucinations are suggested to be perceptual phenomena, with a neuronal origin in the speech perception areas in the temporal lobe. The phenomenology of auditory hallucinations is conceptualized along three domains, or dimensions; a perceptual dimension, experienced as someone speaking to the patient; a cognitive dimension, experienced as an inability to inhibit, or ignore the voices, and an emotional dimension, experienced as the “voices” having primarily a negative, or sinister, emotional tone. I will review cognitive, imaging, and neurochemistry data related to these dimensions, primarily the first two. The reviewed data are summarized in a model that sees auditory hallucinations as initiated from temporal lobe neuronal hyper-activation that draws attentional focus inward, and which is not inhibited due to frontal lobe hypo-activation. It is further suggested that this is maintained through abnormal glutamate and possibly gamma-amino-butyric-acid transmitter mediation, which could point towards new pathways for pharmacological treatment. A final section discusses new methods of acquiring quantitative data on the phenomenology and subjective experience of auditory hallucination that goes beyond standard interview questionnaires, by suggesting an iPhone/iPod app. PMID:26110121

  20. The Influence of Gatekeeping and Utilization Review on Patient Satisfaction

    PubMed Central

    Kerr, Eve A; Hays, Ron D; Mitchinson, Allison; Lee, Martin; Siu, Albert L

    1999-01-01

    OBJECTIVE To examine the influence of utilization review and denial of specialty referrals on patient satisfaction with overall medical care, willingness to recommend one’s physician group to a friend, and desire to disenroll from the health plan. DESIGN Two cross-sectional questionnaires: one of physician groups and one of patient satisfaction. SETTING Eighty-eight capitated physician groups in California. PARTICIPANTS Participants were 11,710 patients enrolled in a large California network-model HMO in 1993 who received care in one of the 88 physician groups. MEASUREMENTS AND MAIN RESULTS Our main measures were how groups conducted utilization review for specialty referrals and tests, patient-reported denial of specialty referrals, and patient satisfaction with overall medical care. Patients in groups that required preauthorization for access to many types of specialists were significantly (p≤ .001) less satisfied than patients in groups that had few preauthorization requirements, even after adjusting for patient and other group characteristics. Patients who had wanted to see a specialist in the previous year but did not see one were significantly less satisfied than those who had wanted to see a specialist and actually saw one (p < .001). In addition, patients who did not see a specialist when desired were more likely to want to disenroll from the health plan than patients who saw the specialist (40% vs 18%, p≤ .001) and more likely not to recommend their group to a friend (38% vs 13%, p≤ .001). CONCLUSIONS Policies that limited direct access to specialists, and especially denial of patient-desired referrals, were associated with significantly lower patient satisfaction, increased desire to disenroll, and lower likelihood of recommending the group to a friend. Health plans and physician groups need to take these factors into account when designing strategies to reduce specialty care use. PMID:10337038

  1. Status Review of Wildlife Mitigation, Columbia Basin Hydroelectric Projects, Washington Facilities (Intrastate) Final Report.

    SciTech Connect

    Howerton, Jack

    1984-11-01

    This report was prepared for BPA in fulfillment of section 1004 (b)(1) of the Pacific Northwest Electric Power Planning and Conservation Act of 1980, to review the status of past, present, and proposed future wildlife planning and mitigation program at existing hydroelectric projects in the Columbia River Basin. The project evaluations will form the basis for determining any needed remedial measures or additional project analysis. Projects addressed are: Merwin Dam; Swift Project; Yale Project; Cowlitz River; Boundary Dam; Box Canyon Dam; Lake Chelan; Condit Project; Enloe Project; Spokane River; Tumwater and Dryden Dam; Yakima; and Naches Project.

  2. Patient Perceptions of Participating in the RSNA Image Share Project: a Preliminary Study.

    PubMed

    Hiremath, Atheeth; Awan, Omer; Mendelson, David; Siegel, Eliot L

    2016-04-01

    The purpose of this study was to gauge patient perceptions of the RSNA Image Share Project (ISP), a pilot program that provides patients access to their imaging studies online via secure Personal Health Record (PHR) accounts. Two separate Institutional Review Board exempted surveys were distributed to patients depending on whether they decided to enroll or opt out of enrollment in the ISP. For patients that enrolled, a survey gauged baseline computer usage, perceptions of online access to images through the ISP, effect of patient access to images on patient-physician relationships, and interest in alternative use of images. The other survey documented the age and reasons for declining participation for those that opted out of enrolling in the ISP. Out of 564 patients, 470 enrolled in the ISP (83 % participation rate) and 456 of these 470 individuals completed the survey for a survey participation rate of 97 %. Patients who enrolled overwhelmingly perceived access to online images as beneficial and felt it bolstered their patient-physician relationship. Out of 564 patients, 94 declined enrollment in the ISP and all 94 individuals completed the survey for a survey participation rate of 100 %. Patients who declined to participate in the ISP cited unreliable access to Internet and existing availability of non-web-based intra-network images to their physicians. Patients who participated in the ISP found having a measure of control over their images to be beneficial and felt that patient-physician relationships could be negatively affected by challenges related to image accessibility. PMID:26452494

  3. Should we pay the patient? Review of financial incentives to enhance patient compliance.

    PubMed Central

    Giuffrida, A.; Torgerson, D. J.

    1997-01-01

    OBJECTIVE: To determine whether financial incentives increase patients' compliance with healthcare treatments. DATA SOURCES: Systematic literature review of computer databases--Medline, Embase, PsychLit, EconLit, and the Cochrane Database of Clinical Trials. In addition, the reference list of each retrieved article was reviewed and relevant citations retrieved. STUDY SELECTION: Only randomised trials with quantitative data concerning the effect, of financial incentives (cash, vouchers, lottery tickets, or gifts) on compliance with medication, medical advice, or medical appointments were included in the review. Eleven papers were identified as meeting the selection criteria. DATA EXTRACTION: Data on study populations, interventions, and outcomes were extracted and analysed using odds ratios and the number of patients needed to be treated to improve compliance by one patient. RESULTS: 10 of the 11 studies showed improvements in patient compliance with the use of financial incentives. CONCLUSIONS: Financial incentives can improve patient compliance. PMID:9314754

  4. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review

    PubMed Central

    Ghimire, Saurav; Castelino, Ronald L.; Lioufas, Nicole M.; Peterson, Gregory M.; Zaidi, Syed Tabish R.

    2015-01-01

    Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that

  5. Learning from open source software projects to improve scientific review

    PubMed Central

    Ghosh, Satrajit S.; Klein, Arno; Avants, Brian; Millman, K. Jarrod

    2012-01-01

    Peer-reviewed publications are the primary mechanism for sharing scientific results. The current peer-review process is, however, fraught with many problems that undermine the pace, validity, and credibility of science. We highlight five salient problems: (1) reviewers are expected to have comprehensive expertise; (2) reviewers do not have sufficient access to methods and materials to evaluate a study; (3) reviewers are neither identified nor acknowledged; (4) there is no measure of the quality of a review; and (5) reviews take a lot of time, and once submitted cannot evolve. We propose that these problems can be resolved by making the following changes to the review process. Distributing reviews to many reviewers would allow each reviewer to focus on portions of the article that reflect the reviewer's specialty or area of interest and place less of a burden on any one reviewer. Providing reviewers materials and methods to perform comprehensive evaluation would facilitate transparency, greater scrutiny, and replication of results. Acknowledging reviewers makes it possible to quantitatively assess reviewer contributions, which could be used to establish the impact of the reviewer in the scientific community. Quantifying review quality could help establish the importance of individual reviews and reviewers as well as the submitted article. Finally, we recommend expediting post-publication reviews and allowing for the dialog to continue and flourish in a dynamic and interactive manner. We argue that these solutions can be implemented by adapting existing features from open-source software management and social networking technologies. We propose a model of an open, interactive review system that quantifies the significance of articles, the quality of reviews, and the reputation of reviewers. PMID:22529798

  6. Learning from open source software projects to improve scientific review.

    PubMed

    Ghosh, Satrajit S; Klein, Arno; Avants, Brian; Millman, K Jarrod

    2012-01-01

    Peer-reviewed publications are the primary mechanism for sharing scientific results. The current peer-review process is, however, fraught with many problems that undermine the pace, validity, and credibility of science. We highlight five salient problems: (1) reviewers are expected to have comprehensive expertise; (2) reviewers do not have sufficient access to methods and materials to evaluate a study; (3) reviewers are neither identified nor acknowledged; (4) there is no measure of the quality of a review; and (5) reviews take a lot of time, and once submitted cannot evolve. We propose that these problems can be resolved by making the following changes to the review process. Distributing reviews to many reviewers would allow each reviewer to focus on portions of the article that reflect the reviewer's specialty or area of interest and place less of a burden on any one reviewer. Providing reviewers materials and methods to perform comprehensive evaluation would facilitate transparency, greater scrutiny, and replication of results. Acknowledging reviewers makes it possible to quantitatively assess reviewer contributions, which could be used to establish the impact of the reviewer in the scientific community. Quantifying review quality could help establish the importance of individual reviews and reviewers as well as the submitted article. Finally, we recommend expediting post-publication reviews and allowing for the dialog to continue and flourish in a dynamic and interactive manner. We argue that these solutions can be implemented by adapting existing features from open-source software management and social networking technologies. We propose a model of an open, interactive review system that quantifies the significance of articles, the quality of reviews, and the reputation of reviewers. PMID:22529798

  7. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review

    PubMed Central

    Hall, Louise H.; Johnson, Judith; Watt, Ian; Tsipa, Anastasia; O’Connor, Daryl B.

    2016-01-01

    Objective To determine whether there is an association between healthcare professionals’ wellbeing and burnout, with patient safety. Design Systematic research review. Data Sources PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles. Eligibility Criteria for Selecting Studies Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations. Results Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety. Conclusions Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed. Implications This review illustrates the need for healthcare organisations to consider improving employees’ mental health as well as creating safer work environments when planning interventions to improve patient safety. Systematic Review Registration PROSPERO registration number: CRD42015023340. PMID:27391946

  8. A review of health outcomes in patients with psoriasis.

    PubMed

    Li, Kai; Armstrong, April W

    2012-01-01

    Psoriasis, a chronic inflammatory skin condition, is a complex disease in terms of its significant comorbidities and impact on patients' quality of life. The objective of this article is to elucidate the health outcomes of the disease, including its economic and psychosocial burden on the patient. Current treatments options and the economic considerations of treatment costs are reviewed. Psoriasis is a multidimensional disease, so patients benefit from having a multidisciplinary team of dermatologists and other physicians for management of it and of associated comorbid conditions. PMID:22117868

  9. Support for patients with celiac disease: A literature review

    PubMed Central

    Card, Tim; Ciclitira, Paul J; Swift, Gillian L; Nasr, Ikram; Sanders, David S; Ciacci, Carolina

    2015-01-01

    Background Celiac disease (CD) is a lifelong disorder. Patients are at increased risk of complications and comorbidity. Objectives We conducted a review of the literature on patient support and information in CD and aim to issue recommendations about patient information with regards to CD. Methods Data source: We searched PubMed for English-language articles published between 1900 and June 2014, containing terms related to costs, economics of CD, or education and CD. Study selection: Papers deemed relevant by any of the participating authors were included in the study. Data synthesis: No quantitative synthesis of data was performed. Instead we formulated a consensus view of the information that should be offered to all patients with CD. Results There are few randomized clinical trials examining the effect of patient support in CD. Patients and their families receive information from many sources. It is important that health care personnel guide the patient through the plethora of facts and comments on the Internet. An understanding of CD is likely to improve dietary adherence. Patients should be educated about current knowledge about risk factors for CD, as well as the increased risk of complications. Patients should also be advised to avoid other health hazards, such as smoking. Many patients are eager to learn about future non-dietary treatments of CD. This review also comments on novel therapies but it is important to stress that no such treatment is available at present. Conclusion Based on mostly observational data, we suggest that patient support and information should be an integral part of the management of CD, and is likely to affect the outcome of CD. PMID:25922674

  10. The Recovery of Walking in Stroke Patients: A Review

    ERIC Educational Resources Information Center

    Jang, Sung Ho

    2010-01-01

    We reviewed the literature on walking recovery of stroke patients as it relates to the following subjects: epidemiology of walking dysfunction, recovery course of walking, and recovery mechanism of walking (neural control of normal walking, the evaluation methods for leg motor function, and motor recovery mechanism of leg). The recovery of walking…

  11. Treatment considerations for patient with Amelogenesis Imperfecta: a review

    PubMed Central

    Chen, Chiung-Fen; Hu, Jan CC; Bresciani, Eduardo; Peters, Mathilde C; Estrella, Maria Regina

    2016-01-01

    Objectives Amelogenesis imperfecta (AI) is a group of inherited disorders primary affecting the structural of enamel. Patients with AI experience poor esthetic, excessive tooth sensitivity and compromised chewing function that dental treatments are frequently required at early age. This review describes the non-enamel implications, stage-specific management strategies and outcomes of selected restorative materials based on literature evidence.

  12. Design review plan for Multi-Function Waste Tank Facility (Project W-236A)

    SciTech Connect

    Renfro, G.G.

    1994-12-20

    This plan describes how the Multi-Function Waste Tank Facility (MWTF) Project conducts reviews of design media; describes actions required by Project participants; and provides the methodology to ensure that the design is complete, meets the technical baseline of the Project, is operable and maintainable, and is constructable. Project W-236A is an integrated project wherein the relationship between the operating contractor and architect-engineer is somewhat different than that of a conventional project. Working together, Westinghouse Hanford Company (WHC) and ICF Karser Hanford (ICF KH) have developed a relationship whereby ICF KH performs extensive design reviews and design verification. WHC actively participates in over-the-shoulder reviews during design development, performs a final review of the completed design, and conducts a formal design review of the Safety Class I, ASME boiler and Pressure Vessel Code items in accordance with WHC-CM-6-1, Standard Engineering Practices.

  13. Practical review of immunizations in adult patients with cancer

    PubMed Central

    Ariza-Heredia, Ella J; Chemaly, Roy F

    2015-01-01

    Compared with the general population, patients with cancer in general are more susceptible to vaccine-preventable infections, either by an increased risk due to the malignancy itself or immunosuppressive treatment. The goal of immunizations in these patients is therefore to provide protection against these infections, and to decrease the number of vulnerable patients who can disseminate these organisms. The proper timing of immunization with cancer treatment is key to achieving better vaccine protection. As the oncology field continues to advance, leading to better quality of life and longer survival, immunization and other aspects of preventive medicine ought to move to the frontline in the care of these patients. Herein, we review the vaccines most clinically relevant to patients with cancer, as well as special cases including vaccines after splenectomy, travel immunization and recommendations for family members. PMID:26110220

  14. Literature Review on Decentralization: Strengthening Local Educational Capacity. Educational Policy and Planning Project. A Government of Indonesia-USAID Project.

    ERIC Educational Resources Information Center

    Chieuw, Juliet SF.; Mandolang, Nadine H.

    This literature review, while not comprehensive, is aimed at informing the Strengthening Local Education Capacity project under way in Indonesia. Strategies that strengthen educational capacities at the school and local levels were reviewed, followed by strategies for local governance. Two school governance models, public choice and public…

  15. [Exercise in haemodyalisis patients: a literature systematic review].

    PubMed

    Segura-Ortí, Eva

    2010-01-01

    Exercise as a therapeutic tool used in End-stage renal disease patients (ESRD) in hemodialysis (HD) is not routinately applied, as it occurs with cardiac or respiratory patients. Lack of awareness of research in this field may contribute to the current situation. Thus, the aims of this review are: 1) to systematically review the literature of exercise training on adult HD patients or patients at a pre-HD stage; 2) to show the evidence on the benefits of exercise for counteracting physiological, functional and psychological impairments found even in older ESRD patients; 3) to recommend requirements of future research in order to include exercise prescription in the HD patients treatment. The Data bases reviewed from 2005 to 2009 were: MEDLINE (Ovid), CINAHL (EBSCOHost), SportDicus (EBSCOHost), Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), MedicLatina (EBSCOHost), PEDro y PubMed. Additionally, references from identified articles, several reviews on ESRD and abstracts to Nephrology Congresses were also reviewed. Randomized Controlled Trials on aerobic, strength and combined programs for HD patients were selected. Data from the studies was compiled and Van Tulder criteria were used for methodological quality assessment. Metanalysis included 6 studies on aerobic exercise, 2 on strength exercise and 5 on combined exercise programs. 640 patients were included in 16 included studies. Effects on physical function, health related quality of life and other secondary measurements were summarized by the Standardized Mean Difference (SMD) Moderate evidence exists on positive effects of aerobic training on peak oxygen consumption at the graded exercise test (SMD 6.55; CI 95%: 4.31-8.78). There is high evidence on positive effects of strength training on health related quality of life (SMD 11.03; CI 95%: 5.63-16.43). Finally, moderate evidence exists on positive effects of combined exercise on peak oxygen consumption at the graded exercise test (SMD 5.57; CI

  16. Patient exposure tracking: the IAEA smart card project.

    PubMed

    Rehani, Madan M; Frush, Donald P

    2011-09-01

    The existing approach of radiation protection is largely based on the collective dose to the population with provisions for protection at an individual level through justification and optimisation. With the individual patient dose now exceeding the life-long occupational dose to a worker in a typical radiology practice, there is a need to establish approaches based on the protection of an individual patient. Radiation exposure tracking seems a way forward in this respect. Technological advances in recent years have provided opportunities for tracking to becoming a reality. The IAEA project on Smart Card/SmartRadTrack is described in this paper. The tracking is now a reality in a few dozen centres in many countries connected by picture archiving and communication systems, and there is hope that this will extend to cover other countries and continents. PMID:21778155

  17. Patient safety through intelligent procedures in medication: the PSIP project.

    PubMed

    Beuscart, Régis; McNair, Peter; Brender, Jytte

    2009-01-01

    The European project Patient Safety through Intelligent Procedures in medication (PSIP) aims at preventing medical errors. The objective are: (1) to facilitate the systematic production of epidemiological knowledge on Adverse Drug Events (ADE) and (2) to improve the entire medication cycle in a hospital environment. The first sub-objective is to produce knowledge on ADE: to know, as exactly as possible, per hospital, per medical department, their number, type, consequences and causes, including human factors. Data Mining of structured hospital data bases, and semantic mining of free-texts will provide a list of observed ADE, with frequencies and probabilities, thus giving a better understanding of potential risks. The second sub-objective is to develop innovative knowledge based on the mining results and to deliver professionals and patients contextualized alerts and recommendations fitting the local risk parameters. This knowledge will be implemented in a PSIP-Platform independent of existing ICT applications. PMID:19745230

  18. Economic evaluation in patient safety: a literature review of methods.

    PubMed

    de Rezende, Bruna Alves; Or, Zeynep; Com-Ruelle, Laure; Michel, Philippe

    2012-06-01

    Patient safety practices, targeting organisational changes for improving patient safety, are implemented worldwide but their costs are rarely evaluated. This paper provides a review of the methods used in economic evaluation of such practices. International medical and economics databases were searched for peer-reviewed publications on economic evaluations of patient safety between 2000 and 2010 in English and French. This was complemented by a manual search of the reference lists of relevant papers. Grey literature was excluded. Studies were described using a standardised template and assessed independently by two researchers according to six quality criteria. 33 articles were reviewed that were representative of different patient safety domains, data types and evaluation methods. 18 estimated the economic burden of adverse events, 3 measured the costs of patient safety practices and 12 provided complete economic evaluations. Healthcare-associated infections were the most common subject of evaluation, followed by medication-related errors and all types of adverse events. Of these, 10 were selected that had adequately fulfilled one or several key quality criteria for illustration. This review shows that full cost-benefit/utility evaluations are rarely completed as they are resource intensive and often require unavailable data; some overcome these difficulties by performing stochastic modelling and by using secondary sources. Low methodological transparency can be a problem for building evidence from available economic evaluations. Investing in the economic design and reporting of studies with more emphasis on defining study perspectives, data collection and methodological choices could be helpful for strengthening our knowledge base on practices for improving patient safety. PMID:22396602

  19. Sleep disorders in patients with myasthenia gravis: a systematic review.

    PubMed

    Fernandes Oliveira, Ezequiel; Nacif, Sergio R; Alves Pereira, Nixon; Fonseca, Nina Teixeira; Urbano, Jéssica Julioti; Perez, Eduardo Araújo; Cavalcante, Valéria; Santos Oliveira, Claudia; Insalaco, Giuseppe; Oliveira, Acary Sousa Bulle; Oliveira, Luis Vicente Franco

    2015-06-01

    [Purpose] This systematic review evaluated the presence of sleep-disordered breathing in patients with myasthenia gravis and clarified the role of physiotherapy. [Subjects and Methods] We followed the PRISMA declaration criteria. The evaluation was performed in accordance with the STROBE statement for observational and cross-sectional studies and the CONSORT checklist for clinical trials. Searches were followed by hand on MEDLINE, EMBASE, SciELO, PubMed Central, and the Cochrane Central Register of Controlled Trials. [Results] Our searches yielded a total of 36 studies published between 1970 and 2014. The number of patients involved ranged from 9-490. Of the 36 studies, 19 articles were excluded because they did not meet the inclusion criteria. Therefore, 17 observational, cross-sectional, or clinical studies assessing the quality of sleep and prevalence of sleep disorders in patients with myasthenia gravis were eligible for our review. [Conclusion] Some studies of patients with MG show that patients with MG are associated with poor sleep quality, excessive daytime sleepiness, presence of restless syndrome, and a higher incidence of SDB, while other studies do not report such associations. Therefore, given the current inconclusive evidence and limited literature, further study of sleep disturbances in patients with MG is needed. PMID:26180370

  20. Sleep disorders in patients with myasthenia gravis: a systematic review

    PubMed Central

    Fernandes Oliveira, Ezequiel; Nacif, Sergio R.; Alves Pereira, Nixon; Fonseca, Nina Teixeira; Urbano, Jéssica Julioti; Perez, Eduardo Araújo; Cavalcante, Valéria; Santos Oliveira, Claudia; Insalaco, Giuseppe; Oliveira, Acary Sousa Bulle; Oliveira, Luis Vicente Franco

    2015-01-01

    [Purpose] This systematic review evaluated the presence of sleep-disordered breathing in patients with myasthenia gravis and clarified the role of physiotherapy. [Subjects and Methods] We followed the PRISMA declaration criteria. The evaluation was performed in accordance with the STROBE statement for observational and cross-sectional studies and the CONSORT checklist for clinical trials. Searches were followed by hand on MEDLINE, EMBASE, SciELO, PubMed Central, and the Cochrane Central Register of Controlled Trials. [Results] Our searches yielded a total of 36 studies published between 1970 and 2014. The number of patients involved ranged from 9–490. Of the 36 studies, 19 articles were excluded because they did not meet the inclusion criteria. Therefore, 17 observational, cross-sectional, or clinical studies assessing the quality of sleep and prevalence of sleep disorders in patients with myasthenia gravis were eligible for our review. [Conclusion] Some studies of patients with MG show that patients with MG are associated with poor sleep quality, excessive daytime sleepiness, presence of restless syndrome, and a higher incidence of SDB, while other studies do not report such associations. Therefore, given the current inconclusive evidence and limited literature, further study of sleep disturbances in patients with MG is needed. PMID:26180370

  1. Nocardia infections among immunomodulated inflammatory bowel disease patients: A review.

    PubMed

    Abreu, Cândida; Rocha-Pereira, Nuno; Sarmento, António; Magro, Fernando

    2015-06-01

    Human nocardiosis, caused by Nocardia spp., an ubiquitous soil-borne bacteria, is a rare granulomatous disease close related to immune dysfunctions. Clinically can occur as an acute life-threatening disease, with lung, brain and skin being commonly affected. The infection was classically diagnosed in HIV infected persons, organ transplanted recipients and long term corticosteroid treated patients. Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario. Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings. We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals. Eleven cases of nocardiosis associated with anti-tumor necrosis factor (TNF) prescription (9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease (IBD), 4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients, lung disease in 4 patients, hepatic in one and disseminated disease in 3 patients. From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine. In conclusion, nocardiosis requires high levels of clinical suspicion and experience of laboratory staff, in order to establish a timely diagnosis and by doing so avoid worst outcomes. Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential. The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated. PMID:26074688

  2. 18 CFR 806.7 - Concurrent project review by member jurisdictions.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Concurrent project review by member jurisdictions. 806.7 Section 806.7 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.7 Concurrent...

  3. 18 CFR 806.7 - Concurrent project review by member jurisdictions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Concurrent project review by member jurisdictions. 806.7 Section 806.7 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.7 Concurrent...

  4. 77 FR 18885 - Improving Performance of Federal Permitting and Review of Infrastructure Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ..., employees, or agents, or any other person. (Presidential Sig.) THE WHITE HOUSE, March 22, 2012. [FR Doc... and Review of Infrastructure Projects Memorandum of March 22, 2012--Expediting Review of Pipeline Projects From Cushing, Oklahoma, to Port Arthur, Texas, and Other Domestic Pipeline Infrastructure...

  5. A Review of Recent Advances in Perioperative Patient Safety

    PubMed Central

    Fowler, Alexander J.

    2013-01-01

    Major complications in surgery affect up to 16% of surgical procedures. Over the past 50 years, many patient safety initiatives have attempted to reduce such complications. Since the formation of the National Patient Safety Agency in 2001, there have been major advances in patient safety. Most recently, the production and implementation of the Surgical Safety Checklist by the World Health Organisation (WHO), a checklist ensuring that certain ‘never events’ (wrong-site surgery, wrong operation etc.) do not occur, irrespective of healthcare allowance. In this review, a summary of recent advances in patient safety are considered – including improvements in communication, understanding of human factors that cause mistakes, and strategies developed to minimise these. Additionally, the synthesis of best medical practice and harm minimisation is examined, with particular emphasis on communication and appreciation of human factors in the operating theatre. This is based on the resource management systems developed in other high risk industries (e.g. nuclear), and has also been adopted for other high risk medical areas. The WHO global movement to reduce surgical mortality has been highly successful, especially in the healthcare systems of developing nations where mortality reductions of up to 50% have been observed, and reductions in patient complications of 4%. Incident reporting has long been a key component of patient safety and continues to be so; allowing reflection and improved guideline formation. All patients are placed at risk in the surgical environment. It is crucial that this risk is minimised, whilst optimising the patient's outcome. In this review, recent advances in perioperative patient safety are examined and placed in context. PMID:26977290

  6. Assessment of Patient Empowerment - A Systematic Review of Measures

    PubMed Central

    Barr, Paul J.; Scholl, Isabelle; Bravo, Paulina; Faber, Marjan J.; Elwyn, Glyn; McAllister, Marion

    2015-01-01

    Background Patient empowerment has gained considerable importance but uncertainty remains about the best way to define and measure it. The validity of empirical findings depends on the quality of measures used. This systematic review aims to provide an overview of studies assessing psychometric properties of questionnaires purporting to capture patient empowerment, evaluate the methodological quality of these studies and assess the psychometric properties of measures identified. Methods Electronic searches in five databases were combined with reference tracking of included articles. Peer-reviewed articles reporting psychometric testing of empowerment measures for adult patients in French, German, English, Portuguese and Spanish were included. Study characteristics, constructs operationalised and psychometric properties were extracted. The quality of study design, methods and reporting was assessed using the COSMIN checklist. The quality of psychometric properties was assessed using Terwee’s 2007 criteria. Findings 30 studies on 19 measures were included. Six measures are generic, while 13 were developed for a specific condition (N=4) or specialty (N=9). Most studies tested measures in English (N=17) or Swedish (N=6). Sample sizes of included studies varied from N=35 to N=8261. A range of patient empowerment constructs was operationalised in included measures. These were classified into four domains: patient states, experiences and capacities; patient actions and behaviours; patient self-determination within the healthcare relationship and patient skills development. Quality assessment revealed several flaws in methodological study quality with COSMIN scores mainly fair or poor. The overall quality of psychometric properties of included measures was intermediate to positive. Certain psychometric properties were not tested for most measures. Discussion Findings provide a basis from which to develop consensus on a core set of patient empowerment constructs and for

  7. Clinical review: The critical care management of the burn patient

    PubMed Central

    2013-01-01

    Between 4 and 22% of burn patients presenting to the emergency department are admitted to critical care. Burn injury is characterised by a hypermetabolic response with physiologic, catabolic and immune effects. Burn care has seen renewed interest in colloid resuscitation, a change in transfusion practice and the development of anti-catabolic therapies. A literature search was conducted with priority given to review articles, meta-analyses and well-designed large trials; paediatric studies were included where adult studies were lacking with the aim to review the advances in adult intensive care burn management and place them in the general context of day-to-day practical burn management. PMID:24093225

  8. Review of Evaluation Procedures Used in Project POWER.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    Project POWER is a workplace literacy program conducted by Triton College. The project offers courses in English as a Second Language (ESL) and Adult Basic Education (ABE) to employers who are willing to pay their employees for half their class time and for 15 percent of the instructional costs. By the end of January 1990, the project had…

  9. Topical review: skin infections in the foot and ankle patient.

    PubMed

    Hsu, Andrew R; Hsu, Jessica W

    2012-07-01

    There are numerous cutaneous disorders that affect the foot, but of these conditions skin infections have the most significant impact on overall patient morbidity and clinical outcome. Skin infections in foot and ankle patients are common, with often devastating consequences if left unrecognized and untreated in both surgical and nonsurgical cases. There is a diverse array of infectious dermatoses that afflict the foot and ankle patient including tinea pedis, onychomycosis, paronychia, pitted keratolysis, verruca, folliculitis, and erysipelas. Prompt diagnosis, treatment, and surveillance of these common infectious conditions are critical in managing these dermatoses that can potentially progress to form deep abscesses and osteomyelitis. Infections can be managed with a combination of ventilated shoewear and synthetic substances to keep the feet dry, topical and oral antimicrobial agents, and patient education regarding preventative hygiene measures. The purpose of this review is to aid foot and ankle surgeons and other physicians in the diagnosis and treatment of infectious dermatoses affecting the foot. PMID:22835400

  10. Patient participation in public elections: a literature review.

    PubMed

    Regan, Paul; Hudson, Neal; McRory, Barry

    2011-03-01

    Healthcare organisations and nurse leaders have an important role in promoting patients' right to vote, through the development of policy guidelines, integrated networking and innovative practice. Patients' mental capacity to vote is usually assessed by nurses, who must therefore be aware of clients' voting rights and if the right resources are in place to help them do so. Patients' rights, as citizens, are recognised in law and in professional guidelines, but more needs to be done to protect their voting rights. There should also be better access to transport and family support, and more flexible electoral procedures. This article reviews the literature on promoting patients' participation in local and general elections and suggests that their voting rights should be endorsed by organisations and nurse leaders through policy guidelines and a flexible and proactive nursing approach to participation. PMID:21485910

  11. Patient-Centered Endodontic Outcomes: A Narrative Review

    PubMed Central

    Hamedy, Reza; Shakiba, Bita; Fayazi, Sara; Pak, Jacklyn G; White, Shane N

    2013-01-01

    Introduction Root canal treatment (RCT) success criteria inform us of the path to bony healing and of prognostic factors, but tell little about how the patient perceives, feels, or values RCT. Patients choose, undergo, and pay for RCT, they live with the result, and inform their community. The purpose of this narrative review was to appraise patient-centered outcomes of initial non-surgical RCT and nonsurgical retreatment, in adults. Materials and Methods Patient-centered RCT outcome themes were identified in the extant literature: quality of life, satisfaction, anxiety, fear, pain, tooth survival and cost. Narrative review was applied because the disparate themes and data were unsuited to systematic review or meta-analysis. Results Application of the Oral Health Impact Profile (OHIP) demonstrated that disease of pulpal origin affects quality of life with moderate severity, primarily through physical pain and psychological discomfort, and that RCT results in broad improvement of quality of life. Satisfaction with RCT is extremely high, but cost is the primary reason for dissatisfaction. Anxiety and fear affect RCT patients, profoundly influencing their behaviors, including treatment avoidance, and their pain experience. Fear of pain is “fair” to “very much” prior to RCT. Pain is widely feared, disliked, and remembered; however, disease of pulpal origin generally produces moderate, but not severe pain. RCT causes a dramatic decrease in pain prevalence and severity over the week following treatment. Survival rates of teeth after RCT are very high; complication rates are low. Cost is a barrier to RCT, but initial costs, lifetime costs, cost effectiveness, cost utility, and cost benefit all compare extremely well to the alternatives involving replacement using implants or fixed prostheses. Conclusion Dentists must strive to reduce anxiety, fear, experienced and remembered pain, and to accurately inform and educate their patients with respect to technical

  12. Cognitive functioning in meningioma patients: a systematic review.

    PubMed

    Meskal, Ikram; Gehring, Karin; Rutten, Geert-Jan M; Sitskoorn, Margriet M

    2016-06-01

    This systematic review evaluates relevant findings and methodologic aspects of studies on cognitive functioning in meningioma patients prior to and/or following surgery with or without adjuvant radiotherapy. PubMed and Web of Science electronic databases were searched until December 2015. From 1012 initially identified articles, 11 met the inclusion criteria for this review. Multiple methodological limitations were identified which include the lack of pre-treatment assessments, variations in the number and types of neuropsychological tests used, the normative data used to identify patients with cognitive deficits, and the variety of definitions for cognitive impairment. Study results suggest that most of meningioma patients are faced with cognitive deficits in several cognitive domains prior to surgery. Following surgery, most of these patients seem to improve in cognitive functioning. However, they still have impairments in a wide range of cognitive functions compared to healthy controls. Suggestions are given for future research. Adequate diagnosis and treatment of cognitive deficits may ultimately lead to improved outcome and quality of life in meningioma patients. PMID:27048208

  13. Status Review of Wildlife Mitigation, Columbia Basin Hydroelectric Projects, Columbia River Mainstem Facilities, 1984 Final Report.

    SciTech Connect

    Howerton, Jack; Hwang, Diana

    1984-11-01

    This report reviews the status of past, present, and proposed future wildlife planning and mitigation programs at existing hydroelectric projects in the Columbia River Basin. The project evaluations will form the basis for determining any needed remedial measures or additional project analysis. Each hydropower facility report is abstracted separately for inclusion in the Energy Data Base.

  14. 42 CFR 137.294 - What is the typical IHS environmental review process for construction projects?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... process for construction projects? 137.294 Section 137.294 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT... SELF-GOVERNANCE Construction Nepa Process § 137.294 What is the typical IHS environmental review process for construction projects? (a) Most IHS construction projects normally do not have a...

  15. 42 CFR 137.294 - What is the typical IHS environmental review process for construction projects?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... process for construction projects? 137.294 Section 137.294 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT... SELF-GOVERNANCE Construction Nepa Process § 137.294 What is the typical IHS environmental review process for construction projects? (a) Most IHS construction projects normally do not have a...

  16. 42 CFR 137.301 - How are project and program environmental review costs identified?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Construction Nepa Process § 137.301 How are project and program environmental review costs identified? (a) The... identified during the performance of the construction project, the Self-Governance Tribe or, at the request... 42 Public Health 1 2010-10-01 2010-10-01 false How are project and program environmental...

  17. Worker Relocation: A Review of U.S. Department of Labor Mobility Demonstration Projects. Final Report.

    ERIC Educational Resources Information Center

    Fairchild, Charles K.

    This report reviews the knowledge gained in 4 years of operation of labor mobility demonstration projects and provides guidelines on the design and operation of a permanent worker relocation program. Data were gathered both from written material covering the experience of each project and from field trips to some of the projects when additional…

  18. Trust in nurse-patient relationships: a literature review.

    PubMed

    Dinç, Leyla; Gastmans, Chris

    2013-08-01

    The aim of this study was to report the results of a literature review of empirical studies on trust within the nurse-patient relationship. A search of electronic databases yielded 34 articles published between 1980 and 2011. Twenty-two studies used a qualitative design, and 12 studies used quantitative research methods. The context of most quantitative studies was nurse caring behaviours, whereas most qualitative studies focused on trust in the nurse-patient relationship. Most of the quantitative studies used a descriptive design, while qualitative methods included the phenomenological approach, grounded theory, ethnography and interpretive interactionism. Data collection was mainly by questionnaires or interviews. Evidence from this review suggests that the development of trust is a relational phenomenon, and a process, during which trust could be broken and re-established. Nurses' professional competencies and interpersonal caring attributes were important in developing trust; however, various factors may hinder the trusting relationship. PMID:23426234

  19. Bariatric surgery in elderly patients: a systematic review

    PubMed Central

    Giordano, Salvatore; Victorzon, Mikael

    2015-01-01

    Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (%) with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I2 test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone. PMID:26508845

  20. Sarcoidosis in Melanoma Patients: Case Report and Literature Review

    PubMed Central

    Beutler, Bryce D.; Cohen, Philip R.

    2015-01-01

    Sarcoidosis is a systemic inflammatory disease characterized by the development of noncaseating granulomas in multiple organ systems. Many hematologic malignancies and solid tumors, including melanoma, have been associated with sarcoidosis. We describe the clinical and pathologic findings of a 54-year-old man with melanoma-associated sarcoidosis. In addition, we not only review the literature describing characteristics of other melanoma patients with sarcoidosis, but also the features of melanoma patients with antineoplastic therapy-associated sarcoidosis. Sarcoidosis has been described in 80 melanoma patients; sufficient information for analysis was provided in 39 of these individuals. In 43.6% of individuals (17 out of 39), sarcoidosis was directly associated with melanoma; in 56.4% of oncologic patients (22 out of 39), sarcoidosis was induced by antineoplastic therapy that had been administered for the treatment of their metastatic melanoma. The discovery of melanoma preceded the development of sarcoidosis in 12 of the 17 (70.5%) individuals who did not receive systemic treatment. Pulmonary and/or cutaneous manifestations of sarcoidosis were common among both groups of patients. Most patients did not require treatment for sarcoidosis. Melanoma patients—either following antineoplastic therapy or without systemic treatment—may be at an increased risk to develop sarcoidosis. In antineoplastic therapy naive melanoma patients, a common etiologic factor—such as exposure to ultraviolet light—may play a role in their developing melanoma and sarcoidosis. PMID:26083934

  1. Opioid Drugs in Patients With Liver Disease: A Systematic Review

    PubMed Central

    Soleimanpour, Hassan; Safari, Saeid; Shahsavari Nia, Kavous; Sanaie, Sarvin; Alavian, Seyed Moayed

    2016-01-01

    Context The liver, one of the most important organs of the body, is known to be responsible for several functions. The functional contribution of the liver to the metabolism of carbohydrates, protein, drugs and toxins, fats and cholesterol and many other biological processes are still unknown. Liver disorders are classified into two types: acute and chronic. Different drugs are used in liver diseases to treat and control pain. Most pain relief medications such as opioids are metabolized via the liver; therefore, the adverse reactions of drugs are probably higher for patients with liver disease. The current study aimed to evaluate the effects of opioid drugs on patients with liver disease; therefore, it is necessary to select suitable opioids for such patients. Evidence Acquisition This review was written by referring to research literature including 70 articles and four textbooks published from 1958 to 2015 on various reputable sites. Searches were carried out on the key phrases of narcotic pain relievers (opioids), acute and chronic hepatic failure, opioid adverse drug reactions, drug-induced liver injury (DILI) and other similar keywords. References included a variety of research papers (descriptive and analytical), intervention and review articles. Results In patients with liver disease, administration of opioid analgesics should be observed, accurately. As a general rule, lower doses of drugs should be administered at regular intervals based on the signs of drug accumulation. Secondly, the interactions of opioid drugs with different levels of substrates of the P450 cytochrome enzyme should be considered. Conclusions Pain management in patients with liver dysfunction is always challenging to physicians because of the adverse reactions of drugs, especially opioids. Opioids should be used cautiously since they can cause sedation, constipation and sudden encephalopathy effects. Since the clearance of these drugs in patients with hepatic insufficiency is decreased

  2. Neurosurgical procedures in patients with liver cirrhosis: A review

    PubMed Central

    Chen, Ching-Chang; Huang, Yin-Cheng; Yeh, Chun-Nan

    2015-01-01

    Liver cirrhosis, a devastating liver fibrosis caused by hepatitis/inflammation or tumors, is a major comorbid factor in known surgery fields, such as cardiovascular and abdominal surgeries. It is important to review possible comorbid results in neurosurgical procedures in cirrhotic patients. In the reviewed literature, Child-Pugh and model for end-stage liver disease scores are commonly used in the assessment of surgical risks for cirrhotic patients undergoing abdominal, cardiovascular or neurosurgical procedures. The major categories of neurosurgery are traumatic brain injury (TBI), spontaneous intracranial hemorrhage (SICH), brain tumors, and spinal instrumentation procedures. TBI was reported with surgical mortality as high as 34.5% and a complication rate of 87.2%. For SICH, mortality ranged from 22.7% to 47.0%, while complications were reported to be 43.2%. Less is discussed in brain tumor patients; still the postoperative hemorrhage rate approached 26.7%. In spinal fusion instrumentation procedures, the complication rate was as high as 41.0%. Preoperative assessment and correction could possibly decrease complications such as hemorrhage, wound infection and other cirrhosis-related complications (renal, pulmonary, ascites and encephalopathy). In this study, we reviewed the neurosurgical-related literature with regard to liver cirrhosis as a prognostic factor influencing neurosurgical outcomes. PMID:26413225

  3. Status of India's population education programme--the subject of tripartite projects review and annual country review.

    PubMed

    1981-12-01

    A 3-step monitoring of India's population education program was undertaken in 1981 in order to determine the level of implementation and progress of the program. This monitoring program, conducted by the Unesco Mobile Team in collaboration with other institutions, followed 3 procedures: Project Progress Report (PPR); Tripartite Project Review (TPR); and Annual Country Review (ACR). The review meetings of the 10 state population education projects were organized at Chandigarh and Madras during August. The states covered in the review were Bihar, Haryana, Madhaya Pradesh, Punjab, Rajasthan, Chandigarh, Gujarat, Karnataka, Maharashtra, and Tamil Nadu. The Tripartite Review identified the following as problems which were hindering the smooth implementation of the population education program: 1) difficulty in spending funds unless certain formalities were completed by the governments of the states; 2) administrative problems such as getting printing paper for instructional materials, waiving the sales tax for equipment to be purchased under the project, and uncertainty regarding the admissible rates of per diem to be paid to the participants in various training programs; 3) the lack of experience of project staff; 4) problems created by having more than 1 cell in a state such as Rajasthan; and 5) an inadequate time frame within which the project should complete all its activities and make population education an integral part of the school system. The following were among the recommendations made: 1) the Project should be made coterminous with the 6th Five-Year Plan up to March 31, 1985; and 2) there should be only 1 Population Education Cell in every state. Among the points discussed at the annual country review, held during October, were the following: rephasing of the program from a 3 to 5 year project to synchronize it with the 6th plan; and the need for additional funds in view of inflation. PMID:12264113

  4. Review: engaging patients as vigilant partners in safety: a systematic review.

    PubMed

    Schwappach, David L B

    2010-04-01

    Several initiatives promote patient involvement in error prevention, but little is known about its feasibility and effectiveness. A systematic review was conducted on the evidence of patients' attitudes toward engagement in error prevention and the effectiveness of efforts to increase patient participation. Database searches yielded 3,840 candidate articles, of which 21 studies fulfilled the inclusion criteria. Patients share a positive attitude about engaging in their safety at a general level, but their intentions and actual behaviors vary considerably. Studies applied theories of planned behavior and indicate that self-efficacy, preventability of incidents, and effectiveness of actions seem to be central to patients' intention to engage in error prevention. Rigorous evaluations of major educational campaigns are lacking. Interventions embedded within clinical settings have been effective to some extent. Evidence suggests that involvement in safety may be successful if interventions promote complex behavioral change and are sensitively implemented in health care settings. PMID:19671916

  5. 78 FR 18348 - Submission for OMB Review; Use of Project Labor Agreements for Federal Construction Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... estimate. As stated in the final rule in the Federal Register at 75 FR 19169 on April 10, 2010, Project...; Use of Project Labor Agreements for Federal Construction Projects AGENCY: Department of Defense (DOD... identified by Information Collection 9000- 0175, Use of Project Labor Agreements for Federal...

  6. 75 FR 13765 - Submission for OMB Review; Use of Project Labor Agreements for Federal Construction Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-23

    ...; Use of Project Labor Agreements for Federal Construction Projects AGENCY: Department of Defense (DOD... collection requirement regarding Use of Project Labor Agreements for Federal Construction Projects. A request for public comments was published in the Federal Register at 74 FR 33953, on July 14, 2009....

  7. Sleep attacks in patients taking dopamine agonists: review

    PubMed Central

    Homann, Carl Nikolaus; Wenzel, Karoline; Suppan, Klaudia; Ivanic, Gerd; Kriechbaum, Norbert; Crevenna, Richard; Ott, Erwin

    2002-01-01

    Objectives To assess the evidence for the existence and prevalence of sleep attacks in patients taking dopamine agonists for Parkinson's disease, the type of drugs implicated, and strategies for prevention and treatment. Design Review of publications between July 1999 and May 2001 in which sleep attacks or narcoleptic-like attacks were discussed in patients with Parkinson's disease. Results 124 patients with sleep events were found in 20 publications. Overall, 6.6% of patients taking dopamine agonists who attended movement disorder centres had sleep events. Men were over-represented. Sleep events occurred at both high and low doses of the drugs, with different durations of treatment (0-20 years), and with or without preceding signs of tiredness. Sleep attacks are a class effect, having been found in patients taking the following dopamine agonists: levodopa (monotherapy in 8 patients), ergot agonists (apomorphine in 2 patients, bromocriptine in 13, cabergoline in 1, lisuride or piribedil in 23, pergolide in 5,) and non-ergot agonists (pramipexole in 32, ropinirole in 38). Reports suggest two distinct types of events: those of sudden onset without warning and those of slow onset with prodrome drowsiness. Conclusion Insufficient data are available to provide effective guidelines for prevention and treatment of sleep events in patients taking dopamine agonists for Parkinson's disease. Prospective population based studies are needed to provide this information. What is already known on this topicCar crashes in patients with Parkinson's disease have been associated with sleep attacks caused by the dopamine agonists pramipexole and ropiniroleWhether sleep attacks exist, their connection with certain agonists, prevention or treatment, and the justification of legal actions are controversialWhat this study addsSleep attacks as a phenomenon distinct from normal somnolence really do existThey are a class effect of all dopamine drugsEffective prevention and treatment

  8. Patient Portals and Patient Engagement: A State of the Science Review

    PubMed Central

    DeVito Dabbs, Annette; Curran, Christine R

    2015-01-01

    Background Patient portals (ie, electronic personal health records tethered to institutional electronic health records) are recognized as a promising mechanism to support greater patient engagement, yet questions remain about how health care leaders, policy makers, and designers can encourage adoption of patient portals and what factors might contribute to sustained utilization. Objective The purposes of this state of the science review are to (1) present the definition, background, and how current literature addresses the encouragement and support of patient engagement through the patient portal, and (2) provide a summary of future directions for patient portal research and development to meaningfully impact patient engagement. Methods We reviewed literature from 2006 through 2014 in PubMed, Ovid Medline, and PsycInfo using the search terms “patient portal” OR “personal health record” OR “electronic personal health record”. Final inclusion criterion dictated that studies report on the patient experience and/or ways that patients may be supported to make competent health care decisions and act on those decisions using patient portal functionality. Results We found 120 studies that met the inclusion criteria. Based on the research questions, explicit and implicit aims of the studies, and related measures addressed, the studies were grouped into five major topics (patient adoption, provider endorsement, health literacy, usability, and utility). We discuss the findings and conclusions of studies that address the five topical areas. Conclusions Current research has demonstrated that patients’ interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver. Health care delivery factors, mainly provider endorsement and patient portal usability also contribute to patient’s ability to engage through and with the patient portal. Future

  9. [Patients with gastric cancer submitted to gastrectomy: an integrative review].

    PubMed

    Mello, Bruna Schroeder; Lucena, Amália de Fátima; Echer, Isabel Cristina; Luzia, Melissa de Freitas

    2010-12-01

    This study aims to analyze the scientific production about patients with gastric cancer submitted to gastrectomy and describe important aspects of nursing guidelines for these patients. An integrative review was carried out using Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases; twenty two articles were analyzed. Retrospective cross-sectional studies were the most frequent. The scientific production of nursing is numerically small in relation to the medical area. The results show that approaches related to pre and post-operative in gastrectomy for gastric cancer resection subsidize the knowledge of issues essential for nurses to promote efficient intervention for the recovery of such patients. There is still the need for further research on the practice of nursing in the guidelines of this kind of surgery. PMID:21805893

  10. Recommended frequency of ABPI review for patients wearing compression hosiery.

    PubMed

    Furlong, Winnie

    2015-11-11

    This paper is a sequel to the article 'How often should patients in compression have ABPI recorded?' ( Furlong, 2013 ). Monitoring ankle brachial pressure index (ABPI) is essential, especially in those patients wearing compression hosiery, as it can change over time ( Simon et al, 1994 ; Pankhurst, 2004 ), particularly in the presence of peripheral arterial disease (PAD). Leg ulceration caused by venous disease requires graduated compression ( Wounds UK, 2002 ; Anderson, 2008). Once healed, compression hosiery is required to help prevent ulcer recurrence ( Vandongen and Stacey, 2000 ). The Royal College of Nursing ( RCN, 2006 ) guidelines suggest 3-monthly reviews, including ABPI, with no further guidance. Wounds UK (2002) suggests that patients who have ABPI<0.9, diabetes, reduced mobility or symptoms of claudication should have at least 3/12 Doppler, and that those in compression hosiery without complications who are able to report should have vascular assessment yearly. PMID:26559232

  11. Pancreatic injury in patients with septic shock: A literature review

    PubMed Central

    Chaari, Anis; Abdel Hakim, Karim; Bousselmi, Kamel; Etman, Mahmoud; El Bahr, Mohamed; El Saka, Ahmed; Hamza, Eman; Ismail, Mohamed; Khalil, Elsayed Mahmoud; Kauts, Vipin; Casey, William Francis

    2016-01-01

    Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention. PMID:27559431

  12. Comorbidities in idiopathic pulmonary fibrosis patients: a systematic literature review.

    PubMed

    Raghu, Ganesh; Amatto, Valeria C; Behr, Jürgen; Stowasser, Susanne

    2015-10-01

    Idiopathic pulmonary fibrosis (IPF) is associated with a fatal prognosis and manifests in patients over 60 years old who may have comorbidities. The prevalence and impact of comorbidities on the clinical course of IPF is unclear.This systematic literature review examined the prevalence of comorbidities and mortality associated with comorbidities in IPF patients. Relevant observational studies published in English from January 1990 to January 2015 identified via MEDLINE and EMBASE were included; bibliographies of articles were also searched.Among the 126 studies included, prevalence of pulmonary hypertension (PH) was 3-86%, 6-91% for obstructive sleep apnoea, 3-48% for lung cancer and 6-67% for chronic obstructive pulmonary disease (COPD). Nonrespiratory comorbidities included ischaemic heart disease (IHD) (3-68%) and gastro-oesophageal reflux (GER) (0-94%). Mortality was highest among patients with IPF and lung cancer. Most studies assessed relatively small samples of patients with IPF.PH, COPD, lung cancer, GER and IHD are significant comorbidities; differences in IPF severity, case definitions and patient characteristics limited the comparability of findings. The identification and prompt treatment of comorbidities may have a clinically significant impact on overall outcome that is meaningful for patients with IPF. PMID:26424523

  13. Pancreatic injury in patients with septic shock: A literature review.

    PubMed

    Chaari, Anis; Abdel Hakim, Karim; Bousselmi, Kamel; Etman, Mahmoud; El Bahr, Mohamed; El Saka, Ahmed; Hamza, Eman; Ismail, Mohamed; Khalil, Elsayed Mahmoud; Kauts, Vipin; Casey, William Francis

    2016-07-15

    Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention. PMID:27559431

  14. Measurement of Physician-Patient Communication—A Systematic Review

    PubMed Central

    Zill, Jördis M.; Christalle, Eva; Müller, Evamaria; Härter, Martin; Dirmaier, Jörg; Scholl, Isabelle

    2014-01-01

    Background Effective communication with health care providers has been found as relevant for physical and psychological health outcomes as well as the patients' adherence. However, the validity of the findings depends on the quality of the applied measures. This study aimed to provide an overview of measures of physician-patient communication and to evaluate the methodological quality of psychometric studies and the quality of psychometric properties of the identified measures. Methods A systematic review was performed to identify psychometrically tested instruments which measure physician-patient communication. The search strategy included three databases (EMBASE, PsycINFO, PubMed), reference and citation tracking and personal knowledge. Studies that report the psychometric properties of physician-patient communication measures were included. Two independent raters assessed the methodological quality of the selected studies with the COSMIN (COnsensus based Standards for the selection of health status Measurement INtruments) checklist. The quality of psychometric properties was evaluated with the quality criteria of Terwee and colleagues. Results Data of 25 studies on 20 measures of physician-patient communication were extracted, mainly from primary care samples in Europe and the USA. Included studies reported a median of 3 out of the nine COSMIN criteria. Scores for internal consistency and content validity were mainly fair or poor. Reliability and structural validity were rated mainly of fair quality. Hypothesis testing scored mostly poor. The quality of psychometric properties of measures evaluated with Terwee et al.'s criteria was rated mainly intermediate or positive. Discussion This systematic review identified a number of measures of physician-patient communication. However, further psychometric evaluation of the measures is strongly recommended. The application of quality criteria like the COSMIN checklist could improve the methodological quality of

  15. REVIEW OF NEW ENGLAND COMPARATIVE RISK PROJECTS AND RANKINGS

    EPA Science Inventory

    Ten years ago, EPA New England (EPA NE) conducted a pilot comparative risk project:"Unfinished Business in New England: A Comparative Assessment of Environmental Problems" (December 1988). This regional effort was modeled after the national EPA comparative risk project: "Unfinis...

  16. A Review of Wind Project Financing Structures in the USA

    SciTech Connect

    Bolinger, Mark A; Harper, John; Karcher, Matthew

    2008-09-24

    The rapid pace of wind power development in the U.S. over the last decade has outstripped the ability of most project developers to provide adequate equity capital and make efficient use of project-related tax benefits. In response, the sector has created novel project financing structures that feature varying combinations of equity capital from project developers and third-party tax-oriented investors, and in some cases commercial debt. While their origins stem from variations in the financial capacity and business objectives of wind project developers, as well as the risk tolerances and objectives of equity and debt providers, each structure is, at its core, designed to manage project risk and allocate federal tax incentives to those entities that can use them most efficiently. This article surveys the six principal financing structures through which most new utility-scale wind projects (excluding utility-owned projects) in the U.S. have been financed from 1999 to the present. These structures include simple balance-sheet finance, several varieties of all-equity special allocation partnership 'flip' structures, and two leveraged structures. In addition to describing each structure's mechanics, the article also discusses its rationale for use, the types of investors that find it appealing and why, and its relative frequency of use in the market. The article concludes with a generalized summary of how a developer might choose one structure over another.

  17. Review of the Regional Biomass Energy Program: Technical projects

    SciTech Connect

    Lusk, P.

    1994-12-31

    This article summarizes technical projects of the regional Biomass Energy Program. Projects included are as follows: economic impact studies for renewable energy resources; alternative liquid fuels; Wood pellets fuels forum; residential fuel wood consumption; waste to energy decision-makers guide; fuel assessment for cogeneration facilities; municipal solid waste combustion characteristics.

  18. Formal design review report project W-151 mixer pump procurement

    SciTech Connect

    Crass, D.W.

    1997-01-21

    A formal design review for WHC-S-0040 was held on January 21, 1993. The review was completed January 29, 1993. No outstanding action items existed. Comments were recorded on Record Comment Record (RCR) forms and incorporated into the specification. The specification was considered acceptable, approved and issued as WHC-S-0040, Rev. 0 on March 4, 1993.

  19. Preliminary design review report for K Basin Dose Reduction Project

    SciTech Connect

    Blackburn, L.D.

    1996-01-01

    The strategy for reducing radiation dose, originating from radionuclides absorbed in the K East Basin concrete, is to raise the pool water level to provide additional shielding. This report documents a preliminary design review conducted to ensure that design approaches for cleaning/coating basin walls and modifying other basin components were appropriate. The conclusion of this review was that design documents presently conclusion of this review was that design documents presently completed or in process of modification are and acceptable basis for proceeding to complete the design.

  20. Fluid management of the neurological patient: a concise review.

    PubMed

    van der Jagt, Mathieu

    2016-01-01

    Maintenance fluids in critically ill brain-injured patients are part of routine critical care. Both the amounts of fluid volumes infused and the type and tonicity of maintenance fluids are relevant in understanding the impact of fluids on the pathophysiology of secondary brain injuries in these patients. In this narrative review, current evidence on routine fluid management of critically ill brain-injured patients and use of haemodynamic monitoring is summarized. Pertinent guidelines and consensus statements on fluid management for brain-injured patients are highlighted. In general, existing guidelines indicate that fluid management in these neurocritical care patients should be targeted at euvolemia using isotonic fluids. A critical appraisal is made of the available literature regarding the appropriate amount of fluids, haemodynamic monitoring and which types of fluids should be administered or avoided and a practical approach to fluid management is elaborated. Although hypovolemia is bound to contribute to secondary brain injury, some more recent data have emerged indicating the potential risks of fluid overload. However, it is acknowledged that many factors govern the relationship between fluid management and cerebral blood flow and oxygenation and more research seems warranted to optimise fluid management and improve outcomes. PMID:27240859

  1. New perspectives of volemic resuscitation in polytrauma patients: a review.

    PubMed

    Bedreag, Ovidiu Horea; Papurica, Marius; Rogobete, Alexandru Florin; Sarandan, Mirela; Cradigati, Carmen Alina; Vernic, Corina; Dumbuleu, Corina Maria; Nartita, Radu; Sandesc, Dorel

    2016-01-01

    Nowadays, fluid resuscitation of multiple trauma patients is still a challenging therapy. Existing therapies for volume replacement in severe haemorrhagic shock can lead to adverse reactions that may be fatal for the patient. Patients presenting with multiple trauma often develop hemorrhagic shock, which triggers a series of metabolic, physiological and cellular dysfunction. These disorders combined, lead to complications that significantly decrease survival rate in this subset of patients. Volume and electrolyte resuscitation is challenging due to many factors that overlap. Poor management can lead to post-resuscitation systemic inflammation causing multiple organ failure and ultimately death. In literature, there is no exact formula for this purpose, and opinions are divided. This paper presents a review of modern techniques and current studies regarding the management of fluid resuscitation in trauma patients with hemorrhagic shock. According to the literature and from clinical experience, all aspects regarding post-resuscitation period need to be considered. Also, for every case in particular, emergency therapy management needs to be rigorously respected considering all physiological, biochemical and biological parameters. PMID:27574675

  2. Characteristics of patients with pseudochylothorax—a systematic review

    PubMed Central

    Lama, Adriana; Toubes, María E.; Golpe, Antonio; Gude, Francisco; Álvarez-Dobaño, José M.; González-Barcala, Francisco J.; San José, Esther; Rodríguez-Núñez, Nuria; Rábade, Carlos; Rodríguez-García, Carlota; Valdés, Luis

    2016-01-01

    Background Pseudochylothorax (PCT) (cholesterol pleurisy or chyliform effusion) is a cholesterol-rich pleural effusion (PE) that is commonly associated with chronic inflammatory disorders. Nevertheless, the characteristics of patients with PCT are poorly defined. Methods A systematic review was performed across two electronic databases searching for studies reporting clinical findings, PE characteristics, and the most effective treatment of PCT. Case descriptions and retrospective studies were included. Results The review consisted of 62 studies with a total of 104 patients. Median age was 58 years, the male/female ratio was 2.6/1, and in the 88.5% of cases the etiology was tuberculosis (TB) or rheumatoid arthritis (RA). PE was usually unilateral (88%) and occupied greater than one-third of the hemithorax (96.3%). There was no evidence of pleural thickening in 20.6% of patients, and 14 patients had a previous PE. The pleural fluid (PF) was an exudate, usually milky (94%) and with a predominance of lymphocytes (61.1%). The most sensitive tests to establish the diagnosis were the cholesterol/triglycerides ratio (CHOL/TG ratio) >1, and the presence of cholesterol crystals (97.4% and 89.7%, respectively). PF culture for TB was positive in the 34.1% of patients. Favorable outcomes with medical treatment, therapeutic thoracentesis, decortication/pleurectomy, pleurodesis, thoracic drainage and thoracoscopic drainage were achieved in 78.9%, 47.8%, 86.7%, 66.6%, 37.5% and 42.9%, respectively. Conclusions PCT is usually tuberculous or rheumatoid, unilateral and the PF is a milky exudate. The presence of cholesterol crystals and a CHOL/TG ratio >1 are the most sensitive test for the diagnosis. The lack of pleural thickening does not rule out PCT. Treatment should be sequential, treating the underlying causes, and assessing the need for interventional techniques. PMID:27621864

  3. UAS Integration in the NAS Project - FY 14 Annual Review

    NASA Technical Reports Server (NTRS)

    Grindle, Laurie; Randall, Debra; Hackenberg, Davis

    2014-01-01

    This briefing gives insight into the research activities and efforts being executed in order to integrate unmanned aircraft systems into the national airspace system. This briefing is to inform others of the UAS-NAS Projects progress and future directions.

  4. CASCO BAY ESTUARY PROJECT TRIENNIAL IMPLEMENTATION REVIEW MARCH, 2004

    EPA Science Inventory

    The Casco Bay Estuary Project has seven primary goals/priorities which include: minimize pollutant loading from stormwater; open and protect shellfish beds; protect and restore habitat; reduce toxic pollution; promote responsible stewardship; sustain and promote the continued eff...

  5. Review of geography internship of convective wave project

    NASA Technical Reports Server (NTRS)

    Rademacher, Kurt R.; Collins, Charles

    1990-01-01

    The internship of the author is examined in detail. The acquisition of the internship, the personnel of the project, the project itself, and the goals associated with it are described. The authors orientation to the internship, the project's operations, and the conclusion of the findings are also described. The overall goal of the project was to determine the effect of convective waves on wind speeds in the middle and upper troposphere, and how these waves affect the general circulation on a global scale. A more specific goal of the author was the satellite analysis of cloud street formations. This was done to determine frequency and areas in which cloud streets occur off the East Asian and North American coastlines.

  6. The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review

    PubMed Central

    Kirkman, Matthew A; Sevdalis, Nick; Arora, Sonal; Baker, Paul; Vincent, Charles; Ahmed, Maria

    2015-01-01

    Objective To systematically review the latest evidence for patient safety education for physicians in training and medical students, updating, extending and improving on a previous systematic review on this topic. Design A systematic review. Data sources Embase, Ovid Medline and PsycINFO databases. Study selection Studies including an evaluation of patient safety training interventions delivered to trainees/residents and medical students published between January 2009 and May 2014. Data extraction The review was performed using a structured data capture tool. Thematic analysis also identified factors influencing successful implementation of interventions. Results We identified 26 studies reporting patient safety interventions: 11 involving students and 15 involving trainees/residents. Common educational content included a general overview of patient safety, root cause/systems-based analysis, communication and teamwork skills, and quality improvement principles and methodologies. The majority of courses were well received by learners, and improved patient safety knowledge, skills and attitudes. Moreover, some interventions were shown to result in positive behaviours, notably subsequent engagement in quality improvement projects. No studies demonstrated patient benefit. Availability of expert faculty, competing curricular/service demands and institutional culture were important factors affecting implementation. Conclusions There is an increasing trend for developing educational interventions in patient safety delivered to trainees/residents and medical students. However, significant methodological shortcomings remain and additional evidence of impact on patient outcomes is needed. While there is some evidence of enhanced efforts to promote sustainability of such interventions, further work is needed to encourage their wider adoption and spread. PMID:25995240

  7. Reviewing 741 patients records in two hours with FASTVISU

    PubMed Central

    Escudié, Jean-Baptiste; Jannot, Anne-Sophie; Zapletal, Eric; Cohen, Sarah; Malamut, Georgia; Burgun, Anita; Rance, Bastien

    2015-01-01

    The secondary use of electronic health records opens up new perspectives. They provide researchers with structured data and unstructured data, including free text reports. Many applications been developed to leverage knowledge from free-text reports, but manual review of documents is still a complex process. We developed FASTVISU a web-based application to assist clinicians in reviewing documents. We used FASTVISU to review a set of 6340 documents from 741 patients suffering from the celiac disease. A first automated selection pruned the original set to 847 documents from 276 patients’ records. The records were reviewed by two trained physicians to identify the presence of 15 auto-immune diseases. It took respectively two hours and two hours and a half to evaluate the entire corpus. Inter-annotator agreement was high (Cohen’s kappa at 0.89). FASTVISU is a user-friendly modular solution to validate entities extracted by NLP methods from free-text documents stored in clinical data warehouses. PMID:26958189

  8. AgRISTARS. Project management report: Program review presentation to level 1, interagency coordination committee

    NASA Technical Reports Server (NTRS)

    1981-01-01

    The AgRISTARS supporting research projects in the areas of data systems, scene radiation, and pattern recognition are reviewed. The objectives, activities, and accomplishments of FY-80 and the objectives and status of FY-81 programs are described.

  9. Reviewing the Unmet Needs of Patients with Multiple Sclerosis

    PubMed Central

    Mehr, Stanton R.; Zimmerman, Marj P.

    2015-01-01

    Significant innovations in the treatment of patients with multiple sclerosis (MS) have primarily addressed the frequency of flare-ups in relapsing-remitting MS (RRMS). Many advances have been made in this area, and the medical community may be on the verge of a serious discussion of what constitutes a truly effective MS treatment. Certainly, it is important to further delay MS flare-ups and more effectively treat RRMS symptoms. However, great strides in reducing or preventing MS-related disability and providing neuroprotection have been elusive. Many unmet needs are still voiced by patients with MS, clinicians, and caregivers. Current information on the need for progress in various areas is reviewed in this article, including psychosocial care, treatments for progressive MS, biomarker identification, functional outcome measures, individualization of treatment, reducing side effects of medications, and improving medication adherence. PMID:26702334

  10. General management of nonagenarian patients: a review of the literature.

    PubMed

    Rivoirard, Romain; Chargari, Cyrus; Trone, Jane-Chloé; Falk, Alexander Tuan; Guy, Jean-Baptiste; Eddekaoui, Houda; Lahmar, Rima; Pacaut, Cécile; Mery, Benoite; Assouline, Avi; Auberdiac, Pierre; Moriceau, Guillaume; Gonthier, Regis; Guillot, Aline; Merrouche, Yacine; Magné, Nicolas

    2014-01-01

    The number of nonagenarian people in the world is steadily growing. This phenomenon will increase in future years: in 2050, world population prospects estimate 71.16 million people aged 90 years or older. The two main causes of death among people aged 85 years or more in Europe in 2003 were cardiovascular and cerebrovascular diseases and cancers. However, the elderly are often excluded from clinical trials; they are underrepresented in clinical registries and especially nonagenarians. Care (medical, surgical, oncology) of these very elderly is currently insufficiently based on scientific recommendations. For the physician, the choice to treat or not to treat very elderly patients (for fear of side effects) is difficult. Oncology is particularly affected by this problem. Here we review these different fields of internal medicine management of nonagenarian patients with a special focus on oncology and on comprehensive geriatric assessment as a base for all care decision taking. PMID:25536522

  11. Reviewing the Unmet Needs of Patients with Multiple Sclerosis.

    PubMed

    Mehr, Stanton R; Zimmerman, Marj P

    2015-11-01

    Significant innovations in the treatment of patients with multiple sclerosis (MS) have primarily addressed the frequency of flare-ups in relapsing-remitting MS (RRMS). Many advances have been made in this area, and the medical community may be on the verge of a serious discussion of what constitutes a truly effective MS treatment. Certainly, it is important to further delay MS flare-ups and more effectively treat RRMS symptoms. However, great strides in reducing or preventing MS-related disability and providing neuroprotection have been elusive. Many unmet needs are still voiced by patients with MS, clinicians, and caregivers. Current information on the need for progress in various areas is reviewed in this article, including psychosocial care, treatments for progressive MS, biomarker identification, functional outcome measures, individualization of treatment, reducing side effects of medications, and improving medication adherence. PMID:26702334

  12. An Approach to Tailoring Major Technical Reviews Based on Project Characteristics and Stakeholder Interests

    NASA Technical Reports Server (NTRS)

    Richstein, Alan B.; Nolte, Jerome T.; Pfarr, Barbara B.

    2004-01-01

    There are numerous technical reviews that occur throughout the systems engineering process life cycle. Many are well known by project managers and stakeholders such as developers and end users, an example of much is the critical design review (CDR). This major milestone for a large, complex new project may last two or more days, include an extensive agenda of topics, and entail hundreds of hours of developer time to prepare presentation materials and associated documents. Additionally, the weeks of schedule spent on review preparation is at least partly at the expense of other work. This paper suggests an approach for tailoring technical reviews, based on the project characteristics and the project manager s identification of the key stakeholders and understanding of their most important issues and considerations. With this insight the project manager can communicate to, manage expectations oc and establish formal agreement with the stakeholders as to which reviews, and at what depth, are most appropriate to achieve project success. The authors, coming from diverse organizations and backgrounds, have drawn on their personal experiences and summarized the best practices of their own organizations to create a common framework to provide guidance on the adaptation of design reviews to other system engineers.

  13. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery.

    PubMed

    Rizk, Paul; Morris, William; Oladeji, Philip; Huo, Michael

    2016-06-01

    Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms. PMID:27239384

  14. Patient-based radiographic exposure factor selection: a systematic review

    SciTech Connect

    Ching, William; Robinson, John; McEntee, Mark

    2014-09-15

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system.

  15. Limb pterygium syndromes: a review and report of eleven patients.

    PubMed

    Hall, J G; Reed, S D; Rosenbaum, K N; Gershanik, J; Chen, H; Wilson, K M

    1982-08-01

    Conditions with limb pterygia and congenital contractures were reviewed as part of a study of over 350 infants with arthrogryposis. Emphasis was placed on inheritance and variability of distinct pterygium conditions. Eleven patients with limb pterygia were recognized in our study and are described here. Seven of the 350 patients with congenital contractures had the autosomal recessively inherited multiple pterygium syndrome (Patients 1-7). Three of the seven are sibs, a fourth was born to consanguineous parents, and three were chance isolated cases. These seven had multiple joint webs, unusual finger contractures, syndactyly, rocker bottom feet, ptosis, antimongoloid slant of palpebral fissures, epicanthal folds, highly arched palate, scoliosis, and short stature. There is intrafamilial variability. Three patients from one family had a lethal multiple pterygium syndrome. Two were monozygotic twins. They had webbing and contractures of the elbows, knees, neck, and fingers, calcaneovalgus deformity of the feet, and an unusual facial appearance: hypertelorism, flat nose, antimongoloid slant of palpebral fissures, apparently low-set ears. One had a cleft palate. Internal malformations included: bilateral pulmonary hypoplasia, small heart, absence of the appendix, and attenuation of the ascending and transverse colon. One sporadic case of lethal popliteal pterygium with facial clefts was studied. Multiple anomalies included: ankyloblepharon filiforme adnatum, upslanting palpebral fissures, hypoplasia of nasal cartilages, frenula, clefts into the oropharynx lateral to the mouth, apparently low-set ears with slit-like canals, large popliteal pterygia, syndactyly with fusion of all digits in hands and feet, and hypoplastic labia. PMID:7124793

  16. Clinical review: early patient mobilization in the ICU.

    PubMed

    Hodgson, Carol L; Berney, Sue; Harrold, Megan; Saxena, Manoj; Bellomo, Rinaldo

    2013-01-01

    Early mobilization (EM) of ICU patients is a physiologically logical intervention to attenuate critical illness-associated muscle weakness. However, its long-term value remains controversial. We performed a detailed analytical review of the literature using multiple relevant key terms in order to provide a comprehensive assessment of current knowledge on EM in critically ill patients. We found that the term EM remains undefined and encompasses a range of heterogeneous interventions that have been used alone or in combination. Nonetheless, several studies suggest that different forms of EM may be both safe and feasible in ICU patients, including those receiving mechanical ventilation. Unfortunately, these studies of EM are mostly single center in design, have limited external validity and have highly variable control treatments. In addition, new technology to facilitate EM such as cycle ergometry, transcutaneous electrical muscle stimulation and video therapy are increasingly being used to achieve such EM despite limited evidence of efficacy. We conclude that although preliminary low-level evidence suggests that EM in the ICU is safe, feasible and may yield clinical benefits, EM is also labor-intensive and requires appropriate staffing models and equipment. More research is thus required to identify current standard practice, optimal EM techniques and appropriate outcome measures before EM can be introduced into the routine care of critically ill patients. PMID:23672747

  17. Information on the Internet for asplenic patients: a systematic review

    PubMed Central

    Downing, Mark A.; Omar, Ahmed H.; Sabri, Elham; McCarthy, Anne E.

    2011-01-01

    Background Asplenic patients in general have poor knowledge about their condition. Patients are increasingly turning to the Internet for their health care information, therefore this is a resource that many asplenic patients will use. The aim of our study was to determine the quality of information on the Internet for asplenic patients. Methods We identified websites by entering “splenectomy OR spleen removal” into 3 Internet search engines on July 28, 2008. The top 50 English-language websites from each search engine were included in our analysis. We evaluated the websites with our own 21-point content scale as well as 4 commonly used quality-assessment tools. All websites were analyzed independently by 2 reviewers. Correlations were made between the quality assessment instruments, content, readability and target audience. Results We included 89 websites in the study. The mean content score percentage for all websites was 49% (95% confidence interval 44%–54%). The long-term risk of infection was mentioned in 84% of websites, and the need for vaccination was mentioned in 79%. The mean quality assessment tool score was 61%, and the mean reading grade level was 11. Conclusion Whereas websites on average did not cover most of the information that asplenic patients should receive, the long-term risk of serious infection and the need for vaccination was consistently mentioned. Websites were inconsistent with respect to adhering to standards advocated by the quality assessment instruments we used, and the mean reading grade level was far above what is recommended for patient literature. PMID:21651833

  18. Review of BPA Funded Sturgeon, Resident Fish and Wildlife Projects for 1990/1991.

    SciTech Connect

    United States. Bonneville Power Administration.

    1990-12-01

    The Bonneville Power Administration (BPA) held a public meeting on November 19--21, 1991, for the purpose of review, coordination, and consultation of the BPA-funded projects for sturgeon, resident fish, and wildlife in the Columbia River Basin (Basin). The comments received after the meeting were favorable and the participants agreed that the meeting was stimulating and productive. The information exchanged should lead to better coordination with other projects throughout the Basin. This document list the projects by title, the project leaders and BPA's project officers, and an abstract of each leader's presentation.

  19. 13 CFR 302.9 - Inter-governmental review of projects.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Project under EDA's Public Works and Economic Development program or a proposed construction Project or... required by 15 CFR part 13 and Executive Order 12372, “Intergovernmental Review of Federal Programs,” as... planning organizations in metropolitan areas, as provided for in 15 CFR part 13....

  20. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Projects that may require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA... under § 806.4, and provided that the project sponsor is notified in writing by the Executive...

  1. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Projects that may require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA... under § 806.4, and provided that the project sponsor is notified in writing by the Executive...

  2. Second and Third Grade Students in the Hunters Point-Bayview SEED Project: A Diagnostic Review.

    ERIC Educational Resources Information Center

    Counelis, James Steve

    This report supplements the first South East Education Development project (SEED) on first grade children. Full and partial records of 624 second grade students and 591 third grade students are the basis of this diagnostic review. The empirical data obtained for the SEED project students included: each student's sex and number of full days in…

  3. Interaction between ingested nutrients and gut endocrine cells in patients with irritable bowel syndrome (Review)

    PubMed Central

    EL-SALHY, MAGDY; GILJA, ODD HELGE; GUNDERSEN, DORIS; HATLEBAKK, JAN G.; HAUSKEN, TRYGVE

    2014-01-01

    Several endocrine cell abnormalities have been reported in different segments of the gastrointestinal tract of patients with irritable bowel syndrome (IBS). These cells have specialized microvilli that project into the lumen; they function as sensors for the gut contents and respond to luminal stimuli (mostly ingested nutrients) by releasing hormones into the lamina propria, where they exert their effects via a paracrine/endocrine mode of action. Certain food items trigger the symptoms experienced by IBS patients, including those rich in fermentable oligo-, di- and monosaccharides, and polyols (FODMAPs). In this review, we present the argument that the effects of both FODMAPs and the proportional intake of proteins, fats and carbohydrates on IBS symptoms may be caused by an interaction with the gut endocrine cells. Since the gut hormones control and regulate gastrointestinal motility and sensation, this interaction may be responsible for abnormal gastrointestinal motility and the visceral hypersensitivity observed in these patients. There is no consistent evidence that IBS patients suffer from food allergy. The role of gluten intolerance in the development of IBS symptoms in these patients remains a matter of controversy. Individual guidance on food management, which includes restrictions in the intake of FODMAP-rich foods and testing diets with different proportions of proteins, fats and carbohydrates has been found to reduce the symptoms, improve the quality of life, and make the habitual diet of IBS patients more healthy. PMID:24939595

  4. Mediators of Change in Psychosocial Interventions for Cancer Patients: A Systematic Review

    PubMed Central

    Moyer, Anne; Goldenberg, Matthew; Hall, Matthew A.; Knapp-Oliver, Sarah K.; Sohl, Stephanie J.; Sarma, Elizabeth A.; Schneider, Stefan

    2012-01-01

    Careful reviews and meta-analyses have made valuable contributions to understanding the efficacy of psychosocial interventions for cancer patients. An important next step is to determine the mediators that explain the influence of efficacious interventions on outcomes. This systematic review summarizes tests of mediating variables from twenty-two projects conducted from 1989–2010. Although all authors provided some type of rationale for considering particular mediating relationships, the investigations varied widely with respect to the extent to which formal theoretical constructs were tested, the type and goals of the interventions studied, and the broad types of outcomes and potential mediators examined. Although there was some evidence supporting selected mediating relationships, with positive findings often found when mediating variables represented behaviors targeted by an intervention, the findings were mixed. Expanding the focus of research to include mechanisms in psychosocial oncology intervention research is necessary for providing a unified picture of how mediating relationships may be operating in this field. PMID:22873734

  5. Independent Research Projects in General Chemistry Classes as an Introduction to Peer-Reviewed Literature

    ERIC Educational Resources Information Center

    Tribe, Lorena; Cooper, Evan L.

    2008-01-01

    A well-structured independent literature research project with a poster session was used to introduce students to peer-reviewed literature in a general chemistry course. Overall, students reported an enhanced appreciation of the course due to performing research at some level, using peer-reviewed literature, and presenting their results in a…

  6. A Review of the AIDP Project After the First Year.

    ERIC Educational Resources Information Center

    Broadbent, William A.

    This document provides an assessment of the progress Leeward Community College has made toward fulfilling the objectives of its five-year 1.4 million dollar Advanced Institutional Development Program (AIDP) grant at the end of the first year of funding. Essentially, the objectives of the project fall into four major program areas: community…

  7. 77 FR 47337 - Project-Level Predecisional Administrative Review Process

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-08

    ... submitted specific written comments regarding the proposed project or activity unless the issue is based on... Chief of the Forest Service (Chief), to provide for a predecisional objection process based on Section... part 218 on January 9, 2004 (69 FR 1529), followed by a final rule on September 17, 2008 (73 FR...

  8. Secondary Health Project: Concepts Review. Research Report 70.

    ERIC Educational Resources Information Center

    Agency for Instructional Television, Bloomington, IN.

    This report describes a preliminary evaluation in September 1979 of 12 program topics and their stated objectives for an instructional television series, the Secondary School Health Project, which addresses issues relevant to the personal and social growth of adolescents. The study addressed the following questions: (1) How can the series' topics…

  9. A comprehensive review of palliative care in patients with cancer.

    PubMed

    Jaiswal, Reena; Alici, Yesne; Breitbart, William

    2014-02-01

    One of the most challenging roles for the psychiatrist is to help guide terminally ill patients physically, psychologically and spiritually through the dying process. Patients with advanced cancer, and other life-threatening medical illnesses are at increased risk for developing major psychiatric complications and have an enormous burden of both physical as well as psychological symptoms. In fact, surveys suggest that psychological symptoms such as depression, anxiety, and hopelessness are as frequent, if not more so, than pain and other physical symptoms in palliative care settings. Psychiatrists have a unique role and opportunity to offer competent and compassionate palliative care to those with life-threatening illness. In this article we provide a comprehensive review of basic concepts and definitions of palliative care and the experience of dying, and the role of the psychiatrist in palliative care including assessment and management of common psychiatric disorders in the terminally ill, with an emphasis on suicide and desire for hastened death. Psychotherapies developed for use in palliative care settings, and management of grief and bereavement are also reviewed. PMID:24716503

  10. Missed injuries in trauma patients: A literature review

    PubMed Central

    Pfeifer, Roman; Pape, Hans-Christoph

    2008-01-01

    Background Overlooked injuries and delayed diagnoses are still common problems in the treatment of polytrauma patients. Therefore, ongoing documentation describing the incidence rates of missed injuries, clinically significant missed injuries, contributing factors and outcome is necessary to improve the quality of trauma care. This review summarizes the available literature on missed injuries, focusing on overlooked muscoloskeletal injuries. Methods Manuscripts dealing with missed injuries after trauma were reviewed. The following search modules were selected in PubMed: Missed injuries, Delayed diagnoses, Trauma, Musculoskeletal injuires. Three time periods were differentiated: (n = 2, 1980–1990), (n = 6, 1990–2000), and (n = 9, 2000-Present). Results We found a wide spread distribution of missed injuries and delayed diagnoses incidence rates (1.3% to 39%). Approximately 15 to 22.3% of patients with missed injuries had clinically significant missed injuries. Furthermore, we observed a decrease of missed pelvic and hip injuries within the last decade. Conclusion The lack of standardized studies using comparable definitions for missed injuries and clinically significant missed injuries call for further investigations, which are necessary to produce more reliable data. Furthermore, improvements in diagnostic techniques (e.g. the use of multi-slice CT) may lead to a decreased incidence of missed pelvic injuries. Finally, the standardized tertiary trauma survey is vitally important in the detection of clinically significant missed injuries and should be included in trauma care. PMID:18721480

  11. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program PROCEDURE FOR MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... property that may be included inadvertently in a Special Flood Hazard Area (SFHA) may request...

  12. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program PROCEDURE FOR MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... property that may be included inadvertently in a Special Flood Hazard Area (SFHA) may request...

  13. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program PROCEDURE FOR MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... property that may be included inadvertently in a Special Flood Hazard Area (SFHA) may request...

  14. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support such... Washington, DC, and shall be accompanied by the appropriate payment, in accordance with 44 CFR part 72. ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Review of proposed...

  15. Status of power-reactor projects undergoing licensing review

    SciTech Connect

    Silver, E.G.

    1982-07-01

    Recent regulatory and other actions relating to power reactors undergoing licensing review are summarized in Table 1 as of May 1, 1982. Except as otherwise noted, all the information presented in this article is taken from NRC press releases or from the reactor docket file, both of which are available at the NRC Public Document Room, 1717 H Street NW, Washington, DC 20555.

  16. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... by the appropriate payment, in accordance with 44 CFR part 72. All such requests for CLOMAs shall be... MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... will be issued in the form of a letter, termed a Conditional Letter of Map Amendment. The data...

  17. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... by the appropriate payment, in accordance with 44 CFR part 72. All such requests for CLOMAs shall be... MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... will be issued in the form of a letter, termed a Conditional Letter of Map Amendment. The data...

  18. Residential Segregation: A Review of the Literature. Project Report.

    ERIC Educational Resources Information Center

    Page, Douglas B.

    A review of the literature on residential segregation reveals that Blacks remain the most segregated group in American cities, despite the more recent arrival of Hispanic and Asian groups. By one measure--the index of dissimilarity with respect to Whites--Blacks are 1.6 times more segregated than Hispanics, and twice as segregated as Asians. Race…

  19. Solar Technology Assessment Project. Volume VII. A review of OTEC

    SciTech Connect

    Yuen, P.C.

    1981-04-01

    The Ocean Thermal Energy Conversion (OTEC) principle is discussed along with general system and cycle types, specific OTEC designs, applications, and the ocean thermal resource. the historic development and present status of OTEC are reviewed. Power system components of the more technically advanced closed-cycle OTEC concept are discussed: heat exchangers, corrosion and biofouling countermeasures, working fluids, ammonia power systems, and on-platform seawater sytems. Several open-cycle features are also discussed. A critical review of the ocean engineering aspects of the OTEC power system is presented. Major subsystems such as platform, cold water pipe, mooring system, dynamic positioning system and power transmission cable system are assessed for their relationships with the ocean environment and with each other. Nine available studies of OTEC costs are reviewed, and tentative comparisons are made between OTEC and traditional fuel costs. OTEC products and markets are considered. Possible environmental and social effects of OTEC development are discussed. International and national laws regulating OTEC plants are reviewed, specifically, the United Nations Third Conference on the Law of the Sea and the Ocean Thermal Energy Conversion Act of 1980. Coast Guard regulations, OSHA laws, and state and local government regulations are also considered as well as attitudes of the utilities. (LEW)

  20. Dropouts: A Review of Literature. Project Talent Search.

    ERIC Educational Resources Information Center

    Self, Timothy C.

    This report reviews the research literature from 1975-1983 on potential secondary school dropouts and strategies for effective dropout prevention programs. The information provided is intended to help communities in modifying and/or constructing treatment programs for potential dropouts. The report is divided into three sections. In the first…

  1. REVIEW ARTICLE: UHP lamp systems for projection applications

    NASA Astrophysics Data System (ADS)

    Derra, Guenther; Moench, Holger; Fischer, Ernst; Giese, Hermann; Hechtfischer, Ulrich; Heusler, Gero; Koerber, Achim; Niemann, Ulrich; Noertemann, Folke-Charlotte; Pekarski, Pavel; Pollmann-Retsch, Jens; Ritz, Arnd; Weichmann, Ulrich

    2005-09-01

    Projection systems have found widespread use in conference rooms and other professional applications during the last decade and are now entering the home TV market at a considerable pace. Projectors as small as about one litre are able to deliver several thousand screen lumens and are, with a system efficacy of over 10 lm W-1, the most efficient display systems realized today. Short arc lamps are a key component for projection systems of the highest efficiency for small-size projection displays. The introduction of the ultra high performance (UHP) lamp system by Philips in 1995 can be identified as one of the key enablers of the commercial success of projection systems. The UHP lamp concept features outstanding arc luminance, a well suited spectrum, long life and excellent lumen maintenance. For the first time it combines a very high pressure mercury discharge lamp with extremely short and stable arc gap with a regenerative chemical cycle keeping the discharge walls free from blackening, leading to lifetimes of over 10 000 h. Since the introduction of the UHP lamp system, many important new technology improvements have been realized: burner designs for higher lamp power, advanced ignition systems, miniaturized electronic drivers and innovative reflector concepts. These achievements enabled the impressive increase of projector light output, a remarkable reduction in projector size and even higher optical efficiency in projection systems during the last years. In this paper the concept of the UHP lamp system is described, followed by a discussion of the technological evolution the UHP lamp has undergone so far. Last, but not least, the important improvements of the UHP lamp system including the electronic driver and the reflector are discussed.

  2. Depression in cancer patients: Pathogenesis, implications and treatment (Review)

    PubMed Central

    SMITH, HAMISH R.

    2015-01-01

    Depression is a common comorbidity in cancer cases, affecting >10% of patients. A cancer diagnosis is life-changing, and is a source of considerable psychological and emotional stress. Non-pathological sadness may be a normal response to a cancer diagnosis, however, stress beyond the coping mechanisms of patients may result in major depressive disorder. The current review, in addition to the obvious psychosocial elements of depression, explores its biological mechanisms, including tissue damage, inflammatory mediators and the chronic stress response, and how these immune and endocrine pathways may underlie depression in cancer. Possible iatrogenic causes of depression in cancer are also explored. There is a strong need to identify and treat depression in cancer patients in order to increase quality of life and reduce mortality. The most popular clinical and potential future biochemical screening tools for depression in cancer are briefly discussed. The interventions used will vary for every patient, but may include psychosocial therapies or pharmacotherapy; however, a paucity of research on the most effective management of depression in cancer means the optimal combination of therapies is unknown. Selection of antidepressants should be carefully considered, given the common side effects of chemotherapy (such as nausea), and the necessity to avoid serious interactions, including reducing the effectiveness of chemotherapeutic drugs. The possible link between the chronic stress response, which may predispose patients to depression, and the risk of mortality from cancer is also explored. The complex interactions between the endocrine, nervous and immune systems, which continue to be elucidated, may offer the opportunity for the development of more rapid and efficacious treatments for depression in cancer in the future. PMID:25788991

  3. Dosimetric review of cardiac implantable electronic device patients receiving radiotherapy.

    PubMed

    Prisciandaro, Joann I; Makkar, Akash; Fox, Colleen J; Hayman, James A; Horwood, Laura; Pelosi, Frank; Moran, Jean M

    2015-01-01

    A formal communication process was established and evaluated for the management of patients with cardiac implantable electronic devices (CIEDs) receiving radiation therapy (RT). Methods to estimate dose to the CIED were evaluated for their appropriateness in the management of these patients. A retrospective, institutional review board (IRB) approved study of 69 patients with CIEDs treated with RT between 2005 and 2011 was performed. The treatment sites, techniques, and the estimated doses to the CIEDs were analyzed and compared to estimates from published peripheral dose (PD) data and three treatment planning systems(TPSs) - UMPlan, Eclipse's AAA and Acuros algorithms. When measurements were indicated, radiation doses to the CIEDs ranged from 0.01-5.06 Gy. Total peripheral dose estimates based on publications differed from TLD measurements by an average of 0.94 Gy (0.05-4.49 Gy) and 0.51 Gy (0-2.74 Gy) for CIEDs within 2.5 cm and between 2.5 and 10 cm of the treatment field edge, respectively. Total peripheral dose estimates based on three TPSs differed from measurements by an average of 0.69 Gy (0.02-3.72 Gy) for CIEDs within 2.5 cm of the field edge. Of the 69 patients evaluated in this study, only two with defibrillators experienced a partial reset of their device during treatment. Based on this study, few CIED-related events were observed during RT. The only noted correlation with treatment parameters for these two events was beam energy, as both patients were treated with high-energy photon beams (16 MV). Differences in estimated and measured CIED doses were observed when using published PD data and TPS calculations. As such, we continue to follow conservative guidelines and measure CIED doses when the device is within 10 cm of the field or the estimated dose is greater than 2 Gy for pacemakers or 1 Gy for defibrillators. PMID:25679176

  4. Multidisciplinary in-hospital teams improve patient outcomes: A review

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    Background: The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Methods: Acting like “well-oiled machines,” multidisciplinary in-hospital teams include “staff” from different levels of the treatment pyramid (e.g. staff including nurses’ aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the “silo effect” by enhancing communication between the different levels of healthcare workers and thus reduces AE (e.g. morbidity/mortality) while improving patient and healthcare worker satisfaction. Results: Multiple articles across diverse disciplines incorporate a variety of concepts of “teamwork” for staff covering emergency rooms (ERs), hospital wards, intensive care units (ICUs), and most critically, operating rooms (ORs). Cohesive teamwork improved communication between different levels of healthcare workers, and limited adverse events, improved outcomes, decreased the length of stay (LOS), and yielded greater patient “staff” satisfaction. Conclusion: Within hospitals, delivering the best medical/surgical care is a “team sport.” The goals include: Maximizing patient safety (e.g. limiting AE) and satisfaction, decreasing the LOS, and increasing the quality of outcomes. Added benefits include optimizing healthcare workers’ performance, reducing hospital costs/complications, and increasing job satisfaction. This review should remind hospital administrators of the critical need to keep multidisciplinary teams together, so that they can continue to operate their “well-oiled machines” enhancing the quality/safety of patient care, while enabling “staff” to optimize their performance and enhance their job satisfaction. PMID:25289149

  5. Summary for the Next Generation Nuclear Plant Project in Review

    SciTech Connect

    L.E. Demick

    2010-08-01

    This paper reports on the major progress that the NGNP Project has made toward developing and commercializing the HTGR technology. Significant R&D progress has been made in addressing key technical issues for qualification of the HTGR fuel and graphite, codification of high temperature materials and verification and validation of design codes. Work is also progressing in heat transfer/transport design and testing and in development of the high temperature steam electrolysis hydrogen production process. A viable licensing strategy has been formulated in coordination with the NRC and DOE. White papers covering key licensing issues have been and will continue to be submitted and necessary discussions of these key issues have begun with the NRC. Continued government support is needed to complete the Project objectives as established in the 2005 Energy Policy Act.

  6. Summary for the Next Generation Nuclear Plant Project in Review

    SciTech Connect

    L.E. Demick

    2010-09-01

    This paper reports on the major progress that the NGNP Project has made toward developing and commercializing the HTGR technology. Significant R&D progress has been made in addressing key technical issues for qualification of the HTGR fuel and graphite, codification of high temperature materials and verification and validation of design codes. Work is also progressing in heat transfer/transport design and testing and in development of the high temperature steam electrolysis hydrogen production process. A viable licensing strategy has been formulated in coordination with the NRC and DOE. White papers covering key licensing issues have been and will continue to be submitted and necessary discussions of these key issues have begun with the NRC. Continued government support is needed to complete the Project objectives as established in the 2005 Energy Policy Act.

  7. Constructing a Patient Education System: A Performance Technology Project

    ERIC Educational Resources Information Center

    Bell, Edith E.

    2009-01-01

    The purpose of the patient education system described here was to distribute patient education material to and within medical practices managed by a small medical practice management company. The belief was that patient education opportunities improved health care outcomes and increased patient participation in health care decisions and compliance…

  8. A review of NASA-sponsored technology assessment projects

    NASA Technical Reports Server (NTRS)

    Mascy, A. C.; Alexander, A. D., III; Wood, R. D.

    1978-01-01

    Recent technology assessment studies sponsored by NASA are reviewed, and a summary of the technical results as well as a critique of the methodologies are presented. The reviews include Assessment of Lighter-Than-Air Technology, Technology Assessment of Portable Energy RDT&P, Technology Assessment of Future Intercity Passenger Transportation Systems, and Technology Assessment of Space Disposal of Radioactive Nuclear Waste. The use of workshops has been introduced as a unique element of some of these assessments. Also included in this report is a brief synopsis of a method of quantifying opinions obtained through such group interactions. Representative of the current technology assessments, these studies cover a broad range of socio-political factors and issues in greater depth than previously considered in NASA sponsored studies. In addition to the lessons learned through the conduct of these studies, a few suggestions for improving the effectiveness of future technology assessments are provided.

  9. Memory deficits in Alzheimer's patients: a comprehensive review.

    PubMed

    Carlesimo, G A; Oscar-Berman, M

    1992-06-01

    Despite considerable experimental work on Alzheimer's disease (AD), the underlying cognitive mechanisms as well as the precise localization of neuropathological changes critical for memory loss remains undefined. A review of the neuropsychological literature on long-term memory deficits in AD patients suggests that AD patients display (a) a pervasive deficit of explicit memory, (b) a partial deficiency of implicit memory for verbal and visuoperceptual material (as measured by repetition priming procedures), and (c) a substantial sparing of implicit memory for visuomotor skills. The explicit memory loss is likely a result of encoding as well as consolidation difficulties. A faulty lexical-semantic knowledge structure appears responsible for deficient repetition priming effects. Since neuropathological changes diffusely affect the brain of AD patients, establishing a clear relationship between localization of cerebral lesions and memory deficits is particularly difficult. Nevertheless, data suggest that extensive involvement of the hippocampal-amygdala complex plays a major role in explicit memory loss. Damage to associative cortical areas likely is involved in repetition priming deficits. The relative integrity of primary motor and sensory cortical areas and of the basal ganglia likely subsume, by contrast, the normal learning of visuomotor skills. PMID:1300219

  10. Older patients in the emergency department: a review.

    PubMed

    Samaras, Nikolaos; Chevalley, Thierry; Samaras, Dimitrios; Gold, Gabriel

    2010-09-01

    Older patients account for up to a quarter of all emergency department (ED) visits. Atypical clinical presentation of illness, a high prevalence of cognitive disorders, and the presence of multiple comorbidities complicate their evaluation and management. Increased frailty, delayed diagnosis, and greater illness severity contribute to a higher risk of adverse outcomes. This article will review the most common conditions encountered in older patients, including delirium, dementia, falls, and polypharmacy, and suggest simple and efficient strategies for their evaluation and management. It will discuss age-related changes in the signs and symptoms of acute coronary events, abdominal pain, and infection, examine the yield of different diagnostic approaches in this population, and list the underlying medical problems present in half of all "social" admission cases. Complete geriatric assessments are time consuming and beyond the scope of most EDs. We propose a strategy based on the targeting of high-risk patients and provide examples of simple and efficient tools that are appropriate for ED use. PMID:20619500

  11. Review on immunotherapy in airway allergen sensitised patients.

    PubMed

    van der Valk, J P M; de Jong, N W; Gerth van Wijk, R

    2015-07-01

    Allergen immunotherapy is a more than 100-year-old treatment in particular for birch pollen, grass pollen, house dust mite and cat dander sensitised allergic patients. The mechanism of allergen-specific immunotherapy is complex. Different hypotheses have been postulated to explain the mode of action, such as a decrease of the number of tissue mast cells, eosinophils and basophils, an increase of IgG4 and IgA synthesis, a shift from Th2 to Th1 cells and an increase in the number and function of IL-10 producing T-regulatory cells (T-reg). All these immunological effects may contribute to immune tolerance and long-term changes in the immune system. The efficacy and safety of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) with pollen and house dust mite have been investigated in many trials, meta-analyses and reviews. Nowadays grass pollen SLIT and SCIT, and birch pollen and house dust mite SCIT are implemented in clinical practice to treat therapy-resistant patients. However, the treatment is not effective for all patients and often not without side effects. Therefore, the development of new, safer and more effective immunotherapies is needed. These are approached along novel routes, including improved administration, combined treatment with immune response modifiers, fusion with immune response modifiers, allergen coupled to adjuvants and reconstruction of natural extracts with multiple recombinant allergens or with modified allergens. These developments are promising, but more research is required to implement them in clinical practice. PMID:26228190

  12. A review on quality of life in keratinocyte carcinoma patients.

    PubMed

    Waalboer-Spuij, R; Nijsten, T E C

    2013-06-01

    Health-related quality of life issues in patients with cutaneous malignancies is being re-explored. This is motivated by the heavy burden they put on dermatological care, it is more and more considered a chronic disease and new non-invasive therapies are being introduced. The purpose of this review is to identify the relevant quality of life (QOL) issues and to summarize the instruments used for investigating QOL in keratinocyte carcinoma patients. With a systematic literature search in Embase, MEDLINE OvidSP, PubMed publisher and Cochrane Central, 10 questionnaires and 4 studies reporting on quality of life issues were identified. Generic (UK Sickness Impact profile [UKSIP], Short Form 36-item Health Survey [SF-36], Functional Assessment of Cancer Therapy-General [FACT-G]) and dermatology specific (Dermatology Life Quality Index [DLQI] and Skindex-29, -16, -17) instruments demonstrated little to no QOL impairment. This may be explained by failing to capture the relevant domains such as "emotions", "appearance" and "anxiety". Skin cancer specific questionnaires (Skin Cancer Index [SCI], Skin Cancer Quality of Life Impact Tool [SCQOLIT] and Actinic Keratosis Quality of Life [AKQoL]) demonstrated good validity and responsiveness and represent the effect on QOL properly. However, there are some points of critique to these questionnaires. Optimal management of patients with actinic neoplasia syndrome and the selection and evaluation of therapies may benefit from the use of PROs in this ever increasing population. PMID:23670061

  13. Nasal reconstruction in children: a review of 29 patients.

    PubMed

    Pittet, B; Montandon, D

    1998-11-01

    Acquired large nasal defects are much more common in adulthood than in childhood because of the frequency of skin tumors after a certain age. However, from their experience in treating a number of children with sequelae of noma and burns, the authors have collected a series of 17 total and 12 partial nasal reconstructions in children aged 1 to 15 years. After reviewing the various methods used for recreating the lining, the support, and the skin cover in the whole series, three cases are reported in detail. A 1-year-old patient received a tempororetroauricular flap after total amputation of the nose and was observed for 17 years. Another patient, who was burned as a baby, underwent reconstruction at age 10 with a deltopectoral flap and was observed for 7 years. The third patient underwent total nose reconstruction at age 12 with an Indian forehead flap. From their experience, the authors conclude that, for psychosocial reasons, nasal reconstruction should be started early, despite possible reoperation at a later age. The best results are certainly obtained at the end of growth or at least after the age of 12. Adjacent bone or soft tissue defects further enhance the difficult challenge of restoring a satisfactory aesthetic appearance in these children. PMID:10029764

  14. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    receiving all elements of the COPD admission care bundle, versus 63% in September 2014. Appropriate blood gas analysis, nebuliser administration, and respiratory review also improved. Prescription of steroids and antibiotics remained static, with 96% of patients receiving these treatments within four hours in the emergency department (ED). The only criteria which showed a decline was appropriate oxygen prescription, which dipped from 97% to 87%. After the effect of initial strategies plateaued, this quality improvement project facilitated a further increase in compliance with the CQUIN targets, both improving patient care, and safeguarding continued CQUIN funding. There is further work to be done to maintain and support further improvement in standards, and to encourage use of the COPD admission bundle paperwork for documentation purposes. PMID:26734406

  15. Electronic band structure and photoemission: A review and projection

    SciTech Connect

    Falicov, L.M.

    1987-09-01

    A brief review of electronic-structure calculations in solids, as a means of interpreting photoemission spectra, is presented. The calculations are, in general, of three types: ordinary one-electron-like band structures, which apply to bulk solids and are the basis of all other calculations; surface modified calculations, which take into account, self-consistently if at all possible, the presence of a vacuum-solid interface and of the electronic modifications caused thereby; and many-body calculations, which go beyond average-field approximations and consider dynamic rearrangement effects caused by electron-electron correlations during the photoemission process. 44 refs.

  16. How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time

    PubMed Central

    Baines, Rebecca; Langelaan, Maaike; de Bruijne, Martine; Spreeuwenberg, Peter; Wagner, Cordula

    2015-01-01

    Objectives To assess whether, compared with previous years, hospital care became safer in 2011/2012, expressing itself in a fall in preventable adverse event (AE) rates alongside patient safety initiatives. Design Retrospective patient record review at three points in time. Setting In three national AE studies, patient records of 2004, 2008 and 2011/2012 were reviewed in, respectively, 21 hospitals in 2004, 20 hospitals in 2008 and 20 hospitals in 2011/2012. In each hospital, 400, 200 and 200 patient records were sampled, respectively. Participants In total, 15 997 patient admissions were included in the study, 7926 patient admissions from 2004, 4023 from 2008 and 4048 from 2011/2012. Interventions The main patient safety initiatives in hospital care at a national level between 2004 and 2012 have been small as well as large-scale multifaceted programmes. Main outcome measures Rates of both AEs and preventable AEs. Results Uncorrected crude overall AE rates showed no change in 2011/2012 in comparison with 2008, whereas preventable AE rates showed a reduction of 45%. After multilevel corrections, the decrease in preventable AE rate in 2011/2012 was still clearly visible with a decrease of 30% in comparison to 2008 (p=0.10). In 2011/2012, fewer preventable AEs were found in older age groups, or related to the surgical process, in comparison with 2008. Conclusions Our study shows some improvements in preventable AEs in the areas that were addressed during the comprehensive national safety programme. There are signs that such a programme has a positive impact on patient safety. PMID:26150548

  17. Patient-based radiographic exposure factor selection: a systematic review

    PubMed Central

    Ching, William; Robinson, John; McEntee, Mark

    2014-01-01

    Introduction Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Methods Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. Results The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Conclusion Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system. PMID:26229654

  18. Measurement of patient safety: a systematic review of the reliability and validity of adverse event detection with record review

    PubMed Central

    Hanskamp-Sebregts, Mirelle; Zegers, Marieke; Vincent, Charles; van Gurp, Petra J; de Vet, Henrica C W; Wollersheim, Hub

    2016-01-01

    Objectives Record review is the most used method to quantify patient safety. We systematically reviewed the reliability and validity of adverse event detection with record review. Design A systematic review of the literature. Methods We searched PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library and from their inception through February 2015. We included all studies that aimed to describe the reliability and/or validity of record review. Two reviewers conducted data extraction. We pooled κ values (κ) and analysed the differences in subgroups according to number of reviewers, reviewer experience and training level, adjusted for the prevalence of adverse events. Results In 25 studies, the psychometric data of the Global Trigger Tool (GTT) and the Harvard Medical Practice Study (HMPS) were reported and 24 studies were included for statistical pooling. The inter-rater reliability of the GTT and HMPS showed a pooled κ of 0.65 and 0.55, respectively. The inter-rater agreement was statistically significantly higher when the group of reviewers within a study consisted of a maximum five reviewers. We found no studies reporting on the validity of the GTT and HMPS. Conclusions The reliability of record review is moderate to substantial and improved when a small group of reviewers carried out record review. The validity of the record review method has never been evaluated, while clinical data registries, autopsy or direct observations of patient care are potential reference methods that can be used to test concurrent validity. PMID:27550650

  19. Independent management and financial review, Yucca Mountain Project, Nevada. Final report

    SciTech Connect

    1995-07-15

    The Yucca Mountain Project is one part of the Department of Energy`s Office of Civilian Radioactive Waste Management Program (the Program) which was established by the Nuclear Waste Policy Act of 1982, and as amended in 1987. The Program`s goal is to site the nation`s first geologic repository for the permanent disposal of high-level nuclear waste, in the form of spent fuel rod assemblies, generated by the nuclear power industry and a smaller quantity of Government radioactive waste. The Program, which also encompasses the transportation system and the multipurpose canister system was not the subject of this Report. The subject of this Review was only the Yucca Mountain Project in Nevada. While the Review was directed toward the Yucca Mountain Project rather than the Program as a whole, there are certain elements of the Project which cannot be addressed except through discussion of some Program issues. An example is the Total System Life Cycle Cost addressed in Section 7 of this report. Where Program issues are discussed in this Report, the reader is reminded of the scope limitations of the National Association of Regulatory Utility Commissioners (NARUC) contract to review only the Yucca Mountain Project. The primary scope of the Review was to respond to the specific criteria contained in the NARUC scope of work. In responding to these criteria, the Review Team understood that some interested parties have expressed concern over the requirements of the Nuclear Waste Policy Act relative to the Yucca Mountain Project and the nature of activities currently being carried out by the Department of Energy at the Yucca Mountain Project site. The Review Team has attempted to analyze relevant portions of the Nuclear Waste Policy Act as Amended, but has not conducted a thorough analysis of this legislation that could lead to any specific legal conclusions about all aspects of it.

  20. Acupuncture for patients with chronic urticaria: a systematic review protocol

    PubMed Central

    Yao, Qin; Ye, Yongming; Liu, Xiaoxu; Qin, Zongshi; Liu, Zhishun

    2015-01-01

    Introduction This systematic review protocol aims to describe a meta-analysis to assess the effectiveness and safety of acupuncture therapy for patients with chronic urticaria. Methods and analysis We will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, the Web of Science, Traditional Chinese Medicine, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database) and Wan-Fang Database from their inception. Other sources will also be searched, including the reference lists of identified publications and conference proceedings. Any clinical randomised controlled trials related to acupuncture for treating chronic urticaria without restriction of publication status and languages will be included. Study selection, data extraction and assessment of study quality will be performed independently by 2 researchers. Data will be synthesised by either the fixed-effects or random-effects model according to a heterogeneity test. Improvement in pruritus and wheals will be assessed as the primary outcomes. Adverse events, quality of life and the recurrence rate after at least 3 months of the treatment will also be evaluated as secondary outcomes. RevMan V.5.2 statistical software will be used for meta-analysis, if possible. If it is not appropriate for a meta-analysis, then a descriptive analysis or a subgroup analysis will be conducted. The results will be expressed as a risk ratio for dichotomous data and mean difference (MD) or standardised MD for continuous data. Dissemination and ethics The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualised. Trial registration number PROSPERO CRD42015015702. PMID:26338683

  1. Breckinridge Project, initial effort. Report XI, Volume V. Critical review of the design basis. [Critical review

    SciTech Connect

    1982-01-01

    Report XI, Technical Audit, is a compendium of research material used during the Initial Effort in making engineering comparisons and decisions. Volumes 4 and 5 of Report XI present those studies which provide a Critical Review of the Design Basis. The Critical Review Report, prepared by Intercontinental Econergy Associates, Inc., summarizes findings from an extensive review of the data base for the H-Coal process design. Volume 4 presents this review and assessment, and includes supporting material; specifically, Design Data Tabulation (Appendix A), Process Flow Sheets (Appendix B), and References (Appendix C). Volume 5 is a continuation of the references of Appendix C. Studies of a proprietary nature are noted and referenced, but are not included in these volumes. They are included in the Limited Access versions of these reports and may be reviewed by properly cleared personnel in the offices of Ashland Synthetic Fuels, Inc.

  2. Breckinridge Project, initial effort. Report XI, Volume IV. Critical review of the design basis. [Critical review

    SciTech Connect

    1981-05-01

    Report XI, Technical Audit, is a compendium of research material used during the Initial Effort in making engineering comparisons and decisions. Volumes 4 and 5 of Report XI present those studies which provide a Critical Review of the Design Basis. The Critical Review Report, prepared by Intercontinental Econergy Associates, Inc., summarizes findings from an extensive review of the data base for the H-Coal process design. Volume 4 presents this review and assessment, and includes supporting material; specifically, Design Data Tabulation (Appendix A), Process Flow Sheets (Appendix B), and References (Appendix C). Volume 5 is a continuation of the references of Appendix C. Studies of a proprietary nature are noted and referenced, but are not included in these volumes. They are included in the Limited Access versions of these reports and may be reviewed by properly cleared personnel in the offices of Ashland Synthetic Fuels, Inc.

  3. Radiocarpal and Midcarpal Instability in Rheumatoid Patients: A Systematic Review

    PubMed Central

    Raven, Eric E.J.; van den Bekerom, Michel P.J.; Beumer, Annechien; van Dijk, C. Niek

    2015-01-01

    Background: This study was aimed at identifying the criteria for the diagnosis of Radiocarpal instability in rheumatoid arthritis RA). Methods: The main databases were searched to identify studies describing the pathophysiology of Radiocarpal instability in patients with RA. We focussed on the epidemiology, radiographic parameters, criteria for instability and on treatment options. Results. In the search 108 articles were found, of these 12 studies were included for this review. Instability occurs in at an average of 35.2% of the rheumatoid wrists. The instability was found between 8 and 13 years after onset of rheumatoid arthritis. A strong correlation was found between instability, duration of RA and Larsen score. Several radiographic methods were described to evaluate Radiocarpal instability in RA. Several treatment options for instability in patients with RA are described. All with their own indications and limitations. Conclusion: On a standard AP radiograph deformity can be measured using the carpal height and the ulnar translation index of Chamay. This gives an indication for instability. For describing the deterioration of the joints the Larsen score is most used. If there are more radiographs in time the Simmen classification can be used. For real assessment of instability dynamic radiographs are needed. Level of Evidence: Level IV. PMID:26448803

  4. Assessment of Smolt Condition for Travel Time Analysis Project, 1987-1997 Project Review.

    SciTech Connect

    Schrock, Robin M.; Hans, Karen M.; Beeman, John W.

    1997-12-01

    The assessment of Smolt Condition for Travel Time Analysis Project (Bonneville Power Administration Project 87-401) monitored attributes of salmonid smolt physiology in the Columbia and Snake River basins from 1987 to 1997, under the Northwest Power Planning Council Fish and Wildlife Program, in cooperation with the Smolt Monitoring Program of the Fish Passage Center. The primary goal of the project was to investigate the physiological development of juvenile salmonids related to migration rates. The assumption was made that the level of smolt development, interacting with environmental factos such as flow, would be reflected in travel times. The Fish Passage Center applied the physiological measurements of smolt condition to Water Budget management, to regulate flows so as to decrease travel time and increase survival.

  5. The multiple lifestyle modification for patients with prehypertension and hypertension patients: a systematic review protocol

    PubMed Central

    Li, Juan; Zheng, Hui; Du, Huai-bin; Tian, Xiao-ping; Jiang, Yi-jing; Zhang, Shao-lan; Kang, Yu; Li, Xiang; Chen, Jie; Lu, Chao; Lai, Zhen-hong; Liang, Fan-rong

    2014-01-01

    Introduction The objective of this systematic review is to investigate the effectiveness, efficacy and safety of multiple concomitant lifestyle modification therapies for patients with hypertension or prehypertension. Methods and analysis Electronic searches will be performed in the Cochrane Library, OVID, EMBASE, etc, along with manual searches in the reference lists of relevant papers found during electronic search. We will identify eligible randomised controlled trials utilising multiple lifestyle modifications to lower blood pressure. The control could be drug therapy, single lifestyle change or no intervention. Changes in systolic blood pressure and diastolic blood pressure constitute primary end points, and secondary end points include the number of patients meeting the office target blood pressure, the number of patients reporting microvascular or macrovascular complications, etc. We will extract descriptive, methodological and efficacy data from identified randomised controlled trials (RCTs). We will calculate the relative risk for proportion of patients with a normal blood pressure in the experimental group. Dichotomous data will be analysed using risk difference and continuous data using weighted mean differences, both with 95% CI. We will use the χ2 test and the I2 statistic to assess heterogeneity. We will use the fixed effects model to compute the efficacy unless there is evidence of heterogeneity. If heterogeneity of effect size persists with respect to blood pressure change, further metaregression will be performed within groups. We will examine the potential for publication bias by using a funnel plot. Dissemination We will synthesise results from RCTs which provide more precise and accurate information on the effect of multiple lifestyle changes on blood pressure. The results of this review will increase the understanding of multiple lifestyle modifications for patients with hypertension or prehypertension. Trail registration number Our protocol

  6. Culture, cultural factors and psychiatric diagnosis: review and projections

    PubMed Central

    ALARCÓN, RENATO D.

    2009-01-01

    This paper aims to provide conceptual justifications for the inclusion of culture and cultural factors in psychiatric diagnosis, and logistic suggestions as to the content and use of this approach. A discussion of the scope and limitations of current diagnostic practice, criticisms from different quarters, and the role and relevance of culture in the diagnostic encounter, precede the examination of advantages and disadvantages of the approach. The cultural content of psychiatric diagnosis should include the main, well-recognized cultural variables, adequate family data, explanatory models, and strengths and weaknesses of every individual patient. The practical aspects include the acceptance of “cultural discordances” as a component of an updated definition of mental disorder, and the use of a refurbished cultural formulation. Clinical “telescoping” strategies to obtain relevant cultural data during the diagnostic interview, and areas of future research (including field trials on the cultural formulation and on “culture bound syndromes”), are outlined. PMID:19812742

  7. Review of BPA Funded Sturgeon, Resident Fish and Wildlife Projects, 1989/1990.

    SciTech Connect

    United States. Bonneville Power Administration.

    1990-12-01

    The Bonneville Power Administration (BPA) held a public meeting on November 6-7, 1990, for the purpose of review, coordination, and consultation of the BPA-funded projects for sturgeon, resident fish, and wildlife in the Columbia River Basin (Basin). The comments received after the meeting were favorable and the participants agreed that the meeting was stimulating and productive. The information exchanged should lead to better coordination with other projects throughout the Basin. The following pages list the projects by title, the project leaders and BPA's project officers, and an abstract of each leaders presentation. These summaries are in some cases preliminary; they are subject to change and should not be quoted without consulting the project leader.

  8. Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review

    PubMed Central

    Birgisson, Natalia E.; Zhao, Qiuhong; Secura, Gina M.; Madden, Tessa

    2015-01-01

    Abstract The Contraceptive CHOICE Project (CHOICE) sought to reduce unintended pregnancies in the St. Louis Region by removing cost, education, and access barriers to highly effective contraception. CHOICE was a prospective cohort study of over 9,000 women 14–45 years of age who received tiered contraceptive counseling to increase awareness of all reversible methods available, particularly long-acting reversible contraceptive (LARC) methods. Participants were provided with contraception of their choice at no cost for 2–3 years. We studied contraceptive method choice, continuation, and population outcomes of repeat abortion and teen pregnancy. Seventy-five percent of study participants chose one of the three LARC methods (46% levonorgestrel intrauterine system, 12% copper intrauterine device, and 17% subdermal implant). LARC users reported greater continuation than non-LARC users at 12 months (87% versus 57%) and 24 months (77% versus 41%). In our cohort, LARC methods were 20 times more effective than non-LARC methods. As a result, we observed a reduction in the percent of repeat abortions from 2006 to 2010 in St. Louis compared with Kansas City and nonmetropolitan Missouri and found substantial reductions in teen pregnancy, birth, and abortion (34.0, 19.4, and 9.7 per 1000 teens, respectively) compared with national rates among sexually experienced teens (158.5, 94.0, and 41.5 per 1000, respectively). Improved access to LARC methods can result in fewer unintended pregnancies and abortions and considerable cost savings to the health care system. PMID:25825986

  9. A Review of NASA's Radiation-Hardened Electronics for Space Environments Project

    NASA Technical Reports Server (NTRS)

    Keys, Andrew S.; Adams, James H.; Patrick, Marshall C.; Johnson, Michael A.; Cressler, John D.

    2008-01-01

    NASA's Radiation Hardened Electronics for Space Exploration (RHESE) project develops the advanced technologies required to produce radiation hardened electronics, processors, and devices in support of the requirements of NASA's Constellation program. Over the past year, multiple advancements have been made within each of the RHESE technology development tasks that will facilitate the success of the Constellation program elements. This paper provides a brief review of these advancements, discusses their application to Constellation projects, and addresses the plans for the coming year.

  10. Preoperative Imatinib Treatment in Patients With Advanced Gastrointestinal Stromal Tumors: Patient Experiences and Systematic Review of 563 Patients

    PubMed Central

    Xu, Jia; Ling, Tian-Long; Wang, Ming; Zhao, Wen-Yi; Cao, Hui

    2015-01-01

    Preoperative IM therapy for GIST is now a research focus. Due to the low incidence of the disease, there are few RCTs on the preoperative treatment for advanced GIST, let alone relevant meta-analysis. Efficacy of this therapy and targeting population are still undetermined. Therefore, the first part of this article is composed of a controlled retrospective study and demonstrates that preoperative therapy with IM can significantly improve the outcome of advanced GIST. In the second part of the paper, we further investigated what portion of advanced GIST patients benefit more from the therapy, based on a meta-analysis. As the disease is relatively rare, we involved 563 cases in the meta-analysis, much higher than in the controlled clinical studies (51 cases). The objective of this paper is to investigate effects of surgical resection on imatinib-treated advanced GIST. Twenty-two consecutive advanced GIST patients (Group A) with preoperative IM treatment were compared to 29 patients (Group B) who underwent initial tumor resection during the same period. Subsequently, a systematic review of 563 patients was applied to identify the benefit of the advanced GIST patients receiving imatinib before surgery. Compared with Group B, less patients in Group A underwent multivisceral resection (18.2% versus 48.3%, P = 0.026) or suffered tumor rupture at time of surgery (0% versus 17.2%, P = 0.04). The 3-year estimated progression-free survival of Group A (94.4%) was also superior to that of Group B (61.4%; P = 0.045). Subsequent meta-analysis indicated that primarily unresectable patients had higher complete resection and 2-year PFS rates than recurrent/metastasis patients (P = 0.005 and 0.20, respectively); (b) stable disease (SD) patients had better outcome in resection including resectability rate (P < 0.0001), PFS (P < 0.00001) and OS (P = 0.0008) than progressive disease (PD) patients; (c) in recurrent/metastatic PD patients, surgery played a minor role, because they had a

  11. Fish Habitat Improvement Projects in the Fifteenmile Creek and Trout Creek Basins of Central Oregon: Field Review and Management Recommendations.

    SciTech Connect

    Kauffman, J. Boone

    1993-07-01

    A field review of stream habitat improvement project sites in the lower Deschutes River Basin was conducted by riparian ecology, fisheries, and hydrology specialists. Habitat management objectives, limiting factors, project implementation, land use history, and other factors were discussed at each site. This information, in conjunction with the reviewer`s field inspections of portions of a particular habitat project, provided the basis for this report.

  12. Columbia Basin Fish and Wildlife Authority Project Abstracts; May 25-27, Portland, Oregon, 1997 Annual Review.

    SciTech Connect

    Allee, Brian J.

    1997-06-26

    Abstracts are presented from the 1997 Columbia Basin Fish and Wildlife Program Review of Projects. The purpose was to provide information and education on the approximate 127 million dollars in Northwest electric ratepayer fish and wildlife mitigation projects funded annually.

  13. Summary of the National Demonstration Project and recommendations for the patient-centered medical home.

    PubMed

    Crabtree, Benjamin F; Nutting, Paul A; Miller, William L; Stange, Kurt C; Stewart, Elizabeth E; Jaén, Carlos Roberto

    2010-01-01

    This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care. The NDP was launched in June 2006 as the first national test of a particular PCMH model in a diverse sample of 36 family practices, randomized to facilitated or self-directed groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical record audits, and patient and clinical staff surveys. Peer-reviewed manuscripts from the NDP provide answers to 4 key questions: (1) Can the NDP model be built? (2) What does it take to build the NDP model? (3) Does the NDP model make a difference in quality of care? and (4) Can the NDP model be widely disseminated? We find that although it is feasible to transform independent practices into the NDP conceptualization of a PCMH, this transformation requires tremendous effort and motivation, and benefits from external support. Most practices will need additional resources for this magnitude of transformation. Recommendations focus on the need for the PCMH model to continue to evolve, for delivery system reform, and for sufficient resources for implementing personal and practice development plans. In the meantime, we find that much can be done before larger health system reform. PMID:20530397

  14. Summary of the National Demonstration Project and Recommendations for the Patient-Centered Medical Home

    PubMed Central

    Crabtree, Benjamin F.; Nutting, Paul A.; Miller, William L.; Stange, Kurt C.; Stewart, Elizabeth E.; Jaén, Carlos Roberto

    2010-01-01

    This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care. The NDP was launched in June 2006 as the first national test of a particular PCMH model in a diverse sample of 36 family practices, randomized to facilitated or self-directed groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical record audits, and patient and clinical staff surveys. Peer-reviewed manuscripts from the NDP provide answers to 4 key questions: (1) Can the NDP model be built? (2) What does it take to build the NDP model? (3) Does the NDP model make a difference in quality of care? and (4) Can the NDP model be widely disseminated? We find that although it is feasible to transform independent practices into the NDP conceptualization of a PCMH, this transformation requires tremendous effort and motivation, and benefits from external support. Most practices will need additional resources for this magnitude of transformation. Recommendations focus on the need for the PCMH model to continue to evolve, for delivery system reform, and for sufficient resources for implementing personal and practice development plans. In the meantime, we find that much can be done before larger health system reform. PMID:20530397

  15. A Review of Psychosocial Outcomes for Patients Seeking Cosmetic Surgery

    PubMed Central

    Honigman, Roberta J.; Phillips, Katharine A.; Castle, David J.

    2006-01-01

    The authors reviewed the literature on psychological and psychosocial outcomes for individuals undergoing cosmetic surgery, to address whether elective cosmetic procedures improve psychological well-being and psychosocial functioning and whether there are identifiable predictors of an unsatisfactory psychological outcome. They conducted a search of appropriate computerized databases for studies that evaluated psychological and psychosocial status both before and after elective cosmetic surgery. They identified 37 relevant studies of varying cosmetic procedures that utilized disparate methodologies. Overall, patients appeared generally satisfied with the outcome of their procedures, although some exhibited transient and some exhibited longer-lasting psychological disturbance. Factors associated with poor psychosocial outcome included being young, being male, having unrealistic expectations of the procedure, previous unsatisfactory cosmetic surgery, minimal deformity, motivation based on relationship issues, and a history of depression, anxiety, or personality disorder. Body dysmorphic disorder was also recognized by some studies as a predictor of poor outcome, a finding reinforced by reference to the psychiatric literature. The authors conclude that although most people appear satisfied with the outcome of cosmetic surgical procedures, some are not, and attempts should be made to screen for such individuals in cosmetic surgery settings. PMID:15083026

  16. Patterns of patient safety culture: a complexity and arts-informed project of knowledge translation.

    PubMed

    Mitchell, Gail J; Tregunno, Deborah; Gray, Julia; Ginsberg, Liane

    2011-01-01

    The purpose of this paper is to describe patterns of patient safety culture that emerged from an innovative collaboration among health services researchers and fine arts colleagues. The group engaged in an arts-informed knowledge translation project to produce a dramatic expression of patient safety culture research for inclusion in a symposium. Scholars have called for a deeper understanding of the complex interrelationships among structure, process and outcomes relating to patient safety. Four patterns of patient safety culture--blinding familiarity, unyielding determination, illusion of control and dismissive urgency--are described with respect to how they informed creation of an arts-informed project for knowledge translation. PMID:22273559

  17. A May American Economic Review Papers Seminar and an Analytic Project for Advanced Undergraduates

    ERIC Educational Resources Information Center

    Elliott, Catherine S.

    2004-01-01

    The author describes two learning activities for teaching economics at the advanced undergraduate level: a May American Economic Review (AER) papers seminar and an analytic project. Both activities help students learn to "do economics." The May AER papers seminar promotes in-depth synthesis and interpretation on the basis of printed session papers…

  18. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... restoration of real property submitted by a project applicant to the Trust for its review, and which the... EA regarding its proposal for the Trust's evaluation and revision. In accordance with 40 CFR 1506.5(b... CFR 1506.5(c), the EIS shall be prepared by the Trust and/or by contractors who are selected by...

  19. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... restoration of real property submitted by a project applicant to the Trust for its review, and which the... EA regarding its proposal for the Trust's evaluation and revision. In accordance with 40 CFR 1506.5(b... CFR 1506.5(c), the EIS shall be prepared by the Trust and/or by contractors who are selected by...

  20. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... restoration of real property submitted by a project applicant to the Trust for its review, and which the... EA regarding its proposal for the Trust's evaluation and revision. In accordance with 40 CFR 1506.5(b... CFR 1506.5(c), the EIS shall be prepared by the Trust and/or by contractors who are selected by...

  1. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... restoration of real property submitted by a project applicant to the Trust for its review, and which the... EA regarding its proposal for the Trust's evaluation and revision. In accordance with 40 CFR 1506.5(b... CFR 1506.5(c), the EIS shall be prepared by the Trust and/or by contractors who are selected by...

  2. Learning to Live Together: A Review of UNESCO's Associated Schools Project Network

    ERIC Educational Resources Information Center

    Schweisfurth, Michele

    2005-01-01

    Some 7400 schools belong to the global network of UNESCO's Associated School Project Network. They are committed to promoting ideals such as human rights, intercultural understanding, peace and environmental protection. This study is based on an extensive review undertaken in 2003. It discusses the origins and analyzes the achievements of the…

  3. 42 CFR 137.294 - What is the typical IHS environmental review process for construction projects?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false What is the typical IHS environmental review process for construction projects? 137.294 Section 137.294 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Construction Nepa Process...

  4. NAIT CPD. Competency Profile Development: A Systems Approach for Program Review Projects.

    ERIC Educational Resources Information Center

    Dhariwal, Mave

    The Engineering Technologies Division of the Northern Alberta Institute of Technology (NAIT) in Canada has developed a systems approach to program review called Competency Profile Development (CPD). This approach utilizes a combination of organizational communication, project management, management-by-objectives, a modified Developing A Curriculum…

  5. 77 FR 58111 - Notice of Submission for OMB Review; Institute of Education Sciences; FAFSA Completion Project...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-19

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF EDUCATION Notice of Submission for OMB Review; Institute of Education Sciences; FAFSA Completion Project Evaluation SUMMARY: The Institute of Education Sciences (IES) at the U.S. Department of Education (ED) is...

  6. Biggest Pork Barrel Ever: $225-Million for Projects That Bypassed Merit Reviews.

    ERIC Educational Resources Information Center

    Cordes, Colleen

    1988-01-01

    Congress has quietly approved millions of dollars for campus research projects not subjected to traditional merit reviews. The wisdom of allowing legislators to direct federal money to specific campuses is questioned less and less, and the practice is more prevalent than ever. (MSE)

  7. Phase 5 storage (Project W-112) Central Waste Complex operational readiness review, final report

    SciTech Connect

    Wight, R.H.

    1997-05-30

    This document is the final report for the RFSH conducted, Contractor Operational Readiness Review (ORR) for the Central Waste Complex (CWC) Project W-112 and Interim Safety Basis implementation. As appendices, all findings, observations, lines of inquiry and the implementation plan are included.

  8. 78 FR 59011 - Improving Performance of Federal Permitting and Review of Infrastructure Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ..., 2013 (78 FR 53436) is extended to October 31, 2013. ADDRESSES: Comments should be addressed to: Julie A... Request for Information (RFI) in the Federal Register (78 FR 53436) seeking information on a draft IIP... Improving Performance of Federal Permitting and Review of Infrastructure Projects AGENCY: Office...

  9. Project CERES. Ceres Unified School District, Ceres, California. A Submission to the Joint Dissemination Review Panel.

    ERIC Educational Resources Information Center

    Baker, Octave V.

    One of seven career education programs chosen for nationwide dissemination by the Department of Health, Education, and Welfare's Joint Dissemination Review Panel (JDRP), Project CERES (Career Education Responsive to Every Student) is being conducted for grades K-6 with planned expansion to grades 7-12. For the years 1972-76, it received funding…

  10. Chemical research projects office fuel tank sealants review. [flight testing of fluorosilicone sealants

    NASA Technical Reports Server (NTRS)

    Rosser, R. W.; Parker, J. A.

    1974-01-01

    The status of high-temperature fuel tank sealants for military and potentially commercial supersonic aircraft is examined. The interrelationships of NASA's sealants program comprise synthesis and development of new fluoroether elastomers, sealant prediction studies, flight simulation and actual flight testing of best state-of-the-art fluorosilicone sealants. The technical accomplishments of these projects are reviewed.

  11. In-Service Workshop Model. Development Work, Volunteer Service and Project Review. Core Curriculum Resource Materials.

    ERIC Educational Resources Information Center

    Edwards, Dan

    A model is provided for an inservice workshop to provide systematic project review, conduct individual volunteer support and problem solving, and conduct future work planning. Information on model use and general instructions are presented. Materials are provided for 12 sessions covering a 5-day period. The first session on climate setting and…

  12. Summary of literature review of risk communication: Hanford Environmental Dose Reconstruction Project

    SciTech Connect

    Byram, S.J.

    1991-05-01

    The Hanford Environmental Dose Reconstruction (HEDR) Project will estimate radiation exposures people may have received from radioactive materials released during past operations at the Department of Energy's Hanford Site near Richland, Washington. The project is being conducted by Pacific Northwest Laboratory (PNL) under the direction of an independent Technical Steering Panel (TSP). The Centers for Disease Control (CDC) will use HEDR dose estimates in studies to investigate a potential link between thyroid disease and historical Hanford emissions. The HEDR Project was initiated to address public concerns about the possible health impacts from past releases of radioactive materials from Hanford. The TSP recognized early in the project that special mechanisms would be required to communicate effectively to the many different concerned audiences. To identify and develop these mechanisms, the TSP issued Directive 89-7 to PNL in May 1989. The TSP directed PNL to examine methods to communicate the causes and effects of uncertainties in the dose estimates. A literature review was conducted as the first activity in response to the TSP's directive. This report presents the results of the literature review. The objective of the literature review was to identify key principles'' that could be applied to develop communications strategies for the project. 26 refs., 6 figs.

  13. A decision tool to guide the ethics review of a challenging breed of emerging genomic projects.

    PubMed

    Joly, Yann; So, Derek; Osien, Gladys; Crimi, Laura; Bobrow, Martin; Chalmers, Don; Wallace, Susan E; Zeps, Nikolajs; Knoppers, Bartha

    2016-08-01

    Recent projects conducted by the International Cancer Genome Consortium (ICGC) have raised the important issue of distinguishing quality assurance (QA) activities from research in the context of genomics. Research was historically defined as a systematic effort to expand a shared body of knowledge, whereas QA was defined as an effort to ascertain whether a specific project met desired standards. However, the two categories increasingly overlap due to advances in bioinformatics and the shift toward open science. As few ethics review policies take these changes into account, it is often difficult to determine the appropriate level of review. Mislabeling can result in unnecessary burdens for the investigators or, conversely, in underestimation of the risks to participants. Therefore, it is important to develop a consistent method of selecting the review process for genomics and bioinformatics projects. This paper begins by discussing two case studies from the ICGC, followed by a literature review on the distinction between QA and research and a comparative analysis of ethics review policies from Canada, the United States, the United Kingdom, and Australia. These results are synthesized into a novel two-step decision tool for researchers and policymakers, which uses traditional criteria to sort clearly defined activities while requiring the use of actual risk levels to decide more complex cases. PMID:26785834

  14. Creating a Patient-Centered Health Care Delivery System: A Systematic Review of Health Care Quality From the Patient Perspective.

    PubMed

    Mohammed, Khaled; Nolan, Margaret B; Rajjo, Tamim; Shah, Nilay D; Prokop, Larry J; Varkey, Prathibha; Murad, Mohammad H

    2016-01-01

    Patient experience is one of key domains of value-based purchasing that can serve as a measure of quality and be used to improve the delivery of health services. The aims of this study are to explore patient perceptions of quality of health care and to understand how perceptions may differ by settings and condition. A systematic review of multiple databases was conducted for studies targeting patient perceptions of quality of care. Two reviewers screened and extracted data independently. Data synthesis was performed following a meta-narrative approach. A total of 36 studies were included that identified 10 quality dimensions perceived by patients: communication, access, shared decision making, provider knowledge and skills, physical environment, patient education, electronic medical record, pain control, discharge process, and preventive services. These dimensions can be used in planning and evaluating health care delivery. Future research should evaluate the effect of interventions targeting patient experience on patient outcomes. PMID:25082873

  15. Letter report: Media information review, 1991. Hanford Environmental Dose Reconstruction Project

    SciTech Connect

    Harvey, G.L.

    1992-04-01

    The media information review, requested by the Communications Subcommittee of the Technical Steering Panel (TSP), provides a general indication of the media`s areas of interests with regard to the Hanford Environmental Dose Reconstruction (HEDR) Project. This review briefly assesses 24 newspaper and magazine articles collected between September 1991 and January 1992 by Pacific Northwest Laboratory (PNL). Articles that mention the project, activities closely associated with it, or members of the Panel were included in the analysis. Attempts were made to identify general categories and issues found within the articles and display the results in an order of ranking. This review is unscientific and is not meant to display a technical analysis of the materials.

  16. Patient-oriented pharmacy on a special ward: results of a pilot project in Germany.

    PubMed

    Litzinger, A; Rohde-Boehler, R

    1997-04-01

    In Germany a pilot project in patient-oriented pharmacy has been started in the Berufsgenossenschaftliche Unfallklinik Ludwigshafen to demonstrate the efficiency of this modem way of practising pharmacy in hospital. A special ward of the orthopaedic department (spinal injuries, 25 beds) was chosen for this project. Since February 1st, 1994, the pharmacists have taken over the stock management on the ward and dispense oral drugs in unit-dose systems for each patient. The pharmacists participate also in ward rounds and check the patients' medication charts in order to support and inform the physicians. So the project is a combination of improved patient care and an advisory service in pharmaceutical questions for the medical staff. In the first year of this project, which is still ongoing (February 1994-January 1995), 123 patients were treated on the ward; the average duration of stay was about 77 days. During this first year the pharmacists registered 111 questions and events leading to pharmaceutical interventions. The most important results of the project are the improvement in drug safety and more effective drug use. Other positive results are: during the course of the project the cooperation between the medical and pharmaceutical staff has been improved and the drug management by the pharmacy has resulted in a 17 per cent reduction of medication costs in comparison to the year before. All these results clearly demonstrate the success of these first steps in patient-oriented pharmacy. PMID:9151349

  17. Projecting Future Heat-Related Mortality under Climate Change Scenarios: A Systematic Review

    PubMed Central

    Barnett, Adrian Gerard; Wang, Xiaoming; Vaneckova, Pavla; FitzGerald, Gerard; Tong, Shilu

    2011-01-01

    Background: Heat-related mortality is a matter of great public health concern, especially in the light of climate change. Although many studies have found associations between high temperatures and mortality, more research is needed to project the future impacts of climate change on heat-related mortality. Objectives: We conducted a systematic review of research and methods for projecting future heat-related mortality under climate change scenarios. Data sources and extraction: A literature search was conducted in August 2010, using the electronic databases PubMed, Scopus, ScienceDirect, ProQuest, and Web of Science. The search was limited to peer-reviewed journal articles published in English from January 1980 through July 2010. Data synthesis: Fourteen studies fulfilled the inclusion criteria. Most projections showed that climate change would result in a substantial increase in heat-related mortality. Projecting heat-related mortality requires understanding historical temperature–mortality relationships and considering the future changes in climate, population, and acclimatization. Further research is needed to provide a stronger theoretical framework for projections, including a better understanding of socioeconomic development, adaptation strategies, land-use patterns, air pollution, and mortality displacement. Conclusions: Scenario-based projection research will meaningfully contribute to assessing and managing the potential impacts of climate change on heat-related mortality. PMID:21816703

  18. Medical Utilization of Kiosks in the Delivery of Patient Education: A Systematic Review

    PubMed Central

    Yvonne Chan, Yu-Feng; Nagurka, Roxanne; Bentley, Suzanne; Ordonez, Edgardo; Sproule, William

    2014-01-01

    Background: The utilization of kiosks has previously been shown to be effective for collecting information, delivering educational modules, and providing access to health information. We discuss a review of current literature for the utilization of kiosks for the delivery of patient education. Methods: The criteria for inclusion in this literature review were: (1) study discusses the utilization of kiosks for patient health education; (2) study discusses the use of touch screens for patient health information; (3) published in English. Our review includes searches via MEDLINE databases and Google Scholar for the years 1996-2014. Results: Overall, 167 articles were screened for final eligibility, and after discarding duplicates and non-eligible studies with abstract. Full-text review of 28 articles was included in the final analysis. Conclusion: The review of available literature demonstrates the effectiveness of touch screen kiosks to educate patients and to improve healthcare, both at a performance and cost advantage over other modes of patient education. PMID:25097831

  19. Patient-derived bladder cancer xenografts: a systematic review.

    PubMed

    Bernardo, Carina; Costa, Céu; Sousa, Nuno; Amado, Francisco; Santos, Lúcio

    2015-10-01

    Patient-derived tumor xenografts (PDTXs) are said to accurately reflect the heterogeneity of human tumors. In the case of human bladder cancer, few studies are available featuring these models. The best methodology to develop and the real value of the model remain unclear. This systematic review aims to elucidate the best methodology to establish and use PDTXs to study the characteristics and behavior of human bladder tumors. The value and potential application of these models are also addressed. A comprehensive literature search was performed to identify published studies using xenograft models directly established from human bladder cancer samples into mice. A total of 12 studies were included in the final analysis. All studies differed in design; the reported take rate varied between 11% and 80%, with the implantation via dorsal incision and with matrigel obtaining the higher take rate. Advanced stage and high-grade tumors were associated with increased take rate. Xenografts preserved the original tumor identity in the establishment phase and after serial passages. Although some studies suggest a correlation between engraftment success and clinical prognosis, evidence about the association between the response of xenografts to treatment and the clinical response of the tumor of origin is still missing. All methodological approaches resulted in the establishment of tumor xenografts with preservation of the original tumor identity but variable take rate. The time needed to establish the model and propagate xenografts to a number suitable for drug testing is the main limitation of the model, along with the success rate and lack of consistency in the early passages. Comparison between tumor response in mice and clinical outcome remains to be assessed. PMID:25742701

  20. The Iodine Satellite (iSat) Project Development Towards Critical Design Review (CDR)

    NASA Technical Reports Server (NTRS)

    Dankanich, John W.; Selby, Michael; Polzin, Kurt A.; Kamhawi, Hani; Hickman, Tyler; Byrne, Larry

    2016-01-01

    Despite the prevalence of Small Satellites in recent years, the systems flown to date have very limited propulsion capability. SmallSats are typically secondary payloads and have significant constraints for volume, mass, and power in addition to limitations on the use of hazardous propellants or stored energy (i.e. high pressure vessels). These constraints limit the options for SmallSat maneuverability. NASA's Space Technology Mission Directorate approved the iodine Satellite flight project for a rapid demonstration of iodine Hall thruster technology in a 12U configuration under the Small Spacecraft Technology Program. The project formally began in FY15 as a partnership between NASA MSFC, NASA GRC, and Busek Co, Inc., with the Air Force supporting the propulsion technology maturation. The team is in final preparation of the Critical Design Review prior to initiating the fabrication and integration phase of the project. The iSat project is on schedule for a launch opportunity in November 2017.

  1. Clinical review: Ventilatory strategies for obstetric, brain-injured and obese patients

    PubMed Central

    Lapinsky, Stephen E; Posadas-Calleja, Juan Gabriel; McCullagh, Iain

    2009-01-01

    The ventilatory management of patients with acute respiratory failure is supported by good evidence, aiming to reduce lung injury by pressure limitation and reducing the duration of ventilatory support by regular assessment for discontinuation. Certain patient groups, however, due to their altered physiology or disease-specific complications, may require some variation in usual ventilatory management. The present manuscript reviews the ventilatory management in three special populations, namely the patient with brain injury, the pregnant patient and the morbidly obese patient. PMID:19291279

  2. 18 CFR 401.35 - Classification of projects for review under Section 3.8 of the Compact.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Classification of projects for review under Section 3.8 of the Compact. 401.35 Section 401.35 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Project Review Under Section 3.8 of the Compact...

  3. 18 CFR 401.35 - Classification of projects for review under Section 3.8 of the Compact.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Classification of projects for review under Section 3.8 of the Compact. 401.35 Section 401.35 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Project Review Under Section 3.8 of the Compact...

  4. Ethics Review for a Multi-Site Project Involving Tribal Nations in the Northern Plains.

    PubMed

    Angal, Jyoti; Petersen, Julie M; Tobacco, Deborah; Elliott, Amy J

    2016-04-01

    Increasingly, Tribal Nations are forming ethics review panels, which function separately from institutional review boards (IRBs). The emergence of strong community representation coincides with a widespread effort supported by the U.S. Department of Health & Human Services and other federal agencies to establish a single IRB for all multi-site research. This article underscores the value of a tribal ethics review board and describes the tribal oversight for the Safe Passage Study-a multi-site, community-based project in the Northern Plains. Our experience demonstrates the benefits of tribal ethics review and makes a strong argument for including tribal oversight in future regulatory guidance for multi-site, community-based research. PMID:26928897

  5. Media information review, January--June 1992. Hanford Environmental Dose Reconstruction Project

    SciTech Connect

    Harvey, G.L.

    1992-07-01

    The media information review, requested by the Communications Subcommittee of the Technical Steering Panel (TSP), provides a general indication of the media`s areas of interests with regard to the Hanford Environmental Dose Reconstruction (HEDR) Project. This review briefly assesses 14 newspaper articles/advertisements collected between January and June 1992 by Battelle Pacific Northwest Laboratories (BNW). Articles that mention the project, activities closely associated with it, or members of the Panel were included in the analysis. The sources of the articles and announcements include most newspapers in the Northwest (dailies and weeklies) as collected and distributed to the US Department of Energy (DOE) and Hanford contractors by Westinghouse Hanford Company, Communications. National and international media coverage was provided during the review period by Burrelle`s Press Clipping Service, New York, and A.T.P., New Jersey. The articles and advertisements represent those collected and judged applicable to issues and activities associated with the Technical Steering Panel and the Hanford Environmental dose Reconstruction Project. The collection is not considered inclusive of every written account of the subject, but as good a representative collection as reasonable. This review is unscientific and is not meant to display a technical analysis of the materials.

  6. Department of Energy review of the National Spallation Neutron Source Project

    SciTech Connect

    1997-06-01

    A Department of Energy (DOE) review of the Conceptual Design Report (CDR) for the National Spallation Neutron Source (NSNS) was conducted. The NSNS will be a new high-power spallation neutron source; initially, it will operate at 1 megawatt (MW), but is designed to be upgradeable to significantly higher power, at lower cost, when accelerator and target technologies are developed for higher power. The 53-member Review Committee examined the projected cost, schedule, technical scope, and management structure described in the CDR. For each of the major components of the NSNS, the Committee determined that the project team had produced credible designs that can be expected to work well. What remains to be done is to integrate the design of these components. With the exception of the liquid mercury target, the NSNS Project will rely heavily on proven technologies and, thus, will face a relatively low risk to successful project completion. The Total Project Cost (TPC) presented to the Committee in the CDR was $1.266 billion in as-spent dollars. In general, the Committee felt that the laboratory consortium had presented a credible estimate for each of the major components but that value engineering might produce some savings. The construction schedule presented to the Committee covered six years beginning in FY 1999. The Committee questioned whether all parts of the project could be completed according to this schedule. In particular, the linac and the conventional facilities appeared to have overly optimistic schedules. The NSNS project team was encouraged to reexamine these activities and to consider a more conservative seven-year schedule. Another concern of the Committee was the management structure. In summary, the Committee felt that this Conceptual Design Report was a very credible proposal, and that there is a high probability for successful completion of this major project within the proposed budget, although the six-year proposed schedule may be optimistic.

  7. A psychological study of spinal cord injured patients involved in the Madras Paraplegia Project.

    PubMed

    Somasundaram, O; Balakrishnan, S; Ravindran, O S; Shanmugasundaram, T K

    1992-11-01

    The psychological features of spinal cord injured (SCI) patients involved in the Madras Paraplegia Project are described. Three hundred and twenty-eight patients were studied. Based on personality tests, 11% were extroverts, 14% were introverts and 76% were neither extroverts nor introverts. Twenty-four percent of the subjects were neurotic, 11% had a depressive illness, and 26% had pathological anxiety. The study has highlighted the psychological status of SCI patients, and the usefulness of a psychiatric team in the multidisciplinary care of such patients. This is probably the first large psychological study of SCI patients from a developing country. PMID:1484733

  8. Design review report: 200 East upgrades for Project W-314, tank farm restoration and safe operations

    SciTech Connect

    Boes, K.A.

    1998-04-15

    This Design Review Report (DRR) documents the contractor design verification methodology and records associated with project W-314`s 200 East (200E) Upgrades design package. The DRR includes the documented comments and their respective dispositions for this design. Acceptance of the comment dispositions and closure of the review comments is indicated by the signatures of the participating reviewers. Project W-314 is a project within the Tank Waste Remediation System (TWRS) Tank Waste Retrieval Program. This project provides capital upgrades for the existing Hanford tank farm waste transfer, instrumentation, ventilation, and electrical infrastructure systems. To support established TWRS programmatic objectives, the project is organized into two distinct phases. The initial focus of the project (i.e., Phase 1) is on waste transfer system upgrades needed to support the TWRS Privatization waste feed delivery system. Phase 2 of the project will provide upgrades to support resolution of regulatory compliance issues, improve tank infrastructure reliability, and reduce overall plant operating/maintenance costs. Within Phase 1 of the W-314 project, the waste transfer system upgrades are further broken down into six major packages which align with the project`s work breakdown structure. Each of these six sub-elements includes the design, procurement, and construction activities necessary to accomplish the specific tank farm upgrades contained within the package. The first design package (AN Valve Pit Upgrades) was completed in November 1997, and the associated design verification activities are documented in HNF-1893. The second design package, 200 East (200E) Upgrades, was completed in March 1998. This design package identifies modifications to existing valve pits 241-AX-B and 241-A-B, as well as several new waste transfer pipelines to be constructed within the A Farm Complex of the 200E Area. The scope of the valve pit modifications includes new pit cover blocks, valve

  9. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    PubMed

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile. PMID:26447343

  10. Systematic review of measurement properties of patient-reported outcome measures used in patients undergoing hip and knee arthroplasty

    PubMed Central

    Harris, Kristina; Dawson, Jill; Gibbons, Elizabeth; Lim, Chris R; Beard, David J; Fitzpatrick, Raymond; Price, Andrew J

    2016-01-01

    Objectives To identify patient-reported outcome measures (PROMs) that have been developed and/or used with patients undergoing hip or knee replacement surgery and to provide a shortlist of the most promising generic and condition-specific instruments. Methods A systematic review of the literature was performed to identify measures used in patients undergoing hip and knee replacement and extract and evaluate information on their methodological quality. Results Thirty-two shortlisted measures were reviewed for the quality of their measurement properties. On the basis of the review criteria, the measures with most complete evidence to date are the Oxford Hip Score (OHS) (for patients undergoing hip replacement surgery) and the Oxford Knee Score (OKS), with OKS-Activity and Participation Questionnaire (for patients undergoing knee replacement surgery). Conclusion A large number of these instruments lack essential evidence of their measurement properties (eg, validity, reliability, and responsiveness) in specific populations of patients. Further research is required on almost all of the identified measures. The best-performing condition-specific PROMs were the OKS, OHS, and Western Ontario and McMaster Universities Osteoarthritis Index. The best-performing generic measure was the Short Form 12. Researchers can use the information presented in this review to inform further psychometric studies of the reviewed measures. PMID:27524925

  11. A review of selected school-based conflict resolution and peer mediation projects.

    PubMed

    Powell, K E; Muir-McClain, L; Halasyamani, L

    1995-12-01

    Many U.S. schools are implementing curricula and other activities to reduce interpersonal violence among students. Most involve conflict resolution or peer mediation (CR/PM) training. Little is known about the effectiveness or manner of implementing these projects. This paper examines nine projects supported by four state health departments. Available data suggest some projects may modify youths' self-reported attitudes about violent behavior, improve school discipline, and reduce absenteeism. The review also revealed considerable variation in implementation, especially in the role of professionally trained consultants and amount of teacher and student training. More attention should be paid to evaluating CR/PM projects. Some data suggest they may contribute positively to community efforts to reduce violence among youth, but insufficient information exists to know which projects best serve which students, and how projects should be implemented. Until consensus emerges, project personnel should carefully assess the implementation and impact of their activities. Routinely collected data, such as disciplinary actions, can be used for evaluation, often with only minor modification. PMID:8789708

  12. “Nothing About Me Without Me”: An Interpretative Review of Patient Accessible Electronic Health Records

    PubMed Central

    Callahan, Ryan; Sevdalis, Nick; Mayer, Erik K; Darzi, Ara

    2015-01-01

    Background Patient accessible electronic health records (PAEHRs) enable patients to access and manage personal clinical information that is made available to them by their health care providers (HCPs). It is thought that the shared management nature of medical record access improves patient outcomes and improves patient satisfaction. However, recent reviews have found that this is not the case. Furthermore, little research has focused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers. Objective We provide a systematic review of reviews of the impact of giving patients record access from both a patient and HCP point of view. The review covers a broad range of outcome measures, including patient safety, patient satisfaction, privacy and security, self-efficacy, and health outcome. Methods A systematic search was conducted using Web of Science to identify review articles on the impact of PAEHRs. Our search was limited to English-language reviews published between January 2002 and November 2014. A total of 73 citations were retrieved from a series of Boolean search terms including “review*” with “patient access to records”. These reviews went through a novel scoring system analysis whereby we calculated how many positive outcomes were reported per every outcome measure investigated. This provided a way to quantify the impact of PAEHRs. Results Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as HCPs were found but eight were included for the analysis of outcome measures. We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than

  13. ALARA Design Review for the Resumption of the Plutonium Finishing Plant (PFP) Cementation Process Project Activities

    SciTech Connect

    DAYLEY, L.

    2000-06-14

    The requirements for the performance of radiological design reviews are codified in 10CFR835, Occupational Radiation Protection. The basic requirements for the performance of ALARA design reviews are presented in the Hanford Site Radiological Control Manual (HSRCM). The HSRCM has established trigger levels requiring radiological reviews of non-routine or complex work activities. These requirements are implemented in site procedures HNF-PRO-1622 and 1623. HNF-PRO-1622 Radiological Design Review Process requires that ''radiological design reviews [be performed] of new facilities and equipment and modifications of existing facilities and equipment''. In addition, HNF-PRO-1623 Radiological Work Planning Process requires a formal ALARA Review for planned activities that are estimated to exceed 1 person-rem total Dose Equivalent (DE). The purpose of this review is to validate that the original design for the PFP Cementation Process ensures that the principles of ALARA (As Low As Reasonably Achievable) were included in the original project design. That is, that the design and operation of existing Cementation Process equipment and processes allows for the minimization of personnel exposure in its operation, maintenance and decommissioning and that the generation of radioactive waste is kept to a minimum.

  14. [Review of the personalised project for elderly people in Béarn and Soule].

    PubMed

    Bouzidi, Carole; Chevalier, Marjorie; Cywinska, Anna

    2016-01-01

    A review was carried out of the implementation of personalised projects, defined in the recommendations of the French national agency for the assessment and the quality of social and medical-social services and institutions (ANSEM), in nursing homes and long-term care units in Béarn and Soule. While highlighting the diversity of the practices and analysing the difficulty of their implementation, the question is raised whether the recommendations can be considered as a systemised and feasible reference. The relevance of the standardisation of the practices of the personalised project in institutions is thereby questioned. PMID:26976312

  15. A review of EPRI projects since 1984 that used electrochemical noise measurement instrumentation

    SciTech Connect

    Syrett, B.C.; Cox, W.M.

    1996-12-31

    This review paper documents the development of a modern approach to online corrosion evaluation: the origins of the approach, configuring multiple techniques to maximize data retrieval, and taking the instrumentation out of the laboratory and into the field. Several Electric Power Research Institute (EPRI) projects conducted over the past decade have used this approach. This paper describes how with the use of modern corrosion surveillance instrumentation the objectives of each of these EPRI projects were achieved and an appropriate corrosion management strategy was developed. The final section includes a discussion of the future of corrosion management systems, and their relation to, and dependence on, electrochemical noise (EN) instrumentation.

  16. 78 FR 79079 - Agency Information Collection (Dental Patient Satisfaction Survey); Activities under OMB Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ... AFFAIRS Agency Information Collection (Dental Patient Satisfaction Survey); Activities under OMB Review... . Please refer to ``OMB Control No. 2900- 0764 (Dental Patient Satisfaction Survey)'' in any correspondence....gov . Please refer to ``OMB Control No. 2900-0764 (Dental Patient Satisfaction Survey)'' in...

  17. Stability of the patient-by-treatment interaction in the Menninger Psychotherapy Research Project.

    PubMed

    Blatt, Sidney J; Shahar, Golan

    2004-01-01

    Consistent with the call to consider person-by-treatment interactions in intervention research, Blatt (1992) found that anaclitic and introjective patients responded differently to psychoanalysis and supportive-expressive therapy (SEP) in the Menninger Psychotherapy Research Project (MPRP). Psychoanalysis was significantly more effective than SEP in reducing malevolent, destructive imagery on the Rorschach among introjective patients, those patients who are primarily preoccupied with control and self-definition. Conversely, SEP was significantly more effective than psychoanalysis in reducing these malevolent, destructive images among anaclitic patients, those patients who are primarily preoccupied with interpersonal relatedness. The present analyses of data from the MPRP demonstrate the stability of this statistically significant patient-by-treatment interaction even in the subsample of patients for whom the anaclitic-introjective distinction was ambiguous, reaffirming the validity of both the anaclitic-introjective distinction and the importance of considering patient characteristics in psychotherapy research and practice. PMID:15113032

  18. 42 CFR 137.365 - What is the procedure for the Secretary's review and approval of project planning and design...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Secretary in Establishing and Implementing Construction Project Agreements § 137.365 What is the procedure... planning standards identified in the construction project agreement. The Secretary shall review and approve design documents for general compliance with requirements of the construction project agreement. (b)...

  19. Ares I Crew Launch Vehicle Project: Forward Plan to Preliminary Design Review

    NASA Technical Reports Server (NTRS)

    Dumbacher, Daniel L.; Reuter, James L.

    2007-01-01

    The Exploration Launch Projects Office, located at NASA's Marshall Space Flight Center, conducted the Ares I Crew Launch Vehicle System Requirements Review (SRR) at the end of 2006, a mere year after the project team was assembled. In Ares' first year, extensive trade studies and evaluations were conducted to refine the design initially recommended by the Exploration Systems Architecture Study, conceptual designs were analyzed for fitness, and the contractual framework was assembled to enable a development effort unparalleled in American space flight since the Space Shuttle. Now, the project turns its focus to the Preliminary Design Review (PDR), scheduled for 2008. Taking into consideration the findings of the SRR, the design of the Ares I is being tightened and refined to meet the operability, reliability, and affordability goals outlined by the Constellation Program. As directed in NASA Procedure and Regulation (NPR) 7123, NASA Systems Engineering Procedural Requirements, the Ares I SRR examined "the functional and performance requirements defined for the system and the preliminary program or project plan and ensures that the requirements and the selected concept will satisfy the mission." The SRR was conducted to ensure the system- and element-level design and interface requirements are defined prior to proceeding into the project's design phase. The Exploration Launch Projects Control Board convened on December 19,2006, and accepted the findings of the SRR and the go-forward plan proceeding to PDR. Based upon these findings, the Ares project believes that operability must drive the vehicle's design, and that a number of design challenges, including system mass and reliability, must be addressed as part of the progress to PDR.

  20. Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature

    PubMed Central

    Sy, Alice; Khalidi, Nader; Dehghan, Natasha; Barra, Lillian; Carette, Simon; Cuthbertson, David; Hoffman, Gary S.; Koening, Curry L.; Langford, Carol A.; McAlear, Carol; Moreland, Larry; Monach, Paul A.; Seo, Philip; Specks, Ulrich; Sreih, Antoine; Ytterberg, Steven R.; Van Assche, Gert; Merkel, Peter A.; Pagnoux, Christian

    2016-01-01

    Background Published small case series suggest that inflammatory bowel disease [IBD; Crohn’s disease (CD) or ulcerative colitis (UC)] and vasculitis co-occur more frequently than would be expected by chance. Objectives To describe this association by an analysis of a large cohort of carefully studied patients and through a systematic literature review. Methods Patients with both IBD and vasculitis enrolled in the Vasculitis Clinical Research Consortium (VCRC) Longitudinal Studies, followed in Canadian Vasculitis research network (CanVasc) centers and/or in the University of Toronto’s IBD clinic were included in this case series. A systematic literature review of patients with IBD and vasculitis involved a PubMed search through February 2014. The main characteristics of patients with Takayasu arteritis (TAK) and IBD were compared to those in patients with TAK without IBD followed in the VCRC. Results The study identified 32 patients with IBD and vasculitis: 13 with large-vessel vasculitis [LVV; 12 with TAK, 1 with giant cell arteritis (GCA); 8 with CD, 5 with UC]; 8 with ANCA-associated vasculitis [AAV; 6 granulomatosis with polyangiitis (GPA), 2 with eosinophilic granulomatosis with polyangiitis (EGPA)]; 5 with isolated cutaneous vasculitis; and 6 with other vasculitides. Patients with LVV and AAV were mostly female (18/21). The diagnosis of IBD preceded that of vasculitis in 12/13 patients with LVV and 8/8 patients with AAV. The review of the literature identified 306 patients with IBD and vasculitis: 144 with LVV (133 TAK; 87 with IBD preceding LVV), 19 with AAV [14 GPA, 1 EGPA, 4 microscopic polyangiitis (MPA)], 66 with isolated cutaneous vasculitis, and 77 with other vasculitides. Patients with IBD and TAK were younger and had more frequent headaches, constitutional symptoms, or gastrointestinal symptoms compared to those patients in the VCRC who had TAK without IBD. Conclusions These findings highlight the risk of vasculitis, especially TAK, in patients

  1. Overview of the Department of Energy's Off-Site Radiation Exposure Review Project (ORERP).

    PubMed

    Church, B W; Wheeler, D L; Campbell, C M; Nutley, R V; Anspaugh, L R

    1990-11-01

    The Off-Site Radiation Exposure Review Project (ORERP) was established by the U.S. Department of Energy to (1) collect, preserve, and disseminate historical data related to radioactive fallout and health effects from nuclear testing, and (2) reconstrut, insofar as possible, the exposures to the off-site public from nuclear testing at the Nevada Test Site and doses to individuals resulting from these exposures. The goals, methods, and example results of the ORERP are presented. PMID:2211109

  2. Overview of the Department of Energy's Off-Site Radiation Exposure Review Project (ORERP)

    SciTech Connect

    Church, B.W.; Wheeler, D.L.; Campbell, C.M.; Nutley, R.V.; Anspaugh, L.R. )

    1990-11-01

    The Off-Site Radiation Exposure Review Project (ORERP) was established by the U.S. Department of Energy to (1) collect, preserve, and disseminate historical data related to radioactive fallout and health effects from nuclear testing, and (2) reconstruct, insofar as possible, the exposures to the off-site public from nuclear testing at the Nevada Test Site and doses to individuals resulting from these exposures. The goals, methods, and example results of the ORERP are presented.

  3. Review of nutritional guidelines for patients undergoing bariatric surgery.

    PubMed

    Leahy, Cheri Rebecca; Luning, Alyssa

    2015-08-01

    Health care providers often supply patients who are undergoing bariatric surgery with varying and sometimes conflicting information regarding nutrition before and after surgery. Nurses and other care providers can benefit from applying current nutritional guidelines to increase patients' understanding, compliance, nutrition, hydration, protein needs, and satisfaction. This article summarizes basic recommendations to help health care providers understand the patients' nutritional requirements and diet recommendations from two weeks before bariatric surgery to four to six weeks after surgery. PMID:26227519

  4. The Iodine Satellite (iSat) Project Development Towards Critical Design Review

    NASA Technical Reports Server (NTRS)

    Dankanich, John W.; Calvert, Derek; Kamhawi, Hani; Hickman, Tyler; Szabo, James; Byrne, Lawrence

    2015-01-01

    Despite the prevalence of small satellites in recent years, the systems flown to date have very limited propulsion capability. SmallSats are typically secondary payloads and have significant constraints for volume, mass, and power in addition to limitations on the use of hazardous propellants or stored energy. These constraints limit the options for SmallSat maneuverability. NASA's Space Technology Mission Directorate approved the iodine Satellite flight project for a rapid demonstration of iodine Hall thruster technology in a 12U (cubesat units) configuration under the Small Spacecraft Technology Program. The mission is a partnership between NASA MSFC, NASA GRC, and Busek Co, Inc., with the Air Force supporting the propulsion technology maturation. The team is working towards the critical design review in the final design and fabrication phase of the project. The current design shows positive technical performance margins in all areas. The iSat project is planned for launch readiness in the spring of 2017.

  5. UNOCAL Parachute Creek Shale Oil Project. Monitoring review committee meeting report. Annual meeting, 1987-1988

    SciTech Connect

    Not Available

    1988-05-25

    The Energy Security Act of 1980 established a program to provide financial assistance to private industry in the construction and operation of commercial-scale synthetic fuels plants. The Parachute Creek Shale Oil Program is one of four projects awarded financial assistance. The support agreement included development of an Environmental Monitoring Plan incorporating existing compliance monitoring and twenty-two supplemental monitoring points for water, air, solid waste, worker health and safety, and socio-economic impacts during the period 1986-1993. A Monitoring Review Committee (MRC) comprised of representatives from the Project, U.S. Department of Treasury, U.S. Department of Energy, U.S. Environmental Protection Agency, and the state convene each year to discuss monitoring information and trends in environmental and health surveillance. This report documents the first annual MRC meeting, held at the Project.

  6. Parachute Creek Shale Oil Project Monitoring Review Committee meeting report, August 9, 1990

    SciTech Connect

    Not Available

    1990-01-01

    The Energy Security Act of 1980 established a program to provide financial assistance to private industry in the construction and operation of commercial-scale synthetic fuels plants. The Parachute Creek Shale Oil Program is one of the four projects awarded financial assistance. The support agreement included development of an Environmental Monitoring Plan, incorporating existing compliance monitoring and supplemental monitoring on water, air, solid waste, worker health and safety, and socioeconomic impacts during the period 1986-1993. Phase I of the project is to produce 10,000 barrels per day of syncrude from oil shale, using the Unishale B process. The third annual meeting of the Monitoring Review Committee for the project included discussions of air, water and biological monitoring programs; spent shale pile inspecting; industrial hygiene monitoring; and medical assessments. Results of sampling 18 supplemental locations found no areas of significant environmental concern.

  7. Reviews.

    ERIC Educational Resources Information Center

    Science Teacher, 1988

    1988-01-01

    Presents information and concerns regarding computer courseware, books, and audiovisual materials reviewed by teachers. Covers a variety of topics including dissection of common classroom specimens, medicine, acid rain projects, molecules, the water cycle, erosion, plankton, and evolution. Notes on availability, price, and needed equipment, where…

  8. Outcome and Safety of Sorafenib in Metastatic Renal Cell Carcinoma Dialysis Patients: A Systematic Review.

    PubMed

    Leonetti, Alessandro; Bersanelli, Melissa; Castagneto, Bruno; Masini, Cristina; Di Meglio, Giovanni; Pellegrino, Benedetta; Buti, Sebastiano

    2016-08-01

    Few data are available about sorafenib use in patients with metastatic renal cell carcinoma (mRCC) undergoing hemodialysis. No systematic review has been previously performed about this issue. The objective of the present review is to investigate pharmacokinetics and clinical outcomes of sorafenib in mRCC patients undergoing hemodialysis. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all the literature about mRCC dialysis patients receiving sorafenib, published from January 1946 to August 2015, was evaluated. Applying inclusion/exclusion criteria, 11 articles were selected for the analysis; 1 patient from our department was also included. The investigated outcomes were pharmacokinetics, toxicity, response rate, progression-free survival, and overall survival where available. A total of 36 patients were included. Median treatment duration was 6.0 months on overall population; median progression-free survival was 6.3 months (calculated on 19 patients); response rate was 22% (on 29 patients); median overall survival was 14.9 months (on 28 patients). Of note, 24 patients started sorafenib at reduced dose; 6 of 36 patients (17%) required dose reduction due to adverse events (AEs). Sorafenib treatment was discontinued in 7 patients (19%) because of AEs. Most of AEs were Grade 1-2; severe toxicities (Grade 4-5) included G4 anemia (1 case), G4 hypertension (1 case), G4 cerebellar hemorrhage (1 patient), and a case of G5 subarachnoid hemorrhage. This review confirmed the efficacy of sorafenib treatment in mRCC patients receiving hemodialysis. Nevertheless, drug toxicity seems to be increased in these patients, despite the initiation of therapy at reduced doses; therefore, sorafenib should be used with caution in dialysis patients. PMID:26899142

  9. Transition from Pediatric to Adult Health Care in Patients with Chronic Illnesses: An Integrative Review.

    PubMed

    Lewis, Jennifer; Slobodov, Gennady

    2015-01-01

    A systematic review of the literature was performed to identify barriers, themes, or additional insight specific to the transitional care processes from a pediatric to an adult health care setting for patients with spina bifida. PMID:26630779

  10. [Muscular strength in patients with fibromyalgia. A literature review].

    PubMed

    Dombernowsky, Tilde; Dreyer, Lene; Bartels, Else Marie; Danneskiold-Samsøe, Bente

    2008-01-21

    Do patients with fibromyalgia (FM) have reduced muscular strength? We examined 22 articles and conclude from the results of these that FM patients have reduced muscular strength in their hands and quadriceps. The material also suggests generalised reduced muscular strength. However, the studies have several methodological shortcomings and future studies should be carefully designed with respect to patients as well as the control group and should be larger. To avoid CNS influence from e.g. fatigue and pain, muscular electro-stimulation may be used to ensure that the actual maximal muscular strength is also measured. PMID:18282450

  11. The emergency physician and patient confidentiality: a review.

    PubMed

    Larkin, G L; Moskop, J; Sanders, A; Derse, A

    1994-12-01

    Confidentiality is a promise rooted in tradition, law, and medical ethics. Emergency physicians treat a variety of patients to whom confidentiality is of vital importance: employees, celebrities, victims of violence or disaster, minors, students, criminals, drug abusers, and patients with STDs. EDs should develop methods of ensuring confidentiality for all patients. Although confidentiality is an important principle that should be respected and guarded, it is not absolute. Various laws mandate disclosure of certain patient information; in addition, an overriding moral duty may occasionally require a breach of confidentiality. As Beauchamp and Childress noted, "the therapeutic role may sometimes have to yield to one's role as citizen and as protector of the interests of others." In general, however, circumstances requiring a breach of confidentiality are rare. PMID:7978601

  12. Circadian Rhythm Disturbances in Patients with Alzheimer's Disease: A Review

    PubMed Central

    Weldemichael, Dawit A.; Grossberg, George T.

    2010-01-01

    Circadian Rhythm Disturbances (CRDs) affect as many as a quarter of Alzheimer's disease (AD) patients during some stage of their illness. Alterations in the suprachiasmatic nucleus and melatonin secretion are the major factors linked with the cause of CRDs. As a result, the normal physiology of sleep, the biological clock, and core body temperature are affected. This paper systematically discusses some of the causative factors, typical symptoms, and treatment options for CRDs in patients with AD. This paper also emphasizes the implementation of behavioral and environmental therapies before embarking on medications to treat CRDs. Pharmacotherapeutic options are summarized to provide symptomatic benefits for the patient and relieve stress on their families and professional care providers. As of today, there are few studies relative to CRDs in AD. Large randomized trials are warranted to evaluate the effects of treatments such as bright light therapy and engaging activities in the reduction of CRDs in AD patients. PMID:20862344

  13. Implementing Thrombosis Guidelines in Cancer Patients: A Review

    PubMed Central

    Farge-Bancel, Dominique; Bounameaux, Henri; Brenner, Benjamin; Büller, Harry R.; Kakkar, Ajay; Pabinger, Ingrid; Streiff, Michael; Debourdeau, Philippe

    2014-01-01

    Venous thromboembolism is a frequent and serious complication in patients with cancer. It is an independent prognostic factor of death in cancer patients and the second leading cause of death, but physicians often underestimate its importance, as well as the need for adequate prevention and treatment. Management of venous thromboembolism in patients with cancer requires the coordinated efforts of a wide range of clinicians, highlighting the importance of a multidisciplinary approach. However, a lack of consensus among various national and international clinical practice guidelines has contributed to knowledge and practice gaps among practitioners, and inconsistent approaches to venous thromboembolism. The 2013 international guidelines for thrombosis in cancer have sought to address these gaps by critically re-evaluating the evidence coming from clinical trials and synthesizing a number of guidelines documents. An individualized approach to prophylaxis is recommended for all patients. PMID:25386357

  14. Safety of patients--actual problem of modern medicine (review).

    PubMed

    Tsintsadze, Neriman; Samnidze, L; Beridze, T; Tsintsadze, M; Tsintsadze, Nino

    2011-09-01

    Safety of patients is actual problem of up-to-date medicine. The current successful treatment of various sicknesses is achieved by implementation in clinical practice such medical preparations (medications), which are characterized with the high therapeutic activity, low toxicity and prolonged effects. In spite of evidence of the pharmacotherapeutical advances, the frequency of complications after medication has grown - that is why the safety of patients is the acute actual problem of medicine and ecological state of human population today. PMID:22156680

  15. Optimal management of cervical cancer in HIV-positive patients: a systematic review.

    PubMed

    Ntekim, Atara; Campbell, Oladapo; Rothenbacher, Dietrich

    2015-09-01

    The clinical management of cervical cancer in HIV-positive patients has challenges mainly due to the concerns on immune status. At present, their mode of management is similar to HIV-seronegative patients involving the use of chemotherapy and radiotherapy concurrently as indicated. HIV infection, cancer, radiotherapy, and chemotherapy lower immunity through reduction in CD4 cell counts. At present there are no treatment guidelines for HIV-positive patients. This study was done to systematically review the literature on cervical cancer management in HIV-positive patients and treatment outcomes. A systematic literature search was done in the major databases to identify studies on the management of HIV-positive patients with cervical cancer. Identified studies were assessed for eligibility and inclusion in the review following the guidelines of The Cochrane Handbook for Systematic Reviews and CRD's (Centre for Reviews and Dissemination) guidance for undertaking reviews in health care. Eight eligible studies were identified from the literature. Three of them were prospective while five were retrospective studies. Notably, the average age at diagnosis of cervical cancer in HIV-positive patients was a decade lower than in seronegative patients. There was no difference in distribution of stages of disease at presentation between HIV-positive and negative patients. Mild acute toxicity (Grades 1 and 2) was higher in HIV-positive patients than in HIV-negative patients in hematopoietic system. In the grades 3 and 4 reactions, anemia was reported in 4% versus 2% while gastrointestinal reactions were reported in 5% versus 2% respectively. In general, patients who were started early on HAART had higher rates of treatment completion. The study supports the suggestion that HAART should be commenced early at cervical cancer diagnosis in HIV-positive patients diagnosed with cervical cancer to ensure less toxicity and better treatment compliance. PMID:26136407

  16. Treatment goal setting for complex patients: protocol for a scoping review

    PubMed Central

    Grudniewicz, Agnes; Nelson, Michelle; Kuluski, Kerry; Lui, Vincci; Cunningham, Heather V; X Nie, Jason; Colquhoun, Heather; Wodchis, Walter P; Taylor, Susan; Loganathan, Mayura; Upshur, Ross E

    2016-01-01

    Introduction An increasing number of people are living longer with multiple health and social care needs, and may rely heavily on health system resources. When dealing with multiple conditions, patients, caregivers and healthcare providers (HCPs) often experience high treatment burden due to unclear care trajectories, a myriad of treatment decisions and few guidelines on how to manage care needs. By understanding patient and caregiver priorities, and setting treatment goals, HCPs may help improve patient outcomes and experiences. This study aims to examine the extent and nature of the literature on treatment goal setting in complex patients, identify gaps in evidence and areas for further inquiry and guide a research programme to develop definitions, measures and recommendations for treatment goal setting. Methods and analysis This study protocol outlines a scoping review of the peer reviewed and the grey literature, using established scoping review methodology. Literature will be identified using a multidatabase and grey literature search strategy developed by two librarians. Papers and reports on the topic of goal setting that address complexity or complex patients will be included. Results of the search will be screened independently by two reviewers and included studies will be abstracted and charted in duplicate. Ethics and dissemination Ethics approval is not required for this scoping review. Working with the knowledge users on the team, we will prepare educational materials and presentations to disseminate study findings to HCPs, caregivers and patients, and at relevant national and international conferences. Results will also be published in a peer-reviewed journal. PMID:27225653

  17. 78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ... Care Act; Health Insurance Market Rules; Rate Review'' (77 FR 70584). These standards apply to health... Essential Health Benefits, Actuarial Value, and Accreditation'' (77 FR 70644), herein referred to as the EHB.... Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review; Final Rule...

  18. Economic Development Impacts of Community Wind Projects: A Review and Empirical Evaluation

    SciTech Connect

    Lantz, E.; Tegen, S.

    2009-01-01

    Community wind projects have long been touted (both anecdotally and in the literature) to increase the economic development impacts of wind projects, but most analyses of community wind have been based on expected results from hypothetical projects. This report provides a review of previous economic development analyses of community wind projects and compares these projected results with empirical impacts from projects currently in operation. A review of existing literature reveals two primary conclusions. First, construction-period impacts are often thought to be comparable for both community-and absentee-owned facilities. Second, operations-period economic impacts are observed to be greater for community-owned projects. The majority of studies indicate that the range of increased operations-period impact is on the order of 1.5 to 3.4 times. New retrospective analysis of operating community wind projects finds that total employment impacts from completed community wind projects are estimated to be on the order of four to six 1-year jobs per-MW during construction and 0.3 to 0.6 long-term jobs per-MW during operations. In addition, when comparing retrospective results of community wind to hypothetical average absentee projects, construction-period employment impacts are 1.1 to 1.3 times higher and operations-period impacts are 1.1 to 2.8 times higher for community wind. Comparing the average of the completed community wind projects studied here with retrospective analysis of the first 1,000 MW of wind in Colorado and Iowa indicates that construction-period impacts are as much as 3.1 times higher for community wind, and operations-period impacts are as much as 1.8 times higher. Ultimately, wind projects are a source of jobs and economic development, and community wind projects are shown to have increased impact both during the construction and operations-period of a wind power plant. The extent of increased impact is primarily a function of local ownership and

  19. A framework of counseling for patients with stroke in nursing: a narrative literature review.

    PubMed

    Oikarinen, Anne; Kääriäinen, Maria; Kyngäs, Helvi

    2014-10-01

    Stroke is a major cause of death in developed countries. Its prevalence and disability burden are expected to increase in the future because of an aging population. The consequences of stroke are specific to the individual. Whereas some patients experience long-term functional and cognitive deficits, others may recover completely and be discharged quickly. Counseling is needed to help patients and their families cope with the effects of stroke after discharge. This is a systematic literature review with a narrative analysis. The purpose was to describe the content and characteristics of stroke patients' counseling. A review of studies published between January 2000 and February 2013 describing stroke patients' counseling was conducted by CINAHL and Medline databases. Studies were selected based on inclusion criteria, and the quality of the included studies was assessed. The final data (n = 33) were extracted and synthesized. Seven prominent themes were identified in the literature relating to (a) information about the disease and concerns regarding stroke, (b) the aims of counseling, (c) counseling methods, (d) interaction as a method for counseling, (e) the stroke nurse as a counselor, (f) emotional support, and (g) decision making in patients' care. The results of the review show that stroke patients' counseling is a multifaceted phenomenon with distinctive characteristics. The findings of the review can be used to develop counseling for patients with stroke and their families. In addition, the review can be used when educating stroke nurses for stroke units. PMID:25188689

  20. Interventions to improve screening and appropriate referral of patients with cancer for distress: systematic review protocol

    PubMed Central

    McCarter, Kristen; Britton, Ben; Baker, Amanda; Halpin, Sean; Beck, Alison; Carter, Gregory; Wratten, Chris; Bauer, Judy; Booth, Debbie; Forbes, Erin; Wolfenden, Luke

    2015-01-01

    Introduction It is estimated that 35–40% of patients with cancer experience distress at some stage during their illness. Distress may affect functioning, capacity to cope, treatment compliance, quality of life and survival of patients with cancer. Best practice clinical guidelines recommend routine psychosocial distress screening and referral for further assessment and/or psychosocial support for patients with cancer. However, evidence suggests this care is not provided consistently. Methods and analysis We developed our methods following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The review is registered with PROSPERO and any amendments to the protocol will be tracked. The primary aim of this systematic review is to examine the impact of interventions delivered in healthcare settings that are aimed at (1) improving routine screening of patients for psychosocial distress and (2) referral of distressed patients with cancer for further assessment and/or psychosocial support. The effectiveness of such interventions in reducing psychosocial distress, and any unintended adverse effect of the intervention will also be assessed in patients with cancer. Data sources will include the bibliographic databases Cochrane Central Register of Controlled trials (CENTRAL) in the Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL. Eligible studies must compare an intervention (or two or more interventions) in a healthcare setting to improve the rate of screening for psychosocial distress and/or referral for further assessment and/or psychosocial support for patients with cancer with no intervention or ‘usual’ practice. Two investigators will independently review titles and abstracts, followed by full article reviews and data extraction. Disagreements will be resolved by consensus and if necessary, a third reviewer. Where studies are sufficiently homogenous, trial data will be pooled and meta-analyses performed. Ethics and

  1. Visual impairment in stroke patients--a review.

    PubMed

    Sand, K M; Midelfart, A; Thomassen, L; Melms, A; Wilhelm, H; Hoff, J M

    2013-01-01

    Approximately 30% of all stroke patients suffer from post-stroke visual impairment. Hemianopia is the most common symptom, but also neglect, diplopia, reduced visual acuity, ptosis, anisocoria, and nystagmus are frequent. Partial or complete recovery of visual disorders can occur, but many patients suffer permanent disability. This disability is often less evident than impairment of motor and speech functions, but is negatively correlated with rehabilitation outcome and can lead to a significant reduction in day-to-day functioning. To be visually impaired after stroke reduces quality of life and causes social isolation because of difficulties in navigating/orientating in the surroundings. A thorough diagnosis including targeted examination and later follow-up with eye examination and perimetry is essential in order to establish the extent of the visual impairment and to select the best rehabilitation strategy. Patients seem to profit from visual rehabilitation focused on coping strategies. PMID:23190292

  2. Rationing of nursing care and nurse-patient outcomes: a systematic review of quantitative studies.

    PubMed

    Papastavrou, Evridiki; Andreou, Panayiota; Efstathiou, Georgios

    2014-01-01

    Bedside rationing in nursing care refers to withholding or failure to carry out certain aspects of care because of limited resources such as time, staffing or skill mix. The absence of previous systematic reviews on nursing care rationing leads to a gap of synthesized knowledge on the factors and processes related to rationing and the potential negative consequences on both patients and nurses. The aim of this study was to gain an in-depth understanding of the factors and processes related to nursing care rationing. Selected papers were methodologically assessed based on their design, sampling, measurement and statistical analysis. Seventeen quantitative studies were reviewed, and findings were categorized into four themes: elements of nursing care being rationed, causes of rationing, nurse outcomes and patient outcomes. Results revealed that communication with patients and families, patient ambulation, and mouth care were common elements of rationed care. Nurse-patient workload and communication barriers were reported as potential causes of rationing. Patient-related outcomes included patient falls, nosocomial infections and low patient satisfaction levels. Nurse-related outcomes included low job and occupational satisfaction. In addition, rationing appears to be an important organizational variable linked with patient safety and quality of care. This review increases understanding of what is actually occurring at the point of care delivery so that managers will be able to improve processes that lead to high quality of care and better patient and nurse outcomes. PMID:23296644

  3. Cerebral gliosarcoma: Analysis of 16 patients and review of literature

    PubMed Central

    Singh, Gajendra; Das, Kuntal K.; Sharma, Pradeep; Guruprasad, B.; Jaiswal, Sushila; Mehrotra, Anant; Srivastava, Arun K.; Sahu, Rabi N.; Jaiswal, Awadhesh K.; Behari, Sanjay

    2015-01-01

    Background: Gliosarcoma (GS), a subtype of glioblastoma (GBM), is a rare primary neoplasm of the central nervous system. Certain features like temporal lobe affinity, tendency for extraneural metastasis and poorer outcome compared to GBM indicate that GS may indeed be a separate clinicopathologic entity. This led us to revisit this entity in our settings. Materials and Methods: Between 2009 and 2014, 16 cases of histologically proven GSs (14 primary, two secondary) were treated. Patient data were retrieved retrospectively. Statistical analysis was performed with? Statistical Package for Social Sciences, version 17.0. (Chicago, Illinois, USA). Survival was analyzed by Kaplan–Meier method. Results: GS predominantly affected males in their fifth decade of life. Raised intracranial pressure was the most common mode of clinical presentation. Temporal lobe was the most commonly affected part of the brain and majority of primary and all of secondary GBM were located peripherally. In 7 (43.8%) patients, tumor was radiologically well-demarcated and enhanced strongly and homogenously on contrast as compared to 9 (56.2%) patients where the tumor was ill-defined and showed heterogenous patchy or ring enhancement. Extent of excision was total in seven patients (43.8%), near total in 4 (25%) and subtotal in five patients (31.2%). Median survival was 6 months. Patients with well-demarcated, enhancing mass on imaging intraoperatively had firm tumors with a good plane of cleavage and had a better survival (8 months) compared to those in whom the tumor radiologically and intraoperatively mimicked GBM (2 months). Conclusion: GS is associated with poor survival (median survival 6 months). Radiological and intraoperative findings help categorize these tumors into GBM like GS and meningioma like GS. While the former histologically mimics GBM and has very poor survival (2 months), GS with meningioma like feature tends to have better survival (8 months). PMID:26396606

  4. Cancer in the Family: Review of the Psychosocial Perspectives of Patients and Family Members

    ERIC Educational Resources Information Center

    Mitschke, Diane B.

    2008-01-01

    As advances in cancer care have led to more treatment options and longer survival for cancer patients, a focus on quality of life for patients and their families has gained importance. This review provides a discussion of stress and coping theory, documents the relevance of this topic area for social work practice, and illuminates the results of a…

  5. 76 FR 71623 - Agency Information Collection (Spinal Cord Injury Patient Care Survey) Under OMB Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-18

    ... AFFAIRS Agency Information Collection (Spinal Cord Injury Patient Care Survey) Under OMB Review AGENCY.... 2900-New (VA Form 10-0515).'' SUPPLEMENTARY INFORMATION: Title: Spinal Cord Injury Patient Care Survey... Collection. Abstract: Information collected on VA Form 10-0515 will be used to determine spinal cord...

  6. Behavioral Interventions to Reduce Alcohol Use Among Patients with Hepatitis C: A Systematic Review.

    PubMed

    Sims, Omar T; Maynard, Quentin R; Melton, Pam A

    2016-10-01

    Alcohol use is a barrier to pharmacologic treatment for hepatitis C virus (HCV). It is advantageous for medical and clinical social workers engaged in HCV care to be knowledgeable of behavioral interventions that can be used to reduce alcohol use among patients with HCV. This article identifies and describes studies that designed and implemented behavioral interventions to reduce alcohol use among patients with HCV in clinical settings. To achieve this goal, this article conducts a rigorous systematic review to identify peer-reviewed articles, describes each behavioral intervention, and reports primary outcomes of each study included in the review. PMID:27295132

  7. Literature Review of Gastrointestinal Physiology in the Elderly, in Pediatric Patients, and in Patients with Gastrointestinal Diseases.

    PubMed

    Bai, Jane P F; Burckart, Gilbert J; Mulberg, Andrew E

    2016-02-01

    Oral bioavailability studies during the development of new medical entities or generic drugs are typically performed in healthy volunteers. Approved drug products are, however, used by patients with diverse disease backgrounds, and by pediatric and elderly patients. To provide the knowledge base for assessing the potential effects of age or co-morbidity on the in vivo performance of an orally absorbed, systemically active drug product, the literature regarding the gastrointestinal (GI) physiological characteristics (pH, permeability, and transit time) in children, in the elderly, and in patients with GI diseases (irritable bowel syndrome, ulcerative colitis, and Crohn's disease) is reviewed herein, with the knowledge gaps highlighted. PMID:26539698

  8. Review article: systematic review of three key strategies designed to improve patient flow through the emergency department.

    PubMed

    Elder, Elizabeth; Johnston, Amy Nb; Crilly, Julia

    2015-10-01

    To explore the literature regarding three key strategies designed to promote patient throughput in the ED. CINAHL, Medline, PubMed, Scopus and Australian Government databases were searched for articles published between 1980 and 2014 using the key search terms ED flow/throughput, ED congestion, crowding, overcrowding, models of care, physician-assisted triage, medical assessment units, nurse practitioner, did not wait (DNW) and ED length of stay (LOS). Abstracts and articles not published in English and articles published before 1980 were excluded from the review. Quantitative and qualitative studies were considered for inclusion. The National Health Medical Research Council (NHMRC) Level of Evidence Hierarchy (2009) was applied to included studies. Twenty-one articles met criteria for review. The level of evidence assessed using the NHMRC guidelines of studies ranged from I to IV, with the majority falling into the Level II-2 (n = 6) and III-3 (n = 9) range. ED LOS was the outcome most often reported. Study quality was limited with few studies adjusting for confounding factors. Only one level I systematic review was included in this review. Advanced practice nursing roles, physician-assisted triage and medical assessment units are models of care that can positively impact ED throughput. They have been shown to decrease ED LOS and DNW rates. Confounding factors, such as site specific staffing requirements, patient acuity and rest-of-hospital processes, can also impact on patient throughput through the ED. PMID:26206428

  9. Knowledge Translation of Interprofessional Collaborative Patient-Centred Practice: The Working Together Project Experience

    ERIC Educational Resources Information Center

    MacDonald, Colla J.; Archibald, Douglas; Stodel, Emma; Chambers, Larry W.; Hall, Pippa

    2008-01-01

    The Working Together (WT) project involved the design and delivery of an online learning resource for healthcare teams in long-term care (LTC) so that knowledge regarding interprofessional collaborative patient-centred practice (ICPCP) could be readily accessed and then transferred to the workplace. The purpose of this paper is to better…

  10. Professional Support of Self-Help Groups: A Support Group Project for Chronic Fatigue Syndrome Patients.

    ERIC Educational Resources Information Center

    Carlsen, Benedicte

    2003-01-01

    Study follows a collaborative support group project between a team of health professionals and a Chronic Fatigue Syndrome patients' group. While advantageous for professionals to decide upon the aim of a joint intervention in dialogue with participants, simply asking participants what their aims are does not guarantee actual agreement. Case study…

  11. "A day in my life" photography project: the silent voice of pediatric bone marrow transplant patients.

    PubMed

    Breitwieser, Carrie L; Vaughn, Lisa M

    2014-01-01

    A photovoice project was conducted with pediatric bone marrow transplant (BMT) patients to examine their coping skills and interpretation of their experience during a BMT, especially when hospitalized. We also wanted to determine how photovoice could be used within a pediatric BMT unit. Sixteen children (ages 4-14) and 2 young adults (ages 22 and 25) from a pediatric BMT unit participated in the project. Six BMT outpatients participated in the data analysis and evaluation phase. Fourteen clinical staff evaluated the impact of the project on their practice. Three primary themes emerged from the pre- and post-BMT photos, accompanying detailed notes, and BMT outpatient analysis of the photos: (a) BMT is "torture," (b) BMT is "time slipping away," and (c) BMT requires normalization, comfort, distraction, and support. BMT patients and staff concluded that photovoice helped express and release emotions regarding the challenges of BMT. BMT staff noted that the results of this project reminded them of the importance of being patient-centered and mindful of patient experience and the therapeutic relationship. PMID:25013004

  12. Intravenous Hypnotic Regimens in Patients With Liver Disease; A Review Article

    PubMed Central

    Soleimanpour, Hassan; Safari, Saeid; Rahmani, Farzad; Jafari Rouhi, Asghar; Alavian, Seyed Moayed

    2015-01-01

    Context: The liver as an important organ in the body has many essential functions in physiological processes. One of the major activities of liver is drug metabolism. Hepatic dysfunction affecting hepatic physiological activities, especially drug metabolism can cause many problems during anesthesia and administration of different drugs to patients. Evidence Acquisition: Studies on hepatic disorders and hypnotic anesthetics prescribed in hepatic disorders were included in this review. For this purpose, reliable databases were used. Results: Anesthesia should be performed with caution in patients with hepatic dysfunction and drugs with long half-life should be avoided in these patients. Conclusions: A review of the literature on the use of hypnotic drugs in patients with liver dysfunction showed that some hypnotic drugs used during anesthesia could be safely used in patients with impaired liver function. In these patients, certain drugs should be used with caution. PMID:25793176

  13. Spouses of Cancer Patients: A Review of the Literature.

    ERIC Educational Resources Information Center

    Keitel, Merle A.; And Others

    1990-01-01

    Discusses impact on the spouse when his or her partner is being treated for cancer. Defines the disease, outlines treatment effects, and describes issues affecting psychological and marital adjustment of spouses. Offers implications for counselors who work with spouses of cancer patients. (Author/NB)

  14. Implant surgery in healthy compromised patients-review of literature.

    PubMed

    Gheorghiu, I M; Stoian, I M

    2014-01-01

    Systemic diseases are of major importance in terms of prosthetic restorations supported by dental implants in healthy compromised patients. Each treatment stage from conception of the treatment plan to the long-term monitoring is under the necessity of the interdisciplinary approach to the underlying disease. PMID:25870664

  15. Sleep disorders in patients with traumatic brain injury: a review.

    PubMed

    Castriotta, Richard J; Murthy, Jayasimha N

    2011-03-01

    Traumatic brain injury (TBI) is a global problem and causes long-term disability in millions of individuals. This is a major problem for both military- and civilian-related populations. The prevalence of sleep disorders in individuals with TBI is very high, yet mostly unrecognized. Approximately 46% of all chronic TBI patients have sleep disorders, which require nocturnal polysomnography and the Multiple Sleep Latency Test for diagnosis. These disorders include sleep apnoea (23% of all TBI patients), post-traumatic hypersomnia (11%), narcolepsy (6%) and periodic limb movements (7%). Over half of all TBI patients will have insomnia complaints, most often with less severe injury and after personal assault, and half of these may be related to a circadian rhythm disorder. Hypothalamic injury with decreased levels of wake-promoting neurotransmitters such as hypocretin (orexin) and histamine may be involved in the pathophysiology of excessive sleepiness associated with TBI. These sleep disorders result in additional neurocognitive deficits and functional impairment, which might be attributed to the original brain injury itself and thus be left without specific treatment. Most standard treatment regimens of sleep disorders appear to be effective in these patients, including continuous positive airway pressure for sleep apnoea, pramipexole for periodic limb movements and cognitive behavioural therapy for insomnia. The role of wake-promoting agents and CNS stimulants for TBI-associated narcolepsy, post-traumatic hypersomnia and excessive daytime sleepiness requires further study with larger numbers of patients to determine effectiveness and benefit in this population. Future research with multiple collaborating centres should attempt to delineate the pathophysiology of TBI-associated sleep disorders, including CNS-derived hypersomnia and circadian rhythm disturbances, and determine definitive, effective treatment for associated sleep disorders. PMID:21062105

  16. A literature review on the patients with autoimmune diseases following vaccination against infections

    PubMed Central

    Liang, Yan; Meng, Fan-Ya; Pan, Hai-Feng; Ye, Dong-Qing

    2015-01-01

    Due to immune abnormalities and the use of steroids and immunosuppressant treatment, patients with rheumatic diseases are susceptible to infections. Vaccination is one of the most important prevention tools in modern medicine. A discussion on risk-benefit or cost-benefit analysis, and advisory on individual vaccines or vaccination programs falls outside the scope of this review. In particularly, this review summarizes the knowledge about the effectiveness and safety vaccinations in patients with autoimmune inflammatory rheumatic diseases (AIIRD) treated with biologics. Finally, we aim to provide vaccination plans basis for clinical management of rheumatic patients depending upon prevaccination antibody titers, drug treatments and immunological potential. PMID:25875802

  17. Invasive Candidiasis due to Candida Norvegensis in a Liver Transplant Patient: Case Report and Literature Review

    PubMed Central

    Musso, Maria; Giannella, Maddalena; Antonini, Mario; Bordi, Eugenio; Ettorre, Giuseppe Maria; Tessitore, Loretta; Mariano, Andrea; Capone, Alessandro

    2014-01-01

    Candida norvegensis is an emerging fluconazole-resistant pathogen isolated in most cases from skin and mucous membranes of immunocompromized patients. Documented invasive candidiasis (IC) due to C. norvegensis has been rarely reported, thus the clinical features of patients at risk for this pathogen are poorly defined. We report a liver transplant patient who developed IC due to C. norvegensis and review other cases of C. norvegensis IC published in the literature. PMID:25002960

  18. River Protection Project Integrated safety management system phase II verification review plan - 7/29/99

    SciTech Connect

    SHOOP, D.S.

    1999-09-10

    The purpose of this review is to verify the implementation status of the Integrated Safety Management System (ISMS) for the River Protection Project (RPP) facilities managed by Fluor Daniel Hanford, Inc. (FDH) and operated by Lockheed Martin Hanford Company (LMHC). This review will also ascertain whether within RPP facilities and operations the work planning and execution processes are in place and functioning to effectively protect the health and safety of the workers, public, environment, and federal property over the RPP life cycle. The RPP ISMS should support the Hanford Strategic Plan (DOERL-96-92) to safely clean up and manage the site's legacy waste and deploy science and technology while incorporating the ISMS central theme to ''Do work safely'' and protect human health and the environment.

  19. First NASA Aviation Safety Program Weather Accident Prevention Project Annual Review

    NASA Technical Reports Server (NTRS)

    Colantonio, Ron

    2000-01-01

    The goal of this Annual Review was to present NASA plans and accomplishments that will impact the national aviation safety goal. NASA's WxAP Project focuses on developing the following products: (1) Aviation Weather Information (AWIN) technologies (displays, sensors, pilot decision tools, communication links, etc.); (2) Electronic Pilot Reporting (E-PIREPS) technologies; (3) Enhanced weather products with associated hazard metrics; (4) Forward looking turbulence sensor technologies (radar, lidar, etc.); (5) Turbulence mitigation control system designs; Attendees included personnel from various NASA Centers, FAA, National Weather Service, DoD, airlines, aircraft and pilot associations, industry, aircraft manufacturers and academia. Attendees participated in discussion sessions aimed at collecting aviation user community feedback on NASA plans and R&D activities. This CD is a compilation of most of the presentations presented at this Review.

  20. Review of the independent risk assessment of the proposed Cabrillo liquified natural gas deepwater port project.

    SciTech Connect

    Gritzo, Louis Alan; Hightower, Marion Michael; Covan, John Morgan; Luketa-Hanlin, Anay Josephine

    2006-01-01

    In March 2005, the United States Coast Guard requested that Sandia National Laboratories provide a technical review and evaluation of the appropriateness and completeness of models, assumptions, analyses, and risk management options presented in the Cabrillo Port LNG Deepwater Port Independent Risk Assessment-Revision 1 (Cabrillo Port IRA). The goal of Sandia's technical evaluation of the Cabrillo Port IRA was to assist the Coast Guard in ensuring that the hazards to the public and property from a potential LNG spill during transfer, storage, and regasification operations were appropriately evaluated and estimated. Sandia was asked to review and evaluate the Cabrillo Port IRA results relative to the risk and safety analysis framework developed in the recent Sandia report, ''Guidance on Risk Analysis and Safety Implications of a Large Liquefied Natural Gas (LNG) Spill over Water''. That report provides a framework for assessing hazards and identifying approaches to minimize the consequences to people and property from an LNG spill over water. This report summarizes the results of the Sandia review of the Cabrillo Port IRA and supporting analyses. Based on our initial review, additional threat and hazard analyses, consequence modeling, and process safety considerations were suggested. The additional analyses recommended were conducted by the Cabrillo Port IRA authors in cooperation with Sandia and a technical review panel composed of representatives from the Coast Guard and the California State Lands Commission. The results from the additional analyses improved the understanding and confidence in the potential hazards and consequences to people and property from the proposed Cabrillo Port LNG Deepwater Port Project. The results of the Sandia review, the additional analyses and evaluations conducted, and the resolutions of suggested changes for inclusion in a final Cabrillo Port IRA are summarized in this report.

  1. Identification of suicidal ideations with the help of projective tests: a review.

    PubMed

    Kumar, Devvarta; Nizamie, S Haque; Abhishek, Priyadarshee; Prasanna, Lavanya Tumkur

    2014-12-01

    Identification of the presence of suicidal ideations in an individual is crucial for the timely intervention. However, these ideations may remain unidentified as an individual with serious intentions of self-harm may not express them explicitly. Various projective tests can provide crucial clues to clinicians about the presence of suicidal ideations in an individual's mind. The present review is intended to update clinicians working in the field of suicide prevention about salient findings on these tests which can serve as a ready reckoner for them. We also highlight the status of research in this domain. PMID:25153298

  2. Do racial and ethnic minority patients fare worse after SCI?: a critical review of the literature.

    PubMed

    Gary, Kelli W; Nicholls, Elizabeth; Shamburger, Aisha; Stevens, Lillian F; Arango-Lasprilla, Juan C

    2011-01-01

    A number of researchers have identified differences in SCI outcomes between racial and ethnic groups, but findings have never been synthesized to give clinicians and researchers a coherent picture of the problem. The goals of the current project were to (1) conduct a critical literature review of studies specifically investigating racial and ethnic disparities in spinal cord injury care, services, and outcomes; (2) explore possible causative factors that may explain these disparities; (3) propose strategies that may reduce disparities and improve access, service, and outcomes for minority patients with SCI; and (4) generate ideas for future research in this area. A search using MEDLINE/PubMed, PsycINFO, CINAHL, and HealthSource resulted in 49 articles discussing hospital, mental health, physical functioning, employment, quality of life, and family outcomes. Results indicated that after an SCI, racial and ethnic minority groups have shorter hospital lengths of stay, higher rehospitalizations rates, higher levels of depression, more days in poor health, greater degrees of unemployment, more difficulties with mobility, lower self-reported subjective well-being and quality of life and life satisfaction, and greater risk of marital breakup. A variety of causative factors, intervention strategies, and directions for future research are presented. PMID:22142762

  3. Review of perioperative pain management of opioid-dependent patients.

    PubMed

    Vadivelu, Nalini; Mitra, Sukanya; Kai, Alice M; Kodumudi, Gopal; Gritsenko, Karina

    2016-01-01

    Opioid dependence can occur due to prescription opioid use, recreational opioid use, or as a result of opioid use for the treatment of drug addiction. Pain control in these patients is truly a challenge. It is important to understand the patient's condition such as the phenomenon of drug dependence, drug addiction, and pseudoaddiction to provide effective analgesia. This may be accomplished using appropriate multimodal therapies and by treatment of coexisting diseases such as anxiety. The goal is to provide effective analgesia, prevent cognitive and emotional problems, and produce a positive postoperative rehabilitation process. Multimodal options include pharmacological and nonpharmacological approaches, psychological support, and interventional pain procedures, all focused toward providing optimal pain control while preventing undertreatment, withdrawal symptoms, and other complications. PMID:27575830

  4. Anticoagulant therapy and its impact on dental patients: a review.

    PubMed

    Thean, D; Alberghini, M

    2016-06-01

    Several new oral anticoagulants have been studied in the past decade, and have now started to enter the market. These drugs are reported to be as effective as, or more effective than, warfarin. In Australia, the Therapeutic Goods Administration has approved dabigatran, rivaroxaban and apixaban. The use of these newer anticoagulants is likely to increase in time, and it is important for dentists to have a sound understanding of the mechanisms of action, reversal strategies, and management guidelines for patients taking oral anticoagulants. This article discusses the process of coagulation, available anticoagulants and their monitoring and reversal, and provides clinical advice on the management of patients on anticoagulants who require dental treatment. PMID:26042924

  5. Systematic Review of the Literature on Pain in Patients with Polytrauma Including Traumatic Brain Injury

    PubMed Central

    Dobscha, Steven K.; Clark, Michael E.; Morasco, Benjamin J.; Freeman, Michele; Campbell, Rose; Helfand, Mark

    2010-01-01

    Objective To review the literature addressing the assessment and management of pain in patients with polytraumatic injuries including traumatic brain injury (TBI) and blast-related headache, and to identify patient, clinician and systems factors associated with pain-related outcomes. Design Systematic review. Methods We conducted searches in MEDLINE of literature published from 1950 through July 2008. Due to a limited number of studies using controls or comparators, we included observational and rigorous qualitative studies. We systematically rated the quality of systematic reviews, cohort, and case-control design studies. Results One systematic review, 93 observational studies, and one qualitative research study met inclusion criteria. The literature search yielded no published studies that assessed measures of pain intensity or pain-related functional interference among patients with cognitive deficits due to TBI, that compared patients with blast-related headache with patients with other types of headache, or that assessed treatments for blast-related headache pain. Studies on the association between TBI severity and pain reported mixed findings. There was limited evidence that the following factors are associated with pain among TBI patients: severity, location, and multiplicity of injuries; insomnia; fatigue; depression; and post-traumatic stress disorder. Conclusions Very little evidence is currently available to guide pain assessment and treatment approaches in patients with polytrauma. Further research employing systematic observational as well as controlled intervention designs is clearly indicated. PMID:19818031

  6. Recent changes in bacteremia in patients with cancer: a systematic review of epidemiology and antibiotic resistance.

    PubMed

    Montassier, E; Batard, E; Gastinne, T; Potel, G; de La Cochetière, M F

    2013-07-01

    Bacteremia remains a major cause of life-threatening complication in patients with cancer. Significant changes in the spectrum of microorganisms isolated from blood culture have been reported in cancer patients over the past years. The aim of our systematic review was to inventory the recent trends in epidemiology and antibiotic resistance of microorganisms causing bacteremia in cancer patients. Data for this review was identified by searches of Medline, Scopus and Cochrane Library for indexed articles and abstracts published in English since 2008. The principal search terms were: "antimicrobial resistance", "bacteremia", "bacterial epidemiology", "bloodstream infection", "cancer patients", "carbapenem resistance", "Escherichia coli resistance", "extended-spectrum β-lactamase producing E. coli", "febrile neutropenia", "fluoroquinolone resistance", "neutropenic cancer patient", "vancomycin-resistant Enterococcus", and "multidrug resistance". Boolean operators (NOT, AND, OR) were also used in succession to narrow and widen the search. Altogether, 27 articles were selected to be analyzed in the review. We found that Gram-negative bacteria were the most frequent pathogen isolated, particularly in studies with minimal use of antibiotic prophylaxis. Another important trend is the extensive emergence of antimicrobial-resistant strains associated with increased risk of morbidity, mortality and cost. This increasing incidence of antibiotic resistance has been reported in Gram-negative bacteria as well as in Gram-positive bacteria. This exhaustive review, reporting the recent findings in epidemiology and antibiotic resistance of bacteremia in cancer patients, highlights the necessity of local continuous surveillance of bacteremia and stringent enforcement of antibiotic stewardship programs in cancer patients. PMID:23354675

  7. Clinical review: Fever in intensive care unit patients

    PubMed Central

    Ryan, Michael; Levy, Mitchell M

    2003-01-01

    Fever is a common response to sepsis in critically ill patients. Fever occurs when either exogenous or endogenous pyrogens affect the synthesis of prostaglandin E2 in the pre-optic nucleus. Prostaglandin E2 slows the rate of firing of warm sensitive neurons and results in increased body temperature. The febrile response is well preserved across the animal kingdom, and experimental evidence suggests it may be a beneficial response to infection. Fever, however, is commonly treated in critically ill patients, usually with antipyretics, without good data to support such a practice. Fever induces the production of heat shock proteins (HSPs), a class of proteins critical for cellular survival during stress. HSPs act as molecular chaperones, and new data suggest they may also have an anti-inflammatory role. HSPs and the heat shock response appear to inhibit the activation of NF-κβ, thus decreasing the levels of proinflammatory cytokines. The anti-inflammatory effects of HSPs, coupled with improved survival of animal models with fever and infection, call into question the routine practice of treating fever in critically ill patients. PMID:12793871

  8. Acquired aplastic anemia in children: a review of 100 patients.

    PubMed

    Chuansumrit, A; Hathirat, P; Isarangkura, P

    1990-06-01

    A retrospective study of acquired aplastic anemia in 100 Thai children treated with testosterone and prednisolone during 1969 to 1987 is reported. The age ranged from 3-14.5 years (mean 10.3 years). The male to female ratio was 2.3:1. The duration of follow up ranged from 1-17 year (mean 5 years). Prior exposure to possible etiologic agents was found in 36% : antipyretics, Ya-chood, insecticides, benzene, chloramphenicol and paint. The presenting symptoms were bleeding and anemia 72%, fever with either bleeding or anemia 28%. The common sites of bleeding were purpura, epistaxis, gum and teeth, and the gastrointestinal tract. All patients received appropriate supportive treatment and testosterone combined with prednisolone. The results of treatment were evaluated in 80 cases who were followed up until death or at least one year after the diagnosis. Two-thirds of the patients presented with laboratory findings similar to severe aplastic anemia; the fatality rate was 50% (40/80). Most of them succumbed to infection or bleeding in the first 6 months after diagnosis. The recovery rate was 50% with complete, partial and initial responses in 28%, 17% and 5% respectively. The late malignancy rate was 2%. For severe aplastic anemia or for patients who have poor prognostic factors, early approaches of bone marrow transplantation or antilymphocyte globulin administration should be considered. PMID:2237600

  9. Reviewing birth control methods for new clinic patients.

    PubMed

    1980-01-01

    The DHEW guidelines governing funding for family planning services specify that each new patient be educated about the commonly used birth control methods on the first visit. Pills, IUDs, the diaphragm, condoms, foam, natural family planning, and sterilization plus any additional methods offered by the clinic should be explained in terms of how it is used, effectiveness, contraindications, and side effects. Patients need to be able to compare effectiveness rates for the the methods. The 2 rates should include the level of effectiveness to be expected if you used the method right all the time and the level of effectiveness if you make the average number of mistakes. Suggestions for setting the tone of a group discussion are minimimize interruptions; maximize physical comfort; watch body language; encourage questions and reading. A patient who has made up her mind to a method and finds she has a contraindication to a method may be upset and have difficulty choosing another method. Other first visit topics which should be explained either in discussion or literature are why family planning is important; reproductive anatomy and physiology; locations for emergency medical care; clinic procedures, including fees; vaginities and sexually transmitted infections; pregnancy options; and, list of services available. PMID:12336138

  10. What Is Our Current Understanding of One-to-One Computer Projects: A Systematic Narrative Research Review

    ERIC Educational Resources Information Center

    Fleischer, Hakan

    2012-01-01

    The aim of this article is to review cross-disciplinary accumulated empirical research on one-to-one computer projects in school settings as published in peer-reviewed journals between 2005 and 2010, particularly the results of teacher- and pupil-oriented studies. Six hundred and five research articles were screened at the abstract and title…

  11. 43 CFR 404.51 - Are proposed projects under the Rural Water Supply Program reviewed by the Administration?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Water Supply Program reviewed by the Administration? 404.51 Section 404.51 Public Lands: Interior... SUPPLY PROGRAM Feasibility Studies § 404.51 Are proposed projects under the Rural Water Supply Program... the Reclamation's Rural Water Supply Program. This includes review under Executive Order 12322...

  12. Endocrine disruptors and female cancer: Informing the patients (Review).

    PubMed

    Del Pup, Lino; Mantovani, Alberto; Luce, Amalia; Cavaliere, Carla; Facchini, Gaetano; Di Francia, Raffaele; Caraglia, Michele; Berretta, Massimiliano

    2015-07-01

    Pollutants altering the endocrine system, known as endocrine disruptors (ED), may modify the risk of female cancers. The carcinogenic effect of ED on humans has been confirmed by experimental studies for various substances including pesticides, DDT, dioxins, phthalates, bisphenol A, diethylstilbestrol, as well as heavy metals, but it is difficult to quantify precisely for several reasons hereby reviewed. Carcinogenesis is a complex and multifactorial mechanism that manifests itself over a long period of time, making difficult the detection of the specific contribution of the pollutants, whose absorbed dose is often unknown. The combined effect of various substances leads to complex interactions whose outcome is difficult to predict. These substances may accumulate and carry out their harmful effect on critical periods of life, probably also at doses considered harmless to an adult. ED can also have epigenetic adverse effects on the health of future generations. In conclusion, the carcinogenic effects of endocrine disruptors on female cancer types is plausible although additional studies are needed to clarify their mechanisms and entities. In the last part of the review we suggest ways to reduce ED exposure as it is mandatory to implement necessary measures to limit exposure, particularly during those periods of life most vulnerable to the impact of oncogenic environmental causes, such as the embryonic period and puberty. PMID:25998096

  13. Improving patient and project outcomes using interorganisational innovation, collaboration and co-design.

    PubMed

    Evans, Liz; Green, Stuart; Howe, Cathy; Sharma, Kiran; Marinho, Fatima; Bell, Derek; Thomas, Paul

    2014-01-01

    Background Common mental disorders (CMDs) are a leading cause of disability. The Department of Health has launched a large-scale initiative to improve access to evidence-based psychological treatments, such as cognitive behavioural therapy (CBT), through the Improving Access to Psychological Therapy (IAPT) programme. Access to IAPT services by black and minority ethnic (BME) communities is lower than for other groups. Setting The London Borough of Ealing in west London; a diverse borough with areas of high BME population and relatively high deprivation. Aim To compare the outcomes of two linked quality improvement (QI) projects undertaken by Ealing Mental Health and Wellbeing Service (MHWBS), both with the same aim of increasing access to talking therapies for BME communities. Methods Application of QI methodologies supported by the NIHR CLAHRC for northwest London in two different settings in Ealing. One, the 'Southall project', was set within a wider initiative for collaborative improvements and shared learning (the Southall Initiative for Integrated Care) in an ethnically diverse area of Ealing; it was undertaken between April 2010 and September 2011. The second, 'the Ealing project', operated in the two other Ealing localities that did not have the advantage of a broader initiative for collaborative improvements; it was undertaken between April 2011 and September 2012. Results Comparison of the monthly referral rates of BME patients (standardised per 10 000 general practitioner (GP)-registered patients) show that the Southall project was more effective in increasing referrals from BME communities than the Ealing project. Conclusion Broad local participation and ownership in the project design of the Southall project may explain why it was more effective in achieving its aims than the Ealing project which lacked these ownership-creating mechanisms. PMID:25949710

  14. On the usage of health records for the design of virtual patients: a systematic review

    PubMed Central

    2013-01-01

    Background The process of creating and designing Virtual Patients for teaching students of medicine is an expensive and time-consuming task. In order to explore potential methods of mitigating these costs, our group began exploring the possibility of creating Virtual Patients based on electronic health records. This review assesses the usage of electronic health records in the creation of interactive Virtual Patients for teaching clinical decision-making. Methods The PubMed database was accessed programmatically to find papers relating to Virtual Patients. The returned citations were classified and the relevant full text articles were reviewed to find Virtual Patient systems that used electronic health records to create learning modalities. Results A total of n = 362 citations were found on PubMed and subsequently classified, of which n = 28 full-text articles were reviewed. Few articles used unformatted electronic health records other than patient CT or MRI scans. The use of patient data, extracted from electronic health records or otherwise, is widespread. The use of unformatted electronic health records in their raw form is less frequent. Patient data use is broad and spans several areas, such as teaching, training, 3D visualisation, and assessment. Conclusions Virtual Patients that are based on real patient data are widespread, yet the use of unformatted electronic health records, abundant in hospital information systems, is reported less often. The majority of teaching systems use reformatted patient data gathered from electronic health records, and do not use these electronic health records directly. Furthermore, many systems were found that used patient data in the form of CT or MRI scans. Much potential research exists regarding the use of unformatted electronic health records for the creation of Virtual Patients. PMID:24011027

  15. A comprehensive review of urologic complications in patients with diabetes.

    PubMed

    Arrellano-Valdez, Fernando; Urrutia-Osorio, Marta; Arroyo, Carlos; Soto-Vega, Elena

    2014-01-01

    Diabetes Mellitus (DM) is a chronic disease characterized by hyperglycemia, as a result of abnormal insulin production, insulin function, or both. DM is associated with systemic complications, such as infections, neuropathy and angiopathy, which involve the genitourinary tract. The three most significant urologic complications include: bladder cystopathy, sexual dysfunction and urinary tract infections. Almost half of the patients with DM have bladder dysfunction or cystopathy, which can be manifested in women as hypersensitivity (in 39-61% of the diabetic women) or neurogenic bladder. In males it can be experienced as lower urinary tract symptoms (in 25% of diabetic males with a nearly twofold increased risk when seen by age groups). Additionally, an increased prostate volume affects their micturition as well as their urinary tract. Involving sexual dysfunction in women, it includes reduced libido, decreased arousal, clitoral erectile dysfunction and painful or non-sensitive intercourse; and in diabetic males it varies from low libido, ejaculatory abnormalities and erectile dysfunction. Globally, sexual disorders have a prevalence of 18-42%. Erectile dysfunction is ranked as the third most important complication of DM. Urinary tract infections are observed frequently in diabetic patients, and vary from emphysematous infections, Fournier gangrene, staghorn infected lithiasis to repetitive bacterial cystitis. The most frequent finding in diabetic women has been lower urinary tract infections. Because of the high incidence of obesity worldwide and its association with diabetes, it is very important to keep in mind the urologic complication associated with DM in patients, in order to better diagnose and treat this population. PMID:25332855

  16. Male infertility in cancer patients: Review of the literature.

    PubMed

    Dohle, Gert R

    2010-04-01

    The number of men surviving cancer at a young age has increased dramatically in the past 20 years as a result of early detection and improved cancer treatment protocols; more than 75% of young cancer patients nowadays are long-term survivors. Quality of life has become an important issue in childhood and adult cancer patients. The commonest cancers in patients of reproductive age are leukaemia, Hodgkin's lymphomas and testicular germ cell tumors. Fertility is often impaired after chemotherapy and radiation therapy. Cryopreservation of semen before cancer treatment starts is currently the only method to preserve future male fertility. In some malignancies, especially in germ cell tumors, sperm quality is already abnormal at the time of diagnosis. In approximately 12% of men, no viable spermatozoa are present for cryopreservation before the start of chemotherapy. Cytotoxic therapy influences spermatogenesis at least temporarily and in some cases permanently. The amount of damage inflicted by chemotherapy on spermatogenesis depends on the combination of drugs used and on the cumulative dose given for cancer treatment. Alkylating agents, such as cyclophosphamide and procarbazine, are most detrimental to germ cells. Radiation therapy, especially whole-body irradiation, is also associated with the risk of permanent sterility. Besides the cancer treatment, tumor type and pretreatment fertility are of prognostic value for future fertility in male cancer survivors. After cancer treatment, many men need artificial reproductive techniques to achieve fatherhood; usually in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is indicated for successful treatment. About 15% of men will use their cryopreserved semen because of persistent azoospermia after cancer treatment. Treatment results with cryopreserved semen are generally good and comparable to general IVF and ICSI results. So far, no studies have reported an increased rate of congenital abnormalities or

  17. Lipodystrophy among patients with HIV infection on antiretroviral therapy: a systematic review protocol

    PubMed Central

    Lana, Lorena Gomes Cunha; Junqueira, Daniela Rezende Garcia; Perini, Edson; Menezes de Pádua, Cristiane

    2014-01-01

    Introduction Lipodystrophy is a frequent and disfiguring adverse effect of antiretroviral therapy (ART) in patients with HIV. It affects the quality of life of the patient and adherence to treatment, and generates new needs for comprehensive healthcare services. The aim of this study will be to conduct a systematic review of the literature from observational studies and describe lipodystrophy among patients with HIV infection during current or previous use of ART. Methods and analysis A systematic review of observational studies published in MEDLINE, CINAHL, LILACS, EMBASE and International Pharmaceutical Abstracts will be carried out. Citations of included studies will be checked to identify additional studies not identified in the electronic searches. It will include any observational study that considered lipodystrophy as the primary or secondary outcome and that had enrolled adolescent and adult patients with HIV infection who were on current or previous ART for at least 6 months. Data extraction and analysis will be performed independently by two reviewers. The extracted data will be discussed, decisions documented and, where necessary, the authors of the studies will be contacted for clarification. Measures of frequency, prevalence and incidence of lipodystrophy will be stratified according to definition, method of diagnosis and risk factors of the outcome. Ethics and dissemination Ethics is not required given this is a protocol for a systematic review. The findings of this study will be widely disseminated through peer-reviewed publications and conference presentations. Updates of the review will be conducted to inform and guide healthcare practice. Protocol registration PROSPERO—42013005450. PMID:24625638

  18. Expectation in Life Review: A Term of Spiritual Needs Easily Understood by Chinese Hospice Patients.

    PubMed

    Deng, Di; Deng, Qing; Liu, Xiaofang; Xie, Cong Hua; Wu, Xin

    2015-11-01

    Terms such as spirituality and spiritual needs are abstract and difficult to understand. Realization of spirituality of hospice patients was premise in addressing expression of their spiritual needs. This study investigated expectations expressed during life review and tried to prove that the expectation was intelligible term for spiritual needs in Chinese hospice from May 2011 to June 2013. Among the 107 recruited patients, families were the most frequent emotion-expressing recipients, and 133 expectations related to patients' spiritual needs were identified. The emotion-expressing recipients and the patient's expectations were not affected by demographic characteristics. The expectations in life review with hospice patients and their families had the features of spiritual essence. The identified expectation contents could be used to address spiritual needs in hospice care in Chinese. PMID:24963084

  19. The Effect of Community Pharmacy–Based Interventions on Patient Health Outcomes: A Systematic Review

    PubMed Central

    Blalock, Susan J.; Roberts, Andrew W.; Lauffenburger, Julie C.; Thompson, Trey; O'Connor, Shanna K.

    2016-01-01

    Many studies have demonstrated the beneficial effects that pharmacist-provided patient care services can have on patient health outcomes. However, the effectiveness of patient care services delivered by pharmacists in community pharmacy settings, where organizational barriers may affect service implementation or limit effectiveness, remains unclear. The authors systematically reviewed the literature on the effectiveness of pharmacist-delivered patient care services in community pharmacy settings in the United States. Of the 749 articles retrieved, 21 were eligible for inclusion in the review. Information concerning 134 outcomes was extracted from the included articles. Of these, 50 (37.3%) demonstrated statistically significant, beneficial intervention effects. The percentage of studies reporting favorable findings ranged from 50% for blood pressure to 0% for lipids, safety outcomes, and quality of life. Our findings suggest that evidence supporting the effectiveness of pharmacist-provided direct patient care services delivered in the community pharmacy setting is more limited than in other settings. PMID:23035056

  20. ‘Practical’ resources to support patient and family engagement in healthcare decisions: a scoping review

    PubMed Central

    2014-01-01

    Background Extensive literature exists on public involvement or engagement, but what actual tools or guides exist that are practical, tested and easy to use specifically for initiating and implementing patient and family engagement, is uncertain. No comprehensive review and synthesis of general international published or grey literature on this specific topic was found. A systematic scoping review of published and grey literature is, therefore, appropriate for searching through the vast general engagement literature to identify ‘patient/family engagement’ tools and guides applicable in health organization decision-making, such as within Alberta Health Services in Alberta, Canada. This latter organization requested this search and review to inform the contents of a patient engagement resource kit for patients, providers and leaders. Methods Search terms related to ‘patient engagement’, tools, guides, education and infrastructure or resources, were applied to published literature databases and grey literature search engines. Grey literature also included United States, Australia and Europe where most known public engagement practices exist, and Canada as the location for this study. Inclusion and exclusion criteria were set, and include: English documents referencing ‘patient engagement’ with specific criteria, and published between 1995 and 2011. For document analysis and synthesis, document analysis worksheets were used by three reviewers for the selected 224 published and 193 grey literature documents. Inter-rater reliability was ensured for the final reviews and syntheses of 76 published and 193 grey documents. Results Seven key themes emerged from the literature synthesis analysis, and were identified for patient, provider and/or leader groups. Articles/items within each theme were clustered under main topic areas of ‘tools’, ‘education’ and ‘infrastructure’. The synthesis and findings in the literature include 15 different terms and

  1. What is known about the patient's experience of medical tourism? A scoping review

    PubMed Central

    2010-01-01

    Background Medical tourism is understood as travel abroad with the intention of obtaining non-emergency medical services. This practice is the subject of increasing interest, but little is known about its scope. Methods A comprehensive scoping review of published academic articles, media sources, and grey literature reports was performed to answer the question: what is known about the patient's experience of medical tourism? The review was accomplished in three steps: (1) identifying the question and relevant literature; (2) selecting the literature; (3) charting, collating, and summarizing the information. Overall themes were identified from this process. Results 291 sources were identified for review from the databases searched, the majority of which were media pieces (n = 176). A further 57 sources were included for review after hand searching reference lists. Of the 348 sources that were gathered, 216 were ultimately included in this scoping review. Only a small minority of sources reported on empirical studies that involved the collection of primary data (n = 5). The four themes identified via the review were: (1) decision-making (e.g., push and pull factors that operate to shape patients' decisions); (2) motivations (e.g., procedure-, cost-, and travel-based factors motivating patients to seek care abroad); (3) risks (e.g., health and travel risks); and (4) first-hand accounts (e.g., patients' experiential accounts of having gone abroad for medical care). These themes represent the most discussed issues about the patient's experience of medical tourism in the English-language academic, media, and grey literatures. Conclusions This review demonstrates the need for additional research on numerous issues, including: (1) understanding how multiple information sources are consulted and evaluated by patients before deciding upon medical tourism; (2) examining how patients understand the risks of care abroad; (3) gathering patients' prospective and retrospective

  2. Laser in-situ keratomileusis in patients with diabetes mellitus: a review of the literature

    PubMed Central

    Simpson, Rachel G; Moshirfar, Majid; Edmonds, Jason N; Christiansen, Steven M

    2012-01-01

    Purpose A growing number of diabetic patients request laser in situ keratomileusis (LASIK) for elective vision correction each year. While the United States Food and Drug Administration considers diabetes a relative contraindication to LASIK surgery, there are several reports in the literature of LASIK being performed safely in this patient population. The purpose of this review was to examine whether diabetes should still be considered a contraindication to LASIK surgery by reviewing the ocular and systemic complications of diabetes, and examining the existing data on the outcomes of LASIK in diabetic patients. Methods A literature review was conducted through PubMed, Medline, and Ovid to identify any study on LASIK surgery in patients with diabetes mellitus. This search was conducted without date restrictions. The search used the Medical Subject Headings (MeSH®) term LASIK linked by the word “and” to the following MeSH and natural language terms: diabetes, diabetes mellitus, systemic disease, and contraindications. Abstracts for all studies meeting initial search criteria were reviewed for relevance. There were no prospective clinical studies identified. Three retrospective studies were identified. Key sources from these papers were identified, reviewed, and included as appropriate. An additional literature search was conducted to identify any study of ocular surgery on patients with diabetes using the MeSH terms refractive surgery, photorefractive keratectomy, radial keratotomy, cataract surgery, vitrectomy, and iridectomy linked by the word “and” to the following MeSH terms: diabetes, diabetes mellitus, and systemic disease. This search was conducted without date restrictions. Abstracts of studies meeting the initial search criteria were reviewed and articles deemed relevant to the subject were included in this review. Conclusion LASIK may be safe in diabetic patients with tight glycemic control and no ocular or systemic complications. PMID:23109803

  3. A Review on Vitamin D Deficiency Treatment in Pediatric Patients

    PubMed Central

    Lee, Ji Yeon; So, Tsz-Yin; Thackray, Jennifer

    2013-01-01

    Vitamin D is essential for calcium absorption and for maintaining bone health in the pediatric population. Vitamin D deficiency may develop from nutritional deficiencies, malabsorption, enzyme-inducing medications, and many other etiologies. It may present as hypocalcemia before bone demineralization at periods of increased growth velocity (infancy and adolescence) because the increased calcium demand of the body cannot be met. In children, inadequate concentrations of vitamin D may cause rickets and/or symptomatic hypocalcemia, such as seizures or tetany. In this review, we will discuss the pharmacology behind vitamin D supplementation, laboratory assessments of vitamin D status, current literature concerning vitamin D supplementation, and various supplementation options for the treatment of vitamin D deficiency in the pediatric population. PMID:24719588

  4. Palliative care outcome measures in COPD patients: a conceptual review.

    PubMed

    Antoniu, Sabina Antonela; Boiculese, Lucian Vasile

    2016-04-01

    In chronic obstructive pulmonary disease (COPD), palliative care is appropriate in very advanced stages based on recognition of its need when conventional therapy is no longer able to control symptoms, disease morbidity, or to improve/maintain an acceptable quality of life. Palliative care aims to improve quality of life, or, if applied specifically at the end-of-life, to ensure comfortable care. In COPD palliative care effectiveness of interventions should be quantified with outcome measures able to better capture the holistic nature of approaches and not only the specific features of disease. These should include: physical outcomes, psychological outcomes, social outcomes, spiritual outcomes. Such measures are discussed in this review along with arguments supporting their use. PMID:26967768

  5. Medication Adherence in Patients with Bipolar Disorder: A Comprehensive Review.

    PubMed

    Levin, Jennifer B; Krivenko, Anna; Howland, Molly; Schlachet, Rebecca; Sajatovic, Martha

    2016-09-01

    Poor medication adherence is a pervasive problem that causes disability and suffering as well as extensive financial costs among individuals with bipolar disorder (BD). Barriers to adherence are numerous and cross multiple levels, including factors related to bipolar pathology and those unique to an individual's circumstances. External factors, including treatment setting, healthcare system, and broader health policies, can also affect medication adherence in people with BD. Fortunately, advances in research have suggested avenues for improving adherence. A comprehensive review of adherence-enhancement interventions for the years 2005-2015 is included. Specific bipolar adherence-enhancement approaches that target knowledge gaps, cognitive patterns, specific barriers, and motivation may be helpful, as may approaches that capitalize on technology or novel drug-delivery systems. However, much work remains to optimally facilitate long-term medication adherence in people with BD. For adherence-enhancement approaches to be widely adapted, they need to be easily accessible, affordable, and practical. PMID:27435356

  6. Factors that influence patient preferences for prostate cancer management options: A systematic review

    PubMed Central

    Showalter, Timothy N; Mishra, Mark V; Bridges, John FP

    2015-01-01

    Purpose We performed a systematic review to evaluate evidence regarding factors that influence patient preferences for management options for localized prostate cancer. Methods We followed a prespecified search protocol (PROSPERO identifier CRD42014009173) to identify studies that evaluated patient preferences for prostate cancer management options for localized prostate cancer. We queried PubMed, the Cochrane Database of Systematic Reviews, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL) Plus, and Econ-Lit databases. Two separate reviewers completed the article selection process and review, including coding of study characteristics. Study quality was scored according to the PREFS checklist, which consists of five criteria: Purpose, Respondents, Explanation, Findings, and Significance. Reviewers summarized the primary findings of each article included in the analysis. Results Of the 606 citations identified in the literature search, there were a total of 21 articles that met all selection criteria, reporting results for a total of 4,131 subjects. Themes identified in the studies included: the importance of patient perceptions of treatment efficacy and side effects; the influence of physician recommendations on patient decision-making; and the prioritization of concerns regarding treatment side effects among those men who prefer radiation therapy or active surveillance. The articles had an average PREFS score of 3.4 (standard deviation [SD] 1.0), which is similar to a recent study for breast cancer treatment preferences. Conclusion This systematic review of factors that influence patient preferences for prostate cancer management options identified a small, but high quality, group of articles that satisfied the selection criteria. The available evidence suggests that interventions aimed at informing patients regarding the comparative effectiveness of prostate cancer management alternatives should include the influence of physician

  7. Methods to improve rehabilitation of patients following breast cancer surgery: a review of systematic reviews

    PubMed Central

    Loh, Siew Yim; Musa, Aisya Nadia

    2015-01-01

    Context Breast cancer is the most prevalent cancer amongst women but it has the highest survival rates amongst all cancer. Rehabilitation therapy of post-treatment effects from cancer and its treatment is needed to improve functioning and quality of life. This review investigated the range of methods for improving physical, psychosocial, occupational, and social wellbeing in women with breast cancer after receiving breast cancer surgery. Method A search for articles published in English between the years 2009 and 2014 was carried out using The Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, PubMed, and ScienceDirect. Search terms included: ‘breast cancer’, ‘breast carcinoma’, ‘surgery’, ‘mastectomy’, ‘lumpectomy’, ‘breast conservation’, ‘axillary lymph node dissection’, ‘rehabilitation’, ‘therapy’, ‘physiotherapy’, ‘occupational therapy’, ‘psychological’, ‘psychosocial’, ‘psychotherapy’, ‘exercise’, ‘physical activity’, ‘cognitive’, ‘occupational’, ‘alternative’, ‘complementary’, and ‘systematic review’. Study selection Systematic reviews on the effectiveness of rehabilitation methods in improving post-operative physical, and psychological outcomes for breast cancer were selected. Sixteen articles met all the eligibility criteria and were included in the review. Data extraction Included review year, study aim, total number of participants included, and results. Data synthesis Evidence for exercise rehabilitation is predominantly in the improvement of shoulder mobility and limb strength. Inconclusive results exist for a range of rehabilitation methods (physical, psycho-education, nutritional, alternative-complementary methods) for addressing the domains of psychosocial, cognitive, and occupational outcomes. Conclusion There is good evidence for narrowly-focused exercise rehabilitation in improving physical outcome particularly for shoulder

  8. Intracranial Metastatic Disease Spares the Limbic Circuit: A Review of 697 Metastatic Lesions in 107 Patients

    SciTech Connect

    Marsh, James C.; Herskovic, Arnold M.; Gielda, Benjamin T.; Hughes, Frank F.; Hoeppner, Thomas; Turian, Julius; Abrams, Ross A.

    2010-02-01

    Purpose: We report the incidence of metastatic involvement of the limbic circuit in a retrospective review of patients treated at our institution. This review was performed to assess the feasibility of selectively sparing the limbic system during whole-brain radiotherapy and prophylactic cranial irradiation. Methods and Materials: We identified 697 intracranial metastases in 107 patients after reviewing contrast-enhanced CT and/or MR image sets for each patient. Lesions were localized to the limbic circuit or to the rest of the brain/brain stem. Patients were categorized by tumor histology (e.g., non-small-cell lung cancer, small-cell lung cancer, breast cancer, and other) and by total number of intracranial metastases (1-3, oligometastatic; 4 or more, nonoligometastatic). Results: Thirty-six limbic metastases (5.2% of all metastases) were identified in 22 patients who had a median of 16.5 metastases/patient (limbic metastases accounted for 9.9% of their lesions). Sixteen metastases (2.29%) involved the hippocampus, and 20 (2.86%) involved the rest of the limbic circuit; 86.2% of limbic metastases occurred in nonoligometastatic patients, and 13.8% occurred in oligometastatic patients. The incidence of limbic metastases by histologic subtype was similar. The incidence of limbic metastases in oligometastatic patients was 4.9% (5/103): 0.97%, hippocampus; 3.9%, remainder of the limbic circuit. One of 53 oligometastatic patients (1.9%) had hippocampal metastases, while 4/53 (7.5%) had other limbic metastases. Conclusions: Metastatic involvement of the limbic circuit is uncommon and limited primarily to patients with nonoligometastatic disease, supporting our hypothesis that it is reasonable to selectively exclude or reduce the dose to the limbic circuit when treating patients with prophylactic cranial irradiation or whole-brain radiotherapy for oligometastatic disease not involving these structures.

  9. Value versus Use for Patients: Findings from an ICT supported Cystic Fibrosis Self-Management Project.

    PubMed

    Roehrer, Erin; Cummings, Elizabeth; Ellis, Leonie; Turner, Paul

    2015-01-01

    This paper presents findings from the implementation of an online symptom monitoring diary that was part of a broader project aimed to support self-management of cystic fibrosis and the development of an online community of practice (CoP). The findings challenge conventional perspectives on how value is acquired by patients and their families from electronic tools designed to provide them with support. Additionally, the findings highlight complex relationships between user needs and subsequent tool use that challenge approaches to the measurement of value from ehealth projects. PMID:25676995

  10. Incidence of deep vein thrombosis in catatonic patients: A chart review.

    PubMed

    Ishida, Takuto; Sakurai, Hitoshi; Watanabe, Koichiro; Iwashita, Satoru; Mimura, Masaru; Uchida, Hiroyuki

    2016-07-30

    Catatonia is a syndrome of motor and psychological disturbances, which is accompanied by blood stasis that increases the risk of deep vein thrombosis (DVT). The aim of this study was to examine the incidence of DVT in catatonic patients in comparison to that in non-catatonic physically restrained patients. We conducted a chart review of involuntarily hospitalized patients from 2010 to 2013 at Sakuragaoka Memorial Hospital in Japan. Routine screening of DVT has been conducted for catatonic patients and restrained patients in this hospital. Catatonic patients were identified based on descriptions of charts and sorted to two subtypes (i.e. retarded and excited forms). A Doppler ultrasound scanning was performed to examine the presence of DVT. The incidence of DVT was compared among retarded and excited catatonic patients and non-catatonic restrained patients. There were 79 catatonic patients, of whom 42 were retarded. The incidence of DVT was 25.3% (20/79) in the catatonic patients. The retarded catatonic patients demonstrated a significantly higher incidence rate than the restrained non-catatonic patients (35.7% [15/42] vs. 10.6% [31/272], adjusted OR, 4.47). The incidence of DVT in catatonic patients, especially in the retarded form, was considerably high, which suggests the importance of prophylaxis of DVT. PMID:27156025

  11. [Why do cardiologists disregard sexual health of their patients? A critical review].

    PubMed

    Scardi, Sabino

    2016-05-01

    Sexual activity is an essential aspect of normal human function, well-being and quality of life. Sexual dysfunction is a common problem of increasing incidence in patients with cardiovascular disease, particularly younger and male, and continues over time in life, but these issues are not often discussed in daily practice both for a limited patient-physician relationship and clinicians' poor knowledge. Many studies suggest that the majority of patients and their partners have questions or concerns about their sexual health. Healthcare providers can help their patients if they are aware of the problem. Cardiologists need more knowledge and specific practical training in providing information on sexual concerns and sexual counseling to cardiac patients. This review aims at providing clinicians with most recent evidence about sexual dysfunction, and its management in patients with cardiac disease. Sexual couseling of cardiac patients is an important role for healthcare providers. PMID:27310908

  12. Hawaii Energy Strategy Project 2: Fossil Energy Review. Task IV. Scenario development and analysis

    SciTech Connect

    Yamaguchi, N.D.; Breazeale, K.

    1993-12-01

    The Hawaii Energy Strategy (HES) Program is a seven-project effort led by the State of Hawaii Department of Business, Economic Development & Tourism (DBEDT) to investigate a wide spectrum of Hawaii energy issues. The East-West Center`s Program on Resources: Energy and Minerals, has been assigned HES Project 2, Fossil Energy Review, which focuses on fossil energy use in Hawaii and the greater regional and global markets. HES Project 2 has four parts: Task I (World and Regional Fossil Energy Dynamics) covers petroleum, natural gas, and coal in global and regional contexts, along with a discussion of energy and the environment. Task II (Fossil Energy in Hawaii) focuses more closely on fossil energy use in Hawaii: current utilization and trends, the structure of imports, possible future sources of supply, fuel substitutability, and energy security. Task III`s emphasis is Greenfield Options; that is, fossil energy sources not yet used in Hawaii. This task is divided into two sections: first, an in-depth {open_quotes}Assessment of Coal Technology Options and Implications for the State of Hawaii,{close_quotes} along with a spreadsheet analysis model, which was subcontracted to the Environmental Assessment and Information Sciences Division of Argonne National Laboratory; and second, a chapter on liquefied natural gas (LNG) in the Asia-Pacific market and the issues surrounding possible introduction of LNG into the Hawaii market.

  13. Surgical Management of the Forefoot in Patients with Rheumatoid Arthritis - A Review Article

    PubMed Central

    Nash, W.J.; Al-Nammari, S.; Khan, W.S.; Pengas, I.P.

    2015-01-01

    Foot and ankle pathologies cause a significant disease burden on rheumatoid patients. Forefoot pathologies causes pain, callosities and possibly ulceration, and can cause problems with footwear. Forefoot correction in rheumatoid patients has historically comprised of excision of diseased joints. While satisfaction was high with this procedure, complications, changing expectations and improvement in medical therapy have raised expectation of patients, physicians and surgeons alike. This review assesses the role of joint preserving osteotomies and arthrodesis, as well as associated complications. It also describes the role of the multidisciplinary team in the management of these patients. PMID:25861409

  14. Health Care Employee Perceptions of Patient-Centered Care: A Photovoice Project

    PubMed Central

    Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L.

    2015-01-01

    Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspective is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, several areas for improvement were identified. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. PMID:25274626

  15. Current management of parainfluenza pneumonitis in immunocompromised patients: a review

    PubMed Central

    Falsey, Ann R

    2012-01-01

    Parainfluenza viruses (PIV) are common respiratory viruses that belong to the Paramyxoviridae family. PIV infection can lead to a wide variety of clinical syndromes ranging from mild upper respiratory illness to severe pneumonia. Severe disease can be seen in elderly or chronically ill persons and may be fatal in persons with compromised immune systems, particularly children with severe combined immunodeficiency disease syndrome and hematopathic stem cell transplant recipients. At present, there are no licensed antiviral agents for the treatment of PIV infection. Aerosolized or systemic ribavirin in combination with intravenous gamma globulin has been reported in small, uncontrolled series and case reports of immunocompromised patients. A number of agents show antiviral activity in vitro and in animals, but none are currently approved for human use. PMID:22893749

  16. Psychiatric and psychological comorbidities in patients with psoriasis- a review.

    PubMed

    Rabin, F; Bhuiyan, S I; Islam, T; Haque, M A; Islam, M A

    2012-10-01

    Psoriasis is a common inflammatory skin disease. The impact of psoriasis on quality of life is significant even when it involves relatively limited body surface area (BSA). Life stresses have been found as both a cause of psoriasis and as an aggravating factor in the disease. In different large epidemiological studies up to 79% patients of psoriasis had a negative impact on their lives, and Psoriasis was reported to be associated stressful life event in 10-90%, depression in 24-51%, felt shame and embarrassment over their appearance in 89%, lack of confidence in 42%, family friction in 26%, wish to be dead to active suicidal ideation in 9.7-5.5%, addiction and alcoholism in 18% and also significant impact upon sexual function. Children with psoriasis had 25-47% higher risk of developing any psychiatric disorder, 23-62% higher risk of develop depression and 32-250% higher risk of anxiety. PMID:23134936

  17. Advanced Mixed Waste Treatment Project melter system preliminary design technical review meeting

    SciTech Connect

    Eddy, T.L.; Raivo, B.D.; Soelberg, N.R.; Wiersholm, O.

    1995-02-01

    The Idaho National Engineering Laboratory Advanced Mixed Waste Treatment Project sponsored a plasma are melter technical design review meeting to evaluate high-temperature melter system configurations for processing heterogeneous alpha-contaminated low-level radioactive waste (ALLW). Thermal processing experts representing Department of Energy contractors, the Environmental Protection Agency, and private sector companies participated in the review. The participants discussed issues and evaluated alternative configurations for three areas of the melter system design: plasma torch melters and graphite arc melters, offgas treatment options, and overall system configuration considerations. The Technical Advisory Committee for the review concluded that graphite arc melters are preferred over plasma torch melters for processing ALLW. Initiating involvement of stakeholders was considered essential at this stage of the design. For the offgas treatment system, the advisory committee raised the question whether to a use wet-dry or a dry-wet system. The committee recommended that the waste stream characterization, feed preparation, and the control system are essential design tasks for the high-temperature melter treatment system. The participants strongly recommended that a complete melter treatment system be assembled to conduct tests with nonradioactive surrogate waste material. A nonradioactive test bed would allow for inexpensive design and operational changes prior to assembling a system for radioactive waste treatment operations.

  18. A review of projection radiography of plasma and biological objects in X-Pinch radiation

    NASA Astrophysics Data System (ADS)

    Shelkovenko, T. A.; Pikuz, S. A.; Hammer, D. A.

    2016-03-01

    A review of studies on the X-pinch as a radiation source for X-ray projection shadow radiography (XPSR) and X-ray absorption spectroscopy (XAS) is presented. The ultimate capabilities of the techniques and ways of their achievement are considered. XPSR has been successfully used to study high-energy-density plasma objects, in particular, exploding wires and wire arrays. Using XPSR, the internal structure and dynamics of a wire explosion and wire array implosion have been investigated for the first time, which has made it possible to develop an adequate consistent theory of the processes occurring in the wire loads of generators with currents from several units of kiloamperes to a few tens of megamperes. The use of XAS for diagnostics of wire loads has allowed one for the first time to measure the parameters of matter in the wire core and plasma corona of the load. X-ray images of various biological objects have obtained, including those with the use of the phase contrast method. This review is a logical continuation of the review "X-Pinch" [Plasma Phys. Rep. 41, 319, 493 (2015)], in which the X-pinch as a physical object was considered.

  19. Pemetrexed clinical studies in performance status 2 patients with non-small cell lung cancer (Review)

    PubMed Central

    ZINNER, RALPH; GRUL, CARLA VISSEREN; SPIGEL, DAVID R.; OBASAJU, COLEMAN

    2016-01-01

    Because poor performance status (PS) is an independent prognostic factor in non-small cell lung cancer (NSCLC), PS scores are widely used by oncologists to make treatment decisions. Advanced NSCLC patients with an Eastern Cooperative Oncology Group PS of 2 have poor prognoses and are frequently excluded from clinical trials. This article reviews the efficacy and safety of pemetrexed in this patient group. We identified English-language literature (through March 2015) involving completed and ongoing studies through searches of PubMed, meeting abstracts, ClinicalTrials.gov and the European Clinical Trials Register; search terms included ‘pemetrexed,’ ‘NSCLC’ and ‘PS2’. Only studies reporting ≥1 subset analysis of PS2 patients receiving pemetrexed were chosen. Our search identified a total of ten pemetrexed studies in PS2 patients. Eight studies included only chemonaive patients, one study included both chemonaive patients and patients with one prior chemotherapy regimen and one study included only patients with one prior regimen. In subset analyses in these studies, PS2 patients had worse outcomes than PS0-1 patients regardless of treatment. In a phase 3 study, chemonaive advanced NSCLC patients with PS2 receiving pemetrexed-carboplatin versus pemetrexed experienced improved overall survival [hazard ratio (HR)=0.62; P=0.001], progression-free survival (HR=0.46; P<0.001) and response (P=0.032). This review confirms the poorer outcomes in PS2 vs. PS0-1 patients. Although it is not an approved combination therapy, in clinical studies, PS2 patients treated with pemetrexed plus carboplatin as first-line therapy had improved response rates and survival. Additional research on PS2 patients is needed. PMID:26530033

  20. Development testing of mobile health interventions for cancer patient self-management: A review.

    PubMed

    Darlow, Susan; Wen, Kuang-Yi

    2016-09-01

    As the vision of mobile health (mHealth) is beginning to be realized, rigorous intervention development protocols are needed in order to draw optimal efficacy and effectiveness to support patient-centered oncology care. The purpose of the current study was to conduct a review of published articles that describe the development process of mHealth interventions for patients' cancer care self-management. The review search yielded 11 interventions, reported by 14 manuscripts. The following trends emerged: importance of stakeholder engagement during the development process, addressing the unique needs and experiences of cancer patients and care providers, ensuring user satisfaction with the system, and identifying perceived benefits and limitations of the system. This review provides practical suggestions for mHealth intervention development. Assessments of user perceptions should be both qualitative and quantitative, and researchers should follow an established framework when developing a randomized controlled trial employing mHealth. PMID:25916831

  1. Is video review of patient encounters an effective tool for medical student learning? A review of the literature

    PubMed Central

    Hammoud, Maya M; Morgan, Helen K; Edwards, Mary E; Lyon, Jennifer A; White, Casey

    2012-01-01

    Purpose To determine if video review of student performance during patient encounters is an effective tool for medical student learning. Methods Multiple bibliographic databases that include medical, general health care, education, psychology, and behavioral science literature were searched for the following terms: medical students, medical education, undergraduate medical education, education, self-assessment, self-evaluation, self-appraisal, feedback, videotape, video recording, televised, and DVD. The authors examined all abstracts resulting from this search and reviewed the full text of the relevant articles as well as additional articles identified in the reference lists of the relevant articles. Studies were classified by year of student (preclinical or clinical) and study design (controlled or non-controlled). Results A total of 67 articles met the final search criteria and were fully reviewed. Most studies were non-controlled and performed in the clinical years. Although the studies were quite variable in quality, design, and outcomes, in general video recording of performance and subsequent review by students with expert feedback had positive outcomes in improving feedback and ultimate performance. Video review with self-assessment alone was not found to be generally effective, but when linked with expert feedback it was superior to traditional feedback alone. Conclusion There are many methods for integrating effective use of video-captured performance into a program of learning. We recommend combining student self-assessment with feedback from faculty or other trained individuals for maximum effectiveness. We also recommend additional research in this area. PMID:23761999

  2. In-home medication reviews: a novel approach to improving patient care through coordination of care.

    PubMed

    Willis, Joel S; Hoy, Robert H; Jenkins, Wiley D

    2011-12-01

    The use of multiple medications, in persons 65 years and older, has been linked to increased risk for cognitive impairment, falls, hip fractures, hospitalizations, adverse drug reactions, and mortality. The purpose of this study was to determine if trained undergraduate students, in conjunction with pharmacists, could provide in-home medication reviews and demonstrate benefit to the health and welfare of a senior population affiliated with a primary care facility. Students received training in the completion of an in-home medication inventory, assessing a home for fall risk, and performing blood pressures. Once trained and proven proficient students performed the assessments in homes of Decatur Family Medicine Residency patients 65 years and older. Collected medication inventories were reviewed by a hospital pharmacist for fall risk medications, major drug interactions, or duplicate therapy. Changes to patient management were made by the primary care provider as needed. In all, 75 students visited 118 patients in Fall 2010. Findings from the medication review include: 102 (86%) patients were prescribed at least one fall risk medication; 43% were prescribed 3 or more; 14% had the potential for a major drug interaction; and 7% were prescribed duplicate therapies. Fifty-seven patients had a subsequent change made to their clinical medication list. The results demonstrate that an in-home outreach can be successfully performed by student volunteers and provide data of high clinical relevance and use. This application of the patient-centered medical home can readily and directly improve patient safety. PMID:21499935

  3. “Il Corpo Ritrovato”: Dermocosmetological Skin Care Project for the Oncologic Patient

    PubMed Central

    Fabbrocini, G.; Romano, M. C.; Cameli, N.; Mariano, M.; Pastore, F.; Annunziata, M. C.; Mazzella, C.; De Vita, Valerio; Mauriello, Maria Chiara; Monfrecola, G.

    2011-01-01

    Neoplastic disease and its therapeutic options have a huge impact on the patient's quality of life from both the emotional and the working point of view. The project “Il Corpo Ritrovato” aims at creating an interdisciplinary network of physicians to improve the quality of life of the oncologic patient, focusing on such important aspects as dermocosmetological skin care but also on the evaluation of new therapeutic and diagnostic algorithms in order to make further progress in the field of prevention. PMID:22084736

  4. Spent Nuclear Fuel (SNF) Project Cask and MCO Helium Purge System Design Review Completion Report Project A.5 and A.6

    SciTech Connect

    ARD, K.E.

    2000-04-19

    This report documents the results of the design verification performed on the Cask and Multiple Canister Over-pack (MCO) Helium Purge System. The helium purge system is part of the Spent Nuclear Fuel (SNF) Project Cask Loadout System (CLS) at 100K area. The design verification employed the ''Independent Review Method'' in accordance with Administrative Procedure (AP) EN-6-027-01.

  5. Clinical Outcomes of Heart-Lung Transplantation: Review of 10 Single-Center Consecutive Patients

    PubMed Central

    Yun, Jae Kwang; Choi, Se Hoon; Park, Seung-Il

    2016-01-01

    Background Heart-lung transplantation (HLT) has provided hope to patients with end-stage lung disease and irreversible heart dysfunction. We reviewed the clinical outcomes of 10 patients who underwent heart-lung transplantation at Asan Medical Center. Methods Between July 2010 and August 2014, a total of 11 patients underwent HLT at Asan Medical Center. After excluding one patient who underwent concomitant liver transplantation, 10 patients were enrolled in our study. We reviewed the demographics of the donors and the recipients’ baseline information, survival rate, cause of death, and postoperative complications. All patients underwent follow-up, with a mean duration of 26.1±16.7 months. Results Early death occurred in two patients (20%) due to septic shock. Late death occurred in three patients (38%) due to bronchiolitis obliterans (n=2) and septic shock (n=1), although these patients survived for 22, 28, and 42 months, respectively. The actuarial survival rates at one year, two years, and three years after HLT were 80%, 67%, and 53%, respectively. Conclusion HLT is a procedure that is rarely performed in Korea, even in medical centers with large heart and lung transplant programs. In order to achieve acceptable clinical outcomes, it is critical to carefully choose the donor and the recipient and to be certain that all aspects of the transplant procedure are planned in advance with the greatest care. PMID:27298792

  6. Transilluminated powered phlebectomy surgery for varicose veins: a review of 339 consecutive patients.

    PubMed

    Franz, Randall W; Knapp, Eric D

    2009-01-01

    Transilluminated powered phlebectomy (TIPP) is a promising alternative to traditional ambulatory phlebectomy procedures. This retrospective review of 339 patients represents the senior author's first consecutive series of 400 cases performed using TIPP for the treatment of varicose veins in a 6-year period. Patients were followed for 12 weeks postoperatively. Data analyzed included operative time, intraoperative complications, stab incision ranges, postoperative complications, and patient satisfaction. The mean operative time was 19.7 minutes, and 246 (61.5%) cases involved 10 to 20 incisions. Postoperative complications included an episode of symptomatic deep vein thrombosis in one (0.3%) patient, excessive or hypertrophic scarring in two (0.6%) patients, discoloration of the lower extremity skin due to hemosiderin staining in eight (2.3%) patients, and cellulitis in one (0.3%) patient. No recurrences were observed at a follow-up of 12 weeks. Three hundred thirty-eight (99.7%) patients reported good outcomes and were satisfied with the procedure. This review by an individual surgeon is beneficial in analyzing the outcomes and complications associated with TIPP, as a standard protocol was followed and an adequate volume was performed to advance past the learning curve associated with the technique. When concomitant saphenous vein incompetence is present, staged treatment of varicosities with TIPP after endovenous laser ablation is recommended. With proper training and experience, utilization of TIPP with a lower oscillation frequency and secondary tumescence results in good outcome and high patient satisfaction. PMID:18774685

  7. Use and toxicity of complementary and alternative medicines among patients visiting emergency department: Systematic review

    PubMed Central

    Jatau, Abubakar Ibrahim; Aung, Myat Moe Thwe; Kamauzaman, Tuan Hairulnizam Tuan; Chedi, Basheer A. Z.; Sha’aban, Abubakar; Rahman, Ab Fatah Ab

    2016-01-01

    Many studies have been conducted in health-care settings with regards to complementary and alternative medicine (CAM) use among patients. However, information regarding CAM use among patients in the emergency department (ED) is scarce. The aim of this article was to conduct a systematic review of published studies with regards to CAM use among the ED patients. A literature search of published studies from inception to September 2015 was conducted using PubMed, Scopus, and manual search of the reference list. 18 studies that met the inclusion criteria were reviewed. The prevalence rate of CAM use among ED patients across the studies ranged of 1.4-68.1%. Herbal therapy was the sub-modality of CAM most commonly used and frequently implicated in CAM-related ED visits. Higher education, age, female gender, religious affiliation, and chronic diseases were the most frequent factors associated with CAM use among the ED patients. Over 80% of the ED physicians did not ask the patients about the CAM therapy. Similarly, 80% of the ED patients were ready to disclose CAM therapy to the ED physician. The prevalence rate of CAM use among patients at ED is high and is growing with the current increasing popularity, and it has been a reason for some of the ED visits. There is a need for the health-care professionals to receive training and always ask patients about CAM therapy to enable them provide appropriate medical care and prevent CAM-related adverse events. PMID:27104042

  8. Use and toxicity of complementary and alternative medicines among patients visiting emergency department: Systematic review.

    PubMed

    Jatau, Abubakar Ibrahim; Aung, Myat Moe Thwe; Kamauzaman, Tuan Hairulnizam Tuan; Chedi, Basheer A Z; Sha'aban, Abubakar; Rahman, Ab Fatah Ab

    2016-01-01

    Many studies have been conducted in health-care settings with regards to complementary and alternative medicine (CAM) use among patients. However, information regarding CAM use among patients in the emergency department (ED) is scarce. The aim of this article was to conduct a systematic review of published studies with regards to CAM use among the ED patients. A literature search of published studies from inception to September 2015 was conducted using PubMed, Scopus, and manual search of the reference list. 18 studies that met the inclusion criteria were reviewed. The prevalence rate of CAM use among ED patients across the studies ranged of 1.4-68.1%. Herbal therapy was the sub-modality of CAM most commonly used and frequently implicated in CAM-related ED visits. Higher education, age, female gender, religious affiliation, and chronic diseases were the most frequent factors associated with CAM use among the ED patients. Over 80% of the ED physicians did not ask the patients about the CAM therapy. Similarly, 80% of the ED patients were ready to disclose CAM therapy to the ED physician. The prevalence rate of CAM use among patients at ED is high and is growing with the current increasing popularity, and it has been a reason for some of the ED visits. There is a need for the health-care professionals to receive training and always ask patients about CAM therapy to enable them provide appropriate medical care and prevent CAM-related adverse events. PMID:27104042

  9. Comparison of Kilovoltage Cone-Beam Computed Tomography With Megavoltage Projection Pairs for Paraspinal Radiosurgery Patient Alignment and Position Verification

    SciTech Connect

    Kriminski, Sergey A. Lovelock, D. Michael; Seshan, Venkatraman E.; Ali, Imad; Munro, Peter; Amols, Howard I.; Fuks, Zvi; Bilsky, Mark; Yamada, Yoshiya

    2008-08-01

    Purpose: Implanted gold markers and megavoltage (MV) portal imaging are commonly used for setup verification of paraspinal tumors treated with high-dose, single-fraction radiotherapy. We investigated whether the use of kilovoltage cone-beam computed tomography (CBCT) imaging eliminates the need for marker implantation. Methods and Materials: Patients with paraspinal disease who were eligible for single-fraction stereotactic body radiotherapy were accrued to an institutional review board-approved protocol. Each of 16 patients underwent implantation of fiducial markers near the target. The markers were visible on the MV images. Three MV image pairs were acquired for each patient (initial, verification, and final) and were registered to the reference images. Every MV pair was complemented by a CBCT scan. CBCT image registration was performed automatically by maximizing the mutual information using a region of interest that excluded the markers. The corrections, as determined from the MV images, were compared with these from CBCT and were used for actual patient setup. Results: The mean and standard deviation of the absolute values of the differences between the CBCT and MV corrections were 1.0 {+-} 0.7, 1.0 {+-} 0.6, and 1.0 {+-} 0.8 mm for the left-right, anteroposterior, and superoinferior directions, respectively. The absolute differences between the corresponding pre- and post-treatment kilovoltage CBCT image registration were 0.6 {+-} 0.5, 0.6 {+-} 0.5, and 1.0 {+-} 0.8 mm. Conclusion: The setup corrections found using CBCT without the use of implanted markers were consistent with the marker registration on MV projections. CBCT has additional advantages, including better positioning precision and robust automatic three-dimensional registration, as well as eliminating the need for invasive marker implantation. We have adopted CBCT for the setup of all single-fraction paraspinal patients. Our data have also demonstrated that target displacements during treatment

  10. Patient complaints in healthcare systems: a systematic review and coding taxonomy

    PubMed Central

    Reader, Tom W; Gillespie, Alex; Roberts, Jane

    2014-01-01

    Background Patient complaints have been identified as a valuable resource for monitoring and improving patient safety. This article critically reviews the literature on patient complaints, and synthesises the research findings to develop a coding taxonomy for analysing patient complaints. Methods The PubMed, Science Direct and Medline databases were systematically investigated to identify patient complaint research studies. Publications were included if they reported primary quantitative data on the content of patient-initiated complaints. Data were extracted and synthesised on (1) basic study characteristics; (2) methodological details; and (3) the issues patients complained about. Results 59 studies, reporting 88 069 patient complaints, were included. Patient complaint coding methodologies varied considerably (eg, in attributing single or multiple causes to complaints). In total, 113 551 issues were found to underlie the patient complaints. These were analysed using 205 different analytical codes which when combined represented 29 subcategories of complaint issue. The most common issues complained about were ‘treatment’ (15.6%) and ‘communication’ (13.7%). To develop a patient complaint coding taxonomy, the subcategories were thematically grouped into seven categories, and then three conceptually distinct domains. The first domain related to complaints on the safety and quality of clinical care (representing 33.7% of complaint issues), the second to the management of healthcare organisations (35.1%) and the third to problems in healthcare staff–patient relationships (29.1%). Conclusions Rigorous analyses of patient complaints will help to identify problems in patient safety. To achieve this, it is necessary to standardise how patient complaints are analysed and interpreted. Through synthesising data from 59 patient complaint studies, we propose a coding taxonomy for supporting future research and practice in the analysis of patient complaint data

  11. Impact of climate change on UK estuaries: A review of past trends and potential projections

    NASA Astrophysics Data System (ADS)

    Robins, Peter E.; Skov, Martin W.; Lewis, Matt J.; Giménez, Luis; Davies, Alan G.; Malham, Shelagh K.; Neill, Simon P.; McDonald, James E.; Whitton, Timothy A.; Jackson, Suzanna E.; Jago, Colin F.

    2016-02-01

    UK estuarine environments are regulated by inter-acting physical processes, including tidal, wave, surge, river discharge and sediment supply. They regulate the fluxes of nutrients, pollutants, pathogens and viruses that determine whether coastlines achieve the Good Environmental Status (GEnS) required by the EU's Marine Strategy Directive. We review 20th century trends and 21st century projections of changes to climatic drivers, and their potential for altering estuarine bio-physical processes. Sea-level rise will cause some marine habitats to expand, and others diminish in area extent. The overall consequences of estuarine morphodynamics to these habitat shifts, and vice-versa, are unknown. Increased temperatures could intensify microbial pathogen concentrations and increase public health risk. The patterns of change of other climatic drivers are difficult to predict (e.g., river flows and storm surges). Projected increased winter river flows throughout UK catchments will enhance the risks of coastal eutrophication, harmful algal blooms and hypoxia in some contexts, although there are spatial variabilities in river flow projections. The reproductive success of estuarine biota is sensitive to saline intrusion and corresponding turbidity maxima, which are projected to gradually shift landwards as a result of sea-level rise. Although more-frequent flushing events in winter and longer periods of drought in summer are predicted, whereby the subsequent estuarine mixing and recovery rates are poorly understood. With rising estuarine salinities, subtidal species can penetrate deeper into estuaries, although this will depend on the resilience/adaptation of the species. Many climate and impact predictions lack resolution and spatial cover. Long-term monitoring and increased research, which considers the catchment-river-estuary-coast system as a whole, is needed to support risk predicting and mitigatory strategies.

  12. Use of the adult attachment projective picture system in psychodynamic psychotherapy with a severely traumatized patient

    PubMed Central

    George, Carol; Buchheim, Anna

    2014-01-01

    The following case study is presented to facilitate an understanding of how the attachment information evident from Adult Attachment Projective Picture System (AAP) assessment can be integrated into a psychodynamic perspective in making therapeutic recommendations that integrate an attachment perspective. The Adult Attachment Projective Picture System (AAP) is a valid representational measure of internal representations of attachment based on the analysis of a set of free response picture stimuli designed to systematically activate the attachment system (George and West, 2012). The AAP provides a fruitful diagnostic tool for psychodynamic-oriented clinicians to identify attachment-based deficits and resources for an individual patient in therapy. This paper considers the use of the AAP with a traumatized patient in an inpatient setting and uses a case study to illustrate the components of the AAP that are particularly relevant to a psychodynamic conceptualization. The paper discusses also attachment-based recommendations for intervention. PMID:25140164

  13. Improving the documentation of the daily review of patients in general intensive care.

    PubMed

    Zucco, Liana; Webb, Carly

    2014-01-01

    Following the daily review of patients on the general intensive care unit (GICU), ongoing issues are addressed and a management plan formulated. Within our unit, the documentation of this daily review is freehand and should include all items covered within the local GICU daily review checklist. However, an initial audit of the daily review demonstrated an average completion rate of only 57%, with several aspects of care consistently missed, most notably: eye and mouth care in ventilated patients (44% and 40%, respectively), glucose control (33%), stress ulcer prophylaxis (54%), and inspection and need for peripheral and central lines (24%). The current system relied on doctors learning the requirements for the clerking and remembering to document them all. It is known that there is a low level of reliability in successfully applying proven medical evidence; this is partly explained by dependence on vigilance and hard work by the clinician, and absence of checklists and protocols to reduce the impact of human factors on results. The majority of doctors on the unit believe they consistently record all items of this checklist, highlighting the gap between the ideal that clinicians strive towards and the outcome. An abbreviated daily review checklist was therefore implemented in the form of a laminated bookmark into the medical notes, to act as a reminder of the items that should be considered in the daily review and prompt subsequent documentation. Bookmarks were implemented over two PDSA cycles and medical notes re-audited. Post-intervention, the documentation of the daily review improved to an overall completion rate of >77%, with notable improvements in eye and mouth care in ventilated patients (89%, 95% respectively), glucose control (67%), stress ulcer prophylaxis (100%), and inspection and need for peripheral and central lines (43%). The daily review checklist concisely summarised onto bookmarks were cheap and simple to create, durable and easy to use, and

  14. Improving the documentation of the daily review of patients in general intensive care

    PubMed Central

    Zucco, Liana; Webb, Carly

    2014-01-01

    Following the daily review of patients on the general intensive care unit (GICU), ongoing issues are addressed and a management plan formulated. Within our unit, the documentation of this daily review is freehand and should include all items covered within the local GICU daily review checklist. However, an initial audit of the daily review demonstrated an average completion rate of only 57%, with several aspects of care consistently missed, most notably: eye and mouth care in ventilated patients (44% and 40%, respectively), glucose control (33%), stress ulcer prophylaxis (54%), and inspection and need for peripheral and central lines (24%). The current system relied on doctors learning the requirements for the clerking and remembering to document them all. It is known that there is a low level of reliability in successfully applying proven medical evidence; this is partly explained by dependence on vigilance and hard work by the clinician, and absence of checklists and protocols to reduce the impact of human factors on results. The majority of doctors on the unit believe they consistently record all items of this checklist, highlighting the gap between the ideal that clinicians strive towards and the outcome. An abbreviated daily review checklist was therefore implemented in the form of a laminated bookmark into the medical notes, to act as a reminder of the items that should be considered in the daily review and prompt subsequent documentation. Bookmarks were implemented over two PDSA cycles and medical notes re-audited. Post-intervention, the documentation of the daily review improved to an overall completion rate of >77%, with notable improvements in eye and mouth care in ventilated patients (89%, 95% respectively), glucose control (67%), stress ulcer prophylaxis (100%), and inspection and need for peripheral and central lines (43%). The daily review checklist concisely summarised onto bookmarks were cheap and simple to create, durable and easy to use, and

  15. A Systematic Review of Applying Patient Satisfaction Outcomes in Plastic Surgery

    PubMed Central

    Clapham, Philip J.; Pushman, Allison G.; Chung, Kevin C.

    2015-01-01

    Background We performed a systematic review of patient satisfaction studies in the Plastic Surgery literature. The specific aim was to evaluate the status of satisfaction research that has been undertaken to date and to identify areas for improvement. Methods Four medical databases were searched using satisfaction and Plastic Surgery related search terms. Quality of selected articles was assessed by two trained reviewers. Results Out of the total of 2,936 articles gleaned by the search, 178 were included in the final review. The majority of the articles (58%) in our review examined patient satisfaction in breast surgery populations. Additionally, 53% of the articles were limited in scope and only measured features of care in one or two domains of satisfaction. Finally, the majority of the studies (68%) were based solely on the use of ad-hoc satisfaction measurement instruments that did not undergo a formal development. Conclusion Given the important policy implications of patient satisfaction data within Plastic Surgery, we found a need to further refine research on patient satisfaction in Plastic Surgery. The scarcity of satisfaction research in the craniofacial, hand, and other reconstructive specialties, as well as the narrow scope of satisfaction measurement and the use of unvalidated instruments are current barriers preventing Plastic Surgery patient satisfaction studies from producing meaningful results. PMID:20517109

  16. A systematic review of disease-related stigmatization in patients living with inflammatory bowel disease.

    PubMed

    Taft, Tiffany H; Keefer, Laurie

    2016-01-01

    Chronic illness stigma is a global public health issue. Most widely studied in HIV/AIDS and mental illness, stigmatization of patients living with inflammatory bowel disease (IBD), chronic autoimmune conditions affecting the digestive tract, has garnered increasing attention in recent years. In this paper, we systematically review the scientific literature on stigma as it relates to IBD across its three domains: perception, internalization, and discrimination experiences. We aim to document the current state of research, identify gaps in our knowledge, recognize unique challenges that IBD patients may face as they relate to stigmatization, and offer suggestions for future research directions. Based on the current review, patients living with IBD may encounter stigmatization and this may, in turn, impact several patient outcomes including quality of life, psychological functioning, and treatment adherence. Significant gaps exist related to the understanding of IBD stigma, providing opportunity for future studies to address this important public health issue. PMID:27022294

  17. A systematic review of disease-related stigmatization in patients living with inflammatory bowel disease

    PubMed Central

    Taft, Tiffany H; Keefer, Laurie

    2016-01-01

    Chronic illness stigma is a global public health issue. Most widely studied in HIV/AIDS and mental illness, stigmatization of patients living with inflammatory bowel disease (IBD), chronic autoimmune conditions affecting the digestive tract, has garnered increasing attention in recent years. In this paper, we systematically review the scientific literature on stigma as it relates to IBD across its three domains: perception, internalization, and discrimination experiences. We aim to document the current state of research, identify gaps in our knowledge, recognize unique challenges that IBD patients may face as they relate to stigmatization, and offer suggestions for future research directions. Based on the current review, patients living with IBD may encounter stigmatization and this may, in turn, impact several patient outcomes including quality of life, psychological functioning, and treatment adherence. Significant gaps exist related to the understanding of IBD stigma, providing opportunity for future studies to address this important public health issue. PMID:27022294

  18. Review of recent studies on interventions for cognitive deficits in patients with cancer.

    PubMed

    Gehring, Karin; Roukema, Jan Anne; Sitskoorn, Margriet M

    2012-02-01

    Research has demonstrated that patients with cancer experience cognitive deficits, often due to aggressive anticancer treatments. In this article, we critically review the interventional studies that have been conducted to investigate beneficial effects on cognitive function in cancer patients. Pharmacological agents that have been studied include psychostimulants, such as methylphenidate and modafinil, erythropoietin, and hormonal (supplement) treatments for patients who receive hormonal suppression therapy. In addition, several cognitive rehabilitation programs have been evaluated in cancer patients. Recently, the approach of physical exercise to treat cognitive deficits has received great interest, and findings from novel studies are keenly anticipated. Although, in general, the studies reviewed were well designed, future studies may wish to include larger sample sizes and pay more attention to the accurate assessment of cognitive function. PMID:22316373

  19. Is Gastroparesis Found More Frequently in Patients with Cystic Fibrosis? A Systematic Review.

    PubMed

    Corral, Juan E; Dye, Corey W; Mascarenhas, Maria R; Barkin, Jamie S; Salathe, Matthias; Moshiree, Baharak

    2016-01-01

    Cystic fibrosis (CF) is associated with different gastrointestinal motility disturbances and syndromes. We aim to assess gastric emptying in patients with CF compared to healthy controls by a systematic review of existing literature. Medical databases and abstracts from major gastroenterology and CF meetings were reviewed. Emptying times in CF patients were compared with healthy controls using random effects models. Subgroup analysis stratified results by age and diagnostic modality. Nineteen studies from 7 countries included 574 subjects (359 CF patients and 215 controls). Using pooled analysis frequency of gastroparesis was high (38%, 95% CI 30-45%) but results were highly dependent on the diagnostic modality. Delayed gastric emptying is more common in CF compared to general population. Scintigraphy identified rapid gastric emptying in a subgroup of CF patients, but this finding disappeared with adequate pancreatic enzyme replacement and after other diagnostic modalities were included. PMID:27313953

  20. Is Gastroparesis Found More Frequently in Patients with Cystic Fibrosis? A Systematic Review

    PubMed Central

    Corral, Juan E.; Dye, Corey W.; Mascarenhas, Maria R.; Barkin, Jamie S.; Salathe, Matthias; Moshiree, Baharak

    2016-01-01

    Cystic fibrosis (CF) is associated with different gastrointestinal motility disturbances and syndromes. We aim to assess gastric emptying in patients with CF compared to healthy controls by a systematic review of existing literature. Medical databases and abstracts from major gastroenterology and CF meetings were reviewed. Emptying times in CF patients were compared with healthy controls using random effects models. Subgroup analysis stratified results by age and diagnostic modality. Nineteen studies from 7 countries included 574 subjects (359 CF patients and 215 controls). Using pooled analysis frequency of gastroparesis was high (38%, 95% CI 30–45%) but results were highly dependent on the diagnostic modality. Delayed gastric emptying is more common in CF compared to general population. Scintigraphy identified rapid gastric emptying in a subgroup of CF patients, but this finding disappeared with adequate pancreatic enzyme replacement and after other diagnostic modalities were included. PMID:27313953

  1. Decreasing IV Infiltrates in the Pediatric Patient--System-Based Improvement Project.

    PubMed

    Major, Tracie Wilt; Huey, Tricia K

    2016-01-01

    Intravenous infiltrates pose tremendous risk for the hospitalized pediatric patient. Infiltrate events increase hospital-acquired harm, the number of painful procedures, use of supplies, length of stay, and nursing time; it threatens relationships essential in patient- and family-centered care. The goal of this quality improvement project was to achieve a 10% decrease in the baseline infiltrate rate on two inpatient units and in the overall infiltrate rate across all of the pediatric units. A Lean Six Sigma methodology was used to guide project activities. Improvement strategies focused on evidence-based education, intravenous (IV) catheter securement, and family engagement. A comparative purposive sample was used to evaluate the pre- and post-implementation period to determine if desired project success measures were achieved. Data analysis revealed positive results across all units, with the number of events (n = 51 pre; n = 19 post) and the infiltration rates (13.5 pre; 7.1 post) decreasing over a three-month period. A decrease was also noted in the overall percent of IVs that infiltrated in the first 24 hours (45% pre; 42% post). A statistically significant increase (t = 15.16; p < 0.001) was noted in nurses' education pre- and post-assessment survey scores. The family engagement strategy revealed overall parental responses to be 88% positive. By decreasing infiltrates, quality of care improved, resulting in the delivery of safe, effective, and patient-centered IV therapy. PMID:27019937

  2. Effects of improved patient participation in primary care on health-related outcomes: a systematic review

    PubMed Central

    Sanders, Ariëtte R J; van Weeghel, Inge; Vogelaar, Maartje; Verheul, William; Pieters, Ron H M; de Wit, Niek J; Bensing, Jozien M

    2013-01-01

    Background. In primary care, many consultations address symptom-based complaints. Recovery from these complaints seldom exceeds placebo effects. Patient participation, because of its supposed effects on trust and patient expectancies, is assumed to benefit patients’ recovery. While the idea is theoretically promising, it is still unclear what the effects of increased patient participation are on patient outcomes. Aim. To review the effects of controlled intervention studies aiming to improve patient participation in face-to-face primary care consultations on patient-oriented and/or disease-oriented outcomes. Methods. This study is a systematic review. A systematic search was undertaken for randomized controlled trials designed to measure the effects of interventions that aimed to improve adult patients’ participation in primary care visits. The CINAHL, Cochrane, EMBASE, PsycINFO and PubMed databases were searched. Results. Seven different trials fulfilled the inclusion criteria. Three of the studies were related to symptom-based complaints. Five studies measured patient-oriented outcomes, the primary outcome of interest for this review. All studies suffered from substantial bias. Studies varied widely in their aims, types of complaints/diseases, strength of the interventions and their outcomes. The effects on patient-oriented outcomes and disease-oriented outcomes were ambiguous. Conclusion. Little research has been performed on health outcomes of interventions aiming to increase patient participation in general practice visits among patients suffering from symptom-based complaints. The results still are non-conclusive. The quality of the trials has been weak, possibly due to the complexity of the concept. This weak quality may explain the lack of conclusive results. Proposals for future research designs are offered. PMID:23629738

  3. The Association Between Patient-Reported and Objective Oral Anticancer Medication Adherence Measures: A Systematic Review

    PubMed Central

    Atkinson, Thomas M.; Rodríguez, Vivian M.; Gordon, Mallorie; Avildsen, Isabelle K.; Emanu, Jessica C.; Jewell, Sarah T.; Anselmi, Kimberly A.; Ginex, Pamela K.

    2016-01-01

    Problem Identification Oral anticancer medication (OAM) use has been steadily increasing, leading to several patient benefits. A notable challenge for nurses is accurate monitoring of patient OAM regimens because nonadherence is associated with poor health outcomes and decreased survival. Currently, no gold standard measure of OAM adherence exists. The authors conducted a systematic review of the association between objective and patient-reported measures of OAM adherence. Literature Search A systematic electronic literature search was conducted using PubMed, EMBASE, Scopus, PsycINFO®, Cochrane Library, Web of Science, and CINAHL® databases through November 2014. Data Evaluation Articles were independently reviewed to determine whether they included an original characterization of the level of association between objective and patient-reported measures of OAM adherence. Synthesis From a total of 11,135 articles retrieved, eight studies met inclusion criteria. Objective adherence was primarily assessed using pill counts or Medication Event Monitoring System (MEMSCap™). Patient-reported adherence was most commonly assessed using study-specific questionnaires. Significant positive correlations were observed between objective and patient-reported adherence across most studies, with three studies reporting higher rates of adherence via patient reporting. Conclusions Despite variation in the OAMs and measures used, patient-reported adherence rates were equal to or higher than objective adherence measures across studies. Social desirability bias may be a concern; however, given the significant concordance observed, using patient-reported methods in future studies of OAM adherence may be justified. Implications for Nursing This review provides evidence to support nursing use of patient-reported measures to accurately monitor OAM adherence and potentially improve the quality of patient–provider communication. PMID:27541550

  4. Psychotherapy Interventions for Managing Anxiety and Depressive Symptoms in Adult Brain Tumor Patients: A Scoping Review

    PubMed Central

    Kangas, Maria

    2015-01-01

    Background Adult brain tumor (BT) patients and longer-term survivors are susceptible to experiencing emotional problems, including anxiety and/or depression disorders, which may further compromise their quality-of-life (QOL) and general well-being. The objective of this paper is to review psychological approaches for managing anxiety and depressive symptoms in adult BT patients. A review of psychological interventions comprising mixed samples of oncology patients, and which included BT patients is also evaluated. The review concludes with an overview of a recently developed transdiagnostic psychotherapy program, which was specifically designed to treat anxiety and/or depressive symptoms in adult BT patients. Methods Electronic databases (PsycINFO, Medline, Embase, and Cochrane) were searched to identify published studies investigating psychological interventions for managing anxiety and depressive symptoms in adult BT patients. Only four randomized controlled trials (RCTs) were identified. Results Only one of the RCTs tested a psychosocial intervention, which was specifically developed for primary BT patients, and which was found to improve QOL including existential well-being as well as reducing depressive symptoms. A second study tested a combined cognitive rehabilitation and problem-solving intervention, although was not found to significantly improve mood or QOL. The remaining two studies tested multidisciplinary psychosocial interventions in heterogeneous samples of cancer patients (included BT patients) with advanced stage disease. Maintenance of QOL was found in both studies, although no secondary gains were found for improvements in mood. Conclusion There is a notable paucity of psychological interventions for adult BT patients across the illness trajectory. Further research is required to strengthen the evidence base for psychological interventions in managing anxiety and depressive symptoms, and enhancing the QOL of distressed adults diagnosed with a BT

  5. Twiddler syndrome in a patient with tremor dominant Parkinson's disease. A case report and literature review.

    PubMed

    Sobstyl, Michał; Ząbek, Mirosław; Górecki, Wojciech; Brzuszkiewicz-Kuźmicka, Grażyna

    2015-01-01

    Twiddler syndrome is described as a spontaneous rotation or intentional external manipulation of implanted cardiac or occasionally deep brain stimulation (DBS) devices. We report this hardware related complication in a patient with tremor dominant Parkinson's disease (PD), who underwent unilateral subthalamic nucleus (STN) DBS and subsequently developed twiddler syndrome. The clinical course of twiddler syndrome in this patient is described. Some surgical nuances which may prevent its occurrence are suggested. Our case report indicates that twiddler syndrome occurs in DBS patients. Impedance check of DBS hardware, plain chest X-ray, or palpation for a knobbly extension lead through the skin above the IPG allows the correct diagnosis and subsequently a prompt surgical revision. Our subsequent literature review revealed only 10 patients with twiddler syndrome in DBS patient population worldwide. This number may suggest that this syndrome may be unrecognized or underreported, given the number of patients with movement disorders implanted with DBS hardware worldwide. PMID:26652885

  6. Boston type 1 keratoprosthesis from patient selection through postoperative management: a review for the keratoprosthetic surgeon

    PubMed Central

    Williamson, Samantha L; Cortina, M Soledad

    2016-01-01

    For the anterior segment surgeon, the implantation of Boston type 1 keratoprosthesis is a multistep process that begins with careful patient selection. Success depends on thorough preoperative evaluation, detailed surgical planning, and frequent postoperative follow-up. New practice patterns have emerged for each of these phases as the international experience with keratoprosthesis grows. This review details special considerations that can improve outcomes and also allow surgeons to consider its use in challenging patient populations at each step. PMID:27041986

  7. Understanding Patient Perspectives on Communication About the Cost of Cancer Care: A Review of the Literature

    PubMed Central

    Hofstatter, Erin W.

    2010-01-01

    Purpose: Patient-physician communication about cost when making treatment decisions has been promoted as a potential solution to the rising cost of oncologic care and suggested as an important component of high-quality oncologic care. However, little is known regarding the perspectives of patients with cancer on such discussions with their physicians. Methods: A literature review was performed in July 2009, with search terms including but not limited to patient-physician communication, cost of cancer care, and cost communication. Results: The cost of cancer care is high and seems to affect decisions that many patients make about the treatment they receive. Yet there is scant oncology literature on patient-physician cost communication, with the only formal study examining oncologist perspectives. Extrapolation from the general medicine literature may not be appropriate for this unique population of patients, and there are some data to suggest that patients with cancer may prefer not to discuss finances with their oncologists. Practical guidelines and tools for discussions of cost with patients with cancer are also limited. Conclusion: To my knowledge, patient preferences surrounding discussion of cost of cancer care have gone largely unstudied and are thus unknown. If the goal is to provide high-quality care while controlling rising health care costs, more research is needed to better understand patient perspectives on communication surrounding the cost of oncologic care, particularly given the significant impact such discussions may have on cancer outcomes, cost, and overall patient satisfaction. PMID:21037869

  8. The Doctor-Patient Relationship in the Adolescent Cancer Setting: A Developmentally Focused Literature Review.

    PubMed

    Siembida, Elizabeth J; Bellizzi, Keith M

    2015-09-01

    Several national reports and many individuals in the clinical oncology community have defined the adolescent and young adult (AYA) cancer population as individuals diagnosed between the ages of 15 and 39. However, neuroscience and developmental research have identified important decision-making skills (e.g., information processing, reasoning, emotion regulation) that are not fully developed during adolescence, making general, AYA-focused doctor-patient interaction guidelines potentially questionable for the adolescent cancer population. Most studies include adolescents in samples of pediatric cancer patients or include adolescents in samples of young adult cancer patients, but studies rarely consider adolescent cancer patients as a distinct, developmentally unique group. A systematic literature review was undertaken in October 2014 to begin to understand what is known about the doctor-patient relationship and communication preferences within adolescent oncology. From the 25 included studies, three important conclusions emerged: (1) discrepancies among adolescent patients, parents, and providers about the desired extent of involvement in treatment-related decisions; (2) patient desire for developmentally and culturally appropriate information provision; and (3) the desire and preference for how information is delivered, with recognition that these preferences may change with age. There was some variation in themes by study design, with studies directly observing medical consultations reporting less adolescent involvement in discussions than studies that surveyed doctors. The results of this review support the need for developmentally focused research and clinical guidelines that emphasize the experience of adolescent cancer patients separate from their older and younger counterparts. PMID:26812664

  9. Diet and Inflammatory Bowel Disease: Review of Patient-Targeted Recommendations

    PubMed Central

    Hou, Jason K.; Lee, Dale; Lewis, James

    2014-01-01

    Patients have strong beliefs about the role of diet in the cause of inflammatory bowel disease (IBD) and in exacerbating or alleviating ongoing symptoms from IBD. The rapid increase in the incidence and prevalence of IBD in the past several decades strongly suggests an environmental trigger for IBD, one of which may be dietary patterns. There are several pathways where diet may influence intestinal inflammation such as direct dietary antigens, altering the gut microbiome, and affecting gastrointestinal permeability. However, data that altering diet can change the natural history of IBD are scarce and evidence based dietary guidelines for patients with IBD are lacking. Patients therefore seek non-medical resources for dietary guidance such as patient support groups and unverified sources on the internet. The aim of this review is to identify patient-targeted dietary recommendations for IBD and to critically appraise the nutritional value of these recommendations. We review patient-targeted dietary information for IBD from structured internet searches and popular defined diets. Patient-targeted dietary recommendations focus on food restrictions and are highly conflicting. High quality dietary intervention studies are needed to facilitate creation of evidence-based dietary guidelines for patients with IBD. PMID:24107394

  10. Diet and inflammatory bowel disease: review of patient-targeted recommendations.

    PubMed

    Hou, Jason K; Lee, Dale; Lewis, James

    2014-10-01

    Patients have strong beliefs about the role of diet in the cause of inflammatory bowel disease (IBD) and in exacerbating or alleviating ongoing symptoms from IBD. The rapid increase in the incidence and prevalence of IBD in recent decades strongly suggests an environmental trigger for IBD, one of which may be dietary patterns. There are several pathways where diet may influence intestinal inflammation, such as direct dietary antigens, altering the gut microbiome, and affecting gastrointestinal permeability. However, data that altering diet can change the natural history of IBD are scarce, and evidence-based dietary guidelines for patients with IBD are lacking. Patients, therefore, seek nonmedical resources for dietary guidance, such as patient support groups and unverified sources on the Internet. The aim of this review is to identify patient-targeted dietary recommendations for IBD and to critically appraise the nutritional value of these recommendations. We review patient-targeted dietary information for IBD from structured Internet searches and popular defined diets. Patient-targeted dietary recommendations focus on food restrictions and are highly conflicting. High-quality dietary intervention studies are needed to facilitate creation of evidence-based dietary guidelines for patients with IBD. PMID:24107394

  11. Effects of Screening for Psychological Distress on Patient Outcomes in Cancer: a Systematic Review

    PubMed Central

    Meijer, Anna; Roseman, Michelle; Delisle, Vanessa C.; Milette, Katherine; Levis, Brooke; Syamchandra, Achyuth; Stefanek, Michael E.; Stewart, Donna E.; de Jonge, Peter; Coyne, James C.; Thombs, Brett D.

    2013-01-01

    Objective Several practice guidelines recommend routine screening for psychological distress in cancer care. The objective was to evaluate the effect of screening cancer patients for psychological distress by assessing the (1) effectiveness of interventions to reduce distress among patients identified as distressed; and (2) effects of screening for distress on distress outcomes. Methods CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO, and SCOPUS databases were searched through April 6, 2011 with manual searches of 45 relevant journals, reference list review, citation tracking of included articles, and trial registry reviews through June 30, 2012. Articles in any language on cancer patients were included if they (1) compared treatment for patients with psychological distress to placebo or usual care in a randomized controlled trial (RCT); or (2) assessed the effect of screening on psychological distress in a RCT. Results There were 14 eligible RCTs for treatment of distress, and 1 RCT on the effects of screening on patient distress. Pharmacological, psychotherapy and collaborative care interventions generally reduced distress with small to moderate effects. One study investigated effects of screening for distress on psychological outcomes, and it found no improvement. Conclusion Treatment studies reported modest improvement in distress symptoms, but only a single eligible study was found on the effects of screening cancer patients for distress, and distress did not improve in screened patients versus those receiving usual care. Because of the lack of evidence of beneficial effects of screening cancer patients for distress, it is premature to recommend or mandate implementation of routine screening. PMID:23751231

  12. Nurses as patient navigators in cancer diagnosis: review, consultation and model design.

    PubMed

    Gilbert, J E; Green, E; Lankshear, S; Hughes, E; Burkoski, V; Sawka, C

    2011-03-01

    The diagnostic phase of cancer care is an anxious time for patients. Patient navigation is a way of assisting and supporting individuals during this time. The aim of this review is to explore patient navigation and its role in the diagnostic phase of cancer care. We reviewed the literature for definitions and models of navigation, preparation for the role and impact on patient outcomes, specifically addressing the role of the nurse in patient navigation. Interviews and focus groups with healthcare providers and managers provided further insight from these stakeholder groups. Common to most definitions of navigation is the navigator's multifaceted role in facilitating processes of care, assisting patients to overcome barriers and providing information and support. Navigation may be provided by laypersons, clerical staff and/or healthcare professionals. In the diagnostic phase it has the potential to affect efficiency of diagnostic testing, patients' experience during this time and preparation for decision-making around treatment options. Patient care during the diagnostic phase requires various levels of navigation, according to individual informational, physical and psychosocial needs. Identifying those individuals who require more support--whether physical or psychosocial--during the diagnostic phase is of critical importance. PMID:20955374

  13. The increasing influence of risk assessment on forensic patient review board decisions.

    PubMed

    Hilton, N Zoe; Simpson, Alexander I; Ham, Elke

    2016-08-01

    Previous studies of decisions about forensic patients' placement in secure hospitals indicate some changes over time in the use of empirically supported risk factors. Our aim was to investigate whether, in more recent cases, risk assessment instruments were cited by a forensic patient review board or by the clinicians who made recommendations to the board and whether there was evidence of an association between risk assessment results and either dispositions or recommendations. Among review board hearings held in 2009-2012 pertaining to 63 different maximum security patients found not criminally responsible on account of mental disorder in Ontario, Canada, dispositions were most strongly associated with psychiatrists' testimony, consistent with previous studies. However, dispositions were associated with the scores on the Violence Risk Appraisal Guide (VRAG), such that transferred patients had a lower risk of violent recidivism than detained patients. An association between clinical opinions and risk assessment results was also evident and significantly larger than in previous research. There was no evidence that risk assessment was cited selectively in higher risk cases or when scores were concordant with the review board decision. This research may provide a baseline for studies of the effect of 2014 legislation introducing a high-risk designation for forensic patients in Canada. We recommend further efforts to measure the effect of nonpharmacological treatment participation and in-hospital security decisions on forensic decision-making. (PsycINFO Database Record PMID:27504642

  14. Preventable Adverse Events in Surgical Care in Sweden: A Nationwide Review of Patient Notes.

    PubMed

    Nilsson, Lena; Risberg, Madeleine Borgstedt; Montgomery, Agneta; Sjödahl, Rune; Schildmeijer, Kristina; Rutberg, Hans

    2016-03-01

    Adverse events (AEs) occur in health care and may result in harm to patients especially in the field of surgery. Our objective was to analyze AEs in surgical patient care from a nationwide perspective and to analyze the frequency of AEs that may be preventable.In total 19,141 randomly selected admissions in 63 Swedish hospitals were reviewed each month during 2013 using a 2-stage record review method based on the identification of predefined triggers. The subgroup of 3301 surgical admissions was analyzed. All AEs were categorized according to site, type, level of severity, and degree of preventability.We reviewed 3301 patients' records and 507 (15.4%) were associated with AEs. A total of 62.5% of the AEs were considered probably preventable, over half contributed to prolonged hospital care or readmission, and 4.7% to permanent harm or death. Healthcare acquired infections composed of more than one third of AEs. The majority of the most serious AEs composed of healthcare acquired infections and surgical or other invasive AEs. The incidence of AEs was 13% in patients 18 to 64 years old and 17% in ≥65 years. Pressure sores and drug-related AEs were more common in patients being ≥65 years. Urinary retention and pressure sores showed the highest degree of preventability. Patients with probably preventable AEs had in median 7.1 days longer hospital stay.We conclude that AEs are common in surgical care and the majority are probably preventable. PMID:26986126

  15. Intestinal Infections Among Febrile Hospitalized Patients in the Republic of Armenia: A Retrospective Chart Review.

    PubMed

    Zardaryan, Eduard; Paronyan, Lusine; Bakunts, Vahe; Gevorgyan, Zaruhi; Asoyan, Vigen; Apresyan, Hripsime; Hovhannisyan, Alvard; Palayan, Karo; Kuchuloria, Tinatin; Rivard, Robert G; Bautista, Christian T

    2016-10-01

    In the past, several enteric outbreaks in 1996, 1998, 1999, and 2003 caused by Salmonella typhi, a Gram-negative bacterium, have occurred in Armenia. This study describes the demographic, epidemiological, and clinical characteristics of febrile hospitalized patients with intestinal infections in Armenia. Using a chart review study design, medical data from adult patients who were hospitalized at the Nork hospital during 2010-2012 were reviewed. A total of 600 medical charts were reviewed. Of these, 51 % were diagnosed with intestinal infections. Among these patients, 59 % had an intestinal infection of known etiology, with three main pathogens identified: Salmonella sp. (32 %), Shigella sp. (32 %), and Staphylococcus aureus (18 %). After controlling for the calendar year, age in years, and gender, patients detected with Salmonella sp. were more likely to reported the presence of a family member with similar signs or symptoms [odds ratio (OR) 9.0; 95 % CI 2.4-33.7] and the lack of a water tap at home (OR 3.9; 95 % CI 1.7-9.5). Evidence indicates that Salmonella sp., Shigella sp., and S. aureus as the most common etiologies reported among febrile hospitalized patients. A high percentage of patients had intestinal infections of unknown etiology; thus, improvement in laboratory capacity (enabling more advanced tests, such as polymerase chain reaction) would increase the identification of the enteropathogens causing disease in Armenia. PMID:26992893

  16. Outcomes of ureteroscopy for patients with stones in a solitary kidney: evidence from a systematic review

    PubMed Central

    Rai, Bhavan Prasad; Somani, Bhaskar K.

    2016-01-01

    Introduction Management of urolithiasis in a solitary functioning kidney can be clinically challenging. The aim of this article was to review the outcomes of URS for patients with stone disease in a solitary kidney and critically appraise the existing evidence and outcome reporting standards. Material and methods We conducted a systematic review in line with PRISMA checklist and Cochrane guidelines between January 1980 and February 2015. Our inclusion criteria were all English language articles reporting on a minimum of 10 patients with a solitary kidney undergoing ureteroscopy for stone disease. Results A total of 116 patients (mean age 50 years) underwent URS for stones in solitary kidney. For a mean stone size of 16.8 mm (range: 5–60 mm) and 1.23 procedures/patient, the mean stone free rate was 87%. No significant change in renal function was recorded in any of the studies although a transient elevation in creatinine was reported in 10 (8.6%) patients. A total of 33 (28%) complications were recorded a majority (n = 21) of which were Clavien grade I. The Clavien grade II/III complications as reported by authors were urosepsis, steinstrasse and renal colic. None of the procedures required conversion to open surgery with no cases of renal haematoma or ureteric perforation. Conclusions This contemporary review highlights URS as a viable treatment option for stone disease in patients with a solitary kidney. It is associated with superior clearance rates to SWL and fewer high-risk complications compared to PCNL. PMID:27123332

  17. Patient Receptivity to Tobacco Cessation Counseling and Services in a Dental Teaching Institute: A Patient Review

    PubMed Central

    Patil, Pavan Uday; Vivek, S; Chandrasekhar, Thatimatla; Parimi, Nalini; Praveen, B H; Lingaraj, Sunil

    2015-01-01

    Background: The dentists are in a unique position to render tobacco cessation counseling to their patients. The current study is set to assess the attitudes of tobacco users toward tobacco cessation counseling attending a dental teaching institute and hospital in Andhra Pradesh. Materials and Methods: A systematic random sampling method was used to select the sample. Survey was conducted among 660 patients attending a dental teaching institute. Patients who have completed oral examination in the department of oral medicine and radiology were asked to complete pretested questionnaire. The questionnaire was designed in both English and Telugu (local language). Results: Among the study subjects 88.9% were planning to quit the habit, 72.27% had agreed that they discussed about ill-effects of tobacco, 82% of the subjects said that dentist should routinely offer quit tobacco assistance and services. Conclusion: The present study indicates the majority of patients are receptive towards tobacco counseling and services in the dental setting. In this study, the majority of tobacco users were planning to quit. Majority of patients were unaware of the resources available to help them to quit. Dentists have a significant opportunity to disseminate information to patients who need assistance in quitting the habit of tobacco usage. PMID:25709362

  18. Projecting hydropower production under future climates: a review of modelling challenges and open questions

    NASA Astrophysics Data System (ADS)

    Schaefli, Bettina

    2015-04-01

    Hydropower is a pillar for renewable electricity production in almost all world regions. The planning horizon of major hydropower infrastructure projects stretches over several decades and consideration of evolving climatic conditions plays an ever increasing role. This review of model-based climate change impact assessments provides a synthesis of the wealth of underlying modelling assumptions, highlights the importance of local factors and attempts to identify the most urgent open questions. Based on existing case studies, it critically discusses whether current hydro-climatic modelling frameworks are likely to provide narrow enough water scenario ranges to be included into economic analyses for end-to-end climate change impact assessments including electricity market models. This will be completed with an overview of not or indirectly climate-related boundary conditions, such as economic growth, legal constraints, national subsidy frameworks or growing competition for water, which might locally largely outweigh any climate change impacts.

  19. The Swift Supergiant Fast X-Ray Transients Project:. [A Review, New Results and Future Perspectives

    NASA Technical Reports Server (NTRS)

    Romano, P.; Mangano, V.; Ducci, L.; Esposito, P.; Vercellone, S.; Bocchino, F.; Burrows, D. N.; Kennea, J. A.; Krimm, H. A.; Gehrels, N.; Farinelli, R.; Ceccobello, C.

    2013-01-01

    We present a review of the Supergiant Fast X-ray Transients (SFXT) Project, a systematic investigation of the properties of SFXTs with a strategy that combines Swift monitoring programs with outburst follow-up observations. This strategy has quickly tripled the available sets of broad-band data of SFXT outbursts, and gathered a wealth of out-of-outburst data, which have led us to a broad-band spectral characterization, an assessment of the fraction of the time these sources spend in each phase, and their duty cycle of inactivity. We present some new observational results obtained through our outburst follow-ups, as fitting examples of the exceptional capabilities of Swift in catching bright flares and monitor them panchromatically.

  20. Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa

    PubMed Central

    2014-01-01

    Background Access to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa. Methods A systematic review of peer-reviewed literature on mHealth projects in Africa, between 2003 and 2013, was carried out using PubMed and OvidSP. Data was synthesized using a SWOT analysis methodology. Results were grouped to assess specific aspects of project implementation in terms of sustainability and mid/long-term results, integration to the health system, management process, scale-up and replication, and legal issues, regulations and standards. Results Forty-four studies on mHealth projects in Africa were included and classified as: “patient follow-up and medication adherence” (n = 19), “staff training, support and motivation” (n = 2), “staff evaluation, monitoring and guidelines compliance” (n = 4), “drug supply-chain and stock management” (n = 2), “patient education and awareness” (n = 1), “disease surveillance and intervention monitoring” (n = 4), “data collection/transfer and reporting” (n = 10) and “overview of mHealth projects” (n = 2). In general, mHealth projects demonstrate positive health-related outcomes and their success is based on the accessibility, acceptance and low-cost of the technology, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement. Threats such as dependency on funding, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness challenge their implementation. mHealth projects can potentially be scaled-up to help tackle problems faced by healthcare systems like poor management of drug stocks, weak surveillance and reporting systems or

  1. Clinical outcomes in pediatric hemodialysis patients in the USA: lessons from CMS' ESRD CPM Project.

    PubMed

    Neu, Alicia M; Frankenfield, Diane L

    2009-07-01

    Although prospective randomized trials have provided important information and allowed the development of evidence-based guidelines in adult hemodialysis (HD) patients, with approximately 800 prevalent pediatric HD patients in the United States, such studies are difficult to perform in this population. Observational data obtained through the Center for Medicare & Medicaid Services' (CMS') End Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project have allowed description of the clinical care provided to pediatric HD patients as well as identification of risk factors for failure to reach adult targets for clinical parameters such as hemoglobin, single-pool Kt/V (spKt/V) and serum albumin. In addition, studies linking data from the ESRD CPM Project and the United States Renal Data System have allowed evaluation of associations between achievement of those targets and the outcomes of hospitalization and death. The results of those studies, while unable to prove cause and effect, suggest that the adult ESRD CPM targets may assist in identifying pediatric HD patients at risk for poor outcomes. PMID:18509683

  2. Automated patient setup and gating using cone beam computed tomography projections

    NASA Astrophysics Data System (ADS)

    Wan, Hanlin; Bertholet, Jenny; Ge, Jiajia; Poulsen, Per; Parikh, Parag

    2016-03-01

    In radiation therapy, fiducial markers are often implanted near tumors and used for patient positioning and respiratory gating purposes. These markers are then used to manually align the patients by matching the markers in the cone beam computed tomography (CBCT) reconstruction to those in the planning CT. This step is time-intensive and user-dependent, and often results in a suboptimal patient setup. We propose a fully automated, robust method based on dynamic programming (DP) for segmenting radiopaque fiducial markers in CBCT projection images, which are then used to automatically optimize the treatment couch position and/or gating window bounds. The mean of the absolute 2D segmentation error of our DP algorithm is 1.3+/- 1.0 mm for 87 markers on 39 patients. Intrafraction images were acquired every 3 s during treatment at two different institutions. For gated patients from Institution A (8 patients, 40 fractions), the DP algorithm increased the delivery accuracy (96+/- 6% versus 91+/- 11% , p  <  0.01) compared to the manual setup using kV fluoroscopy. For non-gated patients from Institution B (6 patients, 16 fractions), the DP algorithm performed similarly (1.5+/- 0.8 mm versus 1.6+/- 0.9 mm, p  =  0.48) compared to the manual setup matching the fiducial markers in the CBCT to the mean position. Our proposed automated patient setup algorithm only takes 1-2 s to run, requires no user intervention, and performs as well as or better than the current clinical setup.

  3. Patient neglect in healthcare institutions: a systematic review and conceptual model

    PubMed Central

    2013-01-01

    Background Patient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error. Method The Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion criteria of reporting primary data on the occurrence or causes of patient neglect. Qualitative and quantitative data extraction investigated (1) the definition of patient neglect, (2) the forms of behaviour associated with neglect, (3) the reported frequency of neglect, and (4) the causes of neglect. Results Patient neglect is found to have two aspects. First, procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care. Second, caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The perceived frequency of neglectful behaviour varies by observer. Patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The causes of patient neglect frequently relate to organisational factors (e.g. high workloads that constrain the behaviours of healthcare staff, burnout), and the relationship between carers and patients. Conclusion A social psychology-based conceptual model is developed to explain the occurrence and nature of patient neglect. This model will facilitate investigations of i) differences between patients and healthcare staff in how they perceive neglect, ii) the association with patient neglect and health outcomes, iii) the relative importance of system and organisational factors in causing neglect, and iv) the design of interventions and

  4. Projection of electrocardiographic signs in praecordial maps after exercise in patients with ischaemic heart disease.

    PubMed Central

    Fox, K M; Selwyn, A P; Shillingford, J P

    1979-01-01

    Praecordial surface maps of the electrocardiogram were recorded before and after exercise using 16 electrodes covering the left hemithorax. The ST segment and R and S wave changes were measured in the praecordial maps from 20 individuals with no detectable cardiovascular disease. These showed no significant alteration in ST segments of R/S. In contrast in 40 patients with angiocardiographically proven coronary artery disease it was possible clearly to outline the distribution, severity, and time course of praecordial areas of ST segment depression (36 patients) and ST segment elevation (10 patients). In addition these praecordial areas of ST segment changes were accompanied by a regional and significant fall in the R/S. The praecordial electrocardiogram with exercise complements the anatomical information obtained from the coronary arteriogram by clearly outlining electrocardiographic projections of regional myocardial ischaemia or cell death. PMID:508472

  5. [Rehabilitation project and tele-monitoring of patients with mildly deteriorating cognition and their caregivers].

    PubMed

    Galante, E

    2009-01-01

    Dementia is a highly invalidating condition, constituting one of the major issues that health systems will face in future years. A great amount of research is focused on the looking out for effective therapies for dementia. Moreover, it is well-known that in the next thirty years the request for assistance and support services for patients will dramatically increase. It is also well-known that the perspective of institutionalization of demented patients is often source of anxiety and depression for caregivers. Telemedicine could provide an alternative option monitored by expert health operators and to caregivers the possibility to be supported in their assistance role. The project here presented entails a program of non-pharmacological treatment of cognitive and behavioural disturbances devoted to patients and caregivers, followed by a 12-months telemonitoring intervention, aimed at verifying compliance to treatments, offering constant support to caregivers and ensure patients and caregivers with a prompt access to operators of the Alzheimer Unit in case of sudden onset of health or assistance needs. It is expected that our combined cognitive-behavioural intervention devoted to patients and caregivers, followed by the 12-months telemonitoring program could produce many positive effects. In particular, we expect a slowing down of cognitive decline, a better control of behavioural disturbances and a delay in patients' institutionalization. Moreover, the accomplishment of improved information on disease and assistance options, and the reduction of caregivers' feelings of loneliness and hopelessness might engender the reduction of their anxiety and depression symptoms. PMID:19621541

  6. [Disease management for heart failure patients: role of wireless technologies for telemedicine. The ICAROS project].

    PubMed

    Villani, Alessandra; Malfatto, Gabriella; Della Rosa, Francesco; Branzi, Giovanna; Boarin, Simona; Borghi, Claudio; Cosentino, Eugenio; Gualerzi, Massimo; Coruzzi, Paolo; Molinari, Enrico; Compare, Angelo; Cassi, Maurizio; Collatina, Stefano; Parati, Gianfranco

    2007-02-01

    Healthcare costs for heart failure are increasing. The need for a better care, however, has to be matched with a policy of cost containment. A way to improve the cost-effectiveness of heart failure care is the disease management approach, in which therapy, education and follow-up are tailored for each patient by a multidisciplinary team. Such a complex intervention can be facilitated by the use of telemedicine, which allows the remote control of considerable amounts of clinical data. In Italy, a few studies with telemedicine have been reported. A recent development in this field is represented by the ICAROS project (Integrated Care vs Conventional Intervention in Cardiac Failure Patients: Randomized Open Label Study), whose aim is to improve the clinical and psychological care of heart failure patients employing advanced wireless telecommunication technology. So far, we randomized 60 patients: 30 in usual ambulatory care, 30 in an intensive treatment group. The latter patients were instructed to use a portable computer to get in touch daily with the heart failure clinic and receive feedback instruction for the management of drug therapy and daily problems. At the first year of follow-up, the treatment group showed good compliance to drug prescriptions, and could easily handle the portable computer. The preliminary results of this ongoing study support the feasibility and appropriateness of new technologies for the management of heart failure, even in elderly patients in whom a limited expertise with these appliances could have been anticipated. PMID:17402355

  7. Progressive Mobility Protocol Reduces Venous Thromboembolism Rate in Trauma Intensive Care Patients: A Quality Improvement Project.

    PubMed

    Booth, Kathryn; Rivet, Josh; Flici, Richelle; Harvey, Ellen; Hamill, Mark; Hundley, Douglas; Holland, Katelyn; Hubbard, Sandra; Trivedi, Apurva; Collier, Bryan

    2016-01-01

    The intensive care unit (ICU) trauma population is at high risk for complications associated with immobility. The purpose of this project was to compare ICU trauma patient outcomes before and after implementation of a structured progressive mobility (PM) protocol. Outcomes included hospital and ICU stays, ventilator days, falls, respiratory failure, pneumonia, or venous thromboembolism (VTE). In the preintervention cohort, physical therapy (PT) consults were placed 53% of the time. This rose to more than 90% during the postintervention period. PT consults seen within 24 hr rose from a baseline 23% pre- to 74%-94% in the 2 highest compliance postintervention months. On average, 40% of patients were daily determined to be too unstable for mobility per protocol guidelines-most often owing to elevated intracranial pressure. During PM sessions, there were no adverse events (i.e., extubation, hypoxia, fall). There were no significant differences in clinical outcomes between the 2 cohorts regarding hospital and ICU stays, average ventilator days, mortality, falls, respiratory failure, or pneumonia overall or within ventilated patients specifically. There was, however, a difference in the incidence of VTE between the preintervention cohort (21%) and postintervention cohort (7.5%) (p = .0004). A PM protocol for ICU trauma patients is safe and may reduce patient deconditioning and VTE complications in this high-risk population. Multidisciplinary commitment, daily protocol reinforcement, and active engagement of patients/families are the cornerstones to success in this ICU PM program. PMID:27618376

  8. Integrated Framework for Patient Safety and Energy Efficiency in Healthcare Facilities Retrofit Projects.

    PubMed

    Mohammadpour, Atefeh; Anumba, Chimay J; Messner, John I

    2016-07-01

    There is a growing focus on enhancing energy efficiency in healthcare facilities, many of which are decades old. Since replacement of all aging healthcare facilities is not economically feasible, the retrofitting of these facilities is an appropriate path, which also provides an opportunity to incorporate energy efficiency measures. In undertaking energy efficiency retrofits, it is vital that the safety of the patients in these facilities is maintained or enhanced. However, the interactions between patient safety and energy efficiency have not been adequately addressed to realize the full benefits of retrofitting healthcare facilities. To address this, an innovative integrated framework, the Patient Safety and Energy Efficiency (PATSiE) framework, was developed to simultaneously enhance patient safety and energy efficiency. The framework includes a step -: by -: step procedure for enhancing both patient safety and energy efficiency. It provides a structured overview of the different stages involved in retrofitting healthcare facilities and improves understanding of the intricacies associated with integrating patient safety improvements with energy efficiency enhancements. Evaluation of the PATSiE framework was conducted through focus groups with the key stakeholders in two case study healthcare facilities. The feedback from these stakeholders was generally positive, as they considered the framework useful and applicable to retrofit projects in the healthcare industry. PMID:27492415

  9. Metal-on-Metal Hip Arthroplasty: A Review of Adverse Reactions and Patient Management.

    PubMed

    Drummond, James; Tran, Phong; Fary, Camdon

    2015-01-01

    Recent alarming joint registry data highlighting increased revision rates has prompted further research into the area of metal-on-metal hip replacements and resurfacings. This review article examines the latest literature on the topic of adverse reactions to metal debris and summarises the most up-to-date guidelines on patient management. Adverse reactions to metal debris can cause significant damage to soft tissue and bone if not diagnosed early. Furthermore, not every patient with an adverse reaction to metal debris will be symptomatic. As such, clinicians must remain vigilant when assessing and investigating these patients in order to detect failing implants and initiate appropriate management. PMID:26132653

  10. Blood glucose management in the patient undergoing cardiac surgery: A review

    PubMed Central

    Reddy, Pingle; Duggar, Brian; Butterworth, John

    2014-01-01

    Both diabetes mellitus and hyperglycemia per se are associated with negative outcomes after cardiac surgery. In this article, we review these associations, the possible mechanisms that lead to adverse outcomes, and the epidemiology of diabetes focusing on those patients requiring cardiac surgery. We also examine outpatient and perioperative management of diabetes with the same focus. Finally, we discuss our own efforts to improve glycemic management of patients undergoing cardiac surgery at our institution, including keys to success, results of implementation, and patient safety concerns. PMID:25429332

  11. Effects of rehabilitation for pain relief in patients with rheumatoid arthritis: a systematic review

    PubMed Central

    Park, Youngju; Chang, Moonyoung

    2016-01-01

    [Purpose] The purpose of this study was to find evidence for the effectiveness of rehabilitation for pain relief in patients with rheumatoid arthritis. [Subjects and Methods] A systematic review was conducted of MEDLINE, The Cochrane Central Register of Controlled Trials (CENTRAL), and OVID, for studies published from July 2005 to July 2015. We extracted data regarding patients, intervention, comparison, and outcomes, and assessed the methodological quality of the data. [Results] Nine randomized controlled trials comparing the effects of pain relief in patients with rheumatoid arthritis were found. [Conclusion] Physical therapy and occupational therapy can reduce pain in rheumatoid arthritis. PMID:26957779

  12. Camouflage therapy workshop for pediatric dermatology patients: a review of 6 cases.

    PubMed

    Padilla-España, L; del Boz, J; Ramírez-López, M B; Fernández-Sánchez, M E

    2014-06-01

    Certain skin conditions, such as vitiligo, acne, vascular malformations, and surgical scars, can impair the quality of life of pediatric patients, especially adolescents-even to the point of hindering psychosocial development. We review the cases of 6 patients with discoloration or scarring, predominantly of the face, who attended our cosmetic camouflage workshops from January through December 2012. The quality-of-life impact of their skin disorder was assessed before and after workshop attendance. Cosmetic camouflage is an easily replicated, cheap, and noninvasive adjunctive treatment of great potential value in managing skin conditions that impair the physical and emotional well-being of pediatric patients. PMID:24369988

  13. Granuloma annulare and necrobiosis lipoidica with sequential occurrence in a patient: report and review of literature

    PubMed Central

    Rupley, Katherine A.; Riahi, Ryan R.; Hooper, Deirdre O’Boyle

    2015-01-01

    Granuloma annulare (GA) and necrobiosis lipoidica (NL) are granulomatous diseases of undetermined etiology. Rarely, both dermatoses have been reported to occur concomitantly in patients. GA and NL are characterized histologically by areas of necrobiosis of collagen. The two diseases share some common characteristics, which may suggest that these dermatoses could occur as a spectrum in some patients or possibly share a similar pathogenesis. We report on a 67-year-old Caucasian woman with a history of NL on the anterior shins that later developed lesions of GA on the breasts, trunk, and wrist. We also review the literature and discuss the characteristics of patients with concomitant GA and NL. PMID:25692078

  14. A Technological Review of the Instrumented Footwear for Rehabilitation with a Focus on Parkinson's Disease Patients.

    PubMed

    Maculewicz, Justyna; Kofoed, Lise Busk; Serafin, Stefania

    2016-01-01

    In this review article, we summarize systems for gait rehabilitation based on instrumented footwear and present a context of their usage in Parkinson's disease (PD) patients' auditory and haptic rehabilitation. We focus on the needs of PD patients, but since only a few systems were made with this purpose, we go through several applications used in different scenarios when gait detection and rehabilitation are considered. We present developments of the designs, possible improvements, and software challenges and requirements. We conclude that in order to build successful systems for PD patients' gait rehabilitation, technological solutions from several studies have to be applied and combined with knowledge from auditory and haptic cueing. PMID:26834696

  15. The level of association between functional performance status measures and patient-reported outcomes in cancer patients: a systematic review

    PubMed Central

    Andreotti, Charissa F.; Roberts, Kailey E.; Saracino, Rebecca M.; Hernandez, Marisol; Basch, Ethan

    2016-01-01

    Purpose The process of assessing patient symptoms and functionality using patient-reported outcomes (PROs) and functional performance status (FPS) is an essential aspect of patient-centered oncology research and care. However, PRO and FPS measures are often employed separately or inconsistently combined. Thus, the purpose of this study was to conduct a systematic review of the level of association between PRO and FPS measures to determine their differential or combined utility. Methods A systematic search was conducted using five databases (1966 to February 2014) to identify studies that described an association between PRO and FPS. Studies were excluded if they were non-cancer specific, did not include adults aged 18 or older, or were review articles. Publications were selected for review by consensus among two authors, with a third author arbitrating as needed. Results A total of 18 studies met inclusion criteria. FPS was primarily assessed by clinicians using the ECOG Performance Status or Karnofsky Performance Status measures. PROs were captured using a variety of measures, with numerous domains assessed (e.g., pain, fatigue, and general health status). Concordance between PROs and FPS measures was widely variable, falling in the low to moderate range (0.09–0.72). Conclusions Despite consistency in the method of capture of PROs or FPS, domain capture varied considerably across reviewed studies. Irrespective of the method of capturing PROs or FPS, the quantified level of association between these two areas was moderate at best, providing evidence that FPS and PRO assessments offer unique information to assist clinicians in their decision-making. PMID:26314706

  16. The role of antioxidant micronutrients in the rate of recovery of burn patients: a systematic review.

    PubMed

    Adjepong, Mary; Agbenorku, Pius; Brown, Patricia; Oduro, Ibok

    2016-01-01

    Burn injury can be detrimental to the health of individuals, meanwhile victims lose proteins and micronutrients in wound exudates. Victims also experience extensive protein catabolism. These make them prone to malnutrition. Burn patients also suffer a lot of emotional trauma that reduce nutrient intake. The aim of this paper was to review primary evidence on the effect of antioxidant micronutrients on the recovery rate of burn patients. Electronic databases such as PubMed, BioMed, and Cochrane were systematically searched between January 1, 2014, and January 30, 2014. Keywords include vitamin A, vitamin C, vitamin E, ascorbic acid, zinc, copper, selenium, tocopherol, carotenoids, dietary intake, supplementation, wound healing, infection, recovery rate, and burn patients. The systematic search was done to retrieve all published data from 1990 to 2013. A total of 518 journal articles were obtained, and after the removal of duplicates, reviews, commentaries, and studies with non-human subjects, 11 papers were accepted for review. The review considered only papers that were published, and there might be some unpublished data that may have been omitted. Generally, the wound healing time and infection rates were reduced by the administration of the antioxidant micronutrients. The review revealed that there was no such published work in developing countries and children were excluded from most studies. It was also stated clearly that there was no uniformity in burn management; hence, there is a need for more studies on burn management in various populations. PMID:27574687

  17. Design review report: AN valve pit upgrades for Project W-314, tank farm restoration and safe operations

    SciTech Connect

    Boes, K.A.

    1998-01-13

    This Design Review Report (DRR) documents the contractor design verification methodology and records associated with project W-314`s AN Valve Pit Upgrades design package. The DRR includes the documented comments and their respective dispositions for this design. Acceptance of the comment dispositions and closure of the review comments is indicated by the signatures of the participating reviewers. Project W-314, Tank Farm Restoration and Safe Operations, is a project within the Tank Waste Remediation System (TWRS) Tank Waste Retrieval Program. This project provides capital upgrades for the existing Hanford tank farms` waste transfer, instrumentation, ventilation, and electrical infrastructure systems. To support established TWRS programmatic objectives, the project is organized into two distinct phases. The initial focus of the project (i.e., Phase 1) is on waste transfer system upgrades needed to support the TWRS Privatization waste feed delivery system. Phase 2 of the project will provide upgrades to support resolution of regulatory compliance issues, improve tank infrastructure reliability, and reduce overall plant operating/maintenance costs. Within Phase 1 of the W-314 project, the waste transfer system upgrades are further broken down into six major packages which align with the project`s work breakdown structure. Each of these six sub-elements includes the design, procurement, and construction activities necessary to accomplish the specific tank farm upgrades contained within the package. The first package to be performed is the AN Valve Pit Upgrades package. The scope of the modifications includes new pit cover blocks, valve manifolds, leak detectors, transfer line connections (for future planned transfer lines), and special protective coating for the 241-AN-A and 241-AN-B valve pits.

  18. Medicus Deus: a review of factors affecting hospital library services to patients between 1790–1950

    PubMed Central

    Perryman, Carol

    2006-01-01

    Question: What are some of the historical societal, medical, and public health trends leading to today's provision of hospital library services to patients? Data Sources: Literature from the archives of the Bulletin of the Medical Library Association and other library sources, medical journals, primary historical documents, and texts from the history of medicine form the core of this review. Study Selection: The period of review extends from about 1790 through 1950 and focuses solely on trends in the United States. Of primary concern are explicitly documented examples that appear to illustrate the patient-physician relationship and those between librarians and their patient-patrons during the earliest years of the profession's development. Data Extraction: An historical timeline was created to allow the identification of major trends that may have affected library services. Multiple literature searches were conducted using library, medical, and health anthropology resources. When possible, primary sources were preferred over reviews. Main Results: Juxtapositioning historical events allows the reader to obtain an overview of the roots of consumer health services in medical libraries and to consider their potential legacy in today's health care libraries. Conclusion: This review article highlights early developments in hospital library service to patients. Further research is needed to verify a preliminary conclusion that in some medical library settings, services to the general public are shaped by the broader health care environment as it has evolved. PMID:16888658

  19. Instruments to assess patient satisfaction after teleconsultation and triage: a systematic review

    PubMed Central

    Allemann Iseli, Martina; Kunz, Regina; Blozik, Eva

    2014-01-01

    Background Patient satisfaction is crucial for the acceptance, use, and adherence to recommendations from teleconsultations regarding health care requests and triage services. Objectives Our objectives are to systematically review the literature for multidimensional instruments that measure patient satisfaction after teleconsultation and triage and to compare these for content, reliability, validity, and factor analysis. Methods We searched Medline, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for literature on these instruments. Two reviewers independently screened all obtained references for eligibility and extracted data from the eligible articles. The results were presented using summary tables. Results We included 31 publications, describing 16 instruments in our review. The reporting on test development and psychometric characteristics was incomplete. The development process, described by ten of 16 instruments, included a review of the literature (n=7), patient or stakeholder interviews (n=5), and expert consultations (n=3). Four instruments evaluated factor structure, reliability, and validity; two of those four demonstrated low levels of reliability for some of their subscales. Conclusion A majority of instruments on patient satisfaction after teleconsultation showed methodological limitations and lack rigorous evaluation. Users should carefully reflect on the content of the questionnaires and their relevance to the application. Future research should apply more rigorously established scientific standards for instrument development and psychometric evaluation. PMID:25028538

  20. Solitary central osteoma of mandible in a geriatric patient: Report and review

    PubMed Central

    Bhujbal, Ravi B.; Nayak, Ajay G.

    2016-01-01

    Solitary central osteomas of jaw are extremely rare lesions with only few previously documented cases. This paper reports a case of large solitary central osteoma involving mandible symphysis- parasymphysis region in an elderly female patient. A brief review of similar cases reported in the literature is also provided in this paper. Key words:Osteomas, osteogenic,bone, tumor, jaw, mandible. PMID:27034765

  1. The Tell-Tale Tasks: A Review of Saccadic Research in Psychiatric Patient Populations

    ERIC Educational Resources Information Center

    Gooding, Diane C.; Basso, Michele A.

    2008-01-01

    This review focuses on saccade research with adult psychiatric patients. It begins with an introduction of the various types of saccades and the tasks used to evoke them. The functional significance of the different types of eye movements is briefly discussed. Research findings regarding the saccadic performance of different adult psychiatric…

  2. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis.

    PubMed

    Fonseca, Nina Teixeira; Urbano, Jessica Julioti; Nacif, Sergio Roberto; Silva, Anderson Soares; Peixoto, Roger Andre Oliveira; Urbano, Giovanni Julioti; Oliveira, Ezequiel Fernandes; Santos, Israel Reis; Oliveira, Claudia Santos; Insalaco, Giuseppe; Oliveira, Luis Vicente Franco

    2016-07-01

    The purpose of this study was to conduct a systematic review of the available evidence on sleep disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD). [Subjects and Methods] Two independent reviewers performed a computer-assisted search of the MEDLINE, SciELO, LILACS, and BIREME Virtual Health Library medical databases from their inception to November 2015. [Results] One thousand one hundred twenty-six articles were found that met the inclusion criteria. Articles were excluded if they were not in English, the patients did not undergo HD, or the studies were not cross-sectional or clinical trials. After reading the full text, a further 300 studies were excluded because they did not use polysomnography. The remaining 18 studies with ESRD patients undergoing HD comprised 8 clinical trials and 10 cross-sectional studies. This systematic review followed the criteria outlined by the PRISMA declaration. [Conclusion] In this systematic review, a high prevalence of sleep disorders was observed in ESRD, including sleep-disordered breathing. This knowledge may enable health professionals to devise new strategies for the diagnosis and treatment of these patients, in order to reduce morbidity and mortality and improve their quality of life. PMID:27512289

  3. The Use of Errorless Learning Strategies for Patients with Alzheimer's Disease: A Literature Review

    ERIC Educational Resources Information Center

    Li, Ruijie; Liu, Karen P. Y.

    2012-01-01

    The aim of this article was to review the evidence of errorless learning on learning outcomes in patients with early-stage Alzheimer's disease. A computer-aided literature search from 1999 to 2011 was carried out using MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and PsycArticles. Keywords included…

  4. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis

    PubMed Central

    Fonseca, Nina Teixeira; Urbano, Jessica Julioti; Nacif, Sergio Roberto; Silva, Anderson Soares; Peixoto, Roger Andre Oliveira; Urbano, Giovanni Julioti; Oliveira, Ezequiel Fernandes; Santos, Israel Reis; Oliveira, Claudia Santos; Insalaco, Giuseppe; Oliveira, Luis Vicente Franco

    2016-01-01

    The purpose of this study was to conduct a systematic review of the available evidence on sleep disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD). [Subjects and Methods] Two independent reviewers performed a computer-assisted search of the MEDLINE, SciELO, LILACS, and BIREME Virtual Health Library medical databases from their inception to November 2015. [Results] One thousand one hundred twenty-six articles were found that met the inclusion criteria. Articles were excluded if they were not in English, the patients did not undergo HD, or the studies were not cross-sectional or clinical trials. After reading the full text, a further 300 studies were excluded because they did not use polysomnography. The remaining 18 studies with ESRD patients undergoing HD comprised 8 clinical trials and 10 cross-sectional studies. This systematic review followed the criteria outlined by the PRISMA declaration. [Conclusion] In this systematic review, a high prevalence of sleep disorders was observed in ESRD, including sleep-disordered breathing. This knowledge may enable health professionals to devise new strategies for the diagnosis and treatment of these patients, in order to reduce morbidity and mortality and improve their quality of life. PMID:27512289

  5. Evaluation of the Role of Enteral Nutrition in Managing Patients with Diabetes: A Systematic Review

    PubMed Central

    Ojo, Omorogieva; Brooke, Joanne

    2014-01-01

    The aim of this systematic review is to evaluate the role of enteral nutrition in managing patients with diabetes on enteral feed. The prevalence of diabetes is on the increase in the UK and globally partly due to lack of physical activities, poor dietary regimes and genetic susceptibility. The development of diabetes often leads to complications such as stroke, which may require enteral nutritional support. The provision of enteral feeds comes with its complications including hyperglycaemia which if not managed can have profound consequences for the patients in terms of clinical outcomes. Therefore, it is essential to develop strategies for managing patients with diabetes on enteral feed with respect to the type and composition of the feed. This is a systematic review of published peer reviewed articles. EBSCOhost Research, PubMed and SwetsWise databases were searched. Reference lists of identified articles were reviewed. Randomised controlled trials comparing enteral nutrition diabetes specific formulas with standard formulas were included. The studies which compared diabetes specific formulas (DSF) with standard formulas showed that DSF was more effective in controlling glucose profiles including postprandial glucose, HbA1c and insulinemic response. The use of DSF appears to be effective in managing patients with diabetes on enteral feed compared with standard feed. PMID:25412151

  6. The Prevalence of Body Dysmorphic Disorder in Patients Undergoing Cosmetic Surgery: a Systematic Review.

    PubMed

    Panayi, Andreana

    2015-09-01

    Body dysmorphic disorder (BDD) is a somatoform disorder characterised by a distressing obsession with an imagined or slight appearance defect, which can significantly impair normal day-to-day functioning. Patients with BDD often first present, and are hence diagnosed, in cosmetic surgery settings. Several studies have investigated the prevalence rate of BDD in the general population or have done so for patients referring to cosmetic medical centers. To date, however, no review has been undertaken to compare the prevalence in the general community versus in a cosmetic surgery setting. Despite the lack of such a review it is a commonly held belief that BDD is more common in patients seeking cosmetic surgery. The current study aims to review the available literature in order to investigate whether BDD is indeed more prevalent in patients requesting cosmetic surgery, and if that is the case, to provide possible reasons for the difference in prevalence. In addition this review provides evidence on the effectiveness of cosmetic surgery as a treatment of BDD. PMID:26417812

  7. Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach

    PubMed Central

    Barak, Michal; Bahouth, Hany; Leiser, Yoav; Abu El-Naaj, Imad

    2015-01-01

    According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient's airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Additionally, some of these patients may not yet have been cleared of a cervical spine injury, and all are regarded as having a full stomach and having an increased risk of regurgitation and pulmonary aspiration. The requirements of the intended maxillofacial operation may often preclude the use of an oral intubation tube, and alternative methods for securing the airway should be considered before the start of the surgery. In order to improve the clinical outcome of patients with maxillofacial trauma, cooperation between maxillofacial surgeons, anesthesiologists, and trauma specialists is needed. In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients. PMID:26161411

  8. Patient reporting of suspected adverse drug reactions: a review of published literature and international experience

    PubMed Central

    Blenkinsopp, A; Wilkie, P; Wang, M; Routledge, P A

    2007-01-01

    Aims To synthesize data from published studies and international experience to identify evidence of potential benefits and drawbacks of direct patient reporting of suspected adverse drug reactions (ADRs) by patients. Methods Structured search of MEDLINE, CINAHL and PsycINFO supplemented by internet searches and requests for information to key contacts. Results Seven studies (eight papers) were included in the review. None of the studies concerned spontaneous reporting by patients. Information on patient reporting systems was obtained for six countries, with summary data reported by four. Patient reports identified possible new ADRs that had not previously been reported by health professionals. The quality of patient reports appears to be similar to that of health professional reports. There is some evidence that patients report an ADR when they consider their health professional has not paid attention to their concerns. Patient reports may, at least initially, be more time consuming to process. Conclusions Overall, the evidence indicates that patient reporting of suspected ADRs has more potential benefits than drawbacks. Evaluation of patient reporting systems is needed to provide further evidence. PMID:17274788

  9. Information Needs Priorities in Patients Diagnosed With Cancer: A Systematic Review

    PubMed Central

    Tariman, Joseph D.; Doorenbos, Ardith; Schepp, Karen G.; Singhal, Seema; Berry, Donna L.

    2014-01-01

    Information-sharing is an integral part of cancer care. Several studies have examined the information needs of patients with various types of cancer. However, the priorities of information needs among patients with cancer have not been reported. A systematic review was performed to identify published studies that examined priorities of information needs in patients with cancer. PubMed (1966 to February 2012), PsycINFO (1967 to February 2012), and CINAHL (1982 to February 2012) databases were searched to access relevant medical, psychological, and nursing literature. Thirty studies involving patients with breast, prostate, lung, colorectal, gynecologic, hematologic, and other cancers revealed patients’ information needs priorities. The top three patient information priorities were related to prognosis, diagnosis, and treatment options. The top information priorities reported in this systematic review could serve as a start to elicit patients’ information needs and guide patient education across the cancer care continuum. Being able to prioritize the most-needed information can make patient encounters more meaningful and useful. PMID:24910808

  10. Clinical outcomes of implant therapy in ectodermal dysplasia patients: a systematic review.

    PubMed

    Wang, Y; He, J; Decker, A M; Hu, J C; Zou, D

    2016-08-01

    The purpose of this review was to determine the outcome of oral function reconstruction in ectodermal dysplasia (ED) patients who have received dental implant therapy. A search was made of the PubMed and Web of Science databases; key words used were "(ectodermal dysplasia) AND (implant OR implants)", with supplementary retrieval key words "dental implant", "zygomatic implant", "anodontia", and "edentulous". Patient age, use of bone graft, implant site, type of implant, and survival rate of the implants were included in the subsequent data analysis. Forty-five articles published between 1988 and October 2015 were included in this analysis. The cases of a total of 96 patients were retrieved (22 children and 74 adults); these patients received a total of 701 implants. Fourteen implants were removed during a median follow-up time of 24 months. The 24-month implant survival rate was 97.9% in adult subjects and 98.6% in children. Sixty-eight percent of adult patients underwent bone augmentation prior to implant placement. Based on this review, dental implants are commonly used in the oral reconstruction of ED patients. However, long-term data on bone augmentation and implant success are needed, as well as additional clinical evidence on bone resorption, the esthetic outcomes of implant therapy, and physiological considerations in ED patients. PMID:27052318

  11. Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis

    PubMed Central

    2013-01-01

    Background Delay in seeking care is a major impediment to effective management of tuberculosis (TB) in China. To elucidate factors that underpin patient and diagnostic delays in TB management, we conducted a systematic review and meta-analysis of factors that are associated with delays in TB care-seeking and diagnosis in the country. Methods This review was prepared following standard procedures of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and checklist. Relevant studies published up to November 2012 were identified from three major international and Chinese literature databases: Medline/PubMed, EMBASE and CNKI (China National Knowledge Infrastructure). Results We included 29 studies involving 38,947 patients from 17 provinces in China. Qualitative analysis showed that key individual level determinants of delays included socio-demographic and economic factors, mostly poverty, rural residence, lack of health insurance, lower educational attainment, stigma and poor knowledge of TB. Health facility determinants included limited availability of resources to perform prompt diagnosis, lack of qualified health workers and geographical barriers. Quantitative meta-analysis indicated that living in rural areas was a risk factor for patient delays (pooled odds ratio (OR) (95% confidence interval (CI)): 1.79 (1.62, 1.98)) and diagnostic delays (pooled OR (95% CI): 1.40 (1.23, 1.59)). Female patients had higher risk of patient delay (pooled OR (95% CI): 1.94 (1.13, 3.33)). Low educational attainment (primary school and below) was also a risk factor for patient delay (pooled OR (95% CI): 2.14 (1.03, 4.47)). The practice of seeking care first from Traditional Chinese Medicine (TMC) providers was also identified as a risk factor for diagnostic delay (pooled OR (95% CI): 5.75 (3.03, 10.94)). Conclusion Patient and diagnostic delays in TB care are mediated by individual and health facility factors. Population

  12. Patient's perceptions of the cannabis-psychosis link--a systematic review.

    PubMed

    Buadze, Anna; Kaiser, Stefan; Stohler, Rudolf; Roessler, Wulf; Seifritz, Erich; Liebrenz, Michael

    2012-01-01

    Over the past years a growing research effort has investigated the relation between cannabis use and schizophrenia at a neurobiological, epidemiological and clinical level. A number of systematic reviews and meta analyses have summarized the available evidence in the field. Conversely the patient's perception of the link between cannabis use and psychosis has been under investigation. Since patient's beliefs and attitudes strongly correlate with adherence to all forms of treatment, we conducted a systematic PUBMED database search for any English and German-language articles published until January 2012 that addressed patient's perception of a cannabis psychosis link. Six studies including psychotic subjects met inclusion criteria yielding a total sample of 97. The vast majority of patients with either schizophrenia or a recent psychosis disagreed with a causal link between cannabis use and their mental illness. We qualitatively reviewed the explanatory models underlying their views, which were multi-factorial, psychological, social, biological, esoteric and irrational factors. Most patient's believed that the temporal sequence of events did not clearly indicate a causal relationship for them. They thus discarded the hypothesis of a causal link between cannabis use and psychosis. Despite the heterogeneity of the included studies, findings are comparable and support the robustness of this review. Limitations and implications for clinicians and psychosis research are discussed. PMID:22716137

  13. A systematic review of patient-rated measures of radiodermatitis in breast cancer radiotherapy

    PubMed Central

    Schnur, Julie B.; Love, Bianca; Scheckner, Bari L.; Green, Sheryl; Wernicke, A. Gabriella; Montgomery, Guy H.

    2013-01-01

    During breast cancer radiotherapy, nearly all patients will experience radiodermatitis. Study objectives were to: 1) systematically review the literature on radiodermatitis and breast cancer; 2) summarize and describe patient-rated radiodermatitis measures; 3) determine whether consensus exists regarding subjective radiodermatitis measurement; and 4) provide recommendations for future research. PubMed and CINAHL were searched from their inception through August 2009. Study inclusion/exclusion criteria were: full abstract available; manuscript in English; focused on radiodermatitis resulting from breast cancer radiotherapy, and described a patient-rated empirical assessment of radiodermatitis. Three reviewers examined abstracts, and decisions about inclusion were reached by consensus. 22/237 mutually identified studies met selection criteria. Using a standardized abstraction form, three authors independently extracted relevant information. Results indicated that: 1) only 9% of the studies reviewed included a patient-rated measure; 2) generally, extant scales are very brief and focus almost exclusively on physical reactions, and 3) there is no “gold standard” measure of patient-rated radiodermatitis at this time. We conclude that significantly more research is needed to determine the best (most valid, reliable, sensitive, comprehensive) measure(s) to evaluate the experience of radiodermatitis from the patient’s perspective, and that further scale development efforts are needed. PMID:20838323

  14. A French multicentric study and review of pulmonary Nocardia spp. in cystic fibrosis patients.

    PubMed

    Rodriguez-Nava, Verónica; Durupt, Stéphane; Chyderiotis, Sandra; Freydière, Anne-Marie; Karsenty, Judith; de Montclos, Michèle; Reix, Philippe; Durieu, Isabelle; Nove-Josserand, Raphaele; Chiron, Raphael; Bremont, François; Têtu, Laurent; Murris, Marlène; Terru, Dominique; Godreuil, Sylvain; Bergeron, Emmanuelle; Freney, Jean; Boiron, Patrick; Vandenesch, François; Marchandin, Hélène; Segonds, Christine; Doléans-Jordheim, Anne

    2015-08-01

    Some bacterial species recovered from the airways of cystic fibrosis (CF) patients are indisputably associated with lung infections, whereas the clinical relevance of others, such as Nocardia spp., remains unclear. Sixteen French CF cases of colonization/infection with Nocardia spp. were reviewed in order to evaluate the epidemiology, the clinical impact and the potential treatment of these bacteria, and results were compared to those of the literature. Five Nocardia species were identified, Nocardia cyriacigeorgica being the major species (50 % of cases). At first isolation, Nocardia was the sole pathogen recovered in six patients. Seven patients presented pulmonary exacerbation. For 12 patients, antimicrobial treatment against Nocardia was started immediately, mainly based on cotrimoxazole (6 of the 12 cases). In this study, we highlight the heterogeneity of the clinical management of Nocardia spp. in CF. Guidelines for the clinical management of Nocardia infections in CF patients are proposed. PMID:25344657

  15. [Novel oral anticancer drugs: a review of adverse drug reactions, interactions and patient adherence].

    PubMed

    Bartal, Alexandra; Mátrai, Zoltán; Szucs, Attila; Belinszkaja, Galina; Langmár, Zoltán; Rosta, András

    2012-01-15

    Each aspect of oncological care is widely affected by the spread of oral anticancer agents, which raises several questions in terms of safe medication use and patient adherence. Over the past decade targeted therapies have appeared in clinical practice and revolutionized the pharmacological treatment of malignancies. Regular patient - doctor visits and proper patient education is crucial in order to comply with the therapy previously agreed upon with the oncologist, to increase patient adherence, to detect and to treat adverse effects in early stages. Since the information on the new medicines in Hungarian language is sparse it is the intention of the authors to give an overview of the basic knowledge, patient safety issues, adverse effects and interactions. Official drug information summaries and data on pharmacokinetics, interactions and adverse effects from the literature are reviewed as the basis for this overview. PMID:22217686

  16. Testicular feminization syndrome: a report of three Ethiopian patients and a brief review.

    PubMed Central

    Tsega, E.; Damtew, B.

    1979-01-01

    The clinical features of 3 Ethiopian patients presenting with the complete syndrome of testicular feminization are described. All 3 were seen because of primary amenorrhoea. At laparotomy, one patient had testes located intra-abdominally, a second lodged in the inguinal canals and a third as masses in the labia majora. Also, one of these patients had bilateral inguinal herniae, a usual feature of this syndrome. Since the incidence of malignancy is high among individuals with undescended testes, they were removed in 2 patients. In the third patient, however, the testes were not removed because of delay in development of secondary sex characteristics. The literature on testicular feminization is also briefly reviewed. Images Fig. 1 Fig. 2 Fig. 3 PMID:547282

  17. Testicular feminization syndrome: a report of three Ethiopian patients and a brief review.

    PubMed

    Tsega, E; Damtew, B

    1979-11-01

    The clinical features of 3 Ethiopian patients presenting with the complete syndrome of testicular feminization are described. All 3 were seen because of primary amenorrhoea. At laparotomy, one patient had testes located intra-abdominally, a second lodged in the inguinal canals and a third as masses in the labia majora. Also, one of these patients had bilateral inguinal herniae, a usual feature of this syndrome. Since the incidence of malignancy is high among individuals with undescended testes, they were removed in 2 patients. In the third patient, however, the testes were not removed because of delay in development of secondary sex characteristics. The literature on testicular feminization is also briefly reviewed. PMID:547282

  18. Centipede bite victims: a review of patients presenting to two emergency departments in Hong Kong.

    PubMed

    Fung, H T; Lam, S K; Wong, O F

    2011-10-01

    OBJECTIVE. To review the clinical characteristics of patients presenting after centipede bites in Hong Kong. DESIGN. Descriptive case series. SETTING. Emergency departments of two public hospitals in Hong Kong. PATIENTS. Patients presenting after centipede bites between 2006 and 2010. MAIN OUTCOME MEASURES. Demographics, time and locations of bites, symptoms and signs, treatments and outcomes. RESULTS. A total of 46 relevant patient records were retrieved. The bites were frequently at night, indoors, on lower limbs, and consistently resulted in pain. The majority of the victims were treated with analgesia, anti-histamines, and antibiotics. One patient developed necrosis and five re-attended for delayed pruritus and relapsed/recurrent swelling. CONCLUSIONS. Centipede bites are usually uncomplicated, but may lead to necrosis or delayed hypersensitive reactions. PMID:21979475

  19. Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians.

    PubMed

    Broderick-Forsgren, Kathleen; Hunter, Wynn G; Schulteis, Ryan D; Liu, Wen-Wei; Boggan, Joel C; Sharma, Poonam; Thomas, Steven; Zaas, Aimee; Bae, Jonathan

    2016-05-01

    Background Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program. Objective This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools-business cards and white boards-to improve provider identification. Methods This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use. Results We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P < .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P < .05 for all), but had no effect on photograph recognition. Conclusions Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools. PMID:27168887

  20. Clinical Immunology Review Series: An approach to the patient with recurrent superficial abscesses

    PubMed Central

    Johnston, S L

    2008-01-01

    ARTICLES PUBLISHED IN THIS CLINICAL IMMUNOLOGY REVIEW SERIES allergy in childhood, allergy diagnosis by use of the clinical immunology laboratory, anaphylaxis, angioedema, management of pulmonary disease in primary antibody deficiency, recurrent infections in childhood, recurrent infections in adulthood, recurrent oro-genital ulceration, recurrent superficial abscesses, urticaria, vasculitis/CTD Patients may be referred to the immunology clinic for investigation of recurrent superficial abscess formation. In the majority of adult patients this clinical presentation does not equate with an underlying primary immune deficiency. Nevertheless, recurrent mucocutaneous abscesses can be associated with significant morbidity and long-term complications, including scarring and fistula formation, and may be associated with underlying immune-mediated disease. This review sets out an approach to the patient with recurrent superficial abscesses, focusing on the differential diagnoses, investigation and management of both the common causes and those associated with specific immune deficiency. PMID:18422735

  1. Review of cases of patient risk associated with ginseng abuse and misuse

    PubMed Central

    Paik, Doo Jin; Lee, Chang Ho

    2014-01-01

    Ginseng has long been used as a functional food or therapeutic supplement and it is empirically known to be safe and nontoxic. During recent decades, a number of in vitro and in vivo experiments, as well as human studies have been conducted to prove the safety of various types of ginseng samples and their components. Clinical trials, case reports, and in vitro and in vivo research articles addressing the safety, toxicity, and other adverse events of ginseng application were selected and reviewed. Patient risks associated with ginseng abuse and misuse such as affective disorder, allergy, cardiovascular and renal toxicity, genital organ bleeding, gynecomastia, hepatotoxicity, hypertension, reproductive toxicity, and anticoagulant-ginseng interaction were reviewed and summarized. There are some cases of patient risk associated with ginseng abuse and misuse depending on patients' conditions although further investigation in more cases is required to clarify these issues. PMID:26045681

  2. Bench-to-bedside review: early tracheostomy in critically ill trauma patients.

    PubMed

    Shirawi, Nehad; Arabi, Yaseen

    2006-02-01

    A significant proportion of trauma patients require tracheostomy during intensive care unit stay. The timing of this procedure remains a subject of debate. The decision for tracheostomy should take into consideration the risks and benefits of prolonged endotracheal intubation versus tracheostomy. Timing of tracheostomy is also influenced by the indications for the procedure, which include relief of upper airway obstruction, airway access in patients with cervical spine injury, management of retained airway secretions, maintenance of patent airway and airway access for prolonged mechanical ventilation. This review summarizes the potential advantages of tracheostomy versus endotracheal intubation, the different indications for tracheostomy in trauma patients and studies examining early versus late tracheostomy. It also reviews the predictors of prolonged mechanical ventilation, which may guide the decision regarding the timing of tracheostomy. PMID:16356202

  3. Outcome of ureteroscopy for stone disease in patients with horseshoe kidney: Review of world literature

    PubMed Central

    Ishii, Hiro; Rai, Bhavan; Traxer, Olivier; Kata, Slawomir G.; Somani, Bhaskar K.

    2015-01-01

    Introduction and Objectives: The management of urolithiasis in patients with horseshoe kidney (HSK) is difficult. Stone formation occurred in 1:5 patients with HSK due to impaired urinary drainage and infections. Percutaneous nephrolithotomy and shock wave lithotripsy can be technically challenging due to altered anatomy. Materials and Methods: We conducted a systematic review of the literature to look at the role of ureteroscopy for stone management in these patients. We searched MEDLINE, PubMed and the Cochrane Library from January 1990 to April 2013 for results of ureteroscopy and stone treatment in HSK patients. Inclusion criteria were all English language articles reporting on ureteroscopy in patients with HSK. Data were extracted on the outcomes and complications. Results: A total of 3 studies was identified during this period. Forty-one patients with HSK underwent flexible ureteroscopy and stone treatment. The mean age was 42 with a male:female ratio nearly 3:1. The mean stone size was 16 mm (range: 3-35 mm). The mean operating time was 86 min with multiple stones seen in 15 patients. All 41 patients had a ureteral access sheath used and flexible ureteroscopy and holmium laser fragmentation done. Thirty-two (78%) patients were stone-free with a mean hospital stay of 1-day. Minor complications (Clavien I or II) were seen in 13 (32%) of which 6 had stent discomfort, 3 needed intravenous antibiotics for <24 h, 3 had hematuria of which 2 needed blood transfusion and one had pyelonephritis needing re-admission and antibiotics. There were no major complications found in the review. Conclusions: Retrograde stone treatment using ureteroscopy and lasertripsy in HSK patients can be performed with good stone clearance rate, but with a slightly higher complication rate. This procedure should, therefore, be done in high volume stone center with an experienced stone surgeon/team. PMID:26692667

  4. Pain in patients with COPD: a systematic review and meta-analysis

    PubMed Central

    van Dam van Isselt, Eléonore F; Groenewegen-Sipkema, Karin H; Spruit-van Eijk, Monica; Chavannes, Niels H; de Waal, Margot W M; Janssen, Daisy J A; Achterberg, Wilco P

    2014-01-01

    Objectives To systematically investigate the prevalence of pain, factors related with pain and pain management interventions in patients with chronic obstructive pulmonary disease (COPD). Design Systematic review and meta-analysis. Data sources and study eligibility criteria PubMed (MEDLINE), EMBASE, CINAHL and PsychINFO from 1966 to December 2013. Studies were included if they presented clinical data on pain or symptom burden in patients with COPD, or pain as a domain of quality of life (QoL). All types of study designs were included. Results Of the 1571 articles that were identified, 39 met the inclusion criteria and were included in this review. Fourteen studies focused on pain and symptom burden (including pain) in patients with COPD and 25 studies focused on QoL using a questionnaire that included a separate pain domain. Reported pain prevalence in high-quality studies ranged from 32 to 60%. Included studies report that pain is more prevalent in patients with COPD compared to participants from the general population. Comorbidity, nutritional status, QoL and several symptoms were related to pain. None of the included studies reported a significant relationship between lung function and pain prevalence or severity. However, studies investigating pain in patients with moderate COPD reported higher pain prevalence compared to studies in patients with severe of very severe COPD. Conclusions Although literature on this topic is limited and shows substantial heterogeneity, pain seems to be a significant problem in patients with COPD and is related to several other symptoms, comorbidity and QoL. Data synthesis suggests that pain is more prevalent in patients with moderate COPD compared to patients with severe or very severe COPD. Further research is needed and should focus on determining a more accurate pain prevalence, investigating the relationship between pain prevalence, disease severity and comorbidity and explore implementation and efficacy of pain management

  5. Contracts for field projects and supporting research on enhanced oil recovery. Progress review number 87

    SciTech Connect

    1997-10-01

    Approximately 30 research projects are summarized in this report. Title of the project, contract number, company or university, award amount, principal investigators, objectives, and summary of technical progress are given for each project. Enhanced oil recovery projects include chemical flooding, gas displacement, and thermal recovery. Most of the research projects though are related to geoscience technology and reservoir characterization.

  6. A retrospective review of patient factors, transfusion practices, and outcomes in patients with transfusion-associated circulatory overload.

    PubMed

    Lieberman, Lani; Maskens, Carolyn; Cserti-Gazdewich, Christine; Hansen, Mark; Lin, Yulia; Pendergrast, Jacob; Yi, Qi Long; Callum, Jeannie

    2013-10-01

    Transfusion-associated circulatory overload (TACO) is a common yet underrecognized and underreported complication of transfusion associated with significant morbidity and mortality. The objective of this study was to examine patient and transfusion characteristics in a cohort of TACO cases. A retrospective medical record review of 100 consecutive TACO episodes reported at 2 academic centers was performed. Information related to demographics, medical history, radiologic and echocardiographic investigations, infusion practices, reaction features, management, and outcome were collected. Ninety-eight cases were accessible for review. A history of congestive heart failure (41%), renal dysfunction (44%), and age more than 70 years (56%) were common in TACO patients. Suboptimal fluid status management and inappropriate infusion practices were often seen (eg, verbal orders, double red cell transfusions, rapid infusion rates, lack or improper timing of preemptive diuretics). The median volume of blood ordered was 500 mL, and the median volume of crystalloid or colloid (preceding 24 hours) was 2200 mL. A physician order specifying the infusion rate was documented in 50% of transfusion orders. Preemptive diuretics were ordered in only 29% of cases, most commonly introduced midway or after the transfusion at a dose of furosemide 20 mg intravenously. After TACO, 18% of patients required transfer to the intensive care unit, 8% suffered a major complication, and 2% died. Suboptimal ordering and infusion practices may be contributing to the high incidence and severity of TACO. Research in TACO prevention strategies, such as slow rates of infusion and preemptive diuretics, is warranted. PMID:24075097

  7. Patient satisfaction surveys in dental school clinics: a review and comparison.

    PubMed

    Ebn Ahmady, Arezoo; Pakkhesal, Mina; Zafarmand, A Hamid; Lando, Harry Alan

    2015-04-01

    Health care is becoming more patient-centered and, as a result, patients' experiences of care and assessment of satisfaction are taken more seriously. Patient satisfaction influences treatment cooperation, and better cooperation leads to healthier patients in the long term. This generalization clearly applies in the dental school clinic setting. Furthermore, dental school clinics' administrators and clinicians should know about the dimensions of their patient satisfaction in order to provide the highest quality of care. The aim of this study was to review studies published between 1980 and March 2014 to identify the dimensions used to measure patients' satisfaction when they receive services in dental school clinics. The PubMed database was used to access published studies using patient satisfaction surveys in dental school clinics, and the dimensions used in these surveys were then categorized. Through several stages of searching in PubMed, the authors selected 41 articles from a total of 730; after further critical appraisal, nine articles were retained. Five dimensions included in patient surveys were identified: quality, interaction, access, environment, and cost. Determining the dimensions used in patient satisfaction surveys in dental school clinics can assist academic dental institutions in providing the highest quality of care. PMID:25838009

  8. Quality of Life in Patients with an Implantable Cardioverter Defibrillator: A Systematic Review

    PubMed Central

    Tomzik, Juliane; Koltermann, Katharina C.; Zabel, Markus; Willich, Stefan N.; Reinhold, Thomas

    2015-01-01

    Despite the indisputable mortality advantages of implantable cardioverter defibrillators (ICDs), no consensus exists regarding their impact on quality of life (QoL). This systematic review investigates differences in QoL between patients with ICDs and controls. We systematically searched the MEDLINE, EMBASE, Cochrane, Web of Science, and PsychINFO databases. Articles were included if they were published after the year 2000 and reported on original studies with a control group. Five randomized controlled trials with a total of 5,138 patients and 10 observational studies with a total of 1,513 patients met the inclusion criteria. Nine studies found comparable QoL for ICD recipients and patients in the control groups, three studies found an increased QoL for ICD patients, and three studies found a decreased QoL for ICD patients. The question of whether QoL relates to ICD therapy cannot be answered conclusively due to the heterogeneity of the existing studies. Lower QoL was apparent among patients with an ICD who experienced several device discharges. Medical staff should be particularly aware of the signs of both psychological and physical disorders in these patients. Further investigations on QoL in ICD patients are desirable, but ethical reasons restrict the conduct of randomized trials. PMID:26664905

  9. Organizing Pneumonia in Rheumatoid Arthritis Patients: A Case-Based Review

    PubMed Central

    Mori, Shunsuke; Koga, Yukinori; Sugimoto, Mineharu

    2015-01-01

    We treated 21 patients with organizing pneumonia (OP) associated with rheumatoid arthritis (RA) or related to biological disease-modifying antirheumatic drugs (DMARDs) at our institution between 2006 and 2014. Among these cases, 3 (14.3%) preceded articular symptoms of RA, 4 (19.0%) developed simultaneously with RA onset, and 14 (66.7%) occurred during follow-up periods for RA. In the case of OP preceding RA, increased levels of anti-cyclic citrullinated peptide antibodies and rheumatoid factor were observed at the OP onset. RA disease activity was related to the development of OP in the simultaneous cases. In the cases of OP developing after RA diagnosis, 10 of 14 patients had maintained low disease activity with biological DMARD therapy at the OP onset, and among them, 6 patients developed OP within the first year of this therapy. In the remaining four patients, RA activity was not controlled at the OP onset. All patients responded well to systemic steroid therapy, but two patients suffered from relapses of articular and pulmonary symptoms upon steroid tapering. In most of the RA patients, DMARD therapy was introduced or restarted during the steroid tapering. We successfully restarted a biological DMARD that had not been previously used for patients whose RA would otherwise have been difficult to control. In this study, we also perform a review of the literature on RA-associated or biological DMARD-related OP and discuss the pathogenesis and management of OP occurring in RA patients. PMID:26543387

  10. Patient Compliance in Home-Based Self-Care Telehealth Projects.

    PubMed

    Maeder, Anthony; Poultney, Nathan; Morgan, Gary; Lippiatt, Robert

    2015-12-01

    This paper presents the findings of a literature review on patient compliance in home-based self-care telehealth monitoring situations, intended to establish a knowledge base for this aspect which is often neglected alongside more conventional clinical, economic and service evaluations. A systematic search strategy led to 72 peer-reviewed published scientific papers being selected as most relevant to the topic, 58 of which appeared in the last 10 years. Patient conditions in which most evidence for compliance was found were blood pressure, heart failure and stroke, diabetes, asthma, chronic obstructive pulmonary disease and other respiratory diseases. In general, good compliance at the start of a study was found to drop off over time, most rapidly in the period immediately after the start. Success factors identified in the study included the extent of patient health education, telehealth system implementation style, user training and competence in system usage, active human support from the healthcare provider and maintaining strong participant motivation. PMID:26556057

  11. Tri-State Synfuels Project Review: Volume 12. Fluor project status. [Proposed Henderson, Kentucky coal to gasoline plant; engineering

    SciTech Connect

    Not Available

    1982-06-01

    The purpose of this report is to document and summarize activities associated with Fluor's efforts on the Tri-State Synfuels Project. The proposed facility was to be coal-to-transport fuels facility located in Henderson, Kentucky. Tri-State Synfuels Company was participating in the project as a partner of the US Department of Energy per terms of a Cooperative Agreement resulting from DOE's synfuel's program solicitation. Fluor's initial work plan called for preliminary engineering and procurement services to the point of commitment for construction for a Sasol Fischer-Tropsch plant. Work proceeded as planned until October 1981 when results of alternative coal-to-methanol studies revealed the economic disadvantage of the Synthol design for US markets. A number of alternative process studies followed to determine the best process configuration. In January 1982 Tri-State officially announced a change from Synthol to a Methanol to Gasoline (MTG) design basis. Further evaluation and cost estimates for the MTG facility eventually led to the conclusion that, given the depressed economic outlook for alternative fuels development, the project should be terminated. Official announcement of cancellation was made on April 13, 1982. At the time of project cancellation, Fluor had completed significant portions of the preliminary engineering effort. Included in this report are descriptions and summaries of Fluor's work during this project. In addition location of key project data and materials is identified and status reports for each operation are presented.

  12. The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: A systematic review

    PubMed Central

    Eechaute, Christophe; Vaes, Peter; Van Aerschot, Lieve; Asman, Sara; Duquet, William

    2007-01-01

    Background The assessment of outcomes from the patient's perspective becomes more recognized in health care. Also in patients with chronic ankle instability, the degree of present impairments, disabilities and participation problems should be documented from the perspective of the patient. The decision about which patient-assessed instrument is most appropriate for clinical practice should be based upon systematic reviews. Only rating scales constructed for patients with acute ligament injuries were systematically reviewed in the past. The aim of this study was to review systematically the clinimetric qualities of patient-assessed instruments designed for patients with chronic ankle instability. Methods A computerized literature search of Medline, Embase, Cinahl, Web of Science, Sport Discus and the Cochrane Controlled Trial Register was performed to identify eligible instruments. Two reviewers independently evaluated the clinimetric qualities of the selected instruments using a criteria list. The inter-observer reliability of both the selection procedure and the clinimetric evaluation was calculated using modified kappa coefficients. Results The inter-observer reliability of the selection procedure was excellent (k = .86). Four instruments met the eligibility criteria: the Ankle Joint Functional Assessment Tool (AJFAT), the Functional Ankle Outcome Score (FAOS), the Foot and Ankle Disability Index (FADI) and the Functional Ankle Ability Measure (FAAM). The inter-observer reliability of the quality assessment was substantial to excellent (k between .64 and .88). Test-retest reliability was demonstrated for the FAOS, the FADI and the FAAM but not for the AJFAT. The FAOS and the FAAM met the criteria for content validity and construct validity. For none of the studied instruments, the internal consistency was sufficiently demonstrated. The presence of floor- and ceiling effects was assessed for the FAOS but ceiling effects were present for all subscales

  13. The Utah Remote Monitoring Project: Improving Health Care One Patient at a Time

    PubMed Central

    Lenert, Leslie; Petersen, Marta; Woolsey, Sarah; McAdam-Marx, Carrie; Coursey, Jeffrey M.; Whittaker, Thomas C.; Hyer, Christian; LaMarche, Deb; Carroll, Patricia; Chuy, Libbey

    2014-01-01

    Abstract Background: The expanding role of technology to augment diabetes care and management highlights the need for clinicians to learn about these new tools. As these tools continue to evolve and enhance improved outcomes, it is imperative that clinicians consider the role of telemonitoring, or remote monitoring, in patient care. This article describes a successful telemonitoring project in Utah. Subjects and Methods: This was a nonrandomized prospective observational preintervention–postintervention study, using a convenience sample. Patients with uncontrolled diabetes and/or hypertension from four rural and two urban primary care clinics and one urban stroke center participated in a telemonitoring program. The primary clinical outcome measures were changes in hemoglobin A1C (A1C) and blood pressure. Other outcomes included fasting lipids, weight, patient engagement, diabetes knowledge, hypertension knowledge, medication adherence, and patient perceptions of the usefulness of the telemonitoring program. Results: Mean A1C decreased from 9.73% at baseline to 7.81% at the end of the program (P<0.0001). Systolic blood pressure also declined significantly, from 130.7 mm Hg at baseline to 122.9 mm Hg at the end (P=0.0001). Low-density lipoprotein content decreased significantly, from 103.9 mg/dL at baseline to 93.7 mg/dL at the end (P=0.0263). Other clinical parameters improved nonsignificantly. Knowledge of diabetes and hypertension increased significantly (P<0.001 for both). Patient engagement and medication adherence also improved, but not significantly. Per questionnaires at study end, patients felt the telemonitoring program was useful. Conclusions: Telemonitoring improved clinical outcomes and may be a useful tool to help enhance disease management and care of patients with diabetes and/or hypertension. PMID:24991923

  14. A systematic review of patient acceptance of screening for oral cancer outside of dental care settings.

    PubMed

    Paudyal, Priyamvada; Flohr, Francesca D; Llewellyn, Carrie D

    2014-10-01

    This systematic review summarised the literature on patient acceptability of screening for oral cancer outside dental care settings. A comprehensive search of relevant literature was performed in EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, CINAHAL, psycINFO, CANCERLIT and BNI to identify relevant articles published between 1975 and Dec 2013. Studies reporting acceptability of oral cancer screening to undiagnosed individuals attending non-dental settings were eligible for inclusion. A total of 2935 references were initially identified from the computerised search but 2217 were excluded after screening the titles. From the abstracts of the remaining 178 articles, 47 full text articles were retrieved for further scrutiny, and 12 studies were found to be eligible for inclusion. In these studies, knowledge about oral cancer, anxiety related to the screening process, preference for care provision, and financial cost were influencing factors for the acceptance of screening. Written information provided to patients in primary care was reported to boost immediate knowledge levels of oral cancer, lessen anxiety, and increase intentions for screening. The majority of screening methods were entirely acceptable to patients; lack of acceptability from the patients' viewpoint was not a significant barrier to carrying out opportunistic screening of high-risk populations. In conclusion, the available evidence suggests that acceptance of, and satisfaction with oral cancer screening is high, particularly where patients have previously been educated about oral cancer. Further research focusing on patient's preferences would enable streamlining of the approach to oral cancer screening taken by any national programme. PMID:25127201

  15. Patient and program factors that bridge the detoxification-treatment gap: a structured evidence review.

    PubMed

    Timko, Christine; Below, Maureen; Schultz, Nicole R; Brief, Deborah; Cucciare, Michael A

    2015-05-01

    Although completion of detoxification (detox) and a successful transition from detox to substance use disorder (SUD) treatment and/or mutual-help groups are associated with better SUD outcomes, many patients do not complete detox or do not receive SUD care following detox. The purpose of this structured evidence review, summarizing data extraction on a yield of 26 articles, is to identify patient, program, and system factors associated with the outcomes of completion of alcohol detox and successful transitions from alcohol detox to SUD treatment and mutual-help group participation. The review found wide variability among studies in the rates at which patients complete a detox episode (45 to 95%) and enter SUD treatment or mutual-help groups after detox (14 to 92%). Within program factors, behavioral practices that contribute to both detox completion and transitioning to SUD care after detox entail involving the patient's family and utilizing motivational-based approaches. Such practices should be targeted at younger patients, who are less likely to complete detox. Although more studies using a randomized controlled trial design are needed, the evidence suggests that barriers to detox completion and transition to SUD care can be overcome to improve patient outcomes. PMID:25530425

  16. Health-related quality of life in Guillain-Barré syndrome patients: a systematic review.

    PubMed

    Darweesh, Sirwan K L; Polinder, Suzanne; Mulder, Maxim J H L; Baena, Cristina P; van Leeuwen, Nikki; Franco, Oscar H; Jacobs, Bart C; van Doorn, Pieter A

    2014-03-01

    Guillain-Barré syndrome (GBS) encompasses a broad spectrum of health-related quality of life (HRQL) determinants, including mobility, fatigue, pain, and depression. We systematically reviewed the literature on functional outcome domains in which GBS patients experience limitations in the short and long terms and evaluated determinants of HRQL in GBS patients. MEDLINE and EMBASE were systematically searched by two independent reviewers for articles covering HRQL data of GBS patients. Of 730 abstracts screened, 17 articles covering data of 14 studies matched the selection criteria. The included articles showed that many GBS patients experienced physical limitations, even years after the acute phase of the disease, while results were inconsistent for perceived levels of pain, fatigue, and general mental well-being. Only three papers covered HRQL assessments at more than one time point, generally showing large improvements in HRQL in the first year after GBS onset, but not thereafter. We appraised the methodological quality of included studies using a 13-item checklist; none of the articles fulfilled all items and only seven articles presented data on correlations between HRQL and determinants. In conclusion, the majority of studies on HRQL in GBS patients are cross-sectional and of low methodological quality. This paper provides guidance for much needed high-quality studies on patterns of patient-perceived recovery after GBS onset. PMID:24456426

  17. A review of surgical strategies for penile prosthesis implantation in patients with Peyronie's disease.

    PubMed

    Anaissie, James; Yafi, Faysal A

    2016-06-01

    The introduction of the inflatable penile prosthesis (IPP) has revolutionized the treatment of patients with both Peyronie's disease (PD) and erectile dysfunction (ED). A thorough literature review was performed in order to review the surgical strategies used to treat PD, using the PubMed online database with the keywords "penile prosthesis", "surgical management" and "Peyronie's disease". Patient satisfaction rates of 72-100% and partner satisfaction rates of 89% have been reported in the literature, although strong preoperative education may be needed to prepare patients for risks such as penile shortening, seen in up to 54% of patients. Three-piece IPPs are most commonly used, and when comparing the two most popular models (AMS 700 CX vs. Coloplast Titan), no significant differences were seen in functional outcomes or patient satisfaction. Simple insertion of an IPP has been shown to resolve curvature in 33-90% of patients, but surgeons may often need to also utilize ancillary straightening procedures for residual curvatures. Manual modeling can correct residual curvature with an 86-100% success rate, but with a 4% risk of urethral injury. When the post-modeling residual curvature exceeds 30 degrees, a plaque-releasing incision or plication is recommended to further reduce curvature. Grafting is recommended if the resulting incisional defect is larger than two centimeters. Alternative straightening techniques such as plication prior to IPP insertion, endoscopic plaque resection, the "scratch technique" and bone saw plaque incision have also been described. PMID:27298781

  18. Rubinstein-Taybi syndrome: Clinical profile of 11 patients and review of literature

    PubMed Central

    Kumar, Suresh; Suthar, Renu; Panigrahi, Inusha; Marwaha, Ram K.

    2012-01-01

    BACKGROUND: Rubinstein-Taybi syndrome (RSTS) is a rare congenital neurodevelopmental disorder, characterized by postnatal growth deficiency, typical dysmorphic features, broad thumbs and toes, and mental retardation. Very few cases are reported in literature from developing countries. Diagnosis is often delayed due to non-familiarity with the characteristic features of this syndrome. AIMS: To report 11 cases of RSTS and to review the current literature. SETTINGS AND DESIGN: Retrospective study conducted in genetic and metabolic unit of a tertiary care teaching hospital in north India over a period of 3½ years. MATERIALS AND METHODS: 11 patients with diagnosis of RSTS were identified, and their case sheets were reviewed. RESULTS: Developmental delay was presenting complaint in 10 patients, and seizure in 1 case. 7 patients had microcephaly (head circumference below −3 SD), and a prominent beaked nose was seen in 9 patients. The intelligence quotient (IQ) varied from 22-62 in 7 patients who had mental retardation. The most notable features in hands were broadness, shortening, and flattening of the distal phalanx of thumbs or great toes. Additionally, we also noted webbing of neck, microphthalmia, and pachygyria (on MRI brain) in 1 patient each. CONCLUSIONS: The diagnosis of RSTS is primarily clinical and based on characteristic phenotype that is often combined with a variety of somatic anomalies. An early diagnosis facilitates appropriate genetic counseling and in planning the management. PMID:23162289

  19. Patient Values and Preferences in Decision Making for Antithrombotic Therapy: A Systematic Review

    PubMed Central

    Mulla, Sohail; Akl, Elie A.; Jankowski, Milosz; Vandvik, Per Olav; Ebrahim, Shanil; McLeod, Shelley; Bhatnagar, Neera; Guyatt, Gordon H.

    2012-01-01

    Background: Development of clinical practice guidelines involves making trade-offs between desirable and undesirable consequences of alternative management strategies. Although the relative value of health states to patients should provide the basis for these trade-offs, few guidelines have systematically summarized the relevant evidence. We conducted a systematic review relating to values and preferences of patients considering antithrombotic therapy. Methods: We included studies examining patient preferences for alternative approaches to antithrombotic prophylaxis and studies that examined, in the context of antithrombotic prophylaxis or treatment, how patients value alternative health states and experiences with treatment. We conducted a systematic search and compiled structured summaries of the results. Steps in the process that involved judgment were conducted in duplicate. Results: We identified 48 eligible studies. Sixteen dealt with atrial fibrillation, five with VTE, four with stroke or myocardial infarction prophylaxis, six with thrombolysis in acute stroke or myocardial infarction, and 17 with burden of antithrombotic treatment. Conclusion: Patient values and preferences regarding thromboprophylaxis treatment appear to be highly variable. Participant responses may depend on their prior experience with the treatments or health outcomes considered as well as on the methods used for preference elicitation. It should be standard for clinical practice guidelines to conduct systematic reviews of patient values and preferences in the specific content area. PMID:22315262

  20. Antibiotic efficacy in patients with a moderate probability of acute rhinosinusitis: a systematic review.

    PubMed

    Burgstaller, Jakob M; Steurer, Johann; Holzmann, David; Geiges, Gabriel; Soyka, Michael B

    2016-05-01

    The aim of this systematic review was to synthesize the results of original studies assessing antibiotic efficacy at different time points after initiating treatment in patients with a moderate probability of acute bacterial rhinosinusitis. We searched the Cochrane library for systematic reviews on the efficacy of antibiotic treatment in patients with acute rhinosinusitis (ARS). Only randomized controlled trials (RCTs) that compared treatment of any antibiotic with placebo were included. The synthesis of the results of six RCTs showed a benefit of antibiotic treatment compared to placebo for the rate of improvement after 3 [pooled odds ratio (OR) 2.78 (95 % confidence interval (CI) 1.39-5.58)] and 7 [OR 2.29 (95 % CI 1.19-4.41)] days after initiation in patients with symptoms and signs of ARS lasting for 7 or more days. After 10 days [pooled OR 1.36 (95 % CI 0.66-2.90)], improvement rates did not differ significantly between patients treated with or without antibiotics. Compared to placebo, antibiotic treatment relieves symptoms in a significantly higher proportion of patients within the first days of treatment. Reporting an overall average treatment efficacy may underestimate treatment benefits in patients with a self-limiting illness. PMID:25597034

  1. How Patients Take Malaria Treatment: A Systematic Review of the Literature on Adherence to Antimalarial Drugs

    PubMed Central

    Bruxvoort, Katia; Goodman, Catherine; Kachur, S. Patrick; Schellenberg, David

    2014-01-01

    Background High levels of patient adherence to antimalarial treatment are important in ensuring drug effectiveness. To achieve this goal, it is important to understand levels of patient adherence, and the range of study designs and methodological challenges involved in measuring adherence and interpreting results. Since antimalarial adherence was reviewed in 2004, there has been a major expansion in the use of artemisinin-based combination therapies (ACTs) in the public sector, as well as initiatives to make them more widely accessible through community health workers and private retailers. These changes and the large number of recent adherence studies raise the need for an updated review on this topic. Objective We conducted a systematic review of studies reporting quantitative results on patient adherence to antimalarials obtained for treatment. Results The 55 studies identified reported extensive variation in patient adherence to antimalarials, with many studies reporting very high adherence (90–100%) and others finding adherence of less than 50%. We identified five overarching approaches to assessing adherence based on the definition of adherence and the methods used to measure it. Overall, there was no clear pattern in adherence results by approach. However, adherence tended to be higher among studies where informed consent was collected at the time of obtaining the drug, where patient consultations were directly observed by research staff, and where a diagnostic test was obtained. Conclusion Variations in reported adherence may reflect factors related to patient characteristics and the nature of their consultation with the provider, as well as methodological variations such as interaction between the research team and patients before and during the treatment. Future studies can benefit from an awareness of the impact of study procedures on adherence outcomes, and the identification of improved measurement methods less dependent on self-report. PMID:24465418

  2. A Systematic Review of Music Therapy Practice and Outcomes with Acute Adult Psychiatric In-Patients

    PubMed Central

    Carr, Catherine; Odell-Miller, Helen; Priebe, Stefan

    2013-01-01

    Background and Objectives There is an emerging evidence base for the use of music therapy in the treatment of severe mental illness. Whilst different models of music therapy have been developed in mental health care, none have specifically accounted for the features and context of acute in-patient settings. This review aimed to identify how music therapy is provided for acute adult psychiatric in-patients and what outcomes have been reported. Review Methods A systematic review using medical, psychological and music therapy databases. Papers describing music therapy with acute adult psychiatric in-patients were included. Analysis utilised narrative synthesis. Results 98 papers were identified, of which 35 reported research findings. Open group work and active music making for nonverbal expression alongside verbal reflection was emphasised. Aims were engagement, communication and interpersonal relationships focusing upon immediate areas of need rather than longer term insight. The short stay, patient diversity and institutional structure influenced delivery and resulted in a focus on single sessions, high session frequency, more therapist direction, flexible use of musical activities, predictable musical structures, and clear realistic goals. Outcome studies suggested effectiveness in addressing a range of symptoms, but were limited by methodological shortcomings and small sample sizes. Studies with significant positive effects all used active musical participation with a degree of structure and were delivered in four or more sessions. Conclusions No single clearly defined model exists for music therapy with adults in acute psychiatric in-patient settings, and described models are not conclusive. Greater frequency of therapy, active structured music making with verbal discussion, consistency of contact and boundaries, an emphasis on building a therapeutic relationship and building patient resources may be of particular importance. Further research is required to

  3. Worsening renal function in patients with baseline renal impairment treated with intravenous voriconazole: A systematic review.

    PubMed

    Turner, R Brigg; Martello, Jay L; Malhotra, Ashim

    2015-10-01

    The objective of this paper was to review the risk of worsening renal function in patients with pre-existing renal impairment receiving intravenous voriconazole (IVV). Controversy exists regarding the cause and risk of renal dysfunction in patients treated with IVV. Whilst some studies implicate renally excreted cyclodextrin, a pharmaceutical formulation stabiliser, as the cause of renal dysfunction following voriconazole administration, others provide contradicting evidence. Here we analyse the available literature to gain an insight into the significance of renal toxicity in patients treated with IVV. PubMed was searched for relevant studies to December 2014. To account for publication bias, abstracts from the Interscience Conference on Antimicrobial Agents and Chemotherapy, the Infectious Diseases Society of America/ID Week, and the European Congress of Clinical Microbiology and Infectious Diseases from 2008-2014 were reviewed. Bibliographies of all identified articles were reviewed and cross-referenced for additional sources. Seven retrospective studies were identified for inclusion in the review; no prospective studies were identified. Based on the available evidence, we conclude that there is no strong evidence suggesting an increased incidence of worsening renal function with IVV use. No study thus far has provided direct conclusive evidence for cellular and physiological renal toxicity due to IVV at clinically prevalent doses. PMID:26253129

  4. Psychosocial interventions for patients with advanced cancer – a systematic review of the literature

    PubMed Central

    Uitterhoeve, R J; Vernooy, M; Litjens, M; Potting, K; Bensing, J; De Mulder, P; van Achterberg, T

    2004-01-01

    Advanced cancer is associated with emotional distress, especially depression and feelings of sadness. To date, it is unclear which is the most effective way to address these problems. This review focuses on the effects of psychosocial interventions on the quality of life (QoL) of patients with advanced cancer. It was hypothesised that patients will benefit from psychosocial interventions by improving QoL, especially in the domain of emotional functioning. The review was conducted using systematic review methodology involving a systematic search of the literature published between 1990 and 2002, quality assessment of included studies, systematic data extraction and narrative data synthesis. In all, 10 randomised controlled studies involving 13 trials were included. Overall interventions and outcome measures across studies were heterogeneous. Outcome measures, pertaining to the QoL dimension of emotional functioning, were most frequently measured. A total of 12 trials evaluating behaviour therapy found positive effects on one or more indicators of QoL, for example, depression. The results of the review support recommendation of behaviour therapy in the care of patients with advanced cancer. PMID:15316564

  5. A narrative review of the published chiropractic literature regarding older patients from 2001–2010

    PubMed Central

    Gleberzon, Brian J.

    2011-01-01

    Introduction: The purpose of this article was to perform a narrative review of the chiropractic literature regarding older patients between 2001 and 2010. Methods: A three step search strategy of the literature involved electronic searching, hand searching and reference tracking. Results: One hundred and eighty eight articles germane to chiropractic geriatric practice and education were retrieved. Discussion: Compared to the review of the literature conducted prior to 2000, the number of references on chiropractic geriatric education increased from 3 to 11, the number of demographic studies increased from 9 to 18, the number of case reports increased from 25 to 83, the number of clinical trials increased from 4 to 21 (only two RCTs found) and the number of references on clinical guidelines and general clinical information increased from 18 to 55. Conclusion: This review found 188 retrievable articles available to practitioners to effectively care plan for their older patients, a better than three fold increase in the number of references found during a similar review conducted at the end of the previous decade. However, there is clearly a gap in the evidence base of chiropractic geriatric care, particularly the under-representation of clinical trials of all kinds involving older chiropractic patients. PMID:21629461

  6. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

    PubMed Central

    Doyle, Cathal; Lennox, Laura; Bell, Derek

    2013-01-01

    Objective To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Design Systematic review. Setting A wide range of settings within primary and secondary care including hospitals and primary care centres. Participants A wide range of demographic groups and age groups. Primary and secondary outcome measures A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. Results This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. Conclusions The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness. PMID:23293244

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

    PubMed Central

    Hesselink, Gijs; Berben, Sivera; Beune, Thimpe

    2016-01-01

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

  8. Striking a balance between national interests and patients' needs: cross-border projects meeting European challenges.

    PubMed

    Burger, Renate; Kostera, Thomas

    2010-01-01

    The article deals with the new opportunities for EU member state citizens to go abroad for medical treatment. The European Court of Justice has facilitated the access to medical treatment for EU citizens in other EU states. This development has worried national governments since they feared reduced control in their healthcare systems. The cross-border project "healthacross" between Austria and the Czech Republic however illustrates in which way authorities can respond to patients needs in two different countries. Nevertheless a plethora of administrative and practical problems have to be solved for cross-border co-operation in the provision of healthcare. PMID:21391444

  9. Evaluation of standardized teaching plans for hospitalized pediatric patients: a performance improvement project.

    PubMed

    Blagojevic, Joanne; Stephens, Sigrid

    2008-01-01

    Discharge teaching in a pediatric hospital setting is difficult because the situation involves multiple learners, time constraints, and differing skill levels of nurse teachers. Shortened length of stay forces nurses to complete patient education efficiently. Unstructured education can lead to failed learning, as evidenced by readmissions and postdischarge feedback. A performance improvement project was conducted to evaluate the effectiveness of standardized teaching plans for diabetes mellitus and infant cardiopulmonary resuscitation. Preliminary data indicated a passing score of at least 90% on posttests by all learners, suggesting that standardized teaching plans may help nurses complete prescribed discharge teaching. PMID:18507236

  10. The effectiveness of exercise programmes in patients with multiple myeloma: A literature review.

    PubMed

    Gan, J H; Sim, C Y L; Santorelli, L A

    2016-02-01

    A limited number of clinical studies have investigated the effectiveness of participation in exercise training programmes for patients with multiple myeloma (MM), exploring the different biomedical, physical, psychological and quality of life. The aim of this literature review is to evaluate current quantitative and qualitative evidence concerning the effectiveness of participation in exercise programmes for patients with MM in improving physiological and/or psychological status. A literature search encompassing studies published between January 1998 and July 2013 was conducted through ten electronic databases. This search was further expanded through citation chaining, manual grey literature searches, and peer review consultation. In total, seven interventional studies were identified and appraised using Critical Appraisal Skill Programme (CASP) or Centre for Evidence-Based Management of Amsterdam (CEBMa). Though the majority of the studies presented encouraging data, however, three studies that implemented individualized exercise interventions for patients at different stages of MM and myeloablative treatment showed mixed results. In conclusion, the effectiveness of participation in exercise programmes remains unclear for patients with MM, as the studies reviewed were flawed by relatively weak methodological approaches. PMID:26633247

  11. Personal Prayer in Patients Dealing with Chronic Illness: A Review of the Research Literature

    PubMed Central

    Jors, Karin; Baumann, Klaus

    2015-01-01

    Background. Prayer is commonly used among patients for health purposes. Therefore, this review focused on three main questions: (1) why do people turn to prayer in times of illness?, (2) what are the main topics of their prayers?, and (3) how do they pray? Method. We undertook a systematic review of the literature by searching the databases PubMed, Medline, and PsycINFO. The following inclusion criteria were used: (1) participants in the study were patients dealing with an illness, (2) the study examined the use of private rather than intercessory prayer, and (3) the content and purpose of prayer rather than its effects were investigated. Results. 16 articles were included in the final review. Participants suffered from a variety of chronic diseases, mostly cancer. Five main categories for the reasons and topics of prayer were found: (1) disease-centered prayer, (2) assurance-centered prayer, (3) God-centered prayer, (4) others-centered prayer, and (5) lamentations. Among these, disease-centered prayer was most common. Conclusions. Although most patients with chronic diseases do pray for relief from their physical and mental suffering, the intention of their prayers is not only for healing. Rather, prayer can be a resource that allows patients to positively transform the experience of their illness. PMID:25815041

  12. Has general practitioner computing made a difference to patient care? A systematic review of published reports.

    PubMed Central

    Sullivan, F.; Mitchell, E.

    1995-01-01

    OBJECTIVE--To review findings from studies of the influence of desktop computers on primary care consultations. DESIGN--Systematic review of world reports from 1984 to 1994. SETTING--The computerised catalogues of Medline, BIDS, and GPlit were searched, as well as conference proceedings, books, bibliographies, and references in books and journal articles. SUBJECTS--30 papers met the inclusion criteria and were included for detailed review. INTERVENTIONS--A validated scheme for assessing methodological adequacy was used to score each paper. MAIN OUTCOME MEASURES--Papers were rated on sample formation, baseline differences, unit of allocation, outcome measures, and follow up. Differences in outcomes were also recorded. RESULTS--Four of the six papers dealing with the consultation process showed that consultations took longer. Doctor initiated and "medical" content of consultations increased at the expense of a reduction in patient initiated and "social" content. Each of the 21 studies which looked at clinician performance showed an improvement when a computer was used (from 8% to 50%, with better results for single preventive measures). Only one of the three studies looking at patient outcomes showed an improvement (diastolic blood pressure control 5 mm Hg better after one year, with fewer doctor-patient consultations). CONCLUSIONS--Using a computer in the consultation may help improve clinician performance but may increase the length of the consultation. More studies are needed to assess the effects on patient outcomes of using a computer in consultations. PMID:7580494

  13. A systematic review of dental disease in patients undergoing cancer therapy

    PubMed Central

    Napeñas, Joel J.; Hodgson, Brian D.; Stokman, Monique A.; Mathers-Stauffer, Vickie; Elting, Linda S.; Spijkervet, Fred K. L.; Brennan, Michael T.

    2010-01-01

    Introduction This purpose of this systematic review was to evaluate the literature and update our current understanding of the impact of present cancer therapies on the dental apparatus (teeth and periodontium) since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies. Review method A systematic literature search was conducted with assistance from a research librarian in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 1990 and 31 December 2008. Each study was independently assessed by two reviewers. Taking into account predetermined quality measures, a weighted prevalence was calculated for the prevalence of dental caries, severe gingival disease, and dental infection. Data on DMFT/dmft, DMFS/dmfs, plaque, and gingival indexes were also gathered. The level of evidence, recommendation, and guideline (if possible) were given for published preventive and management strategies. Results Sixty-four published papers between 1990 and 2008 were reviewed. The weighted overall prevalence of dental caries was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (SD, 7.98; n = 457). The overall plaque index for patients who were post-antineoplastic therapy was 1.38 (SD, 0.25; n = 189). The GI for patients who were post-chemotherapy was 1.02 (SD, 0.15; n = 162). The weighted prevalence of dental infections/abscess during chemotherapy was reported in three studies and was 5.8%. Conclusions Patients who were post-radiotherapy had the highest DMFT. The use of fluoride products and chlorhexidine rinses are beneficial in patients who are post-radiotherapy. There continues to be lack of clinical studies on the extent and severity of dental disease that are associated with infectious complications during cancer therapy. PMID:20449756

  14. Interventions to improve patient hand hygiene: a systematic review.

    PubMed

    Srigley, J A; Furness, C D; Gardam, M

    2016-09-01

    Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HCAIs). The aim of this systematic review was to determine the efficacy of patient hand hygiene interventions in reducing HCAIs and improving patient hand hygiene rates compared to usual care. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HCAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Ten studies were included, most of which were uncontrolled before-after studies (N=8). The majority of interventions (N=7) were multi-modal, with components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HCAI outcomes and four studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. In conclusion, interventions to improve patient hand hygiene may reduce the incidence of HCAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes. PMID:27262906

  15. Life-threatening complications of ascariasis in trauma patients: a review of the literature

    PubMed Central

    Li, Quan-yue; Zhao, Dong-hai; Qu, Hai-yan; Zhou, Chuan-nong

    2014-01-01

    BACKGROUND: Ascariasis is one of the most common human parasitic infections worldwide. In some rare cases, ascariasis may cause serious consequences even sudden death. This study was undertaken to review the life-threatening complications of ascariasis in trauma patients reported in the literature. DATA SOURCES: Relevant articles about ascariasis and trauma were searched from Pubmed, Google scholar, Scirus, and Wanfang databases. RESULTS: Twenty-four patients with ascariasis were collected from 21 articles searched. Most of these patients were from tropical and subtropical countries. Of the 24 patients, 12 were children. Their major complications occurred in the airway passage and digestive tract. There were 3 fatal cases in these patients. Twelve of the 24 patients described in 10 articles were reported in the last 10 years. CONCLUSIONS: Early diagnosis and prompt intervention are essential to minimize the high morbidity and mortality of these serious complications in trauma patients. Physicians should be aware of the possibility of Ascaris infection in a trauma patient from endemic area of ascariasis. History of Ascaris infection and routine examination of feces for Ascaris eggs may be helpful to make a correct diagnosis. PMID:25225578

  16. Morbidity and mortality among patients with respiratory syncytial virus infection: a 2-year retrospective review.

    PubMed

    Anderson, Neil W; Binnicker, Matthew J; Harris, Dana M; Chirila, Razvan M; Brumble, Lisa; Mandrekar, Jay; Hata, D Jane

    2016-07-01

    Previous studies have demonstrated high morbidity and mortality for adult patients with respiratory syncytial virus (RSV) infection. We performed a retrospective, multicenter, two-year chart review of all patients (n = 334) testing positive for RSV by the ProFlu + (®) Influenza A/B and RSV assay (Hologic, Bedford, MA). We analyzed indicators of morbidity and mortality in children <6 years old, immunocompetent and immunosuppressed adults, and transplant patients. Significant morbidity and mortality was observed among hematopoietic stem cell transplant patients (7.3%, 60-day mortality), solid organ transplant patients (13.3%, 60-day mortality), and COPD patients (12.8%, 60-day mortality). Of the patients positive for RSV, 144 (43.1%) of 334 received antibacterials or antifungals following diagnosis. Of these patients, a bacterial or fungal pathogen was not recovered from 60% of cases. Despite advances in RSV treatment, certain populations appear to be inadequately treated, while others appear to be inappropriately treated with unnecessary antimicrobials. PMID:27179369

  17. 18 CFR 401.35 - Classification of projects for review under Section 3.8 of the Compact.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Classification of projects for review under Section 3.8 of the Compact. 401.35 Section 401.35 Conservation of Power and Water... water resources of the Basin and is not required to be submitted under Section 3.8 of the Compact:...

  18. 18 CFR 401.35 - Classification of projects for review under Section 3.8 of the Compact.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Classification of projects for review under Section 3.8 of the Compact. 401.35 Section 401.35 Conservation of Power and Water... water resources of the Basin and is not required to be submitted under Section 3.8 of the Compact:...

  19. Investigating the Quality of Project-Based Science and Technology Learning Environments in Elementary School: A Critical Review of Instruments

    ERIC Educational Resources Information Center

    Thys, Miranda; Verschaffel, Lieven; Van Dooren, Wim; Laevers, Ferre

    2016-01-01

    This paper provides a systematic review of instruments that have the potential to measure the quality of project-based science and technology (S&T) learning environments in elementary school. To this end, a comprehensive literature search was undertaken for the large field of S&T learning environments. We conducted a horizontal bottom-up…

  20. 18 CFR 401.35 - Classification of projects for review under Section 3.8 of the Compact.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Classification of projects for review under Section 3.8 of the Compact. 401.35 Section 401.35 Conservation of Power and Water... water resources of the Basin and is not required to be submitted under Section 3.8 of the Compact:...

  1. The Hunters Point-Bayview SEED Project: A Diagnostic Review of Reading Achievement in the First Three Grades.

    ERIC Educational Resources Information Center

    Counelis, James Steve

    A diagnostic review of reading achievement in the first three grades of the South East Education Development (SEED) project is presented. Comparisons are made with the 1969-1970 SEED data, which is considered baseline. The findings indicated that: (1) no significant difference existed in the pooled attendance for each grade between two successive…

  2. 43 CFR 404.51 - Are proposed projects under the Rural Water Supply Program reviewed by the Administration?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Are proposed projects under the Rural Water Supply Program reviewed by the Administration? 404.51 Section 404.51 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Feasibility Studies §...

  3. Project Match; Ontario-Montclair School District, Ontario, California. A Submission to the Joint Dissemination Review Panel.

    ERIC Educational Resources Information Center

    Baker, Octave V.

    One of seven career education programs chosen for nationwide dissemination by the Department of Health, Education and Welfare's Joint Dissemination Review Panel (JDRP), Project MATCH (Matching Attitudes and Talents to Career Horizons) is being conducted for grades K-8 in Ontario, California. For the years 1974-78, it received federal funding under…

  4. Effectiveness of neural mobilization in patients with spinal radiculopathy: a critical review.

    PubMed

    Efstathiou, Michalis A; Stefanakis, Manos; Savva, Christos; Giakas, Giannis

    2015-04-01

    Spinal radiculopathy (SR) is a multifactorial nerve root injury that can result in significant pain, psychological stress and disability. It can occur at any level of the spinal column with the highest percentage in the lumbar spine. Amongst the various interventions that have been suggested, neural mobilization (NM) has been advocated as an effective treatment option. The purpose of this review is to (1) examine pathophysiological aspects of spinal roots and peripheral nerves, (2) analyze the proposed mechanisms of NM as treatment of injured nerve tissues and (3) critically review the existing research evidence for the efficacy of NM in patients with lumbar or cervical radiculopathy. PMID:25892373

  5. The Clinical Librarian and the Patient: Report of a Project at McMaster University Medical Centre.

    ERIC Educational Resources Information Center

    Marshall, Joanne G.; Hamilton, John D.

    In June 1975 a clinical librarian project was initiated in the Gastroenterology Programme of McMaster University Medical Centre (MUMC). The objectives of the project were to assist patients in participating more knowledgeably in their own health care and to assist health professionals in applying the latest information from the biomedical…

  6. Sleeping on a problem: the impact of sleep disturbance on intensive care patients - a clinical review.

    PubMed

    Delaney, Lori J; Van Haren, Frank; Lopez, Violeta

    2015-01-01

    Sleep disturbance is commonly encountered amongst intensive care patients and has significant psychophysiological effects, which protract recovery and increases mortality. Bio-physiological monitoring of intensive care patients reveal alterations in sleep architecture, with reduced sleep quality and continuity. The etiological causes of sleep disturbance are considered to be multifactorial, although environmental stressors namely, noise, light and clinical care interactions have been frequently cited in both subjective and objective studies. As a result, interventions are targeted towards modifiable factors to ameliorate their impact. This paper reviews normal sleep physiology and the impact that sleep disturbance has on patient psychophysiological recovery, and the contribution that the clinical environment has on intensive care patients' sleep. PMID:25852963

  7. Seven patients diagnosed as intracranial hemorrhage combined with intracranial tumor: case description and literature review

    PubMed Central

    Zeng, Chun; Tang, Shuang; Jiang, Yongming; Xiong, Xuehua; Zhou, Shuai

    2015-01-01

    In the present study, 7 patients with brain hemorrhage combined with intracranial tumor were investigated for about 3 years. Furthermore, the previous reports related with such cases were also reviewed. In all of these patients, hemorrhage was a main characteristic of the diagnosed neoplasm. The clinical data were identified by computed tomography (CT) scanning in the present study. CT scanning results demonstrated that there was a neoplastic core with high or low density and multifocal clots generally at the borders of the tumors. Increase of tumor tissues with intravenous injection of approximate 70% hypaque was analyzed in all the 7 patients with brain hemorrhage. The parts that were increased showed peripheral distributions corresponding to the hemorrhage sites. In conclusion, the intracranial brain hemorrhage related with the several types of tumors, including hemangiopericytoma, metastatic carcinomas, oligodendroglioma, and glioblastoma multiforme, which may be helpful to these patients. PMID:26770623

  8. Radiation exposure to caregivers from patients undergoing common radionuclide therapies: a review.

    PubMed

    Stefanoyiannis, A P; Ioannidou, S P; Round, W H; Carinou, E; Mavros, M N; Liotsou, T; Geronikola-Trapali, X; Armeniakos, I; Chatziioannou, S N

    2015-12-01

    The contribution of radionuclide therapies (RNTs) to effective patient treatment is widely appreciated. The administration of high doses has necessitated investigating the potential radiation hazard to caregivers from patients undergoing RNTs. This work aimed to review the literature regarding measured effective doses to caregivers from such patients. The main selection criterion was the presence of real radiation exposure measurements. The results were categorised according to the treatment protocol and dose parameters. Analysis of the collected data demonstrated that the measured effective dose values were within the dose constraints defined by the International Commission on Radiological Protection, provided that the radiation protection instructions were followed by both patients and caregivers. In conclusion, the radiation risk for caregivers was almost negligible. In this context, treatments could be administered more often on an outpatient basis, once cost-effectiveness criteria were established and radiation protection training and procedures were appropriately applied. PMID:25431487

  9. EDTA-dependent pseudothrombocytopenia: a clinical study of 18 patients and a review of the literature.

    PubMed

    Berkman, N; Michaeli, Y; Or, R; Eldor, A

    1991-03-01

    EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) is the phenomenon of a spurious low platelet count due to the appearance of antibodies that cause platelet agglutination in blood anticoagulated with EDTA. We review here the clinical features of 18 patients with EDTA-PTCP treated in our hospital from 1984 to 1987 as well as those of 34 patients reported in the literature. This phenomenon appears more frequently in severely ill patients, in association with autoimmune, neoplastic, atherosclerosis-related, and liver diseases. In the majority of our patients, EDTA-PTCP appeared during hospitalization, indicating that the antibody is an acquired one. Neither splenomegaly nor the presence of autoimmune markers were features of this entity. Unlike true thrombocytopenias, EDTA-PTCP is associated with a normal mean platelet volume. Awareness of this entity is essential since EDTA-PTCP is frequently misdiagnosed and therefore incorrectly treated. PMID:1899964

  10. Interruptions of nurses' activities and patient safety: an integrative literature review1

    PubMed Central

    Monteiro, Cintia; Avelar, Ariane Ferreira Machado; Pedreira, Mavilde da Luz Gonçalves

    2015-01-01

    OBJECTIVES: to identify characteristics related to the interruption of nurses in professional practice, as well as to assess the implications of interruptions for patient safety. METHOD: integrative literature review. The following databases were searched: Pubmed/Medline, LILACS, SciELO and Cochrane Library, using the descriptors interruptions and patient safety. An initial date was not established, but the final date was December 31, 2013. A total of 29 papers met the inclusion criteria. RESULTS: all the papers included describe interruptions as a harmful factor for patient safety. Data analysis revealed three relevant categories: characteristics of interruptions, implications for patient safety, and interventions to minimize interruptions. CONCLUSION: interruptions favor the occurrence of errors in the health field. Therefore, there is a need for further studies to understand such a phenomenon and its effects on clinical practice. PMID:25806646

  11. Instruments to measure patient experience of health care quality in hospitals: a systematic review protocol

    PubMed Central

    2014-01-01

    Background Improving and sustaining the quality of care in hospitals is an intractable and persistent challenge. The patients’ experience of the quality of hospital care can provide insightful feedback to enable clinical teams to direct quality improvement efforts in areas where they are most needed. Yet, patient experience is often marginalised in favour of aspects of care that are easier to quantify (for example, waiting time). Attempts to measure patient experience have been hindered by a proliferation of instruments using various outcome measures with varying degrees of psychometric development and testing. Methods/Design We will conduct a systematic review and utility critique of instruments used to measure patient experience of health care quality in hospitals. The databases Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (Psych Info) and Web of Knowledge will be searched from inception until end November 2013. Search strategies will include the key words; patient, adult, hospital, secondary care, questionnaires, instruments, health care surveys, experience, satisfaction and patient opinion in various combinations. We will contact experts in the field of measuring patient experience and scrutinise all secondary references. A reviewer will apply an inclusion criteria scale to all titles and abstracts. A second reviewer will apply the inclusion criteria scale to a random 10% selection. Two reviewers will independently evaluate the methodological rigour of the testing of the instruments using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Disagreements will be resolved through consensus. Instruments will be critiqued and grouped using van der Vleuten’s utility index. We will present a narrative synthesis on the utility of all instruments and make recommendations for instrument selection in

  12. A retrospective chart review of pirfenidone-treated patients in Sweden: the REPRIS study

    PubMed Central

    Sköld, Carl Magnus; Janson, Christer; Elf, Åsa Klackenberg; Fiaschi, Marie; Wiklund, Kerstin; Persson, Hans Lennart

    2016-01-01

    Background Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease that usually results in respiratory failure and death. Pirfenidone was approved as the first licensed therapy for IPF in Europe based on phase III trials where patients with a forced vital capacity (FVC) >50% of predicted were included. The aim of this study was to characterise patients treated with pirfenidone in Swedish clinical practice and to describe the adherence to the reimbursement restriction since reimbursement was only applied for patients with FVC below 80% of predicted. Methods This was a retrospective, observational chart review of IPF patients treated with pirfenidone from three Swedish university clinics. Patients initiated on treatment during the period 28 June 2012 to 20 November 2014 were included. Data on patient characteristics, basis of diagnosis, treatment duration, quality of life, and adverse drug reactions (ADRs) were collected from medical charts. Results Forty-four patients were screened and 33 were included in the study. The mean treatment duration from start of pirfenidone until discontinuation or end of study was 38 weeks. At the initiation of pirfenidone treatment, FVC was 62.7% (12.1) [mean (SD)], diffusion capacity (DLco) was 45.1% (13.8) of predicted, and the ratio of forced expiratory volume on 1 sec (FEV1) to FVC was 0.78 (0.1). The percentage of patients with an FVC between 50 and 80% was 87%. Ten of the patients had ADRs including gastrointestinal and skin-related events, cough and signs of impaired hepatic function, but this led to treatment discontinuation in only two patients. Conclusion Data from this chart review showed that adherence to the Swedish reimbursement restriction was followed in the majority of patients during the study period. At the start of pirfenidone treatment, lung function, measured as FVC, was lower in the present cohort of Swedish IPF patients compared with other registry and real-life data. About a third of the

  13. Reviews

    NASA Astrophysics Data System (ADS)

    2001-11-01

    BOOK REVIEW Search for Life BOOK REVIEW Health Physics BOOK REVIEW Language and Literacy in Science Education BOOK REVIEW Science Web Reader—Physics Correction GCSE BOOK REVIEW Physics for Higher Tier GCSE BOOK REVIEW Modular Science GCSE BOOK REVIEW Modular Science for AQA: Foundation level and Higher level GCSE BOOK REVIEW Physics for OCR A GCSE BOOK REVIEW Physics Matters, 3rd edition GCSE BOOK REVIEW Physics GCSE BOOK REVIEW Science Foundations: Physics (new edition) GCSE BOOK REVIEW Target Science: Physics Foundation Tier GCSE BOOK REVIEW Target Science: Physics Foundation Tier: AQA WEB WATCH Medical physics organizations

  14. Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews

    PubMed Central

    Paré, Guy; Jaana, Mirou

    2015-01-01

    Background Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. Objective This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. Methods A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. Results A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively

  15. Peripheral arterial disease in diabetic patients with renal insufficiency: a review.

    PubMed

    Lepäntalo, Mauri; Fiengo, Leslie; Biancari, Fausto

    2012-02-01

    Peripheral arterial disease is common among diabetic patients with renal insufficiency, and most of the diabetic patients with end-stage renal disease (ESRD) have peripheral arterial disease. Ischaemia is probably overrepresented as an etiological factor for a diabetic foot ulcer in this group of patients compared with other diabetic patients. ESRD is a strong risk factor for both ulceration and amputation in diabetic patients. It increases the risk of nonhealing of ulcers and major amputation with an OR of 2.5-3. Renal disease is a more important predictor of poor outcome after revascularizations than commonly expected. Preoperative vascular imaging is also affected by a number of limitations, mostly related to side effects of contrast agents poorly eliminated because of kidney dysfunction. Patients with renal failure have high perioperative morbidity and mortality. Persistent ischaemia, extensive infection, forefoot and heel gangrene, poor run-off, poor cardiac function, and the length of dialysis-dependent renal failure all affect the outcome adversely. Despite dismal overall outcome, recent data indicate that by proper selection, favourable results can be obtained even in ESRD patients, with the majority of studies reporting 1-year limb salvage rates of 65-75% after revascularization among survivors. High 1-year mortality of 38% reported in a recent review has to be taken into consideration, though. The preferential use of endovascular-first approach is attractive in this vulnerable multimorbid group of patients, but the evidence for endovascular treatment is very scarce. The need for complete revascularization of the foot may be even more important than in other patients with ischaemic ulcerated diabetic foot because there are a number of factors counteracting healing in these patients. Typically, half of the patients are reported to lose their legs despite open bypass. To control tissue damage and improve chances of ulcer healing, one should understand that

  16. Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of β-lactams

    PubMed Central

    2011-01-01

    Introduction Several reports have shown marked heterogeneity of antibiotic pharmacokinetics (PK) in patients admitted to ICUs, which might potentially affect outcomes. Therefore, the pharmacodynamic (PD) parameter of the efficacy of β-lactam antibiotics, that is, the time that its concentration is above the bacteria minimal inhibitory concentration (T > MIC), cannot be safely extrapolated from data derived from the PK of healthy volunteers. Methods We performed a full review of published studies addressing the PK of intravenous β-lactam antibiotics given to infected ICU patients. Study selection comprised a comprehensive bibliographic search of the PubMed database and bibliographic references in relevant reviews from January 1966 to December 2010. We selected only English-language articles reporting studies addressing β-lactam antibiotics that had been described in at least five previously published studies. Studies of the PK of patients undergoing renal replacement therapy were excluded. Results A total of 57 studies addressing six different β-lactam antibiotics (meropenem, imipenem, piperacillin, cefpirome, cefepime and ceftazidime) were selected. Significant PK heterogeneity was noted, with a broad, more than twofold variation both of volume of distribution and of drug clearance (Cl). The correlation of antibiotic Cl with creatinine clearance was usually reported. Consequently, in ICU patients, β-lactam antibiotic half-life and T > MIC were virtually unpredictable, especially in those patients with normal renal function. A better PD profile was usually obtained by prolonged or even continuous infusion. Tissue penetration was also found to be compromised in critically ill patients with septic shock. Conclusions The PK of β-lactam antibiotics are heterogeneous and largely unpredictable in ICU patients. Consequently, the dosing of antibiotics should be supported by PK concepts, including data derived from studies of the PK of ICU patients and therapeutic drug

  17. Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review

    PubMed Central

    Edwards, Adrian; Hood, Kerry; Ryan, Rebecca; Prout, Hayley; Cadbury, Naomi; MacBeth, Fergus; Butow, Phyllis; Butler, Christopher

    2008-01-01

    Objective To assess the effects on patients, clinicians, and the healthcare system of interventions before consultations to help patients or their representatives gather information in consultations by question asking. Design Systematic review with meta-analysis. Data sources Electronic literature searches of seven databases and hand searching of one journal and bibliographies of relevant articles. Review methods Inclusion criteria included randomised controlled trials. Main outcome measures Primary outcomes were question asking; patients’ anxiety, knowledge, and satisfaction; and length of consultation. Results 33 randomised trials of variable quality involving 8244 patients were identified. A few studies showed positive effects. Meta-analyses showed small and statistically significantly increases in question asking (standardised mean difference 0.27, 95% confidence interval 0.19 to 0.36) and patients’ satisfaction (0.09, 0.03 to 0.16). Non-statistically significant changes occurred in patients’ anxiety before consultations (weighted mean difference −1.56, −7.10 to 3.97), patients’ anxiety after consultations (standardised mean difference −0.08, −0.22 to 0.06), patients’ knowledge (−0.34, −0.94 to 0.25), and length of consultation (0.10, −0.05 to 0.25). Interventions comprising written materials had similar effects on question asking, consultation length, and patients’ satisfaction as those comprising the coaching of patients. Interventions with additional training of clinicians had little further effect than those targeted at patients alone for patients’ satisfaction and consultation length. Conclusions Interventions for patients before consultations produce small benefits for patients. This may be because patients and clinicians have established behaviours in consultations that are difficult to change. Alternatively small increases in question asking may not be sufficient to make notable changes to other outcomes. PMID:18632672

  18. Clinical outcomes in patients with isolated serous tubal intraepithelial carcinoma (STIC): A comprehensive review.

    PubMed

    Patrono, Maria Guadalupe; Iniesta, Maria D; Malpica, Anais; Lu, Karen H; Fernandez, Rodrigo Orozco; Salvo, Gloria; Ramirez, Pedro T

    2015-12-01

    OBJECTIVE. Serous tubal intraepithelial carcinoma (STIC) is currently considered the precursor lesion of pelvic (i.e., ovarian or peritoneal) high-grade serous carcinoma. The incidence of STIC has been reported to range from 0.6% to 7% in BRCA mutations carriers. However, the clinical outcome of patients with 'isolated' STIC remains elusive. The aim of this study is to review the published literature on isolated STIC to determine outcomes of these ients and present a summary of management strategies. METHODS. A systematic English-language literature search was conducted in PubMed, MEDLINE-Ovid, Scopus, EBSCO host, Cochrane Library of articles published from February 2006 to April 2015. Study inclusion criteria for review were the following: risk-reducing salpingo-oophorectomy (RRSO), BRCA mutation carriers, non-BRCA mutation carriers, and benign surgical indication. Exclusion criteria were as follows: the presence of synchronous gynecological cancers, concurrent non-gynecological malignancies, the presence of ovarian intraepithelial lesions, and articles that did not include any clinical information and were restricted to pathology information only. RESULTS. A total of 78 patients with isolated STIC were included in our analysis. The median age for all patients was 53.7 years (range; 37-83). Surgical indication was RRSO in 67 patients with BRCA mutations or high-risk personal or family history. In the other 11 patients, an incidental STIC was detected after surgery for non-cancerous indications. Eleven (16.4%) patients received chemotherapy after the diagnosis of STIC. The follow-up time ranged from 2 to 150 months. Three (4.5%) patients with BRCA mutations were diagnosed with primary peritoneal carcinoma (PPC) during the follow-up at 43, 48 and 72 months after RRSO. CONCLUSIONS. The rate of primary peritoneal carcinoma in patients with BRCA mutations and isolated STIC is 4.5%. The role of adjuvant therapy remains elusive and routine surveillance with tumor markers

  19. Reconstructive surgery for hypospadias: A systematic review of long-term patient satisfaction with cosmetic outcomes

    PubMed Central

    Adams, Julie; Bracka, Aivar

    2016-01-01

    Introduction: Research on long-term results of hypospadias has focused on surgical techniques and functional outcomes, and it is only recently that patient satisfaction with appearance and psychosocial outcomes have been considered. The aim of this study was to provide an evidence-based systematic review of adolescent and adult patient perceptions of cosmetic outcomes following childhood surgery for hypospadias. Methods: A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery. Results: A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity. Conclusions: Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery. PMID:27127350

  20. 32 CFR 211.7 - Initiating an informal DoD review of a proposed project.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... project, (3) The nature of the project. (4) The requester is encouraged to provide as much additional... project. 211.7 Section 211.7 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS MISSION COMPATIBILITY EVALUATION PROCESS Project Evaluation...