Science.gov

Sample records for adequate medical care

  1. Medical Care during Pregnancy

    MedlinePlus

    ... 5 Things to Know About Zika & Pregnancy Medical Care During Pregnancy KidsHealth > For Parents > Medical Care During ... médica durante el embarazo The Importance of Prenatal Care Millions of American women give birth every year, ...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical devices; adequate directions for use. 801... (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for use means directions under which the layman can use a device...

  3. [The importance of adequate medical history taking in dentistry].

    PubMed

    van Diermen, D E; Brand, H S; Vissink, A

    2006-05-01

    A patient's medical history is a vital part of his or her dental history and increases the dentist's awareness of diseases and medication which might interfere with the patient's dental treatment. This article describes the essential characteristics of a solid medical history, according to the Dutch Guidelines for Dental Education published in 1997. In future the importance of patients' medical histories will increase along with the number of medically complex patients who visit the dental general practice. PMID:16729560

  4. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Medical devices; adequate directions for use. 801.5 Section 801.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate...

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Medical devices; adequate directions for use. 801.5 Section 801.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate...

  6. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Medical devices; adequate directions for use. 801.5 Section 801.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate...

  7. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Medical devices; adequate directions for use. 801.5 Section 801.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate...

  8. [Is personalism or utilitarianism an adequate foundation of medical ethics?].

    PubMed

    Biesaga, T

    1998-01-01

    The article rejects utilitarianism as a proper theory for medical ethics. Utilitarians lavishly use various slogans of effective action, development and better civilization. However, the principle of prosperity of humanity in the utilitarian interpretation makes the value of the human person subject to society. Social interest threatens the individual here because it defines his/her value of life. The drift towards maximalization of benefits and prosperity of humanity strikes the seriously ill, e.g. babies with brain damages, Down's syndrome, etc., people after accidents and with serious brain defects, the terminally ill. The principle of quality of life (lebensunwertes Leben) used by utylitarians allows them to argue, that euthanasia, abortion is in the interest of the patient. Some utilitarians openly admit that such ideas as "universal happiness", "prosperity", "benefit" are empty ideas, fictions to which one cannot attribute any contents. So utilitarianism, not defining its fundamental ideas, can easily change medical ethics in a theory of elimination of the uncomfortable people. Therefore, as a theory utilitarianism cannot serve as the basis for medical ethics.

  9. Are family medicine residents adequately trained to deliver palliative care?

    PubMed Central

    Mahtani, Ramona; Kurahashi, Allison M.; Buchman, Sandy; Webster, Fiona; Husain, Amna; Goldman, Russell

    2015-01-01

    Objective To explore educational factors that influence family medicine residents’ (FMRs’) intentions to offer palliative care and palliative care home visits to patients. Design Qualitative descriptive study. Setting A Canadian, urban, specialized palliative care centre. Participants First-year (n = 9) and second-year (n = 6) FMRs. Methods Semistructured interviews were conducted with FMRs following a 4-week palliative care rotation. Questions focused on participant experiences during the rotation and perceptions about their roles as family physicians in the delivery of palliative care and home visits. Participant responses were analyzed to summarize and interpret patterns related to their educational experience during their rotation. Main findings Four interrelated themes were identified that described this experience: foundational skill development owing to training in a specialized setting; additional need for education and support; unaddressed gaps in pragmatic skills; and uncertainty about family physicians’ role in palliative care. Conclusion Residents described experiences that both supported and inadvertently discouraged them from considering future engagement in palliative care. Reassuringly, residents were also able to underscore opportunities for improvement in palliative care education. PMID:27035008

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  11. Spectator Medical Care.

    PubMed

    Carlson, L

    1992-01-01

    Recent world events-including the fear of terrorism during last year's Super Bowl-illustrate how vulnerable spectators can be to medical emergencies during sporting events. A physician who studies and coordinates crowd care for events ranging from the Super Bowl to local fairs gives tips on planning and executing a spectator medical plan.

  12. Medication adherence: WHO cares?

    PubMed

    Brown, Marie T; Bussell, Jennifer K

    2011-04-01

    The treatment of chronic illnesses commonly includes the long-term use of pharmacotherapy. Although these medications are effective in combating disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed. Factors contributing to poor medication adherence are myriad and include those that are related to patients (eg, suboptimal health literacy and lack of involvement in the treatment decision-making process), those that are related to physicians (eg, prescription of complex drug regimens, communication barriers, ineffective communication of information about adverse effects, and provision of care by multiple physicians), and those that are related to health care systems (eg, office visit time limitations, limited access to care, and lack of health information technology). Because barriers to medication adherence are complex and varied, solutions to improve adherence must be multifactorial. To assess general aspects of medication adherence using cardiovascular disease as an example, a MEDLINE-based literature search (January 1, 1990, through March 31, 2010) was conducted using the following search terms: cardiovascular disease, health literacy, medication adherence, and pharmacotherapy. Manual sorting of the 405 retrieved articles to exclude those that did not address cardiovascular disease, medication adherence, or health literacy in the abstract yielded 127 articles for review. Additional references were obtained from citations within the retrieved articles. This review surveys the findings of the identified articles and presents various strategies and resources for improving medication adherence.

  13. Adolf Hitler's medical care.

    PubMed

    Doyle, D

    2005-02-01

    For the last nine years of his life Adolf Hitler, a lifelong hypochondriac had as his physician Dr Theodor Morell. Hitler's mood swings, Parkinson's disease, gastro-intestinal symptoms, skin problems and steady decline until his suicide in 1945 are documented by reliable observers and historians, and in Morell's diaries. The bizarre and unorthodox medications given to Hitler, often for undisclosed reasons, include topical cocaine, injected amphetamines, glucose, testosterone, estradiol, and corticosteroids. In addition, he was given a preparation made from a gun cleaner, a compound of strychnine and atropine, an extract of seminal vesicles, and numerous vitamins and 'tonics'. It seems possible that some of Hitler's behaviour, illnesses and suffering can be attributed to his medical care. Whether he blindly accepted such unorthodox medications or demanded them is unclear. PMID:15825245

  14. Adolf Hitler's medical care.

    PubMed

    Doyle, D

    2005-02-01

    For the last nine years of his life Adolf Hitler, a lifelong hypochondriac had as his physician Dr Theodor Morell. Hitler's mood swings, Parkinson's disease, gastro-intestinal symptoms, skin problems and steady decline until his suicide in 1945 are documented by reliable observers and historians, and in Morell's diaries. The bizarre and unorthodox medications given to Hitler, often for undisclosed reasons, include topical cocaine, injected amphetamines, glucose, testosterone, estradiol, and corticosteroids. In addition, he was given a preparation made from a gun cleaner, a compound of strychnine and atropine, an extract of seminal vesicles, and numerous vitamins and 'tonics'. It seems possible that some of Hitler's behaviour, illnesses and suffering can be attributed to his medical care. Whether he blindly accepted such unorthodox medications or demanded them is unclear.

  15. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  16. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  17. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian...

  18. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  19. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  20. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian...

  1. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian...

  2. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian...

  3. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  4. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian...

  5. Intersection of race/ethnicity and gender in depression care: screening, access, and minimally adequate treatment

    PubMed Central

    Hahm, Hyeouk Chris; Cook, Benjamin; Ault-Brutus, Andrea; Alegria, Margarita

    2015-01-01

    Objectives This study was conducted to understand the interaction of race/ethnicity and gender in depression screening, any mental health care, and adequate care. Methods 2010–2012 electronic health records data of adult primary care patients from a New England urban health care system was used (n = 65,079). Multivariate logit regression models were used to assess the associations between race/ethnicity, gender, and other covariates with depression screening, any depression care among those screened positive, and adequate depression care among users. Secondly, disparities were evaluated by race/ethnicity and gender and incorporated differences due to insurance, marital status, and area-level SES measures. Findings Black and Asian males and females were less likely to be screened for depression compared to their white counterparts, while Latino males and females were more likely to be screened. Among those that screened PHQ-9>10, black males and females, Latino males, and Asian males and females were less likely to receive any mental health care than their white counterparts. The black-white disparity in screening was greater for females compared to males. The Latino-white disparity for any mental health care and adequacy of care was greater for males compared to females. Conclusions Our approach underscores the importance of identifying disparities at each step of depression care by both race/ethnicity and gender. Targeting certain groups in specific stages of care would be more effective (i.e., screening of black females, any mental health care and adequacy of care for Latino males) than a blanket approach to disparities reduction. PMID:25727113

  6. Minimally adequate mental health care and latent classes of PTSD symptoms in female Iraq and Afghanistan veterans.

    PubMed

    Hebenstreit, Claire L; Madden, Erin; Koo, Kelly H; Maguen, Shira

    2015-11-30

    Female veterans of Operations Enduring and Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) represent a growing segment of Department of Veterans Affairs (VA) health care users. A retrospective analysis used national VA medical records to identify factors associated with female OEF/OIF/OND veterans' completion of minimally adequate care (MAC) for PTSD, defined as the completion of at least nine mental health outpatient visits within a 15-week period or at least twelve consecutive weeks of medication use. The sample included female OEF/OIF/OND veterans with PTSD who initiated VA health care between 2007-2013, and were seen in outpatient mental health (N=2183). Multivariable logistic regression models examined factors associated with completing MAC for PTSD, including PTSD symptom expression (represented by latent class analysis), sociodemographic, military, clinical, and VA access factors. Within one year of initiating mental health care, 48.3% of female veterans completed MAC. Race/ethnicity, age, PTSD symptom class, additional psychiatric diagnoses, and VA primary care use were significantly associated with completion of MAC for PTSD. Results suggest that veterans presenting for PTSD treatment should be comprehensively evaluated to identify factors associated with inadequate completion of care. Treatments that are tailored to PTSD symptom class may help to address potential barriers.

  7. PG medical training and accreditation: responsibility of the government for the adequate health service delivery.

    PubMed

    Bhattarai, M D

    2012-09-01

    On one hand there is obvious inadequate health coverage to the rural population and on the other hand the densely populated urban area is facing the triple burden of increasing non-communicable and communicable health problems and the rising health cost. The postgraduate medical training is closely interrelated with the adequate health service delivery and health economics. In relation to the prevailing situation, the modern medical education trend indicates the five vital issues. These are i). Opportunity needs to be given to all MBBS graduates for General Specialist and Sub-Specialist Training inside the country to complete their medical education, ii). Urgent need for review of PG residential training criteria including appropriate bed and teacher criteria as well as entry criteria and eligibility criteria, iii). Involvement of all available units of hospitals fulfilling the requirements of the residential PG training criteria, iv). PG residential trainings involve doing the required work in the hospitals entitling them full pay and continuation of the service without any training fee or tuition fee, and v). Planning of the proportions of General Specialty and Sub-Specialty Training fields, particularly General Practice (GP) including its career and female participation. With increased number of medical graduates, now it seems possible to plan for optimal health coverage to the populations with appropriate postgraduate medical training. The medical professionals and public health workers must make the Government aware of the vital responsibility and the holistic approach required.

  8. Medical care delivery in space

    NASA Technical Reports Server (NTRS)

    Stewart, Don F.

    1989-01-01

    Consideration is given to the delivery of medical care in space. The history of aviation medicine is reviewed. Medical support for the early space programs is discussed, including the Mercury, Gemini, Apollo, and Skylab programs. The process of training crew members for basic medical procedures for the Space Shuttle program is briefly described and medical problems during the Shuttle program are noted. Plans for inflight medical care on the Space Station are examined, including the equipment planned for the Health Maintenance Facility, the use of exercise to help prevent medical problems.

  9. Medical education and indigent patient care.

    PubMed

    Lyon, Deborah S

    2003-12-01

    The 20th century model of medical education has focused on a network of urban medical centers serving primarily indigent patients in an unspoken contract of medical services in exchange for student and resident education. The improvement in federal and state reimbursement for indigent care services, along with the decline in reimbursement rates from the private sector, has led to competition for these patients from nonacademic providers. As numbers of patients seeking care at urban teaching centers have steadily declined, concerns about adequate teaching volume and revenue generation have led to very creative problem-solving. Bringing marketing concerns into the indigent care environment is not a straightforward undertaking, but the rewards might far exceed the simple goal of "getting our numbers back up." PMID:14613672

  10. 32 CFR 564.37 - Medical care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care... medical care is obtained are enumerated in AR 40-3. (b) Elective care. Elective care in civilian...

  11. 32 CFR 564.37 - Medical care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care... medical care is obtained are enumerated in AR 40-3. (b) Elective care. Elective care in civilian...

  12. 32 CFR 564.37 - Medical care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care... medical care is obtained are enumerated in AR 40-3. (b) Elective care. Elective care in civilian...

  13. 32 CFR 564.37 - Medical care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care... medical care is obtained are enumerated in AR 40-3. (b) Elective care. Elective care in civilian...

  14. The functions of medical care.

    PubMed Central

    Childs, A W

    1975-01-01

    Medical care has several important functions other than restoring or maintaining health. These other functions are assessment and certification of health status, prognostication, segregation of the ill to limit communication of illness, and helping to cope with the problems of illness--the caring function. Medical care serving these "paracurative" functions may legitimately be given indepedently, without associated curing or preventive intent of the provider of care. Although such services do not result in benefits to health, such as extension of life or reduction of disability, they do have other valued outcomes, outcomes not measurable as a gain in personal health status. For example, caring activities may result in satisfaction, comfort, or desirable affective states, even while the patient's health status deteriorates during an incurable illness. The physician's approach to patients, the economist's analysis of the benefits of health services, the planner's decisions about health programs, the evaluator's judgments about the quality of care, or the patient's expectations about treatment are strongly influenced by his assumptions about the purpose of medical care or the proper outcome of the process. When the health worker assumes that the only useful outcome is health, he may consider the paracurative services to be ineffective, inefficient, or undesirable. In contrast, when he recognizes and understands the paracurative functions of medical care, he may better perform his function in the medical care system. PMID:803689

  15. Debt and foregone medical care.

    PubMed

    Kalousova, Lucie; Burgard, Sarah A

    2013-06-01

    Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and ratios of debt to income and debt to assets were positively associated with foregoing medical or dental care in the past 12 months, even after adjusting for the poorer socioeconomic and health characteristics of those foregoing care and for respondents' household incomes and net worth. These overall associations were driven largely by credit card and medical debt, while housing debt and automobile and student loans were not associated with foregoing care. These results suggest that debt is an understudied aspect of health stratification.

  16. Resources for inflight medical care.

    PubMed

    Rayman, Russell B; Zanick, David; Korsgard, Trina

    2004-03-01

    With the anticipated growth of air travel, inflight illness and injury are expected to increase as well. This is because more elderly people and people with preexisting disease are taking to the air. Although inflight medical events and deaths are uncommon, physician passengers are occasionally called upon to render care. Resources for the physician may include emergency medical kits, automatic external defibrillators (AEDs), ECG monitors, portable oxygen bottles, and first-aid kits. Most airlines provide around-the-clock air-to-ground radio consultation either with their own medical department personnel or contracted medical consultants. Furthermore, some flight attendants are trained in cardiopulmonary resuscitation, first-aid, and operation of AEDs. This paper describes those inflight resources available to a physician who is called upon to treat an ill or injured passenger. In a broader sense, it is also providing advice to physicians who administer inflight medical care. The Aviation Medical Assistance Act of 1998 ("Good Samaritan act") is also discussed.

  17. Debt and Foregone Medical Care

    ERIC Educational Resources Information Center

    Kalousova, Lucie; Burgard, Sarah A.

    2013-01-01

    Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and…

  18. Perioperative hypertension due to undiagnosed aortic coarctation: are current standards of care adequate?

    PubMed

    Rose, Michael; Murrell, David

    2004-04-01

    A 12-year-old male presented for a superficial parotidectomy for chronic parotitis. The patient had an unremarkable past medical history and was admitted on the day of surgery for his procedure without further anaesthetic or surgical review. During the patient's intraoperative course, higher than expected blood pressures were noted and treated with clonidine. After further high blood pressure readings in the postoperative care unit, close surveillance of blood pressures for the following 24 h was arranged. The hypertension was ongoing, and further examination and investigation confirmed the diagnosis of coarctation of the aorta. We examine the possible reasons for failure to diagnose this patient's hypertension preoperatively and suggest that there is a need for greater surveillance of blood pressures in the paediatric population presenting for surgery. A discussion of the significance of hypertension in paediatrics and recommendations for minimum standards of care to address shortcomings in the diagnosis and treatment of paediatric hypertension are proposed.

  19. 32 CFR 564.37 - Medical care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care; policies outlining the manner, conditions, procedures, and eligibility for care; and the sources from...

  20. The right to medical care.

    PubMed

    van der Vyver, J D

    1989-01-01

    The right to medical care, as a category of human rights, falls under the heading of Leistungsrechte; that is, rights of the individual that require of the state that it do something--in this instance to provide the services concerned. In South Africa the government's health care policy contemplated involves (a) differentiation based on race in the provision of health care services; and (b) privatization of such services. It is submitted that in developing societies, where private initiative cannot cope with the demands in respect of health care, privatization would be premature and existing inequalities in health care services provided for the different racial groups require greater government involvement, with a view to eliminating racial discrimination through programmes of affirmative action. Privatization, furthermore, requires government-sponsored incentives, such as tax concessions, that would inspire private persons to contribute financially towards health care services. PMID:2495397

  1. Medical management after managed care.

    PubMed

    Robinson, James C; Yegian, Jill M

    2004-01-01

    Health insurers are under conflicting pressures to improve the quality and moderate the costs of health care yet to refrain from interfering with decision making by physicians and patients. This paper examines the contemporary evolution of medical management, drawing on examples from UnitedHealth Group, WellPoint Health Networks, and Active Health Management. It highlights the role of claims data, predictive modeling, notification requirements, and online enrollee self-assessments; the choice between focusing on behavior change among patients or among physicians; and the manner in which medical management is packaged and priced to accommodate the diversity in willingness to pay for quality initiatives in health care.

  2. Autonomous Medical Care for Exploration

    NASA Technical Reports Server (NTRS)

    Johnson-Throop, Kathy A.; Polk, J. D.; Hines, John W.; Nall, Marsha M.

    2005-01-01

    The goal of Autonomous Medical Care (AMC) is to ensure a healthy, well-performing crew which is a primary need for exploration. The end result of this effort will be the requirements and design for medical systems for the CEV, lunar operations, and Martian operations as well as a ground-based crew health optimization plan. Without such systems, we increase the risk of medical events occurring during a mission and we risk being unable to deal with contingencies of illness and injury, potentially threatening mission success. AMC has two major components: 1) pre-flight crew health optimization and 2) in-flight medical care. The goal of pre-flight crew health optimization is to reduce the risk of illness occurring during a mission by primary prevention and prophylactic measures. In-flight autonomous medical care is the capability to provide medical care during a mission with little or no real-time support from Earth. Crew medical officers or other crew members provide routine medical care as well as medical care to ill or injured crew members using resources available in their location. Ground support becomes telemedical consultation on-board systems/people collect relevant data for ground support to review. The AMC system provides capabilities to incorporate new procedures and training and advice as required. The on-board resources in an autonomous system should be as intelligent and integrated as is feasible, but autonomous does not mean that no human will be involved. The medical field is changing rapidly, and so a challenge is to determine which items to pursue now, which to leverage other efforts (e.g. military), and which to wait for commercial forces to mature. Given that what is used for the CEV or the Moon will likely be updated before going to Mars, a critical piece of the system design will be an architecture that provides for easy incorporation of new technologies into the system. Another challenge is to determine the level of care to provide for each

  3. Medication Information Flow in Home Care.

    PubMed

    Norri-Sederholm, Teija; Saranto, Kaija; Paakkonen, Heikki

    2016-01-01

    Critical success factors in medication care involve communication and information sharing. Knowing the information needs of each actor in medication process in home care, is the first step to ensure that the right type of information is available, when needed. The aim of the study was to describe the needed and delivered information in home care in order to perform medication care successfully. A total of 15 nurses from primary home care participated a workshop focusing on medication treatment. The qualitative data was collected by focus group technique. Data was analyzed according to content analysis. Three medication information themes were formulated: Client-related information, medication, and medication error. The critical medication information were generic drug information, validity of the list of medication and client's clinical status. As a conclusion findings, show the diversity of the medication information in home care. PMID:27332222

  4. 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)

  5. [Medical care for asylum seekers and refugees at the University Medical Center Hamburg-Eppendorf--A case series].

    PubMed

    Sothmann, Peter; Schmedt auf der Günne, Nina; Addo, Marylyn; Lohse, Ansgar; Schmiedel, Stefan

    2016-01-01

    As the number of refugees rises, medical care for refugees, asylum seekers and people with unclear residence status becomes a priority task for our health system. While access to health care is restricted for these groups of people in many German states, Hamburg provides unrestricted access to healthcare for refugees by handing out health insurance cards on arrival. Daily practice shows, however, that adequate medical care is still not always easy to achieve. In this case series we demonstrate that barriers to health care still exist on many levels. We discuss these barriers and further propose strategies to improve and to secure access to adequate health care. PMID:26710201

  6. [Medical care for asylum seekers and refugees at the University Medical Center Hamburg-Eppendorf--A case series].

    PubMed

    Sothmann, Peter; Schmedt auf der Günne, Nina; Addo, Marylyn; Lohse, Ansgar; Schmiedel, Stefan

    2016-01-01

    As the number of refugees rises, medical care for refugees, asylum seekers and people with unclear residence status becomes a priority task for our health system. While access to health care is restricted for these groups of people in many German states, Hamburg provides unrestricted access to healthcare for refugees by handing out health insurance cards on arrival. Daily practice shows, however, that adequate medical care is still not always easy to achieve. In this case series we demonstrate that barriers to health care still exist on many levels. We discuss these barriers and further propose strategies to improve and to secure access to adequate health care.

  7. Why Medical Students Choose Primary Care Careers.

    ERIC Educational Resources Information Center

    Kassler, William J.; And Others

    1991-01-01

    A study of factors influencing medical students to choose primary care careers, in contrast with high-technology careers, found students attracted by opportunity to provide direct care, ambulatory care, continuity of care, and involvement in psychosocial aspects of care. Age, race, gender, marital status, and some attitudes were not influential.…

  8. Medical care at the Super Bowl.

    PubMed

    Ellis, J M

    2000-06-01

    Although coordinating medical care at the Super Bowl is something that we look forward to and have a lot of fun doing, we take it very seriously and understand the importance of delivering medical care at what many people consider to be the greatest sporting event in the world. It is certainly one of the most watched and recognized events in the world and because of this, we attempt to set up a system that will allow for the best medical care available and standardization of this medical care through our experience within Medical Sports Group.

  9. Challenges and coping strategies of orphaned children in Tanzania who are not adequately cared for by adults.

    PubMed

    Daniel, Marguerite; Mathias, Angela

    2012-10-01

    Orphaned children in poor rural communities sometimes have no adult who is able to care for them or else the adult caregiver is not able to provide adequate care. Tanzania remains one of the poorest countries in the world, and poverty frequently constrains foster care. Although HIV prevalence is declining, AIDS is still a major cause of orphaning. This article explores the challenges and coping strategies accompanying two possible life trajectories for orphaned children without adequate adult care: 1) that they remain in rural areas in child-headed households, or 2) that they are trafficked to an urban area. Antonovsky's salutogenic model is used as the theoretical framework. The data come from two separate phenomenological studies with vulnerable children. In the first study, in-depth interviews were held with 12 orphaned children in a poor rural area; data concerning three child heads of households are included here. In the second study, 15 girls who were trafficked from rural areas to Dar es Salaam gave extended life-history narrations; data are included for nine of the girls who were orphaned. Loss of parents, a lack of cash, and the need to balance school attendance with food production were chronic stressors for the children heading households, while resources included income-generation strategies and the ability to negotiate with teachers for time to cultivate. For the trafficked girls chronic stressors included exploitation, long working hours, little or no pay, isolation and rape. Resources for them, although limited, included faith networks and neighbours; escape from the exploitative situation frequently involved external help. We conclude that given physical and social assets the child-headed households were able to cope with the challenges of caring for themselves and a younger child, but isolation and dependency on employers made it difficult for the trafficked girls to cope with this exploitation. The salutogenic model proved a useful tool in

  10. Medical care and health under state socialism.

    PubMed

    Deacon, B

    1984-01-01

    This paper derives a conception of ideal socialist and communist medical care and health policy. This model is based on a review of Marxist and allied critiques of capitalist medical care policy and on theoretical work on socialist social policy. The ideal conception, operationalized in terms of 16 criteria, is then applied to a review of medical care and health policy in the Soviet Union. Hungary, and Poland. It is concluded that medical care policy in all three countries exhibits very few characteristics of socialist medical care. The possibility (for the moment repressed) provided by the Solidarity movement in Poland of a new development toward a more genuine socialist medical care and health policy is also described.

  11. Barriers to help-seeking, detection, and adequate treatment for anxiety and mood disorders: implications for health care policy.

    PubMed

    Mechanic, David

    2007-01-01

    Recently, the focus of health policies and initiatives has been directed toward mental health. More precisely, depressive and anxiety disorders have received particular attention because of their disabling outcomes and prevalence among most populations. Despite this increased interest, numerous issues regarding patients' willingness to seek treatment and the adequate recognition and treatment of these disorders by clinicians remain to be addressed. This article considers the factors that influence patients and physicians in their reticence to acknowledge and adequately treat depression and anxiety disorders. It also reviews the impact of society and the media, together with other factors relating to health care organization and administration that affect the treatment of depression and anxiety. In view of the multifaceted challenge involved, efforts to achieve a consensus in determining treatment for those with depressive and anxiety disorders are essential. A consensus will require easy, measurable, and reliable disability indicators; evidence that treatment of patients with varying levels of need is cost effective; and that persons who most need and would benefit from care can be reliably identified among the highly prevalent population of persons with more transient symptoms. Governments and other policymakers should be encouraged to provide appropriate coverage for access to primary and secondary care, the treatments required, and sufficient resources so that care is available when necessary. An important aspect of the challenge is to incorporate these efforts within the realistic constraints of primary care. PMID:17288503

  12. Medical use of marijuana in palliative care.

    PubMed

    Johannigman, Suzanne; Eschiti, Valerie

    2013-08-01

    Marijuana has been documented to provide relief to patients in palliative care. However, healthcare providers should use caution when discussing medical marijuana use with patients. This article features a case study that reveals the complexity of medical marijuana use. For oncology nurses to offer high-quality care, examining the pros and cons of medical marijuana use in the palliative care setting is important. PMID:23899972

  13. Assessment of medical students' proficiency in dermatology: Are medical students adequately prepared to diagnose and treat common dermatologic conditions in the United States?

    PubMed

    Ulman, Catherine A; Binder, Stephen Bruce; Borges, Nicole J

    2015-01-01

    This study assessed whether a current medical school curriculum is adequately preparing medical students to diagnose and treat common dermatologic conditions. A 15-item anonymous multiple choice quiz covering fifteen diseases was developed to test students' ability to diagnose and treat common dermatologic conditions. The quiz also contained five items that assessed students' confidence in their ability to diagnose common dermatologic conditions, their perception of whether they were receiving adequate training in dermatology, and their preferences for additional training in dermatology. The survey was performed in 2014, and was completed by 85 students (79.4%). Many students (87.6%) felt that they received inadequate training in dermatology during medical school. On average, students scored 46.6% on the 15-item quiz. Proficiency at the medical school where the study was performed is considered an overall score of greater than or equal to 70.0%. Students received an average score of 49.9% on the diagnostic items and an average score of 43.2% on the treatment items. The findings of this study suggest that United States medical schools should consider testing their students and assessing whether they are being adequately trained in dermatology. Then schools can decide if they need to re-evaluate the timing and delivery of their current dermatology curriculum, or whether additional curriculum hours or clinical rotations should be assigned for dermatologic training. PMID:25989840

  14. Ineffective Staff, Ineffective Supervision, or Ineffective Administration? Why Some Nursing Homes Fail to Provide Adequate Care.

    ERIC Educational Resources Information Center

    Sheridan, John E.; And Others

    1992-01-01

    This study involved 530 nursing staff working in 25 for-profit and nonprofit nursing homes, 2 of which failed to meet residential care standards. Nursing home climate in failed homes was perceived as being significantly lower in human relations and higher in laissez-faire and status orientation dimensions that the climate in the successful homes.…

  15. Medicare and Caregivers: Planning for Medical Care

    MedlinePlus

    ... turn Javascript on. Medicare and Caregivers Planning for Medical Care If you find that an older relative ... friend needs your help to deal with a medical condition, there are a number of steps you ...

  16. The Costs and Risks of Medical Care

    PubMed Central

    McPhee, Stephen J.; Myers, Lois P.; Schroeder, Steven A.

    1982-01-01

    Understanding the costs and risks of medical care, as well as the benefits, is essential to good medical practice. The literature on this topic transcends disciplines, making it a challenge for clinicians and medical educators to compile information on costs and risks for use in patient care. This annotated bibliography presents summaries of pertinent references on (1) financial costs of care, (2) excessive use of medical services, (3) clinical risks of care, (4) decision analysis, (5) cost-benefit analyses, (6) factors affecting physician use of services and (7) strategies to improve physician ordering patterns. PMID:6814071

  17. Emergency Medical Care Training and Adolescents.

    ERIC Educational Resources Information Center

    Topham, Charles S.

    1982-01-01

    Describes an 11-week emergency medical care training program for adolescents focusing on: pretest results; factual emergency instruction and first aid; practical experience training; and assessment. (RC)

  18. Clinical review: Medication errors in critical care

    PubMed Central

    Moyen, Eric; Camiré, Eric; Stelfox, Henry Thomas

    2008-01-01

    Medication errors in critical care are frequent, serious, and predictable. Critically ill patients are prescribed twice as many medications as patients outside of the intensive care unit (ICU) and nearly all will suffer a potentially life-threatening error at some point during their stay. The aim of this article is to provide a basic review of medication errors in the ICU, identify risk factors for medication errors, and suggest strategies to prevent errors and manage their consequences. PMID:18373883

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

    PubMed

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

    2013-08-01

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

  20. Rolling Medical Practice: Ambulant Mobile Medical Care for Rural Areas.

    PubMed

    Schwartze, Jonas; Wolf, Klaus-Hendrik; Schulz, Sebastian; Rochon, Maike; Wagner, Markus; Bannenberg, Uwe; Drews, Markus; Fischer, Thomas; Hellwig, Torben; Hofmann, Stefan; Höft-Budde, Petra; Jäger, Ralf; Lorenz, Stefan; Naumann, Ruth; Plischke, Maik; Reytarowski, Jörg; Richter, Constanze; Steinbrügge, Christiana; Ziegenspeck, Anja; von Ingelheim, Julius; Haux, Reinhold

    2015-01-01

    We designed, constructed, and evaluated a mobile medical care vehicle called "Rollende Arztpraxis" (rolling medical practice, RMP) that delivers the full medical care of a general practitioner to increase medical care supply in rural areas. Six communities have been identified, where the RMP has been visited 501 times in 14 months. Two different schedules of stops and treatment times have been tested. We show that the RMP treated mainly elderly and multimorbid patients. An accompanying study showed high acceptance and satisfaction of treated patients and treating doctors. An economic evaluation of three different utilization models with three treatment modes each showed no financial sustainability. We show that ambulatory care in rural areas can be complemented by a mobile care unit, if legal and financial barriers can be overcome. PMID:26262211

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

    PubMed Central

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

    2013-01-01

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

  2. Medical futility and care of dying patients.

    PubMed Central

    Jecker, N S

    1995-01-01

    In this article, I address ethical concerns related to forgoing futile medical treatment in terminally ill and dying patients. Any discussion of medical futility should emphasize that health professionals and health care institutions have ethical responsibilities regarding medical futility. Among the topics I address are communicating with patients and families, resolving possible conflicts, and developing professional standards. Finally, I explore why acknowledging the futility of life-prolonging medical interventions can be so difficult for patients, families, and health professionals. PMID:7571593

  3. The Changing Medical Care System: Some Implications for Medical Education.

    ERIC Educational Resources Information Center

    Foreman, Spencer

    1986-01-01

    The medical care system is undergoing widespread and significant changes. Individual hospitals may be disappearing as mergers, acquisitions, and a variety of multi-institutional arrangements become the dominant form and as a host of free-standing medical enterprises spread out into the community. (MLW)

  4. Can Chronic Pain Patients Be Adequately Treated Using Generic Pain Medications to the Exclusion of Brand-Name Ones?

    PubMed

    Candido, Kenneth D; Chiweshe, Joseph; Anantamongkol, Utchariya; Knezevic, Nebojsa Nick

    2016-01-01

    According to the Food and Drug Administration (FDA) reports, approximately 8 in 10 prescriptions filled in the United States are for generic medications, with an expectation that this number will increase over the next few years. The impetus for this emphasis on generics is the cost disparity between them and brand-name products. The use of FDA-approved generic drugs saved 158 billion dollars in 2010 alone. In the current health care climate, there is continually increasing pressure for prescribers to write for generic alternative medications, occasionally at the expense of best clinical practices. This creates a conflict wherein both physicians and patients may find brand-name medications clinically superior but nevertheless choose generic ones. The issue of generic versus brand medications is a key component of the discussion of health payers, physicians and their patients. This review evaluates some of the important medications in the armamentarium of pain physicians that are frequently used in the management of chronic pain, and that are currently at the forefront of this issue, including Opana (oxymorphone; Endo Pharmaceuticals, Inc., Malvern, PA), Gralise (gabapentin; Depomed, Newark, CA), and Horizant (gabapentin enacarbil; XenoPort, Santa Clara, CA) that are each available in generic forms as well. We also discuss the use of Lyrica (pregabalin; Pfizer, New York, NY), which is currently unavailable as generic medication, and Cymbalta (duloxetine; Eli Lilly, Indianapolis, IN), which has been recently FDA approved to be available in a generic form. It is clear that the use of generic medications results in large financial savings for the cost of prescriptions on a national scale. However, cost-analysis is only part of the equation when treating chronic pain patients and undervalues the relationships of enhanced compliance due to single-daily dosing and stable and reliable pharmacokinetics associated with extended-duration preparations using either retentive

  5. Prehospital Burn Care for Emergency Medical Technicians.

    ERIC Educational Resources Information Center

    Lindstrom, Robert A.; And Others

    1978-01-01

    Describes the development, objectives, content, and evaluation of a unique, 60-minute, synchronized slide/tape program on prehospital burn care for emergency medical technicians; and presents a design for valid content-reference formative evaluation. (Author/VT)

  6. Integrating Primary Medical Care With Addiction Treatment

    PubMed Central

    Weisner, Constance; Mertens, Jennifer; Parthasarathy, Sujaya; Moore, Charles; Lu, Yun

    2010-01-01

    Context The prevalence of medical disorders is high among substance abuse patients, yet medical services are seldom provided in coordination with substance abuse treatment. Objective To examine differences in treatment outcomes and costs between integrated and independent models of medical and substance abuse care as well as the effect of integrated care in a subgroup of patients with substance abuse–related medical conditions (SAMCs). Design Randomized controlled trial conducted between April 1997 and December 1998. Setting and Patients Adult men and women (n=592) who were admitted to a large health maintenance organization chemical dependency program in Sacramento, Calif. Interventions Patients were randomly assigned to receive treatment through an integrated model, in which primary health care was included within the addiction treatment program (n=285), or an independent treatment-as-usual model, in which primary care and substance abuse treatment were provided separately (n=307). Both programs were group based and lasted 8 weeks, with 10 months of aftercare available. Main Outcome Measures Abstinence outcomes, treatment utilization, and costs 6 months after randomization. Results Both groups showed improvement on all drug and alcohol measures. Overall, there were no differences in total abstinence rates between the integrated care and independent care groups (68% vs 63%, P=.18). For patients without SAMCs, there were also no differences in abstinence rates (integrated care, 66% vs independent care, 73%; P=.23) and there was a slight but nonsignificant trend of higher costs for the integrated care group ($367.96 vs $324.09, P=.19). However, patients with SAMCs (n=341) were more likely to be abstinent in the integrated care group than the independent care group (69% vs 55%, P=.006; odds ratio [OR], 1.90; 95% confidence interval [CI], 1.22-2.97). This was true for both those with medical (OR, 3.38; 95% CI, 1.68-6.80) and psychiatric (OR, 2.10; 95% CI, 1

  7. Computers, medical care and privacy.

    PubMed

    Fresse, J

    1985-01-01

    This paper describes Physician Actuated Computerized Treatment (PACT) which provides paperless Medical Office Management (MOM) (1). Software, hardware and physician are fused to produce an on-line database medical management system containing medical records, clerical functions and bookkeeping. PACT developed in the 1980's, was financed entirely by private physicians in a working clinical environment. MOM operates on a mini-computer with a minimum of 10 MB hard disk and 16K of memory. Maximum system design is a function of cost and total desired on-line storage. User friendly screens can prompt the operator in English, Spanish, French, German and Italian. Data entry is in native language.

  8. Medical education and health care in Uganda.

    PubMed

    Kiely, J M

    1980-10-01

    Health care and medical education in Uganda, once the best in Black Africa, have been adversely affected by the economic, political, and social upheavals in this developing country during the past decade. Crop failures, inadequate public health measures, shortage of medical equipment and essential drugs, and lack of sufficient medical school faculty have resulted in a major crisis. Substantial aid from the medical profession in developed countries will be necessary to help restore medical practice and education to the level present before the regime of Idi Amin.

  9. 20 CFR 702.401 - Medical care defined.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Medical care defined. 702.401 Section 702.401... WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.401 Medical care defined. (a) Medical care shall include medical, surgical, and other...

  10. 20 CFR 702.401 - Medical care defined.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Medical care defined. 702.401 Section 702.401... WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.401 Medical care defined. (a) Medical care shall include medical, surgical, and other...

  11. 20 CFR 702.401 - Medical care defined.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Medical care defined. 702.401 Section 702.401... WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.401 Medical care defined. (a) Medical care shall include medical, surgical, and other...

  12. Child Health and Access to Medical Care

    ERIC Educational Resources Information Center

    Leininger, Lindsey; Levy, Helen

    2015-01-01

    It might seem strange to ask whether increasing access to medical care can improve children's health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children's health.…

  13. Medical care of the Atlanta Hawks.

    PubMed

    Bernot, M P

    2000-06-01

    NBA players are among the best athletes in the world. Providing medical care for this elite group is a rewarding privilege. It requires a multidisciplinary approach emphasizing a carefully planned prevention program. When injuries occur, team physicians must provide an immediate accurate diagnosis and trainers must treat early and frequently to insure a rapid and successful return to sports.

  14. MEDICAL CARE AND PUBLIC HEALTH SERVICES

    PubMed Central

    Emerson, Haven

    1952-01-01

    Medical care applies to the individual, and public health to the community. One is the concentrated application of diagnosis and treatment for the life, the comfort of a patient, and includes guidance in health as for motherhood, infancy, childhood and old age. Public health services, provided by the community through its local government and the local department of health, are concerned with the prevention of diseases of all kinds. Some are controlled by sanitary authority, but the majority of preventable diseases are dealt with by public health education. It is not the function of the health department to treat the sick. The family physicians, the hospitals and dispensaries provide for medical care. Medical care of the sick and public health protection are two parallel activities to make use of medical science, one for treatment, the other for prevention of disease. PMID:13009462

  15. Primary medical care in Seychelles.

    PubMed

    Sullivan, F M; Shamlaye, C

    1992-07-01

    This paper describes some of the current health problems faced by a tropical country whose standard of living and lifestyle is approaching that of many countries in Western Europe. Long-term health problems such as cardiovascular diseases and diabetes have become at least as important as infectious diseases. A change in approach to a more proactive style of primary care is needed to allow the contribution of community doctors to be effective. The system of primary care in the Republic of Seychelles is based on the UK model of general practice where recent improvements in education and organization are raising standards. How some of these improvements might be transferred elsewhere is discussed.

  16. Roles of Nurses in Home Medical Care.

    PubMed

    Tomiyama, Miyuki

    2016-01-01

    Some patients of advanced age with heart failure (HF) require repeated hospital care. In an aging society, the importance of medical and social care support systems for patients with HF further increases. In Onomichi-city, a comprehensive community care system has been in place since its introduction in 1997. The system is called "Onomichi Type". This is an interprofessional care system in which a variety of healthcare professionals, with common basic knowledge of disease prevention, treatment and welfare, collaborate with other care professionals. These professionals gain shared knowledge in regard to care management, and fulfill their respective roles at Care Conferences held during a patient's hospital stay. Elderly patients also often have multiple comorbidities and take a lot of medicines. Some patients might forget to take their medicine, whereas others might take an overdose. Thus, sharing a patient's complete medical information with pharmacists is also necessary. We began to collaborate with pharmacists in hospitals and at pharmacies in 2014. The pharmacist plays a great role in providing comprehensive community medical care. PMID:27477730

  17. Medical care from space: Telemedicine.

    PubMed

    Feliciani, Francesco

    2003-05-01

    'Telemedicine' can be defined in various ways, but the underlying concept is based on the simple fact that, thanks to modern telecommunications links, diagnostic and therapeutic medical information can be passed between patient and doctor without either of them having to travel. Initially and for quite a long period, voice communication, via telephone or radio, was used to solicit the opinion of a doctor in the case of an emergency, but the potential of Telemedicine was boosted dramatically by the widespread introduction of modern information and communication technology (ICT) into the healthcare sector. Today we are at the point where the boundary separating Telemedicine and medical ICT is somewhat blurred. The prospect of using satellite communications technologies and associated connectivity services to support even wider application of the benefits of Telemedicine was the reason why ESA began actively pursuing activities in this challenging domain back in 1996.

  18. Rural medical care: an experimental delivery system.

    PubMed

    Reid, R A; Eberle, B J; Gonzales, L; Quenk, N L; Oseasohn, R

    1975-05-01

    The experimental medical care delivery system has been operational since February, 1969. An average of over 200 patient visits per month were managed at the clinic during the past year. The average visit cost is $23.00, which is competitive with cost rates at neighborhood health centers. The average time per patient visit has been approximately 1 hr and 20 min. Of persons using the clinic, the largest number are women of childbearing age. Elderly patients have visited the clinic most frequently. Illness problems have accounted for the majority of patient visits. The program represents a cooperative effort between a rural community and a university to solve a problem of national interest. The implementation of this program has provided the opportunity to operationalize the family nurse practitioner concept in a system of medical care delivery. The feasibility of providing high quality medical care in a rural community by extending medical resources concentrated in an urban area has been demonstrated. This type of delivery system does provide a viable alternative for extending medical care to rural communities. A clinic manned by paramedical personnel offers the urban medical center along with concerned physicians the opportunity to extend their resources to rural areas which have been unable to attract and retain physicians.

  19. NURSES’ PERCEPTIONS OF FUTILE MEDICAL CARE

    PubMed Central

    Rostami, Somayeh; Jafari, Hedayat

    2016-01-01

    The increasing progress in medical and health sciences has enhanced patient survival over the years. However, increased longevity without quality of life in terminally ill patients has been a challenging issue for care providers, especially nurses, since they are required to determine the futility or effectiveness of treatments. Futile care refers to the provision of medical care with futile therapeutic outcomes for the patient. Interest in this phenomenon has grown rapidly over the years. In this study, we aimed to review and identify nurses’ perceptions of futile care, based on available scientific resources. In total, 135 articles were retrieved through searching scientific databases (with no time restrictions), using relevant English and Farsi keywords. Finally, 16 articles, which were aligned with the study objectives, were selected and evaluated in this study. Overlapping studies were excluded or integrated, based on the research team’s opinion. According to the literature, futile care cannot be easily defined in medical sciences, and ethical dilemmas surrounding this phenomenon are very complex. Considering the key role of nurses in patient care and end-of-life decision-making and their great influence on the attitudes of patients and their families, support and counseling services on medical futility and the surrounding ethical issues are necessary for these members of healthcare teams. PMID:27147925

  20. NURSES' PERCEPTIONS OF FUTILE MEDICAL CARE.

    PubMed

    Rostami, Somayeh; Jafari, Hedayat

    2016-04-01

    The increasing progress in medical and health sciences has enhanced patient survival over the years. However, increased longevity without quality of life in terminally ill patients has been a challenging issue for care providers, especially nurses, since they are required to determine the futility or effectiveness of treatments. Futile care refers to the provision of medical care with futile therapeutic outcomes for the patient. Interest in this phenomenon has grown rapidly over the years. In this study, we aimed to review and identify nurses' perceptions of futile care, based on available scientific resources. In total, 135 articles were retrieved through searching scientific databases (with no time restrictions), using relevant English and Farsi keywords. Finally, 16 articles, which were aligned with the study objectives, were selected and evaluated in this study. Overlapping studies were excluded or integrated, based on the research team's opinion. According to the literature, futile care cannot be easily defined in medical sciences, and ethical dilemmas surrounding this phenomenon are very complex. Considering the key role of nurses in patient care and end-of-life decision-making and their great influence on the attitudes of patients and their families, support and counseling services on medical futility and the surrounding ethical issues are necessary for these members of healthcare teams. PMID:27147925

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

    PubMed

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

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

  2. Child Health and Access to Medical Care

    PubMed Central

    Leininger, Lindsey; Levy, Helen

    2016-01-01

    It might seem strange to ask whether increasing access to medical care can improve children’s health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children’s health. Nonetheless, they find that, on the whole, policies to improve access indeed improve children’s health, with the caveat that context plays a big role—medical care “matters more at some times, or for some children, than others.” Focusing on studies that can plausibly show a causal effect between policies to increase access and better health for children, and starting from an economic framework, they consider both the demand for and the supply of health care. On the demand side, they examine what happens when the government expands public insurance programs (such as Medicaid), or when parents are offered financial incentives to take their children to preventive appointments. On the supply side, they look at what happens when public insurance programs increase the payments that they offer to health-care providers, or when health-care providers are placed directly in schools where children spend their days. They also examine how the Affordable Care Act is likely to affect children’s access to medical care. Leininger and Levy reach three main conclusions. First, despite tremendous progress in recent decades, not all children have insurance coverage, and immigrant children are especially vulnerable. Second, insurance coverage alone doesn’t guarantee access to care, and insured children may still face barriers to getting the care they need. Finally, as this issue of Future of Children demonstrates, access to care is only one of the factors that policy makers should consider as they seek to make the nation’s children healthier. PMID:27516723

  3. 20 CFR 725.705 - Arrangements for medical care.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Arrangements for medical care. 725.705... Arrangements for medical care. (a) Operator liability. If an operator has been determined liable for the... arrangements to provide medical care to the miner, notify the miner and medical care facility selected of...

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-13

    ... SECURITY Federal Emergency Management Agency Recovery Policy, RP9525.4, Emergency Medical Care and Medical..., Emergency Medical Care and Medical Evacuations. This is an existing policy that is scheduled for review to... policy identifies the extraordinary emergency medical care and medical evacuation expenses that...

  5. Medical ethics in pediatric critical care.

    PubMed

    Orioles, Alberto; Morrison, Wynne E

    2013-04-01

    Ethically charged situations are common in pediatric critical care. Most situations can be managed with minimal controversy within the medical team or between the team and patients/families. Familiarity with institutional resources, such as hospital ethics committees, and national guidelines, such as publications from the American Academy of Pediatrics, American Medical Association, or Society of Critical Care Medicine, are an essential part of the toolkit of any intensivist. Open discussion with colleagues and within the multidisciplinary team can also ensure that when difficult situations arise, they are addressed in a proactive, evidence-based, and collegial manner.

  6. Home Medical Care for Heart Failure.

    PubMed

    Yumino, Dai

    2016-01-01

    As heart failure progresses to the end stage, it becomes more difficult to maintain the same level of quality of life using the established therapy for the heart failure patients. We believe that an innovative home medical care for heart failure therapy that focuses on the individual's quality of daily living and early intervention is necessary. The roles of home medical care include: early discharge to home as opposed to long hospitalization; the prevention of re-hospitalization; the provision of good care; treatment of any exacerbations; and options available at the end of the patient's life at home. Being able to provide all of the above will allow heart failure patients to live at their home. Home medical care for heart failure requires collaborative teamwork among multiple institutions and medical professionals. Among this collaborative group, the role of pharmacists is critical. Since many of the elderly with heart failure are taking multiple medications, it is important to evaluate the compliance and to intervene for improvement. Pharmacists visiting the patient's home will be able to check the patient's living environment, to evaluate medication compliance, to reconsider the necessary medications for the specific patient, and to consult physicians. Pharmacists can also explain clearly to patients and their family members any changes in medical therapy, as the conditions for an end-stage heart failure patient may change drastically in a short time. By achieving all of the above, it may be possible to prevent re-hospitalization and to help maintain the quality of life for heart failure patients. PMID:27477731

  7. Obstetric medical care in Canada.

    PubMed

    Magee, Laura A; Cote, Anne-Marie; Joseph, Geena; Firoz, Tabassum; Sia, Winnie

    2016-09-01

    Obstetric medicine is a growing area of interest within internal medicine in Canada. Canadians continue to travel broadly to obtain relevant training, particularly in the United Kingdom. However, there is now a sufficient body of expertise in Canada that a cadre of 'home-grown' obstetric internists is emerging and staying within Canada to improve maternity care. As this critical mass of practitioners grows, it is apparent that models of obstetric medicine delivery have developed according to local needs and patterns of practice. This article aims to describe the state of obstetric medicine in Canada, including general internal medicine services as the rock on which Canadian obstetric medicine has been built, the Canadian training curriculum and opportunities, organisation of obstetric medicine service delivery and the future. PMID:27630747

  8. Obstetric medical care in Canada.

    PubMed

    Magee, Laura A; Cote, Anne-Marie; Joseph, Geena; Firoz, Tabassum; Sia, Winnie

    2016-09-01

    Obstetric medicine is a growing area of interest within internal medicine in Canada. Canadians continue to travel broadly to obtain relevant training, particularly in the United Kingdom. However, there is now a sufficient body of expertise in Canada that a cadre of 'home-grown' obstetric internists is emerging and staying within Canada to improve maternity care. As this critical mass of practitioners grows, it is apparent that models of obstetric medicine delivery have developed according to local needs and patterns of practice. This article aims to describe the state of obstetric medicine in Canada, including general internal medicine services as the rock on which Canadian obstetric medicine has been built, the Canadian training curriculum and opportunities, organisation of obstetric medicine service delivery and the future.

  9. 32 CFR 564.39 - Medical care benefits.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Medical care benefits. 564.39 Section 564.39... REGULATIONS Medical Attendance and Burial § 564.39 Medical care benefits. (a) A member of the ARNG who incurs a disease or injury under the conditions enumerated herein is entitled to medical care, in...

  10. 32 CFR 564.39 - Medical care benefits.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Medical care benefits. 564.39 Section 564.39... REGULATIONS Medical Attendance and Burial § 564.39 Medical care benefits. (a) A member of the ARNG who incurs a disease or injury under the conditions enumerated herein is entitled to medical care, in...

  11. 32 CFR 564.39 - Medical care benefits.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Medical care benefits. 564.39 Section 564.39... REGULATIONS Medical Attendance and Burial § 564.39 Medical care benefits. (a) A member of the ARNG who incurs a disease or injury under the conditions enumerated herein is entitled to medical care, in...

  12. 32 CFR 564.39 - Medical care benefits.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Medical care benefits. 564.39 Section 564.39... REGULATIONS Medical Attendance and Burial § 564.39 Medical care benefits. (a) A member of the ARNG who incurs a disease or injury under the conditions enumerated herein is entitled to medical care, in...

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

    PubMed Central

    2011-01-01

    Background An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB) - a contributory benefits social program aimed at informal P/EOL caregivers - operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. Methods As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. Results Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. Conclusions This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to

  14. Medical liability and health care reform.

    PubMed

    Nelson, Leonard J; Morrisey, Michael A; Becker, David J

    2011-01-01

    We examine the impact of the Affordable Care Act (ACA) on medical liability and the controversy over whether federal medical reform including a damages cap could make a useful contribution to health care reform. By providing guaranteed access to health care insurance at community rates, the ACA could reduce the problem of under-compensation resulting from damages caps. However, it may also exacerbate the problem of under-claiming in the malpractice system, thereby reducing incentives to invest in loss prevention activities. Shifting losses from liability insurers to health insurers could further undermine the already weak deterrent effect of the medical liability system. Republicans in Congress and physician groups both pushed for the adoption of a federal damages cap as part of health care reform. Physician support for damages caps could be explained by concerns about the insurance cycle and the consequent instability of the market. Our own study presented here suggests that there is greater insurance market stability in states with caps on non-economic damages. Republicans in Congress argued that the enactment of damages caps would reduce aggregate health care costs. The Congressional Budget Office included savings from reduced health care utilization in its estimates of cost savings that would result from the enactment of a federal damages cap. But notwithstanding recent opinions offered by the CBO, it is not clear that caps will significantly reduce health care costs or that any savings will be passed on to consumers. The ACA included funding for state level demonstration projects for promising reforms such as offer and disclosure and health courts, but at this time the benefits of these reforms are also uncertain. There is a need for further studies on these issues.

  15. Computers, health care, and medical information science.

    PubMed

    Lincoln, T L; Korpman, R A

    1980-10-17

    The clinical laboratory is examined as a microcosm of the entire health care delivery system. The introduction of computers into the clinical laboratory raises issues that are difficult to resolve by the methods of information science or medical science applied in isolation. The melding of these two disciplines, together with the contributions of other disciplines, has created a new field of study called medical information science. The emergence of this new discipline and some specific problem-solving approaches used in its application in the clinical laboratory are examined.

  16. No payments, copayments and faux payments: are medical practitioners adequately equipped to manage Medicare claiming and compliance?

    PubMed

    Faux, M A; Wardle, J L; Adams, J

    2015-02-01

    The complexity of Medicare claiming means it is often beyond the comprehension of many, including medical practitioners who are required to interpret and apply Medicare every day. A single Medicare service can be the subject of 30 different payment rates, multiple claiming methods and a myriad of rules, with severe penalties for non-compliance, yet the administrative infrastructure and specialised human resourcing of Medicare may have decreased over time. As a result, medical practitioners experience difficulties accessing reliable information and support concerning their claiming and compliance obligations. Some commentators overlook the complexity of Medicare and suggest that deliberate misuse of the system by medical practitioners is a significant contributor to rising healthcare costs, although there is currently no empirical evidence to support this view. Quantifying the precise amount of leakage caused by inappropriate claiming has proven an impossible task, although current estimates are $1-3 billion annually. The current government's proposed copayment plan may cause increases in non-compliance and incorrect Medicare claiming, and a causal link has been demonstrated between medical practitioner access to Medicare education and significant costs savings. Medicare claiming is a component of almost every medical interaction in Australia, yet most education in this area currently occurs on an ad hoc basis. Research examining medical practitioner experiences and understanding regarding Medicare claiming and compliance is urgently required to adapt medicine responsibly to our rapidly changing healthcare environment. PMID:25650538

  17. No payments, copayments and faux payments: are medical practitioners adequately equipped to manage Medicare claiming and compliance?

    PubMed

    Faux, M A; Wardle, J L; Adams, J

    2015-02-01

    The complexity of Medicare claiming means it is often beyond the comprehension of many, including medical practitioners who are required to interpret and apply Medicare every day. A single Medicare service can be the subject of 30 different payment rates, multiple claiming methods and a myriad of rules, with severe penalties for non-compliance, yet the administrative infrastructure and specialised human resourcing of Medicare may have decreased over time. As a result, medical practitioners experience difficulties accessing reliable information and support concerning their claiming and compliance obligations. Some commentators overlook the complexity of Medicare and suggest that deliberate misuse of the system by medical practitioners is a significant contributor to rising healthcare costs, although there is currently no empirical evidence to support this view. Quantifying the precise amount of leakage caused by inappropriate claiming has proven an impossible task, although current estimates are $1-3 billion annually. The current government's proposed copayment plan may cause increases in non-compliance and incorrect Medicare claiming, and a causal link has been demonstrated between medical practitioner access to Medicare education and significant costs savings. Medicare claiming is a component of almost every medical interaction in Australia, yet most education in this area currently occurs on an ad hoc basis. Research examining medical practitioner experiences and understanding regarding Medicare claiming and compliance is urgently required to adapt medicine responsibly to our rapidly changing healthcare environment.

  18. Large Independent Primary Care Medical Groups

    PubMed Central

    Casalino, Lawrence P.; Chen, Melinda A.; Staub, C. Todd; Press, Matthew J.; Mendelsohn, Jayme L.; Lynch, John T.; Miranda, Yesenia

    2016-01-01

    PURPOSE In the turbulent US health care environment, many primary care physicians seek hospital employment. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. We wanted to describe these groups, their advantages, and their challenges. METHODS We identified 21 groups and studied 5 that varied in size and location. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers—leaders of a health plan, hospital, and specialty medical group that shared patients with the group. We triangulated responses from group leaders, group physicians, and external observers to identify key themes. RESULTS The groups’ physicians work in small practices, with the group providing economies of scale necessary to develop laboratory and imaging services, health information technology, and quality improvement infrastructure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Unlike hospital-employed and multispecialty groups, independent primary care groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Each group was positively regarded by external observers. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale. CONCLUSIONS Large, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting. PMID:26755779

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

    PubMed

    Azuma, Kazunari; Ohta, Shoichi

    2016-02-01

    Medical care for an ultra-aging society has been shifted from hospital-centered to local community-based. This shift has yielded the so-called Integrated Community Care System. In the system, emergency medical care is considered important, as primary care doctors and home health care providers play a crucial role in coordinating with the department of emergency medicine. Since the patients move depending on their physical condition, a hospital and a community should collaborate in providing a circulating service. The revision of the medical payment system in 2014 clearly states the importance of "functional differentiation and strengthen and coordination of medical institutions, improvement of home health care". As part of the revision, the subacute care unit has been integrated into the community care unit, which is expected to have more than one role in community coordination. The medical fee has been set for the purpose of promoting the home medical care visit, and enhancing the capability of family doctors. In the section of end-of-life care for the elderly, there have been many issues such as reduction of the readmission rate and endorsement of a patient's decision-making, and judgment for active emergency medical care for patient admission. The concept of frailty as an indicator of prognosis has been introduced, which might be applied to the future of emergency medicine. As described above, the importance of a primary doctor and a family doctor should be identified more in the future; thereby it becomes essential for doctors to closely work with the hospital. Advancing the cooperation between a hospital and a community for seamless patient-centered care, the emergency medicine as an integrated community care will further develop by adapting to an ultra-aging society. PMID:26915240

  20. 20 CFR 702.407 - Supervision of medical care.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Supervision of medical care. 702.407 Section... AND HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the...

  1. 20 CFR 702.407 - Supervision of medical care.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Supervision of medical care. 702.407 Section...'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the...

  2. 32 CFR 732.22 - Recovery of medical care payments.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 5 2014-07-01 2014-07-01 false Recovery of medical care payments. 732.22 Section 732.22 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Medical and Dental Care From Nonnaval Sources § 732.22 Recovery of...

  3. 32 CFR 732.22 - Recovery of medical care payments.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 5 2013-07-01 2013-07-01 false Recovery of medical care payments. 732.22 Section 732.22 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Medical and Dental Care From Nonnaval Sources § 732.22 Recovery of...

  4. 20 CFR 702.407 - Supervision of medical care.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Supervision of medical care. 702.407 Section...'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the...

  5. The Prairie State Games: Organization of Medical Care.

    ERIC Educational Resources Information Center

    Noble, H. Bates; And Others

    1988-01-01

    This description of the medical services provided at the Prairie State Games (Illinois), an Olympic-style sports festival, suggests guidelines for providing medical care at large-scale athletic events and covers such areas as medical organization, personnel, medical facilities, communication, equipment, and injury care. A summary of injuries over…

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  7. Justice and care: the implications of the Kohlberg-Gilligan debate for medical ethics.

    PubMed

    Sharpe, V A

    1992-12-01

    Carol Gilligan has identified two orientations to moral understanding; the dominant 'justice orientation' and the under-valued 'care orientation'. Based on her discernment of a 'voice of care', Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.

  8. [Organisation of medical care delivery to citizens, enjoying a right to get medical care at military-medical organisations of the Ministry of Defence of the Russian Federation].

    PubMed

    Fisun, A Ya; Kuvshinov, K Ye; Pastukhov, A G; Zemlyakov, S V

    2015-09-01

    One of the main priorities of the medical service of the armed forces of the Russian federation is a realization of rights for military retirees and members of their families to free medical care. For this purpose was founded a system of organization of medical care delivery at military-medical subdivisions, units and organizations of the ministry of defence of the Russian federation, based on territorial principle of medical support. In order to improve availability and quality of medical care was determined the order of free medical care delivery to military servicemen and military retirees in medical organizations of state and municipal systems of the health care.

  9. Undergraduate medical education in emergency medical care: A nationwide survey at German medical schools

    PubMed Central

    Beckers, Stefan K; Timmermann, Arnd; Müller, Michael P; Angstwurm, Matthias; Walcher, Felix

    2009-01-01

    Background Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Methods Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Results Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21); problem-based learning at 29% (n = 10), e-learning at 3% (n = 1), and internship in ambulance service is mandatory at 11% (n = 4). In terms of assessment methods, multiple-choice exams (15 to 70 questions) are favoured (89%, n = 31), partially supplemented by open questions (31%, n = 11). Some faculties also perform single practical tests (43%, n = 15), objective structured clinical examination (OSCE; 29%, n = 10) or oral examinations (17%, n = 6). Conclusion Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard level of education

  10. Minors' rights to consent to medical care.

    PubMed

    Holder, A R

    1987-06-26

    The author reviews the legal trend in the United States during the last 25 years toward allowing adolescents greater freedom to make decisions regarding their health care. She discusses courts' use of the "mature minor" rule; state statutes permitting treatment of venereal disease and drug and alcohol abuse without parental knowledge; constitutional rights of adolescents to contraception at federally funded facilities; state requirements for parental or judicial involvement in adolescents' abortion decisions; and treatment refusal of elective as opposed to lifesaving treatment. Holder suggests that physicians consult their state or county medical societies for the specific laws that apply where they practice.

  11. Medical care for people under detention.

    PubMed

    Ritom, M H

    2003-03-01

    Human Rights traditionally refer to rights and freedom that are inherent to every human being. They are based on Human Rights Law and concern the respect for dignity and worth of a person. These rights are universal, inalienable, indivisible, inter-related and interdependent. Members of Societies are detained for varied reasons and are made up of different age groups and gender. The United Nations through its numerous agencies, associated Conventions, Treaties and Resolutions have laid down guidelines that govern the rights of those under detention. Article 5 of General Assembly Resolution 45/111 clearly stipulates that except for those limitations that are demonstrably necessitated by the fact of incarceration, all prisoners shall retain the human rights and fundamental freedom set out in the Universal Declaration of Human Rights. As such, the Medical and Health Care of People under Detention should not be any different from the other members of societies. The Right to Health and Medical Care is stipulated under various Articles contained in the UN Bill of Human Rights (UDHR, ICCPCR and ICESCR) as well as other Conventions, e.g. Convention against Torture (CAT), Convention on Rights of the Child (CRC) and Convention for the Extinction of all Forms of Discrimination against Women (CEDAW). The United Nations have also developed specific guidelines and instruments for Treatment of People under Detention. These include the General Assembly Resolution 45/111 December 1990 elucidating the Basic Principles for Treatment of Prisoners, ECOSOG resolution 663C and 2076 regarding the Standard Minimum Rules for the Treatment of Prisoners which covers rules pertaining to accommodation and Medical Services, General Assembly Resolution 37/194 on Principles of Medical Ethics relevant to the role of health personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. PMID:14556353

  12. Promoting social responsibility amongst health care users: medical tourists’ perspectives on an information sheet regarding ethical concerns in medical tourism

    PubMed Central

    2013-01-01

    Background Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. Results According to feedback provided in interviews with former Canadian medical tourists, the majority of participants responded positively to the information sheet and indicated that this document prompted them to engage in further consideration of these issues. Participants indicated some frustration after reading the information sheet regarding a lack of know-how in terms of learning more about the concerns discussed in the document and changing their decision-making. This frustration was due to participants’ desperation for medical care, a topic which participants frequently discussed regarding ethical concerns related to health care provision. Conclusions The overall perceptions of former medical tourists indicate that an information sheet may promote further consideration of ethical concerns of medical tourism. However, given that these interviews were performed with former medical tourists, it remains unknown whether such a document might impact upon the decision-making of prospective medical tourists. Furthermore, participants indicated a need for an additional tool such as a website for continued discussion about these concerns. As such, along with dissemination of the information sheet

  13. The medical director in integrated clinical care models.

    PubMed

    Parker, Thomas F; Aronoff, George R

    2015-07-01

    Integrated clinical care models, like Accountable Care Organizations and ESRD Seamless Care Organizations, present new opportunities for dialysis facility medical directors to affect changes in care that result in improved patient outcomes. Currently, there is little scholarly information on what role the medical director should play. In this opinion-based review, it is predicted that dialysis providers, the hospitals in which the medical director and staff physicians practice, and the payers with which they contract are going to insist that, as care becomes more integrated, dialysis facility medical directors participate in new ways to improve quality and decrease the costs of care. Six broad areas are proposed where dialysis unit medical directors can have the greatest effect on shifting the quality-care paradigm where integrated care models are used. The medical director will need to develop an awareness of the regional medical care delivery system, collect and analyze actionable data, determine patient outcomes to be targeted that are mutually agreed on by participating physicians and institutions, develop processes of care that result in improved patient outcomes, and lead and inform the medical staff. Three practical examples of patient-centered, quality-focused programs developed and implemented by dialysis unit medical directors and their practice partners that targeted dialysis access, modality choice, and fluid volume management are presented. Medical directors are encouraged to move beyond traditional roles and embrace responsibilities associated with integrated care.

  14. Emerging trends in the outsourcing of medical and surgical care.

    PubMed

    Boyd, Jennifer B; McGrath, Mary H; Maa, John

    2011-01-01

    As total health care expenditures are expected to constitute an increasing portion of the US gross domestic product during the coming years, the US health care system is anticipating a historic spike in the need for care. Outsourcing medical and surgical care to other nations has expanded rapidly, and several ethical, legal, and financial considerations require careful evaluation. Ultimately, the balance between cost savings, quality, and patient satisfaction will be the key determinant in the future of medical outsourcing.

  15. 20 CFR 725.705 - Arrangements for medical care.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Arrangements for medical care. 725.705... FEDERAL MINE SAFETY AND HEALTH ACT, AS AMENDED Medical Benefits and Vocational Rehabilitation § 725.705 Arrangements for medical care. (a) Operator liability. If an operator has been determined liable for...

  16. 42 CFR 431.12 - Medical care advisory committee.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Medical care advisory committee. 431.12 Section 431... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Single State Agency § 431.12 Medical care advisory committee. (a) Basis and purpose. This section, based on section...

  17. 42 CFR 431.12 - Medical care advisory committee.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Medical care advisory committee. 431.12 Section 431... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Single State Agency § 431.12 Medical care advisory committee. (a) Basis and purpose. This section, based on section...

  18. 42 CFR 431.12 - Medical care advisory committee.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Medical care advisory committee. 431.12 Section 431... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Single State Agency § 431.12 Medical care advisory committee. (a) Basis and purpose. This section, based on section...

  19. Psychotropic Medication Management in a Residential Group Care Program

    ERIC Educational Resources Information Center

    Spellman, Douglas F.; Griffith, Annette K.; Huefner, Jonathan C.; Wise, Neil, III; McElderry, Ellen; Leslie, Laurel K.

    2010-01-01

    This article presents a psychotropic medication management approach that is used within a residential care program. The approach is used to assess medications at youths' times of entry and to facilitate decision making during care. Data from a typical case study have indicated that by making medication management decisions slowly, systematically,…

  20. 20 CFR 725.705 - Arrangements for medical care.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Arrangements for medical care. 725.705... FEDERAL MINE SAFETY AND HEALTH ACT, AS AMENDED Medical Benefits and Vocational Rehabilitation § 725.705 Arrangements for medical care. (a) Operator liability. If an operator has been determined liable for...

  1. 32 CFR 564.40 - Procedures for obtaining medical care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Procedures for obtaining medical care. 564.40... care. (a) When a member of the ARNG incurs a disease or an injury, while performing training duty under... benefits. (b) Authorization for care in civilian facility. (1) An individual who desires medical or...

  2. 75 FR 62348 - Reimbursement Offsets for Medical Care or Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-08

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AN55 Reimbursement Offsets for Medical Care or Services AGENCY: Department... to amend its regulations concerning the reimbursement of medical care and services delivered to... payers are required to reimburse VA for costs related to care provided by VA to a veteran covered...

  3. [Challenges for the future of psychiatry and psychiatric medical care].

    PubMed

    Higuchi, Teruhiko

    2013-01-01

    situation, is the fact that the "psychiatry exception" system (unbalanced ratio of staff to psychiatric patients) is still present today. (2) To reach a fundamental solution, the policy of low fees for psychiatric services has to be abolished. (3) Multi-disciplinary medical teams, as practiced in other developed countries, is not yet adequately applied in Japan. From the aspect of medical fees, it is not adequately encouraged either. The only place where team medicine is actually practiced is in the "forced hospitalization" ward, but, as stated in the supplementary resolution of the Japanese diet (national assembly), high-quality medicine should not only be practiced in the "forced hospitalization" ward, but also in general psychiatry. (4) The policy of transition from hospitalization-centered to community-centered medical care, which was initiated a long time ago by the Japanese government, is not proceeding in reality, and it is time that we put our heads together and find ways to overcome this problem. It is significant that "psychiatric disorders" have been included as one of the "five diseases," (a system adopted by the government concerning community health care), and now we have the best opportunity to improve community-centered psychiatric care.

  4. Ghana--medical care amid economic problems.

    PubMed

    Bacon, L

    1980-07-01

    Describing the pattern of disease encountered in primary health care (PHC) in Ghana and the facilities available to treat it, this discussion provides an account of the rapidly deteriorating economic situation and its effects on the inhabitants and on medical practice. During the 1977-79 period Ghana suffered severe economic and political difficulties, affecting work at the University Hospital in Legon, Ghana. The workload differs from that in developed countries in several ways: tropical diseases are common; the diseases of proverty are rife; diseases due to poor public health and an absence of some diseases, e.g., myocardial infarct and multiple sclerosis. There is no equivalent of the British general practioner, but there are 4 main sources of care: 54 government hospitals with 137 health centrs and health posts distributed around the country; 57 private but relatively low cost hospitals and clinics; exclusive, high cost private clinics; and traditional healers and herbalists practicing their art. Between 1976-79 the economy of Ghana went into a steep decline. Exact figures for inflation are difficult to come by; 15% per year was popularly quoted. The cedi (the Ghanaian unit of currency) was officially devalued. Goods became very scarce as well as expensive. Basic food items, spare parts for vehicles and other machinery, petroleum products, soap, and all medical supplies were hard to obtain. There was public unrest during this period. Strikes became frequent. Notable from the health perspective was a strike of all professionals, including doctors, in June 1977, strikes of government employed nurses in April 1978 and May 1979. The main events were 3 changes of government. Although exact data are not easy to obtain, the diseases of poverty appeared to be on the increase. Lack of money tended to keep those not entitled to free treatment away from private hospitals, but the deteriorating situation at the clinics seemed to more than compensate for this. Shortages

  5. 42 CFR 34.7 - Medical and other care; death.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Medical and other care; death. 34.7 Section 34.7... EXAMINATIONS MEDICAL EXAMINATION OF ALIENS § 34.7 Medical and other care; death. (a) An alien detained by or in... further care. (b) In case of the death of an alien, the body shall be delivered to the consular...

  6. 42 CFR 34.7 - Medical and other care; death.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Medical and other care; death. 34.7 Section 34.7... EXAMINATIONS MEDICAL EXAMINATION OF ALIENS § 34.7 Medical and other care; death. (a) An alien detained by or in... further care. (b) In case of the death of an alien, the body shall be delivered to the consular...

  7. 42 CFR 34.7 - Medical and other care; death.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Medical and other care; death. 34.7 Section 34.7... EXAMINATIONS MEDICAL EXAMINATION OF ALIENS § 34.7 Medical and other care; death. (a) An alien detained by or in... further care. (b) In case of the death of an alien, the body shall be delivered to the consular...

  8. 42 CFR 34.7 - Medical and other care; death.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Medical and other care; death. 34.7 Section 34.7... EXAMINATIONS MEDICAL EXAMINATION OF ALIENS § 34.7 Medical and other care; death. (a) An alien detained by or in... further care. (b) In case of the death of an alien, the body shall be delivered to the consular...

  9. 42 CFR 34.7 - Medical and other care; death.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Medical and other care; death. 34.7 Section 34.7... EXAMINATIONS MEDICAL EXAMINATION OF ALIENS § 34.7 Medical and other care; death. (a) An alien detained by or in... further care. (b) In case of the death of an alien, the body shall be delivered to the consular...

  10. Teaching Emergency Care to First-Year Medical Students

    ERIC Educational Resources Information Center

    McCally, Michael; And Others

    1977-01-01

    At the George Washington University School of Medicine a 52-hour course in emergency care was adapted for first-year medical students from an 81-hour program for training emergency medical technicians. (Author/LBH)

  11. Situational Analysis of Palliative Care Education in Thai Medical Schools

    PubMed Central

    Suvarnabhumi, Krishna; Sowanna, Non; Jiraniramai, Surin; Jaturapatporn, Darin; Kanitsap, Nonglak; Soorapanth, Chiroj; Thanaghumtorn, Kanate; Limratana, Napa; Akkayagorn, Lanchasak; Staworn, Dusit; Praditsuwan, Rungnirand; Uengarporn, Naporn; Sirithanawutichai, Teabaluck; Konchalard, Komwudh; Tangsangwornthamma, Chaturon; Vasinanukorn, Mayuree; Phungrassami, Temsak

    2013-01-01

    Objective The Thai Medical School Palliative Care Network conducted this study to establish the current state of palliative care education in Thai medical schools. Methods A questionnaire survey was given to 2 groups that included final year medical students and instructors in 16 Thai medical schools. The questionnaire covered 4 areas related to palliative care education. Results An insufficient proportion of students (defined as fewer than 60%) learned nonpain symptoms control (50.0%), goal setting and care planning (39.0%), teamwork (38.7%), and pain management (32.7%). Both medical students and instructors reflected that palliative care education was important as it helps to improve quality of care and professional competence. The percentage of students confident to provide palliative care services under supervision of their senior, those able to provide services on their own, and those not confident to provide palliative care services were 57.3%, 33.3%, and 9.4%, respectively. Conclusions The lack of knowledge in palliative care in students may lower their level of confidence to practice palliative care. In order to prepare students to achieve a basic level of competency in palliative care, each medical school has to carefully put palliative care content into the undergraduate curriculum. PMID:25278759

  12. External Ventricular Catheters: Is It Appropriate to Use an Open/Monitor Position to Adequately Trend Intracranial Pressure in a Neuroscience Critical Care Environment?

    PubMed

    Sunderland, Nicole E; Villanueva, Nancy E; Pazuchanics, Susan J

    2016-10-01

    Intracranial pressure (ICP) monitoring can be an important assessment tool in critically and acutely ill patients. An external ventricular drain offers a comprehensive way to monitor ICP and drain cerebrospinal fluid. The Monro-Kellie hypothesis, Pascal's principle, and fluid dynamics were used to formulate an assumption that an open/monitor position on the stopcock is an adequate trending measure for ICP monitoring while concurrently draining cerebrospinal fluid. Data were collected from 50 patients and totaled 1053 separate number sets. The open/monitor position was compared with the clamped position every hour. An order for "open to drain" was needed for appropriate measurement and nursing care. Results showed the absolute average differences between open/monitor and clamped positions at 1.6268 mm Hg. This finding suggests that it is appropriate to use an open/monitor position via an external ventricular drain for adequate trending of patients' ICP. PMID:27579963

  13. Health and medical care in Ethiopia.

    PubMed

    Hodes, R M; Kloos, H

    1988-10-01

    Ethiopia is a country of 45 million people in northeast Africa. With a stagnant, agriculture-based economy and a per capita gross national product of $110 in 1984, it is one of the world's poorest nations. 70% of the children are mildly to severely malnourished, and 25.7% of children born alive die before the age of 5. Life expectancy is 41 years. The population is growing at the rate of 2.9%/year, but only 2% of the people use birth control. After the 1974 revolution, the socialist government nationalized land and created 20,000 peasant associations and kebeles (urban dwellers' associations), which are the units of local government. The government has set ambitious goals for development in all sectors, including health, but famine, near famine, forced resettlement programs, and civil war have prevented any real progress from being made. The government's approach to health care is based on an emphasis on primary health care and expansion of rural health services, but the Ministry of Health is allocated only 3.5% of the national budget. Ethiopia has 3 medical schools -- at Addis Ababa, Gondar, and the Jimma Institute of Health Sciences. Physicians are government employees but also engage in private practice. A major problem is that a large proportion of medical graduates emigrate. Ethiopia has 87 hospitals with 11,296 beds, which comes to 1 bed per 3734 people. There are 1949 health stations and 141 health centers, but many have no physician, and attrition among health workers is high due to lack of ministerial support. Health care is often dispensed legally or illegally by pharmacists. Overall, there is 1 physician for 57,876 people, but in the southwest and west central Ethiopia 1 physician serves between 200,000 and 300,000 people. In rural areas, where 90% of the population lives, 85% live at least 3 days by foot from a rural health unit. Immunization of 1-year olds against tuberculosis, diphtheria-pertussis-tetanus, poliomyelitis, and measles is 11, 6, 6, and

  14. Health and medical care in Ethiopia.

    PubMed

    Hodes, R M; Kloos, H

    1988-10-01

    Ethiopia is a country of 45 million people in northeast Africa. With a stagnant, agriculture-based economy and a per capita gross national product of $110 in 1984, it is one of the world's poorest nations. 70% of the children are mildly to severely malnourished, and 25.7% of children born alive die before the age of 5. Life expectancy is 41 years. The population is growing at the rate of 2.9%/year, but only 2% of the people use birth control. After the 1974 revolution, the socialist government nationalized land and created 20,000 peasant associations and kebeles (urban dwellers' associations), which are the units of local government. The government has set ambitious goals for development in all sectors, including health, but famine, near famine, forced resettlement programs, and civil war have prevented any real progress from being made. The government's approach to health care is based on an emphasis on primary health care and expansion of rural health services, but the Ministry of Health is allocated only 3.5% of the national budget. Ethiopia has 3 medical schools -- at Addis Ababa, Gondar, and the Jimma Institute of Health Sciences. Physicians are government employees but also engage in private practice. A major problem is that a large proportion of medical graduates emigrate. Ethiopia has 87 hospitals with 11,296 beds, which comes to 1 bed per 3734 people. There are 1949 health stations and 141 health centers, but many have no physician, and attrition among health workers is high due to lack of ministerial support. Health care is often dispensed legally or illegally by pharmacists. Overall, there is 1 physician for 57,876 people, but in the southwest and west central Ethiopia 1 physician serves between 200,000 and 300,000 people. In rural areas, where 90% of the population lives, 85% live at least 3 days by foot from a rural health unit. Immunization of 1-year olds against tuberculosis, diphtheria-pertussis-tetanus, poliomyelitis, and measles is 11, 6, 6, and

  15. Bolstering the pipeline for primary care: a proposal from stakeholders in medical education.

    PubMed

    Shi, Hanyuan; Lee, Kevin C

    2016-01-01

    The Association of American Medical Colleges reports an impending shortage of over 90,000 primary care physicians by the year 2025. An aging and increasingly insured population demands a larger provider workforce. Unfortunately, the supply of US-trained medical students entering primary care residencies is also dwindling, and without a redesign in this country's undergraduate and graduate medical education structure, there will be significant problems in the coming decades. As an institution producing fewer and fewer trainees in primary care for one of the poorest states in the United States, we propose this curriculum to tackle the issue of the national primary care physician shortage. The aim is to promote more recruitment of medical students into family medicine through an integrated 3-year medical school education and a direct entry into a local or state primary care residency without compromising clinical experience. Using the national primary care deficit figures, we calculated that each state medical school should reserve 20-30 primary care (family medicine) residency spots, allowing students to bypass the traditional match after successfully completing a series of rigorous externships, pre-internships, core clerkships, and board exams. Robust support, advising, and personal mentoring are also incorporated to ensure adequate preparation of students. The nation's health is at risk. With full implementation in allopathic medical schools in 50 states, we propose a long-term solution that will serve to provide more than 1,000-2,700 new primary care providers annually. Ultimately, we will produce happy, experienced, and empathetic doctors to advance our nation's primary care system. PMID:27389607

  16. Bolstering the pipeline for primary care: a proposal from stakeholders in medical education

    PubMed Central

    Shi, Hanyuan; Lee, Kevin C.

    2016-01-01

    The Association of American Medical Colleges reports an impending shortage of over 90,000 primary care physicians by the year 2025. An aging and increasingly insured population demands a larger provider workforce. Unfortunately, the supply of US-trained medical students entering primary care residencies is also dwindling, and without a redesign in this country's undergraduate and graduate medical education structure, there will be significant problems in the coming decades. As an institution producing fewer and fewer trainees in primary care for one of the poorest states in the United States, we propose this curriculum to tackle the issue of the national primary care physician shortage. The aim is to promote more recruitment of medical students into family medicine through an integrated 3-year medical school education and a direct entry into a local or state primary care residency without compromising clinical experience. Using the national primary care deficit figures, we calculated that each state medical school should reserve 20–30 primary care (family medicine) residency spots, allowing students to bypass the traditional match after successfully completing a series of rigorous externships, pre-internships, core clerkships, and board exams. Robust support, advising, and personal mentoring are also incorporated to ensure adequate preparation of students. The nation's health is at risk. With full implementation in allopathic medical schools in 50 states, we propose a long-term solution that will serve to provide more than 1,000–2,700 new primary care providers annually. Ultimately, we will produce happy, experienced, and empathetic doctors to advance our nation's primary care system. PMID:27389607

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

    ERIC Educational Resources Information Center

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

    This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers medical emergencies. The objectives for the chapter are for students to be able to describe the causes, signs, and symptoms for specified medical emergencies and to describe emergency care for them. Informative…

  18. Children's Medications: A Guide for Schools and Day Care Centers.

    ERIC Educational Resources Information Center

    Bates, Richard D.; Nahata, Milap C.

    Noting the lack of reference sources available on the use of medications in schools and day care centers, this book was created to help school and day care center personnel become more aware of the medicine being given to children at home and at school. Using detailed medication charts, the book answers questions about how to administer medicines…

  19. 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).…

  20. Medical Care and Your 1- to 2-Year-Old

    MedlinePlus

    ... Zika & Pregnancy Medical Care and Your 1- to 2-Year-Old KidsHealth > For Parents > Medical Care and Your 1- to 2-Year-Old Print A A A Text Size ... Following simple instructions? Saying a few words? Combining two words by age 2? The doctor may ask ...

  1. Medical Care: "Say Ahh!". Health and the Consumer.

    ERIC Educational Resources Information Center

    Florida State Dept. of Education, Tallahassee. Div. of Elementary and Secondary Education.

    Secondary level students learn about medical care in this learning activity package, which is one in a series. The developers believe that consumer education in the health field would ensure better patient care and help eliminate incompetent medical practices and practitioners. The learning package includes instructions for the teacher,…

  2. Medical Care and Your 1- to 3-Month-Old

    MedlinePlus

    ... Pregnancy Medical Care and Your 1- to 3-Month-Old KidsHealth > For Parents > Medical Care and Your 1- to 3-Month-Old Print A A A Text Size What's ... When to Call the Doctor During these early months, you may have many questions about your baby's ...

  3. Medical Care and Your 8- to 12-Month-Old

    MedlinePlus

    ... Pregnancy Medical Care and Your 8- to 12-Month-Old KidsHealth > For Parents > Medical Care and Your 8- to 12-Month-Old Print A A A Text Size What's ... baby visits during this period, once at 9 months and again at 12 months . If you have ...

  4. Medical Care and Your 4- to 7-Month-Old

    MedlinePlus

    ... Pregnancy Medical Care and Your 4- to 7-Month-Old KidsHealth > For Parents > Medical Care and Your 4- to 7-Month-Old Print A A A Text Size What's ... really begin to show their personality during these months. So you might find yourself talking to your ...

  5. Limitation of medical care: an ethnographic analysis.

    PubMed

    Ventres, W; Nichter, M; Reed, R; Frankel, R

    1993-01-01

    This ethnographic study has shown how one attempt to apply ethical principles through a routine procedure failed to fit the clinical context and, in the two cases studied, served to counteract the very foundation these principles were based on--that patients or their families have the right to determine life-and-death decisions regarding code status. The results suggest that the use of well-meaning forms that are intended to facilitate decision making can, in the absence of appropriate guidelines, routinize the doctor-patient discourse to meet bureaucratic needs, narrowing rather than expanding understanding and communication. Bioethical principles implemented in abstraction, apart from the complex intricacies of the doctor-patient-family relationship and the sociocultural influences upon which this relationship is dependent, may be counter-productive to patient interests. As bioethicists and clinicians work to implement the demands of the Patient Self-Determination Act, they will undoubtedly try to forestall legal problems, assure ethical consistency, facilitate auditing, and promote documentation by creating forms. They may look to create inventories, such as the Limitation of Medical Care form described here, or turn to other, less explicit, means of documentation. This study suggests that, in these efforts, genuine attention should be given to patient concerns, not just to the ethical or institutional needs of medicine. This shift in focus from outcome to process can enhance patient and clinician satisfaction, help resolve difficulties in reaching consensus between involved decision makers, and return the power in DNR decision making to patients and families.

  6. Intravenous Medication Administration in Intensive Care: Opportunities for Technological Solutions

    PubMed Central

    Moss, Jacqueline; Berner, Eta; Bothe, Olaf; Rymarchuk, Irina

    2008-01-01

    Medication administration errors have been shown to be frequent and serious. Error is particularly prevalent in highly technical specialties such as critical care. The purpose of this study was to describe the characteristics of intravenous medication administration in five intensive care units. These data were used within the context of a larger study to design information system decision support to decrease medication administration errors in these settings. Nurses were observed during the course of their work and their intravenous medication administration process, medication order source, references used, calculation method, number of medications prepared simultaneously, and any interruptions occurring during the preparation and delivery phases of the administration event were recorded. In addition, chart reviews of medication administration records were completed and nurses were asked to complete an anonymous drop-box questionnaire regarding their experiences with medication administration error. The results of this study are discussed in terms of potential informatics solutions for reducing medication administration error. PMID:18998790

  7. The Patient-Centered Medical Neighborhood: Transformation of Specialty Care.

    PubMed

    Spatz, Christin; Bricker, Patricia; Gabbay, Robert

    2014-01-01

    The growing need for coordinated care of those with medically complex diseases is becoming more important in today's health care system, wherein reimbursement changes are driving methods to improve quality and cost. This article discusses the 6 key processes that, according to the American College of Physicians, define an effective medical neighborhood; the evidence supporting the need for this coordinated system; and pilot medical neighborhood strategies being implemented.

  8. [SOROKA UNIVERSITY MEDICAL CENTER: THE ROAD TO LEADERSHIP IN QUALITY OF MEDICAL CARE, SERVICE AND RESEARCH].

    PubMed

    Davidson, Ehud; Sheiner, Eyal

    2016-02-01

    Soroka University Medical Center is a tertiary hospital, and the sole medical center in the Negev, the southern part of Israel. Soroka has invested in quality, service and research. The region has developed joint programs in order to advance the quality of medical care whilst optimizing the utilization of available resources. In this editorial we describe the path to leadership in quality of medical care, service and research.

  9. [SOROKA UNIVERSITY MEDICAL CENTER: THE ROAD TO LEADERSHIP IN QUALITY OF MEDICAL CARE, SERVICE AND RESEARCH].

    PubMed

    Davidson, Ehud; Sheiner, Eyal

    2016-02-01

    Soroka University Medical Center is a tertiary hospital, and the sole medical center in the Negev, the southern part of Israel. Soroka has invested in quality, service and research. The region has developed joint programs in order to advance the quality of medical care whilst optimizing the utilization of available resources. In this editorial we describe the path to leadership in quality of medical care, service and research. PMID:27215117

  10. Schizophrenia in the Netherlands: Continuity of Care with Better Quality of Care for Less Medical Costs

    PubMed Central

    van der Lee, Arnold; de Haan, Lieuwe; Beekman, Aartjan

    2016-01-01

    Background Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment. Methods Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008–2011 in the Netherlands. Included were 7,392 patients under 70 years of age with schizophrenia in 2008, insured during the whole period. We assessed the relationship between continuous elective psychiatric care and the outcome measures: acute treatment events, psychiatric hospitalization, somatic care and health care costs. Results Continuous elective psychiatric care was accessed by 73% of the patients during the entire three year follow-up period. These patients received mostly outpatient care and accessed more somatic care, at a total cost of €36,485 in three years, than those without continuous care. In the groups accessing fewer or no years of elective care 34%-68% had inpatient care and acute treatment events, while accessing less somatic care at average total costs of medical care from €33,284 to €64,509. Conclusions Continuous elective mental and somatic care for 73% of the patients with schizophrenia showed better quality of care at lower costs. Providing continuous elective care to the remaining patients may improve health while reducing acute illness episodes. PMID:27275609

  11. Defining Medical Levels of Care for Exploration Missions

    NASA Technical Reports Server (NTRS)

    Hailey, M.; Reyes, D.; Urbina, M.; Rubin, D.; Antonsen, E.

    2017-01-01

    NASA medical care standards establish requirements for providing health and medical programs for crewmembers during all phases of a mission. These requirements are intended to prevent or mitigate negative health consequences of long-duration spaceflight, thereby optimizing crew health and performance over the course of the mission. Current standards are documented in the two volumes of the NASA-STD-3001 Space Flight Human-System Standard document, established by the Office of the Chief Health and Medical Officer. Its purpose is to provide uniform technical standards for the design, selection, and application of medical hardware, software, processes, procedures, practices, and methods for human-rated systems. NASA-STD-3001 Vol. 1 identifies five levels of care for human spaceflight. These levels of care are accompanied by several components that illustrate the type of medical care expected for each. The Exploration Medical Capability (ExMC) of the Human Research Program has expanded the context of these provided levels of care and components. This supplemental information includes definitions for each component of care and example actions that describe the type of capabilities that coincide with the definition. This interpretation is necessary in order to fully and systematically define the capabilities required for each level of care in order to define the medical requirements and plan for infrastructure needed for medical systems of future exploration missions, such as one to Mars.

  12. Harm in the absence of care: Towards a medical ethics that cares.

    PubMed

    Martinsen, Elin

    2011-03-01

    The aim of this article is to investigate the concept of care in contemporary medical practice and medical ethics. Although care has been hailed throughout the centuries as a crucial ideal in medical practice and as an honourable virtue to be observed in codes of medical ethics, I argue that contemporary medicine and medical ethics suffer from the lack of a theoretically sustainable concept of care and then discuss possible reasons that may help to explain this absence. I draw on the empirical studies of Carol Gilligan on care and connectedness as ontologically situated realities in human life. Based on a philosophical elaboration of her findings on the ethics of care emphasizing relationality, I try to show how the notion of 'relational ontology' originating from this stream of thought may be of help in developing a medical ethics that acknowledges care as a perspective to be observed in all interactions between physicians and patients.

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

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

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

  14. Barriers to improving primary care of depression: perspectives of medical group leaders.

    PubMed

    Whitebird, Robin R; Solberg, Leif I; Margolis, Karen L; Asche, Stephen E; Trangle, Michael A; Wineman, Arthur P

    2013-06-01

    Using clinical trials, researchers have demonstrated effective methods for treating depression in primary care, but improvements based on these trials are not being implemented. This might be because these improvements require more systematic organizational changes than can be made by individual physicians. We interviewed 82 physicians and administrative leaders of 41 medical groups to learn what is preventing those organizational changes. The identified barriers to improving care included external contextual problems (reimbursement, scarce resources, and access to/communication with specialty mental health), individual attitudes (physician and patient resistance), and internal care process barriers (organizational and condition complexity, difficulty standardizing and measuring care). Although many of these barriers are challenging, we can overcome them by setting clear priorities for change and allocating adequate resources. We must improve primary care of depression if we are to reduce its enormous adverse social and economic impacts. PMID:23515301

  15. Pharmacogenomically actionable medications in a safety net health care system

    PubMed Central

    Carpenter, Janet S; Rosenman, Marc B; Knisely, Mitchell R; Decker, Brian S; Levy, Kenneth D; Flockhart, David A

    2016-01-01

    Objective: Prior to implementing a trial to evaluate the economic costs and clinical outcomes of pharmacogenetic testing in a large safety net health care system, we determined the number of patients taking targeted medications and their clinical care encounter sites. Methods: Using 1-year electronic medical record data, we evaluated the number of patients who had started one or more of 30 known pharmacogenomically actionable medications and the number of care encounter sites the patients had visited. Results: Results showed 7039 unique patients who started one or more of the target medications within a 12-month period with visits to 73 care sites within the system. Conclusion: Findings suggest that the type of large-scale, multi-drug, multi-gene approach to pharmacogenetic testing we are planning is widely relevant, and successful implementation will require wide-scale education of prescribers and other personnel involved in medication dispensing and handling. PMID:26835014

  16. Guidelines for providing medical care to Southeast Asian refugees.

    PubMed

    Hoang, G N; Erickson, R V

    1982-08-13

    Almost 500,000 Southeast Asian refugees have arrived in the United States since 1975. While these refugees have not presented substantial public health problems, they have important personal health problems frequently requiring medical attention. Medical care providers in this country need to be aware of disease patterns and prevalence among these refugees. As well, they need to be aware of the cultural and religious backgrounds and previous medical practices of this refugee population, particularly as these practice influence the refugees' ability to obtain and maintain medical services provided in this country. Historical, cultural, religious, ethical, and medical information is provided to help US health care facilities develop culturally appropriate medical care services for Southeast Asian refugees. PMID:7097923

  17. Reducing medication errors in critical care: a multimodal approach

    PubMed Central

    Kruer, Rachel M; Jarrell, Andrew S; Latif, Asad

    2014-01-01

    The Institute of Medicine has reported that medication errors are the single most common type of error in health care, representing 19% of all adverse events, while accounting for over 7,000 deaths annually. The frequency of medication errors in adult intensive care units can be as high as 947 per 1,000 patient-days, with a median of 105.9 per 1,000 patient-days. The formulation of drugs is a potential contributor to medication errors. Challenges related to drug formulation are specific to the various routes of medication administration, though errors associated with medication appearance and labeling occur among all drug formulations and routes of administration. Addressing these multifaceted challenges requires a multimodal approach. Changes in technology, training, systems, and safety culture are all strategies to potentially reduce medication errors related to drug formulation in the intensive care unit. PMID:25210478

  18. Health Information Technology Will Shift the Medical Care Paradigm

    PubMed Central

    2008-01-01

    The current paradigm of medical care depends heavily on the autonomous and highly trained doctor to collect and process information necessary to care for each patient. This paradigm is challenged by the increasing requirements for knowledge by both patients and doctors; by the need to evaluate populations of patients inside and outside one’s practice; by consistently unmet quality of care expectations; by the costliness of redundant, fragmented, and suboptimal care; and by a seemingly insurmountable demand for chronic disease care. Medical care refinements within the old paradigm may not solve these challenges, suggesting a shift to a new paradigm is needed. A new paradigm could be considerably more reliant on health information technology because that offers the best option for addressing our challenges and creating a foundation for future medical progress, although this process will be disruptive. PMID:18373152

  19. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Condition of participation: Acceptance of patients... HEALTH SERVICES Administration § 484.18 Condition of participation: Acceptance of patients, plan of care... that the patient's medical, nursing, and social needs can be met adequately by the agency in...

  20. The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO).

    PubMed

    Popescu, R A; Schäfer, R; Califano, R; Eckert, R; Coleman, R; Douillard, J-Y; Cervantes, A; Casali, P G; Sessa, C; Van Cutsem, E; de Vries, E; Pavlidis, N; Fumasoli, K; Wörmann, B; Samonigg, H; Cascinu, S; Cruz Hernández, J J; Howard, A J; Ciardiello, F; Stahel, R A; Piccart, M

    2014-01-01

    The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire 'cancer journey'. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today's and tomorrow's professional cancer care.

  1. Effects of the Growth of Managed Care on Academic Medical Centers and Graduate Medical Education.

    ERIC Educational Resources Information Center

    Gold, Marsha R.

    1996-01-01

    Ways in which the proliferation of competitive health care financing and service delivery systems based on managed care affects the financial support available to academic medical centers (AMCs), especially graduate medical education programs, are discussed. Analysis is based on case studies of AMCs. Trends, potential conflicts, and areas for…

  2. Medication reconciliation: a prescription for safer care.

    PubMed

    Mitchell, Jonathan I; Owen, Marie M; Colquhoun, Margaret H; Lawand, Christina

    2013-01-01

    Four national healthcare organizations - Accreditation Canada, the Canadian Institute for Health Information, the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada - recently collaborated to better understand and share comprehensive information about medication reconciliation in Canada. This article summarizes the key findings of their joint report titled Medication Reconciliation in Canada: Raising the Bar and profiles innovative approaches and tools for healthcare organizations across Canada. PMID:24485236

  3. Implications of utilization shifts on medical-care price measurement.

    PubMed

    Dunn, Abe; Liebman, Eli; Shapiro, Adam Hale

    2015-05-01

    The medical-care sector often experiences changes in medical protocols and technologies that cause shifts in treatments. However, the commonly used medical-care price indexes reported by the Bureau of Labor Statistics hold the mix of medical services fixed. In contrast, episode expenditure indexes, advocated by many health economists, track the full cost of disease treatment, even as treatments shift across service categories (e.g., inpatient to outpatient hospital). In our data, we find that these two conceptually different measures of price growth show similar aggregate rates of inflation over the 2003-2007 period. Although aggregate trends are similar, we observe differences when looking at specific disease categories.

  4. The Need for Domestic Violence Laws with Adequate Legal and Social Support Services.

    ERIC Educational Resources Information Center

    Hemmons, Willa M.

    1981-01-01

    Describes the need for comprehensive domestic violence programs that include medical, legal, economic, psychological, and child care services. Although most states have family violence legislation, more work is needed to adequately implement these programs. (Author/JAC)

  5. [Health policies and politicized health? An analysis of sexual and reproductive health policies in Peru from the perspective of medical ethics, quality of care, and human rights].

    PubMed

    Miranda, J Jaime; Yamin, Alicia Ely

    2008-01-01

    Health professionals view medical ethics as a discipline that provides the basis for more adequate patient care. In recent years the concepts of quality of care and human rights - with their attending discourses - have joined the concept of medical ethics among the paradigms to consider in care for humans both at the individual and health policy levels. The current study seeks to analyze such paradigms, based on a case study of sexual and reproductive health policies in Peru in the last 10 years.

  6. Luxury Primary Care, Academic Medical Centers, and the Erosion of Science and Professional Ethics

    PubMed Central

    Donohoe, Martin

    2004-01-01

    Medical schools and teaching hospitals have been hit particularly hard by the financial crisis affecting health care in the United States. To compete financially, many academic medical centers have recruited wealthy foreign patients and established luxury primary care clinics. At these clinics, patients are offered tests supported by little evidence of their clinical and/or cost effectiveness, which erodes the scientific underpinnings of medical practice. Given widespread disparities in health, wealth, and access to care, as well as growing cynicism and dissatisfaction with medicine among trainees, the promotion by these institutions of an overt, two-tiered system of care, which exacerbates inequities and injustice, erodes professional ethics. Academic medical centers should divert their intellectual and financial resources away from luxury primary care and toward more equitable and just programs designed to promote individual, community, and global health. The public and its legislators should, in turn, provide adequate funds to enable this. Ways for academic medicine to facilitate this largesse are discussed. PMID:14748866

  7. Kaiser Permanente Medical Care Programs (KP-MCP)

    Cancer.gov

    The Division of Research within KP-MCP conducts, publishes, and disseminates high-quality epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large.

  8. 42 CFR 431.12 - Medical care advisory committee.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... other representatives of the health professions who are familiar with the medical needs of low-income population groups and with the resources available and required for their care; (2) Members of...

  9. Young Adults Seeking Medical Care: Do Race and Ethnicity Matter?

    MedlinePlus

    ... to medical care, National Health Interview Survey Does health insurance coverage differ by race and ethnicity for young ... having health insurance coverage. Definitions Terms related to health insurance Health insurance coverage: Health insurance is broadly defined ...

  10. 32 CFR 732.22 - Recovery of medical care payments.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... possible under workers compensation, no-fault insurance, or under medical payments insurance (all... statement. (c) For care rendered in States with no-fault insurance laws, comply with procedures outlined...

  11. 32 CFR 732.22 - Recovery of medical care payments.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... possible under workers compensation, no-fault insurance, or under medical payments insurance (all... statement. (c) For care rendered in States with no-fault insurance laws, comply with procedures outlined...

  12. 32 CFR 732.22 - Recovery of medical care payments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... possible under workers compensation, no-fault insurance, or under medical payments insurance (all... statement. (c) For care rendered in States with no-fault insurance laws, comply with procedures outlined...

  13. Advanced Respite Care: Medically Challenged. Teacher Edition. Respite Care Series.

    ERIC Educational Resources Information Center

    Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

    This curriculum guide is designed to help teachers to provide advanced-level training for care providers who want to work with individuals who are chronically or terminally ill and require specialized care. The curriculum contains seven units. Each of the instructional units includes some or all of these basic components: performance objectives,…

  14. Medical care delivery in the US space program

    NASA Technical Reports Server (NTRS)

    Stewart, Donald F.

    1991-01-01

    The stated goal of this meeting is to examine the use of telemedicine in disaster management, public health, and remote health care. NASA has a vested interest in providing health care to crews in remote environments. NASA has unique requirements for telemedicine support, in that our flight crews conduct their job in the most remote of all work environments. Compounding the degree of remoteness are other environmental concerns, including confinement, lack of atmosphere, spaceflight physiological deconditioning, and radiation exposure, to name a few. In-flight medical care is a key component in the overall support for missions, which also includes extensive medical screening during selection, preventive medical programs for astronauts, and in-flight medical monitoring and consultation. This latter element constitutes the telemedicine aspect of crew health care. The level of in-flight resources dedicated to medical care is determined by the perceived risk of a given mission, which in turn is related to mission duration, planned crew activities, and length of time required for return to definitive medical care facilities.

  15. [Evolution of China's rural cooperative medical care system.].

    PubMed

    Cai, Tian-Xin

    2009-11-01

    The rural cooperative medical care system of our country originated from the beginning of the 50s of the 20(th) century, which developed abnormally due to leftist ideology during the period of the Cultural Revolution. An institutional reform of the rural cooperative medical care system had began after the reform and opening up in China, but with the development of rural productivity and rapid transformation of economic structure, the traditional cooperative medical care system declined rapidly due to incompatibility with the new model of economic and social development. At the beginning of the 90s of the 20(th) century, exploring the developmental path of rural cooperative medical service, under the conditions of market economy and adopting the approach of "main individual investment with partial collective and appropriate government support", to try to establish rural cooperative medical funds, so that the rural cooperative medical system could bottom out gradually, but still failed to achieve the expected goal of universal access to health care in 2000. However, the promotion and establishment of a new rural cooperative medical care and aid system could become a major achievement aim in the 21(st) century. PMID:20193440

  16. [The development of organization of medical social care of adolescents].

    PubMed

    Chicherin, L P; Nagaev, R Ia

    2014-01-01

    The model of the subject of the Russian Federation is used to consider means of development of health protection and health promotion in adolescents including implementation of the National strategy of activities in interest of children for 2012-2017 approved by decree No761 of the President of Russia in June 1 2012. The analysis is carried out concerning organization of medical social care to this group of population in medical institutions and organizations of different type in the Republic of Bashkortostan. Nowadays, in 29 territories medical social departments and rooms, 5 specialized health centers for children, 6 clinics friendly to youth are organized. The analysis of manpower support demonstrates that in spite of increasing of number of rooms and departments of medical social care for children and adolescents decreasing of staff jobs both of medical personnel and psychologists and social workers occurs. The differences in priorities of functioning of departments and rooms of medical social care under children polyclinics, health centers for children and clinics friendly to youth are established. The questionnaire survey of pediatricians and adolescents concerning perspectives of development of adolescent service established significant need in development of specialized complex center. At the basis of such center problems of medical, pedagogical, social, psychological, legal profile related to specific characteristics of development and medical social needs of adolescents can be resolved. The article demonstrates organizational form of unification on the functional basis of the department of medical social care of children polyclinic and clinic friendly to youth. During three years, number of visits of adolescents to specialists of the center increases and this testifies awareness of adolescents and youth about activities of department of medical social care. The most percentage of visits of adolescents to specialists was made with prevention purpose. Among

  17. [The development of organization of medical social care of adolescents].

    PubMed

    Chicherin, L P; Nagaev, R Ia

    2014-01-01

    The model of the subject of the Russian Federation is used to consider means of development of health protection and health promotion in adolescents including implementation of the National strategy of activities in interest of children for 2012-2017 approved by decree No761 of the President of Russia in June 1 2012. The analysis is carried out concerning organization of medical social care to this group of population in medical institutions and organizations of different type in the Republic of Bashkortostan. Nowadays, in 29 territories medical social departments and rooms, 5 specialized health centers for children, 6 clinics friendly to youth are organized. The analysis of manpower support demonstrates that in spite of increasing of number of rooms and departments of medical social care for children and adolescents decreasing of staff jobs both of medical personnel and psychologists and social workers occurs. The differences in priorities of functioning of departments and rooms of medical social care under children polyclinics, health centers for children and clinics friendly to youth are established. The questionnaire survey of pediatricians and adolescents concerning perspectives of development of adolescent service established significant need in development of specialized complex center. At the basis of such center problems of medical, pedagogical, social, psychological, legal profile related to specific characteristics of development and medical social needs of adolescents can be resolved. The article demonstrates organizational form of unification on the functional basis of the department of medical social care of children polyclinic and clinic friendly to youth. During three years, number of visits of adolescents to specialists of the center increases and this testifies awareness of adolescents and youth about activities of department of medical social care. The most percentage of visits of adolescents to specialists was made with prevention purpose. Among

  18. Survey of Courses Offered in U.S. Medical Schools on Health Care Delivery and Finance.

    ERIC Educational Resources Information Center

    Thompson, Warren G.; And Others

    1987-01-01

    Medical educators urge that medical students be familiar with medical care costs and the impact of these costs on the delivery of health care. A survey on whether medical schools offered courses that discussed health care delivery systems, government health care policy and legislation, and medical economics is discussed. (MLW)

  19. Finding Low-Cost Medical Care

    MedlinePlus

    ... costs and insurance requirements before you get care. Free and Low-Cost Clinics and Health Centers If ... in school), you may be able to find free or low-cost health clinics in your neighborhood. ...

  20. 38 CFR 21.6240 - Medical treatment, care and services.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Medical treatment, care and services. 21.6240 Section 21.6240 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Temporary Program of Vocational Training for Certain New Pension Recipients Medical...

  1. 42 CFR 431.12 - Medical care advisory committee.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Medical care advisory committee. 431.12 Section 431.12 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Single State...

  2. Health Care Practices for Medical Textiles in Government Hospitals

    ERIC Educational Resources Information Center

    Akubue, B. N.; Anikweze, G. U.

    2015-01-01

    The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…

  3. Nutritional care of medical inpatients: a health technology assessment

    PubMed Central

    Lassen, Karin O; Olsen, Jens; Grinderslev, Edvin; Kruse, Filip; Bjerrum, Merete

    2006-01-01

    Background The inspiration for the present assessment of the nutritional care of medical patients is puzzlement about the divide that exists between the theoretical knowledge about the importance of the diet for ill persons, and the common failure to incorporate nutritional aspects in the treatment and care of the patients. The purpose is to clarify existing problems in the nutritional care of Danish medical inpatients, to elucidate how the nutritional care for these inpatients can be improved, and to analyse the costs of this improvement. Methods Qualitative and quantitative methods are deployed to outline how nutritional care of medical inpatients is performed at three Danish hospitals. The practices observed are compared with official recommendations for nutritional care of inpatients. Factors extraneous and counterproductive to optimal nutritional care are identified from the perspectives of patients and professional staff. A review of the literature illustrates the potential for optimal nutritional care. A health economic analysis is performed to elucidate the savings potential of improved nutritional care. Results The prospects for improvements in nutritional care are ameliorated if hospital management clearly identifies nutritional care as a priority area, and enjoys access to management tools for quality assurance. The prospects are also improved if a committed professional at the ward has the necessary time resources to perform nutritional care in practice, and if the care staff can requisition patient meals rich in nutrients 24 hours a day. At the kitchen production level prospects benefit from a facilitator contact between care and kitchen staff, and if the kitchen staff controls the whole food path from the kitchen to the patient. At the patient level, prospects are improved if patients receive information about the choice of food and drink, and have a better nutrition dialogue with the care staff. Better nutritional care of medical patients in Denmark

  4. Introducing Medical Self-Care in the Curriculum.

    ERIC Educational Resources Information Center

    Keever, Bill D.; Lelm, Kathy

    1984-01-01

    Medical self-care is the involvement of laypersons, on their own behalf, in health promotion and decision making, disease prevention, and disease detection and treatment. A description of a self-care course that was designed and taught at Western Illinois University is offered. Results of a postcourse evaluation are presented. (DF)

  5. Caring, Competence and Professional Identities in Medical Education

    ERIC Educational Resources Information Center

    MacLeod, Anna

    2011-01-01

    This paper considers the multiple discourses that influence medical education with a focus on the discourses of competence and caring. Discourses of competence are largely constituted through, and related to, biomedical and clinical issues whereas discourses of caring generally focus on social concerns. These discourses are not necessarily equal…

  6. A Medical Student Organized and Directed Primary Care Preceptorship

    ERIC Educational Resources Information Center

    Skinner, Stephen R.; Rogers, Kenneth D.

    1974-01-01

    The Western Pennsylvania Health Preceptorship Program was judged to be effective in introducing students to the practice of primary care medicine and the analyses of determinants of health in communities in Western Pennsylvania and in giving them an understanding of the organization and financing of medical care. (Editor/PG)

  7. Describing Primary Care Encounters: The Primary Care Network Survey and the National Ambulatory Medical Care Survey

    PubMed Central

    Binns, Helen J.; Lanier, David; Pace, Wilson D.; Galliher, James M.; Ganiats, Theodore G.; Grey, Margaret; Ariza, Adolfo J.; Williams, Robert

    2007-01-01

    PURPOSE The purpose of this study was to describe clinical encounters in primary care research networks and compare them with those of the National Ambulatory Medical Care Survey (NAMCS). METHODS Twenty US primary care research networks collected data on clinicians and patient encounters using the Primary Care Network Survey (PRINS) Clinician Interview (PRINS-1) and Patient Record (PRINS-2), which were newly developed based on NAMCS tools. Clinicians completed a PRINS-1 about themselves and a PRINS-2 for each of 30 patient visits. Data included patient characteristics; reason for the visit, diagnoses, and services ordered or performed. We compared PRINS data with data obtained from primary care physicians during 5 cycles of NAMCS (1997–2001). Data were weighted; PRINS reflects participating networks and NAMCS provides national estimates. RESULTS By discipline, 89% of PRINS clinicians were physicians, 4% were physicians in residency training, 5% were advanced practice nurses/nurse-practitioners, and 2% were physician’s assistants. The majority (53%) specialized in pediatrics (34% specialized in family medicine, 9% in internal medicine, and 4% in other specialties). All NAMCS clinicians were physicians, with 20% specializing in pediatrics. When NAMCS and PRINS visits were compared, larger proportions of PRINS visits involved preventive care and were made by children, members of minority racial groups, and individuals who did not have private health insurance. A diagnostic or other assessment service was performed for 99% of PRINS visits and 76% of NAMCS visits (95% confidence interval, 74.9%–78.0%). A preventive or counseling/education service was provided at 64% of PRINS visits and 37% of NAMCS visits (95% confidence interval, 35.1%–38.0%). CONCLUSIONS PRINS presents a view of diverse primary care visits and differs from NAMCS in its methods and findings. Further examinations of PRINS data are needed to assess their usefulness for describing encounters that

  8. [Development of ambulatory medical care in former East Germany].

    PubMed

    Weiss, O

    1991-12-01

    Outpatient medical care was well organised in the former GDR. Contrary to the FRG in the GDR a governmental Public Health system had been developed with only few privately established physicians. The care was mainly carried by outpatient departments in the city and in the country as well as by governmental doctors' practices. The personnel development and the results of the work are described and the advantages and disadvantages of this form of organisation of outpatient care are characterised.

  9. Autonomous Medical Care for Exploration Class Space Missions

    NASA Technical Reports Server (NTRS)

    Hamilton, Douglas; Smart, Kieran; Melton, Shannon; Polk, James D.; Johnson-Throop, Kathy

    2007-01-01

    The US-based health care system of the International Space Station (ISS) contains several subsystems, the Health Maintenance System, Environmental Health System and the Countermeasure System. These systems are designed to provide primary, secondary and tertiary medical prevention strategies. The medical system deployed in Low Earth Orbit (LEO) for the ISS is designed to enable a "stabilize and transport" concept of operations. In this paradigm, an ill or injured crewmember would be rapidly evacuated to a definitive medical care facility (DMCF) on Earth, rather than being treated for a protracted period on orbit. The medical requirements of the short (7 day) and long duration (up to 6 months) exploration class missions to the Moon are similar to LEO class missions with the additional 4 to 5 days needed to transport an ill or injured crewmember to a DCMF on Earth. Mars exploration class missions are quite different in that they will significantly delay or prevent the return of an ill or injured crewmember to a DMCF. In addition the limited mass, power and volume afforded to medical care will prevent the mission designers from manifesting the entire capability of terrestrial care. NASA has identified five Levels of Care as part of its approach to medical support of future missions including the Constellation program. In order to implement an effective medical risk mitigation strategy for exploration class missions, modifications to the current suite of space medical systems may be needed, including new Crew Medical Officer training methods, treatment guidelines, diagnostic and therapeutic resources, and improved medical informatics.

  10. Autonomous medical care for exploration class space missions.

    PubMed

    Hamilton, Douglas; Smart, Kieran; Melton, Shannon; Polk, James D; Johnson-Throop, Kathy

    2008-04-01

    The US-based health care system of the International Space Station contains several subsystems, the Health Maintenance System, Environmental Health System and the Countermeasure System. These systems are designed to provide primary, secondary and tertiary medical prevention strategies. The medical system deployed in low Earth orbit for the International Space Station is designed to support a "stabilize and transport" concept of operations. In this paradigm, an ill or injured crewmember would be rapidly evacuated to a definitive medical care facility (DMCF) on Earth, rather than being treated for a protracted period on orbit. The medical requirements of the short (7 day) and long duration (up to 6 months) exploration class missions to the moon are similar to low Earth orbit class missions but also include an additional 4 to 5 days needed to transport an ill or injured crewmember to a DMCF on Earth. Mars exploration class missions are quite different in that they will significantly delay or prevent the return of an ill or injured crewmember to a DMCF. In addition the limited mass, power and volume afforded to medical care will prevent the mission designers from manifesting the entire capability of terrestrial care. National Aeronautics and Space Administration has identified five levels of care as part of its approach to medical support of future missions including the Constellation program. To implement an effective medical risk mitigation strategy for exploration class missions, modifications to the current suite of space medical systems may be needed, including new crew medical officer training methods, treatment guidelines, diagnostic and therapeutic resources, and improved medical informatics.

  11. Toward Ubiquitous Communication Platform for Emergency Medical Care

    NASA Astrophysics Data System (ADS)

    Ishibashi, Kenichi; Morishima, Naoto; Kanbara, Masayuki; Sunahara, Hideki; Imanishi, Masami

    Interaction between emergency medical technicians (EMTs) and doctors is essential in emergency medical care. Doctors require diverse information related to a patient to provide efficient aid. In 2005, we started the Ikoma119 project and have developed a ubiquitous communication platform for emergency medical care called Mobile ER. Our platform, which is based on wireless internet technology, has such desirable properties as low-cost, location-independent service, and ease of service introduction. We provide an overview of our platform and describe the services that we have developed. We also discuss the remaining issues to realize our platform's actual operation.

  12. Reflection and critical thinking of humanistic care in medical education.

    PubMed

    Shiau, Shu-Jen; Chen, Chung-Hey

    2008-07-01

    The purpose of this paper is to stress the importance and learning issues of humanistic care in medical education. This article will elaborate on the following issues: (1) introduction; (2) reflection and critical thinking; (3) humanistic care; (4) core values and teaching strategies in medical education; and (5) learning of life cultivation. Focusing on a specific approach used in humanistic care, it does so for the purpose of allowing the health professional to understand and apply the concepts of humanistic value in their services.

  13. [The growing importance of ethics in medical care and research].

    PubMed

    Sass, Hans-Martin

    2009-01-01

    The integration of medical humanities into future patient care and medical research will become as importance for trust, care and health as the natural sciences were during the last 100 years. In particular, improvements of lay health literacy and responsibility, new forms of physician-nurse partnership and expert-lay interaction, also revisions of clinical research towards models of informed contract will improve trust and health on a global scale, allow for healthier and happier citizens and populations and eventually might reduce health care costs. PMID:19823790

  14. Ongoing patient randomization: an innovation in medical care research.

    PubMed Central

    Cargill, V; Cohen, D; Kroenke, K; Neuhauser, D

    1986-01-01

    Hospitals often have rotational assignment of patients to one of several similar provider care teams. The research potential of these arrangements has gone unnoticed. By changing to random assignment of patients and physicians to provider care teams (firms) this kind of organization can be used for sequential, randomized clinical trials which are ethical and efficient. The paper describes such arrangements at three different hospitals: Cleveland Metropolitan General Hospital, Brooke Army Medical Center, and University Hospitals of Cleveland. Associated methodologic issues are discussed. This is a new, more widely applicable method for medical care research. PMID:3546202

  15. Portraits of care: medical research through portraiture.

    PubMed

    Aita, Virginia A; Lydiatt, William M; Gilbert, Mark A

    2010-06-01

    The Portraits of Care study used portraiture to investigate ideas about care and care giving at the intersection of art and medicine. The study employed mixed methods involving both qualitative and quantitative research techniques. All aspects of the study were approved by the Institutional Review Board. The study included 26 patient and 20 caregiver subjects. Patient subjects were drawn from across the lifespan and included healthy and ill patients. Caregiver subjects included professional and familial caregivers. All subjects gave their informed consent for the study and the subsequent exhibition of artwork. The artist drew or painted 100 portraits during the 2-year study. A multi-disciplinary analysis team carried out the initial analysis of portraits and subject data. Findings from their qualitative analysis were used to develop a quantitative survey and qualitative journal tool that the public used to give feedback at the subsequent exhibition. Exhibition data confirmed the initial findings. Study results showed the introspection of subjects that revealed their sense of identity and psychological status. Patients appear as 'whole people', not fragmented by diagnosis. Caregivers' portraits reveal their commitment to care. There is also a sense of mutuality and fluidity in the background stories of subjects. Many patient subjects have been caregivers and, at times, caregivers are also patients. Public data emphasised the identity transformation of subjects, the centrality of the idea of mortality, the presence of hope despite adversity, and the importance of empathy and compassion in care.

  16. Non-Technical Medical Care: An In-Home Care Program.

    ERIC Educational Resources Information Center

    Oklahoma State Dept. of Human Services, Oklahoma City.

    This document describes the Non-Technical Medical Care (NTMC) program, a personal care service offered by the Oklahoma Department of Human Services to eligible persons in their own homes. These NTMC program goals are listed: to provide personal care services to frail elderly and disabled persons, allowing them to remain in their homes; and to…

  17. Medical Care of the Aquatics Athlete.

    PubMed

    Nichols, Andrew W

    2015-01-01

    Competitive swimmers are affected by several musculoskeletal and medical complaints that are unique to the sport. 'Swimmer's shoulder,' the most common overuse injury, is usually caused by some combination of impingement, rotator cuff tendinopathy, scapular dyskinesis, and instability. The condition may be treated with training modifications, stroke error correction, and strengthening exercises targeting the rotator cuff, scapular stabilizers, and core. Implementation of prevention programs to reduce the prevalence of shoulder pathology is crucial. Knee pain usually results from the breaststroke kick in swimmers, and the 'egg beater' kick in water polo players and synchronized swimmers. Lumbar back pain also is common in aquatics athletes. Among the medical conditions of particular importance in swimmers are exercise-induced bronchoconstriction, respiratory illnesses, and ear problems. Participants in other aquatics sports (water polo, diving, synchronized swimming, and open water swimming) may experience medical ailments specific to the sport. PMID:26359841

  18. An intravenous medication safety system: preventing high-risk medication errors at the point of care.

    PubMed

    Hatcher, Irene; Sullivan, Mark; Hutchinson, James; Thurman, Susan; Gaffney, F Andrew

    2004-10-01

    Improving medication safety at the point of care--particularly for high-risk drugs--is a major concern of nursing administrators. The medication errors most likely to cause harm are administration errors related to infusion of high-risk medications. An intravenous medication safety system is designed to prevent high-risk infusion medication errors and to capture continuous quality improvement data for best practice improvement. Initial testing with 50 systems in 2 units at Vanderbilt University Medical Center revealed that, even in the presence of a fully mature computerized prescriber order-entry system, the new safety system averted 99 potential infusion errors in 8 months.

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

    PubMed Central

    Razzak, Junaid A.; Kellermann, Arthur L.

    2002-01-01

    Prevention is a core value of any health system. Nonetheless, many health problems will continue to occur despite preventive services. A significant burden of diseases in developing countries is caused by time-sensitive illnesses and injuries, such as severe infections, hypoxia caused by respiratory infections, dehydration caused by diarrhoea, intentional and unintentional injuries, postpartum bleeding, and acute myocardial infarction. The provision of timely treatment during life-threatening emergencies is not a priority for many health systems in developing countries. This paper reviews evidence indicating the need to develop and/or strengthen emergency medical care systems in these countries. An argument is made for the role of emergency medical care in improving the health of populations and meeting expectations for access to emergency care. We consider emergency medical care in the community, during transportation, and at first-contact and regional referral facilities. Obstacles to developing effective emergency medical care include a lack of structural models, inappropriate training foci, concerns about cost, and sustainability in the face of a high demand for services. A basic but effective level of emergency medical care responds to perceived and actual community needs and improves the health of populations. PMID:12481213

  20. Adequate Wound Care and Use of Bed Nets as Protective Factors against Buruli Ulcer: Results from a Case Control Study in Cameroon

    PubMed Central

    Landier, Jordi; Boisier, Pascal; Fotso Piam, Félix; Noumen-Djeunga, Blanbin; Simé, Joseph; Wantong, Fidèle Gaetan; Marsollier, Laurent; Fontanet, Arnaud; Eyangoh, Sara

    2011-01-01

    Background Buruli ulcer is an infectious disease involving the skin, caused by Mycobacterium ulcerans. Its exact transmission mechanism remains unknown. Several arguments indicate a possible role for insects in its transmission. A previous case-control study in the Nyong valley region in central Cameroon showed an unexpected association between bed net use and protection against Buruli ulcer. We investigated whether this association persisted in a newly discovered endemic Buruli ulcer focus in Bankim, northwestern Cameroon. Methodology/Principal Findings We conducted a case-control study on 77 Buruli ulcer cases and 153 age-, gender- and village-matched controls. Participants were interviewed about their activities and habits. Multivariate conditional logistic regression analysis identified systematic use of a bed net (Odds-Ratio (OR) = 0.4, 95% Confidence Interval [95%CI] = [0.2–0.9], p-value (p) = 0.04), cleansing wounds with soap (OR [95%CI] = 0.1 [0.03–0.3], p<0.0001) and growing cassava (OR [95%CI] = 0.3 [0.2–0.7], p = 0.005) as independent protective factors. Independent risk factors were bathing in the Mbam River (OR [95%CI] = 6.9 [1.4–35], p = 0.02) and reporting scratch lesions after insect bites (OR [95%CI] = 2.7 [1.4–5.4], p = 0.004). The proportion of cases that could be prevented by systematic bed net use was 32%, and by adequate wound care was 34%. Conclusions/Significance Our study confirms that two previously identified factors, adequate wound care and bed net use, significantly decreased the risk of Buruli ulcer. These associations withstand generalization to different geographic, climatic and epidemiologic settings. Involvement of insects in the household environment, and the relationship between wound hygiene and M. ulcerans infection should now be investigated. PMID:22087346

  1. [The role of motivation of medical personnel in system of medical care quality support].

    PubMed

    Pogosian, S G; Sidorenkov, D A; Balokhina, S A; Orlov, A E

    2014-01-01

    The article considers causes of insufficient quality of medical care. The low motivation of paramedical personnel during medical services rendering is examined. The sociological survey data made it possible to analyze opinion of students of medical college as future paramedical personnel concerning attractiveness of this profession. Their social and material status was established. The notions concerning possibility of carrier and professional progress were established too. The factors hampering involvement of this category of professionals into public health system and negatively impacting medical care quality were analyzed.

  2. A Strategic Approach to Medical Care for Exploration Missions

    NASA Technical Reports Server (NTRS)

    Antonsen, E.; Canga, M.

    2016-01-01

    Exploration missions will present significant new challenges to crew health, including effects of variable gravity environments, limited communication with Earth-based personnel for diagnosis and consultation for medical events, limited resupply, and limited ability for crew return. Providing health care capabilities for exploration class missions will require system trades be performed to identify a minimum set of requirements and crosscutting capabilities which can be used in design of exploration medical systems. Current and future medical data, information, and knowledge must be cataloged and put in formats that facilitate querying and analysis. These data may then be used to inform the medical research and development program through analysis of risk trade studies between medical care capabilities and system constraints such as mass, power, volume, and training. These studies will be used to define a Medical Concept of Operations to facilitate stakeholder discussions on expected medical capability for exploration missions. Medical Capability as a quantifiable variable is proposed as a surrogate risk metric and explored for trade space analysis that can improve communication between the medical and engineering approaches to mission design. The resulting medical system approach selected will inform NASA mission architecture, vehicle, and subsystem design for the next generation of spacecraft.

  3. Medically Complex Home Care and Caregiver Strain

    ERIC Educational Resources Information Center

    Moorman, Sara M.; Macdonald, Cameron

    2013-01-01

    Purpose of the study: To examine (a) whether the content of caregiving tasks (i.e., nursing vs. personal care) contributes to variation in caregivers' strain and (b) whether the level of complexity of nursing tasks contributes to variation in strain among caregivers providing help with such tasks. Design and methods: The data came from the Cash…

  4. Does managed care affect the diffusion of psychotropic medications?

    PubMed Central

    Domino, Marisa E.

    2011-01-01

    Newer technologies to treat many mental illnesses have shown substantial heterogeneity in diffusion rates across states. In this paper, I investigate whether variation in the level of managed care penetration is associated with changes in state-level diffusion of three newer classes of psychotropic medications in fee-for-service Medicaid programs from 1991-2005. Three different types of managed care programs are examined: capitated managed care, any type of managed care and behavioral health carve-outs. A fourth order polynomial fixed effect regression model is used to model the diffusion path of newer antidepressant and antipsychotic medications controlling for time-varying state characteristics. Substantial differences are found in the diffusion paths by the degree of managed care use in each state Medicaid program. The largest effect is seen through spillover effects of capitated managed care programs; states with greater capitated managed care have greater initial shares of newer psychotropic medications. The influence of carve-outs and of all types of managed care combined on the diffusion path was modest. PMID:21384465

  5. Effectively marketing prepaid medical care with decision support systems.

    PubMed

    Forgionne, G A

    1991-01-01

    The paper reports a decision support system (DSS) that enables health plan administrators to quickly and easily: (1) manage relevant medical care market (consumer preference and competitors' program) information and (2) convert the information into appropriate medical care delivery and/or payment policies. As the paper demonstrates, the DSS enables providers to design cost efficient and market effective medical care programs. The DSS provides knowledge about subscriber preferences, customer desires, and the program offerings of the competition. It then helps administrators structure a medical care plan in a way that best meets consumer needs in view of the competition. This market effective plan has the potential to generate substantial amounts of additional revenue for the program. Since the system's data base consists mainly of the provider's records, routine transactions, and other readily available documents, the DSS can be implemented at a nominal incremental cost. The paper also evaluates the impact of the information system on the general financial performance of existing dental and mental health plans. In addition, the paper examines how the system can help contain the cost of providing medical care while providing better services to more potential beneficiaries than current approaches.

  6. [Update on current care guidelines: Self-medication, Current Care Guideline].

    PubMed

    2016-01-01

    Self-medication should always be temporary. Self-medication can be used to relief or treat many symptoms and conditions. In general self-medication is safe when used properly. However all medicines may cause adverse events or have interactions with other drugs. It is important to consider all used drugs and other self-medication products when new drugs are added to the medication list. Persons using the drugs as well as health care personnel should be aware of benefits and harms of drugs.The guideline has recommendations for 10 symptoms that are typically treated with self-medication. PMID:27483629

  7. [Update on current care guidelines: Self-medication, Current Care Guideline].

    PubMed

    2016-01-01

    Self-medication should always be temporary. Self-medication can be used to relief or treat many symptoms and conditions. In general self-medication is safe when used properly. However all medicines may cause adverse events or have interactions with other drugs. It is important to consider all used drugs and other self-medication products when new drugs are added to the medication list. Persons using the drugs as well as health care personnel should be aware of benefits and harms of drugs.The guideline has recommendations for 10 symptoms that are typically treated with self-medication.

  8. Medical savings accounts: assessing their impact on efficiency, equity and financial protection in health care.

    PubMed

    Wouters, Olivier J; Cylus, Jonathan; Yang, Wei; Thomson, Sarah; McKee, Martin

    2016-07-01

    Medical savings accounts (MSAs) allow enrolees to withdraw money from earmarked funds to pay for health care. The accounts are usually accompanied by out-of-pocket payments and a high-deductible insurance plan. This article reviews the association of MSAs with efficiency, equity, and financial protection. We draw on evidence from four countries where MSAs play a significant role in the financing of health care: China, Singapore, South Africa, and the United States of America. The available evidence suggests that MSA schemes have generally been inefficient and inequitable and have not provided adequate financial protection. The impact of these schemes on long-term health-care costs is unclear. Policymakers and others proposing the expansion of MSAs should make explicit what they seek to achieve given the shortcomings of the accounts. PMID:26883211

  9. Modelling medical care usage under medical insurance scheme for urban non-working residents.

    PubMed

    Xiong, Linping; Tian, Wenhua; Tang, Weidong

    2013-06-01

    This research investigates and evaluates China's urban medical care usage for non-working residents using microsimulation techniques. It focuses on modelling medical services usage and simulating medical expenses on hospitalization treatments as well as clinic services for serious illness in an urban area for the period of 2008-2010. A static microsimulation model was created to project the impact of the medical insurance scheme. Four kinds of achievements have been made. For three different scenarios, the model predicted the hospitalization services costs and payments, as well as the balance of the social pool fund and the medical burden on families. PMID:23433685

  10. [Medical care, medical education, and the job market for physicians: internship in Mexico].

    PubMed

    Frenk, J

    1984-01-01

    This article endeavors to establish a connection between the emergence and development of internship in Mexico and a series of macrosocial changes, including the extension of Government intervention in medical care, the labor market processes that have led to unemployment among physicians, and the responses of the medical education system. The author considers that this comprehensive analysis will be of use in understanding at least in part the complex dynamics of the influence exerted on each other by medical care and medical education, and particularly how changes in conditions on the labor market for physicians have led to the formulation of ideological paradigms of medical practice and to their institutionalization in the programs of study of the medical schools. The study is also important for developed and developing countries with increasing numbers of physicians and which therefore need to understand the possible causes and effects of this trend. PMID:6394274

  11. [Military medical and health care system in the Song Dynasty].

    PubMed

    DU, J

    2016-05-01

    The military medical and health care system in the Song Dynasty manifested as two aspects, namely disease prevention and medical treatment. Disease prevention included ensuring food and drink safety, avoiding dangerous stations and enjoying regular vacations, etc. Medical treatment included sending medical officials to patrol, stationing military physicians to follow up, applying emergency programs, establishing military medical and pharmacy centers, dispensing required medicines, and accommodating and nursing sick and injured personnel, etc. Meanwhile, the imperial court also supervised the implementation of military medical mechanism, in order to check the soldiers' foods, check and restrict the military physicians' responsibilities, etc., which did play a positive role in protecting soldier's health, guaranteeing the military combat effectiveness, and maintaining national security. PMID:27485867

  12. New Models of CKD Care Including Pharmacists: Improving Medication Reconciliation and Medication Management

    PubMed Central

    St Peter, Wendy L.; Wazny, Lori D.; Patel, Uptal D.

    2014-01-01

    Purpose of review Chronic kidney disease patients are complex, have many medication-related problems (MRPs) and high rates of medication nonadherence, and are less adherent to some medications than patients with higher levels of kidney function. Nonadherence in CKD patients increases the odds of uncontrolled hypertension, which can increase the risk of CKD progression. This review discusses reasons for gaps in medication-related care for CKD patients, pharmacy services to reduce these gaps, and successful models that incorporate pharmacist care. Recent findings Pharmacists are currently being trained to deliver patient-centered care, including identification and management of MRPs and helping patients overcome barriers to improve medication adherence. A growing body of evidence indicates that pharmacist services for CKD patients, including medication reconciliation and medication therapy management, positively affect clinical and cost outcomes including lower rates of decline in glomerular filtration rates, reduced mortality, and fewer hospitalizations and hospital days, but more robust research is needed. Team-based models including pharmacists exist today and are being studied in a wide range of innovative care and reimbursement models. Summary Opportunities are growing to include pharmacists as integral members of CKD and dialysis healthcare teams to reduce MRPs, increase medication adherence, and improve patient outcomes. PMID:24076556

  13. Geriatric rehabilitation on an acute-care medical unit.

    PubMed

    Jackson, M F

    1984-09-01

    This study examined a geriatric rehabilitation pilot project on an acute-care medical unit. Over a 6-week period, using a 35-item geriatric rating scale and a mental assessment tool, changes in behaviours of 23 patients admitted to the geriatric rehabilitation module were compared to changes in behaviours of 10 elderly patients on a regular medical unit. The patients' demographic characteristics, their nursing and medical diagnoses, and discharge patterns were reviewed. Significant changes in behaviours of patients on the rehabilitation model included: increased ability to care for themselves, to maintain balance, and to communicate with others; decreased restlessness at night; decreased confusion; decreased incidence of incontinence; and improved social skills. The paper describes the geriatric rehabilitation programme and discusses implications for nursing of elderly patients in acute-care hospitals. PMID:6567647

  14. Medical loss ratio regulation under the Affordable Care Act.

    PubMed

    Harrington, Scott E

    2013-01-01

    The minimum medical loss ratio (MLR) regulations in the Affordable Care Act guarantee that a specific percentage of health insurance premiums is spent on medical care and specified activities to improve health care quality. This paper analyzes the regulations' potential unintended consequences and incentive effects, including: higher medical costs and premiums for some insurers; less innovation to align consumer, provider, and health plan incentives, less consumer choice and increased market concentration; and the risk that insurers will pay rebates if claim costs are lower than projected when premiums are established, despite the regulations' permitted "credibility adjustments." The paper discusses modifications and alternatives to the MLR regulations to help achieve their stated goals with less potential for adverse effects. PMID:23720876

  15. Consumerism: forcing medical practices toward patient-centered care.

    PubMed

    Ozmon, Jeff

    2007-01-01

    Consumerism has been apart of many industries over the years; now consumerism may change the way many medical practices deliver healthcare. With the advent of consumer-driven healthcare, employers are shifting the decision-making power to their employees. Benefits strategies like health savings accounts and high-deductible insurance plans now allow the patients to control how and where they spend their money on medical care. Practices that seek to attract the more affluent and informed consumers are beginning to institute patient-centered systems designs that invite patients to actively participate in their healthcare. This article will outline the changes in the healthcare delivery system facing medical practices, the importance of patient-centered care, and six strategies to implement to change toward more patient-centered care.

  16. Medication safety in residential aged-care facilities: a perspective.

    PubMed

    Wilson, Nicholas M; March, Lyn M; Sambrook, Philip N; Hilmer, Sarah N

    2010-10-01

    Medication safety must be tailored to the distinctive issues in residential aged-care facilities (RACFs). The health and functional characteristics of their residents are different to those of hospital inpatients and community-dwelling older adults, and there are unique staffing and management issues. Understanding the aetiology and epidemiology of drug-related problems is vital in developing methods to improve patient safety. In this perspective review, we discuss tools that are used to quantify exposure to 'high-risk' medications and their evaluation in residential aged-care settings. Drug withdrawal interventions are described as a potential way to reduce adverse drug events in RACFs. Multidisciplinary professional interventions, education programs and improved communication between health professionals have been shown to improve medication safety in RACFs. Technological advances and other administrative strategies may also improve resident safety. This perspective addresses issues in medication safety facing RACFs and methods to improve the safety of medicines for their residents.

  17. 42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.60 Medical or other remedial care provided by licensed practitioners. (a) “Medical care...

  18. 42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.60 Medical or other remedial care provided by licensed practitioners. (a) “Medical care...

  19. 42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.60 Medical or other remedial care provided by licensed practitioners. (a) “Medical care...

  20. 42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.60 Medical or other remedial care provided by licensed practitioners. (a) “Medical care...

  1. 42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.60 Medical or other remedial care provided by licensed practitioners. (a) “Medical care...

  2. A Strategic Approach to Medical Care for Exploration Missions

    NASA Technical Reports Server (NTRS)

    Canga, Michael A.; Shah, Ronak V.; Mindock, Jennifer A.; Antonsen, Erik L.

    2016-01-01

    Exploration missions will present significant new challenges to crew health, including effects of variable gravity environments, limited communication with Earth-based personnel for diagnosis and consultation for medical events, limited resupply, and limited ability for crew return. Providing health care capabilities for exploration class missions will require system trades be performed to identify a minimum set of requirements and crosscutting capabilities, which can be used in design of exploration medical systems. Medical data, information, and knowledge collected during current space missions must be catalogued and put in formats that facilitate querying and analysis. These data are used to inform the medical research and development program through analysis of risk trade studies between medical care capabilities and system constraints such as mass, power, volume, and training. Medical capability as a quantifiable variable is proposed as a surrogate risk metric and explored for trade space analysis that can improve communication between the medical and engineering approaches to mission design. The resulting medical system design approach selected will inform NASA mission architecture, vehicle, and subsystem design for the next generation of spacecraft.

  3. Nurses' medication administration practices at two Singaporean acute care hospitals.

    PubMed

    Choo, Janet; Johnston, Linda; Manias, Elizabeth

    2013-03-01

    This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design.

  4. Comradery, community, and care in military medical ethics.

    PubMed

    Gross, Michael L

    2011-10-01

    Medical ethics prohibits caregivers from discriminating and providing preferential care to their compatriots and comrades. In military medicine, particularly during war and when resources may be scarce, ethical principles may dictate priority care for compatriot soldiers. The principle of nondiscrimination is central to utilitarian and deontological theories of justice, but communitarianism and the ethics of care and friendship stipulate a different set of duties for community members, friends, and family. Similar duties exist among the small cohesive groups that typify many military units. When members of these groups require medical care, there are sometimes moral grounds to treat compatriot soldiers ahead of enemy or allied soldiers regardless of the severity of their respective wounds. PMID:21858476

  5. Psychological and medical care of gender nonconforming youth.

    PubMed

    Vance, Stanley R; Ehrensaft, Diane; Rosenthal, Stephen M

    2014-12-01

    Gender nonconforming (GN) children and adolescents, collectively referred to as GN youth, may seek care to understand their internal gender identities, socially transition to their affirmed genders, and/or physically transition to their affirmed genders. Because general pediatricians are often the first point of contact with the health care system for GN youth, familiarity with the psychological and medical approaches to providing care for this population is crucial. The objective of this review is to provide an overview of existing clinical practice guidelines for GN youth. Such guidelines emphasize a multidisciplinary approach with collaboration of medical, mental health, and social services/advocacy providers. Appropriate training needs to be provided to promote comprehensive, culturally competent care to GN youth, a population that has traditionally been underserved and at risk for negative psychosocial outcomes.

  6. Use of dental care by HIV-infected medical patients.

    PubMed

    Coulter, I D; Marcus, M; Freed, J R; Der-Martirosian, C; Cunningham, W E; Andersen, R M; Maas, W R; Garcia, I; Schneider, D A; Genovese, B; Shapiro, M F; Bozzette, S A

    2000-06-01

    Although increasing attention has been paid to the use of dental care by HIV patients, the existing studies do not use probability samples, and no accurate population estimates of use can be made from this work. The intent of the present study was to establish accurate population estimates of the use of dental services by patients under medical care. The study, part of the HIV Cost and Services Utilization Study (HCSUS), created a representative national probability sample, the first of its kind, of HIV-infected adults in medical care. Both bivariate and logistic regressions were conducted, with use of dental care in the preceding 6 months as the dependent variable and demographic, social, behavioral, and disease characteristics as independent variables. Forty-two percent of the sample had seen a dental health professional in the preceding 6 months. The bivariate logits for use of dental care show that African-Americans, those whose exposure to HIV was caused by hemophilia or blood transfusions, persons with less education, and those who were employed were less likely to use dental care (p < 0.05). Sixty-five percent of those with a usual source of care had used dental care in the preceding 6 months. Use was greatest among those obtaining dental care from an AIDS clinic (74%) and lowest among those without a usual source of dental care (12%). We conclude that, in spite of the high rate of oral disease in persons with HIV, many do not use dental care regularly, and that use varies by patient characteristics and availability of a regular source of dental care. PMID:10890713

  7. Integrating cancer rehabilitation into medical care at a cancer hospital.

    PubMed

    Grabois, M

    2001-08-15

    In spite of national health care legislative and model program initiatives, cancer rehabilitation has not kept pace with rehabilitation for patients with other medical problems. This article discusses, from a historical perspective, unsuccessful health care legislation related to cancer and problems in establishing and expanding cancer rehabilitation programs. The attempts to establish a cancer rehabilitation program at the Texas Medical Center and the University of Texas M. D. Anderson Cancer Center are reviewed. Lessons learned over past 40 years and strategies for maintaining the success of a cancer rehabilitation program are discussed. PMID:11519034

  8. Medical smart cards: health care access in your pocket.

    PubMed

    Krohn, R W

    2000-01-01

    The wallet-sized medical smart card, embedded with a programmable computer chip, stores and transmits a cardholder's clinical, insurance coverage and biographical information. When fully deployed, smart cards will conduct many functions at the point of care, from claims submission to medical records updates in real time. Ultimately, the smart card will make the individual patient record and all clinical and economic transactions within that patient log as portable, accessible and secure as an ATM account.

  9. Stoicism, the physician, and care of medical outliers

    PubMed Central

    Papadimos, Thomas J

    2004-01-01

    Background Medical outliers present a medical, psychological, social, and economic challenge to the physicians who care for them. The determinism of Stoic thought is explored as an intellectual basis for the pursuit of a correct mental attitude that will provide aid and comfort to physicians who care for medical outliers, thus fostering continued physician engagement in their care. Discussion The Stoic topics of good, the preferable, the morally indifferent, living consistently, and appropriate actions are reviewed. Furthermore, Zeno's cardinal virtues of Justice, Temperance, Bravery, and Wisdom are addressed, as are the Stoic passions of fear, lust, mental pain, and mental pleasure. These concepts must be understood by physicians if they are to comprehend and accept the Stoic view as it relates to having the proper attitude when caring for those with long-term and/or costly illnesses. Summary Practicing physicians, especially those that are hospital based, and most assuredly those practicing critical care medicine, will be emotionally challenged by the medical outlier. A Stoic approach to such a social and psychological burden may be of benefit. PMID:15588293

  10. Modeling of medical care with stochastic Petri Nets.

    PubMed

    Leite, Cicilia R M; Martin, Daniel L; Sizilio, Glaucia R A; Dos Santos, Keylly E A; de Araujo, Bruno G; Valentim, Ricardo A M; Neto, Adriao D D; de Melo, Jorge D; Guerreiro, Ana M G

    2010-01-01

    Due to the need for management, control, and monitoring of information in an effient way. The hospital automation has been the object of a number of studies owing to constantly evolving technologies. However, many hospital processes are still manual in private and public hospitals. Thus, the aim of this study is to model and simulate of medical care provided to patients in the Intensive Care Unit (ICU), using stochastic Petri Nets and their possible use in a number of automation processes.

  11. Medical futility: definition, determination, and disputes in critical care.

    PubMed

    Bernat, James L

    2005-01-01

    Physicians may employ the concept of medical futility to justify a decision not to pursue certain treatments that may be requested or demanded by patients or surrogates. Medical futility means that the proposed therapy should not be performed because available data show that it will not improve the patient's medical condition. Medical futility remains ethically controversial for several reasons. Some physicians summarily claim a treatment is futile without knowing the relevant outcome data. There is no unanimity regarding the statistical threshold for a treatment to be considered futile. There is often serious disagreement between physicians and families regarding the benefits to the patient of continued treatment. Medical futility has been conceptualized as a power struggle for decisional authority between physicians and patients/surrogates. Medical futility disputes are best avoided by strategies that optimize communication between physicians and surrogates; encourage physicians to provide families with accurate, current, and frequent prognostic estimates; assure that physicians address the emotional needs of the family and try to understand the problem from the family's perspective; and facilitate excellent palliative care through the course of the illness. Critical care physicians should support the drafting of state laws embracing futility considerations and should assist hospital policymakers in drafting hospital futility policies that both provide a fair process to settle disputes and embrace an ethic of care. PMID:16159066

  12. Traveling abroad for medical care: U.S. medical tourists' expectations and perceptions of service quality.

    PubMed

    Guiry, Michael; Vequist, David G

    2011-01-01

    The SERVQUAL scale has been widely used to measure service quality in the health care industry. This research is the first study that used SERVQUAL to assess U.S. medical tourists' expectations and perceptions of the service quality of health care facilities located outside the United States. Based on a sample of U.S. consumers, who had traveled abroad for medical care, the results indicated that there were significant differences between U.S. medical tourists' perceived level of service provided and their expectations of the service that should be provided for four of the five dimensions of service quality. Reliability had the largest service quality gap followed by assurance, tangibles, and empathy. Responsiveness was the only dimension without a significantly different gap score. The study establishes a foundation for future research on service quality in the rapidly growing medical tourism industry.

  13. Traveling abroad for medical care: U.S. medical tourists' expectations and perceptions of service quality.

    PubMed

    Guiry, Michael; Vequist, David G

    2011-01-01

    The SERVQUAL scale has been widely used to measure service quality in the health care industry. This research is the first study that used SERVQUAL to assess U.S. medical tourists' expectations and perceptions of the service quality of health care facilities located outside the United States. Based on a sample of U.S. consumers, who had traveled abroad for medical care, the results indicated that there were significant differences between U.S. medical tourists' perceived level of service provided and their expectations of the service that should be provided for four of the five dimensions of service quality. Reliability had the largest service quality gap followed by assurance, tangibles, and empathy. Responsiveness was the only dimension without a significantly different gap score. The study establishes a foundation for future research on service quality in the rapidly growing medical tourism industry. PMID:21815742

  14. [Structured medication management in primary care - a tool to promote medication safety].

    PubMed

    Mahler, Cornelia; Freund, Tobias; Baldauf, Annika; Jank, Susanne; Ludt, Sabine; Peters-Klimm, Frank; Haefeli, Walter Emil; Szecsenyi, Joachim

    2014-01-01

    Patients with chronic disease usually need to take multiple medications. Drug-related interactions, adverse events, suboptimal adherence, and self-medication are components that can affect medication safety and lead to serious consequences for the patient. At present, regular medication reviews to check what medicines have been prescribed and what medicines are actually taken by the patient or the structured evaluation of drug-related problems rarely take place in Germany. The process of "medication reconciliation" or "medication review" as developed in the USA and the UK aim at increasing medication safety and therefore represent an instrument of quality assurance. Within the HeiCare(®) project a structured medication management was developed for general practice, with medical assistants playing a major role in the implementation of the process. Both the structured medication management and the tools developed for the medication check and medication counselling will be outlined in this article; also, findings on feasibility and acceptance in various projects and experiences from a total of 200 general practices (56 HeiCare(®), 29 HiCMan,115 PraCMan) will be described. The results were obtained from questionnaires and focus group discussions. The implementation of a structured medication management intervention into daily routine was seen as a challenge. Due to the high relevance of medication reconciliation for daily clinical practice, however, the checklists - once implemented successfully - have been applied even after the end of the project. They have led to the regular review and reconciliation of the physicians' documentation of the medicines prescribed (medication chart) with the medicines actually taken by the patient.

  15. The Prairie State Games: Organization of Medical Care.

    PubMed

    Noble, H B; Porter, M; Grogg, E P; Robinson, M

    1988-02-01

    In brief: The finals of the Prairie State Games, an Olympic-style sports festival, annually attract nearly 3,000 Illinois amateur athletes, who sustain an average of 265 injuries per year. Although most of the injuries are orthopedic, a moderate number of heat-related problems occur. Most injuries are associated with soccer, wrestling, and basketball. A medical director who is a physician coordinates the efforts of the more than 30 volunteer physicians and 60 athletic trainers who constitute the medical corps. This article describes the guidelines for providing medical care at this large-scale athletic event.

  16. Psychiatric Correlates of Medical Care Costs among Veterans Receiving Mental Health Care

    ERIC Educational Resources Information Center

    Simpson, Tracy L.; Moore, Sally A.; Luterek, Jane; Varra, Alethea A.; Hyerle, Lynne; Bush, Kristen; Mariano, Mary Jean; Liu, Chaun-Fen; Kivlahan, Daniel R.

    2012-01-01

    Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether…

  17. Origins of authority: the organization of medical care in Sweden.

    PubMed

    Gustafsson, R A

    1989-01-01

    Earlier research by Gardell and Gustafsson indicates a general discrepancy between perceived needs and organizational structure in Swedish somatic hospitals; the work organization directs the work process as if cure and medical treatment were the only appropriate goals in almost all kinds of health care settings. The standard organizational model for general hospitals, here named "the acute care model"--which is a merger of medical and administrative hierarchies--forces great segments of the staff into a work content that is neither appropriate for patients' needs nor satisfying for the personnel. The present study is a historical-sociological discourse in which the structural antecedents of the acute care model are traced. It gives an exposé of the main stages in the formation of the Swedish health care system from the middle ages to the present. In 1864 a regulation of the hospital boards was issued. This meant the definite consolidation of the acute care model and was in line with earlier developments, which were characterized by an incremental interorganizational activity demarcation that divided the core of institutional care into three branches: somatic hospitals, mental hospitals, and homes for the elderly. The driving forces in the formation of the total health care system are shown to be closely related to premedical and extramedical factors, such as military needs, mercantilism, and the emergence of the middle class.

  18. [Compassionate care and management in the medical-social sector].

    PubMed

    Lambert Barraquier, Arièle

    2016-05-01

    Compassionate care can appear ambiguous when subject to critical examination. The spotlight falls on the responsibility and activity of management with regard to policy guidance and the management of activities in the medical-social field. Discussion around this subject enables an assessment of current standards and ethical progress to be carried out.

  19. A Model for Medical Care in Underserved Areas.

    ERIC Educational Resources Information Center

    Mufson, Maurice A.; Melnick, Donald E.

    1981-01-01

    Marshall University School of Medicine, a new community-based medical school in Huntington, West Virginia which aims to improve the number and distribution of physicians in West Virginia through active involvement of its faculty and residents in primary care delivery, is described. (Author/MLW)

  20. 32 CFR 1656.20 - Expenses for emergency medical care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Section 1656.20 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM ALTERNATIVE SERVICE § 1656.20 Expenses for emergency medical care. (a) Claims for payment of actual and... occurs while the ASW is acting in accord with orders of Selective Service to engage in travel or...

  1. 32 CFR 1656.20 - Expenses for emergency medical care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Section 1656.20 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM ALTERNATIVE SERVICE § 1656.20 Expenses for emergency medical care. (a) Claims for payment of actual and... occurs while the ASW is acting in accord with orders of Selective Service to engage in travel or...

  2. 32 CFR 1656.20 - Expenses for emergency medical care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Section 1656.20 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM ALTERNATIVE SERVICE § 1656.20 Expenses for emergency medical care. (a) Claims for payment of actual and... occurs while the ASW is acting in accord with orders of Selective Service to engage in travel or...

  3. 32 CFR 1656.20 - Expenses for emergency medical care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Section 1656.20 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM ALTERNATIVE SERVICE § 1656.20 Expenses for emergency medical care. (a) Claims for payment of actual and... occurs while the ASW is acting in accord with orders of Selective Service to engage in travel or...

  4. 32 CFR 1656.20 - Expenses for emergency medical care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Section 1656.20 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM ALTERNATIVE SERVICE § 1656.20 Expenses for emergency medical care. (a) Claims for payment of actual and... occurs while the ASW is acting in accord with orders of Selective Service to engage in travel or...

  5. One Approach to Improving Indigenous Health Care through Medical Education.

    ERIC Educational Resources Information Center

    Hays, Richard

    2002-01-01

    Australia's newest medical school, located at James Cook University (Queensland), is committed to improving Aboriginal health care. At least five Indigenous students must be admitted per year, and Indigenous people sit on committees responsible for student selection, curriculum design, staff selection, training, and research. All staff receive…

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  8. Medical care collection or recovery--VA. Notice.

    PubMed

    1998-10-13

    In a companion document published in the "Proposed Rules" section of this issue of the Federal Register, we proposed to amend VA's medical regulations concerning collection or recovery by VA for medical care or services provided or furnished to a veteran: (i) For a non-service connected disability for which the veteran is entitled to care (or the payment of expenses of care) under a health-plan contract; (ii) For a non-service connected disability incurred incident to the veteran's employment and covered under a worker's compensation law or plan that provides reimbursement or indemnification for such care and services; or (iii) For a non-service connected disability incurred as a result of a motor vehicle accident in a State that requires automobile accident reparations insurance. The proposed rule includes methodology for establishing charges for VA medical care or services. Using this methodology, information for calculating proposed charge amounts at individual VA facilities for inpatient facility charges, skilled nursing facility/sub-acute inpatient facility charges, outpatient facility charges, and physician charges is set forth below. If this methodology were adopted subsequently as a final rule, the applicable data in this document, designed for the period August 1998 through September 1999, would be used for the period from the effective date of the final rule through September 1999. Accordingly, interested parties may wish to retain this document for future reference.

  9. The Aging Brain Care Medical Home: Preliminary Data.

    PubMed

    LaMantia, Michael A; Alder, Catherine A; Callahan, Christopher M; Gao, Sujuan; French, Dustin D; Austrom, Mary G; Boustany, Karim; Livin, Lee; Bynagari, Bharath; Boustani, Malaz A

    2015-06-01

    The Aging Brain Care (ABC) Medical Home aims to improve the care, health outcomes, and medical costs of Medicare beneficiaries with dementia or depression across central Indiana. This population health management program, funded by the Centers for Medicare and Medicaid Services Innovation Center, expanded an existing collaborative dementia and depression care program to serve 1,650 older adults in a local safety-net hospital system. During the first year, 20 full-time clinical staff were hired, trained, and deployed to deliver a collaborative care intervention. In the first 18 months, an average of 13 visits was provided per person. Thirty percent of the sample had a diagnosis of dementia, and 77% had a diagnosis of depression. Sixty-six percent of participants with high depression scores (Patient Health Questionnaire-9 score ≥14) had at least a 50% reduction in their depressive symptoms. Fifty-one percent of caregivers of individuals with dementia had at least a 50% reduction in caregiver stress symptoms (measured by the Healthy Aging Brain Care Monitor-Caregiver Version). After 18 months, the ABC Medical Home has demonstrated progress toward improving the health of older adults with dementia and depression. Scalable and practical models like this show initial promise for answering the challenges posed by the nation's rapidly aging population. PMID:26096394

  10. Developing a medication communication framework across continuums of care using the Circle of Care Modeling approach

    PubMed Central

    2013-01-01

    Background Medication errors are a common type of preventable errors in health care causing unnecessary patient harm, hospitalization, and even fatality. Improving communication between providers and between providers and patients is a key aspect of decreasing medication errors and improving patient safety. Medication management requires extensive collaboration and communication across roles and care settings, which can reduce (or contribute to) medication-related errors. Medication management involves key recurrent activities (determine need, prescribe, dispense, administer, and monitor/evaluate) with information communicated within and between each. Despite its importance, there is a lack of conceptual models that explore medication communication specifically across roles and settings. This research seeks to address that gap. Methods The Circle of Care Modeling (CCM) approach was used to build a model of medication communication activities across the circle of care. CCM positions the patient in the centre of his or her own healthcare system; providers and other roles are then modeled around the patient as a web of relationships. Recurrent medication communication activities were mapped to the medication management framework. The research occurred in three iterations, to test and revise the model: Iteration 1 consisted of a literature review and internal team discussion, Iteration 2 consisted of interviews, observation, and a discussion group at a Community Health Centre, and Iteration 3 consisted of interviews and a discussion group in the larger community. Results Each iteration provided further detail to the Circle of Care medication communication model. Specific medication communication activities were mapped along each communication pathway between roles and to the medication management framework. We could not map all medication communication activities to the medication management framework; we added Coordinate as a separate and distinct recurrent activity

  11. Markets and medical care: the United States, 1993-2005.

    PubMed

    White, Joseph

    2007-09-01

    Many studies arguing for or against markets to finance medical care investigate "market-oriented" measures such as cost sharing. This article looks at the experience in the American medical marketplace over more than a decade, showing how markets function as institutions in which participants who are self-seeking, but not perfectly rational, exercise power over other participants in the market. Cost experience here was driven more by market power over prices than by management of utilization. Instead of following any logic of efficiency or equity, system transformations were driven by beliefs about investment strategies. At least in the United States' labor and capital markets, competition has shown little ability to rationalize health care systems because its goals do not resemble those of the health care system most people want. PMID:17718663

  12. Markets and Medical Care: The United States, 1993–2005

    PubMed Central

    White, Joseph

    2007-01-01

    Many studies arguing for or against markets to finance medical care investigate “market-oriented” measures such as cost sharing. This article looks at the experience in the American medical marketplace over more than a decade, showing how markets function as institutions in which participants who are self-seeking, but not perfectly rational, exercise power over other participants in the market. Cost experience here was driven more by market power over prices than by management of utilization. Instead of following any logic of efficiency or equity, system transformations were driven by beliefs about investment strategies. At least in the United States' labor and capital markets, competition has shown little ability to rationalize health care systems because its goals do not resemble those of the health care system most people want. PMID:17718663

  13. [Management and organization of ambulatory medical care in a district].

    PubMed

    Schneider, K; Keune, H G; Miethe, D; Ringel, M; Szkibik, B

    1990-01-01

    An analysis is given of the management and organization of out-patient medical care in 15 districts and of the District Physician's responsibilities as well as the profile of a District Health Department. Compared to the situation of a decade ago, substantial changes in the territorial health organization have occurred (decentralization, formation of care areas, affiliation of small health facilities to bigger ones). The District Physician's scope of responsibility is increasingly determined by activities within the framework of the District Council, the proportion of organizational work has increased. In order to be able to fulfill his tasks the District Physician needs the support of a special Health Department. Skeleton regulations for out-patient medical care are necessary.

  14. Variation in Child Health Care Utilization by Medical Complexity

    PubMed Central

    Kuo, Dennis Z.; Melguizo-Castro, Maria; Goudie, Anthony; Nick, Todd G.; Robbins, James M.; Casey, Patrick H.

    2014-01-01

    Objectives Children with medical complexity (CMC) have multiple specialty need, technology dependence, and high health care utilization. The objective of this study is to profile types of pediatric health care utilization and costs by increasing levels of medical complexity. Methods Cross-sectional study of the 2007, 2008 and 2009 Full-Year Data Sets from the Medical Expenditure Panel Survey. Medical complexity was defined by a higher number of positive items from the five question Children with Special Health Care Needs (CSHCN) Screener. CMC were defined by ≥4 positive screener items. Outcomes included the number of inpatient, outpatient, and emergency department visits, associated costs and diagnoses, and reported satisfaction. ICD-9 codes were grouped by Clinical Classifications Software. Results Of 27,755 total study subjects ≤17 years, 4,851 had special needs and 541 were CMC. Older age, male gender, white/non-Hispanic race/ethnicity, and public insurance were all associated with medical complexity (all p<.001). CMC had an annual mean of 19 annual outpatient visits ($616) and 0.26 inpatient visits ($3,308), with other significant cost drivers including home health ($2,957) and prescriptions ($2,182). The most common reasons for non-CSHCN and less-complex CSHCN outpatient visits were viral illnesses, while the main reasons for CMC visits were for mental health. Compared to families without CSHCN, those with CMC have, on average, lower satisfaction with health care (8.4 versus 8.9 out of 10, p<.001). Conclusion Health care models for CMC should account for mental health conditions that may be driving high numbers of outpatient encounters. PMID:24740726

  15. Variation in child health care utilization by medical complexity.

    PubMed

    Kuo, Dennis Z; Melguizo-Castro, Maria; Goudie, Anthony; Nick, Todd G; Robbins, James M; Casey, Patrick H

    2015-01-01

    Children with medical complexity (CMC) have multiple specialty need, technology dependence, and high health care utilization. The objective of this study is to profile types of pediatric health care utilization and costs by increasing levels of medical complexity. This is a cross-sectional study of the 2007, 2008 and 2009 Full-Year Data Sets from the Medical Expenditure Panel Survey. Medical complexity was defined by a higher number of positive items from the five question children with special health care needs (CSHCN) Screener. CMC were defined by ≥ 4 positive screener items. Outcomes included the number of inpatient, outpatient, and emergency department visits, associated costs and diagnoses, and reported satisfaction. ICD-9 codes were grouped by Clinical Classifications Software. Of 27,755 total study subjects ≤ 17 years, 4,851 had special needs and 541 were CMC. Older age, male gender, white/non-Hispanic race/ethnicity, and public insurance were all associated with medical complexity (all p < 0.001). CMC had an annual mean of 19 annual outpatient visits ($616) and 0.26 inpatient visits ($3,308), with other significant cost drivers including home health ($2,957) and prescriptions ($2,182). The most common reasons for non-CSHCN and less-complex CSHCN outpatient visits were viral illnesses, while the main reasons for CMC visits were for mental health. Compared to families without CSHCN, those with CMC have, on average, lower satisfaction with health care (8.4 vs. 8.9 out of 10, p < 0.001). Health care models for CMC should account for mental health conditions that may be driving high numbers of outpatient encounters. PMID:24740726

  16. 20 CFR 10.304 - Are there any exceptions to these procedures for obtaining medical care?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... EMPLOYEES' COMPENSATION ACT, AS AMENDED Medical and Related Benefits Emergency Medical Care § 10.304 Are there any exceptions to these procedures for obtaining medical care? In cases involving emergencies or... for obtaining medical care? 10.304 Section 10.304 Employees' Benefits OFFICE OF WORKERS'...

  17. 20 CFR 10.300 - What are the basic rules for authorizing emergency medical care?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  18. Agents for change: nonphysician medical providers and health care quality.

    PubMed

    Boucher, Nathan A; Mcmillen, Marvin A; Gould, James S

    2015-01-01

    Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization's quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts.

  19. [The revised system of hospitalization for medical care and protection].

    PubMed

    Fukuo, Yasuhisa

    2014-01-01

    The Act to Partially Amend the Act on Mental Health and Welfare for the Mentally Disabled was passed on June 13, 2013. Major amendments regarding hospitalization for medical care and protection include the points listed below. The guardianship system will be abolished. Consent by a guardian will no longer be required in the case of hospitalization for medical care and protection. In the case of hospitalization for medical care and protection, the administrators of the psychiatric hospital are required to obtain the consent of one of the following persons: spouse, person with parental authority, person responsible for support, legal custodian, or curator. If no qualified person is available, consent must be obtained from the mayor, etc. of the municipality. The following three obligations are imposed on psychiatric hospital administrators. (1) Assignment of a person, such as a psychiatric social worker, to provide guidance and counseling to patients hospitalized for medical care and protection regarding their postdischarge living environment. (2) Collaboration with community support entities that consult with and provide information as necessary to the person hospitalized, their spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. (3) Organizational improvements to promote hospital discharge. With regard to requests for discharge, the revised law stipulates that, in addition to the person hospitalized with a mental disorder, others who may file a request for discharge with the psychiatric review board include: the person's spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. If none of the above persons are available, or if none of them are able to express their wishes, the mayor, etc. of the municipality having jurisdiction over the place of residence of the person hospitalized may request a discharge. In order to promote transition to life in the

  20. [The revised system of hospitalization for medical care and protection].

    PubMed

    Fukuo, Yasuhisa

    2014-01-01

    The Act to Partially Amend the Act on Mental Health and Welfare for the Mentally Disabled was passed on June 13, 2013. Major amendments regarding hospitalization for medical care and protection include the points listed below. The guardianship system will be abolished. Consent by a guardian will no longer be required in the case of hospitalization for medical care and protection. In the case of hospitalization for medical care and protection, the administrators of the psychiatric hospital are required to obtain the consent of one of the following persons: spouse, person with parental authority, person responsible for support, legal custodian, or curator. If no qualified person is available, consent must be obtained from the mayor, etc. of the municipality. The following three obligations are imposed on psychiatric hospital administrators. (1) Assignment of a person, such as a psychiatric social worker, to provide guidance and counseling to patients hospitalized for medical care and protection regarding their postdischarge living environment. (2) Collaboration with community support entities that consult with and provide information as necessary to the person hospitalized, their spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. (3) Organizational improvements to promote hospital discharge. With regard to requests for discharge, the revised law stipulates that, in addition to the person hospitalized with a mental disorder, others who may file a request for discharge with the psychiatric review board include: the person's spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. If none of the above persons are available, or if none of them are able to express their wishes, the mayor, etc. of the municipality having jurisdiction over the place of residence of the person hospitalized may request a discharge. In order to promote transition to life in the

  1. The impact of managed care on patients' trust in medical care and their physicians.

    PubMed

    Mechanic, D; Schlesinger, M

    1996-06-01

    Social trust in health care organizations and interpersonal trust in physicians may be mutually supportive, but they also diverge in important ways. The success of medical care depends most importantly on patients' trust that their physicians are competent, take appropriate responsibility and control, and give their patients' welfare the highest priority. Utilization review and structural arrangements in managed care potentially challenge trust in physicians by restricting choice, contradicting medical decisions and control, and restricting open communication with patients. Gatekeeping and incentives to limit care also raise serious trust issues. We argue that managed care plans rather than physicians should be required to disclose financial arrangements, that limits be placed on incentives that put physicians at financial risk, and that professional norms and public policies should encourage clear separation of interests of physicians from health plan organization and finance. PMID:8637148

  2. [The sociological survey in the organization of evaluation of quality of medical care in the system of mandatory medical insurance].

    PubMed

    Bul'khina, G R

    2010-01-01

    The three-year experience of medical insurance company "ASKO-VAZ" of implementing the technique of sociologic surveys is discussed. The purpose was to study the degree of citizens? satisfaction of their interaction with medical sub-system in receiving medical care. The issue of awareness of medical personnel about functioning of system of mandatory medical insurance was examined.

  3. Medical Assistants as Flow Managers in Primary Care: Challenges and Recommendations.

    PubMed

    Gray, Caroline P; Harrison, Michael I; Hung, Dorothy

    2016-01-01

    As healthcare organizations look for ways to reduce costs and improve quality, many rely increasingly on allied healthcare professionals and, in particular, medical assistants (MAs) to supplement the work of physicians and other health professionals. MAs usually work in primary care, where they often play important roles on healthcare teams. Drawing on an empirical study of a large, multispecialty delivery system engaged in reconfiguration of primary care, we found that using MAs as flow managers required overcoming several challenges. These included entrenched social and occupational hierarchies between physicians and MAs, a lack of adequate training and mentorship, and difficulty attracting and retaining talented MAs. We offer several recommendations for healthcare organizations interested in using MAs as flow managers in their practices. PMID:27356444

  4. Adolescent drug misuse treatment and use of medical care services.

    PubMed

    Freeborn, D K; Polen, M R; Mullooly, J P

    1995-05-01

    Research on adults has documented that use of medical services decreases after initiation of treatment for alcohol problems, but little is known about this relationship among adolescents. We studied utilization and costs of care following participation in the Adolescent Chemical Health Program (ACHP) of Kaiser Permanente, Northwest Region, in 1986-88. Three groups of adolescents (and their parents) were identified: adolescents who were assessed and initiated treatment in ACHP (n = 561), adolescents who were assessed and recommended for treatment but did not return for treatment (n = 278), and adolescents with no known substance use problems (n = 381). Medical records were reviewed for 1 year pre- and 1.5 years postassessment. After adjusting for preassessment medical visits, severity of alcohol and drug use, gender, and age, analyses suggested that substance user treatment was not associated with reduced use of medical services or costs by either adolescents or parents. PMID:7558471

  5. Accountable care organization readiness and academic medical centers.

    PubMed

    Berkowitz, Scott A; Pahira, Jennifer J

    2014-09-01

    As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices.

  6. Accountable care organization readiness and academic medical centers.

    PubMed

    Berkowitz, Scott A; Pahira, Jennifer J

    2014-09-01

    As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices. PMID:24979282

  7. Commercial pressures on professionalism in american medical care: from Medicare to the Affordable Care Act.

    PubMed

    Marmor, Theodore R; Gordon, Robert W

    2014-01-01

    Since the passage of Medicare, the self-regulation characteristic of professionalism in health care has come under steady assault. While Canadian physicians chose to relinquish financial autonomy, they have enjoyed far greater professional autonomy over their medical judgments than their U.S. counterparts who increasingly have their practices micromanaged. The Affordable Care Act illustrates the ways that managerial strategies and a market model of health care have shaped the financing and delivery of health care in the U.S., often with little or no evidence of their effectiveness.

  8. [Current status of palliative care in medical oncology].

    PubMed

    Sasaki, Tsubasa; Ohta, Syuji; Seki, Nobuhiko; Eguchi, Kenji

    2010-06-01

    A team approach is efficient in palliative care for cancer patients. People suffered from cancer have a right to receive high-quality palliative care earlier in cancer treatment. In Japan the National Act for Strategy against Cancer was enacted in 2007. Systematic educational programs supported by the Ministry of Health Labor and Welfare has been conducted for medical staffs, home care staffs, local pharmacists, care managers etc. at core institutes in each district. Pain control is still major target for cancer palliative medicine. Recently various types of opioids can be used routinely in daily clinical setting for Japanese cancer patients. Complementary and alternative medicine (CAM) may also effective in some patients but further study for proving scientific evidence in CAM should be warranted. Tailor-maid pain control will be established in the near future with molecular based pharmacogenomics.

  9. Ethical constraints on rationing medical care by age.

    PubMed

    Jecker, N S; Pearlman, R A

    1989-11-01

    In a statement published in this issue, the Public Policy Committee of the American Geriatrics Society endorses the view that chronological age should not be a criterion for exclusion of individuals from medical care. This article aims to amplify the Committee's position by placing it within a broader context and identifying its justification in ethical argument. The paper is divided into three parts. The first part clarifies the difference between allocation (the distribution of funds between categories) and rationing (the distribution of funds within a single category). It is argued that given the current allocation of funds to medical care, some form of rationing is unavoidable. As others have noted, rationing is already occurring in an informal and piecemeal fashion. However, ethically sound rationing requires publicly debated and defensible policies. The second section of the paper reviews a number of arguments advanced in favor of rationing medical care on the basis of age. Objections to these arguments are carefully set out. The final part of the paper details and defends a series of positive arguments establishing special duties to the elderly. The paper concludes that to the extent that scarcity forces rationing, older persons should not be excluded because they are old.

  10. Medical care capabilities for Space Station Freedom: A phase approach

    NASA Technical Reports Server (NTRS)

    Doarn, C. R.; Lloyd, C. W.

    1992-01-01

    As a result of Congressional mandate Space Station Freedom (SSF) was restructured. This restructuring activity has affected the capabilities for providing medical care on board the station. This presentation addresses the health care facility to be built and used on the orbiting space station. This unit, named the Health Maintenance Facility (HMF) is based on and modeled after remote, terrestrial medical facilities. It will provide a phased approach to health care for the crews of SSF. Beginning with a stabilization and transport phase, HMF will expand to provide the most advanced state of the art therapeutic and diagnostic capabilities. This presentation details the capabilities of such a phased HMF. As Freedom takes form over the next decade there will be ever-increasing engineering and scientific developmental activities. The HMF will evolve with this process until it eventually reaches a mature, complete stand-alone health care facility that provides a foundation to support interplanetary travel. As man's experience in space continues to grow so will the ability to provide advanced health care for Earth-orbital and exploratory missions as well.

  11. Swedish Medical Students' Views of the Changing Professional Role of Medical Doctors and the Organisation of Health Care

    ERIC Educational Resources Information Center

    Holmstrom, Inger; Sanner, Margareta A.

    2004-01-01

    Medical students will influence future health care considerably. Their professional orientation while at medical school will be related to their future professional development. Therefore, it is important to study this group's view of the role of medical doctors, especially because Swedish health care is currently undergoing major changes and…

  12. Pharmacy impact on medication reconciliation in the medical intensive care unit

    PubMed Central

    Wills, Brittany M.; Darko, William; Seabury, Robert; Probst, Luke A.; Miller, Christopher D.; Cwikla, Gregory M.

    2016-01-01

    Objective: Pharmacy-driven medication history (MH) programs have been shown to reduce the number of serious or potentially life-threatening (S/PLT) medication discrepancies (MDs) in many settings, but not Intensive Care Units (ICUs). Methods: MHs were repeated over a 6-week period. Demographics, number, and nature of MDs were documented. Discrepancy severity was graded using a previously published method. Primary outcome was the proportion of MHs containing >1 S/PLT MDs. Findings: Sixty-three MHs were repeated. Pharmacy MHs were less likely to contain ≥1 S/PLT MDs (0% vs. 50%, P < 0.001). Conclusion: Pharmacy MHs contained fewer S/PLT MDs in this small sample. S/PLT MDs on admission and home medication lists were common in patients admitted to the medical ICU. Pharmacy-driven medication reconciliation (MR) reduced the number and frequency of these discrepancies. Further research is required to improve current MR procedures. PMID:27162810

  13. [Intercultural aspects of medical care for undocumented migrants].

    PubMed

    Cerda-Hegerl, Patricia

    2008-01-01

    In view of the cultural diversity in German society today, the time has long since come when medical care must adjust to its new clientele. This article provides an overview for doctors, medical personnel and psychologists of approaches, backgrounds and networks of migration to Germany, in particular over the little known undocumented migration. This migration has steadily increased in recent years. The author deals with the circumstances which create psychological problems for migrants and what happens when migrants living in this shadow world fall ill. In addition, the article offers an agenda for interculturally competent action in caring for documented and undocumented migrants. Dimensions of cultural differences such as collectivism versus individualism (most of the countries of origin of these migrants in Germany with or without documents are collectivistic) are explained along with differences in styles of communication. The following styles with their impact in actual practice are analyzed: indirect versus direct communication; emotional control versus expressiveness; functionalism versus relationship orientation.

  14. [Intercultural aspects of medical care for undocumented migrants].

    PubMed

    Cerda-Hegerl, Patricia

    2008-01-01

    In view of the cultural diversity in German society today, the time has long since come when medical care must adjust to its new clientele. This article provides an overview for doctors, medical personnel and psychologists of approaches, backgrounds and networks of migration to Germany, in particular over the little known undocumented migration. This migration has steadily increased in recent years. The author deals with the circumstances which create psychological problems for migrants and what happens when migrants living in this shadow world fall ill. In addition, the article offers an agenda for interculturally competent action in caring for documented and undocumented migrants. Dimensions of cultural differences such as collectivism versus individualism (most of the countries of origin of these migrants in Germany with or without documents are collectivistic) are explained along with differences in styles of communication. The following styles with their impact in actual practice are analyzed: indirect versus direct communication; emotional control versus expressiveness; functionalism versus relationship orientation. PMID:18421653

  15. Launching complex medical workups from an urgent care platform.

    PubMed

    Paschal, Dean

    2012-02-01

    The basic parameters for medical workups have scarcely changed in the past 30 years. That is, what the internal medicine community has deemed acceptable for outpatient, inpatient, emergency department, and urgent care evaluation has remained pretty much stable or stagnant during all that time. We are failing to take advantage of the phenomenal speed and accuracy of new laboratory and imaging technologies. Due to Hurricane Katrina, which destroyed the Veterans Administration Hospital in New Orleans, those of us who work in its urgent care clinic were forced to undertake complex medical workups from an 8-to-5, walk-in platform. We have been amazed at the efficiency of this. Workups that used to take weeks can often be done in a few hours or days. What we have discovered here serendipitously may be worth deliberately duplicating elsewhere.

  16. Medical student instructional costs in a primary care clerkship.

    PubMed

    Pawlson, L G; Schroeder, S A; Donaldson, M S

    1979-07-01

    Using a variety of techniques, such as logs kept daily by the faculty, direct observation, and on-site interviews, the authors determined the instructional costs of a required third-year primary care clerkship based in an ambulatory care setting. Included in the analysis were labor costs of both faculty members and nonfaculty personnel, space and materials, and general university overhead. Total instructional costs were $54.20/student/day. If other third-year clinical clerkships generate equivalent costs, the direct instructional costs of clerkships for third-year medical students would be in excess of $11,500/student/year. The study results imply that ambulatory-based teaching of medical students generates considerable costs and thus requires support from student tuition, federal or state government, or other sources.

  17. The economics of health care quality and medical errors.

    PubMed

    Andel, Charles; Davidow, Stephen L; Hollander, Mark; Moreno, David A

    2012-01-01

    Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. Additional costs of $1.4 billion were attributed to increased mortality rates with $1.1 billion or 10 million days of lost productivity from missed work based on short-term disability claims. The authors estimate that the economic impact is much higher, perhaps nearly $1 trillion annually when quality-adjusted life years (QALYs) are applied to those that die. Using the Institute of Medicine's (IOM) estimate of 98,000 deaths due to preventable medical errors annually in its 1998 report, To Err Is Human, and an average of ten lost years of life at $75,000 to $100,000 per year, there is a loss of $73.5 billion to $98 billion in QALYs for those deaths--conservatively. These numbers are much greater than those we cite from studies that explore the direct costs of medical errors. And if the estimate of a recent Health Affairs article is correct-preventable death being ten times the IOM estimate-the cost is $735 billion to $980 billion. Quality care is less expensive care. It is better, more efficient, and by definition, less wasteful. It is the right care, at the right time, every time. It should mean that far fewer patients are harmed or injured. Obviously, quality care is not being delivered consistently throughout U.S. hospitals. Whatever the measure, poor quality is costing payers and

  18. The Geriatrics in Primary Care Demonstration: Integrating Comprehensive Geriatric Care into the Medical Home: Preliminary Data.

    PubMed

    Engel, Peter A; Spencer, Jacqueline; Paul, Todd; Boardman, Judith B

    2016-04-01

    Three thousand nine hundred thirty-one veterans aged 75 and older receive primary care (PC) in two large practices of the Department of Veterans Affairs (VA) Boston Healthcare System. Cognitive and functional disabilities are endemic in this group, creating needs that predictably exceed available or appropriate resources. To address this problem, Geriatrics in Primary Care (GPC) embeds geriatric services directly into primary care. An on-site consulting geriatrician and geriatric nurse care manager work directly with PC colleagues in medicine, nursing, social work, pharmacy, and mental health within the VA medical home. This design delivers interdisciplinary geriatric care within PC that emphasizes comprehensive evaluations, care management, planned transitions, informed resource use, and a shift in care focus from multiple subspecialties to PC. Four hundred thirty-five veterans enrolled during the project's 4-year course. Complex, fragmented care was evident in a series of 50 individuals (aged 82 ± 7) enrolled during Months 1 to 6. The year before, these individuals made 372 medical or surgical subspecialty clinic visits (7.4 ± 9.8); 34% attended five or more subspecialty clinics, 48% had dementia, and 18% lacked family caregivers. During the first year after enrollment the mean number of subspecialty clinic visits declined significantly (4.7 ± 5.0, P = .01), whereas the number of PC-based visits remained stable (3.1 ± 1.5 and 3.3 ± 1.5, respectively, P = .50). Telephone contact by GPC (2.3 ± 2.0) and collaboration with PC clinicians replaced routine follow-up geriatric care. GPC facilitated planned transitions to rehabilitation centers (n = 5), home hospice (n = 2), dementia units (n = 3), and home care (n = 37). GPC provides efficient, comprehensive geriatric care and case management while preserving established relationships between patients and the PC team. Preliminary results suggest "care defragmentation," as reflected by a significant reduction in

  19. Infectious medical waste management. A home care responsibility.

    PubMed

    Ralph, I G

    1993-01-01

    With the proliferation of bloodborne diseases in the United States, more attention is being focused on the issues of infectious medical waste and its disposal. Home care organizations must be aware of the potential risks involved in handling infectious wastes, and adhere to industry standards of disposal and transport. Education of staff, patients, and community about the management of infectious waste is crucial in today's healthcare arena.

  20. Working on reform. How workers' compensation medical care is affected by health care reform.

    PubMed Central

    Himmelstein, J; Rest, K

    1996-01-01

    The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies? Images p13-a p14-a p15-a p16-a p18-a p19-a p20-a p22-a p24-a PMID:8610187

  1. Cognitive aid use improves transition of care by graduating medical students during a simulated crisis

    PubMed Central

    Bauer, Brooke; Rebel, Annette; Dilorenzo, Amy; Schell, Randall M.; Dority, Jeremy S.; Lukens, Faith; Sloan, Paul A.

    2016-01-01

    Background Residents are expected to have transition of care (ToC) skills upon entering graduate medical education. It is unclear whether experience and training during medical school is adequate. Objective The aim of the project was to assess: 1) graduating medical students’ ability to perform ToC in a crisis situation, and 2) whether using a cognitive aid improves the ToC quality. Methods The authors developed simulation scenarios for rapid response teams and a cognitive aid to assist in the ToC during crisis situations. Graduating medical students were enrolled and randomly divided into teams of three students, randomly assigned into one of two groups: teams using a cognitive aid for ToC (CA), or not using a cognitive aid (nCA). In the scenario, teams respond to a deteriorating patient and then transfer care to the next provider after stabilization. Three faculty reviewed the recording to assess completeness of the ToC and the overall quality. A completeness score was expressed as a fraction of the maximum score. Statistical analysis was performed using a t-test and Mann-Whitney U test. Results A total of 112 senior medical students participated: CA n=19, nCA n=17. The completeness score of the ToC and overall quality improved when using the cognitive aid (completeness score: CA 0.80±0.06 vs. nCA 0.52±0.07, p<0.01; ToC quality: CA 3.16±0.65 vs. nCA 1.92±0.56, p<0.01). Participants’ rating of knowledge and comfort with the ToC process increased after the simulation. Conclusion The completeness of information transfer during the ToC process by graduating medical students improved by using a cognitive aid in a simulated patient crisis. PMID:27435838

  2. Terrorism and the ethics of emergency medical care.

    PubMed

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

    2001-06-01

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

  3. Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives.

    PubMed

    Glasser, Irene; Wang, Fei; Reardon, Jane; Vergara, Cunegundo D; Salvietti, Ralph; Acevedo, Myrtha; Santana, Blanca; Fortunato, Gil

    2016-10-01

    We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation.

  4. Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives.

    PubMed

    Glasser, Irene; Wang, Fei; Reardon, Jane; Vergara, Cunegundo D; Salvietti, Ralph; Acevedo, Myrtha; Santana, Blanca; Fortunato, Gil

    2016-10-01

    We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation. PMID:26807853

  5. Some Basic Determinants of Medical Care and Health Policy

    PubMed Central

    Somers, Anne R.

    1966-01-01

    Long-term trends in our economy and social structure are radically affecting the supply and demand for health services. Population increases, both generally and in the over-65-years-of-age bracket, growing ratio of nonwhites to whites, increasing proportion of women, increasing urbanization, industrialization, educational levels and per capita income are only some of the major factors affecting the demand for health services. Major developments in the science, technology and organization of medical care are and will continue breaking traditional patterns in rendering such care, and definitely point in the direction of multidisciplinary and institutional makeup in the delivery of health services. Changes in the financing of medical care are bringing in a foray of public programs sponsored by all levels of the government, contributing to the unique American pluralistic health care economy with its “mix” of public and private activities. Questions, intended to point up some of the more far-reaching issues, are appended to each section of the paper. PMID:5971547

  6. From Cure to Care: Assessing the Ethical and Professional Learning Needs of Medical Learners in a Care-Based Facility

    ERIC Educational Resources Information Center

    Hall, Pippa; O'Reilly, Jane; Dojeiji, Sue; Blair, Richard; Harley, Anne

    2009-01-01

    The purpose of this study was to assess the ethical and professional learning needs of medical trainees on clinical placements at a care-based facility, as they shifted from acute care to care-based philosophy. Using qualitative data analysis and grounded theory techniques, 12 medical learners and five clinical supervisors were interviewed. Five…

  7. [Contribution of the rehabilitation approach for home medical care--a case study of a patient with higher cortical dysfunction].

    PubMed

    Kato, Nobuko; Suzuki, Miki

    2004-12-01

    Although the main theme of this meeting is the continuous care process from acute phase to chronic phase, it is also strongly emphasized on rehabilitation medicine. However, most of the patients who really need rehabilitation have not followed such a process. We will show you a patient with traumatic brain injury, who returned home directly from an acute phase hospital, who had difficulties in ADL and QOL. We took initiatives in medical and care services in order to support the patient and his family to alleviate his difficulties in ADL and QOL. Thereafter, he was able to continue living at home with more comfort. We must offer adequate medical rehabilitation and other necessary support providing medical services and welfare before a patient returns home.

  8. 26 CFR 1.105-2 - Amounts expended for medical care.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Amounts expended for medical care. 1.105-2... Amounts expended for medical care. Section 105(b) provides an exclusion from gross income with respect to... the taxpayer to reimburse him for expenses incurred for the medical care (as defined in section...

  9. Educational Implications of Nurse Practitioner Students and Medical Residents' Attitudes toward Managed Care.

    ERIC Educational Resources Information Center

    Breer, M. Lynn; Pohl, Joanne M.; Stommel, Manfred; Barkauskas, Violet H.; Schillo, Barbara; Oakley, Deborah

    2002-01-01

    Attitudes toward managed care of 431 medical residents and 153 advanced practice nursing students were compared. Medical students were more likely to agree that managed care emphasizes cost over quality and threatens autonomy. Nursing students were more likely to agree that it encourages preventive care. Medical students were less enthusiastic…

  10. [Health policies and politicized health? An analysis of sexual and reproductive health policies in Peru from the perspective of medical ethics, quality of care, and human rights].

    PubMed

    Miranda, J Jaime; Yamin, Alicia Ely

    2008-01-01

    Health professionals view medical ethics as a discipline that provides the basis for more adequate patient care. In recent years the concepts of quality of care and human rights - with their attending discourses - have joined the concept of medical ethics among the paradigms to consider in care for humans both at the individual and health policy levels. The current study seeks to analyze such paradigms, based on a case study of sexual and reproductive health policies in Peru in the last 10 years. PMID:18209830

  11. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... reasons enumerated in 38 CFR 17.47(i)(2). (Authority: 38 U.S.C. 1724) Enrollment Provisions and Medical... VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries §...

  12. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... reasons enumerated in 38 CFR 17.47(i)(2). (Authority: 38 U.S.C. 1724) Enrollment Provisions and Medical... VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries §...

  13. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reasons enumerated in 38 CFR 17.47(i)(2). (Authority: 38 U.S.C. 1724) Enrollment Provisions and Medical... VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries §...

  14. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... reasons enumerated in 38 CFR 17.47(i)(2). (Authority: 38 U.S.C. 1724) Enrollment Provisions and Medical... VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries §...

  15. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... reasons enumerated in 38 CFR 17.47(i)(2). (Authority: 38 U.S.C. 1724) Enrollment Provisions and Medical... VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries §...

  16. Innovative approaches to educating medical students for practice in a changing health care environment: the National UME-21 Project.

    PubMed

    Rabinowitz, H K; Babbott, D; Bastacky, S; Pascoe, J M; Patel, K K; Pye, K L; Rodak, J; Veit, K J; Wood, D L

    2001-06-01

    In today's continually changing health care environment, there is serious concern that medical students are not being adequately prepared to provide optimal health care in the system where they will eventually practice. To address this problem, the Health Resources and Services Administration (HRSA) developed a $7.6 million national demonstration project, Undergraduate Medical Education for the 21st Century (UME-21). This project funded 18 U.S. medical schools, both public and private, for a three-year period (1998-2001) to implement innovative educational strategies. To accomplish their goals, the 18 UME-21 schools worked with more than 50 organizations external to the medical school (e.g., managed care organizations, integrated health systems, Area Health Education Centers, community health centers). The authors describe the major curricular changes that have been implemented through the UME-21 project, discuss the challenges that occurred in carrying out those changes, and outline the strategies for evaluating the project. The participating schools have developed curricular changes that focus on the core primary care clinical clerkships, take place in ambulatory settings, include learning objectives and competencies identified as important to providing care in the future health care system, and have faculty development and internal evaluation components. Curricular changes implemented at the 18 schools include having students work directly with managed care organizations, as well as special demonstration projects to teach students the knowledge, skills, and attitudes necessary for successfully managing care. It is already clear that the UME-21 project has catalyzed important curricular changes within 12.5% of U.S. medical schools. The ongoing national evaluation of this project, which will be completed in 2002, will provide further information about the project's impact and effectiveness.

  17. 45 CFR 156.245 - Treatment of direct primary care medical homes.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING... 45 Public Welfare 1 2012-10-01 2012-10-01 false Treatment of direct primary care medical homes... direct primary care medical homes. A QHP issuer may provide coverage through a direct primary...

  18. The Teaching Polyclinic: A Model for Community Medical Care, Teaching and Research

    ERIC Educational Resources Information Center

    Montejo, Ernesto de la Torre; Arzola, Ramon Casanova

    1976-01-01

    Describes national medical care services, in the Republic of Cuba, developed since the revolution of 1959. The comprehensive care polyclinic, basic unit for primary care services, is described in terms of human resources (teachers, medical personnel, other specialists) and functions (community health care, regionalization, provision of dispensary…

  19. Teaching Medical Students about Quality and Cost of Care at Case Western Reserve University.

    ERIC Educational Resources Information Center

    Headrick, Linda A.; And Others

    1992-01-01

    At Case Western University (Ohio), medical students critically analyze the quality and cost of asthma care in the community by studying patients in primary care practices. Each writes a case report, listing all medical charges and comparing them with guidelines for asthma care. Several recommendations for improved care have emerged. (MSE)

  20. A Patient-Held Medical Record Integrating Depression Care into Diabetes Care

    PubMed Central

    Satoh-Asahara, Noriko; Ito, Hiroto; Akashi, Tomoyuki; Yamakage, Hajime; Kotani, Kazuhiko; Nagata, Daisuke; Nakagome, Kazuyuki; Noda, Mitsuhiko

    2016-01-01

    PURPOSE Depression is frequently observed in people with diabetes. The purpose of this study is to develop a tool for individuals with diabetes and depression to communicate their comorbid conditions to health-care providers. METHOD We searched the Internet to review patient-held medical records (PHRs) of patients with diabetes and examine current levels of integration of diabetes and depression care in Japan. RESULTS Eight sets of PHRs were found for people with diabetes. All PHRs included clinical follow-up of diabetes and multidisciplinary clinical pathways for diabetes care. No PHRs included depression monitoring and/or treatment. In terms of an integrated PHR for a patient comorbid with diabetes and depression, necessary components include hopes/preferences, educational information on diabetes complications and treatment, medical history, stress and coping, resources, and monitoring diabetes and depression. CONCLUSION A new PHR may be suitable for comorbid patients with diabetes and depression. PMID:27478395

  1. Features and application of wearable biosensors in medical care.

    PubMed

    Ajami, Sima; Teimouri, Fotooheh

    2015-12-01

    One of the new technologies in the field of health is wearable biosensor, which provides vital signs monitoring of patients, athletes, premature infants, children, psychiatric patients, people who need long-term care, elderly, and people in impassable regions far from health and medical services. The aim of this study was to explain features and applications of wearable biosensors in medical services. This was a narrative review study that done in 2015. Search conducted with the help of libraries, books, conference proceedings, through databases of Science Direct, PubMed, Proquest, Springer, and SID (Scientific Information Database). In our searches, we employed the following keywords and their combinations; vital sign monitoring, medical smart shirt, smart clothing, wearable biosensors, physiological monitoring system, remote detection systems, remote control health, and bio-monitoring system. The preliminary search resulted in 54 articles, which published between 2002 and 2015. After a careful analysis of the content of each paper, 41 sources selected based on their relevancy. Although the use of wearable in healthcare is still in an infant stage, it could have a magic effect on healthcare. Smart wearable in the technology industry for 2015 is one that is looking to be a big and profitable market. Wearable biosensors capable of continuous vital signs monitoring and feedback to the user will be significantly effective in timely prevention, diagnosis, treatment, and control of diseases. PMID:26958058

  2. Prioritizing health disparities in medical education to improve care.

    PubMed

    Awosogba, Temitope; Betancourt, Joseph R; Conyers, F Garrett; Estapé, Estela S; Francois, Fritz; Gard, Sabrina J; Kaufman, Arthur; Lunn, Mitchell R; Nivet, Marc A; Oppenheim, Joel D; Pomeroy, Claire; Yeung, Howa

    2013-05-01

    Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. PMID:23659676

  3. Features and application of wearable biosensors in medical care.

    PubMed

    Ajami, Sima; Teimouri, Fotooheh

    2015-12-01

    One of the new technologies in the field of health is wearable biosensor, which provides vital signs monitoring of patients, athletes, premature infants, children, psychiatric patients, people who need long-term care, elderly, and people in impassable regions far from health and medical services. The aim of this study was to explain features and applications of wearable biosensors in medical services. This was a narrative review study that done in 2015. Search conducted with the help of libraries, books, conference proceedings, through databases of Science Direct, PubMed, Proquest, Springer, and SID (Scientific Information Database). In our searches, we employed the following keywords and their combinations; vital sign monitoring, medical smart shirt, smart clothing, wearable biosensors, physiological monitoring system, remote detection systems, remote control health, and bio-monitoring system. The preliminary search resulted in 54 articles, which published between 2002 and 2015. After a careful analysis of the content of each paper, 41 sources selected based on their relevancy. Although the use of wearable in healthcare is still in an infant stage, it could have a magic effect on healthcare. Smart wearable in the technology industry for 2015 is one that is looking to be a big and profitable market. Wearable biosensors capable of continuous vital signs monitoring and feedback to the user will be significantly effective in timely prevention, diagnosis, treatment, and control of diseases.

  4. Patient satisfaction in Malaysia's busiest outpatient medical care.

    PubMed

    Ganasegeran, Kurubaran; Perianayagam, Wilson; Manaf, Rizal Abdul; Jadoo, Saad Ahmed Ali; Al-Dubai, Sami Abdo Radman

    2015-01-01

    This study aimed to explore factors associated with patient satisfaction of outpatient medical care in Malaysia. A cross-sectional exit survey was conducted among 340 outpatients aged between 13 and 80 years after successful clinical consultations and treatment acquirements using convenience sampling at the outpatient medical care of Tengku Ampuan Rahimah Hospital (HTAR), Malaysia, being the country's busiest medical outpatient facility. A survey that consisted of sociodemography, socioeconomic, and health characteristics and the validated Short-Form Patient Satisfaction Questionnaire (PSQ-18) scale were used. Patient satisfaction was the highest in terms of service factors or tangible priorities, particularly "technical quality" and "accessibility and convenience," but satisfaction was low in terms of service orientation of doctors, particularly the "time spent with doctor," "interpersonal manners," and "communication" during consultations. Gender, income level, and purpose of visit to the clinic were important correlates of patient satisfaction. Effort to improve service orientation among doctors through periodical professional development programs at hospital and national level is essential to boost the country's health service satisfaction. PMID:25654133

  5. Features and application of wearable biosensors in medical care

    PubMed Central

    Ajami, Sima; Teimouri, Fotooheh

    2015-01-01

    One of the new technologies in the field of health is wearable biosensor, which provides vital signs monitoring of patients, athletes, premature infants, children, psychiatric patients, people who need long-term care, elderly, and people in impassable regions far from health and medical services. The aim of this study was to explain features and applications of wearable biosensors in medical services. This was a narrative review study that done in 2015. Search conducted with the help of libraries, books, conference proceedings, through databases of Science Direct, PubMed, Proquest, Springer, and SID (Scientific Information Database). In our searches, we employed the following keywords and their combinations; vital sign monitoring, medical smart shirt, smart clothing, wearable biosensors, physiological monitoring system, remote detection systems, remote control health, and bio-monitoring system. The preliminary search resulted in 54 articles, which published between 2002 and 2015. After a careful analysis of the content of each paper, 41 sources selected based on their relevancy. Although the use of wearable in healthcare is still in an infant stage, it could have a magic effect on healthcare. Smart wearable in the technology industry for 2015 is one that is looking to be a big and profitable market. Wearable biosensors capable of continuous vital signs monitoring and feedback to the user will be significantly effective in timely prevention, diagnosis, treatment, and control of diseases. PMID:26958058

  6. Prioritizing health disparities in medical education to improve care

    PubMed Central

    Awosogba, Temitope; Betancourt, Joseph R.; Conyers, F. Garrett; Estapé, Estela S.; Francois, Fritz; Gard, Sabrina J.; Kaufman, Arthur; Lunn, Mitchell R.; Nivet, Marc A.; Oppenheim, Joel D.; Pomeroy, Claire; Yeung, Howa

    2015-01-01

    Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. PMID:23659676

  7. Transgender and Gender Nonconforming Adolescent Care: Psychosocial and Medical Considerations

    PubMed Central

    Guss, Carly; Shumer, Daniel; Katz-Wise, Sabra L.

    2015-01-01

    Purpose of review Transgender individuals display incongruence between their assigned birth sex and their current gender identity, and may identify as male, female or elsewhere on the gender spectrum. Gender nonconformity describes an individual whose gender identity, role, or expression are not typical for individuals in a given assigned sex category. This update highlights recent literature pertaining to the psychosocial and medical care of transgender and gender nonconforming (TGN) adolescents with applications for the general practitioner. Recent findings The psychological risks and outcomes of TGN adolescents are being more widely recognized. Moreover, there is increasing evidence that social and medical gender transition reduces gender dysphoria, defined as distress that accompanies the incongruence between one’s birth sex and identified gender. Unfortunately, lack of education about TGN adolescents in medical training persists. Summary Recent literature highlights increased health risks in TGN adolescents and improved outcomes following gender dysphoria treatment. It is important for clinicians to become familiar with the range of treatment options and referral resources available to TGN adolescents in order to provide optimal and welcoming care to all adolescents. PMID:26087416

  8. Right-siting of medical care: role of the internist.

    PubMed

    Pinheiro, Leslie

    2009-02-01

    General internal medicine is now an essential service, and may in time be the main vehicle of delivery of healthcare to an ageing population, since resources are finite. One model for an equitable system of healthcare delivery may be the integration of General Internal Medicine as the core matrix, around which the various subspecialties deliver quality care. This is now a reality in many hospitals, where all subspecialists serve for varying periods in general medical wards, some even achieving dual accreditation. This promotes integration rather than fragmentation of services. Subspecialties will thrive, for the general workload will also be shared by internists in an equitable fashion. The obvious beneficiaries are the patients, and the health economics will also benefit the funding bodies. The services provided by internists must also be expanded into new fields, e.g. medicine for disasters, so as to promote cost-effective medical care, research and teaching, and also to achieve right-siting of patient care. It must also be emphasised that the specialties remain integral parts of the matrix, so that all departments complement one another, rather than compete with each other. The collegiality engendered is essential for a more congenial workplace, so as to promote staff retention. PMID:19271047

  9. Social network approaches to recruitment, HIV prevention, medical care, and medication adherence.

    PubMed

    Latkin, Carl A; Davey-Rothwell, Melissa A; Knowlton, Amy R; Alexander, Kamila A; Williams, Chyvette T; Boodram, Basmattee

    2013-06-01

    This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.

  10. Medication errors in primary care in Riyadh City, Saudi Arabia.

    PubMed

    Khoja, T; Neyaz, Y; Qureshi, N A; Magzoub, M A; Haycox, A; Walley, T

    2011-02-01

    Medication errors can cause a variety of adverse drug events but are potentially preventable. This cross-sectional study analysed all medication prescriptions from 5 public and 5 private primary health care clinics in Riyadh city, collected by simple random sampling during 1 working day. Prescriptions for 2463 and 2836 drugs from public and private clinics respectively were examined for errors, which were analysed using Neville et al.'s classification of prescription errors. Prescribing errors were found on 990/5299 (18.7%) prescriptions. Both type B and type C errors (major and minor nuisance) were more often associated with prescriptions from public than private clinics. Type D errors (trivial) were significantly more likely to occur with private health sector prescriptions. Type A errors (potentially serious) were rare (8/5299 drugs; 0.15%) and the rate did not differ significantly between the 2 health sectors. The development of preventive strategies for avoiding prescription errors is crucial. PMID:21735951

  11. Introducing managed care to the medical school curriculum: effect on student attitudes.

    PubMed

    Field, T S; Baldor, R A; Casey, L M; Chuman, A; Lasser, D; Ehrlich, A; Gurwitz, J H

    1998-07-01

    In order to assess the effect of clinical training and didactic instruction on medical student attitudes toward managed care, we conducted a survey of all medical students at the midpoint of their third year clerkships at the University of Massachusetts Medical School. The students were exposed to clinical training in managed care settings and a 2-day required course on the principles underlying managed care. The main outcome measures were student attitudes toward the concepts of managed care, managed care organizations, and future careers in managed care. Students also assessed the attitudes of medical faculty toward managed care. Attitudes of students with previous clinical training in managed care settings did not differ from those of students without such exposure toward the concepts underlying managed care or managed care organizations and were less positive about careers in managed care. Student responses before and after the 2-day course on managed care demonstrated that attitudes moved in a significantly positive direction. Seventy-one percent of students reported that the opinions they had heard from medical faculty about managed care were negative. Preparing medical students to practice medicine effectively in managed care settings will require focused attention on managed care issues in the medical school curriculum and the combined efforts of academic health centers and managed care organizations.

  12. The dislocation of medical dominance: making space for interprofessional care.

    PubMed

    Bleakley, Alan

    2013-09-01

    The historical transition of modern medicine from an autonomous profession to a team-based interprofessional practice can be described in terms of space rather than time, with "place" as the unit of analysis. Imagining modern medicine spatially was instigated by Foucault, who described medical dominance as a territorializing of both individual body spaces and public spaces--the former through the diagnostic medical gaze, the latter in a gaze of health surveillance. However, much has happened since Foucault's (1963) analysis. The diagnostic gaze has been dispersed to develop a collaborative gaze including patients and healthcare professionals; political interests have appropriated the public health gaze; and the medical profession is subject to democratic processes of accountability. Medicine has lost its territorial imperative as new "liquid" and "nomadic" work practices emerge, making space for interprofessional care. Such dislocation of medical dominance and its multiple relocations are poorly theorised. Deleuze and Guattari distinguish between "striated" and "smooth" spaces. Striated space is associated with hierarchies and boundaries, where smooth space includes boundary crossing and democratic collaboration. Smooth or liminal spaces in hospitals, such as corridors, can paradoxically act as catalysts for collaboration or assembly democracy, affording opportunities for improvised interprofessional encounters. Such encounters can act as an antidote to planned protocols or imperatives for interprofessional collaboration. PMID:23930686

  13. Can managed care reduce employers' retiree medical liability?

    PubMed

    Taylor, R S; Newton, B

    1991-01-01

    The Financial Accounting Standards Board (FASB) has forced U.S. companies to look squarely at their current retiree health obligations and their future commitments. Accounting Statement No. 106 (FAS 106) requires employers to accrue liabilities for retiree health benefits during employees' active service, rather than record the costs as benefits are paid. Employers are scrambling to find ways to reduce the statement's effect on corporate balance sheets. While managed health care has been increasingly employed to control benefit costs in active employee health plans, it has not been as popular in retiree plans. This article reviews important demographic and health trends in the retiree population and summarizes employers' early responses to FAS 106. It explores why managed health care has thus far played a limited role in reducing employers' postretirement medical liability, and offers insight into how that role could be increased in the future. PMID:10116958

  14. Jewish medical ethics and end-of-life care.

    PubMed

    Kinzbrunner, Barry M

    2004-08-01

    While Judaism espouses the infinite value of human life, Judaism recognizes that all life is finite and, as such, its teachings are compatible with the principles of palliative medicine and end-of-life care as they are currently practiced. Jewish medical ethics as derived from Jewish law, has definitions for the four cardinal values of secular medical ethics: autonomy, beneficence, nonmaleficence, and justice, with the major difference between Jewish law and secular medical ethics being that orthodox or traditional Jews are perceived to limit their autonomy by choosing, with the assistance and advice of their rabbis, to follow God's law as defined by the Bible and post-Biblical sources. With an understanding of Jewish medical ethics as defined by Jewish law, various issues pertaining to the care of Jewish patients who are near the end-of-life can be better understood. Jewish tradition contains within its textual sources the concept of terminal illness. The shortening of life through suicide, assisted suicide, or euthanasia is categorically forbidden. For patients who are terminally ill, treatments that are not potentially curative may be refused, especially when harm may result. Under certain circumstances, treatments may be withheld, but active treatment already started may not usually be withdrawn. While patients should generally not be lied to regarding their conditions, withholding information or even providing false information may be appropriate when it is felt that the truth will cause significant harm. Pain and suffering must be treated aggressively, even if there is an indirect risk of unintentionally shortening life. Finally, patients may execute advance directives, providing that the patient's rabbi is involved in the process.

  15. [Public and private: insurance companies and medical care in Mexico].

    PubMed

    Tamez, S; Bodek, C; Eibenschutz, C

    1995-01-01

    During the late 70's and early 80's in Mexico, as in the rest of Latin-America, sanitary policies were directed to support the growth of the private sector of health care at the expense of the public sector. This work analyzes the evolution of the health insurance market as a part of the privatization process of health care. The analysis based on economic data, provides the political profile behind the privatization process as well as the changes in the relations between the State and the health sector. The central hypothesis is that the State promotes and supports the growth of the private market of medical care via a series of legal, fiscal and market procedures. It also discusses the State roll in the legal changes related to the national insurance activity. A comparative analysis is made about the evolution of the insurance industry in Argentina, Brazil, Chile and Mexico during the period 1986-1992, with a particular enfasis in the last country. One of the principal results is that the Premium/GNP and Premium/per capita, display a general growth in the 4 countries. This growth is faster for Mexico for each one) because the privatization process occurred only during the most recent years. For the 1984-1991 period in Mexico the direct premium as percentage of the GNP raised from 0.86% to 1.32%. If one focussed only in the insurance for health and accidents branches the rice goes form 8.84% in 1984 to 19.08% in 1991. This indicates that the insurance industry is one of the main targets of the privatization process of the health care system in Mexico. This is also shown by the State support to fast expansion of the big medical industrial complex of the country. Considering this situation in the continuity of the neoliberal model of Mexico, this will profound the inequity and inequality. PMID:12973592

  16. [Public and private: insurance companies and medical care in Mexico].

    PubMed

    Tamez, S; Bodek, C; Eibenschutz, C

    1995-01-01

    During the late 70's and early 80's in Mexico, as in the rest of Latin-America, sanitary policies were directed to support the growth of the private sector of health care at the expense of the public sector. This work analyzes the evolution of the health insurance market as a part of the privatization process of health care. The analysis based on economic data, provides the political profile behind the privatization process as well as the changes in the relations between the State and the health sector. The central hypothesis is that the State promotes and supports the growth of the private market of medical care via a series of legal, fiscal and market procedures. It also discusses the State roll in the legal changes related to the national insurance activity. A comparative analysis is made about the evolution of the insurance industry in Argentina, Brazil, Chile and Mexico during the period 1986-1992, with a particular enfasis in the last country. One of the principal results is that the Premium/GNP and Premium/per capita, display a general growth in the 4 countries. This growth is faster for Mexico for each one) because the privatization process occurred only during the most recent years. For the 1984-1991 period in Mexico the direct premium as percentage of the GNP raised from 0.86% to 1.32%. If one focussed only in the insurance for health and accidents branches the rice goes form 8.84% in 1984 to 19.08% in 1991. This indicates that the insurance industry is one of the main targets of the privatization process of the health care system in Mexico. This is also shown by the State support to fast expansion of the big medical industrial complex of the country. Considering this situation in the continuity of the neoliberal model of Mexico, this will profound the inequity and inequality.

  17. The State of Transgender Health Care: Policy, Law, and Medical Frameworks

    PubMed Central

    2014-01-01

    I review the current status of transgender people’s access to health care in the United States and analyze federal policies regarding health care services for transgender people and the limitations thereof. I suggest a preliminary outline to enhance health care services and recommend the formulation of explicit federal policies regarding the provision of health care services to transgender people in accordance with recently issued medical care guidelines, allocation of research funding, education of health care workers, and implementation of existing nondiscrimination policies. Current policies denying medical coverage for sex reassignment surgery contradict standards of medical care and must be amended. PMID:24432926

  18. The state of transgender health care: policy, law, and medical frameworks.

    PubMed

    Stroumsa, Daphna

    2014-03-01

    I review the current status of transgender people's access to health care in the United States and analyze federal policies regarding health care services for transgender people and the limitations thereof. I suggest a preliminary outline to enhance health care services and recommend the formulation of explicit federal policies regarding the provision of health care services to transgender people in accordance with recently issued medical care guidelines, allocation of research funding, education of health care workers, and implementation of existing nondiscrimination policies. Current policies denying medical coverage for sex reassignment surgery contradict standards of medical care and must be amended. PMID:24432926

  19. The state of transgender health care: policy, law, and medical frameworks.

    PubMed

    Stroumsa, Daphna

    2014-03-01

    I review the current status of transgender people's access to health care in the United States and analyze federal policies regarding health care services for transgender people and the limitations thereof. I suggest a preliminary outline to enhance health care services and recommend the formulation of explicit federal policies regarding the provision of health care services to transgender people in accordance with recently issued medical care guidelines, allocation of research funding, education of health care workers, and implementation of existing nondiscrimination policies. Current policies denying medical coverage for sex reassignment surgery contradict standards of medical care and must be amended.

  20. Assessment of medical waste management at a primary health-care center in Sao Paulo, Brazil

    SciTech Connect

    Moreira, A.M.M.; Guenther, W.M.R.

    2013-01-15

    Highlights: Black-Right-Pointing-Pointer Assessment of medical waste management at health-care center before/after intervention. Black-Right-Pointing-Pointer Qualitative and quantitative results of medical waste management plan are presented. Black-Right-Pointing-Pointer Adjustments to comply with regulation were adopted and reduction of waste was observed. Black-Right-Pointing-Pointer The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of Sao Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized

  1. Legal Care as Part of Health Care: The Benefits of Medical-Legal Partnership.

    PubMed

    Murphy, Johnna S; Lawton, Ellen M; Sandel, Megan

    2015-10-01

    Many of the social determinants of health are rooted in legal problems. Medical-legal partnerships (MLPs) have the potential to positively change clinical systems. This change can be accomplished by integrating legal staff into health care clinics to educate staff and residents on social determinants of health and their legal origins. When the MLP team works directly with patients to identify and address legal needs that improve health outcomes, and incorporate legal insights and solutions into health care practice where the patient population is overwhelmingly impacted by social conditions, outcomes are beneficial to children and families.

  2. Mothers' satisfaction with medical care: perceptions of racism, family stress, and medical outcomes in children with diabetes.

    PubMed

    Auslander, W F; Thompson, S J; Dreitzer, D; Santiago, J V

    1997-08-01

    Patient satisfaction is an important indicator of medical outcomes. This study used an ecological framework to identify sociodemographic, family, and community predictors of mothers' satisfaction with their children's medical care and to determine the extent to which satisfaction is associated with medical outcomes such as adherence to treatment and health status of children with diabetes. Although individual demographics have little influence on satisfaction, family and community stressors are significant predictors of mothers' satisfaction with medical care. Mothers who reported greater perceptions of racism and family stress were significantly less satisfied with their children's medical care than those from less stressful environments. Mothers' satisfaction with medical care was significantly associated with adherence but was not significantly related to the children's health status.

  3. End-of-life care curricula in undergraduate medical education: a comparison of allopathic and osteopathic medical schools.

    PubMed

    Rothman, Margaret D; Gugliucci, Marilyn R

    2008-01-01

    End-of-life care curricula in osteopathic medical schools were compared with allopathic school offerings. An 8-question online survey of undergraduate medical education administrators at all United States osteopathic medical schools (n = 26) and 26 allopathic schools geographically closest to them was conducted in 2007. Responses from 80% (n = 21) of osteopathic schools and 77% (n = 20) of allopathic schools revealed that both osteopathic and allopathic medical schools offered end-of-life care education. Of note is that 71% of the osteopathic medical school respondents had a course that concentrates on end-of-life care compared with 37% of allopathic school respondents (P = .03). This disparity in percentages may be due to a number of reasons, 2 of which may include course identification methods and the primary care orientation and philosophy inherent in osteopathic medical schools.

  4. [Medical Care for Refugees by the Public Health Services: Always Ready--But for How Much Longer?].

    PubMed

    Tinnemann, P; Gundlach, F; Nitschke, H; Bunte, A; Teichert, U

    2016-04-01

    Refugees continue seeking sanctuary in Germany and it can reasonably be expected that their health will be affected by the conditions they lived in before and during flight. Ensuring nationwide care for refugees should be demand oriented, effective and efficient, which requires tackling mostly similar challenges a community level in a consistent manner. The aim must be providing adequate medical care based on the principle of respect for human dignity and ensuring public health standards. Within the currently situation, this basic expectations are often not sufficiently met. Generally accepted national standards, longer-term strategies and sustainable care are not yet achieved noticeably by public health services in Germany.To warrant permanent and sustainable high-quality medical care for refugees, local networks of involved institutions should be established with a longer-term perspective. Moreover, the financially eroded and personnel thinned public health service will only be able to fulfil statutory requirements and expectations of the local, state and federal policy makers for a limited amount of time only. Safeguarding that services are coping with the size of challenges over longer periods of time and anchoring the acquired expertise of medical care for refugees within the public health services, requires immediately better financial and personnel resources. Then the public health services will be a reliable partner supporting all people in Germany, particularly those that require subsidiary and socially-compensatory supply. PMID:27078828

  5. State Regulation of Medication Administration by Unlicensed Assistive Personnel in Residential Care and Adult Day Services Settings.

    PubMed

    Carder, Paula C; O'Keeffe, Janet

    2016-09-01

    Residential care settings and adult day services are two community-based care options used by older adults with chronic health conditions. Most states have regulatory provisions that allow unlicensed assistive personnel (UAP) to administer medications. The current national policy study examined state regulations to identify which states permit UAP to administer medications, as well as staffing and training requirements. Key findings include states lack clear and adequate provisions for nurse oversight of UAP who administer medications, although adult day service regulations provide a greater level of nurse oversight than residential care settings. Specifically, 32 states require residential care to hire a nurse, but only six include provisions regarding nurse availability (e.g., on-call, on-site, number of hours). In contrast, 10 of 20 states that require adult day service programs to hire a nurse provide availability provisions. Nurse oversight of UAP is an important means of assuring quality care and reducing errors; thus, state regulatory agencies might need to strengthen nurse oversight provisions. [Res Gerontol Nurs. 2016; 9(5):209-222.]. PMID:27054368

  6. Pediatric palliative care and pediatric medical ethics: opportunities and challenges.

    PubMed

    Feudtner, Chris; Nathanson, Pamela G

    2014-02-01

    The fields of pediatric palliative care (PPC) and pediatric medical ethics (PME) overlap substantially, owing to a variety of historical, cultural, and social factors. This entwined relationship provides opportunities for leveraging the strong communication skills of both sets of providers, as well as the potential for resource sharing and research collaboration. At the same time, the personal and professional relationships between PPC and PME present challenges, including potential conflict with colleagues, perceived or actual bias toward a palliative care perspective in resolving ethical problems, potential delay or underuse of PME services, and a potential undervaluing of the medical expertise required for PPC consultation. We recommend that these challenges be managed by: (1) clearly defining and communicating clinical roles of PPC and PME staff, (2) developing questions that may prompt PPC and PME teams to request consultation from the other service, (3) developing explicit recusal criteria for PPC providers who also provide PME consultation, (4) ensuring that PPC and PME services remain organizationally distinct, and (5) developing well-defined and broad scopes of practice. Overall, the rich relationship between PPC and PME offers substantial opportunities to better serve patients and families facing difficult decisions.

  7. Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care

    PubMed Central

    Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

    2016-01-01

    Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736–1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215–0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust—the most significant predictor of patient satisfaction—is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction

  8. Risks to health care workers from nano-enabled medical products.

    PubMed

    Murashov, Vladimir; Howard, John

    2015-01-01

    Nanotechnology is rapidly expanding into the health care industry. However, occupational safety and health risks of nano-enabled medical products have not been thoroughly assessed. This manuscript highlights occupational risk mitigation practices for nano-enabled medical products throughout their life cycle for all major workplace settings including (1) medical research laboratories, (2) pharmaceutical manufacturing facilities, (3) clinical dispensing pharmacies, (4) health care delivery facilities, (5) home health care, (6) health care support, and (7) medical waste management. It further identifies critical research needs for ensuring worker protection in the health care industry. PMID:25950806

  9. Home iv antibiotic therapy through a medical day care unit.

    PubMed

    Gourdeau, M; Deschênes, L; Caron, M; Desmarais, M

    1993-05-01

    An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin) were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%). The duration of out-patient therapy ranged from two to 62 days with a mean duration of 9.4 days if treated at the unit, or 13.2 days in the home care model (1476 patient-days). Vein access was peripheral and catheters remained functional for an average of 4.9 days (range 0.5 to 22 days). Only two patients experienced adverse drug reactions that necessitated modification of treatment. One other case was readmitted to the hospital for surgical debridement. The average cost per patient-day was $66 compared with $375 for in-hospital therapy. This program proved to be safe, efficient, and cost-effective.

  10. Home iv antibiotic therapy through a medical day care unit

    PubMed Central

    Gourdeau, Marie; Deschênes, Louise; Caron, Martine; Desmarais, Marc

    1993-01-01

    An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin) were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%). The duration of out-patient therapy ranged from two to 62 days with a mean duration of 9.4 days if treated at the unit, or 13.2 days in the home care model (1476 patient-days). Vein access was peripheral and catheters remained functional for an average of 4.9 days (range 0.5 to 22 days). Only two patients experienced adverse drug reactions that necessitated modification of treatment. One other case was readmitted to the hospital for surgical debridement. The average cost per patient-day was $66 compared with $375 for in-hospital therapy. This program proved to be safe, efficient, and cost-effective. PMID:22346440

  11. Access to medical care under Medicaid: differentials by race.

    PubMed

    Link, C R; Long, S H; Settle, R F

    1982-01-01

    The Medicaid program was designed to help correct for the unequal access to medical care by income and race in pre-1965 America. Previous evaluations of the program have claimed that on average the eligible poor have enjoyed considerable gains in access, but that the benefits of Medicaid have not been shared equally by blacks and whites. We reexamined the evidence on differential access by race early in the program (1969) and evaluate that claim for the mature program (1976). Our evaluation is conducted within the context of multivariate models of physician and hospital utilization designed to control for a variety of socioeconomic, health status, and resource supply characteristics. While earlier evaluations overstated the extent of racial differentials in 1969, blacks who were not chronically ill had significantly lower levels of ambulatory care--both within and outside of the South. Between 1969 and 1976 all race, region, and health status groups of nonelderly Medicaid recipients experienced increases in physician visits that far outpaced those of the entire nonelderly U.S. population. By 1976 blacks clearly achieved equality with whites in Medicaid ambulatory care use. The only statistically significant shortfall we find is in hospital utilization among Southern blacks in good health.

  12. 20 CFR 10.506 - May the employer monitor the employee's medical care?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false May the employer monitor the employee's medical care? 10.506 Section 10.506 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS... employer monitor the employee's medical care? The employer may monitor the employee's medical progress...

  13. 20 CFR 10.506 - May the employer monitor the employee's medical care?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false May the employer monitor the employee's medical care? 10.506 Section 10.506 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS... employer monitor the employee's medical care? The employer may monitor the employee's medical progress...

  14. 28 CFR 115.235 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Education § 115.235 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its... examinations. (c) The agency shall maintain documentation that medical and mental health practitioners...

  15. 28 CFR 115.235 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Education § 115.235 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its... examinations. (c) The agency shall maintain documentation that medical and mental health practitioners...

  16. 28 CFR 115.335 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ....335 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its facilities have... agency shall maintain documentation that medical and mental health practitioners have received...

  17. 28 CFR 115.335 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ....335 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its facilities have... agency shall maintain documentation that medical and mental health practitioners have received...

  18. 28 CFR 115.335 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ....335 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its facilities have... agency shall maintain documentation that medical and mental health practitioners have received...

  19. 28 CFR 115.235 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Education § 115.235 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its... examinations. (c) The agency shall maintain documentation that medical and mental health practitioners...

  20. 48 CFR 831.7001-4 - Medical services and hospital care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... hospital care. 831.7001-4 Section 831.7001-4 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... and Procedures 831.7001-4 Medical services and hospital care. (a) VA may pay the customary student... Government. (b) When the customary student's health fee does not cover medical services or hospital care,...

  1. 78 FR 55671 - Hospital Care and Medical Services for Camp Lejeune Veterans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... hospital care and medical services. As discussed in a separate notice (78 FR 39832, July 2, 2013), we are... AFFAIRS 38 CFR Part 17 RIN 2900-AO78 Hospital Care and Medical Services for Camp Lejeune Veterans AGENCY... January 1, 1957, and ending on December 31, 1987. The law requires VA to furnish hospital care and...

  2. Improving the Quality of Nursing Home Care and Medical-Record Accuracy with Direct Observational Technologies

    ERIC Educational Resources Information Center

    Schnelle, John F.; Osterweil, Dan; Simmons, Sandra F.

    2005-01-01

    Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medical record data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and…

  3. Health Insurance, Medical Care, and Health Outcomes: A Model of Elderly Health Dynamics

    ERIC Educational Resources Information Center

    Yang, Zhou; Gilleskie, Donna B.; Norton, Edward C.

    2009-01-01

    Prescription drug coverage creates a change in medical care consumption, beyond standard moral hazard, arising both from the differential cost-sharing and the relative effectiveness of different types of care. We model the dynamic supplemental health insurance decisions of Medicare beneficiaries, their medical care demand, and subsequent health…

  4. 32 CFR 732.25 - Accounting classifications for nonnaval medical and dental care expenses.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... and dental care expenses. 732.25 Section 732.25 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Accounting Classifications for Nonnaval Medical and Dental Care Expenses and Standard Document Numbers § 732.25 Accounting classifications...

  5. 32 CFR 732.25 - Accounting classifications for nonnaval medical and dental care expenses.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... and dental care expenses. 732.25 Section 732.25 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Accounting Classifications for Nonnaval Medical and Dental Care Expenses and Standard Document Numbers § 732.25 Accounting classifications...

  6. 32 CFR 732.25 - Accounting classifications for nonnaval medical and dental care expenses.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... and dental care expenses. 732.25 Section 732.25 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Accounting Classifications for Nonnaval Medical and Dental Care Expenses and Standard Document Numbers § 732.25 Accounting classifications...

  7. 32 CFR 732.25 - Accounting classifications for nonnaval medical and dental care expenses.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... and dental care expenses. 732.25 Section 732.25 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Accounting Classifications for Nonnaval Medical and Dental Care Expenses and Standard Document Numbers § 732.25 Accounting classifications...

  8. 32 CFR 732.25 - Accounting classifications for nonnaval medical and dental care expenses.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... and dental care expenses. 732.25 Section 732.25 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Accounting Classifications for Nonnaval Medical and Dental Care Expenses and Standard Document Numbers § 732.25 Accounting classifications...

  9. The integration of a telemental health service into rural primary medical care.

    PubMed

    Davis, G L; Boulger, J G; Hovland, J C; Hoven, N T

    2007-07-01

    Mental health care shortages in rural areas have resulted in the majority of services being offered through primary medical care settings. The authors argue that a paradigm shift must occur so that those in need of mental health care have reasonable, timely access to these services. Changes proposed include integrating mental health services into primary medical care settings, moving away from the traditional view of mental health care services (one therapist, one hour, and one client), and increasing the consultative role of psychologists and other mental health care providers in primary medical care. Characteristics of mental health providers that facilitate effective integration into primary medical care are presented. The results of a needs assessment survey and an example of a telemental health project are described. This project involved brief consultations with patients and their physicians from a shared care model using a broadband internet telecommunications link between a rural clinic and mental health service providers in an urban area.

  10. Standardised mortality ratio based on the sum of age and percentage total body surface area burned is an adequate quality indicator in burn care: An exploratory review.

    PubMed

    Steinvall, Ingrid; Elmasry, Moustafa; Fredrikson, Mats; Sjoberg, Folke

    2016-02-01

    Standardised Mortality Ratio (SMR) based on generic mortality predicting models is an established quality indicator in critical care. Burn-specific mortality models are preferred for the comparison among patients with burns as their predictive value is better. The aim was to assess whether the sum of age (years) and percentage total body surface area burned (which constitutes the Baux score) is acceptable in comparison to other more complex models, and to find out if data collected from a separate burn centre are sufficient for SMR based quality assessment. The predictive value of nine burn-specific models was tested by comparing values from the area under the receiver-operating characteristic curve (AUC) and a non-inferiority analysis using 1% as the limit (delta). SMR was analysed by comparing data from seven reference sources, including the North American National Burn Repository (NBR), with the observed mortality (years 1993-2012, n=1613, 80 deaths). The AUC values ranged between 0.934 and 0.976. The AUC 0.970 (95% CI 0.96-0.98) for the Baux score was non-inferior to the other models. SMR was 0.52 (95% CI 0.28-0.88) for the most recent five-year period compared with NBR based data. The analysis suggests that SMR based on the Baux score is eligible as an indicator of quality for setting standards of mortality in burn care. More advanced modelling only marginally improves the predictive value. The SMR can detect mortality differences in data from a single centre. PMID:26700877

  11. Considering Point-of-Care Electronic Medical Resources in Lieu of Traditional Textbooks for Medical Education.

    PubMed

    Hale, LaDonna S; Wallace, Michelle M; Adams, Courtney R; Kaufman, Michelle L; Snyder, Courtney L

    2015-09-01

    Selecting resources to support didactic courses is a critical decision, and the advantages and disadvantages must be carefully considered. During clinical rotations, students not only need to possess strong background knowledge but also are expected to be proficient with the same evidence-based POC resources used by clinicians. Students place high value on “real world” learning and therefore may place more value on POC resources that they know practicing clinicians use as compared with medical textbooks. The condensed nature of PA education requires students to develop background knowledge and information literacy skills over a short period. One way to build that knowledge and those skills simultaneously is to use POC resources in lieu of traditional medical textbooks during didactic training. Electronic POC resources offer several advantages over traditional textbooks and should be considered as viable options in PA education. PMID:26309211

  12. Exploring the medical home in Ryan White HIV care settings: a pilot study.

    PubMed

    Beane, Stephanie N; Culyba, Rebecca J; DeMayo, Michael; Armstrong, Wendy

    2014-01-01

    Amid increased attention to the cost of health care, health information technology, and specialization and fragmentation in medicine, the medical home has achieved recognition as a model for more effective and efficient health care. Little data are available on recently funded HIV medical home demonstration projects, and no research richly describes existing medical home characteristics, implementation challenges, and impact on outcomes in longstanding HIV outpatient settings. The Ryan White HIV/AIDS Program (RWP) provides federal funding for primary and specialty care for people living with HIV. Although RWP clinics developed independently of the medical home model, existing data indirectly support that, with emphasis on primary, comprehensive, and patient-centered care, RWP clinics operate as medical homes. This study explores the development, definition, and implementation of medical home characteristics by RWP-funded providers in order to better understand how it fits with broader debates about medical homes and health care reform.

  13. Exploring the Medical Home in Ryan White HIV Care Settings: A Pilot Study

    PubMed Central

    Beane, Stephanie N.; Culyba, Rebecca J.; DeMayo, Michael; Armstrong, Wendy

    2014-01-01

    Amid increased attention to the cost of health care, health information technology, and specialization and fragmentation in medicine, the medical home has achieved recognition as a model for more effective and efficient health care. Little data are available on recently funded HIV medical home demonstration projects, and no research richly describes existing medical home characteristics, implementation challenges, and impact on outcomes in longstanding HIV outpatient settings. The Ryan White HIV/AIDS Program (RWP) provides federal funding for primary and specialty care for people living with HIV. Although RWP clinics developed independently of the medical home model, existing data indirectly support that, with emphasis on primary, comprehensive, and patient-centered care, RWP clinics operate as medical homes. This study explores the development, definition, and implementation of medical home characteristics by RWP-funded providers in order to better understand how it fits with broader debates about medical homes and health care reform. PMID:24560357

  14. [Palliative Care for Neurological Intractable Diseases and Home Medical Support].

    PubMed

    Yokoyama, Kazumasa; Ogino, Mieko; Ishigaki, Yasunori; Hattori, Nobutaka

    2015-08-01

    Many medical doctors regard the end stage and palliative care of neurological intractable diseases as the point at which aggressive treatment should be interrupted and death is imminent. However, the definition of health by the World Health Organization as the physical, psychological, and social goal to achieve a fully favorable health condition should be revisited. In the real clinical setting, the health condition, as the ability to adapt and self-manage in the face of social, physical, and emotional challenges with the aim to overcome stress (resilience), is dynamic and involves a healthy condition and satisfaction with one's own living. The most important step in palliative therapy that is shared by neurologists is the maintenance of the health status with the help of multi-disciplinary team with the view to improving the quality of life. PMID:26241362

  15. Medical Management and Trauma-Informed Care for Children in Foster Care.

    PubMed

    Schilling, Samantha; Fortin, Kristine; Forkey, Heather

    2015-10-01

    Children enter foster care with a myriad of exposures and experiences, which can threaten their physical and mental health and development. Expanding evidence and evolving guidelines have helped to shape the care of these children over the past two decades. These guidelines address initial health screening, comprehensive medical evaluations, and follow-up care. Information exchange, attention to exposures, and consideration of how the adversities, which lead to foster placement, can impact health is crucial. These children should be examined with a trauma lens, so that the child, caregiver, and community supports can be assisted to view their physical and behavioral health from the perspective of what we now understand about the impact of toxic stress. Health care providers can impact the health of foster children by screening for the negative health consequences of trauma, advocating for trauma-informed services, and providing trauma-informed anticipatory guidance to foster parents. By taking an organized and comprehensive approach, the health care provider can best attend to the needs of this vulnerable population. PMID:26381646

  16. Medical Management and Trauma-Informed Care for Children in Foster Care.

    PubMed

    Schilling, Samantha; Fortin, Kristine; Forkey, Heather

    2015-10-01

    Children enter foster care with a myriad of exposures and experiences, which can threaten their physical and mental health and development. Expanding evidence and evolving guidelines have helped to shape the care of these children over the past two decades. These guidelines address initial health screening, comprehensive medical evaluations, and follow-up care. Information exchange, attention to exposures, and consideration of how the adversities, which lead to foster placement, can impact health is crucial. These children should be examined with a trauma lens, so that the child, caregiver, and community supports can be assisted to view their physical and behavioral health from the perspective of what we now understand about the impact of toxic stress. Health care providers can impact the health of foster children by screening for the negative health consequences of trauma, advocating for trauma-informed services, and providing trauma-informed anticipatory guidance to foster parents. By taking an organized and comprehensive approach, the health care provider can best attend to the needs of this vulnerable population.

  17. Long-term care benefits may reduce end-of-life medical care costs.

    PubMed

    Holland, Stephen K; Evered, Sharrilyn R; Center, Bruce A

    2014-12-01

    Abstract This study explores whether personal care services for functionally dependent or cognitively impaired individuals paid for by a long-term care (LTC) insurance policy can reduce health care utilization and costs at the end of life. This retrospective study uses propensity score matching methodology, hierarchical multiple regression, and Poisson regression to compare 830 decedents who utilized benefits from a voluntary LTC insurance plan ("claimants") to 6860 decedents who never purchased coverage but were similar to claimants on 17 variables, including age, sex, frailty, burden of illness markers, and propensity to have needed LTC services. Claimants using LTC benefits experienced significantly lower health care costs at end of life, including 14% lower total medical costs, 13% lower pharmacy costs, 35% lower inpatient admission costs, and 16% lower outpatient visit costs. They also experienced 8% fewer inpatient admissions and 10% fewer inpatient days. The presence of dementia at the end of life moderated these effects. This study suggests that use of insurance-based LTC services measurably reduces health care expenditures at the end of life. (Population Health Management 2014;17:332-339).

  18. Point-of-Care Clinical Ultrasound for Medical Students

    PubMed Central

    Heiberg, J.; Hansen, L. S.; Wemmelund, K.; Sørensen, A. H.; Ilkjaer, C.; Cloete, E.; Nolte, D.; Roodt, F.; Dyer, R.; Swanevelder, J.; Sloth, E.

    2015-01-01

    Purpose: Our institution has recently implemented a point-of-care (POC) ultrasound training program, consisting of an e-learning course and systematic practical hands-on training. The aim of this prospective study was to evaluate the learning outcome of this curriculum. Materials and Methods: 16 medical students with no previous ultrasound experience comprised the study group. The program covered a combination of 4 well-described point-of-care (POC) ultrasound protocols (focus assessed transthoracic echocardiography, focused assessment with sonography in trauma, lung ultrasound, and dynamic needle tip positioning for ultrasound-guided vascular access) and it consisted of an e-learning course followed by 4 h of practical hands-on training. Practical skills and image quality were tested 3 times during the study: at baseline, after e-learning, and after hands-on training. Results: Practical skills improved for all 4 protocols; after e-learning as well as after hands-on training. The number of students who were able to perform at least one interpretable image of the heart increased from 7 at baseline to 12 after e-learning, p<0.01, and to all 16 students after hands-on-training, p<0.01. The number of students able to cannulate an artificial vessel increased from 3 to 8 after e-learning and to 15 after hands-on training. Conclusion: Medical students with no previous ultrasound experience demonstrated a considerable improvement in practical skill after interactive e-learning and 4 h of hands-on training. PMID:27689155

  19. Focusing on Patient Safety: the Challenge of Securely Sharing Electronic Medical Records in Complex Care Continuums.

    PubMed

    Key, Diana; Ferneini, Elie M

    2015-09-01

    The Patient Protection and Affordable Care Act's (PPACA) regulated approach to inclusive provision of care will increase the challenge health care administrators face ensuring secure communication and secure sharing of electronic medical records between divisions and care subcontractors. This analysis includes a summary overview of the PPACA; the Health Care and Education Reconciliation Act (HCERA) of 2010; and required Essential Health Benefits (EHB). The analysis integrates an overview of how secure communication and secure sharing of electronic medical records will be essential to clinical outcomes across complex care continuums; as well as the actionable strategies health care leadership can employ to overcome associated IT security challenges.

  20. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and...

  1. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and...

  2. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and...

  3. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and...

  4. Cinemeducation: an innovative approach to teaching psychosocial medical care.

    PubMed

    Alexander, M; Hall, M N; Pettice, Y J

    1994-01-01

    This article discusses the use of clips of popular movies on videotape to educate family practice residents in the psychosocial aspects of medical care. Video clips anchor residents' insights about patients from clinical practice and illustrate family life cycle issues and Diagnostic and Statistical Manual of Mental Disorders-Revised diagnoses. Movies capture learners' attention, expose residents to diverse life-styles, engage the humanistic side of physicians, and imprint powerful pictorial images in memory. Teaching with film clips is time efficient and provides emotionally engaging experiences for faculty and residents. Selected films are reviewed for suitable clips and then incorporated into 1-hour teaching conferences. Successful "cinemeducation" requires appropriate films on videocassette, a VCR with a real-time counter, a television screen in clear view of all class members, audio speakers with sufficient volume to hear dialogue without distortion, and a willingness to be open to the emotional impact of movies. A detailed list identifies movie scenes that can be readily incorporated into the psychosocial teaching program of any medical education curriculum. PMID:7926359

  5. An innovative approach to reducing medical care utilization and expenditures.

    PubMed

    Orme-Johnson, D W; Herron, R E

    1997-01-01

    In a retrospective study, we assessed the impact on medical utilization and expenditures of a multicomponent prevention program, the Maharishi Vedic Approach to Health (MVAH). We compared archival data from Blue Cross/Blue Shield Iowa for MVAH (n = 693) with statewide norms for 1985 through 1995 (n = 600,000) and with a demographically matched control group (n = 4,148) for 1990, 1991, 1994, and 1995. We found that the 4-year total medical expenditures per person in the MVAH group were 59% and 57% lower than those in the norm and control groups, respectively; the 11-year mean was 63% lower than the norm. The MVAH group had lower utilization and expenditures across all age groups and for all disease categories. Hospital admission rates in the control group were 11.4 times higher than those in the MVAH group for cardiovascular disease, 3.3 times higher for cancer, and 6.7 times higher for mental health and substance abuse. The greatest savings were seen among MVAH patients older than age 45, who had 88% fewer total patients days compared with control patients. Our results confirm previous research supporting the effectiveness of MVAH for preventing disease. Our evaluation suggests that MVAH can be safely used as a cost-effective treatment regimen in the managed care setting.

  6. Participation of Medical Students in the Care of Patients with AIDS.

    ERIC Educational Resources Information Center

    Whalen, James P.

    1987-01-01

    Issues concerning the care of patients with acquired immunodeficiency syndrome (AIDS) that need to be addressed in the medical literature include the need for education of medical trainees about AIDS and the question of whether medical students should be subjected to the same risks as licensed medical personnel. (MSE)

  7. Preliminary noise reduction efforts in a medical intensive care unit.

    PubMed

    Nannapaneni, Srikant; Lee, Sarah J; Kashiouris, Markos; Elmer, Jennifer L; Thakur, Lokendra K; Nelson, Sarah B; Bowron, Catherine T; Danielson, Richard D; Surani, Salim; Ramar, Kannan

    2015-01-01

    Noise is a significant contributor to sleep disruption in the intensive care unit (ICU) that may result in increased patient morbidity such as delirium and prolonged length of stay in ICU. We conducted a pre-post intervention study in a 24-bed tertiary care academic medical ICU to reduce the mean noise levels. Baseline dosimeter recordings of ICU noise levels demonstrated a mean noise level of 54.2 A-weighted decibels (dBA) and peak noise levels of 109.9 dBA, well above the Environmental Protection Agency's recommended levels. There were 1735 episodes of "defects" (maximum noise levels > 60 dBA). Following implementation of multipronged interventions, although the mean noise levels did not change significantly between pre- and post-intervention (54.2 vs 53.8 dBA; p = 0.96), there was a significant reduction in the number of "defects" post-intervention (1735 vs 1289, p ≤ 0.000), and the providers felt that the patients were sleeping longer in the ICU post-intervention.

  8. Equality in medical care under national health insurance in Montreal.

    PubMed

    Siemiatycki, J; Richardson, L; Pless, I B

    1980-07-01

    In November 1974, four years after national health insurance in Canada had eliminated all out-of-pocket payment for physicians' services, we surveyed 1559 households in a socially heterogeneous area of Montreal to assess social-class differences in the use of physicians' services. When reported health status as well as age and sex were taken into account, the rates of physician visits during the two-week period preceding the survey were essentially the same in the low, middle, and high economic classes, thus confirming that disparity of access had been reduced. However, relative to other groups, the poor still made considerable use of hospital clinics and emergency rooms for primary care and more of their visits entailed prescriptions and physician-initiated requests to return. The latter observations may indicate that the poor, as compared with other groups consulted the doctor for more advanced conditions. Official statistics showed no increase in the workload of the average physician, although the number of physician visits per person per year had risen steadily. There was no evidence of abuse of "free" medical care by the poor.

  9. The origin of registry-based medical research and care.

    PubMed

    Irgens, L M

    2012-01-01

    During the last decades, registers comprising medical data have played an increasingly important role in medicine, both in health care and research. It is reasonable to expect that their importance will also increase in the future. Thus, a search for the origin of register-based medicine seems meaningful. Admittedly, collections of individual data on a number of patients may have occurred way back in history (Tidsskr Nor Laegeforen, 96, 1976:295). However, if we accept WHO's definition of a register, it implies more than a number of notifications. A register requires that a permanent record be established, that the cases be followed up and that basic statistical tabulations be prepared both on frequency and survival (Epidemiological Methods on the study of chronic diseases, Geneva, WHO Expert committee on Health Statistics, 1967). Thus, a register should aim at improving surveillance, health care and research. If we apply these criteria, we find the origin of register-based medicine in Norway in terms of the National Leprosy Registry, representing the world's first national patient register for any disease, established 1856 (Int J Epidemiol, 2, 1973: 81).

  10. Impact of managed care on the development of new medical technology: ethical concerns

    NASA Astrophysics Data System (ADS)

    Saha, Pamela; Saha, Subrata

    1995-10-01

    During the last three decades, development of new medical technology has been largely responsible for the spectacular advances in the diagnosis and treatment of many human diseases. This has contributed to improved medical care of our population. However, concerns have been raised that in today's managed care environment of health care, introduction of new medical technology will be difficult. Cost-sensitive health care providers should consider various ethical issues involved before demanding that only those technologies that save money and show highly positive cost benefit ratio will be reimbursed. The impact of such considerations on the innovations of new medical devices and their developments is discussed.

  11. Contributions of medical family therapy to the changing health care system.

    PubMed

    Doherty, William J; McDaniel, Susan H; Hepworth, Jeri

    2014-09-01

    Medical family therapy is a form of professional practice that uses a biopsychosocial approach and systemic family therapy principles in the collaborative treatment of individuals and families dealing with medical problems. It emerged out of the experience of family therapists working in primary medical care settings in the 1980s and 1990s. This article describes how contemporary medical family therapy can contribute to a transformed health care system in four areas: the patient experience of health care, the health of the population, the containment of health care costs, and enhanced practice environments.

  12. Orientation of Medical Residents to the Psychosocial Aspects of Primary Care: Influence of Training Program.

    ERIC Educational Resources Information Center

    Eisenthal, Sherman; And Others

    1994-01-01

    A survey of 63 general medical residents found most accepted the psychosocial role of the primary care physician, found it most appropriate in ambulatory care settings, felt ambivalent about their ability to perform it, and assigned it secondary priority in patient care. More attention by training programs to ambulatory care and psychosocial…

  13. The Trends in Health Care Delivery for Women: Challenges for Medical Education.

    ERIC Educational Resources Information Center

    Weisman, Carol S.

    2000-01-01

    Discusses four trends in the U.S. health care system that affect how women's health care is delivered: (1) the restructuring of primary care; (2) initiatives in quality assessment; (3) changes in patterns of health insurance coverage; and (4) threats to the health care safety net. Indicates that medical educators must link training to these…

  14. APIC position paper: Safe injection, infusion, and medication vial practices in health care.

    PubMed

    Dolan, Susan A; Arias, Kathleen Meehan; Felizardo, Gwen; Barnes, Sue; Kraska, Susan; Patrick, Marcia; Bumsted, Amelia

    2016-07-01

    The transmission of bloodborne viruses and other microbial pathogens to patients during routine health care procedures continues to occur because of the use of improper injection, infusion, medication vial, and point-of-care testing practices by health care personnel. These unsafe practices occur in various clinical settings and result in unacceptable and devastating events for patients. This document updates the Association for Professionals in Infection Control and Epidemiology 2010 position paper on safe injection, infusion, and medication vial practices in health care.

  15. Acute care nurse practitioners: creating and implementing a model of care for an inpatient general medical service.

    PubMed

    Howie, Jill N; Erickson, Mitchel

    2002-09-01

    Changes in medical education and healthcare reimbursement are recent threats to most academic medical centers' dual mission of patient care and education. Financial pressures stem from reduced insurance reimbursement, capitation, and changes in public funding for medical residency education. Pressures for innovation result from increasing numbers of patients, higher acuity of patients, an aging population of patients with complex problems, and restrictions on residency workloads. A framework for addressing the need for innovation in the medical service at a large academic medical center is presented. The framework enables acute care nurse practitioners to provide inpatient medical management in collaboration with a hospitalist. The model's development, acceptance, successes, pitfalls, and evaluation are described. The literature describing the use of nurse practitioners in acute care settings is reviewed.

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

    PubMed

    Dick, W

    1994-01-01

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

  17. Social network approaches to recruitment, HIV prevention, medical care, and medication adherence

    PubMed Central

    Latkin, Carl A.; Davey-Rothwell, Melissa A.; Knowlton, Amy R.; Alexander, Kamila A.; Williams, Chyvette T.; Boodram, Basmattee

    2013-01-01

    This article reviews current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates and treatment access and outcomes. Social network analysis is a value tool to link social structural factors to individual behaviors. Social networks provide an avenue for low cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, and optimizing HIV medical care and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics. PMID:23673888

  18. Medication use in European primary care patients with lower respiratory tract infection: an observational study

    PubMed Central

    Hamoen, Marleen; Broekhuizen, Berna DL; Little, Paul; Melbye, Hasse; Coenen, Samuel; Goossens, Herman; Butler, Chris C; Francis, Nick A; Verheij, Theo JM

    2014-01-01

    Background It is largely unknown what medication is used by patients with lower respiratory tract infection (LRTI). Aim To describe the use of self-medication and prescribed medication in adults presenting with LRTI in different European countries, and to relate self-medication to patient characteristics. Design and setting An observational study in 16 primary care networks in 12 European countries. Method A total of 2530 adult patients presenting with LRTI in 12 European countries filled in a diary on any medication used before and after a primary care consultation. Patient characteristics related to self-medication were determined by univariable and multivariable logistic regression analysis. Results The frequency and types of medication used differed greatly between European countries. Overall, 55.4% self-medicated before consultation, and 21.5% after consultation, most frequently with paracetamol, antitussives, and mucolytics. Females, non-smokers, and patients with more severe symptoms used more self-medication. Patients who were not prescribed medication during the consultation self-medicated more often afterwards. Self-medication with antibiotics was relatively rare. Conclusion A considerable amount of medication, often with no proven efficacy, was used by adults presenting with LRTI in primary care. There were large differences between European countries. These findings should help develop patient information resources, international guidelines, and international legislation concerning the availability of over-the-counter medication, and can also support interventions against unwarranted variations in care. In addition, further research on the effects of symptomatic medication is needed. PMID:24567621

  19. Factors associated with medication information in diabetes care: differences in perceptions between patients and health care professionals

    PubMed Central

    Längst, Gerda; Seidling, Hanna Marita; Stützle, Marion; Ose, Dominik; Baudendistel, Ines; Szecsenyi, Joachim; Wensing, Michel; Mahler, Cornelia

    2015-01-01

    Purpose This qualitative study in patients with type 2 diabetes and health care professionals (HCPs) aimed to investigate which factors they perceive to enhance or impede medication information provision in primary care. Similarities and differences in perspectives were explored. Methods Eight semistructured focus groups were conducted, four with type 2 diabetes patients (n=25) and four with both general practitioners (n=13) and health care assistants (n=10). Sessions were audio and video recorded, transcribed verbatim, and subjected to computer-aided qualitative content analysis. Results Diabetes patients and HCPs broadly highlighted similar factors as enablers for satisfactory medication information delivery. Perceptions substantially differed regarding impeding factors. Both patients and HCPs perceived it to be essential to deliver tailored information, to have a trustful and continuous patient–provider relationship, to regularly reconcile medications, and to provide tools for medication management. However, substantial differences in perceptions related to impeding factors included the causes of inadequate information, the detail required for risk-related information, and barriers to medication reconciliation. Medication self-management was a prevalent topic among patients, whereas HCPs’ focus was on fulfilling therapy and medication management responsibilities. Conclusion The findings suggest a noteworthy gap in perceptions between information provision and patients’ needs regarding medication-related communication. Medication safety and adherence may be improved if HCPs collaborate more closely with diabetes patients in managing their medication, in particular by incorporating the patients’ perspective. Health care systems need to be structured in a way that supports this process. PMID:26508840

  20. Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

    PubMed Central

    Green, Bonnie L.; Saunders, Pamela A.; Power, Elizabeth; Dass-Brailsford, Priscilla; Schelbert, Kavitha Bhat; Giller, Esther; Wissow, Larry; Hurtado de Mendoza, Alejandra; Mete, Mihriye

    2016-01-01

    Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.

  1. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients.

    PubMed

    LaVeist, T A; Nickerson, K J; Bowie, J V

    2000-01-01

    The authors examine determinants of satisfaction with medical care among 1,784 (781 African American and 1,003 white) cardiac patients. Patient satisfaction was modeled as a function of predisposing factors (gender, age, medical mistrust, and perception of racism) and enabling factors (medical insurance). African Americans reported less satisfaction with care. Although both black and white patients tended not to endorse the existence of racism in the medical care system, African American patients were more likely to perceive racism. African American patients were significantly more likely to report mistrust. Multivariate analysis found that the perception of racism and mistrust of the medical care system led to less satisfaction with care. When perceived racism and medical mistrust were controlled, race was no longer a significant predictor of satisfaction.

  2. [The university hospital palliative care team's approach to the transfer of end-stage cancer patients from hospital care to home medical care].

    PubMed

    Yoshino, Kazuho; Nishiumi, Noboru; Kushino, Nobuhisa; Tsukada, Michiko; Douzono, Sachiko; Saito, Yuki; Yagame, Mitsunori; Tokuda, Yutaka

    2009-12-01

    The palliative care team's roles are to provide a symptom relief to cancer patients, help them accept their medical conditions, and offer advice regarding the selection of appropriate medical treatments to suit their needs. Seeking the comfort of their homes, patients prefer a home care of superior medical care provided at hospitals. In 2008, 25 of the end-stage cancer patients at hospitals were expressed their desires to have a home medical care, and 10 of them were allowed to do so. We considered the following contributing factors that a patient should have for a smooth transition from hospital care to home medical care: (1) life expectancy of more than 2 months, (2) no progressive breathing difficulties experienced daily, (3) good awareness of medical condition among patients and families, (4) living with someone who has a good understanding of the condition, (5) availability of an appropriate hospital in case of a sudden change in medical requirements, and (6) good collaboration between emergency care hospitals, home physicians, and visiting nurses. To treat the end-stage cancer patients at home, there is a need for information sharing and a joint training of physicians specialized in cancer therapy, palliative care teams, home physicians, and visiting nurses. This would ensure a sustainable "face-to-face collaboration" in community health care.

  3. Medicine on Mars: Remote medical care and the space exploration initiative

    NASA Technical Reports Server (NTRS)

    Simmons, S. C.; Billica, R. D.

    1992-01-01

    Mars exploration missions as described in the Synthesis Group report will involve extended exposures of crew members to remote, hazardous environments for up to 100 days. Maintenance of crew health and performance will be critical to ensure mission success. Because of the great distances between the Earth and Mars, round trip telecommunication will take from seven to forty minutes and immediate return to Earth will not be feasible: an autonomous medical care system that integrates preventive, occupational, and environmental aspects of health care and provides diagnostic and treatment capabilities will be necessary. Providing medical care for Mars explorers will pose some unique technical and engineering challenges. Medical care equipment will need to be designed to be modular and portable to ensure that it is interchangeable between vehicle and planetary surface elements. Miniaturization will be necessary to reduce mass and volume. Computerized systems that automatically acquire and manage medical information and provide medical references (literature), decision support, and automated medical record keeping will be a crucial part of a Martian medical care system. Medical care will also rely on remote consultation with Earth-based specialists. This presentation will provide an overview of the health and medical concerns associated with Mars exploration missions and will describe some specific concepts for Mars medical care systems.

  4. Swedish medical students' views of the changing professional role of medical doctors and the organisation of health care.

    PubMed

    Holmström, Inger; Sanner, Margareta A; Rosenqvist, Urban

    2004-01-01

    Medical students will influence future health care considerably. Their professional orientation while at medical school will be related to their future professional development. Therefore, it is important to study this group's view of the role of medical doctors, especially because Swedish health care is currently undergoing major changes and financial cut backs. Here, the theoretical framework was contemporary theories of competence development, which has shown that people's understanding of their work influences their actions. The aim of this study was to describe medical students' views of their future professional role in health care. In total, 57 fourth-year medical students at a Swedish university were asked to write a short essay about how they conceptualised their professional role in future health care. Fifty-three students (93%) replied. The essays were analysed qualitatively in three steps and four themes were subsequently identified: the professional role in change, organisation of health care, working conditions and the possibilities of having a balanced life. Some factors mentioned that would strongly influence the professional role were being team leader, increased specialisation, supporting the patient and computer science and technology. The students expressed ambiguous feelings about power and leadership. The results indicate that the students share a rather dark view of both the medical profession and health care, which seems to be related to stress and financial cut backs. Mentoring, time for reflection and changes in the curricula might be needed.

  5. Mental health consumers' with medical co-morbidity experience of the transition through tertiary medical services to primary care.

    PubMed

    Cranwell, Kate; Polacsek, Meg; McCann, Terence V

    2016-04-01

    Medical comorbidity in people with long-term mental illness is common and often undetected; however, these consumers frequently experience problems accessing and receiving appropriate treatment in public health-care services. The aim of the present study was to understand the lived experience of mental health consumers with medical comorbidity and their carers transitioning through tertiary medical to primary care services. An interpretative, phenomenological analysis approach was used, and semistructured, video-recorded, qualitative interviews were used with 12 consumers and four primary caregivers. Four main themes and related subthemes were abstracted from the data, highlighting consumer's and carers' experience of transition through tertiary medical to primary care services: (i) accessing tertiary services is difficult and time consuming; (ii) contrasting experiences of clinician engagement and support; (iii) lack of continuity between tertiary medical and primary care services; and (iv) Mental Health Hospital Admission Reduction Programme (MH HARP) clinicians facilitating transition. Our findings have implications for organisational change, expanding the role of MH HARP clinicians (whose primary role is to provide consumers with intensive support and care coordination to prevent avoidable tertiary medical hospital use), and the employment of consumer and carer consultants in tertiary medical settings, especially emergency departments. PMID:26735771

  6. Mental health consumers' with medical co‐morbidity experience of the transition through tertiary medical services to primary care

    PubMed Central

    Cranwell, Kate; Polacsek, Meg

    2016-01-01

    Abstract Medical comorbidity in people with long‐term mental illness is common and often undetected; however, these consumers frequently experience problems accessing and receiving appropriate treatment in public health‐care services. The aim of the present study was to understand the lived experience of mental health consumers with medical comorbidity and their carers transitioning through tertiary medical to primary care services. An interpretative, phenomenological analysis approach was used, and semistructured, video‐recorded, qualitative interviews were used with 12 consumers and four primary caregivers. Four main themes and related subthemes were abstracted from the data, highlighting consumer's and carers’ experience of transition through tertiary medical to primary care services: (i) accessing tertiary services is difficult and time consuming; (ii) contrasting experiences of clinician engagement and support; (iii) lack of continuity between tertiary medical and primary care services; and (iv) Mental Health Hospital Admission Reduction Programme (MH HARP) clinicians facilitating transition. Our findings have implications for organisational change, expanding the role of MH HARP clinicians (whose primary role is to provide consumers with intensive support and care coordination to prevent avoidable tertiary medical hospital use), and the employment of consumer and carer consultants in tertiary medical settings, especially emergency departments. PMID:26735771

  7. Medical Care in a Free Clinic: A Comprehensive Evaluation of Patient Experience, Incentives, and Barriers to Optimal Medical Care with Consideration of a Facility Fee

    PubMed Central

    Liu, Xinwei; Nash, Bee; Sullivan, Sara; Garris, Stephanie; Hardy, Marvin; Lee, Michael; Simms-Cendan, Judith; Pasarica, Magdalena

    2016-01-01

    Free and charitable clinics are important contributors to the health of the United States population. Recently, funding for these clinics has been declining, and it is, therefore, useful to identify what qualities patients value the most in clinics in an effort to allocate funding wisely. In order to identify targets and incentives for improvement of patients’ health, we performed a comprehensive analysis of patients’ experience at a free clinic by analyzing a patient survey (N=94). The survey also assessed patient opinions of a small facility fee, which could be used to offset the decrease in funds. Interestingly, our patients believed it is appropriate to be charged a facility fee (78%) because it increases involvement in their care (r = 0.69, p < 0.001) and self-respect (r = 0.66, p < 0.001). Incentives to medical care include continuity of care, faith-based care, having a patient medical provider partnership, and charging a facility fee. Barriers include affordable housing, transportation, medication, and accessible information. In order to improve medical care in the uninsured population, our study suggested that we need to: 1) offer continuity of medical care; 2) offer affordable preventive health screenings; 3) support affordable transportation, housing, and medications; and 4) consider including a facility fee. PMID:27014534

  8. Psychiatric and Medical Health Care Policies in Juvenile Detention Facilities

    ERIC Educational Resources Information Center

    Pajer, Kathleen A.; Kelleher, Kelly; Gupta, Ravindra A.; Rolls, Jennifer; Gardner, William

    2007-01-01

    A study aims to examine the existing health care policies in U.S. juvenile detention centres. The results conclude that juvenile detention facilities have many shortfalls in providing care for adolescents, particularly mental health care.

  9. Patients’ Perceptions Towards the Participation of Medical Students in their Care

    PubMed Central

    Ghobain, Mohammed Al; Alghamdi, Abdullah; Arab, Ala; Alaem, Nora; Aldress, Turki; Ruhyiem, Mead

    2016-01-01

    Objectives: Patient interaction is a vital part of healthcare training. This study aimed to investigate patients’ perceptions of the participation of medical students in their care. Methods: This descriptive cross-sectional study was conducted between October 2014 and March 2015 among 430 patients admitted to the medical and surgical wards at the King Abdulaziz Medical City, Riyadh, Saudi Arabia. An Arabic questionnaire was designed to assess the demographic characteristics of the patients and their perceptions of students’ participation in their medical care. Results: A total of 416 patients completed the survey (response rate: 97%). Overall, 407 patients (98%) acknowledged the educational benefit of involving medical students in their care. A total of 368 patients (88%) had no objection to a medical student being involved in their care. Of these, 98% were willing to be asked about their medical history by medical students, 89% would permit physical examinations by medical students and 39% preferred that the gender of the medical student match their own. Education level (P <0.003), a positive prior experience with a medical student (P <0.001) and perception of the medical students’ attitudes (P <0.001) had a significant effect on patients’ acceptance of medical students participating in their care. Conclusion: In general, the patients had a positive perception of medical students, with most patients acknowledging the educational benefit of student participation in patient care. As patients’ perceptions of students’ professionalism, confidence and respect for privacy were significantly related to acceptance of care, education on these aspects should be a priority in medical curricula. PMID:27226915

  10. Electronic Medical Record and Quality Ratings of Long Term Care Facilities Long-Term Care Facility Characteristics and Reasons and Barriers for Adoption of Electronic Medical Record

    ERIC Educational Resources Information Center

    Daniels, Cheryl Andrea

    2013-01-01

    With the growing elderly population, compounded by the retirement of the babyboomers, the need for long-term care (LTC) facilities is expected to grow. An area of great concern for those that are seeking a home for their family member is the quality of care provided by the nursing home to the residents. Electronic medical records (EMR) are often…

  11. Obesity disparities in preventive care: findings from the National Ambulatory Medical Care Survey, 2005-2007.

    PubMed

    Hernandez-Boussard, Tina; Ahmed, Shushmita M; Morton, John M

    2012-08-01

    Obesity and its consequences are a major health concern. There are conflicting reports regarding utilization of preventive health-care services among obese patients. Our objective was to determine whether obese patients receive the same preventive care as normal weight patients. Weighted patient clinic visit data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed for all adult patient visits with height/weight data (N = 866,415,856) from 2005 to 2007. Preventive care practice patterns were compared among different weight groups of normal, obese, and morbidly obese. Obese patients received the least number of preventive exams with a clear gradient present by weight. Obese patients were significantly less likely to receive cancer screening including breast examination (normal weight, reference, obese, odds ratio (OR), 0.8), mammogram (obese OR, 0.7), pap smear (obese OR, 0.7), pelvic exam (obese OR, 0.8), and rectal exam (obese OR, 0.7). The obese population also received less tobacco (obese OR, 0.7) and injury prevention education (obese OR, 0.7), yet significantly more diet, exercise, and weight reduction education. Significant differences in clinic practice patterns relative to normal weight patients were also evident with more physician referral (obese OR, 1.2) and less likely to see physician at the index clinic visit (obese OR, 0.8) and less likely to receive psychotherapy referral (obese OR, 0.6). Significant gaps in preventive care exist for the obese including cancer screening, tobacco cessation and injury prevention counseling, and psychological referral. Although obese patients received more weight-related education, this emphasis may have the consequence of de-emphasizing other needed preventive health measures.

  12. Medical tourism and its impact on the US health care system.

    PubMed

    Forgione, Dana A; Smith, Pamela C

    2007-01-01

    The health care industry within the United States continues to face unprecedented increases in costs, along with the task of providing care to an estimated 46 million uninsured or underinsured patients. These patients, along with both insurers and employers, are seeking to reduce the costs of treatment through international outsourcing of medical and surgical care. Knows as medical tourism, this trend is on the rise, and the US health care system has not fully internalized the effects this will have on its economic structure and policies. The demand for low-cost health care services is driving patients to seek treatment on a globally competitive basis, while balancing important quality of care issues. In this article, we outline some of the issues facing legislators, health care policy makers, providers, and health service researchers regarding the impact of medical tourism on the US health care system. PMID:18972983

  13. 28 CFR 115.283 - Ongoing medical and mental health care for sexual abuse victims and abusers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Ongoing medical and mental health care... Facilities Medical and Mental Care § 115.283 Ongoing medical and mental health care for sexual abuse victims and abusers. (a) The facility shall offer medical and mental health evaluation and, as...

  14. 28 CFR 115.383 - Ongoing medical and mental health care for sexual abuse victims and abusers.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Ongoing medical and mental health care... Medical and Mental Care § 115.383 Ongoing medical and mental health care for sexual abuse victims and abusers. (a) The facility shall offer medical and mental health evaluation and, as appropriate,...

  15. 28 CFR 115.283 - Ongoing medical and mental health care for sexual abuse victims and abusers.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Ongoing medical and mental health care... Facilities Medical and Mental Care § 115.283 Ongoing medical and mental health care for sexual abuse victims and abusers. (a) The facility shall offer medical and mental health evaluation and, as...

  16. 28 CFR 115.283 - Ongoing medical and mental health care for sexual abuse victims and abusers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Ongoing medical and mental health care... Facilities Medical and Mental Care § 115.283 Ongoing medical and mental health care for sexual abuse victims and abusers. (a) The facility shall offer medical and mental health evaluation and, as...

  17. 28 CFR 115.83 - Ongoing medical and mental health care for sexual abuse victims and abusers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Ongoing medical and mental health care... Medical and Mental Care § 115.83 Ongoing medical and mental health care for sexual abuse victims and abusers. (a) The facility shall offer medical and mental health evaluation and, as appropriate,...

  18. 28 CFR 115.83 - Ongoing medical and mental health care for sexual abuse victims and abusers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Ongoing medical and mental health care... Medical and Mental Care § 115.83 Ongoing medical and mental health care for sexual abuse victims and abusers. (a) The facility shall offer medical and mental health evaluation and, as appropriate,...

  19. 28 CFR 115.383 - Ongoing medical and mental health care for sexual abuse victims and abusers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Ongoing medical and mental health care... Medical and Mental Care § 115.383 Ongoing medical and mental health care for sexual abuse victims and abusers. (a) The facility shall offer medical and mental health evaluation and, as appropriate,...

  20. 28 CFR 115.383 - Ongoing medical and mental health care for sexual abuse victims and abusers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Ongoing medical and mental health care... Medical and Mental Care § 115.383 Ongoing medical and mental health care for sexual abuse victims and abusers. (a) The facility shall offer medical and mental health evaluation and, as appropriate,...

  1. 28 CFR 115.83 - Ongoing medical and mental health care for sexual abuse victims and abusers.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Ongoing medical and mental health care... Medical and Mental Care § 115.83 Ongoing medical and mental health care for sexual abuse victims and abusers. (a) The facility shall offer medical and mental health evaluation and, as appropriate,...

  2. The Place of the General Practitioner in Modern Medical Care-Some International Comparisons

    PubMed Central

    Fry, John

    1970-01-01

    Dr J Fry considers the role of medical care in a changing world in relation to social demands and the cost of providing a comprehensive service. A consideration of services in other countries, such as the USA, USSR, Europe and Australia, provides lessons towards improving the NHS and also warnings of the faults inherent in these differing systems of medical care. PMID:5440757

  3. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities...

  4. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities...

  5. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities...

  6. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities...

  7. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities...

  8. Antibiogram of Medical Intensive Care Unit at Tertiary Care Hospital Setting of Pakistan

    PubMed Central

    Qadeer, Aayesha; Akhtar, Aftab; Ain, Qurat Ul; Saadat, Shoab; Mansoor, Salman; Ishtiaq, Wasib; Ilyas, Abid; Khan, Ali Y; Ajam, Yousaf

    2016-01-01

    Objective: To determine the frequency of micro-organisms causing sepsis as well as to determine the antibiotic susceptibility and resistance of microorganisms isolated in a medical intensive care unit. Materials and methods: This is a cross-sectional analysis of 802 patients from a medical intensive care unit (ICU) of Shifa International Hospital, Islamabad, Pakistan over a one-year period from August 2015 to August 2016. Specimens collected were from blood, urine, endotracheal secretions, catheter tips, tissue, pus swabs, cerebrospinal fluid, ascites, bronchoalveolar lavage (BAL), and pleural fluid. All bacteria were identified by standard microbiological methods, and antibiotic sensitivity/resistance was performed using the disk diffusion technique, according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data was collected using a critical care unit electronic database and data analysis was done by using  the Statistical Package for Social Sciences (SPSS), version 20 (IBM SPSS Statistics, Armonk, NY). Results: Gram-negative bacteria were more frequent as compared to gram-positive bacteria. Most common bacterial isolates were Acinetobacter (15.3%), Escherichia coli (15.3%), Pseudomonas aeruginosa (13%), and Klebsiella pneumoniae (10.2%), whereas Enterococcus (7%) and methicillin-resistant staphylococcus aureus (MRSA) (6.2%) were the two most common gram-positive bacteria. For Acinetobacter, colistin was the most effective antibiotic (3% resistance). For E.coli, colistin (0%), tigecycline (0%), amikacin (7%), and carbapenems (10%) showed low resistance. Pseudomonas aeruginosa showed low resistance to colistin (7%). For Klebsiella pneumoniae, low resistance was seen for tigecycline (0%) and minocycline (16%). Overall, ICU mortality was 31.3%, including miscellaneous cases. Conclusion: Gram-negative infections, especially by multidrug-resistant organisms, are on the rise in ICUs. Empirical antibiotics should be used according to the local

  9. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., and medical supervision. Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in...

  10. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., and medical supervision. Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in...

  11. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., and medical supervision. Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in...

  12. Evaluation of a Nutrition Care Process-based audit instrument, the Diet-NCP-Audit, for documentation of dietetic care in medical records.

    PubMed

    Lövestam, Elin; Orrevall, Ylva; Koochek, Afsaneh; Karlström, Brita; Andersson, Agneta

    2014-06-01

    Adequate documentation in medical records is important for high-quality health care. Documentation quality is widely studied within nursing, but studies are lacking within dietetic care. The aim of this study was to translate, elaborate and evaluate an audit instrument, based on the four-step Nutrition Care Process model, for documentation of dietetic care in medical records. The audit instrument includes 14 items focused on essential parts of dietetic care and the documentation's clarity and structure. Each item is to be rated 0-1 or 0-2 points, with a maximum total instrument score of 26. A detailed manual was added to facilitate the interpretation and increase the reliability of the instrument. The instrument is based on a similar tool initiated 9 years ago in the United States, which in this study was translated to Swedish and further elaborated. The translated and further elaborated instrument was named Diet-NCP-Audit. Firstly, the content validity of the Diet-NCP-Audit instrument was tested by five experienced dietitians. They rated the relevance and clarity of the included items. After a first rating, minor improvements were made. After the second rating, the Content Validity Indexes were 1.0, and the Clarity Index was 0.98. Secondly, to test the reliability, four dietitians reviewed 20 systematically collected dietetic notes independently using the audit instrument. Before the review, a calibration process was performed. A comparison of the reviews was performed, which resulted in a moderate inter-rater agreement with Krippendorff's α = 0.65-0.67. Grouping the audit results in three levels: lower, medium or higher range, a Krippendorff's α of 0.74 was considered high reliability. Also, an intra-rater reliability test-retest with a 9 weeks interval, performed by one dietitian, showed strong agreement. To conclude, the evaluated audit instrument had high content validity and moderate to high reliability and can be used in auditing documentation of dietetic

  13. Standard medical care for psychogenic nonepileptic seizures in Brazil.

    PubMed

    Valente, Kette D; Rzezak, Patricia; LaFrance, W Curt

    2015-04-01

    Knowledge about health systems can promote implementation of more specific and strategic health practices for patients with psychogenic nonepileptic seizures (PNES). For this purpose, we surveyed the current management of PNES (standard medical care [SMC]) by Brazilian League Against Epilepsy members. Respondents reported diagnosing PNES with a mean frequency of 3patients/month. Video-EEG (vEEG) was considered the best method for the diagnosis. Respondents who have vEEG in their facilities refer to vEEG significantly more often than those who have no vEEG (p<0.001). Therefore, South and Southeast Brazil regions referred patients more frequently to vEEG than other regions (p=0.004). Psychotherapy was considered the most effective (92.2%) treatment option, followed by education (75%) and psychopharmacology (70.3%). There were no regional differences considering treatment. The study identified current national diagnostic and treatment practices across the country and identified relevant Brazilian regional differences. PMID:25800126

  14. Medical education: meeting the challenge of implementing primary health care in sub-Saharan Africa.

    PubMed

    Ahmed, Mushtaq; Vellani, Camer W; Awiti, Alex O

    2011-06-01

    Medical education in sub-Saharan Africa must be defined by its health needs and the health care services required. The sociodemographic milieu that determines the disease pattern makes a compelling case for primary health care in the context of community participation and multisector community development as the driver of a plan for medical education, in tandem with clinicians' role in continuity of care. Such ideas have been derived from the experience of planning for undergraduate medical education at the Aga Khan University Medical College, Nairobi, whose curriculum incorporates broad-based general education and liberal arts principles.

  15. The "medical neighborhood": integrating primary and specialty care for ambulatory patients.

    PubMed

    Greenberg, Jeffrey O; Barnett, Michael L; Spinks, Melissa A; Dudley, Jessica C; Frolkis, Joseph P

    2014-03-01

    As health care organizations create larger networks, better coordination of primary and specialty care is paramount. Attention has focused on strengthening primary care by creating patient-centered medical homes. The "medical neighborhood" provides a framework for structured, reciprocal relationships that integrate specialty care and extend the principles of the medical home to all practicing physicians. The foundation of the medical neighborhood is the collaborative care agreement, which outlines mutual expectations for primary care physicians and specialists as they care for patients together. These expectations include a preconsultation exchange between the referring physician and the consultant, the consultation, and subsequent comanagement of patients over time. Although independent practices can create individualized collaborative care agreements with specific specialist colleagues, large health care provider networks and accountable care organizations should have 1 agreement for all affiliated physicians. Challenges to the medical neighborhood include fee-for-service reimbursement, existing referral relationships, and building a robust electronic platform, including a referral management module. Cooperation between physicians, regardless of their specialty, and innovation in payment models and electronic platforms will all be essential if medical neighborhoods are to succeed.

  16. Undergraduate medical education in palliative medicine: the first step in promoting palliative care in Lebanon.

    PubMed

    Naccache, Nicole; Abou Zeid, Hicham; Nasser Ayoub, Eliane; Antakly, Marie-Claire

    2008-01-01

    Effective delivery of high-quality palliative care requires effective interprofessional team working by skilled healthcare professionals. Palliative care is therefore highly suitable for sowing the seeds of interprofessional team working in early professional undergraduate medical education. Integrating palliative medicine in undergraduate medical education curricula seems to be a must. In this review, we present as an example the Palliative and End-of-Life Care Curriculum (PEOLC) used in Canada for undergraduate medical education and underline the need for such a national curriculum in Lebanon. One must keep in mind that medical education does not stop at the end of the medical school, ongoing learning needs exist. Continuous medical education in palliative care should also be emphasized; the overall goal is promoting palliative medicine. Respecting and protecting human dignity is the right of every patient. PMID:19534074

  17. Integration of medical and information technology in U.S. health care

    NASA Astrophysics Data System (ADS)

    Gruber, William H.; Pollack, Marc M.; Rosenthal, David S.

    1994-12-01

    One of the most powerful forces affecting the success of health reform in the United States is information technology (IT). The integration of medical technology (such as imaging) with IT (such as the electronic medical record, guidelines, care paths and outcomes research) provides the opportunity to simultaneously improve the quality of health care and control health care cost inflation. The effective integration of medical technology with IT has the potential to achieve clinically appropriate and cost effective medical care in the appropriate location with the support of technologically delivered guidelines and using telemedicine applications such as telediagnosis, teleradiology, and telemonitoring. These savings will provide the investment and research funding to enable the United States to continue as the world's leader in medical technology and telemedicine. This paper validates the potential for these benefits from the effective integration of clinical IT and medical technology with a case study of the progress achieved at Harvard University Health Services.

  18. [Abdominal cure procedures. Adequate use of Nobecutan Spray].

    PubMed

    López Soto, Rosa María

    2009-12-01

    Open abdominal wounds, complicated by infection and/or risk of eventration tend to become chronic and usually require frequent prolonged cure. Habitual changing of bandages develop into one of the clearest risk factors leading to the deterioration of perilesional cutaneous integrity. This brings with it new complications which draw out the evolution of the process, provoking an important deterioration in quality of life for the person who suffers this and a considerable increase in health costs. What is needed is a product and a procedure which control the risk of irritation, which protect the skin, which favor a patient's comfort and which shorten treatment requirements while lowering health care expenses. This report invites medical personnel to think seriously about the scientific rationale, and treatment practice, as to why and how to apply Nobecutan adequately, this reports concludes stating the benefits in the adequate use of this product. The objective of this report is to guarantee the adequate use of this product in treatment of complicated abdominal wounds. This product responds to the needs which are present in these clinical cases favoring skin care apt isolation and protection, while at the same time, facilitating the placement and stability of dressings and bandages used to cure wounds. In order for this to happen, the correct use of this product is essential; medical personnel must pay attention to precautions and recommendations for proper application. The author's experiences in habitual handling of this product during various years, included in the procedures for standardized cures for these wounds, corroborates its usefulness; the author considers use of this product to be highly effective while being simple to apply; furthermore, one succeeds in providing quality care and optimizes resources employed.

  19. NAPNAP Position Statement. Position Statement on Pediatric Health Care/Medical Home: Key Issues on Care Coordination, Transitions, and Leadership.

    PubMed

    2016-01-01

    The National Association of Pediatric Nurse Practitioners (NAPNAP) affirms that the delivery of children's health care should be family-centered, accessible, comprehensive, coordinated, culturally appropriate, compassionate, and focused on the overall well-being of children and families. All qualified pediatric health care providers should collaborate in providing health care services for children in pediatric health care/medical homes. Interventions must address the concepts of family-centered partnerships, community-based systems, and transitional care from pediatric to adult services. PMID:27326431

  20. Recipients in need of ancillary services and their receipt of HIV medical care in California.

    PubMed

    Chan, D; Absher, D; Sabatier, S

    2002-08-01

    For many individuals with access to quality medical care, HIV disease is no longer a critical short term illness but a chronic condition giving rise to more clients requiring ongoing medical care. Programs funded by the federal Ryan White Comprehensive AIDS Resources Emergency Act not only provide essential medical care for these individuals but also facilitate access to medical care services. These programmes fund services, including case management, transportation, and translation assistance, that feature ongoing assistance and enable individuals to remain in the health care system. Because of the importance of maintaining the strict drug regimen, retention in care is also an important part of the overall HIV care component. This study analyzed the relationship of ancillary services and a federal health programme client's receipt of medical care and retention in the health care system. We defined a cohort in need of ancillary services in part by a questionnaire designed to identify factors relating to need. These factors included education, language, and substance use. By merging client level data files we were able to identify medical service utilization trends among the individuals in the cohort who received a high number of ancillary services (more than 11 ancillary service visits in the two-year study period, n = 138) and those who received few services (fewer than six ancillary service visits in the two-year study period, n = 132). Results suggest that the receipt of ancillary services is associated with receipt of and retention in primary medical care. We found that for federal health programme clients in need of ancillary services, a positive relationship existed between their receipt of ancillary services and their access to primary medical care (p medical doctor at least once in three

  1. [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.

  2. Challenges of managing medications for older people at transition points of care.

    PubMed

    Manias, Elizabeth; Hughes, Carmel

    2015-01-01

    In clinical practice, pharmacists play a very important role in identifying and correcting medication discrepancies as older patients move across transition points of care. With increasing complexity of health care needs of older people, these discrepancies are likely to increase. The major concern with identifying and correcting medication discrepancies is that medication reconciliation is considered a retrospective problem--that is, dealing with medication discrepancies after they have occurred. It is argued here that a more proactive stance should be taken where doctors, nurses and pharmacists collectively work together to prevent medication discrepancies from happening in the first place. Improved involvement of patients and family members will help to facilitate better management of medications across transition points of care. Efficient use of information technology aids, such as electronic medication reconciliation tools, should also assist with organizational systems problems associated with the working culture, heavy workloads, and staff and skill mix of health professionals.

  3. Challenges of managing medications for older people at transition points of care.

    PubMed

    Manias, Elizabeth; Hughes, Carmel

    2015-01-01

    In clinical practice, pharmacists play a very important role in identifying and correcting medication discrepancies as older patients move across transition points of care. With increasing complexity of health care needs of older people, these discrepancies are likely to increase. The major concern with identifying and correcting medication discrepancies is that medication reconciliation is considered a retrospective problem--that is, dealing with medication discrepancies after they have occurred. It is argued here that a more proactive stance should be taken where doctors, nurses and pharmacists collectively work together to prevent medication discrepancies from happening in the first place. Improved involvement of patients and family members will help to facilitate better management of medications across transition points of care. Efficient use of information technology aids, such as electronic medication reconciliation tools, should also assist with organizational systems problems associated with the working culture, heavy workloads, and staff and skill mix of health professionals. PMID:25455760

  4. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    ERIC Educational Resources Information Center

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  5. Medication Adherence and Health Care Utilization in Pediatric Chronic Illness: A Systematic Review

    PubMed Central

    Hommel, Kevin A.

    2013-01-01

    BACKGROUND AND OBJECTIVE: Advanced understanding of modifiable predictors of health care use in pediatric chronic illness is critical to reducing health care costs. We examined the relationship between medication non-adherence and health care use in children and adolescents who have a chronic medical condition. METHODS: A systematic review of articles by using PubMed, PsycINFO, and CINAHL was conducted. Additional studies were identified by searching reference sections of relevant manuscripts. Studies that tested the relationship between medication non-adherence and health care use (ie, hospitalizations, emergency department visits, outpatient visits) or cost in children and adolescents (mean age ≤18 years) who have a chronic medical condition were included. Extraction of articles was completed by using predefined data fields. RESULTS: Ten studies met our inclusion criteria. Nine of the 10 studies reviewed (90%) demonstrated a relationship between medication non-adherence and increased health care use. The directionality of this relationship varied depending on the outcome variable of interest. CONCLUSIONS: Medication non-adherence is related to increased health care use in children and adolescents who have a chronic medical condition and should be addressed in clinical care. Future studies should include randomized controlled trials examining the impact of adherence promotion efforts on health care use and costs. PMID:23999953

  6. Fly-By medical care: Conceptualizing the global and local social responsibilities of medical tourists and physician voluntourists

    PubMed Central

    2011-01-01

    Background Medical tourism is a global health practice where patients travel abroad to receive health care. Voluntourism is a practice where physicians travel abroad to deliver health care. Both of these practices often entail travel from high income to low and middle income countries and both have been associated with possible negative impacts. In this paper, we explore the social responsibilities of medical tourists and voluntourists to identify commonalities and distinctions that can be used to develop a wider understanding of social responsibility in global health care practices. Discussion Social responsibility is a responsibility to promote the welfare of the communities to which one belongs or with which one interacts. Physicians stress their social responsibility to care for the welfare of their patients and their domestic communities. When physicians choose to travel to another county to provide medical care, this social responsibility is expanded to this new community. Patients too have a social responsibility to use their community's health resources efficiently and to promote the health of their community. When these patients choose to go abroad to receive medical care, this social responsibility applies to the new community as well. While voluntourists and medical tourists both see the scope of their social responsibilities expand by engaging in these global practices, the social responsibilities of physician voluntourists are much better defined than those of medical tourists. Guidelines for engaging in ethical voluntourism and training for voluntourists still need better development, but medical tourism as a practice should follow the lead of voluntourism by developing clearer norms for ethical medical tourism. Summary Much can be learned by examining the social responsibilities of medical tourists and voluntourists when they engage in global health practices. While each group needs better guidance for engaging in responsible forms of these practices

  7. [The development of strategic management of high-tech surgical medical care].

    PubMed

    Nechaev, V S; Krasnov, A V

    2013-01-01

    The high-tech surgical medical care is one of the most effective types of medical care in Russia. However high-tech surgical treatment very often is inaccessible for patients. The development of basics of strategic management of high-tech surgical care makes it possible to enhance availability of this type of care and to shorten the gap between volumes of rendered care and population needs. This approach can be resulted in decrease of disability and mortality of the most prevalent diseases of cardio-vascular diseases, malignant neoplasms, etc. The prerequisites can be developed to enhance life quality and increase longevity of population.

  8. Ethics of care in medical tourism: Informal caregivers' narratives of responsibility, vulnerability and mutuality.

    PubMed

    Whitmore, Rebecca; Crooks, Valorie A; Snyder, Jeremy

    2015-09-01

    This study examines the experiences of informal caregivers in medical tourism through an ethics of care lens. We conducted semi-structured interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery, asking questions that dealt with their experiences prior to, during and after travel. Thematic analysis revealed three themes central to an ethics of care: responsibility, vulnerability and mutuality. Ethics of care theorists have highlighted how care has been historically devalued. We posit that medical tourism reproduces dominant narratives about care in a novel care landscape. Informal care goes unaccounted for by the industry, as it occurs in largely private spaces at a geographic distance from the home countries of medical tourists.

  9. Ethics of care in medical tourism: Informal caregivers' narratives of responsibility, vulnerability and mutuality.

    PubMed

    Whitmore, Rebecca; Crooks, Valorie A; Snyder, Jeremy

    2015-09-01

    This study examines the experiences of informal caregivers in medical tourism through an ethics of care lens. We conducted semi-structured interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery, asking questions that dealt with their experiences prior to, during and after travel. Thematic analysis revealed three themes central to an ethics of care: responsibility, vulnerability and mutuality. Ethics of care theorists have highlighted how care has been historically devalued. We posit that medical tourism reproduces dominant narratives about care in a novel care landscape. Informal care goes unaccounted for by the industry, as it occurs in largely private spaces at a geographic distance from the home countries of medical tourists. PMID:26313855

  10. The Impact of the Medical Home on Access to Care for Children with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Cheak-Zamora, Nancy C.; Farmer, Janet E.

    2015-01-01

    Children with autism spectrum disorders (ASD) experience difficulty accessing health care services. Using parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs, we examined whether having a medical home reduces unmet need for specialty care services for children with ASD (n = 3,055). Descriptive…

  11. Finding Medical Care for Colorectal Cancer Symptoms: Experiences among Those Facing Financial Barriers

    ERIC Educational Resources Information Center

    Thomson, Maria D.; Siminoff, Laura A.

    2015-01-01

    Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer…

  12. Physician Perspectives on Providing Primary Medical Care to Adults with Autism Spectrum Disorders (ASD)

    ERIC Educational Resources Information Center

    Warfield, Marji Erickson; Crossman, Morgan K.; Delahaye, Jennifer; Der Weerd, Emma; Kuhlthau, Karen A.

    2015-01-01

    We conducted in-depth case studies of 10 health care professionals who actively provide primary medical care to adults with autism spectrum disorders. The study sought to understand their experiences in providing this care, the training they had received, the training they lack and their suggestions for encouraging more physicians to provide this…

  13. Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat, India

    PubMed Central

    Strehlow, Matthew C; Rao, G.V. Ramana; Newberry, Jennifer A

    2016-01-01

    Background: Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care. We sought to identify obstacles in the cellular communication process among GVK Emergency Management and Research Institute (GVK EMRI) EMTs in Gujarat, India. Methods: A convenience sample of practicing EMTs in Gujarat, India were surveyed regarding the barriers to call initiation and completion. Results: 108 EMTs completed the survey. Overall, ninety-seven (89.8%) EMTs responded that the most common reason they did not initiate a call with the call center physician was insufficient time. Forty-six (42%) EMTs reported that they were unable to call the physician one or more times during a typical workweek (approximately 5-6 twelve-hour shifts/week) due to their hands being occupied performing direct patient care. Fifty-eight (54%) EMTs reported that they were unable to reach the call center physician, despite attempts, at least once a week. Conclusion: This study identified multiple barriers to communication, including insufficient time to call for advice and inability to reach call center physicians. Identification of simple interventions and best practices may improve communication and ensure timely and appropriate prehospital care.  PMID:27551654

  14. The Affordable Care Act and the Burden of High Cost Sharing and Utilization Management Restrictions on Access to HIV Medications for People Living with HIV/AIDS.

    PubMed

    Zamani-Hank, Yasamean

    2016-08-01

    The HIV/AIDS epidemic continues to be a critical public health issue in the United States, where an estimated 1.2 million individuals live with HIV infection. Viral suppression is one of the primary public health goals for People Living with HIV/AIDS (PLWHA). A crucial component of this goal involves adequate access to health care, specifically anti-retroviral HIV medications. The enactment of the Affordable Care Act (ACA) in 2010 raised hopes for millions of PLWHA without access to health care coverage. High cost-sharing requirements enacted by health plans place a financial burden on PLWHA who need ongoing access to these life-saving medications. Plighted with poverty, Detroit, Michigan, is a center of attention for examining the financial burden of HIV medications on PLWHA under the new health plans. From November 2014 to January 2015, monthly out-of-pocket costs and medication utilization requirements for 31 HIV medications were examined for the top 12 insurance carriers offering Qualified Health Plans on Michigan's Health Insurance Marketplace Exchange. The percentage of medications requiring quantity limits and prior authorization were calculated. The average monthly out-of-pocket cost per person ranged from $12 to $667 per medication. Three insurance carriers placed all 31 HIV medications on the highest cost-sharing tier, charging 50% coinsurance. High out-of-pocket costs and medication utilization restrictions discourage PLWHA from enrolling in health plans and threaten interrupted medication adherence, drug resistance, and increased risk of viral transmission. Health plans inflicting high costs and medication restrictions violate provisions of the ACA and undermine health care quality for PLWHA. (Population Health Management 2016;19:272-278). PMID:26565514

  15. Shifting subjects of health-care: placing "medical tourism" in the context of Malaysian domestic health-care reform.

    PubMed

    Ormond, Meghann

    2011-01-01

    "Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers.

  16. Shifting subjects of health-care: placing "medical tourism" in the context of Malaysian domestic health-care reform.

    PubMed

    Ormond, Meghann

    2011-01-01

    "Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers. PMID:22216474

  17. [The combination of "Careworks" insurance plan integrated with medical and long-term care insurance].

    PubMed

    Sumii, Hiroshi

    2006-11-01

    The social security system in Japan was greatly revolutionized when the long-term care insurance plan began in April 2000. Thus, Japan began the 21st century with two great social insurance plans, that is, medical care insurance and long-term care insurance. Each delivery system is divided: the medical care insurance plan is for the acute stage, and the long-term care is for the chronic stage. Both systems can be intended to cooperate to provide continuous care throughout life. The public health and welfare system has been trying hard to efficiently integrate the medical and long-term care insurance plans. However, it is necessary to establish a new insurance plan for ensuring the integrated adequacy of both insurance systems. One's life is destined to shift from medical care to long-term care at some point. As one ages or becomes disabled, it becomes difficult to lead an independent life with self-decision, and social support become necessary from third parties, instead of from the family or from one's own means. The society imposes the responsibility of payment of the medical and long-term care plan premiums on the individual throughout life. However, the structure of these insurance foundations should be combined under an integrated system, "Careworks", in order to also combine the concepts of length of life from the medicine and the respect of living from the long-term case to improve the social security of the life.

  18. Medical students' attitudes toward underserved populations: changing associations with choice of primary care versus non-primary care residency.

    PubMed

    Wayne, Sharon; Timm, Craig; Serna, Lisa; Solan, Brian; Kalishman, Summers

    2010-05-01

    The number of medical students entering primary care residencies continues to decrease. The association between student attitudes toward underserved populations and residency choice has received little attention even though primary care physicians see a larger proportion of underserved patients than most other specialists. We evaluated attitudes toward underserved populations in 826 medical students using a standardized survey, and used logistic regression to assess the effect of attitudes, along with other variables, on selection of a primary care residency. We compared results between two groups defined by year of entry to medical school (1993-99 and 2000-05) to determine whether associations differed by time period. Students' attitudes regarding professional responsibility toward underserved populations remained high over the study period; however, there was a statistically. significant association between positive attitudes and primary care residency in the early cohort only. This association was not found in the more recent group.

  19. Did the Olympics need more drugs? a doctor's reflection on providing medical care during Op OLYMPICS.

    PubMed

    Monteiro de Barros, James; Ross, D A

    2014-09-01

    This paper examines some of the medical problems arising from the successful deployment of Defence Medical Services personnel to Op OLYMPICS (mid-June 2012-September 2012). It does not aim to be all encompassing in its scope, but focuses on the most pressing issues affecting a junior military doctor's ability to work effectively under field conditions. This will entail a discussion about whether in a deployment such as Op OLYMPICS medical care should be based upon offering solely primary healthcare in medical centres or using Role 1 medical treatment facilities, which include primary healthcare and pre-hospital emergency care. The main recommendations arising from the deployment are: clinicians should deploy with a minimum of basic emergency drugs and equipment; a medical facility treating a large population at risk for a prolonged period should have a broad stock of medications available on site; and medical risk assessments must be performed on all Reservists during mobilisation.

  20. Health Care of the Elderly in Medically Disadvantaged Populations.

    ERIC Educational Resources Information Center

    German, Pearl S.; And Others

    1978-01-01

    This study of three disadvantaged urban areas reports on the relationship between available resources and ambulatory health care. Findings indicate a high proportion of elderly receiving care for serious conditions but a sharp drop in care for less serious but potentially disabling conditions. (Author)

  1. Obstetrics Patients' Assessment of Medical Students' Role in Their Care.

    ERIC Educational Resources Information Center

    Magrane, Diane

    1988-01-01

    Obstetric patients rated the skills and assessed the roles of students caring for them during a clinical clerkship. They rated skills and attitudes high, generally, with lower ratings for their ability to answer questions and preparation to participate in care. Most felt students improved their care, primarily in supportive ways. (Author/MSE)

  2. Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

    PubMed

    Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

    2016-01-01

    The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

  3. Social selection in seeking medical care for reduced fecundity among women in Denmark.

    PubMed

    Rachootin, P; Olsen, J

    1981-12-01

    This study is based on a representative sample of 709 Danish women aged between 25 and 45 who were interviewed in 1979. The purpose was to estimate the proportion of women with reduced fecundity who seek medical care and to identify sociodemographic variables associated with presentation to the medical care system. The study showed that the majority of women with reduced fecundity did not seek medical care. The propensity to seek care was not significantly associated with a woman's age or education, nor with family income or the employment status of the head of the household. Women living in rural areas or in homes with two or more rooms per family member had a greater tendency to seek medical care for secondary reduced fecundity compared with women living in cities or in more crowded homes. The implications of these findings for epidemiological studies of the association of reduced fecundity and occupation are discussed. PMID:7338701

  4. [The role and place of pathology services in ensuring and improving the quality of medical care: Organizational and legal aspects].

    PubMed

    Timofeev, I V

    2015-01-01

    The paper considers the legal and organizational issues of the activity of pathology services in improving medical care. It shows the main (diagnostic and medico-organizational) areas of pathology work to improve the quality of medical care.

  5. Improving access to a primary care medical clinic.

    PubMed Central

    Meditz, R. W.; Manberg, C. L.; Rosner, F.

    1992-01-01

    Patients presenting to an episodic care walk-in clinic often warrant prompt but not necessarily emergency attention. Legitimate reasons often prohibit these patients from attending regularly scheduled daytime weekday clinics. Most patients interviewed thought that having a single primary care provider was important to ensure continuity of care. Access to primary care can be improved by scheduling clinics and ancillary services on nontraditional times and days. Enhanced communication can help patients differentiate routine from urgent from emergency conditions. Printed and audiovisual materials can be used to increase awareness of the benefits of comprehensive care. PMID:1507251

  6. Are patient-centered care values as reflected in teaching scenarios really being taught when implemented by teaching faculty? A discourse analysis on an Indonesian medical school's curriculum

    PubMed Central

    2011-01-01

    Background According to The Indonesian Medical Council, 2006, Indonesian competence-based medical curriculum should be oriented towards family medicine. We aimed to find out if the educational goal of patient-centered care within family medicine (comprehensive care and continuous care) were adequately transferred from the expected curriculum to implemented curriculum and teaching process. Methods Discourse analysis was done by 3 general practitioners of scenarios and learning objectives of an Indonesian undergraduate medical curriculum. The coders categorized those sentences into two groups: met or unmet the educational goal of patient-centered care. Results Text analysis showed gaps in patient-centered care training between the scenarios and the learning objectives which were developed by both curriculum committee and the block planning groups and the way in which the material was taught. Most sentences in the scenarios were more relevant to patient-centered care while most sentences in the learning objectives were more inclined towards disease-perspectives. Conclusions There is currently a discrepancy between expected patient-centered care values in the scenario and instructional materials that are being used. PMID:21513582

  7. A Proposal for Electronic Medical Records in U.S. Primary Care

    PubMed Central

    Bates, David W.; Ebell, Mark; Gotlieb, Edward; Zapp, John; Mullins, H.C.

    2003-01-01

    Delivery of excellent primary care—central to overall medical care—demands that providers have the necessary information when they give care. This paper, developed by the National Alliance for Primary Care Informatics, a collaborative group sponsored by a number of primary care societies, argues that providers’ and patients’ information and decision support needs can be satisfied only if primary care providers use electronic medical records (EMRs). Although robust EMRs are now available, only about 5% of U.S. primary care providers use them. Recently, with only modest investments, Australia, New Zealand, and England have achieved major breakthroughs in implementing EMRs in primary care. Substantial benefits realizable through routine use of electronic medical records include improved quality, safety, and efficiency, along with increased ability to conduct education and research. Nevertheless, barriers to adoption exist and must be overcome. Implementing specific policies can accelerate utilization of EMRs in the U.S. PMID:12509352

  8. [Rendering anesthesiological and resuscitation care to wounded by a medical reinforcement group in an armed conflict].

    PubMed

    Polushin, Iu S; Gavrilin, S V; Pashchenko, O V; Samandarov, V Kh; Lebedev, V F; Somov, S V

    2001-10-01

    The authors describe the aims and content of anesthesiologic and reanimatologic care of the medical reinforcement group in the medical institution of the 1st echelon of specialized care. Basing on the experience of treatment of 825 casualties with gunshot injuries the rational methods of anesthesia and intensive care are shown including the prolonged controlled ventilation, infusion-transfusion therapy, early enteral nutrition. The main causes of lethal outcomes are analyzed. The conclusion was made that during counter-terrorist operations it is reasonable to include anesthesiologists and reanimatologists into the medical reinforcement group.

  9. Other-regarding behavior and motivation in health care provision: an experiment with medical and non-medical students.

    PubMed

    Hennig-Schmidt, Heike; Wiesen, Daniel

    2014-05-01

    Other-regarding motivation is a fundamental determinant of public service provision. In health care, one example is physicians who act benevolently towards their patients when providing medical services. Such patient-regarding motivation seems closely associated with a personal sacrifice that health service providers are willing to make. Surprisingly, evidence on physicians' motivation is rare. This paper contributes to the literature by investigating prospective physicians', in particular, medical students', motivations and behavior. We measure the willingness to sacrifice own profit in order to increase the patients' health benefit. We conduct the same analysis for non-medical students. In a controlled incentivized laboratory experiment, participants decide, in the role of physicians, on the provision of medical services under fee-for-service or capitation schemes. Overall, 42 medical students and 44 non-medical students participated in five experimental sessions conducted between 2006 and 2008. We find substantial differences under both payment systems: compared to medical students, students of non-medical majors are less patient-regarding, less willing to sacrifice their own profit, and they state less motivation to improve patients' health. This results in significantly lower patient health benefits. Some implications for health care policies in light of physician shortage and for physician payment systems are discussed.

  10. HCFA's health care quality improvement program: the medical informatics challenge.

    PubMed Central

    Grant, J B; Hayes, R P; Pates, R D; Elward, K S; Ballard, D J

    1996-01-01

    The peer-review organizations (PROs) were created by Congress in 1984 to monitor the cost and quality of care received by Medicare beneficiaries. In order to do this, the Health Care Financing Administration (HCFA) contracted with the PROs through a series of contracts referred to as "Scopes of Work." Under the Fourth Scope of Work, the HCFA initiated the Health Care Quality Improvement Program (HCQIP) in 1990, as an application of the principles of continuous quality improvement. Since then, the PROs have participated with health care providers in cooperative projects to improve the quality of primarily inpatient care provided to Medicare beneficiaries. Through HCFA-supplied administrative data and clinical data abstracted from patient records, the PROs have been able to identify opportunities for improvements in patient care. In May 1995, the HCFA proposed a new Fifth Scope of Work, which will shift the focus of HCQIP from inpatient care projects to projects in outpatient and managed care settings. This article describes the HCQIP process, the types of data used by the PROs to conduct cooperative projects with health care providers, and the informatics challenges in improving the quality of care received by Medicare beneficiaries. PMID:8750387

  11. [Treatment path of wound patient in the HUC medical care district].

    PubMed

    Lepäntalo, Mauri; Ahokas, Terttuliisa; Heinänen, Tuula; Heiskanen-Kuisma, Kaija; Hietanen, Helvi; Juutilainen, Vesa; Iivanainen, Antti; Iso-Aho, Merja; Tukiainen, Erkki; Sane, Timo; Valtonen, Ville

    2009-01-01

    Unorganized care on chronic wounds is expensive. Resources are focused on the care of complicated wounds, although a significant proportion of the wounds could be prevented or treated at an early stage. Good care is cost-effective, a delayed care and inoperative treatment chain will waste money and resources. Specialization of medical and nursing staff in wound care will improve treatment outcome. Prerequisites for the necessary care must be guaranteed by creating a complete treatment path for problematic wounds in the capital region.

  12. Medical Respite and Linkages to Outpatient Health Care Providers among Individuals Experiencing Homelessness.

    PubMed

    Zur, Julia; Linton, Sabriya; Mead, Holly

    2016-01-01

    Medical respite programs provide nursing care and case management to individuals experiencing homelessness following hospitalization for an acute medical problem. One goal of these programs is to link clients to outpatient providers to decrease their reliance on hospital services. Through qualitative interviews with staff members (n = 8) and clients (n = 14) at a medical respite program, we explored processes of, and challenges associated with, linking clients to outpatient care. Six themes were identified, which offer insight about important considerations when linking clients to outpatient providers and highlight the value of medical respite programs for this population. PMID:27074404

  13. 75 FR 9102 - Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-01

    ..., or dental care. This change responds to the increase in medical costs since 1992, when the current... Part 43 Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States... intervening period, the cost of medical care and treatment has increased substantially. That increase...

  14. Delayed entry into HIV medical care in a nationally representative sample of HIV-infected adults receiving medical care in the USA.

    PubMed

    Robertson, McKaylee; Wei, Stanley C; Beer, Linda; Adedinsewo, Demilade; Stockwell, Sandra; Dombrowski, Julia C; Johnson, Christopher; Skarbinski, Jacek

    2016-01-01

    Before widespread antiretroviral therapy (ART), an estimated 17% of people delayed HIV care. We report national estimates of the prevalence and factors associated with delayed care entry in the contemporary ART era. We used Medical Monitoring Project data collected from June 2009 through May 2011 for 1425 persons diagnosed with HIV from May 2004 to April 2009 who initiated care within 12 months. We defined delayed care as entry >three months from diagnosis. Adjusted prevalence ratios (aPRs) were calculated to identify risk factors associated with delayed care. In this nationally representative sample of HIV-infected adults receiving medical care, 7.0% (95% confidence interval [CI]: 5.3-8.8) delayed care after diagnosis. Black race was associated with a lower likelihood of delay than white race (aPR 0.38). Men who have sex with women versus women who have sex with men (aPR 1.86) and persons required to take an HIV test versus recommended by a provider (aPR 2.52) were more likely to delay. Among those who delayed 48% reported a personal factor as the primary reason. Among persons initially diagnosed with HIV (non-AIDS), those who delayed care were twice as likely (aPR 2.08) to develop AIDS as of May 2011. Compared to the pre-ART era, there was a nearly 60% reduction in delayed care entry. Although relatively few HIV patients delayed care entry, certain groups may have an increased risk. Focus on linkage to care among persons who are required to take an HIV test may further reduce delayed care entry.

  15. Delayed entry into HIV medical care in a nationally representative sample of HIV-infected adults receiving medical care in the USA.

    PubMed

    Robertson, McKaylee; Wei, Stanley C; Beer, Linda; Adedinsewo, Demilade; Stockwell, Sandra; Dombrowski, Julia C; Johnson, Christopher; Skarbinski, Jacek

    2016-01-01

    Before widespread antiretroviral therapy (ART), an estimated 17% of people delayed HIV care. We report national estimates of the prevalence and factors associated with delayed care entry in the contemporary ART era. We used Medical Monitoring Project data collected from June 2009 through May 2011 for 1425 persons diagnosed with HIV from May 2004 to April 2009 who initiated care within 12 months. We defined delayed care as entry >three months from diagnosis. Adjusted prevalence ratios (aPRs) were calculated to identify risk factors associated with delayed care. In this nationally representative sample of HIV-infected adults receiving medical care, 7.0% (95% confidence interval [CI]: 5.3-8.8) delayed care after diagnosis. Black race was associated with a lower likelihood of delay than white race (aPR 0.38). Men who have sex with women versus women who have sex with men (aPR 1.86) and persons required to take an HIV test versus recommended by a provider (aPR 2.52) were more likely to delay. Among those who delayed 48% reported a personal factor as the primary reason. Among persons initially diagnosed with HIV (non-AIDS), those who delayed care were twice as likely (aPR 2.08) to develop AIDS as of May 2011. Compared to the pre-ART era, there was a nearly 60% reduction in delayed care entry. Although relatively few HIV patients delayed care entry, certain groups may have an increased risk. Focus on linkage to care among persons who are required to take an HIV test may further reduce delayed care entry. PMID:26493721

  16. The health care-child welfare partnership: transitioning medically complex children to the community.

    PubMed

    Hochstadt, N J; Yost, D M

    1989-01-01

    There is a growing number of medically complex children residing in hospitals who could benefit from home care. This paper describes a unique federally funded grant project designed to develop alternative home resources for those medically complex children whose parents are unable to provide the requisite home care. Building on an innovative partnership between a pediatric hospital and a community child welfare agency, this project recruited, trained, and supported foster parents to care for those children. Problems, solutions, and strategies for developing alternative home care resources for this population are presented.

  17. An ecological perspective on medical care: environmental, occupational, and public health impacts of medical supply and pharmaceutical chains.

    PubMed

    Vatovec, Christine; Senier, Laura; Bell, Michael

    2013-09-01

    Healthcare organizations are increasingly examining the impacts of their facilities and operations on the natural environment, their workers, and the broader community, but the ecological impacts of specific healthcare services provided within these institutions have not been assessed. This paper provides a qualitative assessment of healthcare practices that takes into account the life-cycle impacts of a variety of materials used in typical medical care. We conducted an ethnographic study of three medical inpatient units: a conventional cancer ward, palliative care unit, and a hospice center. Participant observations (73 participants) of healthcare and support staff including physicians, nurses, housekeepers, and administrators were made to inventory materials and document practices used in patient care. Semi-structured interviews provided insight into common practices. We identified three major domains that highlight the cumulative environmental, occupational health, and public health impacts of medical supplies and pharmaceuticals used at our research sites: (1) medical supply procurement; (2) generation, handling, and disposal of medical waste; and (3) pharmaceutical handling and disposal. Impacts discovered through ethnographic inquiry included occupational exposures to chemotherapy and infectious waste, and public health exposures to pharmaceutical waste. This study provides new insight into the environmental, occupational, and public health impacts resulting from medical practices. In many cases, the lack of clear guidance and regulations regarding environmental impacts contributed to elevated harms to the natural environment, workers, and the broader community.

  18. 78 FR 10608 - David Grant United States Air Force Medical Center Specialty Care Travel Reimbursement...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-14

    ... adequate clinical case mix of patients for approved Graduate Medical Education program functioning in the... demonstration would be initially conducted at DGMC and its satellite clinic, the McClellan Clinic (MCC) as well as the clinic located at Beale Air Force Base (Beale). However, it could be expanded to other...

  19. Mass Gathering Medical Care: Resource Document for the National Association of EMS Physicians Position Statement.

    PubMed

    Schwartz, Brian; Nafziger, Sarah; Milsten, Andrew; Luk, Jeffrey; Yancey, Arthur

    2015-01-01

    Mass gatherings are heterogeneous in terms of size, duration, type of event, crowd behavior, demographics of the participants and spectators, use of recreational substances, weather, and environment. The goals of health and medical services should be the provision of care for participants and spectators consistent with local standards of care, protection of continuing medical service to the populations surrounding the event venue, and preparation for surge to respond to extraordinary events. Pre-event planning among jurisdictional public health and EMS, acute care hospitals, and event EMS is essential, but should also include, at a minimum, event security services, public relations, facility maintenance, communications technicians, and the event planners and organizers. Previous documented experience with similar events has been shown to most accurately predict future needs. Future work in and guidance for mass gathering medical care should include the consistent use and further development of universally accepted consistent metrics, such as Patient Presentation Rate and Transfer to Hospital Rate. Only by standardizing data collection can evaluations be performed that link interventions with outcomes to enhance evidence-based EMS services at mass gatherings. Research is needed to evaluate the skills and interventions required by EMS providers to achieve desired outcomes. The event-dedicated EMS Medical Director is integral to acceptable quality medical care provided at mass gatherings; hence, he/she must be included in all aspects of mass gathering medical care planning, preparations, response, and recovery. Incorporation of jurisdictional EMS and community hospital medical leadership, and emergency practitioners into these processes will ensure that on-site care, transport, and transition to acute care at appropriate receiving facilities is consistent with, and fully integrated into the community's medical care system, while fulfilling the needs of event

  20. Mass Gathering Medical Care: Resource Document for the National Association of EMS Physicians Position Statement.

    PubMed

    Schwartz, Brian; Nafziger, Sarah; Milsten, Andrew; Luk, Jeffrey; Yancey, Arthur

    2015-01-01

    Mass gatherings are heterogeneous in terms of size, duration, type of event, crowd behavior, demographics of the participants and spectators, use of recreational substances, weather, and environment. The goals of health and medical services should be the provision of care for participants and spectators consistent with local standards of care, protection of continuing medical service to the populations surrounding the event venue, and preparation for surge to respond to extraordinary events. Pre-event planning among jurisdictional public health and EMS, acute care hospitals, and event EMS is essential, but should also include, at a minimum, event security services, public relations, facility maintenance, communications technicians, and the event planners and organizers. Previous documented experience with similar events has been shown to most accurately predict future needs. Future work in and guidance for mass gathering medical care should include the consistent use and further development of universally accepted consistent metrics, such as Patient Presentation Rate and Transfer to Hospital Rate. Only by standardizing data collection can evaluations be performed that link interventions with outcomes to enhance evidence-based EMS services at mass gatherings. Research is needed to evaluate the skills and interventions required by EMS providers to achieve desired outcomes. The event-dedicated EMS Medical Director is integral to acceptable quality medical care provided at mass gatherings; hence, he/she must be included in all aspects of mass gathering medical care planning, preparations, response, and recovery. Incorporation of jurisdictional EMS and community hospital medical leadership, and emergency practitioners into these processes will ensure that on-site care, transport, and transition to acute care at appropriate receiving facilities is consistent with, and fully integrated into the community's medical care system, while fulfilling the needs of event

  1. A concept of operations for contingency medical care on the International Space Station.

    PubMed

    Bacal, Kira; Beck, George; McSwain, Norman E

    2004-08-01

    The U.S.-based health care system of the International Space Station (ISS) provides the resources to care for an in-flight medical contingency. The current system was designed for use in conjunction with a return vehicle possessing medical capabilities that would allow rapid and safe transport of an ill or injured crew member to a terrestrial medical facility. Because plans for such a vehicle have been indefinitely delayed, a mismatch has been created between the limited onboard medical capabilities and the current mission profile. This has driven the medical concept of operations to one in which as many medical conditions as possible must be treated on orbit, with return to Earth delayed or avoided. This article describes this proposed new plan, the implementation of which will require numerous changes to the medical system, including modifications to training practices, treatment guidelines, diagnostic and therapeutic resources, and informatics.

  2. Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers.

    PubMed

    Solimeo, Samantha L; Stewart, Kenda R; Stewart, Gregory L; Rosenthal, Gary

    2014-12-01

    Implementation of a patient centered medical home challenges primary care providers to change their scheduling practices to enhance patient access to care as well as to learn how to use performance metrics as part of a self-reflective practice redesign culture. As medical homes become more commonplace, health care administrators and primary care providers alike are eager to identify barriers to implementation. The objective of this study was to identify non-technological barriers to medical home implementation from the perspective of primary care providers. We conducted qualitative interviews with providers implementing the medical home model in Department of Veterans Affairs clinics-the most comprehensive rollout to date. Primary care providers reported favorable attitudes towards the model but discussed the importance of data infrastructure for practice redesign and panel management. Respondents emphasized the need for administrative leadership to support practice redesign by facilitating time for panel management and recognizing providers who utilize non-face-to-face ways of delivering clinical care. Health care systems considering adoption of the medical home model should ensure that they support both technological capacities and vertically aligned expectations for provider performance. PMID:26250631

  3. 78 FR 21631 - Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-11

    ... BUDGET Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third... the cost of inpatient medical services furnished by military treatment facilities through...

  4. Faculty of Prehospital Care, Royal College of Surgeons Edinburgh guidance for medical provision for wilderness medicine.

    PubMed

    Mellor, Adrian; Dodds, Naomi; Joshi, Raj; Hall, John; Dhillon, Sundeep; Hollis, Sarah; Davis, Pete; Hillebrandt, David; Howard, Eva; Wilkes, Matthew; Langdana, Burjor; Lee, David; Hinson, Nigel; Williams, Thomas Harcourt; Rowles, Joe; Pynn, Harvey

    2015-01-01

    To support leaders and those involved in providing medical care on expeditions in wilderness environments, the Faculty of Pre-Hospital Care (FPHC) of The Royal College of Surgeons of Edinburgh convened an expert panel of leading healthcare professionals and expedition providers. The aims of this panel were to: (1) provide guidance to ensure the best possible medical care for patients within the geographical, logistical and human factor constraints of an expedition environment. (2) Give aspiring and established expedition medics a 'benchmark' of skills they should meet. (3) Facilitate expedition organisers in selecting the most appropriate medical cover and provider for their planned activity. A system of medical planning is suggested to enable expedition leaders to identify the potential medical risks and their mitigation. It was recognised that the scope of practice for wilderness medicine covers elements of primary healthcare, pre-hospital emergency medicine and preventative medicine. Some unique competencies were also identified. Further to this, the panel recommends the use of a matrix and advisory expedition medic competencies relating to the remoteness and medical threat of the expedition. This advice is aimed at all levels of expedition medic, leader and organiser who may be responsible for delivering or managing the delivery of remote medical care for participants. The expedition medic should be someone equipped with the appropriate medical competencies, scope of practice and capabilities in the expedition environment and need not necessarily be a qualified doctor. In addition to providing guidance regarding the clinical competencies required of the expedition medic, the document provides generic guidance and signposting to the more pertinent aspects of the role of expedition medic.

  5. Faculty of Prehospital Care, Royal College of Surgeons Edinburgh guidance for medical provision for wilderness medicine.

    PubMed

    Mellor, Adrian; Dodds, Naomi; Joshi, Raj; Hall, John; Dhillon, Sundeep; Hollis, Sarah; Davis, Pete; Hillebrandt, David; Howard, Eva; Wilkes, Matthew; Langdana, Burjor; Lee, David; Hinson, Nigel; Williams, Thomas Harcourt; Rowles, Joe; Pynn, Harvey

    2015-01-01

    To support leaders and those involved in providing medical care on expeditions in wilderness environments, the Faculty of Pre-Hospital Care (FPHC) of The Royal College of Surgeons of Edinburgh convened an expert panel of leading healthcare professionals and expedition providers. The aims of this panel were to: (1) provide guidance to ensure the best possible medical care for patients within the geographical, logistical and human factor constraints of an expedition environment. (2) Give aspiring and established expedition medics a 'benchmark' of skills they should meet. (3) Facilitate expedition organisers in selecting the most appropriate medical cover and provider for their planned activity. A system of medical planning is suggested to enable expedition leaders to identify the potential medical risks and their mitigation. It was recognised that the scope of practice for wilderness medicine covers elements of primary healthcare, pre-hospital emergency medicine and preventative medicine. Some unique competencies were also identified. Further to this, the panel recommends the use of a matrix and advisory expedition medic competencies relating to the remoteness and medical threat of the expedition. This advice is aimed at all levels of expedition medic, leader and organiser who may be responsible for delivering or managing the delivery of remote medical care for participants. The expedition medic should be someone equipped with the appropriate medical competencies, scope of practice and capabilities in the expedition environment and need not necessarily be a qualified doctor. In addition to providing guidance regarding the clinical competencies required of the expedition medic, the document provides generic guidance and signposting to the more pertinent aspects of the role of expedition medic. PMID:26629337

  6. The Use of Psychotropic Medication for Children in Foster Care

    ERIC Educational Resources Information Center

    Crismon, M. Lynn; Argo, Tami

    2009-01-01

    The use of psychotropic medication for foster children is in itself not unique; however, these children are of particular interest because of the stress associated with their life situations. A thorough assessment of the child and family should occur before beginning these medications, and in general, they should only be used in the presence of a…

  7. Labors of love: the transformation of care in the Non-Medical Attendant program at Walter Reed Army Medical Center.

    PubMed

    Wool, Zoë H; Messinger, Seth D

    2012-03-01

    In this paper, we explore the Non-Medical Attendant program at Walter Reed Army Medical Center in Washington, DC, which subsidizes the presence of war-injured soldiers' family members as they live for months or even years at Walter Reed during treatment and rehabilitation. We elaborate the ambiguities of the program and draw on ethnographic research to demonstrate how the program's vagaries combine with the context of an overburdened military medical system and the more familiar strains of family caregiving to place family members in a gray zone of care where the line between labors of love and institutionally compensated work is blurred. PMID:22574390

  8. Holistic Health Care: A Challenge to Podiatric Medical Practice.

    ERIC Educational Resources Information Center

    Levy, Leonard A.; Levine, Peter M.

    1980-01-01

    As the profession of podiatric medicine becomes more closely identified with the delivery of primary care, it is suggested that it is essential for practicing podiatrists and students to have more educational opportunities in the field of holistic health care, psychiatry, and the behavioral sciences. (Author/MLW)

  9. Adult Day Care and Medical and Hospital Claims.

    ERIC Educational Resources Information Center

    Chappell, Neena L.; Blandford, Audrey A.

    1987-01-01

    Examined effect of adult day care (ADC) on utilization of health care practitioner and inpatient hospital services. Data from three separate ADC studies revealed that, when operative for some time, ADC may result in dramatic decreases in hospital inpatient stays. Findings warrant further research. (Author/NB)

  10. 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.

  11. [The actual issues of private health care and voluntary medical insurance in foreign countries].

    PubMed

    Kasimovskiy, K K; Jhiliyayeva, Ye P; Zaika, N M

    2014-01-01

    The article demonstrates the issues private health care and voluntary medical insurance are facing nowadays in Australia, Great Britain, Ireland and the USA. The possible directions of overcoming these problems are discussed.

  12. Medical innovation and age-specific trends in health care utilization: findings and implications.

    PubMed

    Wong, Albert; Wouterse, Bram; Slobbe, Laurentius C J; Boshuizen, Hendriek C; Polder, Johan J

    2012-01-01

    Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends in health care utilization are presented for different health care sectors in the Netherlands, for the period 1981-2009. For the hospital sector we also explore the link between these trends and the state of medical technology. Using aggregated data from a Dutch health survey and a nationwide hospital register, regression analysis was used to examine age-specific trends in the probability of utilizing health care. To determine the influence of medical technology, the growth in age-specific probabilities of hospital care was regressed on the number of medical patents while adjusting for confounders related to demographics, health status, supply and institutional factors. The findings suggest that for most health care sectors, the trend in the probability of health care utilization is highest for ages 65 and up. Larger advances in medical technology are found to be significantly associated with a higher growth of hospitalization probability, particularly for the higher ages. Age-specific trends will raise questions on the sustainability of intergenerational solidarity in health care, as solidarity will not only be strained by the ageing population, but also might find itself under additional pressure as the gap in health care utilization between elderly and non-elderly grows over time. For hospital care utilization, this process might well be accelerated by advances in medical technology.

  13. [The evaluation of costs: standards of medical care and clinical statistic groups].

    PubMed

    Semenov, V Iu; Samorodskaia, I V

    2014-01-01

    The article presents the comparative analysis of techniques of evaluation of costs of hospital treatment using medical economic standards of medical care and clinical statistical groups. The technique of evaluation of costs on the basis of clinical statistical groups was developed almost fifty years ago and is largely applied in a number of countries. Nowadays, in Russia the payment for completed case of treatment on the basis of medical economic standards is the main mode of payment for medical care in hospital. It is very conditionally a Russian analogue of world-wide prevalent system of diagnostic related groups. The tariffs for these cases of treatment as opposed to clinical statistical groups are counted on basis of standards of provision of medical care approved by Minzdrav of Russia. The information derived from generalization of cases of treatment of real patients is not applied.

  14. The standard of medical care under the Australian Civil Liability Acts: ten years on.

    PubMed

    Lee, Joseph

    2014-12-01

    It has been more than a decade since the modified Bolam test was legislatively enacted.by the Australian States following the medical indemnity crisis. Since its implementation, the modified Bolam test has been configured by judges as a defence to the common law standard of care in medical diagnosis and treatment. The article argues against this interpretation and suggests an alternative way of implementing this statutory test. It is proposed that the modified Bolam test ought to have been applied as a single yardstick to determine the required standard of care in diagnosis and treatment. Changes are also recommended to reform the test with a view to striking a balance between the interests of patients and doctors in medical disputes, and strengthening judicial supervision of the medical profession. These proposed reforms could resolve the shortcomings of the common law more effectively. They may also enhance the standard of medical care in Australia in the long run.

  15. Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review

    PubMed Central

    Opondo, Dedan; Eslami, Saied; Visscher, Stefan; de Rooij, Sophia E.; Verheij, Robert; Korevaar, Joke C.; Abu-Hanna, Ameen

    2012-01-01

    Background Inappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting. Objective The aim of this systematic review is to quantify the extent of inappropriate prescription to elderly persons in the primary care setting. Methods We systematically searched Ovid-Medline and Ovid-EMBASE from 1950 and 1980 respectively to March 2012. Two independent reviewers screened and selected primary studies published in English that measured (in)appropriate medication prescription among elderly persons (>65 years) in the primary care setting. We extracted data sources, instruments for assessing medication prescription appropriateness, and the rate of inappropriate medication prescriptions. We grouped the reported individual medications according to the Anatomical Therapeutic and Chemical (ATC) classification and compared the median rate of inappropriate medication prescription and its range within each therapeutic class. Results We included 19 studies, 14 of which used the Beers criteria as the instrument for assessing appropriateness of prescriptions. The median rate of inappropriate medication prescriptions (IMP) was 20.5% [IQR 18.1 to 25.6%.]. Medications with largest median rate of inappropriate medication prescriptions were propoxyphene 4.52(0.10–23.30)%, doxazosin 3.96 (0.32 15.70)%, diphenhydramine 3.30(0.02–4.40)% and amitriptiline 3.20 (0.05–20.5)% in a decreasing order of IMP rate. Available studies described unequal sets of medications and different measurement tools to estimate the overall prevalence of inappropriate prescription. Conclusions Approximately one in five prescriptions to elderly persons in primary care is inappropropriate despite the attention that has been directed to quality of prescription. Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly

  16. Clinical metric and medication persistency effects: evidence from a Medicaid care management program.

    PubMed

    Berg, Gregory D; Leary, Fredric; Medina, Wendie; Donnelly, Shawn; Warnick, Kathleen

    2015-02-01

    The objective was to estimate clinical metric and medication persistency impacts of a care management program. The data sources were Medicaid administrative claims for a sample population of 32,334 noninstitutionalized Medicaid-only aged, blind, or disabled patients with diagnosed conditions of asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, or heart failure between 2005 and 2009. Multivariate regression analysis was used to test the hypothesis that exposure to a care management intervention increased the likelihood of having the appropriate medication or procedures performed, as well as increased medication persistency. Statistically significant clinical metric improvements occurred in each of the 5 conditions studied. Increased medication persistency was found for beta-blocker medication for members with coronary artery disease, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and diuretic medications for members with heart failure, bronchodilator and corticosteroid medications for members with chronic obstructive pulmonary disease, and aspirin/antiplatelet medications for members with diabetes. This study demonstrates that a care management program increases the likelihood of having an appropriate medication dispensed and/or an appropriate clinical test performed, as well as increased likelihood of medication persistency, in people with chronic conditions.

  17. Medical Students' Education in the Ambulatory Care Setting: Background Paper 1 of the Medical School Objectives Project.

    ERIC Educational Resources Information Center

    Hunt, Carl E.; Kallenberg, Gene A.; Whitcomb, Michael E.

    1999-01-01

    Reports on strategies being developed by medical schools to carry out education in the ambulatory care setting, based on studies of 38 institutions. Highlights three main strategies: longitudinal preceptorships; multi-specialty clerkships; and community-oriented and population-based activities that provide relevant educational experiences for…

  18. Bolstering medical education to enhance critical care capacity in Cambodia.

    PubMed

    Albert, Tyler J; Fassier, Thomas; Chhuoy, Meng; Bounchan, Youttiroung; Tan, Sokhak; Ku, No; Chhor, Nareth; LoGerfo, James P; West, T Eoin

    2015-04-01

    The capacity to care for the critically ill has long been viewed as a fundamental element of established and comprehensive health care systems. Extending this capacity to health care systems in low- and middle-income countries is important given the burden of disease in these regions and the significance of critical care in overall health system strengthening. However, many practicalities of improving access and delivery of critical care in resource-limited settings have yet to be elucidated. We have initiated a program to build capacity for the care of critically ill patients in one low-income Southeast Asian country, Cambodia. We are leveraging existing international academic partnerships to enhance postgraduate critical care education in Cambodia. After conducting a needs assessment and literature review, we developed a three-step initiative targeting training in mechanical ventilation. First, we assessed and revised the current resident curriculum pertaining to mechanical ventilation. We addressed gaps in training, incorporated specific goals and learning objectives, and decreased the hours of lectures in favor of additional bedside training. Second, we are incorporating e-learning, e-teaching, and e-assessment into the curriculum, with both live, interactive and independent, self-paced online instruction. Third, we are developing a train-the-trainer program defined by bidirectional international faculty exchanges to provide hands-on, case-based, and bedside training to achieve competency-based outcomes. In targeting specific educational needs and a key population-the next generation of Cambodian intensivists-this carefully designed approach should address some existing gaps in the health care system and hopefully yield a lasting impact.

  19. Medical student socio-demographic characteristics and attitudes toward patient centered care: Do race, socioeconomic status and gender matter? A report from the Medical Student CHANGES study

    PubMed Central

    Hardeman, Rachel R.; Burgess, Diana; Phelan, Sean; Yeazel, Mark; Nelson, David; van Ryn, Michelle

    2015-01-01

    Objective To determine whether attitudes toward patient-centered care differed by socio-demographic characteristics (race, gender, socioeconomic status) among a cohort of 3191 first year Black and White medical students attending a stratified random sample of US medical schools. Methods This study used baseline data from Medical Student CHANGES, a large national longitudinal cohort study of medical students. Multiple logistic regression was used to assess the association of race, gender and SES with attitudes toward patient-centered care. Results Female gender and low SES were significant predictors of positive attitudes toward patient-centered care. Age was also a significant predictor of positive attitudes toward patient-centered care such that students older than the average age of US medical students had more positive attitudes. Black versus white race was not associated with attitudes toward patient-centered care. Conclusions New medical students' attitudes toward patient-centered care may shape their response to curricula and the quality and style of care that they provide as physicians. Some students may be predisposed to attitudes that lead to both greater receptivity to curricula and the provision of higher-quality, more patient-centered care. Practice implications Medical school curricula with targeted messages about the benefits and value of patient-centered care, framed in ways that are consistent with the beliefs and world-view of medical students and the recruitment of a socioeconomically diverse sample of students into medical schools are vital for improved care. PMID:25499003

  20. [The expertise evaluation of organization of rendering of acute, emergency and urgent medical care in rural regions of Novosibirsk oblast'].

    PubMed

    Ivaninskiĭ, O I; Sharapov, I V; Sadovoĭ, M A

    2013-01-01

    The most problematic spheres in the resource support of emergency medical care to rural residents are the completeness of staff of physicians in rural medical surgeries, community hospitals and departments of emergency medical care in central district hospitals. The provision of feldsher obstetrics posts with sanitary motor transport and medical equipment is yet another problematic sphere. The main troubles during provision of emergency medical care at feldsher obstetrics posts are related to surgery treatment. The organization of emergency and urgent medical care suffers of many unresolved problems related to informational program support at feldsher obstetrics posts, polyclinics of central district hospitals.

  1. [The sociological evaluation of quality of medical care rendered to the patients with body overweight and obesity].

    PubMed

    Alekseeva, N S; Lobykina, E N; Salmina-Khvostova, O I

    2009-01-01

    The evaluation of quality of medical care rendered to the patients with body overweight and obesity was carried out in the conditions of curative preventive institution and private medical clinics on the municipal level. The study revealed the problems related to the organization of medical care provision to this category of patients addressing to the public medical institutions. The conclusion is made about the need of enhancing the actual system of medical care of patients with body overweight and obesity. It is rational to consider patients' opinion during the optimization of the available high quality medical care.

  2. Delayed entry into HIV medical care after HIV diagnosis: risk factors and research methods.

    PubMed

    Jenness, Samuel M; Myers, Julie E; Neaigus, Alan; Lulek, Julie; Navejas, Michael; Raj-Singh, Shavvy

    2012-01-01

    Timely linkage to HIV medical care has the potential to improve individual health outcomes and prevent secondary HIV transmission. Recent research found that estimates of delayed care entry varied by study design, with higher estimates among studies using only HIV case surveillance data. In this analysis, we compared the prevalence and risk factors for care delay using data from two studies with different designs conducted in New York City. The Medical Monitoring Project (MMP) used a retrospective design to estimate historical delay among persons currently receiving care, while the Never in Care (NIC) study used a prospective design to estimate current delay status among persons who were care-naive at baseline. Of 513 MMP subjects in 2007-2008, 23% had delayed care entry greater than three months after diagnosis. Independent risk factors for care delay were earlier year of diagnosis and testing positive in a nonmedical environment. Of 28 NIC subjects in 2008-2010, over half had tested positive in a nonmedical environment. The primary-stated reasons for delay were the same in both studies: denial of HIV status and lack of perceived need for medical care. The strengths and weaknesses of surveillance only, prospective, and retrospective study designs with respect to investigating this issue are explored. Future studies and interventions should be mindful of the common selection biases and measurement limitations with each design. A triangulation of estimates from varying designs is suggested for accurately measuring care linkage efforts over time.

  3. Bacterial resistance to silver in wound care and medical devices.

    PubMed

    Landsdown, A B G; Williams, A

    2007-01-01

    This review discusses the molecular and genetic evidence for silver resistance in bacteria isolated from skin wounds and medical devices with reference to a case study of resistant Enterobacter cloacae from the leg ulcers of an elderly woman.

  4. Medical care delivery at the Beijing 2008 Olympic Games

    PubMed Central

    Zhang, Jin-jun; Wang, Li-dong; Chen, Zhi; Ma, Jun; Dai, Jian-ping

    2011-01-01

    BACKGROUND: Beijing successfully hosted the 2008 Olympic Games, and the services including medical services were widely appreciated by both participants and visitors. We retrospectively analyzed the quality of the medical services provided to athletes, spectators, VIPs, and the workforce during the Beijing 2008 Olympic Games. The information thus gathered would be useful for planning strategies for managing mass gatherings. METHODS: Medical encounter forms filled during the Beijing 2008 Olympic Games were retrospectively reviewed. Descriptive statistics was used to characterize the data by accreditation and diagnostic categories. RESULTS: A total of 22 892 medical encounters were documented during the Beijing 2008 Olympic Games. Among them, 10 549 (46.08%) involved the workforce, 3 365 (14.70%) athletes, 3 019 (13.19%) spectators, 585 (2.56%) members of the media, 1 065 (4.65%) VIPs, and 4 309 (18.82%) others. Of the 22 892 cases, physical injury accounted for 27.90% (6 386), respiratory disease 18.21% (4 169), and heat-related illnesses 2.68% (615). CONCLUSIONS: Preparations of the medical service for the Beijing 2008 Olympic Games were made for 7 years, and the service provided has been praised worldwide. This study provides valuable information that may be useful for planning medical services for upcoming Olympic Games, including the London 2012 Olympic Games and other mass gatherings. PMID:25215021

  5. Barriers to Care for Depressed Older People: Perceptions of Aged Care among Medical Professionals

    ERIC Educational Resources Information Center

    McCabe, Marita P.; Davison, Tanya; Mellor, David; George, Kuruvilla

    2009-01-01

    The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care,…

  6. Medical Care and Your 6- to 12-Year-Old

    MedlinePlus

    ... KidsHealth in the Classroom What Other Parents Are Reading Upsetting News Reports? What to Say Vaccines: Which ... also might talk with your child about the importance of personal care and hygiene; warn against using ...

  7. Who Pays for the Medical Care of People with Disabilities? Disability Statistics Abstract, Number 13.

    ERIC Educational Resources Information Center

    Trupin, Laura; Rice, Dorothy P.; Max, Wendy

    This statistical abstract presents data on the sources of payment for medical care for people with disabilities in different age groups. All estimates come from the National Medical Expenditures Survey, a nationally representative survey of the civilian non-institutionalized population of the U.S. conducted in 1987. Six categories of payment…

  8. First-Year Residents' Caring, Medical Knowledge, and Clinical Judgment in Relation to Laboratory Utilization.

    ERIC Educational Resources Information Center

    Yarnold, Paul R.; And Others

    1994-01-01

    A study of 36 first-year Northwestern University (Illinois) medical residents found that students' medical knowledge was a predictor of increased laboratory test use, that clinical judgment was a predictor of decreased laboratory use, and that level of caring was statistically unrelated to amount of laboratory use. (Author/MSE)

  9. A Medical School for the Mountains: Training Doctors for Rural Care.

    ERIC Educational Resources Information Center

    Casto, James E.

    2001-01-01

    The Pikeville College School of Osteopathic Medicine (Kentucky) trains primary care physicians for practice in rural Appalachian communities. Describes the medical school's creation, funding, and mission; scholarships and provision of textbooks and supplies to students; rural residency requirements; and new approaches to medical education and to…

  10. Educational Gaps in Medical Care and Health Behavior: Evidence from US Natality Data

    ERIC Educational Resources Information Center

    Price, Joseph; Price, Joshua; Simon, Kosali

    2011-01-01

    The US Natality files provide information on medical procedures and health related behavior during pregnancy and childbirth. The data set represents nearly the universe of mothers who give birth in the US, providing the most complete coverage possible of medical care and health behavior among a specific patient population. We document gaps in…

  11. 20 CFR 10.310 - What are the basic rules for obtaining medical care?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false What are the basic rules for obtaining... are the basic rules for obtaining medical care? (a) The employee is entitled to receive all medical... considers necessary to treat the work-related injury. The employee need not be disabled to receive...

  12. Medical Students' Personal Qualities and Values as Correlates of Primary Care Interest

    ERIC Educational Resources Information Center

    Borges, Nicole J.; Jones, Bonnie J.

    2004-01-01

    Medical schools must use selection methods that validly measure applicants' noncognitive qualities, but primary-care (PC) schools have a particular need. This study correlated entering students' personality and values scores with their professed interest in PC. 93 medical students completed instruments assessing personality (16PF & PSP), values,…

  13. 42 CFR 456.242 - UR plan requirements for medical care evaluation studies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false UR plan requirements for medical care evaluation studies. 456.242 Section 456.242 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization...

  14. 42 CFR 456.242 - UR plan requirements for medical care evaluation studies.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false UR plan requirements for medical care evaluation studies. 456.242 Section 456.242 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization...

  15. 42 CFR 456.243 - Content of medical care evaluation studies.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Content of medical care evaluation studies. 456.243 Section 456.243 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental...

  16. 42 CFR 456.243 - Content of medical care evaluation studies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.243 Section 456.243 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental...

  17. 42 CFR 456.242 - UR plan requirements for medical care evaluation studies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false UR plan requirements for medical care evaluation studies. 456.242 Section 456.242 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization...

  18. 42 CFR 456.242 - UR plan requirements for medical care evaluation studies.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false UR plan requirements for medical care evaluation studies. 456.242 Section 456.242 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization...

  19. 42 CFR 456.243 - Content of medical care evaluation studies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Content of medical care evaluation studies. 456.243 Section 456.243 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental...

  20. 42 CFR 456.243 - Content of medical care evaluation studies.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Content of medical care evaluation studies. 456.243 Section 456.243 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental...