Science.gov

Sample records for active supportive care

  1. Supporting Active Patient and Health Care Collaboration: A Prototype for Future Health Care Information Systems.

    PubMed

    Åhlfeldt, Rose-Mharie; Persson, Anne; Rexhepi, Hanife; Wåhlander, Kalle

    2016-12-01

    This article presents and illustrates the main features of a proposed process-oriented approach for patient information distribution in future health care information systems, by using a prototype of a process support system. The development of the prototype was based on the Visuera method, which includes five defined steps. The results indicate that a visualized prototype is a suitable tool for illustrating both the opportunities and constraints of future ideas and solutions in e-Health. The main challenges for developing and implementing a fully functional process support system concern both technical and organizational/management aspects.

  2. Active ambulatory care management supported by short message services and mobile phone technology in patients with arterial hypertension.

    PubMed

    Kiselev, Anton R; Gridnev, Vladimir I; Shvartz, Vladimir A; Posnenkova, Olga M; Dovgalevsky, Pavel Ya

    2012-01-01

    The use of short message services and mobile phone technology for ambulatory care management is the most accessible and most inexpensive way to transition from traditional ambulatory care management to active ambulatory care management in patients with arterial hypertension (AH). The aim of this study was to compare the clinical efficacy of active ambulatory care management supported by short message services and mobile phone technology with traditional ambulatory care management in AH patients. The study included 97 hypertensive patients under active ambulatory care management and 102 patients under traditional ambulatory care management. Blood pressure levels, body mass, and smoking history of patients were analyzed in the study. The duration of study was 1 year. In the active ambulatory care management group, 36% of patients were withdrawn from the study within a year. At the end of the year, 77% of patients from the active care management group had achieved the goal blood pressure level. That was more than 5 times higher than that in the traditional ambulatory care management group (P < .001). The risk ratio of achieving and maintaining the goal blood pressure in patients of active care management group was 5.44, CI (3.2-9.9; P = .005). Implementation of active ambulatory care management supported by short message services and mobile phone improves the quality of ambulatory care of hypertensive patients.

  3. Active Supportive and Palliative Care Research Grants | Division of Cancer Prevention

    Cancer.gov

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  4. Care staff intentions to support adults with an intellectual disability to engage in physical activity: an application of the Theory of Planned Behaviour.

    PubMed

    Martin, Emma; McKenzie, Karen; Newman, Emily; Bowden, Keith; Morris, Paul Graham

    2011-01-01

    Researchers suggest that people with an intellectual disability (ID) undertake less physical activity than the general population and many rely, to some extent, on others to help them to access activities. The Theory of Planned Behaviour (TPB) model was previously found to significantly predict the intention of care staff to facilitate a healthy diet in those they supported. The present study examined whether the TPB was useful in predicting the intentions of 78 Scottish care staff to support people with ID to engage in physical activity. Regression analyses indicated that perceived behavioural control was the most significant predictor of both care staff intention to facilitate physical activity and reported physical activity levels of the people they supported. Attitudes significantly predicted care staff intention to support physical activity, but this intention was not itself significantly predictive of reported activity levels. Increasing carers' sense of control over their ability to support clients' physical activity may be more effective in increasing physical activity than changing their attitudes towards promoting activity.

  5. Palliative Care: Video Tells a Mother's Story of Caring Support

    MedlinePlus

    ... this page please turn JavaScript on. Feature: Palliative Care Video Tells a Mother's Story of Caring Support ... the treatment …" Frequently Asked Questions What is palliative care, and when is it provided? Palliative care combines ...

  6. Developing a web 2.0 diabetes care support system with evaluation from care provider perspectives.

    PubMed

    Lin, Yung-Hsiu; Chen, Rong-Rong; Guo, Sophie Huey-Ming; Chang, Hui-Yu; Chang, Her-Kun

    2012-08-01

    Diabetes is a life-long illness condition that many diabetic patients end up with related complications resulted largely from lacking of proper supports. The success of diabetes care relies mainly on patient's daily self-care activities and care providers' continuous support. However, the self-care activities are socially bounded with patient's everyday schedules that can easily be forgotten or neglected and the care support from providers has yet been fully implemented. This study develops a Web 2.0 diabetes care support system for patients to integrate required self-care activities with different context in order to enhance patient's care knowledge and behavior adherence. The system also supports care managers in a health service center to conduct patient management through collecting patient's daily physiological information, sharing care information, and maintaining patient-provider relationships. After the development, we evaluate the acceptance of the system through a group of nursing staffs.

  7. Supportive Care for Chronic Lymphocytic Leukemia

    MedlinePlus

    ... Chronic Lymphocytic Leukemia Supportive Care for Chronic Lymphocytic Leukemia Supportive care for chronic lymphocytic leukemia (CLL) is ... Treating Hairy Cell Leukemia More In Chronic Lymphocytic Leukemia About Chronic Lymphocytic Leukemia Causes, Risk Factors, and ...

  8. Determinants of physical activity among patients with type 2 diabetes: the role of perceived autonomy support, autonomous motivation and self-care competence.

    PubMed

    Koponen, Anne M; Simonsen, Nina; Suominen, Sakari

    2017-03-01

    Based on self-determination theory (SDT), this study investigated, whether the three central SDT variables (perceived autonomy support, autonomous motivation and self-care competence), were associated with engagement in physical activity (PA) among patients with type 2 diabetes when the effect of a wide variety of other important life-context factors (perceived health, medication, duration of diabetes, mental health, stress and social support) was controlled for. Patients from five municipalities in Finland with registry-based entitlement to a special reimbursement for medicines used in the treatment of type 2 diabetes (n = 2866, mean age 63 years, 56% men) participated in this mail survey in 2011. Of all measured explanatory factors, autonomous motivation was most strongly associated with engagement in PA. Autonomous motivation mediated the effect of perceived autonomy support on patients' PA. Thus, perceived autonomy support (from one's physician) was associated with the patient's PA through autonomous motivation. This result is in line with SDT. Interventions for improved diabetes care should concentrate on supporting patients' autonomous motivation for PA. Internalizing the importance of good self-care seems to give sufficient energy to maintain a physically active lifestyle.

  9. Patients with chronic pain may need extra support when prescribed physical activity in primary care: a qualitative study

    PubMed Central

    Joelsson, Monica; Bernhardsson, Susanne; Larsson, Maria E. H.

    2017-01-01

    Background Physical activity plays an important role in the prevention and treatment of chronic musculoskeletal pain, but chronic pain may implicate a poor rehabilitation outcome. The concept of physical activity on prescription (PAP) is a therapeutic option for various diseases, but there is a lack of knowledge about how patients with chronic musculoskeletal pain experience receiving the prescription. Objectives The objective of this study was to describe the experiences of and thoughts about receiving a prescription for physical activity of people with chronic musculoskeletal pain. Design Interviews analysed using qualitative content analysis with an inductive approach. Setting Three primary healthcare centres in a mixed rural and suburban area in the vicinity of a large city in western Sweden. Subjects Fifteen individuals with chronic musculoskeletal pain. Results Four categories were identified with the overarching theme “Physical activity in chronic pain requires extra support”. There were several barriers for increasing activity level and these patients suffered from the additional burden of pain. The categories were: “Important to identify needs”, “Barriers and facilitators for physical activity”, “Perceptions of PAP vary” and “Effects found of receiving PAP”. Conclusions Despite the many positive experiences of receiving PAP, patients described confusion about the role and execution of PAP. Chronic pain is an additional barrier for increasing activity level, and it is crucial to consider these patients’ circumstances. This study suggests that patients with chronic musculoskeletal pain have a greater need for information and extra support to overcome existing barriers, before or when physical activity is prescribed. Key Points Physical activity is important for prevention and treatment of chronic pain and has earlier been shown to be increased by “physical activity on prescription”. Patients with chronic musculoskeletal pain

  10. Business models for health care decision support.

    PubMed

    Gaughan, Phil

    2003-01-01

    CareScience, Inc. is a public company (NASDAQ: CARE) that originated ten years ago to commercialize risk adjustment and complication predictions developed by the Wharton School of Business and the University of Pennsylvania School of Medicine. Over the past decade, the company has grown to approximately 200 clients and 150 employees. Among the "firsts" recorded by the company, CareScience was the first to offer a clinical decision support system as an Application Service Provider (ASP), the first to offer peer-to-peer clinical data sharing among health care provider organizations and practitioners (Santa Barbara Care Data Exchange), and the first to provide a care management outsourcing arrangement.

  11. Legal mechanisms supporting accountable care principles.

    PubMed

    Ramanathan, Tara

    2014-11-01

    Public health and private providers and facilities may shape the future of the US health system by engaging in new ways to deliver care to patients. "Accountable care" contracts allow private health care and public health providers and facilities to collaboratively serve defined populations. Accountable care frameworks emphasize health care quality and cost savings, among other goals. In this article, I explore the legal context for accountable care, including the mechanisms by which providers, facilities, and public health coordinate activities, avoid inefficiencies, and improve health outcomes. I highlight ongoing evaluations of the impact of accountable care on public health outcomes.

  12. [Mental health care systems and provisions in the immediate and acute phase of the Great East Japan Earthquake: situational and support activities in Miyagi Prefecture].

    PubMed

    Matsumoto, Kazunori

    2014-01-01

    The Great East Japan Earthquake on March 11, 2011, which measured 9.0 on the Richter scale, was followed by a huge tsunami that caused catastrophic damage to the area extending from the Tohoku to Kanto regions. It was also accompanied by the meltdown of the Fukushima Daiichi Nuclear Power Station. Mental health service provisions were hit equally hard by the disaster, with a wide range of support and relief activities being implemented. This article reviews damage that was inflicted and support activities that were carried out in the mental health field in Miyagi Prefecture in the immediate aftermath and acute phase of the disaster, and also examines future challenges. Almost all mental health institutions in Miyagi Prefecture were affected by the disaster, and experienced difficulties such as feeding inpatients and securing necessary medication. Mental health institutions in the coastal area, in particular, were severely hit. Three hospitals-were seriously damaged by the tsunami, which forced them to make arrangements for the transfer of 300 inpatients. In the aftermath of the earthquake, it became difficult to access medical institutions, and confusion ensued regarding the provision of mental health services. Many municipalities in Miyagi Prefecture were seriously affected by the disaster, and information-gathering was crippled due to the disruption of communication and transport networks. Consequently, the administrative function regarding mental health service provisions was significantly impaired. Through official, private, and academic channels, volunteers in the field of mental health were sent to the affected areas in the immediate aftermath of the disaster. It was very difficult to coordinate these volunteers because of the confusion in gathering-information and in the chain of command for support activities. The number of support teams working in the affected areas peaked one to two months after the earthquake, but it became clear that continuous and long

  13. Supporting Students in Foster Care

    ERIC Educational Resources Information Center

    Palmieri, Lauren E.; La Salle, Tamika P.

    2017-01-01

    Students living in foster care are at risk for experiencing many challenges in school, spanning domains of social-emotional, behavioral, and academic functioning. They are twice as likely to be absent from school and to have received and out-of-school suspension and up to three and a half times more likely to receive special education services.…

  14. Redesigning ambulatory care business processes supporting clinical care delivery.

    PubMed

    Patterson, C; Sinkewich, M; Short, J; Callas, E

    1997-04-01

    The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care.

  15. Metabolism Supports Macrophage Activation

    PubMed Central

    Langston, P. Kent; Shibata, Munehiko; Horng, Tiffany

    2017-01-01

    Macrophages are found in most tissues of the body, where they have tissue- and context-dependent roles in maintaining homeostasis as well as coordinating adaptive responses to various stresses. Their capacity for specialized functions is controlled by polarizing signals, which activate macrophages by upregulating transcriptional programs that encode distinct effector functions. An important conceptual advance in the field of macrophage biology, emerging from recent studies, is that macrophage activation is critically supported by metabolic shifts. Metabolic shifts fuel multiple aspects of macrophage activation, and preventing these shifts impairs appropriate activation. These findings raise the exciting possibility that macrophage functions in various contexts could be regulated by manipulating their metabolism. Here, we review the rapidly evolving field of macrophage metabolism, discussing how polarizing signals trigger metabolic shifts and how these shifts enable appropriate activation and sustain effector activities. We also discuss recent studies indicating that the mitochondria are central hubs in inflammatory macrophage activation. PMID:28197151

  16. Decision support for patient care: implementing cybernetics.

    PubMed

    Ozbolt, Judy; Ozdas, Asli; Waitman, Lemuel R; Smith, Janis B; Brennan, Grace V; Miller, Randolph A

    2004-01-01

    The application of principles and methods of cybernetics permits clinicians and managers to use feedback about care effectiveness and resource expenditure to improve quality and to control costs. Keys to the process are the specification of therapeutic goals and the creation of an organizational culture that supports the use of feedback to improve care. Daily feedback on the achievement of each patient's therapeutic goals provides tactical decision support, enabling clinicians to adjust care as needed. Monthly or quarterly feedback on aggregated goal achievement for all patients on a clinical pathway provides strategic decision support, enabling clinicians and managers to identify problems with supposed "best practices" and to test hypotheses about solutions. Work is underway at Vanderbilt University Medical Center to implement feedback loops in care and management processes and to evaluate the effects.

  17. The Role of Mobile Technologies in Health Care Processes: The Case of Cancer Supportive Care

    PubMed Central

    Cucciniello, Maria; Guerrazzi, Claudia

    2015-01-01

    Background Health care systems are gradually moving toward new models of care based on integrated care processes shared by different care givers and on an empowered role of the patient. Mobile technologies are assuming an emerging role in this scenario. This is particularly true in care processes where the patient has a particularly enhanced role, as is the case of cancer supportive care. Objective This paper aims to review existing studies on the actual role and use of mobile technology during the different stages of care processes, with particular reference to cancer supportive care. Methods We carried out a review of literature with the aim of identifying studies related to the use of mHealth in cancer care and cancer supportive care. The final sample size consists of 106 records. Results There is scant literature concerning the use of mHealth in cancer supportive care. Looking more generally at cancer care, we found that mHealth is mainly used for self-management activities carried out by patients. The main tools used are mobile devices like mobile phones and tablets, but remote monitoring devices also play an important role. Text messaging technologies (short message service, SMS) have a minor role, with the exception of middle income countries where text messaging plays a major role. Telehealth technologies are still rarely used in cancer care processes. If we look at the different stages of health care processes, we can see that mHealth is mainly used during the treatment of patients, especially for self-management activities. It is also used for prevention and diagnosis, although to a lesser extent, whereas it appears rarely used for decision-making and follow-up activities. Conclusions Since mHealth seems to be employed only for limited uses and during limited phases of the care process, it is unlikely that it can really contribute to the creation of new care models. This under-utilization may depend on many issues, including the need for it to be embedded

  18. Information Persistence Services Designed to Support Home Care

    PubMed Central

    Queirós, Alexandra; Augusto, Filipe; Rodríguez, Yosvany Llerena; Cardoso, Carlos; Grade, José Miguel; Quintas, João

    2015-01-01

    Background Due to the challenges faced by health and social care systems, in particular those related to actual demographic trends, home care emerges as a potentially cost-effective solution to answer the needs of citizens, and to allow the reallocation of resources to alternatives to hospitalization or institutionalization. Objective Home care services require cooperation between different actors, including health and social caregivers, care receivers, and their informal caregivers (eg, relatives or friends), across time, space, and organizational boundaries. Therefore, it is foreseeable that eHealth services can contribute to their improvement. The aim of this study is to evaluate information persistence services based on the Reference Information Model (RIM) of the Health Level Seven (HL7) version 3 to support formal caregivers, both health and social care providers, and informal caregivers in the context of home care services. Methods A pilot study was set up involving two Portuguese institutions that provide home care services for the elderly. Defining of information requirements was performed according to a comprehensive process. This included a review of the literature, observations of work activities, interviews with caregivers, care receivers and their relatives, analysis of paper documentation related to care receivers’ histories, health conditions and care plans, and brainstorming groups involving specialized professionals. Following this, information objects were implemented and validated. Results The methodological approach, as well as the information persistence services, proved to be robust and adequate to specify, implement, and validate different types of information objects related to home care services for the elderly. This study also reinforces the application of the RIM of the HL7 version 3 beyond the strict scope of health care, allowing the persistence of not only health care information, but also information related to social assistance

  19. TRICARE: changes included in the National Defense Authorization Act for Fiscal Year 2010; enhancement of transitional dental care for members of the Reserve Component on active duty for more than 30 days in support of a contingency operation. Final rule.

    PubMed

    2011-12-28

    The Department is publishing this final rule to implement section 703 of the National Defense Authorization Act for Fiscal Year 2010 (NDAA for FY10). Specifically, that legislation amends the transitional health care dental benefits for Reserve Component members on active duty for more than 30 days in support of a contingency operation. The legislation entitles these Reserve Component members to dental care in the same manner as a member of the uniformed services on active duty for more than 30 days, thus providing care to the Reserve member in both military dental treatment facilities and authorized private sector dental care. This final rule does not eliminate any medical or dental care that is currently covered as transitional health care for the member.

  20. Music therapy in supportive cancer care.

    PubMed

    Stanczyk, Malgorzata Monika

    2011-06-08

    The purpose of this paper is to show some aspects of music therapy application in cancer care and to present the integration of music therapy program into a continuous supportive cancer care for inpatients. A cancer diagnosis is one of the most feared and serious life events that causes stress in individuals and families. Cancer disrupts social, physical and emotional well-being and results in a range of emotions, including anger, fear, sadness, guilt, embarrassment and shame. Music therapy is a part of a complementary medicine program in supportive cancer care which accompanies medical treatment. There are many benefits of music therapy for cancer patients-interactive music therapy techniques (instrumental improvisation, singing) as well as receptive music therapy techniques (listening to recorded or live music, music and imaginary) can be used to improve mood, decrease stress, pain, anxiety level and enhance relaxation. Music therapy is an effective form of supporting cancer care for patients during the treatment process. It may be also basic for planning effective programs of rehabilitation to promote wellness, improve physical and emotional well-being and the quality of life.

  1. Music therapy in supportive cancer care

    PubMed Central

    Stanczyk, Malgorzata Monika

    2011-01-01

    The purpose of this paper is to show some aspects of music therapy application in cancer care and to present the integration of music therapy program into a continuous supportive cancer care for inpatients. A cancer diagnosis is one of the most feared and serious life events that causes stress in individuals and families. Cancer disrupts social, physical and emotional well-being and results in a range of emotions, including anger, fear, sadness, guilt, embarrassment and shame. Music therapy is a part of a complementary medicine program in supportive cancer care which accompanies medical treatment. There are many benefits of music therapy for cancer patients—interactive music therapy techniques (instrumental improvisation, singing) as well as receptive music therapy techniques (listening to recorded or live music, music and imaginary) can be used to improve mood, decrease stress, pain, anxiety level and enhance relaxation. Music therapy is an effective form of supporting cancer care for patients during the treatment process. It may be also basic for planning effective programs of rehabilitation to promote wellness, improve physical and emotional well-being and the quality of life. PMID:24376975

  2. Care Staff Intentions to Support Adults with an Intellectual Disability to Engage in Physical Activity: An Application of the Theory of Planned Behaviour

    ERIC Educational Resources Information Center

    Martin, Emma; McKenzie, Karen; Newman, Emily; Bowden, Keith; Morris, Paul Graham

    2011-01-01

    Researchers suggest that people with an intellectual disability (ID) undertake less physical activity than the general population and many rely, to some extent, on others to help them to access activities. The Theory of Planned Behaviour (TPB) model was previously found to significantly predict the intention of care staff to facilitate a healthy…

  3. [Indicators of care activity].

    PubMed

    Aguilera Navarro, J M; Cueli Rincón, B

    2003-12-01

    Quality indicators are tools to measure and improve quality of care. These indicator may evaluate estructural process or outcome measures. Development of quality indicators is a important goal of the quality program in a clinical department.

  4. Innovations to support hydration care across health and social care.

    PubMed

    Campbell, Naomi

    2016-01-01

    It is known that the primary cause of dehydration in elderly care is caused by a person not regularly drinking enough. Dehydration is a much-publicised national concern, associated with poor outcomes of care and acute hospital admissions. However, in November last year, NHS England stated that the scale of dehydration is not known; in comparison, it confirmed at least three million people are at risk of malnutrition. The stark comparison in information occurs because there is no nationally recognised screening tool to identify who is at risk of dehydration. An innovative nursing role, focused on finding solutions to reduce the risk of dehydration in the care of older and vulnerable persons, has led to the development of a simple dehydration screening tool called 'ROC to drink' (ROC stands for 'reliance on a carer'), which focuses on the level of support needed to drink. An innovative tea cup has been designed to help raise standards for monitoring drinks and raise awareness about intake.

  5. 77 FR 42185 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-18

    ... COMMISSION 47 CFR Part 54 Rural Health Care Support Mechanism AGENCY: Federal Communications Commission... support on a limited, interim, fiscally responsible basis for specific Rural Health Care Pilot Program... will preserve transitioning Pilot Program participants' connectivity and the resulting health...

  6. Supportive Housing in Foster Care: The Views of Young People

    ERIC Educational Resources Information Center

    Sinkkonen, Hanna-Maija; Kyttälä, Minna

    2015-01-01

    This study investigated Finnish young people's experiences of supportive housing. Supportive housing is an after-care programme that should support the transition from foster care to independent adulthood. It is directed mainly at young people who have been taken into foster care by social workers. The sample consisted of 39 young people (23…

  7. 47 CFR 54.602 - Health care support mechanism.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 3 2013-10-01 2013-10-01 false Health care support mechanism. 54.602 Section... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Defined Terms and Eligibility § 54.602 Health care support mechanism. (a) Telecommunications Program. Rural health...

  8. 47 CFR 54.602 - Health care support mechanism.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 3 2014-10-01 2014-10-01 false Health care support mechanism. 54.602 Section... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Defined Terms and Eligibility § 54.602 Health care support mechanism. (a) Telecommunications Program. Rural health...

  9. Supportive and Palliative Care Research | Division of Cancer Prevention

    Cancer.gov

    Supportive and palliative care research includes studies to prevent or treat the acute and chronic symptoms and morbidities related to cancer and its treatment, and to examine the effects of cancer and its treatment on quality of life and psychosocial issues and treatment strategies at the end of life. Active Projects can range from caregiver issues to geriatrics, physical functioning to cognitive dysfunction. | Examining symptoms and morbidities related to cancer, its treatment, quality of life and end of life.

  10. ECLSS medical support activities

    NASA Technical Reports Server (NTRS)

    Crump, William J.; Kilgore, Melvin V., Jr.

    1991-01-01

    During the period from April 10, 1990 to April 9, 1991, the Consortium for the Space Life Sciences provided technical assistance to the NASA/MSFC water recovery efforts. This assistance was in the form of literature reviews, technical recommendations, and presentations. This final report summarizes the activities completed during this period and identifies those areas requiring additional efforts. The tasks which the University of Alabama in Huntsville (UAH) water recovery team addressed were either identified by MSFC technical representatives or chosen from those outlined in the subject statement of work.

  11. Employer Support for Families with Child Care Needs.

    ERIC Educational Resources Information Center

    Fischer, Jan Lockwood

    Present and past employer support for child care is reviewed in this paper. The first half of the discussion is devoted to a general and brief historical survey describing employer support for families needing child care and detailing working mothers' increasing demand for child care services. Also briefly mentioned are government programs…

  12. 75 FR 48235 - Rural Health Care Universal Service Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-09

    ... Communications Commission 47 CFR Part 54 Rural Health Care Universal Service Support Mechanism; Proposed Rule #0... COMMUNICATIONS COMMISSION 47 CFR Part 54 Rural Health Care Universal Service Support Mechanism AGENCY: Federal... of health care, and addresses each of the major recommendations in the National Broadband...

  13. Helsinn: 20 years in primary cancer supportive care.

    PubMed

    Cantoreggi, Sergio

    2016-11-01

    Sergio Cantoreggi speaks to Henry Ireland, Commissioning Editor: Sergio Cantoreggi, PhD, is the Chief Scientific Officer and Global Head of Research and Development of the Helsinn Group, a mid-sized pharmaceutical company headquartered in Lugano, Switzerland, and focused on providing cancer supportive care solutions to oncology patients worldwide. Dr Cantoreggi has overall responsibility for all R&D activities of the Helsinn Group and has contributed to six major regulatory approvals of cancer supportive care agents in the USA, Europe and Japan. Dr Cantoreggi joined Helsinn Healthcare in 2000 as drug development scientist and was appointed Head of R&D in 2005. In 2010, he was promoted to his current role. From 1994 to 2000 he worked as toxicologist and regulatory scientist for Du Pont, Sandoz and Novartis. Prior to joining industry, Dr Cantoreggi completed a postdoctoral fellowship and earned a Master of Science degree in chemistry and a Doctoral degree in natural sciences with a thesis on the mechanism of chemical carcinogenesis from the Swiss Federal Institute of Technology in Zürich, Switzerland. Sergio Cantoreggi discusses Helsinn's role in cancer supportive care, describing current treatment options for patients, the company's pipeline and Helsinn's work in supporting the field as a whole.

  14. Staff perceptions of caring: the importance of a supportive environment.

    PubMed

    Sikma, Suzanne K

    2006-06-01

    Five themes of caring interventions emerged from the perspective of staff caregivers-valuing personhood and the work, belonging, knowing, acting together, and promoting quality. Three themes of caring organizational conditions identified by participants included communicating, providing resources, and trusting. The research-based Model of Caring in the Organizational Environment can be used to assess and improve the caring environment of nursing homes as well as to develop caring managers and staff. Organizational well-being for nursing homes is everyone's responsibility and requires formal and informal leaders who can create supportive caring organizational conditions, engage in caring interventions with staff, and inspire the synergy of caring.

  15. Speak Up -- Diabetes: Five Ways to Be Active in Your Care at the Hospital

    MedlinePlus

    ... to be active in your care at the hospital is supported by American Association of Diabetes Educators ... to be active in your care at the hospital The Joint Commission is the largest health care ...

  16. COPD self-management supportive care: chaos and complexity theory.

    PubMed

    Cornforth, Amber

    This paper uses the emergent theories of chaos and complexity to explore the self-management supportive care of chronic obstructive pulmonary disease (COPD) patients within the evolving primary care setting. It discusses the concept of self-management support, the complexity of the primary care context and consultations, smoking cessation, and the impact of acute exacerbations and action planning. The author hopes that this paper will enable the acquisition of new insight and better understanding in this clinical area, as well as support meaningful learning and facilitate more thoughtful, effective and high quality patient-centred care within the context of primary care.

  17. Quality care as ethical care: a poststructural analysis of palliative and supportive district nursing care.

    PubMed

    Nagington, Maurice; Walshe, Catherine; Luker, Karen A

    2016-03-01

    Quality of care is a prominent discourse in modern health-care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse-patient-carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi-structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health-care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved.

  18. Child Care and Other Support Programs

    ERIC Educational Resources Information Center

    Floyd, Latosha; Phillips, Deborah A.

    2013-01-01

    The U.S. military has come to realize that providing reliable, high-quality child care for service members' children is a key component of combat readiness. As a result, the Department of Defense (DoD) has invested heavily in child care. The DoD now runs what is by far the nation's largest employer-sponsored child-care system, a sprawling network…

  19. From risky to safer home care: health care assistants striving to overcome a lack of training, supervision, and support

    PubMed Central

    Swedberg, Lena; Chiriac, Eva Hammar; Törnkvist, Lena; Hylander, Ingrid

    2013-01-01

    Patients receiving home care are becoming increasingly dependent upon competent caregivers’ 24-h availability due to their substantial care needs, often with advanced care and home care technology included. In Sweden, care is often carried out by municipality-employed paraprofessionals such as health care assistants (HC assistants) with limited or no health care training, performing advanced care without formal training or support. The aim of this study was to investigate the work experience of the HC assistants and to explore how they manage when delivering 24-h home care to patients with substantial care needs. Grounded theory methodology involving multiple data sources comprising interviews with HC assistants (n=19) and field observations in patients’ homes was used to collect data and constant comparative analysis was used for analysis. The initial analysis revealed a number of barriers, competence gap; trapped in the home setting; poor supervision and unconnected to the patient care system, describing the risks associated with the situations of HC assistants working in home care, thus affecting their working conditions as well as the patient care. The core process identified was the HC assistants’ strivings to combine safe home care with good working conditions by using compensatory processes. The four identified compensatory processes were: day-by-day learning; balancing relations with the patient; self-managing; and navigating the patient care system. By actively employing the compensatory processes, the HC assistants could be said to adopt an inclusive approach, by compensating for their own barriers as well as those of their colleagues’ and taking overall responsibility for their workplace. In conclusion, the importance of supporting HC assistants in relation to their needs for training, supervision,and support from health care professionals must be addressed when organising 24-h home care to patients with substantial care needs in the future. PMID

  20. Healthy cities as catalysts for caring and supportive environments.

    PubMed

    Green, Geoff; Jackisch, Josephine; Zamaro, Gianna

    2015-06-01

    'Caring and Supportive Environments' are fundamental to a social model of health and were a core theme of Phase V (2009-13) of the WHO European Healthy Cities Network. Deploying the methodology of realist evaluation, this article synthesizes qualitative evidence from 112 highly structured case studies from 68 Network cities and 71 responses to a General Evaluation Questionnaire, which asked cities to analyze city attributes and trends. A schematic model was developed to describe the interaction between action targeted toward children, migrants, older people and action on social and health services, health literacy and active citizenship-the six subtopics clustered within the theme Caring and Supportive Environments. Four hypotheses were tested: (i) there are prerequisites and processes of local governance that increase city capacity for creating supportive environments; (ii) investing in health and social services, active citizenship and health literacy enhance the social inclusion of vulnerable population groups; (iii) there are synergies between social investment and healthy urban planning; and (iv) these investments promote greater equity in health. The evaluation revealed many innovative practices. Providers of health and social services have developed partnerships with agencies influencing wider determinants of health. Health literacy campaigns address the wider context of people's lives. In a period of economic austerity, cities have utilized the social assets of their citizens. Realist evaluation can help illuminate the pathways from case study interventions to health outcomes, and the prerequisites and processes required to initiate and sustain such investments.

  1. 78 FR 13935 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-01

    ...In this document, the Federal Communications Commission reforms its universal service support program for health care, transitioning its existing Internet Access and Rural Health Care Pilot programs into a new, efficient Healthcare Connect Fund. This Fund will expand health care provider access to broadband, especially in rural areas, and encourage the creation of state and regional broadband......

  2. Employer-Supported Child Care: Investing in Human Resources.

    ERIC Educational Resources Information Center

    Burud, Sandra L.; And Others

    This book for employers interested in establishing child care programs is organized into five major topic areas. Part One provides an overview of employer-supported child care. Part Two discusses the processes of identifying and estimating benefits of child care to companies, and tax considerations. Part Three presents practical guidelines and a…

  3. Improving supportive and palliative care for adults with cancer.

    PubMed

    Richardson, Alison

    Although many patients with cancer report positively on their experience of care, others claim they are not receiving the information and support they need at different stages of their care pathway. The national cancer patient survey (Department of Health, 2002), for example, showed wide variations in the quality of care delivered across the country.

  4. 76 FR 37307 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-27

    ... COMMISSION 47 CFR Part 54 Rural Health Care Support Mechanism AGENCY: Federal Communications Commission... services under the rural health care program. Grandfathered providers do not currently qualify as ``rural,'' but play a key role in delivering health care services to surrounding regions that do qualify...

  5. 78 FR 38606 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-27

    ... COMMISSION 47 CFR Part 54 Rural Health Care Support Mechanism AGENCY: Federal Communications Commission... Form. This announcement is consistent with the Universal Service--Rural Health Care Program, Report and... of the Instructions; Page 8, line 122, the Rural Health Care Program offset indicator was...

  6. 76 FR 37280 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-27

    ... COMMISSION 47 CFR Part 54 Rural Health Care Support Mechanism AGENCY: Federal Communications Commission...) adopts an interim rule permitting health care providers that are located in a ``rural area'' under the... rural health care program prior to July 1, 2005, to continue to be treated as if they are located...

  7. Big data and ambulatory care: breaking down legal barriers to support effective use.

    PubMed

    Thorpe, Jane Hyatt; Gray, Elizabeth Alexandra

    2015-01-01

    Big data is heralded as having the potential to revolutionize health care by making large amounts of data available to support care delivery, population health, and patient engagement. Critics argue that big data's transformative potential is inhibited by privacy requirements that restrict health information exchange. However, there are a variety of permissible activities involving use and disclosure of patient information that support care delivery and management. This article presents an overview of the legal framework governing health information, dispels misconceptions about privacy regulations, and highlights how ambulatory care providers in particular can maximize the utility of big data to improve care.

  8. Supporting Children's Transition to School Age Care

    ERIC Educational Resources Information Center

    Dockett, Sue; Perry, Bob

    2016-01-01

    While a great deal of research has focused on children's experiences as they start school, less attention has been directed to their experiences--and those of their families and educators--as they start school age care. This paper draws from a recent research project investigating practices that promote positive transitions to school and school…

  9. Employers Roundtable: Employer Supported Child Care.

    ERIC Educational Resources Information Center

    Delaware Valley Child Care Council, Philadelphia, PA.

    This booklet outlines a number of options available to employers to enable them to better cope with child care issues that they and their employees face. Major options include: (1) flexible work policies, such as flexible scheduling, alternate work places, shorter work weeks, and the consolidating of sick leave, holidays, and vacation time into…

  10. Sleep and nursing care activities in an intensive care unit.

    PubMed

    Ritmala-Castren, Marita; Virtanen, Irina; Leivo, Sanna; Kaukonen, Kirsi-Maija; Leino-Kilpi, Helena

    2015-09-01

    This study aimed to describe the quality of sleep of non-intubated patients and the night-time nursing care activities in an intensive care unit. The study also aimed to evaluate the effect of nursing care activities on the quality of sleep. An overnight polysomnography was performed in 21 alert, non-intubated, non-sedated adult patients, and all nursing care activities that involved touching the patient were documented by the bedside nurse. The median (interquartile range) amount of sleep was 387 (170, 486) minutes. The portion of deep non-rapid-eye-movement (non-REM) sleep varied from 0% to 42% and REM sleep from 0% to 65%. The frequency of arousals and awakenings varied from two to 73 per hour. The median amount of nursing care activities was 0.6/h. Every tenth activity presumably awakened the patient. Patients who had more care activities had more light N1 sleep, less light N2 sleep, and less deep sleep. Nursing care was often performed while patients were awake. However, only 31% of the intervals between nursing care activities were over 90 min. More attention should be paid to better clustering of care activities.

  11. Cultural Support Workers and Long Day Care Services

    ERIC Educational Resources Information Center

    Miller, Melinda G.; Knowles, Meg; Grieshaber, Susan

    2011-01-01

    In Australia, eligible long day care services may apply for support at the state level to assist with the transition of children from culturally or linguistically diverse backgrounds into childcare settings. For staff in childcare services, this support comes in the form of a cultural support worker (CSW). The primary role of a CSW is to build…

  12. Effect of a Primary Care Walking Intervention with and without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial

    PubMed Central

    Harris, Tess; Iliffe, Steve; Whincup, Peter H.; Ekelund, Ulf; Furness, Cheryl; Anokye, Nana; Ibison, Judith; DeWilde, Steve; David, Lee; Dale, Rebecca; Cook, Derek G.

    2017-01-01

    Background Pedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations. Methods and Findings A parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45–75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012–2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in ≥10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329–955) and 677 for nurse support (95% CI 365–989); additional MVPA in bouts

  13. Interpretive medicine: Supporting generalism in a changing primary care world.

    PubMed

    Reeve, Joanne

    2010-01-01

    Patient-centredness is a core value of general practice; it is defined as the interpersonal processes that support the holistic care of individuals. To date, efforts to demonstrate their relationship to patient outcomes have been disappointing, whilst some studies suggest values may be more rhetoric than reality. Contextual issues influence the quality of patient-centred consultations, impacting on outcomes. The legitimate use of knowledge, or evidence, is a defining aspect of modern practice, and has implications for patient-centredness. Based on a critical review of the literature, on my own empirical research, and on reflections from my clinical practice, I critique current models of the use of knowledge in supporting individualised care. Evidence-Based Medicine (EBM), and its implementation within health policy as Scientific Bureaucratic Medicine (SBM), define best evidence in terms of an epistemological emphasis on scientific knowledge over clinical experience. It provides objective knowledge of disease, including quantitative estimates of the certainty of that knowledge. Whilst arguably appropriate for secondary care, involving episodic care of selected populations referred in for specialist diagnosis and treatment of disease, application to general practice can be questioned given the complex, dynamic and uncertain nature of much of the illness that is treated. I propose that general practice is better described by a model of Interpretive Medicine (IM): the critical, thoughtful, professional use of an appropriate range of knowledges in the dynamic, shared exploration and interpretation of individual illness experience, in order to support the creative capacity of individuals in maintaining their daily lives. Whilst the generation of interpreted knowledge is an essential part of daily general practice, the profession does not have an adequate framework by which this activity can be externally judged to have been done well. Drawing on theory related to the

  14. Supporting Nutrition in Early Care and Education Settings: The Child and Adult Care Food Program (CACFP)

    ERIC Educational Resources Information Center

    Stephens, Samuel A.

    2016-01-01

    Child care centers, Head Start programs, and family child care providers serving young children--as well as after school programs and homeless shelters that reach older children, adults, and families--are supported in providing healthy meals and snacks by reimbursements through the Child and Adult Care Food Program (CACFP). Administered by the…

  15. The financial hazard of personalized medicine and supportive care.

    PubMed

    Carrera, Pricivel M; Olver, Ian

    2015-12-01

    Personalized medicine is revolutionizing the delivery of oncological care, promising benefits both at the patient and health system levels. The cost of targeted therapies, unfortunately, is becoming more expensive and unaffordable. Where supportive care in cancer concerns the prevention and management of the adverse effects of cancer and its treatment and is the thrust of the Multinational Association of Supportive Care in Cancer, financing of and value in personalized medicine is an important area of research and engagement for the association. Discussing patients' concerns with and identifying those at most risk for the financial hazard of cancer treatment and offering financial counseling and assistance and/or referral to support networks are potential key areas for (exploring and providing) better supportive care. The time is now to turn the concern of patients and their carers, providers, and other advocates regarding the affordability of cancer treatment into a collective cause towards coordinated action.

  16. 78 FR 54967 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-09

    ... COMMISSION 47 CFR Part 54 Rural Health Care Support Mechanism AGENCY: Federal Communications Commission... information collection associated with the Commission's Universal Service--Rural Health Care Program, Report... August 23, 2013). OMB Expiration Date: August 31, 2016. Title: Universal Service--Rural Health...

  17. From Institutional to Community Support: Consequences for Medical Care

    ERIC Educational Resources Information Center

    van Loon, Jos; Knibbe, Jeroen; Van Hove, Geert

    2005-01-01

    Background: Concerns have been raised about the quality of medical care available for people with intellectual disabilities in community-based services. The aims of this study were to evaluate a model of medical care developed during a programme of deinstitutionalization, based on a specialist physician supporting general practitioners (GPs).…

  18. Supporting Self-management of Asthma Care.

    PubMed

    Keep, Suzanne M; Reiffer, Alice; Bahl, Thomas E

    2016-03-01

    Asthma is a major public health concern, with an estimated 18.8 million adults in the United States having the disease. Asthma can be controlled with a variety of effective treatment options; however, only half the people with asthma report their asthma is well controlled. Uncontrolled asthma leads to high direct and indirect costs as well as decreased quality of life. The pathophysiology of asthma, current asthma practice guidelines, and common barriers to self-management will be discussed. Through use of motivational interviewing techniques and knowledge of available self-management tools, the home care clinician is poised to help increase self-management of asthma, decrease hospitalizations, and improve quality of life.

  19. Supporting relationships between family and staff in continuing care settings.

    PubMed

    Austin, Wendy; Goble, Erika; Strang, Vicki; Mitchell, Agnes; Thompson, Elizabeth; Lantz, Helen; Balt, Linda; Lemermeyer, Gillian; Vass, Kelly

    2009-08-01

    In this Canadian study, a participatory action research approach was used to examine the relationships between families of residents of traditional continuing care facilities and the health care team. The objectives were to (a) explore the formation and maintenance of family-staff relationships, with attention paid to the relational elements of engagement and mutual respect; (b) explore family and staff perspectives of environmental supports and constraints; and (c) identify practical ways to support and enhance these relationships. Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships. The nature of these relationships are discussed using the themes of "Everybody Knows Your Name," "Loss and Laundry," "It's the Little Things That Count," and "The Chasm of Us Versus Them." Families' and staff's ideas of behaviors that support or undermine relationships are identified, as are concrete suggestions for improving family- staff relationships in traditional continuing care settings in Canada.

  20. Needs for Psychosocial Support in Home Care Hospice Patients.

    ERIC Educational Resources Information Center

    Gotay, Carolyn Cook

    There is little research documenting the psychosocial support needs of hospice patients and their families. To assess hospice patients' and families' use of and perceptions of need for support, 77 patients and their families were interviewed during home care for terminal illness (Group 1), and 50 family members (84% spouses) were interviewed 1…

  1. Machine Learning and Decision Support in Critical Care

    PubMed Central

    Johnson, Alistair E. W.; Ghassemi, Mohammad M.; Nemati, Shamim; Niehaus, Katherine E.; Clifton, David A.; Clifford, Gari D.

    2016-01-01

    Clinical data management systems typically provide caregiver teams with useful information, derived from large, sometimes highly heterogeneous, data sources that are often changing dynamically. Over the last decade there has been a significant surge in interest in using these data sources, from simply re-using the standard clinical databases for event prediction or decision support, to including dynamic and patient-specific information into clinical monitoring and prediction problems. However, in most cases, commercial clinical databases have been designed to document clinical activity for reporting, liability and billing reasons, rather than for developing new algorithms. With increasing excitement surrounding “secondary use of medical records” and “Big Data” analytics, it is important to understand the limitations of current databases and what needs to change in order to enter an era of “precision medicine.” This review article covers many of the issues involved in the collection and preprocessing of critical care data. The three challenges in critical care are considered: compartmentalization, corruption, and complexity. A range of applications addressing these issues are covered, including the modernization of static acuity scoring; on-line patient tracking; personalized prediction and risk assessment; artifact detection; state estimation; and incorporation of multimodal data sources such as genomic and free text data. PMID:27765959

  2. The Critical Care Obesity Paradox and Implications for Nutrition Support.

    PubMed

    Patel, Jayshil J; Rosenthal, Martin D; Miller, Keith R; Codner, Panna; Kiraly, Laszlo; Martindale, Robert G

    2016-09-01

    Obesity is a leading cause of preventable death worldwide. The prevalence of obesity has been increasing and is associated with an increased risk for other co-morbidities. In the critical care setting, nearly one third of patients are obese. Obese critically ill patients pose significant physical and on-physical challenges to providers, including optimization of nutrition therapy. Intuitively, obese patients would have worse critical care-related outcome. On the contrary, emerging data suggests that critically ill obese patients have improved outcomes, and this phenomenon has been coined "the obesity paradox." The purposes of this review will be to outline the historical views and pathophysiology of obesity and epidemiology of obesity, describe the challenges associated with obesity in the intensive care unit setting, review critical care outcomes in the obese, define the obesity-critical care paradox, and identify the challenges and role of nutrition support in the critically ill obese patient.

  3. Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care

    PubMed Central

    Mazutti, Sandra Regina Gonzaga; Nascimento, Andréia de Fátima; Fumis, Renata Rego Lins

    2016-01-01

    Objective To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. Methods This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance. Results A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations. Conclusion The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means. PMID:27626949

  4. Spirituality in Renal Supportive Care: A Thematic Review

    PubMed Central

    Egan, Richard; Wood, Sarah; MacLeod, Rod; Walker, Robert

    2015-01-01

    Chronic kidney disease is marked by a reduced life expectancy and a high symptom burden. For those who reach end-stage renal disease, the prognosis is poor, and this combined with the growing prevalence of the disease necessitates supportive and palliative care programmes that will address people’s psychosocial, cultural and spiritual needs. While there is variation between countries, research reveals that many renal specialist nurses and doctors are reluctant to address spirituality, initiate end-of-life conversations or implement conservative treatment plans early. Yet, other studies indicate that the provision of palliative care services, which includes the spiritual dimension, can reduce symptom burden, assist patients in making advanced directives/plans and improve health-related quality of life. This review brings together the current literature related to renal supportive care and spirituality under the following sections and themes. The introduction and background sections situate spirituality in both healthcare generally and chronic kidney disease. Gaps in the provision of chronic kidney disease spiritual care are then considered, followed by a discussion of the palliative care model related to chronic kidney disease and spirituality. Chronic kidney disease spiritual needs and care approaches are discussed with reference to advanced care planning, hope, grief and relationships. A particular focus on quality of life is developed, with spirituality named as a key dimension. Finally, further challenges, such as culture, training and limitations, are explicated. PMID:27417819

  5. Decision Support for Patient Preference-based Care Planning

    PubMed Central

    Ruland, Cornelia M.

    1999-01-01

    Objective: While preference elicitation techniques have been effective in helping patients make decisions consistent with their preferences, little is known about whether information about patient preferences affects clinicians in clinical decision making and improves patient outcomes. The purpose of this study was to evaluate a decision support system for eliciting elderly patients' preferences for self-care capability and providing this information to nurses in clinical practice—specifically, its effect on nurses' care priorities and the patient outcomes of preference achievement and patient satisfaction. Design: Three-group quasi-experimental design with one experimental and two control groups (N = 151). In the experimental group computer-processed information about individual patient's preferences was placed in patients' charts to be used for care planning. Results: Information about patient preferences changed nurses' care priorities to be more consistent with patient preferences and improved patients' preference achievement and physical functioning. Further, higher consistency between patient preferences and nurses' care priorities was associated with higher preference achievement, and higher preference achievement with greater patient satisfaction. Conclusion: This study demonstrated that decision support for eliciting patient preferences and including them in nursing care planning is an effective and feasible strategy for improving nursing care and patient outcomes. PMID:10428003

  6. Electronic health records and support for primary care teamwork

    PubMed Central

    Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A.; Scholle, Sarah Hudson

    2015-01-01

    Objective Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Methods Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. Results EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Discussion Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. Conclusions EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. PMID:25627278

  7. Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury: Guidance for the Primary Care Manager in Deployed and Non-deployed Settings (Clinical Support Tool)

    DTIC Science & Technology

    2014-01-01

    rehabilitation provider for daily m onitored progressive return to activity process J • Rem ain in Stage 1 - Rest B • Provide sym ptom m anagem ent...m ild) on NSI) NoYes No Yes Yes No • Rem ain at Stage 1 - Rest B • Provide sym ptom m anagem ent • Provide follow -up guidance E • Refer to... Sleep issues D. Exertional Testing • Exert to 65-85% of target heart rate (THR=220-age) using push-ups, sit-ups, running in place, step aerobics

  8. [The trial of the domiciliary nutrition support team in which a home medical care office offers].

    PubMed

    Yamashita, Hisaki; Kamei, Miwa; Yamada, Akiko; Toshima, Kazue; Morita, Hideki; Kodama, Naoto; Okabayashi, Kiyoshi

    2010-12-01

    The function of home care support by a medical office is to offer the best medical care for the patient. It is essential that the medical office is capable of taking a call 24-hour a day and 365-day a year from a patient who needs help at home. Our medical office was specialized in home care treatment. Furthermore, we offer a home rehabilitation or a home nutrition education to the patient. On the other hand, a nutritional support is important as well as medical supports. To offer a high quality medical care at home, we created a nutrient support system in our hospital, and formed an at-home nutrition support team(at-home NST). The team is consisted of a medical staff and dietitian, a physical therapist and a speech therapist. As a result of the at-home NST, We improved the followings: (1) we were able to collect a nutritional data basis including a patient 's height and weight, (2) we made a good use of patient's eating habit at home during the medical treatment, and (3) we could make a good use of medical service to a home care patient by managing the information accumulated by nutritional surveillance. In multidisciplinary collaboration, at-home NST can grasp a versatility status of the patient positively. We continue to offer a medical care that is demanded from a home care patient because the activity of the at-home NST raises a quality of medical service we provide.

  9. Coping strategies, care manager support and mental health outcome among Japanese family caregivers.

    PubMed

    Yamada, Miho; Hagihara, Akihito; Nobutomo, Koichi

    2008-07-01

    Coping and social support are regarded as major modifiers of the caregiving stress and negative mental health effects experienced by caregivers. Under Japan's Long-term Care Insurance (LTCI) system, care managers have played a major role in providing psychosocial support for family caregivers while coordinating formal and informal care resources for elderly people. However, since the launch of the LTCI system in 2000, no evaluation has examined the role care managers play in buffering the negative effects of the caregiver burden among family caregivers in Japan. This study examined the direct and buffering effects of stress-coping strategies and care manager support on caregiver burden and depression among Japanese family caregivers (n = 371) caring for community-dwelling persons aged 65 or over who were having difficulties with the activities of daily living. A self-administrated questionnaire survey was conducted between February and March 2005 in a rural suburb in south-western Japan. Hierarchical regression analyses revealed the following. (i) Coping strategies and 'social talk' by care managers had direct effects on caregiver burden and depression. (ii) 'Avoidant' coping and 'social talk' by care managers had buffering effects on the care needs-depression relationship. (iii) 'Information giving' by care managers had no significant direct effect, but it had a negative effect on the care needs-depression relationship. Overall, results concerning 'approaching' coping were in line with those of previous studies, while findings concerning 'avoidant' coping were not consistent with findings in Western countries. The type of care manager support appeared to have a variable influence on caregiver burden and depression.

  10. Support workers as agents for health behavior change: An Australian study of the perceptions of clients with complex needs, support workers, and care coordinators.

    PubMed

    Lawn, Sharon; Westwood, Tania; Jordans, Sarah; O'Connor, Julianne

    2016-04-06

    An expanding aging population has placed increased demands on health care resources in many countries. Enhancing community aged care support workers' role to support greater client self-management and reablement is therefore timely. This article presents perceptions of the impact of an Australian practice change initiative designed to enhance knowledge, skills, and confidence of support workers to support behavior change in clients with complex health care needs. A comprehensive training program was delivered in 2013. Methods included thematic analysis of interviews with clients, focus groups with support workers and coordinators, and collection of case studies of client/support worker behavior change interactions. Client, support worker, and coordinator responses were highly positive, reporting improvement in the quality of interactions with clients, client health outcomes, care coordination, communication, and teamwork. Mental health literacy remained the biggest knowledge gap. This research showed that support workers are ideally placed to be more actively involved in motivating clients to achieve behavior change goals.

  11. [The informational analytical support of management of regional health care on the basis of expertise].

    PubMed

    Finchenko, E A; Tsytsorina, I A; Shalygina, L S; Ivaninskii, O I; Sharapov, I V

    2014-01-01

    principles of elaboration of system of informational analytical support of management of regional health care. The unified expertise questionnaire was developed to be used as a document basis of expertise system. The study results can be implemented in practical activities of regional health administration and medical organizations. The results of study made it possible to substantiate the development of the system of informational analytical support of regional health care and to determine priority directions of its formation.

  12. Everyday Miracles: Supporting Parents of Infants in Foster Care

    ERIC Educational Resources Information Center

    Wotherspoon, Evelyn; McInnis, Jan

    2013-01-01

    This article describes a model for supporting parents and their infants during separations due to temporary foster care. Using a case example, the authors describe a model for visit coaching, including their process for assessment and strategies used for intervention. The lessons learned are: (a) that individual parents can present very…

  13. Congressman Greg Walden speaks out in support of home care.

    PubMed

    Kincheloe, Jeff

    2005-05-01

    Support for the mission of home care and hospice from Congress continues to expand as more members of the House and Senate take time out of their busy schedules to visit with a home care or hospice patient. Take the case of Congressman Greg Walden (R-OR) who is currently in his fourth term representing the people of Oregon's Second Congressional District, which includes twenty counties in central, southern and eastern Oregon. He is a passionate advocate for home care and hospice who as chair of the Congressional Rural Health Care Coalition, is a key figure in the fight to restore the 5% rural add on for home health services to rural patients.

  14. Primary Health Care Providers' Perspectives: Facilitating Older Patients' Access to Community Support Services.

    PubMed

    Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Wu, Amina; Lam, Annie

    2016-12-01

    The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons' access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to find relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to find that they relied on out-of-date resources and inefficient search strategies to find CSSs. Our findings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs.

  15. Family-centered developmentally supportive care: the Swedish example.

    PubMed

    Westrup, B

    2015-10-01

    The prematurely born infant is probably the most vulnerable patient in our hospitals due to the immaturity of all organ systems including the brain. Over recent years, the importance of neurodevelopmentally supportive care has been clarified. In addition, to provide the best possible treatment and environmental conditions for the vital functions of the infant to properly develop, we also must support the psychological processes of bonding and attachment between parents and their newborn infant, which is so crucial for long-term health and development. By integrating scientific findings from natural and behavioral science in multidisciplinary developmentally supportive intervention programs, recommendations for redesigning nurseries and integrating families have developed to meet these challenges. It not only is "baby- and family-friendly" but also has economic benefits and improves the long-term development of the child. The basis of family-centered developmentally supportive care interventions is the recognition that the newborn infant is a human being in his or her own right, and letting the caregivers be guided by the current needs of the individual infant and family. In this context, the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is unique since it is the only program designed to be implemented from the moment the infant is born. Different strategies can be used to support the nursing and medical teams to help the family become the primary caregivers of their own infants. Sweden has a long tradition of engaging parents in the actual care and of around-the-clock visiting hours. Nurseries have, or are remodeling to have, the facilities enabling parents to live in the units throughout the entire hospital stay. Skin-to-skin contact is widely implemented. In order to ensure that these strategies are in tune with the individual needs of the infant and the families, all major nurseries have trained NIDCAP professionals. Care and

  16. Care Partnerships: Toward Technology to Support Teens’ Participation in Their Health Care

    PubMed Central

    Hong, Matthew K.; Wilcox, Lauren; Machado, Daniel; Olson, Thomas A.; Simoneaux, Stephen F.

    2016-01-01

    Adolescents with complex chronic illnesses, such as cancer and blood disorders, must partner with family and clinical caregivers to navigate risky procedures with life-altering implications, burdensome symptoms and lifelong treatments. Yet, there has been little investigation into how technology can support these partnerships. We conducted 38 in-depth interviews (15 with teenage adolescents with chronic forms of cancer and blood disorders, 15 with their parents, and eight with clinical caregivers) along with nine non-participant observations of clinical consultations to better understand common challenges and needs that could be supported through design. Participants faced challenges primarily concerning: 1) teens’ limited participation in their care, 2) communicating emotionally-sensitive information, and 3) managing physical and emotional responses. We draw on these findings to propose design goals for sociotechnical systems to support teens in partnering in their care, highlighting the need for design to support gradually evolving partnerships in care. PMID:28164178

  17. Decision support systems for robotic surgery and acute care

    NASA Astrophysics Data System (ADS)

    Kazanzides, Peter

    2012-06-01

    Doctors must frequently make decisions during medical treatment, whether in an acute care facility, such as an Intensive Care Unit (ICU), or in an operating room. These decisions rely on a various information sources, such as the patient's medical history, preoperative images, and general medical knowledge. Decision support systems can assist by facilitating access to this information when and where it is needed. This paper presents some research eorts that address the integration of information with clinical practice. The example systems include a clinical decision support system (CDSS) for pediatric traumatic brain injury, an augmented reality head- mounted display for neurosurgery, and an augmented reality telerobotic system for minimally-invasive surgery. While these are dierent systems and applications, they share the common theme of providing information to support clinical decisions and actions, whether the actions are performed with the surgeon's own hands or with robotic assistance.

  18. [For a coordination of the supportive care for people affected by severe illnesses: proposition of organization in the public and private health care centres].

    PubMed

    Krakowski, Ivan; Boureau, François; Bugat, Roland; Chassignol, Laurent; Colombat, Philippe; Copel, Laure; d'Hérouville, Daniel; Filbet, Marylène; Laurent, Bernard; Memran, Nadine; Meynadier, Jacques; Parmentier, Gérard; Poulain, Philippe; Saltel, Pierre; Serin, Daniel; Wagner, Jean-Philippe

    2004-05-01

    The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor communication between the teams, by the administrative difficulties encountered by the teams participating in the supportive care. The working group insists on the fact that the supportive care is not a new speciality. He proposes the creation of units. departments or pole of responsibility of supportive care with a "basic coordination" involving the activities of chronic pain, palliative care, psycho-oncology, and social care. This coordination can be extended, according to the "history" and missions of health care centres. Service done with the implementation of a "unique counter" for the patients and the teams is an important point. The structure has to comply with the terms and conditions of contract (Consultation, Unit or Centre of chronic pain, structures of palliative care, of psycho-oncology, of nutrition, of social care). A common technical organization is one of the interests. The structure has to set up strong links with the private practitioners, the networks, the home medical care (HAD) and the nurses

  19. The Memory Club: Providing support to persons with early-stage dementia and their care partners.

    PubMed

    Gaugler, Joseph E; Gallagher-Winker, Karen; Kehrberg, Kathy; Lunde, Angela M; Marsolek, Connie M; Ringham, Kathryn; Thompson, Gerise; Barclay, Michelle

    2011-05-01

    There is a growing emphasis on delivering services for persons with early-stage dementia (ie, ''persons with memory loss,'' or PWMLs) and their family members (care partners). The goal of this evaluation was to determine whether participation in the Memory Club, a 10- to 13-session joint support group, would result in decreased distress, enhanced preparation for care, and improved feelings of confidence managing the challenges of early-stage dementia. The single group, pre-/post-test evaluation included 63 PWMLs and 61 care partners who participated in three Memory Club sites in Minnesota. Paired T-test results found that care partners reported significant (P < .05) increases in preparation activities, feelings of preparation, and confidence in managing memory loss. The results suggest that the Memory Club can fill an important gap in early-stage dementia care by offering care partners the opportunity to plan, prepare, and increase coping skills in the face of early dementia progression.

  20. Health Care Provider Physical Activity Prescription Intervention

    ERIC Educational Resources Information Center

    Josyula, Lakshmi; Lyle, Roseann

    2013-01-01

    Purpose: To examine the feasibility and impact of a health care provider’s (HCP) physical activity (PA) prescription on the PA of patients on preventive care visits. Methods: Consenting adult patients completed health and PA questionnaires and were sequentially assigned to intervention groups. HCPs prescribed PA using a written prescription only…

  1. Potential of physician assistants to support primary care

    PubMed Central

    Bowen, Sarah; Botting, Ingrid; Huebner, Lori-Anne; Wright, Brock; Beaupre, Beth; Permack, Sheldon; Jones, Ian; Mihlachuk, Ainslie; Edwards, Jeanette; Rhule, Chris

    2016-01-01

    Abstract Objective To determine effective strategies for introducing physician assistants (PAs) in primary care settings and provide guidance to support ongoing provincial planning for PA roles in primary care. Design Time-series research design using multiple qualitative methods. Setting Manitoba. Participants Physician assistants, supervising family physicians, clinic staff, members of the Introducing Physician Assistants into Primary Care Steering Committee, and patients receiving care from PAs. Methods The PA role was evaluated at 6 health care sites between 2012 and 2014; sites varied in size, funding models, geographic locations (urban or rural), specifics of the PA role, and setting type (clinic or hospital). Semistructured interviews and focus groups were conducted; patient feedback on quality improvement was retrieved; observational methods were employed; and documents were reviewed. A baseline assessment was conducted before PA placement. In 2013, there was a series of interviews and focus groups about the introduction of PAs at the 3 initial sites; in 2014 interviews and focus groups included all 6 sites. Main findings The concerns that were expressed during baseline interviews about the introduction of PAs (eg, community and patient acceptance) informed planning. Most concerns that were identified did not materialize. Supervising family physicians, site staff, and patients were enthusiastic about the introduction of PAs. There were a few challenges experienced at the site level (eg, front-desk scheduling), but they were perceived as manageable. Unanticipated challenges at the provincial level were identified (eg, diagnostic test ordering). Increased attachment and improved access—the goals of introducing PAs to primary care—were only some of the positive effects that were reported. Conclusion This first systematic multisite evaluation of PAs in primary care in Canada demonstrated that with appropriate collaborative planning, PAs can effectively

  2. Developmental Care Rounds: An Interdisciplinary Approach to Support Developmentally Appropriate Care of Infants Born with Complex Congenital Heart Disease.

    PubMed

    Lisanti, Amy Jo; Cribben, Jeanne; Connock, Erin McManus; Lessen, Rachelle; Medoff-Cooper, Barbara

    2016-03-01

    Newborn infants with complex congenital heart disease are at risk for developmental delay. Developmental care practices benefit prematurely born infants in neonatal intensive care units. Cardiac intensive care units until recently had not integrated developmental care practices into their care framework. Interdisciplinary developmental care rounds in our center have helped in the promotion of developmentally supportive care for infants before and after cardiac surgery. This article discusses basic principles of developmental care, the role of each member of the interdisciplinary team on rounds, common developmental care practices integrated into care from rounds, and impacts to patients, families, and staff.

  3. [Foci of infection and oral supportive care in cancer patients].

    PubMed

    Stokman, M A; Vissink, A; Spijkervet, F K L

    2008-04-01

    Radiation therapy in the head and neck area and treatment with high dose chemotherapy entail damage to healthy tissue in the mouth. In order to reduce to a minimum the chances of these side effects of cancer treatment developing, it is necessary to carry out oral foci tests prior to oncological therapy. In addition supplementary oral and dental care measures seem to be important in order to limit the side effects of oncological therapy on the teeth, salivary glands and jaw as much as possible. This supportive oral care is not only necessary during, but also for years after the oncology treatment. Therefore not only dental professionals affiliated to oncology teams will have to take care of cancer patients, but also family dentists and dental hygienists.

  4. Relational citizenship: supporting embodied selfhood and relationality in dementia care.

    PubMed

    Kontos, Pia; Miller, Karen-Lee; Kontos, Alexis P

    2017-02-01

    We draw on findings from a mixed-method study of specialised red-nosed elder-clowns in a long-term care facility to advance a model of 'relational citizenship' for individuals with dementia. Relational citizenship foregrounds the reciprocal nature of engagement and the centrality of capacities, senses, and experiences of bodies to the exercise of human agency and interconnectedness. We critically examine elder-clown strategies and techniques to illustrate how relational citizenship can be supported and undermined at the micro level of direct care through a focus on embodied expressions of creativity and sexuality. We identify links between aesthetic enrichment and relational practices in art, music and imagination. Relational citizenship offers an important rethinking of notions of selfhood, entitlement, and reciprocity that are central to a sociology of dementia, and it also provides new ethical grounds to explore how residents' creative and sexual expression can be cultivated in the context of long-term care.

  5. Volunteer activity in specialist paediatric palliative care: a national survey

    PubMed Central

    Burbeck, Rachel; Low, Joe; Sampson, Elizabeth L; Scott, Rosalind; Bravery, Ruth; Candy, Bridget

    2015-01-01

    Objective To assess the involvement of volunteers with direct patient/family contact in UK palliative care services for children and young people. Method Cross-sectional survey using a web-based questionnaire. Setting UK specialist paediatric palliative care services. Participants Volunteer managers/coordinators from all UK hospice providers (n=37) and one National Health Service palliative care service involving volunteers (covering 53 services in total). Main outcomes Service characteristics, number of volunteers, extent of volunteer involvement in care services, use of volunteers’ professional skills and volunteer activities by setting. Results A total of 21 providers covering 31 hospices/palliative care services responded (30 evaluable responses). Referral age limit was 16–19 years in 23 services and 23–35 years in seven services; three services were Hospice at Home or home care only. Per service, there was a median of 25 volunteers with direct patient/family contact. Services providing only home care involved fewer volunteers than hospices with beds. Volunteers entirely ran some services, notably complementary therapy and pastoral/faith-based care. Complementary therapists, school teachers and spiritual care workers most commonly volunteered their professional skills. Volunteers undertook a wide range of activities including emotional support and recreational activities with children and siblings. Conclusions This is the most detailed national survey of volunteer activity in palliative care services for children and young people to date. It highlights the range and depth of volunteers’ contribution to specialist paediatric palliative care services and will help to provide a basis for future research, which could inform expansion of volunteers’ roles. PMID:24644170

  6. Effects of Mobile Phone Usage in Supporting Leg Lymphedema Self-care

    PubMed Central

    Okutsu, Ayako; Koiyabashi, Kikuyo

    2014-01-01

    Objective: The aim of this study was to implement self-care support for leg lymphedema patients using mobile phones and to investigate the effects thereof. Patients and Methods: A total of 30 patients with lymphedema following female genital cancer surgery (stages I to II) who were referred from a nearby gynecologist were randomly divided into groups for routine self-care support (control group) and mobile telephone-assisted support (intervention group) and received the self-care support appropriate to their group. The (total) circumference of the leg with edema, FACT-G (cancer patient QOL), MHP (mental health status), and self-care self-assessment were comparatively investigated at three months after the initial interview. Results: No significant reduction in the (total) circumferences of legs with edema was confirmed in either the control or intervention group. The intervention group was significantly better than the control group in terms of the activity circumstances and FACT-G mental status at three months after the initial interview. The intervention group was also significantly better in psychological, social, and physical items in the MHP. The intervention group was significantly better than the control group in terms of circumstances of self-care implementation at three months after the initial interview. Additionally, comparison of the circumstances of implementation for different aspects of self-care content showed that the intervention group was significantly better at selecting shoes, observing edema, moisturizing, self-drainage, wearing compression garments, and implementing bandaging. Conclusion: Compared with routine self-care support, mobile telephone-assisted support is suggested to be effective for leg lymphedema patients’ QOL and mental health status as well as their self-care behaviors. PMID:25648778

  7. Decision support system based semantic web for personalized patient care.

    PubMed

    Douali, Nassim; De Roo, Jos; Jaulent, Marie-Christine

    2012-01-01

    Personalized medicine may be considered an extension of traditional approaches to understanding and treating diseases, but with greater precision. A profile of a patient's genetic variation can guide the selection of drugs or treatment protocols that minimize harmful side effects or ensure a more successful outcome. In this paper we describe a decision support system designed to assist physicians for personalized care, and methodology for integration in the clinical workflow. A reasoning method for interacting heterogeneous knowledge and data is a necessity in the context of personalized medicine. Development of clinical decision support based semantic web for personalized patient care is to achieve its potential and improve the quality, safety and efficiency of healthcare.

  8. Supporting Siblings as a Standard of Care in Pediatric Oncology.

    PubMed

    Gerhardt, Cynthia A; Lehmann, Vicky; Long, Kristin A; Alderfer, Melissa A

    2015-12-01

    In this study, evidence is provided for supporting siblings as a standard of care in pediatric oncology. Using Medline, PsycInfo, and CINAHL, a systematic search of articles published over the past two decades about siblings of children with cancer was conducted. A total of 125 articles, which were primarily descriptive studies, were evaluated by the four investigators using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. There is moderate-quality evidence, as well as support from community stakeholders, to justify a strong recommendation that siblings of children with cancer should be provided with psychosocial services and that parents and professionals are advised about how to meet siblings' needs.

  9. Flexible learning to support safe, person-centred care.

    PubMed

    Rae, Ann

    2012-02-01

    Effective Practitioner is an educational initiative that supports nurses, midwives and allied health professionals to deliver person-centred, safe and effective care. It offers access to flexible work-based learning and development resources. This article describes the progress of the initiative and sets out the expected effects on service delivery, as well as exploring the Scottish context and the initiative's relevance to the rest of the UK and abroad.

  10. [The major directions of population support with high-tech medical care].

    PubMed

    2011-01-01

    The article deals with issues of organization of the activities and strategy of development of new federal high-tech technology medical centers. The emphasis is made on the issues of centers functioning in present conditions. The substantiation of directions of enhancement of medical support of population with high-tech medical care is discussed.

  11. 'We're in the sandwich': Aged care staff members' negotiation of constraints and the role of the organisation in enacting and supporting an ethic of care.

    PubMed

    Petriwskyj, Andrea; Gibson, Alexandra; Webby, Glenys

    2015-12-01

    Aged care staff are often seen as holding power in care relationships, particularly in client engagement. Such a perception, however, may limit our understanding and analysis of the dynamics and politics within care spaces. This paper uses interview and focus group data from both staff and clients of an Australian aged care provider to identify the positions given to, and taken up by, staff in client engagement. Focusing on one of these positions, in which staff are seen as managing and negotiating constraints, the paper uses an ethic of care lens to examine the context in which engagement - and this position taking - occurs. Findings reflect the importance of the organisational and systemic context to the practice of care ethics and the potential vulnerability and disempowerment of care giving staff. Implications for the support of staff in client engagement and the role of care organisations beyond structures and processes to an active participant in an ethic of care are discussed.

  12. Upgrading physical activity counselling in primary care in the Netherlands.

    PubMed

    Verwey, Renée; van der Weegen, Sanne; Spreeuwenberg, Marieke; Tange, Huibert; van der Weijden, Trudy; de Witte, Luc

    2016-06-01

    The systematic development of a counselling protocol in primary care combined with a monitoring and feedback tool to support chronically ill patients to achieve a more active lifestyle. An iterative user-centred design method was used to develop a counselling protocol: the Self-management Support Programme (SSP). The needs and preferences of future users of this protocol were identified by analysing the literature, through qualitative research, and by consulting an expert panel. The counselling protocol is based on the Five A's model. Practice nurses apply motivational interviewing, risk communication and goal setting to support self-management of patients in planning how to achieve a more active lifestyle. The protocol consists of a limited number of behaviour change consultations intertwined with interaction with and responses from the It's LiFe! monitoring and feedback tool. This tool provides feedback on patients' physical activity levels via an app on their smartphone. A summary of these levels is automatically sent to the general practice so that practice nurses can respond to this information. A SSP to stimulate physical activity was defined based on user requirements of care providers and patients, followed by a review by a panel of experts. By following this user-centred approach, the organization of care was carefully taken into account, which has led to a practical and affordable protocol for physical activity counselling combined with mobile technology.

  13. Activity recognition with smartphone support.

    PubMed

    Guiry, John J; van de Ven, Pepijn; Nelson, John; Warmerdam, Lisanne; Riper, Heleen

    2014-06-01

    In this paper, the authors describe a method of accurately detecting human activity using a smartphone accelerometer paired with a dedicated chest sensor. The design, implementation, testing and validation of a custom mobility classifier are also presented. Offline analysis was carried out to compare this custom classifier to de-facto machine learning algorithms, including C4.5, CART, SVM, Multi-Layer Perceptrons, and Naïve Bayes. A series of trials were carried out in Ireland, initially involving N=6 individuals to test the feasibility of the system, before a final trial with N=24 subjects took place in the Netherlands. The protocol used and analysis of 1165min of recorded activities from these trials are described in detail in this paper. Analysis of collected data indicate that accelerometers placed in these locations, are capable of recognizing activities including sitting, standing, lying, walking, running and cycling with accuracies as high as 98%.

  14. [Perception of the mothers concerning the received social support in home care to the premature children].

    PubMed

    Simioni, Angelita Dos Santos; Geib, Lorena Teresinha Consalter

    2008-01-01

    This study of qualitative approach aimed at knowing the perception of mothers of premature newborn concerning the social support received in the home care. The sample included 12 mothers of premature, older than 20 years, in the coverage area of Family Health Units of Passo Fundo-RS. The data were collected through semi-structured interview, genogram and echomap. The thematic analysis evidenced the grandmothers as builders and maintaining of the social nest; the discouragement of the abandonment; the safe base; and the social inclusion promoted by the friends. The social support not supplied is centered in the care to the newborn and in the activities of the home. This way, the mothers' perception reveals a predominant intrafamiliar support, whose expansion would allow configuring a more effective social net for the strengthness of the maternal care.

  15. Defense Health Care: Acquisition Process for TRICARE’s Third Generation of Managed Care Support Contracts

    DTIC Science & Technology

    2014-03-01

    Selection Team Roles and Responsibilities for TRICARE’s Contract Award Process 11 Figure 3: Timeline of Bid Protest Events for TRICARE’s North Region...14-195 TRICARE Managed Care Support Contracts Figure 2: Source Selection Team Roles and Responsibilities for TRICARE’s Contract Award Process

  16. Nutritional support of children in the intensive care unit.

    PubMed Central

    Seashore, J. H.

    1984-01-01

    Nutritional support is an integral and essential part of the management of 5-10 percent of hospitalized children. Children in the intensive care unit are particularly likely to develop malnutrition because of the nature and duration of their illness, and their inability to eat by mouth. This article reviews the physiology of starvation and the development of malnutrition in children. A method of estimating the nutritional requirements of children is presented. The techniques of nutritional support, including enteral, peripheral, and central parenteral nutrition are discussed in detail. Appropriate formulas are given for different age groups. Electrolyte, vitamin, and mineral supplements are discussed. Guidelines are provided for choosing between peripheral and central total parenteral nutrition. A monitoring protocol is suggested and complications of nutritional therapy are reviewed. Safe and effective nutritional support requires considerable investment of time and effort by members of the nutrition team. PMID:6433586

  17. Transforming Staff Practice through Active Support

    ERIC Educational Resources Information Center

    Riches, Vivienne C.; Harman, Anthony D.; Keen, Deb; Pennell, Donna; Harley, Jane H.; Walker, Michelle

    2011-01-01

    Background: Active support is being introduced in many residential and respite homes in an effort to improve engagement in meaningful activity of people with intellectual disability. Method: A train-the-trainer approach was used in a large government organisation that supports people with intellectual disability in Australia. Five apprentice…

  18. Exploring Primary Care Activities in ACT Teams

    PubMed Central

    Vanderlip, Erik R.; Williams, Nancy A.; Fiedorowicz, Jess G.; Katon, Wayne

    2014-01-01

    Background People with serious mental illness often receive inadequate primary and preventive care services. Federal healthcare reform endorses team-based care that provides high quality primary and preventive care to at risk populations. Assertive Community Treatment (ACT) teams offer a proven, standardized treatment approach effective in improving mental health outcomes for the seriously mentally ill. Much is known about the effectiveness of ACT teams in improving mental health outcomes, but the degree to which medical care needs are addressed is not established. Purpose The purpose of this study was to explore the extent to which ACT teams address the physical health of the population they serve. Methods ACT team leaders were invited to complete an anonymous, web-based survey to explore attitudes and activities involving the primary care needs of their clients. Information was collected regarding the use of health screening tools, physical health assessments, provision of medical care and collaboration with primary care systems. Results Data was analyzed from 127 team leaders across the country, of which 55 completed the entire survey. Nearly every ACT team leader believed ACT teams have a role in identifying and managing the medical co-morbidities of their clientele. ACT teams report participation in many primary care activities. Conclusions ACT teams are providing a substantial amount of primary and preventive services to their population. The survey suggests standardization of physical health identification, management or referral processes within ACT teams may result in improved quality of medical care. ACT teams are in a unique position to improve physical health care by virtue of having medically trained staff and frequent, close contact with their clients. PMID:24337472

  19. Using social media in supportive and palliative care research.

    PubMed

    Casañas i Comabella, Carolina; Wanat, Marta

    2015-06-01

    Difficulties relating to supportive and palliative care research are often reported. However, studies have highlighted that people near the end of life are happy to participate in research and want their voices heard. Thus, one may raise a twofold question: are we limiting the free will of people who are seriously ill? And are we missing important data, which probably cannot be obtained from other sources? In light of this landscape, a new opportunity has emerged: the use of social media (SM). This paper provides a comprehensive summary of SM, including its theoretical underpinnings, and recent examples of successful uses of SM in healthcare research. It also outlines the opportunities (wider reach, direct access, the potential of Big Data, readiness of research data, empowered participants) and challenges (anonymity of participants, digital divide, sample bias, screening and 'saying no' to participants, data analysis) of using SM in end-of-life care research. Finally, it describes the practical steps that a researcher could follow to recruit patients using SM. Implications for palliative care clinicians, researchers and policymakers are also discussed, with a focus on the need to facilitate patient-centred care through the use of SM. The need for relevant and updated guidelines in this new, emerging field is highlighted.

  20. Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

    PubMed Central

    Park, Grace; Miller, Diane; Tien, George; Sheppard, Irene; Bernard, Michael

    2014-01-01

    Background A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions. Description of integrated practice An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues. Early results The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased). Conclusion Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients. PMID:24648834

  1. The Challenge of Employer-Supported Child Care: Meeting Parent Needs.

    ERIC Educational Resources Information Center

    Friedman, Dana E.

    After a brief historical overview of child care provision and a characterization of current interest in employer support for day care services, this paper describes pressures on employers to support child care, delineates a rationale for employer support, and identifies employer options for supporting parents' needs for services, information,…

  2. Desktop teleradiology in support of rural orthopedic trauma care.

    PubMed Central

    Reid, J. G.; McGowan, J. J.; Ricci, M. A.; McFarlane, G.

    1997-01-01

    Research has shown that diagnostic quality images for most teleradiology applications requires a sophisticated telemedicine system and access to a large amount of bandwidth. While the ideal standards have been set by those involved in evaluating teleradiology, these standards are impractical for many small rural health centers which deliver routine trauma care. While there is no disagreement about the ultimate need for this level of teleradiology support, the purpose of this research was to determine whether Orthopedists would be able to read plain radiographs of orthopedic trauma injuries using a desktop teleradiology system in support of rural trauma care. METHOD: Two radiology residents and two orthopedic residents viewed forty radiographs, twenty through a desktop teleradiology system and twenty in person. Diagnostic findings and certainty of diagnosis were recorded. FINDINGS: There was no statistically significant difference between modalities in orthopedic residents' ability to correctly diagnose orthopedic trauma injuries. Further, for those instances when the diagnosis was imprecise, the residents were aware of their inability to make an accurate diagnosis. CONCLUSION: Although the study was relatively limited and further research needs to be done, the use of desktop teleradiology in support of rural orthopedic trauma consultation is a promising alternative to the more expensive forms of telemedicine technology. PMID:9357657

  3. Development of an allergy management support system in primary care

    PubMed Central

    Flokstra - de Blok, Bertine MJ; van der Molen, Thys; Christoffers, Wianda A; Kocks, Janwillem WH; Oei, Richard L; Oude Elberink, Joanne NG; Roerdink, Emmy M; Schuttelaar, Marie Louise; van der Velde, Jantina L; Brakel, Thecla M; Dubois, Anthony EJ

    2017-01-01

    Background Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs) are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS) for primary care. Methods Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists’ allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE)-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard) and AMSS diagnostic categories. Results The two-page patient-completed AMSS questionnaire consists of 12 (mainly) multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other allergies were identified, and the corresponding management recommendations were formulated. The agreement between the allergy specialists’ assessments and the AMSS was 69.2% (CI 67.2–71.2). Conclusion Using a systematic approach, it was possible to develop an AMSS that allows for the formulation of diagnostic and management recommendations for GPs managing allergic patients. The AMSS thus holds promise for the improvement of the quality of primary care for this increasing group of patients. PMID:28352197

  4. Multi-centred mixed-methods PEPFAR HIV care & support public health evaluation: study protocol

    PubMed Central

    2010-01-01

    Background A public health response is essential to meet the multidimensional needs of patients and families affected by HIV disease in sub-Saharan Africa. In order to appraise curret provision of HIV care and support in East Africa, and to provide evidence-based direction to future care programming, and Public Health Evaluation was commissioned by the PEPFAR programme of the US Government. Methods/Design This paper described the 2-Phase international mixed methods study protocol utilising longitudinal outcome measurement, surveys, patient and family qualitative interviews and focus groups, staff qualitative interviews, health economics and document analysis. Aim 1) To describe the nature and scope of HIV care and support in two African countries, including the types of facilities available, clients seen, and availability of specific components of care [Study Phase 1]. Aim 2) To determine patient health outcomes over time and principle cost drivers [Study Phase 2]. The study objectives are as follows. 1) To undertake a cross-sectional survey of service configuration and activity by sampling 10% of the facilities being funded by PEPFAR to provide HIV care and support in Kenya and Uganda (Phase 1) in order to describe care currently provided, including pharmacy drug reviews to determine availability and supply of essential drugs in HIV management. 2) To conduct patient focus group discussions at each of these (Phase 1) to determine care received. 3) To undertake a longitudinal prospective study of 1200 patients who are newly diagnosed with HIV or patients with HIV who present with a new problem attending PEPFAR care and support services. Data collection includes self-reported quality of life, core palliative outcomes and components of care received (Phase 2). 4) To conduct qualitative interviews with staff, patients and carers in order to explore and understand service issues and care provision in more depth (Phase 2). 5) To undertake document analysis to appraise

  5. Role of supportive care for terminal stage hepatocellular carcinoma.

    PubMed

    Kumar, Manoj; Panda, Dipanjan

    2014-08-01

    Patients with end stage or terminal HCC are those presenting with tumors leading to a very poor Performance Status (ECOG 3-4) or Child-Pugh C patients with tumors beyond the transplantation threshold. Among HCC patients, 15-20% present with end stage or terminal stage HCC. Their median survival is less than 3-4 months. The management of end stage or terminal HCC is only symptomatic and no definitive tumor directed treatment is indicated. Patients with end stage or terminal HCC should receive palliative support including management of pain, nutrition and psychological support. In general, they should not be considered for participating in clinical trials. This review focuses on palliative care of terminal stage HCC.

  6. [Supportive care, cognition and quality of life in brain metastases].

    PubMed

    Le Rhun, É; Taillibert, S; Blonski, M; Jouniaux Delbez, N; Delgadillo, D; Taillia, H; Auquier, P; Belin, C; Bonnetain, F; Varin, D; Tallet, A; Taillandier, L

    2015-02-01

    Brain metastases impact on the survival of the patients, but on their quality of life as well. The objective of the management of these patients is then double. Currently, due to medical advances, survivals tend to improve, especially for some tumor subtypes. During the course of the disease, different neurological signs and symptoms can be observed according to the location, the number and the volume of the metastase(s). Patients and caregivers are especially worried about the loss of autonomy and cognitive impairments. A permanent dialogue, during the course of the disease, is mandatory, in order to adapt the management to the objectives determined by the patients and the medical team. These objectives may vary according to the objective response rates of the disease to anticancer therapies, according to the impact of the disease and its management in daily living. Anticancer therapies and supportive care must be appreciated according to their impact on the survival, on the preservation of the functional independence and the quality of life of the patient, on their abilities to preserve the neurological status and delay the apparition of new neurological signs and symptoms, and their adverse events. Supportive care, cognition and quality of life should be regularly evaluated and adapted according to the objectives of the management of brain metastases patients. Different approaches are described in this paper.

  7. Supportive care for patients with Guillain-Barré syndrome.

    PubMed

    Hughes, Richard A C; Wijdicks, Eelco F M; Benson, Estelle; Cornblath, David R; Hahn, Angelika F; Meythaler, Jay M; Sladky, John T; Barohn, Richard J; Stevens, James C

    2005-08-01

    A multidisciplinary consensus group searched MEDLINE from 1966 to May 2003, extracted relevant references, and prepared recommendations on supportive care for Guillain-Barré syndrome. In the absence of randomized controlled trials, we agreed on recommendations by consensus based on observational studies and expert opinion. In the acute phase in bed-bound adult patients, the group recommended the use of heparin and graduated pressure stockings to prevent deep vein thrombosis, monitoring for blood pressure, pulse, autonomic disturbances, and respiratory failure, and the timely institution of artificial ventilation and tracheostomy. Pain management is difficult, but carbamazepine or gabapentin may help. The cautious use of narcotic analgesics may be needed. Disabled patients should be treated by a multidisciplinary rehabilitation team and should receive an assistive exercise program. Persistent fatigue following Guillain-Barré syndrome is common and may be helped by an exercise program. Because of a very small and possibly only theoretical increase in the risk of recurrence following immunization, the need for immunization should be reviewed on an individual basis. More research is needed to identify optimal methods for all aspects of supportive care.

  8. Unmet Supportive Care Needs among Breast Cancer Survivors of Community-Based Support Group in Kuching, Sarawak

    PubMed Central

    Fong, Emmanuel Joseph; Cheah, Whye Lian

    2016-01-01

    Background. Recognizing the needs of cancer survivors is one of the important aspects in healthcare delivery. This study aimed to determine the prevalence of unmet supportive care needs and its associated factors among the breast cancer survivors of community-based support group in Kuching, Sarawak. Materials and Methods. This was a cross-sectional study using Supportive Care Needs Survey (SCNS-SF34). All the members of community-based breast cancer support groups in Kuching were invited. A total of 101 respondents were face-to-face interviewed after the consent was obtained. Data was entered and analyzed using SPSS version 20. Results. The respondents endorsed health system and information domain with the highest mean score (2.48; 95% CI: 2.32–2.64). Top 10 items with “moderate to high” level unmet needs had a prevalence of 14.9% to 34.7% of respondents indicating need. Significantly higher level of unmet needs was associated with survivors who were younger (less than 60 years old), had higher education attainment, were unemployed, had survival duration of up to 5 years, and were undergoing active treatment. Conclusion. Systematic delivery of health information which is targeted, culturally sensitive, and linguistically appropriate for addressing younger age, education level, employment status, length of survivorship, and treatment stage should be considered not only at hospital-based setting but also at the community-based support groups. PMID:27239346

  9. Creative caring in the NICU: parent-to-parent support.

    PubMed

    Lindsay, J K; Roman, L; DeWys, M; Eager, M; Levick, J; Quinn, M

    1993-06-01

    When infants are admitted to a neonatal intensive care unit, the parents are immediately confronted with the crisis surrounding a critically ill newborn and often require additional support. Parents experience feelings of anxiety, fear, anger, and guilt over this unanticipated event. In addition, parents often describe the withdrawal of friends and the denial responses of well-meaning family members during their infant's illness. In an effort to address the NICU parents' need for support, Butterworth Hospital in collaboration with Michigan State University initiated a demonstration and research project focused on parent-to-parent support. The primary goal of the program is to improve parenting outcomes by providing emotional, informational, and role modeling support to parents of high-risk infants utilizing experienced volunteer parents. The program model includes professional program coordinators who recruit and train volunteer parents with past NICU experience. Volunteers are then matched to new NICU families based on infant's diagnosis, similar geographic location, and other characteristics. Volunteers provide support through hospital visits, phone contact, and home visits during the infant's hospitalization and throughout the infant's first year of life. The program was evaluated by analyzing the differences between a treatment group and a comparison group of parents. Significant differences between groups were found on measures of maternal mood states, maternal-infant relationships, and home environment. Services to over 900 families by 110 volunteer parents have convinced staff that the volunteer parents are a valuable and indispensable component of the services at Butterworth Hospital and that families of high-risk infants benefit from past experiences and ongoing support of volunteer parents.

  10. Support for Government Provision of Health Care and the Patient Protection and Affordable Care Act

    PubMed Central

    Corman, Juliane; Levin, David

    2016-01-01

    Since the 1930s, US politicians have argued about whether healthcare should be the responsibility of the federal government. Both major political parties have cited public opinion concerning Americans’ support for or rejection of government provision of healthcare to support their position. With the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, however, the political debate has changed. Where it had been about the government provision of healthcare as an abstract principle, it became a debate imbued with evaluations of the implementation of the ACA itself. This spawned a new line of research examining the consequences of the ACA’s implementation on public attitudes toward government provision of healthcare. The change in support for government provision of healthcare and the new post-ACA research highlight a need for a long-term examination of trends in support over the past two decades that will provide context for the new studies. This study provides that examination. PMID:27257309

  11. [Physical activities, psychiatric care and mental health].

    PubMed

    Davanture, Olivier

    2014-02-01

    At Ville-Evrard psychiatric hospital, sports activities are used as one of several therapeutic tools. The day-long multi-sport sessions, led notably by a nurse, form part of the care programme. Sport not only enables the patients to exert themselves, it is above all a form of therapeutic mediation which encourages verbal and non-verbal communication.

  12. [On hi-tech cardiologic care model in medical support of train operation safety].

    PubMed

    Pfaf, V F; Gorokhova, S G; Kotenko, V A

    2015-01-01

    The article covers hi-tech cardiologic care model in system of medical support of train operation safety, with definition of structure blocks in this model. Discussion covers peculiarities of the model functioning in comparison with the governmental system of hi-tech medical care, including its closed cycle principle characteristics, wide patients selection among railway workers, continuous and close cooperation between various medical speicalities, with active involvement of occupational fitness specialists (medical examination committees of various levels, including Central Medical Examination Committee), major extent of interventional rentgenosurgical technologies applied in diseases without significant functional failure.

  13. Personal resources supporting living at home as described by older home care clients.

    PubMed

    Eloranta, Sini; Routasalo, Pirkko; Arve, Seija

    2008-08-01

    This study describes the personal resources of older (> or = 75 years) home care clients in Finland and their perceptions of factors that enhance and constrain their ability to live independently at home. The data were collected by unstructured interviews with 21 older home care clients. Inductive content analysis were used to analyse the data. The resources of older people consisted of a sense of control over one's life and a determination to remain active. Factors enhancing older people's resources were their involvement in leisure activities and social networks, factors undermining their resources were conditions on living imposed by outsiders, declining health and loneliness. The results show that home care professionals do not yet have sufficient skills and abilities to identify and support older people's existing resources. As well as having access to necessary resources, it is also crucial that older people know how to use them.

  14. Huddle-coaching: a dynamic intervention for trainees and staff to support team-based care.

    PubMed

    Shunk, Rebecca; Dulay, Maya; Chou, Calvin L; Janson, Susan; O'Brien, Bridget C

    2014-02-01

    Many outpatient clinics where health professionals train will transition to a team-based medical home model over the next several years. Therefore, training programs need innovative approaches to prepare and incorporate trainees into team-based delivery systems. To address this need, educators at the San Francisco Veterans Affairs (VA) Medical Center included trainees in preclinic team "huddles," or briefing meetings to facilitate care coordination, and developed an interprofessional huddle-coaching program for nurse practitioner students and internal medicine residents who function as primary providers for patient panels in VA outpatient primary care clinics. The program aimed to support trainees' partnerships with staff and full participation in the VA's Patient Aligned Care Teams. The huddle-coaching program focuses on structuring the huddle process via scheduling, checklists, and designated huddle coaches; building relationships among team members through team-building activities; and teaching core skills to support collaborative practice. A multifaceted evaluation of the program showed positive results. Participants rated training sessions and team-building activities favorably. In interviews, trainees valued their team members and identified improvements in efficiency and quality of patient care as a result of the team-based approach. Huddle checklists and scores on the Team Development Measure indicated progress in team processes and relationships as the year progressed. These findings suggest that the huddle-coaching program was a worthwhile investment in trainee development that also supported the clinic's larger mission to deliver team-based, patient-aligned care. As more training sites shift to team-based care, the huddle-coaching program offers a strategy for successfully incorporating trainees.

  15. 47 CFR 54.625 - Support for services beyond the maximum supported distance for rural health care providers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... provider to the farthest point on the jurisdictional boundary of the city in that state with the largest... 47 Telecommunication 3 2011-10-01 2011-10-01 false Support for services beyond the maximum... Support for Health Care Providers § 54.625 Support for services beyond the maximum supported distance...

  16. 47 CFR 54.625 - Support for services beyond the maximum supported distance for rural health care providers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... provider to the farthest point on the jurisdictional boundary of the city in that state with the largest... 47 Telecommunication 3 2010-10-01 2010-10-01 false Support for services beyond the maximum... Support for Health Care Providers § 54.625 Support for services beyond the maximum supported distance...

  17. Dietary protein considerations to support active aging.

    PubMed

    Wall, Benjamin T; Cermak, Naomi M; van Loon, Luc J C

    2014-11-01

    Given our rapidly aging world-wide population, the loss of skeletal muscle mass with healthy aging (sarcopenia) represents an important societal and public health concern. Maintaining or adopting an active lifestyle alleviates age-related muscle loss to a certain extent. Over time, even small losses of muscle tissue can hinder the ability to maintain an active lifestyle and, as such, contribute to the development of frailty and metabolic disease. Considerable research focus has addressed the application of dietary protein supplementation to support exercise-induced gains in muscle mass in younger individuals. In contrast, the role of dietary protein in supporting the maintenance (or gain) of skeletal muscle mass in active older persons has received less attention. Older individuals display a blunted muscle protein synthetic response to dietary protein ingestion. However, this reduced anabolic response can largely be overcome when physical activity is performed in close temporal proximity to protein consumption. Moreover, recent evidence has helped elucidate the optimal type and amount of dietary protein that should be ingested by the older adult throughout the day in order to maximize the skeletal muscle adaptive response to physical activity. Evidence demonstrates that when these principles are adhered to, muscle maintenance or hypertrophy over prolonged periods can be further augmented in active older persons. The present review outlines the current understanding of the role that dietary protein occupies in the lifestyle of active older adults as a means to increase skeletal muscle mass, strength and function, and thus support healthier aging.

  18. Active Play Opportunities at Child Care

    PubMed Central

    Saelens, Brian E.; Christakis, Dimitri A.

    2015-01-01

    BACKGROUND AND OBJECTIVES: Physical activity (PA) is important for children’s health and development, yet preschoolers are not meeting PA recommendations. The objective of this study was to examine different PA opportunities at child care and how variation in indoor versus outdoor and free versus teacher-led opportunities relate to children’s PA. METHODS: An observational study of 98 children (mean age 4.5 years, 49% girls) from 10 child care centers. Classrooms were observed for at least 4 full days per center (total 50 days) to categorize time into (1) not an active play opportunity (APO); (2) naptime; (3) APO, outdoor free play; (4) APO, outdoor teacher-led; (5) APO, indoor free play; and (6) APO, indoor teacher-led. Children wore accelerometers during observations. Linear regression models examined the influence of APO categories on moderate-vigorous physical activity (MVPA) and sedentary time. RESULTS: Children’s activity was 73% sedentary, 13% light, and 14% MVPA. For 88% of time children did not have APOs, including 26% time as naptime. On average, 48 minutes per day were APOs (41% sedentary, 18% light, and 41% MVPA), 33 minutes per day were outdoors. The most frequent APO was outdoor free play (8% of time); outdoor teacher-led time was <1%. Children were more active and less sedentary outdoors versus indoors and during the child-initiated APOs (indoors and outdoors) versus teacher-led APOs. CONCLUSIONS: Preschoolers were presented with significantly fewer than recommended opportunities for PA at child care. More APOs are needed for children to meet recommendations, particularly those that encourage more outdoor time, more teacher-led and child-initiated active play, and flexibility in naptime for preschoolers. PMID:25986016

  19. The Effect of Telephone Support Groups on Costs of Care for Veterans with Dementia

    ERIC Educational Resources Information Center

    Wray, Laura O.; Shulan, Mollie D.; Toseland, Ronald W.; Freeman, Kurt E.; Vasquez, Bob Edward; Gao, Jian

    2010-01-01

    Purpose: Few studies have addressed the effects of caregiver interventions on the costs of care for the care recipient. This study evaluated the effects of a caregiver education and support group delivered via the telephone on care recipient health care utilization and cost. Design and Methods: The Telehealth Education Program (TEP) is a…

  20. Improving Support Services for Family Child Care through Relationship-Based Training

    ERIC Educational Resources Information Center

    Bromer, Juliet; Bibbs, Tonya

    2011-01-01

    Family child care (FCC) providers often experience isolation from other early childhood and child care professionals. Yet, research suggests that providers who network with other providers, engage with community resources, and belong to support groups tend to offer higher quality child care. For example, the Family Child Care Network Impact Study…

  1. Helping Families Improve: An Evaluation of Two Primary Care Approaches to Parenting Support in the Netherlands

    ERIC Educational Resources Information Center

    de Graaf, Ireen; Onrust, Simone; Haverman, Merel; Janssens, Jan

    2009-01-01

    The present study evaluated two primary care parenting interventions. First, we evaluated the most widely used Dutch practices for primary care parenting support. Second, we assessed the applicability of the Primary Care Triple P approach, which is now being utilized in a wide variety of primary care settings. Both interventions target parents of…

  2. Engineering of a clinical decision support framework for the point of care use.

    PubMed

    Wilk, Szymon; Michalowski, Wojtek; O'Sullivan, Dympna; Farion, Ken; Matwin, Stan

    2008-11-06

    Computerized decision support for use at the point of care has to be comprehensive. It means that clinical information stored in electronic health records needs to be integrated with various forms of clinical knowledge (elicited from experts, discovered from data or summarized in systematic reviews of clinical trials). In order to provide such comprehensive support we created the MET-A3Support framework for constructing clinical applications aimed at various medical conditions. We employed the multiagent system paradigm and the O-MaSE methodology to define an engineering process involving three main activities: requirements engineering, analysis and design. Then we applied the process to build MET-A3Support. The paper describes the engineering process and its results, including models representing selected elements of our framework.

  3. Basic Education and Policy Support (BEPS) Activity.

    ERIC Educational Resources Information Center

    Creative Associates International, Inc., Washington, DC.

    The Basic Education and Policy Support (BEPS) Activity is a multi-year, worldwide, indefinite quantity contract by which the U.S. Agency for International Development (USAID) Global Bureau Center for Human Capacity (G/HCD) can work to achieve four objectives: (1) improve the quality, efficiency, access, and equity of education, particularly basic…

  4. Supporting Classroom Activities with the BSUL System

    ERIC Educational Resources Information Center

    Ogata, Hiroaki; Saito, Nobuji A.; Paredes J., Rosa G.; San Martin, Gerardo Ayala; Yano, Yoneo

    2008-01-01

    This paper presents the integration of ubiquitous computing systems into classroom settings, in order to provide basic support for classrooms and field activities. We have developed web application components using Java technology and configured a classroom with wireless network access and a web camera for our purposes. In this classroom, the…

  5. Long-term care services and support systems for older adults: The role of technology.

    PubMed

    Czaja, Sara J

    2016-01-01

    The aging of the population, especially the increase in the "oldest old," is a remarkable achievement that presents both opportunities and challenges for policymakers, researchers, and society. Although many older adults enjoy relatively good health into their later years, many have one or more chronic conditions or diseases and need help with disease management activities or activities important to independent living. Technology is playing an increasingly important role in the health care arena and is becoming ubiquitous in health management activities. There are a variety of technology applications that can be used to enhance the mobility and quality of life of people who have limitations and help to foster the ability of those with chronic conditions to remain at home. Technology applications can also provide a central role in providing support to family caregivers in terms of enhancing access to information and community resources and connections to formal and informal support services. Monitoring technologies may also allow caregivers to check on the status or activities of their loved one while they are at work or at a distant location. Furthermore, telemedicine applications can aid the ability of care providers to monitor patients and deliver health services. The objective of this article is to highlight the potential role that technology can play in the provision of long-term support for older adults and their families. Challenges and barriers that currently limit the full potential of technology to be realized for these populations will also be discussed. Finally the role of psychological science toward maximizing the potential of technology applications in enhancing long term care and support services will be highlighted. (PsycINFO Database Record

  6. Improving nutritional support for adults in primary and secondary care.

    PubMed

    Cartwright, Andrea

    There has been serious concern about the nutritional care provided in some secondary and primary care settings. As a result, best practice, benchmarking initiatives and nutritional guidance have been issued by government and non-government agencies. This article helps nurses to synthesise these initiatives and improve their knowledge of nutritional care.

  7. Relationships, Expertise, Incentives, and Governance: Supporting Care Home Residents' Access to Health Care. An Interview Study From England

    PubMed Central

    Goodman, Claire; Davies, Sue L.; Gordon, Adam L.; Meyer, Julienne; Dening, Tom; Gladman, John R.F.; Iliffe, Steve; Zubair, Maria; Bowman, Clive; Victor, Christina; Martin, Finbarr C.

    2015-01-01

    Objectives To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes. Methods Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health. Results Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive. Conclusion The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations. PMID:25687930

  8. Unmet Supportive Care Needs of Iranian Cancer Patients and its Related Factors

    PubMed Central

    Jabbarzadeh Tabrizi, Faranak; Rahmani, Azad; Asghari Jafarabadi, Mohammad; Jasemi, Madineh; Allahbakhshian, Atefeh

    2016-01-01

    Introduction: Investigation of supportive care needs of cancer patients is important to implement any supportive care programs. There is no relevant studies investigated supportive care needs of Iranian cancer patients and factors affecting such needs. So, the aims of present study were to determine the unmet supportive care needs of Iranian cancer patients and its predictive factors. Methods: In this descriptive- correlational study 274 cancer patients in one referral medical center in North West of Iran participated. For data collection, demographic and cancer related information checklist and Supportive Care Needs Survey (SCNS) was used. Logistic regression was used for data analysis of un-adjusted and adjusted Odds Ratios (ORs) for patients needs and analysis of variables of study based on Backward LR procedure SPSS Ver.13. Results: More than fifty percent of participants reported unmet needs in 18 items of SCNS. Most frequent unmet needs were related to health system and information domains and most meet needs were related to sexuality and psychological domains. The result of logistic regression identified predictors of each domain of supportive care needs. The variable such as sex, age and living situation were most important predictors of unmet needs. Conclusion: The results showed that Iranian cancer patients have many supportive care needs in different domains. In general female cancer patients are at risk of more unmet supportive care needs. So, health care professionals should be more sensitive to fulfillment of supportive care needs of female. PMID:28032075

  9. Virtual coach technology for supporting self-care.

    PubMed

    Ding, Dan; Liu, Hsin-Yi; Cooper, Rosemarie; Cooper, Rory A; Smailagic, Asim; Siewiorek, Dan

    2010-02-01

    "Virtual Coach" refers to a coaching program or device aiming to guide users through tasks for the purpose of prompting positive behavior or assisting with learning new skills. This article reviews virtual coach interventions with the purpose of guiding rehabilitation professionals to comprehend more effectively the essential components of such interventions, the underlying technologies and their integration, and example applications. A design space of virtual coach interventions including self-monitoring, context awareness, interface modality, and coaching strategies were identified and discussed to address when, how, and what coaching messages to deliver in an automated and intelligent way. Example applications that address various health-related issues also are provided to illustrate how a virtual coach intervention is developed and evaluated. Finally, the article provides some insight into addressing key challenges and opportunities in designing and implementing virtual coach interventions. It is expected that more virtual coach interventions will be developed in the field of rehabilitation to support self-care and prevent secondary conditions in individuals with disabilities.

  10. Health care advocacy turns into political activism.

    PubMed Central

    Spears, T

    1995-01-01

    Some advocacy groups are becoming more willing to engage in political activism. One is the Ontario Lung Association, which has been calling attention to government inaction on air-pollution issues such as controlling smog and improving indoor air quality. These lobbying efforts are supported by some physicians, who believe that environmental factors are behind the increased incidence of respiratory illness. PMID:7743456

  11. The Canadian experience: Using telemedicine for the support of medical care at remote sites

    NASA Technical Reports Server (NTRS)

    House, Maxwell

    1991-01-01

    While the majority of Canadians live in a narrow strip about 200 miles wide just north of the 45th parallel, a significant proportion of the population lives in non-urban, remote and sometimes isolated areas. Given this widely dispersed population, the provision of health services has always been a challenge. A list of non-urban health needs include the following: consulting services; clinical laboratory resources; investigative techniques (e.g., EEG, radiology, ultrasound, nuclear medicine); continuing education for physicians, nurses and other health professionals; teaching and training programs for administrative and support staff (dietary, housekeeping, maintenance); community health education and improved general education for health workers and families. For nearly three decades physicians and other health care professionals in the United States and Canada have been exploring the application of telecommunications to health care in rural and remote areas. The terms telemedicine and telehealth are used interchangeably to describe this activity. The prefix 'tele' refers to distance and now includes all types of communication over distance that support health care and health educational programs. Actually, telemedicine is as old as the telephone, which is still the most widely used communications technology in health care.

  12. Parent Perceptions of How Nurse Encounters Can Provide Caring Support for the Family in Early Acute Care Following Children’s Severe Traumatic Brain Injury

    PubMed Central

    Roscigno, Cecelia I.

    2016-01-01

    Objective A child’s severe traumatic brain injury (TBI) creates a family crisis requiring extensive cultural, informational, psychological, and environmental support. Nurses need to understand parents’ expectations of caring in early acute care so they can tailor their attitudes, beliefs, and behaviors appropriately to accommodate the family’s needs. Methods In a previous qualitative study of 42 parents or caregivers from 37 families of children with moderate to severe TBI, parents of children with severe TBI (n = 25) described their appraisals of nurse caring and uncaring behaviors in early acute care. Swanson’s theory of caring was used to categorize parents’ descriptions in order to inform nursing early acute care practices and family-centered care. Results Caring nurse encounters included: (a) involving parents in the care of their child and reflecting on all socio-cultural factors shaping family resources and responses (knowing); (b) respecting that family grief can be co-mingled with resilience, and that parents are typically competent to be involved in decision-making (maintaining belief); (d) actively listening and engaging parents in order to fully understand family values and needs (being with); (e) decreasing parents’ workload to get information, emotional support, and providing a safe cultural, psychological, and physical environment for the family (doing for), and; (f) providing anticipatory guidance to navigate the early acute care system and giving assistance to learn and adjust to their situation (enabling). Conclusion Application of Swanson’s caring theory is prescriptive in helping individual nurses and early acute care systems to meet important family needs following children’s severe TBI. PMID:26871242

  13. NovaMedTech - a regional program for supporting new medical technologies in personalized health care.

    PubMed

    Ask, Per; Ekstrand, Kristina; Hult, Peter; Lindén, Maria; Pettersson, Nils-Erik

    2012-01-01

    NovaMedTech is an initiative funded from EU structural funds for supporting new medical technologies for personalized health care. It aims at bringing these technologies into clinical use and to the health care market. The program has participants from health care, industry and academia in East middle Sweden. The first three year period of the program was successful in terms of product concepts tried clinically, and number of products brought to a commercialization phase. Further, the program has led to a large number of scientific publications. Among projects supported, we can mention: Intelligent sensor networks; A digital pen to collect medical information about health status from patients; A web-based intelligent stethoscope; Methodologies to measure local blood flow and nutrition using optical techniques; Blood flow assessment from ankle pressure measurements; Technologies for pressure ulcer prevention; An IR thermometer for improved accuracy; A technique that identifies individuals prone to commit suicide among depressed patients; Detection of infectious disease using an electronic nose; Identification of the lactate threshold from breath; Obesity measurements using special software and MR camera; and An optical probe guided tumor resection. During the present three years period emphasis will be on entrepreneurial activities supporting the commercialization and bringing products to the market.

  14. Social Support Can Buffer against Stress and Shape Brain Activity

    PubMed Central

    Hostinar, Camelia E.; Gunnar, Megan R.

    2015-01-01

    Social support from close relationship partners is an important resource for coping with stress, particularly during childhood. We discuss ethical challenges associated with studying stress and its social buffering in the laboratory, as well as emerging evidence regarding two potential neural substrates for the social buffering of stress: hypothalamic oxytocin activity and activation of areas in the prefrontal cortex associated with effective self-regulation. We also address the role of early-life social experiences in shaping brain development, as well as recommendations for practice and policy that would advance the ethical treatment of children and reduce social inequalities in early-life experiences and opportunities–e.g., investing in programs that prevent child maltreatment and facilitating access to high-quality child care for economically disadvantaged families. We also debate the ethical implications of using oxytocin nasal sprays to simulate the stress-reducing properties of social support and advise waiting for more evidence before recommending their use. PMID:26478822

  15. Five opportunities for healthcare leaders to better support person- and family-centred care in long-term care settings

    PubMed Central

    Lui, Kai Yan Grace; Holyoke, Paul

    2016-01-01

    The benefits of Person- and Family-Centred Care (PFCC) are well documented, and many healthcare organizations have expressed their commitment to take this approach. Yet, it can be a difficult endeavour, with common barriers identified at the point-of-care, organizational and system levels. We implemented a PFCC education program with healthcare leaders, providers, and support staff working in home, community, and long-term care organizations across Canada. Focus groups were then conducted with almost 200 workshop participants and 20 long-term care home residents and family members. Five key opportunities for healthcare leaders to better support the provision of PFCC were revealed. In this article, specific recommendations from focus group participants for addressing each of these five opportunities are provided. These findings can assist healthcare leaders to proactively ensure the supports and processes are in place to enable staff to provide care in a more person- and family-centred way.

  16. [Psychological support for disaster victims: an evidence-based care model].

    PubMed

    Figueroa, Rodrigo A; Marín, Humberto; González, Matías

    2010-02-01

    A search for meta analyses and systematic reviews on psychological support to disaster victims was carried out to devise a local support model. Based on 36 meta analyses and systematic reviews, the support should be carried out in five echelon levels: diffusion, social support, general medical care, general psychiatric care and psychiatric care carried out by experts. Only victims with well-established formal psychiatric disorders should receive psychotherapy or psychotropic medication. The rest should only receive psychological first aid. According to the best evidence available, a model for psychological care is proposed.

  17. Using an internet intervention to support self-management of low back pain in primary care: protocol for a randomised controlled feasibility trial (SupportBack)

    PubMed Central

    Geraghty, Adam W A; Stanford, Rosie; Little, Paul; Roberts, Lisa; Foster, Nadine E; Hill, Jonathan C; Hay, Elaine; Stuart, Beth; Turner, David; Yardley, Lucy

    2015-01-01

    Introduction Low back pain (LBP) is a prevalent and costly condition. The majority of patients experiencing LBP are managed in primary care, where first-line care recommendations consist of advice to self-manage and remain active. Internet interventions present a potential means of providing patients with tailored self-management advice and evidence-based support for increasing physical activity. Methods/analysis This protocol describes a single-blind, randomised controlled feasibility trial of an internet intervention developed to support the self-management of LBP in primary care. Patients are being randomised to 1 of 3 groups receiving either usual primary care, usual primary care with the addition of an internet intervention or an internet intervention with physiotherapist telephone support. Patients are followed up at 3 months. Primary outcomes are the feasibility of (1) the trial design/methods, (2) the delivery of the internet intervention and (3) the provision of telephone support by physiotherapists. Secondary outcomes will include exploratory analysis of estimates and variation in clinical outcomes of pain and disability, in order to inform a future main trial. Ethics/dissemination This feasibility trial has undergone ethical scrutiny and been approved by the National Health Service (NHS) Research Ethics Committee, REC Reference 13/SC/0202. The feasibility findings will be disseminated to the research community through presentations at conferences and publication in peer review journals. Broader dissemination will come following a definitive trial. Trial registration number ISRCTN 31034004. PMID:26399575

  18. [Medical care support intervention to the patient and family who has chosen a terminal care at home - an influence of satisfactory experience on the culture of terminal care].

    PubMed

    Sugimoto, Kaoru; Ishikawa, Mariko; Kouketsu, Nobuko; Ozaki, Mitsuyo; Tomita, Ikue; Hong, Youngjae; Miura, Hisayuki; Nishikawa, Mitsunori; Yokoe, Yuriko; Nakashima, Kazumitsu

    2010-12-01

    The National Center for Geriatrics and Gerontology in Japan implemented a home medical care support system for aged patients in April 2009. In this study, we report a case of terminal care system where a medical care intervention was carried out by a close coordination of visiting nurses and other staffs with a "at-home terminal care" brochure on hand, and we discussed how this system was brought forward satisfactory and how it affected this culture.

  19. Supportive care after curative treatment for breast cancer (survivorship care): resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

    PubMed

    Ganz, Patricia A; Yip, Cheng Har; Gralow, Julie R; Distelhorst, Sandra R; Albain, Kathy S; Andersen, Barbara L; Bevilacqua, Jose Luiz B; de Azambuja, Evandro; El Saghir, Nagi S; Kaur, Ranjit; McTiernan, Anne; Partridge, Ann H; Rowland, Julia H; Singh-Carlson, Savitri; Vargo, Mary M; Thompson, Beti; Anderson, Benjamin O

    2013-10-01

    Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources. Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment

  20. Nurse-led delivery of specialist supportive care for bipolar disorder: a randomized controlled trial.

    PubMed

    Crowe, M; Inder, M; Carlyle, D; Wilson, L; Whitehead, L; Panckhurst, A; O'Brien, T; Frampton, C; Joyce, P

    2012-06-01

    The aim of the study is (1) to assess the feasibility of delivering nurse-led specialist supportive care as an adjunct to usual care in the clinical setting; (2) to examine the relationship between the delivery of specialist supportive care and improved self-efficacy and functioning and reduced depressive symptoms. A randomized controlled trial of the clinical effectiveness of specialist supportive care as an adjunct to usual care was conducted in community mental health services at one site. Participants were randomized to either usual care or usual care and the adjunctive intervention. Self-report measures of depression, general functioning and self-efficacy were completed by participants in both groups at baseline and 9 months. The intervention was delivered parallel to usual treatment arrangements. While recruitment numbers were sufficient, a low rate of engagement meant we were unable to show significant differences in depressive symptoms or self-efficacy between the usual care group and the specialist supportive care plus usual care group. This study demonstrated that it was difficult to engage patients with bipolar disorder in specialist supportive care when they were currently in a mood episode and under the care of community mental health services.

  1. Toward a Broader Role for Occupational Therapy in Supportive Oncology Care

    PubMed Central

    Duker, Leah I. Stein

    2016-01-01

    Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care. PMID:27295001

  2. Policy approach to nutrition and physical activity education in health care professional training1234

    PubMed Central

    Loy, Lisel; Zatz, Laura Y

    2014-01-01

    Nutrition and physical activity are key risk factors for a host of today's most prevalent and costly chronic conditions, such as obesity and diabetes; yet, health care providers are not adequately trained to educate patients on the components of a healthy lifestyle. The purpose of this article is to underscore the need for improved nutrition and physical activity training among health care professionals and to explore opportunities for how policy can help support a shift in training. We first identify key barriers to sufficient training in nutrition and physical activity. Then, we provide an overview of how recent changes in the government and institutional policy environment are supporting a shift toward prevention in our health care system and creating an even greater need for improved training of health care professionals in nutrition and physical activity. Last, we outline recommendations for additional policy changes that could drive enhanced training for health care professionals and recommend future directions in research. PMID:24646822

  3. Policy approach to nutrition and physical activity education in health care professional training.

    PubMed

    Levy, Matthew D; Loy, Lisel; Zatz, Laura Y

    2014-05-01

    Nutrition and physical activity are key risk factors for a host of today's most prevalent and costly chronic conditions, such as obesity and diabetes; yet, health care providers are not adequately trained to educate patients on the components of a healthy lifestyle. The purpose of this article is to underscore the need for improved nutrition and physical activity training among health care professionals and to explore opportunities for how policy can help support a shift in training. We first identify key barriers to sufficient training in nutrition and physical activity. Then, we provide an overview of how recent changes in the government and institutional policy environment are supporting a shift toward prevention in our health care system and creating an even greater need for improved training of health care professionals in nutrition and physical activity. Last, we outline recommendations for additional policy changes that could drive enhanced training for health care professionals and recommend future directions in research.

  4. Critical care nurses' perceptions of obstacles, supports, and knowledge needed in providing quality end-of-life care.

    PubMed

    Crump, Saundra K; Schaffer, Marjorie A; Schulte, Evie

    2010-01-01

    In response to critical care nurses' perceptions of increasing stress and conflict in difficult end-of-life (EOL) situations, the researchers conducted a study to identify perceived obstacles, supports, and knowledge needed to provide quality EOL care. The conclusions were as follows: (1) families and patients need clear, direct, and consistent information to make EOL decisions; (2) physician-related issues affect nurses' ability to provide quality EOL care; (3) critical care nurses need more knowledge, skill, and a sense of cultural competency to provide quality care; and (4) having properly completed advance directives can reduce confusion about the goals of care. Recommendations for improving EOL care were made as a result of the study.

  5. Enhancing the Empowerment of Youth in Foster Care: Supportive Services

    ERIC Educational Resources Information Center

    Kaplan, Sandra J.; Skolnik, Louise; Turnbull, Ayme

    2009-01-01

    This paper reviews the research on youth empowerment in seven child welfare programmatic areas. A lack of studies specifically focused on the empowerment of youth in foster care was found. Conceptual perspectives and existing data, however, suggest that the empowerment of youth in and transitioning out of care is essential and should be overtly…

  6. Supporting Infant Teachers in Their Care of Fussy Babies

    ERIC Educational Resources Information Center

    Jurie, Cindy; Baker, Marsha

    2008-01-01

    Child care teachers cope with juggling multiple competing demands: (1) managing relationships with parents; (2) coping with individual infant temperaments; and (3) meeting the group needs of the other infants in their care. Infant teachers often play a unique role in that they may be the first adults to listen and understand what the experience of…

  7. Transitional Child Care: State Experiences and Emerging Policies under the Family Support Act.

    ERIC Educational Resources Information Center

    Ebb, Nancy; And Others

    This guide is designed to provide information about transitional child care (TCC) program policies and operations and to offer recommendations to policymakers and advocates. Transitional child care is a new federal child care program that every state must implement by April 1, 1990. Established by the Family Support Act (FSA) of 1988, TCC is…

  8. Supporting Care Leavers to Fulfil Their Educational Aspirations: Resilience, Relationships and Resistance to Help

    ERIC Educational Resources Information Center

    Driscoll, Jenny

    2013-01-01

    Most children in state care do not do as well in school as their peers, but the period of leaving care and transition to adulthood may offer a "turning point" for positive change. Based on a small study of care leavers in England, this article employs the concept of resilience to explore the significance of supportive relationships in…

  9. The Community Perinatal Care Study: Home Visiting and Nursing Support for Pregnant Women

    ERIC Educational Resources Information Center

    Johnston, David; Tough, Suzanne; Siever, Jodi

    2006-01-01

    This article describes The Community Perinatal Care Study, a community-based study of pregnancy support that was conducted in Calgary, Alberta, Canada, between 2001 and 2004. The study was conducted to learn how to improve community-based pregnancy care and to improve prenatal care and healthy births, particularly for women with increased…

  10. Strategies for Providing Spiritual Care & Support to Nursing Students.

    PubMed

    Milner, Kerry A; Foito, Kim; Watson, Sherylyn

    2016-01-01

    Nurse educators need to equip nursing students with suitable resources and education so they can develop their own spiritual care, as well as recognize spiritual care needs in patients. There is a paucity of literature on teaching strategies for spiritual care and prayer in undergraduate nursing programs. This article describes how one faith-based school implemented strategies to facilitate spiritual development in students, which are integrated throughout the curriculum and utilized in the U.S. and a study-abroad program in Ireland.

  11. Implementation of Active Support in Victoria, Australia: An Exploratory Study

    ERIC Educational Resources Information Center

    Mansell, Jim; Beadle-Brown, Julie; Bigby, Christine

    2013-01-01

    Background: Active support is an effective intervention to support engagement of residents with intellectual disability in group homes. This survey explored resident characteristics of the people supported by organisations implementing active support, the provision of active support, its procedures and systems, and resident engagement in…

  12. Correlated activity supports efficient cortical processing

    PubMed Central

    Hung, Chou P.; Cui, Ding; Chen, Yueh-peng; Lin, Chia-pei; Levine, Matthew R.

    2015-01-01

    Visual recognition is a computational challenge that is thought to occur via efficient coding. An important concept is sparseness, a measure of coding efficiency. The prevailing view is that sparseness supports efficiency by minimizing redundancy and correlations in spiking populations. Yet, we recently reported that “choristers”, neurons that behave more similarly (have correlated stimulus preferences and spontaneous coincident spiking), carry more generalizable object information than uncorrelated neurons (“soloists”) in macaque inferior temporal (IT) cortex. The rarity of choristers (as low as 6% of IT neurons) indicates that they were likely missed in previous studies. Here, we report that correlation strength is distinct from sparseness (choristers are not simply broadly tuned neurons), that choristers are located in non-granular output layers, and that correlated activity predicts human visual search efficiency. These counterintuitive results suggest that a redundant correlational structure supports efficient processing and behavior. PMID:25610392

  13. A Framework to Support the Sharing and Reuse of Computable Phenotype Definitions Across Health Care Delivery and Clinical Research Applications

    PubMed Central

    Richesson, Rachel L.; Smerek, Michelle M.; Blake Cameron, C.

    2016-01-01

    Introduction: The ability to reproducibly identify clinically equivalent patient populations is critical to the vision of learning health care systems that implement and evaluate evidence-based treatments. The use of common or semantically equivalent phenotype definitions across research and health care use cases will support this aim. Currently, there is no single consolidated repository for computable phenotype definitions, making it difficult to find all definitions that already exist, and also hindering the sharing of definitions between user groups. Method: Drawing from our experience in an academic medical center that supports a number of multisite research projects and quality improvement studies, we articulate a framework that will support the sharing of phenotype definitions across research and health care use cases, and highlight gaps and areas that need attention and collaborative solutions. Framework: An infrastructure for re-using computable phenotype definitions and sharing experience across health care delivery and clinical research applications includes: access to a collection of existing phenotype definitions, information to evaluate their appropriateness for particular applications, a knowledge base of implementation guidance, supporting tools that are user-friendly and intuitive, and a willingness to use them. Next Steps: We encourage prospective researchers and health administrators to re-use existing EHR-based condition definitions where appropriate and share their results with others to support a national culture of learning health care. There are a number of federally funded resources to support these activities, and research sponsors should encourage their use. PMID:27563686

  14. Supporting Patient Care in the Emergency Department with a Computerized Whiteboard System

    PubMed Central

    Aronsky, Dominik; Jones, Ian; Lanaghan, Kevin; Slovis, Corey M.

    2008-01-01

    Efficient information management and communication within the emergency department (ED) is essential to providing timely and high-quality patient care. The ED whiteboard (census board) usually serves as an ED’s central access point for operational and patient-related information. This article describes the design, functionality, and experiences with a computerized ED whiteboard, which has the ability to display relevant operational and patient-related information in real time. Embedded functionality, additional whiteboard views, and the integration with ED and institutional information system components, such as the computerized patient record or the provider order entry system, provide rapid access to more detailed information. As an information center, the computerized whiteboard supports our ED environment not only for providing patient care, but also for operational, educational, and research activities. PMID:18096913

  15. Eva Between Anxiety and Hope: Integrating Anthroposophic Music Therapy in Supportive Oncology Care

    PubMed Central

    Ben-Arye, Eran; Ben-Arye, Yotam; Barak, Yael

    2015-01-01

    Music therapy is a significant modality in the treatment of patients with cancer, who suffer emotional and spiritual distress as well as chemotherapy side effects that impair their quality of life. In this article, we present a case study of a patient challenged with recurrent ovarian cancer who received, concomitant with chemotherapy, a special form of music therapy based on anthroposophic medicine (AM) aimed at alleviating anxiety and improving her general well-being. AM-centered music therapy goals are discussed in regard to two modes of treatment: receptive listening and clinical composition. Next, these two treatment modes are discussed in a broader context by reviewing conventional music therapy interventions during chemotherapy on two axes: a. standardized vs. individualized treatment; b. patient’s involvement on a passive to active continuum. In conclusion, psycho-oncology care can be enriched by adding anthroposophic medicine-oriented music therapy integrated within patients’ supportive care. PMID:26973967

  16. Eva Between Anxiety and Hope: Integrating Anthroposophic Music Therapy in Supportive Oncology Care.

    PubMed

    Ben-Arye, Eran; Ben-Arye, Yotam; Barak, Yael

    2015-11-30

    Music therapy is a significant modality in the treatment of patients with cancer, who suffer emotional and spiritual distress as well as chemotherapy side effects that impair their quality of life. In this article, we present a case study of a patient challenged with recurrent ovarian cancer who received, concomitant with chemotherapy, a special form of music therapy based on anthroposophic medicine (AM) aimed at alleviating anxiety and improving her general well-being. AM-centered music therapy goals are discussed in regard to two modes of treatment: receptive listening and clinical composition. Next, these two treatment modes are discussed in a broader context by reviewing conventional music therapy interventions during chemotherapy on two axes: a. standardized vs. individualized treatment; b. patient's involvement on a passive to active continuum. In conclusion, psycho-oncology care can be enriched by adding anthroposophic medicine-oriented music therapy integrated within patients' supportive care.

  17. Worldwide overview of critical care nursing organizations and their activities.

    PubMed

    Williams, G; Chaboyer, W; Thornsteindóttir, R; Fulbrook, P; Shelton, C; Wojner, A; Chan, D

    2001-12-01

    While critical care has been a specialty within nursing for almost 50 years, with many countries having professional organizations representing these nurses, it is only recently that the formation of an international society has been considered. A three-phased study was planned: the aim of the first phase was to identify critical care organizations worldwide; the aim of the second was to describe the characteristics of these organizations, including their issues and activities; and the aim of the third was to plan for an international society, if international support was evident. In the first phase, contacts in 44 countries were identified using a number of strategies. In the second phase, 24 (55%) countries responded to a survey about their organizations. Common issues for critical care nurses were identified, including concerns over staffing levels, working conditions, educational programme standards and wages. Critical care nursing organizations were generally favourable towards the notion of establishing a World Federation of their respective societies. Some of the important issues that will need to be addressed in the lead up to the formation of such a federation are now being considered.

  18. [Ethical challenge in palliative support of intensive care patients].

    PubMed

    Salomon, Fred

    2015-01-01

    Intensive care medicine and palliative care medicine were considered for a long time to be contrasting concepts in therapy. While intensive care medicine is directed towards prolonging life and tries to stabilize disordered body functions, palliative care medicine is focused upon the relief of disturbances to help patients in the face of death. Today both views have become congruent. Palliative aspects are equally important in curative therapy. In the course of illness or in respect of the patient's will, the aim of therapy may change from curative to palliative. Two examples are presented to illustrate the ethical challenges in this process. They follow from the medical indication, attention to the patient's will, different opinions in the team, truth at the bedside and from what must be done in the process of withdrawing therapy.

  19. The Impact of Stress and Support on Direct Care Workers' Job Satisfaction

    ERIC Educational Resources Information Center

    Ejaz, Farida K.; Noelker, Linda S.; Menne, Heather L.; Bagaka's, Joshua G.

    2008-01-01

    Purpose: This research applies a stress and support conceptual model to investigate the effects of background characteristics, personal and job-related stressors, and workplace support on direct care workers' (DCW) job satisfaction. Design and Methods: Researchers collected survey data from 644 DCWs in 49 long-term care (LTC) organizations. The…

  20. How to Support Toddlers' Autonomy: A Qualitative Study with Child Care Educators

    ERIC Educational Resources Information Center

    Côté-Lecaldare, Marilena; Joussemet, Mireille; Dufour, Sarah

    2016-01-01

    Research Findings: The present study explored the concrete manifestations of autonomy support (AS) toward toddlers. Eight child care educators were interviewed. Based on our assessment, these educators all valued AS. A qualitative content analysis revealed 18 practices that this group of child care educators considered supportive of toddlers'…

  1. Checklist and Decision Support in Nutritional Care for Burned Patients

    DTIC Science & Technology

    2014-10-01

    in Nutritional Care for Burned Patients PRINCIPAL INVESTIGATOR: Steven E. Wolf, MD CONTRACTING ORGANIZATION: REPORT DATE... Nutritional Care for Burned Patients 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Steven E Wolf, MD Betty Diamond...Study/Product Aim(s) were as follows: 1) To determine under what conditions compliance with nutritional goals are not met in severely burned adults, 2

  2. Questionnaire survey on current status of home care and support for patients with hematological diseases.

    PubMed

    Adachi, Akiko; Tsukada, Yuiko; Kondo, Sakiko; Asakura, Keiko; Matsuki, Eri; Kawagoe, Shohei; Hashiguchi, Saori; Nonaka, Hiroshi; Takeda, Junzo; Okamoto, Shinichiro

    2014-11-01

    In order to survey the current status of home care and support for patients with hematological diseases, questionnaires were sent to 3,591 hospitals and home care facilities in Tokyo and surrounding prefectures. The first survey showed that 81.7% of medical staff members at hospitals reported that they had experience with home care and support, but only 24.9% of home care facility staff members had such experience. The second questionnaire, surveying 1,202 personnel, identified four factors hampering successful establishment of home care and support networks for hematological diseases. These included insufficient familial support for patients, difficulty making end of life decisions by family members and patients, limited access to transfusion support, and financial problems.

  3. Supportive care in pediatric oncology: oncologic emergencies and management of fever and neutropenia.

    PubMed

    Henry, Meret; Sung, Lillian

    2015-02-01

    Advancements in the care of children with cancer have, in part, been achieved through improvements in supportive care. Situations that require prompt care can occur at the time of presentation as well as during treatment. This article discusses the approach to children with fever and neutropenia, a complication encountered daily by care providers, as well as oncologic emergencies that can be seen at the time of a child's initial diagnosis: hyperleukocytosis, tumor lysis syndrome, superior vena cava syndrome, and spinal cord compression.

  4. Carers' quality of life and experiences of adult social care support in England.

    PubMed

    Rand, Stacey; Malley, Juliette

    2014-07-01

    Informal carers make a vital contribution to the well-being of the people they care for or look after. Against the policy background in England, the purpose of this study was to explore the views of carers who are in contact with adult social care support services. A qualitative study with 31 carers, who were recruited via local authorities and carers' organisations, was conducted between April and July 2012 to collect data on carers' experiences and perceptions of their quality of life (QoL) with and without adult social care and support for themselves or the person they look after. Through framework analysis, three key themes were identified: (i) definitions of social care services 'for' the carer or 'for' care recipient and social care outcomes; (ii) carers' access to social care services; and (iii) the meaning and value of informal care. We find that carers' QoL is affected by social care support directed at carers and support directed at those they care for, as well as access to services, the experience of stigma in communities, and in how individual needs and preferences are considered when making decisions about care. While there is much to welcome in the direction of policy in England, this study has shown that there are some gaps in thinking around these areas that will need to be addressed if the lives of carers are to be improved.

  5. Greater Minneapolis Day Care Association 2000-2001 Annual Report: Supporting Quality Child Care.

    ERIC Educational Resources Information Center

    Greater Minneapolis Day Care Association, MN.

    This annual report of the Greater Minneapolis Day Care Association (GMDCA) details the accomplishments of the organization for 2000-2001. The report begins with a letter from the executive director focusing on the need to change our thinking about the care and education of young children, then describes components of quality child care and how the…

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

    PubMed Central

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

    2012-01-01

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

  7. Being Active at Child Care. Facilitator's Guide [and Videotape]. Active Me, Healthy Me.

    ERIC Educational Resources Information Center

    Levenhagen, Kathryn A.

    Noting that childhood obesity is a growing concern for parents, educators, and health care providers, this guide and videotape, "Being Active at Child Care," is from a three-part series, "Active Me, Healthy Me," exploring ways to keep children active while in child care settings. The 13-minute videotape demonstrates in both a child care center and…

  8. [Creating a good relationship between hospital and clinic for the support of end-of-life home care patients-usefulness of questionnaires to indicate the capacity of home care-supporting clinics for palliative care].

    PubMed

    Takahashi, Osamu; Kato, Toshihiko; Shimizu, Kazuko; Chiba, Yasuko; Ishiguro, Motoko; Iwadare, Midori

    2012-12-01

    We have been practicing palliative care for terminal cancer patients at outpatient sections, patient wards, by home care, and by visiting nursing stations for the last 4 years. After the establishment of our palliative care unit in June 2011, it became difficult for us to provide sufficient home care support by ourselves, because of the increasing number of the patients and their widespread locations. It is therefore necessary to cooperate with regional medical clinics in order to support the patients who need home care even after their condition deteriorates. To determine the extent to which the home care-supporting clinics perform palliative care, we used an original questionnaire. Twenty-five clinics agreed to the publication of their names as our cooperating clinics. The number of patients who received palliative care at home from home care clinics after visiting our hospital increased from 8% to 14%, and the rate of patients who died at home also increased from 10% to 13%. Information about cooperating with home care clinics is very important and the improvement of palliative care skills necessary for home care doctors to continue their support for End-Of-Life cancer patients. Furthermore, the hospital should offer a strict and timely backup when the condition of patients treated at home suddenly deteriorates.

  9. Taking care of the caregiver: support groups for nephrology nurses.

    PubMed

    Chayu, Tami; Zur, Rabina; Kreitler, Shulamith

    2007-01-01

    The purpose of the study was to examine the need for support groups in nephrology nurses (NN) in Israel. A questionnaire with 10 questions and demographic background information was administered to nephrology nurses in different hospitals and different parts of the country. Out of 350 distributed questionnaires, 305 nurses responded. The findings showed that there is a need for support groups among NN in Israel. Conclusions--It is necessary to organise support groups for nurses in every dialysis unit.

  10. Caregivers' Support Network Characteristics Associated with Viral Suppression among HIV Care Recipients.

    PubMed

    Denison, Julie A; Mitchell, Mary M; Maragh-Bass, Allysha C; Knowlton, Amy R

    2017-03-17

    Informal care receipt is associated with health outcomes among people living with HIV. Less is known about how caregivers' own social support may affect their care recipient's health. We examined associations between network characteristics of informal caregivers and HIV viral suppression among former or current drug using care recipients. We analyzed data from 258 caregiver-recipient dyads from the Beacon study, of whom 89% of caregivers were African American and 59% were female. In adjusted logistic regression analysis, care recipients had lower odds of being virally suppressed if their caregiver was female, was caring for youth involved in the criminal justice system, and had network members who used illicit drugs. Caregivers' greater numbers of non-kin in their support network was positively associated with viral suppression among care recipients. The findings reveal contextual factors affecting ART outcomes and the need for interventions to support caregivers, especially HIV caregiving women with high-risk youth.

  11. Supporting Children's Participation in Finnish Child Care Centers

    ERIC Educational Resources Information Center

    Venninen, Tuulikki; Leinonen, Jonna; Lipponen, Lasse; Ojala, Mikko

    2014-01-01

    Children's participation in the early childhood education context is a multidimensional issue and educators have a significant role in enhancing participation. In this paper, we focus on the existing challenges to children's participation and the ways that child care educators can work as teams to meet those challenges. The data were collected…

  12. Health Care Professionals' Views about Supporting Patients' Self-Management

    ERIC Educational Resources Information Center

    Mikkonen, Irma; Hynynen, Marja-Anneli

    2012-01-01

    Purpose: The aim of this study was to describe nurses' and other health care professionals' views about their patient education skills and how to develop them. Design/methodology/approach: The data for the study were collected from the participants of the online education course on patient education. The data were analyzed using qualitative…

  13. Methane activation on supported transition metal catalysts

    NASA Astrophysics Data System (ADS)

    Carstens, Jason Ned

    At present, there is considerable interest in utilizing methane more efficiently as both a fuel source and as a starting material for the production of other, more valuable products. However, methane is a very stable molecule with strong C-H bonds that are difficult to break. This makes methane combustion or the formation of carbon-carbon bonds quite difficult. The present work focuses on the use of supported transition metal catalysts as a means of activating methane (i.e. breaking C-H bonds) at low temperatures to produce valuable products or energy. The conversion of methane into higher hydrocarbons. A low temperature (<750 K), direct process to effectively convert methane into higher hydrocarbons would be quite desirable. Such a process is thermodynamically feasible if the reaction is broken up into two separate steps. The first step is the adsorption of methane onto a transition metal catalyst at temperatures above about 600 K to produce a surface carbon species. The second step is a low temperature (<373 K) hydrogenation to convert the carbon species into higher hydrocarbons. T. Koerts et al. have pursued this approach by dissociatively absorbing methane onto silica supported transition metal catalysts at temperatures ranging between 573 K and 773 K. The result was a surface carbonaceous species and hydrogen. In the second step, the carbonaceous intermediates produced small alkanes upon hydrogenation around 373 K. A maximum yield to higher hydrocarbons of 13% was obtained on a ruthenium catalyst. The present study was conducted to further investigate the nature of the carbonaceous species reported by Koerts. Methane combustion. This investigation was conducted in an effort to better understand the mechanism of methane combustion on Pd catalysts. In the first part of this study, temperature programmed reduction (TPR) was used to investigate the oxidation and reduction dynamics of a 10 wt% Pd/ZrOsb2 catalyst used for methane combustion. TPR experiments indicate

  14. Supporting Academic Middle Managers in Higher Education: Do We Care?

    ERIC Educational Resources Information Center

    Floyd, Alan

    2016-01-01

    In the current higher education environment, the need to develop and support good leaders and managers could hardly be more pressing. Yet, research on how academic middle managers are supported in their roles is surprisingly sparse. The purpose of this paper is to address this perceived gap in the literature by reporting on the findings from two…

  15. Association of Parent and Peer Support with Adolescent Physical Activity.

    ERIC Educational Resources Information Center

    Prochaska, Judith J.; Rodgers, Miki W.; Sallis, James F.

    2002-01-01

    Investigated the association between social support and adolescent physical activity when assessing physical activity using different methods and when separating social support into parent and peer support. Self-report and accelerometer data indicated that parent and peer support significantly correlated with physical activity. Perceived social…

  16. Supporting cancer patients with palliative care needs: district nurses' role perceptions.

    PubMed

    Griffiths, Jane; Ewing, Gail; Rogers, Margaret; Barclay, Stephen; Martin, Anna; McCabe, Janet; Todd, Chris

    2007-01-01

    The aim of this study was to examine UK district nurses' perceptions of their role in supporting palliative care cancer patients. Patients with cancer are living longer with the disease. District nurses are the largest UK workforce caring for people with cancer at home, the preferred place of care. Meeting patients' supportive and palliative care needs is complex. Little is known about district nurses' supportive role in the early phase of palliative care. Semistructured interviews were conducted with 34 district nurses. Data were analyzed thematically, with assistance from Atlas/ti. A dominant theme emerging from the interviews was ambiguity in the district nurses' supportive role in early palliative care. District nurses discussed the importance of making contact early on to support cancer patients and their families but had difficulty articulating this "support." Ambiguity, lack of confidence, and perceived skill deficits presented district nurses with dilemmas that were difficult to resolve. District nurses have great potential for meeting cancer patients' supportive and palliative care needs, a potential not currently realized. Education alone is unlikely to improve practice without an understanding of the tensions faced by district nurses in their work. Recognizing and addressing dilemmas in the everyday work of district nurses is central to moving practice forward.

  17. Supporting employees' work-family needs improves health care quality: Longitudinal evidence from long-term care.

    PubMed

    Okechukwu, Cassandra A; Kelly, Erin L; Bacic, Janine; DePasquale, Nicole; Hurtado, David; Kossek, Ellen; Sembajwe, Grace

    2016-05-01

    We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1214 employees' scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n = 30) and collected monthly for six months after employees' data collection; (2), employees' dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents' incidence of all pressure ulcers (-2.62%) and other injuries (-9.79%). Higher family-supportive organizational climate was associated with significant decreases in all falls (-17.94%) and falls with injuries (-7.57%). Managers' concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95%CI 1.08-1.99), but family-supportive organizational climate was associated with lower likelihood

  18. Impact of decision support in electronic medical records on lipid management in primary care.

    PubMed

    Gill, James M; Chen, Ying Xia; Glutting, Joseph J; Diamond, James J; Lieberman, Michael I

    2009-10-01

    Electronic decision-support tools may help to improve management of hyperlipidemia and other chronic diseases. This study examined the impact of lipid management tools integrated into an electronic medical record (EMR) in primary care practices. This randomized controlled trial was conducted in a national network of physicians who use an outpatient EMR. Adult primary care physicians were randomized by office to receive an electronic form that was embedded in the EMR. The form contained prompts regarding suboptimal care based on Adult Treatment Panel-III (ATP-III) guidelines, as well as reporting tools to identify patients outside of office visits whose lipid management was suboptimal. All active patients, ages 20-79 years, whose physicians participated in the study, were categorized as high, moderate, or low cardiovascular risk, and the proportion who were tested for hyperlipidemia, at lipid goal, and on lipid-lowering medications if not at goal were measured according to ATP-III guidelines. A total of 105 physicians from 25 offices and 64,150 patients were included in the study. Outcomes improved for most measures from before to 1 year after the intervention (November 1, 2005 to October 31, 2006). However, after controlling for confounding variables and for clustering in multilevel modeling, only up-to-date lipid testing for high-risk patients was statistically better in the intervention group as compared to the control group (adjusted odds ratio 15.0, P < 0.05). This study showed few differences in quality of lipid management after implementing an EMR-based disease management intervention in primary care settings. Future studies may need to examine more comprehensive interventions that include office staff in a team approach to care.

  19. The Australian experiment: how primary health care organizations supported the evolution of a primary health care system.

    PubMed

    Nicholson, Caroline; Jackson, Claire L; Marley, John E; Wells, Robert

    2012-03-01

    Primary health care in Australia has undergone 2 decades of change. Starting with a vision for a national health strategy with general practice at its core, Australia established local meso-level primary health care organizations--Divisions of General Practice--moving from focus on individual practitioners to a professional collective local voice. The article identifies how these meso-level organizations have helped the Australian primary health care system evolve by supporting the roll-out of initiatives including national practice accreditation, a focus on quality improvement, expansion of multidisciplinary teams into general practice, regional integration, information technology adoption, and improved access to care. Nevertheless, there are still challenges to ensuring equitable access and the supply and distribution of a primary care workforce, addressing the increasing rates of chronic disease and obesity, and overcoming the fragmentation of funding and accountability in the Australian system.

  20. Supporting Youth in the Transition from Foster Care: Formal and Informal Connections

    ERIC Educational Resources Information Center

    Collins, Mary Elizabeth; Spencer, Renee; Ward, Rolanda

    2010-01-01

    Social support is needed by everyone, but particularly by vulnerable populations at times of transition. This study utilizes data collected from 96 former foster youth regarding supports they received during the transition from care. The report addresses three questions: (1) What types of supportive relationships did the sample report? (2) What…

  1. Care of Black Children with Sickle Cell Disease: Fathers, Maternal Support, and Esteem.

    ERIC Educational Resources Information Center

    Slaughter, Diana T.; Dilworth-Anderson, Peggye

    1988-01-01

    Compared primary caregivers' perceptions of social support received in father-present (N=15) and father-absent (N=19) Black families caring for a child with sickle cell anemia. Found most support to caregivers came from extended kin network, despite father presence or absence. Caregivers reported decrease in network support between diagnosis in…

  2. Time To Care: Redesigning Child Care To Promote Education, Support Families, and Build Communities.

    ERIC Educational Resources Information Center

    Lombardi, Joan

    Refuting the widely held belief that the child care crisis in America is irresolvableor that it can be resolved by simply relying on market forcesthis book presents an alternative vision for ensuring that American families with children will have access to high-quality, affordable child care, shifting the perception of the issue as primarily one…

  3. "You Have to Care" Perceptions of Supporting Autonomy in Support Settings for Adults with Intellectual Disability

    ERIC Educational Resources Information Center

    Petner-Arrey, Jami Lynn

    2011-01-01

    This study investigated the perceptions of persons with intellectual disability (ID) receiving support and the persons providing support regarding the autonomy of people with ID and how they perceive that it is either supported or denied within daily interactions between direct support professionals (DSPs) and people with disabilities. The…

  4. Integrating Supportive Care Principles Into Dialysis Decision Making: A Primer for Palliative Medicine Providers.

    PubMed

    Moss, Alvin H

    2017-03-01

    Despite advances in predialysis care and dialysis technology, patients with advanced chronic kidney disease and end-stage renal disease continue to experience multiple comorbidities, a high symptom burden, a shortened life expectancy, and substantial physical, emotional, and spiritual suffering. Patients with acute kidney injury and end-stage renal disease, especially if they are older, often undergo prolonged hospitalizations, greater use of intensive medical treatment, and limited survival. Unfortunately, most nephrologists are not trained to conduct shared decision-making conversations to elicit patients' values, preferences, and goals for treatment and address their patients' multifactorial suffering. These patients would benefit from the integration of supportive care principles into their care. This article addresses how supportive care specialists can collaborate with nephrology clinicians to provide patient-centered supportive care and identifies resources to assist them in this endeavor.

  5. Across the health-social care divide: elderly people as active users of health care and social care.

    PubMed

    Roberts, K

    2001-03-01

    Several ways in which elderly people may assume an active role when using welfare services are discussed here. Selected findings are presented from a study that explored the experience and behaviour of elderly people on discharge from inpatient care with regard to criteria indicating user influence or control (namely participation, representation, access, choice, information and redress). Data were collected via semistructured interviews with service users (n = 30) soon after their return home from hospital. A number of differences were revealed between health care and social care in relation to users being provided with opportunities to assume an active role and in being willing and able to assume an active role. These differences were manifest in elderly service users accessing services, seeking information, exercising choice and acting independently of service providers. It appeared paradoxical that contact points were more easily defined with regard to health care yet users were more likely to exercise choice and act independently in securing social care. It is suggested that social care needs and appropriate service delivery are more easily recognised than making the link between perceived health care needs and appropriate services. In addition, it appeared that informal and private providers are more widely available and accessible for social care. If comprehensive continuing care is to be provided, incorporating both health and social care elements, greater uniformity appears to be required across the welfare sector. Lessons for social care provision from the delivery of health care suggest the clear definition of contact points to facilitate service use. Making health care more accessible, however, does not appear to be easily attainable due to the monopoly provision of health care and the lack of direct purchasing power by potential users.

  6. [Quality of life and supportive care in head and neck cancers].

    PubMed

    Babin, Emmanuel; Heutte, Natacha; Grandazzi, Guillaume; Prévost, Virginie; Robard, Laetitia

    2014-05-01

    The quality of life of patients treated for head and neck cancers and their carers is part of the current concerns of health care teams. Assessment tools were created and helped to highlight the severe physical effects (pain, mucositis…) and chronic (mutilation, post-radiation complications…) related to the disease or to different treatments but also to consider the psychosocial impact of this disease. Improving the quality of life through a thoughtful and comprehensive support that must be associated with somatic care, mental health care, rehabilitation and inclusion of social difficulties and suffering relatives. Supportive care shall ensure a good quality of life for patients treated and their families but also reduce the physical effects associated with the disease and treatment. They rely on coordination of care including the cancer networks established in the cancer plan to ensure comprehensive and continuous care for these patients.

  7. Nutritional care and support among adults living with HIV at Hawassa Referral Hospital, southern Ethiopia: A qualitative study.

    PubMed

    Tafese, Zelalem; Birhan, Yifru; Abebe, Hiwot

    2013-11-01

    Background Improving nutritional care and support for people living with HIV (PLHIV) is an integral part of comprehensive HIV treatment according to the National Nutritional Strategy of Ethiopia. However, there is no adequate published study that assesses the nutritional care and support services for adult people living with HIV/ AIDS (PLHIV) in this setting. Objective The objective of the study was to identify the existing nutritional care and support services and determine the challenges facing adults living with HIV at Hawassa Referral Hospital in southern Ethiopia. Methods A qualitative study was carried out using focus group discussions (FGDs), in-depth interviews and participant observation. Four FDGs were held and five in-depth interviews were conducted. A two-week participant observation was also conducted by trained nurses. All interviews and FDGs were tape-recorded and transcribed; those conducted in Amharic were translated back to English. Finally thematic analysis of the transcripts was performed. Results Most of the FDG participants were unsatisfied with their nutritional care and support services and expressed difficulty with disclosing their HIV status for fear of stigma and discrimination. The in-depth interviews and participant observation showed results similar to those of the FDG. Some key informants expressed a fear that such poor nutritional care and support may threaten the quality of life of people living with HIV and suggested that all stakeholders work on improving the services. Conclusion Current nutritional care and support services for people living with HIV are not well coordinated. They focus mainly on monthly supplementation of antiretroviral drugs and occasional handouts of food. The need to provide health education on antiretroviral drugs and nutrition, and to emphasise strategies aimed at improving the nutritional status of peoples living with HIV is critical. Furthermore, the study recommended strengthening the initiatives of some

  8. The role of peer support in diabetes care and self-management.

    PubMed

    Brownson, Carol A; Heisler, Michele

    2009-03-01

    In light of the growing prevalence and healthcare costs of diabetes mellitus, it is critically important for healthcare providers to improve the efficiency and effectiveness of their diabetes care. A key element of effective disease management for diabetes is support for patient self-management. Barriers to care exist for both patients and healthcare systems. As a result, many people with diabetes do not get the care and support needed to successfully manage their diabetes.Disease management approaches that incorporate peer support may be a promising way to help provide self-management support to patients with diabetes. Trained peers provide emotional support, instrumental (tangible or material) support, education, and skills training to those they serve, and outreach and care coordination for provider systems. They play a unique role that complements and supports clinical care.To describe how peers are currently supporting diabetes care, a number of databases were searched for studies describing the roles of peers using relevant key words. This paper reviews current literature that describes the roles and duties of peers in interventions to improve diabetes care, with a focus on their contributions to six essential elements of self-management support: (i) access to regular, high-quality clinical care; (ii) an individualized approach to assessment and treatment; (iii) patient-centered collaborative goal setting; (iv) education and skills training; (v) ongoing follow-up and support; and (vi) linkages to community resources.Peers worked under a variety of titles, which did not define their duties. The scope of their work ranged from assisting health professionals to playing a central role in care. Providing education and follow-up support were the two most common roles. In all but one study, these roles were carried out during face-to-face contact, most frequently in community sites.A growing body of literature supports the value of peer models for diabetes

  9. The Integrated Medical Model: A Decision Support Tool for In-flight Crew Health Care

    NASA Technical Reports Server (NTRS)

    Butler, Doug

    2009-01-01

    This viewgraph presentation reviews the development of an Integrated Medical Model (IMM) decision support tool for in-flight crew health care safety. Clinical methods, resources, and case scenarios are also addressed.

  10. Family Education and Support Services in Systems of Care

    ERIC Educational Resources Information Center

    Gyamfi, Phyllis; Walrath, Christine; Burns, Barbara J.; Stephens, Robert L.; Geng, Yisong; Stambaugh, Leyla

    2010-01-01

    This study examines the use of family education and support (FES) services within community-based mental health systems. Using data from the national evaluation of the Children's Mental Health Initiative (CMHI), 2,853 caregivers and their children ages 6 to 18 years from 39 communities participated in this study. The findings indicated that during…

  11. About Supportive and Palliative Care Research | Division of Cancer Prevention

    Cancer.gov

    The program supports research in three areas: prevention or treatment of acute or chronic symptoms and morbidities related to cancer, its treatment and caregiving (symptom management research); effects on quality of life from cancer, its treatment and caregiving (quality of life research); and end-of-life psychosocial issues, caregiving and treatment strategies (end-of-life research). |

  12. The Role and Timing of Palliative Care in Supporting Persons with Intellectual Disability and Advanced Dementia

    ERIC Educational Resources Information Center

    McCarron, Mary; McCallion, Philip; Fahey-McCarthy, Elizabeth; Connaire, Kevin

    2011-01-01

    Aim: To better describe the role and timing of palliative care in supporting persons with intellectual disabilities and advanced dementia (AD). Background: Specialist palliative care providers have focused mostly on people with cancers. Working with persons with intellectual disabilities and AD offers opportunities to expand such palliative care…

  13. Postsecondary Strengths, Challenges, and Supports Experienced by Foster Care Alumni College Graduates

    ERIC Educational Resources Information Center

    Salazar, Amy M.; Jones, Kevin R.; Emerson, John C.; Mucha, Lauren

    2016-01-01

    Young people transitioning from foster care to college experience unique identities and circumstances that make being successful in college especially challenging. We used qualitative survey data from 248 college graduates who were formerly in foster care to explore the strengths, challenges, and supports they experienced while in college that…

  14. Care, Empowerment and Self-Determination in the Practice of Peer Support

    ERIC Educational Resources Information Center

    Scott, Anne; Doughty, Carolyn

    2012-01-01

    The concept of "care" has been fraught with negative connotations within the disability movement; the concepts of empowerment, choice and control have been developed as alternatives. The peer-support movement in the mental health sector draws from this tradition, and is uncomfortable with the provision of care. Drawing on the feminist ethic of…

  15. Community-Based Learning to Support South African Early Group Care

    ERIC Educational Resources Information Center

    Casper, Virginia; Lamb-Parker, Faith

    2012-01-01

    The Developing Families Project-South Africa (DFP-SA) is a community-based model of education and training for the care, support and education of vulnerable children birth-to-three and their caregivers, guardians and families in rural and peri-urban townships. The approach fosters interactive learning among community members about early care and…

  16. The Work-Family Support Roles of Child Care Providers across Settings

    ERIC Educational Resources Information Center

    Bromer, Juliet; Henly, Julia R.

    2009-01-01

    This paper presents a qualitative investigation of the work-family support roles of a sample of 29 child care providers serving low-income families in the Chicago area (16 family, friend, and neighbor providers (FFN), 7 licensed family child care providers (FCC), and 6 center-based teachers). Providers report offering low-income parents…

  17. [Home support for a child receiving palliative care provided by a self-employed nurse].

    PubMed

    Diamantidis-Zinchiri, Catherine

    2011-01-01

    Complex and demanding, paediatric palliative care at home is beginning to develop. How can a self-employed nurse, by definition isolated, care for a child approaching the end of life and his/her family at home? What resources and tools does the nurse have to provide this support?

  18. Ethics support in institutional elderly care: a review of the literature.

    PubMed

    van der Dam, Sandra; Molewijk, Bert; Widdershoven, Guy A M; Abma, Tineke A

    2014-09-01

    Clinical ethics support mechanisms in healthcare are increasing but little is known about the specific developments in elderly care. The aim of this paper is to present a systematic literature review on the characteristics of existing ethics support mechanisms in institutional elderly care. A review was performed in three electronic databases (Pubmed, CINAHL/PsycINFO, Ethxweb). Sixty papers were included in the review. The ethics support mechanisms are classified in four categories: 'institutional bodies' (ethics committee and consultation team); 'frameworks' (analytical tools to assist care professionals); 'educational programmes and moral case deliberation'; and 'written documents and policies'. For each category the goals, methods and ways of organising are described. Ethics support often serves several goals and can be targeted at various levels: case, professional or organisation. Over the past decades a number of changes have taken place in the development of ethics support in elderly care. Considering the goals, ethics support has become more outreaching and proactive, aiming to qualify professionals to integrate ethics in daily care processes. The approaches in clinical ethics support have become more diverse, more focused on everyday ethical issues and better adapted to the concrete learning style of the nursing staff. Ethics support has become less centrally organised and more connected to local contexts and primary process within the organisation.

  19. SMART: a system supporting medical activities in real-time.

    PubMed

    Pisanelli, D M; Consorti, F; Merialdo, P

    1997-01-01

    This paper describes the system SMART whose goal is real-time assistance to physicians who execute diagnostic or therapeutic protocols in a clinical context. SMART is able to retrieve a protocol from its knowledge base and to monitor its execution step by step for a single patient. Different protocols for different patients can be followed at the same time in a health care structure. The prototype realized supports the execution of protocols for evaluating surgical risks. It has been implemented according to the specifications given by the 4th Surgical Clinic of "Policlinico Umberto I" and reflects the activities actually performed in that hospital. However, the protocol model defined is general purpose and we envisage an easy application to other contexts and therefore to the informatization of other protocols.

  20. Volunteers supporting older people in formal care settings in England: personal and local factors influencing prevalence and type of participation.

    PubMed

    Hussein, Shereen; Manthorpe, Jill

    2014-12-01

    In the UK context of financial austerity and the promotion of the social responsibility through the concept of the "Big Society," volunteers are becoming a more important part of the labor workforce. This is particularly so in the long-term care (LTC) sector, where both shortages of staff and demands for support are particularly high. This article investigate the levels and profile of contribution of volunteers in the LTC sector using a large national data set, National Minimum Data Set for Social Care, linked to local area levels of rurality and socio-economic status. The analysis shows that volunteer activity in formal care services varies between sectors and service types, with no strong relationship between local area deprivation, unemployment levels, and levels of volunteering. However, some significant association was found with level of rurality. The contribution of volunteers is most evident in provision of counseling, support, advocacy, and advice.

  1. Nurses' adherence to the Kangaroo Care Method: support for nursing care management1

    PubMed Central

    da Silva, Laura Johanson; Leite, Josete Luzia; Scochi, Carmen Gracinda Silvan; da Silva, Leila Rangel; da Silva, Thiago Privado

    2015-01-01

    OBJECTIVE: construct an explanatory theoretical model about nurses' adherence to the Kangaroo Care Method at the Neonatal Intensive Care Unit, based on the meanings and interactions for care management. METHOD: qualitative research, based on the reference framework of the Grounded Theory. Eight nurses were interviewed at a Neonatal Intensive Care Unit in the city of Rio de Janeiro. The comparative analysis of the data comprised the phases of open, axial and selective coding. A theoretical conditional-causal model was constructed. RESULTS: four main categories emerged that composed the analytic paradigm: Giving one's best to the Kangaroo Method; Working with the complexity of the Kangaroo Method; Finding (de)motivation to apply the Kangaroo Method; and Facing the challenges for the adherence to and application of the Kangaroo Method. CONCLUSIONS: the central phenomenon revealed that each nurse and team professional has a role of multiplying values and practices that may or may not be constructive, potentially influencing the (dis)continuity of the Kangaroo Method at the Neonatal Intensive Care Unit. The findings can be used to outline management strategies that go beyond the courses and training and guarantee the strengthening of the care model. PMID:26155013

  2. A comprehensive information technology system to support physician learning at the point of care.

    PubMed

    Cook, David A; Sorensen, Kristi J; Nishimura, Rick A; Ommen, Steve R; Lloyd, Farrell J

    2015-01-01

    MayoExpert is a multifaceted information system integrated with the electronic medical record (EMR) across Mayo Clinic's multisite health system. It was developed as a technology-based solution to manage information, standardize clinical practice, and promote and document learning in clinical contexts. Features include urgent test result notifications; models illustrating expert-approved care processes; concise, expert-approved answers to frequently asked questions (FAQs); a directory of topic-specific experts; and a portfolio for provider licensure and credentialing. The authors evaluate MayoExpert's reach, effectiveness, adoption, implementation, and maintenance. Evaluation data sources included usage statistics, user surveys, and pilot studies.As of October 2013, MayoExpert was available at 94 clinical sites in 12 states and contained 1,368 clinical topics, answers to 7,640 FAQs, and 92 care process models. In 2012, MayoExpert was accessed at least once by 2,578/3,643 (71%) staff physicians, 900/1,374 (66%) midlevel providers, and 1,728/2,291 (75%) residents and fellows. In a 2013 survey of MayoExpert users with 536 respondents, all features were highly rated (≥67% favorable). More providers reported using MayoExpert to answer questions before/after than during patient visits (68% versus 36%). During November 2012 to April 2013, MayoExpert sent 1,660 notifications of new-onset atrial fibrillation and 1,590 notifications of prolonged QT. MayoExpert has become part of routine clinical and educational operations, and its care process models now define Mayo Clinic best practices. MayoExpert's infrastructure and content will continue to expand with improved templates and content organization, new care process models, additional notifications, better EMR integration, and improved support for credentialing activities.

  3. Participatory design of computer-supported organizational learning in health care: methods and experiences.

    PubMed

    Timpka, T; Sjöberg, C; Hallberg, N; Eriksson, H; Lindblom, P; Hedblom, P; Svensson, B; Marmolin, H

    1995-01-01

    This paper outlines a Computer-Supported Co-operative Work (CSCW) system for primary care and presents from its participatory design process time consumption, costs, and experiences. The system integrates a hypermedia environment, a computerized patient record, and an electronicmessage system. It is developed to coordinate organizational learning in primary care from micro to macro levels by connecting strategic planning to monitoring of patient routines. Summing up design experiences, critical issues for making CSCW systems support cost-effectiveness of health care are discussed.

  4. Participatory design of computer-supported organizational learning in health care: methods and experiences.

    PubMed Central

    Timpka, T.; Sjöberg, C.; Hallberg, N.; Eriksson, H.; Lindblom, P.; Hedblom, P.; Svensson, B.; Marmolin, H.

    1995-01-01

    This paper outlines a Computer-Supported Co-operative Work (CSCW) system for primary care and presents from its participatory design process time consumption, costs, and experiences. The system integrates a hypermedia environment, a computerized patient record, and an electronicmessage system. It is developed to coordinate organizational learning in primary care from micro to macro levels by connecting strategic planning to monitoring of patient routines. Summing up design experiences, critical issues for making CSCW systems support cost-effectiveness of health care are discussed. PMID:8563401

  5. Emergency medical support units to critical care transport teams in Iraq.

    PubMed

    Collins, Sean T

    2008-03-01

    Early in the author's deployment in the United States Air Force to southern Iraq, his unit was exposed to the first of many mass casualties sent to his Expeditionary Medical Support System unit. Within minutes of the injured military members' arrival, the four-bed evaluation station was transformed into an open bay trauma room where patients were treated and supported until they could be evacuated to more definitive care. Patients were transitioned with awe-inspiring speed and professionalism to Critical Care Air Transport teams for care during aeromedical evacuation. The lessons learned from the frequency of these events are valuable to any similar transport case with critically ill and injured patients.

  6. Peer Support for Diabetes Management in Primary Care and Community Settings in Anhui Province, China

    PubMed Central

    Zhong, Xuefeng; Wang, Zhimin; Fisher, Edwin B.; Tanasugarn, Chanuantong

    2015-01-01

    PURPOSE We evaluated a peer leader–support program (PLSP) for diabetes self-management in China in terms of acceptability and feasibility; implementation; perceived advantages; disadvantages and barriers; reach and recruitment; effectiveness in terms of diabetes knowledge and clinical impacts; adoption; and sustainability. METHODS Within each of 3 cities in Anhui Province, 2 subcommunities were randomly assigned to usual care or PLSP. Peer leaders and staff of Community Health Service Centers (CHSCs) co-led biweekly educational meetings. Peer leaders also led biweekly discussion meetings, promoted regular care through the CHSCs, organized informal health promotion activities (eg, walking and tai chi groups), and provided informal individual support to participants through casual contact. RESULTS Qualitative evaluations indicated acceptance of and positive responses to the program among patients, peer leaders, and CHSC staff. Implementation was successful in 2 of 3 subcommunities, the third failing for lack of staff resources. Reported advantages included peer support as a bridge between CHSCs and their patients. In 2 sites where the PLSP was implemented, analyses controlling for baseline differences and site showed significant benefits for PLSP relative to controls (P <0.05) for knowledge, self-efficacy, BMI, systolic blood pressure, diastolic blood pressure, and both fasting and 2-hour post-prandial blood glucose. The Anhui Provincial Health Bureau has extended the PLSP model to other communities and to cardiovascular disease prevention and management. CONCLUSION The PLSP was well accepted, feasible given sufficient administrative and staff resources, effective for those who participated, and generalizable to other sites and health problems. PMID:26304972

  7. Telemedical support of prehospital emergency care in mass casualty incidents.

    PubMed

    Plischke, M; Wolf, K H; Lison, T; Pretschner, D P

    1999-09-09

    In the German emergency medical service system (EMSS) medical treatment can be improved in most of mass casualty incidents (MCI). Currently, the incident commander who is responsible for classification of the victims (depending on their urgency and condition, the so called triage) and ordered transportation uses paper-based documentation. Triage tags are used to identify and classify patients and gather treatment information. This can cause problems in medical treatment and in transportation of injured victims. Object-oriented modelling, simulation, and visualisation of processes can show deficits in treatment and data processing and thereby help to optimise medical workflow and logistics. If documentation by paramedics and emergency physicians is done electronically, all patient records could be send to a telemedical centre for central data administration. A telemedical supported triage tag helps identifying victims and managing detailed identification protocols. The paper-based documentation in emergency would become obsolete, if hospitals can query all protocols, diagnoses, and findings from the telemedical centre. Safety and security aspects can be guaranteed. The complete medical treatment workflow can be supported by telemedicine. Therefore, in case of MCI, telemedicine can optimise medical treatment and exonerate the paramedics from unnecessary documentation.

  8. Pediatricians' role in supporting parents as they care for infants and young children.

    PubMed

    Sparrow, Joshua

    2011-08-01

    Primary care pediatric health care clinicians can integrate basic principles and strategies of the field of infant mental health within the time constraints of their current practice, while advocating for additional resources to support the expansion of the preventive potential afforded by new scientific advances in this field. Infant mental health is a relatively young field with the potential to reduce human suffering and health care costs associated with early-onset developmental, emotional, and behavioral disorders. This will depend not only on primary care pediatric diagnostic acumen, but also on related investments in health care preventive screenings and interventions, training and infrastructure, as well as community supports. The health and development of infants, young children, and families emerge from the interactions of a wide range of factors-including health, education, and economic policy, as well as attributes of local communities and the larger physical environment-and impact economics and security at national and global levels.

  9. The future of mental health care: peer-to-peer support and social media

    PubMed Central

    Naslund, J. A.; Aschbrenner, K. A.; Marsch, L. A.; Bartels, S. J.

    2016-01-01

    Aims People with serious mental illness are increasingly turning to popular social media, including Facebook, Twitter or YouTube, to share their illness experiences or seek advice from others with similar health conditions. This emerging form of unsolicited communication among self-forming online communities of patients and individuals with diverse health concerns is referred to as peer-to-peer support. We offer a perspective on how online peer-to-peer connections among people with serious mental illness could advance efforts to promote mental and physical wellbeing in this group. Methods In this commentary, we take the perspective that when an individual with serious mental illness decides to connect with similar others online it represents a critical point in their illness experience. We propose a conceptual model to illustrate how online peer-to-peer connections may afford opportunities for individuals with serious mental illness to challenge stigma, increase consumer activation and access online interventions for mental and physical well-being. Results People with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours. These individuals could also access interventions for mental and physical wellbeing delivered through social media that could incorporate mutual support between peers, help promote treatment engagement and reach a wider demographic. Unforeseen risks may include exposure to misleading information, facing hostile or derogatory comments from others, or

  10. The POIS (Parkland On-Line Information System) Implementation of the IBM Health Care Support/Patient Care System

    PubMed Central

    Mishelevich, David J.; Hudson, Betty G.; Van Slyke, Donald; Mize, Elaine I.; Robinson, Anna L.; Brieden, Helen C.; Atkinson, Jack; Robertson, James

    1980-01-01

    The installation of major components of a comprehensive Hospital Information System (HIS) called POIS, the Parkland On-line Information System, including identified success factors is described for the Dallas County Hospital District (DCHD) known also as the Parkland Memorial Hospital. Installation of the on-line IBM Health Care Support (HCS) Registration and Admissions Packages occurred in 1976 and implementation of the HCS Patient Care System (PCS) began in 1977 which includes on-line support of health care areas such as nursing stations and ancillary areas. The Duke Hospital Information System (DHIS) is marketed as the IBM HCS/Patient Care System (PCS). DCHD was the validation site. POIS has order entry, result reporting and work management components. While most of the patient care components are currently installed for the inpatient service, the Laboratories are being installed for the outpatient and Emergency areas as well. The Clinic Appointment System developed at the University of Michigan is also installed. The HCS family of programs use DL/1 and CICS and were installed in the OS versions, currently running under MVS on an IBM 370/168 Model 3 with 8 megabytes of main memory. ImagesFigure 1-AFigure 1-B

  11. WORKING AND CARING: THE SIMULTANEOUS DECISION OF LABOR FORCE PARTICIPATION AND INFORMAL ELDERLY AND CHILD SUPPORT ACT IVITIES IN MEXICO.

    PubMed

    van Gameren, Edwin; Velandia Naranjo, Durfari

    2015-11-02

    We analyze factors determining women's decisions to participate in the labor market and provide elderly care and nonfinancial support to their (grand)children. We use data from the Mexican Health and Aging Study, a survey of people aged 50 and over, applying a three-equation, reduced-form SUR model. Results suggest that care needs are the driving force behind caregiving activities. Traditional roles also appear to be relevant in the labor force participation decision: women with a closer labor market connection when they were young are more likely to work. Simulations of demographic changes illustrate potential effects for future caregiving and participation rates.

  12. WORKING AND CARING: THE SIMULTANEOUS DECISION OF LABOR FORCE PARTICIPATION AND INFORMAL ELDERLY AND CHILD SUPPORT ACT IVITIES IN MEXICO*

    PubMed Central

    van Gameren, Edwin; Velandia Naranjo, Durfari

    2016-01-01

    We analyze factors determining women’s decisions to participate in the labor market and provide elderly care and nonfinancial support to their (grand)children. We use data from the Mexican Health and Aging Study, a survey of people aged 50 and over, applying a three-equation, reduced-form SUR model. Results suggest that care needs are the driving force behind caregiving activities. Traditional roles also appear to be relevant in the labor force participation decision: women with a closer labor market connection when they were young are more likely to work. Simulations of demographic changes illustrate potential effects for future caregiving and participation rates. PMID:26924883

  13. Early detection of critical illness outside the intensive care unit: Clarifying treatment plans and honoring goals of care using a supportive care team.

    PubMed

    Granich, Russ; Sutton, Zoe; Kim, Yan S; Anderson, Megan; Wood, Helen; Scharf, John E; Ragins, Arona; Escobar, Gabriel J

    2016-11-01

    Given the high mortality experienced by patients who deteriorate outside the intensive care unit, issues related to patient preferences around escalation of care are common. However, the literature on early warning systems (EWSs) provides limited information on how respecting patient preferences can be incorporated into clinical workflows. In this report, we describe how we developed workflows for integrating supportive care with an automated EWS in the context of a 2-hospital pilot. We used the Institute for Healthcare Improvement's Plan-Do-Study-Act approach to achieve consensus with clinicians and administrators. The workflows will serve as the basis for dissemination to an additional 19 hospitals. We were successful in integrating an automated EWS with supportive care. Our workflows take local resource availability into account and have been well received by hospitalists, nurses, and families. Our work demonstrates that one can achieve integration of proactive supportive care into the operation of an EWS. Creation of a palliative care response arm that is complementary to a clinical rescue arm ensures that patient preferences are respected. Journal of Hospital Medicine 2016;11:S40-S47. © 2016 Society of Hospital Medicine.

  14. Changing access to mental health care and social support when people living with HIV/AIDS become service providers.

    PubMed

    Li, Alan Tai-Wai; Wales, Joshua; Wong, Josephine Pui-Hing; Owino, Maureen; Perreault, Yvette; Miao, Andrew; Maseko, Precious; Guiang, Charlie

    2015-01-01

    As people living with HIV/AIDS (PHAs) achieve more stable health, many have taken on active peer support and professional roles within AIDS service organizations. Although the increased engagement has been associated with many improved health outcomes, emerging program and research evidence have identified new challenges associated with such transition. This paper reports on the results of a qualitative interpretive study that explored the effect of this role transition on PHA service providers' access to mental health support and self care. A total of 27 PHA service providers of diverse ethno-racial backgrounds took part in the study. Results show that while role transition often improves access to financial and health-care benefits, it also leads to new stress from workload demands, emotional triggers from client's narratives, feeling of burnout from over-immersion in HIV at both personal and professional levels, and diminished self care. Barriers to seeking support included: concerns regarding confidentiality; self-imposed and enacted stigma associated with accessing mental health services; and boundary issues resulting from changes in relationships with peers and other service providers. Evolving support mechanisms included: new formal and informal peer support networks amongst colleagues or other PHA service providers to address both personal and professional challenges, and having access to professional support offered through the workplace. The findings suggest the need for increased organizational recognition of HIV support work as a form of emotional labor that places complex demands on PHA service providers. Increased access to employer-provided mental health services, supportive workplace policies, and adequate job-specific training will contribute to reduced work-related stress. Community level strategies that support expansion of social networks amongst PHA service providers would reduce isolation. Systemic policies to increase access to insurance

  15. Child Care under the Family Support Act: Early Lessons from the States.

    ERIC Educational Resources Information Center

    Children's Defense Fund, Washington, DC.

    A Children's Defense Fund (CDF) survey indicates that many AFDC families are being forced to place their children in low-quality and potentially dangerous child care. Family Support Act (FSA) childcare typically lacks basic health and safety and precautions, fails to provide sufficient assistance to support quality childcare and preschool…

  16. Supportive Housing for Homeless Families: Foster Care Outcomes and Best Practices. Summary

    ERIC Educational Resources Information Center

    Lenz-Rashid, Sonja

    2013-01-01

    The "Supportive Housing for Homeless Families: Foster Care Outcomes and Best Practices" report describes the outcome evaluation of Cottage Housing Incorporated's Serna Village program in Sacramento, California. Serna Village is a supportive housing program serving homeless families. Outcomes from the program illustrate that it is…

  17. The Effects of Health Care and Father Support for Mother on the Children's Emotions

    ERIC Educational Resources Information Center

    Lestari, Tri Riana; Suwandi, Tjipto; Nursalam; Narendra, Moersintowarti B.

    2015-01-01

    Toddler stage is referred to as the golden era (golden age period), especially at the age of 0-2 years, the brain development reach 80%. This study examines the effects of health care support and father support for mother on the emotions of children aged less than 2 years. This study was observational, with cross-sectional design. The sampling…

  18. Surveying Community Nursing Support for Persons with an Intellectual Disability and Palliative Care Needs

    ERIC Educational Resources Information Center

    Bailey, Maria; Doody, Owen; Lyons, Rosemary

    2016-01-01

    Palliative care services have developed over the years to support all persons with life-limiting conditions. Moreover, services for people with an intellectual disability have moved from the traditional institutional setting to supporting people with an intellectual disability to live in their own community and family home. The expansion of…

  19. Family Support Builds Stronger Families: The Roots of Family-Supportive Child Care

    ERIC Educational Resources Information Center

    Seiderman, Ethel

    2009-01-01

    Parent Services Project (PSP) is one model of family support that emerged from the heightened awareness of families' needs. Founded in 1980 to integrate family support into four San Francisco Bay Area early childhood programs, PSP since has spread to more than 800 organizations serving 30,000 families in Alaska, California, Delaware, Florida,…

  20. Barriers to cancer care, perceived social support, and patient navigation services for Korean breast cancer patients.

    PubMed

    Lim, Jung-Won

    2015-01-01

    The present study aimed to examine the relationships among barriers to cancer care, perceived social support, and patient navigation services (PNS) for Korean breast cancer patients. For Korean breast cancer patients, PNS are comprised of five services, including emotional, financial, information, transportation, and disease management. The study findings demonstrated that transportation and disease management barriers were directly associated with PNS, whereas emotional and financial barriers were indirectly associated with PNS through perceived social support. The current study provides a preliminary Korean patient navigation model to identify how barriers to cancer care can be reduced through social support and PNS.

  1. Biochemical Lab Activity Supports Evolution Theory

    ERIC Educational Resources Information Center

    Dyman, Daniel J.

    1974-01-01

    Described is thin-layer chromatography (TLC), a technique that can be conveniently used in the laboratory to generate evidence supporting the principle that degrees of biochemical similarity reflect degrees of evolutionary relatedness among organisms. (Author/PEB)

  2. Dose adjustment and supportive care before and during treatment.

    PubMed

    Brunello, Antonella; Loaldi, Elena; Balducci, Lodovico

    2009-10-01

    Though elderly patients represent a majority of cancer patients, their treatment of is still inadequate, mainly due to the lack of data deriving from randomized clinical trials. Factors limiting the use of standard chemotherapy regimens in elderly cancer patients are the fear of toxicity and unexpected side effects. The assessment of comorbidity and the multidimensional geriatric assessment are of major importance in the decision plan. All supportive measures must be adopted in order to successfully treat vulnerable and unfit elderly patients with cancer, and in particular, the use of growth factors when chemotherapy is given with curative intent; rule out anemia and possible causes of anemia, and correct them whenever possible; choose cytotoxics according to expected adverse events and possible interference with concomitant medications. Particular attention must be paid to treatment of pain in the elderly with cancer. Caregivers must be involved in the treatment plan, and phone contacts with the patient and caregivers are needed to verify physical conditions and compliance to prescriptions.

  3. Viking mission support. [Deep Space Network activities

    NASA Technical Reports Server (NTRS)

    Johnston, D. W. H.

    1977-01-01

    Statistics listing the Deep Space Network tracking and command support and the discrepancy report status for 1 January through 28 February 1977 are presented in tables. The initial Viking extended mission period of normal DSN support, following the nonstandard operations during the solar conjunction period is included. Operational testing subsequent to the MK III data system installations at DSS 12, 44, and 62 during this period are also discussed.

  4. Physical activity promotion in the health care system.

    PubMed

    Vuori, Ilkka M; Lavie, Carl J; Blair, Steven N

    2013-12-01

    Physical activity (PA) and exercise training (ET) have great potential in the prevention, management, and rehabilitation of a variety of diseases, but this potential has not been fully realized in clinical practice. The health care system (HCS) could do much more to support patients in increasing their PA and ET. However, counseling on ET is not used widely by the HCS owing partly to attitudes but mainly to practical obstacles. Extensive searches of MEDLINE, the Cochrane Library, the Database of Abstracts of Reviews of Effects, and ScienceDirect for literature published between January 1, 2000, and January 31, 2013, provided data to assess the critical characteristics of ET counseling. The evidence reveals that especially brief ET counseling is an efficient, effective, and cost-effective means to increase PA and ET and to bring considerable clinical benefits to various patient groups. Furthermore, it can be practiced as part of the routine work of the HCS. However, there is a need and feasible means to increase the use and improve the quality of ET counseling. To include PA and ET promotion as important means of comprehensive health care and disease management, a fundamental change is needed. Because exercise is medicine, it should be seen and dealt with in the same ways as pharmaceuticals and other medical interventions regarding the basic and continuing education and training of health care personnel and processes to assess its needs and to prescribe and deliver it, to reimburse the services related to it, and to fund research on its efficacy, effectiveness, feasibility, and interactions and comparability with other preventive, therapeutic, and rehabilitative modalities. This change requires credible, strong, and skillful advocacy inside the medical community and the HCS.

  5. Children's Physical Activity in Day Care and Preschool

    ERIC Educational Resources Information Center

    Reunamo, Jyrki; Hakala, Liisa; Saros, Leila; Lehto, Satu; Kyhälä, Anna-Liisa; Valtonen, Juha

    2014-01-01

    The purpose of the study was to investigate the dynamics of physical activity (PA) in day care and preschool. The participants were 823 Finnish 1-7-year-old children from 50 day care centres and preschools. The research methods were systematic observation, evaluation of children's skills and interviews with children. Altogether 18,366 observations…

  6. Primary brain tumor patients' supportive care needs and multidisciplinary rehabilitation, community and psychosocial support services: awareness, referral and utilization.

    PubMed

    Langbecker, Danette; Yates, Patsy

    2016-03-01

    Primary brain tumors are associated with significant physical, cognitive and psychosocial changes. Although treatment guidelines recommend offering multidisciplinary rehabilitation and support services to address patients' residual deficits, the extent to which patients access such services is unclear. This study aimed to assess patients' supportive care needs early after diagnosis, and quantify service awareness, referral and utilization. A population-based sample of 40 adults recently diagnosed with primary brain tumors was recruited through the Queensland Cancer Registry, representing 18.9 % of the eligible population of 203 patients. Patients or carer proxies completed surveys of supportive care needs at baseline (approximately 3 months after diagnosis) and 3 months later. Descriptive statistics summarized needs and service utilization, and linear regression identified predictors of service use. Unmet supportive care needs were highest at baseline for all domains, and highest for the physical and psychological needs domains at each time point. At follow-up, participants reported awareness of, referral to, and use of 32 informational, support, health professional or practical services. All or almost all participants were aware of at least one informational (100 %), health professional (100 %), support (97 %) or practical service (94 %). Participants were most commonly aware of speech therapists (97 %), physiotherapists (94 %) and diagnostic information from the internet (88 %). Clinician referrals were most commonly made to physiotherapists (53 %), speech therapists (50 %) and diagnostic information booklets (44 %), and accordingly, participants most commonly used physiotherapists (56 %), diagnostic information booklets (47 %), diagnostic information from the internet (47 %), and speech therapists (43 %). Comparatively low referral to and use of psychosocial services may limit patients' abilities to cope with their condition and the changes they

  7. Correlates of social support in older American Indians: the Native Elder Care Study

    PubMed Central

    Conte, Kathleen P.; Schure, Marc B.; Goins, R. Turner

    2017-01-01

    Objectives This study examined social support and identified demographic and health correlates among American Indians aged 55 years and older. Methods Data were derived from the Native Elder Care Study, a cross-sectional study of 505 community-dwelling American Indians aged ≥55 years. Social support was assessed using the Medical Outcomes Study Social Support Survey measure (MOS-SSS) of which psychometric properties were examined through factor analyses. Logistic regression analyses were used to identify associations between age, sex, educational attainment, marital status, depressive symptomatology, lower body physical functioning, and chronic pain and social support. Results Study participants reported higher levels of affectionate and positive interaction social support (88.2% and 81.8%, respectively) than overall (75.9%) and emotional (69.0%) domains. Increased age, being married/partnered, and female sex were associated with high social support in the final model. Decreased depressive symptomatology was associated with high overall, affectionate, and positive interaction support, and decreased chronic pain with affectionate support. The count of chronic conditions and functional disability were not associated with social support. Conclusions Overall, we found high levels of social support for both men and women in this population, with the oldest adults in our study exhibiting the highest levels of social support. Strong cultural values of caring for older adults and a historical tradition of community cooperation may explain this finding. Future public health efforts may be able to leverage social support to reduce health disparities and improve mental and physical functioning. PMID:25322933

  8. Social support and adjustment to caring for elder family members: A multi-study analysis.

    PubMed

    Smerglia, Virginia L; Miller, Nancy B; Sotnak, Diane L; Geiss, Carrie A

    2007-03-01

    This multi-study analysis systematically examines research findings on relationships between social support and caregiver adjustment to discover whether informal support helps family caregivers. Caring for older relatives is an ongoing stressful life course event and role. Informal social support is often used as a predictor of caregiver adjustment outcomes. It is widely believed to enhance adjustment. Yet the varied research results do not necessarily support this belief. A computer-generated literature search of social sciences and medical databases produced thirty-five caregiving articles, published in refereed journals, which meet study parameters. A coding form was developed to categorize social support and adjustment variables for cross-tabular analyses. The findings show most relationships (61%) between social support and caregiver adjustment are not positively significant. Of the minority of positively significant relationships, neither perceived (available) nor received support is more important and neither instrumental nor socioemotional support is more likely to aid adjustment. Researchers and health care professionals need to explore the negative impact of social support and attributes of caregiver-care recipient relationships.

  9. Integration of clinical decision support with on-line encounter documentation for well child care at the point of care.

    PubMed Central

    Porcelli, P. J.; Lobach, D. F.

    1999-01-01

    Electronic medical record systems and clinical practice guideline (CPG) support applications are emerging in the clinical environment to document and support care. Applications which integrate online documentation with CPG are often complex systems bound to a proprietary infrastructure and as such, can be difficult to adapt to changing care guidelines. This paper describes integration of point-of-care clinical documentation to an Internet-based CPG system that was easily modified, utilized available software resources, and separated patient information from CPG. The system combined a text-based encounter documentation tool, Inbox, with a web-based CPG system, SIEGFRIED (System for Interactive Electronic Guidelines with Feedback and Resources for Instructional and Educational Development), which interactively presented care guidelines to providers. Age-specific well child care documentation templates were developed using Inbox for point-of-care documentation. SIEGFRIED contained the knowledge base of child safety education guidelines and executed independent of the program presenting the guidelines. The CPG were accessed from within the documentation template via an Internet hyperlink. Patient chart evaluation indicated that 77% of safety topics were reviewed and 32% of the charts contained documentation indicating all the safety topics were reviewed. Last, routine use of the Inbox-SIEGFRIED system was not realized due to the clinical time constraints and workload of the medical providers, and lack of data entry experience. A user survey indicated time cost (network access and software execution) were negative aspects of the system. However, the system function was highly regarded and the Internet-based patient education materials were described as useful and accurate. In summary, the system was functional, met original development goals, and provided valuable patient education materials; however, routine system use was prevented by time requirements. We recommend

  10. Optimizing psychosocial support during office-based buprenorphine treatment in primary care: patients’ experiences and preferences

    PubMed Central

    Fox, Aaron D.; Masyukova, Mariya; Cunningham, Chinazo O.

    2015-01-01

    Background Buprenorphine maintenance treatment is effective and has been successfully integrated into HIV and primary care settings. However, one key barrier to providers prescribing buprenorphine is their perception that they are unable to provide adequate counseling or psychosocial support to patients with opioid addiction. This qualitative study investigated supportive elements of office-based buprenorphine treatment that patients perceived to be most valuable. Methods We conducted five focus groups with 33 buprenorphine treatment-experienced participants. Focus groups were audio-recorded and transcribed. Iterative readings of transcripts and grounded theory analysis revealed common themes. Results Overall, participants perceived that buprenorphine treatment helped them to achieve their treatment goals and valued the flexibility, accessibility, and privacy of treatment. Participants identified interpersonal and structural elements of buprenorphine treatment that provided psychosocial support. Participants desired good physician-patient relationships, but also valued care delivery models that were patient-centered, created a safe place for self-disclosure, and utilized coordinated team-based care. Conclusions Participants derived psychosocial support from their prescribing physician, but were also open to collaborative or team-based models of care, as long as they were voluntary and confidential. Buprenorphine prescribing physicians without access to referral options for psychosocial counseling could focus on maintaining non-judgmental attitudes and shared decision making during patient encounters. Adding structure and psychosocial support to buprenorphine treatment through coordinated team-based care also seems to have great promise. PMID:26566712

  11. Understanding receptivity to informal supportive cancer care in regional and rural Australia: a Heideggerian analysis.

    PubMed

    Pascal, J; Johnson, N; Dickson-Swift, V; McGrath, P; Dangerfield, F

    2016-05-01

    The concept of receptivity is a new way of understanding the personal and social factors that affect a person living with and beyond cancer, and how these factors influence access to formal supportive care service provision and planning. This article contributes to new knowledge through applying the concept of receptivity to informal supportive cancer care in regional Australia. Literature indicates that a cancer diagnosis is a life-changing experience, particularly in regional communities, where survival rates are lower and there are significant barriers to accessing services. Heideggerian phenomenology informed the design of the study and allowed for a rich and nuanced understanding of participants lived experiences of informal supportive cancer care. These experiences were captured using in-depth interviews, which were subsequently thematically analysed. Nineteen participants were recruited from across regional Victoria, Australia. Participants self-reported a range of stages and types of cancer. Significantly, findings revealed that most participants were not referred to, and did not seek, formal supportive care. Instead, they were receptive to informal supportive care. Understanding receptivity and the role of anxiety and fear of death has implications for partners, family, community members, as well as professionals working with people with living with and beyond cancer.

  12. The Effectiveness of Staff Support: Evaluating Active Support Training Using a Conditional Probability Approach.

    ERIC Educational Resources Information Center

    Felce, David; Bowley, Clare; Baxter, Helen; Jones, Edwin; Lowe, Kathy; Emerson, Eric

    2000-01-01

    Active Support, a package of procedures which includes activity planning, support planning, and training on providing effective assistance, was evaluated in five community residences serving 19 adults with severe mental retardation. Findings indicated that the likelihood of a resident engaging in activity significantly increased following staff…

  13. Marshalling Social Support: A Care-Getting Model for Persons Living with Cancer

    ERIC Educational Resources Information Center

    Kahana, Eva; Kahana, Boaz; Wykle, May; Kulle, Diana

    2009-01-01

    This article offers a stress theory-based conceptual framework for understanding proactive options for care-getting for patients living with cancer that is also relevant to patients living with other chronic or life-threatening illnesses. Barriers and facilitators to active efforts for obtaining responsive care from both informal and formal…

  14. Evaluation of a mentorship program to support chronic kidney disease care

    PubMed Central

    Pang, Jocelyn; Grill, Allan; Bhatt, Monisha; Woodward, Graham L.; Brimble, Scott

    2016-01-01

    Abstract Problem addressed Primary care providers (PCPs) are ideally situated to detect and manage patients with chronic kidney disease (CKD), but they could use more support from nephrologists to accomplish this. Objective of program To improve early detection and management of CKD in primary care, and improve referrals to nephrologists through education and greater partnership between nephrologists and PCPs. Program description Nephrologists provided mentorship to PCPs in Ontario through a collaborative relationship. Nephrologists provided PCPs with educational orientation sessions and need-based advice on patient cases. Conclusion Primary care providers with more than 5 years of experience were more likely to use the program. Primary care providers expressed high satisfaction with the program and reported that it was effective in supporting routine CKD screening efforts, management of early CKD, appropriate referrals, and building a collaborative relationship with nephrologists. PMID:27521409

  15. Significance of Kampo, Traditional Japanese Medicine, in Supportive Care of Cancer Patients

    PubMed Central

    Yamakawa, Jun-ichi; Motoo, Yoshiharu; Moriya, Junji; Ogawa, Masao; Uenishi, Hiroaki; Akazawa, Sumiyo; Sasagawa, Toshiyuki; Nishio, Matomo; Kobayashi, Junji

    2013-01-01

    The current standard treatment for cancer is a multidisciplinary therapy whereby various types of treatment are properly combined. Chemotherapy with multiple anticancer drugs is now common, and traditional, complementary, and alternative therapies are adopted as supportive measures. Medical care in Japan is distinguished by the ability for patients to access both Western and Kampo medical cares at the same time. There is a high degree of trust in the safety of Kampo therapies because they are practiced by medical doctors who are educated with fundamental diagnosis of Western medicine. Highly reliable clinical studies are being published, demonstrating that palliative or supportive care for cancer patients using Kampo preparations alleviates adverse effects of chemotherapy or radiotherapy. This paper reports the circumstances around cancer care in Japan where traditional therapeutic Kampo formulas are used for patients undergoing cancer treatment with cutting-edge chemotherapy, specifically to alleviate adverse effects of anticancer drugs. PMID:23861712

  16. Information in Support of Population Activities.

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific, and Cultural Organization, Paris (France).

    As part of UNESCO's World Population Year, information services in support of population programs are explained and listed. The information system of the International Planned Parenthood Federation is described and the management of population literature discussed. Information needs of population workers and special aspects of the training and…

  17. Social activities of older men who require daily support and the purpose of such activities.

    PubMed

    Hirano, Michiyo; Saeki, Kazuko; Ueda, Izumi; Honda, Hikaru; Mizuno, Yoshiko

    2017-01-01

    Objectives The purpose of this study was to analyze the social activities of older men who require daily support, and to clarify the purpose of such activities, in order to develop effective living support and preventive long-term care service, suitable for this population.Methods Individual, semi-structured interviews were conducted with 17 older men. Data were analyzed using inductive and qualitative methods.Results Four categories of social activities were identified, and four categories of purposes of these social activities were extracted. The following were the identified social activities: maintenance of "comfortable relationships with others," including family, relatives, friends, and neighbors; "participation and use of services and programs with clear objectives and relationships with others," such as long-term care insurance system services, clubs for the elderly, and hobby groups; maintenance of "relationships with former colleagues, depending on their experience of working with them," where some individuals actively participated in gatherings with former colleagues, while others did not keep in touch at all; and participation in "activities to enrich their feelings and quality of life within their living space," such as reading, watching TV, and doing household chores. The purposes of the observed social activities were to build "relationships with society through communication with other people" and to have a "sense of security by spending time with people of the same age and with those older than them." Hence, participants engaged in clubs for the elderly, as well as in hobby groups. In addition, participants made time for exercising regularly, which maintained their cognitive function and was intended for the "maintenance and activation of their physical functions by continuing to exercise," and "continuing to learn by thinking." Furthermore, participants engaged in the exercise or hobby groups that they were interested in, in order to

  18. Study protocol: Cost-effectiveness of transmural nutritional support in malnourished elderly patients in comparison with usual care

    PubMed Central

    2010-01-01

    Background Malnutrition is a common consequence of disease in older patients. Both in hospital setting and in community setting oral nutritional support has proven to be effective. However, cost-effectiveness studies are scarce. Therefore, the aim of our study is to investigate the effectiveness and cost-effectiveness of transmural nutritional support in malnourished elderly patients, starting at hospital admission until three months after discharge. Methods This study is a randomized controlled trial. Patients are included at hospital admission and followed until three months after discharge. Patients are eligible to be included when they are ≥ 60 years old and malnourished according to the following objective standards: Body Mass Index (BMI in kg/m2) < 20 and/or ≥ 5% unintentional weight loss in the previous month and/or ≥ 10% unintentional weight loss in the previous six months. We will compare usual nutritional care with transmural nutritional support (energy and protein enriched diet, two additional servings of an oral nutritional supplement, vitamin D and calcium supplementation, and consultations by a dietitian). Each study arm will consist of 100 patients. The primary outcome parameters will be changes in activities of daily living (determined as functional limitations and physical activity) between intervention and control group. Secondary outcomes will be changes in body weight, body composition, quality of life, and muscle strength. An economic evaluation from a societal perspective will be conducted alongside the randomised trial to evaluate the cost-effectiveness of the intervention in comparison with usual care. Conclusion In this randomized controlled trial we will evaluate the effect of transmural nutritional support in malnourished elderly patients after hospital discharge, compared to usual care. Primary endpoints of the study are changes in activities of daily living, body weight, body composition, quality of life, and muscle strength. An

  19. Spinal Muscular Atrophy Type I: Is It Ethical to Standardize Supportive Care Intervention in Clinical Trials?

    PubMed Central

    Finkel, Richard S.; Bishop, Kathie M.; Nelson, Robert M.

    2016-01-01

    The natural history of spinal muscular atrophy type I (SMA-I) has changed as improved medical support has become available. With investigational drugs for spinal muscular atrophy now in clinical trials, efficient trial design focuses on enrolling recently diagnosed infants, providing best available supportive care, and minimizing subject variation. The quandary has arisen whether it is ethically appropriate to specify a predefined level of nutritional and/or ventilation support for spinal muscular atrophy type I subjects while participating in these studies. We conducted a survey at 2 spinal muscular atrophy investigator meetings involving physician investigators, clinical evaluators, and study coordinators from North America, Europe, and Asia-Pacific. Each group endorsed the concept that having a predefined degree of nutritional and ventilation support was warranted in this context. We discuss how autonomy, beneficence/non-maleficence, noncoercion, social benefit, and equipoise can be maintained when a predefined level of supportive care is proposed, for participation in a clinical trial. PMID:27760875

  20. Social support networks and primary care use by HIV-infected drug users.

    PubMed

    Ramaswamy, Megha; Kelly, Patricia J; Li, Xuan; Berg, Karina M; Litwin, Alain H; Arnsten, Julia H

    2013-01-01

    HIV-infected current and former drug users utilize primary care and preventive health services at suboptimal rates, but little is known about how social support networks are associated with health services use. We investigated the relationship between social support networks and the use of specific types of health services by HIV-infected drug users receiving methadone maintenance. We found that persons with greater social support, in particular more social network members or more network members aware of their HIV status, were more likely to use primary care services. In contrast, social support networks were not related to emergency room or inpatient hospital use. Interventions that build social support might improve coordinated and continuous health services utilization by HIV-infected persons in outpatient drug treatment.

  1. Support Systems for Military Families: The Military Takes Care of Its Own -- Sometimes.

    DTIC Science & Technology

    1981-08-20

    military pro- vide fulltime child care for personnel’s children (Brende, 1977; Nida , 1980). Wheatland (1977) discovered problems in offering child...according to Nida (1980). Specific areas of concern in military child care include the following: Overseas Schooling. In Europe, 130,000 American children...NICHOLS, R. The support of Army families during the absence of their-sponsors. U.S. Army War College, Carlisle Barracks, PA, 1g76. NIDA , P.D. What you

  2. Influencing dressing choice and supporting wound management using remote 'tele-wound care'.

    PubMed

    King, Brenda

    2014-06-01

    This article describes a local involvement in a project to evaluate a remote system of wound management, incorporating the use of digital and mobile technology. It outlines how this involvement influenced the current system of 'tele wound care' (remote wound management) in a large community organisation. The system allows remote wound assessment, management advice and ongoing monitoring of wounds to ensure that the dressing choice remains appropriate and that timely wound care support can be provided to community nurses, practice nurses and GPs.

  3. Supporting Readiness: Ensuring Excellent PTSD and Depression Care for Service Members

    DTIC Science & Technology

    2016-01-01

    P osttraumatic stress disorder (PTSD) and depression are common and treatable psychological health concerns. Without appropriate treatment, these...independent look to date at how the MHS treats service members with PTSD and depression through a research initiative supported by the Department of...and Depression Care for Service Members BRIEF C O R P O R A T I O N Service members with PTSD or depression need excellent care to meet their

  4. Caring for our own: the role of institutionalized support structures in Native American nursing student success.

    PubMed

    Cech, Erin A; Metz, Anneke M; Babcock, Tracy; Smith, Jessi L

    2011-09-01

    In this project, the authors asked 19 Native American baccalaureate nursing students to discuss their experiences with a formal institutionalized student support program called "Caring for Our Own: A Reservation/University Partnership Program." The authors investigated the importance of different types of support structures within this program, as viewed by Native American nursing students. They distinguished between four institutionalized support structures: tangible, informational, emotional, and belonging. The authors found that students consider tangible support (such as stipends) to be comparatively less important than other types of support, particularly emotional and belonging support. Responses also revealed the importance of a fifth type of institutionalized support-motivational. The authors further discuss how these institutionalized support structures might lead to successful outcomes for Native American nursing students.

  5. Classroom Writing Activities to Support the Curriculum.

    ERIC Educational Resources Information Center

    Piper, Judy

    1990-01-01

    Offers writing activities related to the reading of E. B. White's "Charlotte's Web," including showing the movie, using HyperCard, showing a video about a webspinning spider as a prewriting activity, and using computer graphics and video cameras to create related visual projects. (SR)

  6. Semantic Support Environment for Research Activity

    ERIC Educational Resources Information Center

    Ismail, Maizatul Akmar; Yaacob, Mashkuri; Kareem, Sameem Abdul

    2008-01-01

    Scholarly activities are a collection of academic related activities such as research, teaching and consultation work which result in research outputs such as journals, theses and articles in proceedings. The output will then be disseminated to researchers all over the world by means of the WWW. The four pillars of this scholarship i.e. discovery,…

  7. The neurologist's role in supporting transition to adult health care: A consensus statement.

    PubMed

    Brown, Lawrence W; Camfield, Peter; Capers, Melissa; Cascino, Greg; Ciccarelli, Mary; de Gusmao, Claudio M; Downs, Stephen M; Majnemer, Annette; Miller, Amy Brin; SanInocencio, Christina; Schultz, Rebecca; Tilton, Anne; Winokur, Annick; Zupanc, Mary

    2016-08-23

    The child neurologist has a critical role in planning and coordinating the successful transition from the pediatric to adult health care system for youth with neurologic conditions. Leadership in appropriately planning a youth's transition and in care coordination among health care, educational, vocational, and community services providers may assist in preventing gaps in care, delayed entry into the adult care system, and/or health crises for their adolescent patients. Youth whose neurologic conditions result in cognitive or physical disability and their families may need additional support during this transition, given the legal and financial considerations that may be required. Eight common principles that define the child neurologist's role in a successful transition process have been outlined by a multidisciplinary panel convened by the Child Neurology Foundation are introduced and described. The authors of this consensus statement recognize the current paucity of evidence for successful transition models and outline areas for future consideration.

  8. The care unit in nursing home research: Evidence in support of a definition

    PubMed Central

    2011-01-01

    Background Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. Methods An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η2, and ω2), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. Results In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported

  9. Supporting parental bonding in the NICU: a care plan for nurses.

    PubMed

    Haut, C; Peddicord, K; O'Brien, E

    1994-12-01

    New and improved technology in the NICU has assisted in supporting critically ill neonates, especially those born at very low birth weights. These small patients require the dedicated hand of the NICU staff, but also the love and support of their parents. Family bonding in the NICU is often a very difficult process, which is interrupted by separation of parent and child at birth and continued by the physical constraints of this highly complex critical care environment. Neonatal nurses are most often the front line managers and coordinators of family care in the NICU. They are charged with the challenge of understanding and providing "state of the art" technological care in an environment that must also adapt to the ever changing needs of parents and families who cannot be considered visitors, but an integral part of their infants' care and survival. Each infant and family in the NICU requires individualized assessment and nursing care. This article reviews the process of parental bonding as it relates to the premature or ill infant and provides for nurses a plan of care written to foster and support family bonding in the NICU. Stages of bonding with a sick or premature infant are explored in the context of a theoretical framework of adaptation provided by Sister Callista Roy.

  10. The Importance of Supportive Care in Optimizing Treatment Outcomes of Patients with Advanced Prostate Cancer

    PubMed Central

    2012-01-01

    Optimal oncologic care of older men with prostate cancer, including effective prevention and management of the disease and treatment side effects (so-called best supportive care measures) can prolong survival, improve quality of life, and reduce depressive symptoms. In addition, the proportion of treatment discontinuations can be reduced through early reporting and management of side effects. Pharmacologic care may be offered to manage the side effects of androgen-deprivation therapy and chemotherapy, which may include hot flashes, febrile neutropenia, fatigue, and diarrhea. Nonpharmacologic care (e.g., physical exercise, acupuncture, relaxation) has also been shown to benefit patients. At the Georges Pompidou European Hospital, the Program of Optimization of Chemotherapy Administration has demonstrated that improved outpatient follow-up by supportive care measures can reduce the occurrence of chemotherapy-related side effects, reduce cancellations and modifications of treatment, reduce chemotherapy wastage, and reduce the length of stay in the outpatient unit. The importance of supportive care measures to optimize management and outcomes of older men with advanced prostate cancer should not be overlooked. PMID:23015682

  11. The Basis for Using the Internet to Support the Information Needs of Primary Care

    PubMed Central

    Westberg, Edward E.; Miller, Randolph A.

    1999-01-01

    Synthesizing the state of the art from the published literature, this review assesses the basis for employing the Internet to support the information needs of primary care. The authors survey what has been published about the information needs of clinical practice, including primary care, and discuss currently available information resources potentially relevant to primary care. Potential methods of linking information needs with appropriate information resources are described in the context of previous classifications of clinical information needs. Also described is the role that existing terminology mapping systems, such as the National Library of Medicine's Unified Medical Language System, may play in representing and linking information needs to answers. PMID:9925225

  12. Study of Managed Care Activities in USAF and other DoD Medical Treatment Facilities

    DTIC Science & Technology

    1990-07-27

    general medical and surgical capability, as well as outpatient surgery: physical therapy; neurology; pediatrics : ENT; primary care: OB-GYN; mental health...Number FTEs: Military 1029 + Civilian 270 zK E. Mission of MTF: Enhance Medical Readiness posture to MZ support the wartime mission; support the...DTIC .. ~F IAC TE JUL 01 1991 AD- A2 3 7 919 0 STUDY OF MANAGED CARE ACTIVITIES IN USAF AND OTHER DOD MEDICAL TREATMENT FACILITIES m 2, 0 a C 0 Mo I

  13. The use of mobile devices for information sharing in a technology-supported model of care in A&E.

    PubMed

    Baldwin, Lynne P; Low, Phuay Hui; Picton, Claire; Young, Terry

    2007-01-01

    Using a case study as an example, this paper illustrates the current model of care in Accident and Emergency (A & E); in particular, the 'cells' in which data/information is stored and how explicit and accessible it is (or is not) to healthcare professionals. It is a model of care which may be summed up as static information/dynamic clinicians. This paper then describes how mobile devices may be used to track patients through an A&E department. From there, a model of care is proposed that has at its core the notion of dynamic information/static clinicians which takes into account the potential and likelihood of such mobile technology being used to support healthcare professionals in the future. It is argued, however, that such 'disruptive technologies' are merely tools at our disposal and that it is human activity which must be foremost when considering how we might work differently ('better') in treating and/or dealing with patients.

  14. ERMHAN: A Context-Aware Service Platform to Support Continuous Care Networks for Home-Based Assistance.

    PubMed

    Paganelli, Federica; Spinicci, Emilio; Giuli, Dino

    2008-01-01

    Continuous care models for chronic diseases pose several technology-oriented challenges for home-based continuous care, where assistance services rely on a close collaboration among different stakeholders such as health operators, patient relatives, and social community members. Here we describe Emilia Romagna Mobile Health Assistance Network (ERMHAN) a multichannel context-aware service platform designed to support care networks in cooperating and sharing information with the goal of improving patient quality of life. In order to meet extensibility and flexibility requirements, this platform has been developed through ontology-based context-aware computing and a service oriented approach. We also provide some preliminary results of performance analysis and user survey activity.

  15. Translational Cognition for Decision Support in Critical Care Environments: A Review

    PubMed Central

    Patel, Vimla L.; Zhang, Jiajie; Yoskowitz, Nicole A.; Green, Robert; Sayan, Osman R.

    2008-01-01

    The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers. PMID:18343731

  16. Role and Success of Finnish Early Childhood Education and Care in Supporting Child Welfare Clients: Perspectives from Parents and Professionals

    ERIC Educational Resources Information Center

    Pölkki, Pirjo L.; Vornanen, Riitta H.

    2016-01-01

    Day care in Finland comprising care, education and teaching--called Educare or the ECEC model--can be used as an open care (community care) support measure for children whose development is at risk. The general aim of the study was to investigate whether the needs of child welfare client children and their parents are fulfilled in day care…

  17. Integrative Review of the Supportive Care Needs of Arab People Affected by Cancer

    PubMed Central

    Alananzeh, Ibrahim; Levesque, Janelle; Kwok, Cannas; Everett, Bronwyn

    2016-01-01

    This review aimed to identify the unmet supportive care needs to conduct an integrative review of the literature, to identify the unmet supportive care needs of Arab people affected by cancer (patients and caregivers), and the impact of these needs on quality of life and psychosocial well-being. In July 2015 databases, search engines and electronic list servers were searched, with no limit on the year of publication. Reference lists of included articles and published reviews were also hand searched. Six studies met the inclusion criteria. Most studies examined the supportive care/unmet needs of Arab cancer patients and their family caregivers. Language, communication, information, and the need to get relief from dependency were the most frequently reported unmet needs among Arab cancer patients. For immigrant Arab patients, physical unmet needs were higher than other migrant groups and native Anglo-Australians. Arab caregivers’ unmet needs included concerns about providing suitable care for their family member, sharing their experience with other caregivers, obtaining information, and, in the case of pediatric cancers, dealing with siblings’ emotional reactions. The existing literature exploring the unmet supportive care needs of Arab people affected by cancer is limited suggesting that comprehensive studies are needed to enhance our understanding of these needs and to inform service planning. PMID:27981153

  18. Classroom Writing Activities to Support the Curriculum.

    ERIC Educational Resources Information Center

    Piper, Judy

    1993-01-01

    Describes a range of classroom writing activities to go along with three books for children or adolescents: "On My Honor" (Marion Dane Bauer), "Knots on a Counting Rope" (Bill Martin, Jr. and John Archambault), and "Piggybook" (Anthony Browne). (SR)

  19. Embodying medical expertise in decision support systems for health care management: techniques and benefits.

    PubMed

    Frank, M S

    1998-11-01

    Health care providers and payers are faced with ever-increasing pressures to lower costs, improve quality, and maximize profits. As medical information technology evolves, more medically related data are being collected, stored electronically within a data warehouse, and made available for decision support in the pursuit of lower costs and higher quality in health care. The article describes how medical expertise can be captured and integrated into decision support systems to improve awareness and predictability of disease and disease-associated financial risk within a population of patients, ultimately providing patient-centric and provider-centric opportunities to improve health and decrease costs. The concept of medical logic engineering is introduced.

  20. Supporting the information domains of fall-risk management in home care via health information technology.

    PubMed

    Alhuwail, Dari; Koru, Güneş; Mills, Mary Etta

    2016-01-01

    In the United States, home care clinicians often start the episode of care devoid of relevant fall-risk information. By collecting and analyzing qualitative data from 30 clinicians in one home health agency, this case study aimed to understand how the currently adopted information technology solutions supported the clinicians' fall-risk management (FRM) information domains, and explored opportunities to adopt other solutions to better support FRM. The currently adopted electronic health record system and fall-reporting application served only some information domains with a limited capacity. Substantial improvement in addressing the FRM information domains is possible by effectively modifying the existing solutions and purposefully adopting new solutions.

  1. Making Personalized Health Care Even More Personalized: Insights From Activities of the IOM Genomics Roundtable.

    PubMed

    David, Sean P; Johnson, Samuel G; Berger, Adam C; Feero, W Gregory; Terry, Sharon F; Green, Larry A; Phillips, Robert L; Ginsburg, Geoffrey S

    2015-01-01

    Genomic research has generated much new knowledge into mechanisms of human disease, with the potential to catalyze novel drug discovery and development, prenatal and neonatal screening, clinical pharmacogenomics, more sensitive risk prediction, and enhanced diagnostics. Genomic medicine, however, has been limited by critical evidence gaps, especially those related to clinical utility and applicability to diverse populations. Genomic medicine may have the greatest impact on health care if it is integrated into primary care, where most health care is received and where evidence supports the value of personalized medicine grounded in continuous healing relationships. Redesigned primary care is the most relevant setting for clinically useful genomic medicine research. Taking insights gained from the activities of the Institute of Medicine (IOM) Roundtable on Translating Genomic-Based Research for Health, we apply lessons learned from the patient-centered medical home national experience to implement genomic medicine in a patient-centered, learning health care system.

  2. The Performance of mHealth in Cancer Supportive Care: A Research Agenda

    PubMed Central

    2015-01-01

    Background Since the advent of smartphones, mHealth has risen to the attention of the health care system as something that could radically change the way health care has been viewed, managed, and delivered to date. This is particularly relevant for cancer, as one of the leading causes of death worldwide, and for cancer supportive care, since patients and caregivers have key roles in managing side effects. Given adequate knowledge, they are able to expect appropriate assessments and interventions. In this scenario, mHealth has great potential for linking patients, caregivers, and health care professionals; for enabling early detection and intervention; for lowering costs; and achieving better quality of life. Given its great potential, it is important to evaluate the performance of mHealth. This can be considered from several perspectives, of which organizational performance is particularly relevant, since mHealth may increase the productivity of health care providers and as a result even the productivity of health care systems. Objective This paper aims to review studies on the evaluation of the performance of mHealth, with particular focus on cancer care and cancer supportive care processes, concentrating on its contribution to organizational performance, as well as identifying some indications for a further research agenda. Methods We carried out a review of literature, aimed at identifying studies related to the performance of mHealth in general or focusing on cancer care and cancer supportive care. Results Our analysis revealed that studies are almost always based on a single dimension of performance. Any evaluations of the performance of mHealth are based on very different methods and measures, with a prevailing focus on issues linked to efficiency. This fails to consider the real contribution that mHealth can offer for improving the performance of health care providers, health care systems, and the quality of life in general. Conclusions Further research

  3. A family nursing educational intervention supports nurses and families in an adult intensive care unit.

    PubMed

    Eggenberger, Sandra K; Sanders, Marita

    2016-11-01

    The family experience of critical illness is filled with distress that may have a lasting impact on family coping and family health. A nurse can become a source of comfort that helps the family endure. Yet, nurses often report a lack of confidence in communicating with families and families report troubling relationships with nurses. In spite of strong evidence supporting nursing practice focused on the family, family nursing interventions often not implemented in the critical care setting. This pilot study examined the influence of an educational intervention on nurses' attitudes towards and confidence in providing family care, as well as families' perceptions of support from nurses in an adult critical care setting. An academic-clinical practice partnership used digital storytelling as an educational strategy. A Knowledge to Action Process Framework guided this study. Results of pre-intervention data collection from families and nurses were used to inform the educational intervention. A convenience sample of family members completed the Iceland Family Perceived Support Questionnaire (ICE-FPSQ) to measure perception of support provided by nurses. Video, voice, and narrative stories of nurses describing their experiences caring for family members during a critical illness and family members' experiences with a critically ill family member also guided education plans. When comparing the pre and post results of the Family Nurse Practice Scale (FNPS), nurses reported increased confidence, knowledge, and skill following the educational intervention. Qualitative data from nurses reported satisfaction with the educational intervention. Findings suggest that engaging nurses in educational opportunities focused on families while using storytelling methods encourages empathic understandings. Academic-clinician teams that drive directions show promise in supporting families and nurses in critical care settings. Plans are moving forward to use this study design and methods in

  4. Dementia-Related Work Activities of Home Care Nurses and Aides: Frequency, Perceived Competence, and Continuing Education Priorities

    ERIC Educational Resources Information Center

    Morgan, Debra G.; Kosteniuk, Julie G.; O'Connell, Megan E.; Dal Bello-Haas, Vanina; Stewart, Norma J.; Karunanayake, Chandima

    2016-01-01

    An understanding of the specific dementia learning needs of home care staff is needed to plan relevant continuing education (CE) programs and supports. The study's objective was to examine frequency and perceived competence in performing 20 dementia-related work activities, and identify CE priorities among home care staff. A cross-sectional survey…

  5. Social support is associated with blood pressure responses in parents caring for children with developmental disabilities.

    PubMed

    Gallagher, Stephen; Whiteley, Jenny

    2012-01-01

    The present study tested whether parents caring for children with developmental disabilities would have higher blood pressure compared to parents of typically developing children (controls). It also examined the psychosocial factors underlying this observation. Thirty-five parents of children with developmental disability and thirty controls completed standard measures of perceived stress, child challenging behaviours and social support and wore an ambulatory blood pressure (BP) monitor throughout the day, for one day. Relative to controls, parents caring for children with developmental disabilities reported poorer psychosocial functioning and had a higher mean systolic BP. Of the psychosocial predictors, only social support was found to be predictive. Moreover, variations in social support accounted for some of the between group differences with the β for parental group attenuated from .42 to .34 in regression analyses. It appears that social support may influence blood pressure responses in parental caregivers. Finally, our findings underscore the importance of providing psychosocial interventions to improve the health of family caregivers.

  6. Electronic palliative care co-ordination system: an electronic record that supports communication for end-of-life care - a pilot in Richmond, UK.

    PubMed

    Millington-Sanders, Catherine; Nadicksbernd, J J; O'Sullivan, Caoimhe; Morgan, Tom; Raleigh, Anna; Yeun, Peter; Ormerod, Georgina

    2013-01-01

    Most people prefer to die at home, however, the majority die in an acute hospital. Supporting a patient in their preferred place of care may be aided by exchange of information across sectors. Richmond piloted an electronic palliative care coordination system (EPaCCS) to enhance interprofessional communication for end-of-life care. One such EPaCCS is the Coordinate My Care (CMC) hosted by the Royal Marsden NHS Foundation Trust, now supported across London. It focused clinicians on having advance care planning conversations with patients and their carers and then documenting the outcome onto an electronic web-based record that can be shared with key healthcare professionals.

  7. Electronic palliative care co-ordination system: an electronic record that supports communication for end-of-life care - a pilot in Richmond, UK.

    PubMed

    Millington-Sanders, Catherine; Nadicksbernd, J J; O'Sullivan, Caoimhe; Morgan, Tom; Raleigh, Anna; Yeun, Peter; Ormerod, Georgina

    2012-01-01

    Most people prefer to die at home, however, the majority die in an acute hospital. Supporting a patient in their preferred place of care may be aided by exchange of information across sectors. Richmond piloted an electronic palliative care coordination system (EPaCCS) to enhance interprofessional communication for end-of-life care. One such EPaCCS is the Coordinate My Care (CMC) hosted by the Royal Marsden NHS Foundation Trust, now supported across London. It focused clinicians on having advance care planning conversations with patients and their carers and then documenting the outcome onto an electronic web-based record that can be shared with key healthcare professionals.

  8. Using Oceanography to Support Active Learning

    NASA Astrophysics Data System (ADS)

    Byfield, V.

    2012-04-01

    Teachers are always on the lookout for material to give their brightest students, in order to keep them occupied, stimulated and challenged, while the teacher gets on with helping the rest. They are also looking for material that can inspire and enthuse those who think that school is 'just boring!' Oceanography, well presented, has the capacity to do both. As a relatively young science, oceanography is not a core curriculum subject (possibly an advantage), but it draws on the traditional sciences of biology, chemistry, physic and geology, and can provide wonderful examples for teaching concepts in school sciences. It can also give good reasons for learning science, maths and technology. Exciting expeditions (research cruises) to far-flung places; opportunities to explore new worlds, a different angle on topical debates such as climate change, pollution, or conservation can bring a new life to old subjects. Access to 'real' data from satellites or Argo floats can be used to develop analytical and problem solving skills. The challenge is to make all this available in a form that can easily be used by teachers and students to enhance the learning experience. We learn by doing. Active teaching methods require students to develop their own concepts of what they are learning. This stimulates new neural connections in the brain - the physical manifestation of learning. There is a large body of evidence to show that active learning is much better remembered and understood. Active learning develops thinking skills through analysis, problem solving, and evaluation. It helps learners to use their knowledge in realistic and useful ways, and see its importance and relevance. Most importantly, properly used, active learning is fun. This paper presents experiences from a number of education outreach projects that have involved the National Oceanography Centre in Southampton, UK. All contain some element of active learning - from quizzes and puzzles to analysis of real data from

  9. PEGASUS: Designing a System for Supporting Group Activity

    ERIC Educational Resources Information Center

    Kyprianidou, Maria; Demetriadis, Stavros; Pombortsis, Andreas; Karatasios, George

    2009-01-01

    Purpose: The purpose of this paper is to present the design and first results of the integration of a web-based system person-centred group-activity support system (PEGASUS) in university instruction, as a means for advancing person-centred learning by supporting group activity. The PEGASUS is expected to help students and teachers in two distinct…

  10. CANoE: A Context-Aware Notification Model to Support the Care of Older Adults in a Nursing Home

    PubMed Central

    Nava-Muñoz, Sandra; Morán, Alberto L.

    2012-01-01

    Taking care of elders in a nursing home is not an easy task. Caregivers face two major problems: a lack of awareness of the situations surrounding the elderly care and the lack of information regarding the availability and the activities of other caregivers to support their coordination process. Various efforts have proposed solutions to cope with these problems, but they do it without considering all the requirements imposed by the criticality of this type of environment. In this paper we propose CANoE, a model for the design of context-aware notifications in critical environments, such as a nursing home. The main feature of this model is that it considers three sources of context (the environment, and the issuer and the receiver of the notification) for adapting the content, the terms of delivery and the presentation of the notification message. Based on the CANoE model we developed the CANoE-Aw and CU-IDA systems, which were evaluated through two case studies in a nursing home. The results of these evaluations provide evidence that caregivers achieved an increased awareness of the situations of care of the elderly and perceived the systems as adequate tools to support their coordination while attending a situation of care. PMID:23112666

  11. Predictors of Caregiver Supportive Behaviors towards Reproductive Health Care for Women with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Lin, Lan-Ping; Lin, Pei-Ying; Chu, Cordia M.; Lin, Jin-Ding

    2011-01-01

    Although many previous studies have begun to address the reproductive health needs of women with intellectual disabilities; however, the supportive behaviors of caregivers to assist their reproductive health is not well understood. Data from a cross-sectional survey of ""2009 National Survey on Reproductive Health Care Needs and Health…

  12. The Role of the Corporation in Promoting Early Childhood Education and Care and Family Support Systems.

    ERIC Educational Resources Information Center

    Galinsky, Ellen

    Corporations have assumed many roles in promoting early childhood education and care and family support. To select services or programs to offer their employees, many companies go through a planning phase that involves an analysis of employees' needs and a review of community resources. The three most frequent solutions to helping employees solve…

  13. Air Force Health Care Providers: Automation Concerns Relating to - Needs, Experience, and Support,

    DTIC Science & Technology

    1987-05-22

    aerospace physiology clinical psychology clinical social work alcohol rehabilitation dietitian occupational theraphy pharmacy optometry podiatry... occupational medicine family practice primary care pediatrics pathology radiology radiation therapy neuroradiology nuclear medicine diagnostic...operations. (5) Coputerized Occupational Health Program (CCFI) (a) COHP supports the requirements of the Occupational Safety and Health Act of 1970. It

  14. Factors Predicting Oncology Care Providers' Behavioral Intention to Adopt Clinical Decision Support Systems

    ERIC Educational Resources Information Center

    Wolfenden, Andrew

    2012-01-01

    The purpose of this quantitative correlation study was to examine the predictors of user behavioral intention on the decision of oncology care providers to adopt or reject the clinical decision support system. The Unified Theory of Acceptance and Use of Technology (UTAUT) formed the foundation of the research model and survey instrument. The…

  15. The Quality of Care and Support (QOCS) for People with Disability Scale: Development and Psychometric Properties

    ERIC Educational Resources Information Center

    Lucas-Carrasco, Ramona; Eser, Erhan; Hao, Yuantao; McPherson, Kathryn M.; Green, Ann; Kullmann, Lajos

    2011-01-01

    This paper describes the development of a Quality of Care and Support (QOCS) scale for use with adult persons with physical and intellectual disabilities. In the pilot phase of the study, 12 centers from around the world carried out focus groups with people with physical and disabilities, their carers, and with professionals in order to identify…

  16. Educational Supports for Middle School Youths Involved in the Foster Care System

    ERIC Educational Resources Information Center

    Tyre, Ashli D.

    2012-01-01

    Despite our knowledge of poor educational outcomes for youths in foster care, the literature on methods or models for addressing the needs of this vulnerable group of students remains extremely limited. Therefore, the purpose of the present study is to describe a school-based educational support model that provides advocacy, tutoring, and…

  17. Personalisation of Adult Social Care: Self-Directed Support and the Choice and Control Agenda

    ERIC Educational Resources Information Center

    Kendall, Sophie; Cameron, Ailsa

    2014-01-01

    In 2007, "self-directed support" was introduced in adult social care in England to establish choice and control--in the assessment process itself and over service provision--for "all" service users. The personalisation agenda is underpinned by a range of ideologies, particularly a civil rights empowerment approach and…

  18. Supports for Community-Based Mental Health Care: An Optimistic Review of Federal Legislation.

    ERIC Educational Resources Information Center

    Bentley, Kia J.

    1994-01-01

    Describes and summarizes recent relevant federal legislative initiatives and analyzes their potential in providing support for community-based mental health care for adults in United States. Contends that these legislative mandates and options can be source of optimism and ammunition for advocates and change agents as they work to improve mental…

  19. Computer Decision Support to Improve Autism Screening and Care in Community Pediatric Clinics

    ERIC Educational Resources Information Center

    Bauer, Nerissa S.; Sturm, Lynne A.; Carroll, Aaron E.; Downs, Stephen M.

    2013-01-01

    An autism module was added to an existing computer decision support system (CDSS) to facilitate adherence to recommended guidelines for screening for autism spectrum disorders in primary care pediatric clinics. User satisfaction was assessed by survey and informal feedback at monthly meetings between clinical staff and the software team. To assess…

  20. Understanding and Supporting Parent-Child Relationships during Foster Care Visits: Attachment Theory and Research.

    ERIC Educational Resources Information Center

    Haight, Wendy L.; Kagle, Jill Doner; Black, James E.

    2003-01-01

    Parent visitation between parents and their children in foster care is the primary intervention for maintaining and supporting the development of parent child relationships necessary for reunification. This article examines the aspects of attachment relationships that provide an approach for understanding, assessing, and intervening in parent…

  1. Social Support, a Mediator in Collaborative Depression Care for Cancer Patients

    ERIC Educational Resources Information Center

    Oh, Hyunsung; Ell, Kathleen

    2015-01-01

    Objective: This study assessed whether perceived social support (PSS) is a factor in improving physical and functional well-being observed among cancer patients receiving collaborative depression care. Methods: A secondary analysis was conducted of data collected in a randomized clinical trial testing the effectiveness of collaborative depression…

  2. Interventions to support recovery after domestic and sexual violence in primary care.

    PubMed

    Hegarty, Kelsey; Tarzia, Laura; Hooker, Leesa; Taft, Angela

    2016-10-01

    Experiences of domestic and sexual violence are common in patients attending primary care. Most often they are not identified due to barriers to asking by health practitioners and disclosure by patients. Women are more likely than men to experience such violence and present with mental and physical health symptoms to health practitioners. If identified through screening or case finding as experiencing violence they need to be supported to recover from these traumas. This paper draws on systematic reviews published in 2013-2015 and a further literature search undertaken to identify recent intervention studies relevant to recovery from domestic and sexual violence in primary care. There is limited evidence as to what interventions in primary care assist with recovery from domestic violence; however, they can be categorized into the following areas: first line response and referral, psychological treatments, safety planning and advocacy, including through home visitation and peer support programmes, and parenting and mother-child interventions. Sexual violence interventions usually include trauma informed care and models to support recovery. The most promising results have been from nurse home visiting advocacy programmes, mother-child psychotherapeutic interventions, and specific psychological treatments (Cognitive Behaviour Therapy, Trauma informed Cognitive Behaviour Therapy and, for sexual assault, Exposure and Eye Movement Desensitization and Reprocessing Interventions). Holistic healing models have not been formally tested by randomized controlled trials, but show some promise. Further research into what supports women and their children on their trajectory of recovery from domestic and sexual violence is urgently needed.

  3. Systems of Social Support in Families Who Care for Dependent African American Elders

    ERIC Educational Resources Information Center

    Williams, Sharon Wallace; Dilworth-Anderson, Peggye

    2002-01-01

    Purpose: This study examined connections (linking, compensatory, or none) between three systems of social support (informal, church, and formal). Predictors of each system were also examined. Design and Methods: A community sample of 187 caregivers who provided care to older African American participants in the Duke Established Populations for…

  4. [Support at the end of life in care homes by nursing assistants].

    PubMed

    Croyère, Nicole

    2015-11-01

    In nursing homes, the nursing assistant supports patients at the end of life, notably as they move into palliative care. This involves team work to relieve pain, limit treatments considered disproportionate and improve comfort. Relations with the residents and their families are particularly important in this context.

  5. Review of State Policies and Programs to Support Young People Transitioning Out of Foster Care

    ERIC Educational Resources Information Center

    Dworsky, Amy; Havlicek, Judy

    2009-01-01

    This comprehensive review of policies and programs designed to support youth transitioning out of foster care spans all 50 states and the District of Columbia. As part of the review, Chapin Hall administered a web-based survey of state independent living services coordinators to collect up-to-date information about their state's policies and…

  6. Marshalling Social Support: A “Care-Getting” Model for Persons Living with Cancer

    PubMed Central

    Kahana, Eva; Kahana, Boaz; Wykle, May; Kulle, Diana

    2009-01-01

    This paper offers a stress theory based conceptual framework for understanding proactive options for care-getting for patients living with cancer that is also relevant to patients living with other chronic or life threatening illnesses. Barriers and facilitators to active efforts for obtaining responsive care from both informal and formal sources are discussed. This “Care-Getting” model explores benefits of proactive care-getting for diminishing physical discomfort/suffering, burden of illness and disability, and psychological distress. We highlight unique issues in care-getting that patients face at different stages of the life course. Implications of prior research related to the model for practice and intervention are discussed. PMID:20107524

  7. Randomized Trial of Population-Based Clinical Decision Support to Facilitate Care Transitions.

    PubMed

    Eisenstein, Eric L; Willis, Janese M; Edwards, Rex; Anstrom, Kevin J; Kawamoto, Kensaku; Fiol, Guilherme Del; Johnson, Fred S; Lobach, David F

    2017-01-01

    Medicaid beneficiaries in 6 North Carolina counties were randomly assigned to 1 of 3 clinical decision support (CDS) care transition strategies: (1) usual care (Control), (2) CDS messaging to patients and their medical homes (Reports), or (3) CDS messaging to patients, their medical homes, and their care managers (Reports+). We included 7146 Medicaid patients and evaluated transitions from specialist visit, ER and hospital encounters back to the patient's medical home. Patients enrolled in Medicare and Medicaid were not eligible. The number of care manager contacts was greater for patients in the Reports+ Group than in the Control Group. However, there were no treatment-related differences in emergency department (ED) encounter rates, or in the secondary outcomes of outpatient and hospital encounter rates and medical costs. Study monitors found study intervention documentation in approximately 60% of patient charts. These results highlight the importance of effectively integrating information interventions into healthcare delivery workflow systems.

  8. Social support associated with quality of life in home care patients with intractable neurological disease in Japan.

    PubMed

    Nishida, Tomoko; Ando, Eriko; Sakakibara, Hisataka

    2012-01-01

    The aim of the present study was to investigate what kinds of social supports contribute to the higher quality of life (QOL) of home care patients with intractable neurological disease. We investigated the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and social supports to 74 patients with intractable neurological disease in a city of the Aichi prefecture, Japan. Association between WHOQOL and social supports was examined using multiple logistic regression analyses adjusting activities of daily living (ADL). High WHOQOL scores were associated with "attending patient gatherings held by the public health center," "having someone who will listen empathically to anxieties or troubles," and ADL. Physical health was associated with ADL, while psychological well-being was related to "having a hobby," "having someone who will listen," and "having a hospital for admission in emergencies." Patients not having someone who will listen were more likely to participate in the gatherings. The present findings suggest that having someone who will provide emotional support is important for home care patients with neurological diseases. Patient gatherings held by the public health center were expected to provide patients with emotional support.

  9. [A qualitative study of cancer patients receiving palliative support in hospital care].

    PubMed

    Getino Canseco, María

    2013-09-01

    This article focuses on patients with cancer during the terminal phase. It deals with the care that individuals need after trying to seek health solutions in different hospitals when the disease is deemed incurable and they then require palliative care (PC) to obtain welfare and assist them to die. In the Spanish health system these patients are cared for in palliative care units or services. The main objective of palliative care is to give comfort. Comforting is destined to alleviate and support patients and families during the process of health / disease / care / patient death. During this period, it is important to care for the ailing body. Similarly, when a disease is incurable, the pain and suffering runs its inexorable course and leaves perceptible traces. These signs can be an indication that death is nigh. Although scientific advances have produced positive results in the control of pain, in some cases there are critical moments when situations of misery and despair arise for the terminal patients.

  10. Control Systems Cyber Security Standards Support Activities

    SciTech Connect

    Robert Evans

    2009-01-01

    The Department of Homeland Security’s Control Systems Security Program (CSSP) is working with industry to secure critical infrastructure sectors from cyber intrusions that could compromise control systems. This document describes CSSP’s current activities with industry organizations in developing cyber security standards for control systems. In addition, it summarizes the standards work being conducted by organizations within the sector and provides a brief listing of sector meetings and conferences that might be of interest for each sector. Control systems cyber security standards are part of a rapidly changing environment. The participation of CSSP in the development effort for these standards has provided consistency in the technical content of the standards while ensuring that information developed by CSSP is included.

  11. Micro‐provision of Social Care Support for Marginalized Communities – Filling the Gap or Building Bridges to the Mainstream?

    PubMed Central

    2015-01-01

    Abstract As English social care services reconstruct themselves in response to the personalization agenda, there is increased interest in the contribution of micro‐providers – very small community‐based organizations, which can work directly with individuals. These micro‐providers are assumed to be able to cater for the ‘seldom heard’ groups which have been marginalized within mainstream social care services. This article reviews recent literature from the UK published in peer‐reviewed journals from 2000 to 2013 on support provision for people with protected characteristics under the Equality Act 2010. It considers the marginalising dynamics in mainstream, statutory social care support provision, and how far local community, specialist or small‐scale services are responding to unmet need for support and advice among marginalized groups. The review found that there is a tradition of compensatory self‐organization, use of informal networks and a mobilization of social capital for all these groups in response to marginalization from mainstream, statutory services. This requires recognition and nurturing in ways that do not stifle its unique nature. Specialist and community‐based micro‐providers can contribute to a wider range of choices for people who feel larger, mainstream services are not suitable or accessible. However, the types of compensatory activity identified in the research need recognition and investment, and its existence does not imply that the mainstream should not address marginalization. PMID:27840462

  12. A care improvement program acting as a powerful learning environment to support nursing students learning facilitation competencies.

    PubMed

    Jukema, Jan S; Harps-Timmerman, Annelies; Stoopendaal, Annemiek; Smits, Carolien H M

    2015-11-01

    Change management is an important area of training in undergraduate nursing education. Successful change management in healthcare aimed at improving practices requires facilitation skills that support teams in attaining the desired change. Developing facilitation skills in nursing students requires formal educational support. A Dutch Regional Care Improvement Program based on a nationwide format of change management in healthcare was designed to act as a Powerful Learning Environment for nursing students developing competencies in facilitating change. This article has two aims: to provide comprehensive insight into the program components and to describe students' learning experiences in developing their facilitation skills. This Dutch Regional Care Improvement Program considers three aspects of a Powerful Learning Environment: self-regulated learning; problem-based learning; and complex, realistic and challenging learning tasks. These three aspects were operationalised in five distinct areas of facilitation: increasing awareness of the need for change; leadership and project management; relationship building and communication; importance of the local context; and ongoing monitoring and evaluation. Over a period of 18 months, 42 nursing students, supported by trained lecturer-coaches, took part in nine improvement teams in our Regional Care Improvement Program, executing activities in all five areas of facilitation. Based on the students' experiences, we propose refinements to various components of this program, aimed at strengthenin the learning environment. There is a need for further detailed empirical research to study the impact this kind of learning environment has on students developing facilitation competencies in healthcare improvement.

  13. Micro-provision of Social Care Support for Marginalized Communities - Filling the Gap or Building Bridges to the Mainstream?

    PubMed

    Needham, Catherine; Carr, Sarah

    2015-12-01

    As English social care services reconstruct themselves in response to the personalization agenda, there is increased interest in the contribution of micro-providers - very small community-based organizations, which can work directly with individuals. These micro-providers are assumed to be able to cater for the 'seldom heard' groups which have been marginalized within mainstream social care services. This article reviews recent literature from the UK published in peer-reviewed journals from 2000 to 2013 on support provision for people with protected characteristics under the Equality Act 2010. It considers the marginalising dynamics in mainstream, statutory social care support provision, and how far local community, specialist or small-scale services are responding to unmet need for support and advice among marginalized groups. The review found that there is a tradition of compensatory self-organization, use of informal networks and a mobilization of social capital for all these groups in response to marginalization from mainstream, statutory services. This requires recognition and nurturing in ways that do not stifle its unique nature. Specialist and community-based micro-providers can contribute to a wider range of choices for people who feel larger, mainstream services are not suitable or accessible. However, the types of compensatory activity identified in the research need recognition and investment, and its existence does not imply that the mainstream should not address marginalization.

  14. Relationship between parent–infant attachment and parental satisfaction with supportive nursing care

    PubMed Central

    Ghadery-Sefat, Akram; Abdeyazdan, Zahra; Badiee, Zohreh; Zargham-Boroujeni, Ali

    2016-01-01

    Background: Parent–infant attachment is an important factor in accepting parenting role, accelerating infant survival, and adjusting to the environment outside the uterus. Since family supportive interventions can strengthen the parent–infant caring relationship, this study sought to investigate the relationship between mother–infant attachment and satisfaction of the mothers with the supportive nursing care received in the neonatal intensive care unit (NICU). Materials and Methods: In this descriptive–correlational study, 210 mothers with premature infants who were hospitalized in the NICUs affiliated to Isfahan Medical University hospitals took part. The data were collected via Maternal Postnatal Attachment Scale and researcher's self-tailored questionnaire based on Nurse Parent Support Tool. Pearson correlation coefficient and multiple linear regressions were used to analyze the collected data. Results: The results showed that the overall score of mother–infant attachment and the overall score of maternal satisfaction correlated with a correlation coefficient of r = 0.195. Also, the overall score of mother–infant attachment and mothers’ satisfaction scores in the emotional, communicative-informative, and self-confidence domains correlated with correlation coefficients of r = 0.182, r = 0.0.189, and r = 0.0.304, respectively. The results of multiple regression analysis revealed that about 15% of changes in the dependent variable (mother–infant attachment) could be explained by different dimensions of mothers’ satisfaction. Conclusions: The results of the study showed that mother–infant attachment improved by increasing mothers’ satisfaction of supportive nursing care. Therefore, it seems necessary to increase maternal satisfaction through given nursing care support, in order to promote mother–infant attachment. PMID:26985225

  15. Quality of life (QOL), supportive care, and spirituality in hematopoietic stem cell transplant (HSCT) patients.

    PubMed

    Sirilla, Janet; Overcash, Janine

    2013-04-01

    For many patients, a hematopoietic stem cell transplant (HSCT) can be challenging to physical and emotional health. Supportive care needs can be overwhelming for many patients and families. The purpose of this study was to evaluate the effect of quality of life (QOL), spiritual well-being, and supportive care resources post-HSCT. This descriptive, repeated-measures study included people over the age of 18 years undergoing HSCT for any cancer diagnosis. The Functional Assessment in Cancer Therapy--Bone Marrow Transplant scale, the Functional Assessment of Chronic Illness Therapy--Spiritual--12 scale, and a resource questionnaire were administered prior to HSCT and following HSCT at 30, 60, 90, and 180 days. Three groups of HSCT patients were examined: allogeneic, autologous, and overall. Data analysis included descriptive statistics and correlations. In the sample (n = 159), the autologous HSCT group reported the highest QOL scores. Spirituality scores increased for the autologous HSCT group at 90 days, but decreased for the overall and allogeneic groups. The type of supportive care resources most used were information from the physician and nurse, the Leukemia and Lymphoma Society Support as the most used form of support group, and Faith, Prayer and Spiritual Healing. QOL and spiritual well-being scores correlated best at 180 days (6 months) for autologous and allogeneic patients.

  16. The importance of work or productive activity in life care planning and case management

    PubMed Central

    Reid, Christine; Riddick-Grisham, Susan

    2015-01-01

    Abstract INTRODUCTION: The importance of work or productive activity for the well-being, community integration, and quality of life of people living with disabilities is addressed, with implications for life care planning and case management. BACKGROUND: The role of work or productive activity in our society, and consequences of deprivation if rehabilitation services do not address vocational effects of disabilities, is explored. A continuum of productivity options is introduced; types of vocational rehabilitation assessment processes and interventions are described. PURPOSE: The role of vocational rehabilitation services in life care planning and case management is discussed, focusing on quality of life for people living with disabilities. CONCLUSION: Rehabilitation and health care professionals should understand the importance of work or other productive activity, and support the development of appropriate plans to address those needs among people who have disabilities. PMID:26409330

  17. Perceived social support among HIV patients newly enrolled in care in rural Ethiopia.

    PubMed

    Lifson, Alan R; Workneh, Sale; Hailemichael, Abera; Demissie, Workneh; Slater, Lucy; Shenie, Tibebe

    2015-01-01

    Social support significantly enhances physical and mental health for persons with human immunodeficiency virus (HIV). We surveyed 142 rural Ethiopian HIV patients newly enrolled in care for perceived social support and factors associated with low support levels. Using the Social Provisions Scale (SPS), the mean summary score was 19.1 (possible scores = 0-48). On six SPS subscales, mean scores (possible scores = 0-8), were: Reliable Alliance (others can be counted on for tangible assistance) = 2.8, Attachment (emotional closeness providing sense of security) = 2.9, Reassurance of Worth (recognition of competence and value by others) = 3.2, Guidance (provision of advice or information by others) = 3.2, Social Integration (belonging to a group with similar interests and concerns) = 3.5, and Nurturance (belief that others rely on one for their well-being) = 3.6. In multivariate analysis, factors significantly associated with lower social support scores were: lower education level (did not complete primary school) (p = .019), lower total score on knowledge items about HIV care/treatment (p = .038), and greater number of external stigma experiences in past three months (p < .001); greater number of chronic disease symptoms was of borderline significance (p = .098). Among rural Ethiopian patients newly entering HIV care, we found moderate and varying levels of perceived social support, with lowest scores for subscales reflecting emotional closeness and reliance on others for tangible assistance. Given that patients who have recently learned their diagnosis and entered care may be an especially vulnerable group, programs to help identify and address social support needs can provide multiple benefits in facilitating the best possible physical, emotional and functional quality of life for people living with HIV.

  18. [The theory of dependent-care--a conceptual framework for assessing, supporting, and promoting parental competencies].

    PubMed

    Holoch, Elisabeth

    2010-02-01

    Parental competencies have influence on the professional health care needs of a child and its caregivers. One reason for this is the influence of parental competencies on the healthy development of the child. This applies especially to infants and young children. In order to develop their inborn abilities to regulate themselves and their behaviour, infants and young children are dependent on the perception of and appropriate response to their behaviour by the persons they are most closely attached to. The differentiation of self-regulating abilities is a precondition for a healthy development. The current rise of sleeping and feeding disorders, as well as interaction problems among infants and young children, indicates that parents are increasingly dependent on support in the perception and development of their parental competencies. Paediatric nurses can make an important contribution to this, where a concept of parental competencies, defined by nursing professionals, is available. The Theory of Dependent-Care and especially the concept of Dependent-Care Agency will be presented in this paper. It will be examined how they can provide a theoretical framework for the systematic assessment, support, and promotion of parental competencies by paediatric nurses. To conclude, issues for further investigation of parental Dependent-Care Agency and the necessity for a more detailed conceptualisation of the Theory of Dependent-Care will be demonstrated.

  19. Community-based home support agencies: comparing the quality of care of cooperative and non-profit organizations.

    PubMed

    Leviten-Reid, Catherine; Hoyt, Ann

    2009-06-01

    In the province of Québec, services focusing on the instrumental activities of daily living are delivered to seniors by a combination of non-profit organizations and cooperatives. But do these organizations perform differently? This study asks whether home support cooperatives deliver higher-quality care than non-profit home support agencies. The specific effects of consumer and worker participation on the board of directors are also tested. Data were collected in 2006 and 2007 from 831 individuals receiving home support services from nine cooperatives and nine non-profits. Two consumer-centered measures of quality were used: a summated, 39-point satisfaction score and a 4-point overall quality score. Data were analyzed using ordered logistic regression. Results show that although organizational type was not a predictor of the two quality outcomes, worker involvement in governance was positively associated with the satisfaction score, while consumer involvement was positively associated with the overall quality score.

  20. Support for information management in critical care: a new approach to identify needs.

    PubMed Central

    Rosenal, T. W.; Forsythe, D. E.; Musen, M. A.; Seiver, A.

    1995-01-01

    Managing information is necessary to support clinical decision making and action in critical care. By understanding the nature of information management and its relationship to sound clinical practice, we should come to use technology more wisely. We demonstrated that a new approach inspired by ethnographic research methods could identify useful and unexpected findings about clinical information management. In this approach, a clinician experienced in a specific domain (critical care), with advice from a medical anthropologist, made short-term observations of information management in that domain. We identified 8 areas in a critical care Unit in which information management was seriously in need of better support. We also found interesting differences in how these needs were viewed by nurses and physicians. Our interest in this approach was at two levels: 1. Identify and describe representative instances of sub-optimal information management in a critical care Unit. 2. Investigate the effectiveness of such short-term observations by clinicians. Our long-range goal is to explore the use of this approach and the information it reveals to optimize the process of developing and selecting new information support tools, preparing for their introduction, and optimizing clinical outcomes. PMID:8563267

  1. Caring for a child with Juvenile Huntington's Disease: helpful and unhelpful support.

    PubMed

    Brewer, Helen M; Smith, Jonathan A; Eatough, Virginia; Stanley, Cath A; Glendinning, Neil W; Quarrell, Oliver W J

    2007-03-01

    There has been little research into the psychosocial impact of Juvenile Huntington's Disease on the child and family. This study investigates the social and health care needs of those affected by Juvenile Huntington's Disease. Ten semi-structured interviews with carers were analysed using the qualitative methodology interpretative phenomenological analysis. This article reports three themes on the social support that families received. The first theme describes how parents perceived the support that they received from family and friends. The second and third themes describe how parents perceived helpful and unhelpful experiences of professional support. This corresponds to the view that social support is a 'double-edged sword', which can both ameliorate the effects of, and be a source of, stress. This information should be useful to those supporting the family of a child with a chronic or terminal illness.

  2. Growing up Active: A Study into Physical Activity in Long Day Care Centers

    ERIC Educational Resources Information Center

    Cashmore, Aaron W.; Jones, Sandra C.

    2008-01-01

    The child care center is an ideal setting in which to implement strategies to promote physical activity and healthy weight, but there is a paucity of empirical evidence on factors that influence physical activity in these settings. The current study gathered initial qualitative data to explore these factors. Child care workers from five long day…

  3. Nutritional support and quality of life in cancer patients undergoing palliative care.

    PubMed

    Prevost, V; Grach, M-C

    2012-09-01

    In palliative care, the nutrition provided has to be tailored to the patient's needs, enhancing patient comfort and quality of life (QoL). We conducted a literature search to review methods of measuring QoL, and modalities of nutritional intervention and their influence on QoL of cancer patients in palliative care. Original papers published in English were selected from PubMed database by using the search terms, palliative medicine, cancer, nutrition and quality of life. Specific tools that are particularly recommended to assess QoL in a palliative care setting are reviewed. The main goal in palliative care is to maintain oral nutrition by providing nutritional counselling. Enteral nutritional support showed inconsistent effects on survival and QoL. An evidence-base for parenteral nutrition is still lacking. Ethical considerations concerning provision of food and hydration in end-of-life care are discussed. Nutritional status should be assessed early and regularly during treatment using appropriate tools. In the particularly acute context of palliative care, optimal patient management requires adequate education and counselling to patients and families. Meaningful interactions between the patient, caregivers and medical team would also increase the chance of resolving nutrition-related issues and help to fulfil each patient's specific nutritional needs and thus improve the QoL.

  4. Activities in dementia care: A comparative assessment of activity types.

    PubMed

    Lokon, Elizabeth; Sauer, Philip E; Li, Yue

    2016-12-05

    This exploratory study compares the impact of five activity types on the well-being of institutionalized people with dementia: the intergenerational art program Opening Minds through Art, art and music therapies, creative activities, non-creative activities, and no activities at all. We validated the Scripps Modified Greater Cincinnati Chapter Well-Being Observational Tool, and used that instrument to systematically observe N = 67 people with dementia as they participated in different activity types. People with dementia showed the highest well-being scores during Opening Minds through Art compared to all other activities. No significant well-being differences were found between creative activities led by licensed art/music therapist versus regular activity staff. Furthermore, no significant well-being differences were found between creative and non-creative activities that were both led by regular activity staff. Overall, people with dementia benefit from participating in activities, regardless of the type (creative or non-creative), or who conducts them (licensed therapists or activity staff). However, in order for people with dementia to reach significantly high levels of overall well-being, we recommend that activities are specifically designed for people with dementia and incorporate a 1:1 ratio between people with dementia and well-trained volunteers/staff members.

  5. The impact of the carer support needs assessment tool (CSNAT) in community palliative care using a stepped wedge cluster trial.

    PubMed

    Aoun, Samar M; Grande, Gunn; Howting, Denise; Deas, Kathleen; Toye, Chris; Troeung, Lakkhina; Stajduhar, Kelli; Ewing, Gail

    2015-01-01

    Family caregiving towards the end-of-life entails considerable emotional, social, financial and physical costs for caregivers. Evidence suggests that good support can improve caregiver psychological outcomes. The primary aim of this study was to investigate the impact of using the carer support needs assessment tool (CSNAT), as an intervention to identify and address support needs in end of life home care, on family caregiver outcomes. A stepped wedge design was used to trial the CSNAT intervention in three bases of Silver Chain Hospice Care in Western Australia, 2012-14. The intervention consisted of at least two visits from nurses (2-3 weeks apart) to identify, review and address caregivers' needs. The outcome measures for the intervention and control groups were caregiver strain and distress as measured by the Family Appraisal of Caregiving Questionnaire (FACQ-PC), caregiver mental and physical health as measured by SF-12v2, and caregiver workload as measured by extent of caregiver assistance with activities of daily living, at baseline and follow up. Total recruitment was 620. There was 45% attrition for each group between baseline and follow-up mainly due to patient deaths resulting in 322 caregivers completing the study (233 in the intervention group and 89 in the control group). At follow-up, the intervention group showed significant reduction in caregiver strain relative to controls, p=0.018, d=0.348 (95% CI 0.25 to 0.41). Priority support needs identified by caregivers included knowing what to expect in the future, having time for yourself in the day and dealing with your feelings and worries. Despite the challenges at the clinician, organisational and trial levels, the CSNAT intervention led to an improvement in caregiver strain. Effective implementation of an evidence-informed and caregiver-led tool represents a necessary step towards helping palliative care providers better assess and address caregiver needs, ensuring adequate family caregiver support

  6. Cultivating Faculty Support for Institutional Effectiveness Activities: Benchmarking Best Practices.

    ERIC Educational Resources Information Center

    Welsh, John F.; Metcalf, Jeff

    2003-01-01

    Measured the impact of four predictor variables on faculty perceptions about the importance of institutional effectiveness activities. Found that three variables are critical to faculty support for institutional effectiveness activities: (1) institutional motivation for pursuing these activities; (2) level of involvement or participation in…

  7. The Effect of Active Support Training on Engagement, Opportunities for Choice, Challenging Behaviour and Support Needs

    ERIC Educational Resources Information Center

    Koritsas, Stella; Iacono, Teresa; Hamilton, David; Leighton, Daniel

    2008-01-01

    Background: The aim of this study was to evaluate active support (AS) training and to investigate changes to perceived engagement in domestic tasks, opportunities for choice, frequency of challenging behaviour, and level of support needs. Method: Participants were 12 adults with ID aged 27-57 years (M = 37 years) residing in three group homes, and…

  8. Responsive partisanship: public support for the clinton and obama health care plans.

    PubMed

    Kriner, Douglas L; Reeves, Andrew

    2014-08-01

    We examine the contours of support for the Clinton and Obama health care plans during the 1990s and 2000s based on our own compilation of 120,000 individual-level survey responses from throughout the debates. Despite the rise of the Tea Party, and the racialization of health care politics, opinion dynamics are remarkably similar in both periods. Party ID is the single most powerful predictor of support for reform and the president's handling of it. Contrary to prominent claims, after controlling for partisanship, demographic characteristics are at best weak predictors of support for reform. We also show that Clinton and Obama did not "lose" blacks, seniors, or wealthy voters over the course of the debate. The small and often nonexistent relationship between these characteristics and support for the plan are constant over time. Instead, the modest fluctuations in support for reform appear to follow the ebb and flow of elite rhetoric. Both mean levels of support and its volatility over time covary with elite partisan discourse. These findings suggest that presidents courting public opinion should seek consensus among their own party's elites before appealing to other narrower interests.

  9. [A consideration of the support for terminal care at the private skilled nursing home].

    PubMed

    Arao, Yuki; Sasabe, Mayako; Yamada, Yukari; Motoyama, Yuki; Morita, Katsuko; Kawazoe, Masahiro; Ono, Yoshiharu

    2009-12-01

    The increase in the number of residents in elderly care facilities has developed into a growing demand for home-based terminal care rather than treatments at medical institutions. Like many others, the Active Life Toyonaka (private skilled nursing home) has received more requests from its residents for adequate terminal care. It is unfortunate, however, that quite a few residents are obliged to be hospitalized for medical reasons that result in death. The purpose of our study is to determine what a terminal care should be like in a private skilled nursing home. The study has been conducted with the focuse on the successful case of a 90-year-old male resident diagnosed as having prostate cancer with bone metastasis. Our study has concluded that the crucial factors for a better terminal care should go as follows: (1) Having good coordination with medical institutions, (2) Reporting every change in residents' condition and administering an immediate treatment for alleviating pains of the residents, (3) Providing the residents with comfortable life of less restraint on activities in home-based care, (4) Sharing the same information among the staff of all divisions who is in charge of residents (doctors, nurses, caregivers, etc.) and (5) Establishing relationships of mutual trust with residents and their families. Nurses, especially, need to play important roles as coordinators among all the personnel concerned.

  10. 45 CFR 302.52 - Distribution of support collected in Title IV-E foster care maintenance cases.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... foster care maintenance cases. 302.52 Section 302.52 Public Welfare Regulations Relating to Public... Distribution of support collected in Title IV-E foster care maintenance cases. Effective October 1, 1984, the... collected in foster care maintenance cases shall be treated in accordance with the provisions of §...

  11. 45 CFR 302.52 - Distribution of support collected in Title IV-E foster care maintenance cases.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... foster care maintenance cases. 302.52 Section 302.52 Public Welfare Regulations Relating to Public... Distribution of support collected in Title IV-E foster care maintenance cases. Effective October 1, 1984, the... collected in foster care maintenance cases shall be treated in accordance with the provisions of §...

  12. 45 CFR 302.52 - Distribution of support collected in Title IV-E foster care maintenance cases.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... foster care maintenance cases. 302.52 Section 302.52 Public Welfare Regulations Relating to Public... Distribution of support collected in Title IV-E foster care maintenance cases. Effective October 1, 1984, the... collected in foster care maintenance cases shall be treated in accordance with the provisions of §...

  13. 45 CFR 302.52 - Distribution of support collected in Title IV-E foster care maintenance cases.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... foster care maintenance cases. 302.52 Section 302.52 Public Welfare Regulations Relating to Public... Distribution of support collected in Title IV-E foster care maintenance cases. Effective October 1, 1984, the... collected in foster care maintenance cases shall be treated in accordance with the provisions of §...

  14. 45 CFR 302.52 - Distribution of support collected in Title IV-E foster care maintenance cases.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... foster care maintenance cases. 302.52 Section 302.52 Public Welfare Regulations Relating to Public... Distribution of support collected in Title IV-E foster care maintenance cases. Effective October 1, 1984, the... collected in foster care maintenance cases shall be treated in accordance with the provisions of §...

  15. Transitioning the Adult with Type 2 Diabetes From the Acute to Chronic Care Setting: Strategies to Support Pragmatic Implementation Success.

    PubMed

    Magee, Michelle; Bardsley, Joan K; Wallia, Amisha; Smith, Kelly M

    2017-01-01

    Scientific evidence is available to guide the how to of medications management when patients with diabetes are hospitalized or present to the Emergency Department. However, few clinical trials in the diabetes field have addressed the execution, coupled with established implementation effectiveness evaluation frameworks to help inform and assess implementation practices to support the transition in care. These deficiencies may be overcome by (1) applying the principles of implementation and delivery systems science; (2) engaging the principles of human factors (HF) throughout the design, development, and evaluation planning activities; and (3) utilizing mixed methods to design the intervention, workflow processes, and evaluate the intervention for sustainability within existing care delivery models. This article provides a discussion of implementation science and human factors science including an overview of commonly used frameworks which can be applied to structure design and implementation of sustainable and generalizable interventions.

  16. "Stroke Nav": a wireless data collection and review system to support stroke care delivery.

    PubMed

    Gibson, Oliver J; Balami, Joyce S; Pope, George A; Tarassenko, Lionel; Reckless, Ian P

    2012-10-01

    "Stroke Nav" is a novel system to support the care of stroke patients. The system contains purpose-built web-based software to facilitate accurate near-real time data collection by clinicians throughout the complex care settings traversed by patients. Tools are included to facilitate pre-defined and bespoke data review with graphical dashboards showing performance metrics and other aggregate data. The software was designed collaboratively by health care professionals and engineers, and is accessible via the hospital intranet using desktop or laptop computers and wireless mobile devices. Stroke Nav is being routinely used in two hospitals, with over 1400 patients registered, and is now being introduced in other hospitals. The system is delivering benefits in relation to multidisciplinary communication, knowledge management, patient safety, clinical audit and service performance.

  17. A Web-Based GIS for Health Care Decision-Support

    PubMed Central

    Richard, Jean-Baptiste; Toubiana, Laurent; Le Mignot, Loïc; Ben Said, Mohamed; Mugnier, Claude; Le Bihan–Benjamin, Christine; Jaïs, Jean Philippe; Landais, Paul

    2005-01-01

    This Web-based application allows access to the epidemiology of the demand and the supply of care concerning End-Stage Renal Disease (ESRD). It is a Web-based Geographic Information System (Web-GIS), the SIGNe (Système d’Information Géographique pour la Néphrologie), designed for the Renal Epidemiology and Information Network (REIN) dedicated to ESRD. It is a visualisation and decision-support tool. This Web-GIS was coupled to a data warehouse and embedded in a n-tier architecture designed as the Multi-Source Information System (MSIS). It provides maps matching the offer of care to the demand. It is presented with insights on the design and underlying technologies. It is dedicated to professionals and to public health care decision-makers. PMID:16779063

  18. A Web-based GIS for health care decision-support.

    PubMed

    Jean-Baptiste, Richard; Toubiana, Laurent; Le Mignot, Loïc; Ben Said, Mohamed; Mugnier, Claude; Le Bihan-Benjamin, Christine; Jaïs, Jean Philippe; Landais, Paul

    2005-01-01

    This Web-based application allows to access views of End-Stage Renal Disease (ESRD) concerning the epidemiology of the demand and the supply of care. It is a Web-based Geographic Information System (Web-GIS), the SIGNe (Système d'Information Géographique pour la Néphrologie), designed for the Renal Epidemiology and Information Network (REIN) dedicated to ESRD. It is a visualisation and decision-support tool. This Web-GIS was coupled to a data warehouse and embedded in an n-tier architecture designed as the Multi-Source Information System (MSIS). It provides maps matching the offer of care to the demand. It is presented with insights on the design and underlying technologies. It is dedicated to professionals and to public health care decision-makers.

  19. Service oriented architecture to support real-time implementation of artifact detection in critical care monitoring.

    PubMed

    Nizami, Shermeen; Green, James Robert; McGregor, Carolyn

    2011-01-01

    The quality of automated real-time critical care monitoring is impacted by the degree of signal artifact present in clinical data. This is further complicated when different clinical rules applied for disease detection require source data at different frequencies and different signal quality. This paper proposes a novel multidimensional framework based on service oriented architecture to support real-time implementation of clinical artifact detection in critical care settings. The framework is instantiated through a Neonatal Intensive Care case study which assesses signal quality of physiological data streams prior to detection of late-onset neonatal sepsis. In this case study requirements and provisions of artifact and clinical event detection are determined for real-time clinical implementation, which forms the second important contribution of this paper.

  20. Supporting Youth Transitioning out of Foster Care. Issue Brief 1: Education Programs. OPRE Report No. 2014-66

    ERIC Educational Resources Information Center

    Dworsky, Amy; Smithgall, Cheryl; Courtney, Mark E.

    2014-01-01

    Youth transitioning out of foster care and into adulthood need many supports to navigate the challenges they face. Over the past three decades, federal child welfare policy has significantly increased the availability of those supports. In 1999, the Foster Care Independence Act amended Title IV-E of the Social Security Act to create the Chafee…

  1. Supportive Nursing Care and Satisfaction of Patients Receiving Electroconvulsive Therapy: A Randomized Controlled Clinical Trial

    PubMed Central

    Navidian, Ali; Ebrahimi, Hossein; Keykha, Roghaieh

    2015-01-01

    Background: Patient satisfaction is the most important criterion in evaluating the quality of care. Besides, its assessment in patients with severe mental disorder treated by electroconvulsive therapy (ECT) is highly appropriate. The ECT is accompanied by lower satisfaction and may exacerbate the patients’ condition. Objectives: The current study aimed to determine the effect of supportive nursing care on the satisfaction of patients receiving ECT. Patients and Methods: This randomized controlled trial was conducted in the education center of Baharan psychiatric hospital, Zahedan, Iran. Seventy hospitalized patients receiving ECT were randomly divided into two groups of control (n = 35) and intervention (n = 35).The socio-personal and Webster Satisfaction Questionnaire were used as data collection tools. The intervention group received supportive nursing care by nurses trained in informational, emotional, and physical aspects. The control group received only regular nursing care. The levels of satisfaction were measured and compared between groups, before and after the intervention. Data were analyzed using the SPSS software, and Chi-square, independent and paired t tests, as well as covariance analysis were performed. Results: The results showed similarities in socio-personal characteristics of both groups. However, there was a significant difference (P < 0.001) between the means of satisfaction in the groups, predominantly for the intervention group. In other words, a significant difference (P < 0.001) was observed between the means of satisfaction of the intervention (54.71 ± 5.27) and control (36.28 ± 7.00) groups after intervention by controlling the effect of socio-personal variables. Conclusions: Results of the current study confirmed the effect of supportive nursing care on increasing the level of satisfaction in ECT receiving patients, recommending the use of this therapeutic method. PMID:26473077

  2. Diagnoses Treated in Ambulatory Care Among Homeless-Experienced Veterans: Does Supported Housing Matter?

    PubMed Central

    Gabrielian, Sonya; Yuan, Anita H.; Andersen, Ronald M.; Gelberg, Lillian

    2016-01-01

    Purpose Little is known about how permanent supported housing influences ambulatory care received by homeless persons. To fill this gap, we compared diagnoses treated in VA Greater Los Angeles (VAGLA) ambulatory care between Veterans who are formerly homeless—now housed/case managed through VA Supported Housing (“VASH Veterans”)—and currently homeless. Methods We performed secondary database analyses of homeless-experienced Veterans (n = 3631) with VAGLA ambulatory care use from October 1, 2010 to September 30, 2011. We compared diagnoses treated—adjusting for demographics and need characteristics in regression analyses—between VASH Veterans (n = 1904) and currently homeless Veterans (n = 1727). Results On average, considering 26 studied diagnoses, VASH (vs currently homeless) Veterans received care for more (P < .05) diagnoses (mean = 2.9/1.7). Adjusting for demographics and need characteristics, VASH Veterans were more likely (P < .05) than currently homeless Veterans to receive treatment for diagnoses across categories: chronic physical illness, acute physical illness, mental illness, and substance use disorders. Specifically, VASH Veterans had 2.5, 1.7, 2.1, and 1.8 times greater odds of receiving treatment for at least 2 condition in these categories, respectively. Among participants treated for chronic illnesses, adjusting for predisposing and need characteristics, VASH (vs currently homeless) Veterans were 9%, 8%, and 11% more likely to have 2 or more visits for chronic physical illnesses, mental illnesses, and substance use disorder, respectively. Conclusion Among homeless-experienced Veterans, permanent supported housing may reduce disparities in the treatment of diagnoses commonly seen in ambulatory care. PMID:27343544

  3. Connecting Arctic/Antarctic Researchers and Educators (CARE): Supporting Teachers and Researchers Beyond the Research Experience

    NASA Astrophysics Data System (ADS)

    Warburton, J.; Warnick, W. K.; Breen, K.; Fischer, K.; Wiggins, H.

    2007-12-01

    Teacher research experiences (TREs) require long-term sustained support for successful transfer of research experiences into the classroom. Specifically, a support mechanism that facilitates focused discussion and collaboration among teachers and researchers is critical to improve science content and pedagogical approaches in science education. Connecting Arctic/Antarctic Researchers and Educators (CARE) is a professional development network that utilizes online web meetings to support the integration of science research experiences into classroom curriculum. CARE brings together teachers and researchers to discuss field experiences, current science issues, content, technology resources, and pedagogy. CARE is a component of the Arctic Research Consortium of the U.S. (ARCUS) education program PolarTREC--Teachers and Researchers Exploring and Collaborating. PolarTREC is a three-year (2007-2009) teacher professional development program celebrating the International Polar Year (IPY) that advances polar science education by bringing K-12 educators and polar researchers together in hands-on field experiences in the Arctic and Antarctic. Currently in its second year, the program fosters the integration of research and education to produce a legacy of long-term teacher-researcher collaborations, improved teacher content knowledge through experiences in scientific inquiry, and broad public interest and engagement in polar science. The CARE network was established to develop a sustainable learning community through which teachers and researchers will further their work to bring polar research into classrooms. Through CARE, small groups of educators are formed on the basis of grade-level and geographic region; each group also contains a teacher facilitator. Although CARE targets educators with previous polar research experiences, it is also open to those who have not participated in a TRE but who are interested in bringing real-world polar science to the classroom

  4. Using integrated bio-physiotherapy informatics in home health-care settings: A qualitative analysis of a point-of-care decision support system.

    PubMed

    Canally, Culum; Doherty, Sean; Doran, Diane M; Goubran, Rafik A

    2015-06-01

    The growing need to gain efficiencies within a home care setting has prompted home care practitioners to focus on health informatics to address the needs of an aging clientele. The remote and heterogeneous nature of the home care environment necessitates the use of non-intrusive client monitoring and a portable, point-of-care graphical user interface. Using a grounded theory approach, this article examines the simulated use of a graphical user interface by practitioners in a home care setting to explore the salient features of monitoring the activity of home care clients. The results demonstrate the need for simple, interactive displays that can provide large amounts of geographical and temporal data relating to patient activity. Additional emerging themes from interviews indicate that home care professionals would use a graphical user interface of this type for patient education and goal setting as well as to assist in the decision-making process of home care practitioners.

  5. What Physicians from Diverse Specialties Know and Support in Health Care Reform

    PubMed Central

    Ganjian, Sheila; Dowling, Patrick T.; Hove, Jason; Moreno, Gerardo

    2015-01-01

    Background The US is in an unprecedented era of health care reform that is pushing medical professionals and medical educators to evaluate the future of their patients, careers, and the field of medicine. Objectives To describe physician familiarity and knowledge with the Patient Protection and Affordable Care Act (ACA), and to determine if knowledge is associated with support and endorsement of the ACA. Methods Cross-sectional internet-based survey of 559 physicians practicing in California. Primary outcomes were physician support and endorsement of ACA: 1) overall impact on the country (1 item), and 2) perceived impact on physician’s medical practice (1 item). The primary predictor was knowledge of the ACA as measured with 10 questions. Other measures included age, gender, race-ethnicity, specialty, political views, provision of direct care, satisfaction with the practice of medicine, and compensation type. Descriptive statistics and multiple variable regression models were calculated. Results Respondents were 65% females, and the mean age was 54 years (+/− 9.7). Seventy-seven percent of physicians understood the ACA somewhat well/very well, and 59% endorsed the ACA, but 36% of physicians believed that health care reform will most likely hurt their practice. Primary care physicians were more likely to perceive that the new law will help their practice, compared to procedural specialties. Satisfaction with the practice of medicine, political affiliation, compensation type, and more knowledge of the health care law were independently associated with endorsement of the ACA. Conclusions Endorsement of the ACA varied by specialty, knowledge, and satisfaction with the practice of medicine. PMID:25853599

  6. Influence of backup bearings and support structure dynamics on the behavior of rotors with active supports

    NASA Astrophysics Data System (ADS)

    Flowers, George T.

    1995-02-01

    This semiannual status report lists specific accomplishments made on the research of the influence of backup bearings and support structure dynamics on the behavior of rotors with active supports. Papers have been presented representing work done on the T-501 engine model; an experimental/simulation study of auxiliary bearing rotordynamics; and a description of a rotordynamical model for a magnetic bearing supported rotor system, including auxiliary bearing effects. A finite element model for a foil bearing has been developed. Additional studies of rotor/bearing/housing dynamics are currently being performed as are studies of the effects of sideloading on auxiliary bearing rotordynamics using the magnetic bearing supported rotor model.

  7. Influence of backup bearings and support structure dynamics on the behavior of rotors with active supports

    NASA Technical Reports Server (NTRS)

    Flowers, George T.

    1995-01-01

    This semiannual status report lists specific accomplishments made on the research of the influence of backup bearings and support structure dynamics on the behavior of rotors with active supports. Papers have been presented representing work done on the T-501 engine model; an experimental/simulation study of auxiliary bearing rotordynamics; and a description of a rotordynamical model for a magnetic bearing supported rotor system, including auxiliary bearing effects. A finite element model for a foil bearing has been developed. Additional studies of rotor/bearing/housing dynamics are currently being performed as are studies of the effects of sideloading on auxiliary bearing rotordynamics using the magnetic bearing supported rotor model.

  8. Street Smarts: Activities That Help Teenagers Take Care of Themselves.

    ERIC Educational Resources Information Center

    Kirby, Michael

    Because growing up has become the art of survival for many young people, a professionally conducted course in street smarts can help them identify problems, understand consequences, and make good decisions. The information and activities contained in this text can teach students how to take care of themselves when confronted with challenges. It…

  9. Supportive care of women with breast cancer: key concerns and practical solutions.

    PubMed

    Zdenkowski, Nicholas; Tesson, Stephanie; Lombard, Janine; Lovell, Melanie; Hayes, Sandra; Francis, Prudence A; Dhillon, Haryana M; Boyle, Frances M

    2016-11-21

    Patients diagnosed with breast cancer may have supportive care needs for many years after diagnosis. High quality multidisciplinary care can help address these needs and reduce the physical and psychological effects of breast cancer and its treatment. Ovarian suppression and extended endocrine therapy benefits are associated with vasomotor, musculoskeletal, sexual and bone density-related side effects. Aromatase inhibitor musculoskeletal syndrome is a common reason for treatment discontinuation. Treatment strategies include education, exercise, simple analgesia and a change to tamoxifen or another aromatase inhibitor. Chemotherapy-induced alopecia may be a constant reminder of breast cancer to the patient, family, friends, acquaintances and even strangers. Alopecia can be prevented in some patients using scalp-cooling technology applied at the time of chemotherapy infusion. The adverse impact of breast cancer diagnosis and treatment on sexual wellbeing is under-reported. Identification of physical and psychological impacts is needed for implementation of treatment strategies. Fear of cancer recurrence reduces quality of life and increases distress, with subsequent impact on role functioning. Identification and multidisciplinary management are key, with referral to psychosocial services recommended where indicated. The benefits of exercise include reduced fatigue, better mental health and reduced musculoskeletal symptoms, and may also include reduced incidence of breast cancer recurrence. Identification and management of unmet supportive care needs are key aspects of breast cancer care, to maximise quality of life and minimise breast cancer recurrence.

  10. Health Care Providers' Perceptions of Nutrition Support in Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients.

    PubMed

    Montgomery, Kathleen; Belongia, Meghan; Schulta, Christina; Mulberry, Mollie Haddigan; Nugent, Melodee L; Simpson, Pippa M

    2016-07-01

    One of the most common side effects of medical treatment for patients with an oncologic diagnosis is malnutrition. There is limited research that broadly assesses the perceptions of health care providers (HCPs) regarding nutrition support in the pediatric population. The purpose of this study was to describe the perceptions of nutrition support among pediatric oncology and hematopoietic stem cell transplant HCPs. The study used a cross-sectional descriptive design using a 31-item survey. Results of the survey indicated that nurses were more likely to initiate conversations about nutrition support during the first month of diagnosis, while midlevel providers and physicians initiated discussions in response to a change in nutritional status evidenced by decreased oral intake or weight loss. Participants reported resistance by patients and families more often for enteral nutrition compared with parenteral nutrition. Findings suggest a need to develop a more unified service line-based approach for initiating discussions related to nutrition support that incorporate patient and family perceptions.

  11. A communication competence approach to examining health care social support, stress, and job burnout.

    PubMed

    Wright, Kevin B; Banas, John A; Bessarabova, Elena; Bernard, Daniel R

    2010-06-01

    Drawing upon Kreps's (1988) Relational Health Communication Competence Model (RHCCM), this study examined the effect of perceived communication competence on perceived stress and subsequently perceived job burnout. In addition, the role of social support satisfaction as a potential mediator between perceived communication competence and perceived stress was explored. The extended RHCCM was proposed and tested in a survey of 221 health care workers from three Veterans Administration hospitals in the United States. The model was tested by structural equation modeling. The results indicated support for the extended model. The implications of the findings for the extended RHCCM are discussed along with limitations of the study and directions for future research.

  12. Bridging knowledge: reflections on crossing the boundaries between long-term care and support.

    PubMed

    McDaid, David; Cieza, Alarcos; Gomez, Ana Rico

    2009-06-22

    In March 2009 members of the research, policy and practice communities in the fields of ageing and disability came together in Barcelona for the first international conference on bridging knowledge in long-term care and support. This paper presents a brief snapshot of some of the key themes and ideas that emerged during three days of presentation and debate on methods, policy and practice.

  13. Wartime Burn Care in Iraq: 28th Combat Support Hospital, 2003

    DTIC Science & Technology

    2007-11-01

    provide medical support to both the Baghdad and Tikrit regions. In Baghdad, the CSH occupied Ibn Sina Hospital in the International Zone (Green Zone...The 28th CSH rede- ployed to the United States in February 2004, turning over operations at Ibn Sina Hospital to the 31st CSH. At the time of this...writing, Ibn Sina Hospital has been continuously operated by a U.S. Army CSH, providing care to U.S., coalition, and Iraqi military and civilian

  14. Bridging knowledge: reflections on crossing the boundaries between long-term care and support

    PubMed Central

    McDaid, David; Cieza, Alarcos; Gomez, Ana Rico

    2009-01-01

    In March 2009 members of the research, policy and practice communities in the fields of ageing and disability came together in Barcelona for the first international conference on bridging knowledge in long-term care and support. This paper presents a brief snapshot of some of the key themes and ideas that emerged during three days of presentation and debate on methods, policy and practice. PMID:19590760

  15. Fusing the boundaries between home and child care to support children's scientific learning

    NASA Astrophysics Data System (ADS)

    Fleer, Marilyn

    1996-06-01

    Parent involvement in early childhood education is highly valued by staff and families alike. However, limited research is available to guide professionals in how best to involve families in the early childhood programs developed for their children. This article reports on a study which investigated the impact of a science teaching and learning program on families of children attending an Australian Child Care Centre. Particular reference is made to the level of scientific support families gave to their children.

  16. How older black women perceive the effects of stigma and social support on engagement in HIV care.

    PubMed

    McDoom, M Maya; Bokhour, Barbara; Sullivan, Meg; Drainoni, Mari-Lynn

    2015-02-01

    As black women over age 50 represent a growing share of women living with HIV, understanding what helps them persist and engage in ongoing HIV care will become increasingly important. Delineating the specific roles of social support and stigma on HIV care experiences among this population remains unclear. We qualitatively examined how experiences with stigma and social support either facilitated or inhibited engagement in HIV care, from the perspective of older black women. Semi-structured interviews were conducted with 20 older black women currently receiving HIV care at primary care clinics in the Metropolitan Boston area. Women expressed that experiences with stigma and seeking support played an important role in evaluating the risks and benefits of engaging in care. Social support facilitated their ability to engage in care, while stigma interfered with their ability to engage in care throughout the course of their illness. Providers in particular, can facilitate engagement by understanding the changes in these women's lives as they struggle with stigma and disclosure while engaging in HIV care. The patient's experiences with social support and stigma and their perceptions about engagement are important considerations for medical teams to tailor efforts to engage older black women in regular HIV care.

  17. [Support to spiritual needs in hospital care. Integration perspective in modern hospitals].

    PubMed

    Proserpio, Tullio; Piccinelli, Claudia; Arice, Carmine; Petrini, Massimo; Mozzanica, Mario; Veneroni, Laura; Clerici, Carlo Alfredo

    2014-01-01

    Within the course of medical care in the most advanced health care settings, an increasing attention is being paid to the so-called care humanization. According to this perspective, we try to integrate the usual care pathways with aspects related to the spiritual and religious dimension of all people and their families, as well as the employees themselves. It is clearly important to establish this kind of practices on the basis of scientific evidences. That is the reason why it's a necessity to improve the knowledge about the importance that spiritual assistance can offer within the current health service. The aim of this work is to show the relevance of the integration of spiritual perspectives in the hospital setting according to a multidisciplinary point of view. In this work many data that emerge from the international scientific literature, as well as the definition that is given to the concept of "spirituality" are analyzed; about this definition in fact there is not unanimous consent even today. It is also analyzed the legal situation in force within the European territory according to the different laws and social realities. Finally, the possible organizational practices related to spiritual support are described and the opportunity to specific accreditation pathways and careful training of chaplains able to integrate traditional religious practices with modern spiritual perspectives is discussed.

  18. Helmsley trust support for telehealth improves access to care in rural and frontier areas.

    PubMed

    Stingley, Shelley; Schultz, Heidi

    2014-02-01

    Rural residents in need of health care face many challenges. In 2009 the Leona M. and Harry B. Helmsley Charitable Trust created the Rural Healthcare Program to improve access to and quality of care in areas of the upper Midwest challenged by health care workforce shortages and low population density. The program has focused its efforts on telehealth in seven upper Midwestern states. Since 2009 the Rural Healthcare Program has approved $22 million in grants to eighty-five rural hospitals to implement eEmergency services. The service's videoconferencing technology connects rural emergency department staff with emergency physicians and nurses located at the service's "hub." Initial analyses indicate that eEmergency has helped participating rural hospitals increase patients' access to specialists, increase the use of evidence-based treatment, decrease time to transfer a patient to a facility able to provide a higher level of care, and reduce unnecessary patient transfers. This article describes the health care challenges rural communities face and the telehealth projects supported by the Helmsley Trust's Rural Healthcare Program.

  19. [The added value of information summaries supporting clinical decisions at the point-of-care.

    PubMed

    Banzi, Rita; González-Lorenzo, Marien; Kwag, Koren Hyogene; Bonovas, Stefanos; Moja, Lorenzo

    2016-11-01

    Evidence-based healthcare requires the integration of the best research evidence with clinical expertise and patients' values. International publishers are developing evidence-based information services and resources designed to overcome the difficulties in retrieving, assessing and updating medical information as well as to facilitate a rapid access to valid clinical knowledge. Point-of-care information summaries are defined as web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. Their validity must be assessed against marketing claims that they are evidence-based. We periodically evaluate the content development processes of several international point-of-care information summaries. The number of these products has increased along with their quality. The last analysis done in 2014 identified 26 products and found that three of them (Best Practice, Dynamed e Uptodate) scored the highest across all evaluated dimensions (volume, quality of the editorial process and evidence-based methodology). Point-of-care information summaries as stand-alone products or integrated with other systems, are gaining ground to support clinical decisions. The choice of one product over another depends both on the properties of the service and the preference of users. However, even the most innovative information system must rely on transparent and valid contents. Individuals and institutions should regularly assess the value of point-of-care summaries as their quality changes rapidly over time.

  20. Seeking support after hospitalisation for injury: a nested qualitative study of the role of primary care

    PubMed Central

    Christie, Nicola; Beckett, Kate; Earthy, Sarah; Kellezi, Blerina; Sleney, Jude; Barnes, Jo; Jones, Trevor; Kendrick, Denise

    2016-01-01

    Background In the UK, studies suggest that the transition from hospital to home after an injury can be a difficult time and many patients report feeling inadequately prepared. Patients often use primary care services after hospital discharge. These consultations provide opportunities to consider problems that patients experience and to facilitate recovery. Little is known, however, about how patients and service providers view care after hospital discharge and the role played by primary care services, specifically GPs. Aim To identify good practice and unmet needs in respect of post-discharge support for injured patients. Design and setting Qualitative study using semi-structured interviews at four sites (Bristol, Leicester/Loughborough, Nottingham, and Surrey). Method Qualitative interviews with 40 service providers and 45 hospitalised injured patients. Results Although there were examples of well-managed hospital discharges, many patients felt they were not provided with the information they needed about their injury, what to expect in terms of recovery, pain control, return to work, psychological problems, and services to help meet their needs. They also described difficulty accessing services such as physiotherapy or counselling. Service providers identified problems with communication between secondary and primary care, lack of access to physiotherapy, poor communication about other services that may help patients, GP service and resource constraints, and difficulties in providing information to patients concerning likely prognosis. Conclusion Discharge from hospital after an injury can be problematic for patients. Changes in both secondary and primary care are required to resolve this problem. PMID:26639949

  1. African American women's preventative care usage: the role of social support and racial experiences and attitudes.

    PubMed

    Pullen, Erin; Perry, Brea; Oser, Carrie

    2014-09-01

    Research suggests that African Americans are less likely to utilise preventative care services than Americans of European descent, and that these patterns may contribute to racial health disparities in the United States. Despite the persistence of inequalities in preventative care utilisation, culturally relevant factors influencing the use of these gateway health services have been understudied among marginalised groups. Using a stratified sample of 205 low-income African American women, this research examines the predictors of receiving a physical exam, with a particular emphasis on how differing levels of social support from friend and family networks and experiences of racial discrimination and cultural mistrust shape utilisation. The findings underscore the importance of traditional predictors of utilisation, including insurance status and having a usual physician. However, they also indicate that supportive ties to friendship networks are associated with higher predicted rates of having an annual physical exam, while social support from family and sentiments of cultural mistrust are associated with lower rates of utilisation. Broadly, the findings indicate that even as traditional predictors of help-seeking become less relevant, it will be critical to explore how variations in discrimination experiences and social relationships across marginalised groups drive patterns of preventative care utilisation.

  2. Impact of an electronic clinical decision support system on workflow in antenatal care: the QUALMAT eCDSS in rural health care facilities in Ghana and Tanzania.

    PubMed

    Mensah, Nathan; Sukums, Felix; Awine, Timothy; Meid, Andreas; Williams, John; Akweongo, Patricia; Kaltschmidt, Jens; Haefeli, Walter E; Blank, Antje

    2015-01-01

    Background The implementation of new technology can interrupt established workflows in health care settings. The Quality of Maternal Care (QUALMAT) project has introduced an electronic clinical decision support system (eCDSS) for antenatal care (ANC) and delivery in rural primary health care facilities in Africa. Objective This study was carried out to investigate the influence of the QUALMAT eCDSS on the workflow of health care workers in rural primary health care facilities in Ghana and Tanzania. Design A direct observation, time-and-motion study on ANC processes was conducted using a structured data sheet with predefined major task categories. The duration and sequence of tasks performed during ANC visits were observed, and changes after the implementation of the eCDSS were analyzed. Results In 24 QUALMAT study sites, 214 observations of ANC visits (144 in Ghana, 70 in Tanzania) were carried out at baseline and 148 observations (104 in Ghana, 44 in Tanzania) after the software was implemented in 12 of those sites. The median time spent combined for all centers in both countries to provide ANC at baseline was 6.5 min [interquartile range (IQR) =4.0-10.6]. Although the time spent on ANC increased in Tanzania and Ghana after the eCDSS implementation as compared to baseline, overall there was no significant increase in time used for ANC activities (0.51 min, p=0.06 in Ghana; and 0.54 min, p=0.26 in Tanzania) as compared to the control sites without the eCDSS. The percentage of medical history taking in women who had subsequent examinations increased after eCDSS implementation from 58.2% (39/67) to 95.3% (61/64) p<0.001 in Ghana but not in Tanzania [from 65.4% (17/26) to 71.4% (15/21) p=0.70]. Conclusions The QUALMAT eCDSS does not increase the time needed for ANC but partly streamlined workflow at sites in Ghana, showing the potential of such a system to influence quality of care positively.

  3. The impact of Multimedia Software Support on the Knowledge and Self-Care Behaviors of Patients with Type 2 Diabetes: a Randomized Clinical Trial

    PubMed Central

    Farmahini Farahani, Moloud; Purfarzad, Zahra; Ghorbani, Mojtaba; Ghamari Zare, Zohre; Ghorbani, Fateme

    2016-01-01

    Introduction: Education is the most effective and economical part of diabetes treatment. The purpose of this study was to investigate the effect of a training program with multimedia software on the knowledge and self-care behaviors of patients with type 2 diabetes. Methods: This study was a randomized controlled clinical trial in which 60 patients referred to diabetes clinic at Arak city were divided randomly into experimental (n=30) and control (n=30) groups. The instruments for collecting data were "Summary of Diabetes self-care activities questionnaire" and "knowledge of self-care in patients with diabetes". Data were collected before and 2 months after the intervention in the both groups. Educational program with equal content was applied for both experimental group (self-care program with multimedia software support) & control group (lecture and presentation with PowerPoint). Data analysis was done using SPSS Ver.13. Results: Implementation of the self-care program with multimedia software support resulted in improvements in patients’ self-care behaviors in the experimental group, whereas these behaviors had not significant changes in the control group after eight weeks. There was a significant difference in the mean score of knowledge in both the experiment and control groups before and after the intervention. Conclusion: Considering beneficial effects of training program with multimedia software support on the knowledge and self-care behaviors and the importance of this issue, suggested that the patients preferably provide terms of use of educational software for themselves. PMID:27354975

  4. Sink effect in activated carbon-supported hydrodesulfurization catalysts

    SciTech Connect

    Laine, J.; Labady, M.; Severino, F.; Yunes, S.

    1997-03-01

    A synergistic effect has been proposed in previous papers, attempting to explain the higher activity of activated carbon-supported hydrodesulfurization (HDS) catalysts with respect to conventional alumina-supported catalysts, reported earlier. However, activated carbon characteristics can be strongly affected by the raw material and the method of activation. Thus, previous work using Ni-Mo catalysts supported on two different activated carbons (one prepared by {open_quotes}physical{close_quotes} and the other by {open_quotes}chemical{close_quotes} activation) showed different optimal Ni concentrations for higher HDS activity, such difference being attributed to the predominance of Topsoe`s Type I {open_quotes}NiMoS{close_quotes} phase in one carbon and the predominance of Type II in the other. Due to the lack of proper characterization of the activated carbon supported catalysts of the previous work, this paper presents further data suggesting that microporosity provided by the activated carbon may be the responsible for the above referred synergism. 12 refs., 1 fig., 3 tabs.

  5. A Fiscal Intermediary Based on Needs Assessment to Support a Managed Care Approach to Outpatient Child and Adolescent Psychiatry Care at BAMC.

    DTIC Science & Technology

    1991-06-05

    OUTPATIENT CHILD AND ADOLESCENT PSYCHIATRY CARE AT BAMC 12. PERSONAL AUTHOR(S) SMITH, THOMAS CLARK III 13a. TYPE OF REPORT 13b. TIME COVERED 114...construct a patient profile for child and adolescent 20. DISTRIBUTION/AVAILABILITY OF ABSTRACT 21. ABSTRACT SECURITY CLASSIFICATION QIUNCLASSIFIED...1 9, 4 13311WP A FISCAL INTERMEDIARY BASED NEEDS ASSESSMENT TO SUPPORT A MANAGED CARE APPROACH TO OUTPATIENT CHILD AND ADOLESCENT PSYCHIATRIC CARE AT

  6. Designing Real-Life Cases To Support Authentic Design Activities.

    ERIC Educational Resources Information Center

    Bennett, Sue; Harper, Barry; Hedberg, John

    Teachers in a range of disciplines are interested in engaging their students in authentic activities that reflect the experiences of real-world practitioners. Adopting this approach requires the design and implementation of learning environments that incorporate and support such activities. This paper describes two real-life cases at the…

  7. Elderly Demand for Family-based Care and Support: Evidence from a Social Intervention Strategy

    PubMed Central

    Aboagye, Emmanuel; Agyemang, Otuo Serebour; Tjerbo, Trond

    2014-01-01

    This paper examines the influence of the national health insurance scheme on elderly demand for family-based care and support. It contributes to the growing concern on the rapid increase in the elderly population globally using micro-level social theory to examine the influence the health insurance has on elderly demand for family support. A qualitative case study approach is applied to construct a comprehensive and thick description of how the national health insurance scheme influences the elderly in their demand for family support. Through focused interviews and direct observation of six selected cases, in-depth information on primary carers, living arrangement and the interaction between the health insurance as structure and elders as agents are analyzed. The study highlights that the interaction between the elderly and the national health insurance scheme has produced a new stratum of relationship between the elderly and their primary carers. Consequently, this has created equilibrium between the elderly demand for support and support made available by their primary carers. As the demand of the elderly for support is declining, supply of support by family members for the elderly is also on the decline. PMID:24576369

  8. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study

    PubMed Central

    2014-01-01

    Background General Practitioners (GPs) are well-positioned to provide grief support to patients. Most GPs view the provision of bereavement care as an important aspect of their role and the GP is the health professional that many people turn to when they need support. We aimed to explore GPs’ understandings of bereavement care and their education and professional development needs in relation to bereavement care. Methods An in-depth qualitative design was adopted using a social constructionist approach as our aims were exploratory and applied. Nineteen GPs (12 women and 7 men) living in Western Australia were interviewed; 14 were based in metropolitan Perth and 5 in rural areas. GPs were invited, via a letter, to participate in a semi-structured interview. The interviews occurred within each GP’s workplace or, for the rural GPs, via telephone, and all interviews were digitally audio-recorded and transcribed. Results Analysis was based upon constant comparison and began as soon as possible after each interview. The data revealed four tensions or opposing views concerning bereavement and bereavement care. These were (1) whether grief is a standardised versus an individual process, (2) the role of the GP in intervening versus promoting resilience, (3) the GP as a broker of services versus a service provider, and (4) the need for formal education and professional development versus ‘on-the-job’ experiential learning. Conclusions GPs have a critical role in exploring distress, including grief. However, changes need to be made to ensure GPs have up-to-date knowledge of contemporary theories and approaches. GPs urgently need education both at the undergraduate and postgraduate degree levels, and in continuing professional development. Otherwise GPs will rely on out-dated theories and constructions of grief, which may be detrimental to patient care. PMID:24670040

  9. Primary care physicians’ perspectives on facilitating older patients’ access to community support services

    PubMed Central

    Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Lam, Annie

    2017-01-01

    Abstract Objective To understand how family physicians facilitate older patients’ access to community support services (CSSs) and to identify similarities and differences across primary health care (PHC) models. Design Qualitative, multiple-case study design using semistructured interviews. Setting Four models of PHC delivery, specifically 2 family health teams (FHTs), 4 non-FHTs family health organizations, 4 fee-for-service practices, and 2 community health centres in urban Ontario. Participants Purposeful sampling of 23 family physicians in solo and small and large group practices within the 4 models of PHC. Methods A multiple-case study approach was used. Semistructured interviews were conducted and data were analyzed using within- and cross-case analysis. Case study tactics to ensure study rigour included memos and an audit trail, investigator triangulation, and the use of multiple, rather than single, case studies. Main findings Three main themes were identified: consulting and communicating with the health care team to create linkages; linking patients and families to CSSs; and relying on out-of-date resources and ineffective search strategies for information on CSSs. All participants worked with their team members; however, those in FHTs and community health centres generally had a broader range of health care providers available to assist them. Physicians relied on home-care case managers to help make linkages to CSSs. Physicians recommended the development of an easily searchable, online database containing available CSSs. Conclusion This study shows the importance of interprofessional teamwork in primary care settings to facilitate linkages of older patients to CSSs. The study also provides insight into the strategies physicians use to link older persons to CSSs and their recommendations for change. This understanding can be used to develop resources and approaches to better support physicians in making appropriate linkages to CSSs. PMID:28115458

  10. The prevalence and nature of supportive care needs in lung cancer patients

    PubMed Central

    Giuliani, M.E.; Milne, R.A.; Puts, M.; Sampson, L.R.; Kwan, J.Y.Y.; Le, L.W.; Alibhai, S.M.H.; Howell, D.; Abdelmutti, N.; Liu, G.; Papadakos, J.; Catton, P.; Jones, J.

    2016-01-01

    Purpose In the present work, we set out to comprehensively describe the unmet supportive care and information needs of lung cancer patients. Methods This cross-sectional study used the Supportive Care Needs Survey Short Form 34 (34 items) and an informational needs survey (8 items). Patients with primary lung cancer in any phase of survivorship were included. Demographic data and treatment details were collected from the medical charts of participants. The unmet needs were determined overall and by domain. Univariable and multivariable regression analyses were performed to determine factors associated with greater unmet needs. Results From August 2013 to February 2014, 89 patients [44 (49%) men; median age: 71 years (range: 44–89 years)] were recruited. The mean number of unmet needs was 8 (range: 0–34), and 69 patients (78%) reported at least 1 unmet need. The need proportions by domain were 52% health system and information, 66% psychological, 58% physical, 24% patient care, and 20% sexuality. The top 2 unmet needs were “fears of the cancer spreading” [n = 44 of 84 (52%)] and “lack of energy/tiredness” [n = 42 of 88 (48%)]. On multivariable analysis, more advanced disease and higher MD Anderson Symptom Inventory scores were associated with increased unmet needs. Patients reported that the most desired information needs were those for information on managing symptoms such as fatigue (78%), shortness of breath (77%), and cough (63%). Conclusions Unmet supportive care needs are common in lung cancer patients, with some patients experiencing a very high number of unmet needs. Further work is needed to develop resources to address those needs. PMID:27536176

  11. Recent developments in the use of online resources and mobile technologies to support mental health care.

    PubMed

    Turvey, Carolyn L; Roberts, Lisa J

    2015-01-01

    This review describes recent developments in online and mobile mental health applications, including a discussion of patient portals to support mental health care. These technologies are rapidly evolving, often before there is systematic investigation of their effectiveness. Though there are some reviews of the effectiveness of mental health mobile apps, perhaps the more significant development is innovation in technology evaluation as well as new models of interprofessional collaboration in developing behavioural health technologies. Online mental health programs have a strong evidence base. Their role in population health strategies needs further exploration, including the most effective use of limited clinical staff resources. Patient portals and personal health records serve to enhance mental health treatment also, though concerns specific to mental health must be addressed to support broader adoption of portals. Provider concerns about sharing psychiatric notes with patients hinder support for portals. Health information exchange for mental health information requires thoughtful consent management strategies so mental health patients can benefit. Finally, the broad array of health information technologies may overwhelm patients. User-friendly, well-designed, patient-centred health information technology homes may integrate these functions to promote a holistic approach to care plans and overall wellness. Such technology homes have special security needs and require providers and patients to be well informed about how best to use these technologies to support behavioural health interventions.

  12. Recovering activity and illusion: the nephrology day care unit.

    PubMed

    Remón Rodríguez, C; Quirós Ganga, P L; González-Outón, J; del Castillo Gámez, R; García Herrera, A L; Sánchez Márquez, M G

    2011-01-01

    Day Care Units are an alternative to hospital care that improves more efficiency. The Nephrology, by its technical characteristics, would be benefit greatly from further development of this care modality. The objectives of this study are to present the process we have developed the Nephrology Day Care Unit in the Puerto Real University Hospital (Cádiz, Spain). For this project we followed the Deming Management Method of Quality improvement, selecting opportunities, analyzing causes, select interventions, implement and monitor results. The intervention plan includes the following points: 1) Define the place of the Day Care Unit in the organization of our Clinical Department of Nephrology, 2) Define the Manual of organization, 3) Define the structural and equipment resources, 4) Define the Catalogue of services and procedures, 5) Standards of Care Processes. Protocols and Clinical Pathways; and 6) Information and Registration System. In the first 8 months we have been performed nearly 2000 procedures, which corresponds to an average of about 10 procedures per day, and essentially related to Hemodialysis in critical or acute patients, the Interventional Nephrology, the Clinical Nephrology and Peritoneal Dialysis. The development of the Nephrology Day Care Units can help to increase our autonomy, our presence in Hospitals, recover the progressive loss of clinical activity (diagnostic and therapeutic skills) in the past to the benefit of other Specialties. It also contributes to: Promote and develop the Diagnostic and Interventional Nephrology; improve the clinical management of patients with Primary Health Level, promote the Health Education and Investigation, collaborate in the Resources Management, and finally, to make more attractive and exciting our Specialty, both for nephrologists to training specialists.

  13. Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer.

    PubMed

    Breitbart, William

    2002-05-01

    Existential and spiritual issues are at the frontier of new clinical and research focus in palliative and supportive care of cancer patients. As concepts of adequate supportive care expand beyond a focus on pain and physical symptom control, existential and spiritual issues such as meaning, hope and spirituality in general have received increased attention from supportive care clinicians and clinical researchers. This paper reviews the topics of spirituality and end-of-life care, defines spirituality, and suggests measures of spirituality that deal with two of its main components: faith/religious beliefs and meaning/spiritual well-being. These two constructs of spirituality are reviewed in terms of their role in supportive care. Finally, a review of existing psychotherapeutic interventions for spiritual suffering are reviewed and a novel meaning-centered group psychotherapy for advanced cancer patients is described.

  14. The importance of evidence-based supportive care practice guidelines in childhood cancer-a plea for their development and implementation.

    PubMed

    Loeffen, E A H; Kremer, L C M; Mulder, R L; Font-Gonzalez, A; Dupuis, L L; Sung, L; Robinson, P D; van de Wetering, M D; Tissing, W J E

    2017-04-01

    As cure rates in pediatric oncology have improved substantially over the last decades, supportive care has become increasingly important to reduce morbidity and mortality and improve quality of life in children with cancer. Currently, large variations exist in pediatric oncology supportive care practice, which might negatively influence care. This plea underlines the importance of development and implementation of trustworthy supportive care clinical practice guidelines, which we believe is the essential next step towards better supportive care practice, and thus a higher quality of care. To facilitate international development and endorsement, the International Pediatric Oncology Guidelines in Supportive Care Network has been established.

  15. Active Component Support to Reserve Component Training, Changes to Training Support XXI

    DTIC Science & Technology

    2007-11-02

    provide support to reserve units in the Pacific Command area of responsibility. Training Support Mobilization Compliance MACA Hybrid Alternative eSB...mobilization, compliance, and Military Assistance to Civil Authorities ( MACA ).”16 The plan establishes and explains the command relationship between the CONUSA...CA TSBn TSB TSD CSS TSBn CONUSA OCAR USARC RPA Execution RSC Integrated Active Reserve l OMA l RPA RPA request MACA XXXX XXXX $ RPA Guidance

  16. Job Satisfaction: Insights from Home Support Care Workers in Three Canadian Jurisdictions.

    PubMed

    Panagiotoglou, Dimitra; Fancey, Pamela; Keefe, Janice; Martin-Matthews, Anne

    2017-03-01

    This mixed-methods study identified the personal and workplace characteristics that drive the job satisfaction of home support workers (HSWs) providing assistance to elderly clients. Data were based on a standardized measure of job satisfaction, along with in-depth qualitative interviews with 176 home support workers from three Canadian provincial jurisdictions (British Columbia, n = 108; Ontario, n = 28; Nova Scotia, n = 40). We anticipated that variability in demographic profiles between the three groups of workers and different job descriptions would be associated with differences in perceived job satisfaction. This was not the case. Results from the qualitative analysis highlight key areas that contributed to job satisfaction. These are job (scheduling, travel, and safety), economic (income security), and organizational (communication, support, and respect) factors. Given these findings, we recommend improvements to workplace communication, increased travel time allowance between clients, and wage parity with equivalent positions in long-term care facilities.

  17. Cold Season Ground Validation Activities in support of GPM

    NASA Astrophysics Data System (ADS)

    Hudak, D. R.; Petersen, W. A.

    2012-12-01

    A fundamental component of the next-generation global precipitation data products that will be addressed by the GPM mission is the hydrologic cycle at higher latitudes. In this respect, falling snow represents a primary contribution to regional atmospheric and terrestrial water budgets. The current study provides provide information on the precipitation microphysics and processes associated with cold season precipitation and precipitating cloud systems across multiple scales. It also addresses the ability of in-situ ground-based sensors as well as multi-frequency active and passive microwave sensors to detect and estimate falling snow, and more generally to contribute to our knowledge and understanding of the complete global water cycle. The work supports the incorporation of appropriate physics into GPM snowfall retrieval algorithms and the development of improved ground validation techniques for GPM product evaluation. Important information for developing GPM falling snow retrieval algorithms will be provided by a field campaign that took place in the winter of 2011/12 in the Great Lakes area of North America, termed the GPM Cold Season Precipitation Experiment (GCPEx). GCPEx represented a collaboration among the NASA, Environment Canada (EC), the Canadian Space Agency and several US, Canadian and European universities. The data collection strategy for GCPEx was coordinated, stacked high-altitude and in-situ cloud aircraft missions sampling within a broader network of ground-based volumetric observations and measurements. The NASA DSC-8 research aircraft provided a platform for the downward-viewing dual-frequency radar and multi-frequency radiometer observations. The University of North Dakota Citation and the Canadian NRC Convair-580 aircraft provided in-situ profiles of cloud and precipitation microphysics using a suite of optical array probes and bulk measurement instrumentation. Ground sampling was focused about a densely-instrumented central location that is

  18. Primary Care Resident Training for Obesity, Nutrition, and Physical Activity Counseling: A Mixed-Methods Study.

    PubMed

    Antognoli, Elizabeth L; Seeholzer, Eileen L; Gullett, Heidi; Jackson, Brigid; Smith, Samantha; Flocke, Susan A

    2016-07-08

    National guidelines have been established to support the role of primary care physicians in addressing obesity. Preparing primary care residents to recognize and treat overweight/obesity has been identified as an essential component of postgraduate medical training that is currently lacking. This study aims to identify how primary care residency programs are preparing physicians to counsel about obesity, nutrition, and physical activity (ONPA) and to examine program members' perspectives regarding the place of ONPA counseling in the curriculum, and its relevance in primary care training. Using mixed methods, we collected and analyzed data on 25 family medicine, internal medicine, and obstetrics/gynecology residency programs across Ohio. Programs averaged 2.8 hours of ONPA-related didactics per year. Ten programs (42%) taught techniques for health behavior counseling. Having any ONPA-related didactics was associated with greater counseling knowledge (p = .01) among residents but poorer attitudes (p < .001) and poorer perceived professional norms (p = .004) toward ONPA counseling. Findings from interview data highlighted similar perceived barriers to ONPA counseling across all three specialties but variation in perception of responsibility to provide ONPA counseling. While widespread expectations that primary care physicians counsel their overweight and obese patients prevail, few residency programs provide training to support such counseling.

  19. Physical activity and social support in adolescents: analysis of different types and sources of social support.

    PubMed

    Mendonça, Gerfeson; Júnior, José Cazuza de Farias

    2015-01-01

    Little is known about the influence of different types and sources of social support on physical activity in adolescents. The aim of this study was to analyse the association between physical activity and different types and sources of social support in adolescents. The sample consisted of 2,859 adolescents between 14-19 years of age in the city of João Pessoa, in Northeastern Brazil. Physical activity was measured with a questionnaire and social support from parents and friends using a 10-item scale five for each group (type of support: encouragement, joint participation, watching, inviting, positive comments and transportation). Multivariable analysis showed that the types of support provided by parents associated with physical activity in adolescents were encouragement for females (P < 0.001) and adolescents between 14-16 years of age (P = 0.003), and transportation (P = 0.014) and comments (P = 0.037) for males. The types of social support provided by friends were: joint participation in male adolescents (P < 0.001) and in these 17-19-year-olds (P < 0.001), and comments in both genders (males: P = 0.009; females: P < 0.001) and 14-16-year-olds (P < 0.001). We conclude that the type of social support associated with physical activity varies according to its source, as well as the gender and age of the adolescents.

  20. Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness.

    PubMed

    Parsell, Cameron; Ten Have, Charlotte; Denton, Michelle; Walter, Zoe

    2017-04-07

    Objectives The aims of the present study were to examine tenants' experiences of a model of integrated health care and supportive housing and to identify whether integrated health care and supportive housing improved self-reported health and healthcare access.Methods The present study used a mixed-method survey design (n=75) and qualitative interviews (n=20) performed between September 2015 and August 2016. Participants were tenants of permanent supportive housing in Brisbane (Qld, Australia). Qualitative data were analysed thematically.Results Integrated health care and supportive housing were resources for tenants to overcome systematic barriers to accessing mainstream health care experienced when homeless. When homeless, people did not have access to resources required to maintain their health. Homelessness meant not having a voice to influence the health care people received; healthcare practitioners treated symptoms of poverty rather than considering how homelessness makes people sick. Integrated healthcare and supportive housing enabled tenants to receive treatment for health problems that were compounded by the barriers to accessing mainstream healthcare that homelessness represented.Conclusions Extending the evidence about housing as a social determinant of health, the present study shows that integrated health care and supportive housing enabled tenants to take control to self-manage their health care. In addition to homelessness directly contributing to ill health, the present study provides evidence of how the experience of homelessness contributes to exclusions from mainstream healthcare.What is known about the topic? People who are homeless experience poor physical and mental health, have unmet health care needs and use disproportionate rates of emergency health services.What does the paper add? The experience of homelessness creates barriers to accessing adequate health care. The provision of onsite multidisciplinary integrated health care in

  1. A Holistic Model of Care to Support Those Living with and beyond Cancer

    PubMed Central

    Cadet, Tamara; Davis, Cindy; Elks, Jacinta; Wilson, Patricia

    2016-01-01

    Background: Globally, the burden of cancer continues to increase and it is well-documented that while not a homogeneous population, cancer patients and cancer survivors face many physical, psychological, social, spiritual, and financial issues. Cancer care is shifting from a disease-focused to a patient-centered approach resulting in an increased need to address these concerns. Methods: Utilizing a quality improvement approach, this paper describes an integrated cancer care model at Bloomhill Cancer Center (BCC) in Queensland, Australia that demonstrates the ability to meet the holistic needs of patients living with and beyond cancer and to identify opportunities for better practice and service provision. Results: Survey results indicate that 67% and 77% of respondents were very satisfied and 27% and 17% were satisfied with their first contact and very satisfied with their first meeting with a nurse at BCC. Clients also reported being very satisfied (46%) or satisfied (30%) with the emotional support they received at BCC and over 90% were very satisfied or satisfied with the touch therapies that the received. Conclusion: Due to the early success of the interventions provided by BCC, the model potentially offers other states and countries a framework for supportive cancer care provision for people living with and beyond cancer. PMID:27869728

  2. Implementation of Behavioural Supports Ontario (BSO): An Evaluation of Three Models of Care.

    PubMed

    Grouchy, Michelle; Cooper, Nancy; Wong, Tommy

    2017-01-01

    Behavioural Supports Ontario (BSO) was launched to enhance the healthcare services for Ontario's seniors, their caregivers and families living and coping with responsive behaviours associated with dementia and other neurological conditions. The implementation of the program varied across and within the local health integration networks (LHINs). By 2015, there were three BSO models operating within the long-term care (LTC) home sector: in-home BSO teams, a mobile team that serves multiple LTC homes within a sub-area of a LHIN and a LHIN-wide mobile team that provides services to all homes. A survey was undertaken to identify the differences among the BSO models of care in relation to care planning, collaboration and team building and home-level resident outcomes. We found that three years after implementation, LTC staff reported that the in-home BSO model out-performs the mobile team across all key measures. There is a role for mobile teams to provide expertise and sharing of best practices across the regions, but future policy and funding should focus on supporting the development of in-home BSO teams.

  3. Supporting children's grief within an adult and pediatric palliative care program.

    PubMed

    Librach, S Lawrence; O'Brien, Heather

    2011-01-01

    "What about the kids?" is a dominant and consuming question for caregivers supporting children/youth around the dying and death of a family member. The concerns and fears encompassed in this question can overwhelm caregivers as they put vast amounts of energy into trying to protect children/youth from the suffering and pain that awaits them. Perhaps the hardest lesson these caregivers must learn is that they cannot protect their child/youth from the death any more than they can stop the death from happening. Instead, what is needed most from children/youth is to be included, prepared, and provided with a safe place for emotional expression. Children, as well as adults, will grieve in their own specific way, mediated by their developmental level, circumstances of the illness and death, and protective factors available to them. Providing comprehensive, whole-person care to palliative patients with children/youth in their care ought to include psychoeducation and support for all members of the family. Our communities' bereaved children/youth will be impacted by the death of their family members in countless ways throughout their lives. As professionals caring for people who are dying, we have a responsibility to mediate this impact to the best of our ability.

  4. Rediscovering Recovery: Reconceptualizing Underlying Assumptions of Citizenship and Interrelated Notions of Care and Support

    PubMed Central

    Vandekinderen, Caroline; Roets, Griet; Roose, Rudi; Van Hove, Geert

    2012-01-01

    Over the last few decades, research, policy, and practice in the field of mental health care and a complementary variety of social work and social service delivery have internationally concentrated on recovery as a promising concept. In this paper, a conceptual distinction is made between an individual approach and a social approach to recovery, and underlying assumptions of citizenship and interrelated notions and features of care and support are identified. It is argued that the conditionality of the individual approach to recovery refers to a conceptualization of citizenship as normative, based on the existence of a norm that operates in every domain of our society. We argue that these assumptions place a burden of self-governance on citizens with mental health problems and risk producing people with mental health problems as nonrecyclable citizens. The social approach to recovery embraces a different conceptualization of citizenship as relational and inclusive and embodies the myriad ways in which the belonging of people with mental health problems can be constructed in practice. As such, we hope to enable social services and professionals in the field to balance their role in the provision of care and support to service users with mental health problems. PMID:23326216

  5. The approaches to learning of support workers employed in the care home sector: an evaluation study.

    PubMed

    Cowan, David T; Roberts, Julia D; Fitzpatrick, Joanne M; While, Alison E; Baldwin, Julie

    2004-02-01

    This study examined the approaches to learning of a cohort (n=76) of National Vocational Qualification (NVQ) Care Award candidates using the Approaches and Study Skills Inventory for Students. The NVQ candidates were support workers (SWs) (sometimes called care assistants) employed in United Kingdom (UK) care homes for older people. The aim was to identify SWs' approaches to learning and to determine whether or not a preparatory six-week College-based course had any impact on these approaches. The findings were encouraging. The course had a positive impact with a statistically significant increase in orientation towards a deep learning approach, which is associated with desirable learning outcomes as well as self-directed and lifelong learning skills. The UK government recognises that lifelong learning enables people to continually develop their talents, thereby enhancing local communities and contributing to a civilised, cohesive society. In a health care environment, adopting a deep approach is likely to be beneficial. Those who use evidence to inform practice, who are able to relate elements of what they are taught to their working experiences and who are able to adapt to meet new challenges, are more likely to enhance their practice and become more effective carers.

  6. Collaborative agency to support integrated care for children, young people and families: an action research study

    PubMed Central

    Stuart, Kaz

    2014-01-01

    Abstract Introduction Collaboration was legislated in the delivery of integrated care in the early 2000s in the UK. This research explored how the reality of practice met the rhetoric of collaboration. Theory The paper is situated against a theoretical framework of structure, agency, identity and empowerment. Collectively and contextually these concepts inform the proposed model of ‘collaborative agency’ to sustain integrated care. The paper brings sociological theory on structure and agency to the dilemma of collaboration. Methods Participative action research was carried out in collaborative teams that aspired to achieve integrated care for children, young people and families between 2009 and 2013. It was a part time, PhD study in collaborative practice. Results The research established that people needed to be able to be jointly aware of their context, to make joint decisions, and jointly act in order to deliver integrated services, and proposes a model of collaborative agency derived from practitioner’s experiences and integrated action research and literature on agency. The model reflects the effects of a range of structures in shaping professional identity, empowerment, and agency in a dynamic. The author proposes that the collaborative agency model will support integrated care, although this is, as yet, an untested hypothesis. PMID:24868192

  7. Easing the transition: sSupport for the new graduate nurse in long-term care.

    PubMed

    Burgess, Jennifer; D'Hondt, Allison

    2007-01-01

    As our population continues to age, more nurses will be needed to enter the specialty of LTC nursing to meet the needs of our senior population. To promote this area of nursing and retain new graduate nurses in LTC, more research is required to support the specific challenges faced by LTC nurses compared with those of other areas of nursing. The authors suggest implementation of support strategies that may include a formal preceptorship program of at least one month in duration, additional clinical support on night shifts, coaching and mentoring models, learning opportunities based on a learning needs assessment, and orientation to the overall culture and environment of the home including time spent with all departments. LTC homes need to examine their approaches to leadership, providing comprehensive orientation and resource support for new graduates and developing strategies specific to their organization's mission and vision that will empower and provide support to ease the unique transition to LTC. These strategies lead to promoting positive relationships, professional development and overall positive outcomes with workplace satisfaction in the LTC setting. The authors encourage federal and provincial government officials to examine this more closely and to better support this effort with the financial resources that are greatly needed in LTC homes to provide the exemplary care that our seniors deserve.

  8. Longitudinal relations among perceived autonomy support from health care practitioners, motivation, coping strategies and dietary compliance in a sample of adults with type 2 diabetes.

    PubMed

    Julien, Etienne; Senécal, Caroline; Guay, Frédéric

    2009-04-01

    The purpose of this study was to test the causal ordering among perceived autonomy support from health care practitioners, motivation, coping strategies and compliance to dietary self-care activities. Using a cross-lagged panel model, we investigate how these variables relate to one another over a one-year period. A total of 365 adults with Type 2 diabetes participated in the study. Results suggest that autonomous motivation and active planning are reciprocally related over time, and that prior autonomous motivation is related to the extent participants subsequently comply with their diet. Results are discussed in light of Self-determination Theory and the coping perspective.

  9. Patient Insights Into the Design of Technology to Support a Strengths-Based Approach to Health Care

    PubMed Central

    Kristjansdottir, Olöf Birna; Stenberg, Una; Krogseth, Tonje; Stange, Kurt C; Ruland, Cornelia M

    2016-01-01

    Background An increasing number of research studies in the psychological and biobehavioral sciences support incorporating patients’ personal strengths into illness management as a way to empower and activate the patients, thus improving their health and well-being. However, lack of attention to patients’ personal strengths is still reported in patient–provider communication. Information technology (IT) has great potential to support strengths-based patient–provider communication and collaboration, but knowledge about the users’ requirements and preferences is inadequate. Objective This study explored the aspirations and requirements of patients with chronic conditions concerning IT tools that could help increase their awareness of their own personal strengths and resources, and support discussion of these assets in consultations with health care providers. Methods We included patients with different chronic conditions (chronic pain, morbid obesity, and chronic obstructive pulmonary disease) and used various participatory research methods to gain insight into the participants’ needs, values, and opinions, and the contexts in which they felt strengths-based IT tools could be used. Results Participants were positive toward using technology to support them in identifying and discussing their personal strengths in clinical consultation, but also underlined the importance of fitting it to their specific requirements and the right contexts of use. Participants recommended that technology be designed for use in preconsultation settings (eg, at home) and felt that it should support them in both identifying strengths and in finding out new ways how strengths can be used to attain personal health-related goals. Participants advocated use of technology to support advance preparation for consultations and empower them to take a more active role. IT tools were suggested to be potentially useful in specific contexts, including individual or group consultations with

  10. The adult day care workforce in England at a time of policy change: implications for learning disability support services.

    PubMed

    Hussein, Shereen; Manthorpe, Jill

    2010-06-01

    More people will receive personal budgets to pay for social care services in England. Such people may or may not continue using services such as adult day care centres. Many day centres are under threat of closure. These trends will affect those working in adult day care. This article examines the profile of this workforce, using recent NMDS-SC data and applying multinomial statistical modelling. We identified nearly 6000 adult day care workers, over half supporting adults with learning disability. The results of the analysis show significant variations between the adult day care, residential care and domiciliary workforces. At the personal level, day care workers are significantly older and less ethnically diverse than other workers. They tend to have been working in the sector for longer, and their work patterns are more stable. The findings are discussed within the context of policy changes affecting learning disabilities and social care workforce strategies.

  11. Help is just a phone call away: after-hours support for palliative care patients wishing to die at home.

    PubMed

    Baird-Bower, Debbie; Roach, Julie; Andrews, Morven; Onslow, Fiona; Curnin, Emma

    2016-06-01

    The 24-hour support for palliative patients is the gold standard of health care in Australia. However, in the state of Tasmania after-hours telephone support was spatially fragmented and inequitable. In 2014, hospice@HOME, a pilot programme introduced in Tasmania in that year, implemented a state-wide after-hours palliative care support service--1800HOSPICE--offering 24-hour support, 7 days a week for palliative patients, caregivers and the public. Six months of after-hours call logs in combination with additional patient data, were analysed to evaluate the use and wider implications of a state-wide after-hours palliative care support number. Family and caregivers mainly used the after-hours support to request changes to support services (25.1%), report changes in patients' overall condition (23.6%) and request acute medical assistance (16.2%). Through the use of the after-hours services by all individuals involved in the care, end-of-life patients were able to reduce ambulance contact and emergency department admission, and thereby increase their likelihood of dying at home (for patients whose preference was to die at home). Overall, 24-hour palliative care telephone support was found to be a valuable tool for all individuals involved in the care of end-of-life patients.

  12. Acceptability of Fitbit for physical activity tracking within clinical care among men with prostate cancer

    PubMed Central

    Rosenberg, Dori; Kadokura, Elyse A; Bouldin, Erin D; Miyawaki, Christina E; Higano, Celestia S.; Hartzler, Andrea L.

    2016-01-01

    Prior research has not examined the acceptability of commercially available fitness tracking devices in men with prostate cancer, many of whom are at risk for conditions that physical activity could alleviate. We conducted an exploratory 3-week field study to examine acceptability of the Fitbit Zip and attitudes towards integrating fitness tracking into clinical care among men with prostate cancer. Twenty-six men used the Fitbit Zip for a one-week baseline phase followed by a 2-week optional use phase and then completed in-depth interviews. Interview data was analyzed using inductive thematic analysis. Participants found the device comfortable and easy to wear. Barriers to use included health and technology difficulties. Participants expressed value in sharing Fitbit data with their health care team. Findings support the use of easy to use and simple fitness trackers among men with prostate cancer and there could be opportunities to integrate fitness tracker data into clinical care. PMID:28269902

  13. Acceptability of Fitbit for physical activity tracking within clinical care among men with prostate cancer.

    PubMed

    Rosenberg, Dori; Kadokura, Elyse A; Bouldin, Erin D; Miyawaki, Christina E; Higano, Celestia S; Hartzler, Andrea L

    2016-01-01

    Prior research has not examined the acceptability of commercially available fitness tracking devices in men with prostate cancer, many of whom are at risk for conditions that physical activity could alleviate. We conducted an exploratory 3-week field study to examine acceptability of the Fitbit Zip and attitudes towards integrating fitness tracking into clinical care among men with prostate cancer. Twenty-six men used the Fitbit Zip for a one-week baseline phase followed by a 2-week optional use phase and then completed in-depth interviews. Interview data was analyzed using inductive thematic analysis. Participants found the device comfortable and easy to wear. Barriers to use included health and technology difficulties. Participants expressed value in sharing Fitbit data with their health care team. Findings support the use of easy to use and simple fitness trackers among men with prostate cancer and there could be opportunities to integrate fitness tracker data into clinical care.

  14. Needs assessment for home-based care and the strengthening of social support networks: the role of community care workers in rural South Africa

    PubMed Central

    Moshabela, Mosa; Sips, Ilona; Barten, Francoise

    2015-01-01

    Background Community care workers (CCWs) in rural South Africa provide medical, personal, household, educational, and social care services to their clients. However, little understanding exists on how provision of services is approached within a household, taking into account available social support networks. Objective The aim of this study was to generate an understanding of the processes that underpin the provision of care by CCWs in rural households and their engagement with clients, primary caregivers (PCGs), and other members of the social support network. Design We analysed in-depth interviews conducted in a triad of participants involved in a home-based care (HBC) encounter – 32 clients, 32 PCGs, and 17 CCWs. For each triad, a purposefully selected CCW was linked with a purposefully selected client and the corresponding PCG using maximum variation sampling. Three coders used an inductive content analysis method to describe participants’ references to the nuances of processes followed by CCWs in servicing HBC clients. Written informed consent was obtained from all participants. Findings The results suggest that, by intuition and prior knowledge, CCWs treated each household uniquely, depending on the clients’ care needs, cooperation, availability of a social network, and the reliability and resilience of the social support system for the client. Four distinct processes took place in rural households: needs assessment for care, rationing of care, appraisal of care, and reinforcement of a social support system. However, there was no particular order or sequence established for these processes, and caregivers followed no prescribed or shared standards. Conclusions CCWs bring a basket of services to a household, but engage in a constant, dynamic, and cyclical process of weighing needs against services provided. The service package is uniquely crafted and tailored for each household, depending on the absorptive capacity of the social support network

  15. Needs assessment for home-based care and the strengthening of social support networks: the role of community care workers in rural South Africa.

    PubMed

    Moshabela, Mosa; Sips, Ilona; Barten, Francoise

    2015-01-01

    Background Community care workers (CCWs) in rural South Africa provide medical, personal, household, educational, and social care services to their clients. However, little understanding exists on how provision of services is approached within a household, taking into account available social support networks. Objective The aim of this study was to generate an understanding of the processes that underpin the provision of care by CCWs in rural households and their engagement with clients, primary caregivers (PCGs), and other members of the social support network. Design We analysed in-depth interviews conducted in a triad of participants involved in a home-based care (HBC) encounter - 32 clients, 32 PCGs, and 17 CCWs. For each triad, a purposefully selected CCW was linked with a purposefully selected client and the corresponding PCG using maximum variation sampling. Three coders used an inductive content analysis method to describe participants' references to the nuances of processes followed by CCWs in servicing HBC clients. Written informed consent was obtained from all participants. Findings The results suggest that, by intuition and prior knowledge, CCWs treated each household uniquely, depending on the clients' care needs, cooperation, availability of a social network, and the reliability and resilience of the social support system for the client. Four distinct processes took place in rural households: needs assessment for care, rationing of care, appraisal of care, and reinforcement of a social support system. However, there was no particular order or sequence established for these processes, and caregivers followed no prescribed or shared standards. Conclusions CCWs bring a basket of services to a household, but engage in a constant, dynamic, and cyclical process of weighing needs against services provided. The service package is uniquely crafted and tailored for each household, depending on the absorptive capacity of the social support network available to

  16. Developing supplemental activities for primary health care maternity services.

    PubMed

    Panitz, E

    1990-12-01

    Supplemental health care activities are described in the context of the augmented product. The potential benefits of supplemental services to recipients and provider are discussed. The author describes a study that was the basis for (re)developing a supplemental maternity service. The implementation of the results in terms of changes in the marketing mix of this supplemental program is discussed. The effects of the marketing mix changes on program participation are presented.

  17. The Use of Multiple Slate Devices to Support Active Reading Activities

    ERIC Educational Resources Information Center

    Chen, Nicholas Yen-Cherng

    2012-01-01

    Reading activities in the classroom and workplace occur predominantly on paper. Since existing electronic devices do not support these reading activities as well as paper, users have difficulty taking full advantage of the affordances of electronic documents. This dissertation makes three main contributions toward supporting active reading…

  18. Impact of supervised drug consumption services on access to and engagement with care at a palliative and supportive care facility for people living with HIV/AIDS: a qualitative study

    PubMed Central

    McNeil, Ryan; Dilley, Laura B; Guirguis-Younger, Manal; Hwang, Stephen W; Small, Will

    2014-01-01

    Introduction Improvements in the availability and effectiveness of highly active antiretroviral therapy (HAART) have prolonged the lives of people living with HIV/AIDS. However, mortality rates have remained high among populations that encounter barriers to accessing and adhering to HAART, notably people who use drugs. This population consequently has a high burden of illness and complex palliative and supportive care needs, but is often unable to access these services due to anti-drug policies and discrimination. In Vancouver, Canada, the Dr. Peter Centre (DPC), which operates a 24-bed residential HIV/AIDS care facility, has sought to improve access to palliative and supportive care services by adopting a comprehensive harm reduction strategy, including supervised injection services. We undertook this study to explore how the integration of comprehensive harm reduction services into this setting shapes access to and engagement with care. Methods Qualitative interviews were conducted with 13 DPC residents between November 2010 and August 2011. Interviews made use of a semistructured interview guide which facilitated discussion regarding how the DPC Residence's model of care (a) shaped healthcare access, (b) influenced healthcare interactions and (c) impacted drug use practices and overall health. Interview transcripts were analysed thematically. Results Participant accounts highlight how the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services. Furthermore, this approach fostered an atmosphere in which drug use could be discussed without the risk of punitive action, and thus increased openness between residents and staff. Finally, participants reported that the environmental supports provided by the DPC Residence decreased drug-related risks and improved health outcomes, including HAART adherence and survival. Conclusions This study highlights how adopting

  19. Education / training in supportive and palliative care in central and eastern Europe. Results of a questionnaire survey.

    PubMed

    Luczak, J; Kluziak, M; Hunter, G Petrie

    2002-05-01

    During the totalitarian era terminal care was excluded from the health care system, and oncology, including education in the field, was rather neglected. The political and economic reforms that started in the 1990s in the countries of eastern and central Europe enhanced the development of palliative care and improvements in cancer treatment standards. This survey was performed to assess the current status of education and training in supportive and palliative care. A questionnaire was prepared and distributed by the authors to national leaders in palliative/supportive care. Data obtained from 16 countries indicate progress in palliative care provision and education, though it is held up by economic difficulties and by the lack of regulations in countries engaged in reforms of their health care systems. Training in supportive care is deficient; the discipline is usually perceived as the management of side-effects of anticancer treatment, so that it is not separated from clinical oncology. Access to professional literature should be improved, and the creation of national literatures should be encouraged. The role of local leaders, NGOs and professional associations must be emphasized. The main goals are: improvement of education, and better quality and availability of palliative and supportive care, not only for patients with cancer but also in other progressive life-threatening diseases.

  20. Weekly versus basic smoking cessation support in primary care: a randomised controlled trial

    PubMed Central

    Aveyard, Paul; Brown, Karen; Saunders, Cas; Alexander, Avril; Johnstone, Elaine; Munafò, Marcus R; Murphy, Mike

    2007-01-01

    Background There is insufficient and conflicting evidence about whether more intensive behavioural support is more effective than basic behavioural support for smoking cessation and whether primary care nurses can deliver effective behavioural support. Methods A randomised controlled trial was performed in 26 UK general practices. 925 smokers of ⩾10 cigarettes per day were randomly allocated to basic or weekly support. All participants were seen before quitting, telephoned around quit day, and seen 1 and 4 weeks after the initial appointment (basic support). Participants receiving weekly support had an additional telephone call at 10 days and 3 weeks after the initial appointment and an additional visit at 2 weeks to motivate adherence to nicotine replacement and renew quit attempts. 15 mg/16 h nicotine patches were given to all participants. The outcome was assessed by intention to treat analyses of the percentage confirmed sustained abstinence at 4, 12, 26 and 52 weeks after quit day. Results Of the 469 and 456 participants in the basic and weekly arms, the numbers (%) who quit and the percentage difference were 105 (22.4%) vs 102 (22.4%), 0.1% (95% CI −5.3% to 5.5%) at 4 weeks, 66 (14.1%) vs 52 (11.4%), −2.6% (95% CI −6.9% to 1.7%) at 12 weeks, 50 (10.7%) vs 40 (8.8%), −1.9% (95% CI −5.7% to 2.0%) at 26 weeks and 36 (7.7%) vs 30 (6.6%), −1.1% (95% CI −4.4% to 2.3%) at 52 weeks. Conclusions The absolute quit rates achieved are those expected from nicotine replacement alone, implying that neither basic nor weekly support were effective. Primary care smoking cessation treatment should provide pharmacotherapy with sufficient support only to ensure it is used appropriately, and those in need of support should be referred to specialists. PMID:17483139

  1. Visually storying living with HIV: bridging stressors and supports in accessing care.

    PubMed

    Schrader, S M; Deering, E N; Zahl, D A; Wallace, M

    2011-08-01

    This paper examines how visual narratives may bridge relational understandings between people living with HIV/AIDS (PLWH/A) and future oral health care providers. Borrowing from literature in participatory visual methods such as photo elicitation and photovoice, we explored how PLWH/A visually choose to represent their daily lives. This study uses a grounded theory action-oriented approach in examining the thematic analysis of 257 photos and 12 related reflective participant journals. Ten collaborative themes emerged from the participants' analysis of their photos. These themes of social support, places, family, staff, group, recovery tools, transportation, friends, medications and food exhibited the indivisible characteristics of stressors and supports commonly found in accessing care. Further researcher reflections also found three meta-themes of stigmatization, maintenance of positive mental health and the development of pride in managing one's health. PLWH/A need to share these visual themes of supports and stressors with future dental providers so that they may hopefully acquire an understanding of chronic illness that is more personalized and relationship centered rather than merely numeric and detached.

  2. Using old technology to implement modern computer-aided decision support for primary diabetes care.

    PubMed Central

    Hunt, D. L.; Haynes, R. B.; Morgan, D.

    2001-01-01

    BACKGROUND: Implementation rates of interventions known to be beneficial for people with diabetes mellitus are often suboptimal. Computer-aided decision support systems (CDSSs) can improve these rates. The complexity of establishing a fully integrated electronic medical record that provides decision support, however, often prevents their use. OBJECTIVE: To develop a CDSS for diabetes care that can be easily introduced into primary care settings and diabetes clinics. THE SYSTEM: The CDSS uses fax-machine-based optical character recognition software for acquiring patient information. Simple, 1-page paper forms, completed by patients or health practitioners, are faxed to a central location. The information is interpreted and recorded in a database. This initiates a routine that matches the information against a knowledge base so that patient-specific recommendations can be generated. These are formatted and faxed back within 4-5 minutes. IMPLEMENTATION: The system is being introduced into 2 diabetes clinics. We are collecting information on frequency of use of the system, as well as satisfaction with the information provided. CONCLUSION: Computer-aided decision support can be provided in any setting with a fax machine, without the need for integrated electronic medical records or computerized data-collection devices. PMID:11825194

  3. Support for learning in the perspective of patient safety in primary health care 1

    PubMed Central

    Paranaguá, Thatianny Tanferri de Brito; Bezerra, Ana Lúcia Queiroz; Tobias, Gabriela Camargo; Ciosak, Suely Itsuko

    2016-01-01

    ABSTRACT Objective: to analyze the support for learning, in the perspective of patient safety, offered in the work environment, according to health professionals working in primary care. Method: a transversal study, held with 86 health professionals working in primary care. A validated instrument was used, applied via the Internet. Descriptive statistical analysis was undertaken with a presentation of median, mean, standard deviation and coefficient of variation. Results: points which are favorable to supporting learning were evidenced, such as mutual respect, autonomy for organizing the work and valorization of new ideas, which obtained means above 7.0. The variables which hinder the process of learning in the work environment, perceived by the professionals, were: resistance to changes, and excess of work impeding reflection on how to improve the work, with means above 6.0. Conclusion: the study found evidence of indicators related to the process of staff development in the area of health and indicates the influence of support for learning for the improvement of the work processes and of patient safety. It is necessary that a culture involving the systematic assessment of educational interventions in health should be established, the aim being to diagnose actions which are more incisive for changing health professionals' attitude and, therefore, clinical practice. PMID:27556877

  4. Lung Cancer Assistant: a hybrid clinical decision support application for lung cancer care

    PubMed Central

    Sesen, M. Berkan; Peake, Michael D.; Banares-Alcantara, Rene; Tse, Donald; Kadir, Timor; Stanley, Roz; Gleeson, Fergus; Brady, Michael

    2014-01-01

    Multidisciplinary team (MDT) meetings are becoming the model of care for cancer patients worldwide. While MDTs have improved the quality of cancer care, the meetings impose substantial time pressure on the members, who generally attend several such MDTs. We describe Lung Cancer Assistant (LCA), a clinical decision support (CDS) prototype designed to assist the experts in the treatment selection decisions in the lung cancer MDTs. A novel feature of LCA is its ability to provide rule-based and probabilistic decision support within a single platform. The guideline-based CDS is based on clinical guideline rules, while the probabilistic CDS is based on a Bayesian network trained on the English Lung Cancer Audit Database (LUCADA). We assess rule-based and probabilistic recommendations based on their concordances with the treatments recorded in LUCADA. Our results reveal that the guideline rule-based recommendations perform well in simulating the recorded treatments with exact and partial concordance rates of 0.57 and 0.79, respectively. On the other hand, the exact and partial concordance rates achieved with probabilistic results are relatively poorer with 0.27 and 0.76. However, probabilistic decision support fulfils a complementary role in providing accurate survival estimations. Compared to recorded treatments, both CDS approaches promote higher resection rates and multimodality treatments. PMID:24990290

  5. Real-Time Support of Pediatric Diabetes Self-Care by a Transport Team

    PubMed Central

    Franklin, Brandi E.; Crisler, S. Crile; Shappley, Rebekah; Armour, Meri M.; McCommon, Dana T.; Ferry, Robert J.

    2014-01-01

    OBJECTIVE The study seeks to improve access for underserved patients via novel integration of Pedi-Flite (a critical care transport team) and to validate whether this safely enhances diabetes care and effectively expands the endocrine workforce. RESEARCH DESIGN AND METHODS The study retrospectively analyzed pager service use in a cohort of established diabetic patients (n = 979) after inception of Pedi-Flite support. Outcomes included incidence and severity of recurrent diabetic ketoacidosis (DKA) and cost savings generated from reduced referrals to the emergency department (ED) and on-call endocrinologist. We generated descriptive statistics to characterize the study population and ED visits for DKA and constructed logistic regression models to examine associations of pager use and likelihood of ED visitation and nonelective inpatient admission from an ED for DKA. RESULTS Pager users comprised 30% of the patient population. They were younger but had more established diabetes than nonusers. While pager users were 2.75 times more likely than nonusers to visit the ED for DKA (P < 0.0001), their visits were less likely to lead to inpatient admissions (odds ratio 0.58; P < 0.02). More than half (n = 587) of all calls to the pager were resolved without need for further referral. Estimates suggest that 439 ED visits and 115 admissions were avoided at a potential cost savings exceeding 760,000 USD. CONCLUSIONS Integration of a transport service provides a novel, cost-effective approach to reduce disparities in diabetes care. Advantages include scalability, applicability to other disease areas and settings, and low added costs. These findings enrich an emerging evidence base for telephonic care-management models supported by allied health personnel. PMID:23959568

  6. Perceptions of Worksite Support and Employee Obesity, Activity and Diet

    PubMed Central

    Lemon, Stephenie C.; Zapka, Jane; Li, Wenjun; Estabrook, Barbara; Magner, Robert; Rosal, Milagros C.

    2008-01-01

    Objectives To examine the associations of perceptions of organizational commitment to employee health and coworker physical activity and eating behaviors with body mass index (BMI), physical activity and eating behaviors in hospital employees. Methods Baseline data from 899 employees participating in a worksite weight gain prevention trial were analyzed. Results Greater perception of organizational commitment to employee health was associated with lower BMI. Greater perception of coworker healthy eating and physical activity behaviors were associated with fruit and vegetable and saturated fat consumption and physical activity, respectively. Conclusions Improving organizational commitment and facilitating supportive interpersonal environments could improve obesity control among working populations. PMID:19063651

  7. Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

    PubMed

    Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

    2014-06-01

    This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.

  8. Redirecting traditional professional values to support safety: changing organisational culture in health care

    PubMed Central

    Carroll, J; Quijada, M

    2004-01-01

    Professionals in healthcare organisations who seek to enhance safety and quality in an increasingly demanding industry environment often identify culture as a barrier to change. The cultural focus on individual autonomy, for example, seems to conflict with desired norms of teamwork, problem reporting, and learning. We offer a definition and explication of why culture is important to change efforts. A cultural analysis of health care suggests professional values that can be redirected to support change. We offer examples of organisations that drew upon cultural strengths to create new ways of working and gradually shifted the culture. PMID:15576686

  9. The cost of changing physical activity behaviour: evidence from a "physical activity pathway" in the primary care setting

    PubMed Central

    2011-01-01

    Background The 'Physical Activity Care Pathway' (a Pilot for the 'Let's Get Moving' policy) is a systematic approach to integrating physical activity promotion into the primary care setting. It combines several methods reported to support behavioural change, including brief interventions, motivational interviewing, goal setting, providing written resources, and follow-up support. This paper compares costs falling on the UK National Health Service (NHS) of implementing the care pathway using two different recruitment strategies and provides initial insights into the cost of changing physical activity behaviour. Methods A combination of a time driven variant of activity based costing, audit data through EMIS and a survey of practice managers provided patient-level cost data for 411 screened individuals. Self reported physical activity data of 70 people completing the care pathway at three month was compared with baseline using a regression based 'difference in differences' approach. Deterministic and probabilistic sensitivity analyses in combination with hypothesis testing were used to judge how robust findings are to key assumptions and to assess the uncertainty around estimates of the cost of changing physical activity behaviour. Results It cost £53 (SD 7.8) per patient completing the PACP in opportunistic centres and £191 (SD 39) at disease register sites. The completer rate was higher in disease register centres (27.3% vs. 16.2%) and the difference in differences in time spent on physical activity was 81.32 (SE 17.16) minutes/week in patients completing the PACP; so that the incremental cost of converting one sedentary adult to an 'active state' of 150 minutes of moderate intensity physical activity per week amounts to £ 886.50 in disease register practices, compared to opportunistic screening. Conclusions Disease register screening is more costly than opportunistic patient recruitment. However, additional costs come with a higher completion rate and better

  10. Social networks of experientially similar others: formation, activation, and consequences of network ties on the health care experience.

    PubMed

    Gage, Elizabeth A

    2013-10-01

    Research documents that interactions among experientially similar others (individuals facing a common stressor) shape health care behavior and ultimately health outcomes. However, we have little understanding of how ties among experientially similar others are formed, what resources and information flows through these networks, and how network embeddedness shapes health care behavior. This paper uses in-depth interviews with 76 parents of pediatric cancer patients to examine network ties among experientially similar others after a serious medical diagnosis. Interviews were conducted between August 2009 and May 2011. Findings demonstrate that many parents formed ties with other families experiencing pediatric cancer, and that information and resources were exchanged during the everyday activities associated with their child's care. Network flows contained emotional support, caregiving strategies, information about second opinions, health-related knowledge, and strategies for navigating the health care system. Diffusion of information, resources, and support occurred through explicit processes (direct information and support exchanges) and implicit processes (parents learning through observing other families). Network flows among parents shaped parents' perceptions of the health care experience and their role in their child's care. These findings contribute to the social networks and social support literatures by elucidating the mechanisms through which network ties among experientially similar others influence health care behavior and experiences.

  11. A Web-based home welfare and care services support system using a pen type image sensor.

    PubMed

    Ogawa, Hidekuni; Yonezawa, Yoshiharu; Maki, Hiromichi; Sato, Haruhiko; Hahn, Allen W; Caldwell, W Morton

    2003-01-01

    A long-term care insurance law for elderly persons was put in force two years ago in Japan. The Home Helpers, who are employed by hospitals, care companies or the welfare office, provide home welfare and care services for the elderly, such as cooking, bathing, washing, cleaning, shopping, etc. We developed a web-based home welfare and care services support system using wireless Internet mobile phones and Internet client computers, which employs a pen type image sensor. The pen type image sensor is used by the elderly people as the entry device for their care requests. The client computer sends the requests to the server computer in the Home Helper central office, and then the server computer automatically transfers them to the Home Helper's mobile phone. This newly-developed home welfare and care services support system is easily operated by elderly persons and enables Homes Helpers to save a significant amount of time and extra travel.

  12. Building multidisciplinary health workforce capacity to support the implementation of integrated, people-centred Models of Care for musculoskeletal health.

    PubMed

    Chehade, M J; Gill, T K; Kopansky-Giles, D; Schuwirth, L; Karnon, J; McLiesh, P; Alleyne, J; Woolf, A D

    2016-06-01

    To address the burden of musculoskeletal (MSK) conditions, a competent health workforce is required to support the implementation of MSK models of care. Funding is required to create employment positions with resources for service delivery and training a fit-for-purpose workforce. Training should be aligned to define "entrustable professional activities", and include collaborative skills appropriate to integrated and people-centred care and supported by shared education resources. Greater emphasis on educating MSK healthcare workers as effective trainers of peers, students and patients is required. For quality, efficiency and sustainability of service delivery, education and research capabilities must be integrated across disciplines and within the workforce, with funding models developed based on measured performance indicators from all three domains. Greater awareness of the societal and economic burden of MSK conditions is required to ensure that solutions are prioritised and integrated within healthcare policies from local to regional to international levels. These healthcare policies require consumer engagement and alignment to social, economic, educational and infrastructure policies to optimise effectiveness and efficiency of implementation.

  13. Promise and challenges with the use of mobile applications to support and improve patient care: an industry perspective.

    PubMed

    Bucklen, K W; Abbott, B M

    2014-05-01

    Mobile applications represent an immense opportunity to support and improve patient health care, as the scope and functionality of medical apps are enabling physicians and patients to manage care in new, fast, and personalized ways. Several challenges exist in medical-app development, including careful attention to quality systems, medical-device regulation, and app life span. Despite these complexities, we find that development of mobile medical apps is a worthwhile undertaking given their potential to improve outcomes for patients.

  14. Expanding the walls of the health care encounter: support and outcomes for patients online.

    PubMed

    Robinson, James D; Turner, Jeanine Warisse; Levine, Betty; Tian, Yan

    2011-03-01

    This paper assesses the relationship between patient-health care provider (HCP) interaction and health behaviors. In total, 109 Native American patients diagnosed with diabetes mellitus were enrolled in a Web-based diabetes monitoring system. The system tracks patient-HCP interaction, and in total 924 personal messages were exchanged. These 924 messages contained 6,411 message units that were content analyzed using a nine-category scheme. Patient blood glucose monitoring was found to be related to the frequency of phatic communication, informational social support, and tangible social support messages, as well as messages containing references to personal contact. Finally, person-centered messages proved to be the single best predictor of patient involvement with the telemedicine system (as measured by the number of times the patient logged into the system).

  15. Supporting a relative's move into long-term care: starting point shapes family members' experiences.

    PubMed

    Sussman, Tamara; Dupuis, Sherry

    2012-12-01

    This grounded-theory study explored family members' experiences supporting a relative's move into a long-term care (LTC) home. Each stage in the transition process, and the role of starting point in shaping the experience, were examined. Twenty family members who moved a relative into an LTC home were interviewed within six weeks of the move. The findings revealed that the starting point had a profound effect on family members' experiences accepting the need for, and timing of, their relative's move into LTC (pre-move), and on believing that the selected LTC home was a positive environment for their relative (post-move). LTC home policies and processes were also important. However, when pre-move acceptance was compromised by circumstances attributed to the starting point, these policies and processes were not as effective in fostering post-move acceptance. Conditions that support positive transitions before, during, and after the move from each starting point are discussed.

  16. An Intelligent Ecosystem for Providing Support in Prehospital Trauma Care in Cuenca, Ecuador.

    PubMed

    Timbi-Sisalima, Cristian; Rodas, Edgar B; Salamea, Juan C; Sacoto, Hernán; Monje-Ortega, Diana; Robles-Bykbaev, Vladimir

    2015-01-01

    According to facts given by the World Health Organization, one in ten deaths worldwide is due to an external cause of injury. In the field of pre-hospital trauma care, adequate and timely treatment in the golden period can impact the survival of a patient. The aim of this paper is to show the design of a complete ecosystem proposed to support the evaluation and treatment of trauma victims, using standard tools and vocabulary such as OpenEHR, as well as mobile systems and expert systems to support decision-making. Preliminary results of the developed applications are presented, as well as trauma-related data from the city of Cuenca, Ecuador.

  17. Enabling health care decisionmaking through clinical decision support and knowledge management.

    PubMed Central

    Lobach, David; Sanders, Gillian D; Bright, Tiffani J; Wong, Anthony; Dhurjati, Ravi; Bristow, Erin; Bastian, Lori; Coeytaux, Remy; Samsa, Gregory; Hasselblad, Vic; Williams, John W; Wing, Liz; Musty, Michael; Kendrick, Amy S

    2012-01-01

    OBJECTIVES To catalogue study designs used to assess the clinical effectiveness of CDSSs and KMSs, to identify features that impact the success of CDSSs/KMSs, to document the impact of CDSSs/KMSs on outcomes, and to identify knowledge types that can be integrated into CDSSs/KMSs. DATA SOURCES MEDLINE(®), CINAHL(®), PsycINFO(®), and Web of Science(®). REVIEW METHODS We included studies published in English from January 1976 through December 2010. After screening titles and abstracts, full-text versions of articles were reviewed by two independent reviewers. Included articles were abstracted to evidence tables by two reviewers. Meta-analyses were performed for seven domains in which sufficient studies with common outcomes were included. RESULTS We identified 15,176 articles, from which 323 articles describing 311 unique studies including 160 reports on 148 randomized control trials (RCTs) were selected for inclusion. RCTs comprised 47.5 percent of the comparative studies on CDSSs/KMSs. Both commercially and locally developed CDSSs effectively improved health care process measures related to performing preventive services (n = 25; OR 1.42, 95% confidence interval [CI] 1.27 to 1.58), ordering clinical studies (n = 20; OR 1.72, 95% CI 1.47 to 2.00), and prescribing therapies (n = 46; OR 1.57, 95% CI 1.35 to 1.82). Fourteen CDSS/KMS features were assessed for correlation with success of CDSSs/KMSs across all endpoints. Meta-analyses identified six new success features: Integration with charting or order entry system. Promotion of action rather than inaction. No need for additional clinician data entry. Justification of decision support via research evidence. Local user involvement. Provision of decision support results to patients as well as providers. Three previously identified success features were confirmed: Automatic provision of decision support as part of clinician workflow. Provision of decision support at time and location of decisionmaking. Provision of a

  18. Support nanostructure boosts oxygen transfer to catalytically active platinum nanoparticles.

    PubMed

    Vayssilov, Georgi N; Lykhach, Yaroslava; Migani, Annapaola; Staudt, Thorsten; Petrova, Galina P; Tsud, Nataliya; Skála, Tomáš; Bruix, Albert; Illas, Francesc; Prince, Kevin C; Matolín, Vladimír; Neyman, Konstantin M; Libuda, Jörg

    2011-04-01

    Interactions of metal particles with oxide supports can radically enhance the performance of supported catalysts. At the microscopic level, the details of such metal-oxide interactions usually remain obscure. This study identifies two types of oxidative metal-oxide interaction on well-defined models of technologically important Pt-ceria catalysts: (1) electron transfer from the Pt nanoparticle to the support, and (2) oxygen transfer from ceria to Pt. The electron transfer is favourable on ceria supports, irrespective of their morphology. Remarkably, the oxygen transfer is shown to require the presence of nanostructured ceria in close contact with Pt and, thus, is inherently a nanoscale effect. Our findings enable us to detail the formation mechanism of the catalytically indispensable Pt-O species on ceria and to elucidate the extraordinary structure-activity dependence of ceria-based catalysts in general.

  19. Support vector machines classifiers of physical activities in preschoolers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The goal of this study is to develop, test, and compare multinomial logistic regression (MLR) and support vector machines (SVM) in classifying preschool-aged children physical activity data acquired from an accelerometer. In this study, 69 children aged 3-5 years old were asked to participate in a s...

  20. Basic Education and Policy Support Activity: Tools and Publications.

    ERIC Educational Resources Information Center

    Creative Associates International, Inc., Washington, DC.

    The Basic Education and Policy Support (BEPS) Activity is a United States Agency for International Development (USAID)-sponsored, multi-year initiative designed to further improve the quality of, effectiveness of, and access to formal and nonformal basic education. This catalog is one element of the BEPS information dissemination process. The…

  1. Physical Activity and Social Support in Adolescents: A Systematic Review

    ERIC Educational Resources Information Center

    Mendonça, Gerfeson; Cheng, Luanna Alexandra; Mélo, Edilânea Nunes; de Farias, José Cazuza, Jr.

    2014-01-01

    The objective of this review was to systematically synthesize the results of original studies on the association between physical activity and social support in adolescents, published until April 2011. Searches were carried out in Adolec, ERIC, Lilacs, Medline, SciELO, Scopus, SportsDiscus and Web of Science electronic databases and the reference…

  2. Development of a clinical decision support system for diabetes care: A pilot study.

    PubMed

    Sim, Livvi Li Wei; Ban, Kenneth Hon Kim; Tan, Tin Wee; Sethi, Sunil Kumar; Loh, Tze Ping

    2017-01-01

    Management of complex chronic diseases such as diabetes requires the assimilation and interpretation of multiple laboratory test results. Traditional electronic health records tend to display laboratory results in a piecemeal and segregated fashion. This makes the assembly and interpretation of results related to diabetes care challenging. We developed a diabetes-specific clinical decision support system (Diabetes Dashboard) interface for displaying glycemic, lipid and renal function results, in an integrated form with decision support capabilities, based on local clinical practice guidelines. The clinical decision support system included a dashboard feature that graphically summarized all relevant laboratory results and displayed them in a color-coded system that allowed quick interpretation of the metabolic control of the patients. An alert module informs the user of tests that are due for repeat testing. An interactive graph module was also developed for better visual appreciation of the trends of the laboratory results of the patient. In a pilot study involving case scenarios administered via an electronic questionnaire, the Diabetes Dashboard, compared to the existing laboratory reporting interface, significantly improved the identification of abnormal laboratory results, of the long-term trend of the laboratory tests and of tests due for repeat testing. However, the Diabetes Dashboard did not significantly improve the identification of patients requiring treatment adjustment or the amount of time spent on each case scenario. In conclusion, we have developed and shown that the use of the Diabetes Dashboard, which incorporates several decision support features, can improve the management of diabetes. It is anticipated that this dashboard will be most helpful when deployed in an outpatient setting, where physicians can quickly make clinical decisions based on summarized information and be alerted to pertinent areas of care that require additional attention.

  3. Development of a clinical decision support system for diabetes care: A pilot study

    PubMed Central

    Sim, Livvi Li Wei; Ban, Kenneth Hon Kim; Tan, Tin Wee; Sethi, Sunil Kumar; Loh, Tze Ping

    2017-01-01

    Management of complex chronic diseases such as diabetes requires the assimilation and interpretation of multiple laboratory test results. Traditional electronic health records tend to display laboratory results in a piecemeal and segregated fashion. This makes the assembly and interpretation of results related to diabetes care challenging. We developed a diabetes-specific clinical decision support system (Diabetes Dashboard) interface for displaying glycemic, lipid and renal function results, in an integrated form with decision support capabilities, based on local clinical practice guidelines. The clinical decision support system included a dashboard feature that graphically summarized all relevant laboratory results and displayed them in a color-coded system that allowed quick interpretation of the metabolic control of the patients. An alert module informs the user of tests that are due for repeat testing. An interactive graph module was also developed for better visual appreciation of the trends of the laboratory results of the patient. In a pilot study involving case scenarios administered via an electronic questionnaire, the Diabetes Dashboard, compared to the existing laboratory reporting interface, significantly improved the identification of abnormal laboratory results, of the long-term trend of the laboratory tests and of tests due for repeat testing. However, the Diabetes Dashboard did not significantly improve the identification of patients requiring treatment adjustment or the amount of time spent on each case scenario. In conclusion, we have developed and shown that the use of the Diabetes Dashboard, which incorporates several decision support features, can improve the management of diabetes. It is anticipated that this dashboard will be most helpful when deployed in an outpatient setting, where physicians can quickly make clinical decisions based on summarized information and be alerted to pertinent areas of care that require additional attention. PMID

  4. The Quality of Caregiving in Child Care: Relations to Teacher Complexity of Thinking and Perceived Supportiveness of the Work Environment

    ERIC Educational Resources Information Center

    Manlove, Elizabeth E.; Vazquez, Arcel; Vernon-Feagans, Lynne

    2008-01-01

    This study examined the relationship between the complexity of thinking about children by child care teachers and observed teachers' caregiving for infants and toddlers. It was hypothesized that the perceived supportiveness of the work environment would affect this relationship. Fifty-six child care teachers completed a survey assessing complexity…

  5. Health Care Decision Support System for the Pediatric Emeregency Department Management.

    PubMed

    Ben Othman, Sarah; Hammadi, Slim; Quilliot, Alain; Martinot, Alain; Renard, Jean-Marie

    2015-01-01

    Health organization management is facing a high amount of complexity due to the inherent dynamics of the processes and the distributed organization of hospitals. It is therefore necessary for health care institutions to focus on this issue in order to deal with patients' requirements and satisfy their needs. The main objective of this study is to develop and implement a Decision Support System which can help physicians to better manage their organization, to anticipate the overcrowding feature, and to establish avoidance proposals for it. This work is a part of HOST project (Hospital: Optimization, Simulation, and Crowding Avoidance) of the French National Research Agency (ANR). It aims to optimize the functioning of the Pediatric Emergency Department characterized by stochastic arrivals of patients which leads to its overcrowding and services overload. Our study is a set of tools to smooth out patient flows, enhance care quality and minimize long waiting times and costs due to resources allocation. So we defined a decision aided tool based on Multi-agent Systems where actors negotiate and cooperate under some constraints in a dynamic environment. These entities which can be either physical agents representing real actors in the health care institution or software agents allowing the implementation of optimizing tools, cooperate to satisfy the demands of patients while respecting emergency degrees. This paper is concerned with agents' negotiation. It proposes a new approach for multi-skill tasks scheduling based on interactions between agents.

  6. Features of Effective Medical Knowledge Resources to Support Point of Care Learning: A Focus Group Study

    PubMed Central

    Cook, David A.; Sorensen, Kristi J.; Hersh, William; Berger, Richard A.; Wilkinson, John M.

    2013-01-01

    Objective Health care professionals access various information sources to quickly answer questions that arise in clinical practice. The features that favorably influence the selection and use of knowledge resources remain unclear. We sought to better understand how clinicians select among the various knowledge resources available to them, and from this to derive a model for an effective knowledge resource. Methods We conducted 11 focus groups at an academic medical center and outlying community sites. We included a purposive sample of 50 primary care and subspecialist internal medicine and family medicine physicians. We transcribed focus group discussions and analyzed these using a constant comparative approach to inductively identify features that influence the selection of knowledge resources. Results We identified nine features that influence users' selection of knowledge resources, namely efficiency (with sub-features of comprehensiveness, searchability, and brevity), integration with clinical workflow, credibility, user familiarity, capacity to identify a human expert, reflection of local care processes, optimization for the clinical question (e.g., diagnosis, treatment options, drug side effect), currency, and ability to support patient education. No single existing resource exemplifies all of these features. Conclusion The influential features identified in this study will inform the development of knowledge resources, and could serve as a framework for future research in this field. PMID:24282535

  7. The Quality of Care and Support (QOCS) for people with disability scale: development and psychometric properties.

    PubMed

    Lucas-Carrasco, Ramona; Eser, Erhan; Hao, Yuantao; McPherson, Kathryn M; Green, Ann; Kullmann, Lajos

    2011-01-01

    This paper describes the development of a Quality of Care and Support (QOCS) scale for use with adult persons with physical and intellectual disabilities. In the pilot phase of the study, 12 centers from around the world carried out focus groups with people with physical and disabilities, their carers, and with professionals in order to identify themes that were relevant for their quality of care. Items generated from the focus groups were then tested in a pilot study with 1400 respondents from 15 different centers worldwide, with items being tested and reduced using both classical and modern psychometric methods. A field trial study was then carried out with 3772 respondents, again with the use of both classical and modern psychometric methods. The outcome of the two rounds of data collection and analysis is a 17-item module for assessment of quality of care in physically or intellectually disabled people. Further modifications are also proposed for the use of the QOCS with adults with intellectual disabilities, including simplification of wording of some of the items, the use of a three-point response scale, and the inclusion of smiley faces.

  8. Depression Care Training Participation: Randomized Trial of Community Engagement or Technical Support

    PubMed Central

    Chung, Bowen; Ngo, Victoria; Ong, Michael; Pulido, Esmeralda; Jones, Felica; Gilmore, James; Mtume, Norma; Johnson, Megan Dwight; Tang, Lingqi; Wells, Kenneth; Sherbourne, Cathy; Miranda, Jeanne

    2015-01-01

    Objective Community Engagement and Planning (CEP) could improve dissemination of depression quality improvement in under-resourced communities; but its effects on provider training participation relative to more standard technical assistance or Resources for Services (RS) are unknown. To compare effects of CEP, which trains networks of healthcare and social-community agencies jointly, and RS, which provides technical support to individual programs, on program and staff-level participation in depression quality improvement trainings. Methods Matched programs from healthcare and social-community programs in two communities were randomized to RS or CEP. Data were from 1622 eligible staff members from 95 enrolled programs. Measures: Primary outcomes: for programs, any staff trained; and for staff, total hours of training. Secondary outcomes: training in specific depression collaborative care components. Results CEP programs relative to RS were more likely to participate in any trainings across sectors (p<.001) and from social-community sectors (p<.001), but not from healthcare. Among staff participating in trainings, CEP relative to RS had greater mean training hours (p<.001) overall and for each depression care component (cognitive behavioral therapy, care management, other trainings, p<.001) except medication management. Conclusions Compared with RS, CEP to implement depression quality improvement increased program and staff training participation overall. CEP had a greater effect on any staff training participation within social-community sectors than RS, but not within healthcare. CEP may be an effective strategy to promote staff participation in depression improvement in under-resourced communities. PMID:25930037

  9. Strategies to Support the Integration of Behavioral Health and Primary Care: What Have We Learned Thus Far?

    PubMed

    Dickinson, W Perry

    2015-01-01

    The articles in this supplement contain a wealth of practical information regarding the integration of behavioral health and primary care. This type of integration effort is complex and greatly benefits from support from outside organizations, as well as collaboration with other practices attempting similar work. This editorial extracts from these articles some of the key lessons learned regarding the integration of behavioral health and primary care for practices and for organizations that support practice transformation.

  10. Overview and Categorization of Robots Supporting Independent Living of Elderly People: What Activities Do They Support and How Far Have They Developed.

    PubMed

    Bedaf, Sandra; Gelderblom, Gert Jan; De Witte, Luc

    2015-01-01

    Over the past decades, many robots for the elderly have been developed, supporting different activities of elderly people. A systematic review in four scientific literature databases and a search in article references and European projects was performed in order to create an overview of robots supporting independent living of elderly people. The robots found were categorized based on their development stage, the activity domains they claim to support, and the type of support provided (i.e., physical, non-physical, and/or non-specified). In total, 107 robots for the elderly were identified. Six robots were still in a concept phase, 95 in a development phase, and six of these robots were commercially available. These robots claimed to provide support related to four activity domains: mobility, self-care, interpersonal interaction & relationships, and other activities. Of the many robots developed, only a small percentage is commercially available. Technical ambitions seem to be guiding robot development. To prolong independent living, the step towards physical support is inevitable and needs to be taken. However, it will be a long time before a robot will be capable of supporting multiple activities in a physical manner in the home of an elderly person in order to enhance their independent living.

  11. Child Care Center Characteristics Associated With Preschoolers’ Physical Activity

    PubMed Central

    Copeland, Kristen A.; Khoury, Jane C.; Kalkwarf, Heidi J.

    2015-01-01

    Introduction Despite children spending long hours in child care centers, it is unknown what center characteristics are associated with children’s moderate to vigorous physical activity (MVPA) at the center and over the 24-hour day. Methods Mixed model ANOVA evaluated associations between 23 center characteristics (e.g., policies, facilities, practices, and staff training) and time in MVPA, measured with accelerometers, at the child care center and over the 24-hour day among 388 preschoolers from 30 randomly selected child care centers in Cincinnati, Ohio. Data collection occurred from November 2009 through January 2011; data analyses occurred in 2012–2014. Results Ninety percent of centers reported scheduling two or more outdoor sessions daily, yet only 40% of children had two or more outdoor sessions; 32% had no time outdoors. Eighty-three percent of centers reported scheduling ≥60 minutes outdoors; 28% of children experienced this during observation. Children spent a mean (SE) of 2.0 (0.06) minutes/hour in MVPA. Children with ≥60 minutes outdoor time had 0.6 minutes/hour more MVPA in child care (p=0.001), and 0.5 minutes/hour over the 24-hour day (p=0.001) than those who did not. Presence of an indoor play space, large outdoor playground, portable or fixed play equipment, staff PA training, weather and clothing policies, and TV/computer use were not related to children’s MVPA. Conclusions Outdoor time occurred less frequently than scheduled. Children with ≥60 minutes of outdoor time at the center were more active than children without. Centers may increase preschoolers’ PA by adhering to the scheduled ≥60 minutes of outdoor time daily. PMID:26585052

  12. Automatic indexing and retrieval of encounter-specific evidence for point-of-care support.

    PubMed

    O'Sullivan, Dympna M; Wilk, Szymon A; Michalowski, Wojtek J; Farion, Ken J

    2010-08-01

    Evidence-based medicine relies on repositories of empirical research evidence that can be used to support clinical decision making for improved patient care. However, retrieving evidence from such repositories at local sites presents many challenges. This paper describes a methodological framework for automatically indexing and retrieving empirical research evidence in the form of the systematic reviews and associated studies from The Cochrane Library, where retrieved documents are specific to a patient-physician encounter and thus can be used to support evidence-based decision making at the point of care. Such an encounter is defined by three pertinent groups of concepts - diagnosis, treatment, and patient, and the framework relies on these three groups to steer indexing and retrieval of reviews and associated studies. An evaluation of the indexing and retrieval components of the proposed framework was performed using documents relevant for the pediatric asthma domain. Precision and recall values for automatic indexing of systematic reviews and associated studies were 0.93 and 0.87, and 0.81 and 0.56, respectively. Moreover, precision and recall for the retrieval of relevant systematic reviews and associated studies were 0.89 and 0.81, and 0.92 and 0.89, respectively. With minor modifications, the proposed methodological framework can be customized for other evidence repositories.

  13. [Consultations in oncological supportive care mono-, multi-, ou interdisciplinary: What should we favour?].

    PubMed

    Garnier, Stéphanie Ranque; Pelletti, Caroline; Quenard, Christelle; Vallet, Fabienne; Lemoine, Patrick; Guastella, Virginie; Rhondali, Wadih

    2015-09-01

    According to the point 7.6 and 7.7 of the Cancer Plan 2014, all cancer patients should have access to supportive care. Indeed, the supportive care consultation in oncology is an important tool for the symptom management of cancer patients at all times of treatment. This consultation can be mono-disciplinary or multi-disciplinary (with different professions: physician, nurse, psychologist, social service assistant…) with or without integration (multidisciplinary or interdisciplinary). There are few studies focusing on the types of consultations (mono- or multidisciplinary) to promote based on their expected outcomes. After describing the different types of consultations (initial, follow-up, unscheduled, discharge) and having highlighted the main issues of these consultations, we will present the possible configurations. Our discussion will concern then the advantages and disadvantages of monodisciplinarity and different types of multidisciplinary highlighting the possible improvements. At the end of this work, after a brief synthesis of the different outcomes associated with each type of consultation, we would like to discuss the type of consultation to choose according to the outcomes.

  14. The Role of Online Social Support in Supporting and Educating Parents of Young Children With Special Health Care Needs in the United States: A Scoping Review

    PubMed Central

    Staten, Lisa K; Rodgers, Rylin Christine; Denne, Scott C

    2016-01-01

    Background When parents of young children with special health care needs (CSHCN) receive their child’s diagnosis, they encounter information they may not understand, emotions they may not know how to cope with, and questions about their child’s immediate and long-term future that frequently lack answers. The challenge of health care providers is how to prepare parents for caring for their CSHCN, for coping with any resulting challenges, and for accessing the systems and services that can assist them. Objective The purpose of this work was to review evidence of the information and support needs of parents of young CSHCN and to determine whether online social support can serve as an avenue for learning and empowerment for these parents. Methods A scoping review identified the challenges, coping mechanisms, and support needs among parents of CSHCN, and the reach and effectiveness of digital technologies with these families and health care providers. We also conducted interviews with professionals serving parents of CSHCN. Results The literature review and interviews suggested that parents best learn the information they need, and cope with the emotional challenges of raising a CSHCN, with support from other parents of CSHCN, and that young parents in recent years have most often been finding this parent-to-parent support through digital media, particularly social media, consistent with the theory of online social support. Evidence also shows that social media, particularly Facebook, is used by nearly all women aged 18-29 years across racial and socioeconomic lines in the United States. Conclusions Parents of young CSHCN experience significant stress but gain understanding, receive support, and develop the ability to care for and be advocates for their child through parent-to-parent emotional and informational social support. Online social support is most effective with young adults of childbearing age, with social media and apps being the most useful within the

  15. Relationship between social support, mental health and health care consciousness in developing the industrial health education of male employees.

    PubMed

    Fujita, Daisuke; Kanaoka, Midori

    2003-11-01

    The purpose of the study is to elucidate the relationship between social support, health care consciousness and mental health in developing the industrial health education aimed at improving the health habits of male employees. A questionnaire survey concerning health practices, mental health based on the General Health Questionnaire, social support from social support networks, and health care consciousness based on the Health Locus of Control was conducted on male employees in three companies in Osaka Prefecture. A total of 1,634 questionnaires were collected. Analyses by age group showed that in all age groups, the higher the social support score, the more favorable the mental health became and the stronger the family care in health care consciousness became. The better the mental health, the greater the number of good health practices was and the lower the fortune dependence in health care consciousness tended to be. The results of the study reconfirm the previous findings that it is necessary to put the mental health of male employees in good condition before everything else in effectively developing health education aimed at improving their health habits. This study also indicates that the level of perception of social support and their internal control of self and family in health care consciousness are definitely related to the stability of subjects' mental health. It is therefore presumed that measures to raise the revel of perception of social support are important since they may improve the mental health of subjects.

  16. Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004–2012

    PubMed Central

    Hamel, Donald J.; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D.; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T.; Okonkwo, Prosper; Kanki, Phyllis J.

    2015-01-01

    Introduction From 2004–2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President’s Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Methods Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Results Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Conclusions Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other

  17. Chemotherapy Plus Best Supportive Care versus Best Supportive Care in Patients with Non-Small Cell Lung Cancer: A Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Jiang, Liyan; Zhang, Wei

    2013-01-01

    Background The use of chemotherapy has been proposed to increase the effectiveness of best supportive care (BSC) in patients with non-small cell lung cancer (NSCLC). Previous trials reported inconsistent findings regarding the efficacy and safety of chemotherapy on overall survival (OS) and treatment-related mortality. We performed a systematic review and meta-analysis to evaluate the effects of chemotherapy plus BSC versus BSC alone on survival of patients with NSCLC. Methodology and Principal Findings We systematically searched PubMed, EmBase, and the Cochrane Central Register of Controlled Trials for relevant literature. All eligible studies included patients with NSCLC who had received chemotherapy and BSC or BSC alone. All eligible studies measured at least 1 of the following outcomes: OS or treatment-related mortality. Overall, patients that received chemotherapy plus BSC had significant longer OS than those that received BSC alone (HR, 0.76; 95%CI, 0.69–0.84; P<0.001). Additionally, chemotherapy plus BSC as compared to BSC alone resulted in a 28% RR reduction (95%CI: 12–40; P = 0.001) in 6-month mortality, 11% RR reduction (95%CI: 8–15; P<0.001) in 12-month mortality, and 5% RR reduction (95%CI: 1–8; P = 0.02) in 2-year mortality. Toxicity was greater in patients that received chemotherapy plus BSC. Conclusion/Significance Chemotherapy plus BSC increased the OS and reduced the 6-month, 12-month, and 2-year mortality of NSCLC patients. PMID:23555583

  18. A phase 3 trial evaluating panitumumab plus best supportive care vs best supportive care in chemorefractory wild-type KRAS or RAS metastatic colorectal cancer

    PubMed Central

    Kim, Tae Won; Elme, Anneli; Kusic, Zvonko; Park, Joon Oh; Udrea, Anghel Adrian; Kim, Sun Young; Ahn, Joong Bae; Valencia, Ricardo Villalobos; Krishnan, Srinivasan; Bilic, Ante; Manojlovic, Nebojsa; Dong, Jun; Guan, Xuesong; Lofton-Day, Catherine; Jung, A Scott; Vrdoljak, Eduard

    2016-01-01

    Background: We assessed the treatment effect of panitumumab plus best supportive care (BSC) vs BSC on overall survival (OS) in patients with chemorefractory wild-type KRAS exon 2 metastatic colorectal cancer (mCRC) and report the first prospective extended RAS analysis in a phase 3 trial. Methods: Patients with wild-type KRAS exon 2 mCRC were randomised 1 : 1 to panitumumab (6 mg kg−1 Q2W) plus BSC or BSC. On-study crossover was prohibited. RAS mutation status was determined by central laboratory testing. The primary endpoint was OS in wild-type KRAS exon 2 mCRC; OS in wild-type RAS mCRC (KRAS and NRAS exons 2, 3, and 4) was a secondary endpoint. Results: Three hundred seventy seven patients with wild-type KRAS exon 2 mCRC were randomised. Median OS was 10.0 months with panitumumab plus BSC vs 7.4 months with BSC (HR=0.73; 95% CI=0.57–0.93; P=0.0096). RAS ascertainment was 86%. In wild-type RAS mCRC, median OS for panitumumab plus BSC was 10.0 vs 6.9 months for BSC (HR=0.70; 95% CI=0.53–0.93; P=0.0135). Patients with RAS mutations did not benefit from panitumumab (OS HR=0.99; 95% CI=0.49–2.00). No new safety signals were observed. Conclusions: Panitumumab significantly improved OS in wild-type KRAS exon 2 mCRC. The effect was more pronounced in wild-type RAS mCRC, validating previous retrospective analyses. PMID:27736842

  19. Matched-Pair Comparison of Radioembolization Plus Best Supportive Care Versus Best Supportive Care Alone for Chemotherapy Refractory Liver-Dominant Colorectal Metastases

    SciTech Connect

    Seidensticker, Ricarda; Denecke, Timm; Kraus, Patrick; Seidensticker, Max; Mohnike, Konrad; Fahlke, Joerg; Kettner, Erika; Dudeck, Oliver; Pech, Maciej; Amthauer, Holger; Ricke, Jens

    2012-10-15

    Purpose: This study was designed to evaluate overall survival after radioembolization or best supportive care (BSC) in patients with chemotherapy-refractory liver-dominant metastatic colorectal cancer (mCRC). Methods: This was a matched-pair comparison of patients who received radioembolization plus BSC or BSC alone for extensive liver disease. Twenty-nine patients who received radioembolization were retrospectively matched with a contemporary cohort of >500 patients who received BSC from 3 centers in Germany. Using clinical databases, patients were initially matched for prior treatments and tumor burden and then 29 patients were consecutively identified with two or more of four matching criteria: synchronous/metachronous metastases, tumor burden, increased ALP, and/or CEA >200 U/ml. Survival was calculated from date of progression before radioembolization or BSC by using Kaplan-Meier analysis. Results: Of 29 patients in each study arm, 16 pairs (55.2%) matched for all four criteria, and 11 pairs (37.9%) matched three criteria. Patients in both groups had a similar performance status (Karnofsky index, median 80% [range, 60-100%]). Compared with BSC alone, radioembolization prolonged survival (median, 8.3 vs. 3.5 months; P < 0.001) with a hazard ratio of 0.3 (95% confidence interval, 0.16-0.55; P < 0.001) in a multivariate Cox proportional hazard model. Treatment-related adverse events following radioembolization included: grade 1-2 fatigue (n = 20, 69%), grade 1 abdominal pain/nausea (n = 14, 48.3%), and grade 2 gastrointestinal ulceration (n = 3, 10.3%). Three cases of grade 3 radiation-induced liver disease were symptomatically managed. Conclusions: Radioembolization offers a promising addition to BSC in treatment-refractory patients for whom there are limited options. Survival was prolonged and adverse events were generally mild-to-moderate in nature and manageable.

  20. Who's there and who cares: age as an indicator of social support networks for caregivers among people living with motor neurone disease.

    PubMed

    Ray, Robin A; Street, Annette F

    2005-11-01

    This paper explores the social support networks available to the informal carers of people living with motor neurone disease (MND). An ethnographic case study was undertaken using eco mapping, observation and conversational interviews to collect data from 18 primary carers of people living with MND. Interviews took place in participants' homes in metropolitan, regional and rural locations. Participants discussed the content of their support network and drew lines between individuals to indicate the type and strength of relationship. Changes to the network were depicted on eco maps during subsequent interviews. While health policy-makers assume that healthy social capital exists in Australian communities and that social cohesion will ensure active and available support networks in times of illness or disability, data from this exploratory study indicated that this was not consistently the case. Support networks varied in size and composition; however, age was identified as a discriminator of the availability and consistency of support. People in older age groups identified more diverse but consistent support systems while people in younger age groups reported more fluctuations in the strength of relationships and declines in support as caregiving became more demanding. Individual assessment of support networks at regular intervals in the caregiving trajectory is vital for all carers. However carers in younger age groups may need specific support to manage the psychological crises that occur and more access to paid care. Older carers may need consistent support to handle more of the instrumental aspects of care and assistance to mobilise their support networks. Community workers should be alert to the possible need for crisis intervention when tensions in relationships threaten carers' ability to provide effective care.

  1. Defense Health Care: More-Specific Guidance Needed for TRICARE’s Managed Care Support Contractor Transitions

    DTIC Science & Technology

    2014-06-01

    military treatment facilities—a system that was also not tested prior to health care delivery, unlike other critical system interfaces. In addition...claims processing, TMA did not test UnitedHealth’s referral process prior to health care delivery. According to both TRO-West and UnitedHealth officials... testing would have been beneficial for determining whether their interface would work at the start of health care

  2. Mesoscopic Patterns of Neural Activity Support Songbird Cortical Sequences

    PubMed Central

    Guitchounts, Grigori; Velho, Tarciso; Lois, Carlos; Gardner, Timothy J.

    2015-01-01

    Time-locked sequences of neural activity can be found throughout the vertebrate forebrain in various species and behavioral contexts. From “time cells” in the hippocampus of rodents to cortical activity controlling movement, temporal sequence generation is integral to many forms of learned behavior. However, the mechanisms underlying sequence generation are not well known. Here, we describe a spatial and temporal organization of the songbird premotor cortical microcircuit that supports sparse sequences of neural activity. Multi-channel electrophysiology and calcium imaging reveal that neural activity in premotor cortex is correlated with a length scale of 100 µm. Within this length scale, basal-ganglia–projecting excitatory neurons, on average, fire at a specific phase of a local 30 Hz network rhythm. These results show that premotor cortical activity is inhomogeneous in time and space, and that a mesoscopic dynamical pattern underlies the generation of the neural sequences controlling song. PMID:26039895

  3. Mesoscopic patterns of neural activity support songbird cortical sequences.

    PubMed

    Markowitz, Jeffrey E; Liberti, William A; Guitchounts, Grigori; Velho, Tarciso; Lois, Carlos; Gardner, Timothy J

    2015-06-01

    Time-locked sequences of neural activity can be found throughout the vertebrate forebrain in various species and behavioral contexts. From "time cells" in the hippocampus of rodents to cortical activity controlling movement, temporal sequence generation is integral to many forms of learned behavior. However, the mechanisms underlying sequence generation are not well known. Here, we describe a spatial and temporal organization of the songbird premotor cortical microcircuit that supports sparse sequences of neural activity. Multi-channel electrophysiology and calcium imaging reveal that neural activity in premotor cortex is correlated with a length scale of 100 µm. Within this length scale, basal-ganglia-projecting excitatory neurons, on average, fire at a specific phase of a local 30 Hz network rhythm. These results show that premotor cortical activity is inhomogeneous in time and space, and that a mesoscopic dynamical pattern underlies the generation of the neural sequences controlling song.

  4. Adherence to physical activity guidelines among cancer support group participants.

    PubMed

    Stevinson, C; Lydon, A; Amir, Z

    2014-03-01

    Physical activity is recommended after cancer diagnosis for physical function, quality of life and survival benefits. This study provided preliminary data on the prevalence of physical activity among adult men and women with cancer in the UK. As part of a national survey of cancer support group participation, questionnaires including items on leisure-time physical activity and demographic information were completed by 748 cancer survivors. Overall, 395 (52.8%) participants reported no weekly moderate or vigorous intensity physical activity, 221 (29.5%) reported some activity but below minimum recommendations and 132 (17.6%) were meeting published guidelines. Gender, health status and socio-economic status were independently associated with meeting guidelines. Among participants in good or fair health who were not meeting guidelines, 59.9% thought that they ought to be more physically active. In conclusion, overall levels of physical activity are low among cancer survivors in the UK. However, the majority of insufficiently active participants showed awareness of the need to increase their activity, and may be receptive to interventions for promoting physical activity in this population.

  5. HOBE+, a case study: a virtual community of practice to support innovation in primary care in Basque Public Health Service

    PubMed Central

    2013-01-01

    Background A virtual professional community of practice (VCoP), HOBE+, has been set up to foster and facilitate innovation in primary care. It is aimed at all primary care professionals of the Basque Public Health Service (Osakidetza) in the provinces of Biscay and Araba. HOBE + is a VCoP that incorporates innovation management from the generation of ideas to their implementation in primary care practice. Methods We used a case study method, based on the data provided by the technology platform that supports the VCoP, and from a survey completed by HOBE + users. The target population was all primary care staff (including all professional categories) from Araba and Biscay provinces of the Basque Country (Spain), who represent the target users of the VCoP. Results From a total of 5190 professionals across all the professional categories invited to join, 1627 (31.3%) actually registered in the VCoP and, during the study period, 90 (5.5% of the registered users) participated actively in some way. The total number of ideas proposed by the registered users was 133. Of these, 23 ideas (17.2%) are being implemented. Finally, 80% of the users who answered the satisfaction survey about their experience with HOBE + considered the initiative useful in order to achieve continuous improvement and real innovation in clinical and managerial processes. Conclusions The experience shows that it is possible to create a virtual CoP for innovation in primary care where professionals from different professional categories propose ideas for innovation that are ultimately implemented. This manuscript objectives are to assess the process of developing and implementing a VCoP open to all primary care professionals in Osakidetza, including the take-up, participation and use of this VCoP in the first 15 months after its launch in October 2011. In addition, the usefulness of the VCoP was assessed through a survey gathering the opinions of the professionals involved. PMID:24188617

  6. Planning for subacute care: predicting demand using acute activity data.

    PubMed

    Green, Janette P; McNamee, Jennifer P; Kobel, Conrad; Seraji, Md Habibur R; Lawrence, Suanne J

    2016-04-07

    Objective The aim of the present study was to develop a robust model that uses the concept of 'rehabilitation-sensitive' Diagnosis Related Groups (DRGs) in predicting demand for rehabilitation and geriatric evaluation and management (GEM) care following acute in-patient episodes provided in Australian hospitals.Methods The model was developed using statistical analyses of national datasets, informed by a panel of expert clinicians and jurisdictional advice. Logistic regression analysis was undertaken using acute in-patient data, published national hospital statistics and data from the Australasian Rehabilitation Outcomes Centre.Results The predictive model comprises tables of probabilities that patients will require rehabilitation or GEM care after an acute episode, with columns defined by age group and rows defined by grouped Australian Refined (AR)-DRGs.Conclusions The existing concept of rehabilitation-sensitive DRGs was revised and extended. When applied to national data, the model provided a conservative estimate of 83% of the activity actually provided. An example demonstrates the application of the model for service planning.What is known about the topic? Health service planning is core business for jurisdictions and local areas. With populations ageing and an acknowledgement of the underservicing of subacute care, it is timely to find improved methods of estimating demand for this type of care. Traditionally, age-sex standardised utilisation rates for individual DRGs have been applied to Australian Bureau of Statistics (ABS) population projections to predict the future need for subacute services. Improved predictions became possible when some AR-DRGs were designated 'rehabilitation-sensitive'. This improved methodology has been used in several Australian jurisdictions.What does this paper add? This paper presents a new tool, or model, to predict demand for rehabilitation and GEM services based on in-patient acute activity. In this model, the methodology

  7. Community leaders' perceptions of Hispanic, single, low-income mothers' needs, concerns, social support, and interactions with health care services.

    PubMed

    Campbell-Grossman, Christie; Hudson, Diane Brage; Keating-Lefler, Rebecca; Yank, Jodell R; Obafunwa, Titilola

    2009-01-01

    Hispanic, single, low-income mothers are a vulnerable population who are often identified as having difficult transitioning to motherhood and successfully using the U.S. health care system. The purpose of this study was to examine needs, concerns, and social support of Hispanic, single, low-income mothers during the transition to motherhood through the eyes of community leaders serving this population in the U.S. Two focus groups were conducted, and 16 Midwestern community leaders working or volunteering with the Hispanic population expressed their opinions. Two investigators and two graduate nursing students evaluated the data. The process of word and context interpretation was completed using a combination of Tesch (1990) and Creswell (2007) techniques. Data were compared to field notes and debriefing summaries were completed during focus group discussions. Four themes and 12 subthemes evolved from the group discussions. Themes were (a) mothers' social support, (b) interactions with health care providers, (c) barriers in trust, and (d) practical life issues. A conclusion was drawn from these data that these women have difficulty accessing social support and information regarding care of themselves and their newborn infants due to limited social networks and barriers to health care. Nurses are in key positions to offer culturally sensitive social support and identify health care barriers with Hispanic, single, low-income mothers during the transition to motherhood. Further research is needed on interventions that effectively deliver information, lower health care barriers, and meet social support needs of Hispanic, single, low-income mothers and their infants.

  8. Enrolment of children and adolescents in psychosocial care: more likely with low family social support and poor parenting skills.

    PubMed

    Nanninga, Marieke; Jansen, Danielle E M C; Knorth, Erik J; Reijneveld, Sijmen A

    2015-04-01

    Knowledge about determinants of child and adolescent enrolment in psychosocial care concerns only single types of care and usually only socio-demographic factors. The social environment is also a likely key determinant but evidence is lacking. The aim of this study was to examine the associations between family social support, parenting skills and child and adolescent enrolment in psychosocial care. We obtained data on 1,331 children (response rate 56.6%), 4-18 years old, enrolled in preventive child health care, and child and adolescent social care and mental health care because of psychosocial problems, and on 463 children (response rate 70.3%) not enrolled in psychosocial care. Results showed that enrolment in psychosocial care was associated with low family social support (odds ratio; 95%-confidence interval: 3.2; 2.4-4.4), and with poor parenting skills, i.e. poor supervision (1.5; 1.1-2.1) and inconsistent disciplining (1.5; 1.1-2.1). Children's psychosocial problems partially mediated the associations with family social support and completely with parenting skills. Children's problems did not moderate the associations. Positive parenting was not associated with care enrolment. We conclude that low family social support and poor parenting are important factors associated with enrolment, in particular because they are associated with more frequent occurrence of children's psychosocial problems. This implies that professionals and policymakers need to be aware that factors in children's social environment are related with enrolment in psychosocial care, in addition to children's psychosocial problems.

  9. The Adam language: Ada extended with support for multiway activities

    NASA Technical Reports Server (NTRS)

    Charlesworth, Arthur

    1993-01-01

    The Adam language is an extension of Ada that supports multiway activities, which are cooperative activities involving two or more processes. This support is provided by three new constructs: diva procedures, meet statements, and multiway accept statements. Diva procedures are recursive generic procedures having a particular restrictive syntax that facilitates translation for parallel computers. Meet statements and multiway accept statements provide two ways to express a multiway rendezvous, which is an n-way rendezvous generalizing Ada's 2-way rendezvous. While meet statements tend to have simpler rules than multiway accept statements, the latter approach is a more straightforward extension of Ada. The only nonnull statements permitted within meet statements and multiway accept statements are calls on instantiated diva procedures. A call on an instantiated diva procedure is also permitted outside a multiway rendezvous; thus sequential Adam programs using diva procedures can be written. Adam programs are translated into Ada programs appropriate for use on parallel computers.

  10. Circles of Care: Development and Initial Evaluation of a Peer Support Model for African Americans with Advanced Cancer

    ERIC Educational Resources Information Center

    Hanson, Laura C.; Armstrong, Tonya D.; Green, Melissa A.; Hayes, Michelle; Peacock, Stacie; Elliot-Bynum, Sharon; Goldmon, Moses V.; Corbie-Smith, Giselle; Earp, Jo Anne

    2013-01-01

    Peer support interventions extend care and health information to underserved populations yet rarely address serious illness. Investigators from a well-defined academic-community partnership developed and evaluated a peer support intervention for African Americans facing advanced cancer. Evaluation methods used the Reach, Efficacy, Adoption,…

  11. Support System of Health Professionals as Observed in the Project of Home Care For the Child With Cancer.

    ERIC Educational Resources Information Center

    Gronseth, Evangeline; And Others

    1981-01-01

    Data acquired in personal interviews administered to physicians and nurses who participated in the first year of the Home Care for the Child with Cancer project provided descriptions of individual sources of social support. The results reveal a range of supportive mechanisms and networks within varied institutional contexts. (Author)

  12. Enhanced support for shared decision making reduced costs of care for patients with preference-sensitive conditions.

    PubMed

    Veroff, David; Marr, Amy; Wennberg, David E

    2013-02-01

    Shared decision making is an approach to care that seeks to fully inform patients about the risks and benefits of available treatments and engage them as participants in decisions about the treatments. Although recent federal and state policies pursue the expanded use of shared decision making as a way to improve care quality and patient experience, payers and providers want evidence that this emerging model of care is cost-effective. We examined data obtained from a year-long randomized investigation. The study compared the effects on patients of receiving a usual level of support in making a medical treatment decision with the effects of receiving enhanced support, which included more contact with trained health coaches through telephone, mail, e-mail, and the Internet. We found that patients who received enhanced support had 5.3 percent lower overall medical costs than patients who received the usual level of support. The enhanced-support group had 12.5 percent fewer hospital admissions than the usual-support group, and 9.9 percent fewer preference-sensitive surgeries, including 20.9 percent fewer preference-sensitive heart surgeries. These findings indicate that support for shared decision making can generate savings. They also suggest that a "remote" model of support-combining telephonic coaching with decision aids, for example-may constitute a relatively low-cost and effective intervention that could reach broader populations without the need for the direct involvement of regular medical care team members.

  13. Lessons Learnt from Applying Action Research to Support Strategy Formation Processes in Long-Term Care Networks

    ERIC Educational Resources Information Center

    Cramer, Hendrik; Dewulf, Geert; Voordijk, Hans

    2015-01-01

    This study demonstrates how action research (AR) that is aimed at scaling-up experiments can be applied to support a strategy formation process (SFP) in a subsidized long-term care network. Previous research has developed numerous AR frameworks to support experiments in various domains, but has failed to explain how to apply AR and action learning…

  14. Neglecting the Importance of the Decision Making and Care Regimes of Personal Support Workers: A Critique of Standardization of Care Planning Through the RAI/MDS

    PubMed Central

    Kontos, Pia C.; Miller, Karen-Lee; Mitchell, Gail J.

    2010-01-01

    Purpose: The Resident Assessment Instrument–Minimum Data Set (RAI/MDS) is an interdisciplinary standardized process that informs care plan development in nursing homes. This standardized process has failed to consistently result in individualized care planning, which may suggest problems with content and planning integrity. We examined the decision making and care practices of personal support workers (PSWs) in relation to the RAI/MDS standardized process. Design and Methods: This qualitative study utilized focus groups and semi-structured interviews with PSWs (n = 26) and supervisors (n = 9) in two nursing homes in central Canada. Results: PSWs evidenced unique occupational contributions to assessment via proximal familiarity and biographical information as well as to individualizing care by empathetically linking their own bodily experiences and forging bonds of fictive kinship with residents. These contributions were neither captured by RAI/MDS categories nor relayed to the interdisciplinary team. Causal factors for PSW exclusion included computerized records, low status, and poor interprofessional collaboration. Intraprofessional collaboration by PSWs aimed to compensate for exclusion and to individualize care. Implications: Exclusive institutional reliance on the RAI/MDS undermines quality care because it fails to capture residents’ preferences and excludes input by PSWs. Recommendations include incorporating PSW knowledge in care planning and documentation and examining PSWs’ nascent occupational identity and their role as interprofessional brokers in long-term care. PMID:20026525

  15. The most important needs and preferences of patients for support from health care professionals: A reflective practice on (transitional) care for young adults with Juvenile Idiopathic Arthritis.

    PubMed

    Ammerlaan, Judy W; van Os-Medendorp, Harmieke; de Boer-Nijhof, Nienke C; Prakken, Berent; Bijlsma, Johannes W J; Kruize, Aike A

    2017-03-12

    In this manuscript, presented as a Reflective Practice, the learning experiences and reflections of a healthcare team on redeveloping the transitional care for young adults with a juvenile rheumatic disease are described. In this process of redeveloping care, the healthcare team experienced that small step, driven by patient stories and involvement of patients in all phases from development to evaluation, led to meaningful results. The eHealth interventions, developed to support the transition and to increase self-management were found to be feasible and evaluated positively by the young adult group. But the healthcare team also experienced that the focus on the patient alone, is not enough to implement self-management interventions and sustain patient centered care in daily practice. How healthcare professionals personally think and feel about patient centered care is essential and needs to be discussed in daily care.It determines the way of being present with attention and commitment in daily health care. It affects the hands, head and heart. A daily reflection on shared answers of the patient and the health care professional to the question 'what is the most important to you?'may help to implement patient centered care in health practice.

  16. EERE-Supported International Activities in Latin America (Fact Sheet)

    SciTech Connect

    Not Available

    2010-05-01

    The Office of Energy Efficiency and Renewable Energy (EERE) is involved in a variety of international initiatives, partnerships, and events that promote greater understanding and use of renewable energy (RE) and energy efficiency (EE) worldwide. In support of the Energy and Climate Partnership of the Americas (ECPA), EERE is working with several Latin American countries to advance EE and RE deployment for economic growth, energy security, poverty relief, and disaster recovery goals. This fact sheet highlights those activities.

  17. Development, deployment and usability of a point-of-care decision support system for chronic disease management using the recently-approved HL7 decision support service standard.

    PubMed

    Lobach, David F; Kawamoto, Kensaku; Anstrom, Kevin J; Russell, Michael L; Woods, Peter; Smith, Dwight

    2007-01-01

    Clinical decision support is recognized as one potential remedy for the growing crisis in healthcare quality in the United States and other industrialized nations. While decision support systems have been shown to improve care quality and reduce errors, these systems are not widely available. This lack of availability arises in part because most decision support systems are not portable or scalable. The Health Level 7 international standard development organization recently adopted a draft standard known as the Decision Support Service standard to facilitate the implementation of clinical decision support systems using software services. In this paper, we report the first implementation of a clinical decision support system using this new standard. This system provides point-of-care chronic disease management for diabetes and other conditions and is deployed throughout a large regional health system. We also report process measures and usability data concerning the system. Use of the Decision Support Service standard provides a portable and scalable approach to clinical decision support that could facilitate the more extensive use of decision support systems.

  18. 76 FR 60134 - Agency Information Collection (Child Care Subsidy) Activity Under OMB Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-28

    ... AFFAIRS Agency Information Collection (Child Care Subsidy) Activity Under OMB Review AGENCY: Human... INFORMATION: Titles a. Child Care Subsidy Application Form, VA Form 0730a. b. Child Care Provider Information (For the Child Care Subsidy Program), VA Form 0730b. OMB Control Number: 2900-0717. Type of...

  19. 76 FR 44091 - Proposed Information Collection (Child Care Subsidy) Activity: Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-22

    ... AFFAIRS Proposed Information Collection (Child Care Subsidy) Activity: Comment Request AGENCY: Human...' eligibility to participate in VA's child care subsidy program. DATES: Written comments and recommendations on.... Child Care Subsidy Application Form, VA Form 0730a. b. Child Care Provider Information (For the...

  20. The effect of clothing care activities on textile formaldehyde content.

    PubMed

    Novick, Rachel M; Nelson, Mindy L; McKinley, Meg A; Anderson, Grace L; Keenan, James J

    2013-01-01

    Textiles are commonly treated with formaldehyde-based residues that may potentially induce allergic contact dermatitis in sensitive individuals. This study examined the initial formaldehyde content in clothing and resulting changes due to care activities. Twenty clothing articles were examined and 17 of them did not have detectable levels of formaldehyde. One shirt contained a formaldehyde concentration of 3172 ppm, and two pairs of pants had formaldehyde concentrations of 1391 ppm and 86 ppm. The two highest results represent formaldehyde levels that are up to 40-fold greater than international textile regulations. The two items with the greatest formaldehyde content were washed and dried in a manner similar to that used by consumers, including hand and machine washing in hot or cold water followed by air or machine drying. The washing and drying procedures reduced formaldehyde levels to between 26 and 72% of untreated controls. Differences in the temperature or type of washing and drying did not result in a clear trend in the subsequent formaldehyde content. In addition, samples were hot ironed, which did not affect the formaldehyde content as significantly. Understanding the formaldehyde content in clothing and its potential reduction through care activities may be useful for manufacturers and formaldehyde-sensitive individuals.

  1. A Comparative Study on Resilience, Perceived Social Support and Hopelessness Among Cancer Patients Treated with Curative and Palliative Care

    PubMed Central

    Somasundaram, Ravindran Ottilingam; Devamani, Kiran A

    2016-01-01

    Aim: Psychological distress is common among patients affected by cancer. In this study, we examined the relationship between resilience, social support, and hopelessness among cancer patients treated with curative and palliative care. Patients and Methods: Sixty cancer patients in the age range of 18–65 years were randomly selected and divided into two groups based on their treatment intent namely, curative care (n = 30) and palliative care (n = 30). Both groups were assessed by the following instruments: Bharathiar University Resilience Scale, Multidimensional Scale of Perceived Social Support and Beck Hopelessness Scale. Results: Resilience was significantly associated with less hopelessness and higher levels of perceived social support. Conclusion: Cancer patients are found to be resilient, and the role of social support and hopelessness on promoting resilience cannot be ignored. PMID:27162423

  2. An Australasian perspective on the curative treatment of patients with pancreatic cancer, supportive care, and future directions for management

    PubMed Central

    Muircroft, Wendy

    2016-01-01

    The management of patients with pancreatic cancer requires an individualised approach and the support of a multidisciplinary team to accurately stage patients and determine their suitability for curative treatment. Guidelines have been developed in Australasia to define the operability for patients who have been diagnosed with pancreatic cancer. This is supported by advances in pancreatic cancer genetics, which show potential for developing targeted therapies for pancreatic cancer. Both surgery and targeted therapies aim to extend the overall survival of patients. Patients who are cured of their cancer may live with permanent changes in gut anatomy and physiology leading to distressing symptoms that may not be addressed. Patients who cannot be cured of pancreatic cancer may have supportive care issues that are often complex, and a strategic approach to manage these needs for patients with pancreatic cancer is underdeveloped in Australasia. Supportive care services need to be in a position to adapt patient care as the evidence base develops. PMID:28105071

  3. Evaluation of computerized decision support for oral anticoagulation management based in primary care.

    PubMed Central

    Fitzmaurice, D A; Hobbs, F D; Murray, E T; Bradley, C P; Holder, R

    1996-01-01

    BACKGROUND: Increasing indications for oral anticoagulation has led to pressure on general practices to undertake therapeutic monitoring. Computerized decision support (DSS) has been shown to be effective in hospitals for improving clinical management. Its usefulness in primary care has previously not been investigated. AIM: To test the effectiveness of using DSS for oral anticoagulation monitoring in primary care by measuring the proportions of patients adequately controlled, defined as within the appropriate therapeutic range of International Normalised Ratio (INR). METHOD: All patients receiving warfarin from two Birmingham inner city general practices were invited to attend a practice-based anticoagulation clinic. In practice A all patients were managed using DSS. In practice B patients were randomized to receive dosing advice either through DSS or through the local hospital laboratory. Clinical outcomes, adverse events and patient acceptability were recorded. RESULTS: Forty-nine patients were seen in total. There were significant improvements in INR control from 23% to 86% (P > 0.001) in the practice where all patients received dosing through DSS. In the practice where patients were randomized to either DSS or hospital dosing, logistic regression showed a significant trend for improvement in intervention patients which was not apparent in the hospital-dosed patients (P < 0.001). Mean recall times were significantly extended in patients who were dosed by the practice DSS through the full 12 months (24 days to 36 days) (P = 0.033). Adverse events were comparable between hospital and practice-dosed patients, although a number of esoteric events occurred. Patient satisfaction with the practice clinics was high. CONCLUSION: Computerized DSS enables the safe and effective transfer of anticoagulation management from hospital to primary care and may result in improved patient outcome in terms of the level of control, frequency of review and general acceptability. PMID

  4. Comparing responses to horticultural-based and traditional activities in dementia care programs.

    PubMed

    Jarrott, Shannon E; Gigliotti, Christina M

    2010-12-01

    Engaging persons with dementia in meaningful activities supports well-being; however, care staff are challenged to implement age- and ability-appropriate activities in a group setting. We compared a randomly assigned treatment group, who received horticultural therapy-based (HT-based) programming to a comparison group, who engaged in traditional activities (TA) programming, on engagement and affect. Horticultural therapy-based programming was implemented twice weekly at 4 treatment sites for 6 weeks, while regular TA were observed at comparison sites. Results revealed no differences between groups on affective domains. Levels of adaptive behavior differed between the groups, with the treatment group demonstrating higher levels of active, passive, and other engagement and the comparison group demonstrating higher levels of self-engagement. Our results highlight the value of HT-based programs and the importance of simultaneously capturing participants' affective and behavioral responses. Theoretical and practical considerations about the facilitation of and context in which the programming occurs are discussed.

  5. SUPPORTING PRETERM INFANT ATTACHMENT AND SOCIOEMOTIONAL DEVELOPMENT IN THE NEONATAL INTENSIVE CARE UNIT: STAFF PERCEPTIONS.

    PubMed

    Twohig, Aoife; Reulbach, Udo; Figuerdo, Ricardo; McCarthy, Anthony; McNicholas, Fiona; Molloy, Eleanor Joan

    2016-01-01

    The infant-parent relationship has been shown to be of particular significance to preterm infant socioemotional development. Supporting parents and infants in this process of developing their relationships is an integral part of neonatal intensive care; however, there is limited knowledge of NICU staff perceptions about this aspect of care. To explore NICU staff perceptions about attachment and socioemotional development of preterm infants, experience of training in this area and the emotional impact of their work. A cross-sectional questionnaire survey of staff perceptions of the emotional experiences of parents and the developing parent-infant relationship in an NICU was conducted in a Level III NICU, after pilot testing, revision, and ethical approval. Fifty-seven (68%) of NICU staff responded to the survey. Respondents identified parents' emotional experiences such as "anxiety," "shock," "loss of control," and "lack of feelings of competence as parents" as highly prevalent. Infant cues of "responding to parent's voice" and "quieting-alerting" were ranked most highly; "crying" and "physiological changes" were ranked lowest. Preterm infant medical risk, maternal emotional state, and mental health are perceived to impact most highly on the developing relationship, as compared with infant state or behavior and socioeconomic factors. Fifty-three (93%) respondents felt confident, and 50 (87.8%) felt competent discussing their emotional experiences with parents. Fifty-four (95%) responded that attending to these areas was an integral part of their role; however, staff had seldom received education in this area. Respondents also perceived that specific psychological support for parents was lacking both during and after the infant's discharge. While all staff surveyed perceived the nature of their work to be emotionally stressful, there were differences among NICU staff disciplines and with years of experience in the NICU in terms of their perceptions about education in

  6. U.S. Veteran Health Care Utilization Increases after Caregivers' Use of National Caregiver Telephone Support Line.

    PubMed

    Griffin, Joan M; Malcolm, Cari; Wright, Pamela; Hagel Campbell, Emily; Kabat, Margaret; Bangerter, Ann K; Sayer, Nina A

    2017-03-25

    The U.S. Department of Veterans Affairs (VA) established the national Caregiver Support Line (CSL) in February 2011. The CSL is operated by licensed master's degree social workers who provide caregivers of veterans with information about caregiver benefits and services, counseling, and referrals to a caregiver support coordinator at the nearest VA medical center. The authors compared differences in veteran health care utilization patterns in the six months before and after a caregiver call to the CSL, hypothesizing that veterans with caregivers using the CSL had improved access to health care services and improved access increased utilization of health care. A pre- and posttest design was used. CSL calls that resulted in referrals to VA health care services or to local VA caregiver support coordinators were included in the sample. Data were extracted from the CSL database and matched to veteran care utilization data using veteran medical record data. Veteran inpatient stays for general medicine, hospice, respite, and long-term care significantly increased after the CSL call, but other inpatient stays (surgery, neurology) did not. Outpatient services for home health, respite, and mental health all significantly increased. Caregivers' use of the national CSL may help facilitate access for veterans to needed care services.

  7. Pharmacologically active microcarriers for endothelial progenitor cell support and survival.

    PubMed

    Musilli, Claudia; Karam, Jean-Pierre; Paccosi, Sara; Muscari, Claudio; Mugelli, Alessandro; Montero-Menei, Claudia N; Parenti, Astrid

    2012-08-01

    The regenerative potential of endothelial progenitor cell (EPC)-based therapies is limited due to poor cell viability and minimal retention following application. Neovascularization can be improved by means of scaffolds supporting EPCs. The aim of the present study was to investigate whether human early EPCs (eEPCs) could be efficiently cultured on pharmacologically active microcarriers (PAMs), made with poly(d,l-lactic-coglycolic acid) and coated with adhesion/extracellular matrix molecules. They may serve as a support for stem cells and may be used as cell carriers providing a controlled delivery of active protein such as the angiogenic factor, vascular endothelial growth factor-A (VEGF-A). eEPC adhesion to fibronectin-coated PAMs (FN-PAMs) was assessed by means of microscopic evaluation and by means of Alamar blue assay. Phospho ERK(1/2) and PARP-1 expression was measured by means of Western blot to assess the survival effects of FN-PAMs releasing VEGF-A (FN-VEGF-PAMs). The Alamar blue assay or a modified Boyden chamber assay was employed to assess proliferative or migratory capacity, respectively. Our data indicate that eEPCs were able to adhere to empty FN-PAMs within a few hours. FN-VEGF-PAMs increased the ability of eEPCs to adhere to them and strongly supported endothelial-like phenotype and cell survival. Moreover, the release of VEGF-A by FN-PAMs stimulated in vitro HUVEC migration and proliferation. These data strongly support the use of PAMs for supporting eEPC growth and survival and for stimulating resident mature human endothelial cells.

  8. Circles of care: development and initial evaluation of a peer support model for African Americans with advanced cancer.

    PubMed

    Hanson, Laura C; Armstrong, Tonya D; Green, Melissa A; Hayes, Michelle; Peacock, Stacie; Elliot-Bynum, Sharon; Goldmon, Moses V; Corbie-Smith, Giselle; Earp, Jo Anne

    2013-10-01

    Peer support interventions extend care and health information to underserved populations yet rarely address serious illness. Investigators from a well-defined academic-community partnership developed and evaluated a peer support intervention for African Americans facing advanced cancer. Evaluation methods used the Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM) framework. Investigators initially recruited and trained 24 lay health advisors who shared information or support with 210 individuals. However, lay advisors reported barriers of medical privacy and lack of confidence working alone with people with cancer. Training was modified to match the support team model for peer support; training reached 193 volunteers, 104 of whom formed support teams for 47 persons with serious illness. Support teams were adopted by 23 community organizations, including 11 African American churches. Volunteers in teams felt prepared to implement many aspects of supportive care such as practical support (32%) or help with cancer or palliative care resources (43%). People with serious illness requested help with practical, emotional, spiritual, and quality of life needs; however, they rarely wanted advocacy (3%) or cancer or palliative care resources (5%) from support teams. Volunteers had difficulty limiting outreach to people with advanced cancer due to medical privacy concerns and awareness that others could benefit. Support teams are a promising model of peer support for African Americans facing advanced cancer and serious illness, with reach, adoption, and implementation superior to the lay advisor model. This formative initial evaluation provides evidence for feasibility and acceptance. Further research should examine the efficacy and potential for maintenance of this intervention.

  9. Support for mandatory health care worker influenza vaccination among allied health professionals, technical staff, and medical students.

    PubMed

    Banach, David B; Zhang, Cen; Factor, Stephanie H; Calfee, David P

    2013-04-01

    Although policies mandating annual influenza vaccination among health care workers (HCWs) are recommended, little is known about which HCWs support mandatory vaccination. We surveyed non-physician, non-nursing HCWs to identify beliefs associated with supporting mandatory HCW vaccination. Although similarities were identified, some beliefs and concerns associated with supporting mandatory vaccination differed among HCW groups. Policy makers should understand these differences and address beliefs and concerns of all HCW groups when attempting to implement a mandatory influenza vaccination policy.

  10. Determinants of the intention for using a lumbar support among home care workers with recurrent low back pain.

    PubMed

    Roelofs, Pepijn D D M; van Poppel, Mireille N M; Bierma-Zeinstra, Sita M A; van Mechelen, Willem

    2010-09-01

    In most effectiveness studies on lumbar supports for patients with low back pain, insufficient data are reported about adherence. In a secondary preventive RCT, we found beneficial effects and a good adherence among home care workers with low back pain. To target the use of lumbar supports on those patients who can benefit optimally from usage, we need to know why people are adherent. We used the attitude, social support and self-efficacy model to identify determinants for prolonged adherence to wearing a lumbar support. The strongest predictor for intending sustained use of a lumbar support was a positive attitude towards lumbar supports, explaining 41% of the variance (B = 1.31; p < 0.001). Social support and self-efficacy played a minor role. The intention for prolonged use of a lumbar support for workers with recurrent back pain was mainly explained by a positive attitude. The discomfort of a lumbar support was outweighed by perceived benefit.

  11. When seeing the same physician, highly activated patients have better care experiences than less activated patients.

    PubMed

    Greene, Jessica; Hibbard, Judith H; Sacks, Rebecca; Overton, Valerie

    2013-07-01

    Measures of the patient care experience are now routinely used in public reports and increasingly influence health provider payment. We examined data from 5,002 patients of forty-nine primary care providers to explore the relationship between patient activation-a term referring to the knowledge, skills, and confidence a patient has for managing his or her health care-and the patient care experience. We found that patients at higher levels of activation had more positive experiences than patients at lower levels seeing the same clinician. The observed differential was maintained when we controlled for demographic characteristics and health status. We did not find evidence that patients at higher levels of activation selected providers who were more patient-centric. The findings suggest that the care experience is transactional, shaped by both providers and patients. Strategies to improve the patient experience, therefore, should focus not only on providers but also on improving patients' ability to elicit what they need from their providers.

  12. Supporting Reflective Activities in Information Seeking on the Web

    NASA Astrophysics Data System (ADS)

    Saito, Hitomi; Miwa, Kazuhisa

    Recently, many opportunities have emerged to use the Internet in daily life and classrooms. However, with the growth of the World Wide Web (Web), it is becoming increasingly difficult to find target information on the Internet. In this study, we explore a method for developing the ability of users in information seeking on the Web and construct a search process feedback system supporting reflective activities of information seeking on the Web. Reflection is defined as a cognitive activity for monitoring, evaluating, and modifying one's thinking and process. In the field of learning science, many researchers have investigated reflective activities that facilitate learners' problem solving and deep understanding. The characteristics of this system are: (1) to show learners' search processes on the Web as described, based on a cognitive schema, and (2) to prompt learners to reflect on their search processes. We expect that users of this system can reflect on their search processes by receiving information on their own search processes provided by the system, and that these types of reflective activity helps them to deepen their understanding of information seeking activities. We have conducted an experiment to investigate the effects of our system. The experimental results confirmed that (1) the system actually facilitated the learners' reflective activities by providing process visualization and prompts, and (2) the learners who reflected on their search processes more actively understood their own search processes more deeply.

  13. Heated Proteins are Still Active in a Functionalized Nanoporous Support

    SciTech Connect

    Chen, Baowei; Qi, Wen N.; Li, Xiaolin; Lei, Chenghong; Liu, Jun

    2013-07-08

    We report that even under the heated condition, the conformation and activity of a protein can be hoarded in a functionalized nanoporous support via non-covalent interaction, although the hoarded protein was not exhibiting the full protein activity, the protein released subsequently still maintained its native conformation and activity. Glucose oxidase (GOX) was spontaneously and largely entrapped in aminopropyl-functionalized mesoporous silica (NH2-FMS) at 20 oC via a dominant electrostatic interaction. Although FMS-GOX displayed 45% activity of the free enzyme in solution, the GOX released from FMS exhibited its 100% activity prior to the entrapment. Surprisingly, the released GOX from FMS still maintained 89% of its initial activity prior to the entrapment after FMS-GOX was incubated at 60 oC for 1 h prior to release, while the free GOX in solution lost nearly all activity under the same incubation. Intrinsic fluorescence emission of GOX and native electrophoresis demonstrated that the heating resulted in significant conformational changes and oligomeric structures of the free GOX, but FMS efficiently maintained the thermal stability of GOX therein and resisted the thermal denaturation and oligomeric aggregation.

  14. Evaluating the Role of Support Group Structures as Vehicles of Palliative Care: Giving Productivity in the Kanye Care Program in Botswana

    PubMed Central

    Kang’ethe, Simon

    2011-01-01

    Aims: The article aims to explore, evaluate, and discuss the role associated with the presence or absence of caregivers’ support groups in the Kanye care program in Botswana. Objective: The objective of the study was to solicit the views, attitudes, and thinking of palliative caregivers on the role, and implication of the presence and absence of support groups as vehicles influencing care-giving productivity. Materials and Methods: The study was explorative and descriptive in nature and used a qualitative design, involving 82 primary caregivers in focus group discussions and five community home-based care nurses in one- to-one interviews. Results: The support groups were found to play the following pivotal roles: (1) facilitate forums of strengthening caregivers; (2) facilitate sharing and exchange of information among caregivers; (3) facilitate counselling, debriefings, and education among caregivers; (4) foster the spirit and feelings of togetherness among caregivers; and (5) act as advocacy fronts and an opportunity of pooling and mobilizing the resources. Conclusion: The article recommends to the Government and the nongovernmental organizations to assist all care programs to institute and facilitate the formation of caregivers’ support groups. PMID:21633616

  15. Investigation of perceived social support in mothers of infants hospitalized in neonatal Intensive Care Unit

    PubMed Central

    Kara, S; Tan, S; Aldemir, S; Yılmaz, AE; Tatlı, MM; Dilmen, U

    2013-01-01

    Purpose: To identify the degree of perceived social support by mothers of infants hospitalized in neonatal intensive care unit (NICU) and to investigate effects depression and anxiety levels on the perceived social support. Method: The study included 50 mothers of infants hospitalized in NICU. Demographic and clinical characteristics of the mothers were collected using a personal data form designed by the study researchers via face-to-face interviews. The Multidimensional Scale of Perceived Social Support Scale (MSPSS) was used to evaluate the degree of perceived social support by the mothers and Hospital Anxiety and Depression (HAD) Scale was used to assess their anxiety and depression levels. Results: The mean age of the mothers was 29.1 ± 4.2 years. There was a significant correlation between the scores of the anxiety and depression subscales (r=0.772; p<0.001), whereas these scores were not significantly correlated with MSPSS total score. The scores MSPSS subscales were significantly correlated with each other, as well as with MSPSS total score. Friend subscale score and depression subscale score were positively correlated with education level (r=0.295, p=0.038 and r=0.407, p=0.003, respectively). The family and spouse subscale scores and MSPSS total score were significantly higher assisted conception technique group compared with the spontaneous conception group (p=0.020, p=0.010 and p=0.016, respectively). The family and spouse subscale scores and MSPSS total score were significantly lower in the mothers with depression subscale score of ≥7 than in the mothers with depression subscale score of <7 (p=0.010, p=0.038 and p=0.018, respectively). In the linear regression model, only education level was found to be a significant factor affecting depression level (p=0.006). Conclusion: The mothers of infants hospitalized in the NICU with higher education levels had higher depression level and perceived social support from friends. Informing the family members and

  16. Strategies to Support Recruitment of Patients with Life-limiting illness for Research: The Palliative Care Research Cooperative Group

    PubMed Central

    Hanson, Laura C.; Bull, Janet; Wessell, Kathryn; Massie, Lisa; Bennett, Rachael E.; Kutner, Jean S.; Aziz, Noreen M.; Abernethy, Amy

    2014-01-01

    Context The Palliative Care Research Cooperative group (PCRC) is the first clinical trials cooperative for palliative care in the United States. Objectives To describe barriers and strategies for recruitment during the inaugural PCRC clinical trial. Methods The parent study was a multi-site randomized controlled trial enrolling adults with life expectancy anticipated to be 1–6 months, randomized to discontinue statins (intervention) vs. to continue on statins (control). To study recruitment best practices, we conducted semi-structured interviews with 18 site Principal Investigators (PI) and Clinical Research Coordinators (CRC), and reviewed recruitment rates. Interviews covered 3 topics – 1) successful strategies for recruitment, 2) barriers to recruitment, and 3) optimal roles of the PI and CRC. Results All eligible site PIs and CRCs completed interviews and provided data on statin protocol recruitment. The parent study completed recruitment of n=381 patients. Site enrollment ranged from 1–109 participants, with an average of 25 enrolled per site. Five major barriers included difficulty locating eligible patients, severity of illness, family and provider protectiveness, seeking patients in multiple settings, and lack of resources for recruitment activities. Five effective recruitment strategies included systematic screening of patient lists, thoughtful messaging to make research relevant, flexible protocols to accommodate patients’ needs, support from clinical champions, and the additional resources of a trials cooperative group. Conclusion The recruitment experience from the multi-site PCRC yields new insights into methods for effective recruitment to palliative care clinical trials. These results will inform training materials for the PCRC and may assist other investigators in the field. PMID:24863152

  17. Guided cobalamin biosynthesis supports Dehalococcoides mccartyi reductive dechlorination activity.

    PubMed

    Yan, Jun; Im, Jeongdae; Yang, Yi; Löffler, Frank E

    2013-04-19

    Dehalococcoides mccartyi strains are corrinoid-auxotrophic Bacteria and axenic cultures that require vitamin B12 (CN-Cbl) to conserve energy via organohalide respiration. Cultures of D. mccartyi strains BAV1, GT and FL2 grown with limiting amounts of 1 µg l(-1) CN-Cbl quickly depleted CN-Cbl, and reductive dechlorination of polychlorinated ethenes was incomplete leading to vinyl chloride (VC) accumulation. In contrast, the same cultures amended with 25 µg l(-1) CN-Cbl exhibited up to 2.3-fold higher dechlorination rates, 2.8-9.1-fold increased growth yields, and completely consumed growth-supporting chlorinated ethenes. To explore whether known cobamide-producing microbes supply Dehalococcoides with the required corrinoid cofactor, co-culture experiments were performed with the methanogen Methanosarcina barkeri strain Fusaro and two acetogens, Sporomusa ovata and Sporomusa sp. strain KB-1, as Dehalococcoides partner populations. During growth with H2/CO2, M. barkeri axenic cultures produced 4.2 ± 0.1 µg l(-1) extracellular cobamide (factor III), whereas the Sporomusa cultures produced phenolyl- and p-cresolyl-cobamides. Neither factor III nor the phenolic cobamides supported Dehalococcoides reductive dechlorination activity suggesting that M. barkeri and the Sporomusa sp. cannot fulfil Dehalococcoides' nutritional requirements. Dehalococcoides dechlorination activity and growth occurred in M. barkeri and Sporomusa sp. co-cultures amended with 10 µM 5',6'-dimethylbenzimidazole (DMB), indicating that a cobalamin is a preferred corrinoid cofactor of strains BAV1, GT and FL2 when grown with chlorinated ethenes as electron acceptors. Even though the methanogen and acetogen populations tested did not produce cobalamin, the addition of DMB enabled guided biosynthesis and generated a cobalamin that supported Dehalococcoides' activity and growth. Guided cobalamin biosynthesis may offer opportunities to sustain and enhance Dehalococcoides activity in contaminated

  18. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2010-10-01 2010-10-01 false Activities to improve the quality of child...

  19. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2014-10-01 2014-10-01 false Activities to improve the quality of child...

  20. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2011-10-01 2011-10-01 false Activities to improve the quality of child...

  1. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2013-10-01 2013-10-01 false Activities to improve the quality of child...

  2. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2012-10-01 2012-10-01 false Activities to improve the quality of child...

  3. Bidirectional linkages between psychological symptoms and sexual activities among African American adolescent girls in psychiatric care.

    PubMed

    Starr, Lisa R; Donenberg, Geri R; Emerson, Erin

    2012-01-01

    The current study examines longitudinal associations between light and heavy sexual experiences and psychiatric symptoms in African American adolescent girls receiving mental health care. Research supports bidirectional associations between adolescent romantic and sexual behaviors and depression and other mental health problems, but this finding has not been examined among African American youth or in clinical samples. African American girls in psychiatric treatment suffer disparities in HIV/AIDS vulnerability, and understanding the context of girls' risk-taking (and how psychological symptoms contribute) may aid prevention efforts. Two-hundred-sixty-five African American girls seeking psychiatric care were assessed for mental health symptoms and light and heavy sexual behaviors. Participants completed a 6-month follow-up. Baseline light sexual activity predicted increased internalizing and externalizing symptoms and substance use at follow-up. Internalizing and externalizing symptoms predicted increased heavy sexual behaviors over time, including HIV-risk behaviors. Results support the association between romantic involvement and depression. Psychological symptoms may play a key role in the emergence of risky sexual behaviors among African American adolescent girls in psychiatric care and should be considered in prevention program development.

  4. Behavioral Informatics and Computational Modeling in Support of Proactive Health Management and Care.

    PubMed

    Pavel, Misha; Jimison, Holly B; Korhonen, Ilkka; Gordon, Christine M; Saranummi, Niilo

    2015-12-01

    Health-related behaviors are among the most significant determinants of health and quality of life. Improving health behavior is an effective way to enhance health outcomes and mitigate the escalating challenges arising from an increasingly aging population and the proliferation of chronic diseases. Although it has been difficult to obtain lasting improvements in health behaviors on a wide scale, advances at the intersection of technology and behavioral science may provide the tools to address this challenge. In this paper, we describe a vision and an approach to improve health behavior interventions using the tools of behavioral informatics, an emerging transdisciplinary research domain based on system-theoretic principles in combination with behavioral science and information technology. The field of behavioral informatics has the potential to optimize interventions through monitoring, assessing, and modeling behavior in support of providing tailored and timely interventions. We describe the components of a closed-loop system for health interventions. These components range from fine grain sensor characterizations to individual-based models of behavior change. We provide an example of a research health coaching platform that incorporates a closed-loop intervention based on these multiscale models. Using this early prototype, we illustrate how the optimized and personalized methodology and technology can support self-management and remote care. We note that despite the existing examples of research projects and our platform, significant future research is required to convert this vision to full-scale implementations.

  5. An electronic health record to support patients and institutions of the health care system.

    PubMed

    Uckert, Frank; Müller, Marcel Lucas; Bürkle, Thomas; Prokosch, Hans-Ulrich

    2004-08-24

    The department of Medical Informatics of the University Hospital Münster and the Gesakon GmbH (an university offspring) initiated the cooperative development of an electronic health record (EHR) called "akteonline.de" in 2000. From 2001 onwards several clinics of the university hospital have already offered this EHR (within pilot projects) as an additional service to selected subsets of their patients. Based on the experiences of those pilot projects the system architecture and the basic data model underwent several evolutionary enhancements, e.g. implementations of electronic interfaces to other clinical systems (considering for example data interchange methods like the Clinical Document Architecture - standardized within the HL7 group - and also interfacing architectures of German GP systems, such as VCS and D2D). "akteonline.de" in its current structure supports patients as well as health care professionals and aims at providing a collaborative health information system which perfectly supports the clinical workflow even across institutional boundaries and including the patient himself. Since such an EHR needs to strictly fulfill high data security and data protection requirements, a complex authorization and access control component has been included. Furthermore the EHR data are encrypted within the database itself and during their transfer across the internet.

  6. Behavioral Informatics and Computational Modeling in Support of Proactive Health Management and Care

    PubMed Central

    Jimison, Holly B.; Korhonen, Ilkka; Gordon, Christine M.; Saranummi, Niilo

    2016-01-01

    Health-related behaviors are among the most significant determinants of health and quality of life. Improving health behavior is an effective way to enhance health outcomes and mitigate the escalating challenges arising from an increasingly aging population and the proliferation of chronic diseases. Although it has been difficult to obtain lasting improvements in health behaviors on a wide scale, advances at the intersection of technology and behavioral science may provide the tools to address this challenge. In this paper, we describe a vision and an approach to improve health behavior interventions using the tools of behavioral informatics, an emerging transdisciplinary research domain based on system-theoretic principles in combination with behavioral science and information technology. The field of behavioral informatics has the potential to optimize interventions through monitoring, assessing, and modeling behavior in support of providing tailored and timely interventions. We describe the components of a closed-loop system for health interventions. These components range from fine grain sensor characterizations to individual-based models of behavior change. We provide an example of a research health coaching platform that incorporates a closed-loop intervention based on these multiscale models. Using this early prototype, we illustrate how the optimized and personalized methodology and technology can support self-management and remote care. We note that despite the existing examples of research projects and our platform, significant future research is required to convert this vision to full-scale implementations. PMID:26441408

  7. Association between overweight and characteristics of young adult students: support for nursing care1

    PubMed Central

    Santiago, Jênifa Cavalcante dos Santos; Moreira, Thereza Maria Magalhães; Florêncio, Raquel Sampaio

    2015-01-01

    OBJECTIVE: to verify associations between overweight and the characteristics of young adult students to support nursing care. METHOD: case-control study conducted with young adults from public schools. The sample was composed of 441 participants (147 cases and 294 controls, with and without excess weight, respectively). Sociodemographic and clinical characteristics were collected together with exposure factors and anthropometrics. Multiple logistic regression was used. The study received Institutional Review Board approval. RESULTS: statistically significant association with overweight: non-Caucasian, having a partner; weight gain during adolescence, mother's excess weight, the use of obesogenic medication, augmented diastolic blood pressure, of abdominal circumference and waist/hip ratio. In addition to these, schooling and weight gain during childhood were also included in the multivariate analysis. After adjustment, the final model included: having a partner, weight gain during adolescence, augmented diastolic blood pressure and abdominal circumference. CONCLUSION: the analysis of predictor variables for excess weight among young adult students supports nurses in planning and developing educational practices aimed to prevent this clinical condition, which is a risk factor for other chronic comorbidities, such as cardiovascular diseases. PMID:26039295

  8. [Case management in long-term care--the task of individual related and family-oriented support for people in need of care and its realization through the reform of long-term care insurance].

    PubMed

    Klie, Thomas; Monzer, Michael

    2008-04-01

    The introduction of standardized Case Management structures to improve coordination and cooperation of all involved in care, such as cost units, service providers, voluntary organizations, families and the different occupational categories involved in nursing, is the main concern of the current reform of German long-term care insurance. In this article, demands on Case Management in care are enunciated and the basics found in expert talks, needed for efficient support of care, assembled. In doing so, the role and function of Case Management is differentiated, the different levels (case, organizational and system levels) distinguished and options and conditions needed to settle such an organization are introduced.

  9. Impact of an activities-based adult dementia care program

    PubMed Central

    Higgins, Margaret; Koch, Kathleen; Hynan, Linda S; Carr, Sandra; Byrnes, Kathleen; Weiner, Myron F

    2005-01-01

    The investigators studied over one year the impact of a newly established once-a-week activity-based day care program for dementia patients combined with 17 educational sessions for caregivers held at the same facility. Outcome measures were patient and caregiver quality of life (QOL), patient behavioral disturbance, and use of community-based resources. Of the 37 enrollees, 3 chose not to start the program and 13 dropped out before the end of one year, largely due to health-related issues. Of the initial group, 21 attended for the entire year. The average patient Mini-Mental State Exam (MMSE) score at entry was 16, indicating a moderate level of dementia. Average score on the CERAD Behavior Rating Scale for Dementia (BRSD) was 30.1, indicating a mild level of behavioral disturbance. Attendance at day care was 91%; at the caregiver educational sessions, 74%. Patient and caregiver enthusiasm for the program was high and all wanted to continue attendance beyond the study period despite the fact that patients reported no change in QOL. Caregivers rated patients as having significantly less QOL, and rated their own QOL as unchanged. Symptomatic patient behaviors, as measured by the BRSD, increased significantly over the period of study. Caregivers reported greater use of community resources. PMID:18568062

  10. Staff perceptions of job satisfaction and life situation before and 6 and 12 months after increased information technology support in dementia care.

    PubMed

    Engström, Maria; Ljunggren, Birgitta; Lindqvist, Ragny; Carlsson, Marianne

    2005-01-01

    We measured staff members' satisfaction with their work before and after increased information technology (IT) support in dementia care. Comparisons were also performed of perceived life satisfaction and sense of coherence. Data were collected before, and 6 and 12 months after implementation of the first part of an IT support project. Instruments used were the Satisfaction with Work Questionnaires, the Life Satisfaction Questionnaire (LSQ) and the Sense of Coherence (SOC) scale. The study was performed in a residential home for persons with dementia. The participants were 33 staff members. The IT technology included general and individualized passage alarms, sensor-activated night-time illumination, fall detectors and Internet communication. Results showed that staff members' job satisfaction and perceived quality of care improved in comparison with the control group. Personal development, workload, expectations and demands, internal motivation and documentation, as well as the total scores for "psychosocial aspects of job satisfaction" and "quality of care aspects", increased in the experimental group. There were significant interaction effects for the factors family relation, close friend relation (LSQ), the total SOC scale and the meaningfulness subscale. The study showed that IT support in dementia care increased staff members' satisfaction with their work in several ways.

  11. Community interventions providing care and support to orphans and vulnerable children: a review of evaluation evidence.

    PubMed

    Schenk, Katie D

    2009-07-01

    Children affected by HIV in their families and communities face multiple risks to their health, education and psychosocial wellbeing. Community interventions for children who have been orphaned or rendered vulnerable take many forms, including educational assistance, home-based care, legal protection and psychosocial support. Despite a recent influx of funding for programme implementation, there exists little evidence to inform policymakers about whether their investments are improving the lives of vulnerable children and meeting key benchmarks including the Millennium Development Goals. This paper reviews the current evidence base on evaluations of community interventions for orphans and vulnerable children (OVC) in high HIV-prevalence African settings, focusing on studies' methodologies. Sources reviewed include published research studies and evidence from the unpublished programmatic "grey literature" located through database and internet searches. A total of 21 studies, varying in scope and generalisability, were identified. Interventions reviewed address children's wellbeing through various strategies within their communities. Evaluation methodologies reflect quantitative and qualitative approaches, including surveys (with and without baseline or comparison data), costing studies, focus groups, interviews, case studies, and participatory review techniques. Varied study methodologies reflect diverse research questions, various intervention types, and the challenges associated with evaluating complex interventions; highlighting the need to broaden the research paradigm in order to build the evidence base by including quasi-experimental and process evaluation approaches, and seeking further insights through participatory qualitative methodologies and costing studies. Although findings overall indicate the value of community interventions in effecting measurable improvements in child and family wellbeing, the quality and rigour of evidence is varied. A strategic

  12. 76 FR 56504 - Proposed Information Collection (Spinal Cord Injury Patient Care Survey) Activity: Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-13

    ... AFFAIRS Proposed Information Collection (Spinal Cord Injury Patient Care Survey) Activity: Comment Request... spinal cord patients' satisfaction with VA rehabilitation and health care system. Affected Public... of automated collection techniques or the use of other forms of information technology. Title:...

  13. Informal care and reciprocity of support are associated with HAART adherence among men in Baltimore, MD, USA.

    PubMed

    Knowlton, Amy R; Yang, Cui; Bohnert, Amy; Wissow, Lawrence; Chander, Geetanjali; Arnsten, Julia A

    2011-10-01

    Research suggests gender differences in interpersonal relationship factors important to health. This study examined relationship factors associated with HAART adherence among men. The sample (n = 154) comprised 95% African Americans and 48% current illicit drug users; 83% reported HAART adherence. Results revealed adherence was associated with comfort level taking HAART in the presence of close friends, and the interaction between informal care (having someone to care for oneself when sick in bed) and reciprocity of support. Among those with informal care, higher reciprocity of support to caregivers was associated with greater adherence. Promoting men's reciprocity of support to their caregivers and enhancing peer norms of medication taking are important strategies for improving men's adherence. The findings complement previous findings on relationship factors adversely associated with women's adherence. Results suggest the merit of interventions targeting men and their informal caregivers, particularly main partners, and gender-specific, contextually tailored strategies to promote HAART adherence.

  14. Informal Care and Reciprocity of Support are Associated with HAART Adherence among Men in Baltimore, MD, USA

    PubMed Central

    Knowlton, Amy R.; Yang, Cui; Bohnert, Amy; Wissow, Lawrence; Chander, Geetanjali; A. Arnsten, Julia

    2010-01-01

    Research suggests gender differences in interpersonal relationship factors important to health. This study examined relationship factors associated with HAART adherence among men. The sample (n=154) comprised 95% African Americans and 48% current illicit drug users; 83% reported HAART adherence. Results revealed adherence was associated with comfort level taking HAART in the presence of close friends, and the interaction between informal care (having someone to care for oneself when sick in bed) and reciprocity of support. Among those with informal care, higher reciprocity of support to caregivers was associated with greater adherence. Promoting men’s reciprocity of support to their caregivers and enhancing peer norms of medication taking are important strategies for improving men’s adherence. The findings complement previous findings on relationship factors adversely associated with women’s adherence. Results suggest the merit of interventions targeting men and their informal caregivers, particularly main partners, and gender-specific, contextually tailored strategies to promote HAART adherence. PMID:20632081

  15. Caring Economics: A New Framework for Conceptualizing and Measuring Economic Activity.

    PubMed

    Ghosh, Indradeep

    2015-01-01

    This article introduces the reader to a new framework for conceptualizing and measuring economic activity called caring economics. Going beyond the conventional understanding of economic activity as that which unfolds in markets, caring economics highlights the work of care and caregiving that occurs within households and is often unpaid. This article also unveils a new set of measures based on the framework of caring economics that are urgently needed by policymakers and business leaders to foster personal, business, and national economic success.

  16. Palliative care and support for persons with HIV/AIDS in 7 African countries: implementation experience and future priorities.

    PubMed

    Alexander, Carla S; Memiah, Peter; Henley, Yvonne B; Kaiza-Kangalawe, Angela; Shumbusho, Anna Joyce; Obiefune, Michael; Enejoh, Victor; Stanis-Ezeobi, Winifred; Eze, Charity; Odion, Ehekhaye; Akpenna, Donald; Effiong, Amana; Miriti, Kenneth; Aduda, Samson; Oko, John; Melaku, Gebremedhin D; Baribwira, Cyprien; Umutesi, Hassina; Shimabale, Mope; Mugisa, Emmanuel; Amoroso, Anthony

    2012-06-01

    To combat morbidity and mortality from the worldwide epidemic of the human immunodeficiency virus (HIV), the United States Congress implemented a President's Emergency Plan for AIDS Relief (PEPFAR) in 30 resource-limited countries to integrate combination antiretroviral therapy (ART) for both prevention and cure. Over 35% of eligible persons have been successfully treated. Initial legislation cited palliative care as an essential aspect of this plan but overall health strengthening became critical to sustainability of programming and funding priorities shifted to assure staffing for care delivery sites; laboratory and pharmaceutical infrastructure; data collection and reporting; and financial management as individual countries are being encouraged to assume control of in-country funding. Given infrastructure requisites, individual care delivery beyond ART management alone has received minimal funding yet care remains necessary for durable viral suppression and overall quality of life for individuals. Technical assistance staff of one implementing partner representing seven African countries met to clarify domains of palliative care compared with the substituted term "care and support" to understand potential gaps in on-going HIV care. They prioritized care needs as: 1) mental health (depression and other mood disorders); 2) communication skills (age-appropriate disclosure of HIV status); 3) support of care-providers (stress management for sustainability of a skilled HIV workforce); 4) Tied Priorities: symptom management in opportunistic infections; end-of-life care; spiritual history-taking; and 5) Tied Priorities: attention to grief-related needs of patients, their families and staff; and management of HIV co-morbidities. This process can inform health policy as funding transitions to new priorities.

  17. Support networks for Chinese older immigrants accessing English health and social care services: the concept of Bridge People.

    PubMed

    Liu, Xiayang; Cook, Glenda; Cattan, Mima

    2017-03-01

    As Chinese immigrants in the United Kingdom age, they experience an increasing need to access health and care services. It has, however, been reported that older Chinese immigrants have difficulties in accessing these services. This study explored the experiences of this population in using health and care services and the strategies that they adopted to address their difficulties. A grounded theory method with a two-staged research design was used. Stage 1 explored the participants' experiences of ageing and use of health and social care services through focus group interviews. Stage 2 investigated the strategies individuals used to support access to and use of services through individual interviews. Forty-four older Chinese people and 15 supporters participated in interviews during August 2011 and May 2013. These older Chinese immigrants were challenged in knowing about and in accessing services. Their difficulties were attributed to language barriers, lack of information and instrumental support, and emotional and cultural issues regarding use of health and care services. Their supporters facilitated access to services and acted as a bridge between the service and the user; therefore, they were given the title 'Bridge People'. Bridge People have different backgrounds: family and friends, public sector workers and staff from community-based Chinese organisations. The defining attributes of these supporters were: bilinguality, bicultural, multifunctionality and accessibility. There is no charge for this support; and the relationship between the Bridge Person and recipient involves trust and influence over decisions regarding use of health and care services. Bridge People should be recognised and identified by health, social care and housing services to promote engagement and use of services by older immigrant Chinese people.

  18. Do active patients seek higher quality prenatal care?: A panel data analysis from Nairobi, Kenya.

    PubMed

    Cohen, Jessica; Golub, Ginger; Kruk, Margaret E; McConnell, Margaret

    2016-11-01

    Despite poverty and limited access to health care, evidence is growing that patients in low-income countries are taking a more active role in their selection of health care providers. Urban areas such as Nairobi, Kenya offer a rich context for studying these "active" patients because of the large number of heterogeneous providers available. We use a unique panel dataset from 2015 in which 402 pregnant women from peri-urban (the "slums" of) Nairobi, Kenya were interviewed three times over the course of their pregnancy and delivery, allowing us to follow women's care decisions and their perceptions of the quality of care they received. We define active antenatal care (ANC) patients as those women who switch ANC providers and explore the prevalence, characteristics and care-seeking behavior of these patients. We analyze whether active ANC patients appear to be seeking out higher quality facilities and whether they are more satisfied with their care. Women in our sample visit over 150 different public and private ANC facilities. Active patients are more educated and more likely to have high risk pregnancies, but have otherwise similar characteristics to non-active patients. We find that active patients are increasingly likely to pay for private care (despite public care being free) and to receive a higher quality of care over the course of their pregnancy. We find that active patients appear more satisfied with their care over the course of pregnancy, as they are increasingly likely to choose to deliver at the facility providing their ANC.

  19. Multi-purpose HealthCare Telemedicine Systems with mobile communication link support

    PubMed Central

    Kyriacou, E; Pavlopoulos, S; Berler, A; Neophytou, M; Bourka, A; Georgoulas, A; Anagnostaki, A; Karayiannis, D; Schizas, C; Pattichis, C; Andreou, A; Koutsouris, D

    2003-01-01

    The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3–12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using

  20. Supporting staff to care for people with dementia who experience distress reactions.

    PubMed

    Elliot, Victoria; Williams, Angelena; Meyer, Julienne

    2014-08-01

    This article outlines the development of distress reaction training in a large care home charity, provided by directly employed My Home Life Admiral nurses, who are mental health nurses specialising in dementia. Reference is made to the limitations of a person-centred approach to care, and the importance of relationship-centred care, which underpins the My Home Life social movement for quality improvement in care homes. The authors argue that relationship-centred care is a more helpful approach to improve the lived experience and wellbeing of residents, relatives and staff. Potentially, it might also help to address high staff turnover in the care home sector.

  1. Using family sculpting as an experiential learning technique to develop supportive care in nursing. A contemporary issue paper.

    PubMed

    De Souza, Joanna M

    2014-09-01

    This article explores the use of family sculpting as an educative tool to achieve a better I-thou awareness of the patient's support needs from a family and social system approach. Ensuring we provide appropriate and effective opportunities for nurses to develop compassion when caring for patients facing ill health is a complex challenge that faces nurse education at all levels. The piece explores a sculpting exercise developed in nurse education which engages students' awareness of the complicated nature of peoples' social networks and through attitudinal learning, helps nurses to provide compassionate care that integrates family support.

  2. Physician and consumer attitudes and behaviors regarding self-help health support groups as an adjunct to traditional medical care.

    PubMed

    Fridinger, F; Goodwin, G; Chng, C L

    1992-01-01

    This study assessed the creditability of self-help health support groups as an adjunct to traditional medical care among a sampling of physicians (N = 120) and group members (N = 73) located in the Dallas/Ft. Worth Metropolitan area. Findings suggest a general lack of awareness of local groups among physicians, referral to only a few select groups, as well as little communication between health care professionals and their patients. Physicians in group practice, surgical specialties, and having never referred patients to support groups responded less favorably. Several benefits were reported by the group members, although for a majority their patient-physician relationship remained relatively unchanged.

  3. Development of the parental needs scale for rare diseases: a tool for measuring the supportive care needs of parents caring for a child with a rare disease

    PubMed Central

    Pelentsov, Lemuel J; Fielder, Andrea L; Laws, Thomas A; Esterman, Adrian J

    2016-01-01

    Background Children and families affected by rare diseases have received scant consideration from the medical, scientific, and political communities, with parents’ needs especially having received little attention. Affected parents often have limited access to information and support and appropriate health care services. While scales to measure the needs of parents of children with chronic illnesses have been developed, there have been no previous attempts to develop a scale to assess the needs of parents of children with rare diseases. Objective To develop a scale for measuring the supportive care needs of parents of children with rare diseases. Method A total of 301 responses to our Parental Needs Survey were randomly divided into two halves, one for exploratory factor analysis and the other for confirmatory factor analysis (CFA). After removing unsuitable items, exploratory factor analysis was undertaken to determine the factor structure of the data. CFA using structural equation modeling was then undertaken to confirm the factor structure. Results Seventy-two items were entered into the CFA, with a scree plot showing a likely four-factor solution. The results provided four independent subscales of parental needs: Understanding the disease (four items); Working with health professionals (four items); Emotional issues (three items); and Financial needs (three items). The structural equation modeling confirmed the suitability of the four-factor solution and demonstrated that the four subscales could be added to provide an overall scale of parental need. Conclusion This is the first scale developed to measure the supportive care needs of parents of children with rare diseases. The scale is suitable for use in surveys to develop policy, in individual clinical assessments, and, potentially, for evaluating new programs. Measuring the supportive care needs of parents caring for a child with a rare disease will hopefully lead to better physical and psychological

  4. NASA Aerosciences Activities to Support Human Space Flight

    NASA Technical Reports Server (NTRS)

    LeBeau, Gerald J.

    2011-01-01

    The Lyndon B. Johnson Space Center (JSC) has been a critical element of the United State's human space flight program for over 50 years. It is the home to NASA s Mission Control Center, the astronaut corps, and many major programs and projects including the Space Shuttle Program, International Space Station Program, and the Orion Project. As part of JSC's Engineering Directorate, the Applied Aeroscience and Computational Fluid Dynamics Branch is charted to provide aerosciences support to all human spacecraft designs and missions for all phases of flight, including ascent, exo-atmospheric, and entry. The presentation will review past and current aeroscience applications and how NASA works to apply a balanced philosophy that leverages ground testing, computational modeling and simulation, and flight testing, to develop and validate related products. The speaker will address associated aspects of aerodynamics, aerothermodynamics, rarefied gas dynamics, and decelerator systems, involving both spacecraft vehicle design and analysis, and operational mission support. From these examples some of NASA leading aerosciences challenges will be identified. These challenges will be used to provide foundational motivation for the development of specific advanced modeling and simulation capabilities, and will also be used to highlight how development activities are increasing becoming more aligned with flight projects. NASA s efforts to apply principles of innovation and inclusion towards improving its ability to support the myriad of vehicle design and operational challenges will also be briefly reviewed.

  5. Coordinating complex decision support activities across distributed applications

    NASA Technical Reports Server (NTRS)

    Adler, Richard M.

    1994-01-01

    Knowledge-based technologies have been applied successfully to automate planning and scheduling in many problem domains. Automation of decision support can be increased further by integrating task-specific applications with supporting database systems, and by coordinating interactions between such tools to facilitate collaborative activities. Unfortunately, the technical obstacles that must be overcome to achieve this vision of transparent, cooperative problem-solving are daunting. Intelligent decision support tools are typically developed for standalone use, rely on incompatible, task-specific representational models and application programming interfaces (API's), and run on heterogeneous computing platforms. Getting such applications to interact freely calls for platform independent capabilities for distributed communication, as well as tools for mapping information across disparate representations. Symbiotics is developing a layered set of software tools (called NetWorks! for integrating and coordinating heterogeneous distributed applications. he top layer of tools consists of an extensible set of generic, programmable coordination services. Developers access these services via high-level API's to implement the desired interactions between distributed applications.

  6. Pacemaker deactivation: withdrawal of support or active ending of life?

    PubMed

    Huddle, Thomas S; Amos Bailey, F

    2012-12-01

    In spite of ethical analyses assimilating the palliative deactivation of pacemakers to commonly accepted withdrawings of life-sustaining therapy, many clinicians remain ethically uncomfortable with pacemaker deactivation at the end of life. Various reasons have been posited for this discomfort. Some cardiologists have suggested that reluctance to deactivate pacemakers may stem from a sense that the pacemaker has become part of the patient's "self." The authors suggest that Daniel Sulmasy is correct to contend that any such identification of the pacemaker is misguided. The authors argue that clinicians uncomfortable with pacemaker deactivation are nevertheless correct to see it as incompatible with the traditional medical ethics of withdrawal of support. Traditional medical ethics is presently taken by many to sanction pacemaker deactivation when such deactivation honors the patient's right to refuse treatment. The authors suggest that the right to refuse treatment applies to treatments involving ongoing physician agency. This right cannot underwrite patient demands that physicians reverse the effects of treatments previously administered, in which ongoing physician agency is no longer implicated. The permanently indwelling pacemaker is best seen as such a treatment. As such, its deactivation in the pacemaker-dependent patient is best seen not as withdrawal of support but as active ending of life. That being the case, clinicians adhering to the usual ethical analysis of withdrawal of support are correct to be uncomfortable with pacemaker deactivation at the end of life.

  7. Mobile technology supporting trainee doctors’ workplace learning and patient care: an evaluation

    PubMed Central

    2013-01-01

    Background The amount of information needed by doctors has exploded. The nature of knowledge (explicit and tacit) and processes of knowledge acquisition and participation are complex. Aiming to assist workplace learning, Wales Deanery funded “iDoc”, a project offering trainee doctors a Smartphone library of medical textbooks. Methods Data on trainee doctors’ (Foundation Year 2) workplace information seeking practice was collected by questionnaire in 2011 (n = 260). iDoc baseline questionnaires (n = 193) collected data on Smartphone usage alongside other workplace information sources. Case reports (n = 117) detail specific instances of Smartphone use. Results Most frequently (daily) used information sources in the workplace: senior medical staff (80% F2 survey; 79% iDoc baseline); peers (70%; 58%); and other medical/nursing team staff (53% both datasets). Smartphones were used more frequently by males (p < 0.01). Foundation Year 1 (newly qualified) was judged the most useful time to have a Smartphone library because of increased responsibility and lack of knowledge/experience. Preferred information source varied by question type: hard copy texts for information-based questions; varied resources for skills queries; and seniors for more complex problems. Case reports showed mobile technology used for simple (information-based), complex (problem-based) clinical questions and clinical procedures (skills-based scenarios). From thematic analysis, the Smartphone library assisted: teaching and learning from observation; transition from medical student to new doctor; trainee doctors’ discussions with seniors; independent practice; patient care; and this ‘just-in-time’ access to reliable information supported confident and efficient decision-making. Conclusion A variety of information sources are used regularly in the workplace. Colleagues are used daily but seniors are not always available. During transitions, constant access to the electronic

  8. An "Ideal" Home for Care: Nel Noddings, Thomas Hill Green, and an Ontological Support for a Phenomenology of Care

    ERIC Educational Resources Information Center

    Decoste, Jordan; Boyd, Dwight

    2009-01-01

    This paper is grounded in a deep appreciation of Nel Noddings' "ethics of care" as an important contribution to moral philosophy and moral education. We seek to offer some philosophical reflections that have the potential to strengthen this important alternative to mainstream ethics and to how moral education might be conceived and practiced…

  9. Development of an online information and support resource for adolescent idiopathic scoliosis patients considering surgery: perspectives of health care providers

    PubMed Central

    2010-01-01

    Background Adolescents with idiopathic scoliosis who are considering spinal surgery face a major decision that requires access to in-depth information and support. Unfortunately, most online resources provide incomplete and inconsistent information and minimal social support. The aim of this study was to develop an online information and support resource for adolescent idiopathic scoliosis (AIS) patients considering spinal surgery. Prior to website development, a user-based needs assessment was conducted. The needs assessment involved a total of six focus groups with three stakeholder groups: (1) post-operative AIS patients or surgical candidates (10-18 years) (n = 11), (2) their parents (n = 6) and (3) health care providers (n = 11). This paper reports on the findings from focus groups with health care providers. Methods Focus group methodology was used to invite a range of perspectives and stimulate discussion. During audio-recorded focus groups, an emergent table of website content was presented to participants for assessment of relevance, viability and comprehensiveness in targeting global domains of need. Specifically, effective presentation of content, desired aspects of information and support, and discussions about the value of peer support and the role of health professionals were addressed. Focus group transcripts were then subject to content analysis through a constant comparative review and analysis. Results Two focus groups were held with health care providers, consisting of 5 and 6 members respectively. Clinicians provided their perceptions of the information and support needs of surgical patients and their families and how this information and support should be delivered using internet technology. Health care providers proposed four key suggestions to consider in the development of this online resource: (1) create the website with the target audience in mind; (2) clearly state the purpose of the website and organize website content to support the

  10. Supporting pregnant Aboriginal and Torres Strait Islander women to quit smoking: views of antenatal care providers and pregnant indigenous women.

    PubMed

    Passey, Megan E; Sanson-Fisher, Rob W; Stirling, Janelle M

    2014-12-01

    To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (n = 121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (n = 127). For example, family support was considered helpful by 64 % of smokers and 91 % of providers; between 56 and 62 % of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85-90 % of providers. Rewards for quitting were considered helpful by 63 % of smokers and 56 % of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women.

  11. Principles supporting dynamic clinical care teams: an American College of Physicians position paper.

    PubMed

    Doherty, Robert B; Crowley, Ryan A

    2013-11-05

    The U.S. health care system is undergoing a shift from individual clinical practice toward team-based care. This move toward team-based care requires fresh thinking about clinical leadership and responsibilities to ensure that the unique skills of each clinician are used to provide the best care for the patient as the patient's needs dictate, while the team as a whole must work together to ensure that all aspects of a patient's care are coordinated for the benefit of the patient. In this position paper, the American College of Physicians offers principles, definitions, and examples to dissolve barriers that prevent movement toward dynamic clinical care teams. These principles offer a framework for an evolving, updated approach to health care delivery, providing policy guidance that can be useful to clinical teams in organizing the care processes and clinician responsibilities consistent with professionalism.

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

    ERIC Educational Resources Information Center

    Silva, Richard J.

    1980-01-01

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

  13. Adolescents’ Daily Activities and the Restorative Niches that Support Them

    PubMed Central

    Roe, Jenny J.; Aspinall, Peter A.

    2012-01-01

    This paper explores wellbeing from the perspective of the psychological dynamics underlying adolescents’ relationship with place. It uses a dynamic model of wellbeing called personal project analysis (PPA) which captures the concept of ‘flourishing’, defined as functioning well in your activities, strivings and interactions with the world [1]. Using PPA methods we identified adolescents’ daily activities and the ‘restorative niches’ that best support them. A series of settings (including home, urban and natural outdoor places) were explored using PPA with 45 young people (aged 11–13) living in Edinburgh, Central Scotland. Participants were asked to think of eight projects of current importance to them, to say where the project took place and to rate each project against a series of core wellbeing dimensions measuring project meaning, manageability, support and affect (how much fun, stress etc.). Latent class analysis was carried out to explore clusters—or sub-groups—in the data and to identify the significant discriminators between clusters. A three-cluster model produced the best fit with project type, project place and wellbeing indicators (fun and stress) significantly discriminating between the three clusters. The three clusters were labeled by their dominant environmental context, ‘faraway’ (e.g., beach, national parks, hills), ‘everyday’ (e.g., home, school, local streets) and ‘citywide’ (e.g., sport settings, urban town context). ‘Faraway’ and ‘citywide’ clusters had a significantly higher wellbeing content, especially for fun and stress; the ‘everyday’ cluster indicated local environs remain a dominant project place for this age group, but are associated with greater stress. We compare findings with adults and suggest that outdoor settings further afield from home have greater significance within adolescent project systems, but that support is needed to facilitate access to these places. PMID:23202680

  14. Supporting activity engagement by family carers at home: maintenance of agency and personhood in dementia

    PubMed Central

    Chung, Pat Yin Fan; Ellis-Hill, Caroline; Coleman, Peter

    2017-01-01

    ABSTRACT An explorative paper to describe how family carers, through the caregiving journey, reaffirm and promote the agency of people with dementia. Agency is an important concept in dementia care and is crucial to the promotion of wellbeing and the delivery of person-centred care. This article is based on one of the key findings of a study that explored family carers’ experiences of engaging their relatives in daily activities in domestic settings. Following research governance and ethical approval, 30 in-depth interviews (initial and follow-up) were carried out with 15 resident-carers of people with dementia who were recruited via local community mental health teams. Then five focus groups were conducted with 21 participants accessed through carers support groups. Interviews and focus groups were transcribed, coded and analysed using a grounded theory method. Findings showed the process in which family carers encouraged and sustained a sense of autonomy and control (agency) in their relative’s daily activities. Key strategies used by carers included: being non-judgemental; facilitating a sense of worth; taking calculated risks; maintaining the continuity of their relative’s identity; enhancing a sense of connection with their relative’s role and identity using enjoyable activities; preventing inactivity and attending to the bodily source of the agency. Lack of support for carers could ultimately pose a risk to the maintenance of the agency of people with dementia. This study provides a deeper insight into the process used by home carers to support the agency of people with dementia. This is essential if practitioners are to identify and develop more realistic intervention strategies and to work in effective partnership with family carers. The implications for the creation of dementia-friendly communities are discussed.

  15. Dying patients' need for emotional support and personalized care from physicians: perspectives of patients with terminal illness, families, and health care providers.

    PubMed

    Wenrich, Marjorie D; Curtis, J Randall; Ambrozy, Donna A; Carline, Jan D; Shannon, Sarah E; Ramsey, Paul G

    2003-03-01

    This study addressed the emotional and personal needs of dying patients and the ways physicians help or hinder these needs. Twenty focus groups were held with 137 individuals, including patients with chronic and terminal illnesses, family members, health care workers, and physicians. Content analyses were performed based on grounded theory. Emotional support and personalization were 2 of the 12 domains identified as important in end-of-life care. Components of emotional support were compassion, responsiveness to emotional needs, maintaining hope and a positive attitude, and providing comfort through touch. Components of personalization were treating the whole person and not just the disease, making the patient feel unique and special, and considering the patient's social situation. Although the levels of emotional support and personalization varied, there was a minimal level, defined by compassion and treating the whole person and not just the disease, that physicians should strive to meet in caring for all dying patients. Participants also identified intermediate and advanced levels of physician behavior that provide emotional and personal support.

  16. Activities and Attributes of Nurse Practitioner Leaders: Lessons from a Primary Care System Change.

    PubMed

    O'Rourke, Tammy; Higuchi, Kathryn Smith

    2016-01-01

    Nurse practitioners (NPs) are being encouraged to practice to the full extent of their skills, and they have a critical role to play in leading health system reform. The evidence in support of NP-led initiatives is growing; however, in spite of the positive outcomes associated with these initiatives, considerable opposition to and debate about the potential for NPs to lead health system change and interprofessional teams continues. To date, we know very little about NP leadership activities, particularly those activities that contribute to primary care system change, and there are very few examples of this type of leadership. The qualitative descriptive study here was part of a larger case study that examined stakeholder participation in a system change led by NPs. The change involved the introduction of a new NP-led model of team-based primary care delivery in Ontario, Canada. Data from participant interviews and public documents were analyzed to describe the activities and attributes (perseverance, risk-taking and effective communication) of two NP leaders who were the drivers of this change. Knowledge of these activities and attributes has the potential to inform NP leadership roles in health system policy planning and implementation. However, to be able to provide effective leadership in system change, NPs need access to educational content about public policy and opportunities to develop and practice the skills required to work with multiple stakeholders, including those who oppose change.

  17. Learning opportunities in a residential aged care facility: the role of supported placements for first-year nursing students.

    PubMed

    Lea, Emma; Marlow, Annette; Bramble, Marguerite; Andrews, Sharon; Crisp, Elaine; Eccleston, Claire; Mason, Ron; Robinson, Andrew

    2014-07-01

    The residential aged care sector is reportedly a less attractive career choice for nursing students than other sectors. Research shows that students are often fearful of working with residents with dementia when they are inadequately supported on clinical placements by aged care staff. Thirty first-year nursing students attended a 2-week placement in one of two Tasmanian aged care facilities as part of the Wicking Dementia Research and Education Centre Teaching Aged Care Facilities Program, which aims to provide students with a quality aged care placement focusing on dementia palliation. Placement experience and dementia knowledge were evaluated through preplacement and postplacement questionnaires and weekly feedback meetings with mentors and students. Students had more positive attitudes related to aged care and higher dementia knowledge at the end of placement. Students described their interactions with residents with dementia and thought that the placement had increased their capacity to provide quality care to these residents. The findings indicate that residential aged care placements can be productive learning environments for novice nursing students.

  18. Australian Family Day Care Educators: A Snapshot of Their Qualifications, Training and Perceived Support

    ERIC Educational Resources Information Center

    Williamson, Lara; Davis, Elise; Priest, Naomi; Harrison, Linda

    2011-01-01

    Introduction: Although the family day care workforce has changed over the past decade in response to evolving childcare regulations and accreditation requirements, there is little research on family day care educators in Australia. The aim of this study was to describe characteristics of Australian family day care educators, including their…

  19. Fostering Supportive Learning Environments in Long-Term Care: The Case of WIN A STEP UP

    ERIC Educational Resources Information Center

    Morgan, Jennifer Craft; Haviland, Sara B.; Woodside, M. Allyson; Konrad, Thomas R.

    2007-01-01

    The education of direct care workers (DCWs) is key to improving job quality and the quality of care in long-term care (LTC). This paper describes the successful integration of a supervisory training program into a continuing education intervention (WIN A STEP UP) for DCWs, identifies the factors that appear to influence the integration of the…

  20. Project Lungisela: Supporting Young People Leaving State Care in South Africa

    ERIC Educational Resources Information Center

    Tanur, Carly

    2012-01-01

    This paper focuses on appropriate responses to the unique challenges faced by young people at risk who are transitioning out of state care in South Africa. Specific lessons are drawn from Project Lungisela, a youth leaving care programme created to assist young people leaving state care in Khayelitsha, Cape Town. Project Lungisela was initiated by…