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Sample records for advice improves patient

  1. [Patient advice].

    PubMed

    Lucio-Villegas Menéndez, M Eulalia; González, Laura López; Gutiérrez Pérez, M Isabel; Lluch, Natalia Aresté; Morató Agustí, M Luisa; Cachafeiro, Santiago Pérez

    2014-05-01

    In wound care, knowing what to do is as important as knowing what not to do. The first step is to evaluate the severity of the lesion and to know whether it is necessary to attend a health center or not. If the wound is simple, the recommended course of action is cleansing with serum or water after washing one's hands, followed by wound disinfection with the most appropriate antiseptic. Antiseptics not should be used for wound cleansing (physiological serum or tap water should be used) or for wound healing with granulation tissue. Equally, antiseptics should not be used in the ear or near the eyes; if there is accidental application, the eye should be washed in abundant water. Povidone iodine should not be used in pregnant women, nor should iodine preparations be used in neonates, in patients with thyroid alterations or in those allergic to iodine. Currently, merbromine/mercurochrome is not used because of its mercury content. Before an antiseptic is applied, all inorganic residues (foreign bodies) and dead tissue should be removed; detritus, slough, purulent exudate, scabs… This will aid healing and the action of antiseptics, since they become inactive in the presence of organic material.

  2. A pilot study to improve adherence among MS patients who discontinue treatment against medical advice.

    PubMed

    Bruce, Jared; Bruce, Amanda; Lynch, Sharon; Strober, Lauren; O'Bryan, Sean; Sobotka, Deborah; Thelen, Joan; Ness, Abigail; Glusman, Morgan; Goggin, Kathy; Bradley-Ewing, Andrea; Catley, Delwyn

    2016-04-01

    Between 30 and 50% of MS patients may prematurely discontinue disease modifying therapies. Little research has examined how to best talk with patients who have discontinued treatment against medical advice. The aim of this pilot study was to determine whether telephone counseling increases disease modifying therapy (DMT) re-initiation among nonadherent patients with multiple sclerosis (MS). Participants were eligible if they had relapsing-remitting disease, had stopped taking a DMT, and had no plan to re-initiate treatment despite a provider recommendation. Following a baseline assessment, 81 patients were randomly assigned to either five 20 min, weekly sessions of Motivational Interviewing/Cognitive Behavioral Therapy (MI-CBT) or Treatment as Usual (TAU) with brief education. At 10 weeks, patients initially assigned to TAU switched over to MI-CBT. Compared to patients in the TAU group, patients undergoing MI-CBT were significantly more likely to indicate they were re-initiating DMT (41.7 vs. 14.3%). These significant results were replicated among patients crossing over from TAU to MI-CBT. Treatment satisfaction was high, with 97% of participants reporting that they would recommend MI-CBT to other patients with MS. Results of this pilot study provide initial support for the use of MI-CBT among MS patients who have discontinued treatment against medical advice.Clinicaltrials.gov: NCT01925690. PMID:26563147

  3. A pilot study to improve adherence among MS patients who discontinue treatment against medical advice.

    PubMed

    Bruce, Jared; Bruce, Amanda; Lynch, Sharon; Strober, Lauren; O'Bryan, Sean; Sobotka, Deborah; Thelen, Joan; Ness, Abigail; Glusman, Morgan; Goggin, Kathy; Bradley-Ewing, Andrea; Catley, Delwyn

    2016-04-01

    Between 30 and 50% of MS patients may prematurely discontinue disease modifying therapies. Little research has examined how to best talk with patients who have discontinued treatment against medical advice. The aim of this pilot study was to determine whether telephone counseling increases disease modifying therapy (DMT) re-initiation among nonadherent patients with multiple sclerosis (MS). Participants were eligible if they had relapsing-remitting disease, had stopped taking a DMT, and had no plan to re-initiate treatment despite a provider recommendation. Following a baseline assessment, 81 patients were randomly assigned to either five 20 min, weekly sessions of Motivational Interviewing/Cognitive Behavioral Therapy (MI-CBT) or Treatment as Usual (TAU) with brief education. At 10 weeks, patients initially assigned to TAU switched over to MI-CBT. Compared to patients in the TAU group, patients undergoing MI-CBT were significantly more likely to indicate they were re-initiating DMT (41.7 vs. 14.3%). These significant results were replicated among patients crossing over from TAU to MI-CBT. Treatment satisfaction was high, with 97% of participants reporting that they would recommend MI-CBT to other patients with MS. Results of this pilot study provide initial support for the use of MI-CBT among MS patients who have discontinued treatment against medical advice.Clinicaltrials.gov: NCT01925690.

  4. Does Expert Advice Improve Educational Choice?

    PubMed Central

    2015-01-01

    This paper reports evidence that an individual meeting with a study counselor at high school significantly improves the quality of choice of tertiary educational field, as self-assessed 18 months after graduation from college. To address endogeneity, we explore the variation in study counseling practices between schools as an instrumental variable (IV). Following careful scrutiny of the validity of the IV, our results indicate a significant and positive influence of study counseling on the quality of educational choice, foremost among males and those with low educated parents. The overall result is stable across a number of robustness checks. PMID:26692388

  5. Patients who leave the emergency department against medical advice

    PubMed Central

    Lee, Choung Ah; Cho, Joon Pil; Choi, Sang Cheon; Kim, Hyuk Hoon; Park, Ju Ok

    2016-01-01

    Objective Discharge against medical advice (DAMA) from the emergency department (ED) accounts for 0.1% to 2.7% of all ED discharges. DAMA carries a risk of increased mortality and readmissions. Our aim was to investigate the general characteristics of DAMA patients and the differences between them and non-DAMA patients. Methods We reviewed data collected by the National Emergency Medical Center between 2010 and 2011. Subjects were categorized into 2 groups, namely, the DAMA group and the non-DAMA group. We compared these groups with respect to age, gender, trauma or non-trauma status, type of hospital, health insurance, level of consciousness on admission, and diagnosis. Results Of 8,000,529 patients, 222,389 (2.78%) left against medical advice. The risk factors for DAMA across all age groups were as follows: no medical insurance (odds ratio [OR], 1.993), initial response to voice (OR, 2.753) or pain (OR, 2.101), trauma admission (OR, 1.126), admission to a local emergency medical center (OR, 1.215), and increased age. A high risk of DAMA was observed among patients with immune, endocrine, psychiatric, neurological, circulatory diseases, and external causes of morbidity and mortality. Conclusion Although DAMA cases account for only a small percentage of hospital discharges, they are important because DAMA patients have high readmission and mortality rates. It is therefore important to understand the general characteristics and predictors of DAMA in order to improve patient outcome and minimize the economic burden on the healthcare system. PMID:27752623

  6. Improving patient adherence to lifestyle advice (IMPALA): a cluster-randomised controlled trial on the implementation of a nurse-led intervention for cardiovascular risk management in primary care (protocol)

    PubMed Central

    Koelewijn-van Loon, Marije S; van Steenkiste, Ben; Ronda, Gaby; Wensing, Michel; Stoffers, Henri E; Elwyn, Glyn; Grol, Richard; van der Weijden, Trudy

    2008-01-01

    Background Many patients at high risk of cardiovascular diseases are managed and monitored in general practice. Recommendations for cardiovascular risk management, including lifestyle change, are clearly described in the Dutch national guideline. Although lifestyle interventions, such as advice on diet, physical exercise, smoking and alcohol, have moderate, but potentially relevant effects in these patients, adherence to lifestyle advice in general practice is not optimal. The IMPALA study intends to improve adherence to lifestyle advice by involving patients in decision making on cardiovascular prevention by nurse-led clinics. The aim of this paper is to describe the design and methods of a study to evaluate an intervention aimed at involving patients in cardiovascular risk management. Methods A cluster-randomised controlled trial in 20 general practices, 10 practices in the intervention arm and 10 in the control arm, starting on October 2005. A total of 720 patients without existing cardiovascular diseases but eligible for cardiovascular risk assessment will be recruited. In both arms, the general practitioners and nurses will be trained to apply the national guideline for cardiovascular risk management. Nurses in the intervention arm will receive an extended training in risk assessment, risk communication, the use of a decision aid and adapted motivational interviewing. This communication technique will be used to support the shared decision-making process about risk reduction. The intervention comprises 2 consultations and 1 follow-up telephone call. The nurses in the control arm will give usual care after the risk estimation, according to the national guideline. Primary outcome measures are self-reported adherence to lifestyle advice and drug treatment. Secondary outcome measures are the patients' perception of risk and their motivation to change their behaviour. The measurements will take place at baseline and after 12 and 52 weeks. Clinical endpoints will

  7. Nutritional advice for community patients: insights from a panel discussion.

    PubMed

    Thomas, Linda V; Jenkins, Gill; Belton, Julie; Clements, Suzie; Jacob, Ciara; Johnson, Naomi; Joy, Deirdre; Low, Jennifer; Munson, Eileen; Sheppard, Jessica

    2016-03-01

    This article describes the conclusions of an expert panel that discussed four case studies; these were examples of patients typically encountered by nurses working in the community. The panel considered the nutritional and lifestyle advice that could be given by nurses relating to conditions such as irritable bowel syndrome (IBS), depression, chronic fatigue syndrome, vulnerability to common infections, elderly care, recurrent urinary tract infection, antibiotic use, and risk of type 2 diabetes. A general conclusion was the importance of motivational interviewing techniques in achieving full understanding of patients' concerns and to determine the best health strategy. As well as specific guidance appropriate for each disorder, a range of information sources for both health professionals and patients are listed in the paper. The panel noted that, although general nutritional advice can be given by nurses working at GP surgeries and in the community, patients should always be referred to registered dietitians or nutritionists if significant dietary changes are considered. PMID:26940615

  8. Nutritional advice for community patients: insights from a panel discussion.

    PubMed

    Thomas, Linda V; Jenkins, Gill; Belton, Julie; Clements, Suzie; Jacob, Ciara; Johnson, Naomi; Joy, Deirdre; Low, Jennifer; Munson, Eileen; Sheppard, Jessica

    2016-03-01

    This article describes the conclusions of an expert panel that discussed four case studies; these were examples of patients typically encountered by nurses working in the community. The panel considered the nutritional and lifestyle advice that could be given by nurses relating to conditions such as irritable bowel syndrome (IBS), depression, chronic fatigue syndrome, vulnerability to common infections, elderly care, recurrent urinary tract infection, antibiotic use, and risk of type 2 diabetes. A general conclusion was the importance of motivational interviewing techniques in achieving full understanding of patients' concerns and to determine the best health strategy. As well as specific guidance appropriate for each disorder, a range of information sources for both health professionals and patients are listed in the paper. The panel noted that, although general nutritional advice can be given by nurses working at GP surgeries and in the community, patients should always be referred to registered dietitians or nutritionists if significant dietary changes are considered.

  9. Improving smoking cessation advice in Australian general practice: what do GPs suggest is needed?

    PubMed

    Young, J M; Ward, J E

    1998-12-01

    Smoking cessation advice from a general practitioner (GP) significantly increases quit rates among patients who smoke. However, smoking is not discussed during most routine consultations with smokers. This study describes GPs' own views about strategies to support their cessation advice. In 1997, a random sample of 311 GPs in NSW (73% response rate) completed a self-administered questionnaire about smoking cessation. Most respondents were 'very confident' about discussing the health effects of smoking (81.7%). Fewer were as confident about negotiating a quit date (21.5%) or using evidence-based smoking cessation techniques (19.3%). The top three preferred strategies to support smoking cessation advice were all resources for patients: subsidised nicotine replacement therapy (rated as 'quite useful' by 60.5%), pamphlets (55.0%) and free access to smoking cessation clinics (50.8%). Skills training (39.7%) was the preferred resource to improve practitioner effectiveness. Interventions combining skills training with patient resources are likely to be well received by GPs. PMID:9889442

  10. Improving the safety of prescriptions of domperidone in primary care: implementing MHRA advice.

    PubMed Central

    Hall, William

    2016-01-01

    Domperidone is a dopamine D2 receptor antagonist acting on the chemoreceptor trigger zone in the medulla and also in the gut, causing antiemetic and gastrokinetic effects respectively. In the past, domperidone was considered largely safe, with many indications and few contraindications listed in the product literature. In 2014, Domperidone became indicated only for the prevention of nausea and vomiting and the duration of treatment was limited to seven days. Furthermore, the maximum daily dose was limited to thirty milligrams. A quality improvement project was undertaken at Holland Park Surgery to improve compliance with MHRA guidelines. Prescriptions of domperidone in the previous nine months were assessed for compliance with the MHRA advice. Domperidone was prescribed for 23 patients; of these 4 were single acute prescriptions, 3 were repeats which had been stopped and 16 were on active repeat at the time of the search. All patients who had active repeat prescriptions had exceeded the recommended duration of treatment. MHRA contraindications were found in 6 (37%) of active repeat prescriptions. The strategy for improvement involved three PDSA cycles and involved engaging with patients for medication reviews and staff to improve prescribing practices. After the third PDSA cycle we demonstrated that all repeat prescriptions had been stopped and that new prescriptions were compliant with MHRA advice. PMID:27239307

  11. Expert advice provided through telemedicine improves healing of chronic wounds: prospective cluster controlled study.

    PubMed

    Zarchi, Kian; Haugaard, Vibeke B; Dufour, Deirdre N; Jemec, Gregor B E

    2015-03-01

    Telemedicine is widely considered as an efficient approach to manage the growing problem of chronic wounds. However, to date, there is no convincing evidence to support the clinical efficacy of telemedicine in wound management. In this prospective cluster controlled study, we tested the hypothesis that advice on wound management provided by a team of wound-care specialists through telemedicine would significantly improve the likelihood of wound healing compared with the best available conventional practice. A total of 90 chronic wound patients in home care met all study criteria and were included: 50 in the telemedicine group and 40 in the conventional group. Patients with pressure ulcers, surgical wounds, and cancer wounds were excluded. During the 1-year follow-up, complete wound healing was achieved in 35 patients (70%) in the telemedicine group compared with 18 patients (45%) in the conventional group. After adjusting for important covariates, offering advice on wound management through telemedicine was associated with significantly increased healing compared with the best available conventional practice (telemedicine vs. conventional practice: adjusted hazard ratio 2.19; 95% confidence interval: 1.15-4.17; P=0.017). This study strongly supports the use of telemedicine to connect home-care nurses to a team of wound experts in order to improve the management of chronic wounds.

  12. Patients with right frontal lesions are unable to assess and use advice to make predictive judgments.

    PubMed

    Gomez-Beldarrain, Marian; Harries, Clare; Garcia-Monco, Juan Carlos; Ballus, Emma; Grafman, Jordan

    2004-01-01

    Frontal lobe damage impairs decision-making. Most studies have employed gambling and probabilistic tasks, which have an emotional (reward-punishment) component and found that patients with ventromedial sector lesions have exceptional difficulty performing normally on these tasks. We have recently presented an economic decision-making task to patients and normal volunteers that required them to not only forecast an economic outcome but also to weigh advice from four advisors about the possible outcome across 40 trials. We studied 20 patients with right frontal lobe lesions and 9 patients with parietal lobe lesions and compared their performance to 20 matched controls. Frontal lobe lesion patients were inconsistent at using advice and their forecasts were poor. Patients with dorsolateral but not orbito-frontal lesions showed some ability to assess advice. Patients with parietal lobe lesions were good at assessing advice but were slow at doing so; they were consistent but poor at using advice and their use of advice was unrelated to their forecasting. All three patient groups were overconfident in their own performance. In contrast, controls could both use and assess advice, their ability to use advice was mediated by their ability to assess it, and they were not overconfident. Group differences on an overall measure of accuracy on this task were associated with an ability to accurately plan. Differences in ability to assess and forecast were associated with planning and working memory performance. These findings indicate that patients with both right dorsolateral and orbito-frontal lesions may be impaired when required to make complex decisions related to forecasting and judgment. Our findings enlarge the scope of decision-making deficits seen in patients with frontal lobe lesions and indicate additional circumstances in which patients with frontal lobe lesions will have difficulty in deciding.

  13. Patients Discharged Against Medical Advice from a Psychiatric Hospital in Iran: A Prospective Study

    PubMed Central

    Sheikhmoonesi, Fatemeh; Khademloo, Mohammad; Pazhuheshgar, Samaneh

    2014-01-01

    Aim: Self- discharged patients are at high risk for readmission and ultimately higher cost for care. We intended to find the proportion of patients who leave hospital against medical advice and explore some of their characteristics. Methods: This prospective study of discharge against medical advice was conducted in psychiatric wards of Zare hospital in Iran, 2011. A psychologist recorded some information on a checklist based on the documented information about the patient who wanted to leave against medical advice. The psychologist interviewed these patients and recorded the reasons for discharge against medical advice. Descriptive statistics were calculated for the variables. Results: The rate of premature discharge was 34.4%. Compared to patients with regular discharges, patients with premature discharge were significantly more likely to be male, self-employed, to have co morbid substance abuse and first admission and positive family history of psychiatric disorder. Disappearance of symptoms was the most frequent reason for premature discharge. Conclusion: The 34.4% rate of premature discharge observed in our study is higher than rate reported in other studies. One possible explanation is our teaching hospital serves a low-income urban area and most patients had low socioeconomic status. Further studies are needed to compare teaching and non-teaching hospital about the rate of premature discharge and the reasons of patients who want to leave against medical advice. PMID:24762365

  14. Factors associated with patient-recalled smoking cessation advice in a low-income clinic.

    PubMed Central

    Pollak, Kathryn I.; Yarnall, Kimberly S. H.; Rimer, Barbara K.; Lipkus, Isaac; Lyna, Pauline R.

    2002-01-01

    It is recommended that providers advise cessation to their patients who smoke. However, patients' reports of cessation advice indicate disparities based on patients' race, gender, age, and smoking level. Providers' reports do not corroborate these disparities. We investigated whether smokers who receive their care in a community health center recalled their providers advising them to quit smoking when their providers documented such advice. We examined 219 patient-provider dyads to assess factors associated with lack of agreement between providers' documentation and patient recall. Patients were asked to recall any provider advice to quit smoking in the post 2 years. After every visit, providers completed a form to record the content of the visit. Most of the patients were African American, married, and uninsured. Sixty-eight percent of the dyads agreed in their documentation/recall. Patient race was the only factor associated with lack of agreement; African-American patients were more likely than white patients to provide discrepant reports. Although this study can not disentangle the racial difference in patient-provider recall/documentation, results may indicate an important area in which health disparities exist. Future studies should address the dynamics of patient-provider communication about smoking cessation, especially in populations that include ethnically diverse patients. PMID:12069216

  15. Whiplash associated disorders: a review of the literature to guide patient information and advice

    PubMed Central

    McClune, T; Burton, A; Waddell, G

    2002-01-01

    Methods: A systematic literature search was conducted, which included both clinical and non-clinical articles to encompass the wide range of patients' informational needs. From the studies and previous reviews retrieved, 163 were selected for detailed review. The review process considered the quantity, consistency, and relevance of all selected articles. These were categorised under a grading system to reflect the quality of the evidence, and then linked to derived evidence statements. Results: The main messages that emerged were: physical serious injury is rare; reassurance about good prognosis is important; over-medicalisation is detrimental; recovery is improved by early return to normal pre-accident activities, self exercise, and manual therapy; positive attitudes and beliefs are helpful in regaining activity levels; collars, rest, and negative attitudes and beliefs delay recovery and contribute to chronicity. These findings were synthesised into patient centred messages with the potential to reduce the risk of chronicity. Conclusions: The scientific evidence on whiplash associated disorders is of variable quality, but sufficiently robust and consistent for the purpose of guiding patient information and advice. While the delivery of appropriate messages can be both oral and written, consistency is imperative, so an innovative patient educational booklet, The Whiplash Book, has been developed and published. PMID:12421771

  16. Belief Revision and Delusions: How Do Patients with Schizophrenia Take Advice?

    PubMed Central

    Kaliuzhna, Mariia; Chambon, Valérian; Franck, Nicolas; Testud, Bérangère; Van der Henst, Jean-Baptiste

    2012-01-01

    The dominant cognitive model that accounts for the persistence of delusional beliefs in schizophrenia postulates that patients suffer from a general deficit in belief revision. It is generally assumed that this deficit is a consequence of impaired reasoning skills. However, the possibility that such inflexibility affects the entire system of a patient's beliefs has rarely been empirically tested. Using delusion-neutral material in a well-documented advice-taking task, the present study reports that patients with schizophrenia: 1) revise their beliefs, 2) take into account socially provided information to do so, 3) are not overconfident about their judgments, and 4) show less egocentric advice-discounting than controls. This study thus shows that delusional patients' difficulty in revising beliefs is more selective than had been previously assumed. The specificities of the task and the implications for a theory of delusion formation are discussed. PMID:22536329

  17. Nutrition Advice and Recipes

    MedlinePlus

    ... Patient Information > Nutrition Advice & Recipes test Nutrition Advice & Recipes This is a very important section for us ... the schedule given to you by your doctor. Recipes from the NPF Chronic Pancreatitis Cookbook The NPF ...

  18. Optimal management of Alzheimer’s disease patients: Clinical guidelines and family advice

    PubMed Central

    Haberstroh, Julia; Hampel, Harald; Pantel, Johannes

    2010-01-01

    Family members provide most of the patient care and administer most of the treatments to patients with Alzheimer’s disease (AD). Family caregivers have an important impact on clinical outcomes, such as quality of life (QoL). As a consequence of this service, family caregivers suffer high rates of psychological and physical illness as well as social and financial burdens. Hence, it is important to involve family caregivers in multimodal treatment settings and provide interventions that are both suitable and specifically tailored to their needs. In recent years, several clinical guidelines have been presented worldwide for evidence-based treatment of AD and other forms of dementia. Most of these guidelines have considered family advice as integral to the optimal clinical management of AD. This article reviews current and internationally relevant guidelines with emphasis on recommendations concerning family advice. PMID:20520788

  19. Prevalence of and Reasons for Patients Leaving Against Medical Advice from Paediatric Wards in Oman.

    PubMed

    Al-Ghafri, Mohamed; Al-Bulushi, Abdullah; Al-Qasmi, Ahmed

    2016-02-01

    The objective of this study was to determine the prevalence of and reasons for patients leaving against medical advice (LAMA) in a paediatric setting in Oman. This retrospective study was carried out between January 2007 and December 2009 and assessed patients who left the paediatric wards at the Royal Hospital, Muscat, Oman, against medical advice. Of 11,482 regular discharges, there were 183 cases of LAMA (prevalence: 1.6%). Dissatisfaction with treatment and a desire to seek a second opinion were collectively the most cited reasons for LAMA according to data from the hospital's electronic system (27.9%) and telephone conversations with patients' parents (55.0%). No reasons for LAMA were documented in the hospital's electronic system for 109 patients (59.6%). The low observed prevalence of LAMA suggests good medical practice at the Royal Hospital. This study indicates the need for thorough documentation of all LAMA cases to ensure the availability of high-quality data for healthcare workers involved in preventing LAMA. PMID:26909217

  20. Variability in treatment advice for elderly patients with aortic stenosis: a nationwide survey in the Netherlands

    PubMed Central

    Bouma, B; van der Meulen, J H P; van den Brink, R B A; Arnold, A; Smidts, A; Teunter, L; Lie, K; Tijssen, J

    2001-01-01

    OBJECTIVE—To determine how the decisions of Dutch cardiologists on surgical treatment for aortic stenosis were influenced by the patient's age, cardiac signs and symptoms, and comorbidity; and to identify groups of cardiologists whose responses to these clinical characteristics were similar.
DESIGN—A questionnaire was produced asking cardiologists to indicate on a six point scale whether they would advise cardiac surgery for each of 32 case vignettes describing 10 clinical characteristics.
SETTING—Nationwide postal survey among all 530 cardiologists in the Netherlands.
RESULTS—52% of the cardiologists responded. There was wide variability in the cardiologists' advice for the individual case vignettes. Six groups of cardiologists explained 60% of the variance. The age of the patient was most important for 41% of the cardiologists; among these, 50% had a high and 50% a low inclination to advise surgery. A further 24% were influenced equally by the patient's age and by the severity of the aortic stenosis and its effect on left ventricular function; among these, 62% had a high and 38% a low inclination to advise surgery. Finally, 23% of the cardiologists were mainly influenced by the left ventricular function and 12% by the aortic valve area. The presence of comorbidity always played a minor role.
CONCLUSIONS—There were systematic differences among groups of cardiologists in their inclination to advise aortic valve replacement for elderly patients, as well as in the way their advice was influenced by the patients' characteristics. These results indicate the need for prospective studies to identify the best treatment for elderly patients according to their clinical profile.


Keywords: aortic stenosis; aortic valve replacement; elderly patients; clinical decision making PMID:11156672

  1. Public expectations of health professionals when patients telephone for medical advice.

    PubMed

    Smith, Saxon; Werren, Julia

    2008-08-01

    This article focuses on the ethical, social and liability implications of patients obtaining unsolicited medical advice over the phone. The ethical discussion centres on the demise of paternalism and the increase in patient autonomy and individualism and the growing public expectations of health professionals. The article then discusses the advantages and disadvantages of telephone consultations from a social and policy perspective. In light of these considerations it considers what the liability implications are for phone consultations. It argues that the ethic of individualism, coupled with recent Australian tort reforms, suggests that only in limited circumstances would a doctor be found liable for negligence in relation to telephone consultations. However, the increasing expectations being placed on medical personnel, as evidenced by the increase in unsolicited telephone consultations, if left untempered, may lead to a situation with which the health care system is ill equipped to deal.

  2. Pediatrician’s perspectives on discharge against medical advice (DAMA) among pediatric patients: a qualitative study

    PubMed Central

    2012-01-01

    Background The phenomenon of discharge against medical advice (DAMA) among pediatric patients places pediatricians in a dilemma between respect for the parent’s decision and the desire to provide complete care for the vulnerable child-patient. Little has been written about factors that affect a pediatrician’s decision to allow a parent to discharge his child against medical advice. This qualitative study aims to answer the question of how pediatric residents in a tertiary government hospital perceive and decide on a DAMA request from a parent or primary caregiver. Methods Using a focus group discussion approach, 11 pediatric residents from a government-run tertiary hospital were recruited for the study. The session was digitally recorded and dominant themes were coded and identified. Results There were three prominent themes that arose in the discussion: variability of definitions of DAMA, factors considered before “allowing” the patient to be DAMA, and the implications of a DAMA request on their performance as pediatricians. Definitions vary from one resident to another based on the main reason for DAMA (terminal, cultural, or financial). A conflict was noted in the definition of Home per Request (HPR) versus DAMA. Factors that influence a pediatrician to sign out a case as DAMA include: their ability to do something about the reason given for the DAMA request, the condition of the patient when the DAMA request was given, their impression of the kind of care that the parents provide, and their legal liabilities. Pediatric residents generally maintain a positive attitude towards the parents who request for DAMA and in the event of readmission, accept the patient into their care again. The occurrence of a variety of definitions and subcategories for DAMA may cause confusion among the pediatricians and should be clarified. The familiarity with cultural traditions contributes to their ability to handle situations that may lead to DAMA but this should always be

  3. The potential carcinogenic risk of tanning beds: clinical guidelines and patient safety advice

    PubMed Central

    Mogensen, Mette; Jemec, Gregor BE

    2010-01-01

    Introduction: In 2009, the WHO listed ultraviolet (UV) radiation as a group 1 carcinogen. In spite of this, each year, millions of people tan indoor in Western countries. The aim of this review is to summarize evidence of tanning bed carcinogenesis and to present guidelines for use of tanning beds and patient safety advice. Methods: A narrative review of the literature was conducted based on both PubMed and Medline searches and on literature review of the retrieved papers. Results: Use of indoor tanning beds represents a significant and avoidable risk factor for the development of both melanoma and nonmelanoma skin cancers. Frequent tanners are more often adolescent females. Tanning beds have additional potential adverse effects such as burns, solar skin damage, infection, and possibly also addictive behavior. Discussion: The effort in preventing UV light-induced carcinogenesis should currently be aimed at developing new strategies for public health information. Tanning beds are one preventable source of UV radiation. In the majority of people solar UV radiation continues to be the major factor and therefore anti-tanning campaigns must always include sunbathers. PMID:21188119

  4. Influence of physician and patient gender on provision of smoking cessation advice in general practice

    PubMed Central

    Young, J.; Ward, J.

    1998-01-01

    OBJECTIVE—To examine the association between physician and patient gender and physicians' self-reported likelihood of providing smoking cessation advice to smokers using hypothetical case scenarios in primary care.
DESIGN—Cross-sectional analysis of a self-administered questionnaire.
SUBJECTS—National random sample of Australian general practitioners (GPs).
MAIN OUTCOME MEASURES—Self-reported likelihood of advising hypothetical male and female smokers to stop smoking during a consultation for ear-syringing ("opportunistic" approach) or a dedicated preventive health "check up".
RESULTS—855 GPs returned questionnaires (67% response rate). Significantly more respondents indicated they would be "highly likely" to initiate an opportunistic discussion about smoking with a male smoker (47.8% (95% confidence intervals (CI) = 44.5 to 51.2)) than a female smoker (36.3% (95% CI = 33.1 to 39.5]). Older, male GPs were less likely to adopt an opportunistic approach to smoking cessation for patients of either sex. Respondents were more likely to recommend that a male patient return for a specific preventive health check up. Furthermore, in the context of a health check up, a greater proportion in total of respondents indicated they would be "highly likely" to discuss smoking with a man (86.9%, 95% CI = 84.5 to 89.0) than a female smoker (82.5%, 95% CI = 79.8 to 84.9).
CONCLUSIONS—As measured by physician self-report, the likelihood of advising smokers to quit during primary care consultations in Australia appears to be influenced by gender bias. Gender-sensitive strategies to support cessation activities are recommended.


Keywords: smoking cessation; gender; general practitioners PMID:10093168

  5. Improving diet, physical activity and other lifestyle behaviours using computer-tailored advice in general practice: a randomised controlled trial

    PubMed Central

    2012-01-01

    Background The adoption and maintenance of healthy behaviours is essential in the primary prevention of chronic non-communicable diseases. This study evaluated the effectiveness of a minimal intervention on multiple lifestyle factors such as diet, physical activity, smoking and alcohol, delivered through general practice, using computer-tailored feedback. Methods Adult patients visiting 21 general practitioners in Brisbane, Australia, were surveyed about ten health behaviours that are risk factors for chronic, non-communicable diseases. Those who completed the self-administered baseline questionnaire entered a randomised controlled trial, with the intervention group receiving computer-tailored printed advice, targeting those health behaviours for which respondents were not meeting current recommendations. The primary outcome was change in summary lifestyle score (Prudence Score) and individual health behaviours at three months. A repeated measures analysis compared change in these outcomes in intervention and control groups after adjusting for age and education. Results 2306 patients were randomised into the trial. 1711 (76%) returned the follow-up questionnaire at 3 months. The Prudence Score (10 items) in the intervention group at baseline was 5.88, improving to 6.25 at 3 months (improvement = 0.37), compared with 5.84 to 5.96 (improvement = 0.12) in the control group (F = 13.3, p = 0.01). The intervention group showed improvement in meeting recommendations for all individual health behaviours compared with the control group. However, these differences were significant only for fish intake (OR 1.37, 95% CI 1.11-1.68), salt intake (OR 1.19, 95% CI 1.05-1.38), and type of spread used (OR 1.28, 95% CI 1.06-1.51). Conclusion A minimal intervention using computer-tailored feedback to address multiple lifestyle behaviours can facilitate change and improve unhealthy behaviours. Although individual behaviour changes were modest, when implemented on a

  6. Strategies to promote adherence to nutritional advice in patients with chronic kidney disease: a narrative review and commentary

    PubMed Central

    Beto, Judith A; Schury, Katherine A; Bansal, Vinod K

    2016-01-01

    Chronic kidney disease (CKD) requires extensive changes to food and lifestyle. Poor adherence to diet, medications, and treatments has been estimated to vary between 20% and 70%, which in turn can contribute to increased mortality and morbidity. Delivering effective nutritional advice in patients with CKD coordinates multiple diet components including calories, protein, sodium, potassium, calcium, phosphorus, and fluid. Dietary intake studies have shown difficulty in adhering to the scope and complexity of the CKD diet parameters. No single educational or clinical strategy has been shown to be consistently effective across CKD populations. Highest adherence has been observed when both diet and education efforts are individualized to each patient and adapted over time to changing lifestyle and CKD variables. This narrative review and commentary summarizes nutrition education literature and published strategies for providing nutritional advice in CKD. A cohort of practical and effective strategies for increasing dietary adherence to nutritional advice are provided that include communicating with “talking control” principles, integrating patient-owned technology, acknowledging the typical food pattern may be snacking rather than formal meals, focusing on a single goal rather than multiple goals, creating active learning and coping strategies (frozen sandwiches, visual hands-on activities, planting herb gardens), and involving the total patient food environment. PMID:26893578

  7. Driving whilst plastered: is it safe, is it legal? A survey of advice to patients given by orthopaedic surgeons, insurance companies and the police.

    PubMed

    Von Arx, O A; Langdown, A J; Brooks, R A; Woods, D A

    2004-09-01

    Many patients, immobilised in a plaster cast after a fracture of the upper or lower limb, wish to drive. They frequently ask permission to do so from the treating surgeon. Insurance companies are apparently willing to insure these patients to drive if they obtain their doctors permission. The DVLA guidelines are unhelpful in these circumstances. We therefore established current practice within the south west region by canvassing 126 consultant orthopaedic surgeons, 27 insurance companies and the 6 regional police constabularies, sending them specific clinical scenarios and asking how they would advise these patients regarding safety to drive. The results were as follows: sixty-seven (53%) of surgeons responded of which 97% gave specific advice regarding safety to drive. The insurance companies were generally unwilling to respond and a national response was received from the Association of Chief Constables, which specifically stated that safety to drive was for the individual patient to decide and the doctor should not give advice. We consider this to be unsatisfactory for all parties and suggest how this situation could be improved for both the patient and other road users welfare.

  8. [How to handle the dilemma of driving for patients with Alzheimer's disease? A survey of advices provided by French caregivers guides].

    PubMed

    Mietkiewicz, Marie-Claude; Ostrowski, Madeleine

    2015-09-01

    For many old people, driving takes an important place in the daily living activities and contributes to carry on their autonomy and self-esteem. However, many studies showed a link between car accidents and Alzheimer's disease, even in the early stages of dementia, and people caring for these patients inevitably ask the question: "Is my patient with Alzheimer's disease still able to drive his car?" Guides devoted to caregivers can play an important role to improve the knowledge of Alzheimer's disease and to afford advices for patients managing. To assess how these guides handle the question of patients driving, we made a survey of the 46 French caregiver guides (re)published between 1988 and 2013. The question of driving is raised with more or less details in 31 guides. All state that driving should be discontinued but that the consequences of this decision on the patient autonomy should be taken into account. A few guides provide clues to assess driving competence for the patients, and many propose advices to support the implementation of the driving discontinuity decision, such as to discuss with the patient to persuade him to stop driving, to ask for assistance by the family physician, to hide the car's keys or to disconnect its battery... In France, physicians are not allowed to prohibit driving or to report dangerous driving to authorities. Ultimately, the caregivers remain faced with the ethical dilemma to choose between safety and the patient's autonomy preservation. Therefore the responsibility for the patient to persist or give up driving only falls to them. PMID:26395306

  9. Comprehension and compliance with the discharge advice and quality of life at home among the postoperative neurosurgery patients discharged from PGIMER, Chandigarh, India

    PubMed Central

    Kumar, Vishal; Singh, Amarjeet; Tewari, Manoj K.; Kaur, Sukhpal

    2016-01-01

    Problem Statement: Neurosurgical patients require special care not only in the hospital but also after their discharge from the hospital. Comprehension and compliance to the instructions given by the doctors/nurses at the time of discharge is important in home care of these patients. Many such patients suffer from various co-morbidities. Variable periods of convalescence affect health-related quality of life in these patients. Purpose of the Study: To determine the degree of compliance of neurosurgery patients and their family caregivers with the discharge advice given by the consultantsTo evaluate the quality of life of these patientsTo know the problems faced by these patients at home. Materials and Methods: This cross-sectional interview-based descriptive study was conducted in 2010 in Chandigarh. These patients were visited at their home. A scale was evolved to evaluate comprehension and compliance to the advice given at the time of discharge, according to the criteria developed by Clark et al. Lawton Brody instrumental activity of daily life and Spitzer quality of life index were used to assess patients' quality of life after the operation. Verbatim responses were recorded for the purpose of qualitative research. Results: Overall, 58 patients and their caregivers were interviewed at home. Mean age of the patients was 38.9 years. Out of 37 patients, 35 showed good comprehension and 33 patients had a good compliance with the instructions given for medication. The condition of 74.1% patients improved after the operation. Depression was reported in 31% of the patients. Many (36.2%) patients had to quit their job due to the disease. Almost half (47.4%) of the patients were independent in daily activities of their life while being evaluated on Barthel activity of daily life index. Conclusion and Recommendations: It is in the long term that the true complexity and impact of operations become apparent. After operation, such patients are likely to have a range of

  10. Comprehension and compliance with the discharge advice and quality of life at home among the postoperative neurosurgery patients discharged from PGIMER, Chandigarh, India

    PubMed Central

    Kumar, Vishal; Singh, Amarjeet; Tewari, Manoj K.; Kaur, Sukhpal

    2016-01-01

    Problem Statement: Neurosurgical patients require special care not only in the hospital but also after their discharge from the hospital. Comprehension and compliance to the instructions given by the doctors/nurses at the time of discharge is important in home care of these patients. Many such patients suffer from various co-morbidities. Variable periods of convalescence affect health-related quality of life in these patients. Purpose of the Study: To determine the degree of compliance of neurosurgery patients and their family caregivers with the discharge advice given by the consultantsTo evaluate the quality of life of these patientsTo know the problems faced by these patients at home. Materials and Methods: This cross-sectional interview-based descriptive study was conducted in 2010 in Chandigarh. These patients were visited at their home. A scale was evolved to evaluate comprehension and compliance to the advice given at the time of discharge, according to the criteria developed by Clark et al. Lawton Brody instrumental activity of daily life and Spitzer quality of life index were used to assess patients' quality of life after the operation. Verbatim responses were recorded for the purpose of qualitative research. Results: Overall, 58 patients and their caregivers were interviewed at home. Mean age of the patients was 38.9 years. Out of 37 patients, 35 showed good comprehension and 33 patients had a good compliance with the instructions given for medication. The condition of 74.1% patients improved after the operation. Depression was reported in 31% of the patients. Many (36.2%) patients had to quit their job due to the disease. Almost half (47.4%) of the patients were independent in daily activities of their life while being evaluated on Barthel activity of daily life index. Conclusion and Recommendations: It is in the long term that the true complexity and impact of operations become apparent. After operation, such patients are likely to have a range of

  11. The role of patient-provider interactions: Using an accounts framework to explain hospital discharges against medical advice.

    PubMed

    Lekas, Helen-Maria; Alfandre, David; Gordon, Peter; Harwood, Katherine; Yin, Michael T

    2016-05-01

    The phenomenon of leaving the hospital against medical advice (AMA) despite being quite common and associated with significant deleterious health outcomes remains inadequately understood and addressed. Researchers have identified certain patient characteristics as predictors of AMA discharges, but the patients' reasons for these events have not been comprehensively explored. Moreover, because the medical authority model dominates this research area, providers' experiences of AMA discharges remain unstudied. We examined the AMA discharge from a patient-centered perspective by analyzing the content of notes providers generate to record such events. We analyzed providers' notes for all inpatients with a primary HIV diagnosis (N = 33) that, in 2012, left an urban hospital AMA. Applying the Scott and Lyman accounts framework, we identified that the notes constituted records of providers' and patients' excuses and justifications for failing to meet the expectations of a provider offering patient-centered care and a compliant patient receiving care. Alongside the patients' reasons for leaving AMA, the notes also revealed the providers' reasons for honoring or discrediting the patients' accounts. The style of the accounts and the professional status of the notes' authors enabled us to contextualize the production and sharing of AMA notes in the hospital hierarchy. Conceptualizing AMA notes as dyadic accounts elicited specific factors that challenge the patient-provider relationship, and generated insights on how to strengthen it, and thus decrease the rates of AMA discharges and their associated health effects. PMID:27023920

  12. The role of patient-provider interactions: Using an accounts framework to explain hospital discharges against medical advice.

    PubMed

    Lekas, Helen-Maria; Alfandre, David; Gordon, Peter; Harwood, Katherine; Yin, Michael T

    2016-05-01

    The phenomenon of leaving the hospital against medical advice (AMA) despite being quite common and associated with significant deleterious health outcomes remains inadequately understood and addressed. Researchers have identified certain patient characteristics as predictors of AMA discharges, but the patients' reasons for these events have not been comprehensively explored. Moreover, because the medical authority model dominates this research area, providers' experiences of AMA discharges remain unstudied. We examined the AMA discharge from a patient-centered perspective by analyzing the content of notes providers generate to record such events. We analyzed providers' notes for all inpatients with a primary HIV diagnosis (N = 33) that, in 2012, left an urban hospital AMA. Applying the Scott and Lyman accounts framework, we identified that the notes constituted records of providers' and patients' excuses and justifications for failing to meet the expectations of a provider offering patient-centered care and a compliant patient receiving care. Alongside the patients' reasons for leaving AMA, the notes also revealed the providers' reasons for honoring or discrediting the patients' accounts. The style of the accounts and the professional status of the notes' authors enabled us to contextualize the production and sharing of AMA notes in the hospital hierarchy. Conceptualizing AMA notes as dyadic accounts elicited specific factors that challenge the patient-provider relationship, and generated insights on how to strengthen it, and thus decrease the rates of AMA discharges and their associated health effects.

  13. Racial Differences in Length of Stay for Patients Who Leave Against Medical Advice from U.S. General Hospitals

    PubMed Central

    Tawk, Rima; Dutton, Matthew

    2015-01-01

    There is a paucity of published literature on the length of hospital stays (LOS) for patients who leave against medical advice (AMA) and on the factors that predict their LOS. The purpose of the study is to examine the relationship between race and the LOS for AMA patients after adjusting for patient and hospital characteristics. National Hospital Discharge Survey (NHDS) data were used to describe LOS for AMA patients aged 18 years or older. Patient characteristics included age, sex, race, marital status, insurance, and diagnosis (ICD-9-CM). Hospital characteristics consisted of ownership, region and bed size. LOS was the major outcome measure. Using data from all years 1988–2006, the expected time to AMA discharge was first examined as a function of race, then adjusting for year terms, patient and hospital characteristics, and major medical diagnoses and mental illness. The unadjusted effect of race on the expected time of leaving AMA was about twice the adjusted effect. After controlling for the other covariates, the expected time to AMA discharge is 20% shorter for Blacks than Whites. The most significant predictors included age, insurance coverage, mental illness, gender, and region. Factors identified in this study offer insights into directions for evidence based- health policy to reduce AMA discharges. PMID:26729149

  14. Racial Differences in Length of Stay for Patients Who Leave Against Medical Advice from U.S. General Hospitals.

    PubMed

    Tawk, Rima; Dutton, Matthew

    2016-01-01

    There is a paucity of published literature on the length of hospital stays (LOS) for patients who leave against medical advice (AMA) and on the factors that predict their LOS. The purpose of the study is to examine the relationship between race and the LOS for AMA patients after adjusting for patient and hospital characteristics. National Hospital Discharge Survey (NHDS) data were used to describe LOS for AMA patients aged 18 years or older. Patient characteristics included age, sex, race, marital status, insurance, and diagnosis (ICD-9-CM). Hospital characteristics consisted of ownership, region and bed size. LOS was the major outcome measure. Using data from all years 1988-2006, the expected time to AMA discharge was first examined as a function of race, then adjusting for year terms, patient and hospital characteristics, and major medical diagnoses and mental illness. The unadjusted effect of race on the expected time of leaving AMA was about twice the adjusted effect. After controlling for the other covariates, the expected time to AMA discharge is 20% shorter for Blacks than Whites. The most significant predictors included age, insurance coverage, mental illness, gender, and region. Factors identified in this study offer insights into directions for evidence based- health policy to reduce AMA discharges. PMID:26729149

  15. Being questioned and receiving advice about alcohol and smoking in health care: Associations with patients' characteristics, health behavior, and reported stage of change

    PubMed Central

    2010-01-01

    Background Alcohol habits are more rarely addressed than other health behavior topics in Swedish health care. This study examined whether differences between topics could be explained by their different associations with patient characteristics or by the differences in the prevalence of the disadvantageous health behavior, i.e., excessive alcohol use and smoking. The study moreover examined whether simply being asked questions about behavior, i.e., alcohol use or smoking, was associated with reported change. Methods The study was based on a cross-sectional postal survey (n = 4 238, response rate 56.5 percent) representative of the adult population in Stockholm County in 2003. Retrospective self-reports were used to assess health care visits during the past 12 months, the questions and advice received there, patients characteristics, health behavior, and the present stage of change. Logistic regression analysis was used to estimate the associations among the 68 percent who had visited health care. Results Among the health care visitors, 23 percent reported being asked about their alcohol habits, and 3 percent reported receiving advice or/and support to modify their alcohol use - fewer than for smoking, physical exercise, or diet. When regression models adjusted for patient characteristics, the differences between health behaviors in the extent of questioning and advice remained. However, when the models also adjusted for smoking and alcohol consumption there was no difference between smoking and alcohol-related advice. In fact one-third of the present smokers and two-fifths of the persons dependent on alcohol reported having receiving advice the previous 12 months. Those who reported being asked questions or receiving advice more often reported a decreased alcohol use and similarly intended to cease smoking within 6 months. Questions about alcohol use were moreover related to a later stage of stage of change independently of advice among women but not among men

  16. Measuring improved patient choice.

    PubMed

    Holmes-Rovner, M; Rovner, D R

    2000-08-01

    Patient decision support (PDS) tools or decision aids have been developed as adjuncts to the clinical encounter. Their aim is to support evidence-based patient choice. Clinical trials of PDS tools have used an array of outcome measures to determine efficacy, including knowledge, satisfaction, health status and consistency between patient choice and values. This paper proposes that the correlation between 'subjective expected utility' (SEU) and decision may be the best primary endpoint for trials. SEU is a measure usually used in behavioural decision theory. The paper first describes how decision support tools may use decision analysis to structure the presentation of evidence and guide patient decision-making. Uses of expected utility (EU) are suggested for evaluating PDS tools when improving population health status is the objective. SEU is the theoretically better measure when internal consistency of patient choices is the objective. PMID:11083037

  17. Self-monitoring of blood glucose: Advice for providers and patients.

    PubMed

    Knapp, Shannon; Manroa, Pooja; Doshi, Krupa

    2016-05-01

    Self-monitoring of blood glucose is a critical element in diabetes management. Providers must determine if and when patients are to perform glucose self-monitoring, set blood glucose targets, and help patients to interpret the results. Patients have a variety of continually evolving meters, supplies, and technology from which to choose. Making sense of these expectations and options is perhaps the greatest challenge for providers and patients. Working together, healthcare providers and certified diabetes educators can ensure that people with diabetes get the most out of self-monitoring of blood glucose. PMID:27168511

  18. Are Patients Receiving Health Promotion Advice in the Chiropractic Teaching Clinic Setting?

    PubMed Central

    Evans, Marion Willard; Page, Gregory; Ndetan, Harrison; Martinez, Daniel; Brandon, Patricia; Daniel, Dwain; Walker, Clark

    2011-01-01

    Purpose: The aim of this study was to analyze patient-reported health issues and levels of engagement, discussion of needed lifestyle changes, and goal setting with the patient’s intern or staff doctor before and after a brief intervention to increase health-promoting activities in the clinic. Methods: Patient surveys were developed and administered to outpatients before and after a brief intervention aimed at increasing staff and intern engagement with patients on health promotion measures. Patients self-reported areas of need and levels of engagement by their doctor or intern. Data were analyzed as pre- and postintervention independent, cross-sectional samples. Frequencies and chi-square assessments were performed. Results: One hundred twenty-eight preintervention surveys and 162 postintervention surveys were collected. Back pain was the most common reason for being seen in the clinic (60% of patients) and most patients were white. More than 10% were smokers in both samples. Many patients reported poor diet, unhealthy weight, sleep issues, stress, or lack of regular physical activity, but 65% of the preintervention group and 72% of the postintervention group said a needed lifestyle change was discussed. Goals were set for 74% of the preintervention group and 84% of the postintervention group (p = .04). Information on lifestyle change was received by 52% of preintervention patients and 62% of postintervention patients and most were satisfied with this information. Goal setting was more common when a lifestyle change was discussed. Written information that was related to physical activity, for example, increased 350% (p < .0001). Conclusion: There are many opportunities for discussing needed lifestyle changes with patients. Patients self-report health behavioral issues related to physical activity, unhealthy weight, diet, stress, and sleep. More can be done in this area by this clinic, but initial assessments of impact from a brief intervention seem to have

  19. Teleophthalmology: improving patient outcomes?

    PubMed

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients' assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  20. Teleophthalmology: improving patient outcomes?

    PubMed Central

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  1. Patients in a private hospital in India leave the emergency department against medical advice for financial reasons

    PubMed Central

    2014-01-01

    Background Some reports indicate financial concerns as a factor affecting ED patients leaving the acute care setting against medical advice (AMA). In India, no person is supposed to be denied urgent care because of inability to pay. Since a large proportion of the Indian health care system is financed by out-of-pocket expenses, we investigate the role of financial constraints for ED patients at a private hospital in India in leaving AMA. Methods A prospective ED-based cross-sectional survey of patients leaving AMA was conducted at a private hospital in India from 1 October 2010 to 31 December 2010. Descriptive statistics and the chi-square test were used to identify associations between financial factors and the decision to leave the hospital AMA. Results Overall, 55 (3.84%) ED patients left AMA, of which 46 (84%) reported leaving because of financial restrictions. Thirty-nine (71%) respondents indicated the medical bill would represent more that 25% of their annual income. Females (19/19) were more likely to leave AMA for financial reasons compared to males (27/36, p = 0.017). Among females who signed out AMA, the decision was never made by the female herself. Conclusion The number of people leaving the ED AMA in a private Indian hospital is relatively high, with most leaving for financial reasons. In most cases, women did not decide to leave the ED AMA for themselves, whereas males did. This survey suggests that steps are needed to ensure that the inability to pay does not prevent emergent care from being provided. PMID:24568343

  2. [Behaviour concerning smoking among the patients making use of advice in women health centres].

    PubMed

    Kowalska, Alina; Szymański, Przemysław; Rzeźnicki, Adam; Stelmach, Włodzimierz

    2007-01-01

    The level of knowledge in the society about the harmful influence of smoking is increasing systematically. But there are still many people ignoring the warnings and prohibitions concerning smoking. The results of the research show that it is highly worrying that there are people for whom smoking is incredibly dangerous, e.g. children, youth, women, especially pregnant women. The aim of the work was to establish the percentage of smoking women among the patients of the women health centre, with the special focus on pregnant women. There were 120 women encompassed in this study in the health centre in Opoczno and 120 women using a similar health centre in Lodz between the 1st and the 15th March 2007, using a auditoria survey questionnaire. The collected data was worked out statistically. In the group of 240 tested people, 87 admitted to smoking, which is 36.3% of the respondents. Among the 185 women who were not pregnant, but were smoking, there were 75 (40.5%) and in the group of 55 pregnant women, there were 12 who smoked (f=0.22). Over 22% of the smoking women smoked over 10 cigarettes a day. From among 87 of the surveyed, 35.6% claimed they smoked everywhere they wanted. Majority of the respondents that is 52.9% lived with at least one other smoking person. Over 70% of them would like to quit smoking. Almost 48% stated their doctor has never talked with them about the influence of smoking on their health and almost 42% stated that no nurse or midwife has ever talked to them about this subject. Frequency of smoking among the tested people who were using the women health centre was high. Especially worrying was the percentage of the smoking pregnant women--every fifth of them smoked. PMID:18409321

  3. [Behaviour concerning smoking among the patients making use of advice in women health centres].

    PubMed

    Kowalska, Alina; Szymański, Przemysław; Rzeźnicki, Adam; Stelmach, Włodzimierz

    2007-01-01

    The level of knowledge in the society about the harmful influence of smoking is increasing systematically. But there are still many people ignoring the warnings and prohibitions concerning smoking. The results of the research show that it is highly worrying that there are people for whom smoking is incredibly dangerous, e.g. children, youth, women, especially pregnant women. The aim of the work was to establish the percentage of smoking women among the patients of the women health centre, with the special focus on pregnant women. There were 120 women encompassed in this study in the health centre in Opoczno and 120 women using a similar health centre in Lodz between the 1st and the 15th March 2007, using a auditoria survey questionnaire. The collected data was worked out statistically. In the group of 240 tested people, 87 admitted to smoking, which is 36.3% of the respondents. Among the 185 women who were not pregnant, but were smoking, there were 75 (40.5%) and in the group of 55 pregnant women, there were 12 who smoked (f=0.22). Over 22% of the smoking women smoked over 10 cigarettes a day. From among 87 of the surveyed, 35.6% claimed they smoked everywhere they wanted. Majority of the respondents that is 52.9% lived with at least one other smoking person. Over 70% of them would like to quit smoking. Almost 48% stated their doctor has never talked with them about the influence of smoking on their health and almost 42% stated that no nurse or midwife has ever talked to them about this subject. Frequency of smoking among the tested people who were using the women health centre was high. Especially worrying was the percentage of the smoking pregnant women--every fifth of them smoked.

  4. Simulation: improving patient outcomes.

    PubMed

    Smith, Abi; Siassakos, Dimitrios; Crofts, Joanna; Draycott, Tim

    2013-06-01

    Effective training has been shown to improve perinatal care and outcome, decrease litigation claims and reduce midwifery sick leave. To be effective, training should be incentivised, in a realistic context, and delivered to inter-professional teams similar to those delivering actual care. Teamwork training is a useful addition, but it should be based on the characteristics of effective teamwork as derived from the study of frontline teams. Implementation of simulation and teamwork training is challenging, with constraints on staff time, facilities and finances. Local adoption and adaptation of effective programmes can help keep costs down, and make them locally relevant whilst maintaining effectiveness. Training programmes need to evolve continually in line with new evidence. To do this, it is vital to monitor outcomes and robustly evaluate programmes for their impact on patient care and outcome, not just on participants. PMID:23721770

  5. Is telephone counselling a useful addition to physician advice and nicotine replacement therapy in helping patients to stop smoking? A randomized controlled trial

    PubMed Central

    Reid, R D; Pipe, A; Dafoe, W A

    1999-01-01

    BACKGROUND: The authors evaluated the incremental efficacy of telephone counselling by a nurse in addition to physician advice and nicotine replacement therapy in helping patients to stop smoking. METHODS: The trial was conducted at the University of Ottawa Heart Institute. A total of 396 volunteers who smoked 15 or more cigarettes daily were randomly assigned to either of 2 groups: usual care (control group) and usual care plus telephone counselling (intervention group); the groups were stratified by sex and degree of nicotine dependence. Usual care involved the receipt of physician advice on 3 occasions, self-help materials and 12 weeks of nicotine replacement therapy. Telephone counselling was provided by a nurse at 2, 6 and 13 weeks after the target quit date. Point-prevalent quit rates were determined at 52 weeks after the target quit date. RESULTS: The point-prevalent quit rates at 52 weeks did not differ significantly between the control and intervention groups (24.1% v. 23.4% respectively). The quit rates did not differ significantly at the secondary measurement points of 4, 12 and 26 weeks. INTERPRETATION: Brief physician assistance, along with nicotine replacement therapy, can help well-motivated smokers to quit. Three additional sessions of telephone counselling by a nurse were ineffective in increasing quit rates. This form of assistance may be useful in the absence of physician advice or when self-selected by patients. PMID:10373999

  6. A patient who refused medical advice: the doctor and the patient should look for a common ground.

    PubMed

    Tong, Sf; Robert, Chen

    2007-01-01

    Treatment refusal is a common encounter in clinical practice. The process of deciding to refuse treatment is often complex. It is our responsibility to try and understand this process of decision making and the underlying reasons for treatment refusal. Many of these reasons are often rational in the context where the decision is made. The patients could be making the best decision for themselves even if these decisions are not necessarily the best in our mind. We should at all times discuss our treatment options and assess their ability to make decisions in achieving common goals. These goals should balance our best treatment strategies and the patients' best interest. This article discusses the reasons underlying treatment refusal and how we can achieve a common goal with our patients. PMID:25606096

  7. A pragmatic randomised controlled trial of ‘PhysioDirect’ telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation

    PubMed Central

    Hollinghurst, Sandra; Coast, Joanna; Busby, John; Bishop, Annette; Foster, Nadine E; Franchini, Angelo; Grove, Sean; Hall, Jeanette; Hopper, Cherida; Kaur, Surinder; Montgomery, Alan A; Salisbury, Chris

    2013-01-01

    Objectives To compare the cost-effectiveness of PhysioDirect with usual physiotherapy care for patients with musculoskeletal problems. Design (1) Cost-consequences comparing cost to the National Health Service (NHS), to patients, and the value of lost productivity with a range of outcomes. (2) Cost-utility analysis comparing cost to the NHS with Quality-Adjusted Life Years (QALYs). Setting Four physiotherapy services in England. Participants Adults (18+) referred by their general practitioner or self-referred for physiotherapy. Interventions PhysioDirect involved telephone assessment and advice followed by face-to-face care if needed. Usual care patients were placed on a waiting list for face-to-face care. Primary and secondary outcomes Primary clinical outcome: physical component summary from the SF-36v2 at 6 months. Also included in the cost-consequences: Measure Yourself Medical Outcomes Profile; a Global Improvement Score; response to treatment; patient satisfaction; waiting time. Outcome for the cost-utility analysis: QALYs. Results 2249 patients took part (1506 PhysioDirect; 743 usual care). (1) Cost-consequences: there was no evidence of a difference between the two groups in the cost of physiotherapy, other NHS services, personal costs or value of time off work. Outcomes were also similar. (2) Cost-utility analysis based on complete cases (n=1272). Total NHS costs, including the cost of physiotherapy were higher in the PhysioDirect group by £19.30 (95% CI −£37.60 to £76.19) and there was a QALY gain of 0.007 (95% CI −0.003 to 0.016). The incremental cost-effectiveness ratio was £2889 and the net monetary benefit at λ=£20 000 was £117 (95% CI −£86 to £310). Conclusions PhysioDirect may be a cost-effective alternative to usual physiotherapy care, though only with careful management of staff time. Physiotherapists providing the service must be more fully occupied than was possible under trial conditions: consideration should be given to the

  8. Improving weekend patient handover.

    PubMed

    Ashton, Catherine

    2014-01-01

    The Royal College of Physicians state that 'handover, particularly of temporary 'on-call' responsibility, has been identified as a point at which errors are likely to occur' [1]. Working a weekend on-call covering medical wards is often busy and stressful for all junior doctors, with added pressure in trying to identify patients and tasks amongst several different pieces of paper and making important care escalation. All handover sheets from a random weekend were collected and studied. Only 57% of patients listed had the minimum expected 3 patient identifiers [2] included and just 11% had any indication of escalation planning. They were also often written on scrap pieces of paper and included varying levels of relevant patient background and information. After liaison with junior doctors and the handover committee, involving senior medical clinicians, a new handover sheet was created and uploaded onto the trust intranet, to rectify some of the problems identified. Junior doctors were also educated about the changes to weekend handover. At 2 months post-introduction, another set of weekend handover sheets were collected. All medical wards used the handover sheets for documentation of patients and tasks at a weekend and inclusion of 3 patient identifiers rose to 80%. There was also a big increase noted in clinical information and background included at weekend handover and anecdotally made weekend handover easier and less stressful. There was also increased consideration of escalation planning. The handover sheet is now being rolled out trust-wide in medicine and introduced to surgical colleagues.

  9. Patients Provide Recommendations for Improving Patient Satisfaction.

    PubMed

    Moore, Angelo D; Hamilton, Jill B; Krusel, Jessica L; Moore, LeeAntoinette G; Pierre-Louis, Bosny J

    2016-04-01

    National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction. PMID:27046182

  10. Improving emergency department patient flow

    PubMed Central

    Jarvis, Paul Richard Edwin

    2016-01-01

    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED’s capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.

  11. Advice for Developing Scholars

    ERIC Educational Resources Information Center

    Kiewra, Kenneth A.

    2008-01-01

    This commentary offers advice for developing scholars culled from this volume's contributors, research on talent development in educational psychology and other domains, and my own experiences as an educational psychologist and journal editor. The advice includes: a) follow your bliss, b) spend and create time, c) build collaborative…

  12. Discharges Against Medical Advice

    PubMed Central

    Franks, Peter; Meldrum, Sean; Fiscella, Kevin

    2006-01-01

    BACKGROUND Prior literature suggests that blacks are more likely to be discharged against medical advice (DAMA). OBJECTIVE We examined whether DAMA from general hospitals varies by race/ethnicity and whether this variation is explained by individual and hospital factors. DESIGN, SUBJECTS, AND MEASUREMENTS We conducted cross-sectional analyses of 1998 to 2000 hospital discharge data, linked to the American Hospital Association data, on adults admitted for acute general hospital care in California, Florida, and New York. A series of hierarchical logistic regression analyses explored factors associated with DAMA, initially adjusting for age and gender, then sequentially adding adjustment for comorbidities, individual socio-economic factors, and finally hospital characteristics. RESULTS Compared with whites, blacks had a 2-fold higher age-gender adjusted odds of DAMA, a risk that progressively diminished with increasing adjustment (final adjusted odds ratio [OR]=0.95, 95% confidence interval [CI]=0.91, 1.00). While Hispanics had an increased risk of DAMA in age-gender-adjusted analyses, the final model revealed a protective effect (adjusted OR=0.66, 95% CI=0.62, 0.70), similar to that observed for Asians. CONCLUSIONS Disparities in DAMA affecting minority patients in general hospitals are largely accounted for by individual and hospital socio-economic factors. The absence of any adjusted disparity affecting blacks, and the protective effect observed for Hispanics and other minorities suggest that individual discrimination and poor communication are not primary determinants of DAMA, but where patients are admitted does contribute to disparities in DAMA. PMID:16918741

  13. Orthogeriatric care: improving patient outcomes

    PubMed Central

    Tarazona-Santabalbina, Francisco José; Belenguer-Varea, Ángel; Rovira, Eduardo; Cuesta-Peredó, David

    2016-01-01

    Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. PMID:27445466

  14. Using a Non-Fit Message Helps to De-Intensify Negative Reactions to Tough Advice.

    PubMed

    Fridman, Ilona; Scherr, Karen A; Glare, Paul A; Higgins, E Tory

    2016-08-01

    Sometimes physicians need to provide patients with potentially upsetting advice. For example, physicians may recommend hospice for a terminally ill patient because it best meets their needs, but the patient and their family dislike this advised option. We explore whether regulatory non-fit could be used to improve these types of situations. Across five studies in which participants imagined receiving upsetting advice from a physician, we demonstrate that regulatory non-fit between the form of the physician's advice (emphasizing gains vs. avoiding losses) and the participants' motivational orientation (promotion vs. prevention) improves participants' evaluation of an initially disliked option. Regulatory non-fit de-intensifies participants' initial attitudes by making them less confident in their initial judgments and motivating them to think more thoroughly about the arguments presented. Furthermore, consistent with previous research on regulatory fit, we showed that the mechanism of regulatory non-fit differs as a function of participants' cognitive involvement in the evaluation of the option.

  15. Sleep Deprivation and Advice Taking

    PubMed Central

    Häusser, Jan Alexander; Leder, Johannes; Ketturat, Charlene; Dresler, Martin; Faber, Nadira Sophie

    2016-01-01

    Judgements and decisions in many political, economic or medical contexts are often made while sleep deprived. Furthermore, in such contexts individuals are required to integrate information provided by – more or less qualified – advisors. We asked if sleep deprivation affects advice taking. We conducted a 2 (sleep deprivation: yes vs. no) ×2 (competency of advisor: medium vs. high) experimental study to examine the effects of sleep deprivation on advice taking in an estimation task. We compared participants with one night of total sleep deprivation to participants with a night of regular sleep. Competency of advisor was manipulated within subjects. We found that sleep deprived participants show increased advice taking. An interaction of condition and competency of advisor and further post-hoc analyses revealed that this effect was more pronounced for the medium competency advisor compared to the high competency advisor. Furthermore, sleep deprived participants benefited more from an advisor of high competency in terms of stronger improvement in judgmental accuracy than well-rested participants. PMID:27109507

  16. Sleep Deprivation and Advice Taking.

    PubMed

    Häusser, Jan Alexander; Leder, Johannes; Ketturat, Charlene; Dresler, Martin; Faber, Nadira Sophie

    2016-01-01

    Judgements and decisions in many political, economic or medical contexts are often made while sleep deprived. Furthermore, in such contexts individuals are required to integrate information provided by - more or less qualified - advisors. We asked if sleep deprivation affects advice taking. We conducted a 2 (sleep deprivation: yes vs. no) ×2 (competency of advisor: medium vs. high) experimental study to examine the effects of sleep deprivation on advice taking in an estimation task. We compared participants with one night of total sleep deprivation to participants with a night of regular sleep. Competency of advisor was manipulated within subjects. We found that sleep deprived participants show increased advice taking. An interaction of condition and competency of advisor and further post-hoc analyses revealed that this effect was more pronounced for the medium competency advisor compared to the high competency advisor. Furthermore, sleep deprived participants benefited more from an advisor of high competency in terms of stronger improvement in judgmental accuracy than well-rested participants. PMID:27109507

  17. Systematic reviews of bed rest and advice to stay active for acute low back pain.

    PubMed Central

    Waddell, G; Feder, G; Lewis, M

    1997-01-01

    BACKGROUND: In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatment recommendations are based on orthopaedic teaching, but the current management is causing increasing dissatisfaction. Many general practitioners (GPs) are confused about what constitutes effective advice. AIM: To review all randomized controlled trials of bed rest and of medical advice to stay active for acute back pain. METHOD: A systematic review based on a search of MEDLINE and EMBASE from 1966 to April 1996 with complete citation tracking for randomized controlled trials of bed rest or medical advice to stay active and continue ordinary daily activities. The inclusion criteria were: primary care setting, patients with low back pain of up to 3 months duration, and patient-centred outcomes (rate of recovery from the acute attack, relief of pain, restoration of function, satisfaction with treatment, days off work and return to work, development of chronic pain and disability, recurrent attacks, and further health care use). RESULTS: Ten trials of bed rest and eight trials of advice to stay active were identified. Consistent findings showed that bed rest is not an effective treatment for acute low back pain but may delay recovery. Advice to stay active and to continue ordinary activities results in a faster return to work, less chronic disability, and fewer recurrent problems. CONCLUSION: A simple but fundamental change from the traditional prescription of bed rest to positive advice about staying active could improve clinical outcomes and reduce the personal and social impact of back pain. PMID:9474831

  18. Improving Patient's Primary Medication Adherence

    PubMed Central

    Leguelinel-Blache, Géraldine; Dubois, Florent; Bouvet, Sophie; Roux-Marson, Clarisse; Arnaud, Fabrice; Castelli, Christel; Ray, Valérie; Kinowski, Jean-Marie; Sotto, Albert

    2015-01-01

    Abstract Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge. This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge. We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10−7). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89). This study highlights that discharge counseling sessions are

  19. Advice for the management of low back pain: a systematic review of randomised controlled trials.

    PubMed

    Liddle, S Dianne; Gracey, Jacqueline H; Baxter, G David

    2007-11-01

    To synthesise the evidence relating to the effectiveness of advice, the relevance of its content and frequency, and to compare the advice being offered to acute, subacute and chronic low back pain (LBP) patients. A systematic review of Randomised Controlled Trials (RCTs) using advice, either alone or with another intervention. The QUOROM guidelines and the Cochrane Collaboration Back Review Group Guidelines for Systematic Reviews were followed throughout: methodological assessment identified RCTs of 'high' or 'medium' methodological quality, based on their inclusion of at least 50% of the specified internal validity criteria. Outcome measures were analysed based on five recommended core outcome domains; pain, work disability, back-specific function, generic health status and satisfaction with care. Relevant RCTs (n=56) were scored for methodological quality; 39 RCTs involving 7347 patients qualified for inclusion, based upon their methodological quality. Advice as an adjunct to exercise was most effective for improving pain, back-specific function and work disability in chronic LBP but, for acute LBP, was no more effective for improving these outcomes than simple advice to stay active. Advice as part of a back school was most effective for improving back-specific function in subacute LBP; these trials generally demonstrated long-term positive results. Advice as an adjunct to exercise was the most common form of treatment for acute and chronic LBP; advice as part of a back school was most commonly used for subacute LBP. Fifteen percent of acute LBP trials had a positive outcome, compared to 86% and 74% of subacute and chronic LBP trials respectively. A wide variety of outcome measures were used, making valid comparisons between treatment outcomes difficult. The advice provided to patients with LBP within RCTs varied considerably depending on symptom duration. The findings of this review have important implications for clinical practice, and for the design of further

  20. Financial Advice: Who Pays

    ERIC Educational Resources Information Center

    Finke, Michael S.; Huston, Sandra J.; Winchester, Danielle D.

    2011-01-01

    Using a cost-benefit framework for financial planning services and proprietary data collected in the summer of 2008, the client characteristics that are associated with the likelihood of paying for professional financial advice, as well as the type of financial services purchased, are identified. Results indicate that respondents who pay for…

  1. Strategic Communication During Whole-System Change: Advice and Guidance for School District Leaders and PR Specialists. Leading Systemic School Improvement #9

    ERIC Educational Resources Information Center

    Duffy, Francis M.; Chance, Patti L.

    2006-01-01

    Times of great change in school districts require strategic communication with internal and external stakeholders including the use of school public relations tools and techniques. This book provides theoretical and practical advice and guidance to district-based change leaders and school public relations specialists on how they can support their…

  2. Can we improve patient safety?

    PubMed

    Corbally, Martin Thomas

    2014-01-01

    Despite greater awareness of patient safety issues especially in the operating room and the widespread implementation of surgical time out World Health Organization (WHO), errors, especially wrong site surgery, continue. Most such errors are due to lapses in communication where decision makers fail to consult or confirm operative findings but worryingly where parental concerns over the planned procedure are ignored or not followed through. The WHO Surgical Pause/Time Out aims to capture these errors and prevent them, but the combination of human error and complex hospital environments can overwhelm even robust safety structures and simple common sense. Parents are the ultimate repository of information on their child's condition and planned surgery but are traditionally excluded from the process of Surgical Pause and Time Out, perhaps to avoid additional stress. In addition, surgeons, like pilots, are subject to the phenomenon of "plan-continue-fail" with potentially disastrous outcomes. If we wish to improve patient safety during surgery and avoid wrong site errors then we must include parents in the Surgical Pause/Time Out. A recent pilot study has shown that neither staff nor parents found it added to their stress, but, moreover, 100% of parents considered that it should be a mandatory component of the Surgical Pause nor does it add to the stress of surgery. Surgeons should be required to confirm that the planned procedure is in keeping with the operative findings especially in extirpative surgery and this "step back" should be incorporated into the standard Surgical Pause. It is clear that we must improve patient safety further and these simple measures should add to that potential. PMID:25279366

  3. Cluster randomized trial in smoking cessation with intensive advice in diabetic patients in primary care. ITADI Study

    PubMed Central

    2010-01-01

    Background It is a priority to achieve smoking cessation in diabetic smokers, given that this is a group of patients with elevated cardiovascular risk. Furthermore, tobacco has a multiplying effect on micro and macro vascular complications. Smoking abstinence rates increase as the intensity of the intervention, length of the intervention and number and diversity of contacts with the healthcare professional during the intervention increases. However, there are few published studies about smoking cessation in diabetics in primary care, a level of healthcare that plays an essential role in these patients. Therefore, the aim of the present study is to evaluate the effectiveness of an intensive smoking cessation intervention in diabetic patients in primary care. Methods/Design Cluster randomized trial, controlled and multicentric. Randomization unit: Primary Care Team. Study population: 546 diabetic smokers older than 14 years of age whose disease is controlled by one of the primary care teams in the study. Outcome Measures: Continuous tobacco abstinence (a person who has not smoked for at least six months and with a CO level of less than 6 ppm measured by a cooximeter) , evolution in the Prochaska and DiClemente's Transtheoretical Model of Change, number of cigarettes/day, length of the visit. Point of assessment: one- year post- inclusion in the study. Intervention: Brief motivational interview for diabetic smokers at the pre-contemplation and contemplation stage, intensive motivational interview with pharmacotherapy for diabetic smokers in the preparation-action stage and reinforcing intevention in the maintenance stage. Statistical Analysis: A descriptive analysis of all variables will be done, as well as a multilevel logistic regression and a Poisson regression. All analyses will be done with an intention to treatment basis and will be fitted for potential confounding factors and variables of clinical importance. Statistical packages: SPSS15, STATA10 y HLM6

  4. Perceived Threat and Corroboration: Key Factors That Improve a Predictive Model of Trust in Internet-based Health Information and Advice

    PubMed Central

    Harris, Peter R; Briggs, Pam

    2011-01-01

    Background How do people decide which sites to use when seeking health advice online? We can assume, from related work in e-commerce, that general design factors known to affect trust in the site are important, but in this paper we also address the impact of factors specific to the health domain. Objective The current study aimed to (1) assess the factorial structure of a general measure of Web trust, (2) model how the resultant factors predicted trust in, and readiness to act on, the advice found on health-related websites, and (3) test whether adding variables from social cognition models to capture elements of the response to threatening, online health-risk information enhanced the prediction of these outcomes. Methods Participants were asked to recall a site they had used to search for health-related information and to think of that site when answering an online questionnaire. The questionnaire consisted of a general Web trust questionnaire plus items assessing appraisals of the site, including threat appraisals, information checking, and corroboration. It was promoted on the hungersite.com website. The URL was distributed via Yahoo and local print media. We assessed the factorial structure of the measures using principal components analysis and modeled how well they predicted the outcome measures using structural equation modeling (SEM) with EQS software. Results We report an analysis of the responses of participants who searched for health advice for themselves (N = 561). Analysis of the general Web trust questionnaire revealed 4 factors: information quality, personalization, impartiality, and credible design. In the final SEM model, information quality and impartiality were direct predictors of trust. However, variables specific to eHealth (perceived threat, coping, and corroboration) added substantially to the ability of the model to predict variance in trust and readiness to act on advice on the site. The final model achieved a satisfactory fit: χ2 5 = 10

  5. Pediatric telephone advice: a new medical service in Israel.

    PubMed

    Sher, C; Mimouni, M; Weitzen, T; Waisman, Y

    1994-08-01

    Although controversy still exists about dispensing medical advice over the telephone, such services are widely offered by pediatricians in the USA. In Israel, however, such services have not yet been developed. In a joint project of the Moked Keshev (a private medical help line) at Magen David Adom (national ambulance service) and the Children's Medical Center of Israel, the first pediatric telephone advice service in Israel was established. In this study we analyzed 512 consecutive incoming calls received during the first 11 months of service operation. Of these, 42% of calls concerned children in the 1 month to 1 year age group. Unexpectedly, calls were almost evenly distributed throughout the week with a slight decrease on Fridays and Saturdays (sabbath), and 45.7% of the calls were received during the morning shift. The three most common reasons for contact were: of a general nature such as fever (23%), gastrointestinal problems (19%), and medical questions (18%). In only 20.7% of the cases were the patients advised to go to the nearest hospital emergency department, emphasizing the non-emergent nature of the calls. At the time of follow-up (within 24 h), patient status was assessed as: improved (73.7%), same (22.6%), and worse (3.8%). Of those who became worse, none required an emergency department evaluation. The present study demonstrates that a Pediatric Telephone Advice Service in Israel is technically functional, medically safe, and contributes to the health management of children.

  6. [Intensive dietary advice program in primary care].

    PubMed

    Sánchez-Robles, Raquel; Gea-Lázaro, María Lourdes

    2012-01-01

    A sedentary lifestyle and inappropriate eating habits are the main causes of major diseases (cardiovascular diseases, type 2 diabetes, and certain types of cancers), as well as a high morbidity and mortality. The Dietary Advice program was designed by the Andalusian Health Department to promote healthy habits (i.e. physical exercise and a balanced diet) to prevent secondary diseases. This program is organised in two phases: Basic Dietary Advice and Intensive Dietary Advice. This paper aims to describe the interventions protocol on the intensive dietary phase of the program focused on the promotion on changes in people's lifestyles from a multi-factorial approach. The program consisted of two individual nurse visits, five workshops and nursing follow up clinics. The individual visits ensured that the team learned of each person needs; likewise, the group activities were aimed at improving the transmission of knowledge and the acquisition of skills, abilities and attitudes towards healthier lifestyles.

  7. TRACE program: improving patient safety.

    PubMed

    Rinehart, Brenda

    2011-01-01

    The Tools for Radiation Awareness and Community Education (TRACE) program was designed as a two phase approach to radiation dose awareness and overall patient dose reduction achieved through patient and community education, physician awareness, staff training, and technological enhancements. It was made possible by the AHRA and Toshiba Putting Patients First grant program. Phase one of the program began by engaging radiation safety committee and management to address new radiation safety policy and procedures followed by patient and community education. Next, fluoroscopy dose reduction was addressed through physician awareness and dose notification. The final step was CT dose reduction through protocol changes. Phase two will contain three components: The implementation of software that will assist in recording and reporting dose; patient and referring physician notification for radiation dose >3 Gy; and CT dose reduction through technology and additional changes to protocols.

  8. Kosmo's Farewell Advice

    NASA Technical Reports Server (NTRS)

    Kosmo, Joe; Ross, Amy

    2012-01-01

    Joe Kosmo shared some final words and advice for his teammates in the Spacesuit and Crew Survival Systems Branch (EC5) and the Crew and Thermal Systems Division (CTSD (EC)) upon his retirement. He knew nothing about spacesuits when he started working for NASA in 1961, but neither did anyone else. He summed up the best lessons learned during his 50 years of developing U.S. spacesuits and encouraged the next generation s space industry workers to challenge what they hear and decide what is right. Topics include and oral history of early NASA manned flights by Richard S. Johnston, U.S. human spaceflight chronology, a history of advanced EVA project funding, and a discussion of NASA's innovative spirit.

  9. Rationale, design and methods of the Study of Work and Pain (SWAP): a cluster randomised controlled trial testing the addition of a vocational advice service to best current primary care for patients with musculoskeletal pain (ISRCTN 52269669)

    PubMed Central

    2014-01-01

    Background Musculoskeletal pain is a major contributor to short and long term work absence. Patients seek care from their general practitioner (GP) and yet GPs often feel ill-equipped to deal with work issues. Providing a vocational case management service in primary care, to support patients with musculoskeletal problems to remain at or return to work, is one potential solution but requires robust evaluation to test clinical and cost-effectiveness. Methods/Design This protocol describes a cluster randomised controlled trial, with linked qualitative interviews, to investigate the effect of introducing a vocational advice service into general practice, to provide a structured approach to managing work related issues in primary care patients with musculoskeletal pain who are absent from work or struggling to remain in work. General practices (n = 6) will be randomised to offer best current care or best current care plus a vocational advice service. Adults of working age who are absent from or struggling to remain in work due to a musculoskeletal pain problem will be invited to participate and 330 participants will be recruited. Data collection will be through patient completed questionnaires at baseline, 4 and 12 months. The primary outcome is self-reported work absence at 4 months. Incremental cost-utility analysis will be undertaken to calculate the cost per additional QALY gained and incremental net benefits. A linked interview study will explore the experiences of the vocational advice service from the perspectives of GPs, nurse practitioners (NPs), patients and vocational advisors. Discussion This paper presents the rationale, design, and methods of the Study of Work And Pain (SWAP) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for musculoskeletal pain patients with work-related issues. Trial registration Current Controlled Trials ISRCTN52269669. PMID:25012813

  10. ADVICE IN THE TEEN MAGAZINES.

    ERIC Educational Resources Information Center

    SIMPSON, ELIZABETH J.

    THE PURPOSES OF THIS STUDY WERE TO DETERMINE (1) WHAT PROBLEMS THE ADVICE COLUMNS AND ARTICLES IN THE TEEN MAGAZINES PRESENT, (2) THE NATURE OF THE ADVICE GIVEN, (3) WHETHER THEY WERE DIRECTED PRIMARILY TOWARD GIRLS, BOYS, OR BOTH, AND (4) WHO THE AUTHORS ARE. OVER A 10-MONTH PERIOD, 84 ISSUES OF DIFFERENT TEEN MAGAZINES WERE EXAMINED BY USING A…

  11. Young children heed advice selectively.

    PubMed

    Rakoczy, Hannes; Ehrling, Christoph; Harris, Paul L; Schultze, Thomas

    2015-10-01

    A rational strategy to update and revise one's uncertain beliefs is to take advice by other agents who are better informed. Adults routinely engage in such advice taking in systematic and selective ways depending on relevant characteristics such as reliability of advisors. The current study merged research in social and developmental psychology to examine whether children also adjust their initial judgment to varying degrees depending on the characteristics of their advisors. Participants aged 3 to 6 years played a game in which they made initial judgments, received advice, and subsequently made final judgments. They systematically revised their judgments in light of the advice, and they did so selectively as a function of advisor expertise. They made greater adjustments to their initial judgment when advised by an apparently knowledgeable informant. This suggests that the pattern of advice taking studied in social psychology has its roots in early development.

  12. Discharged Against Medical Advice: Causes and Consequences

    PubMed Central

    Duffy, Deirdre

    1990-01-01

    Patients discharged against medical advice in a rural general hospital in Alberta were studied retrospectively. The rate of discharge against medical advice (AMA) was 1.4% and was found to be comparable to the rates for other rural and urban general hospitals in central Alberta. Fifty consecutive discharges AMA were compared with 50 randomly selected adult discharges by physician during the same period. Demographic, diagnostic, and therapeutic variables were compared, and the fate of patients discharged AMA after departure was studied. A diagnosis of substance abuse or psychiatric illness discriminated significantly between the groups and accounted for apparent differences in the demographic variables. Those discharged AMA stayed for a shorter time in hospital and were noncompliant while there. PMID:21233917

  13. [Discharge against medical advice].

    PubMed

    Kordts, Peter

    2016-09-01

    The article is on the topic of the doctor's responsibility for the patient in case of treatment discontinuation by the patient. There are two main aspects on this issue: the patient's self-responsibility and the doctor's responsibility in case of treatment discontinuation. In such a case, first of all it is the doctor's responsibility to persuade the patient to keep on with the treatment. The more serious the consequences of the discontinuation are estimated, the further the doctor has to go to persuade the patient to continue the treatment. According to the modern view on the relationship between doctor and patient, in last consequence the doctor has to respect the patient's decision, even though it might be unreasonable. To cover liability, the doctor should keep detailed records of his / her efforts on convincing the patient to continue the treatment. The doctor should also document his / her explanations on consequences of a treatment discontinuation towards the patient. PMID:27642744

  14. Improving assessment with virtual patients.

    PubMed

    Round, Jonathan; Conradi, Emily; Poulton, Terry

    2009-08-01

    Assessments should accurately predict future performance in a wide variety of settings yet be feasible to conduct. In medical education a robust and comprehensive system of assessment is essential to protect the public from inadequate professionals. The parameters for devising such an assessment are well-defined, and good practice for writing examinations well-established. However even excellent written assessments are limited in their predictive validity, and limited in sampling, face and construct validity. The increasing availability and power of computing has led to growing interest in computer simulations for use in examinations, creating assessment virtual patients (AVPs). They can potentially test knowledge and data interpretation, incorporate images, sound or video and test decision making. Such AVPs could represent the most comprehensive, integrated assessment possible that is both objective and feasible. This article focuses on AVP design, distinguishing between linear and branched models, choice and consequence driven designs. It reviews the use of AVPs in the context of assessment theory. It presents different AVP designs discussing their benefits and problems. AVPs can become valuable components in high stakes medical exams, particularly in later years of courses. However this requires application of established assessment principles to AVP design. PMID:19811215

  15. Advice to young behavioral and cognitive scientists.

    PubMed

    Weisman, Ronald G

    2008-02-01

    Modeled on Medawar's Advice to a Young Scientist [Medawar, P.B., 1979. Advice to a Young Scientist. Basic Books, New York], this article provides advice to behavioral and cognitive scientists. An important guiding principle is that the study of comparative cognition and behavior are natural sciences tasked with explaining nature. The author advises young scientists to begin with a natural phenomenon and then bring it into the laboratory, rather than beginning in the laboratory and hoping for an application in nature. He suggests collaboration as a way to include research outside the scientist's normal competence. He then discusses several guides to good science. These guides include Tinbergen's [Tinbergen, N., 1963. On aims and methods of ethology. Zeitschrift für Tierpsychologie, 20, 410-433. This journal was renamed Ethology in 1986. Also reprinted in Anim. Biol. 55, 297-321, 2005] four "why" questions, Platt's [Platt, J.R., 1964. Strong inference. Science 146, 347-353, (http://weber.ucsd.edu/~jmoore/courses/Platt1964.pdf)] notion of strong inference using multiple alternative hypotheses, and the idea that positive controls help scientists to follow Popper's [Popper, K.R., 1959. The Logic of Scientific Discovery. Basic Books, New York, p. 41] advice about disproving hypotheses. The author also recommends Strunk and White's [Strunk, W., White, E.B., 1979. The Elements of Style, third ed. Macmillan, New York] rules for sound writing, and he provides his personal advice on how to use the anticipation of peer review to improve research and how to decode editors' and reviewers' comments about submitted articles.

  16. Advice on healthy eating for older people.

    PubMed

    Fisher, Karen

    As part of its Food and Health Action Plan, the Department of Health is working with the food industry, and with other stakeholders, to establish a coherent national plan to help people in England improve their diets. Maintaining a healthy diet is important for all age groups, but healthy older people have particular needs. Karen Fisher describes the specific nutritional issues affecting healthy older people and suggests advice that nurses can offer people during opportunistic consultations in primary care.

  17. Performance improvement with patient service partners.

    PubMed

    Burns, J P

    1998-01-01

    Once the decision is made to use a patient-focused care delivery system, a variety of methods can be used to successfully design the model. The author describes the process used by a multilevel, multidisciplinary team at a community hospital to design and implement a Service Partner role that would meet and exceed customer expectations. Demonstrated performance improvements included increased patient satisfaction, productive labor dollar savings, and improvements in the work environment for staff members. PMID:9451381

  18. Potential for advice from doctors to reduce the number of patients referred to emergency departments by NHS 111 call handlers: observational study

    PubMed Central

    Anderson, Andrew; Roland, Martin

    2015-01-01

    Objective To determine the effect of using experienced general practitioners (GPs) to review the advice given by call handlers in NHS 111, a national service giving telephone advice to people seeking medical care. Design Observational study following the introduction of GPs to review call handlers’ decisions which had been made using decision support software. Setting NHS 111 call centre covering Cambridgeshire and Peterborough. Intervention When a call handler using standard NHS 111 decision support software would have advised the caller to attend the hospital accident and emergency (A&E) department, the decision was reviewed by an experienced GP. Main outcome measures Percentage of calls where an outcome other than A&E attendance was recommended by the GP. Results Of 1474 cases reviewed, the GP recommended A&E attendance in 400 cases (27.1%). In the remainder of cases, the GP recommended attendance at a primary care out-of-hours centre or minor injury unit in 665 cases (45.2%) and self-management or some alternative strategy in 409 (27.8%). Conclusions Fewer callers to NHS 111 would be sent to emergency departments if the decision was reviewed by an experienced GP. Telephone triage services need to consider whether using relatively unskilled call handlers supported by computer software is the most cost-effective way to handle requests for medical care. PMID:26614624

  19. Improving Patient Satisfaction with Waiting Time

    ERIC Educational Resources Information Center

    Eilers, Gayleen M.

    2004-01-01

    Waiting times are a significant component of patient satisfaction. A patient satisfaction survey performed in the author's health center showed that students rated waiting time lowest of the listed categories--A ratings of 58% overall, 63% for scheduled appointments, and 41% for the walk-in clinic. The center used a quality improvement process and…

  20. Practical advice for home blood pressure measurement

    PubMed Central

    McKay, Donald W; Godwin, Marshall; Chockalingam, Arun

    2007-01-01

    Early diagnosis of hypertension is one benefit of home blood pressure monitoring. Home measurement may also be used for the detection of masked hypertension. Home blood pressure readings have a strong correlation with risk, and the method has many advantages over office measurement in the management of hypertension, especially in patients with chronic kidney disease or diabetes. The present article provides practical advice on incorporating home blood pressure monitoring into practice. Patient education and training are discussed, as are tips to aid in the selection of devices for blood pressure measurement at home. PMID:17534466

  1. Tooth wear: diet analysis and advice.

    PubMed

    Young, William George

    2005-04-01

    Diet analysis and advice for patients with tooth wear is potentially the most logical intervention to arrest attrition, erosion and abrasion. It is saliva that protects the teeth against corrosion by the acids which soften enamel and make it susceptible to wear. Thus the lifestyles and diet of patients at risk need to be analysed for sources of acid and reasons for lost salivary protection. Medical conditions which put patients at risk of tooth wear are principally: asthma, bulimia nervosa, caffeine addiction, diabetes mellitus, exercise dehydration, functional depression, gastroesophageal reflux in alcoholism, hypertension and syndromes with salivary hypofunction. The sources of acid are various, but loss of salivary protection is the common theme. In healthy young Australians, soft drinks are the main source of acid, and exercise dehydration the main reason for loss of salivary protection. In the medically compromised, diet acids and gastroesophageal reflux are the sources, but medications are the main reasons for lost salivary protection. Diet advice for patients with tooth wear must: promote a healthy lifestyle and diet strategy that conserves the teeth by natural means of salivary stimulation; and address the specific needs of the patients' oral and medical conditions. Individualised, patient-empowering erosion WATCH strategies; on Water, Acid, Taste, Calcium and Health, are urgently required to combat the emerging epidemic of tooth wear currently being experienced in westernised societies.

  2. How Expert Advice Influences Decision Making

    PubMed Central

    Meshi, Dar; Biele, Guido; Korn, Christoph W.; Heekeren, Hauke R.

    2012-01-01

    People often use expert advice when making decisions in our society, but how we are influenced by this advice has yet to be understood. To address this, using functional magnetic resonance imaging, we provided expert and novice advice to participants during an estimation task. Participants reported that they valued expert advice more than novice advice, and activity in the ventral striatum correlated with this valuation, even before decisions with the advice were made. When using advice, participants compared their initial opinion to their advisor’s opinion. This comparison, termed the “opinion difference”, influenced advice utilization and was represented in reward-sensitive brain regions. Finally, the left lateral orbitofrontal cortex integrated both the size of the opinion difference and the advisor’s level of expertise, and average activity in this area correlated with mean advice utilization across participants. Taken together, these findings provide neural evidence for how advice engenders behavioral change during the decision-making process. PMID:23185425

  3. The Mediterranean diet adoption improves metabolic, oxidative, and inflammatory abnormalities in Algerian metabolic syndrome patients.

    PubMed

    Bekkouche, L; Bouchenak, M; Malaisse, W J; Yahia, D Ait

    2014-04-01

    This study was aimed to explore the effects of Mediterranean diet (MD) adoption on insulin resistance, oxidative, and inflammatory status in metabolic syndrome (MS) patients. Eighty four patients with MS were randomly recruited in the medical centers of Oran, Algeria. Eighteen healthy participants were selected as a control group. Among these 84 patients, only 36 patients completed the nutritional advices for 3 months. Patients were instructed to follow a Mediterranean-style diet and received some other selected nutritional and physical activity instructions. Anthropometric measurements were performed and a questionnaire was used to assess dietary intake. Blood samples were drawn at baseline and after 3 months of nutritional intervention from all subjects. At baseline, the MS patients were obese and had altered anthropometric parameters, higher systolic and diastolic blood pressure, plasma lipids, glucose, insulin, HOMA-IR, HbA1c, urea, creatinine, uric acid, and lower albumin compared to healthy subjects. A decrease in plasma, erythrocyte, and platelet antioxidant enzymes, and a rise in lipid and protein oxidation, plasma CRP, and fibrinogen were noted in the MS patients. Moreover, they had an unbalanced dietary pattern when compared to Mediterranean recommendations. Patients following the Mediterranean-style diet had significantly reduced weight, BMI, waist circumference, waist/hip circumference ratio, decreased systolic and diastolic blood pressure, plasma glucose, insulin, HOMA-IR, HbA1c, cholesterol, triacylglycerols, CRP, urea, creatinine, creatinine clearance, lipid and protein oxidation, and higher plasma, erythrocyte, and platelet antioxidant enzymes. In conclusion, a lifestyle intervention based mainly on nutritional advices improves metabolic, oxidative, and inflammatory abnormalities of metabolic syndrome.

  4. Technology and simulation to improve patient safety.

    PubMed

    Ghobrial, George M; Hamade, Youssef J; Bendok, Bernard R; Harrop, James S

    2015-04-01

    Improving the quality and efficiency of surgical techniques, reducing technical errors in the operating suite, and ultimately improving patient safety and outcomes through education are common goals in all surgical specialties. Current surgical simulation programs represent an effort to enhance and optimize the training experience, to overcome the training limitations of a mandated 80-hour work week, and have the overall goal of providing a well-balanced resident education in a society with a decreasing level of tolerance for medical errors.

  5. Using a Non-Fit Message Helps to De-Intensify Negative Reactions to Tough Advice.

    PubMed

    Fridman, Ilona; Scherr, Karen A; Glare, Paul A; Higgins, E Tory

    2016-08-01

    Sometimes physicians need to provide patients with potentially upsetting advice. For example, physicians may recommend hospice for a terminally ill patient because it best meets their needs, but the patient and their family dislike this advised option. We explore whether regulatory non-fit could be used to improve these types of situations. Across five studies in which participants imagined receiving upsetting advice from a physician, we demonstrate that regulatory non-fit between the form of the physician's advice (emphasizing gains vs. avoiding losses) and the participants' motivational orientation (promotion vs. prevention) improves participants' evaluation of an initially disliked option. Regulatory non-fit de-intensifies participants' initial attitudes by making them less confident in their initial judgments and motivating them to think more thoroughly about the arguments presented. Furthermore, consistent with previous research on regulatory fit, we showed that the mechanism of regulatory non-fit differs as a function of participants' cognitive involvement in the evaluation of the option. PMID:27341845

  6. Ancient advice for modern mariners

    NASA Astrophysics Data System (ADS)

    Brooks, David A.

    Some unusual preparations may be advised for persons anticipating voyages in sailing research vessels. For example, cooking facilities on sailing ships tend to be of modest means, and a scientist embarking on such a vessel may wonder whether he should bring his own essential provisions. Casting about for ideas, I happened on some relevant advice from Benjamin Franklin, who was seldom reluctant to sermonize on matters at hand. In spite of his numerous Atlantic crossings, Franklin was humble about offering advice to mariners, who he realized were generally suspicious of landlubbers.

  7. Understanding of and adherence to advice after telephone counselling by nurse: a survey among callers to a primary emergency out-of-hours service in Norway

    PubMed Central

    2011-01-01

    Background To investigate how callers understand the information given by telephone by registered nurses in a casualty clinic, to what degree the advice was followed, and the final outcome of the condition for the patients. Methods The study was conducted at a large out-of-hours inter-municipality casualty clinic in Norway during April and May 2010. Telephone interviews were performed with 100 callers/patients who had received information and advice by a nurse as a sole response. Six topics from the interview guide were compared with the telephone record files to check whether the caller had understood the advice. In addition, questions were asked about how the caller followed the advice provided and the patient's outcome. Results 99 out of 100 interviewed callers stated that they had understood the nurse's advice, but interpreted from the telephone records, the total agreement for all six topics was 82.6%. 93 callers/patients stated that they followed the advice and 11 re-contacted the casualty clinic. 22 contacted their GP for the same complaints the same week, of whom five patients received medical treatment and one was hospitalised. There were significant difference between the native-Norwegian and the non-native Norwegian regarding whether they trusted the nurse (p = 0.017), and if they got relevant answers to their questions (p = 0.005). Conclusion Callers to the out-of-hours service seem to understand the advice given by the registered nurses, and a large majority of the patients did not contact their GP or other health services again with the same complaints. Practice Implication Medical and communicative training must be an important part of the continuous improvement strategy within the out-of-hour services. PMID:21892945

  8. Working with industry for improved patient outcomes.

    PubMed

    Shorney, Richard

    Various codes of practice, guidelines and protocols exist that support the engagement between health professionals and industry. Of importance is how these engagements can be encouraged to support improved patient outcomes. This article reviews the policies that exist from both the perspective of the health professionals and that of industry within the wound-care market space. Health professionals' engagement with wound-care companies in various guises in practice, including advancement of medical technologies; education development; provision on the safe and effective use of products; and true, practical research and evaluations of products. Joint working initiatives do exist between the NHS and industry that are transparent, mutually beneficial, support patient safety, ensure improved patient experience, and drive clinical effectiveness.

  9. Dysphonia: medical treatment and a medical voice hygiene advice approach. A prospective randomised pilot study.

    PubMed

    Pedersen, M; Beranova, A; Møller, S

    2004-07-01

    on a comparison of ten dysphonic patients with stroboscopic non- organic (functional) voice disorders, where a micro-organic diagnosis was searched for and treated systematically in a medical regime (for infections, allergies, gastrooesophageal reflux and environmental irritants such as dust, noise, etc.) versus ten dysphonic patients with stroboscopically confirmed non-organic (functional) voice disorders, having only the traditional but optimal voice advice, which we can call medical voice-hygiene advice, including the use of the Accent method. A retrospective group of ten patients treated medically was included, too. A demand cannot be made that the functional group being treated by randomisation with voice advice should also be medically treated at once, the medical approach being the new one. On the other hand, it is strange that no evidence-based research was made before. All patients were measured two times with stored videostroboscopy, a quality-of-life questionnaire and phonetograms with 1-month intervals. All patient groups improved. There was no statistical improvement in favour of the medical group with the voice-related quality-of-life score, also not for the group who received voice-hygiene advice. The geometrical mean values of the phonetogram areas in decibels times semitones were better in all groups, but a statistical difference was not found between the medically treated group and the voice-hygiene advice group. The pilot study showed that both medical treatment and medical voice-hygiene advice had a positive effect on dysphonia in non-organic (functional) voice disorders. There is need of an extensive prospective randomised trial on dysphonia including vocal cord nodules to find out which treatment should be used for this group of patients. It is suggested that an eventual randomisation for microsurgical treatment or regular voice therapy should be made after a period of systematic medical diagnosis and treatment including medical voice

  10. Advice in the Abortion Decision

    ERIC Educational Resources Information Center

    Luscutoff, Sidney A.; Elms, Alan C.

    1975-01-01

    Subjects in this study were asked to report the number of contacts-for-advice they had made when forming decisions to have a therapeutic abortion, or to carry a pregnancy to term. As predicted, the abortion group differed strongly from both other groups on most questions. (Author)

  11. Exercise improves cognitive function in aging patients

    PubMed Central

    Hu, Jian-Ping; Guo, Yan-Hua; Wang, Feng; Zhao, Xin-Ping; Zhang, Quan-Hai; Song, Qing-Hua

    2014-01-01

    A decline in cognitive ability commonly occurs among older individuals. This study sought to explore the restorative effects of exercise in older patients with existing cognitive disabilities. Ninety-six patients with mild cognitive impairment were placed in an exercise program for six months. Following completion of the program, participants were assessed via the Chinese Mini Mental Status Examination (MMSE), Activity of Daily Living (ADL) assessment, and body movement testing and compared to a control group of patients with mild cognitive impairment who did not participate in the exercise program (N = 102). Statistical analyses were performed using the Student’s t-test and chi-square test to compare results between groups. Compared with control group, patients who exercised showed improved cognitive function in immediate memory (p < 0.001) and delayed recall (p = 0.004) function. In addition, activities associated with daily living showed improvement (p < 0.001), as did body movement (p < 0.05), arm stability (p < 0.001), and the appearance of rotation (p < 0.05). Based on these results, we conclude that participation in an exercise program can improve patients’ cognitive function, physical abilities, and body movement capacity. PMID:25419345

  12. Improving patient safety in radiation oncology

    SciTech Connect

    Hendee, William R.; Herman, Michael G.

    2011-01-15

    Beginning in the 1990s, and emphasized in 2000 with the release of an Institute of Medicine report, healthcare providers and institutions have dedicated time and resources to reducing errors that impact the safety and well-being of patients. But in January 2010 the first of a series of articles appeared in the New York Times that described errors in radiation oncology that grievously impacted patients. In response, the American Association of Physicists in Medicine and the American Society of Radiation Oncology sponsored a working meeting entitled ''Safety in Radiation Therapy: A Call to Action''. The meeting attracted 400 attendees, including medical physicists, radiation oncologists, medical dosimetrists, radiation therapists, hospital administrators, regulators, and representatives of equipment manufacturers. The meeting was cohosted by 14 organizations in the United States and Canada. The meeting yielded 20 recommendations that provide a pathway to reducing errors and improving patient safety in radiation therapy facilities everywhere.

  13. [Improving patient safety through voluntary peer review].

    PubMed

    Kluge, S; Bause, H

    2015-01-01

    The intensive care unit (ICU) is one area of the hospital in which processes and communication are of primary importance. Errors in intensive care units can lead to serious adverse events with significant consequences for patients. Therefore quality and risk-management are important measures when treating critically ill patients. A pragmatic approach to support quality and safety in intensive care is peer review. This approach has gained significant acceptance over the past years. It consists of mutual visits by colleagues who conduct standardised peer reviews. These reviews focus on the systematic evaluation of the quality of an ICU's structure, its processes and outcome. Together with different associations, the State Chambers of Physicians and the German Medical Association have developed peer review as a standardized tool for quality improvement. The common goal of all stakeholders is the continuous and sustainable improvement in intensive care with peer reviews significantly increasing and improving communication between professions and disciplines. Peer reviews secure the sustainability of planned change processes and consequently lead the way to an improved culture of quality and safety.

  14. Improving patient safety by instructional systems design

    PubMed Central

    Battles, J B

    2006-01-01

    Education and training are important elements in patient safety, both as a potential contributing factor to risks and hazards of healthcare associated injury or harm and as an intervention to be used in eliminating or preventing such harm. All too often we have relied on training as the only interventions for patient safety without examining other alternatives or realizing that, in some cases, the training systems themselves are part of the problem. One way to ensure safety by design is to apply established design principles to education and training. Instructional systems design (ISD) is a systematic method of development of education and training programs for improved learner performance. The ISD process involves five integrated steps: analysis, development, design, implementation, and evaluation (ADDIE). The application of ISD using the ADDIE approach can eliminate or prevent education and training from being a contributing factor of health associated injury or harm, and can also be effective in preventing injury or harm. PMID:17142604

  15. Improving communication among nurses and patients.

    PubMed

    Unluturk, Mehmet S; Ozcanhan, Mehmet H; Dalkilic, Gokhan

    2015-07-01

    Patients use nurse call systems to signal nurses for medical help. Traditional push button-flashing lamp call systems are not integrated with other hospital automation systems. Therefore, nurse response time becomes a matter of personal discretion. The improvement obtained by integrating a pager system into the nurse call systems does not increase care efficiency, because unnecessary visits are still not eliminated. To obtain an immediate response and a purposeful visit by a nurse; regardless of the location of nurse in hospital, traditional systems have to be improved by intelligent telephone system integration. The results of the developed Nurse Call System Software (NCSS), the Wireless Phone System Software (WPSS), the Location System Software (LSS) and the communication protocol are provided, together with detailed XML message structures. The benefits of the proposed system are also discussed and the direction of future work is presented.

  16. Improving communication among nurses and patients.

    PubMed

    Unluturk, Mehmet S; Ozcanhan, Mehmet H; Dalkilic, Gokhan

    2015-07-01

    Patients use nurse call systems to signal nurses for medical help. Traditional push button-flashing lamp call systems are not integrated with other hospital automation systems. Therefore, nurse response time becomes a matter of personal discretion. The improvement obtained by integrating a pager system into the nurse call systems does not increase care efficiency, because unnecessary visits are still not eliminated. To obtain an immediate response and a purposeful visit by a nurse; regardless of the location of nurse in hospital, traditional systems have to be improved by intelligent telephone system integration. The results of the developed Nurse Call System Software (NCSS), the Wireless Phone System Software (WPSS), the Location System Software (LSS) and the communication protocol are provided, together with detailed XML message structures. The benefits of the proposed system are also discussed and the direction of future work is presented. PMID:25935361

  17. Medical advice for commercial air travelers.

    PubMed

    Bettes, T N; McKenas, D K

    1999-09-01

    Family physicians are often asked to advise patients who are preparing to travel. The Air Carrier Access Act of 1986 has enabled more passengers with medical disabilities to choose air travel. All domestic U.S. airlines are required to carry basic (but often limited) medical equipment, although several physiologic stresses associated with flight may predispose travelers with underlying medical conditions to require emergency care. Recommendations for passengers with respiratory, cardiac or postsurgical conditions must be individualized and should be based on objective testing measures. Specific advice for patients with diabetes, postsurgical or otolaryngologic conditions may make air travel less hazardous for these persons. Air travel should be delayed after scuba diving to minimize the chance of developing decompression sickness. Although no quick cure for jet lag exists, several simple suggestions may make travel across time zones more comfortable.

  18. IQuaD dental trial; improving the quality of dentistry: a multicentre randomised controlled trial comparing oral hygiene advice and periodontal instrumentation for the prevention and management of periodontal disease in dentate adults attending dental primary care

    PubMed Central

    2013-01-01

    Background Periodontal disease is the most common oral disease affecting adults, and although it is largely preventable it remains the major cause of poor oral health worldwide. Accumulation of microbial dental plaque is the primary aetiological factor for both periodontal disease and caries. Effective self-care (tooth brushing and interdental aids) for plaque control and removal of risk factors such as calculus, which can only be removed by periodontal instrumentation (PI), are considered necessary to prevent and treat periodontal disease thereby maintaining periodontal health. Despite evidence of an association between sustained, good oral hygiene and a low incidence of periodontal disease and caries in adults there is a lack of strong and reliable evidence to inform clinicians of the relative effectiveness (if any) of different types of Oral Hygiene Advice (OHA). The evidence to inform clinicians of the effectiveness and optimal frequency of PI is also mixed. There is therefore an urgent need to assess the relative effectiveness of OHA and PI in a robust, sufficiently powered randomised controlled trial (RCT) in primary dental care. Methods/Design This is a 5 year multi-centre, randomised, open trial with blinded outcome evaluation based in dental primary care in Scotland and the North East of England. Practitioners will recruit 1860 adult patients, with periodontal health, gingivitis or moderate periodontitis (Basic Periodontal Examination Score 0–3). Dental practices will be cluster randomised to provide routine OHA or Personalised OHA. To test the effects of PI each individual patient participant will be randomised to one of three groups: no PI, 6 monthly PI (current practice), or 12 monthly PI. Baseline measures and outcome data (during a three year follow-up) will be assessed through clinical examination, patient questionnaires and NHS databases. The primary outcome measures at 3 year follow up are gingival inflammation/bleeding on probing at the

  19. Health innovation for patient safety improvement.

    PubMed

    Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

    2013-01-01

    Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.

  20. Health innovation for patient safety improvement.

    PubMed

    Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

    2013-01-01

    Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare. PMID:23423150

  1. Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial

    PubMed Central

    2013-01-01

    Background The European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers. Methods/design In a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling. Discussion Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers. Trial registration ClinicalTrials.gov. Trial identifier: NCT01501552 PMID:23347874

  2. Functional dysphonia: strategies to improve patient outcomes

    PubMed Central

    Behlau, Mara; Madazio, Glaucya; Oliveira, Gisele

    2015-01-01

    Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient’s perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient’s recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for

  3. Early Palliative Care Improves Patients' Quality of Life

    MedlinePlus

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end-of-life ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also leads to ...

  4. Reasons for discharges against medical advice: a qualitative study

    PubMed Central

    Onukwugha, Eberechukwu; Saunders, Elijah; Mullins, C. Daniel; Pradel, Françoise G.; Zuckerman, Marni; Weir, Matthew R.

    2013-01-01

    Background There is limited information in the literature about reasons for discharges against medical advice (DAMA) as supplied by patients and providers. Information about the reasons for DAMA is necessary for identifying workable strategies to reduce the likelihood and health consequences of DAMA. The objective of this study is to identify the reasons for DAMA based on patient and multi-category provider focus group interviews (FGIs). Methods Patients who discharged against medical advice between 2006 and 2008 from a large, academic medical center along with hospital providers reporting contact with patients who left against medical advice were recruited. Three patient-only groups, one physician-only group, and one nurse/social worker group were held. Focus group interviews were transcribed and a thematic analysis was performed to identify themes within and across groups. Participants discussed the reasons for patient DAMA and identified potential solutions. Results Eighteen patients, 5 physicians, 6 nurses and 4 social workers participated in the FGIs. Seven themes emerged across the separate patient, doctor, nurse/social worker group FGIs of reasons why patients leave against medical advice: 1) drug addiction, 2) pain management, 3) external obligations, 4) wait time, 5) doctor’s bedside manner, 6) teaching hospital setting, and 7) communication. Solutions to tackle DAMA identified by participants revolve mainly around enhanced communication and provider education. Conclusions In a large, academic medical center we find some differences and many similarities across patients and providers in identifying the causes of and solutions to DAMA, many of which relate to communication. PMID:20538627

  5. Commentary: improving persistently elevated HbA1c in diabetes mellitus patients in Nigeria.

    PubMed

    Oghagbon, Efosa K

    2014-01-01

    Glycated hemoglobin (HbA1c) level in patients with diabetes reflects quality of disease control and propensity to develop hyperglycemic complications. During more than 12 years of using HbA1c for monitoring of glycemic control among patients at Nigerian hospitals, the mean glycated hemoglobin ranged from 7.9% ± 2.4 to 8.3% ± 2.2. Most of these patients (63% to 68%) had poor glycemic controls with mean HbA1c greater than 7%. Factors that are implicated in this scenario are: 1) high cost of HbA1c testing, 2) ineffective management of risk factors, 3) poor patient compliance, 4) improperly managed diabetes education program, and 5) health care system defect. Central to improving diabetes glycemia is education of doctors, other health workers and patients, within the confines of an overhauled national health system. Physicians need to increase adherence to diabetes mellitus management guidelines and patients must be enrolled into a well-structured education program at health centers. Doctors, as leader of the health team, should drive such education schemes, which must be based on standard training curriculum, sufficient number of trained diabetes educators, and effective monitoring of patients. The most appropriate diabetes education model features small-to-moderate sized participant groups and makes use of motivational interviewing rather than a traditional advice-giving format. Improved health care funding is mandatory given the issue of cost and this can be helped by increased participation of patients in Nigeria's National Health Insurance Scheme. Failure to address the persistently elevated HbA1c will affect long-term quality of life, longevity and health care services in Nigeria.

  6. Young People's Use of Friends and Family for Sex and Relationships Information and Advice

    ERIC Educational Resources Information Center

    Powell, Eryl

    2008-01-01

    With the recognition that improving access to advice and support on sex and relationships is vital in helping young people make positive healthy choices, the present paper explores how young people gain such information and advice. Drawing on the analysis of questionnaire and interview data collected for a local study of 401 young people from…

  7. 41 CFR 105-50.202-7 - Technical information and advice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... information, personnel management systems services, and technical advice on improving logistical and... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Technical information and advice. 105-50.202-7 Section 105-50.202-7 Public Contracts and Property Management...

  8. Advice from working women with retired partners.

    PubMed

    Cooley, Eileen L; Adorno, Gail

    2016-01-01

    in the 21st century, as more women are employed full-time and couples increasingly share egalitarian values, more women continue employment after their partners have voluntarily retired. However, we know very little about the experiences of this growing population of women. We asked working women with retired partners to share their advice for other women who may face this developmental transition. Open-ended responses from 97 women were analyzed to identify pertinent issues and themes. Four primary content areas were identified: time management, division of household labor, financial planning, and communication. Communication between partners was both a topic of concern as well as the solution suggested to resolve conflicts or differences that may arise when women live with a retired partner. It is expected that future changes in the workforce and improvements in the gender balance within relationships will continue to impact experiences for working women with retired partners.

  9. Advice from working women with retired partners.

    PubMed

    Cooley, Eileen L; Adorno, Gail

    2016-01-01

    in the 21st century, as more women are employed full-time and couples increasingly share egalitarian values, more women continue employment after their partners have voluntarily retired. However, we know very little about the experiences of this growing population of women. We asked working women with retired partners to share their advice for other women who may face this developmental transition. Open-ended responses from 97 women were analyzed to identify pertinent issues and themes. Four primary content areas were identified: time management, division of household labor, financial planning, and communication. Communication between partners was both a topic of concern as well as the solution suggested to resolve conflicts or differences that may arise when women live with a retired partner. It is expected that future changes in the workforce and improvements in the gender balance within relationships will continue to impact experiences for working women with retired partners. PMID:26933760

  10. Trust in Sources of Advice about Infant Care Practices: The SAFE Study.

    PubMed

    Hwang, Sunah S; Rybin, Denis V; Heeren, Timothy C; Colson, Eve R; Corwin, Michael J

    2016-09-01

    Objectives (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Methods Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2-6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination. Weighted frequencies of maternal trust in advice sources were calculated to obtain prevalence estimates. Multivariable logistic regression was used to assess the association of maternal and infant characteristics with maternal trust in advice sources. Results Mothers had the greatest trust in doctors for advice on all infant care practices (56-89 %), while trust was lowest for friends (13-22 %) and the media (10-14 %). In the adjusted analyses, there were significant associations of maternal race/ethnicity, education, and age with trust in advice sources. Conclusions for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices. PMID:27129949

  11. Integrating specialist advice following reforms: an interview-based survey

    PubMed Central

    Naik, Yannish Jones; Anderton, Caroline; Fell, Greg

    2013-01-01

    Objectives To investigate the importance of incorporating secondary care input to aid commissioning following National Health Service reforms which will see the replacement of Primary Care Trusts with Clinical Commissioning Groups; to determine barriers that might arise given that this issue had been raised during public consultations and to explore ways to improve this input. Design Qualitative project with semistructured one-to-one interviews which were audio recorded, transcribed and analysed using thematic content analysis by two investigators. The findings were discussed and organized into a framework. Setting Bradford and Airedale, UK. Participants We interviewed 19 participants from primary care, the medical directorship and a range of specialties. Main outcome measures One-to-one semistructured interviews allowed a flexible dialogue to discuss planned questions and any other themes which participants brought up. This elicited a variety of experiences and ideas which provided the basis for in depth theoretical analysis required for our objectives. Results There was an almost universal agreement that the integration of secondary care advice is important in commissioning. The main perceived barriers were obstacles to good communication and relationships, conflicts of interest and financial pressures. Participants suggested varied and innovative ways to improve communication and integration, and suggestions for organisations. Conclusions Our results support the importance of secondary care input and highlight communication, organisation and integration as three goals for organisations to work towards. Successful achievement of these objectives could have financial implications for organisations as well as benefits for patient care. PMID:23560224

  12. Psychological effects of prescriptive vs general lifestyle advice for weight loss in young women.

    PubMed

    Lim, Siew S; Norman, Robert J; Clifton, Peter M; Noakes, Manny

    2009-11-01

    This study aimed to investigate the effects of prescriptive lifestyle advice with quantifiable dietary and physical goals compared to general lifestyle advice on weight and psychological outcomes in young women with overweight or obesity. A total of 203 women (body mass index 33.3+/-0.3, age 28+/-0.3 years) received either prescriptive or general lifestyle advice for weight loss over 12 weeks. Linear mixed models found that the prescriptive lifestyle advice group had significantly greater weight loss (4.2+/-0.4 kg vs 0.6+/-0.2 kg, P<0.001) compared to the general lifestyle advice group. However, the prescriptive lifestyle advice group also had greater attrition (48% vs 31%, P<0.05) compared to the general lifestyle advice group. Linear mixed models found that the prescriptive lifestyle advice group had greater improvement in psychological distress (-3.0+/-0.04 vs -1.1+/-0.01, P<0.05) and in self-esteem (3.2+/-0.8 vs -0.04+/-0.04, P<0.001) compared to the general lifestyle advice group. Changes in psychological distress and self-esteem remained significantly different between groups after correcting for weight loss. Food cravings decreased significantly over time without group differences (P<0.001 for time). Weight locus of control remained unchanged in either group (P>0.05). Drop-outs had greater baseline psychological distress (15.1+/-0.7 vs 12.5+/-0.4, P<0.01) and higher food cravings (2.42+/-0.07 vs 2.24+/-0.05, P=0.049) compared to completers. In conclusion, a prescriptive approach is associated with greater weight loss and greater improvements in psychological outcomes in young women compared to general lifestyle advice. However, these quantitative targets should be accompanied with qualitative advice on how they could be met in a variety of circumstances.

  13. 5 CFR 2635.107 - Ethics advice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Ethics advice. 2635.107 Section 2635.107 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH General Provisions § 2635.107 Ethics advice. (a) As required by §§...

  14. 5 CFR 2635.107 - Ethics advice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Ethics advice. 2635.107 Section 2635.107 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH General Provisions § 2635.107 Ethics advice. (a) As required by §§...

  15. 5 CFR 2635.107 - Ethics advice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Ethics advice. 2635.107 Section 2635.107 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH General Provisions § 2635.107 Ethics advice. (a) As required by §§...

  16. 16 CFR 1.3 - Advice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Advice. 1.3 Section 1.3 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE GENERAL PROCEDURES Industry Guidance Advisory Opinions § 1.3 Advice. (a) On the basis of the materials submitted, as well as any...

  17. Congratulations! Now What? Advice for New Presidents.

    ERIC Educational Resources Information Center

    Strauss, Jon C.

    1996-01-01

    An experienced college president offers sometimes tongue-in-cheek advice to new presidents, including insights into relationships with constituencies, interpersonal skills, the role of the spouse, accepting advice, sharing confidences, persistence, choosing priorities for change, audience awareness in public speaking, development, community…

  18. 5 CFR 2635.107 - Ethics advice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Ethics advice. 2635.107 Section 2635.107 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH General Provisions § 2635.107 Ethics advice. (a) As required by §§...

  19. 5 CFR 2635.107 - Ethics advice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Ethics advice. 2635.107 Section 2635.107 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH General Provisions § 2635.107 Ethics advice. (a) As required by §§...

  20. 5 CFR 2641.105 - Advice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... formerly served has the primary responsibility to provide oral or written advice concerning a former... on the oral or written advice of an agency ethics official or the OGE cannot ensure that a former..., such as those before whom a post-employment communication or appearance is contemplated, and with...

  1. Young Children's Trust in Overtly Misleading Advice

    ERIC Educational Resources Information Center

    Heyman, Gail D.; Sritanyaratana, Lalida; Vanderbilt, Kimberly E.

    2013-01-01

    The ability of 3- and 4-year-old children to disregard advice from an overtly misleading informant was investigated across five studies (total "n" =212). Previous studies have documented limitations in young children's ability to reject misleading advice. This study was designed to test the hypothesis that these limitations are primarily due to an…

  2. Improving the revenue cycle by taking the patient's perspective.

    PubMed

    Langford, April; Dye, Lyda; Moresco, Jessica; Riefner, Donald C

    2010-09-01

    UPMC revenue cycle operations analyzed front-end processes to improve them, thereby also improving the patient experience. UPMC focused on scheduling, eligibility/insurance verification, and financial counseling to develop an integrated work flow ensuring data integrity and expediting account resolution. Automating the processes increased efficiency and reduced errors, while improving patient satisfaction.

  3. Improving the quality of patient handover on a surgical ward.

    PubMed

    Bradley, Alison

    2014-01-01

    The European Working Time Directive means safe patient hand over is imperative. It is the responsibility of every doctor and an issue of patient safety and clinical governance [1]. The aims of this project were to improve the quality of patient handover between combined assessment unit (CAU) and surgical ward FY1 doctors. The Royal College of Surgeons England (RCSEng) guidelines on surgical patient handover [1] were used as the standard. Data was collected throughout November 2013. A handover tool was then introduced and attached to the front of patient notes when a patient was transferred from CAU to the surgical ward. The doctor handing over the patient and the ward doctor receiving the handover signed this document. Policy was also changed so that handover should take place once the patient had received senior review on the CAU and was deemed appropriate for transfer to the surgical ward. Data from the handover tool was collated and checked against the list of surgical admission for February 2014. The number of patients handed over improved from 15 % to 45%. The quality of patient handover also improved. 0 patient handovers in November 2013 included all of the information recommended by the RCSEng guidelines. 100% of the patient handovers in February 2014 contained all the recommended information. Introduction of a handover tool and formalisation of timing of patient handover helped to improve quality and number of patients being handed over. Further work needs to be done to improve safe handover of surgical patients, particularly out of hours.

  4. The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners.

    PubMed Central

    Swinburn, B A; Walter, L G; Arroll, B; Tilyard, M W; Russell, D G

    1998-01-01

    OBJECTIVES: The purpose of this study was to determine whether written advice from general practitioners increases physical activity among sedentary people more than verbal advice alone. METHODS: Sedentary patients (n = 456) received verbal advice on increasing physical activity and were then randomized to an exercise prescription (green prescription) group or a verbal advice group. RESULTS: The number of people engaging in any recreational physical activity at 6 weeks increased substantially, but significantly more so in the green prescription group. Also, more participants in the green prescription group increased their activity over the period. CONCLUSIONS: A written goal-oriented exercise prescription, in addition to verbal advice, is a useful tool for general practitioners in motivating their parents to increase physical activity. PMID:9491025

  5. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults

    PubMed Central

    Desroches, Sophie; Lapointe, Annie; Ratté, Stéphane; Gravel, Karine; Légaré, France; Turcotte, Stéphane

    2016-01-01

    Background It has been recognized that poor adherence can be a serious risk to the health and wellbeing of patients, and greater adherence to dietary advice is a critical component in preventing and managing chronic diseases. Objectives To assess the effects of interventions for enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. Search methods We searched the following electronic databases up to 29 September 2010: The Cochrane Library (issue 9 2010), PubMed, EMBASE (Embase.com), CINAHL (Ebsco) and PsycINFO (PsycNET) with no language restrictions. We also reviewed: a) recent years of relevant conferences, symposium and colloquium proceedings and abstracts; b) web-based registries of clinical trials; and c) the bibliographies of included studies. Selection criteria We included randomized controlled trials that evaluated interventions enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. Studies were eligible if the primary outcome was the client’s adherence to dietary advice. We defined ‘client’ as an adult participating in a chronic disease prevention or chronic disease management study involving dietary advice. Data collection and analysis Two review authors independently assessed the eligibility of the studies. They also assessed the risk of bias and extracted data using a modified version of the Cochrane Consumers and Communication Review Group data extraction template. Any discrepancies in judgement were resolved by discussion and consensus, or with a third review author. Because the studies differed widely with respect to interventions, measures of diet adherence, dietary advice, nature of the chronic diseases and duration of interventions and follow-up, we conducted a qualitative analysis. We classified included studies according to the function of the intervention and present results in a narrative table using vote counting for each category of intervention. Main results

  6. Pharmacist advice to asthmatics regarding antihistamine use.

    PubMed

    Lantner, R; Tobin, M C

    1991-05-01

    Due to the frequency of asthmatics having concurrent allergic symptoms, patients may seek relief from antihistamines, which are currently labeled with warnings against their use in asthmatics. A survey was conducted in the Chicago area to evaluate the advice rendered by pharmacists regarding the use of antihistamines in asthmatics and their opinions about the current product labeling. Thirty percent of the surveys were returned. Nearly half (48%) of the surveyed pharmacists advise their asthmatic customers to avoid antihistamines and 75% of this group recommend avoidance because they believe antihistamines worsen asthmatic symptoms, despite the lack of sufficient clinical data to support this concern. Only 17% of pharmacists advise that antihistamines pose no problems for asthmatics. The latter group is the most aware that there is controversy surrounding the current labeling. Overall, half the pharmacists surveyed believe the current labeling is not appropriate for patients with asthma. Until the labeling is revised, physicians should be aware that pharmacists may advise their asthmatics against using antihistamines even though antihistamines should be only contraindicated in cases of proven adverse reactions. PMID:2035904

  7. Look Through Patients' Eyes to Improve the Delivery of Care.

    PubMed

    2016-07-01

    By developing and implementing a method for seeing the healthcare experience from the standpoint of patients and family members, the University of Pittsburgh Medical Center has improved care delivery, lowered costs, and improved patient satisfaction. Cross-functional, multidisciplinary teams use a six-step patient and family-centered care methodology to identify gaps and develop changes that will improve the patient experience and clinical outcomes. Committee members shadow patients and family members to get firsthand knowledge about what they are going through and what goes wrong and what goes right. The teams proposed minor and major changes, but none involve adding more staff and few involve more expenditures. PMID:27434940

  8. Improved patient pathways can prevent overcrowding.

    PubMed

    Emeny, Russell; Vincent, Connolly

    2013-03-01

    Emergency department (ED) crowding is a common problem throughout the western world. Not only does crowding create a miserable environment for patients, and to considerable stress and poor job satisfaction among staff, it can also lead EDs to breach the four-hour standard and other care quality indicators. In addition, crowding in EDs correlates with increases in patient mortality, rates of admission, lengths of inpatient stay and costs. This article argues that crowding is best tackled by the consistent application of eight principles, derived from various guidance, to emergency patient pathways, particularly those in acute settings. PMID:23586168

  9. Doing research in general practice: advice for the uninitiated.

    PubMed

    Pierce, M

    1998-11-01

    There is increasing recognition of the importance of primary care research in relation to diabetes. Doing research in general practice is in many ways different from the hospital setting. This article considers some of the potential barriers to doing valid and reliable research in general practice. It is written for both novice researchers and researchers new to the general practice setting. Careful initial definition of the research question is crucial, especially as the clinical material may be less well defined in general practice and patients' problems need addressing on many levels (physical, psychological, social, cultural). Searching the literature for general practice-based studies is not straightforward. If your study involves more than one geographical site you may have to obtain ethical approval from multiple research ethical committees, and it is prudent to discuss your research with the Local Medical Committee. Practical advice is given on working with practices: improving response rates from questionnaires; recruiting and retaining practices; 'getting hold' of the GPs; particular difficulties related to novice or experienced practices; ensuring uniformity of methodology; and the importance of ancillary staff. Contentious issues such as money should be discussed at the outset. Many areas of the country now have General Practice Research Networks, and many of these now have NHS R&D support funding. Training in research methodology can be accessed through the Association of University Departments of General Practice or Royal College of General Practitioners or local departments of general practice. A list of useful contacts is given.

  10. Resources available to help family physicians provide advice to travellers.

    PubMed Central

    Lechky, O

    1995-01-01

    Because many Canadians are travelling to exotic destinations, family physicians may be asked for advice on immunization and health tips to prevent illnesses such as malaria, altitude disease, meningitis and schistosomiasis. A Toronto family physician who is on staff at a travel clinic says a few guiding principles and good resources can help family physicians ensure that their patients are healthy when they return from a trip. PMID:7553504

  11. Hospital Admission for Schizophrenia and Discharge Against Medical Advice in the United States

    PubMed Central

    Robison, Linda M.

    2010-01-01

    Objective: Hospital discharge against medical advice may leave a patient at risk for adverse health outcomes and/or readmission, yet little is known regarding its occurrence, especially among patients with mental illness. The objective of this study was to discern the prevalence of, and predictive factors for, being discharged against medical advice among hospitalized patients with a primary diagnosis of schizophrenia. Method: The 2004 US Healthcare Cost and Utilization Project Nationwide Inpatient Sample was used to discern demographic predictors, length of stay, and costs for discharge against medical advice relative to discharge with medical approval. Inpatient discharges from US community hospitals for patients of all ages with The International Classification of Diseases, 9th Revision, Clinical Modification diagnostic codes 295.0–295.9 were included. Conditional logistic regression was used to discern factors predictive of discharge against medical advice, and least squares mean analysis was used to examine differences in length of stay and mean cost per day relative to discharge with medical approval. Least squares means were adjusted for age (continuous), sex, race, region, payer, hospital setting, and bed size. Results: Within the study population, 1.6% of patients admitted for schizophrenia were discharged against medical advice (n = 3,382/210,722). Patients discharged against medical advice were significantly more likely to be younger (OR = 0.985, 95% CI, 0.982–0.987) and male (OR = 1.421, 95% CI, 1.321–1.529). Race was not a significant factor. Mean ± SE length of stay for discharge against medical advice was 5.0 ± 0.24 days, as compared to 8.7 ± 0.06 days for patients discharged with medical approval (P < .0001). Mean cost per day was significantly higher for discharge against medical advice ($1,886.02 ± 49.67 vs $1,565.79 ± 13.42, P < .0001). Conclusions: Although the percentage of patients discharged against medical advice was small, the

  12. Treatment of Forefoot Problems in Older People: A Randomized Clinical Trial Comparing Podiatric Treatment With Standardized Shoe Advice

    PubMed Central

    van der Zwaard, Babette C.; van der Horst, Henriëtte E.; Knol, Dirk L.; Vanwanseele, Benedicte; Elders, Petra J. M.

    2014-01-01

    PURPOSE Consultations for forefoot pain are frequent in primary care, but scientific support of treatment options is scarce. The purpose of this study is to investigate the effect of podiatric treatment vs standardized advice on proper shoe characteristics and fit of shoes by means of an information leaflet for people aged 50 years and older with forefoot pain in primary care. METHODS In this randomized controlled trial, 205 participants aged 50 years and older with hindering nontraumatic forefoot pain have been recruited at their general practitioner’s office. Exclusion criteria were treatment of forefoot problem of less than 6 months’ duration before inclusion, rheumatoid arthritis, and diabetic neuropathy or having pain considered not to be musculoskeletal (eg, warts). Participants received shoe advice by means of an information leaflet or podiatric care. Foot pain, foot-related dysfunction, general health, and social participation were assessed by means of questionnaires every 3 months for 1 year. Using multilevel analysis, we analyzed results at the level of (1) outcome measures, (2) the individual, and (3) the general practitioner. RESULTS No differences were found between the 2 treatment groups. Both intervention groups showed an improvement over time in foot pain and foot-related dysfunction. CONCLUSION This study found that shoe advice provided to patients consulting their general practitioner for forefoot pain and symptom relief resulted in outcomes similar to treatment outcomes in patients consulting a podiatrist. Based on these results, primary care physicians should be cautious when referring a patient to a podiatrist; instead, they should start by providing advice on proper characteristics and fit of shoes. PMID:25354407

  13. Improving patient safety: lessons from other disciplines.

    PubMed

    Golemboski, Karen

    2011-01-01

    Other industries and certain healthcare specialties have employed a variety of methods to improve safety and quality of services. Techniques such as industry-wide standardized collection and reporting of error data, standardization of practice through checklists, application of electronic health records, and simulator-based interdisciplinary training have improved outcomes in aviation, anesthesiology, and surgery. Although traditionally the clinical laboratory has concentrated on analytical performance, pre- and post-analytical aspects of laboratory services may also be improved through the application of these methods. PMID:21657145

  14. Zika Virus Advice for Mountaineers: A UIAA Medcom Consensus Advice Sheet.

    PubMed

    Hillebrandt, David; Richards, Paul; Clark, Andy; Jean, Dominique

    2016-06-01

    Hillebrandt, David, Paul Richards, Andy Clark, and Dominique Jean. Zika virus advice for mountaineers: A UIAA Medcom consensus advice sheet. High Alt Med Biol. 17:70-71, 2016.-With the current media coverage of the spread of Zika virus from Africa and Asia to Central and South America and its possible relationship with fetal abnormalities, UIAA Medcom has produced an advice sheet for mountaineers visiting risk areas.

  15. Improving outcomes in patients with cystic fibrosis.

    PubMed

    Warwick, Geoffrey; Elston, Caroline

    2011-01-01

    Cystic fibrosis (CF) is the most common fatal inherited disease in Caucasian people. Inheritance follows an autosomal recessive pattern. Recent data indicate that there are more than 9,000 patients with CF in the UK. At a cellular level there is an abnormal CF transmembrane conductance regulator (CFTR), a protein essential for chloride and sodium homoeostasis, caused by a mutation in the CF gene. The consequence of this abnormal protein is thick, viscous secretions in the lungs and GI tract, which lead to recurrent lung infections and pancreatic insufficiency with intestinal malabsorption. Most patients present in early childhood with classic CF. They show one or more of the typical CF phenotypic characteristics (chronic pulmonary disease, GI symptoms and malabsorption, nutritional abnormalities and sinus disease). A minority of patients have atypical CF. They tend to present at an older age, often in adulthood, are mainly pancreatic sufficient, have milder disease and a better prognosis. When CF is suspected the diagnosis can be confirmed by measuring sweat chloride concentration and by looking for CFTR mutations. Immunoreactive trypsinogen is measured in blood taken from a heel prick in all neonates, and is a marker of pancreatic injury consistent with (but not specific for) CF. PMID:21932505

  16. Accelerating patient-care improvement in the ED.

    PubMed

    Forrester, Nancy E

    2003-08-01

    Quality improvement is always in the best interest of healthcare providers. One hospital examined the patient-care delivery process used in its emergency department to determine ways to improve patient satisfaction while increasing the effectiveness and efficiency of healthcare delivery. The hospital used activity-based costing (ABC) plus additional data related to rework, information opportunity costs, and other effectiveness measures to create a process map that helped it accelerate diagnosis and improve redesign of the care process. PMID:12938618

  17. Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

    PubMed

    Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

    2015-09-01

    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities. PMID:26252725

  18. Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

    PubMed

    Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

    2015-09-01

    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

  19. Regional anesthesia for the trauma patient: improving patient outcomes.

    PubMed

    Gadsden, Jeff; Warlick, Alicia

    2015-01-01

    Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile. PMID:26316813

  20. Reducing PICC migrations and improving patient outcomes.

    PubMed

    Elen Hughes, Meinir

    Inadvertent migration of central venous catheters can lead to several issues including delayed therapy and clinical morbidities such as thrombosis. Peripherally inserted central catheters (PICCs) are particularly at risk of movement. An innovative new device which allows anchorage of the catheter has proved very successful in the minimisation of catheter migration. The SecurAcath device incorporates a small blunt anchor which lies beneath the skin in order to secure the catheter in place and prevent inadvertent movement. An evaluation of 31 patients with a SecurAcath device in situ to secure a PICC found only one case of insignificant catheter migration. Some initial problems with infection and pain were encountered and interventions were put in place to minimise their incidence. SecurAcath removal proved to be the most significant challenge but this can be overcome with suitable guidance and training.

  1. Improving Patient Flow Utilizing a Collaborative Learning Model.

    PubMed

    Tibor, Laura C; Schultz, Stacy R; Cravath, Julie L; Rein, Russell R; Krecke, Karl N

    2016-01-01

    This initiative utilized a collaborative learning approach to increase knowledge and experience in process improvement and systems thinking while targeting improved patient flow in seven radiology modalities. Teams showed improvements in their project metrics and collectively streamlined the flow for 530 patients per day by improving patient lead time, wait time, and first case on-time start rates. In a post-project survey of 50 project team members, 82% stated they had more effective solutions as a result of the process improvement methodology, 84% stated they will be able to utilize the process improvement tools again in the future, and 98% would recommend participating in another project to a colleague. PMID:27514106

  2. Understanding barriers to following advice: Evaluation of an advisory service from dairy farmers' perspectives.

    PubMed

    Jensen, Katharina Charlotte; Scheu, Theresa; Duc, Phuong Do; Gundling, Frieder; Wichern, Anika; Hemmel, Malin; Hoedemaker, Martina; Wellbrock, Wiebke; Campe, Amely

    2016-01-01

    In dairy herd health medicine, the success of consultation is sometimes limited as farmers do not always implement given advice. Therefore, the objective of this study was to evaluate a consultation performed during a study in the northwest of Germany and thereby to detect barriers that hinder farmers with long lasting problems in herd health from implementing veterinary advice. Six to twelve months after a non-recurring extensive herd health analysis and consultation, 38 farmers were interviewed by phone. Nearly all farmers were content with the farm visit, and 79% of the farmers stated that they had implemented at least some of the advice. This shows that farmers appreciated this service in general and were willing to follow advice. Even though the results cannot be generalized, factors that could be considered by advisors to improve the success of consultation were detected: Reasons as to why the advice was rejected were mostly related to farmers' expectations. Implementing only some of the advice was caused by a lack of time, self-discipline, money, and a lacking farm successor. Factors that pleased farmers were friendliness of the study veterinarians, in-depth examinations, handling of cows, good advice and how well organized the farm visit was. Factors that displeased the farmers were usually indicated only by one farmer each. Other factors influencing the success of consultation were the teamwork with the practising veterinarian, the self-evaluation of the farmers and the desire of the farmers for a single reason for the herd health problems.

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

    PubMed

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

    2016-01-01

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

  4. "Psst... What Do You Think?" The Relationship between Advice Prestige, Type of Advice, and Academic Performance

    ERIC Educational Resources Information Center

    Smith, Rachel A.; Peterson, Brittany L.

    2007-01-01

    This study investigates the relationship between classmates seeking out a student for advice (advice prestige) and that student's academic performance. Students' conversations could inhibit or encourage their academic performance depending on the conversation's topic. Specifically, it is hypothesized that as more classmates report asking a student…

  5. Effect of a monthly dose of calcidiol in improving vitamin D deficiency and secondary hyperparathyroidism in HIV-infected patients.

    PubMed

    Bañón, Sara; Rosillo, Marta; Gómez, Ana; Pérez-Elias, María J; Moreno, Santiago; Casado, José Luis

    2015-06-01

    There are no data about the optimal supplementation therapy in HIV-infected patients with vitamin D (25OHD) deficiency. The aim of this study was to assess the effect of an oral monthly dose of 16,000 IU calcidiol. We performed a longitudinal cohort study of 365 HIV-infected patients (24 % females) was with sequential determinations of 25OHD, serum parathyroid hormone (PTH), calcium, and alkaline phosphatase. The efficacy and safety of supplementation in 123 patients were compared against dietary and sun exposure advice. Overall, mean baseline 25OHD levels were 19.1 ng/ml (IQR 12-23.6), 63 % of patients had 25OHD deficiency and 27 % secondary hyperparathyroidism. After a median time of 9.3 months (95.61 patients-year on-treatment), 25OHD levels increased in comparison with non-supplemented patients (+16.4 vs. +3.2 ng/ml; p < 0.01), decreasing the rate of 25OHD deficiency (from 84 to 24 %), and decreasing serum PTH (-4.9 pg/ml) and the rate of secondary hyperparathyroidism (from 43 to 31 %; p < 0.001). This improvement was observed irrespective of HIV/HCV coinfection or the use of efavirenz. In a regression analysis, adjusting by seasonality, a lower baseline 25OHD was associated with persistence of deficiency (relative risk, RR 1.07; 95 % CI 1.03-1.1; p < 0.001), whereas calcidiol supplementation was the only factor associated with significant improvement (RR 0.38; 95 % CI 0.12-0.46; p < 0.001). This monthly dose showed no clinical toxicity, and no patient had 25OHD levels above 100 ng/ml, nor hypercalcemia. The use of monthly calcidiol is safe, easy to take, and largely effective to improve vitamin D deficiency and secondary hyperparathyroidism in HIV-infected patients.

  6. Disparities in Who Receives Weight-Loss Advice From a Health Care Provider: Does Income Make a Difference?

    PubMed Central

    Lorts, Cori

    2016-01-01

    Introduction The US Preventive Services Task Force recommends that all patients be screened for obesity and, if needed, be provided weight-loss advice. However, the prevalence of such advice is low and varies by patient demographics. This study aimed to describe the determinants of receiving weight-loss advice among a sample with a high proportion of low-income, racial/ethnic minority individuals. Methods Data were collected from a telephone survey of 1,708 households in 2009 and 2010 in 5 cities in New Jersey. Analyses were limited to 1,109 overweight or obese adults. Multivariate logistic regression determined the association of participants’ characteristics with receiving weight-loss advice from their health care provider. Two models were used to determine differences by income and insurance status. Results Of all overweight or obese respondents, 35% reported receiving advice to lose weight. Receiving advice was significantly associated with income in multivariate analysis. Compared with those with an income at or below 100% of the federal poverty level (FPL), those within 200% to 399% of the FPL had 1.60 higher odds of receiving advice (P = .02), and those with an income of 400% or more of the FPL had 1.73 higher odds of receiving advice (P = .03). The strength of the association did not change after adjusting for health insurance. Conclusion Income is a significant predictor of whether or not overweight or obese adults receive weight-loss advice after adjustment for demographic variables, health status, and insurance status. Further work is needed to examine why disparities exist in who receives weight-loss advice. Health care providers should provide weight-loss advice to all patients, regardless of income. PMID:27710763

  7. Combining Chemotherapy with Bevacizumab Improves Outcomes for Ovarian Cancer Patients

    Cancer.gov

    Results from two phase III randomized clinical trials suggest that, at least for some patients with ovarian cancer, adding the antiangiogenesis agent bevacizumab to chemotherapy increases the time to disease progression and may improve survival.

  8. Weight Advice Associated With Male Firefighter Weight Perception and Behavior

    PubMed Central

    Brown, Austin L.; Poston, Walker S.C.; Jahnke, Sara A.; Haddock, C. Keith; Luo, Sheng; Delclos, George L.; Day, R. Sue

    2016-01-01

    Introduction The high prevalence of overweight and obesity threatens the health and safety of the fire service. Healthcare professionals may play an important role in helping firefighters achieve a healthy weight by providing weight loss counseling to at-risk firefighters. This study characterizes the impact of healthcare professional weight loss advice on firefighter weight perceptions and weight loss behaviors among overweight and obese male firefighters. Methods A national sample of 763 overweight and obese male firefighters who recalled visiting a healthcare provider in the past 12 months reported information regarding healthcare visits, weight perceptions, current weight loss behaviors, and other covariates in 2011–2012. Analyzed in 2013, four unique multilevel logistic regression models estimated the association between healthcare professional weight loss advice and the outcomes of firefighter-reported weight perceptions, intentions to lose weight, reduced caloric intake, and increased physical activity. Results Healthcare professional weight loss advice was significantly associated with self-perception as overweight (OR=4.78, 95% CI=2.16, 10.57) and attempted weight loss (OR=2.06, 95% CI=1.25, 3.38), but not significantly associated with reduced caloric intake (OR=1.26, 95% CI=0.82, 1.95) and increased physical activity (OR=1.51, 95% CI=0.89, 2.61), after adjusting for confounders. Conclusions Healthcare professional weight loss advice appears to increase the accuracy of firefighter weight perceptions, promote weight loss attempts, and may encourage dieting and physical activity behaviors among overweight firefighters. Healthcare providers should acknowledge their ability to influence the health behaviors of overweight and obese patients and make efforts to increase the quality and frequency of weight loss recommendations for all firefighters. PMID:26141913

  9. Practice improvement, part II: update on patient communication technologies.

    PubMed

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support. PMID:24261435

  10. Business Advice Meets Academic Culture

    ERIC Educational Resources Information Center

    Blumenstyk, Goldie

    2012-01-01

    The University of North Texas at Dallas (UNT-Dallas) was conceived 10 years ago as a public institution along tried-and-true lines--a comprehensive metropolitan university meant to serve a diverse student population and to improve the economic outlook of a part of the city that prosperity has left behind. But that was before management consultants…

  11. Operative treatment improves patient function in recalcitrant medial epicondylitis.

    PubMed

    Shahid, M; Wu, F; Deshmukh, S C

    2013-10-01

    The purpose of this retrospective study was to assess the outcome of open surgery for patients with recalcitrant medial epicondylitis following failed conservative management. The clinical results are presented for 15 patients (17 elbows) who were reviewed at a mean follow-up of 66 months. Operative treatment improved patient function significantly with a mean increase in grip strength of 10kg and a mean decrease (improvement) in DASH (Disabilities of the Arm, Shoulder and Hand) score of 25.7. All but one patient experienced little or no residual elbow discomfort and had excellent Mayo elbow performance scores postoperatively. Eleven of the twelve patients who were previously in employment were able to return to work within eight weeks of surgery. This study demonstrates that operative treatment for recalcitrant medial epicondylitis is effective in restoring patient function and strength.

  12. The best advice I ever got.

    PubMed

    Wademan, Daisy

    2005-01-01

    A young manager faces an impasse in his career. He goes to see his mentor at the company, who closes the office door, offers the young man a chair, recounts a few war stories, and serves up a few specific pointers about the problem at hand. Then, just as the young manager is getting up to leave, the elder executive adds one small kernel of avuncular wisdom--which the junior manager carries with him through the rest of his career. Such is the nature of business advice. Or is it? The six essays in this article suggest otherwise. Few of the leaders who tell their stories here got their best advice in stereotypical form, as an aphorism or a platitude. For Ogilvy & Mather chief Shelly Lazarus, profound insight came from a remark aimed at relieving the tension of the moment. For Novartis CEO Daniel Vasella, it was an apt comment, made on a snowy day, back when he was a medical resident. For publishing magnate Earl Graves and Starwood Hotels' Barry Sternlicht, advice they received about trust from early bosses took on ever deeper and more practical meaning as their careers progressed. For Goldman Sachs chairman Henry Paulson, Jr., it was as much his father's example as it was a specific piece of advice his father handed down to him. And fashion designer Liz Lange rejects the very notion that there's inherent wisdom in accepting other people's advice. As these stories demonstrate, people find wisdom when they least expect to, and they never really know what piece of advice will transcend the moment, profoundly affecting how they later make decisions, evaluate people, and examine--and reexamine--their own actions. PMID:15697111

  13. [Strategies for improving care of oncologic patients: SHARE Project results].

    PubMed

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

  14. Agomelatine improves sleep in a patient with fatal familial insomnia.

    PubMed

    Froböse, T; Slawik, H; Schreiner, R; Veselý, Z; Wiegand, M; Bäuml, J; Förstl, H

    2012-01-01

    A young patient with FFI was started on agomelatine 25 mg to medicate nocturnal insomnia. Under this treatment sleep efficiency was improved, slow wave sleep was high and awakenings during sleep period time were far less than before. Clinically the patient was less restless during nighttime.

  15. Mothers' advice about facilitating breastfeeding in a neonatal intensive care unit.

    PubMed

    Nyqvist, K H; Sjödén, P O; Ewald, U

    1994-12-01

    Admission of newborn infants to neonatal intensive care units (NICU) has been considered an obstacle to breastfeeding because of mother-infant separation and hospital feeding routines. In order to obtain advice on facilitating breastfeeding, we interviewed by telephone 178 mothers of fullterm NICU patients three months after the infants' discharge from hospital. Mothers' advice, in order of prominence, concerned the disturbing impact of the NICU environment, lack of systematic breastfeeding advice, distance between infants' and mothers' units in the hospital, conflicts about parents' roles, perceived lack of organization of work, dissatisfaction with nurse behavior towards parents, and importance of skin-to-skin contact during the mother's first visit. Adaptation of the NICU environment, nurses' awareness of mothers' perspectives, and nurse attitudes and behavior change appear to be as important for facilitating breastfeeding as are routines for breastfeeding advice.

  16. [The Health Council of the Netherlands' advice on Lyme disease].

    PubMed

    Verbon, Annelies

    2013-01-01

    There are many misconceptions about Lyme disease. At the initiative of the Dutch Association for Lyme Patients, the Lower House of the Dutch Parliament requested a report on Lyme disease. The Health Council of the Netherlands advised standardization of Lyme serology in all Dutch laboratories as soon as possible. Standardization of diagnostic serological tests was strongly recommended. Studies into new tests which discriminate between active disease and past infection were recommended. Patients with Lyme disease were divided in those with Lyme specific and non-specific symptoms and duration of symptoms. Treatment advice was given for each of these 6 patient categories with a prominent role for the decision of the attending physician. Additionally it was advised to set up specialized treatment centers with a multidisciplinary approach. The report clearly shows the problems in care for Lyme patients from the perspective of both patients and physicians, but is cautious in the solutions offered. PMID:23859114

  17. An integrated approach to safety-driven and ICT-enabled process reengineering: methodological advice and a case study.

    PubMed

    Langer, M; Castellari, R; Locatelli, P; Sini, E; Torresani, M; Facchini, R; Moser, R

    2014-01-01

    Patient safety is a central concern inside any healthcare environment. With the progress of Information and Communication Technologies (ICTs), new solutions have become available to support care and management processes. Analyzing process risks helps identifying areas of improvement and provides ICT-solutions design with indications on what portions of the process need primary interventions. Understanding the link between process reengineering, technology assessment of enabling technologies and risk management allows user acceptance and patient safety improvements. Fondazione IRCCS Istituto Nazionale dei Tumori (INT), offers a good example of process reengineering driven by the purpose of increasing patient safety, enabled by new technologies. A pillar of the evolution of ICT process support at INT is based on Radio Frequency Identification technologies, implemented to identify and trace items and people across processes. This paper will present an integrated approach, based on process reengineering methodologies and risk assessment studies, and methodological advice applied to a case of surgical kits management procedures.

  18. An integrated approach to safety-driven and ICT-enabled process reengineering: methodological advice and a case study.

    PubMed

    Langer, M; Castellari, R; Locatelli, P; Sini, E; Torresani, M; Facchini, R; Moser, R

    2014-01-01

    Patient safety is a central concern inside any healthcare environment. With the progress of Information and Communication Technologies (ICTs), new solutions have become available to support care and management processes. Analyzing process risks helps identifying areas of improvement and provides ICT-solutions design with indications on what portions of the process need primary interventions. Understanding the link between process reengineering, technology assessment of enabling technologies and risk management allows user acceptance and patient safety improvements. Fondazione IRCCS Istituto Nazionale dei Tumori (INT), offers a good example of process reengineering driven by the purpose of increasing patient safety, enabled by new technologies. A pillar of the evolution of ICT process support at INT is based on Radio Frequency Identification technologies, implemented to identify and trace items and people across processes. This paper will present an integrated approach, based on process reengineering methodologies and risk assessment studies, and methodological advice applied to a case of surgical kits management procedures. PMID:24943545

  19. Improving Depression Care in Patients with Diabetes and Multiple Complications

    PubMed Central

    Kinder, Leslie S; Katon, Wayne J; Ludman, Evette; Russo, Joan; Simon, Greg; Lin, Elizabeth HB; Ciechanowski, Paul; Von Korff, Michael; Young, Bessie

    2006-01-01

    BACKGROUND Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes who have multiple complications. OBJECTIVE To determine whether a collaborative care intervention for depression would be as effective in patients with diabetes who had 2 or more complications as in patients with diabetes who had fewer complications. DESIGN The Pathways Study was a randomized control trial comparing collaborative care case management for depression and usual primary care. This secondary analysis compared outcomes in patients with 2 or more complications to patients with fewer complications. PATIENTS Three hundred and twenty-nine patients with diabetes and comorbid depression were recruited through primary care clinics of a large prepaid health plan. MEASUREMENTS Depression was assessed at baseline, 3, 6, and 12 months with the 20-item depression scale from the Hopkins Symptom Checklist. Diabetes complications were determined from automated patient records. RESULTS The Pathways collaborative care intervention was significantly more successful at reducing depressive symptoms than usual primary care in patients with diabetes who had 2 or more complications. Patients with fewer than 2 complications experienced similar reductions in depressive symptoms in both intervention and usual care. CONCLUSION Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression. These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes who have the highest severity of medical problems. PMID:16836628

  20. Smoking cessation strategies for patients with asthma: improving patient outcomes.

    PubMed

    Perret, Jennifer L; Bonevski, Billie; McDonald, Christine F; Abramson, Michael J

    2016-01-01

    Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as "lung age" should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large. PMID:27445499

  1. Smoking cessation strategies for patients with asthma: improving patient outcomes

    PubMed Central

    Perret, Jennifer L; Bonevski, Billie; McDonald, Christine F; Abramson, Michael J

    2016-01-01

    Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as “lung age” should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large. PMID:27445499

  2. Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol

    PubMed Central

    2011-01-01

    Background The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner. Methods/Design An open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines. Discussion Motivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential

  3. Consider the Source: Adolescents and Adults Similarly Follow Older Adult Advice More than Peer Advice

    PubMed Central

    Pedersen, Gloria A.; Dellarco, Danielle V.; Casey, B. J.; Hartley, Catherine A.

    2015-01-01

    Individuals learn which of their actions are likely to be rewarded through trial and error. This form of learning is critical for adapting to new situations, which adolescents frequently encounter. Adolescents are also greatly influenced by their peers. The current study tested the extent to which adolescents rely on peer advice to guide their actions. Adolescent and young adult participants completed a probabilistic learning task in which they chose between four pairs of stimuli with different reinforcement probabilities, with one stimulus in each pair more frequently rewarded. Participants received advice about two of these pairs, once from a similarly aged peer and once from an older adult. Crucially, this advice was inaccurate, enabling the dissociation between experience-based and instruction-based learning. Adolescents and adults learned equally well from experience and no age group difference was evident in the overall influence of advice on choices. Surprisingly, when considering the source of advice, there was no evident influence of peer advice on adolescent choices. However, both adolescents and adults were biased toward choosing the stimulus recommended by the older adult. Contrary to conventional wisdom, these data suggest that adolescents may prioritize the advice of older adults over that of peers in certain decision-making contexts. PMID:26030134

  4. How Patients Can Improve the Accuracy of their Medical Records

    PubMed Central

    Dullabh, Prashila M.; Sondheimer, Norman K.; Katsh, Ethan; Evans, Michael A.

    2014-01-01

    Objectives: Assess (1) if patients can improve their medical records’ accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback’s impact on medical record accuracy. Background: Improving medical record’ accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records’ accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists’ accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians. Methods: The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists’ medication reconciliation logs. Findings/Discussion: (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency—or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms

  5. Cross-Functional Team Processes and Patient Functional Improvement

    PubMed Central

    Alexander, Jeffrey A; Lichtenstein, Richard; Jinnett, Kimberly; Wells, Rebecca; Zazzali, James; Liu, Dawei

    2005-01-01

    Objective To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes. Data Sources/Study Setting Primary data were collected during the period 1992–1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S. Study Design A longitudinal, multilevel analysis assessed the relationship between individual- and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables. Data Collection Methods Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument. Principal Findings Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning. Conclusions Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the

  6. Hypercapnia Improves Tissue Oxygenation in Morbidly Obese Surgical Patients

    PubMed Central

    Hager, Helmut; Reddy, Dayakar; Mandadi, Goutham; Pulley, Debra; Eagon, J Chris; Sessler, Daniel I; Kurz, Andrea

    2006-01-01

    Risk of wound infection is increased in morbidly obese surgical patients, in part because a major determinant of wound infection risk, tissue oxygenation, is marginal. Unlike in lean patients, supplemental inspired oxygen (FIO2) only slightly improves tissue oxygenation in obese patients. Mild hypercapnia improves tissue oxygenation in lean, but has not been evaluated in obese patients. We thus tested the hypothesis that mild hypercapnia markedly improves tissue oxygenation in morbidly obese patients given FIO2 80% during major abdominal surgery. Thirty obese patients (body mass index 61.5±17 kg/m2) scheduled for open gastric bypass were randomly assigned to normocapnia (n=15, end-tidal PCO2 35 mmHg) or hypercapnia (n=15, end-tidal PCO2 50 mmHg); FIO2 was 80%. Anesthetic management and other confounding factors were controlled. Tissue oxygen tension was measured subcutaneously at the upper arm using a polarographic probe in a silastic tonometer. Demographic characteristics, cardiovascular measurements, and PaO2 (222±48 versus 230±68 mmHg in normocapnic versus hypercapnic; mean±SD, P=0.705) were comparable in the groups. Tissue oxygen tension, however, was greater in hypercapnic than in normocapnic patients (78±31 versus 56±13 mmHg, P=0.029). Mild hypercapnia increased tissue oxygenation by an amount believed to be clinically important and could potentially reduce the risk of surgical wound infection in morbidly obese patients. PMID:16931680

  7. Sound source information to improve cardiothoracic patients' comfort.

    PubMed

    Mackrill, Jamie; Cain, Rebecca; Jennings, Paul; England, Michelle

    Hospital sound has been well documented through acoustic measurement and the classification of its adverse effects on patients and nurses. However, little consideration has been given to how the perception of these unavoidable soundscapes can be improved. For instance, does a better understanding of the variety of sounds improve patients' feeling? This paper begins to answer this and documents a pilot questionnaire-based study looking at the effects and potential benefits of sound source information (SSI) on patients' subjective reactions to a ward soundscape. The study was carried out from July to September 2011 with 31 patients in a cardiothoracic ward. Although strong inferences were not made, it was found that this simple intervention created a 21-26% positive change perception (p<0.05). The paper discusses the results in relation to nursing practice, concluding that SSI could be beneficial in helping patients to feel more comfortable.

  8. Kidney Function Can Improve in Patients with Hypertensive CKD

    PubMed Central

    Gadegbeku, Crystal; Lipkowitz, Michael S.; Rostand, Stephen; Lewis, Julia; Wright, Jackson T.; Appel, Lawrence J.; Greene, Tom; Gassman, Jennifer; Astor, Brad C.

    2012-01-01

    The typical assumption is that patients with CKD will have progressive nephropathy. Methodological issues, such as measurement error and regression to the mean, have made it difficult to document whether kidney function might improve in some patients. Here, we used data from 12 years of follow-up in the African American Study of Kidney Disease and Hypertension to determine whether some patients with CKD can experience a sustained improvement in GFR. We calculated estimated GFR (eGFR) based on serum creatinine measurements during both the trial and cohort phases. We defined clearly improved patients as those with positive eGFR slopes that we could not explain by random measurement variation under Bayesian mixed-effects models. Of 949 patients with at least three follow-up eGFR measurements, 31 (3.3%) demonstrated clearly positive eGFR slopes. The mean slope among these patients was +1.06 (0.12) ml/min per 1.73 m2 per yr, compared with −2.45 (0.07) ml/min per 1.73 m2 per yr among the remaining patients. During the trial phase, 24 (77%) of these 31 patients also had clearly positive slopes of 125I-iothalamate–measured GFR during the trial phase. Low levels of proteinuria at baseline and randomization to the lower BP goal (mean arterial pressure ≤92 mmHg) associated with improved eGFR. In conclusion, the extended follow-up from this study provides strong evidence that kidney function can improve in some patients with hypertensive CKD. PMID:22402803

  9. Process Improvements to Reform Patient Flow in the Emergency Department.

    PubMed

    Whatley, Shawn D; Leung, Alexander K; Duic, Marko

    2016-01-01

    Emergency departments (ED) function to diagnose, stabilize, manage and dispose patients as efficiently as possible. Although problems may be suspected at triage, ED physician input is required at each step of the patient journey through the ED, from diagnosis to disposition. If we want timely diagnosis, appropriate treatment and great outcomes, then ED processes should connect patients and physicians as quickly as possible. This article discusses the key concepts of ED patient flow, value and efficiency. Based on these fundamentals, it describes the significant impact of ED process improvements implemented on measures of ED efficiency at a large community ED in Ontario, Canada. PMID:27133605

  10. Process Improvements to Reform Patient Flow in the Emergency Department.

    PubMed

    Whatley, Shawn D; Leung, Alexander K; Duic, Marko

    2016-01-01

    Emergency departments (ED) function to diagnose, stabilize, manage and dispose patients as efficiently as possible. Although problems may be suspected at triage, ED physician input is required at each step of the patient journey through the ED, from diagnosis to disposition. If we want timely diagnosis, appropriate treatment and great outcomes, then ED processes should connect patients and physicians as quickly as possible. This article discusses the key concepts of ED patient flow, value and efficiency. Based on these fundamentals, it describes the significant impact of ED process improvements implemented on measures of ED efficiency at a large community ED in Ontario, Canada.

  11. Advice-giving styles by finnish nurses in dietary counseling concerning type 2 diabetes care.

    PubMed

    Kiuru, Päivi; Poskiparta, Marita; Kettunen, Tarja; Saltevo, Juha; Liimatainen, Leena

    2004-01-01

    Dietary advice-giving is an important part of dietary counseling in diabetes care and prevention. The strategies of advice-giving, however, have not been explicated and the qualitative characteristics of conversations in diabetes counseling have remained mainly unstudied. This article describes the styles in which nurses responsible for diabetes counseling in Finnish primary care practices offer dietary advice for patients with recently diagnosed type 2 diabetes or impaired glucose tolerance. The data consisted of 55 videotaped naturally occurring counseling sessions between 18 patients and five nurses and were analyzed using typology as an analyzing method. Four different styles of dietary advice-giving were recognized from the speech episodes concerning dietary behavior: recommending, persuasive, supportive, and permitting styles. Recommending style of advice-giving is recognized to be the dominant style that has arisen from the data and, actually, it seems to be the starting point in advice-giving practices. The other styles were used rarely, which suggest that the nurses rely upon quite a narrow selection of communication strategies that helps them to control the topics and the situation, although patient-centered counseling is strongly demanded nowadays. On the basis of our results we suggest that health professionals may need to become more aware of their advice-giving practices in routine situations through conscious effort of self-evaluation. A more detailed analysis of interpersonal conversations during counseling sessions is also needed as it may offer valuable information to promote patients' self-management skills by facilitating observation of conversational elements recognized to be successful in diabetes counseling. PMID:15371086

  12. [Writing a scientific review, advice and recommendations].

    PubMed

    Turale, Sue

    2013-12-01

    Writing a scientific article in the aim of being published in a renowned journal is an activity which requires specific abilities and skills. Bringing nursing training up to university level has led more and more nurses to publish papers. This article offers some advice to facilitate this demanding process.

  13. A qualitative study to identify reasons for discharges against medical advice in the cardiovascular setting

    PubMed Central

    Saunders, Elijah; Mullins, C Daniel; Pradel, Françoise G; Zuckerman, Marni; Loh, F Ellen; Weir, Matthew R

    2012-01-01

    Background Cardiovascular disease (CVD) is responsible for the largest number of discharges against medical advice (AMA). However, there is limited information regarding the reasons for discharges AMA in the CVD setting. Objective To identify reasons for discharges AMA among patients with CVD. Design Qualitative study using focus group interviews (FGIs). Participants A convenience sample of patients with a CVD-related discharge diagnosis who left AMA and providers (physicians, nurses and social workers) whose patients have left AMA. Primary and secondary outcomes To identify patients' reasons for discharges AMA as identified by patients and providers. To identify strategies to reduce discharges AMA. Approach FGIs were grouped according to patients, physicians and nurses/social workers. A content analysis was performed independently by three coauthors to identify the nature and range of the participants' viewpoints on the reasons for discharges AMA. The content analysis involved specific categories of reasons as motivated by the Health Belief Model as well as reasons (ie, themes) that emerged from the interview data. Results 9 patients, 10 physicians and 23 nurses/social workers were recruited for the FGIs. Patients and providers reported the same three reasons for discharges AMA: (1) patient's preference for their own doctor, (2) long wait time and (3) factors outside the hospital. Patients identified an unmet expectation to be involved in setting the treatment plan as a reason to leave AMA. Participants identified improved communication as a solution for reducing discharges AMA. Conclusions Patients wanted more involvement in their care, exhibited a strong preference for their own primary physician, felt that they spent a long time waiting in the hospital and were motivated to leave AMA by factors outside the hospital. Providers identified similar reasons except the patients' desire for involvement. Additional research is needed to determine the applicability of

  14. A Web Site to Improve Management of Patients with Inherited Bleeding Disorders in the Emergency Department: Results at 2 Years.

    PubMed

    Tagliaferri, Annarita; Di Perna, Caterina; Biasoli, Chiara; Rivolta, Gianna Franca; Quintavalle, Gabriele; Cervellin, Gianfranco; Barozzi, Marco; Benedettini, Laura; Pattacini, Corrado

    2016-07-01

    Treatment of patients with inherited bleeding disorders (PWIBD) in the emergency department (ED) is challenging. In 2010, a project was started involving all eight hemophilia centers (HC) and all 44 EDs of the Region of Emilia-Romagna (Italy) to improve emergency care for PWIBD. The project incorporates guidelines for emergency treatment, education for ED staff, and a dedicated Web site providing extensive information, proposing treatments, and sharing data with patients' electronic clinical records. A Web algorithm, accessible to PWIBD as well as ED and HC staff, suggests the first dose of concentrate for each type and severity of bleed or trauma. Following training courses in each ED, the network was activated. During 2012 and 2013, the site was visited 14,000 times, the EDs accessed the Web site 1,739 times, and used the algorithms 206 times. In two reference EDs, triage-assessment and triage-treatment times were reduced in 2013 and 2012 (27/20 and 110/71.5 minutes, respectively) and medical advice from the HC increased (54 vs. 24% cases). The main advantages of this system are better management of patients in ED (shorter triage-to-treatment times) and improved collaboration between HCs and EDs. The most critical point remaining is staff turnover in EDs, necessitating continual training. PMID:27071049

  15. The personal shopper--a pilot randomized trial of grocery store-based dietary advice.

    PubMed

    Lewis, K H; Roblin, D W; Leo, M; Block, J P

    2015-06-01

    The objective of this study was to test the feasibility and preliminary efficacy of a store-based dietary education intervention against traditional clinic-based advice. Patients with obesity (n = 55, mean [standard deviation, SD] age 44.3[9.2] years, 64% women, 87% non-Hispanic Black) were randomized to receive dietary counselling either in a grocery store or a clinic. Change between groups (analysis of covariance) was assessed for outcomes including: dietary quality (Healthy Eating Index--2005 [0-100 points]), and nutritional knowledge (0-65-point knowledge scale). Both groups reported improved diet quality at the end of the study. Grocery participants had greater increases in knowledge (mean [SD] change = 5.7 [6.1] points) than clinic participants (mean [SD] change = 3.2 [4.0] points) (P = 0.04). Participants enjoyed the store-based sessions. Grocery store-based visits offer a promising approach for dietary counselling. PMID:25873139

  16. Improving haemophilia patient care through sharing best practice.

    PubMed

    de Moerloose, Philippe; Arnberg, Daniel; O'Mahony, Brian; Colvin, Brian

    2015-10-01

    At the 2014 Annual Congress of the European Haemophilia Consortium (EHC) held in Belfast, Northern Ireland, Pfizer initiated and funded a satellite symposium entitled: 'Improving Patient Care Through Sharing Best Practice'. Co-chaired by Brian Colvin (Pfizer Global Innovative Pharma Business, Rome, Italy) and Brian O'Mahony [President of the EHC, Brussels, Belgium], the symposium provided an opportunity to consider patient care across borders, to review how patient advocacy groups can successfully engage with policymakers in healthcare decision-making and to discuss the importance of patient involvement in data collection to help shape the future environment for people with haemophilia. Professor Philippe de Moerloose (University Hospitals and Faculty of Medicine of Geneva, Switzerland) opened the session by discussing the gap between the haemophilia management guidelines and the reality of care for many patients living in Europe, highlighting the importance of sharing of best practice and building a network of treaters and patient organisations to support the improvement of care across Europe. Daniel Arnberg (SCISS AB, Hägersten, Sweden) reviewed the health technology assessment process conducted in Sweden, the first for haemophilia products, as a case study, focusing on the role of the patient organisation. Finally, Brian O'Mahony reflected on the central role of patients as individuals and also within patient organisations in shaping the future of haemophilia care. PMID:26338268

  17. Improving haemophilia patient care through sharing best practice.

    PubMed

    de Moerloose, Philippe; Arnberg, Daniel; O'Mahony, Brian; Colvin, Brian

    2015-10-01

    At the 2014 Annual Congress of the European Haemophilia Consortium (EHC) held in Belfast, Northern Ireland, Pfizer initiated and funded a satellite symposium entitled: 'Improving Patient Care Through Sharing Best Practice'. Co-chaired by Brian Colvin (Pfizer Global Innovative Pharma Business, Rome, Italy) and Brian O'Mahony [President of the EHC, Brussels, Belgium], the symposium provided an opportunity to consider patient care across borders, to review how patient advocacy groups can successfully engage with policymakers in healthcare decision-making and to discuss the importance of patient involvement in data collection to help shape the future environment for people with haemophilia. Professor Philippe de Moerloose (University Hospitals and Faculty of Medicine of Geneva, Switzerland) opened the session by discussing the gap between the haemophilia management guidelines and the reality of care for many patients living in Europe, highlighting the importance of sharing of best practice and building a network of treaters and patient organisations to support the improvement of care across Europe. Daniel Arnberg (SCISS AB, Hägersten, Sweden) reviewed the health technology assessment process conducted in Sweden, the first for haemophilia products, as a case study, focusing on the role of the patient organisation. Finally, Brian O'Mahony reflected on the central role of patients as individuals and also within patient organisations in shaping the future of haemophilia care.

  18. Provider advice about pregnancy weight gain and adequacy of weight gain.

    PubMed

    Ferrari, Renée M; Siega-Riz, Anna Maria

    2013-02-01

    To explore the association between health care provider advice about weight gain and gestational weight gain. Using data from a prospective cohort study, we explored the association between provider advice about weight gain in pregnancy with weight gain adequacy among 1,454 pregnant women. Provider advice was measured by maternal self-report at 27-30 weeks' gestation. Linear and Poisson regression were used to explore associations. Seventy-eight percent of the women gained outside current recommendations. Fifty-one percent reported receiving weight gain advice from a health care provider. Adjusted Generalized Linear Model (GLM) estimates showed weak effect of provider advice on inadequate or excessive gain (Relative Risk (RR) 0.96, 95% CI 0.74, 1.26 for inadequate gain and RR 1.01, 95% CI 0.97, 1.06 for excessive gain). There is a need for more women to hear about their targeted weight gains during pregnancy and the present advice that exists does little to influence actual gains. Further studies are warranted to find better strategies for providers to motivate their patients to gain weight within the appropriate ranges.

  19. Patient and clinician's ratings of improvement in methadone-maintained patients: Differing perspectives?

    PubMed Central

    2011-01-01

    Background In the last few years there seems to be an emerging interest for including the patients' perspective in assessing methadone maintenance treatment (MMT), with treatment satisfaction surveys being the most commonly-used method of incorporating this point of view. The present study considers the perspective of patients on MMT when assessing the outcomes of this treatment, acknowledging the validity of this approach as an indicator. The primary aim of this study is to evaluate the concordance between improvement assessment performed by two members of the clinical staff (a psychiatrist and a nurse) and assessment carried out by MMT patients themselves. Method Patients (n = 110) and their respective psychiatrist (n = 5) and nurse (n = 1) completed a scale for assessing how the patient's condition had changed from the beginning of MMT, using the Patient Global Impression of Improvement scale (PGI-I) and the Clinical Global Impression of Improvement scale (CGI-I), respectively. Results The global improvement assessed by patients showed weak concordance with the assessments made by nurses (Quadratic-weighted kappa = 0.13, p > 0.05) and by psychiatrists (Quadratic-weighted kappa = 0.19, p = 0.0086), although in the latter, concordance was statistically significant. The percentage of improved patients was significantly higher in the case of the assessments made by patients, compared with those made by nurses (90.9% vs. 80%, Z-statistic = 2.10, p = 0.0354) and by psychiatrists (90.9% vs. 50%, Z-statistic = 6.48, p < 0.0001). Conclusions MMT patients' perception of improvement shows low concordance with the clinical staff's perspective. Assessment of MMT effectiveness should also focus on patient's evaluation of the outcomes or changes achieved, thus including indicators based on the patient's experiences, provided that MMT aim is to be more patient centred and to cover different needs of patients themselves. PMID:21871064

  20. Commentary: quality improvement projects: how do we protect patients' rights?

    PubMed

    Diamond, Louis H; Kliger, Alan S; Goldman, Richard S; Palevsky, Paul M

    2004-01-01

    A recent ruling by the Office of Human Research Protection (OHRP) has renewed an ongoing debate over whether Institutional Review Boards (IRBs) should have oversight not only over clinical research but also over quality improvement projects (QIPs). The authors discussed the similarities and differences among clinical practice, QIPs, and clinical research, pointing out issues to consider when identifying the most appropriate method for QIP oversight and accountability. They note that potential solutions must address ethical issues (eg, patient safety, privacy, and self-determination) and weigh the effect of the underlying QIP goal (administrative versus clinical improvement) on an individual patient and patient populations. They conclude that because QIPs are an extension of clinical practice and have elements of clinical research, it too should have an oversight system. Institutional or regional quality improvement boards, operating parallel to current IRBs, are suggested as 1 means of ensuring that QIP participants are offered the same protections as those who take part in clinical research.

  1. The Role of Practical Advice in Bioterrorism News Coverage.

    PubMed

    Swain, Kristen Alley

    2015-01-01

    This study examined the role of crisis advice appearing in US news coverage of the 2001 anthrax attacks. Coverage of any crisis can spark public outrage, including fear, speculation, and contradictory or confusing evidence, especially when the stories do not contain practical advice. Five coders analyzed 833 news stories from 272 major US newspapers, the Associated Press, National Public Radio, and 4 major US television networks. Practical advice appeared in only a quarter of the stories, even though practical advice for self-protection was mentioned 3 times more often than the vague advice that simply advised people not to panic. Public health officials provided the most practical advice, while scientists provided the least practical advice. Stories containing practical advice also provided more elucidating information, explaining why the threat was low, reducible, treatable, and detectable. Over the 3 phases of the anthrax crisis, an inverse relationship appeared between the amount of news coverage containing practical advice compared to "outrage rhetoric." Stories mentioned practical advice more often during the post-impact phase than earlier in the crisis. Elucidating, explanatory advice emphasized actions, risk comparisons, and tradeoffs. The findings indicate that when journalists use credible sources to provide practical advice and avoid speculation, their coverage can prevent the spread of misinformation and confusion during a bioterror attack. Also, journalists should provide context and sourcing when discussing advice during the outbreak and impact phases of the crisis, because these explanations could counteract outrage and threat distortion.

  2. The Role of Practical Advice in Bioterrorism News Coverage.

    PubMed

    Swain, Kristen Alley

    2015-01-01

    This study examined the role of crisis advice appearing in US news coverage of the 2001 anthrax attacks. Coverage of any crisis can spark public outrage, including fear, speculation, and contradictory or confusing evidence, especially when the stories do not contain practical advice. Five coders analyzed 833 news stories from 272 major US newspapers, the Associated Press, National Public Radio, and 4 major US television networks. Practical advice appeared in only a quarter of the stories, even though practical advice for self-protection was mentioned 3 times more often than the vague advice that simply advised people not to panic. Public health officials provided the most practical advice, while scientists provided the least practical advice. Stories containing practical advice also provided more elucidating information, explaining why the threat was low, reducible, treatable, and detectable. Over the 3 phases of the anthrax crisis, an inverse relationship appeared between the amount of news coverage containing practical advice compared to "outrage rhetoric." Stories mentioned practical advice more often during the post-impact phase than earlier in the crisis. Elucidating, explanatory advice emphasized actions, risk comparisons, and tradeoffs. The findings indicate that when journalists use credible sources to provide practical advice and avoid speculation, their coverage can prevent the spread of misinformation and confusion during a bioterror attack. Also, journalists should provide context and sourcing when discussing advice during the outbreak and impact phases of the crisis, because these explanations could counteract outrage and threat distortion. PMID:26381372

  3. Improving organizational climate for excellence in patient care.

    PubMed

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance. PMID:23903945

  4. [Strategies for improving care of oncologic patients: SHARE Project results].

    PubMed

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients. PMID:27237729

  5. Improving organizational climate for excellence in patient care.

    PubMed

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance.

  6. The implementation of ergonomics advice and the stage of change approach.

    PubMed

    Rothmore, Paul; Aylward, Paul; Karnon, Jonathan

    2015-11-01

    This paper investigates the implementation of injury prevention advice tailored according to the Stage of Change (SOC) approach. The managers of 25 workgroups, drawn from medium to large companies across a wide range of occupational sectors were allocated to receive either standard ergonomics advice or ergonomics advice tailored according to the workgroup SOC. Twelve months after the advice was provided, semi-structured interviews were conducted with each manager. In a multivariate model, managers who had received tailored advice were found to have implemented significantly more of the recommended changes (IRR = 1.68, 95% CI 1.07-2.63) and more "additional" changes (IRR = 1.90, 95% CI 1.12-3.20). Qualitative analysis identified that the key barriers and facilitators to the implementation of changes were largely related to worker resistance to change and the attitudes of senior managers towards health and safety. The findings from this study suggest that the implementation of ergonomics recommendations may be improved by the tailoring of advice according to SOC principles.

  7. The implementation of ergonomics advice and the stage of change approach.

    PubMed

    Rothmore, Paul; Aylward, Paul; Karnon, Jonathan

    2015-11-01

    This paper investigates the implementation of injury prevention advice tailored according to the Stage of Change (SOC) approach. The managers of 25 workgroups, drawn from medium to large companies across a wide range of occupational sectors were allocated to receive either standard ergonomics advice or ergonomics advice tailored according to the workgroup SOC. Twelve months after the advice was provided, semi-structured interviews were conducted with each manager. In a multivariate model, managers who had received tailored advice were found to have implemented significantly more of the recommended changes (IRR = 1.68, 95% CI 1.07-2.63) and more "additional" changes (IRR = 1.90, 95% CI 1.12-3.20). Qualitative analysis identified that the key barriers and facilitators to the implementation of changes were largely related to worker resistance to change and the attitudes of senior managers towards health and safety. The findings from this study suggest that the implementation of ergonomics recommendations may be improved by the tailoring of advice according to SOC principles. PMID:26154235

  8. [Preliminarily analysis on traditional Chinese medicine advices in Treatise on Febrile Diseases].

    PubMed

    Liu, Tong; Zhai, Hua-qiang; Zhang, Tian; Jin, Shi-yuan

    2015-02-01

    To make a systematic analysis on literatures concerning traditional Chinese medicine (TCM) advices in Treatise on Febrile Diseases, and summarize the main connotations of traditional Chinese medicine advices, relevant TCM advices in Treatise on Febrile Diseases were collected, screened, compared, summarized and analyzed according to TCM dosage form preparation methods, TCM administration methods, medication contraindications and nursing after TCM administration. The literatures concerning medications in Treatise on Febrile Diseases were consulted, summarized and compared to standardize medicine advices and facilitate rational clinical application of TCMs. The standard medicine advices were as follows. The boiling water for TCMs shall be tap water and well water. The decoctions that have effects in promoting blood and meridians can be boiled with wine. The decoctions containing toxic components can be boiled with honey. Some TCMs shall be boiled with special methods, e. g. Herba Ephedra that could be boiled before other medicine and skimmed. Japonica rice could be added in decoctions to measure the duration of decoctions. Different dosages were required for different forms (litre, pill, medicine spoon). Administration times, temperature and frequency shall be adjusted according to target positions, functions and stage of illness. As for dietary contraindications during medication, thick porridges are recommended, where foods impacting medicine efficacy are prohibited. Regarding nursing after medication is important to recover physical functions, particularly warm porridges can go with diaphoretic recipes, while thick porridges can go with purgative recipes. And drug efficacies shall be defined by observing urine and excrements, and blood form. In conclusion, Treatise on Febrile Diseases is the first book that discusses TCM advices and records them in details. In this study, new standard medicine advices were proposed to provide important basis for improving clinical

  9. [Preliminarily analysis on traditional Chinese medicine advices in Treatise on Febrile Diseases].

    PubMed

    Liu, Tong; Zhai, Hua-qiang; Zhang, Tian; Jin, Shi-yuan

    2015-02-01

    To make a systematic analysis on literatures concerning traditional Chinese medicine (TCM) advices in Treatise on Febrile Diseases, and summarize the main connotations of traditional Chinese medicine advices, relevant TCM advices in Treatise on Febrile Diseases were collected, screened, compared, summarized and analyzed according to TCM dosage form preparation methods, TCM administration methods, medication contraindications and nursing after TCM administration. The literatures concerning medications in Treatise on Febrile Diseases were consulted, summarized and compared to standardize medicine advices and facilitate rational clinical application of TCMs. The standard medicine advices were as follows. The boiling water for TCMs shall be tap water and well water. The decoctions that have effects in promoting blood and meridians can be boiled with wine. The decoctions containing toxic components can be boiled with honey. Some TCMs shall be boiled with special methods, e. g. Herba Ephedra that could be boiled before other medicine and skimmed. Japonica rice could be added in decoctions to measure the duration of decoctions. Different dosages were required for different forms (litre, pill, medicine spoon). Administration times, temperature and frequency shall be adjusted according to target positions, functions and stage of illness. As for dietary contraindications during medication, thick porridges are recommended, where foods impacting medicine efficacy are prohibited. Regarding nursing after medication is important to recover physical functions, particularly warm porridges can go with diaphoretic recipes, while thick porridges can go with purgative recipes. And drug efficacies shall be defined by observing urine and excrements, and blood form. In conclusion, Treatise on Febrile Diseases is the first book that discusses TCM advices and records them in details. In this study, new standard medicine advices were proposed to provide important basis for improving clinical

  10. Increasing Patient Activation Could Improve Outcomes for Patients with Inflammatory Bowel Disease.

    PubMed

    Shah, Shawn L; Siegel, Corey A

    2015-12-01

    Inflammatory bowel disease (IBD) is a complex disease process that often requires the integration of skills from various health care providers to adequately meet the needs of patients with IBD. The medical and surgical treatment options for IBD have become more complicated and are frequently a source of angst for both the patient and provider. However, it has become more important than ever to engage patients in navigating the treatment algorithm. Although novel in the IBD world, the concept of patients' becoming more active and effective managers of their care has been well studied in other disease processes such as diabetes mellitus and mental illness. This idea of patient activation refers to a patient understanding his or her role in the care process and having the skill sets and self-reliance necessary to manage his or her own health care. Over the past decade, evidence supporting the role of patient activation in chronic illness has grown, revealing improved health outcomes, enhanced patient experiences, and lower overall costs. Patient activation can be measured, and interventions have been shown to improve levels of activation over time and influence outcomes. A focus on patient activation is very appropriate for patients with IBD because this may potentially serve as a tool for IBD providers to not only improve patient outcomes and experience but also reduce health care costs.

  11. [Urinary calculi; the advice of the Health Council].

    PubMed

    Lockefeer, J H

    1989-07-01

    The recently published advice of the Health Council of The Netherlands concerning urolithiasis can be divided in three chapters i.e. treatment, research and recent developments. The treatment with extracorporeal shockwave lithotripsy is considered the treatment of choice in 95% of patients with urolithiasis. The shockwave treatment has to be performed in centres with specialized know-how and facilities for basic and clinical research. The estimated number of extracorporeal shockwave lithotriptors in The Netherlands necessary for treatment of ca. 5400 patients per year with renal stones who are the most likely candidates for lithotripsy is at six. To prevent recurrent stone-forming in most patients metaphylactic therapy is indicated as well. At the moment lithotripsy of gallstones and treatment of kidney stones by means of lasers are in an experimental stage.

  12. Collaborating With Music Therapists to Improve Patient Care.

    PubMed

    Palmer, Jaclyn Bradley; Lane, Deforia; Mayo, Diane

    2016-09-01

    Collaboration between perioperative nurses and music therapists can be beneficial in providing a safe, cost-effective means of managing patients' anxiety and pain and reducing the need for pharmacologic intervention in the perioperative setting. The use of a board-certified music therapist may help to improve patient outcomes, ease nurse workload, and serve as an adjunct therapeutic modality that is enjoyable for both patients and staff members. We conducted a two-year, randomized controlled trial to determine how to best implement a music therapy program, navigate its challenges, and collaborate with nurse colleagues to bring its benefits to surgical patients. This article offers suggestions for alliances between perioperative nursing and music therapy staff members and describes the potential of music therapists to help provide optimal patient care. PMID:27568531

  13. Interventions to Improve Care for Patients with Limited Health Literacy

    PubMed Central

    Sudore, Rebecca L.; Schillinger, Dean

    2009-01-01

    Objective To propose a framework and describe best practices for improving care for patients with limited health literacy (LHL). Methods Review of the literature. Results Approximately half of the U.S. adult population has LHL. Because LHL is associated with poor health outcomes and contributes to health disparities, the adoption of evidence-based best practices is imperative. Feasible interventions at the clinician-patient level (eg, patient-centered communication, clear communication techniques, teach-to-goal methods, and reinforcement), at the system-patient level (eg, clear health education materials, visual aids, clear medication labeling, self-management support programs, and shame-free clinical environments), and at the community-patient level (eg, adult education referrals, lay health educators, and harnessing the mass media) can improve health outcomes for patients with LHL. Conclusion Because LHL is prevalent, and because the recommended communication strategies can benefit patients of all literacy levels, clinicians, health system planners, and health policy leaders should promote the uptake of these strategies into routine care. PMID:20046798

  14. Improving Outcomes for ESRD Patients: Shifting the Quality Paradigm

    PubMed Central

    2014-01-01

    Summary The availability of life-saving dialysis therapy has been one of the great successes of medicine in the past four decades. Over this time period, despite treatment of hundreds of thousands of patients, the overall quality of life for patients with ESRD has not substantially improved. A narrow focus by clinicians and regulators on basic indicators of care, like dialysis adequacy and anemia, has consumed time and resources but not resulted in significantly improved survival; also, frequent hospitalizations and dissatisfaction with the care experience continue to be seen. A new quality paradigm is needed to help guide clinicians, providers, and regulators to ensure that patients’ lives are improved by the technically complex and costly therapy that they are receiving. This paradigm can be envisioned as a quality pyramid: the foundation is the basic indicators (outstanding performance on these indicators is necessary but not sufficient to drive the primary outcomes). Overall, these basics are being well managed currently, but there remains an excessive focus on them, largely because of publically reported data and regulatory requirements. With a strong foundation, it is now time to focus on the more complex intermediate clinical outcomes—fluid management, infection control, diabetes management, medication management, and end-of-life care among others. Successfully addressing these intermediate outcomes will drive improvements in the primary outcomes, better survival, fewer hospitalizations, better patient experience with the treatment, and ultimately, improved quality of life. By articulating this view of quality in the ESRD program (pushing up the quality pyramid), the discussion about quality is reframed, and also, clinicians can better target their facilities in the direction of regulatory oversight and requirements about quality. Clinicians owe it to their patients, as the ESRD program celebrates its 40th anniversary, to rekindle the aspirations of the

  15. Weight management including dietary and physical activity advice provided by Australian physiotherapists: a pilot cross-sectional survey.

    PubMed

    Snodgrass, Suzanne J; Carter, Amy E; Guest, Maya; Collins, Clare E; James, Carole; Kable, Ashley K; Ashby, Samantha E; Plotnikoff, Ronald C

    2014-08-01

    Physiotherapists may have an impact on obesity prevention and treatment by providing nutrition and physical activity advice to overweight or obese clients; yet little is known about physiotherapists' beliefs and practices related to client weight management. The aim of this pilot study was to determine the practices, beliefs, attitudes and knowledge of physiotherapists regarding the provision of weight management advice to overweight or obese clients. Physiotherapists (n = 65) working in multiple practice settings completed a self-administered questionnaire. Logistic regression determined factors associated with the provision of dietary and physical activity advice for weight management. The majority of physiotherapists (n = 53 [81.5%]) believed providing weight management advice was within their scope of practice, yet only a minority had received training during their professional entry level education (n = 13 [20%]) or through professional development (n = 7 [11%]). Most physiotherapists (n = 55 [84.6%]) provided physical activity advice for weight management, but a minority (n = 27 [41.5%]) provided dietary advice. Having received training in weight management during their professional entry level education was associated with providing dietary advice (Odds ratio 8.8, 95% confidence interval 2.0-38.9, p = 0.004). Training in weight management may increase the likelihood of physiotherapists providing dietary advice, improving physiotherapists' management of obesity.

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

    PubMed

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

    2015-01-01

    Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients

  17. Galantamine improves sleep quality in patients with dementia.

    PubMed

    Naharci, Mehmet Ilkin; Ozturk, Ahmet; Yasar, Halit; Cintosun, Umit; Kocak, Necmettin; Bozoglu, Ergun; Tasci, Ilker; Doruk, Huseyin

    2015-12-01

    The purpose of the study was to evaluate the influences of cholinesterase inhibitors on sleep pattern and sleep disturbance. A total of 87 mild to moderate stage dementia patients who were not on cholinesterase enzyme inhibitor and memantine treatment were included in the study. The dementia patients were treated with donepezil, galantamine or rivastigmine, depending on the preference of the clinician. Fifty-five dementia patients (63.2 %) completed the study. Twenty-three elderly subjects, who had normal cognitive functions, were included in the study as the control group. The Pittsburgh Sleep Quality Index was used for evaluating the sleep quality at the beginning and at the final assessment. The improvement in sleep quality was better with regard to changes in Pittsburgh Sleep Quality Index scores with galantamine treatment compared to the donepezil and the control groups. A significant decrease in Pittsburgh Sleep Quality Index scores was detected in the galantamine group after treatment. Although statistically not significant, rivastigmine decreased and donepezil increased the Pittsburgh Sleep Quality Index scores after treatment. Dementia patients who had a poor sleep quality (n: 36), the rate of improvement in sleep disturbance was 81.8 % in the galantamine group, 75 % in the rivastigmine, and 50 % in the donepezil group. Galantamine may be the first choice of cholinesterase inhibitor in mild to moderate dementia patients in terms of improving sleep quality.

  18. Galantamine improves sleep quality in patients with dementia.

    PubMed

    Naharci, Mehmet Ilkin; Ozturk, Ahmet; Yasar, Halit; Cintosun, Umit; Kocak, Necmettin; Bozoglu, Ergun; Tasci, Ilker; Doruk, Huseyin

    2015-12-01

    The purpose of the study was to evaluate the influences of cholinesterase inhibitors on sleep pattern and sleep disturbance. A total of 87 mild to moderate stage dementia patients who were not on cholinesterase enzyme inhibitor and memantine treatment were included in the study. The dementia patients were treated with donepezil, galantamine or rivastigmine, depending on the preference of the clinician. Fifty-five dementia patients (63.2 %) completed the study. Twenty-three elderly subjects, who had normal cognitive functions, were included in the study as the control group. The Pittsburgh Sleep Quality Index was used for evaluating the sleep quality at the beginning and at the final assessment. The improvement in sleep quality was better with regard to changes in Pittsburgh Sleep Quality Index scores with galantamine treatment compared to the donepezil and the control groups. A significant decrease in Pittsburgh Sleep Quality Index scores was detected in the galantamine group after treatment. Although statistically not significant, rivastigmine decreased and donepezil increased the Pittsburgh Sleep Quality Index scores after treatment. Dementia patients who had a poor sleep quality (n: 36), the rate of improvement in sleep disturbance was 81.8 % in the galantamine group, 75 % in the rivastigmine, and 50 % in the donepezil group. Galantamine may be the first choice of cholinesterase inhibitor in mild to moderate dementia patients in terms of improving sleep quality. PMID:25777522

  19. Research and Advice Giving: A Functional View of Evidence-Informed Policy Advice in a Canadian Ministry of Health

    PubMed Central

    Lomas, Jonathan; Brown, Adalsteinn D

    2009-01-01

    Context: As evidence-based medicine grows in influence and scope, its applicability to health policy prompts two questions: Can the principles and, more specifically, the tools used to bring research into the clinical world apply to civil servants offering advice to politicians? If not, what approach should the evidence-oriented health policy organization take to improve the use of research? Methods: This article reviews evidence-based medicine and models of research use in policy. Then it reports the results of interviews with civil servants in the Ontario Ministry of Health, which recently adopted a stewardship rather than an operational role, incorporating many evidence-oriented strategies. The interviews focused on functional roles for research-based evidence in policy advice. Findings: The clinical context and tools for evidence-based medicine can rarely be generalized to policy. Most current models of research use offer lessons to researchers wishing to apply their work to policy but little help for civil servants wishing to become more evidence oriented. The interviews revealed functional roles for research in setting agendas (noting upcoming issues and screening interest groups’ claims), developing new policies (reducing uncertainty, helping speak truth to power, and preventing repetition and duplication), and monitoring or modifying existing policies (continuously improving programs and creating a culture of inquiry). Each area requires different tools to help filter the push of evidence from researchers and set agendas, to facilitate the urgent pull on relevant research by civil servants developing new policy, and to support ongoing linkage and exchange between civil servants and researchers for monitoring and modifying existing policy. Conclusions: A functional framework for evidence-informed policy advice is useful for distinguishing the activity from evidence-based medicine and “auditing” the balance of efforts across the different functional

  20. 32 CFR 776.10 - Informal ethics advice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 5 2014-07-01 2014-07-01 false Informal ethics advice. 776.10 Section 776.10... § 776.10 Informal ethics advice. (a) Advisors. Covered attorneys may seek informal ethics advice either... of Director, JA Division, HQMC; and (5) Head, Standards of Conduct/Government Ethics...

  1. 32 CFR 776.10 - Informal ethics advice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 5 2011-07-01 2011-07-01 false Informal ethics advice. 776.10 Section 776.10... § 776.10 Informal ethics advice. (a) Advisors. Covered attorneys may seek informal ethics advice either... of Director, JA Division, HQMC; and (5) Head, Standards of Conduct/Government Ethics...

  2. 31 CFR 10.37 - Requirements for written advice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Requirements for written advice. 10... Service § 10.37 Requirements for written advice. (a) Requirements. (1) A practitioner may give written... general policy are not considered written advice on a Federal tax matter for purposes of this...

  3. 32 CFR 776.10 - Informal ethics advice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Informal ethics advice. 776.10 Section 776.10 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY MISCELLANEOUS RULES PROFESSIONAL... § 776.10 Informal ethics advice. (a) Advisors. Covered attorneys may seek informal ethics advice...

  4. 32 CFR 776.10 - Informal ethics advice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 5 2012-07-01 2012-07-01 false Informal ethics advice. 776.10 Section 776.10... § 776.10 Informal ethics advice. (a) Advisors. Covered attorneys may seek informal ethics advice either... of Director, JA Division, HQMC; and (5) Head, Standards of Conduct/Government Ethics...

  5. 32 CFR 776.10 - Informal ethics advice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 5 2013-07-01 2013-07-01 false Informal ethics advice. 776.10 Section 776.10... § 776.10 Informal ethics advice. (a) Advisors. Covered attorneys may seek informal ethics advice either... of Director, JA Division, HQMC; and (5) Head, Standards of Conduct/Government Ethics...

  6. Content and Style of Advice in Iran and Canada

    ERIC Educational Resources Information Center

    Tavakoli, Mahin

    2013-01-01

    The content and nature of nonprofessional advice in Iran, a hierarchical and collectivist culture, was compared to the same type of advice in Canada, an egalitarian and individualist culture. A researcher developed a questionnaire that consisted of 10 letters, each describing a writer's problem and asking for advice. The responses of…

  7. Improving Patients Experience in Peadiatric Emergency Waiting Room.

    PubMed

    Ehrler, Frederic; Siebert, Johan; Wipfli, Rolf; Duret, Cyrille; Gervaix, Alain; Lovis, Christian

    2016-01-01

    When visiting the emergency department, the perception of the time spent in the waiting room before the beginning of the care, may influence patients' experience. Based on models of service evaluation, highlighting the importance of informing people about their waiting process and their place in the queue, we have developed an innovative information screen aiming at improving perception of time by patients. Following an iterative process, a group of experts including computer scientists, ergonomists and caregivers designed a solution adapted to the pediatric context. The solution includes a screen displaying five lanes representing triage levels. Patients are represented by individual avatars, drawn sequentially in the appropriate line. The interface has been designed using gamification principle, aiming at increasing acceptance, lowering learning curve and improving satisfaction. Questionnaire based evaluation results revealed high satisfaction from the 278 respondents even if the informative content was not always completely clear. PMID:27332258

  8. Following celebrities’ medical advice: meta-narrative analysis

    PubMed Central

    Tan, Charlie

    2013-01-01

    Objective To synthesise what is known about how celebrities influence people’s decisions on health. Design Meta-narrative analysis of economics, marketing, psychology, and sociology literatures. Data sources Systematic searches of electronic databases: BusinessSource Complete (1886-), Communication & Mass Media Complete (1915-), Humanities Abstracts (1984-), ProQuest Political Science (1985-), PsycINFO (1806-), PubMed (1966-), and Sociology Abstracts (1952-). Inclusion criteria Studies discussing mechanisms of celebrities’ influence on people in any context. Results Economics literature shows that celebrity endorsements act as signals of credibility that differentiate products or ideas from competitors and can catalyse herd behaviour. Marketing studies show that celebrities transfer their desirable attributes to products and use their success to boost their perceived credibility. Psychology shows that people are classically conditioned to react positively to the advice of celebrities, experience cognitive dissonance if they do not, and are influenced by congruencies with their self conceptions. Sociology helps explain the spread of celebrity medical advice as a contagion that diffuses through social networks and people’s desire to acquire celebrities’ social capital. Conclusions The influence of celebrity status is a deeply rooted process that can be harnessed for good or abused for harm. A better understanding of celebrity can empower health professionals to take this phenomenon seriously and use patient encounters to educate the public about sources of health information and their trustworthiness. Public health authorities can use these insights to implement regulations and restrictions on celebrity endorsements and design counter marketing initiatives—perhaps even partnering with celebrities—to discredit bogus medical advice while promoting evidence based practices.

  9. Does L-carnitine improve endothelial function in hemodialysis patients?

    PubMed Central

    Sabri, Mohammad Reza; Fahimi, Farnaz; Hajialiasgar, Soheila; Etminan, Abbas; Nazemi, Sarir; Salehi, Farzaneh

    2012-01-01

    Background: Atherosclerosis is the leading cause of death in hemodialysis patients. These patients are also very prone to L-carnitine deficiency due to kidney disease. In this clinical trial, we investigated the effect of oral L-carnitine on endothelial function of these patients. Materials ans Methods: We studied 31 adult chronic hemodialysis patients in our center and divided them into two groups. The first group (n = 20) received 1500 mg/dialysis interval (every other day) oral L-carnitine. The control group (n = 11) received placebo for one month. Ultrasonographic measurements of flow mediated dilation and carotid intima-media thickness were performed before and after one month of L-carnitine and placebo therapy. Results: This study showed that after one month of L-carnitine or placebo therapy there was no significant improvement in flow mediated dilation (p = 0.80 and p = 0.59, respectively) or decrease in carotid intima-media thickness (p = 0.12 and p = 0.50, respectively). Conclusions: Our study revealed that one month of oral L-carnitine therapy did not improve endothelial function in hemodialysis patients. Long-term studies with large sample size using intravenous form and higher doses of the drug are required to clarify the questionable role of L-carnitine in hemodialysis patients. PMID:23626603

  10. Topical Therapies for Psoriasis: Improving Management Strategies and Patient Adherence.

    PubMed

    Stein Gold, Linda F

    2016-03-01

    Psoriasis is a chronic disease that has a substantial effect on quality of life of patients and often needs long-term treatment. Topical treatments for psoriasis include corticosteroids, vitamin D derivatives, tazarotene, anthralin, tacrolimus, pimecrolimus, and newer formulations of tar. Although many of these treatments are effective, they must be prescribed appropriately and used consistently for a period of weeks to months before clinical evidence of improvement can be seen and patients perceive that the treatment is working. As such, medication dosage/schedule, choice of vehicle, and especially patient adherence to medication are key factors for a treatment to be effective. Addressing patient preferences about treatments and concerns about treatment-related toxicities and managing their expectations represent additional aspects of patient care. Therapies such as calcipotriene and betamethasone dipropionate (Cal/BD) fixed combination foam and new drugs and vehicles continuously enhance the treatment landscape for psoriasis. Because adherence to topical treatment can be a major difficulty, keeping the treatment regimen simple and using new and sophisticated treatment vehicles that are acceptable to patients can likely improve treatment outcomes. PMID:27074696

  11. Need for improved monitoring in patients with acromegaly

    PubMed Central

    Silverstein, Julie M

    2015-01-01

    Acromegaly is a rare and insidious disease characterized by the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF1) and is most commonly due to a pituitary adenoma. Patients with acromegaly who experience prolonged exposure to elevated levels of GH and IGF1 have an increased mortality risk and progressive worsening of disease-related comorbidities. Multimodal treatment with surgery, medical therapy, and radiotherapy provides biochemical control, defined by recent acromegaly clinical guidelines from the Endocrine Society as a reduction of GH levels to <1.0 ng/ml and normalization of IGF1 levels, to a substantial proportion of patients and is associated with improved clinical outcomes. Patients with acromegaly, even those without clinical symptoms of disease, require long-term monitoring of GH and IGF1 levels if the benefits associated with biochemical control are to be maintained and the risk of developing recurrent disease is to be abated. However, suboptimal monitoring is common in patients with acromegaly, and this can have negative health effects due to delays in detection of recurrent disease and implementation of appropriate treatment. Because of the significant health consequences associated with prolonged exposure to elevated levels of GH and IGF1, optimal monitoring in patients with acromegaly is needed. This review article will discuss the biochemical assessments used for therapeutic monitoring in acromegaly, the importance of monitoring after surgery and medical therapy or radiotherapy, the consequences of suboptimal monitoring, and the need for improved monitoring algorithms for patients with acromegaly. PMID:26381160

  12. Topical Therapies for Psoriasis: Improving Management Strategies and Patient Adherence.

    PubMed

    Stein Gold, Linda F

    2016-03-01

    Psoriasis is a chronic disease that has a substantial effect on quality of life of patients and often needs long-term treatment. Topical treatments for psoriasis include corticosteroids, vitamin D derivatives, tazarotene, anthralin, tacrolimus, pimecrolimus, and newer formulations of tar. Although many of these treatments are effective, they must be prescribed appropriately and used consistently for a period of weeks to months before clinical evidence of improvement can be seen and patients perceive that the treatment is working. As such, medication dosage/schedule, choice of vehicle, and especially patient adherence to medication are key factors for a treatment to be effective. Addressing patient preferences about treatments and concerns about treatment-related toxicities and managing their expectations represent additional aspects of patient care. Therapies such as calcipotriene and betamethasone dipropionate (Cal/BD) fixed combination foam and new drugs and vehicles continuously enhance the treatment landscape for psoriasis. Because adherence to topical treatment can be a major difficulty, keeping the treatment regimen simple and using new and sophisticated treatment vehicles that are acceptable to patients can likely improve treatment outcomes.

  13. Caring for LGBTQ patients: Methods for improving physician cultural competence.

    PubMed

    Klein, Elizabeth W; Nakhai, Maliheh

    2016-05-01

    This article summarizes the components of a curriculum used to teach family medicine residents and faculty about LGBTQ patients' needs in a family medicine residency program in the Pacific Northwest region of the United States. This curriculum was developed to provide primary care physicians and physicians-in-training with skills to provide better health care for LGBTQ-identified patients. The curriculum covers topics that range from implicit and explicit bias and appropriate terminology to techniques for crafting patient-centered treatment plans. Additionally, focus is placed on improving the understanding of specific and unique barriers to competent health care encountered by LGBTQ patients. Through facilitated discussion, learners explore the health disparities that disproportionately affect LGBTQ individuals and develop skills that will improve their ability to care for LGBTQ patients. The goal of the curriculum is to teach family medicine faculty and physicians in training how to more effectively communicate with and treat LGBTQ patients in a safe, non-judgmental, and welcoming primary care environment. PMID:27497452

  14. “Prescribing sunshine”: a national, cross-sectional survey of 1,089 New Zealand general practitioners regarding their sun exposure and vitamin D perceptions, and advice provided to patients

    PubMed Central

    2012-01-01

    Background The health effects of ultraviolet radiation vary according to wavelength, timing and pattern of exposure, personal characteristics and practices. Negative effects include skin cancers, eye diseases and immune suppression; positive effects primarily relate to endogenous vitamin D production which protects against bone disease. Drafting comprehensive guidelines regarding appropriate sun protective behaviours and vitamin D sufficiency is challenging. Advice given by general practitioners is potentially influential because they are widely respected. Methods A survey instrument was developed, pre-tested and provided to practising GP’s, either by on-line link or mailed, reply paid hard-copy. Odds ratios, differences in means, or ratios of geometric means from regression models are reported for potential predictor variables with 95% confidence intervals. Results Data (demographic, training, practicing, information accessing, confidence in vitamin D knowledge) suitable for analysis were obtained from 1,089 GPs (32% participation). Many (43%) were ‘not at all confident’ about their vitamin D knowledge. Recent information led 29% to recommend less sun protection during winter months and 10% less all year. Confidence was positively associated with non-‘Western’ medical training, information sources read and practising in a metropolitan centre with a medical school. Reading the Melanoma Clinical Practice Guidelines was associated with lower estimates of the amount of summer sun exposure required to obtain adequate vitamin D. Increasing years in practice was negatively associated with provision of recommended advice about summer and winter sun protection. Greater concern about vitamin D than skin cancer was expressed by females and those in practice longer. Conclusions Concern about the potentially negative impact of skin cancer prevention on vitamin D status may undermine appropriate sun protective recommendations. Reading some educational resources was

  15. The Patient-Centered Medical Home: How Is It Related to Quality and Equity Among the General Adult Population?

    PubMed

    Reibling, Nadine

    2016-10-01

    This study investigates whether patient-reported characteristics of the medical home are associated with improved quality and equity of preventive care, advice on health habits, and emergency department use. We used adjusted risk ratios to examine the association between medical home characteristics and care measures based on the 2010 Medical Expenditure Panel Survey. Medical home characteristics are associated with 6 of the 11 outcome measures, including flu shots, smoking advice, exercise advice, nutrition advice, all advice, and emergency department visits. Educational and income groups benefit relatively equally from medical home characteristics. However, compared with insurance and access to a provider, medical home characteristics have little influence on overall disparities in care. In sum, our findings support that medical home characteristics can improve quality and reduce emergency visits but we find no evidence that medical home characteristics alleviate disparities in care.

  16. Parathyroidectomy Improves Restless Leg Syndrome in Patients on Hemodialysis

    PubMed Central

    Santos, Roberto Sávio Silva; Coelho, Fernando Morgadinho Santos; da Silva, Bruno Caldin; Graciolli, Fabiana Giorgeti; Dominguez, Wagner Velasquez; de Menezes Montenegro, Fabio Luiz; Jorgetti, Vanda; Moysés, Rosa Maria Affonso; Elias, Rosilene Motta

    2016-01-01

    Background Restless leg syndrome (RLS) is a sleep disorder with high prevalence among patients on hemodialysis. It has been postulated that high phosphate and high parathyroid hormone may be implicated in its pathogenesis. Standard international criteria and face-to-face interview are not always applied. Methods this was an interventional prospective study in which 19 patients (6 men, aged 48±11 years) with severe hyperparathyroidism were evaluated. RLS diagnosis and rating scale were accessed based on the International RLS Study Group pre- and post-parathyroidectomy. Patients also underwent standard polysomnography. Results At baseline, RLS was present in 10 patients (52.6%), and pain was the most reported symptom associated with the diagnosis. Patients with RLS had higher serum phosphate (p = 0.008) that remained independently associated with RLS in a logistic regression model, adjusted for hemoglobin, age and gender (HR = 7.28;CI = 1.14–46.3, p = 0.035). After parathyroidectomy, there was a reduction of serum parathyroid hormone, phosphate, calcium and alkaline phosphatase, and an increase of 25(OH)-vitamin D, and Fetuin-A. Parathyroidectomy alleviated RLS (from 52% to 21%; p = 0.04), which was accompanied by a decrease in severity scale, in association with relief of pain and pruritus. Polysomnography in these patients showed an improvement of sleep parameters as measured by sleep efficiency, sleep latency and percentage of REM sleep. Conclusion RLS is associated with high levels of phosphate in patients with severe secondary hyperparathyroidism on hemodialysis. Pain is most reported complain in these patients. Parathyroidectomy provided an opportunity to relief RLS. Whether the reduction of serum phosphorus or parathyroid hormone contributed to this improvement merits further investigation. PMID:27196740

  17. Patient-centered transfer process for patients admitted through the ED boosts satisfaction, improves safety.

    PubMed

    2013-02-01

    To improve safety and patient flow, administrators at Hallmark Health System, based in Melrose, MA, implemented a new patient-centered transfer process for patients admitted through the ED at the health system's two hospitals. Under the new approach, inpatient nurses come down to the ED to take reports on new patients in a process that includes the ED care team as well as family members. The inpatient nurses then accompany the patients up to their designated floors. Since the new patient-transfer process was implemented in June 2012, patient satisfaction has increased by at least one point on patient satisfaction surveys. Administrators anticipate that medical errors or omissions related to the handoff process will show a drop of at least 50%, when data is tabulated.

  18. Optimizing hemodialysis practices in Canada could improve patient survival.

    PubMed

    Yeates, Karen E; Mendelssohn, David C; Ethier, Jean; Trpeski, Lilyanna; Na, Jingbo; Bragg-Gresham, Jennifer L; Eichleay, Margaret A; Pisoni, Ronald L; Port, Fritz K

    2007-01-01

    Data from the Canadian Organ Replacement Registry (CORR) and the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to determine whether practice patterns have changed in Canada since the introduction of the Canadian Society of Nephrology (CSN) Guidelines in 1999. DOPPS data were then used to calculate the impact of not meeting the proposed guideline targets and to estimate the potential life years gained if all Canadian hemodialysis patients achieved guideline targets. For dialysis dose and hemoglobin targets, Canadian facility performance has significantly improved over time. The vascular access use patterns show trends toward a worse pattern with increased catheter use. A calculation of the percentage of attributable risk suggests that 49% of deaths could possibly be averted if all patients currently outside the guidelines achieved them over the next five years. This corresponds to a decrease in the annual death rate from 18 to 10.1 per hundred patient years. These data support the need for improved adherence to guidelines. If Canadian caregivers were to optimize practice patterns, patient outcomes could be improved. PMID:17691708

  19. Improving personal health records for patient-centered care

    PubMed Central

    Feldman, Henry J; Ross, Stephen E; Safran, Charles

    2010-01-01

    Objective To assess the patient-centeredness of personal health records (PHR) and offer recommendations for best practice guidelines. Design Semi-structured interviews were conducted in seven large early PHR adopter organizations in 2007. Organizations were purposively selected to represent a variety of US settings, including medium and large hospitals, ambulatory care facilities, insurers and health plans, government departments, and commercial sectors. Measurements Patient-centeredness was assessed against a framework of care that includes: (1) respect for patient values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between healthcare providers; (7) physical comfort; (8) coordination of care. Within this framework we used evidence for patient preferences (where it exists) to compare existing PHR policies, and propose a best practice model. Results Most organizations enable many patient-centered functions such as data access for proxies and minors. No organization allows patient views of clinical progress notes, and turnaround times for PHR reporting of normal laboratory results can be up to 7 days. Conclusion Findings suggest patient-centeredness for personal health records can be improved, and recommendations are made for best practice guidelines. PMID:20190063

  20. Improving patient care through student leadership in team quality improvement projects.

    PubMed

    Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

    2015-01-01

    In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

  1. [Patient education and treatment documentation - Law to Improve the Rights of Patients].

    PubMed

    Meltendorf, G; Meltendorf, C

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the (German) Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should themselves acquaint with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation.

  2. [Patient education and treatment documentation - law to improve the rights of patients].

    PubMed

    Meltendorf, Gerhard; Meltendorf, Christian

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the German Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should acquaint themselves with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation.

  3. Improving Door to Needle time in Patients for Thrombolysis

    PubMed Central

    Fernandes, Darren; Umasankar, Udayaraj

    2016-01-01

    Ischaemic stroke can result in approximately 2 million brain neurones being damaged for each minute that it is left untreated. Various trials and studies such as the National Institute of Neurologic Disorders (NINDS) trial, the European Cooperative Acute Stroke Study (ECASS), ECASS II, and the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study have clearly demonstrated the beneficial effects of intravenous tissue plasminogen activator (tPA) for treatment of acute stroke. Therefore to minimise damage and improve clinical outcome, we need to identify patients who present within 4.5 hours of symptom onset and reduce the time taken to adminster a thrombolytic agent. This time is commonly referred to as the ‘door to needle’ (DTN) time. Our standard, set by the Clinical Commissioning Group (CCG) is to achieve a median time of scanning and thrombolysis within 55 minutes from the time that the patient enters the hospital. The aim of our QIP was to collect data on what the DTN time was during November 2015, December 2015, and January 2016 and to evaluate how this can be improved after each month. This Quality Improvement Project in the DTN time in patients for thrombolysis has identified areas in the pathway that leads to delays. One major contributing factor is the time for a doctor to come and assess and administer the thrombolytic agent to the patient. Change was implemented by ensuring that the core medical trainee on call is allocated to respond as a priority to all possible thrombolysis calls. This has resulted in a reduction of mean DTN time, from 74 minutes in November to 43 minutes in January. As well as improving patient outcomes, it is proposed that the implementation of change has benefitted the training experience and development of key skills of the core medical trainees. PMID:27559475

  4. Improving Door to Needle time in Patients for Thrombolysis.

    PubMed

    Fernandes, Darren; Umasankar, Udayaraj

    2016-01-01

    Ischaemic stroke can result in approximately 2 million brain neurones being damaged for each minute that it is left untreated. Various trials and studies such as the National Institute of Neurologic Disorders (NINDS) trial, the European Cooperative Acute Stroke Study (ECASS), ECASS II, and the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study have clearly demonstrated the beneficial effects of intravenous tissue plasminogen activator (tPA) for treatment of acute stroke. Therefore to minimise damage and improve clinical outcome, we need to identify patients who present within 4.5 hours of symptom onset and reduce the time taken to adminster a thrombolytic agent. This time is commonly referred to as the 'door to needle' (DTN) time. Our standard, set by the Clinical Commissioning Group (CCG) is to achieve a median time of scanning and thrombolysis within 55 minutes from the time that the patient enters the hospital. The aim of our QIP was to collect data on what the DTN time was during November 2015, December 2015, and January 2016 and to evaluate how this can be improved after each month. This Quality Improvement Project in the DTN time in patients for thrombolysis has identified areas in the pathway that leads to delays. One major contributing factor is the time for a doctor to come and assess and administer the thrombolytic agent to the patient. Change was implemented by ensuring that the core medical trainee on call is allocated to respond as a priority to all possible thrombolysis calls. This has resulted in a reduction of mean DTN time, from 74 minutes in November to 43 minutes in January. As well as improving patient outcomes, it is proposed that the implementation of change has benefitted the training experience and development of key skills of the core medical trainees. PMID:27559475

  5. Effectiveness of Surgical Safety Checklists in Improving Patient Safety.

    PubMed

    Ragusa, Paul S; Bitterman, Adam; Auerbach, Brett; Healy, William A

    2016-01-01

    Wrong-site surgery is all too common. Despite more than a decade of campaigns by major organizations to prevent these events, there are still reports of such mistakes. This article reviews the recent literature on surgical safety checklists and other tools designed to prevent wrong-site surgery and improve patient safety in the operating room. Emphasis is placed on how well institutions comply with these guidelines, the perceptions and attitudes of those who are asked to implement them, and their effectiveness. The literature shows that the implementation of such protocols has improved patient safety. In general, these efforts are viewed favorably by operating room personnel. However, the role of these checklists and other tools in reducing wrong-sided surgeries has not been proven. The goal of the health care profession should be to continue to improve on the advances that have been made in implementing surgical checklists and preventing wrong-site surgery. Practitioners at the authors' institution are continuously searching for ways to improve on the current protocols to prevent wrong-site surgeries. The authors recently employed a protocol in which surgical instruments are kept in the back of the room, away from the patient, until completion of the surgical time-out. This practice helps to ensure that team members are not distracted or preoccupied with setting up equipment during the time-out. This approach also helps to mitigate the hierarchal style in the operating room. PMID:26942472

  6. Improving self-management for patients with long-term conditions.

    PubMed

    Davies, Nicola J

    An increasing number of people are living with long-term conditions. These conditions cannot be cured, but can be managed through education, health promotion, medication, therapy and self-management. Self-management involves people taking responsibility for their own health and wellbeing, as well as learning to manage any long-term illnesses. Nurses play a pivotal role in providing advice, guidance, education and support to people living with long-term conditions. Self-management is important as it not only benefits the patient, but also provides wider opportunities for community and specialist nurses to use and develop their clinical and interpersonal skills.

  7. A Practical Approach to Improving Pain Control in Cancer Patients

    PubMed Central

    Brigden, Malcolm L.; Barnett, Jeffrey B.

    1987-01-01

    Despite a wealth of recent articles, many patients with cancer pain continue to suffer needlessly. The satisfactory treatment of cancer pain requires a variety of practical management strategies. Practicing physicians need a wider understanding of both the basic principles of analgesic therapy and the pharmacologic features of analgesics. Certain analgesics are best not used in cancer care. The use of pharmacologic adjuncts may lessen overall narcotic requirements and side effects. The appropriate use of alternative therapies can dramatically improve the quality of patients' overall survival. PMID:2884781

  8. Assessment of producers' response to Salmonella biosecurity issues and uptake of advice on laying hen farms in England and Wales.

    PubMed

    Gosling, R J; Martelli, F; Wintrip, A; Sayers, A R; Wheeler, K; Davies, R H

    2014-01-01

    High standards of biosecurity are known to reduce the risk of disease outbreaks; however, uptake of advice and implementation of biosecurity measures are dependent on many factors. This study assessed the uptake of targeted biosecurity advice by 60 laying hen farms provided during biosecurity audit visits. Advice was provided as bullet point cards focusing on specific areas identified as benefitting from improvement. These covered site entrance, site tidiness, vaccination, boot hygiene, hand hygiene, house tidiness, rodent control, fly control, red mite control and cleaning and disinfection between flocks. Background knowledge of Salmonella and biosecurity and farmers' willingness and intent to implement additional measures were assessed. About 50% of the principal decision-makers had basic background knowledge of Salmonella, with 22% considered well informed; almost all agreed that biosecurity could impact on Salmonella control and many appeared willing to implement additional biosecurity measures. Sixty-three per cent of study farms were categorised using the Defra Farmer Segmentation Model as Modern Family Businesses (MFBs), with 7-11% of farms being categorised as Custodian, Lifestyle Choice, Pragmatist or Challenged Enterprise; however, categorisation, did not determine uptake of advice. The most frequently used advice cards were boot hygiene, red mite control, hand hygiene, site entrance and cleaning and disinfection; uptake of advice ranged from 54 to 80% depending on the advice card. Uptake of advice by the farmers was encouraging, especially considering it was being provided by people other than their usual source of biosecurity information. Those who did not implement the recommended measures cited cost, difficulty of enforcement and practicality as the main reasons. However, the positive uptake of advice and implementation of recommended measures by many farmers demonstrates that targeted advice, discussed face to face with farmers, on a small number of

  9. Assessment of producers' response to Salmonella biosecurity issues and uptake of advice on laying hen farms in England and Wales.

    PubMed

    Gosling, R J; Martelli, F; Wintrip, A; Sayers, A R; Wheeler, K; Davies, R H

    2014-01-01

    High standards of biosecurity are known to reduce the risk of disease outbreaks; however, uptake of advice and implementation of biosecurity measures are dependent on many factors. This study assessed the uptake of targeted biosecurity advice by 60 laying hen farms provided during biosecurity audit visits. Advice was provided as bullet point cards focusing on specific areas identified as benefitting from improvement. These covered site entrance, site tidiness, vaccination, boot hygiene, hand hygiene, house tidiness, rodent control, fly control, red mite control and cleaning and disinfection between flocks. Background knowledge of Salmonella and biosecurity and farmers' willingness and intent to implement additional measures were assessed. About 50% of the principal decision-makers had basic background knowledge of Salmonella, with 22% considered well informed; almost all agreed that biosecurity could impact on Salmonella control and many appeared willing to implement additional biosecurity measures. Sixty-three per cent of study farms were categorised using the Defra Farmer Segmentation Model as Modern Family Businesses (MFBs), with 7-11% of farms being categorised as Custodian, Lifestyle Choice, Pragmatist or Challenged Enterprise; however, categorisation, did not determine uptake of advice. The most frequently used advice cards were boot hygiene, red mite control, hand hygiene, site entrance and cleaning and disinfection; uptake of advice ranged from 54 to 80% depending on the advice card. Uptake of advice by the farmers was encouraging, especially considering it was being provided by people other than their usual source of biosecurity information. Those who did not implement the recommended measures cited cost, difficulty of enforcement and practicality as the main reasons. However, the positive uptake of advice and implementation of recommended measures by many farmers demonstrates that targeted advice, discussed face to face with farmers, on a small number of

  10. Triheptanoin improves brain energy metabolism in patients with Huntington disease

    PubMed Central

    Adanyeguh, Isaac Mawusi; Rinaldi, Daisy; Henry, Pierre-Gilles; Caillet, Samantha; Valabregue, Romain; Durr, Alexandra

    2015-01-01

    Objective: Based on our previous work in Huntington disease (HD) showing improved energy metabolism in muscle by providing substrates to the Krebs cycle, we wished to obtain a proof-of-concept of the therapeutic benefit of triheptanoin using a functional biomarker of brain energy metabolism validated in HD. Methods: We performed an open-label study using 31P brain magnetic resonance spectroscopy (MRS) to measure the levels of phosphocreatine (PCr) and inorganic phosphate (Pi) before (rest), during (activation), and after (recovery) a visual stimulus. We performed 31P brain MRS in 10 patients at an early stage of HD and 13 controls. Patients with HD were then treated for 1 month with triheptanoin after which they returned for follow-up including 31P brain MRS scan. Results: At baseline, we confirmed an increase in Pi/PCr ratio during brain activation in controls—reflecting increased adenosine triphosphate synthesis—followed by a return to baseline levels during recovery (p = 0.013). In patients with HD, we validated the existence of an abnormal brain energy profile as previously reported. After 1 month, this profile remained abnormal in patients with HD who did not receive treatment. Conversely, the MRS profile was improved in patients with HD treated with triheptanoin for 1 month with the restoration of an increased Pi/PCr ratio during visual stimulation (p = 0.005). Conclusion: This study suggests that triheptanoin is able to correct the bioenergetic profile in the brain of patients with HD at an early stage of the disease. Classification of evidence: This study provides Class III evidence that, for patients with HD, treatment with triheptanoin for 1 month restores an increased MRS Pi/PCr ratio during visual stimulation. PMID:25568297

  11. Improving Patient Understanding of Prescription Drug Label Instructions

    PubMed Central

    Davis, Terry C.; Federman, Alex D.; Bass, Pat F.; Jackson, Robert H.; Middlebrooks, Mark; Parker, Ruth M.

    2008-01-01

    Background Patient misunderstanding of instructions on prescription drug labels is common and a likely cause of medication error and less effective treatment. Objective To test whether the use of more explicit language to describe dose and frequency of use for prescribed drugs could improve comprehension, especially among patients with limited literacy. Design Cross-sectional study using in-person, structured interviews. Patients Three hundred and fifty-nine adults waiting for an appointment in two hospital-based primary care clinics and one federally qualified health center in Shreveport, Louisiana; Chicago, Illinois; and New York, New York, respectively. Measurement Correct understanding of each of ten label instructions as determined by a blinded panel review of patients’ verbatim responses. Results Patient understanding of prescription label instructions ranged from 53% for the least understood to 89% for the most commonly understood label. Patients were significantly more likely to understand instructions with explicit times periods (i.e., morning) or precise times of day compared to instructions stating times per day (i.e., twice) or hourly intervals (89%, 77%, 61%, and 53%, respectively,  < 0.001). In multivariate analyses, dosage instructions with specific times or time periods were significantly more likely to be understood compared to instructions stating times per day (time periods — adjusted relative risk ratio (ARR) 0.42, 95% Confidence Interval (CI) 0.34–0.52; specific times — ARR 0.60, 95% CI 0.49–0.74). Low and marginal literacy remained statistically significant independent predictors of misinterpreting instructions (low - ARR 2.70, 95% CI 1.81–4.03; marginal -ARR 1.66, 95% CI 1.18–2.32). Conclusions Use of precise wording on prescription drug label instructions can improve patient comprehension. However, patients with limited literacy were more likely to misinterpret instructions despite use of more explicit language. PMID

  12. Improving Patient Safety in Anesthesia: A Success Story?

    SciTech Connect

    Botney, Richard

    2008-05-01

    Anesthesia is necessary for surgery; however, it does not deliver any direct therapeutic benefit. The risks of anesthesia must therefore be as low as possible. Anesthesiology has been identified as a leader in improving patient safety. Anesthetic mortality has decreased, and in healthy patients can be as low as 1:250,000. Trends in anesthetic morbidity have not been as well defined, but it appears that the risk of injury is decreasing. Studies of error during anesthesia and Closed Claims studies have identified sources of risk and methods to reduce the risks associated with anesthesia. These include changes in technology, such as anesthetic delivery systems and monitors, the application of human factors, the use of simulation, and the establishment of reporting systems. A review of the important events in the past 50 years illustrates the many steps that have contributed to the improvements in anesthesia safety.

  13. Involvement of a Surgical Service Improves Patient Satisfaction in Patients Admitted with Small Bowel Obstruction

    PubMed Central

    Schmocker, Ryan K.; Vang, Xia; Cherney Stafford, Linda M.; Leverson, Glen E.; Winslow, Emily R.

    2015-01-01

    Background For patients with small bowel obstruction (SBO), surgical care has been associated with improved outcomes; however it remains unknown how it impacts satisfaction. Methods Patients admitted for SBO who completed the hospital satisfaction survey were eligible. Only those with adhesions or hernias were included. Chart review extracted structural characteristics and outcomes. Results 47 patients were included; 74% (n=35) were admitted to a surgical service. 26% (n=12) were admitted to medicine, and 50% of those (n=6) had surgical consultation. Patients with surgical involvement as the consulting or primary service (SURG) had higher satisfaction with the hospital than those cared for by the medical service (80% SURG; 33% MED, p=0.015). SURG patients also had higher satisfaction with physicians (74% SURG; 44% MED; p=0.015). Conclusions Surgical involvement during SBO admissions is associated with increased patient satisfaction, and adds further weight to the recommendation that these patients be cared for by surgeons. PMID:25886702

  14. Improving care in patients with acute coronary syndromes: the Erlanger quality improvement initiative.

    PubMed

    Fesmire, Francis M

    2004-09-01

    Quality improvement (QI) in emergency department (ED) patients with acute coronary syndromes (ACS) is a complex and dynamic phenomenon. ED physicians are faced with the challenge of multitasking a variety of patient complaints. This chaotic environment frequently hampers the ED physician's ability to properly evaluate and treat chest pain patients. Just as an airplane pilot would never take off without performing the comprehensive preflight operational checklist, the ED physician should have a standardized protocol for the evaluation and treatment of chest pain patients. In this report, we describe Erlanger Medical Center's 10-year QI initiative in developing a successful chest pain protocol for the rapid evaluation and treatment of patients with suspected ACS. Our initiative resulted from a collaborative effort among emergency physicians, cardiologists, nuclear radiologists, nursing staff, and administration. The systematic step-wise approach we utilized at our institution consisted of identification of the problem, development of standardized protocols, hospital-based QI initiatives, and continuation of QI efforts through national initiatives. Through this "building of bridges" among physicians, nursing, and administration, we hope that other institutions will modify our protocols to assist them in the development of their own successful QI program for improving the evaluation, treatment, and disposition of patients with suspected ACS.

  15. Music as intervention: a notable endeavor to improve patient outcomes.

    PubMed

    White, J M

    2001-03-01

    Music interventions have been used in medicine and nursing throughout history. Music therapy is an easy-to-administer, relatively inexpensive, noninvasive intervention that has been used to reduce heart rate, blood pressure, myocardial oxygen consumption, gastrointestinal function, anxiety, and pain. A review of theoretic and empirical base for the use of music therapy to improve patient outcomes in a variety of areas of clinical practice is presented. Implications for practice and future research are suggested. PMID:11342404

  16. Improving patient access and streamlining processes through enterprise intelligence systems.

    PubMed

    Dunn, Ronald L

    2014-01-01

    This article demonstrates how enterprise intelligence systems can be used to improve operational efficiency in hospitals. Enterprise intelligence systems mine raw data from disparate systems and transform the data into actionable information, which when used appropriately, support streamlined processes, optimize resources, and positively affect staff efficiency and the quality of patient care. Case studies on the implementation of McKesson Performance Visibility and Capacity Planner enterprise intelligence solutions at the Southlake Regional Health Centre and Lions Gate and Richmond Hospitals are provided.

  17. Computerized systems to provide materials selection advice

    SciTech Connect

    Krisher, A.S.

    1996-07-01

    The rapid advance of computer science has increased the ability to store and retrieve information. These new capabilities are beginning to be applied to the problem of providing sound advice to non-specialist engineers who make materials selection decisions. This paper presents an overview of the large scale systems which exist in finished or near finished form and are (or may soon be) available for use by the public. The paper focuses on systems which transfer knowledge taking into account the many qualifications which enter into the reasoning processes of materials/corrosion specialists. The paper discusses both the strengths and limitations of each system.

  18. Advice on Writing a Scientific Paper

    NASA Astrophysics Data System (ADS)

    Sterken, C.

    2006-04-01

    What makes one author a good communicator and another a poor one? What turns out one manuscript a swift editorial task, and another an editorial nightmare? Based on direct experience from the manuscripts of the lectures and papers presented during this school, advice is given on what to do and on what to avoid when writing a scientific paper. Some feedback recommendation is also provided on how to prepare manuscripts, handle copyright and permissions to reproduce, how to anticipate plagiarism, how to deal with editors and referees, and how to avoid common errors. A few illustrations of English grammar and style for the foreign author are given.

  19. Altitude-Related Illness: Advice to Travellers

    PubMed Central

    Crutcher, Rodney A.

    1990-01-01

    Altitude-related medical problems have received much attention in the recent medical literature. Family physicians must be knowledgeable about these problems so that they can give appropriate advice to travellers. The author, a practising family physician, discusses issues arising from both the modest cabin altitudes experienced in modern-day air travel and the greater altitudes experienced by skiers and trekkers, pilots and mountaineers, and lowland adventurers of all sorts. He reviews the process of acclimatization to altitude and the four principal forms of altitude illness. PMID:21233912

  20. A Narrative of Fear: Advice to Mothers.

    PubMed

    Åström, Berit

    2015-01-01

    Taking present-day research into so-called new momism and intense mothering as a starting point, this article argues that the current mothering discourse, rather than articulating a new phenomenon, perpetuates a regulative discourse developed in the nineteenth century, in advice books written by medical doctors for pregnant women and new mothers. Both the Victorian and the present-day texts play on feelings of guilt and inadequacy in order to control the actions and emotions of mothers, although the threatened outcome differs: present-day mothers are warned that their children may become obese or develop neuropsychological disorders, whereas Victorian mothers are warned that their children might die.

  1. Breast cancer center: improving access to patient care.

    PubMed

    Singh, Jatinder; Edge, Stephen B; Bonaccio, Ermelinda; Schwert, Kathleen Trapp; Braun, Brian

    2014-02-01

    To improve access for patients to the Breast Cancer Center at Roswell Park Cancer Institute, the Opportunities for Improvement Project team defined 3 goals: reduce the delay to initial appointment, reduce delays in treatment at the Breast Cancer Center, and reduce delays in the start of endocrine therapy. The team developed a set of tools using Lean methodology that helped to address variables contributing to inefficiencies that result in delays. The idea behind these tools was to integrate all the business variables, such as volume, clinical space, physician availability, services offered in the Breast Program, and patient types, to produce a system or schedule that is more predictable. A new schedule for physicians, independent mid-level clinics, a survivorship program, a primary nursing model, and new roles and responsibilities were defined and implemented. Mean scores in a Press Ganey survey for wait-time questions improved by 10 points, and patient complaints decreased by almost 40%. The team concluded that delays in the Breast Program were symptoms of a larger dysfunction in systems. Fixing the problems required a comprehensive approach to review all the variables that resulted in delays. PMID:24614049

  2. Model-based advice for mechanical ventilation: From research (INVENT) to product (Beacon Caresystem).

    PubMed

    Rees, Stephen E; Karbing, Dan S

    2015-01-01

    This paper describes the structure and functionality of a physiological model-based system for providing advice on the settings of mechanical ventilation. Use of the system is presented with examples of patients on support and control modes of mechanical ventilation.

  3. Improving patient flow in pre-operative assessment

    PubMed Central

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  4. Improving patient flow in pre-operative assessment.

    PubMed

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  5. [Orthodontic treatment failure: the advice of a forensic expert].

    PubMed

    Tricot-Blestel, Marie-Claude

    2016-03-01

    If patients consider that their orthodontic treatment is a failure, they can claim compensation from their practitioner. Most often, discontented patients call on their third-party liability insurance when they are covered for "legal expenses protection". The patient's insurance company will then get in touch with the practitioner's insurance firm. Three-quarters of all claims are dealt with by the insurance companies. However, if an agreement cannot be reached or if the practitioner's insurance company manages to establish that he/she is not at fault, the patient can apply to the Tribunal de Grande Instance, the French Regional Court. The judge appoints a forensic expert who will examine the patient and follow a very precise procedure involving a dozen different questions. The advice of the forensic expert is therefore very valuable to orthodontists, in particular regarding their duty to inform patients and the importance of the medical file in order to avoid being held accountable following a course of treatment. PMID:27083226

  6. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia

    PubMed Central

    Mayer-Amberg, Norbert; Woltmann, Rainer; Walther, Stefanie

    2016-01-01

    The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various health-care service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The Integrated Care Initiative Schizophrenia has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialized nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient’s departments, and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative) to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarized in a quality monitoring report. In addition, standardized patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre–post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented Integrated Care Initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia. PMID:26779043

  7. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia.

    PubMed

    Mayer-Amberg, Norbert; Woltmann, Rainer; Walther, Stefanie

    2015-01-01

    The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various health-care service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The Integrated Care Initiative Schizophrenia has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialized nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient's departments, and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative) to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarized in a quality monitoring report. In addition, standardized patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre-post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented Integrated Care Initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia. PMID:26779043

  8. Discharge against medical advice: a case study in a public teaching hospital in Tehran, Iran in 2012.

    PubMed

    Bahadori, Mohammadkarim; Raadabadi, Mehdi; Salimi, Mohammad; Ravangard, Ramin

    2013-11-01

     Discharging against medical advice is to leave the hospital despite the advice of the doctor, which can result in complications and readmissions. This study aimed to examine the prevalence of patients' discharge against medical advice (DAMA) and their reasons in a public teaching hospital in Tehran, Iran in 2012. This was an applied and cross-sectional study in which all patients (2601 patients) who had been discharged against medical advice from the studied hospital in 2012 were studied. Required data were collected using a data collection form. Collected data were analyzed using SPSS 18.0 and descriptive and analytical tests including Frequencies and Fisher's Exact Test. The most and least common reasons for DAMA were, respectively, feeling complete recovery by patients (45.4%) and financial problems (1.3%). The results showed that there were significant differences between DAMA prevalence and patients' sex and age (P<0.001). The prevalence of DAMA in the studied hospital was high and according to the existence of social work units in every hospital, it is recommended that patients' consultation with the hospital social workers should be considered as an obligatory stage of the discharge against medical advice process in order to inform patients about its complications and adverse consequences.

  9. Donepezil Improved Cognitive Deficits in a Patient With Neurosyphilis.

    PubMed

    Wu, Yi-Shan; Lane, Hsien-Yuan; Lin, Chieh-Hsin

    2015-01-01

    A large number of patients with neurosyphilis present dementia with a progressive course and psychiatric symptoms such as depression, mania, and psychosis. Despite prompt and proper antibiotic treatment, the recovery is often incomplete, especially when tissue damage has occurred. We reported a patient with persisted cognitive decline associated with neurosyphilis that improved substantially after donepezil therapy. A 43-year-old man manifested significant psychiatric symptoms such as mania, psychosis, and cognitive impairment due to neurosyphilis. Subsequently, the patient was treated with antipsychotics and donepezil concurrent with an adequate antibiotic treatment for neurosyphilis. During the 1-year follow-up, his rapid plasma reagin titer approached from 1:256 to 1:64. His Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-cognitive subscale scores improved from 12 to 25 and 42.3 to 6.3, respectively, after a 6-month donepezil treatment. Donepezil was discontinued. Three months later, worsening of cognitive impairment (MMSE score, 23) was noted. After donepezil was started again for 3 months, his MMSE score improved to 26. Persistent cognitive impairment is commonly associated with neurosyphilis despite adequate penicillin treatment. Treatment of the cognitive impairment is important but difficult. Cholinergic pathways are considered as involving in the cognitive deficit induced by neurosyphilis and donepezil, a cholinesterase inhibitor, which may be useful for the improvement of cognition. In this case report, we described for the first time the successful use of donepezil in treating cognitive impairment associated with neurosyphilis. The role of cholinesterase inhibitors in the treatment of cognitive impairments caused by neurosyphilis needs further studies.

  10. Acculturation among Latino primary caregivers and physician communication: receipt of advice regarding healthy lifestyle behaviors.

    PubMed

    Arellano-Morales, Leticia; Wood, Christine M; Elder, John P

    2013-02-01

    The present study was part of a larger randomized controlled childhood obesity prevention trial based in 11 public recreation centers. The primary aim was to evaluate the effectiveness of a multi-level intervention to prevent the onset of overweight and obesity among children (5-8 years of age). However, the purpose of the current study was to identify sociodemographic variables, such as acculturation, that were associated with receipt of physician advice among Latino primary caregivers. Participants included 221 Latino primary caregivers and their children from San Diego, CA. Cross-sectional baseline data suggested that Latino children with private insurance were more likely to receive physician advice regarding their eating habits. Conversely, primary caregivers between the ages of 30-39 were less likely to receive physician advice regarding their child's eating habits. Current findings highlight the continued need to improve preventive efforts and reduce health disparities among a vulnerable population, such as Latinos.

  11. Bad advice; bad burn: a new problem in burn prevention.

    PubMed

    Deans, L; Slater, H; Goldfarb, I W

    1990-01-01

    Deep partial-thickness burns had been inflicted on the perineal area of an infant who was recently treated in our Burn Center. The burns were a result of advice to the patient's mother by a pediatrician. The doctor told her to use a hair dryer to prevent diaper rash. We surveyed pediatricians, well-baby clinics, and pediatric nurse practitioners in our area and found that approximately half of them advised the use of hair dryers to treat or prevent diaper rash. We tested four widely available hand-held hair dryers to determine potential for inflicting burn injury. All of the dryers are capable of delivering air heated to at least 53 degrees C after 2 minutes of use. We believe that warnings against the use of hair dryers for perineal hygiene should be included in burn prevention programs.

  12. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    PubMed Central

    Swaminathan, Aparna; Vemulapalli, Sreekanth; Patel, Manesh R; Jones, W Schuyler

    2014-01-01

    Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. PMID:25075192

  13. Improving Patient Access to an Interventional US Clinic

    PubMed Central

    Clarke, Ryan K.; Terrell, John A.; Brightmon, Tonya R.

    2014-01-01

    A continuous quality improvement project was conducted to increase patient access to a neurointerventional ultrasonography (US) clinic. The clinic was experiencing major scheduling delays because of an increasing patient volume. A multidisciplinary team was formed that included schedulers, medical assistants, nurses, technologists, and physicians. The team created an Ishikawa diagram of the possible causes of the long wait time to the next available appointment and developed a flowchart of the steps involved in scheduling and completing a diagnostic US examination and biopsy. The team then implemented a staged intervention that included adjustments to staffing and room use (stage 1); new procedures for scheduling same-day add-on appointments (stage 2); and a lead technician rotation to optimize patient flow, staffing, and workflow (stage 3). Six months after initiation of the intervention, the mean time to the next available appointment had decreased from 25 days at baseline to 1 day, and the number of available daily appointments had increased from 38 to 55. These improvements resulted from a coordinated provider effort and had a net present value of more than $275,000. This project demonstrates that structural changes in staffing, workflow, and room use can substantially reduce scheduling delays for critical imaging procedures. © RSNA, 2014 PMID:24428301

  14. Improving patient access to an interventional US clinic.

    PubMed

    Steele, Joseph R; Clarke, Ryan K; Terrell, John A; Brightmon, Tonya R

    2014-01-01

    A continuous quality improvement project was conducted to increase patient access to a neurointerventional ultrasonography (US) clinic. The clinic was experiencing major scheduling delays because of an increasing patient volume. A multidisciplinary team was formed that included schedulers, medical assistants, nurses, technologists, and physicians. The team created an Ishikawa diagram of the possible causes of the long wait time to the next available appointment and developed a flowchart of the steps involved in scheduling and completing a diagnostic US examination and biopsy. The team then implemented a staged intervention that included adjustments to staffing and room use (stage 1); new procedures for scheduling same-day add-on appointments (stage 2); and a lead technician rotation to optimize patient flow, staffing, and workflow (stage 3). Six months after initiation of the intervention, the mean time to the next available appointment had decreased from 25 days at baseline to 1 day, and the number of available daily appointments had increased from 38 to 55. These improvements resulted from a coordinated provider effort and had a net present value of more than $275,000. This project demonstrates that structural changes in staffing, workflow, and room use can substantially reduce scheduling delays for critical imaging procedures.

  15. Patient-Reported Use of Personalized Video Recordings to Improve Neurosurgical Patient-Provider Communication

    PubMed Central

    Porter, Randall

    2015-01-01

    Background: Providing patients with a video recording of their visit with a medical professional is a common-sense method for improving patient-provider communication. Objective: To describe the patient and provider experiences to video recording clinical medical encounters and providing the patient with a copy of the video for informational purposes. Methods: Since 2009, over 2,800 patients of eight different neurosurgeons chose to be video recorded during their encounter with the doctor and were provided access to the recording to watch over again as a way to recall what the doctor had said. The video system was set up as a handheld video camera, and video files were downloaded and made accessible to patients via a secure Internet patient portal. Between 2012 and 2014, patients who participated were surveyed regarding their use of the video and what was recorded on the video. The experience of the providers from a clinical and medico-legal standpoint was also reviewed. Results: Three hundred and thirty-three responses to the survey were received (39.2% response rate). More than half of patients (N=333; 56.2%) watched their video more than once, and over two-thirds (N=333; 68.6%) shared their video with a family member, friend, or another physician. Patients self-reported improved memory after watching their videos (N=299; 73.6% could remember more) and 50.2% responded that having the video made them feel more “at ease” with their medical problem (N=299). Overall, 88.0% of respondents indicated that their video had been helpful to them, and 98.5% would recommend having future visits video recorded. No patient made a comment that the video was intrusive or had prevented them from being open with their doctor. Finally, in the high-risk specialty of neurosurgery, none of the 2,807 patients who have been recorded since 2009 have used a video in a medico-legal action. Conclusions: Patient responses to the recording system and having a copy of their video

  16. [Patient education and treatment documentation - Law to Improve the Rights of Patients].

    PubMed

    Meltendorf, G; Meltendorf, C

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the (German) Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should themselves acquaint with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation. PMID:23824480

  17. [Patient education and treatment documentation - law to improve the rights of patients].

    PubMed

    Meltendorf, Gerhard; Meltendorf, Christian

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the German Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should acquaint themselves with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation. PMID:23888409

  18. Nasal highflow improves ventilation in patients with COPD

    PubMed Central

    Bräunlich, Jens; Köhler, Marcus; Wirtz, Hubert

    2016-01-01

    Background Nasal highflow (NHF) provides a warmed and humidified air stream up to 60 L/min. Recent data demonstrated a positive effect in patients with acute hypoxemic respiratory failure, especially when caused by pneumonia. Preliminary data show a decrease in hypercapnia in patients with COPD. Therefore, NHF should be evaluated as a new ventilatory support device. This study was conducted to assess the impact of different flow rates on ventilatory parameters in patients with COPD. Materials and methods This interventional clinical study was performed with patients suffering from severe COPD. The aim was to characterize flow-dependent changes in mean airway pressure, breathing volumes, breathing frequency, and decrease in partial pressure of CO2 (pCO2). Mean airway pressure was measured in the nasopharyngeal space (19 patients). To evaluate breathing volumes, we used a polysomnographic device (18 patients). All patients received 20 L/min, 30 L/min, 40 L/min, and 50 L/min and – to illustrate the effects – nasal continuous positive airway pressure and nasal bilevel positive airway pressure. Capillary blood gas analyses were performed in 54 patients with hypercapnic COPD before and two hours after the use of NHF. We compared the extent of decrease in pCO2 when using 20 L/min and 30 L/min. Additionally, comfort and dyspnea during the use of NHF were surveyed. Results NHF resulted in a minor flow dependent increase in mean airway pressure. Tidal volume increased, and breathing rate decreased. The calculated minute volume decreased under NHF breathing. In spite of this fact, hypercapnia decreased with increasing flow (20 L/min vs 30 L/min). Additionally, an improvement in dyspnea was observed. The rapid shallow breathing index shows a decrease when using NHF. Conclusion NHF leads to a flow-dependent reduction in pCO2. This is most likely achieved by a washout of the respiratory tract and a functional reduction in dead space. In summary, NHF enhances effectiveness of

  19. Improving the likelihood of neurology patients being examined using patient feedback

    PubMed Central

    Appleton, Jason Philip; Ilinca, Andreea; Lindgren, Arne; Puschmann, Andreas; Hbahbih, Majed; A. Siddiqui, Khurram; de Silva, Rajith; Jones, Matthew; Butterworth, Richard; willmot, mark; Hayton, Tom; Lunn, Michael; Nicholl, David

    2015-01-01

    We aimed to establish whether recall of elements of the neurological examination can be improved by use of a simple patient assessment score. In a previous study we demonstrated that in-patients referred to neurology at two United Kingdom (UK) hospitals were not fully examined prior to referral; we therefore designed a larger quality improvement report with 80% power to detect a 10% increase in tendon hammer or ophthalmoscope use following an educational intervention. In-patients referred to neurology over a four month period (in hospitals in the UK (10), Jordan (1), Sweden (2), and the United Arab Emirates (1)) were asked whether they recalled being examined with a tendon hammer (T), ophthalmoscope (O), and stethoscope (S) since admission. The results were disseminated to local medical teams using various techniques (including Grand Round presentations, email, posters, discounted equipment). Data were then collected for a further four month period post-intervention. Pre-intervention and post-intervention data were available for 11 centres with 407 & 391 patients in each arm respectively. Median age of patients was 51 (range 13-100) and 49 (range 16-95) years respectively, with 44.72% and 44.76% being male in each group. 264 patients (64.86%) recalled being examined with a tendon hammer in the pre-intervention arm, which significantly improved to 298 (76.21%) (p<0.001). Only 119 patients (29.24%) recollected examination with an ophthalmoscope pre-intervention, which significantly improved to 149 (38.11%)(p=0.009). The majority of patients (321 (78.87%)) pre-intervention recalled examination with a stethoscope, which significantly improved to 330 (84.4%) to a lesser extent (p=0.045). Results indicate that most patients are not fully examined prior to neurology referral yet a simple assessment score and educational intervention can improve recall of elements of the neurological examination and thus the likelihood of patients being examined neurologically. This is the

  20. Preparing the patient for surgery to improve outcomes.

    PubMed

    Levett, Denny Z H; Edwards, Mark; Grocott, Mike; Mythen, Monty

    2016-06-01

    The time between contemplation of surgery and the procedure offers a window of opportunity to optimize patients' nutritional, functional and psychological state prior to surgery. Traditionally, preoperative pathways have focused on the underlying disease process and 'fitness for surgery' with physical pre-assessment and risk counselling late in the pathway when little time is available to intervene. With an increasingly elderly and co-morbid surgical population, early physiological assessment and multidisciplinary collaborative decision-making is increasingly important. Multimodal prehabilitation programmes may improve surgical outcome, facilitating rapid recovery from surgery and limiting post-operative functional dependence. Patient education and engagement is important if compliance with behavioural change is to be achieved and maintained. To date, there has been evidence supporting preoperative exercise training, smoking cessation, reduction in alcohol intake, anaemia management and psychosocial support. Further research is needed to identify the most effective elements of these complex preoperative interventions, as well as their optimum timing and duration.

  1. Improving patient and staff outcomes using practice development.

    PubMed

    Hennessey, Catherine Elizabeth; Fry, Margaret

    2016-10-10

    Purpose The purpose of this paper is to examine the impact of a practice development program, "Essentials of Care" (EOC), on patient and staff outcomes, workplace culture and service delivery. Design/methodology/approach A descriptive study design was used to explore the impact of EOC in a district hospital rehabilitation ward. EOC focuses on embedding a person-centered culture within clinical areas and is structured from practice development methodologies. EOC was implemented in a metropolitan district hospital rehabilitation, older person 20-bed, ward. Findings Two projects were implemented during EOC. These projects led to nine significant patient and staff outcomes for medication and continence care practices. Outcomes included a reduction in older person complaints by 80 percent, pressure injuries by 62 percent, ward multi resistant staphylococcus aureus infection rates by 50 percent, clinical incidents by 22 percent, older person falls by 14 percent (per 1,000 bed days) and nursing sick leave by 10 percent. There was also a 13 percent improvement in the post nursing workplace satisfaction survey. Research limitations/implications This is a single site study and findings may not be suitable for generalizing across ward settings and broader population groups. Originality/value The EOC program led to significant improvements for and in clinical practices, staff satisfaction and ward culture. Specifically, the EOC program also identified significant cost savings and brought together the healthcare team in a cohesive and integrated way not previously experienced by staff. Practice development strategies can champion service quality improvement, optimal patient outcomes and consistency within healthcare. PMID:27671421

  2. Improving health outcomes with better patient understanding and education.

    PubMed

    Adams, Robert John

    2010-01-01

    A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual's competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly, better means of evaluating the impact of programs on public health is needed. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework has been

  3. Difference of lifestyle advice between traditional Chinese medical doctors (TCMDs) and Western-style medical doctors (WSMDs) in People's Republic of China.

    PubMed

    Sun, W Y; Chen, W W; Chen, L; Wang, G

    1995-07-01

    The role of physicians in providing lifestyle advice is very important in disease prevention and health promotion. This study was designed to examine (a) the difference of lifestyle advice provided for general practice patients between traditional Chinese medical doctors (TCMDs) and Western-style medical doctors (WSMDs), (b) the difference of lifestyle advice provided for cardiovascular disease (CVD) patients between the TCMDs and WSMDs, (c) the difference of lifestyle advice provided for general practice and CVD patients by the TCMDs, and (d) the difference of lifestyle advice provided for general practice and CVD patients by the WSMDs. One thousand four-hundred and thirty general practice patient records and 640 CVD patient records from a Western-style medical hospital, and 1620 general practice records and 830 CVD patient records from a traditional Chinese medical hospital were selected for comparison. Results indicated that TCMDs were more likely to provide nutrition, exercise, and stress management for their patients than WSMDs. On the other hand, WSMDs were more likely to provide smoking and alcohol consumption for their patients than the TCMDs. In addition, both TCMDs and WSMDs were more likely to provide all categories of lifestyle advice for their CVD patients than their general practice patients.

  4. Improving handwashing in hospitals: a patient education and empowerment program.

    PubMed

    McGuckin, M

    2001-11-01

    Each year, about 5% of people admitted to U.S. hospitals (about 2 million people) acquire an infection there. These infections cause nearly 20,000 deaths each year, and cost an estimated $4.5 billion to treat. Handwashing is the single most effective measure for preventing hospital-acquired infections. Despite widespread knowledge of the importance of handwashing, health care workers wash their hands far less often than is indicated. This Issue Brief describes a novel strategy to improve handwashing among hospital personnel, by involving the people with the most to gain--the patients themselves.

  5. Improving psychosocial health in hemodialysis patients after a disaster.

    PubMed

    Weiner, Sheila; Kutner, Nancy G; Bowles, Tess; Johnstone, Stephanie

    2010-01-01

    Twenty-two social workers implemented a cognitive-behavioral intervention with 69 patients in 22 dialysis units in Louisiana to improve psychosocial health following Hurricanes Katrina and Rita. Pre- and post-intervention questionnaires measured psychosocial status domains (general health status, social functioning, burden of kidney disease, depressed mood, anxiety, and mastery). Participants rated their general health status (p < .05) and social functioning (p < .05) significantly higher after the intervention. Participants who listened to the class Managing stress through communication and problem solving and discussed it with their social worker, had significant improvement in depressed mood score (p < .05) after completing the program, compared to participants who did not discuss this material with their social worker. Sixty-five percent had scores indicating depressed mood before the program, compared with 56% following. The more positive participants' program evaluation, the higher their quality of life (lower perceived burden of kidney disease [p = .05]).

  6. Improving service provision for patients who are prescribed continence products.

    PubMed

    Mangnall, Joanne; Midgley, Kate; Lakin, Stuart; Beckitt, Liz; Shepherd, Laura

    2010-04-01

    It is estimated that 14 million people experience problems with bladder control and 6.5 million people have a bowel control problem (Bladder and Bowel Foundation, 2008). Many will rely on continence products to manage their problem and as such require products which ensure user dignity and discretion is maintained. Locally, an ever-increasing spend on prescribed continence products promoted a review of current service delivery. The combined results of a clinical audit and patient satisfaction survey highlighted areas in which service delivery needed immediate improvement. Significant service re-design has been undertaken with prescribing responsibility for continence-related products being transferred from GP practices to specialist nurses working within the continence service. Improvements in clinical care have been achieved and cost savings have been re-invested in the service. PMID:20559160

  7. [Prevention and Information for Patients Undergoing Periodontal Treatment: Potentials for Improvement from the Patients' Perspective].

    PubMed

    Klingenberg, A; Walther, W; Dörfer, C E; Szecsenyi, J

    2016-05-01

    2 334 patients from 29 dental practices took part in a written survey on their experiences with dental treatment in general as well as treatment of periodontal disease (response rate 80.8%). 72.6% of all participating patients fully agreed that they could recommend their dentist to their friends. 63.6% of patients undergoing treatment of periodontitis (N=328) rated this treatment as "excellent". However, for important aspects (prevention, patient information, treatment) potentials for improvement became obvious. 43.7% of patients treated for periodontitis were not completely satisfied with information on how this disease develops; 40.7% saw potentials for better information on preventive care (dental-hygiene, nutrition). An even higher percentage of patients actually not treated for periodontitis was interested in more information on prevention (51.4%). The results of the survey show that dentists should offer information and exercise on how to prevent periodontal desease more actively. There is a lack of research on the present state of affairs and potentials for improvement concerning treatment and prevention of periodontitis including the patients' perspective. PMID:26086539

  8. Improving outpatient access and patient experiences in academic ambulatory care.

    PubMed

    O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

    2012-02-01

    Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume. PMID:22193182

  9. Improving the provision of meals in hospital. The patients' viewpoint.

    PubMed

    Johns, Nick; Hartwell, Heather; Morgan, Michael

    2010-02-01

    This study examines the provision of hospital meals from the patients' viewpoint, with the aim of improving hospital food service. Patients were approached in early 2008 in a National Health Service hospital in the South of England and invited to comment on the good and bad aspects of eating in hospital. Comments were collected in an abbreviated "key word" format which incurred the minimum of bias and allowed emergent themes to be analysed both quantitatively and qualitatively. Seven main themes emerged, of which "food" and "choice" were mentioned most frequently, but had a low ratio (1.8 and 1.7, respectively) of approving over disapproving comments. The next most mentioned theme, "service staff", showed the highest approving/disapproving ratio (4.8) overall. Less frequent themes were: "meals and lifestyle", "timing and routine", "service quality" and "food quantity". These data, together with qualitative analysis of the responses showed patients' views of hospital food to be positive, on the whole meeting or surpassing their expectations. However, these expectations were low, the experience of eating in hospital contrasted unfavourably with home, and the meals were at best a distraction from the rigours of hospital treatment. Service staff were positively regarded because they offered an important opportunity for "normal" discourse with a non-medical person. On the basis of the findings, changes are recommended in the management of service staff, menus, food presentation, nutritional intake and patients' lifestyle. Of these, the first is likely to have most impact on the experience and viewpoint of hospital patients. PMID:19857535

  10. Training and Action for Patient Safety: Embedding Interprofessional Education for Patient Safety within an Improvement Methodology

    ERIC Educational Resources Information Center

    Slater, Beverley L.; Lawton, Rebecca; Armitage, Gerry; Bibby, John; Wright, John

    2012-01-01

    Introduction: Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based…

  11. Longterm oral cisapride improves interdigestive antroduodenal motility in dyspeptic patients.

    PubMed Central

    Testoni, P A; Bagnolo, F; Fanti, L; Passaretti, S; Tittobello, A

    1990-01-01

    We have evaluated the effect of cisapride on interdigestive antroduodenal motility during a prolonged oral therapy in 20 consecutive dyspeptic subjects. Individuals with less than two migrating motor complexes (MMCs) starting from the antral region in 240 minutes and without evidence of upper gastrointestinal tract diseases were randomly treated with either cisapride (10 cases), or placebo (10 cases) for 15 days. Computerised manometry of antroduodenal region was performed for 240 minutes, in basal conditions and on the 15th day of therapy. Symptomatic evaluation of patients was also performed before and after treatment. After cisapride administration, a significant increase in the incidence of antral migrating motor complexes was noticed (p = 0.022); likewise, the motility index, calculated for phase-2 periods, appeared to be significantly higher both in the antrum and in the duodenum (p less than 0.001). Symptomatic improvement was observed in both groups, with a hardly significant (p = 0.049) reduction of dyspeptic symptoms severity only but not of frequency in cisapride treated patients v controls. We conclude that longterm oral therapy with cisapride improves interdigestive antroduodenal motor activity. PMID:2323591

  12. Success of patient training in improving proficiency of eyedrop administration among various ophthalmic patient populations

    PubMed Central

    Feng, Alexander; O’Neill, John; Holt, Mitchell; Georgiadis, Catherine; Wright, Martha M; Montezuma, Sandra R

    2016-01-01

    Purpose The purpose of this study is to evaluate the success and usefulness of patient education in eyedrop self-administration technique via an educational handout and a short instructional video. Patients and methods We conducted a prospective study that included 34 patients who were self-administering ophthalmic drops. Of the total patients included, 12% had used drops for <12 months, and 88% had used drops for >12 months. Average age of patients in the study was 67 years, with an age range of 19–91 years. Of the total patients included, 82% had glaucoma, 6% had dry eyes, and 12% did not have a specific diagnosis. Subjects were video recorded and assessed by a trained observer on two occasions: at baseline and after they viewed a demonstrational video and handout. A maximum score of 15 points was awarded based on 15 criteria. A written self-assessment was administered at the end of each study. Results Pre- and post-teaching assessment scores improved significantly with education. Patients initially scored an average 2.53 points compared to a post-education score of 6.15 out of 15 points, demonstrating a 2.43 (P=0.008) factor of improvement. After education, 94% of patients versus 47% pre-teaching (P=0.0001) pulled down their lower eyelids. A total of 91% pre-teaching versus 59% post-teaching (P=0.0042) patients squeezed one drop into the lower fornix, 74% pre-teaching versus 26% post-teaching (P=0.0002) patients released the eyelid and closed the eye for 1 minute, and 56% pre-teaching versus 3% post-teaching (P=0.0001) patients applied nasal digital pressure on each eye. We found no significant difference in score changes between those who previously received education and those who had not (P=0.37). A total of 91% patients responded in a postassessment survey that they now feel more confident of their ability to self-administer eyedrops as their doctor prescribed and that the educational materials were responsible. Conclusion Participants demonstrated an

  13. Patient-powered research networks aim to improve patient care and health research.

    PubMed

    Fleurence, Rachael L; Beal, Anne C; Sheridan, Susan E; Johnson, Lorraine B; Selby, Joe V

    2014-07-01

    The era of big data, loosely defined as the development and analysis of large or complex data sets, brings new opportunities to empower patients and their families to generate, collect, and use their health information for both clinical and research purposes. In 2013 the Patient-Centered Outcomes Research Institute launched a large national research network, PCORnet, that includes both clinical and patient-powered research networks. This article describes these networks, their potential uses, and the challenges they face. The networks are engaging patients, family members, and caregivers in four key ways: contributing data securely, with privacy protected; including diverse and representative groups of patients in research; prioritizing research questions, participating in research, and disseminating results; and participating in the leadership and governance of patient-powered research networks. If technical, regulatory, and organizational challenges can be overcome, PCORnet will allow research to be conducted more efficiently and cost-effectively and results to be disseminated quickly back to patients, clinicians, and delivery systems to improve patient health. PMID:25006148

  14. Patient-powered research networks aim to improve patient care and health research.

    PubMed

    Fleurence, Rachael L; Beal, Anne C; Sheridan, Susan E; Johnson, Lorraine B; Selby, Joe V

    2014-07-01

    The era of big data, loosely defined as the development and analysis of large or complex data sets, brings new opportunities to empower patients and their families to generate, collect, and use their health information for both clinical and research purposes. In 2013 the Patient-Centered Outcomes Research Institute launched a large national research network, PCORnet, that includes both clinical and patient-powered research networks. This article describes these networks, their potential uses, and the challenges they face. The networks are engaging patients, family members, and caregivers in four key ways: contributing data securely, with privacy protected; including diverse and representative groups of patients in research; prioritizing research questions, participating in research, and disseminating results; and participating in the leadership and governance of patient-powered research networks. If technical, regulatory, and organizational challenges can be overcome, PCORnet will allow research to be conducted more efficiently and cost-effectively and results to be disseminated quickly back to patients, clinicians, and delivery systems to improve patient health.

  15. Using Public Reports of Patient Satisfaction for Hospital Quality Improvement

    PubMed Central

    Barr, Judith K; Giannotti, Tierney E; Sofaer, Shoshanna; Duquette, Cathy E; Waters, William J; Petrillo, Marcia K

    2006-01-01

    Objective To explore the impact of statewide public reporting of hospital patient satisfaction on hospital quality improvement (QI), using Rhode Island (RI) as a case example. Data Source Primary data collected through semi-structured interviews between September 2002 and January 2003. Study Design The design is a retrospective study of hospital executives at all 11 general and two specialty hospitals in RI. Respondents were asked about hospital QI activities at several points throughout the public reporting process, as well as about hospital structure and processes to accomplish QI. Qualitative analysis of the interview data proceeded through an iterative process to identify themes and categories in the data. Principal Findings Data from the standardized statewide patient satisfaction survey process were used by hospitals to identify and target new QI initiatives, evaluate performance, and monitor progress. While all hospitals fully participated in the public reporting process, they varied in the stage of development of their QI activities and adoption of the statewide standardized survey for ongoing monitoring of their QI programs. Most hospitals placed responsibility for QI within each department, with results reported to top management, who were perceived as giving strong support for QI. The external environment facilitated QI efforts. Conclusion Public reporting of comparative data on patient views can enhance and reinforce QI efforts in hospitals. The participation of key stakeholders facilitated successful implementation of statewide public reporting. This experience in RI offers lessons for other states or regions as they move to public reporting of hospital quality data. PMID:16704506

  16. A Real-Time Screening Alert Improves Patient Recruitment Efficiency

    PubMed Central

    Weng, Chunhua; Batres, Candido; Borda, Tomas; Weiskopf, Nicole G.; Wilcox, Adam B.; Bigger, J Thomas; Davidson, Karina W.

    2011-01-01

    The scarcity of cost-effective patient identification methods represents a significant barrier to clinical research. Research recruitment alerts have been designed to facilitate physician referrals but limited support is available to clinical researchers. We conducted a retrospective data analysis to evaluate the efficacy of a real-time patient identification alert delivered to clinical research coordinators recruiting for a clinical prospective cohort study. Data from log analysis and informal interviews with coordinators were triangulated. Over a 12-month period, 11,295 were screened electronically, 1,449 were interviewed, and 282 were enrolled. The enrollment rates for the alert and two other conventional methods were 4.65%, 2.01%, and 1.34% respectively. A taxonomy of eligibility status was proposed to precisely categorize research patients. Practical ineligibility factors were identified and their correlation with age and gender were analyzed. We conclude that the automatic prescreening alert improves screening efficiency and is an effective aid to clinical research coordinators. PMID:22195213

  17. Advice about Work-Related Issues to Peers and Employers from Head and Neck Cancer Survivors

    PubMed Central

    Dewa, Carolyn S.; Trojanowski, Lucy; Tamminga, Sietske J.; Ringash, Jolie; McQuestion, Maurene; Hoch, Jeffrey S.

    2016-01-01

    Purpose The purpose of this exploratory and descriptive study is to contribute to the sparse return-to-work literature on head and neck cancer (HNC) survivors. Interview participants were asked to reflect upon their work-related experience with cancer by answering two specific questions: (1) What advice would you give someone who has been newly diagnosed with head and neck cancer? (2) What advice would you give to employers of these people? Methods Data were gathered through 10 individual semi-structured in-depth interviews with HNC clinic patients at a regional cancer center’s head and neck clinic in Ontario, Canada. A constant comparative method of theme development was used. Codes identified in and derived from the data were discussed by research team members until consensus was reached. Codes with similar characteristics were grouped together and used to develop overarching themes. Results Work-related advice for peers focused on personal self-care and interactions within workplaces. Work-related advice to employers focused on demonstrating basic human values as well as the importance of communication. Discussion The study results suggest HNC clinic patients should be proactive with employers and help to set reasonable expectations and provide a realistic plan for work to be successfully completed. HNC clinic patients should develop communication skills to effectively disclose their cancer and treatment to employers. Conclusions In this exploratory study, HNC clinic patients’ advice was solution-focused underscoring the importance of self-care and pro-active communication and planning with employers. Employers were advised to demonstrate core human values throughout all phases of the work disability episode beginning at diagnosis. PMID:27070654

  18. Patient counseling program to improve the compliance to imatinib in chronic myeloid leukemia patients.

    PubMed

    Moon, Joon Ho; Sohn, Sang Kyun; Kim, Shi Nae; Park, Seon Yang; Yoon, Sung Soo; Kim, In Ho; Kim, Hyeoung Joon; Kim, Yeo Kyeoung; Min, Yoo Hong; Cheong, June Won; Kim, Jin Seok; Jung, Chul Won; Kim, Dong Hwan

    2012-06-01

    To achieve successful therapeutic outcomes in chronic myeloid leukemia (CML), continuous and adequate imatinib (Gleevec(®), Glivec(®), Novartis Pharmaceuticals, Basel, Switzerland) dosing is essential. Here, we report a patient counseling program ("Care club", "Happy club" in Korea) performed to improve patient compliance with imatinib. From January 2006 to December 2008, patients diagnosed with chronic phase CML and taking imatinb were eligible for this retrospective study. A total of 114 patients from 4 centers in Korea were recruited at a 50:50 ratio for Happy club group versus non-Happy club group at each center. During 36-month follow-up, persistency (the number of days of imatinib prescribed versus 1 year) was higher in the Happy club group (98.2 ± 0.03%) than in the non-Happy club group (79.3 ± 0.16%, P = 0.001), whereas dose compliance (miligrams of imatinib that were actually taken versus miligrams that should have been taken) was not different between two groups; 96.5 ± 0.6% and 96.6 ± 0.7% in the Happy club and non-Happy club (P = 0.958). Overall compliance (the product of persistency and dose compliance) improved in the Happy club group (93.0 ± 2.3%) compared with the non-Happy club group (76.2 ± 7.4%, P = 0.001). The patient counseling program was efficient especially in patients who needed high-dose imatinib (>400 mg/day), and overall compliance was 87.8 ± 6.0% in the Happy club group versus 65.5 ± 16.1% in the non-Happy club group (P = 0.017). In conclusion, the patient counseling program was effective in persisting imatinib medication, resulting in the improvement of overall compliance.

  19. The Massachusetts General Hospital Pulmonary Embolism Response Team (MGH PERT): creation of a multidisciplinary program to improve care of patients with massive and submassive pulmonary embolism.

    PubMed

    Provias, Tim; Dudzinski, David M; Jaff, Michael R; Rosenfield, Kenneth; Channick, Richard; Baker, Joshua; Weinberg, Ido; Donaldson, Cameron; Narayan, Rajeev; Rassi, Andrew N; Kabrhel, Christopher

    2014-02-01

    New and innovative tools have emerged for the treatment of massive and submassive pulmonary embolism (PE). These novel treatments, when considered alongside existing therapy, such as anticoagulation, systemic intravenous thrombolysis, and open surgical pulmonary embolectomy, have the potential to improve patient outcomes. However, data comparing different treatment modalities are sparse, and guidelines provide only general advice for their use. Treatment decisions rest on clinician expertise and institutional resources. Because various medical and surgical specialties offer different perspectives and expertise, a multidisciplinary approach to patients with massive and submassive PE is required. To address this need, we created a novel multidisciplinary program - the Massachusetts General Hospital (MGH) Pulmonary Embolism Response Team (PERT) - which brings together multiple specialists to rapidly evaluate intermediate- and high-risk patients with PE, formulate a treatment plan, and mobilize the necessary resources to provide the highest level of care. Development of a clinical, educational, and research infrastructure, as well as the creation of a national PERT consortium, will make our experience available to other institutions and serve as a platform for future studies to improve the care of complex patients with massive and submassive PE.

  20. 'PhysioDirect' telephone assessment and advice services for physiotherapy: protocol for a pragmatic randomised controlled trial

    PubMed Central

    Salisbury, Chris; Foster, Nadine E; Bishop, Annette; Calnan, Michael; Coast, Jo; Hall, Jeanette; Hay, Elaine; Hollinghurst, Sandra; Hopper, Cherida; Grove, Sean; Kaur, Surinder; Montgomery, Alan

    2009-01-01

    Background Providing timely access to physiotherapy has long been a problem for the National Health Service in the United Kingdom. In an attempt to improve access some physiotherapy services have introduced a new treatment pathway known as PhysioDirect. Physiotherapists offer initial assessment and advice by telephone, supported by computerised algorithms, and patients are sent written self-management and exercise advice by post. They are invited for face-to-face treatment only when necessary. Although several such services have been developed, there is no robust evidence regarding clinical and cost-effectiveness, nor the acceptability of PhysioDirect. Methods/Design This protocol describes a multi-centre pragmatic individually randomised trial, with nested qualitative research. The aim is to determine the effectiveness, cost-effectiveness, and acceptability of PhysioDirect compared with usual models of physiotherapy based on patients going onto a waiting list and receiving face-to-face care. PhysioDirect services will be established in four areas in England. Adult patients in these areas with musculoskeletal problems who refer themselves or are referred by a primary care practitioner for physiotherapy will be invited to participate in the trial. About 1875 consenting patients will be randomised in a 2:1 ratio to PhysioDirect or usual care. Data about outcome measures will be collected at baseline and 6 weeks and 6 months after randomisation. The primary outcome is clinical improvement at 6 months; secondary outcomes include cost, waiting times, time lost from work and usual activities, patient satisfaction and preference. The impact of PhysioDirect on patients in different age-groups and with different conditions will also be examined. Incremental cost-effectiveness will be assessed in terms of quality adjusted life years in relation to cost. Qualitative methods will be used to explore factors associated with the success or failure of the service, the

  1. Improving Publication: Advice for Busy Higher Education Academics

    ERIC Educational Resources Information Center

    Gibbs, Anita

    2016-01-01

    A major challenge for higher education academics is to research and publish when faced with substantial teaching responsibilities, higher student numbers, and higher output expectations. The focus of this piece is to encourage publication more generally by educators, and to build publication capacity, which academic developers can facilitate. The…

  2. 29 CFR 1912a.5 - Advice and recommendations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 7 2010-07-01 2010-07-01 false Advice and recommendations. 1912a.5 Section 1912a.5 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) NATIONAL ADVISORY COMMITTEE ON OCCUPATIONAL SAFETY AND HEALTH § 1912a.5 Advice...

  3. 31 CFR 10.37 - Requirements for other written advice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Requirements for other written advice. 10.37 Section 10.37 Money and Finance: Treasury Office of the Secretary of the Treasury PRACTICE... give written advice (including electronic communications) concerning one or more Federal tax issues...

  4. Low Income Women and Physician Breastfeeding Advice: A Regional Assessment

    ERIC Educational Resources Information Center

    Stolzer, J; Zeece, Pauline

    2006-01-01

    Objectives: The aims of the pilot study presented here were to determine whether low income women were receiving compendious breastfeeding advice from their attending physicians. Design: This study assessed low income women's reports of physician breastfeeding advice using a newly designed Likert scaled survey based on the American Surgeon…

  5. "What Advice Would You Give to Students Starting Your Course?"

    ERIC Educational Resources Information Center

    Meedin, Aneeqa

    2007-01-01

    In this essay, the author, a Biomedical Sciences student at the University of Sheffield, presents an atypical way of addressing the question "What advice would you give to students starting your course?" by transcribing the much-evoked and revered Ten Commandments, the original guide to life, into advice for new and bewildered Biomedical…

  6. 14 CFR § 1209.305 - Legal advice and assistance.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Legal advice and assistance. § 1209.305 Section § 1209.305 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION BOARDS AND COMMITTEES Contract Adjustment Board § 1209.305 Legal advice and assistance. The General Counsel of...

  7. 14 CFR 1209.305 - Legal advice and assistance.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Legal advice and assistance. 1209.305 Section 1209.305 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION BOARDS AND COMMITTEES Contract Adjustment Board § 1209.305 Legal advice and assistance. The General Counsel of NASA shall...

  8. 14 CFR 1209.305 - Legal advice and assistance.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Legal advice and assistance. 1209.305 Section 1209.305 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION BOARDS AND COMMITTEES Contract Adjustment Board § 1209.305 Legal advice and assistance. The General Counsel of NASA shall...

  9. Listen to Your Heart? Calling and Receptivity to Career Advice

    ERIC Educational Resources Information Center

    Dobrow, Shoshana R.; Tosti-Kharas, Jennifer

    2012-01-01

    This study explores calling in the context of career decision making. Specifically, the authors examine receptivity to advice that discourages individuals from pursuing a professional path in their calling's domain. The authors hypothesize that people with a strong calling will be more likely to ignore negative career advice. In Study 1, a…

  10. 5 CFR 1304.4607 - Advice to former Government employees.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Advice to former Government employees. 1304.4607 Section 1304.4607 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET ADMINISTRATIVE PROCEDURES POST EMPLOYMENT CONFLICT OF INTEREST § 1304.4607 Advice to former Government employees. The...

  11. ADVICE--Educational System for Teaching Database Courses

    ERIC Educational Resources Information Center

    Cvetanovic, M.; Radivojevic, Z.; Blagojevic, V.; Bojovic, M.

    2011-01-01

    This paper presents a Web-based educational system, ADVICE, that helps students to bridge the gap between database management system (DBMS) theory and practice. The usage of ADVICE is presented through a set of laboratory exercises developed to teach students conceptual and logical modeling, SQL, formal query languages, and normalization. While…

  12. 14 CFR 1209.305 - Legal advice and assistance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Legal advice and assistance. 1209.305 Section 1209.305 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION BOARDS AND COMMITTEES Contract Adjustment Board § 1209.305 Legal advice and assistance. The General Counsel of NASA shall...

  13. 14 CFR 1209.305 - Legal advice and assistance.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Legal advice and assistance. 1209.305 Section 1209.305 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION BOARDS AND COMMITTEES Contract Adjustment Board § 1209.305 Legal advice and assistance. The General Counsel of NASA shall...

  14. 29 CFR 1400.735-3 - Advice and counseling service.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 4 2012-07-01 2012-07-01 false Advice and counseling service. 1400.735-3 Section 1400.735-3 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE STANDARDS OF CONDUCT, RESPONSIBILITIES, AND DISCIPLINE General § 1400.735-3 Advice and counseling...

  15. 29 CFR 1400.735-3 - Advice and counseling service.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Advice and counseling service. 1400.735-3 Section 1400.735-3 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE STANDARDS OF CONDUCT, RESPONSIBILITIES, AND DISCIPLINE General § 1400.735-3 Advice and counseling...

  16. 29 CFR 1400.735-3 - Advice and counseling service.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 4 2013-07-01 2013-07-01 false Advice and counseling service. 1400.735-3 Section 1400.735-3 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE STANDARDS OF CONDUCT, RESPONSIBILITIES, AND DISCIPLINE General § 1400.735-3 Advice and counseling...

  17. 29 CFR 1400.735-3 - Advice and counseling service.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 4 2011-07-01 2011-07-01 false Advice and counseling service. 1400.735-3 Section 1400.735-3 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE STANDARDS OF CONDUCT, RESPONSIBILITIES, AND DISCIPLINE General § 1400.735-3 Advice and counseling...

  18. 29 CFR 1400.735-3 - Advice and counseling service.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 4 2014-07-01 2014-07-01 false Advice and counseling service. 1400.735-3 Section 1400.735-3 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE STANDARDS OF CONDUCT, RESPONSIBILITIES, AND DISCIPLINE General § 1400.735-3 Advice and counseling...

  19. 5 CFR 1304.4607 - Advice to former Government employees.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Advice to former Government employees. 1304.4607 Section 1304.4607 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET ADMINISTRATIVE PROCEDURES POST EMPLOYMENT CONFLICT OF INTEREST § 1304.4607 Advice to former Government employees. The...

  20. Designing the Recipient: Managing Advice Resistance in Institutional Settings

    ERIC Educational Resources Information Center

    Hepburn, Alexa; Potter, Jonathan

    2011-01-01

    In this paper we consider a collection of conversational practices that arise when a professional is faced with extended resistance to their offered advice. Our data is comprised of telephone calls to a UK child protection helpline. The practices we identify occur repeatedly across our corpus of advice resistance sequences and involve (1) the…

  1. [Errors in medicine. Causes, impact and improvement measures to improve patient safety].

    PubMed

    Waeschle, R M; Bauer, M; Schmidt, C E

    2015-09-01

    The guarantee of quality of care and patient safety is of major importance in hospitals even though increased economic pressure and work intensification are ubiquitously present. Nevertheless, adverse events still occur in 3-4 % of hospital stays and of these 25-50 % are estimated to be avoidable. The identification of possible causes of error and the development of measures for the prevention of medical errors are essential for patient safety. The implementation and continuous development of a constructive culture of error tolerance are fundamental.The origins of errors can be differentiated into systemic latent and individual active causes and components of both categories are typically involved when an error occurs. Systemic causes are, for example out of date structural environments, lack of clinical standards and low personnel density. These causes arise far away from the patient, e.g. management decisions and can remain unrecognized for a long time. Individual causes involve, e.g. confirmation bias, error of fixation and prospective memory failure. These causes have a direct impact on patient care and can result in immediate injury to patients. Stress, unclear information, complex systems and a lack of professional experience can promote individual causes. Awareness of possible causes of error is a fundamental precondition to establishing appropriate countermeasures.Error prevention should include actions directly affecting the causes of error and includes checklists and standard operating procedures (SOP) to avoid fixation and prospective memory failure and team resource management to improve communication and the generation of collective mental models. Critical incident reporting systems (CIRS) provide the opportunity to learn from previous incidents without resulting in injury to patients. Information technology (IT) support systems, such as the computerized physician order entry system, assist in the prevention of medication errors by providing

  2. [Errors in medicine. Causes, impact and improvement measures to improve patient safety].

    PubMed

    Waeschle, R M; Bauer, M; Schmidt, C E

    2015-09-01

    The guarantee of quality of care and patient safety is of major importance in hospitals even though increased economic pressure and work intensification are ubiquitously present. Nevertheless, adverse events still occur in 3-4 % of hospital stays and of these 25-50 % are estimated to be avoidable. The identification of possible causes of error and the development of measures for the prevention of medical errors are essential for patient safety. The implementation and continuous development of a constructive culture of error tolerance are fundamental.The origins of errors can be differentiated into systemic latent and individual active causes and components of both categories are typically involved when an error occurs. Systemic causes are, for example out of date structural environments, lack of clinical standards and low personnel density. These causes arise far away from the patient, e.g. management decisions and can remain unrecognized for a long time. Individual causes involve, e.g. confirmation bias, error of fixation and prospective memory failure. These causes have a direct impact on patient care and can result in immediate injury to patients. Stress, unclear information, complex systems and a lack of professional experience can promote individual causes. Awareness of possible causes of error is a fundamental precondition to establishing appropriate countermeasures.Error prevention should include actions directly affecting the causes of error and includes checklists and standard operating procedures (SOP) to avoid fixation and prospective memory failure and team resource management to improve communication and the generation of collective mental models. Critical incident reporting systems (CIRS) provide the opportunity to learn from previous incidents without resulting in injury to patients. Information technology (IT) support systems, such as the computerized physician order entry system, assist in the prevention of medication errors by providing

  3. Inspiratory muscle training improves antireflux barrier in GERD patients.

    PubMed

    Nobre e Souza, Miguel Ângelo; Lima, Maria Josire Vitorino; Martins, Giovanni Bezerra; Nobre, Rivianny Arrais; Souza, Marcellus Henrique Loiola Ponte; de Oliveira, Ricardo Brandt; dos Santos, Armênio Aguiar

    2013-12-01

    The crural diaphragm (CD) is an essential component of the esophagogastric junction (EGJ), and inspiratory exercises may modify its function. This study's goal is to verify if inspiratory muscle training (IMT) improves EGJ motility and gastroesophageal reflux (GER). Twelve GER disease [GERD; 7 males, 20-47 yr, 9 esophagitis, and 3 nonerosive reflex disease (NERD)] and 7 healthy volunteers (3 males, 20-41 yr) performed esophageal pH monitoring, manometry, and heart rate variability (HRV) studies. A 6-cm sleeve catheter measured average EGJ pressure during resting, peak inspiratory EGJ pressures during sinus arrhythmia maneuver (SAM) and inhalations under 17-, 35-, and 70-cmH2O loads (TH maneuvers), and along 1 h after a meal. GERD patients entered a 5-days-a-week IMT program. One author scored heartburn and regurgitation before and after IMT. IMT increased average EGJ pressure (19.7 ± 2.4 vs. 29.5 ± 2.1 mmHg; P < 0.001) and inspiratory EGJ pressure during SAM (89.6 ± 7.6 vs. 125.6 ± 13.3 mmHg; P = 0.001) and during TH maneuvers. The EGJ-pressure gain across 35- and 70-cmH2O loads was lower for GERD volunteers. The number and cumulative duration of the transient lower esophageal sphincter relaxations decreased after IMT. Proximal progression of GER decreased after IMT but not the distal acid exposure. Low-frequency power increased after IMT and the higher its increment the lower the increment of supine acid exposure. IMT decreased heartburn and regurgitation scores. In conclusion, IMT improved EGJ pressure, reduced GER proximal progression, and reduced GERD symptoms. Some GERD patients have a CD failure, and IMT may prove beneficial as a GERD add-on treatment.

  4. Quit smoking advice from health professionals in Taiwan: the role of funding policy and smoker socioeconomic status

    PubMed Central

    Hu, Teh-wei; Lo, Shu-ying; Yu, Po-tswen; Chao, Kun-yu; Hsiao, Mei-ling

    2009-01-01

    Objectives In 2002, Taiwan launched a program to encourage doctors to provide brief cessation counselling to their patients during routine outpatient visits. This study is to compare and analyse the annual prevalence rate of receiving advice to quit smoking from health professionals before (2004) and after (2005, 2006) the increase in funding and the withdrawal of additional funding (2007). Methods We analysed pooled data from 2004 to 2007 Taiwan Adult Tobacco Survey, an annual random digit dialling telephone survey, to estimate the prevalence of receiving quit advice among ever smokers across these years. Smoking characteristics and the socioeconomic factors of smokers associated with receipt of advice to quit smoking were also examined. Results The prevalence rate of receiving quit advice increased from 21.1% in 2004 to 28.2% in 2006, and then decreased slightly to 27.6% in 2007 after the funds were cut. Multivariate analyses results indicated that increasing financing for smoking cessation services in 2005, being male, older, a daily cigarette user, having previously attempted to quit, perceiving oneself as having poor health and being aware of the benefits of smoking cessation services were significantly positively associated with receiving quit advice from health professionals. In contrast, smokers who were younger, female and occasional cigarette users were less likely to receive quit advice. Also, smokers with socioeconomic disadvantages were not less likely to receive quit advice. Conclusions During the period of increased funding for smoking cessation services, the rates of receiving quit advice increased among all smokers and across different socioeconomic groups. PMID:19965797

  5. Application of Bow-tie methodology to improve patient safety.

    PubMed

    Abdi, Zhaleh; Ravaghi, Hamid; Abbasi, Mohsen; Delgoshaei, Bahram; Esfandiari, Somayeh

    2016-05-01

    Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings. PMID:27142951

  6. Driving improvement in patient care: lessons from Toyota.

    PubMed

    Thompson, Debra N; Wolf, Gail A; Spear, Steven J

    2003-11-01

    Nurses today are attempting to do more with less while grappling with faulty error-prone systems that do not focus on patients at the point of care. This struggle occurs against a backdrop of rising national concern over the incidence of medical errors in healthcare. In an effort to create greater value with scarce resources and fix broken systems that compromise quality care, UPMC Health System is beginning to master and implement the Toyota Production System (TPS)--a method of managing people engaged in work that emphasizes frequent rapid problem solving and work redesign that has become the global archetype for productivity and performance. The authors discuss the rationale for applying TPS to healthcare and implementation of the system through the development of "learning unit" model lines and initial outcomes, such as dramatic reductions in the number of missing medications and thousands of hours and dollars saved as a result of TPS-driven changes. Tracking data further suggest that TPS, with sufficient staff preparation and involvement, has the potential for continuous, lasting, and accelerated improvement in patient care. PMID:14608217

  7. Application of Bow-tie methodology to improve patient safety.

    PubMed

    Abdi, Zhaleh; Ravaghi, Hamid; Abbasi, Mohsen; Delgoshaei, Bahram; Esfandiari, Somayeh

    2016-05-01

    Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

  8. Neurostimulation to improve level of consciousness in patients with epilepsy.

    PubMed

    Gummadavelli, Abhijeet; Kundishora, Adam J; Willie, Jon T; Andrews, John P; Gerrard, Jason L; Spencer, Dennis D; Blumenfeld, Hal

    2015-06-01

    When drug-resistant epilepsy is poorly localized or surgical resection is contraindicated, current neurostimulation strategies such as deep brain stimulation and vagal nerve stimulation can palliate the frequency or severity of seizures. However, despite medical and neuromodulatory therapy, a significant proportion of patients continue to experience disabling seizures that impair awareness, causing disability and risking injury or sudden unexplained death. We propose a novel strategy in which neuromodulation is used not only to reduce seizures but also to ameliorate impaired consciousness when the patient is in the ictal and postictal states. Improving or preventing alterations in level of consciousness may have an effect on morbidity (e.g., accidents, drownings, falls), risk for death, and quality of life. Recent studies may have elucidated underlying networks and mechanisms of impaired consciousness and yield potential novel targets for neuromodulation. The feasibility, benefits, and pitfalls of potential deep brain stimulation targets are illustrated in human and animal studies involving minimally conscious/vegetative states, movement disorders, depth of anesthesia, sleep-wake regulation, and epilepsy. We review evidence that viable therapeutic targets for impaired consciousness associated with seizures may be provided by key nodes of the consciousness system in the brainstem reticular activating system, hypothalamus, basal ganglia, thalamus, and basal forebrain.

  9. Applied Strategies for Improving Patient Safety: A Comprehensive Process To Improve Care in Rural and Frontier Communities

    ERIC Educational Resources Information Center

    Westfall, John M.; Fernald, Douglas H.; Staton, Elizabeth W.; VanVorst, Rebecca; West, David; Pace, Wilson D.

    2004-01-01

    Medical errors and patient safety have gained increasing attention throughout all areas of medical care. Understanding patient safety in rural settings is crucial for improving care in rural communities. To describe a system to decrease medical errors and improve care in rural and frontier primary care offices. Applied Strategies for Improving…

  10. Effective colonoscopy training techniques: strategies to improve patient outcomes

    PubMed Central

    Papanikolaou, Ioannis S; Karatzas, Pantelis S; Varytimiadis, Lazaros T; Tsigaridas, Athanasios; Galanopoulos, Michail; Viazis, Nikos; Karamanolis, Dimitrios G

    2016-01-01

    Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists. PMID:27099542

  11. Goal-Driven Development of a Patient Surveillance Application for Improving Patient Safety

    NASA Astrophysics Data System (ADS)

    Behnam, Saeed Ahmadi; Amyot, Daniel; Forster, Alan J.; Peyton, Liam; Shamsaei, Azalia

    Hospitals strive to improve the safety of their patients. Yet, every year, thousands of patients suffer from adverse events, which are defined as undesirable outcomes caused by health care business processes. There are few tools supporting adverse event detection and these are ineffective. There is hence some urgency in developing such a tool in a way that complies with the organizations goals and privacy legislation. In addition, governments will soon require hospitals to report on adverse events. In this paper, we will show how a pilot application we developed contributes to the patient safety goals of a major teaching hospital and how our goal-driven approach supported the collaboration between the university researchers and hospital decision makers involved. Benefits and challenges related to the modeling of requirements, goals, and processes, and to the development of the application itself, are also discussed.

  12. Saskatchewan: improving patient, nursing and organizational outcomes utilizing formal nurse-patient ratios.

    PubMed

    Rozdilsky, Janlyn; Alecxe, Amber

    2012-03-01

    The issue of nurse-to-patient ratios has been of significant interest to nurses in Saskatchewan. A commitment to a nurse-to-patient pilot project was articulated in a letter of understanding in the 2005 to 2008 contract between the Saskatchewan Union of Nurses (SUN) and the Saskatchewan Association of Health Organizations. The SUN, the Saskatoon Health Region and the Saskatchewan Ministry of Health formed a partnership to engage in the pilot project, which lasted from November 2008 to March 2011. The project involved the creation of a flexible, dynamic and real-time staffing tool to inform day-to-day nurse staffing decisions on a hospital unit and was based on an adaptation of Curley's Synergy Model. A medical unit at St. Paul's Hospital in Saskatoon was selected for implementation, and all front-line nursing staff as well as unit nursing leaders were involved. A project working group adapted the Synergy-based Patient Scoring Tool (PST), which had been utilized for a recent project in British Columbia, to its own patient population. In April 2010, nurses began assessing each patient on every shift with the goal of determining the most suitable care provider. Patient assignment became based on the holistic assessment of patient needs according to the PST results rather than "geography" (for example, one nurse assigned to a multi-bed unit regardless of the acuity/capability of patients in the unit). Whenever possible, staffing on the unit was increased according to tool calculations.Positive impacts in patient outcomes began to be noted during the final data collection period for the project – nosocomial infection rates showed improvement, and the number of falls per patient-days decreased. As well, patient needs were made more visible through use of the PST, which created non-threatening opportunities for dialogue related to legislated scopes of practice. While longer timelines and larger sample size are needed to measure impacts on retention and recruitment of

  13. Eight Weeks of Cosmos caudatus (Ulam Raja) Supplementation Improves Glycemic Status in Patients with Type 2 Diabetes: A Randomized Controlled Trial.

    PubMed

    Cheng, Shi-Hui; Ismail, Amin; Anthony, Joseph; Ng, Ooi Chuan; Hamid, Azizah Abdul; Barakatun-Nisak, Mohd Yusof

    2015-01-01

    Objectives. Optimizing glycemic control is crucial to prevent type 2 diabetes related complications. Cosmos caudatus is reported to have promising effect in improving plasma blood glucose in an animal model. However, its impact on human remains ambiguous. This study was carried out to evaluate the effectiveness of C. caudatus on glycemic status in patients with type 2 diabetes. Materials and Methods. In this randomized controlled trial with two-arm parallel-group design, a total of 101 subjects with type 2 diabetes were randomly allocated to diabetic-ulam or diabetic controls for eight weeks. Subjects in diabetic-ulam group consumed 15 g of C. caudatus daily for eight weeks while diabetic controls abstained from taking C. caudatus. Both groups received the standard lifestyle advice. Results. After 8 weeks of supplementation, C. caudatus significantly reduced serum insulin (-1.16 versus +3.91), reduced HOMA-IR (-1.09 versus +1.34), and increased QUICKI (+0.05 versus -0.03) in diabetic-ulam group compared with the diabetic controls. HbA1C level was improved although it is not statistically significant (-0.76% versus -0.37%). C. caudatus was safe to consume. Conclusions. C. caudatus supplementation significantly improves insulin resistance and insulin sensitivity in patients with type 2 diabetes.

  14. Eight Weeks of Cosmos caudatus (Ulam Raja) Supplementation Improves Glycemic Status in Patients with Type 2 Diabetes: A Randomized Controlled Trial

    PubMed Central

    Cheng, Shi-Hui; Ismail, Amin; Anthony, Joseph; Ng, Ooi Chuan; Hamid, Azizah Abdul; Barakatun-Nisak, Mohd Yusof

    2015-01-01

    Objectives. Optimizing glycemic control is crucial to prevent type 2 diabetes related complications. Cosmos caudatus is reported to have promising effect in improving plasma blood glucose in an animal model. However, its impact on human remains ambiguous. This study was carried out to evaluate the effectiveness of C. caudatus on glycemic status in patients with type 2 diabetes. Materials and Methods. In this randomized controlled trial with two-arm parallel-group design, a total of 101 subjects with type 2 diabetes were randomly allocated to diabetic-ulam or diabetic controls for eight weeks. Subjects in diabetic-ulam group consumed 15 g of C. caudatus daily for eight weeks while diabetic controls abstained from taking C. caudatus. Both groups received the standard lifestyle advice. Results. After 8 weeks of supplementation, C. caudatus significantly reduced serum insulin (−1.16 versus +3.91), reduced HOMA-IR (−1.09 versus +1.34), and increased QUICKI (+0.05 versus −0.03) in diabetic-ulam group compared with the diabetic controls. HbA1C level was improved although it is not statistically significant (−0.76% versus −0.37%). C. caudatus was safe to consume. Conclusions. C. caudatus supplementation significantly improves insulin resistance and insulin sensitivity in patients with type 2 diabetes. PMID:26713097

  15. Eating behaviors among low-income obese adults in the United States: Does health care provider's advice carry any weight.

    PubMed

    Lorts, Cori; Ohri-Vachaspati, Punam

    2016-06-01

    The U.S. Preventive Task Force recommends that all patients be screened for obesity and given appropriate weight loss advice, if needed, as nutrition counseling by primary care physicians is a key objective for Healthy People 2020. This study assesses the association between health care provider's (HCP) advice to lose weight and eating behaviors among obese individuals. Data were collected using a household survey of adults in five New Jersey cities in 2009-10. Analyses presented are limited to 548 obese participants. Negative-binomial regression analysis determined the association of participants' eating behaviors and HCP's advice to lose weight, after adjusting for the participant's attempt to lose weight and demographic variables. Despite being obese, only 48% of the participants received weight loss advice from their HCP while 68% stated they were attempting to lose weight. HCP's advice to lose weight was associated with increased salad and fruit consumption (PR 1.3, 95% CI 1.06-1.61; PR 1.23, 95% CI 1.02-1.48). Attempting to lose weight was positively associated with a higher consumption of fruit (PR 1.39, 95% CI 1.13-1.72), vegetables (PR 1.22, 95% CI 1.07-1.39), and with eating fruits and vegetables as snacks (PR 1.62, 95% CI 1.28-2.05). Attempting to lose weight was negatively associated with consumption of sweet snacks (PR 0.68, 95% CI 0.49-0.94), sugar sweetened beverages (PR 0.71, 95% CI 0.58-0.87) and fast food (PR 0.77, 95% CI 0.62-0.97). There were no significant interactions between HCP's advice and attempts to lose weight. Obese adult's attempt to lose weight, and not HCP's advice to lose weight, was a predictor for healthy eating behaviors. Interventions in medical practices should train HCPs on effective strategies for motivating obese patients to adopt healthier lifestyles. PMID:26876632

  16. Improving Physician-Patient Communication through Coaching of Simulated Encounters

    ERIC Educational Resources Information Center

    Ravitz, Paula; Lancee, William J.; Lawson, Andrea; Maunder, Robert; Hunter, Jonathan J.; Leszcz, Molyn; McNaughton, Nancy; Pain, Clare

    2013-01-01

    Objective: Effective communication between physicians and their patients is important in optimizing patient care. This project tested a brief, intensive, interactive medical education intervention using coaching and standardized psychiatric patients to teach physician-patient communication to family medicine trainees. Methods: Twenty-six family…

  17. The personal shopper – a pilot randomized trial of grocery store-based dietary advice

    PubMed Central

    Lewis, K H; Roblin, D W; Leo, M; Block, J P

    2015-01-01

    The objective of this study was to test the feasibility and preliminary efficacy of a store-based dietary education intervention against traditional clinic-based advice. Patients with obesity (n = 55, mean [standard deviation, SD] age 44.3[9.2] years, 64% women, 87% non-Hispanic Black) were randomized to receive dietary counselling either in a grocery store or a clinic. Change between groups (analysis of covariance) was assessed for outcomes including: dietary quality (Healthy Eating Index – 2005 [0–100 points] ), and nutritional knowledge (0–65-point knowledge scale). Both groups reported improved diet quality at the end of the study. Grocery participants had greater increases in knowledge (mean [SD] change = 5.7 [6.1] points) than clinic participants (mean [SD] change = 3.2 [4.0] points) (P = 0.04). Participants enjoyed the store-based sessions. Grocery store-based visits offer a promising approach for dietary counselling. PMID:25873139

  18. Advice on Giving a Scientific Talk

    NASA Astrophysics Data System (ADS)

    Kurtz, D. W.

    2006-04-01

    What makes one speaker exciting and another boring? You have been to good talks and you have sat through far too many poor ones, so what makes the difference? It doesn't really matter whether it is a scientific talk, a public talk or a classroom lecture: Your prime concern is to think about the audience. You are talking to them. You are performing. Look at them; talk to them; think about what they are hearing and seeing. They very much want you to give a good talk -- that is why they have chosen to be your audience. But at the start of your talk they are worried you might not, so they are nervous. Your first job is to relax them and get their trust that you are going to do a good job. Then you will relax and you will be off to a great start. Of course your content matters; if you have a great discovery, they will forgive you anything. But it is still better to make a good presentation. I give some advice here on what to do, and what not to do, when giving any kind of talk, but with emphasis on short scientific talks presented at conferences. You should be a little nervous at the start of a talk - that is caused by your concern to do a good job. With a good start your talk will flow, you will then present your discoveries, and with a good ending your audience will applaud appreciatively and want to ask you questions. You will have enjoyed performing and want to do it again. Speaking can be fun for you, and rewarding for your audiences.

  19. Dietary Advice on Prescription: A novel approach to dietary counseling.

    PubMed

    Johansson, Gunnar

    2011-01-01

    This article describes a novel approach to giving dietary advice, which is called "Dietary Advice on Prescription" (DAP; Matordning på Recept [MoR] in Swedish). It is the same principle as prescription on medicine and "Physical Activity on Prescription" (PAP; Fysisk aktivitet på Recept [FaR] in Swedish). The main idea is that a written prescription will strengthen the oral advice and emphasize certain aspects of the dietary recommendation. The DAP is on the brink of being tested in a planned study.

  20. Improving healthy behaviors in type 1 diabetic patients by interactive frameworks.

    PubMed

    Kharrazi, Hadi

    2009-11-14

    Patient empowerment is considered to be one of the key factors in improving and maintaining a patient's health status. Patient empowerment in chronic illnesses involves educating the patient after the initial diagnosis and then keeping the patient motivated to adhere to the treatment in the follow up period. The aim of this research is creating an interactive framework to improve adherence to treatment in type 1 diabetic (T1D) patients based on an existing theoretical behavioral change model. The proposed framework learns from the patient's situation based on the patient's adherence to treatment and the patient's personal profile; and then the framework adapts itself to the new situation and creates new strategies to motivate the patient in order to reinforce positive behavior on the part of the patient. Thus, the embedded self-care interactive framework empowers T1D patients in achieving improved health outcomes by adhering to long term treatments.

  1. Improving recreational, residential, and vocational outcomes for patients with schizophrenia.

    PubMed

    Roder, V; Zorn, P; Müller, D; Brenner, H D

    2001-11-01

    As Roder and colleagues propose, we have seen three eras in the development and refinement of social skills training for individuals with schizophrenia. In the 1960s, skills training relied on the use of operant conditioning, as exemplified by the token economy. Reinforcement contingencies succeeded in activating patients with negative symptoms and in improving their social behavior. Contemporary psychiatric rehabilitation can profit from the identification and use of reinforcers to motivate anergic individuals who lack insight to participate actively in community-based programs. During the second era, in the 1970s, social learning through modeling, coaching, role playing, and behavioral assignments was introduced into skills training. These techniques were used to improve nonverbal skills, such as eye contact, fluency of speech, gestures, and facial expression, as well as conversational skills, assertiveness, and emotional expressiveness. Intervention programs of the third and current era are incorporating cognitive methods into the skills training enterprise. For example, in the modules for training social and independent living skills developed and validated by Liberman and his colleagues at the University of California at Los Angeles (1), the deficits in attention, memory, and verbal learning often experienced by persons with schizophrenia are overcome by repetition, shaping of incremental behavioral improvements, video modeling, and feedback for galvanizing attention. Procedural learning techniques that do not rely on the brain capacities that mediate verbal awareness and insight are also used. In this month's Rehab Rounds column, Roder and his colleagues present another example of a skills training approach of the third era that includes elements of cognitive remediation. As autonomous offsprings of integrated psychological therapy (IPT), which was originally developed by Hans Brenner and Volker Roder and their colleagues at the University of Bern in

  2. Walking improvements with nabiximols in patients with multiple sclerosis.

    PubMed

    Coghe, G; Pau, M; Corona, F; Frau, J; Lorefice, L; Fenu, G; Spinicci, G; Mamusa, E; Musu, L; Massole, S; Massa, R; Marrosu, M G; Cocco, E

    2015-11-01

    Recently, nabiximols was approved as a treatment in MS spasticity. Data leading to approval and clinical use of nabiximols, although widely recognised, are based on subjective scales. Movement analysis procedures would obtain more detailed data about the impact on mobility. The aim of the study was to quantitatively assess the functional modification of gait patterns induced by nabiximols in MS. We evaluated three-dimensional gait analysis (spatial-temporal and kinematic) variation by means of one-way ANOVA. Twenty patients were enrolled-9 male and 11 female-with mean EDSS of 5.3 (SD ± 0.81) and mean reduction of numerical rating scale during nabiximols treatment of 1.88. The spatial-temporal parameters of gait revealed an increased speed (+15 %, p < 0.001), cadence (+6 %, p < 0.001) and stride length (+10 %, p < 0.001) after treatment. Regarding the kinematics data, the Gait Profile Score after treatment was reduced by 10 % (p < 0.001): Significant changes involved the pelvic area, hip rotation and knee flexion-extension. We found that nabiximols is able to improve the speed, cadence and stride length. Furthermore, the dynamics of the proximal segment of the legs and the knee movement results after treatment are closer to the physiologic values. PMID:26239223

  3. PhysioDirect: supporting physiotherapists to deliver telephone assessment and advice services within the context of a randomised trial.

    PubMed

    Bishop, Annette; Gamlin, Jill; Hall, Jeanette; Hopper, Cherida; Foster, Nadine E

    2013-06-01

    Physiotherapy-led telephone assessment and advice services for patients with musculoskeletal problems have been developed in many services in the UK, but high quality trial data on clinical and cost effectiveness has been lacking. In order to address this 'The PhysioDirect trial' (ISRCTN55666618), was a pragmatic randomised trial of a PhysioDirect telephone assessment and advice service. This paper describes the PhysioDirect system used in the trial and how physiotherapists were trained and supported to use the system and deliver the PhysioDirect service. The PhysioDirect system used in the trial was developed in Huntingdon and now serves a population of 350,000 people. When initiating or providing physiotherapy-led telephone assessment and advice services training and support for physiotherapists delivering care in this way is essential. An enhanced skill set is required for telephone assessment and advice particularly in listening and communication skills. In addition to an initial training programme, even experienced physiotherapists benefit from a period of skill consolidation to become proficient and confident in assessing patients and delivering care using the telephone. A computer-based system assists the delivery of a physiotherapy-led musculoskeletal assessment and advice service. Clinical Trials Registration Number (ISRCTN55666618).

  4. A Patient Registry to Improve Patient Safety: Recording General Neurosurgery Complications

    PubMed Central

    Sarnthein, Johannes; Stieglitz, Lennart; Clavien, Pierre-Alain; Regli, Luca

    2016-01-01

    Background To improve the transparency of the local health care system, treatment cost was recently referenced to disease related groups. Treatment quality must be legally documented in a patient registry, in particular for the highly specialized treatments provided by neurosurgery departments. Methods In 2013 we have installed a patient registry focused on cranial neurosurgery. Surgeries are characterized by indication, treatment, location and other specific neurosurgical parameters. Preoperative state and postoperative outcome are recorded prospectively using neurological and sociological scales. Complications are graded by their severity in a therapy-oriented complication score system (Clavien-Dindo-Grading system, CDG). Results are presented at the monthly clinical staff meeting. Results Data acquisition compatible with the clinic workflow permitted to include all eligible patients into the registry. Until December 2015, we have registered 2880 patients that were treated in 3959 surgeries and 8528 consultations. Since the registry is fully operational (August 2014), we have registered 325 complications on 1341 patient discharge forms (24%). In 64% of these complications, no or only pharmacological treatment was required. At discharge, there was a clear correlation of the severity of the complication and the Karnofsky Performance Status (KPS, ρ = -0.3, slope -6 KPS percentage points per increment of CDG) and the length of stay (ρ = 0.4, slope 1.5 days per increment of CDG). Conclusions While the therapy-oriented complication scores correlate reasonably well with outcome and length of stay, they do not account for new deficits that cannot be treated. Outcome grading and complication severity grading thus serve a complimentary purpose. Overall, the registry serves to streamline and to complete information flow in the clinic, to identify complication rates and trends early for the internal quality monitoring and communication with patients. Conversely, the

  5. Bevacizumab improves survival for patients with advanced cervical cancer

    Cancer.gov

    Patients with advanced, recurrent, or persistent cervical cancer that was not curable with standard treatment who received the drug bevacizumab (Avastin) lived 3.7 months longer than patients who did not receive the drug, according to an interim analysis

  6. Effect of magnet recognition on provision of smoking cessation advice to inpatients with pneumonia.

    PubMed

    Elkins, Mary Y

    2014-01-01

    The study examined the effect of Magnet recognition on hospital-reported rates of smoking cessation advice (SCA) provided to inpatients with community-acquired pneumonia. Logistic and propensity score regression models estimated the magnet effect on the SCA rate. Predictors were hospital characteristics, socioeconomic factors affecting smoking, and baseline and mid-study SCA rates as variations in hospital-improvement systems. Magnet recognized hospitals reporting higher mid-study SCA rates had higher outcome SCA rates.

  7. Rewarding psychiatric aides for the behavioral improvement of assigned patients1

    PubMed Central

    Pomerleau, Ovide F.; Bobrove, Philip H.; Smith, Rita H.

    1973-01-01

    Different ways of modifying the aide-patient relationship to promote improvement in psychiatric patients were investigated. Psychiatric aides were given information about the behavior of assigned patients, cash awards based on the improvement of assigned patients, and different kinds of supervision by the psychology staff; the effects of these variables on a large number of psychiatrically relevant behaviors were measured. Appropriate behavior of patients increased when the aides were given quantitative information about the improvement of assigned patients. Cash awards for aides, which were not contingent on the behavior of patients had little effect, while cash awards contingent on the behavior of assigned patients were associated with more appropriate behavior. Direct supervision of aide-patient interactions was associated with an increase in appropriate behavior, while required consultation for the aides about assigned patients was not. Behavior of patients deteriorated when the program was terminated. PMID:16795420

  8. Levetiracetam improves verbal memory in high-grade glioma patients

    PubMed Central

    de Groot, Marjolein; Douw, Linda; Sizoo, Eefje M.; Bosma, Ingeborg; Froklage, Femke E.; Heimans, Jan J.; Postma, Tjeerd J.; Klein, Martin; Reijneveld, Jaap C.

    2013-01-01

    Background Treatment of high-grade glioma (HGG) patients with anti-epileptic drugs (AEDs) has met with various side effects, such as cognitive deterioration. The cognitive effects of both older and newer AEDs in HGG patients are largely unknown. The aim of this study was to determine the effect of older and newer AEDs on cognitive performance in postoperative HGG patients. Methods We selected HGG patients from 3 separate cohorts for use of older, newer, or no AEDs, as they represented distinct treatment eras and provided the opportunity to compare older and newer AEDs. In all 3 cohorts, patients were included within 6 weeks following neurosurgery before the start of postoperative treatment. Cognitive functioning was evaluated by an extensive neuropsychological assessment, executed in 6 cognitive domains (attention, executive functioning, verbal memory, working memory, psychomotor functioning, and information processing speed). Results One hundred seventeen patients met the inclusion criteria; 44 patients used no AED, 35 were on monotherapy with a newer AED (all levetiracetam), and 38 were on monotherapy with an older AED (valproic acid or phenytoin). Patients on older and newer AEDs performed equally well as patients not on an AED, and patients on levetiracetam performed even better on verbal memory tests than patients not on an AED. Post-hoc analyses revealed that within the group using older AEDs, patients on valproic acid performed better than patients on phenytoin. Conclusions Neither levetiracetam nor valproic acid was associated with additional cognitive deficits in HGG patients. Both AEDs even appeared to have a beneficial effect on verbal memory in these patients. PMID:23233537

  9. Effectiveness of regular reporting of spirometric results combined with a smoking cessation advice by a primary care physician on smoking quit rate in adult smokers: a randomized controlled trial. ESPIROTAB study

    PubMed Central

    2011-01-01

    Background Undiagnosed airflow limitation is common in the general population and is associated with impaired health and functional status. Smoking is the most important risk factor for this condition. Although primary care practitioners see most adult smokers, few currently have spirometers or regularly order spirometry tests in these patients. Brief medical advice has shown to be effective in modifying smoking habits in a large number of smokers but only a small proportion remain abstinent after one year. The aim of this study is to evaluate the effectiveness of regular reporting of spirometric results combined with a smoking cessation advice by a primary care physician on smoking quit rate in adult smokers. Methods/design Intervention study with a randomized two arms in 5 primary care centres. A total of 485 smokers over the age of 18 years consulting their primary care physician will be recruited. On the selection visit all participants will undergo a spirometry, peak expiratory flow rate, test of smoking dependence, test of motivation for giving up smoking and a questionnaire on socio-demographic data. Thereafter an appointment will be made to give the participants brief structured advice to give up smoking combined with a detailed discussion on the results of the spirometry. After this, the patients will be randomised and given appointment for follow up visits at 3, 6, 12 and 24 months. Both arms will receive brief structured advice and a detailed discussion of the spirometry results at visit 0. The control group will only be given brief structured advice about giving up smoking on the follow up. Cessation of smoking will be tested with the carbon monoxide test. Discussion Early identification of functional pulmonary abnormalities in asymptomatic patients or in those with little respiratory symptomatology may provide "ideal educational opportunities". These opportunities may increase the success of efforts to give up smoking and may improve the opportunities

  10. 3D printing of patient-specific anatomy: A tool to improve patient consent and enhance imaging interpretation by trainees.

    PubMed

    Liew, Yaoren; Beveridge, Erin; Demetriades, Andreas K; Hughes, Mark A

    2015-01-01

    We report the use of three-dimensional or 3D printed, patient-specific anatomy as a tool to improve informed patient consent and patient understanding in a case of posterior lumbar fixation. Next, we discuss its utility as an educational tool to enhance imaging interpretation by neurosurgery trainees. PMID:25822093

  11. 3D printing of patient-specific anatomy: A tool to improve patient consent and enhance imaging interpretation by trainees.

    PubMed

    Liew, Yaoren; Beveridge, Erin; Demetriades, Andreas K; Hughes, Mark A

    2015-01-01

    We report the use of three-dimensional or 3D printed, patient-specific anatomy as a tool to improve informed patient consent and patient understanding in a case of posterior lumbar fixation. Next, we discuss its utility as an educational tool to enhance imaging interpretation by neurosurgery trainees.

  12. Listening to patients changes clinicians' perspectives and improves care.

    PubMed

    Vidal, Kathleen

    2014-01-01

    This article shares strategies of an academic medical center and its system of hospitals in partnering with patients and families to create a climate in which patients, families, and clinicians are comfortable enough to ask questions, suggest alternatives, and even choose to disagree. Relationship-Based Care: A Model for Transforming Practice (Koloroutis, 2004) was instrumental in developing an interdisciplinary relationship-based model of care supported by 4 key processes (admission interview, daily rounds, discharge planning, and follow-up phone calls). These processes-along with patient/ family councils, patient/family/staff retreats, patient/family representation on hospital committees, and a patient experience bundle-have proven successful in aligning patient and family expectations with clinicians' care delivery, as reflected in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. A study suggesting the nature of caring as a nurse-driven activity may vary from caring as a patient-driven activity. Inspired engagement with Koloroutis and Trout (2012) See Me as A Person: Creating Therapeutic Relationships with Patients and Their Families; attunement, wondering, following, and holding build bridges between clinicians perceptions and knowledge, and patients knowledge and expectations.

  13. Exploring the intersectoral partnerships guiding Australia's dietary advice.

    PubMed

    Dixon, Jane; Sindall, Colin; Banwell, Cathy

    2004-03-01

    In 1986, the Ottawa Charter alerted a new generation of health promotion practitioners to the benefits of working with the non-health sectors, including the commercial sector. Since then, the establishment of partnerships with government and non-government bodies has been advanced as a positive way of fostering policies that enhance health and well-being. The food and nutrition field has enthusiastically adopted partnerships between government, non-government and industry. In this article, we focus on the tactics employed by industry bodies to further their cause in a range of fields that are characterized by risk and contestation. We describe the nature of the alliances and interactions between commercial, scientific and government groups whose stated aim is to improve Australia's diet. Our analysis shows that these partnerships have been guided less by the ethos of the Ottawa Charter and more by the interests of the various parties: namely the food industry's need for credibility in making health claims, the financial imperatives of professional bodies and scientists whose public funding is inadequate, and government endorsement of public-private partnerships as the preferred mechanism for service delivery. The symbiotic relationship that is emerging between segments of the food industry and the nutrition professions raises questions about the independence of the dietary advice being given to consumers. We conclude by arguing for a research programme to investigate the consequences of intersectoral partnerships on the nutritional status of the population. PMID:14976167

  14. Giving Advice: Enough Is Enough After Three Solar Cycles

    NASA Astrophysics Data System (ADS)

    Mendillo, Michael

    2009-09-01

    On 1 July 2008, I concluded my 6-year term of service as president-elect, president, and past-president of AGU's Space Physics and Aeronomy (SPA) section. I truly appreciated the trust and confidence placed in me by the SPA electorate, and I greatly enjoyed this unique period of professional service. To have sufficient time to be fully engaged in SPA and AGU matters, I had taken a 6-year leave of service from advisory committees at NASA, the U.S. National Science Foundation, the Space Studies Board of the U.S. National Academy of Sciences (NAS), Department of Defense laboratories, and grant panels at all U.S. federal agencies. When my SPA duties were winding down about a year ago, I resumed my service on committees and panels. I was surprised to find that not only have things not improved, but they are far worse. The occurrence of self-serving advice, subdiscipline protection, and the shameless promotion of projects linked to one’s home institution is now out of control. If these patterns of professional conduct are not addressed seriously, SPA will survive into the 21st century as nothing more than a disjointed series of isolated fads based on bias and hype.

  15. Inspiration from role models and advice for moving forward.

    PubMed

    Newman, Michelle G; McGinn, Lata K

    2012-12-01

    This Behavior Therapy series on overcoming the glass ceiling followed from a highly attended panel at ABCT on the same topic. The current paper summarizes the common themes across the various papers in this series with respect to obstacles prominent women have faced, and how we can learn from their stories to help inform the future. These themes include the importance of role models, messages from a supportive environment, difficulties balancing careers with children, coordinating careers with family, importance of taking charge of one's career, moving forward despite negative internal and external messages, and questions about whether things have changed substantially. In addition, this paper contains a summary of the helpful advice from accomplished women in academia for navigating the academic waters. It is our aspiration that going forward this series will stimulate other conversations as well as increase thought, behavior, solidarity, and awareness about this topic so that we can continue to work toward a future when things will continue to improve for women.

  16. Expanding patient engagement in quality improvement and health system redesign: Three Canadian case studies.

    PubMed

    Baker, G Ross; Fancott, Carol; Judd, Maria; O'Connor, Patricia

    2016-09-01

    Healthcare organizations face growing pressures to increase patient-centred care and to involve patients more in organizational decisions. Yet many providers worry that such involvement requires additional time and resources and do not see patients as capable of contributing meaningfully to decisions. This article discusses three efforts in four organizations to engage patients in quality improvement efforts. McGill University Health Centre, Saskatoon Health Region, and Vancouver Coastal and Fraser Health Regions all engaged patients in quality improvement and system redesign initiatives that were successful in improving care processes, outcomes, and patient experience measures. Patient involvement in redesigning care may provide a way to demonstrate the value of patients' experiences and inputs into problem-solving, building support for their involvement in other areas. Further study of these cases and a broader survey of organizational experiences with patient involvement may help elucidate the factors that support greater patient engagement. PMID:27576853

  17. Influence of Antiflatulent Dietary Advice on Intrafraction Motion for Prostate Cancer Radiotherapy

    SciTech Connect

    Lips, Irene M.; Kotte, Alexis N.T.J.; Gils, Carla H. van; Leerdam, Monique E. van; Heide, Uulke A. van der; Vulpen, Marco van

    2011-11-15

    Purpose: To evaluate the effect of an antiflatulent dietary advice on the intrafraction prostate motion in patients treated with intensity-modulated radiotherapy (IMRT) for prostate cancer. Methods and Materials: Between February 2002 and December 2009, 977 patients received five-beam IMRT for prostate cancer to a dose of 76 Gy in 35 fractions combined with fiducial markers for position verification. In July 2008, the diet, consisting of dietary guidelines to obtain regular bowel movements and to reduce intestinal gas by avoiding certain foods and air swallowing, was introduced to reduce the prostate motion. The intrafraction prostate movement was determined from the portal images of the first segment of all five beams. Clinically relevant intrafraction motion was defined as {>=}50% of the fractions with an intrafraction motion outside a range of 3 mm. Results: A total of 739 patients were treated without the diet and 105 patients were treated with radiotherapy after introduction of the diet. The median and interquartile range of the average intrafraction motion per patient was 2.53 mm (interquartile range, 2.2-3.0) without the diet and 3.00 mm (interquartile range, 2.4-3.5) with the diet (p < .0001). The percentage of patients with clinically relevant intrafraction motion increased statistically significant from 19.1% without diet to 42.9% with a diet (odds ratio, 3.18; 95% confidence interval, 2.07-4.88; p < .0001). Conclusions: The results of the present study suggest that antiflatulent dietary advice for patients undergoing IMRT for prostate cancer does not reduce the intrafraction movement of the prostate. Therefore, antiflatulent dietary advice is not recommended in clinical practice for this purpose.

  18. An integrated care facilitation model improves quality of life and reduces use of hospital resources by patients with chronic obstructive pulmonary disease and chronic heart failure.

    PubMed

    Bird, Stephen; Noronha, Michelle; Sinnott, Helen

    2010-01-01

    As part of the Department of Human Services Hospital Admissions Risk Program (HARP), a group of acute and community based health care providers located in the western suburbs of Melbourne formed a consortium to reduce the demand on hospital emergency services and improve health outcomes for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). The model of care was designed by a team of multidisciplinary specialists and medical consultants. In addition to receiving normal care, patients recruited to the project were assessed by 'Care Facilitators', who identified unmet health care needs and provided information, advice and education for the patient concerning their condition and self-management. Patients declining recruitment received all normal care services. The patients' rates of emergency department (ED) presentations, inpatient admissions and hospital inpatient bed-days before and after their recruitment were calculated from the Western Health patient activity records, and pre- versus post-recruitment rates were compared using ANOVA. Changes relative to the ongoing use by those who declined recruitment were compared using the group-by-time interaction. Patient health outcomes were assessed using established disease-specific tools, and pre- versus post-recruitment values were compared using paired t-tests. Patients recruited to the COPD project reduced (P<0.05) their emergency presentations, admissions and hospital inpatient bed-days by 10, 25 and 18%, respectively, whereas those declining recruitment increased their usage by 45, 41 and 51% respectively. Recruited CHF patients also displayed reductions in emergency presentations (39%), admissions (36%) and hospital inpatient bed-days (33%), whereas those who declined recruitment displayed lesser reductions for ED presentations (26%) and admissions (20%), and increased their use of hospital inpatient bed-days (15%). The recruited COPD patients reported a significant

  19. Improving the care of cancer patients: holistic needs assessment.

    PubMed

    Young, Jenny; Cund, Audrey; Renshaw, Marian; Quigley, Angela; Snowden, Austyn

    This discussion paper presents a review of holistic needs assessments (HNAs) in the care of patients with cancer. HNAs entail a structured review of patient needs as articulated by the patient. This discussion then leads to a care plan grounded in issues pertinent to that patient. Despite policy guidance advocating its use, there are barriers to overcome in order to integrate HNAs into routine care. This article discusses what role communication skills and clinician confidence may have on the use of HNAs in practice, and suggests a strategy to support HNAs becoming the norm. PMID:25723367

  20. Improving the care of cancer patients: holistic needs assessment.

    PubMed

    Young, Jenny; Cund, Audrey; Renshaw, Marian; Quigley, Angela; Snowden, Austyn

    This discussion paper presents a review of holistic needs assessments (HNAs) in the care of patients with cancer. HNAs entail a structured review of patient needs as articulated by the patient. This discussion then leads to a care plan grounded in issues pertinent to that patient. Despite policy guidance advocating its use, there are barriers to overcome in order to integrate HNAs into routine care. This article discusses what role communication skills and clinician confidence may have on the use of HNAs in practice, and suggests a strategy to support HNAs becoming the norm.

  1. Use of Care Paths to Improve Patient Management

    ERIC Educational Resources Information Center

    Campbell, Suzann K.

    2013-01-01

    The purpose of this special issue of Physical & Occupational Therapy in Pediatrics is to present an evidence-based system to guide the physical therapy management of patients in the Neonatal Intensive Care Unit (NICU). Two systematic guides to patient management will be presented. The first is a care path intended primarily for use by physical…

  2. Improving Patient Satisfaction Through Computer-Based Questionnaires.

    PubMed

    Smith, Matthew J; Reiter, Michael J; Crist, Brett D; Schultz, Loren G; Choma, Theodore J

    2016-01-01

    Patient-reported outcome measures are helping clinicians to use evidence-based medicine in decision making. The use of computer-based questionnaires to gather such data may offer advantages over traditional paper-based methods. These advantages include consistent presentation, prompts for missed questions, reliable scoring, and simple and accurate transfer of information into databases without manual data entry. The authors enrolled 308 patients over a 16-month period from 3 orthopedic clinics: spine, upper extremity, and trauma. Patients were randomized to complete either electronic or paper validated outcome forms during their first visit, and they completed the opposite modality at their second visit, which was approximately 7 weeks later. For patients with upper-extremity injuries, the Penn Shoulder Score (PSS) was used. For patients with lower-extremity injuries, the Foot Function Index (FFI) was used. For patients with lumbar spine symptoms, the Oswestry Disability Index (ODI) was used. All patients also were asked to complete the 36-Item Short Form Health Survey (SF-36) Health Status Survey, version 1. The authors assessed patient satisfaction with each survey modality and determined potential advantages and disadvantages for each. No statistically significant differences were found between the paper and electronic versions for patient-reported outcome data. However, patients strongly preferred the electronic surveys. Additionally, the paper forms had significantly more missed questions for the FFI (P<.0001), ODI (P<.0001), and PSS (P=.008), and patents were significantly less likely to complete these forms (P<.0001). Future research should focus on limiting the burden on responders, individualizing forms and questions as much as possible, and offering alternative environments for completion (home or mobile platforms).

  3. Addressing the Financial Consequences of Cancer: Qualitative Evaluation of a Welfare Rights Advice Service

    PubMed Central

    Moffatt, Suzanne; Noble, Emma; White, Martin

    2012-01-01

    Background The onset, treatment and trajectory of cancer is associated with financial stress among patients across a range of health and welfare systems and has been identified as a significant unmet need. Welfare rights advice can be delivered effectively in healthcare settings, has the potential to alleviate financial stress, but has not yet been evaluated. We present an evaluation of a welfare rights advice intervention designed to address the financial consequences of cancer. Methods Descriptive study of welfare outcomes among 533 male and 641 female cancer patients and carers aged 4–95 (mean 62) years, who accessed the welfare rights advice service in North East England between April 2009 and March 2010; and qualitative interview study of a maximum variation sample of 35 patients and 9 carers. Results Over two thirds of cancer patients and carers came from areas of high socio-economic deprivation. Welfare benefit claims were successful for 96% of claims made and resulted in a median increase in weekly income of £70.30 ($109.74, €84.44). Thirty-four different types of benefits or grants were awarded. Additional resources were perceived to lessen the impact of lost earnings, help offset costs associated with cancer, reduce stress and anxiety and increase ability to maintain independence and capacity to engage in daily activities, all of which were perceived to impact positively on well-being and quality of life. Key barriers to accessing benefit entitlements were knowledge, system complexity, eligibility concerns and assumptions that health professionals would alert patients to entitlements. Conclusions The intervention proved feasible, effectively increased income for cancer patients and was highly valued. Addressing the financial sequelae of cancer can have positive social and psychological consequences that could significantly enhance effective clinical management and suitable services should be routinely available. Further research is needed to evaluate

  4. How nurses can use social enterprise to improve services in health care.

    PubMed

    Dawes, David

    This article describes the concept of social enterprise in nursing, and outlines how this model can help to improve care delivered to patients. It provides advice for nurses interested in pursuing this entrepreneurial route and also offers case studies demonstrating how the social enterprise model has been implemented in practice. PMID:19330985

  5. Improving the service for patients receiving extracorporeal photopheresis using Lean principles.

    PubMed

    Rushton, Cherie; Robertson, Leeah; Taylor, Tracie; Taylor, Peter; Button, Paul; Alfred, Arun

    2016-09-01

    The photopheresis unit where the authors work has seen an increased demand both locally and as an outreach service. A Lean assessment of the unit was undertaken to improve processing time and productivity, which in turn would improve the availability of treatment and improve patient care. The assessment indicated that there were excellent nursing standards and patient care; however, patient waiting times and treatment times were prolonged in comparison with other units. The unit reviewed the patient pathway and identified where delays occurred and consequently changed patient scheduling. PMID:27615528

  6. Oxytocin improves compassion toward women among patients with PTSD.

    PubMed

    Palgi, Sharon; Klein, Ehud; Shamay-Tsoory, Simone G

    2016-02-01

    Although impairments in social skills, including empathic abilities, are common in post-traumatic stress disorder (PTSD), the ability to feel compassion-a pro-social behavior that is based on empathy and drives us to help others-has never been assessed among these patients. The first aim of this study was to examine whether patients with PTSD suffer from deficits in compassion and to examine the association between the clusters of PTSD symptoms and these deficits. Furthermore, given that intranasal oxytocin (OT) has been suggested to possibly modulate social behaviors, the second aim of this study was to investigate whether intranasal OT may enhance compassion in these patients. Using a randomized, double-blind, placebo-controlled crossover design, we administered 24 IU of OT and placebo at a one-week interval to 32 patients with PTSD and to 30 matched healthy control participants. The results indicate that patients with PTSD exhibit deficits in compassion and that the numbing cluster emerged as the key predictor of those deficits. Moreover, the results indicate that a single intranasal dose of OT enhances compassion toward women (but not towards men), both in patients with PTSD and in controls. These results offer support for recent suggestions that intranasal OT may potentially be an effective pharmacological intervention for patients with PTSD.

  7. Oxytocin improves compassion toward women among patients with PTSD.

    PubMed

    Palgi, Sharon; Klein, Ehud; Shamay-Tsoory, Simone G

    2016-02-01

    Although impairments in social skills, including empathic abilities, are common in post-traumatic stress disorder (PTSD), the ability to feel compassion-a pro-social behavior that is based on empathy and drives us to help others-has never been assessed among these patients. The first aim of this study was to examine whether patients with PTSD suffer from deficits in compassion and to examine the association between the clusters of PTSD symptoms and these deficits. Furthermore, given that intranasal oxytocin (OT) has been suggested to possibly modulate social behaviors, the second aim of this study was to investigate whether intranasal OT may enhance compassion in these patients. Using a randomized, double-blind, placebo-controlled crossover design, we administered 24 IU of OT and placebo at a one-week interval to 32 patients with PTSD and to 30 matched healthy control participants. The results indicate that patients with PTSD exhibit deficits in compassion and that the numbing cluster emerged as the key predictor of those deficits. Moreover, the results indicate that a single intranasal dose of OT enhances compassion toward women (but not towards men), both in patients with PTSD and in controls. These results offer support for recent suggestions that intranasal OT may potentially be an effective pharmacological intervention for patients with PTSD. PMID:26671007

  8. Advice-Implicative Interrogatives: Building "Client-Centered" Support in a Children's Helpline

    ERIC Educational Resources Information Center

    Butler, Carly W.; Potter, Jonathan; Danby, Susan; Emmison, Michael; Hepburn, Alexa

    2010-01-01

    Interactional research on advice giving has described advice as normative and asymmetric. In this paper we examine how these dimensions of advice are softened by counselors on a helpline for children and young people through the use of questions. Through what we term "advice-implicative interrogatives," counselors ask clients about the relevance…

  9. Dietitians’ Perspectives on Interventions to Enhance Adherence to Dietary Advice for Chronic Diseases in Adults

    PubMed Central

    DESROCHES, SOPHIE; LAPOINTE, ANNIE; DESCHÊNES, SARAH-MAUDE; BISSONNETTE-MAHEUX, VÉRONIQUE; GRAVEL, KARINE; THIRSK, JAYNE; LÉGARÉ, FRANCE

    2016-01-01

    Purpose To assess dietitians’ perspectives on the importance and applicability of interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults in the Canadian context. Methods Based on a Cochrane systematic review, we identified 8 promising interventions for enhancing adherence to dietary advice: behavioural contracts, exchange lists, feedback based on self-monitoring, individualized menu suggestions, multiple interventions, portion size awareness, telephone follow-up, and videos. Thirty-two dietitians then completed a 3-round Delphi study by responding to an electronic questionnaire asking them to rate the importance and applicability in their practice of the 8 interventions on a 7-point Likert scale. Results Using a ≥75% level of agreement, 4 interventions showed strong consensus: multiple interventions, feedback based on self-monitoring, portion size awareness, and videos. Among these, the most significant were (means ± SD for importance and applicability, respectively) feedback based on self-monitoring (6.97 ± 0.18 and 6.72 ± 0.46), portion size awareness (6.69 ± 0.54 and 6.75 ± 0.51), and multiple interventions (6.94 ± 0.25 and 6.81 ± 0.40). Conclusions These findings can guide the development of educational training sessions for dietitians to help them provide practice-relevant interventions that will increase the likelihood that patients adhere to their advice regarding prevention and management of chronic diseases. PMID:26280789

  10. Improvement of tactile roughness discrimination acuity correlates with perception of improved hand function in patients after hand surgery.

    PubMed

    Fujimoto, Shuhei; Kon, Noriko

    2016-04-01

    [Purpose] The purpose of this study was to elucidate how well patients' perceptions related to the improvements in their hand function during hospitalization. [Subjects] Sixteen patients who were hospitalized after hand surgery. [Methods] Using the Japanese Society for Surgery of the Hand edition of the Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire; tactile roughness discrimination acuity, motor imagery, motor function, sensory function, and pain of the upper limb were assessed at admission and discharge. Spearman's rank-order correlation coefficients were calculated using the differences in all assessment items at admission and discharge. A multiple regression analysis (stepwise method) was performed to investigate factors that correlated with improvements in Quick-Disabilities of the Arm, Shoulder, and Hand scores. [Results] The improvement of tactile roughness discrimination acuity was significantly associated with patient perception of improved hand function. [Conclusion] The results suggest that an improvement in tactile roughness discrimination acuity was most strongly correlated with patient perception of improved hand function. PMID:27190473

  11. [Improvements in patient education from the didactical point of view].

    PubMed

    Feicke, J; Spörhase, U

    2012-10-01

    The findings of empirical educational research and the theoretical and experiential knowledge of general didactics and specific didactics of relevant subjects are not adequately considered in the conception and implementation of patient education. The aim of this work is to screen the results of existing research about the quality of instruction, to deduce quality criteria for patient education and to discuss their benefits for the existing practice. The research on the quality of instruction was systematically investigated for this purpose. Subsequently, the 3 empirically validated quality features: "clear structure", "participant-oriented social climate" and "cognitive activation with particular attention to domain-specific components of teaching" we identified were transferred to patient education and concretized by including the theoretical and experiential knowledge of didactics. In the process several domains (conception of manuals, train-the-trainer seminars) were identified in which the quality characteristics can be tied in. The findings of empirical educational research are able to complement the existing measures for quality assurance in the area of patient education. For this purpose the identification and specification together with the possible integration of the 3 quality criteria in the area of patient education are a first step.

  12. MASSIVE TRANSFUSION PROTOCOL: STANDARDIZING CARE TO IMPROVE PATIENT OUTCOMES.

    PubMed

    Porteous, Joan

    2015-06-01

    Providing rapid response is a primary goal when caring for surgical patients with injuries involving massive blood loss. Massive transfusion protocols have been developed in some tertiary care health care facilities to ensure a rapid and efficient response in the provision of care to patients with a massive and uncontrolled hemorrhage. The purpose of this article is to discuss a massive transfusion protocol and to describe the process used to implement a massive transfusion protocol at Winnipeg's Health Sciences Centre (the site) as well as to describe its impact in the operating room department. PMID:26310036

  13. MASSIVE TRANSFUSION PROTOCOL: STANDARDIZING CARE TO IMPROVE PATIENT OUTCOMES.

    PubMed

    Porteous, Joan

    2015-06-01

    Providing rapid response is a primary goal when caring for surgical patients with injuries involving massive blood loss. Massive transfusion protocols have been developed in some tertiary care health care facilities to ensure a rapid and efficient response in the provision of care to patients with a massive and uncontrolled hemorrhage. The purpose of this article is to discuss a massive transfusion protocol and to describe the process used to implement a massive transfusion protocol at Winnipeg's Health Sciences Centre (the site) as well as to describe its impact in the operating room department.

  14. Red meats: time for a paradigm shift in dietary advice.

    PubMed

    Binnie, Mary Ann; Barlow, Karine; Johnson, Valerie; Harrison, Carol

    2014-11-01

    Recent evidence suggests dietary advice to limit red meat is unnecessarily restrictive and may have unintended health consequences. As nutrient-rich high quality protein foods, red meats can play an important role in helping people meet their essential nutrient needs. Yet dietary advice to limit red meat remains standard in many developed countries, even though red meat intakes appear to be within current guidelines. Meanwhile, energy intakes from processed foods have increased dramatically at the expense of nutrient-rich foods, such as red meat. Research suggests these food trends are associated with the growing burden of obesity and associated diseases in recent decades. It is time for dietary advice that emphasizes the value of unprocessed red meat as part of a healthy balanced diet.

  15. Against professional advice: treatment attrition among pregnant methamphetamine users.

    PubMed

    Lindsay, Brianna; Albrecht, Jennifer; Terplan, Mishka

    2011-01-01

    Pregnant methamphetamine users who leave substance use treatment against professional advice may be at risk of poorer health outcomes. To examine the hypothesis that methamphetamine use during pregnancy may be associated with leaving substance use treatment against professional advice, the 2006 Treatment Episode Data Set was analyzed. A logistic regression adjusting for age, race, service setting, prior substance abuse treatment, criminal justice referral, and education was conducted. Inclusion criteria were met by 18,688 pregnant admissions; 26.4% identified methamphetamines as their primary substance of use. Frequency of use was identified as an effect modifier, therefore results were stratified by less than weekly use and weekly or more use. Methamphetamine use was significantly associated with leaving treatment against professional advice regardless of usage level. However, the odds of leaving treatment were greater among women using methamphetamine less than weekly. Further investigation into this association may be warranted due to the complications that may result from methamphetamine use during pregnancy.

  16. Pearls of Publishing: Advice for Increasing Your Acceptance Odds.

    PubMed

    Brand, Jefferson C; Rossi, Michael J; Provencher, Matthew T; Lubowitz, James H

    2016-07-01

    Pearls of wisdom can be a convenient and efficient strategy to improve performance. As Editors, we employ pearls to standardize the review and editorial process, and we offer our own pearls to you to help facilitate acceptance of submitted research manuscripts with the ultimate goal of strengthening scientific conclusions that can affect patient care, and ultimately, improve outcome.

  17. Pearls of Publishing: Advice for Increasing Your Acceptance Odds.

    PubMed

    Brand, Jefferson C; Rossi, Michael J; Provencher, Matthew T; Lubowitz, James H

    2016-07-01

    Pearls of wisdom can be a convenient and efficient strategy to improve performance. As Editors, we employ pearls to standardize the review and editorial process, and we offer our own pearls to you to help facilitate acceptance of submitted research manuscripts with the ultimate goal of strengthening scientific conclusions that can affect patient care, and ultimately, improve outcome. PMID:27373169

  18. 78 FR 55257 - Patient Safety and Quality Improvement: Civil Money Penalty Inflation Adjustment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-10

    ... for Healthcare Research and Quality. The Patient Safety and Quality Improvement Rule, 73 FR 70732 (Nov... maximum CMP amount for violations of the confidentiality provisions of the Rule. (74 FR 42777 (Aug. 25... HUMAN SERVICES Patient Safety and Quality Improvement: Civil Money Penalty Inflation Adjustment...

  19. Lessons Learned: Advice to Employers from Interns

    ERIC Educational Resources Information Center

    Rothman, Miriam

    2007-01-01

    In this article, the author reports the results of a content analysis based on the responses of 345 interns to the request for specific suggestions for how their employer could improve the experience for future interns enrolled in a for-credit business school internship class. The findings suggest that clarity of tasks, communication, and…

  20. Improving Balance in Subacute Stroke Patients: A Randomized Controlled Study

    ERIC Educational Resources Information Center

    Goljar, Nika; Burger, Helena; Rudolf, Marko; Stanonik, Irena

    2010-01-01

    The aim of the study was to compare the efficacy of balance training in a balance trainer, a newly developed mechanical device for training balance, with conventional balance training in subacute stroke patients. This was a randomized controlled study. Fifty participants met the inclusion criteria and 39 finished the study. The participants were…

  1. Improvement with Duloxetine in an Adult ADHD Patient

    ERIC Educational Resources Information Center

    Tourjman, Smadar Valerie; Bilodeau, Mathieu

    2009-01-01

    Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a common and disabling disorder among adults and is treated with stimulant and non stimulant medication. Objective: To report the case of a patient with ADHD showing good clinical response to duloxetine, a selective serotonin and norepinephrine reuptake inhibitor (SSNRI). Case…

  2. Updating patient histories every five years may improve screening

    Cancer.gov

    In order to maintain accurate family histories from their patients, physicians should get a comprehensive family history by age 30, and then update it every five to 10 years because histories change significantly between ages 30 and 50 years. According t

  3. Education in stroke: strategies to improve stroke patient care.

    PubMed

    Gompertz, Patrick; Slack, Andrew; Vogel, Mira; Burrows, Sharon; Clark, Philippa

    2002-07-01

    'Stroke units save lives', but organized care requires expert staff and regular training to be effective. However, the quality of inpatient care for stroke remains poor, and stroke education is often fragmented between the health-care professions. This review describes some national and local strategies aimed at ensuring that all patients are cared for by expert staff.

  4. Blood pressure control. Improving medication compliance among ESRD patients.

    PubMed

    Krevolin, Larry; Ilagan, Justin

    2015-08-01

    Medication compliance among individuals with hypertension symbolizes a growing concern within the medical community. It is said that roughly 50% of hypertensive patients in the United States do not comply with their medication regimen. Uncontrolled hypertension in turn can lead to kidney failure and other complications. Because compliance to medication regimens is complex and difficult to ascertain, solutions to this problem must be multifactorial.

  5. Improving Rural Cancer Patients' Outcomes: A Group-Randomized Trial

    ERIC Educational Resources Information Center

    Elliott, Thomas E.; Elliott, Barbara A.; Regal, Ronald R.; Renier, Colleen M.; Haller, Irina V.; Crouse, Byron J.; Witrak, Martha T.; Jensen, Patricia B.

    2004-01-01

    Significant barriers exist in the delivery of state-of-the-art cancer care to rural populations. Rural providers' knowledge and practices, their rural health care delivery systems, and linkages to cancer specialists are not optimal; therefore, rural cancer patient outcomes are less than achievable. Purpose: To test the effects of a strategy…

  6. Does primary medical practitioner involvement with a specialist team improve patient outcomes? A systematic review.

    PubMed

    Mitchell, Geoffrey; Del Mar, Chris; Francis, Daniel

    2002-11-01

    Patients with chronic or complex medical or psychiatric conditions are treated by many practioners, including general practitioners (GPs). Formal liaison between primary and specialist is often assumed to offer benefits to patients. The aim of this study was to assess the efficacy of formal liaison of GPs with specialist service providers on patient health outcomes, by conducting a systematic review of the published literature in MEDLINE, EMBASE, PsychINFO, CINAHL and Cochrane Library databases using the following search terms: 'family physician': synonyms of 'patient care planning', 'patient discharge' and 'patient care team'; and synonyms of 'randomised controlled trials'. Seven studies were identified, involving 963 subjects and 899 controls. Most health outcomes were unchanged, although some physical and functional health outcomes were improved by formal liaison between GPs and specialist services, particularly among chronic mental illness patients. Some health outcomes worsened during the intervention. Patient retention rates within treatment programmes improved with GP involvement, as did patient satisfaction. Doctor (GP and specialist) behaviour changed with reports of more rational use of resources and diagnostic tests, improved clinical skills, more frequent use of appropriate treatment strategies, and more frequent clinical behaviours designed to detect disease complications. Cost effectiveness could not be determined. In conclusion, formal liaison between GPs and specialist services leaves most physical health outcomes unchanged, but improves functional outcomes in chronically mentally ill patients. It may confer modest long-term health benefits through improvements in patient concordance with treatment programmes and more effective clinical practice. PMID:12434964

  7. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications.

    PubMed

    Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel

    2016-01-01

    Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service.

  8. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications

    PubMed Central

    Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel

    2016-01-01

    Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service. PMID:27559474

  9. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications.

    PubMed

    Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel

    2016-01-01

    Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service. PMID:27559474

  10. Family physicians improve patient health care quality and outcomes.

    PubMed

    Bowman, Marjorie A; Neale, Anne Victoria

    2013-01-01

    This issue exemplifies family physicians' ability to provide great care and to continuously improve. For example, beyond other specialty care, the care provided by family physicians is associated with improved melanoma diagnosis and outcomes and improved preventive services for those with a history of breast cancer. Electronic health records are providing new avenues to both assess outcomes and influence care. However, to truly reward quality care, simplistic and readily measurable items such as laboratory results or assessment of the provision of preventive services must be adjusted for risk. Health insurance influences classic preventive care services more than personal health behaviors. The care provided at federally qualified health centers throughout the nation is highly appreciated by the people they serve and is not plagued by the types of disparities in other settings.

  11. Unexpected Advice for Beginning Graduate Students in Astrophysics

    NASA Astrophysics Data System (ADS)

    Linsky, Jeffrey L.

    2012-08-01

    My experience is that beginning graduate students in astrophysics have unrealistic views of how to negotiate the complexities of graduate school and to prepare themselves for a professional career in astrophysics or some other field. This chapter describes my unexpected advice to students beginning with why they should not plan to write a thesis. Other advice concerns how to find and work with a research supervisor, writing and other skills needed for their research, and the need to be creative and when necessary controversial.

  12. Orthognathic surgery improves quality of life and depression, but not anxiety, and patients with higher preoperative depression scores improve less.

    PubMed

    Brunault, P; Battini, J; Potard, C; Jonas, C; Zagala-Bouquillon, B; Chabut, A; Mercier, J-M; Bedhet, N; Réveillère, C; Goga, D; Courtois, R

    2016-01-01

    This study assessed quality of life (QoL), depression, and anxiety before and after orthognathic surgery and identified risk factors for poorer postoperative outcome. This multicentre prospective study included 140 patients from five French medical centres. We assessed patients before surgery (T1), 3 months after surgery (T2), and 12 months after surgery (T3). We assessed the severity of the orofacial deformity, physical, psychological, social, and environmental QoL (WHOQOL-BREF), and depression and anxiety (GHQ-28). Risk factors for poorer outcome were identified using linear mixed models. Between baseline and 12 months, there was significant improvement in psychological and social QoL and in depression (although below the norms reported in the general population), but not in anxiety. Physical QoL was poorer in patients who were younger, who had a mild orofacial deformity, and who were depressed. Psychological QoL was poorer in younger patients and in depressed patients. Social QoL was poorer in patients who were single, who had a mild orofacial deformity, and who were depressed. Although orthognathic surgery provides a moderate improvement in psychological and social QoL, the systematic screening and treatment of depression could further improve QoL after surgery because it is a major predictor of poor QoL in this population.

  13. Cultures for improving patient safety through learning: the role of teamwork*

    PubMed Central

    Firth-Cozens, J

    2001-01-01

    Improvements in patient safety result primarily from organisational and individual learning. This paper discusses the learning that can take place within organisations and the cultural change necessary to encourage it. It focuses on teams and team leaders as potentially powerful forces for bringing about the management of patient safety and better quality of care. Key Words: patient safety; teamwork; learning PMID:11700376

  14. Improving the doctor/patient relationship: a feminist perspective.

    PubMed

    Foster, P

    1989-07-01

    Since the early 1970s British and American feminists have developed a comprehensive critique of the dominant doctor/patient relationship within mainstream health care services. In Britain, activists in the women's health movement have struggled to put into practice a model of health care delivery based on feminist principles, within which the doctor/patient relationship is radically redesigned. This paper will explore the principles and practice of this feminist health care model. It will then attempt to evaluate alternative strategies for strengthening and expanding feminist health care within the NHS. The paper will draw on data gathered by the author in 1987 through a series of unstructured interviews with feminist health care providers who were working within a variety of NHS settings in the North West of England.

  15. Improving Health Outcomes for Low Health Literacy Heart Failure Patients.

    PubMed

    Friel, Catherine J

    2016-09-01

    According to the National Assessment of Adult Literacy (2003), only 12% of U.S. adults have a proficient level of health literacy, with adults 65 years and older more likely to have a below basic or a basic health literacy level. An estimated 5.8 million individuals in the United States have heart failure (HF) and it is one of the most common reasons for those aged 65 and over to be hospitalized. Many patients with HF are at risk for poor health outcomes due to low health literacy. This article reviews the literature with regard to the effectiveness of methods used to address low health literacy among HF patients and describes a pilot study implemented by a home care agency in the northeast to address high HF readmission rates. PMID:27580282

  16. Computerized decision support systems: improving patient safety in nephrology

    PubMed Central

    Chang, Jamison; Ronco, Claudio; Rosner, Mitchell H.

    2016-01-01

    Incorrect prescription and administration of medications account for a substantial proportion of medical errors in the USA, causing adverse drug events (ADEs) that result in considerable patient morbidity and enormous costs to the health-care system. Patients with chronic kidney disease or acute kidney injury often have impaired drug clearance as well as polypharmacy, and are therefore at increased risk of experiencing ADEs. Studies have demonstrated that recognition of these conditions is not uniform among treating physicians, and prescribed drug doses are often incorrect. Early interventions that ensure appropriate drug dosing in this group of patients have shown encouraging results. Both computerized physician order entry and clinical decision support systems have been shown to reduce the rate of ADEs. Nevertheless, these systems have been implemented at surprisingly few institutions. Economic stimulus and health-care reform legislation present a rare opportunity to refine these systems and understand how they could be implemented more widely. Failure to explore this technology could mean that the opportunity to reduce the morbidity associated with ADEs is missed. PMID:21502973

  17. Myoinositol Improves Embryo Development in PCOS Patients Undergoing ICSI

    PubMed Central

    2016-01-01

    The aim of this study was to investigate the activity of myoinositol, in a court of 217 PCOS women undergoing intracytoplasmic sperm injection (ICSI), on pregnancy rate, embryo development, estradiol, and progesterone concentration in blood serum, superoxide dismutase (SOD), and catalase (CAT) in follicular fluid. Concerning the court of patient, 112 (groups I and II) out of 217 were PCOS women, whereas group III consisted of healthy subjects (not PCOS). Group I patients were treated with 400 μg of folic acid per day for 3 months before ICSI, whereas group II patients received 4000 mg of myoinositol and 400 μg of folic acid per day for 3 months before ICSI. Group II revealed a shorter embryo/blastocyst development period between microinjection and 5-cell stage compared to group I. The difference in SOD concentration between groups I and II and between groups II and III was statistically significant. In group II, 34.62% of pregnancies were obtained, whereas in group I this number reached 20% (NS). Myoinositol increased embryo development dynamics and accelerated blastocyst stage reaching time; however, no effect was shown on clinical pregnancy. Furthermore, it restored SOD concentration, lowered in PCOS women, but did not exert any effect on CAT concentration. PMID:27777587

  18. A Checklist to Improve Patient Safety in Interventional Radiology

    SciTech Connect

    Koetser, Inge C. J.; Vries, Eefje N. de; Delden, Otto M. van; Smorenburg, Susanne M.; Boermeester, Marja A.; Lienden, Krijn P. van

    2013-04-15

    To develop a specific RADiological Patient Safety System (RADPASS) checklist for interventional radiology and to assess the effect of this checklist on health care processes of radiological interventions. On the basis of available literature and expert opinion, a prototype checklist was developed. The checklist was adapted on the basis of observation of daily practice in a tertiary referral centre and evaluation by users. To assess the effect of RADPASS, in a series of radiological interventions, all deviations from optimal care were registered before and after implementation of the checklist. In addition, the checklist and its use were evaluated by interviewing all users. The RADPASS checklist has two parts: A (Planning and Preparation) and B (Procedure). The latter part comprises checks just before starting a procedure (B1) and checks concerning the postprocedural care immediately after completion of the procedure (B2). Two cohorts of, respectively, 94 and 101 radiological interventions were observed; the mean percentage of deviations of the optimal process per intervention decreased from 24 % before implementation to 5 % after implementation (p < 0.001). Postponements and cancellations of interventions decreased from 10 % before implementation to 0 % after implementation. Most users agreed that the checklist was user-friendly and increased patient safety awareness and efficiency. The first validated patient safety checklist for interventional radiology was developed. The use of the RADPASS checklist reduced deviations from the optimal process by three quarters and was associated with less procedure postponements.

  19. Exome Sequencing Can Improve Diagnosis and Alter Patient Management

    PubMed Central

    Dixon-Salazar, Tracy J.; Silhavy, Jennifer L.; Udpa, Nitin; Schroth, Jana; Bielas, Stephanie; Schaffer, Ashleigh E.; Olvera, Jesus; Bafna, Vineet; Zaki, Maha S.; Abdel-Salam, Ghada H.; Mansour, Lobna A.; Selim, Laila; Abdel-Hadi, Sawsan; Marzouki, Naima; Ben-Omran, Tawfeg; Al-Saana, Nouriya A.; Sonmez, F. Müjgan; Celep, Figen; Azam, Matloob; Hill, Kiley J.; Collazo, Adrienne; Fenstermaker, Ali G.; Novarino, Gaia; Akizu, Naiara; Garimella, Kiran V.; Sougnez, Carrie; Russ, Carsten

    2015-01-01

    The translation of “next-generation” sequencing directly to the clinic is still being assessed but has the potential for genetic diseases to reduce costs, advance accuracy, and point to unsuspected yet treatable conditions. To study its capability in the clinic, we performed whole-exome sequencing in 118 probands with a diagnosis of a pediatric-onset neurodevelopmental disease in which most known causes had been excluded. Twenty-two genes not previously identified as disease-causing were identified in this study (19% of cohort), further establishing exome sequencing as a useful tool for gene discovery. New genes identified included EXOC8 in Joubert syndrome and GFM2 in a patient with microcephaly, simplified gyral pattern, and insulin-dependent diabetes. Exome sequencing uncovered 10 probands (8% of cohort) with mutations in genes known to cause a disease different from the initial diagnosis. Upon further medical evaluation, these mutations were found to account for each pro-band's disease, leading to a change in diagnosis, some of which led to changes in patient management. Our data provide proof of principle that genomic strategies are useful in clarifying diagnosis in a proportion of patients with neurodevelopmental disorders. PMID:22700954

  20. Supervised exercise improves cutaneous reinnervation capacity in metabolic syndrome patients

    PubMed Central

    Singleton, J. Robinson; Marcus, Robin L.; Lessard, Margaret; Jackson, Justin E.; Smith, A. Gordon

    2014-01-01

    Objective Unmyelinated cutaneous axons are vulnerable to physical and metabolic injury, but also capable of rapid regeneration. This balance may help determine risk for peripheral neuropathy associated with diabetes or Metabolic Syndrome. Capsaicin application for 48 hours induces cutaneous fibers to die back into the dermis. Re-growth can be monitored by serial skin biopsies to determine intraepidermal nerve fiber density (IENFD). We used this capsaicin axotomy technique to examine the effects of exercise on cutaneous regenerative capacity in the setting of metabolic syndrome. Methods Baseline ankle IENFD and 30 day cutaneous regeneration after thigh capsaicin axotomy were compared for participants with type 2 diabetes (35) or metabolic syndrome (32) without symptoms or exam evidence of neuropathy. 36 participants (17 with metabolic syndrome) then joined twice weekly observed exercise and lifestyle counseling. Axotomy regeneration was repeated in month four during this intervention. Results Baseline distal leg IENFD was significantly reduced for both metabolic syndrome and diabetic groups. With exercise, participants significantly improved exercise capacity and lower extremity power. Following exercise, 30 day reinnervation rate improved (0.051 +/− 0.027 fibers/mm/day before versus 0.072 +/− 0.030, p= 0.002). Those who achieved improvement in more Metabolic Syndrome features experienced a greater degree of 30 day reinnervation (p<0.012) Interpretation Metabolic Syndrome was associated with reduced baseline IENFD and cutaneous regeneration capacity comparable to that seen in diabetes. Exercise induced improvement in metabolic syndrome features increased cutaneous regenerative capacity. The results underscore the potential benefit to peripheral nerve function of a behavioral modification approach to metabolic improvement. PMID:25388934

  1. Improvement of tactile roughness discrimination acuity correlates with perception of improved hand function in patients after hand surgery

    PubMed Central

    Fujimoto, Shuhei; Kon, Noriko

    2016-01-01

    [Purpose] The purpose of this study was to elucidate how well patients’ perceptions related to the improvements in their hand function during hospitalization. [Subjects] Sixteen patients who were hospitalized after hand surgery. [Methods] Using the Japanese Society for Surgery of the Hand edition of the Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire; tactile roughness discrimination acuity, motor imagery, motor function, sensory function, and pain of the upper limb were assessed at admission and discharge. Spearman’s rank-order correlation coefficients were calculated using the differences in all assessment items at admission and discharge. A multiple regression analysis (stepwise method) was performed to investigate factors that correlated with improvements in Quick-Disabilities of the Arm, Shoulder, and Hand scores. [Results] The improvement of tactile roughness discrimination acuity was significantly associated with patient perception of improved hand function. [Conclusion] The results suggest that an improvement in tactile roughness discrimination acuity was most strongly correlated with patient perception of improved hand function. PMID:27190473

  2. Acuity-adaptable patient room improves length of stay and cost of patients undergoing renal transplant: a pilot study.

    PubMed

    Bonuel, Nena; Degracia, Alma; Cesario, Sandra

    2013-01-01

    The acuity-adaptable patient room concept is an emerging care model where patient is cared for in the same room from admission through discharge regardless of the patient level of acuity. After implementation of the care cluster strategy to support the implementation of an acuity-adaptable patient room, a descriptive study was conducted looking at so whether there will be a decreased length of stay and cost on patient cared for in the acuity-adaptable patient room compared to patients cared for in a transitional care process. Result of the study showed decreased length of stay of kidney transplant patients from 9.6 (11.0) days (before acuity-adaptable patient room) to 4.1 (1.3) days (acuity-adaptable patient room). Not only that the acuity-adaptable patient room improves patient outcome and cost but with the nursing competency preparation to support the implementation of the acuity-adaptable patient room, a hybrid nurse was created who possessed both critical care and medical-surgical skills. This can be a potential trend in the professional nurse model to address the health care challenges we face today in terms of nursing shortage, abbreviated plan of care, and facility operation efficiency. PMID:23470704

  3. Acuity-adaptable patient room improves length of stay and cost of patients undergoing renal transplant: a pilot study.

    PubMed

    Bonuel, Nena; Degracia, Alma; Cesario, Sandra

    2013-01-01

    The acuity-adaptable patient room concept is an emerging care model where patient is cared for in the same room from admission through discharge regardless of the patient level of acuity. After implementation of the care cluster strategy to support the implementation of an acuity-adaptable patient room, a descriptive study was conducted looking at so whether there will be a decreased length of stay and cost on patient cared for in the acuity-adaptable patient room compared to patients cared for in a transitional care process. Result of the study showed decreased length of stay of kidney transplant patients from 9.6 (11.0) days (before acuity-adaptable patient room) to 4.1 (1.3) days (acuity-adaptable patient room). Not only that the acuity-adaptable patient room improves patient outcome and cost but with the nursing competency preparation to support the implementation of the acuity-adaptable patient room, a hybrid nurse was created who possessed both critical care and medical-surgical skills. This can be a potential trend in the professional nurse model to address the health care challenges we face today in terms of nursing shortage, abbreviated plan of care, and facility operation efficiency.

  4. Improving the patient evaluation process in a cardiovascular and interventional radiology department.

    PubMed

    Chopra, P S; Kandarpa, K; Aliabadi, P

    1992-01-01

    Brigham & Women's Hospital (BWH) has adopted total quality management (TQM) to increase productivity and efficiency and to improve the quality of patient care services. This article reports on a quality improvement project in the department of radiology designed to improve the process of pre-procedure workup of patients referred for cardiovascular and interventional radiology (CVIR) procedures. The project was initiated, led, and conducted by a physician. PMID:10131643

  5. Use of Aspirin postdiagnosis improves survival for colon cancer patients

    PubMed Central

    Bastiaannet, E; Sampieri, K; Dekkers, O M; de Craen, A J M; van Herk-Sukel, M P P; Lemmens, V; van den Broek, C B M; Coebergh, J W; Herings, R M C; van de Velde, C J H; Fodde, R; Liefers, G J

    2012-01-01

    Background: The preventive role of non-steroid anti-inflammatory drugs (NSAIDs) and aspirin, in particular, on colorectal cancer is well established. More recently, it has been suggested that aspirin may also have a therapeutic role. Aim of the present observational population-based study was to assess the therapeutic effect on overall survival of aspirin/NSAIDs as adjuvant treatment used after the diagnosis of colorectal cancer patients. Methods: Data concerning prescriptions were obtained from PHARMO record linkage systems and all patients diagnosed with colorectal cancer (1998–2007) were selected from the Eindhoven Cancer Registry (population-based cancer registry). Aspirin/NSAID use was classified as none, prediagnosis and postdiagnosis and only postdiagnosis. Patients were defined as non-user of aspirin/NSAIDs from the date of diagnosis of the colorectal cancer to the date of first use of aspirin or NSAIDs and user from first use to the end of follow-up. Poisson regression was performed with user status as time-varying exposure. Results: In total, 1176 (26%) patients were non-users, 2086 (47%) were prediagnosis and postdiagnosis users and 1219 (27%) were only postdiagnosis users (total n=4481). Compared with non-users, a survival gain was observed for aspirin users; the adjusted rate ratio (RR) was 0.77 (95% confidence interval (CI) 0.63–0.95; P=0.015). Stratified for colon and rectal, the survival gain was only present in colon cancer (adjusted RR 0.65 (95%CI 0.50–0.84; P=0.001)). For frequent users survival gain was larger (adjusted RR 0.61 (95%CI 0.46–0.81; P=0.001). In rectal cancer, aspirin use was not associated with survival (adjusted RR 1.10 (95%CI 0.79–1.54; P=0.6). The NSAIDs use was associated with decreased survival (adjusted RR 1.93 (95%CI 1.70–2.20; P<0.001). Conclusion: Aspirin use initiated or continued after diagnosis of colon cancer is associated with a lower risk of overall mortality. These findings strongly support initiation of

  6. Geographic Localization of Housestaff Inpatients Improves Patient-Provider Communication, Satisfaction, and Culture of Safety.

    PubMed

    Olson, Douglas P; Fields, Barry G; Windish, Donna M

    2015-01-01

    This study assesses whether geographic localization of housestaff patients contributes to improved patient knowledge of diagnosis, patient satisfaction, provider satisfaction, and workplace culture of safety. Due to national changes to graduate medical education, housestaff patients were localized to a single general medicine ward. Ninety-three patients prelocalization, 64 patients postlocalization, 26 localized physicians, and 10 localized nurses were surveyed. Validated questionnaires assessed patients' experiences during hospitalization, and physician and nurse job satisfaction. Fifty-seven percent of patients knew their diagnosis prior to localization, compared to 80% postlocalization (p < .0001). Prior to localization, 39% of patients who reported experiencing anxieties or fears during hospitalization felt physicians frequently discussed these emotions with them compared to 85% after localization (p < .0001). Before localization, 51% of patients stated that doctors spent 4 min or more daily with them discussing care, compared to 91% after localization (p < .0001). Both physician and nurse opinion significantly improved regarding some but not all aspects of collaboration, teamwork, patient safety, appropriate handling of errors, and culture of safety. The average length of stay was unchanged and the change in 30-day readmission rate was not statistically significant. Localization of patients to a single inpatient ward improved patient knowledge and satisfaction, and some aspects of interprofessional communication and workplace culture of safety. PMID:26042748

  7. Patient perspectives in the management of asthma: improving patient outcomes through critical selection of treatment options

    PubMed Central

    Scichilone, Nicola; Contino, Adele; Figlioli, Giovanni Battista; Paglino, Giuseppe; Bellia, Vincenzo

    2010-01-01

    Asthma is a chronic inflammatory disorder of the airways that requires long-term treatment, the goal of which is to control clinical symptoms for extended periods with the least possible amount of drugs. International guidelines recommend the addition of an inhaled long-acting beta2-agonist (LABA) to a low- to medium-dose inhaled corticosteroid (ICS) when low doses of ICS fail to control asthma symptoms. The fixed combined administration of ICS/LABA improves patient compliance, reducing the risk of therapy discontinuation. The relative deposition pattern of the inhaled drug to the target site is the result of a complex interaction between the device used, the aerosol formulation and the patient’s adherence to therapy. Different inhalation devices have been introduced in clinical practice over time. The new hydrofluoroalkane (HFA) solution aerosols allow for the particle size to be modified, thus leading to deeper penetration of the medication into the lung. The Modulite® technology allows for the manipulation of inhaled HFA-based solution formulations, such as the fixed beclomethasone/formoterol combination, resulting in a uniform treatment of inflammation and bronchoconstriction. The success of any anti-asthmatic treatment depends on the choice of the correct device and the adherence to therapy. PMID:20165595

  8. NMC code advice on digital communications.

    PubMed

    Moorley, Calvin; Watson, Roger

    Nurses and midwives are increasingly using social media as a professional tool. This is reflected in the Nursing and Midwifery Council's (NMC) new professional code, which says nurses must use social media and other communication responsibly, respecting the right to privacy of others at all times. A growing body of literature documents the positive influence social media, when used appropriately, can have on nurses' practice and the care they deliver to patients. However, nurses need more guidance and training to ensure online professionalism and appropriate behaviour online. Requiring nurses and midwives to complete an online continuous professional development course on social networking at the point of revalidation could keep them up to date and promote online professionalism. PMID:26182587

  9. NMC code advice on digital communications.

    PubMed

    Moorley, Calvin; Watson, Roger

    Nurses and midwives are increasingly using social media as a professional tool. This is reflected in the Nursing and Midwifery Council's (NMC) new professional code, which says nurses must use social media and other communication responsibly, respecting the right to privacy of others at all times. A growing body of literature documents the positive influence social media, when used appropriately, can have on nurses' practice and the care they deliver to patients. However, nurses need more guidance and training to ensure online professionalism and appropriate behaviour online. Requiring nurses and midwives to complete an online continuous professional development course on social networking at the point of revalidation could keep them up to date and promote online professionalism.

  10. More Than Needles: The Importance of Explanations and Self-Care Advice in Treating Primary Dysmenorrhea with Acupuncture.

    PubMed

    Armour, Michael; Dahlen, Hannah G; Smith, Caroline A

    2016-01-01

    Background. Primary dysmenorrhea is a common gynaecological condition. Traditional Chinese medicine (TCM) acupuncturists commonly treat primary dysmenorrhea and dispense specific self-care advice for this condition. The impact of self-care advice on primary dysmenorrhea is unknown. Methods. 19 TCM acupuncture practitioners from New Zealand or Australia and 12 New Zealand women who had recently undergone acupuncture treatment for primary dysmenorrhea as part of a randomised controlled trial participated in this qualitative, pragmatic study. Focus groups and semistructured interviews were used to collect data. These were recorded, transcribed, and analysed using thematic analysis. Results. The overarching theme was that an acupuncture treatment consisted of "more than needles" for both practitioners and participants. Practitioners and participants both discussed the partnership they engaged in during treatment, based on openness and trust. Women felt that the TCM self-care advice was related to positive outcomes for their dysmenorrhea and increased their feelings of control over their menstrual symptoms. Conclusions. Most of the women in this study found improved symptom control and reduced pain. A contributing factor for these improvements may be an increased internal health locus of control and an increase in self-efficacy resulting from the self-care advice given during the clinical trial. PMID:27242909

  11. More Than Needles: The Importance of Explanations and Self-Care Advice in Treating Primary Dysmenorrhea with Acupuncture

    PubMed Central

    2016-01-01

    Background. Primary dysmenorrhea is a common gynaecological condition. Traditional Chinese medicine (TCM) acupuncturists commonly treat primary dysmenorrhea and dispense specific self-care advice for this condition. The impact of self-care advice on primary dysmenorrhea is unknown. Methods. 19 TCM acupuncture practitioners from New Zealand or Australia and 12 New Zealand women who had recently undergone acupuncture treatment for primary dysmenorrhea as part of a randomised controlled trial participated in this qualitative, pragmatic study. Focus groups and semistructured interviews were used to collect data. These were recorded, transcribed, and analysed using thematic analysis. Results. The overarching theme was that an acupuncture treatment consisted of “more than needles” for both practitioners and participants. Practitioners and participants both discussed the partnership they engaged in during treatment, based on openness and trust. Women felt that the TCM self-care advice was related to positive outcomes for their dysmenorrhea and increased their feelings of control over their menstrual symptoms. Conclusions. Most of the women in this study found improved symptom control and reduced pain. A contributing factor for these improvements may be an increased internal health locus of control and an increase in self-efficacy resulting from the self-care advice given during the clinical trial. PMID:27242909

  12. A Career Advice Helpline: A Case Study from South Africa

    ERIC Educational Resources Information Center

    Flederman, Patricia

    2011-01-01

    This case study presents the new career guidance helpline managed by the South African Qualifications Authority in South Africa, a middle-income country. The National Qualifications Framework and Career Advice Helpline represent a national equity-driven initiative using technology to expand access. The model has drawn on contemporary international…

  13. Literacy Coaching Advice: Cultivating Healthy Working Relationships with Teachers

    ERIC Educational Resources Information Center

    Pletcher, Bethanie

    2015-01-01

    This article addresses ways that literacy coaches can form and sustain effective working relationships with teachers. The author has combined firsthand experience as a literacy coach with a review of the literature as it pertains to teacher/coach relationships. There are several common themes that appear in the literature as advice for this aspect…

  14. The Influence of Advice in a Virtual Learning Environment

    ERIC Educational Resources Information Center

    Pulford, Briony D.

    2011-01-01

    The influence of asynchronous discussion in a virtual learning environment, Blackboard, on subsequent coursework grades was examined with 166 psychology students to determine whether asking questions of the tutor online, and/or reading the questions and the given advice, influenced the grades on the report they were writing. A repeated-measures…

  15. Sense about Sex: Media, Sex Advice, Education and Learning

    ERIC Educational Resources Information Center

    Attwood, Feona; Barker, Meg John; Boynton, Petra; Hancock, Justin

    2015-01-01

    The media are widely acknowledged as important in sex and relationship education, but they are usually associated with "bad" effects on young people in contrast to the "good" knowledge represented by more informational and educational formats. In this paper we look at sex advice giving in newspapers, magazines and television in…

  16. Dear student: stem cell scientists' advice to the next generation.

    PubMed

    Borgelt, Emily L; Dharamsi, Shafik; Scott, Christopher Thomas

    2013-06-01

    For the field of pluripotent stem cell biology to realize its promising future, current researchers will need to pass the torch to new generations. We asked a group of successful scientists in this area, "What advice would you give a young person considering a career in stem cell research?"

  17. Do Students Listen to Advice from Their Experienced Peers?

    ERIC Educational Resources Information Center

    Finck, Joseph E.; DeLine, Amy D.

    2008-01-01

    Smith and Peterson (2007) recognize the impact between students seeking out advice and that student's academic performance. And Sallee and Tierney (2007) considered the ways in which students' peer networks facilitate or inhibit access to academic resources. In this paper the authors look at the students who receive suggestions from the previous…

  18. 31 CFR 361.6 - Advice of shipment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Advice of shipment. 361.6 Section 361.6 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT CLAIMS PURSUANT TO THE GOVERNMENT LOSSES IN SHIPMENT...

  19. 31 CFR 361.6 - Advice of shipment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Advice of shipment. 361.6 Section 361.6 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT CLAIMS PURSUANT TO THE GOVERNMENT LOSSES IN SHIPMENT...

  20. 31 CFR 361.6 - Advice of shipment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Advice of shipment. 361.6 Section 361.6 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY BUREAU OF THE FISCAL SERVICE CLAIMS PURSUANT TO THE GOVERNMENT LOSSES IN...

  1. 31 CFR 361.6 - Advice of shipment.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Advice of shipment. 361.6 Section 361.6 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT CLAIMS PURSUANT TO THE GOVERNMENT LOSSES IN SHIPMENT...

  2. An Evaluation of an Occupational Health Advice Service

    ERIC Educational Resources Information Center

    Shearn, P.; Ford, Norma J.; Murphy, R. G.

    2010-01-01

    Objective: The objective of this article is to identify the profile of service users of an occupational health (OH) support service and establish areas of need, and to gather client feedback on the experience of participating in the support service and perceived outcomes and the impact of the advice received. Design and Setting: We carried out…

  3. Senior Advice: Graduating Seniors Write to Psychology Freshmen.

    ERIC Educational Resources Information Center

    Norcross, John C.; Slotterback, Carole S.; Krebs, Paul M.

    2001-01-01

    Describes an assignment in which senior psychology majors write letters of advice to incoming psychology freshmen. Provides a course context and focuses on the representative results and student evaluations of the assignment. Discusses the different purposes the letters have served. (CMK)

  4. 16 CFR 1.72 - Examination, counseling and staff advice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Examination, counseling and staff advice. 1... PRACTICE GENERAL PROCEDURES Administration of the Fair Credit Reporting Act § 1.72 Examination, counseling... counseling. Requests for staff interpretation of the Fair Credit Reporting Act should be directed to...

  5. 16 CFR 1.72 - Examination, counseling and staff advice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Examination, counseling and staff advice. 1... PRACTICE GENERAL PROCEDURES Administration of the Fair Credit Reporting Act § 1.72 Examination, counseling... counseling. Requests for staff interpretation of the Fair Credit Reporting Act should be directed to...

  6. 16 CFR 1.72 - Examination, counseling and staff advice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Examination, counseling and staff advice. 1... PRACTICE GENERAL PROCEDURES Administration of the Fair Credit Reporting Act § 1.72 Examination, counseling... counseling. Requests for staff interpretation of the Fair Credit Reporting Act should be directed to...

  7. 16 CFR 1.72 - Examination, counseling and staff advice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Examination, counseling and staff advice. 1... PRACTICE GENERAL PROCEDURES Administration of the Fair Credit Reporting Act § 1.72 Examination, counseling... counseling. Requests for staff interpretation of the Fair Credit Reporting Act should be directed to...

  8. 16 CFR 1.72 - Examination, counseling and staff advice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Examination, counseling and staff advice. 1... PRACTICE GENERAL PROCEDURES Administration of the Fair Credit Reporting Act § 1.72 Examination, counseling... counseling. Requests for staff interpretation of the Fair Credit Reporting Act should be directed to...

  9. The Public Services Job Hunt: Observations and Advice

    ERIC Educational Resources Information Center

    Saunders, Laura

    2014-01-01

    The library science job market is competitive, and library and information science (LIS) students and new graduates often have questions and concerns about how to engage in a successful job hunt. Based on research with employers and interactions with students and alumni, the author offers advice for job-seekers looking for public services…

  10. A Wizard of Oz Study of Advice Giving and Following.

    ERIC Educational Resources Information Center

    Hill, William C.

    1993-01-01

    Describes a study of graduate students that observed the interaction between users of a graphical statistical package and a human playing the role of a simulated intelligent advisory system to guide the design of advice-offering user-assistance software. The use of video to examine the users' role in the interaction is discussed. (Contains 37…

  11. Styles of Physician Advice about Smoking Cessation in College Students

    ERIC Educational Resources Information Center

    Gemmell, Leigh; DiClemente, Carlo C.

    2009-01-01

    Objective: To examine whether young adult cigarette smokers who were in the precontemplation and contemplation stages of change for smoking cessation would differ in their evaluations of vignettes depicting 2 types of physician advice. Participants: Fifty-seven young adult cigarette smokers who were undergraduate students (49.1% female, mean age =…

  12. 4 CFR 28.8 - Informal procedural advice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 4 Accounts 1 2011-01-01 2011-01-01 false Informal procedural advice. 28.8 Section 28.8 Accounts GOVERNMENT ACCOUNTABILITY OFFICE GENERAL PROCEDURES GOVERNMENT ACCOUNTABILITY OFFICE PERSONNEL APPEALS BOARD; PROCEDURES APPLICABLE TO CLAIMS CONCERNING EMPLOYMENT PRACTICES AT THE GOVERNMENT ACCOUNTABILITY...

  13. 4 CFR 28.8 - Informal procedural advice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 4 Accounts 1 2010-01-01 2010-01-01 false Informal procedural advice. 28.8 Section 28.8 Accounts GOVERNMENT ACCOUNTABILITY OFFICE GENERAL PROCEDURES GOVERNMENT ACCOUNTABILITY OFFICE PERSONNEL APPEALS BOARD; PROCEDURES APPLICABLE TO CLAIMS CONCERNING EMPLOYMENT PRACTICES AT THE GOVERNMENT ACCOUNTABILITY...

  14. 4 CFR 28.8 - Informal procedural advice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 4 Accounts 1 2012-01-01 2012-01-01 false Informal procedural advice. 28.8 Section 28.8 Accounts GOVERNMENT ACCOUNTABILITY OFFICE GENERAL PROCEDURES GOVERNMENT ACCOUNTABILITY OFFICE PERSONNEL APPEALS BOARD; PROCEDURES APPLICABLE TO CLAIMS CONCERNING EMPLOYMENT PRACTICES AT THE GOVERNMENT ACCOUNTABILITY...

  15. 4 CFR 28.8 - Informal procedural advice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 4 Accounts 1 2013-01-01 2013-01-01 false Informal procedural advice. 28.8 Section 28.8 Accounts GOVERNMENT ACCOUNTABILITY OFFICE GENERAL PROCEDURES GOVERNMENT ACCOUNTABILITY OFFICE PERSONNEL APPEALS BOARD; PROCEDURES APPLICABLE TO CLAIMS CONCERNING EMPLOYMENT PRACTICES AT THE GOVERNMENT ACCOUNTABILITY...

  16. 5 CFR 2634.607 - Advice and opinions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... the public. Good faith reliance on such opinions shall provide a defense to any penalty or sanction... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Advice and opinions. 2634.607 Section... opinions. To assist employees in avoiding situations in which they might violate applicable...

  17. 36 CFR 905.735-402 - Advice and determination.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Board Member seeks advice as to the appropriateness of his actions in light of this part, the Executive... particular matter before the Corporation. If advised to do so, the Board Member should submit to the Chairman... participating in the particular matter, if: (a) The Board Member makes a full disclosure of the...

  18. 36 CFR 905.735-402 - Advice and determination.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Board Member seeks advice as to the appropriateness of his actions in light of this part, the Executive... particular matter before the Corporation. If advised to do so, the Board Member should submit to the Chairman... participating in the particular matter, if: (a) The Board Member makes a full disclosure of the...

  19. The Influence of Parental Advice Giving on Children's Friendship.

    ERIC Educational Resources Information Center

    Flyr, Mary L.; And Others

    This study examined how parental advice-giving directly and indirectly influences children's quality of friendship with peers. Participating were 66 third graders, their classroom teachers, 66 mothers and 57 fathers, and 66 friends. All but one dyad of the target children and friend were the same gender. Teachers rated target children on peer…

  20. Fundraising Advice for College and University Presidents: An Insider's Guide

    ERIC Educational Resources Information Center

    Bornstein, Rita

    2011-01-01

    In these financially challenging times, chief executive officers of today's colleges and universities are expected to serve as their institutions' lead fundraisers. Still, many presidents remain uncomfortable in this essential role. With wisdom and insight, Rita Bornstein offers advice on how to identify, cultivate, and successfully solicit gifts…

  1. Time Advice and Learning Questions in Computer Simulations

    ERIC Educational Resources Information Center

    Rey, Gunter Daniel

    2011-01-01

    Students (N = 101) used an introductory text and a computer simulation to learn fundamental concepts about statistical analyses (e.g., analysis of variance, regression analysis and General Linear Model). Each learner was randomly assigned to one cell of a 2 (with or without time advice) x 3 (with learning questions and corrective feedback, with…

  2. Extensive IT outsourcing: advice from providers.

    PubMed

    Smith, Mike; Whiting, Stacilee

    2007-01-01

    In summary, providers are reporting some benefits related to resources and knowledge, improved service levels/performance and stronger IT staff/leadership. Also, on average, providers are reporting satisfactory experiences with application support and CIO outsourcing. However, not all of their expectations are being met, and some providers have discontinued outsourcing due to unmet expectations. Clearly, outsourcing is an option one must research in depth--it is not for everyone. When one evaluates the results of extensive IT outsourcing, it becomes easier to see what outsourcing mix and firm may be a good match for your organization's needs and expected outcomes. As you decide upon the outsourcing mix and firm that is right for you, providers advise you to pay special attention to contractual arrangements. With adequate research and contractual provisions, organizations can find the outsourcing mix that is right for them.

  3. The Armstrong Institute: An Academic Institute for Patient Safety and Quality Improvement, Research, Training, and Practice.

    PubMed

    Pronovost, Peter J; Holzmueller, Christine G; Molello, Nancy E; Paine, Lori; Winner, Laura; Marsteller, Jill A; Berenholtz, Sean M; Aboumatar, Hanan J; Demski, Renee; Armstrong, C Michael

    2015-10-01

    Academic medical centers (AMCs) could advance the science of health care delivery, improve patient safety and quality improvement, and enhance value, but many centers have fragmented efforts with little accountability. Johns Hopkins Medicine, the AMC under which the Johns Hopkins University School of Medicine and the Johns Hopkins Health System are organized, experienced similar challenges, with operational patient safety and quality leadership separate from safety and quality-related research efforts. To unite efforts and establish accountability, the Armstrong Institute for Patient Safety and Quality was created in 2011.The authors describe the development, purpose, governance, function, and challenges of the institute to help other AMCs replicate it and accelerate safety and quality improvement. The purpose is to partner with patients, their loved ones, and all interested parties to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste in health care. A governance structure was created, with care mapped into seven categories, to oversee the quality and safety of all patients treated at a Johns Hopkins Medicine entity. The governance has a Patient Safety and Quality Board Committee that sets strategic goals, and the institute communicates these goals throughout the health system and supports personnel in meeting these goals. The institute is organized into 13 functional councils reflecting their behaviors and purpose. The institute works daily to build the capacity of clinicians trained in safety and quality through established programs, advance improvement science, and implement and evaluate interventions to improve the quality of care and safety of patients.

  4. [New pediatric drug dosage aids. Improving patient safety].

    PubMed

    Strauß, J M

    2016-03-01

    Dosing errors when administering medicine to children occur often and are due, e.g., to the commonly required dilution of the drugs, misjudgment of the patient's weight, confusion between drugs with similar names, and inadequate communication. Various aids (e.g., measuring tapes and dilution tables) have been designed to avoid mistakes to the greatest extent possible. In daily clinical practice, books and pocket cards are still used for rapid orientation. Use of smartphone-based apps continues to increase, whereby the user is ultimately responsible for their validity. In clinical practice, the simplest possible strategies should be used. A culture that encourages disclosure of errors is useful in order to optimize processes and avoid future errors.

  5. Improving cardiovascular health and metabolic comorbidities in patients with psoriatic arthritis

    PubMed Central

    Ogdie, Alexis; Eder, Lihi

    2016-01-01

    Numerous studies have suggested a link between psoriatic arthritis (PsA) and comorbidities, in particular cardiovascular disease and metabolic comorbidities such as diabetes. The co-existence of these comorbidities is likely the result of systemic inflammation. In order to improve the health of patients with PsA and provide optimal care, these comorbidities must be addressed. However, little is known about how to improve metabolic and cardiovascular health in patients with PsA. In this perspective, we describe the research needs in the area of improving cardiovascular disease and metabolic comorbidities among patients with PsA. PMID:27134682

  6. Towards Better Test Utilization – Strategies to Improve Physician Ordering and Their Impact on Patient Outcomes

    PubMed Central

    2015-01-01

    Laboratory medicine is the single highest volume medical activity in healthcare and demand for laboratory testing is increasing disproportionately to medical activity. It has been estimated that $6.8 billion of medical care in the US involves unnecessary testing and procedures that do not improve patient care and may even harm the patient. Physicians face many challenges in accurately, efficiently and safely ordering and interpreting diagnostic tests. In order to improve patient outcomes, laboratory tests must be appropriately ordered, properly conducted, reported in a timely manner, correctly interpreted and affect a decision for future diagnosis and treatment of the patient.

  7. A web-based interactive tool to improve breast cancer patient centredness.

    PubMed

    Gorini, Alessandra; Mazzocco, Ketti; Kondylakis, Haridimos; McVie, Gordon; Pravettoni, Gabriella

    2016-01-01

    The uniqueness of a patient as determined by the integration of clinical data and psychological aspects should be the aspired aim of a personalized medicine approach. Nevertheless, given the time constraints usually imposed by the clinical setting, it is not easy for physicians to collect information about the patient's unique mental dimensions and needs related to her illness. Such information may be useful in tailoring patient-physician communication, improving the patient's understanding of provided information, her involvement in the treatment process, and in general her empowerment during and after the therapeutic journey. The primary objective of this study is to evaluate the effect of an interactive empowerment tool (IEm) on enhancing the breast cancer patient-physician experience, in terms of increasing empowerment, i.e. by providing physicians with a personalised patient's profile, accompanied by specific recommendations to advise them how to interact with each individual patient on the basis of her personal profile. The study will be implemented as a two-arm randomised controlled trial with 100 adult breast cancer patients who fill in the ALGA-BC questionnaire, a computerised validated instrument to evaluate the patient's physical and psychological characteristics following a breast cancer diagnosis. The IEm tool will collect and analyse the patient's answers in real time and send them, together with specific recommendations to the physician's computer immediately before physician's first encounter with the patient. Patients will be randomised to either the intervention group using the IEm tool or to a control group who will only fill in the questionnaire without taking advantage of the tool (physicians will not receive the patient's profile). The proposed approach is supposed to improve the patient-physician communication leading to increased patient participation in the therapeutic process as a consequence leading to improvement in patient empowerment

  8. Patients With Isolated PCL Injuries Improve From Surgery as Much as Patients With ACL Injuries After 2 Years

    PubMed Central

    Owesen, Christian; Sivertsen, Einar Andreas; Engebretsen, Lars; Granan, Lars-Petter; Årøen, Asbjørn

    2015-01-01

    Background: Reports on outcome after posterior cruciate ligament (PCL) reconstruction often contain both isolated PCL and combined knee ligament injuries. This makes it difficult to conclude on the outcome after reconstruction of isolated PCL injuries. Purpose: To investigate the outcome after PCL reconstruction in patients with an isolated PCL injury and to compare this with the outcome of patients treated with reconstruction after isolated anterior cruciate ligament (ACL) injuries. Study Design: Cohort study; Level of evidence, 3. Methods: Seventy-one patients with an isolated PCL injury that was reconstructed surgically and who had registered in the Norwegian Knee Ligament Registry between 2004 and 2010 were included in this study. Patients with isolated ACL reconstructions (n = 9661) who had registered in the same period were included for comparison. Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as the patient-reported outcome measure. Preoperative and 2-year postoperative KOOS scores were compared. Changes in KOOS score reported by the PCL patients were compared with changes reported by the ACL patients. Results: At the 2-year postoperative follow-up of the PCL-reconstructed patients, the patient-reported outcome was improved, measured by KOOS as follows: pain, 15.1 (95% CI, 8.5-21.8; P < .001); symptoms, 0.9 (95% CI, –6.6 to 8.3; P = .82); activities of daily living, 13.2 (95% CI, 6.6-13.9; P < .001); sports, 20.7 (95% CI, 11.8-29.4; P < .001); and quality of life, 26.6 (95% CI, 18.9-34.2; P < .001). According to the KOOS, the incremental improvements were similar for PCL and ACL patients. Time from injury to surgery was longer for the PCL patients compared with ACL patients (median, 21.5 vs 8.0 months; P < .001). Conclusion: Patients undergoing PCL reconstruction can expect the same improvements in KOOS score as patients undergoing ACL reconstruction. However, PCL patients start out with an inferior score on average and consequently end up

  9. Outcomes of prolotherapy in chondromalacia patella patients: improvements in pain level and function.

    PubMed

    Hauser, Ross A; Sprague, Ingrid Schaefer

    2014-01-01

    We retrospectively evaluated the effectiveness of prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in consecutive chondromalacia patients from February 2008 to September 2009. Sixty-nine knees that received prolotherapy in 61 patients (33 female and 36 male) who were 18-82 years old (average, 47.2 years) were enrolled. Patients received 24 prolotherapy injections (15% dextrose, 0.1% procaine, and 10% sarapin) with a total of 40 cc in the anterior knee. At least 6 weeks after their last prolotherapy session, patients provided self-evaluation of knee pain upon rest, activities of daily living (ADL) and exercise, range of motion (ROM), stiffness, and crepitus. Symptom severity, sustained improvement of symptoms, number of pain pills needed, and patient satisfaction before treatment and improvement after treatment were recorded. Following prolotherapy, patients experienced statistically significant decreases in pain at rest, during ADL, and exercise. Stiffness and crepitus decreased after prolotherapy, and ROM increased. Patients reported improved walking ability and exercise ability after prolotherapy. For daily pain level, ROM, daily stiffness, crepitus, and walking and exercise ability, sustained improvement of over 75% was reported by 85% of patients. Fewer patients required pain medication. No side effects of prolotherapy were noted. The average length of time from last prolotherapy session was 14.7 months (range, 6 months to 8 years). Only 3 of 16 knees were still recommended for surgery after prolotherapy. Prolotherapy ameliorates chondromalacia patella symptoms and improves physical ability. Patients experience long-term improvement without requiring pain medications. Prolotherapy should be considered a first-line, conservative therapy for chondromalacia patella. PMID:24596471

  10. Does Pramipexole Treatment Improve Headache in Patients with Concomitant Migraine and Restless Legs Syndrome?

    PubMed Central

    Suzuki, Keisuke; Suzuki, Shiho; Miyamoto, Masayuki; Miyamoto, Tomoyuki; Numao, Ayaka; Watanabe, Yuka; Takashima, Ryotaro; Hirata, Koichi

    2013-01-01

    Background Recent studies have suggested a strong link between migraines and restless legs syndrome (RLS). It is possible that these disorders share a dopaminergic dysfunction in the hypothalamic A11 nucleus that contributes to this association. However, there have been no clinical studies to evaluate the effect of dopaminergic treatment on migraine symptoms in patients with concomitant migraines and RLS. Methods We present an illustrative patient with concomitant RLS and migraine who showed improvement in her headache frequency and RLS symptoms following immediate-release pramipexole (P-IR) treatment and provide review results from the medical records of patients who experienced both migraines and RLS in our previous cross-sectional study. Results Ten patients (nine patients from the previously completed single-center study) received P-IR treatment were included in the study. RLS symptoms improved markedly in all of the subjects. Five out of the 10 patients (50%) reported improvement in migraine headaches. Of these five patients, four (80%) had reported morning headaches before P-IR treatment. Discussion Our results indicate that the identification of RLS in migraine patients is clinically significant and that dopaminergic treatment may improve both migraines, particularly morning headache (80% improvement in this study), and RLS symptoms. However, further clinical studies are warranted to verify our results. PMID:24116342

  11. Oral iodinated activated charcoal improves lung function in patients with COPD.

    PubMed

    Skogvall, Staffan; Erjefält, Jonas S; Olin, Anders I; Ankerst, Jaro; Bjermer, Leif

    2014-06-01

    The effect of 8 weeks treatment with oral iodinated activated charcoal (IAC) on lung function of patients with moderate chronic obstructive pulmonary disease (COPD) was examined in a double blind randomized placebo controlled parallel group study with 40 patients. In the IAC group, patients showed a statistically significant improvement of FEV1 baseline by 130 ml compared to placebo, corresponding to 8.2% improvement (p = 0.031*). Correlation statistics revealed that the improvement of FEV1 baseline was significantly correlated both to FEV1 post-bronchodilator (p = 0.0020**) and FEV1 post-exercise (0.033*) values. This demonstrates that the improved baseline lung function by IAC did not inhibit a further beta2-adrenoceptor relaxation, and thus that patients did not reach a limit for maximal improvement of the lung function after IAC treatment. Eight patients in the IAC group developed abnormal thyroid hormone levels transiently during the treatment. This side effect was not correlated to improvement of lung function (p = 0.82). No serious adverse effects directly related to the treatment were recorded. In summary, this study demonstrates that iodinated activated charcoal surprisingly and significantly improved lung function of patients with moderate COPD. The underlying mechanism of action is unclear, but is likely to be different from the drugs used today. The immediate conclusion is that further studies are now justified in order to determine clinical efficacy of IAC in COPD and explore possible mechanisms of action.

  12. Chronic Disease Management: A Residency-Led Intervention to Improve Outcomes in Diabetic Patients

    PubMed Central

    Fellner, Angela N.; Pettit, Ryan C.; Sorscher, Jonathan; Stephens, Lorraine; Drake, Betsy; Welling, Richard E.

    2012-01-01

    Background When quality improvement processes are integrated into resident education, many opportunities are created for improved outcomes in patient care. For Bethesda Family Medicine (BFM), integrating quality improvement into resident education is paramount in fulfilling the Accreditation Council for Graduate Medical Education Practice-Based Learning and Improvement core competency requirements. Methods A resident-developed diabetes management treatment protocol that targeted 11 evidence-based measures recommended for successful diabetes management was implemented within the BFM residency and all physician practices under its parent healthcare system. This study compares diabetes management at BFM and at 2 other family medicine practices at timepoints before and after protocol implementation. We measured hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) cholesterol, and systolic blood pressure (SBP) in adult diabetics and compared patient outcomes for these measures for the first and third quarters of 2009 and 2010. Results In BFM patients, HbA1c, LDL, and SBP levels decreased, but only HbA1c improvement persisted long term. For the comparison groups, in general levels were lower than those of BFM patients but not significantly so after the first measurement period. Conclusions A resident-led treatment protocol can improve HbA1c outcomes among residents' diabetic patients. Periodic educational interventions can enhance residents' focus on diabetes management. Residents in graduate medical education can initiate treatment protocols to improve patient care in a large healthcare system. PMID:23267258

  13. Hijama improves overall quality of life in chronic renal failure patients: A pilot study.

    PubMed

    Bilal, Muhammad; Khan, Rafeeq Alam; Danial, Khurram

    2015-09-01

    Present study assesses the therapeutic effectiveness of Hijama (blood letting) inpatients of chronic renal failure undergoing hemodialysis for past several years with almost no urinary output.24 patients from Sindh Government Qatar Hospital Karachi were selected randomly under going dialysis 2-3 times/week for an average of 3 years under supervision of Dr. Khurram Danial, in-charge nephrologist at dialysis Centre Sindh Government Qatar Hospital Karachi after the written consent from patients. Each patient was subjected to Hijama session once a week after dialysis for a period of one year in a nearby hospital Aligarh Shifa with the consent of the ethical committee of the hospital. Serum urea, creatinine, complete blood count and electrolytes were determined prior to Hijama as baseline values and were again recorded on monthly basis for twelve months of Hijama sessions. The patient's feedback regarding quality of life after each Hijama session shows that almost all the patients reported a significant recovery from severe fatigue which they used to face during the interval between the dialysis sessions. There was significant recovery in all patients from anorexia and insomnia with the improvement in quality of life as compared to patients not undergoing Hijama. Both systolic and diastolic blood pressures were shifted towards normal in almost all patients after Hijama. Serum Creatinine level was declined significantly, while electrolyte and hematological parameters were also improved significantly. The hemoglobin of all patients undergoing Hijama was maintained near normal without any blood transfusion, which was frequently needed in patients not undergoing Hijama sessions. There was insignificant improvement in Urinary output in 2 out of 24 patients. Results of the present study suggest that Hijama may be performed safely in patients of chronic renal failure on dialysis with overall improvement in quality of life, since there was reduction in fatigue, improvement in

  14. Hijama improves overall quality of life in chronic renal failure patients: A pilot study.

    PubMed

    Bilal, Muhammad; Khan, Rafeeq Alam; Danial, Khurram

    2015-09-01

    Present study assesses the therapeutic effectiveness of Hijama (blood letting) inpatients of chronic renal failure undergoing hemodialysis for past several years with almost no urinary output.24 patients from Sindh Government Qatar Hospital Karachi were selected randomly under going dialysis 2-3 times/week for an average of 3 years under supervision of Dr. Khurram Danial, in-charge nephrologist at dialysis Centre Sindh Government Qatar Hospital Karachi after the written consent from patients. Each patient was subjected to Hijama session once a week after dialysis for a period of one year in a nearby hospital Aligarh Shifa with the consent of the ethical committee of the hospital. Serum urea, creatinine, complete blood count and electrolytes were determined prior to Hijama as baseline values and were again recorded on monthly basis for twelve months of Hijama sessions. The patient's feedback regarding quality of life after each Hijama session shows that almost all the patients reported a significant recovery from severe fatigue which they used to face during the interval between the dialysis sessions. There was significant recovery in all patients from anorexia and insomnia with the improvement in quality of life as compared to patients not undergoing Hijama. Both systolic and diastolic blood pressures were shifted towards normal in almost all patients after Hijama. Serum Creatinine level was declined significantly, while electrolyte and hematological parameters were also improved significantly. The hemoglobin of all patients undergoing Hijama was maintained near normal without any blood transfusion, which was frequently needed in patients not undergoing Hijama sessions. There was insignificant improvement in Urinary output in 2 out of 24 patients. Results of the present study suggest that Hijama may be performed safely in patients of chronic renal failure on dialysis with overall improvement in quality of life, since there was reduction in fatigue, improvement in

  15. A phenomenologic investigation of pediatric residents' experiences being parented and giving parenting advice.

    PubMed

    Bax, A C; Shawler, P M; Blackmon, D L; DeGrace, E W; Wolraich, M L

    2016-09-01

    Factors surrounding pediatricians' parenting advice and training on parenting during residency have not been well studied. The primary purpose of this study was to examine pediatric residents' self-reported experiences giving parenting advice and explore the relationship between parenting advice given and types of parenting residents received as children. Thirteen OUHSC pediatric residents were individually interviewed to examine experiences being parented and giving parenting advice. Phenomenological methods were used to explicate themes and secondary analyses explored relationships of findings based upon Baumrind's parenting styles (authoritative, authoritarian, permissive). While childhood experiences were not specifically correlated to the parenting advice style of pediatric residents interviewed, virtually all reported relying upon childhood experiences to generate their advice. Those describing authoritative parents reported giving more authoritative advice while others reported more variable advice. Core interview themes related to residents' parenting advice included anxiety about not being a parent, varying advice based on families' needs, and emphasis of positive interactions and consistency. Themes related to how residents were parented included discipline being a learning process for their parents and recalling that their parents always had expectations, yet always loved them. Pediatric residents interviewed reported giving family centered parenting advice with elements of positive interactions and consistency, but interviews highlighted many areas of apprehension residents have around giving parenting advice. Our study suggests that pediatric residents may benefit from more general educational opportunities to develop the content of their parenting advice, including reflecting on any impact from their own upbringing. PMID:27367930

  16. A phenomenologic investigation of pediatric residents' experiences being parented and giving parenting advice.

    PubMed

    Bax, A C; Shawler, P M; Blackmon, D L; DeGrace, E W; Wolraich, M L

    2016-09-01

    Factors surrounding pediatricians' parenting advice and training on parenting during residency have not been well studied. The primary purpose of this study was to examine pediatric residents' self-reported experiences giving parenting advice and explore the relationship between parenting advice given and types of parenting residents received as children. Thirteen OUHSC pediatric residents were individually interviewed to examine experiences being parented and giving parenting advice. Phenomenological methods were used to explicate themes and secondary analyses explored relationships of findings based upon Baumrind's parenting styles (authoritative, authoritarian, permissive). While childhood experiences were not specifically correlated to the parenting advice style of pediatric residents interviewed, virtually all reported relying upon childhood experiences to generate their advice. Those describing authoritative parents reported giving more authoritative advice while others reported more variable advice. Core interview themes related to residents' parenting advice included anxiety about not being a parent, varying advice based on families' needs, and emphasis of positive interactions and consistency. Themes related to how residents were parented included discipline being a learning process for their parents and recalling that their parents always had expectations, yet always loved them. Pediatric residents interviewed reported giving family centered parenting advice with elements of positive interactions and consistency, but interviews highlighted many areas of apprehension residents have around giving parenting advice. Our study suggests that pediatric residents may benefit from more general educational opportunities to develop the content of their parenting advice, including reflecting on any impact from their own upbringing.

  17. The Physician Quality Improvement Initiative: Engaging Physicians in Quality Improvement, Patient Safety, Accountability and their Provision of High-Quality Patient Care.

    PubMed

    Wentlandt, Kirsten; Degendorfer, Niki; Clarke, Cathy; Panet, Hayley; Worthington, Jim; McLean, Richard F; Chan, Charlie K N

    2016-01-01

    University Health Network has been working to become a high-reliability organization, with a focus on safe, quality patient care. In response, the Medical Affairs Department has implemented several strategic initiatives to drive accountability, quality improvement and engagement with our physician population. One of these initiatives, the Physician Quality Improvement Initiative (PQII) is a physician-led project designed to provide active medical staff, in collaboration with their physician department chiefs, a comprehensive approach to focused and practical quality improvement in their practice. In this document, we outline the project, including its implementation strategy, logic model and outcomes, and provide discussion on how it fits into UHN's global strategy to provide safe, quality patient care. PMID:27009706

  18. A rehabilitation device to improve the hand grasp function of stroke patients using a patient-driven approach.

    PubMed

    Park, Wanjoo; Jeong, Wookjin; Kwon, Gyu-Hyun; Kim, Yun-Hee; Kim, Laehyun

    2013-06-01

    This paper proposes a robotic hand rehabilitation device for grasp training. The device is designed for stroke patients to train and recover their hand grasp function in order to undertake activities of daily living (ADL). The device consists of a control unit, two small actuators, an infrared (IR) sensor, and pressure sensors in the grasp handle. The advantages of this device are that it is small in size, inexpensive, and available for use at home without specialist's supervision. In addition, a novel patient-driven strategy based on the patient's movement intention detected by the pressure sensors without bio-signals is introduced. Once the system detects a patient's movement intention, it triggers the robotic device to move the patient's hand to form the normal grasping behavior. This strategy may encourage stroke patients to participate in rehabilitation training to recover their hand grasp function and it may also enhance neural plasticity. A user study was conducted in order to investigate the usability, acceptability, satisfaction, and suggestions for improvement of the proposed device. The results of this survey included positive reviews from therapists and a stroke patient. In particular, therapists expected that the proposed patient-driven mode can motivate patients for their rehabilitation training and it can be effective to prevent a compensational strategy in active movements. It is expected that the proposed device will assist stroke patients in restoring their grasp function efficiently.

  19. New Treatment Greatly Improves Prognosis for Patients with AMD (Age-Related Macular Degeneration)

    MedlinePlus

    ... turn JavaScript on. Feature: Age-related Macular Degeneration New Treatment Greatly Improves Prognosis for Patients with AMD ... Eye Institute Photo Courtesy of: NEI In a new study of nearly 650 people with age-related ...

  20. Editorial Commentary: Platelet-Rich Plasma Improves Knee Pain and Function in Patients With Knee Osteoarthritis.

    PubMed

    Lubowitz, James H

    2015-11-01

    Systematic review of overlapping meta-analyses shows that platelet-rich plasma improves knee pain and function in patients with knee osteoarthritis. Ultimately, biologics hold promise for chondroprotection in addition to symptomatic relief. PMID:26542203

  1. Sorafenib Improves Progression-Free Survival in Some Patients with Metastatic Thyroid Cancer

    MedlinePlus

    ... of Endocrine & Neuroendocrine Neoplasias Research Sorafenib Improves Progression-Free Survival in Some Patients with Metastatic Thyroid Cancer ... starting treatment without their disease getting worse ( progression-free survival ), as assessed by independent review. Secondary endpoints ...

  2. Crizotinib Improves Progression-Free Survival in Some Patients with Advanced Lung Cancer

    MedlinePlus

    ... Prevention Lung Cancer Screening Research Crizotinib Improves Progression-Free Survival in Some Patients with Advanced Lung Cancer ( ... starting treatment without their disease getting worse (progression-free survival), as assessed by radiologic review. Results Progression- ...

  3. An Association of Cancer Physicians’ strategy for improving services and outcomes for cancer patients

    PubMed Central

    Baird, Richard; Banks, Ian; Cameron, David; Chester, John; Earl, Helena; Flannagan, Mark; Januszewski, Adam; Kennedy, Richard; Payne, Sarah; Samuel, Emlyn; Taylor, Hannah; Agarwal, Roshan; Ahmed, Samreen; Archer, Caroline; Board, Ruth; Carser, Judith; Copson, Ellen; Cunningham, David; Coleman, Rob; Dangoor, Adam; Dark, Graham; Eccles, Diana; Gallagher, Chris; Glaser, Adam; Griffiths, Richard; Hall, Geoff; Hall, Marcia; Harari, Danielle; Hawkins, Michael; Hill, Mark; Johnson, Peter; Jones, Alison; Kalsi, Tania; Karapanagiotou, Eleni; Kemp, Zoe; Mansi, Janine; Marshall, Ernie; Mitchell, Alex; Moe, Maung; Michie, Caroline; Neal, Richard; Newsom-Davis, Tom; Norton, Alison; Osborne, Richard; Patel, Gargi; Radford, John; Ring, Alistair; Shaw, Emily; Skinner, Rod; Stark, Dan; Turnbull, Sam; Velikova, Galina; White, Jeff; Young, Alison; Joffe, Johnathan; Selby, Peter

    2016-01-01

    The Association of Cancer Physicians in the United Kingdom has developed a strategy to improve outcomes for cancer patients and identified the goals and commitments of the Association and its members. PMID:26913066

  4. An Association of Cancer Physicians' strategy for improving services and outcomes for cancer patients.

    PubMed

    Baird, Richard; Banks, Ian; Cameron, David; Chester, John; Earl, Helena; Flannagan, Mark; Januszewski, Adam; Kennedy, Richard; Payne, Sarah; Samuel, Emlyn; Taylor, Hannah; Agarwal, Roshan; Ahmed, Samreen; Archer, Caroline; Board, Ruth; Carser, Judith; Copson, Ellen; Cunningham, David; Coleman, Rob; Dangoor, Adam; Dark, Graham; Eccles, Diana; Gallagher, Chris; Glaser, Adam; Griffiths, Richard; Hall, Geoff; Hall, Marcia; Harari, Danielle; Hawkins, Michael; Hill, Mark; Johnson, Peter; Jones, Alison; Kalsi, Tania; Karapanagiotou, Eleni; Kemp, Zoe; Mansi, Janine; Marshall, Ernie; Mitchell, Alex; Moe, Maung; Michie, Caroline; Neal, Richard; Newsom-Davis, Tom; Norton, Alison; Osborne, Richard; Patel, Gargi; Radford, John; Ring, Alistair; Shaw, Emily; Skinner, Rod; Stark, Dan; Turnbull, Sam; Velikova, Galina; White, Jeff; Young, Alison; Joffe, Johnathan; Selby, Peter

    2016-01-01

    The Association of Cancer Physicians in the United Kingdom has developed a strategy to improve outcomes for cancer patients and identified the goals and commitments of the Association and its members. PMID:26913066

  5. Ethics seminars: a best-practice approach to navigating the against-medical-advice discharge.

    PubMed

    Clark, Mark A; Abbott, Jean T; Adyanthaya, Tara

    2014-09-01

    Patients who sign out or choose to leave the emergency department (ED) against medical advice (AMA) present important challenges. The current approach to the complex legal, ethical, and medical challenges that arise when adult patients decline medical care in the ED would benefit from a systematic best-practice strategy to maximize patient care outcomes, minimize legal risk, and reach the optimal ethical standard for this at-risk population. Professional responsibilities generated during an AMA encounter include determination of patient decision-making capacity, balancing protection of patient autonomy with prevention of harm, providing the best alternatives for patients who decline some or all of the proposed plan, negotiating to encourage patients to stay, planning for subsequent care, and documenting what transpired. We present two cases that illustrate key insights into a best-practice approach for emergency physicians (EPs) to address problems arising when patients want or need to leave the ED prior to completion of their care. We propose a practical, systematic framework, "AIMED" (assess, investigate, mitigate, explain, and document), that can be consistently applied in situations where patients consider leaving or do leave before their evaluations and urgent treatment are complete. Our goal is to maximize patient outcomes, minimize legal risk, and encourage a consistent and ethical approach to these vulnerable patients. PMID:25269588

  6. Health System Quality Improvement: Impact of Prompt Nutrition Care on Patient Outcomes and Health Care Costs.

    PubMed

    Meehan, Anita; Loose, Claire; Bell, Jvawnna; Partridge, Jamie; Nelson, Jeffrey; Goates, Scott

    2016-01-01

    Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. We implemented a quality improvement program that positioned early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications, guided and monitored by medication administration records. Post-quality improvement program, pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced.

  7. Model-based aviation advice on distal volcanic ash clouds by assimilating aircraft in situ measurements

    NASA Astrophysics Data System (ADS)

    Fu, Guangliang; Heemink, Arnold; Lu, Sha; Segers, Arjo; Weber, Konradin; Lin, Hai-Xiang

    2016-07-01

    The forecast accuracy of distal volcanic ash clouds is important for providing valid aviation advice during volcanic ash eruption. However, because the distal part of volcanic ash plume is far from the volcano, the influence of eruption information on this part becomes rather indirect and uncertain, resulting in inaccurate volcanic ash forecasts in these distal areas. In our approach, we use real-life aircraft in situ observations, measured in the northwestern part of Germany during the 2010 Eyjafjallajökull eruption, in an ensemble-based data assimilation system combined with a volcanic ash transport model to investigate the potential improvement on the forecast accuracy with regard to the distal volcanic ash plume. We show that the error of the analyzed volcanic ash state can be significantly reduced through assimilating real-life in situ measurements. After a continuous assimilation, it is shown that the aviation advice for Germany, the Netherlands and Luxembourg can be significantly improved. We suggest that with suitable aircrafts measuring once per day across the distal volcanic ash plume, the description and prediction of volcanic ash clouds in these areas can be greatly improved.

  8. Lean-driven improvements slash wait times, drive up patient satisfaction scores.

    PubMed

    2012-07-01

    Administrators at LifePoint Hospitals, based in Brentwood, TN, used lean manufacturing techniques to slash wait times by as much as 30 minutes and achieve double-digit increases in patient satisfaction scores in the EDs at three hospitals. In each case, front-line workers took the lead on identifying opportunities for improvement and redesigning the patient-flow process. As a result of the new efficiencies, patient volume is up by about 25% at all three hospitals. At each hospital, the improvement process began with Kaizen, a lean process that involves bringing personnel together to flow-chart the current system, identify problem areas, and redesign the process. Improvement teams found big opportunities for improvement at the front end of the flow process. Key to the approach was having a plan up front to deal with non-compliance. To sustain improvements, administrators gather and disseminate key metrics on a daily basis.

  9. Lean-driven improvements slash wait times, drive up patient satisfaction scores.

    PubMed

    2012-07-01

    Administrators at LifePoint Hospitals, based in Brentwood, TN, used lean manufacturing techniques to slash wait times by as much as 30 minutes and achieve double-digit increases in patient satisfaction scores in the EDs at three hospitals. In each case, front-line workers took the lead on identifying opportunities for improvement and redesigning the patient-flow process. As a result of the new efficiencies, patient volume is up by about 25% at all three hospitals. At each hospital, the improvement process began with Kaizen, a lean process that involves bringing personnel together to flow-chart the current system, identify problem areas, and redesign the process. Improvement teams found big opportunities for improvement at the front end of the flow process. Key to the approach was having a plan up front to deal with non-compliance. To sustain improvements, administrators gather and disseminate key metrics on a daily basis. PMID:22838052

  10. Improvement in clinical outcomes after dry needling in a patient with occipital neuralgia.

    PubMed

    Bond, Bryan M; Kinslow, Christopher

    2015-06-01

    The primary purpose of this case report is to outline the diagnosis, intervention and clinical outcome of a patient presenting with occipital neuralgia. Upon initial presentation, the patient described a four-year history of stabbing neck pain and headaches. After providing informed consent, the patient underwent a total of four dry needling (DN) sessions over a two-week duration. During each of the treatment sessions, needles were inserted into the trapezii and suboccipital muscles. Post-intervention, the patient reported a 32-point change in her neck disability index score along with a 28-point change in her headache disability index score. Thus, it appears that subsequent four sessions of DN over two weeks, our patient experienced meaningful improvement in her neck pain and headaches. To the best of our knowledge, this is the first case report describing DN to successfully improve clinical outcomes in a patient diagnosed with occipital neuralgia. PMID:26136602

  11. Improvement in clinical outcomes after dry needling in a patient with occipital neuralgia

    PubMed Central

    Bond, Bryan M.; Kinslow, Christopher

    2015-01-01

    The primary purpose of this case report is to outline the diagnosis, intervention and clinical outcome of a patient presenting with occipital neuralgia. Upon initial presentation, the patient described a four-year history of stabbing neck pain and headaches. After providing informed consent, the patient underwent a total of four dry needling (DN) sessions over a two-week duration. During each of the treatment sessions, needles were inserted into the trapezii and suboccipital muscles. Post-intervention, the patient reported a 32-point change in her neck disability index score along with a 28-point change in her headache disability index score. Thus, it appears that subsequent four sessions of DN over two weeks, our patient experienced meaningful improvement in her neck pain and headaches. To the best of our knowledge, this is the first case report describing DN to successfully improve clinical outcomes in a patient diagnosed with occipital neuralgia. PMID:26136602

  12. Improvement in clinical outcomes after dry needling in a patient with occipital neuralgia.

    PubMed

    Bond, Bryan M; Kinslow, Christopher

    2015-06-01

    The primary purpose of this case report is to outline the diagnosis, intervention and clinical outcome of a patient presenting with occipital neuralgia. Upon initial presentation, the patient described a four-year history of stabbing neck pain and headaches. After providing informed consent, the patient underwent a total of four dry needling (DN) sessions over a two-week duration. During each of the treatment sessions, needles were inserted into the trapezii and suboccipital muscles. Post-intervention, the patient reported a 32-point change in her neck disability index score along with a 28-point change in her headache disability index score. Thus, it appears that subsequent four sessions of DN over two weeks, our patient experienced meaningful improvement in her neck pain and headaches. To the best of our knowledge, this is the first case report describing DN to successfully improve clinical outcomes in a patient diagnosed with occipital neuralgia.

  13. Relationship between improvements in physical measures and patient satisfaction in rehabilitation after total knee arthroplasty.

    PubMed

    Nazzal, Mahmoud I; Bashaireh, Khaldoon H; Alomari, Mahmoud A; Nazzal, Mohammad S; Maayah, Mikhled F; Mesmar, Mohammad

    2012-06-01

    The aim of this study was to examine patient satisfaction with rehabilitation after total knee arthroplasty (TKA). Fifty-six patients, aged 45-77 years, were enrolled in a post-TKA comprehensive therapy program focusing on knee strengthening and functional activities. The program lasted 3 months and was conducted for 1 h, twice a day, 5 days per week. Pain scores, number of steps climbed (STp), and maximum walked distance (MWD) were determined before the operation and 3 months after cessation of the rehabilitation program. In addition, knee-flexion range of motion (ROM) was measured before the surgery and immediately, 2 weeks and 3 months after the surgery. Pain decreased whereas MWD and STp increased at 3 months postoperation. In addition, the magnitude of improvement in STp correlated positively with the magnitude of change in MWD and pain. There was a significant increase in knee-flexion ROM at 2 weeks and 3 months postoperation compared with preoperation. The patient age also correlated positively with the magnitude of improvement in knee-flexion ROM after 2 weeks and 3 months of therapy. Improvements in MWD and STp were greater and pain was less, among the satisfied patients compared with unsatisfied ones. The results of this study further confirm the importance of therapy for osteoarthritis patients after TKA. In addition, as older patients are less conditioned, they seem to be more inclined to improvement in functionality with rehabilitation. Satisfied patients seem to achieve larger improvements in functional capacity and pain measures.

  14. Delirium detection and improved delirium management in older patients hospitalized for hip fracture.

    PubMed

    Todd, Kristine S; Barry, Jean; Hoppough, Susan; McConnell, Eleanor

    2015-11-01

    Delirium is a common and potentially devastating problem for older patients following hip fracture. Although early detection is recommended, description and evaluation of standardized approaches are scarce. The aims of this quality improvement project were to: (1) implement a clinical algorithm for improving delirium detection and management and (2) assess the impact of the clinical algorithm on length of stay, discharge disposition and patient satisfaction. The pilot study was implemented on an orthopedic unit to evaluate the effectiveness of a clinical protocol for delirium detection and management to improve outcomes. Outcomes of 33 elderly post-operative hip fracture patients were compared to historical controls from the same unit. Delirium was detected in 18% of patients. Length of stay was reduced by 22% (P < .001), discharge disposition showed a 13% improvement (P = .17) and patient satisfaction scores showed a 15% (P = .15) improvement post-intervention. Implementation of a clinical algorithm to promote early detection and treatment of delirium in post-operative hip fracture patients is feasible and associated with improved outcomes.

  15. Advice-giving and the management of uncertainty for cancer survivors.

    PubMed

    Thompson, Sharlene; O'Hair, H Dan

    2008-07-01

    This study examines advice and uncertainty management, in the context of cancer survivorship, with specific emphasis on the relative influence of target receptiveness, advice content, and advice optimism on uncertainty-management processes, coping processes, and advice evaluation. Cancer survivors (N = 184) completed a questionnaire (online or paper) reporting on informal advice received after diagnosis. Results indicated that target receptiveness and advice optimism were positively related to coping processes and advice evaluation. Target receptiveness was positively related to uncertainty management. Appropriateness of advice was significantly related to problem-solving utility, and absence of limitations was significantly related to emotional awareness. Limitations of the study are offered, and implications for future research are advanced in the area of cancer survivorship.

  16. [Improvement of tumoral calcinosis of the right hand after parathyroidectomy in a patient on chronic hemodialysis].

    PubMed

    El Maghraoui, Jaouad; Hammou, Mohamed; Kabbali, Nadia; Arrayhani, Mohamed; Houssaini, Tariq Sqalli

    2016-01-01

    Periarticular tissue calcifications are common in patients with chronic renal failure undergoing hemodialysis. We report the case of a patient on chronic hemodialysis for 10 years with significant improvement of isolated pseudotumoral calcinosis of the right hand after parathyroidectomy The aim of this study was to show the impact of parathyroidectomy on pseudotumoral calcinosis. PMID:27583094

  17. Interventions to improve patient hand hygiene: a systematic review.

    PubMed

    Srigley, J A; Furness, C D; Gardam, M

    2016-09-01

    Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HCAIs). The aim of this systematic review was to determine the efficacy of patient hand hygiene interventions in reducing HCAIs and improving patient hand hygiene rates compared to usual care. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HCAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Ten studies were included, most of which were uncontrolled before-after studies (N=8). The majority of interventions (N=7) were multi-modal, with components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HCAI outcomes and four studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. In conclusion, interventions to improve patient hand hygiene may reduce the incidence of HCAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes. PMID:27262906

  18. Improving Clinical Communication and Promoting Health through Concordance-Based Patient Education

    ERIC Educational Resources Information Center

    Bylund, Carma L.; D'Agostino, Thomas A.; Ho, Evelyn Y.; Chewning, Betty A.

    2010-01-01

    In recent years, communication education has been used as a means of improving the clinician-patient relationship and promoting health. The focus of these interventions has primarily centered on clinician training. An area that has received less focus, although equally important, is training patients to be good communicators. The purpose of the…

  19. Interventions to improve patient hand hygiene: a systematic review.

    PubMed

    Srigley, J A; Furness, C D; Gardam, M

    2016-09-01

    Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HCAIs). The aim of this systematic review was to determine the efficacy of patient hand hygiene interventions in reducing HCAIs and improving patient hand hygiene rates compared to usual care. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HCAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Ten studies were included, most of which were uncontrolled before-after studies (N=8). The majority of interventions (N=7) were multi-modal, with components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HCAI outcomes and four studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. In conclusion, interventions to improve patient hand hygiene may reduce the incidence of HCAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes.

  20. Small-Group Standardized Patient Encounter Improves Athletic Training Students' Psychosocial Intervention and Referral Skills

    ERIC Educational Resources Information Center

    Walker, Stacy E.; Weidner, Thomas G.; Thrasher, Ashley B.

    2016-01-01

    Context: Athletic trainers provide psychological support, counseling, intervention, and referral to patients during clinical practice. However, students are rarely exposed to real-life opportunities to develop these skills. Objective: To determine if a small-group standardized patient (SP) encounter improved athletic training students'…

  1. A Comprehensive Approach to Identifying Intervention Targets for Patient-Safety Improvement in a Hospital Setting

    ERIC Educational Resources Information Center

    Cunningham, Thomas R.; Geller, E. Scott

    2012-01-01

    Despite differences in approaches to organizational problem solving, healthcare managers and organizational behavior management (OBM) practitioners share a number of practices, and connecting healthcare management with OBM may lead to improvements in patient safety. A broad needs-assessment methodology was applied to identify patient-safety…

  2. Identifying priority actions for improving patient satisfaction with outpatient cancer care.

    PubMed

    Gesell, Sabina B; Gregory, Nancy

    2004-01-01

    In parallel to developing new cancer therapies, the healthcare community has the responsibility of creating positive treatment experiences for patients. Data from 5907 cancer outpatients treated at 23 hospitals across the United States were analyzed to identify the top priorities for service improvement in outpatient cancer treatment facilities. They included meeting patients' emotional needs, providing information to patients and family members, reducing waiting times, and providing convenience and coordinated care among physicians and other care providers.

  3. Implementing practice management strategies to improve patient care: the EPIC project.

    PubMed

    Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna

    2012-01-01

    Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.

  4. Rifaximin Improves Driving Simulator Performance in a Randomized Trial of Patients with Minimal Hepatic Encephalopathy

    PubMed Central

    Bajaj, Jasmohan S; Heuman, Douglas M; Wade, James B; Gibson, Douglas P; Saeian, Kia; Wegelin, Jacob A; Hafeezullah, Muhammad; Bell, Debulon E; Sterling, Richard K; Stravitz, R. Todd; Fuchs, Michael; Luketic, Velimir; Sanyal, Arun J

    2010-01-01

    Background & Aims Patients with cirrhosis and minimal hepatic encephalopathy (MHE) have driving difficulties but the effects of therapy on driving performance have not been assessed. We evaluated whether performance on a driving simulator improves in patients with MHE following treatment with rifaximin. Methods Patients with MHE who were current drivers were randomly assigned to placebo or rifaximin groups and followed for 8 weeks (n=42). Patients underwent driving simulation (driving and navigation tasks) at the start (baseline) and end of the study. We evaluated patients’ cognitive abilities, quality-of-life (using the Sickness Impact Profile [SIP]), serum levels of ammonia, levels of inflammatory cytokines, and MELD scores. The primary outcome was percent who improved in driving performance, calculated by: total driving errors=speeding + illegal turns + collisions. Results Over the 8-week study period, patients given rifaximin made significantly greater improvements than those given placebo in avoiding total driving errors (76% vs. 31%, P=0.013), speeding (81% vs. 33%, P=0.005), and illegal turns (62% vs. 19%, P=0.01). Of patients given rifaximin, 91% improved their cognitive performance, compared with 61% of patients given placebo (P=0.01); they also made improvements in the psycho-social dimension of the SIP, compared with the placebo group (P=0.04). Adherence to the assigned drug averaged 92%. Neither group had changes in ammonia levels or MELD scores, but patients in the rifaximin group had increased levels of the anti-inflammatory cytokine interleukin-10. Conclusions Patients with MHE significantly improve driving simulator performance following treatment with rifaximin, compared with placebo. PMID:20849805

  5. Helping COPD patients change health behavior in order to improve their quality of life

    PubMed Central

    Almagro, Pere; Castro, Alejandra

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and debilitating diseases in adults worldwide and is associated with a deleterious effect on the quality of life of affected patients. Although it remains one of the leading causes of global mortality, the prognosis seems to have improved in recent years. Even so, the number of patients with COPD and multiple comorbidities has risen, hindering their management and highlighting the need for futures changes in the model of care. Together with standard medical treatment and therapy adherence – essential to optimizing disease control – several nonpharmacological therapies have proven useful in the management of these patients, improving their health-related quality of life (HRQoL) regardless of lung function parameters. Among these are improved diagnosis and treatment of comorbidities, prevention of COPD exacerbations, and greater attention to physical disability related to hospitalization. Pulmonary rehabilitation reduces symptoms, optimizes functional status, improves activity and daily function, and restores the highest level of independent physical function in these patients, thereby improving HRQoL even more than pharmacological treatment. Greater physical activity is significantly correlated with improvement of dyspnea, HRQoL, and mobility, along with a decrease in the loss of lung function. Nutritional support in malnourished COPD patients improves exercise capacity, while smoking cessation slows disease progression and increases HRQoL. Other treatments such as psychological and behavioral therapies have proven useful in the treatment of depression and anxiety, both of which are frequent in these patients. More recently, telehealthcare has been associated with improved quality of life and a reduction in exacerbations in some patients. A more multidisciplinary approach and individualization of interventions will be essential in the near future. PMID:23901267

  6. Electronic Patient Registries Improve Diabetes Care and Clinical Outcomes in Rural Community Health Centers

    ERIC Educational Resources Information Center

    Pollard, Cecil; Bailey, Kelly A.; Petitte, Trisha; Baus, Adam; Swim, Mary; Hendryx, Michael

    2009-01-01

    Context: Diabetes care is challenging in rural areas. Research has shown that the utilization of electronic patient registries improves care; however, improvements generally have been described in combination with other ongoing interventions. The level of basic registry utilization sufficient for positive change is unknown. Purpose: The goal of…

  7. Lesion Characteristics Related to Treatment Improvement in Object and Action Naming for Patients with Chronic Aphasia

    ERIC Educational Resources Information Center

    Parkinson, R. Bruce; Raymer, Anastasia; Chang, Yu-Ling; FitzGerald, David B.; Crosson, Bruce

    2009-01-01

    Few studies have examined the relationship between degree of lesion in various locations and improvement during treatment in stroke patients with chronic aphasia. The main purpose of this study was to determine whether the degree of lesion in specific brain regions was related to magnitude of improvement over the course of object and action naming…

  8. Improvements in Care and Reduced Self-Management Barriers Among Rural Patients With Diabetes

    ERIC Educational Resources Information Center

    Dettori, Nancy; Flook, Benjamin N.; Pessl, Erich; Quesenberry, Kim; Loh, Johnson; Harris, Colleen; McDowall, Janet M.; Butcher, Marcene K.; Helgerson, Steven D.; Gohdes, Dorothy; Harwell, Todd S.

    2005-01-01

    Improved preventive care and clinical outcomes among patients with diabetes can reduce complications and costs; however, diabetes care continues to be suboptimal. Few studies have described effective strategies for improving care among rural populations with diabetes. In 2000, the Park County Diabetes Project and the Montana Diabetes Control…

  9. Manual Therapy and Exercise to Improve Outcomes in Patients With Muscle Tension Dysphonia: A Case Series

    PubMed Central

    Archer, Kristin R.

    2015-01-01

    Background and Purpose Muscle tension dysphonia (MTD), a common voice disorder that is not commonly referred for physical therapy intervention, is characterized by excessive muscle recruitment, resulting in incorrect vibratory patterns of vocal folds and an alteration in voice production. This case series was conducted to determine whether physical therapy including manual therapy, exercise, and stress management education would be beneficial to this population by reducing excess muscle tension. Case Description Nine patients with MTD completed a minimum of 9 sessions of the intervention. Patient-reported outcomes of pain, function, and quality of life were assessed at baseline and the conclusion of treatment. The outcome measures were the numeric rating scale (NRS), Patient-Specific Functional Scale (PSFS), and Voice Handicap Index (VHI). Cervical and jaw range of motion also were assessed at baseline and postintervention using standard goniometric measurements. Outcomes Eight of the patients had no pain after treatment. All 9 of the patients demonstrated an improvement in PSFS score, with 7 patients exceeding a clinically meaningful improvement at the conclusion of the intervention. Three of the patients also had a clinically meaningful change in VHI scores. All 9 of the patients demonstrated improvement in cervical flexion and lateral flexion and jaw opening, whereas 8 patients improved in cervical extension and rotation postintervention. Discussion The findings suggest that physical therapists can feasibly implement an intervention to improve outcomes in patients with MTD. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the intervention. A clinical implication is the expansion of physical therapy to include referrals from voice centers for the treatment of MTD. PMID:25256740

  10. 45 CFR 162.1601 - Health care payment and remittance advice transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Health care payment and remittance advice... DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Payment and Remittance Advice § 162.1601 Health care payment and remittance advice transaction. The health care payment...

  11. 45 CFR 162.1601 - Health care payment and remittance advice transaction.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Health care payment and remittance advice... DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Payment and Remittance Advice § 162.1601 Health care payment and remittance advice transaction. The health care payment...

  12. Aspects of Recipient Design in Expert Advice-giving on Call-in Radio.

    ERIC Educational Resources Information Center

    Hutchby, Ian

    1995-01-01

    Investigates the management of expertise in advice-giving in the calls to a radio advice line. Analyzes how the expert's talk handles the tension between the personal and public dimensions of advice-giving in such a public forum. (HB)

  13. 19 CFR 177.11 - Requests for advice by field offices.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... public inspection. Disclosure is governed by 31 CFR part 1 and 19 CFR part 103. (8) Judicial review of... 19 Customs Duties 2 2011-04-01 2011-04-01 false Requests for advice by field offices. 177.11... advice by field offices. (a) Generally. Advice or guidance as to the interpretation or proper...

  14. 19 CFR 177.11 - Requests for advice by field offices.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... public inspection. Disclosure is governed by 31 CFR part 1 and 19 CFR part 103. (8) Judicial review of... 19 Customs Duties 2 2010-04-01 2010-04-01 false Requests for advice by field offices. 177.11... advice by field offices. (a) Generally. Advice or guidance as to the interpretation or proper...

  15. 77 FR 48169 - The Information Technology Agreement: Advice and Information on the Proposed Expansion: Part 1...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-13

    ... COMMISSION The Information Technology Agreement: Advice and Information on the Proposed Expansion: Part 1; The Information Technology Agreement: Advice and Information on the Proposed Expansion: Part 2 AGENCY... Information Technology Agreement: Advice and Information on the Proposed Expansion: Part 1, and...

  16. Can bronchodilators improve exercise tolerance in COPD patients without dynamic hyperinflation? *

    PubMed Central

    Scuarcialupi, Maria Enedina Aquino; Berton, Danilo Cortozi; Cordoni, Priscila Kessar; Squassoni, Selma Denis; Fiss, Elie; Neder, José Alberto

    2014-01-01

    OBJECTIVE: To investigate the modulatory effects that dynamic hyperinflation (DH), defined as a reduction in inspiratory capacity (IC), has on exercise tolerance after bronchodilator in patients with COPD. METHODS: An experimental, randomized study involving 30 COPD patients without severe hypoxemia. At baseline, the patients underwent clinical assessment, spirometry, and incremental cardiopulmonary exercise testing (CPET). On two subsequent visits, the patients were randomized to receive a combination of inhaled fenoterol/ipratropium or placebo. All patients then underwent spirometry and submaximal CPET at constant speed up to the limit of tolerance (Tlim). The patients who showed ΔIC(peak-rest) < 0 were considered to present with DH (DH+). RESULTS: In this sample, 21 patients (70%) had DH. The DH+ patients had higher airflow obstruction and lower Tlim than did the patients without DH (DH-). Despite equivalent improvement in FEV1 after bronchodilator, the DH- group showed higher ΔIC(bronchodilator-placebo) at rest in relation to the DH+ group (p < 0.05). However, this was not found in relation to ΔIC at peak exercise between DH+ and DH- groups (0.19 ± 0.17 L vs. 0.17 ± 0.15 L, p > 0.05). In addition, both groups showed similar improvements in Tlim after bronchodilator (median [interquartile range]: 22% [3-60%] vs. 10% [3-53%]; p > 0.05). CONCLUSIONS: Improvement in TLim was associated with an increase in IC at rest after bronchodilator in HD- patients with COPD. However, even without that improvement, COPD patients can present with greater exercise tolerance after bronchodilator provided that they develop DH during exercise. PMID:24831394

  17. Reinforcement learning agents providing advice in complex video games

    NASA Astrophysics Data System (ADS)

    Taylor, Matthew E.; Carboni, Nicholas; Fachantidis, Anestis; Vlahavas, Ioannis; Torrey, Lisa

    2014-01-01

    This article introduces a teacher-student framework for reinforcement learning, synthesising and extending material that appeared in conference proceedings [Torrey, L., & Taylor, M. E. (2013)]. Teaching on a budget: Agents advising agents in reinforcement learning. {Proceedings of the international conference on autonomous agents and multiagent systems}] and in a non-archival workshop paper [Carboni, N., &Taylor, M. E. (2013, May)]. Preliminary results for 1 vs. 1 tactics in StarCraft. {Proceedings of the adaptive and learning agents workshop (at AAMAS-13)}]. In this framework, a teacher agent instructs a student agent by suggesting actions the student should take as it learns. However, the teacher may only give such advice a limited number of times. We present several novel algorithms that teachers can use to budget their advice effectively, and we evaluate them in two complex video games: StarCraft and Pac-Man. Our results show that the same amount of advice, given at different moments, can have different effects on student learning, and that teachers can significantly affect student learning even when students use different learning methods and state representations.

  18. Does coronary artery bypass grafting improve quality of life in elderly patients?

    PubMed

    Baig, Kamran; Harling, Leanne; Papanikitas, Joseph; Attaran, Saina; Ashrafian, Hutan; Casula, Roberto; Athanasiou, Thanos

    2013-09-01

    Traditional outcome measures such as long-term mortality may be of less value than symptomatic improvement in elderly patients undergoing coronary artery bypass grafting (CABG). In this systematic review, we analyse health-related quality of life (HRQOL) as a marker of outcome after CABG. We aimed to assess the role of HRQOL tools in making recommendations for elderly patients undergoing surgery, where symptomatic and quality-of-life improvement may often be the key indications for intervention. Twenty-three studies, encompassing 4793 patients were included. Overall, elderly patients underwent CABG at reasonably low risk. Our findings, therefore, support the conclusion that performing CABG in the elderly may be associated with significant improvements in HRQOL. In order to overcome previous methodological limitations, future work must clearly define and stringently follow-up this elderly population, to develop a more robust, sensitive and specialty-specific HRQOL tool.

  19. Improving the culture of patient safety through the Magnet® journey.

    PubMed

    Swanson, Jane W; Tidwell, Candice A

    2011-09-01

    This article outlines how one academic medical center's nursing service has developed programs to improve patient safety and quality outcomes through the use of the Magnet Re-Designation Accreditation Process(R) and a shared governance model. Successful programs have been implemented across the continuum of care. These programs include educational initiatives that increased both the number of nurses with BSN degrees and specialty certifications and also the number of patient-focused initiatives, such as a reduction in central line infection rates, an increase in hand-washing compliance, and a decrease in fall rates. In this article we will describe how our Magnet Re-Designation Accreditation Process(R) and shared governance model have contributed to strengthening our culture of patient safety. The manner in which the Magnet components of transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation and improvement; and empirical quality results have all contributed to improved patient safety are discussed.

  20. The use of a pro forma to improve quality in clerking vascular surgery patients

    PubMed Central

    Kentley, Jonathan; Fox, Amy; Taylor, Sophia; hassan, yahya; Filipek, Alicja

    2016-01-01

    At our institution, a large tertiary referral centre for vascular surgery, patients are often admitted directly to the ward and clerked by foundation year one (FY1) doctors. We found that these clerkings frequently fell short of national record keeping standards, potentially leading to an increased risk for patients during their hospital stay. In addition, we found that junior doctors did not feel confident in clerking vascular surgery patients. A literature review found that high quality clerkings were strongly linked to improved patient safety, and that the use of a pro forma was one method to improve compliance with documentation guidelines. We devised a clerking pro forma based on national guidelines and introduced it to the department. We found that the use of a pro forma significantly improved documentation standards across a number of domains, including patient demographics, presenting complaint, and family and social histories (p <0.05). Examinations were significantly more comprehensive, with cardiac and vascular examination as well as peripheral pulses documented (p <0.05). In conclusion, we found that using a pro forma helped to aid junior doctors in clerking new patients, and significantly improved the quality of their history and examinations. This leads to a potential positive impact on patient safety during their inpatient stay, and should be rolled out more widely across the hospital. PMID:27418964

  1. Levosimendan may improve survival in patients requiring mechanical assist devices for post-cardiotomy heart failure

    PubMed Central

    Braun, Jan-Peter; Jasulaitis, Dominik; Moshirzadeh, Maryam; Doepfmer, Ulrich R; Kastrup, Marc; von Heymann, Christian; Dohmen, Pascal M; Konertz, Wolfgang; Spies, Claudia

    2006-01-01

    Introduction Most case series suggest that less than half of the patients receiving a mechanical cardiac assist device as a bridge to recovery due to severe post-cardiotomy heart failure survive to hospital discharge. Levosimendan is the only inotropic substance known to improve medium term survival in patients suffering from severe heart failure. Methods This retrospective analysis covers our single centre experience. Between July 2000 and December 2004, 41 consecutive patients were treated for this complication. Of these, 38 patients are included in this retrospective analysis as 3 patients died in the operating room. Levosimendan was added to the treatment protocol for the last nine patients. Results Of 29 patients treated without levosimendan, 20 could be weaned off the device, 9 survived to intensive care unit discharge, 7 left hospital alive and 3 survived 180 days. All 9 patients treated with levosimendan could be weaned, 8 were discharged alive from ICU and hospital, and 7 lived 180 days after surgery (p < 0.002 for 180 day survival). Plasma lactate after explantation of the device was significantly lower (p = 0.002), as were epinephrine doses. Time spent on renal replacement therapy was significantly shorter (p = 0.023). Conclusion Levosimendan seems to improve medium term survival in patients failing to wean off cardiopulmonary bypass and requiring cardiac assist devices as a bridge to recovery. This retrospective analysis justifies prospective randomised investigations of levosimendan in this group of patients. PMID:16420666

  2. Improving patient satisfaction with time spent in an orthopedic outpatient clinic

    PubMed Central

    Levesque, Jerry; Bogoch, Earl R.; Cooney, Barb; Johnston, Brenda; Wright, James G.

    2000-01-01

    Objective To determine if patient satisfaction can be improved by changing patients’ expectations of the clinic visit and by decreasing the total time spent in the clinic. Design A prospective comparative analysis carried out in 4 phases. Setting An university-affiliated orthopedic outpatient clinic. Patients All patients seen in the orthopedic outpatient clinic were eligible. Phase 1 determined the total clinic time required by patient type; phase 2 assessed baseline satisfaction; phase 3 altered patients’ expectations; and phase 4 altered patients’ expectations and scheduled visits by patient type. Intervention Patient questionnaires. Main outcome measure Patient satisfaction with time spent in the clinic. Results Of 708 distributed questionnaires, 622 (88%) were completed (547 totally complete, 75 partially complete). Total time spent in the clinic decreased across phases 2, 3 and 4 (mean 99.2, 94.7 and 85.2 minutes, respectively, but was significantly different only between phases 3 and 4; p = 0.05, Duncan’s multiple range test). The percentage of patients who rated their waiting time as “excellent” increased across phases 2, 3 and 4 (14.6%, 18.8% and 31.1%, respectively; p = 0.0004, χ2 test). Conclusion Patient satisfaction can be improved by altering patient expectations and by decreasing the total time spent in clinic. PMID:11129831

  3. Improvement of survival and prospect of cure in patients with metastatic breast cancer.

    PubMed

    Cheng, Yee Chung; Ueno, Naoto T

    2012-07-01

    Patients with metastatic breast cancer have traditionally been considered incurable with conventional treatment. However, 5-10% of those patients survive more than 5 years, and 2-5% survive more than 10 years. Recent studies suggest that the survival of patients with metastatic breast cancer has been slowly improving. In this review, we examine the possible curative approach for a certain group of patients with metastatic breast cancer. We identify that patients most likely to benefit from such an aggressive approach are young and have good performance status, adequate body functional reserve, long disease-free interval before recurrence, oligometastatic disease, and low systemic tumor load. An aggressive multidisciplinary approach including both local treatment of macroscopic disease and systemic treatment of microscopic disease can result in prolonged disease control in certain patients with metastatic breast cancer. Whether patients with prolonged disease control are "cured" remains controversial.

  4. Identifying and improving knowledge deficits of emergency airway management of tracheotomy and laryngectomy patients: a pilot patient safety initiative.

    PubMed

    El-Sayed, Ivan H; Ryan, Susan; Schell, Hildy; Rappazini, Rosanne; Wang, Steven J

    2010-01-01

    Objectives. To evaluate the knowledge base of hospital staff regarding emergent airway management of tracheotomy and laryngectomy patients, and the impact of the introduction of a bedside airway form. Methods. Cross-sectional surveys of physicians, nurses, and respiratory therapists at a tertiary care hospital prior to and 24 months after introduction of a bedside Emergency Airway Access (EAA) form. Results. Pre- and postintervention surveys revealed several knowledge deficits. Preintervention, 37% of medical internists and 19% overall did not know that laryngectomy patients cannot be orally ventilated, and 67% of internists could not identify the purpose of stay sutures in recently created tracheotomies. Postintervention, these numbers improved for all groups. Furthermore, 80% of respiratory therapists reported encountering the EAA form in an emergent situation and found it useful. Conclusion. A knowledge deficit is identified in caregivers expected to provide emergency management of patients with airway anatomy altered by subspecialty surgeons. Safety initiatives such as the EAA form may improve knowledge among providers.

  5. Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial

    PubMed Central

    Bendtsen, Preben; Müssener, Ulrika; Karlsson, Nadine; López-Pelayo, Hugo; Palacio-Vieira, Jorge; Colom, Joan; Gual, Antoni; Reynolds, Jillian; Wallace, Paul; Segura, Lidia; Anderson, Peter

    2016-01-01

    Objectives The objective of the present study was to explore whether the possibility of offering facilitated access to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increased the proportion of consulting adults who were screened and given brief advice. Design The study was a 12-week implementation study. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands, Poland and Sweden) were asked to screen adults who attended the PHCU for risky drinking. Setting A total of 120 primary healthcare centres from 5 jurisdictions in Europe. Participants 746 individual providers (general practitioners, nurses or other professionals) participated in the study. Primary outcome Change in the proportion of patients screened and referred to eBI comparing a baseline 4-week preimplementation period with a 12-week implementation period. Results The possibility of referring patients to the eBI was not found to be associated with any increase in the proportion of patients screened. However, it was associated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole (p<0.05), mainly driven by a significant increase in brief intervention rates in England from 87% to 96% (p<0.01). The study indicated that staff displayed a low level of engagement in this new technology. Staff continued to offer face-to-face advice to a larger proportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among the referred patients; on average, 18% of the patients logged on to the website with a mean log-on rate across the different countries between 0.58% and 36.95%. Conclusions Referral to eBI takes nearly as much time as brief oral advice and might require more introduction and training before staff are comfortable with referring to eBI. Trial registration number NCT01501552; Post-results. PMID:27311902

  6. Cryotherapy for chronic vasomotor rhinitis: technique and patient selection for improved results.

    PubMed

    Bumsted, R M

    1984-04-01

    Current methods of therapy of chronic vasomotor (non-allergic) rhinitis are frequently unsuccessful. This led to the development of a standardized technique of intranasal cryotherapy (longer freeze duration and larger area of therapy than previously reported) which was utilized in 50 patients. Indications for cryotherapy included: failure of medical therapy in anatomically normal patients with mucosal disease caused only by vasomotor rhinitis. Minimal follow-up was 2 years. Obstructive symptoms (subjective and objective evaluation) were eliminated in 92% and markedly improved in the remaining 8%. Excessive drainage (subjective) was relieved in 47%, markedly improved in 41%, and minimally improved (therapeutic failure) in 12%. Complications were minor; however, increased postoperative pain, drainage and healing duration (compared to prior series) were encountered. This cryotherapy technique provides significantly improved results in the treatment of vasomotor rhinitis when proper patient selection and technique are utilized.

  7. Improving outpatient services for elderly patients in Taiwan: a qualitative study.

    PubMed

    Kuo, Ren-Jieh; Wu, Yung-Hung; Hsu, Tsung-Shin; Chen, Liang-Kung

    2011-01-01

    The rapid pace of population aging poses significant importance of establishing an age-friendly health care system, including outpatient, inpatient, intermediate, and long-term care. The main purpose of this study is to evaluate the quality of outpatient services for elderly patients in Taiwan. Quality function deployment (QFD) is a tool effectively shortening the research-and-development period, reducing costs, and fulfilling customer needs (CNs). This study applied Kano's model and the analytic network process (ANP) to improve the basic framework of QFD. Kano's model enables a thorough understanding of elderly patients' needs and problems with regard to medical care services, so that appropriate outpatient services can be offered to them from the outset. In addition, adapting the supermatrix of ANP to the calculation of the house of quality (HoQ) will reduce subjective judgments. Using Kano's model and an integrated ANP-QFD approach, we extracted five needs of elderly patients and calculated their priorities: 'Professional medical care services convincing patients' (27%), 'With sufficient knowledge to answer patients' questions' (23.5%), 'Providing fast services to solve patients' problems' (19.3%), 'Voluntarily serving patients' (19.1%), and 'Providing proper medical equipment to patients' (11.1%). We then identified six outpatient service attributes deserving of improvement and their priorities: 'Physician with a high level of professionalism and giving clear interpretation of patient's condition' (25%), 'Staff with good communication skills and assistance to patients' (22%), 'High standardization of operating procedures' (18%), 'Staff getting on-the-job training periodically' (15%), 'Facilities sufficient and fitting for elderly patients' (10%), and 'Applying IT (internet) to help patients to receive medical care' (10%). In conclusion, we reconstructed an integrated QFD model which will not only reduce costs but also reveal the crucial outpatient service items

  8. Improving outpatient services for elderly patients in Taiwan: a qualitative study.

    PubMed

    Kuo, Ren-Jieh; Wu, Yung-Hung; Hsu, Tsung-Shin; Chen, Liang-Kung

    2011-01-01

    The rapid pace of population aging poses significant importance of establishing an age-friendly health care system, including outpatient, inpatient, intermediate, and long-term care. The main purpose of this study is to evaluate the quality of outpatient services for elderly patients in Taiwan. Quality function deployment (QFD) is a tool effectively shortening the research-and-development period, reducing costs, and fulfilling customer needs (CNs). This study applied Kano's model and the analytic network process (ANP) to improve the basic framework of QFD. Kano's model enables a thorough understanding of elderly patients' needs and problems with regard to medical care services, so that appropriate outpatient services can be offered to them from the outset. In addition, adapting the supermatrix of ANP to the calculation of the house of quality (HoQ) will reduce subjective judgments. Using Kano's model and an integrated ANP-QFD approach, we extracted five needs of elderly patients and calculated their priorities: 'Professional medical care services convincing patients' (27%), 'With sufficient knowledge to answer patients' questions' (23.5%), 'Providing fast services to solve patients' problems' (19.3%), 'Voluntarily serving patients' (19.1%), and 'Providing proper medical equipment to patients' (11.1%). We then identified six outpatient service attributes deserving of improvement and their priorities: 'Physician with a high level of professionalism and giving clear interpretation of patient's condition' (25%), 'Staff with good communication skills and assistance to patients' (22%), 'High standardization of operating procedures' (18%), 'Staff getting on-the-job training periodically' (15%), 'Facilities sufficient and fitting for elderly patients' (10%), and 'Applying IT (internet) to help patients to receive medical care' (10%). In conclusion, we reconstructed an integrated QFD model which will not only reduce costs but also reveal the crucial outpatient service items

  9. United States - The Leukemia & Lymphoma Society: Working with patients, carers and hospital professionals to improve awareness, treatment and patient choice.

    PubMed

    2014-01-01

    By working locally with patients and carers from diagnosis and treatment through to aftercare, helping professionals to improve their knowledge and awareness about blood cancers and best practice treatment, while also advocating at the national level, the Leukemia & Lymphoma Society (LLS) is working to strengthen coordination between patients, carers and professionals along the whole care pathway. By helping patients to become more engaged and empowered to make informed choices, improve treatment for blood cancers through education, LLS is working to enhance patient-centred care in a largely privatized and fragmented health services system in the United States. By providing web-based resources and a free national helpline, alongside a face to face local support network, LLS is helping patients to learn more about their condition, treatment choices and the care pathways they can access. Free professional development and education seminars are also offered to nurses, oncologists and social workers in hospitals, highlighting new approaches to treatment and care with a patient-centred approach.

  10. The comparison of two physiotherapeutic approaches for gait improvement in sub-acute stroke patients.

    PubMed

    Krawczyk, Maciej; Szczerbik, Ewa; Syczewska, Małgorzata

    2014-01-01

    The functional gait problems encountered by stroke patients include impaired balance, abnormal gait pattern with marked asymmetry, pathological trunk and spinal motion. Many different methods of physiotherapy are used to improve functional ability (especially gait) in stroke patients, but their efficacy and outcome are often not objectively assessed. The goal of this paper is to compare two therapeutic programs: one that is traditionally used in our rehabilitation facilities (exercises in lying position, "open chain" exercises, isolated movements of extremities with trunk stabilization) and the new one (exercises in vertical position, sitting or standing, "closed chain" exercises involving whole paretic side of the body). Fifty one stroke patients, aged 34 to 79 years, participated in the study. Patients were randomly allocated to one of the two groups. Patients underwent clinical assessment (Fugl-Meyer, Rivermead Motor Assessment, Berg Balance Scale) and instrumented gait analysis (using six-camera VICON 460 system) simultaneously three times: prior to the beginning of the rehabilitation program, after 6 weeks of the program, and after another 6 weeks of physiotherapy, at the end of rehabilitation program. Results demonstrated that both rehabilitation programs improved the gait function and clinical status in patients suffering from stroke. Despite the differences between the two programs the progress achieved by the patients in locomotor function is similar. Two equivalent physiotherapy programs could be applied during rehabilitation process depending on the patient's individual preferences and needs, as the amount of functional improvement provided by them is comparable. PMID:24708038

  11. Virtual patient training to improve reproductive health care for women with intellectual disabilities.

    PubMed

    Boyd, Sara E; Sanders, Carla L; Kleinert, Harold L; Huff, Marlene B; Lock, Sharon; Johnson, Stephanie; Clevenger, Kim; Bush, Nathania A; Van Dyke, Eileen; Clark, Tara L

    2008-01-01

    A multimedia virtual patient module, involving the case of a young woman with mild intellectual disabilities with a complaint of diffuse abdominal pain, was developed as a clinical training tool for students in health care professions. Primary objectives following use of the module included improved knowledge and reduced perception of difficulty in treating women's health patients with intellectual disabilities. The module was developed using an iterative, collaborative process of a core development team that included medical professionals, multimedia specialists, the parent of a child with intellectual disability, and a disability advocate. Over the course of the module, students were required to identify appropriate and effective clinician-patient interactions in addition to relevant medical and developmental concerns for this patient population. Pilot data from a sample of nursing, physician assistant, and medical students suggest that the module is an effective tool for both improving students' knowledge and reducing their perception of difficulty in providing care to women's health patients with intellectual disabilities.

  12. Association between High Endocardial Unipolar Voltage and Improved Left Ventricular Function in Patients with Ischemic Cardiomyopathy

    PubMed Central

    Park, Ki; Lai, Dejian; Handberg, Eileen M.; Perin, Emerson C.; Pepine, Carl J.; Anderson, R. David

    2016-01-01

    We know that endocardial mapping reports left ventricular electrical activity (voltage) and that these data can predict outcomes in patients undergoing traditional revascularization. Because the mapping data from experimental models have also been linked with myocardial viability, we hypothesized an association between increased unipolar voltage in patients undergoing intramyocardial injections and their subsequent improvement in left ventricular performance. For this exploratory analysis, we evaluated 86 patients with left ventricular dysfunction, heart-failure symptoms, possible angina, and no revascularization options, who were undergoing endocardial mapping. Fifty-seven patients received bone marrow mononuclear cell (BMC) injections and 29 patients received cell-free injections of a placebo. The average mapping site voltage was 9.7 ± 2 mV, and sites with voltage of ≥6.9 mV were engaged by needle and injected (with BMC or placebo). For all patients, at 6 months, left ventricular ejection fraction (LVEF) improved, and after covariate adjustment this improvement was best predicted by injection-site voltage. For every 2-mV increase in baseline voltage, we detected a 1.3 increase in absolute LVEF units for all patients (P=0.038). Multiple linear regression analyses confirmed that voltage and the CD34+ count present in bone marrow (but not treatment assignment) were associated with improved LVEF (P=0.03 and P=0.014, respectively). In an exploratory analysis, higher endocardial voltage and bone marrow CD34+ levels were associated with improved left ventricular function among ischemic cardiomyopathy patients. Intramyocardial needle injections, possibly through stimulation of angiogenesis, might serve as a future therapy in patients with reduced left ventricular function and warrants investigation. PMID:27547135

  13. Association between High Endocardial Unipolar Voltage and Improved Left Ventricular Function in Patients with Ischemic Cardiomyopathy.

    PubMed

    Park, Ki; Lai, Dejian; Handberg, Eileen M; Moyé, Lem; Perin, Emerson C; Pepine, Carl J; Anderson, R David

    2016-08-01

    We know that endocardial mapping reports left ventricular electrical activity (voltage) and that these data can predict outcomes in patients undergoing traditional revascularization. Because the mapping data from experimental models have also been linked with myocardial viability, we hypothesized an association between increased unipolar voltage in patients undergoing intramyocardial injections and their subsequent improvement in left ventricular performance. For this exploratory analysis, we evaluated 86 patients with left ventricular dysfunction, heart-failure symptoms, possible angina, and no revascularization options, who were undergoing endocardial mapping. Fifty-seven patients received bone marrow mononuclear cell (BMC) injections and 29 patients received cell-free injections of a placebo. The average mapping site voltage was 9.7 ± 2 mV, and sites with voltage of ≥6.9 mV were engaged by needle and injected (with BMC or placebo). For all patients, at 6 months, left ventricular ejection fraction (LVEF) improved, and after covariate adjustment this improvement was best predicted by injection-site voltage. For every 2-mV increase in baseline voltage, we detected a 1.3 increase in absolute LVEF units for all patients (P=0.038). Multiple linear regression analyses confirmed that voltage and the CD34(+) count present in bone marrow (but not treatment assignment) were associated with improved LVEF (P=0.03 and P=0.014, respectively). In an exploratory analysis, higher endocardial voltage and bone marrow CD34(+) levels were associated with improved left ventricular function among ischemic cardiomyopathy patients. Intramyocardial needle injections, possibly through stimulation of angiogenesis, might serve as a future therapy in patients with reduced left ventricular function and warrants investigation. PMID:27547135

  14. Using the Vascular Quality Initiative to improve quality of care and patient outcomes for vascular surgery patients.

    PubMed

    Bensley, Rodney P; Beck, Adam W

    2015-06-01

    The Society for Vascular Surgery Vascular Quality Initiative (VQI) is a collaborative network of vascular specialists from various specialties that seeks to improve the quality and safety of vascular care by sharing data among physicians, medical centers, and regions. Working under a Patient Safety Organization designation by the Agency for Healthcare Research and Quality, the VQI provides a protected environment where data can be pooled and evaluated for trends that might provide opportunities to improve the care we provide our patients. Since its inception in 2011, this national organization has grown rapidly and now involves >300 medical centers that are separated into 18 active regional groups who meet twice yearly to discuss quality improvement. The structure of the VQI provides a powerful platform for data collection and analysis, and has allowed the development of a large body of literature that demonstrates the importance and benefits of participation. Here we provide a brief overview of the VQI to date.

  15. [Role of reporting and learning systems in the improvement of patient safety].

    PubMed

    Lám, Judit; Sümegi, Viktória; Surján, Cecília; Kullmann, Lajos; Belicza, Éva

    2016-06-26

    The principles and requirements of a patient safety related reporting and learning system were defined by the World Health Organization Draft Guidelines for Adverse Event Reporting and Learning Systems published in 2005. Since then more and more Hungarian health care organizations aim to improve their patient safety culture. In order to support this goal the NEVES reporting and learning system and the series of Patient Safety Forums for training and consultation were launched in 2006 and significantly renewed recently. Current operative modifications to the Health Law emphasize patient safety, making the introduction of these programs once again necessary. PMID:27319384

  16. Medical advice and diabetes self-management reported by Mexican-American, Black- and White-non-Hispanic adults across the United States

    PubMed Central

    2012-01-01

    Background Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 Mexican-Americans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with 'undiagnosed diabetes' [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants' diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results Although medical advice to the patient is considered a standard of care for diabetes, approximately one-third of the sample reported not receiving dietary, weight management, or physical activity self

  17. Four Moments for Patient Hand Hygiene: A Patient-Centered, Provider-Facilitated Model to Improve Patient Hand Hygiene.

    PubMed

    Sunkesula, Venkata C K; Knighton, Shanina; Zabarsky, Trina F; Kundrapu, Sirisha; Higgins, Patricia A; Donskey, Curtis J

    2015-08-01

    We found that a majority of hospitalized patients were aware of the importance of hand hygiene, but observations indicated that performance of hand hygiene was uncommon. An intervention in which healthcare personnel facilitated hand hygiene at specific moments significantly increased performance of hand hygiene by patients.

  18. Four Moments for Patient Hand Hygiene: A Patient-Centered, Provider-Facilitated Model to Improve Patient Hand Hygiene.

    PubMed

    Sunkesula, Venkata C K; Knighton, Shanina; Zabarsky, Trina F; Kundrapu, Sirisha; Higgins, Patricia A; Donskey, Curtis J

    2015-08-01

    We found that a majority of hospitalized patients were aware of the importance of hand hygiene, but observations indicated that performance of hand hygiene was uncommon. An intervention in which healthcare personnel facilitated hand hygiene at specific moments significantly increased performance of hand hygiene by patients. PMID:25857700

  19. Improving the communication between teams managing boarded patients on a surgical specialty ward.

    PubMed

    Puvaneswaralingam, Shobitha; Ross, Daniella

    2016-01-01

    Transferring patients from the ward of their specialty or consultant is described as boarding. 1 Boarding patients is becoming increasingly prevalent due to greater pressure on hospital capacity. This practice compromises patient safety through delayed investigations, prolonged hospital stays, and increased risk of hospital-acquired infections. 1 2 We evaluated how regularly boarded patients were reviewed, and how effectively information regarding their management was communicated from their primary specialty to ward staff. We aimed to improve the frequency of patient reviews by ensuring that each patient was reviewed every weekday and increase communication between primary specialty, and medical and nursing teams by 20% from baseline during the data collection period. The project was based in the Otolaryngology ward in Ninewells Hospital, Dundee, where there was a high prevalence of boarded patients. Baseline data showed a clear deficit in communication between the primary specialty and ward staff with only 31% of patient reviews being communicated to ward doctors. We designed and implemented a communication tool, in the form of a sticker, to be inserted into patients' medical notes for use by the primary specialty. Implementation of the sticker improved communication between teams as stickers were completed in 93% of instances. In 88% of patient reviews, the junior doctor was informed of the management plan, showing a large increase from baseline. Through PDSA cycles, we aimed to increase the sustainability and reliability of the sticker; however, we faced challenges with sustainability of sticker insertion. We aim to engage more stakeholders to raise awareness of the problem, brainstorm solutions together, and review the production and implementation of stickers with senior hospital management to discuss the potential use of this tool within practice. There is potentially a large scope for utilisation of this communication tool on a local level, which we hope

  20. Improving the communication between teams managing boarded patients on a surgical specialty ward

    PubMed Central

    Puvaneswaralingam, Shobitha; Ross, Daniella

    2016-01-01

    Transferring patients from the ward of their specialty or consultant is described as boarding. 1 Boarding patients is becoming increasingly prevalent due to greater pressure on hospital capacity. This practice compromises patient safety through delayed investigations, prolonged hospital stays, and increased risk of hospital-acquired infections. 1 2 We evaluated how regularly boarded patients were reviewed, and how effectively information regarding their management was communicated from their primary specialty to ward staff. We aimed to improve the frequency of patient reviews by ensuring that each patient was reviewed every weekday and increase communication between primary specialty, and medical and nursing teams by 20% from baseline during the data collection period. The project was based in the Otolaryngology ward in Ninewells Hospital, Dundee, where there was a high prevalence of boarded patients. Baseline data showed a clear deficit in communication between the primary specialty and ward staff with only 31% of patient reviews being communicated to ward doctors. We designed and implemented a communication tool, in the form of a sticker, to be inserted into patients' medical notes for use by the primary specialty. Implementation of the sticker improved communication between teams as stickers were completed in 93% of instances. In 88% of patient reviews, the junior doctor was informed of the management plan, showing a large increase from baseline. Through PDSA cycles, we aimed to increase the sustainability and reliability of the sticker; however, we faced challenges with sustainability of sticker insertion. We aim to engage more stakeholders to raise awareness of the problem, brainstorm solutions together, and review the production and implementation of stickers with senior hospital management to discuss the potential use of this tool within practice. There is potentially a large scope for utilisation of this communication tool on a local level, which we hope