Rethinking transitions of care: An interprofessional transfer triage protocol in post-acute care.

PubMed

Patel, Radha V; Wright, Lauri; Hay, Brittany

2017-09-01

Readmissions to hospitals from post-acute care (PAC) units within long-term care settings have been rapidly increasing over the past decade, and are drivers of increased healthcare costs. With an average of $11,000 per admission, there is a need for strategies to reduce 30-day preventable hospital readmission rates. In 2018, incentives and penalties will be instituted for long-term care facilities failing to meet all-cause, all-condition hospital readmission rate performance measures. An interprofessional team (IPT) developed and implemented a Transfer Triage Protocol used in conjunction with the INTERACT programme to enhance clinical decision-making and assess the potential to reduce the facility's 30-day preventable hospital readmission rates by 10% within 6 weeks of implementation. Results from quantitative analysis demonstrated an overall 35.2% reduction in the 30-day preventable hospital readmission rate. Qualitative analysis revealed the need for additional staff education, improved screening and communication upon admission and prior to hospital transfer, and the need for more IPT on-site availability. This pilot study demonstrates the benefits and implications for practice of an IPT to improve the quality of care within PAC and decrease 30-day preventable hospital readmissions.

Applying Adult Ventilator-associated Pneumonia Bundle Evidence to the Ventilated Neonate.

PubMed

Weber, Carla D

2016-06-01

Ventilator-associated pneumonia (VAP) in neonates can be reduced by implementing preventive care practices. Implementation of a group, or bundle, of evidence-based practices that improve processes of care has been shown to be cost-effective and to have better outcomes than implementation of individual single practices. The purpose of this article is to describe a safe, effective, and efficient neonatal VAP prevention protocol developed for caregivers in the neonatal intensive care unit (NICU). Improved understanding of VAP causes, effects of care practices, and rationale for interventions can help reduce VAP risk to neonatal patients. In order to improve care practices to affect VAP rates, initial and annual education occurred on improved protocol components after surveying staff practices and auditing documentation compliance. In 2009, a tertiary care level III NICU in the Midwestern United States had 14 VAP cases. Lacking evidence-based VAP prevention practices for neonates, effective adult strategies were modified to meet the complex needs of the ventilated neonate. A protocol was developed over time and resulted in an annual decrease in VAP until rates were zero for 20 consecutive months from October 2012 to May 2014. This article describes a VAP prevention protocol developed to address care practices surrounding hand hygiene, intubation, feeding, suctioning, positioning, oral care, and respiratory equipment in the NICU. Implementation of this VAP prevention protocol in other facilities with appropriate monitoring and tracking would provide broader support for standardization of care. Individual components of this VAP protocol could be studied to strengthen the inclusion of each; however, bundled interventions are often considered stronger when implemented as a whole.

A Unique Approach to Dissemination of Evidence-Based Protocols: A Successful CAUTI Reduction Pilot.

PubMed

Dols, Jean Dowling; White, Sondra K; Timmons, Amy L; Bush, Michelle; Tripp, Joanne; Childers, Amanda Kay; Mathers, Nicholas; Tobias, Maria M

2016-01-01

A unique approach to disseminate an evidence-based protocol for urinary catheter management was led by a staff-driven catheter-associated urinary tract infection (CAUTI) reduction team in one hospital. The nurseeducators, faculty from a local university, and the facility's clinical nurse leader mentored the team. As an approachto reduce CAUTIs in the transplant care and intensive care units, the team developed an interdisciplinary CAUTIEducation Fair, which provided a safe, nonthreateningenvironment to unlearn prior behaviors and showcompetency in new evidence-based ones.

How women are treated during facility-based childbirth: development and validation of measurement tools in four countries - phase 1 formative research study protocol.

PubMed

Vogel, Joshua P; Bohren, Meghan A; Tunçalp, Özge; Oladapo, Olufemi T; Adanu, Richard M; Baldé, Mamadou Diouldé; Maung, Thae Maung; Fawole, Bukola; Adu-Bonsaffoh, Kwame; Dako-Gyeke, Phyllis; Maya, Ernest Tei; Camara, Mohamed Campell; Diallo, Alfa Boubacar; Diallo, Safiatou; Wai, Khin Thet; Myint, Theingi; Olutayo, Lanre; Titiloye, Musibau; Alu, Frank; Idris, Hadiza; Gülmezoglu, Metin A

2015-07-22

Every woman has the right to dignified, respectful care during childbirth. Recent evidence has demonstrated that globally many women experience mistreatment during labour and childbirth in health facilities, which can pose a significant barrier to women attending facilities for delivery and can contribute to poor birth experiences and adverse outcomes for women and newborns. However there is no clear consensus on how mistreatment of women during childbirth in facilities is defined and measured. We propose using a two-phased, mixed-methods study design in four countries to address these research gaps. This protocol describes the Phase 1 qualitative research activities. We will employ qualitative research methodologies among women, healthcare providers and administrators in the facility catchment areas of two health facilities in each country: Ghana, Guinea, Myanmar and Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) will be conducted among women of reproductive age (15-49 years) to explore their perceptions and experiences of facility-based childbirth care, focused on how they were treated by healthcare workers and perceived factors affecting how they were treated. IDIs will also be conducted with healthcare providers of different cadres (e.g.: nurses, midwives, medical officers, specialist obstetricians) and facility administrators working in the selected facilities to explore healthcare providers' perceptions and experiences of facility-based childbirth care and how staff are treated, colleagues and supervisors. Audio recordings will be transcribed and translated to English. Textual data will be analysed using a thematic framework approach and will consist of two levels of analysis: (1) conduct of local analysis workshops with the research assistants in each country; and (2) line-by-line coding to develop a thematic framework and coding scheme. This study serves several roles. It will provide an in-depth understanding of how women are treated during childbirth in four countries and perceived factors associated with this mistreatment. It will also provide data on where and how an intervention could be developed to reduce mistreatment and promote respectful care. The findings from this study will contribute to the development of tools to measure the prevalence of mistreatment of women during facility-based childbirth.

An evaluation of two large scale demand side financing programs for maternal health in India: the MATIND study protocol.

PubMed

Sidney, Kristi; de Costa, Ayesha; Diwan, Vishal; Mavalankar, Dileep V; Smith, Helen

2012-08-27

High maternal mortality in India is a serious public health challenge. Demand side financing interventions have emerged as a strategy to promote access to emergency obstetric care. Two such state run programs, Janani Suraksha Yojana (JSY)and Chiranjeevi Yojana (CY), were designed and implemented to reduce financial access barriers that preclude women from obtaining emergency obstetric care. JSY, a conditional cash transfer, awards money directly to a woman who delivers in a public health facility. This will be studied in Madhya Pradesh province. CY, a voucher based program, empanels private obstetricians in Gujarat province, who are reimbursed by the government to perform deliveries of socioeconomically disadvantaged women. The programs have been in operation for the last seven years. The study outlined in this protocol will assess and compare the influence of the two programs on various aspects of maternal health care including trends in program uptake, institutional delivery rates, maternal and neonatal outcomes, quality of care, experiences of service providers and users, and cost effectiveness. The study will collect primary data using a combination of qualitative and quantitative methods, including facility level questionnaires, observations, a population based survey, in-depth interviews, and focus group discussions. Primary data will be collected in three districts of each province. The research will take place at three levels: the state health departments, obstetric facilities in the districts and among recently delivered mothers in the community. The protocol is a comprehensive assessment of the performance and impact of the programs and an economic analysis. It will fill existing evidence gaps in the scientific literature including access and quality to services, utilization, coverage and impact. The implementation of the protocol will also generate evidence to facilitate decision making among policy makers and program managers who currently work with or are planning similar programs in different contexts.

Emergency Care Capabilities in North East Haiti: A Cross-sectional Observational Study.

PubMed

De Wulf, Annelies; Aluisio, Adam R; Muhlfelder, Dana; Bloem, Christina

2015-12-01

The North East Department is a resource-limited region of Haiti. Health care is provided by hospitals and community clinics, with no formal Emergency Medical System and undefined emergency services. As a paucity of information exists on available emergency services in the North East Department of Haiti, the objective of this study was to assess systematically the existing emergency care resources in the region. This cross-sectional observational study was carried out at all Ministry of Public Health and Population (MSPP)-affiliated hospitals in the North East Department and all clinics within the Fort Liberté district. A modified version of the World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care and Generic Essential Emergency Equipment Lists were completed for each facility. Three MSPP hospitals and five clinics were assessed. Among hospitals, all had a designated emergency ward with 24 hour staffing by a medical doctor. All hospitals had electricity with backup generators and access to running water; however, none had potable water. All hospitals had x-ray and ultrasound capabilities. No computed tomography scanners existed in the region. Invasive airway equipment and associated medications were not present consistently in the hospitals' emergency care areas, but they were available in the operating rooms. Pulse oximetry was unavailable uniformly. One hospital had intermittently functioning defibrillation equipment, and two hospitals had epinephrine. Basic supplies for managing obstetrical and traumatic emergencies were available at all hospitals. Surgical services were accessible at two hospitals. No critical care services were available in the region. Clinics varied widely in terms of equipment availability. They uniformly had limited emergency medical equipment. The clinics also had inconsistent access to basic assessment tools (sphygmomanometers 20% and stethoscopes 60%). A protocol for transferring patients requiring a higher level of care was present in most (80%) clinics and one of the hospitals. However, no facility had a written protocol for transferring patients to other facilities. One hospital reported intermittent access to an ambulance for transfers. Deficits in the supply of emergency equipment and limited protocols for inter-facility transfers exist in North East Department of Haiti. These essential areas represent appropriate targets for interventions aimed at improving access to emergency care within the North East region of Haiti.

Inspection of care: Findings from an innovative demonstration

PubMed Central

Morris, John N.; Sherwood, Clarence C.; Dreyer, Paul

1989-01-01

In this article, information is presented concerning the efficacy of a sample-based approach to completing inspection of care reviews of Medicaid-supported nursing home residents. Massachusetts nursing homes were randomly assigned to full (the control group) or sample (the experimental group) review conditions. The primary research focus was to determine whether the proportion of facilities found to be deficient (based on quality of care and level of care criteria) in the experimental sample was comparable to the proportion in the control sample. The findings supported such a hypothesis: Deficient facilities appear to be equally identifiable using the random or full-sampling protocols, and the process can be completed with a considerable savings of surveyor time. PMID:10313458

Early Appropriate Care: A Protocol to Standardize Resuscitation Assessment and to Expedite Fracture Care Reduces Hospital Stay and Enhances Revenue.

PubMed

Vallier, Heather A; Dolenc, Andrea J; Moore, Timothy A

2016-06-01

We hypothesized that a standardized protocol for fracture care would enhance revenue by reducing complications and length of stay. Prospective consecutive series. Level 1 trauma center. Two hundread and fifty-three adult patients with a mean age of 40.7 years and mean Injury Severity Score of 26.0. Femur, pelvis, or spine fractures treated surgically. Hospital and professional charges and collections were analyzed. Fixation was defined as early (<36 hours) or delayed. Complications and hospital stay were recorded. Mean charges were US $180,145 with a mean of US $66,871 collected (37%). The revenue multiplier was US $59,882/$6989 (8.57), indicating hospital collection of US $8.57 for every professional dollar, less than half of which went to orthopaedic surgeons. Delayed fracture care was associated with more intensive care unit (4.5 vs. 9.4) and total hospital days (9.4 vs. 15.3), with mean loss of actual revenue US $6380/patient delayed (n = 47), because of the costs of longer length of stay. Complications were associated with the highest expenses: mean of US $291,846 charges and US $101,005 collections, with facility collections decreased by 5.1%. An uncomplicated course of care was associated with the most favorable total collections: (US $60,017/$158,454 = 38%) and the shortest mean stay (8.7 days). Facility collections were nearly 9 times more than professional collections. Delayed fixation was associated with more complications, and facility collections decreased 5% with a complication. Furthermore, delayed fixation was associated with longer hospital stay, accounting for US $300K more in actual costs during the study. A standardized protocol to expedite definitive fixation enhances the profitability of the trauma service line. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana.

PubMed

Amoakoh-Coleman, Mary; Agyepong, Irene Akua; Kayode, Gbenga A; Grobbee, Diederick E; Klipstein-Grobusch, Kerstin; Ansah, Evelyn K

2016-09-21

Lack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines. A cross-sectional analysis of the baseline data of a prospective cohort study on adherence to first antenatal care visit guidelines was carried out in 11 facilities in the Greater Accra Region of Ghana. Provider adherence was studied in relation to health facility resource availability such as antenatal workload for clinical staffs, routine antenatal drugs, laboratory testing, protocols, ambulance and equipment. Eleven facilities comprising 6 hospitals (54.5 %), 4 polyclinics (36.4 %) and 1 health center were randomly sampled. Complete provider adherence to first antenatal guidelines for all the 946 participants was 48.1 % (95 % CI: 41.8-54.2 %), varying significantly amongst the types of facilities, with highest rate in the polyclinics. Average antenatal workload per month per clinical staff member was higher in polyclinics compared to the hospitals. All facility laboratories were able to conduct routine antenatal tests. Most routine antenatal drugs were available in all facilities except magnesium sulphate and sulphadoxine-pyrimethamine which were lacking in some. Antenatal service protocols and equipment were also available in all facilities. Although antenatal workload varies across different facility types in the Greater Accra region, other health facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities. These factors therefore do not adequately account for the low and varying proportions of complete adherence to guidelines across facility types. Providers should be continually engaged for a better understanding of the barriers to their adherence to these guidelines.

Strategies for Optimal Implementation of Simulated Clients for Measuring Quality of Care in Low- and Middle-Income Countries.

PubMed

Fitzpatrick, Anne; Tumlinson, Katherine

2017-03-24

The use of simulated clients or "mystery clients" is a data collection approach in which a study team member presents at a health care facility or outlet pretending to be a real customer, patient, or client. Following the visit, the shopper records her observations. The use of mystery clients can overcome challenges of obtaining accurate measures of health care quality and improve the validity of quality assessments, particularly in low- and middle-income countries. However, mystery client studies should be carefully designed and monitored to avoid problems inherent to this data collection approach. In this article, we discuss our experiences with the mystery client methodology in studies conducted in public- and private-sector health facilities in Kenya and in private-sector facilities in Uganda. We identify both the benefits and the challenges in using this methodology to guide other researchers interested in using this technique. Recruitment of appropriate mystery clients who accurately represent the facility's clientele, have strong recall of recent events, and are comfortable in their role as undercover data collectors are key to successful implementation of this methodology. Additionally, developing detailed training protocols can help ensure mystery clients behave identically and mimic real patrons accurately while short checklists can help ensure mystery client responses are standardized. Strict confidentiality and protocols to avoid unnecessary exams or procedures should also be stressed during training and monitored carefully throughout the study. Despite these challenges, researchers should consider mystery client designs to measure actual provider behavior and to supplement self-reported provider behavior. Data from mystery client studies can provide critical insight into the quality of service provision unavailable from other data collection methods. The unique information available from the mystery client approach far outweighs the cost. © Fitzpatrick and Tumlinson.

Strategies for Optimal Implementation of Simulated Clients for Measuring Quality of Care in Low- and Middle-Income Countries

PubMed Central

Fitzpatrick, Anne; Tumlinson, Katherine

2017-01-01

ABSTRACT The use of simulated clients or “mystery clients” is a data collection approach in which a study team member presents at a health care facility or outlet pretending to be a real customer, patient, or client. Following the visit, the shopper records her observations. The use of mystery clients can overcome challenges of obtaining accurate measures of health care quality and improve the validity of quality assessments, particularly in low- and middle-income countries. However, mystery client studies should be carefully designed and monitored to avoid problems inherent to this data collection approach. In this article, we discuss our experiences with the mystery client methodology in studies conducted in public- and private-sector health facilities in Kenya and in private-sector facilities in Uganda. We identify both the benefits and the challenges in using this methodology to guide other researchers interested in using this technique. Recruitment of appropriate mystery clients who accurately represent the facility's clientele, have strong recall of recent events, and are comfortable in their role as undercover data collectors are key to successful implementation of this methodology. Additionally, developing detailed training protocols can help ensure mystery clients behave identically and mimic real patrons accurately while short checklists can help ensure mystery client responses are standardized. Strict confidentiality and protocols to avoid unnecessary exams or procedures should also be stressed during training and monitored carefully throughout the study. Despite these challenges, researchers should consider mystery client designs to measure actual provider behavior and to supplement self-reported provider behavior. Data from mystery client studies can provide critical insight into the quality of service provision unavailable from other data collection methods. The unique information available from the mystery client approach far outweighs the cost. PMID:28126970

Data for improvement and clinical excellence: protocol for an audit with feedback intervention in long-term care.

PubMed

Sales, Anne E; Schalm, Corinne

2010-10-13

There is considerable evidence about the effectiveness of audit coupled with feedback, although few audit with feedback interventions have been conducted in long-term care (LTC) settings to date. In general, the effects have been found to be modest at best, although in settings where there has been little history of audit and feedback, the effects may be greater, at least initially. The primary purpose of the Data for Improvement and Clinical Excellence (DICE) Long-Term Care project is to assess the effects of an audit with feedback intervention delivered monthly over 13 months in four LTC facilities. The research questions we addressed are:1. What effects do feedback reports have on processes and outcomes over time?2. How do different provider groups in LTC and home care respond to feedback reports based on data targeted at improving quality of care? The research team conducting this study comprises researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of monthly feedback reports in nine LTC units in four facilities in Edmonton, Alberta. Data for the feedback reports comes from the Resident Assessment Instrument Minimum Data Set (RAI) version 2.0, a standardized instrument mandated for use in LTC facilities throughout Alberta. Feedback reports consist of one page, front and back, presenting both graphic and textual information. Reports are delivered to all staff working in the four LTC facilities. The primary evaluation uses a controlled interrupted time series design both adjusted and unadjusted for covariates. The concurrent process evaluation uses observation and self-report to assess uptake of the feedback reports. Following the project phase described in this protocol, a similar intervention will be conducted in home care settings in Alberta. Depending on project findings, if they are judged useful by decision makers participating in this research team, we plan dissemination and spread of the feedback report approach throughout Alberta.

Leaving machismo behind.

PubMed

Eschen, A; Castano, F

1999-01-01

A study, which was conducted in Colombia's five largest cities, determined men's, women's, and health care provider's knowledge, attitudes, and needs regarding sexual and reproductive health services for men. Data were collected through 60 focus groups, 720 surveys of service users and nonusers, 45 interviews with health care staff, and 5 couple's life histories. The study found that, due to the inadequate service facilities offered to men, it was difficult for men to achieve the goal of being responsible about their own and their partner's sexual and reproductive health. Only 9 of the 14 health care facilities surveyed rendered services such as vasectomy, health care promotion or prevention, and educational programs aimed at men. According to providers, one reason for lack of services is the low utilization rate even if such services are available. In addition, existing services focus on disease management rather than preventive protocols. The AVSC will work with health care facilities, the Ministry of Health, and health insurance companies in establishing sexual and reproductive health services for men in Bogota, Cali, and Medellin.

Audit of HIV counselling and testing services among primary healthcare facilities in Cameroon: a protocol for a multicentre national cross-sectional study.

PubMed

Tianyi, Frank-Leonel; Tochie, Joel Noutakdie; Agbor, Valirie Ndip; Kadia, Benjamin Momo

2018-03-01

HIV testing is an invaluable entry point to prevention, care and treatment services for people living with HIV and AIDS. Poor adherence to recommended protocols and guidelines reduces the performance of rapid diagnostic tests, leading to misdiagnosis and poor estimation of HIV seroprevalence. This study seeks to evaluate the adherence of primary healthcare facilities in Cameroon to recommended HIV counselling and testing (HCT) procedures and the impact this may have on the reliability of HIV test results. This will be an analytical cross-sectional study involving primary healthcare facilities from all the 10 regions of Cameroon, selected by a multistaged random sampling of primary care facilities in each region. The study will last for 9 months. A structured questionnaire will be used to collect general information concerning the health facility, laboratory and other departments involved in the HCT process. The investigators will directly observe at least 10 HIV testing processes in each facility and fill out the checklist accordingly. Clearance has been obtained from the National Ethical Committee to carry out the study. Informed consent will be sought from the patients to observe the HIV testing process. The final study will be published in a peer-reviewed journal and the findings presented to health policy-makers and the general public. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

An investigation of networking techniques for the ASRM facility

NASA Technical Reports Server (NTRS)

Moorhead, Robert J., II; Smith, Wayne D.; Thompson, Dale R.

1992-01-01

This report is based on the early design concepts for a communications network for the Advanced Solid Rocket Motor (ASRM) facility being built at Yellow Creek near Iuka, MS. The investigators have participated in the early design concepts and in the evaluation of the initial concepts. The continuing system design effort and any modification of the plan will require a careful evaluation of the required bandwidth of the network, the capabilities of the protocol, and the requirements of the controllers and computers on the network. The overall network, which is heterogeneous in protocol and bandwidth, is being modeled, analyzed, simulated, and tested to obtain some degree of confidence in its performance capabilities and in its performance under nominal and heavy loads. The results of the proposed work should have an impact on the design and operation of the ASRM facility.

Deprescribing psychotropic medications in aged care facilities: the potential role of family members.

PubMed

Plakiotis, Christos; Bell, J Simon; Jeon, Yun-Hee; Pond, Dimity; O'Connor, Daniel W

2015-01-01

There is widespread concern in Australia and internationally at the high prevalence of psychotropic medication use in residential aged care facilities. It is difficult for nurses and general practitioners in aged care facilities to cease new residents' psychotropic medications when they often have no information about why residents were started on the treatment, when and by whom and with what result. Most existing interventions have had a limited and temporary effect and there is a need to test different strategies to overcome the structural and practical barriers to psychotropic medication cessation or deprescribing. In this chapter, we review the literature regarding psychotropic medication deprescribing in aged care facilities and present the protocol of a novel study that will examine the potential role of family members in facilitating deprescribing. This project will help determine if family members can contribute information that will prove useful to clinicians and thereby overcome one of the barriers to deprescribing medications whose harmful effects often outweigh their benefits. We wish to understand the knowledge and attitudes of family members regarding the prescribing and deprescribing of psychotropic medications to newly admitted residents of aged care facilities with a view to developing and testing a range of clinical interventions that will result in better, safer prescribing practices.

Modelling optimal location for pre-hospital helicopter emergency medical services.

PubMed

Schuurman, Nadine; Bell, Nathaniel J; L'Heureux, Randy; Hameed, Syed M

2009-05-09

Increasing the range and scope of early activation/auto launch helicopter emergency medical services (HEMS) may alleviate unnecessary injury mortality that disproportionately affects rural populations. To date, attempts to develop a quantitative framework for the optimal location of HEMS facilities have been absent. Our analysis used five years of critical care data from tertiary health care facilities, spatial data on origin of transport and accurate road travel time catchments for tertiary centres. A location optimization model was developed to identify where the expansion of HEMS would cover the greatest population among those currently underserved. The protocol was developed using geographic information systems (GIS) to measure populations, distances and accessibility to services. Our model determined Royal Inland Hospital (RIH) was the optimal site for an expanded HEMS - based on denominator population, distance to services and historical usage patterns. GIS based protocols for location of emergency medical resources can provide supportive evidence for allocation decisions - especially when resources are limited. In this study, we were able to demonstrate conclusively that a logical choice exists for location of additional HEMS. This protocol could be extended to location analysis for other emergency and health services.

Recreational music-making: a cost-effective group interdisciplinary strategy for reducing burnout and improving mood states in long-term care workers.

PubMed

Bittman, Barry; Bruhn, Karl T; Stevens, Christine; Westengard, James; Umbach, Paul O

2003-01-01

This controlled, prospective, randomized study examined the clinical and potential economic impact of a 6-session Recreational Music-making (RMM) protocol on burnout and mood dimensions, as well as on Total Mood Disturbance (TMD) in an interdisciplinary group of long-term care workers. A total of 112 employees participated in a 6-session RMM protocol focusing on building support, communication, and interdisciplinary respect utilizing group drumming and keyboard accompaniment. Changes in burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively. Cost savings were projected by an independent consulting firm, which developed an economic impact model. Statistically-significant reductions of multiple burnout and mood dimensions, as well as TMD scores, were noted. Economic-impact analysis projected cost savings of $89,100 for a single typical 100-bed facility, with total annual potential savings to the long-term care industry of $1.46 billion. A cost-effective, 6-session RMM protocol reduces burnout and mood dimensions, as well as TMD, in long-term care workers.

Effectiveness and safety of a high-dose weekly vitamin D (20,000 IU) protocol in older adults living in residential care.

PubMed

Feldman, Fabio; Moore, Crystal; da Silva, Liz; Gaspard, Gina; Gustafson, Larry; Singh, Sonia; Barr, Susan I; Kitts, David D; Li, Wangyang; Weiler, Hope A; Green, Timothy J

2014-08-01

To report 25 hydroxyvitamin D (25OHD) concentrations, an indicator of vitamin D status, in older adults living in residential care 1 year after a protocol of weekly 20,000 IU of vitamin D was started. Cross-sectional. Five residential care facilities in British Columbia, Canada. Residents aged 65 and older from five facilities (N=236). Participants provided a blood sample. Demographic and health information was obtained from the medical record. Mean 25OHD was 102 nmol/L (95% confidence interval (CI)=98-106 nmol/L). Three percent of residents had a 25OHD concentration of less than 40 nmol/L, 6% <50 nmol/L, and 19% <75 nmol/L. In those who received 20,000 IU/wk or more for 6 months or longer (n=147), mean 25OHD was 112 nmol/L (95% CI=108-117 nmol/L), and none had a 25OHD level of less than 50 nmol/L. Hypercalcemia (>2.6 mmol/L), a potential consequence of too much vitamin D, was present in 14%, although 25OHD levels did not differ in those with and without hypercalcemia (108 vs 101 nmol/L; P=.17). Twelve months after implementation of a 20,000-IU/wk vitamin D protocol for older adults in residential care, mean 25OHD concentrations were high, and there was no evidence of poor vitamin D status. Given the absence of demonstrated benefit of high 25OHD concentrations to the residential care population, dosages less than 20,000 IU/wk of vitamin D are recommended. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program.

PubMed

Hewitt, Jennifer; Refshauge, Kathryn M; Goodall, Stephen; Henwood, Timothy; Clemson, Lindy

2014-01-01

Falls are common among older adults. It is reported that approximately 60% of residents of aged care facilities fall each year. This is a major cause of morbidity and mortality, and a significant burden for health care providers and the health system. Among community dwelling older adults, exercise appears to be an effective countermeasure, but data are limited and inconsistent among studies in residents of aged care communities. This trial has been designed to evaluate whether the SUNBEAM program (Strength and Balance Exercise in Aged Care) reduces falls in residents of aged care facilities. Is the program more effective and cost-effective than usual care for the prevention of falls? Single-blinded, two group, cluster randomized trial. 300 residents, living in 20 aged care facilities. Progressive resistance and balance training under the guidance of a physiotherapist for 6 months, then facility-guided maintenance training for 6 months. Usual care. Number of falls, number of fallers, quality of life, mobility, balance, fear of falling, cognitive well-being, resource use, and cost-effectiveness. Measurements will be taken at baseline, 6 months, and 12 months. The number of falls will be analyzed using a Poisson mixed model. A logistic mixed model will be used to analyze the number of residents who fall during the study period. Intention-to-treat analysis will be used. This study addresses a significant shortcoming in aged care research, and has potential to impact upon a substantial health care problem. Outcomes will be used to inform care providers, and guide health care policies.

Delivering quality care: what can emergency gynaecology learn from acute obstetrics?

PubMed

Bika, O H; Edozien, L C

2014-08-01

Emergency obstetric care in the UK has been systematically developed over the years to high quality standards. More recently, advances have been made in the organisation and delivery of care for women presenting with acute gynaecological problems, but a lot remains to be done, and emergency gynaecology has a lot to learn from the evolution of its sister special interest area: acute obstetric care. This paper highlights areas such as consultant presence, risk management, patient flow pathways, out-of-hours care, clinical guidelines and protocols, education and training and facilities, where lessons from obstetrics are transferrable to emergency gynaecology.

Formative research and development of innovative tools for "Better Outcomes in Labour Difficulty" (BOLD): study protocol.

PubMed

Bohren, Meghan A; Oladapo, Olufemi T; Tunçalp, Özge; Wendland, Melanie; Vogel, Joshua P; Tikkanen, Mari; Fawole, Bukola; Mugerwa, Kidza; Souza, João Paulo; Bahl, Rajiv; Gülmezoglu, A Metin

2015-05-26

Most complications during labour and childbirth could be averted with timely interventions by skilled healthcare providers. Yet, the quality and outcomes of childbirth care remains suboptimal in many health facilities in low-resource settings. To accelerate the reduction of childbirth-related maternal, fetal and newborn mortality and morbidity, the World Health Organization has initiated the "Better Outcomes in Labour Difficulty" (BOLD) project to address weaknesses in labour care processes and better connect health systems and communities. The project seeks to develop a "Simplified, Effective, Labour Monitoring-to-Action" tool (SELMA) to assist healthcare providers to monitor labour and take decisive actions more efficiently; and by developing an innovative set of service prototypes and/or tools termed "Passport to Safer Birth", designed with communities and healthcare providers, to promote access to quality care for women during childbirth. This protocol describes the formative research activities to support the development of these tools. We will employ qualitative research and service design methodologies in eight health facilities and their catchment communities in Nigeria and Uganda. In the health facilities, focus group discussions (FGD) and in-depth interviews (IDI) will be conducted among different cadres of healthcare providers and facility administrators. In the communities, FGDs and IDIs will be conducted among women who have delivered in a health facility. We will use service design methods to explore women's journey to access and receive childbirth care in order to innovate and design services around the needs and expectations of women, within the context of the health system. This formative research will serve several roles. First, it will provide an in-depth understanding of healthcare providers and health system issues to be accounted for in the final design and implementation of SELMA. Second, it will help to identify key moments ("touch points") where women's experiences of childbirth care are shaped, and where the overall experience of quality care could be improved. The synthesis of findings from the qualitative and service design activities will help identify potential areas for behaviour change related to the provision and experience of childbirth care, and serve as the basis for the development of Passport to Safer Birth. Please see related articles 'http://dx.doi.org/ 10.1186/s12978-015-0027-6 ' and 'http://dx.doi.org/ 10.1186/s12978-015-0029-4 '.

A randomized trial of heart failure disease management in skilled nursing facilities (SNF Connect): Lessons learned.

PubMed

Daddato, Andrea; Wald, Heidi L; Horney, Carolyn; Fairclough, Diane L; Leister, Erin C; Coors, Marilyn; Capell, Warren H; Boxer, Rebecca S

2017-06-01

Conducting clinical trials in skilled nursing facilities is particularly challenging. This manuscript describes facility and patient recruitment challenges and solutions for clinical research in skilled nursing facilities. Lessons learned from the SNF Connect Trial, a randomized trial of a heart failure disease management versus usual care for patients with heart failure receiving post-acute care in skilled nursing facilities, are discussed. Description of the trial design and barriers to facility and patient recruitment along with regulatory issues are presented. The recruitment of Denver-metro skilled nursing facilities was facilitated by key stakeholders of the skilled nursing facilities community. However, there were still a number of barriers to facility recruitment including leadership turnover, varying policies regarding research, fear of litigation and of an increased workload. Engagement of facilities was facilitated by their strong interest in reducing hospital readmissions, marketing potential to hospitals, and heart failure management education for their staff. Recruitment of patients proved difficult and there were few facilitators. Identified patient recruitment challenges included patients being unaware of their heart failure diagnosis, patients overwhelmed with their illness and care, and frequently there was no available proxy for cognitively impaired patients. Flexibility in changing the recruitment approach and targeting skilled nursing facilities with higher rates of admissions helped to overcome some barriers. Recruitment of skilled nursing facilities and patients in skilled nursing facilities for clinical trials is challenging. Strategies to attract both facilities and patients are warranted. These include aligning study goals with facility incentives and flexible recruitment protocols to work with patients in "transition crisis."

Oral health care in private and small long-term care facilities: a qualitative study.

PubMed

de Mello, Ana Lúcia Schaefer Ferreira; Padilha, Dalva Maria Pereira

2009-03-01

Elderly people who are institutionalised receive qualified care. Among the services supplied, oral health care has not always been a priority. The aim of this study was to identify the characteristics of oral health care provided to the elderly residents in long-term care facilities (LTC) in Porto Alegre/RS city. Twelve private and small-size LTCs (less than 20 residents) participated in this study. All supervisors and 36 carers were interviewed. The data obtained were organised according to the offer of oral health under the following categories: responsibility for oral care, oral care routines, difficulties carrying out oral care routines. The procedures used most often in order of frequency were tooth brushing, prostheses cleaning, use of mouthwashes, soaking of prostheses and cleaning of the tongue. Among the difficulties mentioned were the high cost of dental assistance, the lack of co-operation both by family members and by the elderly themselves, the oral and general health status of the elderly and the limited time available for carers to carry out the tasks. Oral care is conducted empirically, and the responsibility is left to the carers. Analysis of the statements given reveals that oral care does not follow any kind of protocol or standardisation. The persistence of this situation could lead to unsatisfactory oral health care in private and small LTC facilities.

Mindfulness as a complementary intervention in the treatment of overweight and obesity in primary health care: study protocol for a randomised controlled trial.

PubMed

Salvo, Vera; Kristeller, Jean; Marin, Jesus Montero; Sanudo, Adriana; Lourenço, Bárbara Hatzlhoffer; Schveitzer, Mariana Cabral; D'Almeida, Vania; Morillo, Héctor; Gimeno, Suely Godoy Agostinho; Garcia-Campayo, Javier; Demarzo, Marcelo

2018-05-11

Mindfulness has been applied in the United States and Europe to improve physical and psychological health; however, little is known about its feasibility and efficacy in a Brazilian population. Mindfulness may also be relevant in tackling obesity and eating disorders by decreasing binge eating episodes-partly responsible for weight regain for a large number of people-and increasing awareness of emotional and other triggers for overeating. The aim of the present study protocol is to evaluate and compare the feasibility and efficacy of two mindfulness-based interventions (MBIs) addressing overweight and obesity in primary care patients: a general programme called Mindfulness-Based Health Promotion and a targeted mindful eating protocol called Mindfulness-Based Eating Awareness Training. A randomised controlled trial will be conducted to compare treatment as usual separately in primary care with both programmes (health promotion and mindful eating) added to treatment as usual. Two hundred forty adult women with overweight and obesity will be enrolled. The primary outcome will be an assessment of improvement in eating behaviour. Secondary outcomes will be (1) biochemical control; (2) anthropometric parameters, body composition, dietary intake and basal metabolism; and (3) levels of mindfulness, stress, depression, self-compassion and anxiety. At the end of each intervention, a focus group will be held to assess the programme's impact on the participants' lives, diet and health. A feasibility study on access to benefits from and importance of MBIs at primary care facilities will be conducted among primary care health care professionals and participants. Monthly maintenance sessions lasting at least 1 hour will be offered, according to each protocol, during the 3-month follow-up periods. This clinical trial will result in more effective mindfulness-based interventions as a complementary treatment in primary care for people with overweight and obesity. If the findings of this study confirm the effectiveness of mindfulness programmes in this population, it will be possible to improve quality of life and health while optimising public resources and reaching a greater number of people. In addition, on the basis of the evaluation of the feasibility of implementing this intervention in primary care facilities, we expect to be able to suggest the intervention for incorporation into public policy. ClinicalTrials.gov, NCT02893150 . Registered retrospectively on 30 March 2017.

Mobility of Vulnerable Elders (MOVE): study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities.

PubMed

Slaughter, Susan E; Estabrooks, Carole A; Jones, C Allyson; Wagg, Adrian S

2011-12-16

Almost 90% of residents living in long-term care facilities have limited mobility which is associated with a loss of ability in activities of daily living, falls, increased risk of serious medical problems such as pressure ulcers, incontinence and a significant decline in health-related quality of life. For health workers caring for residents it may also increase the risk of injury. The effectiveness of rehabilitation to facilitate mobility has been studied with dedicated research assistants or extensively trained staff caregivers; however, few investigators have examined the effectiveness of techniques to encourage mobility by usual caregivers in long-term care facilities. This longitudinal, quasi-experimental study is designed to demonstrate the effect of the sit-to-stand activity carried out by residents in the context of daily care with health care aides. In three intervention facilities health care aides will prompt residents to repeat the sit-to-stand action on two separate occasions during each day and each evening shift as part of daily care routines. In three control facilities residents will receive usual care. Intervention and control facilities are matched on the ownership model (public, private for-profit, voluntary not-for-profit) and facility size. The dose of the mobility intervention is assessed through the use of daily documentation flowsheets in the health record. Resident outcome measures include: 1) the 30-second sit-to-stand test; 2) the Functional Independence Measure; 3) the Health Utilities Index Mark 2 and 3; and, 4) the Quality of Life - Alzheimer's Disease. There are several compelling reasons for this study: the widespread prevalence of limited mobility in this population; the rapid decline in mobility after admission to a long-term care facility; the importance of mobility to quality of life; the increased time (and therefore cost) required to care for residents with limited mobility; and, the increased risk of injury for health workers caring for residents who are unable to stand. The importance of these issues is magnified when considering the increasing number of people living in long-term care facilities and an aging population. This clinical trial is registered with ClinicalTrials.gov (trial registration number: NCT01474616).

40 CFR 160.43 - Test system care facilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... (1) In tests with plants or aquatic animals, proper separation of species can be accomplished within..., aquarium, or housing unit. (2) Aquatic toxicity tests for individual projects shall be isolated to the... protocol. (h) For plants, an adequate supply of soil of the appropriate composition, as specified in the...

Increasing the Frequency and Timeliness of Pain Assessment and Management in Long-Term Care: Knowledge Transfer and Sustained Implementation.

PubMed

Hadjistavropoulos, Thomas; Williams, Jaime; Kaasalainen, Sharon; Hunter, Paulette V; Savoie, Maryse L; Wickson-Griffiths, Abigail

2016-01-01

Background. Although feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis. Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.

VOIP for Telerehabilitation: A Risk Analysis for Privacy, Security, and HIPAA Compliance

PubMed Central

Watzlaf, Valerie J.M.; Moeini, Sohrab; Firouzan, Patti

2010-01-01

Voice over the Internet Protocol (VoIP) systems such as Adobe ConnectNow, Skype, ooVoo, etc. may include the use of software applications for telerehabilitation (TR) therapy that can provide voice and video teleconferencing between patients and therapists. Privacy and security applications as well as HIPAA compliance within these protocols have been questioned by information technologists, providers of care and other health care entities. This paper develops a privacy and security checklist that can be used within a VoIP system to determine if it meets privacy and security procedures and whether it is HIPAA compliant. Based on this analysis, specific HIPAA criteria that therapists and health care facilities should follow are outlined and discussed, and therapists must weigh the risks and benefits when deciding to use VoIP software for TR. PMID:25945172

VOIP for Telerehabilitation: A Risk Analysis for Privacy, Security, and HIPAA Compliance.

PubMed

Watzlaf, Valerie J M; Moeini, Sohrab; Firouzan, Patti

2010-01-01

Voice over the Internet Protocol (VoIP) systems such as Adobe ConnectNow, Skype, ooVoo, etc. may include the use of software applications for telerehabilitation (TR) therapy that can provide voice and video teleconferencing between patients and therapists. Privacy and security applications as well as HIPAA compliance within these protocols have been questioned by information technologists, providers of care and other health care entities. This paper develops a privacy and security checklist that can be used within a VoIP system to determine if it meets privacy and security procedures and whether it is HIPAA compliant. Based on this analysis, specific HIPAA criteria that therapists and health care facilities should follow are outlined and discussed, and therapists must weigh the risks and benefits when deciding to use VoIP software for TR.

The Effect of Dining Room Physical Environmental Renovations on Person-Centered Care Practice and Residents' Dining Experiences in Long-Term Care Facilities.

PubMed

Hung, Lillian; Chaudhury, Habib; Rust, Tiana

2016-12-01

This qualitative study evaluated the effect of dining room physical environmental changes on staff practices and residents' mealtime experiences in two units of a long-term care facility in Edmonton, Canada. Focus groups with staff (n = 12) and individual interviews with unit managers (n = 2) were conducted. We also developed and used the Dining Environment Assessment Protocol (DEAP) to conduct a systematic physical environmental evaluation of the dining rooms. Four themes emerged on the key influences of the renovations: (a) supporting independence and autonomy, (b) creating familiarity and enjoyment, (c) providing a place for social experience, and (d) challenges in supporting change. Feedback from the staff and managers provided evidence on the importance of physical environmental features, as well as the integral nature of the role of the physical environment and organizational support to provide person-centered care for residents. © The Author(s) 2015.

Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention

PubMed Central

Knight, Patrick H; Maheshwari, Neelabh; Hussain, Jafar; Scholl, Michael; Hughes, Michael; Papadimos, Thomas J; Guo, Weidun Alan; Cipolla, James; Stawicki, Stanislaw P; Latchana, Nicholas

2015-01-01

Intrahospital transportation of critically ill patients is associated with significant complications. In order to reduce overall risk to the patient, such transports should well organized, efficient, and accompanied by the proper monitoring, equipment, and personnel. Protocols and guidelines for patient transfers should be utilized universally across all healthcare facilities. Care delivered during transport and at the site of diagnostic testing or procedure should be equivalent to the level of care provided in the originating environment. Here we review the most common problems encountered during transport in the hospital setting, including various associated adverse outcomes. Our objective is to make medical practitioners, nurses, and ancillary health care personnel more aware of the potential for various complications that may occur during patient movement from the intensive care unit to other locations within a healthcare facility, focusing on risk reduction and preventive strategies. PMID:26807395

Legal considerations during pediatric emergency mass critical care events.

PubMed

Courtney, Brooke; Hodge, James G

2011-11-01

Recent public health emergencies, such as the 2009 Influenza A/H1N1 Pandemic and Hurricane Katrina, underscore the importance of developing healthcare response plans and protocols for disasters impacting large populations. Significant research and scholarship, including the 2009 Institute of Medicine report on crisis standards of care and the 2008 Task Force for Mass Critical Care recommendations, provide guidance for healthcare responses to catastrophic emergencies. Most of these efforts recognize but do not focus on the unique needs of pediatric populations. In 2008, the Centers for Disease Control and Prevention supported the formation of a task force to address pediatric emergency mass critical care response issues, including legal issues. Liability is a significant concern for healthcare practitioners and facilities during pediatric emergency mass critical care that necessitates a shift to crisis standards of care. This article describes the legal considerations inherent in planning for and responding to catastrophic health emergencies and makes recommendations for pediatric emergency mass critical care legal preparedness. The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010, to review the pediatric emergency mass critical care recommendations developed by a 17-member steering committee. During the meeting, experts determined that the recommendations would be strengthened by a manuscript addressing legal issues. Authors drafted the manuscript through consensus-based study of peer-reviewed research, literature reviews, and expert opinion. The manuscript was reviewed by Pediatric Emergency Mass Critical Care Steering Committee members and additional legal counsel and revised. While the legal issues associated with providing pediatric emergency mass critical care are not unique within the overall context of disaster healthcare, the scope of the parens patriae power of states, informed consent principles, and security should be considered in pediatric emergency mass critical care planning and response efforts because parents and legal guardians may be unavailable to participate in healthcare decision making during disasters. In addition, practitioners who follow properly vetted and accepted pediatric emergency mass critical care disaster protocols in good faith should be protected from civil liability, and healthcare facilities that provide pediatric care should incorporate informed consent and security protocols into their disaster plans.

Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program

PubMed Central

Hewitt, Jennifer; Refshauge, Kathryn M; Goodall, Stephen; Henwood, Timothy; Clemson, Lindy

2014-01-01

Introduction Falls are common among older adults. It is reported that approximately 60% of residents of aged care facilities fall each year. This is a major cause of morbidity and mortality, and a significant burden for health care providers and the health system. Among community dwelling older adults, exercise appears to be an effective countermeasure, but data are limited and inconsistent among studies in residents of aged care communities. This trial has been designed to evaluate whether the SUNBEAM program (Strength and Balance Exercise in Aged Care) reduces falls in residents of aged care facilities. Research question Is the program more effective and cost-effective than usual care for the prevention of falls? Design Single-blinded, two group, cluster randomized trial. Participants and setting 300 residents, living in 20 aged care facilities. Intervention Progressive resistance and balance training under the guidance of a physiotherapist for 6 months, then facility-guided maintenance training for 6 months. Control Usual care. Measurements Number of falls, number of fallers, quality of life, mobility, balance, fear of falling, cognitive well-being, resource use, and cost-effectiveness. Measurements will be taken at baseline, 6 months, and 12 months. Analysis The number of falls will be analyzed using a Poisson mixed model. A logistic mixed model will be used to analyze the number of residents who fall during the study period. Intention-to-treat analysis will be used. Discussion This study addresses a significant shortcoming in aged care research, and has potential to impact upon a substantial health care problem. Outcomes will be used to inform care providers, and guide health care policies. PMID:24591821

Mediating Systems of Care: Emergency Calls to Long-Term Care Facilities at Life's End.

PubMed

Waldrop, Deborah P; McGinley, Jacqueline M; Clemency, Brian

2018-04-09

Nursing home (NH) residents account for over 2.2 million emergency department visits yearly; the majority are cared for and transported by prehospital providers (emergency medical technicians and paramedics). The purpose of this study was to investigate prehospital providers' perceptions of emergency calls at life's end. This article focuses on perceptions of end-of-life calls in long-term care (LTC). This pilot study employed a descriptive cross-sectional design. Concepts from the symbolic interaction theory guided the exploration of perceptions and interpretations of emergency calls in LTC facilities. A purposeful sample of prehospital providers was developed from one agency in a small northeastern U.S. city. Semistructured interviews were conducted with 43 prehospital providers to explore their perceptions of factors that trigger emergency end-of-life calls in LTC facilities. Qualitative data analysis involved iterative coding in an inductive process that included open, systematic, focused, and axial coding. Interview themes illustrated the contributing factors as follows: care crises; dying-related turmoil; staffing ratios; and organizational protocols. Distress was crosscutting and present in all four themes. The findings illuminate how prehospital providers become mediators between NHs and emergency departments by managing tension, conflict, and challenges in patient care between these systems and suggest the importance of further exploration of interactions between LTC staff, prehospital providers, and emergency departments. Enhanced communication between LTC facilities and prehospital providers is important to address potentially inappropriate calls and transport requests and to identify means for collaboration in the care of sick frail residents.

An Examination of Care Practices of Pregnant Women Incarcerated in Jail Facilities in the United States.

PubMed

Kelsey, C M; Medel, Nickole; Mullins, Carson; Dallaire, Danielle; Forestell, Catherine

2017-06-01

The number of incarcerated women in the United States has been steadily increasing over the last 30 years. An estimated 6-10% of these women are pregnant at intake. Previous studies on the health needs and care of pregnant incarcerated women have focused mainly on prison settings. Therefore, we examined the pregnancy-related accommodations and health care provided for regional jail populations. The present study is a quantitative survey (administered through phone or email to employees of predominately jail medical facilities) of common practices and policies employed across 53 jail facilities in the United States as a function of geographic region (North vs. South; West vs. Central vs. East). We examined provision of pregnancy screening, special diets, and drug rehabilitation and prohibition of shackling. Strikingly, across all aspects of the care of pregnant incarcerated women there are areas to be improved upon. Notably, only 37.7% of facilities pregnancy test all women upon entry, 45.7% put opioid addicted women through withdrawal protocol, and 56.7% of facilities use restraints on women hours after having a baby. In this first study to examine practices in regional jails nationwide, we found evidence that standards of care guidelines to improve health and well-being of pregnant incarcerated women, set by agencies such as American College of Obstetricians and Gynecologists, are not being followed in many facilities. Because not following these guidelines could pose major health risks to the mother and developing fetus, better policies, better enforcement of policies, and better common practices are needed to improve the health and welfare of pregnant incarcerated women.

Changing Medicaid and Intermediate Care Facilities for the Mentally Retarded (ICF/MR): Evaluation of Alternatives.

ERIC Educational Resources Information Center

Fernald, Charles Denton

1986-01-01

Some alternatives for changing IFC are evaluated, and a model that can be used for considering other alternatives is presented. Proposals include a system of treatment protocols for diagnosis-related groups and a revision of S.873, The Community and Family Living Amendments of 1985. (Author/CL)

Planning crops and developing propagation protocols [Chapter 3

Treesearch

Douglass F. Jacobs; Kim M. Wilkinson

2009-01-01

Crop planning is an important but often neglected aspect of successful nursery management. Crop planning enables proper scheduling of the necessary time, materials, labor, and space to produce crops. Many painstaking details, such as the careful design of nursery facilities; working with clients; collecting and propagating seeds and cuttings; and making improvements in...

Nairobi Newborn Study: a protocol for an observational study to estimate the gaps in provision and quality of inpatient newborn care in Nairobi City County, Kenya

PubMed Central

Murphy, Georgina A V; Gathara, David; Aluvaala, Jalemba; Mwachiro, Jacintah; Abuya, Nancy; Ouma, Paul; Snow, Robert W; English, Mike

2016-01-01

Introduction Progress has been made in Kenya towards reducing child mortality as part of efforts aligned with the fourth Millennium Development Goal. However, little advancement has been made in reducing mortality among newborns, which now accounts for 45% of all child deaths. The frequently unanticipated nature of neonatal illness, its severity and the high dependency of sick newborns on skilled care make the provision of inpatient hospital services one key component of strategies to improve newborn survival. Methods and analyses This project aims to assess the availability and quality of inpatient newborn care in hospitals in Nairobi City County across the public, private and not-for-profit sectors and align this to the estimated need for such services, providing a description of the quantity and quality gaps between capacity and demand. The population level burden of disease will be estimated using morbidity incidence estimates from a literature review applied to subcounty estimates of population-adjusted births, providing a spatially disaggregated estimate of need within the county. This will be followed by a survey of neonatal services across all health facilities providing 24/7 inpatient newborn care in the county. The survey will include: a retrospective audit of admission registers to estimate the usage of facilities and case-mix of patients; a structural assessment of facilities to gain insight into capacity; a questionnaire to nursing staff focusing on the process of delivering key obstetric and neonatal interventions; and a retrospective case audit to assess adherence to guidelines by clinicians. Ethics and dissemination This study has been approved by the Kenya Medical Research Institute Scientific and Ethics Review Unit (SSC protocol No.2999). Results will be disseminated: to participating facilities through individualised reports and a joint workshop; to local and national stakeholders through meetings and a summary report; and to the international community through peer-review publication and international meetings. PMID:28003285

A nurse-led approach to preventing pressure ulcers.

PubMed

Yap, Tracey L; Kennerly, Susan M

2011-01-01

This article discusses a nurse-led multidisciplinary approach that care providers can use to reduce pressure ulcers (PUs) within their organizations. Given the current understanding of PU etiology and prevention, evidence-based prevention protocols and pressure-relief strategies serve as critical foundational principles that must be applied to significantly influence PU prevalence and incidence. Because nursing plays an important role in rehabilitation facility management, nurses' expertise, leadership, and knowledge make nursing the most appropriate discipline to design protocols, implement innovative solutions, and lead the charge for PU prevention.

Impact of organizational factors on adherence to laboratory testing protocols in adult HIV care in Lusaka, Zambia.

PubMed

Deo, Sarang; Topp, Stephanie M; Westfall, Andrew O; Chiko, Matimbo M; Wamulume, Chibesa S; Morris, Mary; Reid, Stewart

2012-05-02

Previous operational research studies have demonstrated the feasibility of large-scale public sector ART programs in resource-limited settings. However, organizational and structural determinants of quality of care have not been studied. We estimate multivariate regression models using data from 13 urban HIV treatment facilities in Zambia to assess the impact of structural determinants on health workers' adherence to national guidelines for conducting laboratory tests such as CD4, hemoglobin and liver function and WHO staging during initial and follow-up visits as part of Zambian HIV care and treatment program. CD4 tests were more routinely ordered during initial history and physical (IHP) than follow-up (FUP) visits (93.0 % vs. 85.5 %; p < 0.01). More physical space, higher staff turnover and greater facility experience with ART was associated with greater odds of conducting tests. Higher staff experience decreased the odds of conducting CD4 tests in FUP (OR 0.93; p < 0.05) and WHO staging in IHP visit (OR 0.90; p < 0.05) but increased the odds of conducting hemoglobin test in IHP visit (OR 1.05; p < 0.05). Higher staff burnout increased the odds of conducting CD4 test during FUP (OR 1.14; p < 0.05) but decreased the odds of conducting hemoglobin test in IHP visit (0.77; p < 0.05) and CD4 test in IHP visit (OR 0.78; p < 0.05). Physical space plays an important role in ensuring high quality care in resource-limited setting. In the context of protocolized care, new staff members are likely to be more diligent in following the protocol verbatim rather than relying on memory and experience thereby improving adherence. Future studies should use prospective data to confirm the findings reported here.

Availability of essential drugs for managing HIV-related pain and symptoms within 120 PEPFAR-funded health facilities in East Africa: a cross-sectional survey with onsite verification.

PubMed

Harding, Richard; Simms, Victoria; Penfold, Suzanne; Downing, Julia; Powell, Richard A; Mwangi-Powell, Faith; Namisango, Eve; Moreland, Scott; Gikaara, Nancy; Atieno, Mackuline; Kataike, Jennifer; Nsubuga, Clare; Munene, Grace; Banga, Geoffrey; Higginson, Irene J

2014-04-01

World Health Organization's essential drugs list can control the highly prevalent HIV-related pain and symptoms. Availability of essential medicines directly influences clinicians' ability to effectively manage distressing manifestations of HIV. To determine the availability of pain and symptom controlling drugs in East Africa within President's Emergency Plan for AIDS Relief-funded HIV health care facilities. Directly observed quantitative health facilities' pharmacy stock review. We measured availability, expiration and stock-outs of specified drugs required for routine HIV management, including the World Health Organization pain ladder. A stratified random sample in 120 President's Emergency Plan for AIDS Relief-funded HIV care facilities (referral and district hospitals, health posts/centres and home-based care providers) in Kenya and Uganda. Non-opioid analgesics (73%) and co-trimoxazole (64%) were the most commonly available drugs and morphine (7%) the least. Drug availability was higher in hospitals and lower in health centres, health posts and home-based care facilities. Facilities generally did not use minimum stock levels, and stock-outs were frequently reported. The most common drugs had each been out of stock in the past 6 months in 47% of facilities stocking them. When a minimum stock level was defined, probability of a stock-out in the previous 6 months was 32.6%, compared to 45.5% when there was no defined minimum stock level (χ (2) = 5.07, p = 0.024). The data demonstrate poor essential drug availability, particularly analgesia, limited by facility type. The lack of strong opioids, isoniazid and paediatric formulations is concerning. Inadequate drug availability prevents implementation of simple clinical pain and symptom control protocols, causing unnecessary distress. Research is needed to identify supply chain mechanisms that lead to these problems.

Post Rape Care Provision to Minors in Kenya: An Assessment of Health Providers' Knowledge, Attitudes, and Practices.

PubMed

Wangamati, Cynthia Khamala; Gele, Abdi Ali; Sundby, Johanne

2017-03-01

Child sexual abuse (CSA) is a major global health challenge. Extant literature in Kenya indicates an alarming rate of sexually abused minors presenting to poorly equipped health facilities with untrained health providers for post rape care. National guidelines on management of sexual violence have been in existence since 2004; however, little is known on the impact of these guidelines on post rape care provision to minors. Therefore, the study aims to assess the knowledge, attitudes, and practices of health providers with regard to post rape care provision in a Kenyan District health facility. The study used a triangulation of different qualitative methods: review of 42 health records of minors seeking post rape care, 15 in-depth interviews, and informal conversations with health providers. Findings indicate that the Kenyan national guidelines on management of sexual violence were nonexistent in the health facility. Consequently, health providers possessed limited knowledge on post rape care administration. The limited knowledge translated to poor collection and preservation of evidence, inadequate psychosocial support, and clinical care. In addition, rape myth attitudes and religious beliefs contributed to survivor blaming and provider hesitance in provision of legal abortion care, respectively. To facilitate provision of quality post rape care, policy makers and health institutions' managers need to avail protocols in line with evidence-based best practices to guide health providers in post rape care administration. In addition, there is need for rigorous training and supervision of health professionals to ensure better service provision.

Health care workers' gender bias in testing could contribute to missed tuberculosis among women in South Africa.

PubMed

Smith, A; Burger, R; Claassens, M; Ayles, H; Godfrey-Faussett, P; Beyers, N

2016-03-01

Eight communities with high tuberculosis (TB) prevalence, Western Cape, South Africa. To identify sex differences in TB health-seeking behaviour and diagnosis in primary health care facilities and how this influences TB diagnosis. We used data from a prevalence survey among 30,017 adults conducted in 2010 as part of the Zambia, South Africa Tuberculosis and AIDS Reduction (ZAMSTAR) trial. A total of 1670 (5.4%) adults indicated they had a cough of ⩾2 weeks, 950 (56.9%) of whom were women. Women were less likely to report a cough of ⩾2 weeks (5.1% vs. 6.4%, P < 0.001), but were more likely to seek care for their cough (32.6% vs. 26.9%, P = 0.012). Of all adults who sought care, 403 (80.0%) sought care for their cough at a primary health care (PHC) facility (79.0% women vs. 81.4% men, P = 0.511). Women were less likely to be asked for a sputum sample at the PHC facility (63.3% vs. 77.2%, P = 0.003) and less likely to have a positive sputum result (12.6% vs. 20.7%, P = 0.023). The attainment of sex equity in the provision of TB health services requires adherence to testing protocols. Everyone, irrespective of sex, who seeks care for a cough of ⩾2 weeks should be tested.

Prime movers: Advanced practice professionals in the role of stroke coordinator.

PubMed

Rattray, Nicholas A; Damush, Teresa M; Luckhurst, Cherie; Bauer-Martinez, Catherine J; Homoya, Barbara J; Miech, Edward J

2017-07-01

Following a stroke quality improvement clustered randomized trial and a national acute ischemic stroke (AIS) directive in the Veterans Health Administration in 2011, this comparative case study examined the role of advanced practice professionals (APPs) in quality improvement activities among stroke teams. Semistructured interviews were conducted at 11 Veterans Affairs medical centers annually over a 3-year period. A multidisciplinary team analyzed interviews from clinical providers through a mixed-methods, data matrix approach linking APPs (nurse practitioners and physician assistants) with Consolidated Framework for Implementation Research constructs and a group organization measure. Five of 11 facilities independently chose to staff stroke coordinator positions with APPs. Analysis indicated that APPs emerged as boundary spanners across services and disciplines who played an important role in coordinating evidence-based, facility-level approaches to AIS care. The presence of APPs was related to engaging in group-based evaluation of performance data, implementing stroke protocols, monitoring care through data audit, convening interprofessional meetings involving planning activities, and providing direct care. The presence of APPs appears to be an influential feature of local context crucial in developing an advanced, facility-wide approach to stroke care because of their boundary spanning capabilities. ©2017 American Association of Nurse Practitioners.

Barriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration

PubMed Central

Miech, Edward J.; Sico, Jason J.; Phipps, Michael S.; Arling, Greg; Ferguson, Jared; Austin, Charles; Myers, Laura; Baye, Fitsum; Luckhurst, Cherie; Keating, Ava B.; Moran, Eileen; Bravata, Dawn M.

2017-01-01

Objective: To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA). Methods: We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers. Results: Identified barriers to providing timely acute and follow-up TIA care included difficulties accessing brain imaging, a constantly rotating pool of housestaff, lack of care coordination, resource constraints, and inadequate staff education. Key informants revealed that both stroke nurse coordinators and system-level factors facilitated the provision of TIA care. Few facilities had specific TIA protocols. However, stroke nurse coordinators often expanded upon their role to include TIA. They facilitated TIA care by (1) coordinating patient care across services, communicating across service lines, and educating clinical staff about facility policies and evidence-based practices; (2) tracking individual patients from emergency departments to inpatient settings and to discharge for timely follow-up care; (3) providing and referring TIA patients to risk factor management programs; and (4) performing regular audit and feedback of quality performance data. System-level facilitators included clinical service leadership engagement and use of electronic tools for continuous care across services. Conclusions: The local organization within a health care facility may be targeted to cultivate internal facilitators and a systemic infrastructure to provide evidence-based TIA care. PMID:29117959

Factors predictive of increased influenza and pneumococcal vaccination coverage in long-term care facilities: the CMS-CDC standing orders program Project.

PubMed

Bardenheier, Barbara H; Shefer, Abigail; McKibben, Linda; Roberts, Henry; Rhew, David; Bratzler, Dale

2005-01-01

Between 1999 and 2002, a multistate demonstration project was conducted in long-term care facilities (LTCFs) to encourage implementation of standing orders programs (SOP) as evidence-based vaccine delivery strategies to increase influenza and pneumococcal vaccination coverage in LTCFs. Examine predictors of increase in influenza and pneumococcal vaccination coverage in LTCFs. Intervention study. Self-administered surveys of LTCFs merged with data from OSCAR (On-line Survey Certification and Reporting System) and immunization coverage was abstracted from residents' medical charts in LTCFs. Twenty LTCFs were sampled from 9 intervention and 5 control states in the 2000 to 2001 influenza season for baseline and during the 2001 to 2002 influenza season for postintervention. Each state's quality improvement organization (QIO) promoted the use of standing orders for immunizations as well as other strategies to increase immunization coverage among LTCF residents. Multivariate analysis included Poisson regression to determine independent predictors of at least a 10 percentage-point increase in facility influenza and pneumococcal vaccination coverage. Forty-two (20%) and 59 (28%) of the facilities had at least a 10 percentage-point increase in influenza and pneumococcal immunizations, respectively. In the multivariate analysis, predictors associated with increase in influenza vaccination coverage included adoption of requirement in written immunization protocol to document refusals, less-demanding consent requirements, lower baseline influenza coverage, and small facility size. Factors associated with increase in pneumococcal vaccination coverage included adoption of recording pneumococcal immunizations in a consistent place, affiliation with a multifacility chain, and provision of resource materials. To improve the health of LTCF residents, strategies should be considered that increase immunization coverage, including written protocol for immunizations and documentation of refusals, documenting vaccination status in a consistent place in medical records, and minimal consent requirements for vaccinations.

Staff members' perceived training needs regarding sexuality in residential aged care facilities.

PubMed

Villar, Feliciano; Celdrán, Montserrat; Fabà, Josep; Serrat, Rodrigo

2017-01-01

The purpose of the article is to ascertain if staff members of residential aged care facilities (RACF) perceive the need for training regarding residents' sexuality, and what, if any, benefits from the training were perceived, and to compare perceived benefits of training between care assistants and professional/managerial staff. Interviews were conducted with 53 staff members of five different RACF in Spain. Their responses to two semistructured questions were transcribed verbatim and submitted to content analysis. Results show that most interviewees said they lacked training about sexuality and aging. Two potential highlighted benefits of the training are knowledge/attitudinal (countering negative attitudes regarding sexuality) and procedural (developing common protocols and tools to manage situations related to sexuality). Care assistants and professional staff agreed on the need for training, though the former emphasized the procedural impact and the latter the knowledge/attitudinal benefits. The results suggest that RACF staff should have an opportunity to receive training on residents' sexuality, as sexual interest and behavior is a key dimension of residents' lives.

Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis.

PubMed

Christian, Carmen S; Gerdtham, Ulf-G; Hompashe, Dumisani; Smith, Anja; Burger, Ronelle

2018-04-12

This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.

The role of interventional patient hygiene in improving clinical and economic outcomes.

PubMed

Carr, Devin; Benoit, Richard

2009-02-01

To successfully educate, integrate, and empower nonlicensed personnel in the surgical intensive care unit in the use of a skin care protocol to maintain and improve skin integrity. Observational intervention study. Surgical intensive care unit. Data related to alterations in skin integrity were collected over 4 months, representing approximately 2000 patient-days. A total of 97 specific events representing 121 "areas of concern" were identified by nonlicensed personnel. Nonlicensed staff members' knowledge in 6 key areas related to pressure ulcer (PrU) development was surveyed before and after implementation of an interventional patient hygiene (IPH) program incorporating comprehensive bathing and incontinence protocols. A unique point-of-use skin inspection tool was used by nonlicensed personnel to communicate areas of concern to licensed personnel (registered nurses [RNs]). Reduction in PrUs and improvement in nonlicensed staff knowledge of facility protocols. Incidence of new PrUs decreased from 7.14% at baseline to 0% at the end of the study. Nonlicensed staff knowledge increased to 100% in all 6 knowledge areas. Implementation of an IPH program incorporating comprehensive bathing and incontinence management resulted in enhanced communication between nonlicensed staff and RNs as well as improved patient outcomes.

End-of-life practices at a Lebanese hospital: courage or knowledge?

PubMed

Gebara, Jouhayna; Tashjian, Hera

2006-10-01

End-of-life care requires knowledgeable and culturally sensitive clinicians to assist patients and families dealing with the difficult journey of death. The authors present important end-of-life considerations for health care providers dealing with culturally diversified patients. A case study approach is used illustrating two case vignettes derived from the practice of an intensive care setting of a tertiary teaching facility in a large urban area in Lebanon. In a multidisciplinary fashion, practices of end of life were explored and a protocol developed to guide health care providers. Special cultural values were identified such as importance of family involvement and religious beliefs. Implications for practice are described.

A mobility program for an inpatient acute care medical unit.

PubMed

Wood, Winnie; Tschannen, Dana; Trotsky, Alyssa; Grunawalt, Julie; Adams, Danyell; Chang, Robert; Kendziora, Sandra; Diccion-MacDonald, Stephanie

2014-10-01

For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

Health care provider knowledge and routine management of pre-eclampsia in Pakistan.

PubMed

Sheikh, Sana; Qureshi, Rahat Najam; Khowaja, Asif Raza; Salam, Rehana; Vidler, Marianne; Sawchuck, Diane; von Dadelszen, Peter; Zaidi, Shujat; Bhutta, Zulfiqar

2016-09-30

Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices. We conducted a mixed method study in the districts of Hyderabad and Matiari in Sindh province, Pakistan. Focus group discussions and interviews were conducted with community health care providers, which included Lady Health Workers and their supervisors; traditional birth attendants and facility care providers. In total seven focus groups and 26 interviews were conducted. NVivo 10 was used for analysis and emerging themes and sub-themes were drawn. All participants were providing care for pregnant women for more than a decade except one traditional birth attendant and two doctors. The most common cause of pre-eclampsia mentioned by community health care providers was stress of daily life: the burden of care giving, physical workload, short birth spacing and financial constraints. All health care provider groups except traditional birth attendants correctly identified the signs, symptoms, and complications of pre-eclampsia and eclampsia and were referring such women to tertiary health facilities. Only doctors were aware that magnesium sulphate is recommended for eclampsia management and prevention; however, they expressed fears regarding its use at first and secondary level health facilities. This study found several gaps in knowledge regarding aetiology, diagnosis and treatment of pre-eclampsia among health care providers in Sindh. Findings suggest that lesser knowledge regarding management of pre-eclampsia is due to lack of refresher trainings and written guidelines for management of pre-eclampsia and presentation of fewer pre-eclamptic patients at first and secondary level health care facilities. We suggest to include management of pre-eclampsia in regular trainings of health care providers and to provide management protocols at all health facilities. NCT01911494.

Application of the European quality indicators for psychosocial dementia care in long-term care facilities in the Asia-Pacific region: a pilot study.

PubMed

Jeon, Yun-Hee; Chien, Wai Tong; Ha, Ju-Young; Ibrahim, Rahimah; Kirley, Belinda; Tan, Lay Ling; Thaipisuttikul, Papan; Vasse, Emmelyne; Vernooij-Dassen, Myrra; Wang, Huali; Youn, Jong-Chul; Brodaty, Henry

2017-07-17

An Asia-Pacific regional collaboration group conducted its first multi-country research project to determine whether or not European quality indicators (QIs) for psychosocial care in dementia could be implemented as a valid tool in residential aged care across seven Asia-Pacific sites (Australia, Hong Kong Special Administrative Region, Mainland China, Malaysia, Singapore, South Korea, and Thailand). Following the European QI protocol, auditing and data extraction of medical records of consenting residents with dementia were conducted by trained auditors with relevant health care backgrounds. Detailed field notes by the auditors were also obtained to describe the characteristics of the participating care facilities, as well as key issues and challenges encountered, for each of the 12 QIs. Sixteen residential care facilities in the seven Asia-Pacific sites participated in this study. Data from 275 residents' records revealed each of the 12 Qis' endorsement varied widely within and between the study sites (0%-100%). Quality of the medical records, family and cultural differences, definitions and scoring of certain indicators, and time-consuming nature of the QI administration were main concerns for implementation. Several items in the European QIs in the current format were deemed problematic when used to measure the quality of psychosocial care in the residential aged care settings in participating Asia-Pacific countries. We propose refinements of the European QIs for the Asian-Pacific context, taking into account multiple factors identified in this study. Our findings provide crucial insights for future research and implementation of psychosocial dementia care QIs in this region.

A monitoring/auditing mechanism for SSL/TLS secured service sessions in Health Care Applications.

PubMed

Kavadias, C D; Koutsopoulos, K A; Vlachos, M P; Bourka, A; Kollias, V; Stassinopoulos, G

2003-01-01

This paper analyzes the SSL/TLS procedures and defines the functionality of a monitoring/auditing entity running in parallel with the protocol, which is decoding, checking the certificate and permitting session establishment based on the decoded certificate information, the network addresses of the endpoints and a predefined access list. Finally, this paper discusses how such a facility can be used for detection impersonation attempts in Health Care applications and provides case studies to show the effectiveness and applicability of the proposed method.

Barriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration.

PubMed

Damush, Teresa M; Miech, Edward J; Sico, Jason J; Phipps, Michael S; Arling, Greg; Ferguson, Jared; Austin, Charles; Myers, Laura; Baye, Fitsum; Luckhurst, Cherie; Keating, Ava B; Moran, Eileen; Bravata, Dawn M

2017-12-12

To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA). We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers. Identified barriers to providing timely acute and follow-up TIA care included difficulties accessing brain imaging, a constantly rotating pool of housestaff, lack of care coordination, resource constraints, and inadequate staff education. Key informants revealed that both stroke nurse coordinators and system-level factors facilitated the provision of TIA care. Few facilities had specific TIA protocols. However, stroke nurse coordinators often expanded upon their role to include TIA. They facilitated TIA care by (1) coordinating patient care across services, communicating across service lines, and educating clinical staff about facility policies and evidence-based practices; (2) tracking individual patients from emergency departments to inpatient settings and to discharge for timely follow-up care; (3) providing and referring TIA patients to risk factor management programs; and (4) performing regular audit and feedback of quality performance data. System-level facilitators included clinical service leadership engagement and use of electronic tools for continuous care across services. The local organization within a health care facility may be targeted to cultivate internal facilitators and a systemic infrastructure to provide evidence-based TIA care. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Documenting the NICU design dilemma: parent and staff perceptions of open ward versus single family room units

PubMed Central

Domanico, R; Davis, D K; Coleman, F; Davis, B O

2010-01-01

Objective: With neonatal intensive care units (NICUs) evolving from multipatient wards toward family-friendly, single-family room units, the study objective was to compare satisfaction levels of families and health-care staff across these differing NICU facility designs. Study Design: This prospective study documented, by means of institutional review board-approved questionnaire survey protocols, the perceptions of parents and staff from two contrasting NICU environments. Result: Findings showed that demographic subgroups of parents and staff perceived the advantages and disadvantages of the two facility designs differently. Staff perceptions varied with previous experience, acclimation time and employment position, whereas parental perceptions revealed a naiveté bias through surveys of transitional parents with experience in both NICU facilities. Conclusion: Use of transitional parent surveys showed a subject naiveté bias inherent in perceptions of inexperienced parents. Grouping all survey participants demographically provided more informative interpretations of data, and revealed staff perceptions to vary with position, previous training and hospital experience. PMID:20072132

Development and reliability of an observation method to assess food intake of young children in child care.

PubMed

Ball, Sarah C; Benjamin, Sara E; Ward, Dianne S

2007-04-01

To our knowledge, a direct observation protocol for assessing dietary intake among young children in child care has not been published. This article reviews the development and testing of a diet observation system for child care facilities that occurred during a larger intervention trial. Development of this system was divided into five phases, done in conjunction with a larger intervention study; (a) protocol development, (b) training of field staff, (c) certification of field staff in a laboratory setting, (d) implementation in a child-care setting, and (e) certification of field staff in a child-care setting. During the certification phases, methods were used to assess the accuracy and reliability of all observers at estimating types and amounts of food and beverages commonly served in child care. Tests of agreement show strong agreement among five observers, as well as strong accuracy between the observers and 20 measured portions of foods and beverages with a mean intraclass correlation coefficient value of 0.99. This structured observation system shows promise as a valid and reliable approach for assessing dietary intake of children in child care and makes a valuable contribution to the growing body of literature on the dietary assessment of young children.

Effectiveness of Computerized Oculomotor Vision Screening in a Military Population: Pilot Study

DTIC Science & Technology

2012-01-01

Medical Center, Bethesda, MD; 3Clinical Services, Illinois College of Optometry, Chicago, IL Abstract—The prevalence of oculomotor dysfunctions associ - ated...vergence and their associated recovery as well as for the monocular accommodative facility measurements. This study demonstrated that non- eye -care...comprehensive eye examination without dilation on all subjects. The optometrists used the identi- cal testing protocol to determine manifest refraction

Branched Nerve Allografts to Improve Outcomes in Facial Composite Tissue Transplantation

DTIC Science & Technology

2017-12-01

Ethicon, Inc. Somervile, N.J.). Postoperatively, animals were recovered per standard protocol in the animal care facility.  Experimental Design ...official Department of the Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No...a human xenograft with or without oral Tacrolimus. Electrophysiologic assessments were performed pre -operatively and at the study endpoint (24 weeks

Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis

PubMed Central

Christian, Carmen S.; Gerdtham, Ulf-G.; Hompashe, Dumisani; Smith, Anja; Burger, Ronelle

2018-01-01

This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management. PMID:29649095

Lung Focused Resuscitation at a Specialized Donor Care Facility Improves Lung Procurement Rates.

PubMed

Chang, Stephanie H; Kreisel, Daniel; Marklin, Gary F; Cook, Lindsey; Hachem, Ramsey; Kozower, Benjamin D; Balsara, Keki R; Bell, Jennifer M; Frederiksen, Christine; Meyers, Bryan F; Patterson, G Alexander; Puri, Varun

2018-05-01

Lung procurement for transplantation occurs in approximately 20% of brain dead donors and is a major impediment to wider application of lung transplantation. We investigated the effect of lung protective management at a specialized donor care facility on lung procurement rates from brain dead donors. Our local organ procurement organization instituted a protocol of lung protective management at a freestanding specialized donor care facility in 2008. Brain dead donors from 2001 to 2007 (early period) were compared with those from 2009 to 2016 (current period) for lung procurement rates and other solid-organ procurement rates using a prospectively maintained database. An overall increase occurred in the number of brain dead donors during the study period (early group, 791; late group, 1,333; p < 0.0001). The lung procurement rate (lung donors/all brain dead donors) improved markedly after the introduction of lung protective management (early group, 157 of 791 [19.8%]; current group, 452 of 1,333 [33.9%]; p < 0.0001). The overall organ procurement rate (total number of organs procured/donor) also increased during the study period (early group, 3.5 organs/donor; current group, 3.8 organs/donor; p = 0.006). Lung protective management in brain dead donors at a specialized donor care facility is associated with higher lung utilization rates compared with conventional management. This strategy does not adversely affect the utilization of other organs in a multiorgan donor. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Increasing retention in care of HIV-positive women in PMTCT services through continuous quality improvement-breakthrough (CQI-BTS) series in primary and secondary health care facilities in Nigeria: a cluster randomized controlled trial. The Lafiyan Jikin Mata Study.

PubMed

Oyeledun, Bolanle; Oronsaye, Frank; Oyelade, Taiwo; Becquet, Renaud; Odoh, Deborah; Anyaike, Chukwuma; Ogirima, Francis; Ameh, Bernice; Ajibola, Abiola; Osibo, Bamidele; Imarhiagbe, Collins; Abutu, Inedu

2014-11-01

Rates of retention in care of HIV-positive pregnant women in care programs in Nigeria remain generally poor with rates around 40% reported for specific programs. Poor quality of services in health facilities and long waiting times are among the critical factors militating against retention of these women in care. The aim of the interventions in this study is to assess whether a continuous quality improvement intervention using a Breakthrough Series approach in local district hospitals and primary health care clinics will lead to improved retention of HIV-positive women and mothers. A cluster randomized controlled trial with 32 health facilities randomized to receive a continuous quality improvement/Breakthrough Series intervention or not. The care protocol for HIV-infected pregnant women and mothers is the same in all sites. The quality improvement intervention started 4 months before enrollment of individual HIV-infected pregnant women and initially focused on reducing waiting times for women and also ensuring that antiretroviral drugs are dispensed on the same day as clinic attendance. The primary outcome measure is retention of HIV-positive mothers in care at 6 months postpartum. Results of this trial will inform whether quality improvement interventions are an effective means of improving retention in prevention of mother-to-child transmission of HIV programs and will also guide where health system interventions should focus to improve the quality of care for HIV-positive women. This will benefit policymakers and program managers as they seek to improve retention rates in HIV care programs.

Use of 4MAT Learning Theory to Promote Better Skin Care During Radiation Therapy: An Evidence-Based Quality Improvement Project.

PubMed

Bauer, Carole; Magnan, Morris; Laszewski, Pamela

Radiation therapy is a key treatment modality for cancer patients, but it is associated with adverse side effects such as radiation dermatitis. To mitigate the adverse effects of radiation on the skin, patients must participate in skin-related self-care. However, even with self-care instruction, adherence can be poor. This quality improvement project used best available evidence for skin care in patients undergoing radiation therapy and a theoretical framework, 4MATing, to provide a structured approach to patient education designed to enhance adherence to skin care recommendations. Implementation of this approach resulted in increased adherence to a topical skin care protocol in our facility. Patients were highly satisfied with their education. While there was a 4-day delay in the onset of radiation dermatitis, this difference was not statistically significant.

Infectious and Hazardous Waste Protocol for Medical Facilities

DTIC Science & Technology

1991-03-01

possible, have a known immune status to that disease (e.g., chicken pox ). Caregivers who have no immunity or unknown immune status should not provide care...employees living in barracks who are diagnosed as having a highly communicable disease which has a respiratory transmission route (such as chicken pox ...high-risk patients (i.e., neonates, young infants, COPD, immune compromised) until acute symptoms resolve. Varicella ( Chicken pox ) Active Yes Until all

Automatic flexible endoscope reprocessors.

PubMed

Muscarella, L F

2000-04-01

Reprocessing medical instruments is a complex and controversial discipline. If all instruments were constructed of materials not damaged by heat, pressure, and moisture, instrument reprocessing would be greatly simplified. As the number of novel and complex instruments entering the market continues to increase, periodic review of the health care facility's instrument reprocessing protocols to ensure their safety and effectiveness is important. This article reviews the advantages and the limitations of automatic flexible endoscope reprocessors.

Assessment of infection control practices in maternity units in Southern Nigeria.

PubMed

Friday, Okonofua; Edoja, Okpokunu; Osasu, Aigbogun; Chinenye, Nwandu; Cyril, Mokwenye; Lovney, Kanguru; Julia, Hussein

2012-12-01

Puerperal sepsis accounts for 12% of maternal deaths in Nigeria. To date, little is known about the background hospital factors that predispose pregnant women to puerperal infection that leads to mortality. The objective of this study was to investigate the nature and pattern of existing policies and practices relating to infection control in maternity care centres in Edo state, South-South Nigeria. Cross-sectional study consisting of in-depth interviews with service providers, observation of clinical practices and examination of medical records. Public and private health-care facilities in eight local government areas (LGAs) selected from the three senatorial districts of Edo State, Nigeria. Health providers from 63 primary, secondary and tertiary maternity care centres. Sixty-three health-care facilities were sampled from eight LGAs from the three senatorial districts in Edo State. Three pre-tested tools were adapted to the local setting and used to interview key informants in the health facilities and to observe for practices and records relating to infection control. Of the 63 health facilities, 68% (43) reported that they had infection control procedures in place, while only 25% (16) reported that they documented these as manuals or charts. Only 13% (8) of facilities had infection control committees; 11% (7) routinely carried out audits of maternal deaths, while 33% (21) reported that they had an ongoing programme for staff training on infection control. A high proportion of the health facilities reported that staff routinely wash their hands before and after sterile procedures, but only half of the facilities were observed to have 24-h running water and only two-thirds had soap and antiseptic solutions in delivery and operating theatre areas. Although more than 90% (57) of the health facilities reported that they use sterile gloves routinely, unused sterile gloves were found in only 60% (38) of these facilities, and recycled gloves in 11.1% (7). The results of this study suggest the need for improved record-keeping procedures, the development of appropriate policies and protocols for infection control and staff training on infection control in maternity care facilities in Edo State. A public health education and advocacy programme to create awareness on clean delivery places as an approach for reducing maternal morbidity and mortality and to build political will for implementing related activities is also urgently needed.

Status of the transition/transfer process for adolescents with chronic diseases at a national pediatric referral hospital in Argentina.

PubMed

González, Florencia; Rodríguez Celin, María de Las Mercedes; Roizen, Mariana; Mato, Roberto; García Arrigoni, Patricia; Ugo, Florencia; Staciuk, Raquel; Fano, Virginia

2017-12-01

The shift of adolescents from a pediatric to an adult health care facility is a complex process. The objective of this study was to assess the transition/transfer process for adolescents with chronic diseases at Hospital Garrahan. Observational, cross-sectional, qualitative-quantitative study. Retrospective statistical data were obtained in relation to outpatient visits of patients aged 16-26; surveys and/or interviews were done with health care providers, adolescents, and family members from different follow-up programs. The prevalence of care provided to individuals older than 16 years was 7.2%. Surveys were administered to 54 attending health care providers, 150 patients (16-26.7 years old) and 141 family members. In addition, 45 health care providers with management functions were interviewed. Health care providers: 39% had received training on transition. All identified barriers and facilitators among the different participants and facilities. They recognized the importance of encouraging autonomy among their patients, but only 30% of them interviewed their patients alone, and 56.6% delivered medical reports. Strategies: the median age of transfer was 18 years (13-20); 62% had a protocol; 84% had an informal agreement with another facility; joint or parallel care: 49%; only 20% implemented a transition plan. Patients and family members: 4.7% of adolescents attended visits alone, and health care providers had asked 45% about their autonomy and preparation to take care of their health. Adolescents and their parents had feelings (mostly negative) regarding the process and identified facilitation strategies, such as receiving a summary, knowing the new facility, and having trained health care providers. The transition process for adolescents with chronic diseases is still deficient and approaching it involves health care teams and the families. A lack of formal inter-institutional agreements was identified, although there were more informal agreements among health care providers; besides, the need to encourage chronically-ill patients' autonomy was also determined. In relation to facilitation strategies, patients and parents mainly recognized the need to have a medical summary, health care guidelines, and trust in the new provider. Sociedad Argentina de Pediatría

The effectiveness of introducing Group Prenatal Care (GPC) in selected health facilities in a district of Bangladesh: study protocol.

PubMed

Sultana, Marufa; Mahumud, Rashidul Alam; Ali, Nausad; Ahmed, Sayem; Islam, Ziaul; Khan, Jahangir A M; Sarker, Abdur Razzaque

2017-01-31

Despite high rates of antenatal care and relatively good access to health facilities, maternal and neonatal mortality remain high in Bangladesh. There is an immediate need for implementation of evidence-based, cost-effective interventions to improve maternal and neonatal health outcomes. The aim of the study is to assess the effect of the intervention namely Group Prenatal Care (GPC) on utilization of standard number of antenatal care, post natal care including skilled birth attendance and institutional deliveries instead of usual care. The study is quasi-experimental in design. We aim to recruit 576 pregnant women (288 interventions and 288 comparisons) less than 20 weeks of gestational age. The intervention will be delivered over around 6 months. The outcome measure is the difference in maternal service coverage including ANC and PNC coverage, skilled birth attendance and institutional deliveries between the intervention and comparison group. Findings from the research will contribute to improve maternal and newborn outcome in our existing health system. Findings of the research can be used for planning a new strategy and improving the health outcome for Bangladeshi women. Finally addressing the maternal health goal, this study is able to contribute to strengthening health system.

Touch, the essence of caring for people with end-stage dementia: a mental health perspective in Namaste Care.

PubMed

Nicholls, Daniel; Chang, Esther; Johnson, Amanda; Edenborough, Michel

2013-01-01

This article presents the mental health aspects of 'touch' associated with a funded research project: Avoiding 'high tech' through 'high touch' in end-stage dementia: Protocol for care at the end-of-life. These mental health aspects highlight the human need for touch that continues up until and inclusive of the final stages of life. This study was informed by Simard's (2007) 'high touch' protocol based on the End-of-Life Namaste Care programme for people with dementia. The article is situated in relation to the research project which used a three-phase mixed methods approach. Data explored in this article are derived from focus groups conducted at three residential aged care facilities located in metropolitan and regional areas of NSW, Australia. The exploration of touch vis-a-vis mental health fell under two broad themes: touch by others and touch by the person. Sub-elements of these themes comprised touch towards a physical objective, touch towards an emotional objective, touch of objects and touch of others. The overarching outcome of interconnectedness embraced environmental awareness and human and life awareness. These two broad themes, with their accompanying elements, express the essential nature of mental health as a reciprocal connectedness, with reciprocal impacts on both those people with advanced dementia and their carers.

Cost analysis of the History, ECG, Age, Risk factors, and initial Troponin (HEART) Pathway randomized control trial.

PubMed

Riley, Robert F; Miller, Chadwick D; Russell, Gregory B; Harper, Erin N; Hiestand, Brian C; Hoekstra, James W; Lefebvre, Cedric W; Nicks, Bret A; Cline, David M; Askew, Kim L; Mahler, Simon A

2017-01-01

The HEART Pathway is a diagnostic protocol designed to identify low-risk patients presenting to the emergency department with chest pain that are safe for early discharge. This protocol has been shown to significantly decrease health care resource utilization compared with usual care. However, the impact of the HEART Pathway on the cost of care has yet to be reported. We performed a cost analysis of patients enrolled in the HEART Pathway trial, which randomized participants to either usual care or the HEART Pathway protocol. For low-risk patients, the HEART Pathway recommended early discharge from the emergency department without further testing. We compared index visit cost, cost at 30 days, and cardiac-related health care cost at 30 days between the 2 treatment arms. Costs for each patient included facility and professional costs. Cost at 30 days included total inpatient and outpatient costs, including the index encounter, regardless of etiology. Cardiac-related health care cost at 30 days included the index encounter and costs adjudicated to be cardiac-related within that period. Two hundred seventy of the 282 patients enrolled in the trial had cost data available for analysis. There was a significant reduction in cost for the HEART Pathway group at 30 days (median cost savings of $216 per individual), which was most evident in low-risk (Thrombolysis In Myocardial Infarction score of 0-1) patients (median savings of $253 per patient) and driven primarily by lower cardiac diagnostic costs in the HEART Pathway group. Using the HEART Pathway as a decision aid for patients with undifferentiated chest pain resulted in significant cost savings. Copyright © 2016 Elsevier Inc. All rights reserved.

Development of characterization protocol for mixed liquid radioactive waste classification

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zakaria, Norasalwa, E-mail: norasalwa@nuclearmalaysia.gov.my; Wafa, Syed Asraf; Wo, Yii Mei

2015-04-29

Mixed liquid organic waste generated from health-care and research activities containing tritium, carbon-14, and other radionuclides posed specific challenges in its management. Often, these wastes become legacy waste in many nuclear facilities and being considered as ‘problematic’ waste. One of the most important recommendations made by IAEA is to perform multistage processes aiming at declassification of the waste. At this moment, approximately 3000 bottles of mixed liquid waste, with estimated volume of 6000 litres are currently stored at the National Radioactive Waste Management Centre, Malaysia and some have been stored for more than 25 years. The aim of this studymore » is to develop a characterization protocol towards reclassification of these wastes. The characterization protocol entails waste identification, waste screening and segregation, and analytical radionuclides profiling using various analytical procedures including gross alpha/ gross beta, gamma spectrometry, and LSC method. The results obtained from the characterization protocol are used to establish criteria for speedy classification of the waste.« less

Effects of resistance and functional-skills training on habitual activity and constipation among older adults living in long-term care facilities: a randomized controlled trial.

PubMed

Chin A Paw, Marijke J M; van Poppel, Mireille N M; van Mechelen, Willem

2006-07-31

Large-scale RCTs comparing different types of exercise training in institutionalised older people are scarce, especially regarding effects on habitual physical activity and constipation. This study investigated the effects of different training protocols on habitual physical activity and constipation of older adults living in long-term care facilities. A randomized controlled trial with 157 participants, aged 64 to 94 years, who were randomly assigned to 1) resistance training; 2) all-round functional-skills training; 3) both; or 4) an 'educational' control condition. Habitual physical activity was assessed with a physical activity questionnaire and accelerometers. Constipation was assessed by a questionnaire. Measurements were performed at baseline and after six months of training. At baseline the median time spent sitting was 8.2 hr/d, the median time spent on activity of at least moderate intensity was 32 min/d. At baseline, about 22% of the subjects were diagnosed with constipation and 23% were taking laxatives. There were no between-group differences for changes in habitual physical activity or constipation over 6-months. Six months of moderate intensity exercise training neither enhances habitual physical activity nor affects complaints of constipation among older people living in long-term care facilities.

Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association

PubMed Central

Florez, Hermes; Huang, Elbert S.; Kalyani, Rita R.; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S.; Taveira, Tracey H.; Haas, Linda B.

2016-01-01

Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. PMID:26798150

Individualized music for dementia: Evolution and application of evidence-based protocol.

PubMed

Gerdner, Linda A

2012-04-22

The theory-based intervention of individualized music has been evaluated clinically and empirically leading to advancement and refinement of an evidence-based protocol, currently in its 5th edition. An expanded version of the protocol was written for professional health care providers with a consumer version tailored for family caregivers. The underlying mid-range theory is presented along with a seminal study that was followed by further research in the United States, Canada, Great Britain, France, Sweden, Norway, Japan and Taiwan. Key studies are summarized. Given its efficacy when implemented by research staff, studies have advanced to testing the intervention under real-life conditions when implemented and evaluated by trained nursing assistants in long-term care facilities and visiting family members. In addition, one study evaluated the implementation of music by family members in the home setting. Initial research focused on agitation as the dependent variable with subsequent research indicating a more holistic response such as positive affect, expressed satisfaction, and meaningful interaction with others. The article advances by describing on-line programs designed to train health care professionals in the assessment, implementation and evaluation of individualized music. In addition, Gerdner has written a story for a picture book intended for children and their families (in press). The story models principles of individualized music to elicit positive memories, reduce anxiety and agitation, and promote communication. The article concludes with implications for future research.

Individualized music for dementia: Evolution and application of evidence-based protocol

PubMed Central

Gerdner, Linda A

2012-01-01

The theory-based intervention of individualized music has been evaluated clinically and empirically leading to advancement and refinement of an evidence-based protocol, currently in its 5th edition. An expanded version of the protocol was written for professional health care providers with a consumer version tailored for family caregivers. The underlying mid-range theory is presented along with a seminal study that was followed by further research in the United States, Canada, Great Britain, France, Sweden, Norway, Japan and Taiwan. Key studies are summarized. Given its efficacy when implemented by research staff, studies have advanced to testing the intervention under real-life conditions when implemented and evaluated by trained nursing assistants in long-term care facilities and visiting family members. In addition, one study evaluated the implementation of music by family members in the home setting. Initial research focused on agitation as the dependent variable with subsequent research indicating a more holistic response such as positive affect, expressed satisfaction, and meaningful interaction with others. The article advances by describing on-line programs designed to train health care professionals in the assessment, implementation and evaluation of individualized music. In addition, Gerdner has written a story for a picture book intended for children and their families (in press). The story models principles of individualized music to elicit positive memories, reduce anxiety and agitation, and promote communication. The article concludes with implications for future research. PMID:24175165

The problem of bias when nursing facility staff administer customer satisfaction surveys.

PubMed

Hodlewsky, R Tamara; Decker, Frederic H

2002-10-01

Customer satisfaction instruments are being used with increasing frequency to assess and monitor residents' assessments of quality of care in nursing facilities. There is no standard protocol, however, for how or by whom the instruments should be administered when anonymous, written responses are not feasible. Researchers often use outside interviewers to assess satisfaction, but cost considerations may limit the extent to which facilities are able to hire outside interviewers on a regular basis. This study was designed to investigate the existence and extent of any bias caused by staff administering customer satisfaction surveys. Customer satisfaction data were collected in 1998 from 265 residents in 21 nursing facilities in North Dakota. Half the residents in each facility were interviewed by staff members and the other half by outside consultants; scores were compared by interviewer type. In addition to a tabulation of raw scores, ordinary least-squares analysis with facility fixed effects was used to control for resident characteristics and unmeasured facility-level factors that could influence scores. Significant positive bias was found when staff members interviewed residents. The bias was not limited to questions directly affecting staff responsibilities but applied across all types of issues. The bias was robust under varying constructions of satisfaction and dissatisfaction. A uniform method of survey administration appears to be important if satisfaction data are to be used to compare facilities. Bias is an important factor that should be considered and weighed against the costs of obtaining outside interviewers when assessing customer satisfaction among long term care residents.

Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review.

PubMed

Neo, Jun Rong Jeffrey; Sagha-Zadeh, Rana; Vielemeyer, Ole; Franklin, Ella

2016-06-01

Hand hygiene (HH) in health care facilities is a key component to reduce pathogen transmission and nosocomial infections. However, most HH interventions (HHI) have not been sustainable. This review aims to provide a comprehensive summary of recently published evidence-based HHI designed to improve HH compliance (HHC) that will enable health care providers to make informed choices when allocating limited resources to improve HHC and patient safety. The Medline electronic database (using PubMed) was used to identify relevant studies. English language articles that included hand hygiene interventions and related terms combined with health care environments or related terms were included. Seventy-three studies that met the inclusion criteria were summarized. Interventions were categorized as improving awareness with education, facility design, and planning, unit-level protocols and procedures, hospital-wide programs, and multimodal interventions. Past successful HHIs may not be as effective when applied to other health care environments. HH education should be interactive and engaging. Electronic monitoring and reminders should be implemented in phases to ensure cost-effectiveness. To create hospitalwide programs that engage end users, policy makers should draw expertise from interdisciplinary fields. Before implementing the various components of multimodal interventions, health care practitioners should identify and examine HH difficulties unique to their organizations. Future research should seek to achieve the following: replicate successful HHI in other health care environments, develop reliable HHC monitoring tools, understand caregiver-patient-family interactions, examine ways (eg, hospital leadership, financial support, and strategies from public health and infection prevention initiatives) to sustain HHC, and use simulated lab environments to refine study designs. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Quality of care and quality of life of people with dementia living at green care farms: a cross-sectional study.

PubMed

de Boer, Bram; Hamers, Jan P H; Zwakhalen, Sandra M G; Tan, Frans E S; Verbeek, Hilde

2017-07-19

Many countries are introducing smaller, more home-like care facilities that represent a radically new approach to nursing home care for people with dementia. The green care farm is a new type of nursing home developed in the Netherlands. The goal of this study was to compare quality of care, quality of life and related outcomes in green care farms, regular small-scale living facilities and traditional nursing homes for people with dementia. A cross-sectional design was used. Three types of nursing homes were included: (1) green care farms; (2) regular small-scale living facilities; (3) traditional nursing homes. All participating nursing homes were non-profit, collectively funded nursing homes in the south of the Netherlands. One hundred and fifteen residents with a formal diagnosis of dementia were included in the study. Data on quality of care was gathered and consisted of outcome indicators (e.g. falling incidents, pressure ulcers), structure indicators (e.g. hours per resident per day), and process indicators (e.g. presence, accessibility and content of protocols on care delivery). Furthermore, questionnaires on cognition, dependence in activities of daily living, quality of life, social engagement, neuropsychiatric symptoms, agitation, and depression were used. Data showed that quality of care was comparable across settings. No large differences were found on clinical outcome measures, hours per resident per day, or process indicators. Higher quality of life scores were reported for residents of green care farms in comparison with residents of traditional nursing homes. They scored significantly higher on the Quality of Life - Alzheimer's disease Scale (p < 0.05, ES = 0.8) indicating a better quality of life. In addition, residents of green care farms scored higher on three quality of life domains of the Qualidem: positive affect, social relations and having something to do (p < 0.05, ES > 0.7). No differences with regular small-scale living facilities were found. Green care farms seem to be a valuable alternative to existing nursing homes. This is important as people with dementia are a heterogeneous group with varying needs. In order to provide tailored care there also is a need for a variety of living environments.

Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities.

PubMed

Bratt, John H; Torpey, Kwasi; Kabaso, Mushota; Gondwe, Yebo

2011-01-01

To present evidence on unit and total costs of outpatient HIV/AIDS services in ZPCT-supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV/AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in Zambia. Cost data from 2008 were collected in 12 ZPCT-supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV/AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009. Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First-year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT-supported facilities were estimated at US$14.7-$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0-114.2 million for ART and US$57.7 million for ANC including PMTCT. Consistent with the literature, total costs of services were dominated by drugs, laboratory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility-level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening. © 2010 Blackwell Publishing Ltd.

Internet Protocol Handbook. Volume 4. The Domain Name System (DNS) handbook

DTIC Science & Technology

1989-08-01

Mockapetris [Page 1] 4-11 INTERNET PROTOCOL HA TDBOOK - Voue Four 1989 RFC 1034 Domain Concepts and Facilities November 1987 bandwidth consumed in distributing...Domain Names- Concepts and Facilities KFC 1034 RFC 1034 Domain Concepts and Facilities November 1’)87 - Queries contain a bit called recursion desired...during periodic sweeps to reclaim the memory consumed by old RRS. Mockapetris [Page 33] 4-43 INTERNET PROTOCOL HANDBOOK - Volume Four 1989 RFC 1034

Impact of an electronic sepsis initiative on antibiotic use and health care facility-onset Clostridium difficile infection rates.

PubMed

Hiensch, Robert; Poeran, Jashvant; Saunders-Hao, Patricia; Adams, Victoria; Powell, Charles A; Glasser, Allison; Mazumdar, Madhu; Patel, Gopi

2017-10-01

Although integrated, electronic sepsis screening and treatment protocols are thought to improve patient outcomes, less is known about their unintended consequences. We aimed to determine if the introduction of a sepsis initiative coincided with increases in broad-spectrum antibiotic use and health care facility-onset (HCFO) Clostridium difficile infection (CDI) rates. We used interrupted time series data from a large, tertiary, urban academic medical center including all adult inpatients on 4 medicine wards (June 2011-July 2014). The main exposure was implementation of the sepsis screening program; the main outcomes were the use of broad-spectrum antibiotics (including 3 that were part of an order set designed for the sepsis initiative) and HCFO CDI rates. Segmented regression analyses compared outcomes in 3 time segments: before (11 months), during (14 months), and after (12 months) implementation of a sepsis initiative. Antibiotic use and HFCO CDI rates increased during the period of implementation and the period after implementation compared with baseline; these increases were highest in the period after implementation (level change, 50.4 days of therapy per 1,000 patient days for overall antibiotic use and 10.8 HCFO CDIs per 10,000 patient days; P < .05). Remarkably, the main drivers of overall antibiotic use were not those included in the sepsis order set. The implementation of an electronic sepsis screening and treatment protocol coincided with increased broad-spectrum antibiotic use and HCFO CDIs. Because these protocols are increasingly used, further study of their unintended consequences is warranted. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Using photovoice to explore patient perceptions of patient-centered care in the Veterans Affairs health care system

PubMed Central

Balbale, Salva Najib; Morris, Megan A.; LaVela, Sherri L.

2015-01-01

Background Accounting for patient views and context is essential in evaluating and improving patient-centered care initiatives, yet few studies have examined the patient perspective. In the Veterans Affairs (VA) Health Care System, several VA facilities have transitioned from traditionally disease- or problem-based care to patient-centered care. We used photovoice to explore perceptions and experiences related to patient-centered care among Veterans receiving care in VA facilities that have implemented patient-centered care initiatives. Design Participants were provided prompts to facilitate their photography, and were asked to capture salient features in their environment that may describe their experiences and perceptions related to patient-centered care. Follow-up interviews were conducted with each participant to learn more about their photographs and intended meanings. Participant demographic data were also collected. Results Twenty-two Veteran patients (n=22) across two VA sites participated in the photovoice protocol. Participants defined patient-centered care broadly as caring for a person as a whole while accommodating for individual needs and concerns. Participant-generated photography and interview data revealed various contextual factors influencing patient-centered care perceptions, including patient-provider communication and relationships, physical and social environments of care, and accessibility of care. Conclusions This study contributes to the growing knowledge base around patient views and preferences regarding their care, care quality, and environments of care. Factors that shaped patient-centered care perceptions and the patient experience included communication with providers and staff, décor and signage, accessibility and transportation, programs and services offered, and informational resources. Our findings may be integrated into system redesign innovations and care design strategies that embody what is most meaningful to patients. PMID:24452963

Using photovoice to explore patient perceptions of patient-centered care in the Veterans Affairs Health Care System.

PubMed

Balbale, Salva Najib; Morris, Megan A; LaVela, Sherri L

2014-01-01

Accounting for patient views and context is essential in evaluating and improving patient-centered care initiatives, yet few studies have examined the patient perspective. In the Veterans Affairs (VA) Health Care System, several VA facilities have transitioned from traditionally disease- or problem-based care to patient-centered care. We used photovoice to explore perceptions and experiences related to patient-centered care among Veterans receiving care in VA facilities that have implemented patient-centered care initiatives. Participants were provided prompts to facilitate their photography, and were asked to capture salient features in their environment that may describe their experiences and perceptions related to patient-centered care. Follow-up interviews were conducted with each participant to learn more about their photographs and intended meanings. Participant demographic data were also collected. Twenty-two Veteran patients (n = 22) across two VA sites participated in the photovoice protocol. Participants defined patient-centered care broadly as caring for a person as a whole while accommodating for individual needs and concerns. Participant-generated photography and interview data revealed various contextual factors influencing patient-centered care perceptions, including patient-provider communication and relationships, physical and social environments of care, and accessibility of care. This study contributes to the growing knowledge base around patient views and preferences regarding their care, care quality, and environments of care. Factors that shaped patient-centered care perceptions and the patient experience included communication with providers and staff, décor and signage, accessibility and transportation, programs and services offered, and informational resources. Our findings may be integrated into system redesign innovations and care design strategies that embody what is most meaningful to patients.

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors.

PubMed

Mahmood, Mohammad Afzal; Mufidah, Ismi; Scroggs, Steven; Siddiqui, Amna Rehana; Raheel, Hafsa; Wibdarminto, Koentijo; Dirgantoro, Bernardus; Vercruyssen, Jorien; Wahabi, Hayfaa A

2018-01-01

Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped.

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors

PubMed Central

Mufidah, Ismi; Scroggs, Steven; Siddiqui, Amna Rehana; Raheel, Hafsa; Wibdarminto, Koentijo; Dirgantoro, Bernardus; Vercruyssen, Jorien

2018-01-01

Background Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Method Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. Findings The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. Conclusion There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped. PMID:29682538

Pre-hospital care in burn injury

PubMed Central

Shrivastava, Prabhat; Goel, Arun

2010-01-01

The care provided to the victims of burn injury immediately after sustaining burns can largely affect the extent and depth of the wound. Although standard guidelines have been formulated by various burn associations, they are still not well known to public at large in our country. In burn injuries, most often, the bystanders are the first care providers. The swift implementation of the measures described in this article for first aid in thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn, plays a vital role and can effectively reduce the morbidity and mortality to a great extent. In case of burn disasters, triage needs to be carried out promptly as per the defined protocols. Proper communication and transport from the scene of the accident to the primary care centre and onto the burn care facility greatly influences the execution of the management plans PMID:21321651

Implementation of a respiratory rehabilitation protocol: weaning from the ventilator and tracheostomy in difficult-to-wean patients with spinal cord injury.

PubMed

Gundogdu, Ibrahim; Ozturk, Erhan Arif; Umay, Ebru; Karaahmet, Ozgur Zeliha; Unlu, Ece; Cakci, Aytul

2017-06-01

Following repeated weaning failures in acute care services, spinal cord injury (SCI) patients who require prolonged mechanical ventilation and tracheostomy are discharged to their homes or skilled nursing facilities, with a portable mechanical ventilator (MV) and/or tracheostomy tube (TT) with excess risk of complications, high cost and low quality of life. We hypothesized that many difficult-to-wean patients with cervical SCI can be successfully managed in a rehabilitation clinic. The aim of our study was to develop a respiratory rehabilitation, MV weaning and TT decannulation protocol and to evaluate the effectiveness of this protocol in tetraplegic patients. A multidisciplinary and multifaceted protocol, including respiratory assessment and management themes, was developed and performed based on the findings from other studies in the literature. Tetraplegic patients with the diagnosis of difficult-to-wean, who were admitted to the rehabilitation clinic after having been discharged from the intensive care unit to their home with home-type MV and/or TT, were included in this prospective observational study. The respiratory rehabilitation protocol was applied to 35 tetraplegic patients (10 home-type MV and tracheostomy-dependent, and 25 tracheostomized patients) with C1-C7 ASIA impairment scale grade A, B, and C injuries. Seven out of 10 patients successfully weaned from MV and 30 of 35 patients were decannulated. Four patients were referred for diaphragm pace stimulation and tracheal stenosis surgery. The mean durations of MV weaning and decannulation were 37 and 31 days, respectively. A multifaceted, multidisciplinary respiratory management program can change the process of care used for difficult-to-wean patients with SCI. Implications for rehabilitation Findings from this study indicate the significance of a multidimensional evaluation of any reversible factors for prolonged MV- and/or TT-dependent SCI patients. Thus, rehabilitation specialists should take this into consideration and should provide the appropriate amount of time to these patients. The proposed protocol of respiratory rehabilitation for MV- and/or TT-dependent SCI patients shows promising results in terms of changing the care used for these patients. Successful implementation of a respiratory rehabilitation and weaning protocol is dependent on careful planning and detailed communication between the rehabilitation specialist and intensivist during the respiratory rehabilitation process. Because many of the so-called difficult- or impossible-to-wean patients were successfully weaned from MV and TT in the PMR clinic, the need for such an outlet for countries without specialized centers is supported.

Association of Rapid Care Process Implementation on Reperfusion Times Across Multiple ST-Segment-Elevation Myocardial Infarction Networks.

PubMed

Fordyce, Christopher B; Al-Khalidi, Hussein R; Jollis, James G; Roettig, Mayme L; Gu, Joan; Bagai, Akshay; Berger, Peter B; Corbett, Claire C; Dauerman, Harold L; Fox, Kathleen; Garvey, J Lee; Henry, Timothy D; Rokos, Ivan C; Sherwood, Matthew W; Wilson, B Hadley; Granger, Christopher B

2017-01-01

The Mission: Lifeline STEMI Systems Accelerator program, implemented in 16 US metropolitan regions, resulted in more patients receiving timely reperfusion. We assessed whether implementing key care processes was associated with system performance improvement. Hospitals (n=167 with 23 498 ST-segment-elevation myocardial infarction patients) were surveyed before (March 2012) and after (July 2014) program intervention. Data were merged with patient-level clinical data over the same period. For reperfusion, hospitals were grouped by whether a specific process of care was implemented, preexisting, or never implemented. Uptake of 4 key care processes increased after intervention: prehospital catheterization laboratory activation (62%-91%; P<0.001), single call transfer protocol from an outside facility (45%-70%; P<0.001), and emergency department bypass for emergency medical services direct presenters (48%-59%; P=0.002) and transfers (56%-79%; P=0.001). There were significant differences in median first medical contact-to-device times among groups implementing prehospital activation (88 minutes implementers versus 89 minutes preexisting versus 98 minutes nonimplementers; P<0.001 for comparisons). Similarly, patients treated at hospitals implementing single call transfer protocols had shorter median first medical contact-to-device times (112 versus 128 versus 152 minutes; P<0.001). Emergency department bypass was also associated with shorter median first medical contact-to-device times for emergency medical services direct presenters (84 versus 88 versus 94 minutes; P<0.001) and transfers (123 versus 127 versus 167 minutes; P<0.001). The Accelerator program increased uptake of key care processes, which were associated with improved system performance. These findings support efforts to implement regional ST-segment-elevation myocardial infarction networks focused on prehospital catheterization laboratory activation, single call transfer protocols, and emergency department bypass. © 2017 American Heart Association, Inc.

Cost-Effectiveness Analysis of Interventions to Reduce Risk of Aspiration in Elderly Cancer Survivors Residing in Skilled Nursing Facilities.

PubMed

Mantravadi, S

2017-04-01

Aspiration can occur in patients of any age group, but it can be prevented. The primary population at risk is made up of survivors of cancer because of their increased risk of mucositis, mucosal atrophy, and dysphagia associated with chemotherapy, radiotherapy, and the disease process itself. The rate of incidence of aspiration cannot be quantified, because minor cases of aspiration often go unreported. Sequelae ensuing from aspirations can include pneumonia, end-stage kidney disease, dialysis, and death. Analyses of cost, decision-tree modeling, and cost effectiveness were performed to compare a hypothetical, interventional model based on best practices with usual (standard) care. A societal perspective was used as the economic view point. Direct costs, caregiver time, and market values for wages were estimated for the 2 interventions. Effectiveness values for the cost-effectiveness and decision-tree analyses were obtained from the literature. The incremental-cost-effectiveness ratio was calculated and used to compare the intervention with usual care. The interventional method was more costly but more effective than usual care. A sensitivity analysis considered the uncertainty of event probability (aspiration vs no aspiration). The interventional protocol for aspiration reduction continued to be more cost effective than usual care. Aspiration takes a financial toll on all facets of health care, including on nurses, skilled nursing facilities, patients, their families, and insurers, among others. Implementing guidelines that describe best practices for aspiration appears to be a cost-effective strategy for reducing aspirations among cancer survivors - especially elderly patients - who live in skilled nursing facilities.

Chapter 7. Critical care triage. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Christian, Michael D; Joynt, Gavin M; Hick, John L; Colvin, John; Danis, Marion; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on critical care triage. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including critical care triage. Key recommendations include: (1) establish an Incident Management System with Emergency Executive Control Groups at facility, local, regional/state or national levels to exercise authority and direction over resources; (2) developing fair and equitable policies may require restricting ICU services to patients most likely to benefit; (3) usual treatments and standards of practice may be impossible to deliver; (4) ICU care and treatments may have to be withheld from patients likely to die even with ICU care and withdrawn after a trial in patients who do not improve or deteriorate; (5) triage criteria should be objective, ethical, transparent, applied equitably and be publically disclosed; (6) trigger triage protocols for pandemic influenza only when critical care resources across a broad geographic area are or will be overwhelmed despite all reasonable efforts to extend resources or obtain additional resources; (7) triage of patients for ICU should be based on those who are likely to benefit most or a 'first come, first served' basis; (8) a triage officer should apply inclusion and exclusion criteria to determine patient qualification for ICU admission. Judicious planning and adoption of protocols for critical care triage are necessary to optimize outcomes during a pandemic.

Barriers in the implementation of a physical activity intervention in primary care settings: lessons learned.

PubMed

Josyula, Lakshmi K; Lyle, Roseann M

2013-01-01

Barriers encountered in implementing a physical activity intervention in primary health care settings, and ways to address them, are described in this paper. A randomized comparison trial was designed to examine the impact of health care providers' written prescriptions for physical activity, with or without additional physical activity resources, to adult, nonpregnant patients on preventive care or chronic disease monitoring visits. Following abysmal recruitment outcomes, the research protocol was altered to make it more appealing to all the participants, i.e., health care providers, office personnel, and patients. Various barriers--financial, motivational, and executive--to the implementation of health promotion interventions in primary health care settings were experienced and identified. These barriers have been classified by the different participants in the research process, viz., healthcare providers, administrative personnel, researchers, and patients. Some of the barriers identified were lack of time and reimbursement for health promotion activities, and inadequate practice capacity, for health care providers; increased time and labor demands for administrative personnel; constrained access to participants, and limited funding, for researchers; and superseding commitments, and inaccurate comprehension of the research protocol, for patients. Solutions suggested to overcome these barriers include financial support, e.g., funding for researchers, remuneration for health care organization personnel, reimbursement for providers, payment for participants, and free or subsidized postage, and use of health facilities; motivational strategies such as inspirational leadership, and contests within health care organizations; and partnerships, with other expert technical and creative entities, to improve the quality, efficiency, and acceptability of health promotion interventions.

Evaluation of pharmacotherapy complexity in residents of long-term care facilities: a cross-sectional descriptive study.

PubMed

Alves-Conceição, Vanessa; Silva, Daniel Tenório da; Santana, Vanessa Lima de; Santos, Edileide Guimarães Dos; Santos, Lincoln Marques Cavalcante; Lyra, Divaldo Pereira de

2017-07-25

Polypharmacy is a reality in long-term care facilities. However, number of medications used by the patient should not be the only predictor of a complex pharmacotherapy. Although the level of complexity of pharmacotherapy is considered an important factor that may lead to side effects, there are few studies in this field. The aim of this study was to evaluate the complexity of pharmacotherapy in residents of three long-term care facilities. A cross-sectional study was performed to evaluate the complexity of pharmacotherapy using the protocols laid out in the Medication Regimen Complexity Index instrument in three long-term care facilities in northeastern Brazil. As a secondary result, potential drug interactions, potentially inappropriate medications, medication duplication, and polypharmacy were evaluated. After the assessment, the association among these variables and the Medication Regimen Complexity Index was performed. In this study, there was a higher prevalence of women (64.4%) with a high mean age among the study population of 81.8 (±9.7) years. The complexity of pharmacotherapy obtained a mean of 15.1 points (±9.8), with a minimum of 2 and a maximum of 59. The highest levels of complexity were associated with dose frequency, with a mean of 5.5 (±3.6), followed by additional instructions of use averaging 4.9 (±3.7) and by the dosage forms averaging 4.6 (±3.0). The present study evaluated some factors that complicate the pharmacotherapy of geriatric patients. Although polypharmacy was implicated as a factor directly related to complexity, other indicators such as drug interactions, potentially inappropriate medications, and therapeutic duplication can also make the use of pharmacotherapy in such patients more difficult.

Protocols and Hospital Mortality in Critically ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study

PubMed Central

Sevransky, Jonathan E.; Checkley, William; Herrera, Phabiola; Pickering, Brian W.; Barr, Juliana; Brown, Samuel M; Chang, Steven Y; Chong, David; Kaufman, David; Fremont, Richard D; Girard, Timothy D; Hoag, Jeffrey; Johnson, Steven B; Kerlin, Mehta P; Liebler, Janice; O'Brien, James; O'Keefe, Terence; Park, Pauline K; Pastores, Stephen M; Patil, Namrata; Pietropaoli, Anthony P; Putman, Maryann; Rice, Todd W.; Rotello, Leo; Siner, Jonathan; Sajid, Sahul; Murphy, David J; Martin, Greg S

2015-01-01

Objective Clinical protocols may decrease unnecessary variation in care and improve compliance with desirable therapies. We evaluated whether highly protocolized intensive care units have superior patient outcomes compared with less highly protocolized intensive care units. Design Observational study in which participating intensive care units completed a general assessment and enrolled new patients one day each week. Setting and Patients 6179 critically ill patients across 59 intensive care units in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study Interventions: None Measurements and Main Results The primary exposure was the number of intensive care unit protocols; the primary outcome was hospital mortality. 5809 participants were followed prospectively and 5454 patients in 57 intensive care units had complete outcome data. The median number of protocols per intensive care unit was 19 (IQR 15 to 21.5). In single variable analyses, there were no differences in intensive care unit and hospital mortality, length of stay, use of mechanical ventilation, vasopressors, or continuous sedation among individuals in intensive care units with a high vs. low number of protocols. The lack of association was confirmed in adjusted multivariable analysis (p=0.70). Protocol compliance with two ventilator management protocols was moderate and did not differ between intensive care units with high vs. low numbers of protocols for lung protective ventilation in ARDS (47% vs. 52%; p=0.28) and for spontaneous breathing trials (55% vs. 51%; p=0.27). Conclusions Clinical protocols are highly prevalent in United States intensive care units. The presence of a greater number of protocols was not associated with protocol compliance or patient mortality. PMID:26110488

Study protocol for the SMART2D adaptive implementation trial: a cluster randomised trial comparing facility-only care with integrated facility and community care to improve type 2 diabetes outcomes in Uganda, South Africa and Sweden.

PubMed

Guwatudde, David; Absetz, Pilvikki; Delobelle, Peter; Östenson, Claes-Göran; Olmen Van, Josefien; Alvesson, Helle Molsted; Mayega, Roy William; Ekirapa Kiracho, Elizabeth; Kiguli, Juliet; Sundberg, Carl Johan; Sanders, David; Tomson, Göran; Puoane, Thandi; Peterson, Stefan; Daivadanam, Meena

2018-03-17

Type 2 diabetes (T2D) is increasingly contributing to the global burden of disease. Health systems in most parts of the world are struggling to diagnose and manage T2D, especially in low-income and middle-income countries, and among disadvantaged populations in high-income countries. The aim of this study is to determine the added benefit of community interventions onto health facility interventions, towards glycaemic control among persons with diabetes, and towards reduction in plasma glucose among persons with prediabetes. An adaptive implementation cluster randomised trial is being implemented in two rural districts in Uganda with three clusters per study arm, in an urban township in South Africa with one cluster per study arm, and in socially disadvantaged suburbs in Stockholm, Sweden with one cluster per study arm. Clusters are communities within the catchment areas of participating primary healthcare facilities. There are two study arms comprising a facility plus community interventions arm and a facility-only interventions arm. Uganda has a third arm comprising usual care. Intervention strategies focus on organisation of care, linkage between health facility and the community, and strengthening patient role in self-management, community mobilisation and a supportive environment. Among T2D participants, the primary outcome is controlled plasma glucose; whereas among prediabetes participants the primary outcome is reduction in plasma glucose. The study has received approval in Uganda from the Higher Degrees, Research and Ethics Committee of Makerere University School of Public Health and from the Uganda National Council for Science and Technology; in South Africa from the Biomedical Science Research Ethics Committee of the University of the Western Cape; and in Sweden from the Regional Ethical Board in Stockholm. Findings will be disseminated through peer-reviewed publications and scientific meetings. ISRCTN11913581; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals.

PubMed

Dimitrov, Nikolay; Koenig, William; Bosson, Nichole; Song, Sarah; Saver, Jeffrey L; Mack, William J; Sanossian, Nerses

2015-09-01

Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Each county's local emergency medical services agency (LEMSA) was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45%) had stroke routing protocols, covering 23 counties (40%) and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile). In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources.

Antenatal care service quality increases the odds of utilizing institutional delivery in Bahir Dar city administration, North Western Ethiopia: A prospective follow up study.

PubMed

Ejigu Tafere, Tadese; Afework, Mesganaw Fanthahun; Yalew, Alemayehu Worku

2018-01-01

In Ethiopia, more than 62% of pregnant women attend antenatal care at least once, yet only about one in four women give birth at health facility. This gap has fueled the need to investigate on the quality of ANC services at public health facilities and its link with the use of institutional delivery. To assess the linkage between ANC quality and the use of institutional delivery among pregnant women attending ANC at public health facilities of BDR City Administration. A facility based prospective follow up study was conducted. and nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were enrolled.Women were followed from their first ANC visit until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation (GEE) was carried out to control cluster effect among women who received ANC in the same facility. Among 823 pregnant women who completed follow up, only about one third (27.6%) received acceptable quality of ANC services. In one health facility syphilis test was not done at all for the last two years. The odds of giving birth at health institution among pregnant women who received acceptable ANC quality service was about 3.38 times higher than among pregnant women who received unacceptable ANC quality service (AOR = 3.38, 95% CI: 1.67, 6.83). In this study the quality of ANC service provision in public health facilities was compromised/low. Provision of quality ANC service had a great role in promoting institutional delivery. Therefore the local authorities at each level of health sector or the nongovernmental organizations working to improve maternal health need to provide training on focused antenatal care protocol for ANC providers.

Antenatal care service quality increases the odds of utilizing institutional delivery in Bahir Dar city administration, North Western Ethiopia: A prospective follow up study

PubMed Central

Afework, Mesganaw Fanthahun; Yalew, Alemayehu Worku

2018-01-01

Background In Ethiopia, more than 62% of pregnant women attend antenatal care at least once, yet only about one in four women give birth at health facility. This gap has fueled the need to investigate on the quality of ANC services at public health facilities and its link with the use of institutional delivery. Objective To assess the linkage between ANC quality and the use of institutional delivery among pregnant women attending ANC at public health facilities of BDR City Administration Methods A facility based prospective follow up study was conducted. and nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were enrolled.Women were followed from their first ANC visit until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation (GEE) was carried out to control cluster effect among women who received ANC in the same facility. Results Among 823 pregnant women who completed follow up, only about one third (27.6%) received acceptable quality of ANC services. In one health facility syphilis test was not done at all for the last two years. The odds of giving birth at health institution among pregnant women who received acceptable ANC quality service was about 3.38 times higher than among pregnant women who received unacceptable ANC quality service (AOR = 3.38, 95% CI: 1.67, 6.83). Conclusion and recommendation In this study the quality of ANC service provision in public health facilities was compromised/low. Provision of quality ANC service had a great role in promoting institutional delivery. Therefore the local authorities at each level of health sector or the nongovernmental organizations working to improve maternal health need to provide training on focused antenatal care protocol for ANC providers. PMID:29420598

The Achilles' heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability.

PubMed

Rodriguez, Violeta J; LaCabe, Richard P; Privette, C Kyle; Douglass, K Marie; Peltzer, Karl; Matseke, Gladys; Mathebula, Audrey; Ramlagan, Shandir; Sifunda, Sibusiso; Prado, Guillermo Willy; Horigian, Viviana; Weiss, Stephen M; Jones, Deborah L

2017-12-01

The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff-patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention.

The Achilles’ heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

PubMed Central

Rodriguez, Violeta J.; LaCabe, Richard P.; Privette, C. Kyle; Douglass, K. Marie; Peltzer, Karl; Matseke, Gladys; Mathebula, Audrey; Ramlagan, Shandir; Sifunda, Sibusiso; Prado, Guillermo “Willy”; Horigian, Viviana; Weiss, Stephen M.; Jones, Deborah L.

2017-01-01

Abstract The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff–patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention. PMID:28922974

The management of scabies outbreaks in residential care facilities for the elderly in England: a review of current health protection guidelines.

PubMed

White, L C J; Lanza, S; Middleton, J; Hewitt, K; Freire-Moran, L; Edge, C; Nicholls, M; Rajan-Iyer, J; Cassell, J A

2016-11-01

Commonly thought of as a disease of poverty and overcrowding in resource-poor settings globally, scabies is also an important public health issue in residential care facilities for the elderly (RCFE) in high-income countries such as the UK. We compared and contrasted current local Health Protection Team (HPT) guidelines for the management of scabies outbreaks in RCFE throughout England. We performed content analysis on 20 guidelines, and used this to create a quantitative report of their variation in key dimensions. Although the guidelines were generally consistent on issues such as the treatment protocols for individual patients, there was substantial variation in their recommendations regarding the prophylactic treatment of contacts, infection control measures and the roles and responsibilities of individual stakeholders. Most guidelines did not adequately address the logistical challenges associated with mass treatment in this setting. We conclude that the heterogeneous nature of the guidelines reviewed is an argument in favour of national guidelines being produced.

Study on Quality of IUD Services Provided by Trained Professionals at Teaching Institutes.

PubMed

Prasad, Noopur; Jain, M L; Meena, B S

2018-06-01

Access the completeness in IUD services provided by trained professionals and find out the weak links. Study was conducted on 100 IUD trained professionals of tertiary care hospital and nursing teaching institute. All were given questionnaire that was duly filled by them. Data obtained were analysed. Protocols of case selection, pre-insertion counselling, insertion process and follow-up were assessed. All the four criteria were assessed on score of ten. Study group could not get ten points under any of the set criteria. Average of 53% case selection, 31.4% pre-insertion counselling, 42.5% insertion protocols and 46.1% follow-up counselling criteria were observed by study group. Highest compliance of protocols was seen among postgraduate students. Although IUD training is given to all medical professionals and IUD facility is available up to subcentres but the study shows that completeness in services is still lacking. Ensuring ideal place for IUD insertion, proper case selection, use of specific instruments for insertion and observance of insertion protocols are very vital for the success of IUD.

Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district.

PubMed

Thwala, Siphiwe Bridget Pearl; Blaauw, Duane; Ssengooba, Freddie

2018-01-01

Improving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by others. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio. Data collection took place in the final quarter of 2014. Cross-sectional surveys were conducted to classify the 7 hospitals and 8 community health centres (CHCs) in the district as either basic EmNOC (BEmNOC) or comprehensive EmNOC (CEmNOC) facilities using UN EmNOC signal functions. The required density of EmNOC facilities was calculated using UN norms. We also assessed the availability of EmNOC personnel, resuscitation equipment, drugs, fluids, and protocols at each facility. The workload of skilled EmNOC providers at hospitals and CHCs was compared. All 7 hospitals in the district were classified as CEmNOC facilities, but none of the 8 CHCs performed all required signal functions to be classified as BEmNOC facilities. UN norms indicated that 25 EmNOC facilities were required for the district population, 5 of which should be CEmNOCs. None of the facilities had 100% of items on the EmNOC checklists. Hospital midwives delivered an average of 36.4±14.3 deliveries each per month compared to only 7.9±3.2 for CHC midwives (p<0.001). The analysis indicated a shortfall of EmNOC facilities in the district. Full EmNOC services were centralised to hospitals to assure patient safety even though national policy guidelines sanction more decentralisation to CHCs. Studies measuring EmNOC availability need to consider facility opening hours, capacity and staffing in addition to the demonstrated performance of signal functions.

Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district

PubMed Central

Blaauw, Duane; Ssengooba, Freddie

2018-01-01

Background Improving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by others. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio. Methods Data collection took place in the final quarter of 2014. Cross-sectional surveys were conducted to classify the 7 hospitals and 8 community health centres (CHCs) in the district as either basic EmNOC (BEmNOC) or comprehensive EmNOC (CEmNOC) facilities using UN EmNOC signal functions. The required density of EmNOC facilities was calculated using UN norms. We also assessed the availability of EmNOC personnel, resuscitation equipment, drugs, fluids, and protocols at each facility. The workload of skilled EmNOC providers at hospitals and CHCs was compared. Results All 7 hospitals in the district were classified as CEmNOC facilities, but none of the 8 CHCs performed all required signal functions to be classified as BEmNOC facilities. UN norms indicated that 25 EmNOC facilities were required for the district population, 5 of which should be CEmNOCs. None of the facilities had 100% of items on the EmNOC checklists. Hospital midwives delivered an average of 36.4±14.3 deliveries each per month compared to only 7.9±3.2 for CHC midwives (p<0.001). Conclusions The analysis indicated a shortfall of EmNOC facilities in the district. Full EmNOC services were centralised to hospitals to assure patient safety even though national policy guidelines sanction more decentralisation to CHCs. Studies measuring EmNOC availability need to consider facility opening hours, capacity and staffing in addition to the demonstrated performance of signal functions. PMID:29596431

Successful management of risk in the hybrid OR.

PubMed

Childs, Shannon; Bruch, Paul

2015-02-01

The advent of intraoperative magnetic resonance imaging (MRI) surgery has resulted in numerous advances in minimally invasive procedures. This progress has also revealed serious environmental hazards for the patient and perioperative team. At one facility, implementation of an MRI/OR intervention suite has enhanced surgical care and outcomes. Achieving the benefits of intraoperative MRI can occur with a multidisciplinary, interdepartmental approach to the design and layout of the hybrid environment and through implementation of education and safety protocols, including patient screening and prep for scanning. Personnel, including perioperative nurses, must receive expert hands-on training to successfully mitigate risk and provide care in the hybrid OR setting. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

The National Expert Standard Pressure Ulcer Prevention in Nursing and pressure ulcer prevalence in German health care facilities: a multilevel analysis.

PubMed

Wilborn, Doris; Grittner, Ulrike; Dassen, Theo; Kottner, Jan

2010-12-01

The objective of this study was to describe the relationship between the German National Expert Standard Pressure Ulcer Prevention and the pressure ulcer prevalence in German nursing homes and hospitals. The patient outcome pressure ulcer does not only depend on individual characteristics of patients, but also on institutional factors. In Germany, National Expert Standards are evidence-based instruments that build the basis of continuing improvement in health care quality. It is expected that after having implemented the National Expert Standard Pressure Ulcer Prevention, the number of pressure ulcers should decrease in health care institutions. The analysed data were obtained from two cross-sectional studies from 2004-2005. A multilevel analysis was performed to show the impact of the National Expert Standard Pressure Ulcer Prevention on pressure ulcer prevalence. A total of 41.5% of hospitals and 38.8% of the nursing homes claimed to use the National Expert Standard in the process of developing their local protocols. The overall pressure ulcer prevalence grade 2-4 was 4.7%. Adjusted for hospital departments, survey year and individual characteristics, there was no significant difference in the prevalence of pressure ulcers between institutions that refer to the National Expert Standard or those referring to other sources in developing their local protocols (OR=1.14, 95% CI=0.90-1.44). There was no empirical evidence demonstrating that local protocols of pressure ulcer prevention based on the National Expert Standard were superior to local protocols which refer other sources of knowledge with regard to the pressure ulcer prevalence. The use of the National Expert Standard Pressure Ulcer Prevention can neither be recommended nor be refused. The recent definition of implementation of Expert Standards should be mandatory for all health care institutions which introduce Expert Standards. © 2010 Blackwell Publishing Ltd.

Evaluating the Utility of a Structured Clinical Protocol for Reducing the Impact of Behavioural and Psychological Symptoms of Dementia in Progressive Neurological Diseases: A Pilot Study.

PubMed

Ryan, Nicholas P; Scott, Laura; McPhee, Maryanne; Mathers, Susan; Davis, Marie-Claire; Maule, Roxanne; Fisher, Fiona

2018-01-01

Behavioural and psychological symptoms of dementia (BPSD) cause significant distress to both aged care residents and staff. Despite the high prevalence of BPSD in progressive neurological diseases (PNDs) such as multiple sclerosis, Huntington's disease, and Parkinson's disease, the utility of a structured clinical protocol for reducing BPSD has not been systematically evaluated in PND populations. Staff ( n = 51) and individuals with a diagnosis of PND ( n = 13) were recruited into the study, which aimed to evaluate the efficacy of a PND-specific structured clinical protocol for reducing the impact of BPSD in residential aged care (RAC) and specialist disability accommodation (SDA) facilities. Staff were trained in the clinical protocol through face-to-face workshops, which were followed by 9 weeks of intensive clinical supervision to a subset of staff ("behaviour champions"). Staff and resident outcome measures were administered preintervention and immediately following the intervention. The primary outcome was frequency and severity of BPSD, measured using the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH). The secondary outcome was staff coping assessed using the Strain in Dementia Care Scale (SDCS). In SDA, significant reductions in staff ratings of job-related stress were observed alongside a statistically significant decrease in BPSD from T1 to T2. In RAC, there was no significant time effect for BPSD or staff coping; however, a medium effect size was observed for staff job stress. Staff training and clinical support in the use of a structured clinical protocol for managing BPSD were linked to reductions in staff job stress, which may in turn increase staff capacity to identify indicators of resident distress and respond accordingly. Site variation in outcomes may relate to organisational and workforce-level barriers that may be unique to the RAC context and should be systematically addressed in future RCT studies of larger PND samples.

A Review of Protocol Implementations and Energy Efficient Cross-Layer Design for Wireless Body Area Networks

PubMed Central

Hughes, Laurie; Wang, Xinheng; Chen, Tao

2012-01-01

The issues inherent in caring for an ever-increasing aged population has been the subject of endless debate and continues to be a hot topic for political discussion. The use of hospital-based facilities for the monitoring of chronic physiological conditions is expensive and ties up key healthcare professionals. The introduction of wireless sensor devices as part of a Wireless Body Area Network (WBAN) integrated within an overall eHealth solution could bring a step change in the remote management of patient healthcare. Sensor devices small enough to be placed either inside or on the human body can form a vital part of an overall health monitoring network. An effectively designed energy efficient WBAN should have a minimal impact on the mobility and lifestyle of the patient. WBAN technology can be deployed within a hospital, care home environment or in the patient's own home. This study is a review of the existing research in the area of WBAN technology and in particular protocol adaptation and energy efficient cross-layer design. The research reviews the work carried out across various layers of the protocol stack and highlights how the latest research proposes to resolve the various challenges inherent in remote continual healthcare monitoring. PMID:23202185

Postrape care services to minors in Kenya: are the services healing or hurting survivors?

PubMed

Wangamati, Cynthia Khamala; Combs Thorsen, Viva; Gele, Abdi Ali; Sundby, Johanne

2016-01-01

Child sexual abuse is a global problem and a growing concern in Sub-Saharan Africa. It constitutes a profound violation of human rights. To address this problem, Kenya has established the Sexual Offences Act. In addition, Kenya has developed national guidelines on the management of sexual violence to grant minors access to health care. However, little is known about the experiences of sexually abused minors when they interact with the health and legal system. Accordingly, this study uses a triangulation of methods in the follow-up of two adolescent girls. Health records were reviewed, interactions between the girls and service providers were observed, in-depth interviews were conducted with the girls, and informal discussions were held with guardians and service providers. Findings indicated that the minors' rights to quality health care and protection were being violated. Protocols on postrape care delivery were unavailable. Furthermore, the health facility was ill equipped and poorly stocked. Health providers showed little regard for informed assent, confidentiality, and privacy while offering postrape care. Similarly, in the justice system, processing was met with delays and unresponsive law enforcement. Health providers and police officers are in grave need of training in sexual and gender-based violence, its consequences, comprehensive postrape care, and sexual and reproductive health rights to ensure the protection of minors' rights. Health administrators should ensure that facilities are equipped with skilled health providers, medical supplies, and equipment. Additionally, policies on the protection and care of sexually abused minors in Kenya require amendment.

Delivering diabetes care in the Philippines and Vietnam: policy and practice issues.

PubMed

Beran, David; Higuchi, Michiyo

2013-01-01

The aim of this study is the comparison of 2 studies looking at the barriers to access of diabetes care and medicines in the Philippines and Vietnam. These studies used the Rapid Assessment Protocol for Insulin Access. Diabetes care is provided in specialized facilities and appropriate referral systems are lacking. In Vietnam, no problems were reported with regard to diagnostic tools, whereas this was a concern in the public sector in the Philippines. Both countries had high prices for medicines in comparison to international standards. Availability of medicines was better in Vietnam than in the Philippines, especially with regard to insulin. This affected adherence as did a lack of patient education. As countries aim to provide health care to the majority of their populations through universal coverage, the challenge of diabetes cannot be neglected. Trying to achieve universal coverage in parallel to decentralization, national and local governments need adapted guidance for this.

Prescriptions for uncomplicated malaria treatment among pregnant women in the Brazilian Amazon: evidences from the Mafalda Project.

PubMed

Luz, Tatiana Chama Borges; Miranda, Elaine Silva; Freitas, Letícia Figueira; Osório-de-Castro, Claudia Garcia Serpa

2013-06-01

To evaluate antimalarial prescriptions according to quality indicators and to describe adverse events reports among pregnant women with uncomplicated malaria. Descriptive study of medical files of pregnant women 15 years and older, residents in high-risk municipalities in the Brazilian Amazon. Antimalarial medicines were characterized by frequency of prescription, type of plasmodium and health care facilities where prescribing took place, and by possible adverse events. Variables were compared by Pearson's chi-square. A total of 262 medical files were evaluated. Most patients were diagnosed for Plasmodium vivax 71,2%. Chloroquine was the commonest prescribed antimalarial (65.6%). Of P. vivax prescriptions, 9.0%, and 16.2% of P. falciparum prescriptions presented antimalarials not recommended in the official protocol. Prescriptions for P. falciparum , in significantly higher proportion, did not adhere to the official protocol in regard to type of antimalarial and dose/duration of treatment (p = 0,001). They also lacked information on dose and dosing interval (p = 0,004). There were no significant differences among reference centers and basic health care units in respect to the prescribed antimalarials, to prescriptions containing antimalarials not recommended in the official protocol or in respect to lack of dosing information. Chloroquine was the antimalarial most related to the occurrence of adverse events. THE findings indicate that there are flaws in antimalarial prescribing for pregnant women, especially in respect to their adequacy to the official protocol.

Infection control in delivery care units, Gujarat state, India: A needs assessment

PubMed Central

2011-01-01

Background Increasingly, women in India attend health facilities for childbirth, partly due to incentives paid under government programs. Increased use of health facilities can alleviate the risks of infections contracted in unhygienic home deliveries, but poor infection control practices in labour and delivery units also cause puerperal sepsis and other infections of childbirth. A needs assessment was conducted to provide information on procedures and practices related to infection control in labour and delivery units in Gujarat state, India. Methods Twenty health care facilities, including private and public primary health centres and referral hospitals, were sampled from two districts in Gujarat state, India. Three pre-tested tools for interviewing and for observation were used. Data collection was based on existing infection control guidelines for clean practices, clean equipment, clean environment and availability of diagnostics and treatment. The study was carried out from April to May 2009. Results Seventy percent of respondents said that standard infection control procedures were followed, but a written procedure was only available in 5% of facilities. Alcohol rubs were not used for hand cleaning and surgical gloves were reused in over 70% of facilities, especially for vaginal examinations in the labour room. Most types of equipment and supplies were available but a third of facilities did not have wash basins with "hands-free" taps. Only 15% of facilities reported that wiping of surfaces was done immediately after each delivery in labour rooms. Blood culture services were available in 25% of facilities and antibiotics are widely given to women after normal delivery. A few facilities had data on infections and reported rates of 3% to 5%. Conclusions This study of current infection control procedures and practices during labour and delivery in health facilities in Gujarat revealed a need for improved information systems, protocols and procedures, and for training and research. Simply incentivizing the behaviour of women to use health facilities for childbirth via government schemes may not guarantee safe delivery. PMID:21599924

"Other patients are really in need of medical attention"--the quality of health services for rape survivors in South Africa.

PubMed Central

Christofides, Nicola J.; Jewkes, Rachel K.; Webster, Naomi; Penn-Kekana, Loveday; Abrahams, Naeema; Martin, Lorna J.

2005-01-01

OBJECTIVE: To investigate in the South African public health sector where the best services for rape survivors were provided, who provided them, what the providers' attitudes were towards women who had been raped and whether there were problems in delivering care for rape survivors. METHODS: A cross-sectional study of facilities was carried out. Two district hospitals, a regional hospital and a tertiary hospital (where available) were randomly sampled in each of the nine provinces in South Africa. At each hospital, senior staff identified two doctors and two nurses who regularly provided care for women who had been raped. These doctors and nurses were interviewed using a questionnaire with both open-ended and closed questions. We interviewed 124 providers in 31 hospitals. A checklist that indicated what facilities were available for rape survivors was also completed for each hospital. FINDINGS: A total of 32.6% of health workers in hospitals did not consider rape to be a serious medical condition. The mean number of rape survivors seen in the previous six months at each hospital was 27.9 (range = 9.3-46.5). A total of 30.3% of providers had received training in caring for rape survivors. More than three-quarters of regional hospitals (76.9%) had a private exam room designated for use in caring for rape survivors. Multiple regression analysis of practitioner factors associated with better quality of clinical care found these to be a practitioner being older than 40 years (parameter estimate = 2.4; 95% confidence interval (CI) = 0.7-5), having cared for a higher number of rape survivors before (parameter estimate = 0.02; 95% CI = 0.001-0.03), working in a facility that had a clinical management protocol for caring for rape survivors (parameter estimate = 2; 95% CI = 0.12-3.94), having worked for less time in the facility (parameter estimate = -0.2; 95% CI = -0.3 to -0.04) and perceiving rape to be a serious medical problem (parameter estimate = 2.8; 95% CI = 1.9-3.8). CONCLUSION: There are many weaknesses in services for rape survivors in South Africa. Our findings suggest that care can be improved by disseminating clinical management guidelines and ensuring that care is provided by motivated providers who are designated to care for survivors. PMID:16175823

A New Long-Term Care Facilities Model in Nova Scotia, Canada: Protocol for a Mixed Methods Study of Care by Design

PubMed Central

Boudreau, Michelle Anne; Jensen, Jan L; Edgecombe, Nancy; Clarke, Barry; Burge, Frederick; Archibald, Greg; Taylor, Anthony; Andrew, Melissa K

2013-01-01

Background Prior to the implementation of a new model of care in long-term care facilities in the Capital District Health Authority, Halifax, Nova Scotia, residents entering long-term care were responsible for finding their own family physician. As a result, care was provided by many family physicians responsible for a few residents leading to care coordination and continuity challenges. In 2009, Capital District Health Authority (CDHA) implemented a new model of long-term care called “Care by Design” which includes: a dedicated family physician per floor, 24/7 on-call physician coverage, implementation of a standardized geriatric assessment tool, and an interdisciplinary team approach to care. In addition, a new Emergency Health Services program was implemented shortly after, in which specially trained paramedics dedicated to long-term care responses are able to address urgent care needs. These changes were implemented to improve primary and emergency care for vulnerable residents. Here we describe a comprehensive mixed methods research study designed to assess the impact of these programs on care delivery and resident outcomes. The results of this research will be important to guide primary care policy for long-term care. Objective We aim to evaluate the impact of introducing a new model of a dedicated primary care physician and team approach to long-term care facilities in the CDHA using a mixed methods approach. As a mixed methods study, the quantitative and qualitative data findings will inform each other. Quantitatively we will measure a number of indicators of care in CDHA long-term care facilities pre and post-implementation of the new model. In the qualitative phase of the study we will explore the experience under the new model from the perspectives of stakeholders including family doctors, nurses, administration and staff as well as residents and family members. The proposed mixed method study seeks to evaluate and make policy recommendations related to primary care in long-term care facilities with a focus on end-of-life care and dementia. Methods This is a mixed methods study with concurrent quantitative and qualitative phases. In the quantitative phase, a retrospective time series study is being conducted. Planned analyses will measure indicators of clinical, system, and health outcomes across three time periods and assess the effect of Care by Design as a whole and its component parts. The qualitative methods explore the experiences of stakeholders (ie, physicians, nurses, paramedics, care assistants, administrators, residents, and family members) through focus groups and in depth individual interviews. Results Data collection will be completed in fall 2013. Conclusions This study will generate a considerable amount of outcome data with applications for care providers, health care systems, and applications for program evaluation and quality improvement. Using the mixed methods design, this study will provide important results for stakeholders, as well as other health systems considering similar programs. In addition, this study will advance methods used to research new multifaceted interdisciplinary health delivery models using multiple and varied data sources and contribute to the discussion on evidence based health policy and program development. PMID:24292200

A new long-term care facilities model in nova scotia, Canada: protocol for a mixed methods study of care by design.

PubMed

Marshall, Emily Gard; Boudreau, Michelle Anne; Jensen, Jan L; Edgecombe, Nancy; Clarke, Barry; Burge, Frederick; Archibald, Greg; Taylor, Anthony; Andrew, Melissa K

2013-11-29

Prior to the implementation of a new model of care in long-term care facilities in the Capital District Health Authority, Halifax, Nova Scotia, residents entering long-term care were responsible for finding their own family physician. As a result, care was provided by many family physicians responsible for a few residents leading to care coordination and continuity challenges. In 2009, Capital District Health Authority (CDHA) implemented a new model of long-term care called "Care by Design" which includes: a dedicated family physician per floor, 24/7 on-call physician coverage, implementation of a standardized geriatric assessment tool, and an interdisciplinary team approach to care. In addition, a new Emergency Health Services program was implemented shortly after, in which specially trained paramedics dedicated to long-term care responses are able to address urgent care needs. These changes were implemented to improve primary and emergency care for vulnerable residents. Here we describe a comprehensive mixed methods research study designed to assess the impact of these programs on care delivery and resident outcomes. The results of this research will be important to guide primary care policy for long-term care. We aim to evaluate the impact of introducing a new model of a dedicated primary care physician and team approach to long-term care facilities in the CDHA using a mixed methods approach. As a mixed methods study, the quantitative and qualitative data findings will inform each other. Quantitatively we will measure a number of indicators of care in CDHA long-term care facilities pre and post-implementation of the new model. In the qualitative phase of the study we will explore the experience under the new model from the perspectives of stakeholders including family doctors, nurses, administration and staff as well as residents and family members. The proposed mixed method study seeks to evaluate and make policy recommendations related to primary care in long-term care facilities with a focus on end-of-life care and dementia. This is a mixed methods study with concurrent quantitative and qualitative phases. In the quantitative phase, a retrospective time series study is being conducted. Planned analyses will measure indicators of clinical, system, and health outcomes across three time periods and assess the effect of Care by Design as a whole and its component parts. The qualitative methods explore the experiences of stakeholders (ie, physicians, nurses, paramedics, care assistants, administrators, residents, and family members) through focus groups and in depth individual interviews. Data collection will be completed in fall 2013. This study will generate a considerable amount of outcome data with applications for care providers, health care systems, and applications for program evaluation and quality improvement. Using the mixed methods design, this study will provide important results for stakeholders, as well as other health systems considering similar programs. In addition, this study will advance methods used to research new multifaceted interdisciplinary health delivery models using multiple and varied data sources and contribute to the discussion on evidence based health policy and program development.

Ways and Means to Utilize Private Practitioners for Tuberculosis Care in India.

PubMed

Samal, Janmejaya

2017-02-01

The growing interest of utilizing the private practitioners in improving the outreach of public health services including Tuberculosis (TB) control programme stemmed out of people's preference for private health facilities in situations where public health facilities fail to meet the expectations. In different parts of India, many models of Public Private Partnership have been tried and tested and proved successful in providing quality TB care in the concerned community. In this paper, several ways and means have been proposed to effectively utilize private practitioners for TB care in India. These strategies are discussed under different headings: (1) identification of potential private practitioners: (2) orientation of private practitioners: (3) networking of private practitioners with patients and Directly Observed Treatment Short course (DOTS) provider: (4) follow-up and sensitization of patients by private practitioners: (5) let the word of mouth work: and (6) evaluation of the involvement of private practitioners in TB care. However the following points must be addressed before utilizing the private practitioners for TB care: time constraints in notifying the disease, adherence to DOTS regime/alternative to DOTS regime, referral of patients to public health facilities for diagnosis and treatment, follow-up and sensitization of the patients and behaviour change communication and awareness in the community by the private practitioners. Few of these are mandatory for the private practitioners; most are practicable. With the effective utilization of private practitioners many problems can be sorted out that are currently plaguing the system such as irrational and excessive use of certain drugs, over reliance on chest X-ray for diagnosis, under use of sputum microscopy, lack of knowledge regarding standard treatment protocols and varied prescription practices.

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial.

PubMed

van der Heijden, Amber A W A; de Bruijne, Martine C; Feenstra, Talitha L; Dekker, Jacqueline M; Baan, Caroline A; Bosmans, Judith E; Bot, Sandra D M; Donker, Gé A; Nijpels, Giel

2014-06-25

The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n = 253), protocolized (n = 197), and usual care (n = 333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€ 758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant. Current Controlled trials: ISRCTN66124817.

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial

PubMed Central

2014-01-01

Background The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. Methods In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n = 253), protocolized (n = 197), and usual care (n = 333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. Results Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). Conclusions Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant. Trial registration Current Controlled trials: ISRCTN66124817. PMID:24966055

An interprofessional team approach to tracheostomy care: a mixed-method investigation into the mechanisms explaining tracheostomy team effectiveness.

PubMed

Mitchell, Rebecca; Parker, Vicki; Giles, Michelle

2013-04-01

In an effort to reduce tracheostomy-related complications, many acute care facilities have implemented specialist tracheostomy teams. Some studies, however, generate only mixed support for the connection between tracheostomy teams and patient outcomes. This suggests that the effect of collaborative teamwork in tracheostomy care is still not well understood. The aim of this paper is to investigate the mechanisms through which an interprofessional team approach can improve the management of patients with a tracheostomy. The achievement of this research objective requires the collection of rich empirical data, which indicates the use of a qualitative methodology. A case study approach provided an opportunity to collect a wealth of data on tracheostomy team activities and dynamics. Data were collected on an interprofessional tracheostomy team in a large tertiary referral hospital in Australia. The team was composed of clinical nurse consultants, a physiotherapist, a speech pathologist, a dietician, a social worker and medical officers. Data were collected through a focus group and one-to-one, semi-structured in-depth interviews, and thematic analysis was used to analyse experiences of tracheostomy team members. Qualitative analysis resulted in two main themes: interprofessional protocol development and implementation; and interprofessional decision-making. Our findings suggest that tracheostomy teams enhance consistency of care through the development and implementation of interprofessional protocol. In addition, such team allow more efficient and effective communication and decision-making consequent to the collocation of diverse professionals. These findings provide new insight into the role of tracheostomy teams in successfully implementing complex protocol and the explanatory mechanisms through which interprofessional teams may generate positive outcomes for tracheostomy patients. Copyright © 2012. Published by Elsevier Ltd.

Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

PubMed

Munshi, Medha N; Florez, Hermes; Huang, Elbert S; Kalyani, Rita R; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S; Taveira, Tracey H; Haas, Linda B

2016-02-01

Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study: Design and rationale of a cluster randomized controlled trial of Tai Chi in senior housing.

PubMed

Wayne, Peter M; Gagnon, Margaret M; Macklin, Eric A; Travison, Thomas G; Manor, Bradley; Lachman, Margie; Thomas, Cindy P; Lipsitz, Lewis A

2017-09-01

Supporting the health of growing numbers of frail older adults living in subsidized housing requires interventions that can combat frailty, improve residents' functional abilities, and reduce their health care costs. Tai Chi is an increasingly popular multimodal mind-body exercise that incorporates physical, cognitive, social, and meditative components in the same activity and offers a promising intervention for ameliorating many of the conditions that lead to poor health and excessive health care utilization. The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study is an ongoing two-arm cluster randomized, attention-controlled trial designed to examine the impact of Tai Chi on functional indicators of health and health care utilization. We are enrolling participants from 16 urban subsidized housing facilities (n=320 participants), conducting the Tai Chi intervention or education classes and social calls (attention control) in consenting subjects within the facilities for one year, and assessing these subjects at baseline, 6months, and 1year. Physical function (quantified by the Short Physical Performance Battery), and health care utilization (emergency visits, hospitalizations, skilled nursing and nursing home admissions), assessed at 12months are co-primary outcomes. Our discussion highlights our strategy to balance pragmatic and explanatory features into the study design, describes efforts to enhance site recruitment and participant adherence, and summarizes our broader goal of post study dissemination if effectiveness and cost-effectiveness are demonstrated, by preparing training and protocol manuals for use in housing facilities across the U.S. Copyright © 2017 Elsevier Inc. All rights reserved.

Correctional nursing: a study protocol to develop an educational intervention to optimize nursing practice in a unique context.

PubMed

Almost, Joan; Gifford, Wendy A; Doran, Diane; Ogilvie, Linda; Miller, Crystal; Rose, Don N; Squires, Mae

2013-06-21

Nurses are the primary healthcare providers in correctional facilities. A solid knowledge and expertise that includes the use of research evidence in clinical decision making is needed to optimize nursing practice and promote positive health outcomes within these settings. The institutional emphasis on custodial care within a heavily secured, regulated, and punitive environment presents unique contextual challenges for nursing practice. Subsequently, correctional nurses are not always able to obtain training or ongoing education that is required for broad scopes of practice. The purpose of the proposed study is to develop an educational intervention for correctional nurses to support the provision of evidence-informed care. A two-phase mixed methods research design will be used. The setting will be three provincial correctional facilities. Phase one will focus on identifying nurses' scope of practice and practice needs, describing work environment characteristics that support evidence-informed practice and developing the intervention. Semi-structured interviews will be completed with nurses and nurse managers. To facilitate priorities for the intervention, a Delphi process will be used to rank the learning needs identified by participants. Based on findings, an online intervention will be developed. Phase two will involve evaluating the acceptability and feasibility of the intervention to inform a future experimental design. The context of provincial correctional facilities presents unique challenges for nurses' provision of care. This study will generate information to address practice and learning needs specific to correctional nurses. Interventions tailored to barriers and supports within specific contexts are important to enable nurses to provide evidence-informed care.

Evolution of the Lunar Receiving Laboratory to the Astromaterial Sample Curation Facility: Technical Tensions Between Containment and Cleanliness, Between Particulate and Organic Cleanliness

NASA Technical Reports Server (NTRS)

Allton, J. H.; Zeigler, R. A.; Calaway, M. J.

2016-01-01

The Lunar Receiving Laboratory (LRL) was planned and constructed in the 1960s to support the Apollo program in the context of landing on the Moon and safely returning humans. The enduring science return from that effort is a result of careful curation of planetary materials. Technical decisions for the first facility included sample handling environment (vacuum vs inert gas), and instruments for making basic sample assessment, but the most difficult decision, and most visible, was stringent biosafety vs ultra-clean sample handling. Biosafety required handling of samples in negative pressure gloveboxes and rooms for containment and use of sterilizing protocols and animal/plant models for hazard assessment. Ultra-clean sample handling worked best in positive pressure nitrogen environment gloveboxes in positive pressure rooms, using cleanable tools of tightly controlled composition. The requirements for these two objectives were so different, that the solution was to design and build a new facility for specific purpose of preserving the scientific integrity of the samples. The resulting Lunar Curatorial Facility was designed and constructed, from 1972-1979, with advice and oversight by a very active committee comprised of lunar sample scientists. The high precision analyses required for planetary science are enabled by stringent contamination control of trace elements in the materials and protocols of construction (e.g., trace element screening for paint and flooring materials) and the equipment used in sample handling and storage. As other astromaterials, especially small particles and atoms, were added to the collections curated, the technical tension between particulate cleanliness and organic cleanliness was addressed in more detail. Techniques for minimizing particulate contamination in sample handling environments use high efficiency air filtering techniques typically requiring organic sealants which offgas. Protocols for reducing adventitious carbon on sample handling surfaces often generate particles. Further work is needed to achieve both minimal particulate and adventitious carbon contamination. This paper will discuss these facility topics and others in the historical context of nearly 50 years' curation experience for lunar rocks and regolith, meteorites, cosmic dust, comet particles, solar wind atoms, and asteroid particles at Johnson Space Center.

Development of a neuro early mobilisation protocol for use in a neuroscience intensive care unit.

PubMed

Brissie, Megan A; Zomorodi, Meg; Soares-Sardinha, Sharmila; Jordan, J Dedrick

2017-10-01

Through evaluation of the literature and working with a team of multidisciplinary healthcare providers, our objective was to refine an interprofessional Neuro Early Mobilisation Protocol for complex patients in the Neuroscience Intensive Care Unit. Using the literature as a guide, key stakeholders, from multiple professions, designed and refined a Neuro Early Mobilisation Protocol. This project took place at a large academic medical center in the southeast United States classified as both a Level I Trauma Center and Comprehensive Stroke Center. Goals for protocol development were to: (1) simplify the protocol to allow for ease of use, (2) make the protocol more generalizable to the patient population cared for in the Neuroscience Intensive Care Unit, (3) receive feedback from those using the original protocol on ways to improve the protocol and (4) ensure patients were properly screened for inclusion and exclusion in the protocol. Using expert feedback and the evidence, an evidence-based Neuro Early Mobilisation Protocol was created for use with all patients in the Neuroscience Intensive Care Unit. Future work will consist of protocol implementation and evaluation in order to increase patient mobilisation in the Neuroscience Intensive Care Unit. Copyright © 2017 Elsevier Ltd. All rights reserved.

An efficacious oral health care protocol for immunocompromised patients.

PubMed

Solomon, C S; Shaikh, A B; Arendorf, T M

1995-01-01

A twice-weekly oral and perioral examination was provided to 120 patients receiving antineoplastic therapy. Sixty patients were monitored while following the traditional hospital oral care protocol (chlorhexidine, hydrogen peroxide, sodium bicarbonate, thymol glycol, benzocaine mouthrinse, and nystatin). The mouth care protocol was then changed (experimental protocol = chlorhexidine, benzocaine lozenges, amphotericin B lozenges), and patients were monitored until the sample size matched that of the hospital mouth care regime. There was a statistically significant reduction in oral complications upon introduction and maintenance of the experimental protocol.

Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo

PubMed Central

2009-01-01

Background Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP). Methods Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities. Results None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC. Conclusions Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for health providers in RH and infection prevention; 4) improving referral systems to the hospitals; 5) advocating for changes in national RH policies and protocols; and 6) providing technical assistance for monitoring and evaluation of key RH indicators. Together, these initiatives will improve the quality and accessibility of RH services in the DRC - services which are urgently needed and to which Congolese women are entitled by international human rights law. PMID:20025757

Postrape care services to minors in Kenya: are the services healing or hurting survivors?

PubMed Central

Wangamati, Cynthia Khamala; Combs Thorsen, Viva; Gele, Abdi Ali; Sundby, Johanne

2016-01-01

Child sexual abuse is a global problem and a growing concern in Sub-Saharan Africa. It constitutes a profound violation of human rights. To address this problem, Kenya has established the Sexual Offences Act. In addition, Kenya has developed national guidelines on the management of sexual violence to grant minors access to health care. However, little is known about the experiences of sexually abused minors when they interact with the health and legal system. Accordingly, this study uses a triangulation of methods in the follow-up of two adolescent girls. Health records were reviewed, interactions between the girls and service providers were observed, in-depth interviews were conducted with the girls, and informal discussions were held with guardians and service providers. Findings indicated that the minors’ rights to quality health care and protection were being violated. Protocols on postrape care delivery were unavailable. Furthermore, the health facility was ill equipped and poorly stocked. Health providers showed little regard for informed assent, confidentiality, and privacy while offering postrape care. Similarly, in the justice system, processing was met with delays and unresponsive law enforcement. Health providers and police officers are in grave need of training in sexual and gender-based violence, its consequences, comprehensive postrape care, and sexual and reproductive health rights to ensure the protection of minors’ rights. Health administrators should ensure that facilities are equipped with skilled health providers, medical supplies, and equipment. Additionally, policies on the protection and care of sexually abused minors in Kenya require amendment. PMID:27445506

Scaled-Up Mobile Phone Intervention for HIV Care and Treatment: Protocol for a Facility Randomized Controlled Trial.

PubMed

L'Engle, Kelly L; Green, Kimberly; Succop, Stacey M; Laar, Amos; Wambugu, Samuel

2015-01-23

Adherence to prevention, care, and treatment recommendations among people living with HIV (PLHIV) is a critical challenge. Yet good clinical outcomes depend on consistent, high adherence to antiretroviral therapy (ART) regimens. Mobile phones offer a promising means to improve patient adherence and health outcomes. However, limited information exists on the impact that mobile phones for health (mHealth) programs have on ART adherence or the behavior change processes through which such interventions may improve patient health, particularly among ongoing clients enrolled in large public sector HIV service delivery programs and key populations such as men who have sex with men (MSM) and female sex workers (FSW). Our aim is to evaluate an mHealth intervention where text message reminders are used as supportive tools for health providers and as motivators and reminders for ART clients to adhere to treatment and remain linked to care in Ghana. Using an implementation science framework, we seek to: (1) evaluate mHealth intervention effects on patient adherence and health outcomes, (2) examine the delivery of the mHealth intervention for improving HIV care and treatment, and (3) assess the cost-effectiveness of the mHealth intervention. The 36-month study will use a facility cluster randomized controlled design (intervention vs standard of care) for evaluating the impact of mHealth on HIV care and treatment. Specifically, we will look at ART adherence, HIV viral load, retention in care, and condom use at 6 and 12-month follow-up. In addition, participant adoption and satisfaction with the program will be measured. This robust methodology will be complemented by qualitative interviews to obtain feedback on the motivational qualities of the program and benefits and challenges of delivery, especially for key populations. Cost-effectiveness will be assessed using incremental cost-effectiveness ratios, with health effects expressed in terms of viral load suppression and costs of resources used for the intervention. This study and protocol was fully funded, but it was terminated prior to review from ethics boards and study implementation. This cluster-RCT would have provided insights into the health effects, motivational qualities, and cost-effectiveness of mHealth interventions for PLHIV in public sector settings. We are seeking funding from alternate sources to implement the trial.

Study protocol for promoting respectful maternity care initiative to assess, measure and design interventions to reduce disrespect and abuse during childbirth in Kenya

PubMed Central

2013-01-01

Background Increases in the proportion of facility-based deliveries have been marginal in many low-income countries in the African region. Preliminary clinical and anthropological evidence suggests that one major factor inhibiting pregnant women from delivering at facility is disrespectful and abusive treatment by health care providers in maternity units. Despite acknowledgement of this behavior by policy makers, program staff, civil society groups and community members, the problem appears to be widespread but prevalence is not well documented. Formative research will be undertaken to test the reliability and validity of a disrespect and abuse (D&A) construct and to then measure the prevalence of disrespect and abuse suffered by clinic clients and the general population. Methods/design A quasi-experimental design will be followed with surveys at twelve health facilities in four districts and one large maternity hospital in Nairobi and areas before and after the introduction of disrespect and abuse (D&A) interventions. The design is aimed to control for potential time dependent confounding on observed factors. Discussion This study seeks to conduct implementation research aimed at designing, testing, and evaluating an approach to significantly reduce disrespectful and abusive (D&A) care of women during labor and delivery in facilities. Specifically the proposed study aims to: (i) determine the manifestations, types and prevalence of D&A in childbirth (ii) develop and validate tools for assessing D&A (iii) identify and explore the potential drivers of D&A (iv) design, implement, monitor and evaluate the impact of one or more interventions to reduce D&A and (v) document and assess the dynamics of implementing interventions to reduce D&A and generate lessons for replication at scale. PMID:23347548

The Uganda Newborn Study (UNEST): an effectiveness study on improving newborn health and survival in rural Uganda through a community-based intervention linked to health facilities - study protocol for a cluster randomized controlled trial

PubMed Central

2012-01-01

Background Reducing neonatal-related deaths is one of the major bottlenecks to achieving Millennium Development Goal 4. Studies in Asia and South America have shown that neonatal mortality can be reduced through community-based interventions, but these have not been adapted to scalable intervention packages for sub-Saharan Africa where the culture, health system and policy environment is different. In Uganda, health outcomes are poor for both mothers and newborn babies. Policy opportunities for neonatal health include the new national Health Sector Strategic Plan, which now prioritizes newborn health including use of a community model through Village Health Teams (VHT). The aim of the present study is to adapt, develop and cost an integrated maternal-newborn care package that links community and facility care, and to evaluate its effect on maternal and neonatal practices in order to inform policy and scale-up in Uganda. Methods/Design Through formative research around evidence-based practices, and dialogue with policy and technical advisers, we constructed a home-based neonatal care package implemented by the responsible VHT member, effectively a Community Health Worker (CHW). This CHW was trained to identify pregnant women and make five home visits - two before and three just after birth - so that linkages will be made to facility care and targeted messages for home-care and care-seeking delivered. The project is improving care in health units to provide standardized care for the mother and the newborn in both intervention and comparison areas. The study is taking place in a new Demographic Surveillance Site in two rural districts, Iganga and Mayuge, in Uganda. It is a two-arm cluster randomized controlled design with 31 intervention and 32 control areas (villages). The comparison parishes receive the standard care already being provided by the district, but to the intervention villages are added a system for CHWs to visit the mother five times in her home during pregnancy and the neonatal period. Both areas benefit from a standardized strengthening of facility care for mothers and neonates. Discussion UNEST is designed to directly feed into the operationalization of maternal and newborn care in the national VHT strategy, thereby helping to inform scale-up in rural Uganda. The study is registered as a randomized controlled trial, number ISRCTN50321130. PMID:23153395

Vital Signs Directed Therapy: Improving Care in an Intensive Care Unit in a Low-Income Country.

PubMed

Baker, Tim; Schell, Carl Otto; Lugazia, Edwin; Blixt, Jonas; Mulungu, Moses; Castegren, Markus; Eriksen, Jaran; Konrad, David

2015-01-01

Global Critical Care is attracting increasing attention. At several million deaths per year, the worldwide burden of critical illness is greater than generally appreciated. Low income countries (LICs) have a disproportionally greater share of critical illness, and yet critical care facilities are scarce in such settings. Routines utilizing abnormal vital signs to identify critical illness and trigger medical interventions have become common in high-income countries but have not been investigated in LICs. The aim of the study was to assess whether the introduction of a vital signs directed therapy protocol improved acute care and reduced mortality in an Intensive Care Unit (ICU) in Tanzania. Prospective, before-and-after interventional study in the ICU of a university hospital in Tanzania. A context-appropriate protocol that defined danger levels of severely abnormal vital signs and stipulated acute treatment responses was implemented in a four week period using sensitisation, training, job aids, supervision and feedback. Acute treatment of danger signs at admission and during care in the ICU and in-hospital mortality were compared pre and post-implementation using regression models. Danger signs from 447 patients were included: 269 pre-implementation and 178 post-implementation. Acute treatment of danger signs was higher post-implementation (at admission: 72.9% vs 23.1%, p<0.001; in ICU: 16.6% vs 2.9%, p<0.001). A danger sign was five times more likely to be treated post-implementation (Prevalence Ratio (PR) 4.9 (2.9-8.3)). Intravenous fluids were given in response to 35.0% of hypotensive episodes post-implementation, as compared to 4.1% pre-implementation (PR 6.4 (2.5-16.2)). In patients admitted with hypotension, mortality was lower post-implementation (69.2% vs 92.3% p = 0.02) giving a numbers-needed-to-treat of 4.3. Overall in-hospital mortality rates were unchanged (49.4% vs 49.8%, p = 0.94). The introduction of a vital signs directed therapy protocol improved the acute treatment of abnormal vital signs in an ICU in a low-income country. Mortality rates were reduced for patients with hypotension at admission but not for all patients.

Practice variation in the structure of stroke rehabilitation in four rehabilitation centres in the Netherlands.

PubMed

Groeneveld, Iris F; Meesters, Jorit J L; Arwert, Henk J; Roux-Otter, Nienke; Ribbers, Gerard M; van Bennekom, Coen A M; Goossens, Paulien H; Vliet Vlieland, Thea P M

2016-03-01

To describe practice variation in the structure of stroke rehabilitation in 4 specialized multidisciplinary rehabilitation centres in the Netherlands. A multidisciplinary expert group formulated a set of 23 elements concerning the structure of inpatient and outpatient stroke rehabilitation, categorized into 4 domains: admission-related (n = 7), treatment-related (n = 10), client involvement-related (n = 2), and facilities-related (n = 4). In a cross-sectional study in 4 rehabilitation centres data on the presence and content of these elements were abstracted from treatment programmes and protocols. In a structured expert meeting consensus was reached on the presence of practice variation per element. Practice variation was observed in 22 of the 23 structure elements. The element "strategies for patient involvement" appeared similar in all rehabilitation centres, whereas differences were found in the elements regarding admission, exclusion and discharge criteria, patient subgroups, care pathways, team meetings, clinical assessments, maximum time to admission, aftercare and return to work modules, health professionals, treatment facilities, and care-giver involvement. Practice variation was found in a wide range of aspects of the structure of stroke rehabilitation.

Improvement in Total Joint Replacement Quality Metrics: Year One Versus Year Three of the Bundled Payments for Care Improvement Initiative.

PubMed

Dundon, John M; Bosco, Joseph; Slover, James; Yu, Stephen; Sayeed, Yousuf; Iorio, Richard

2016-12-07

In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge. The goal for this initiative is to improve patient care and quality through a patient-centered approach with increased care coordination supported through payment innovation. Length of stay (LOS), readmissions, discharge disposition, and cost per episode of care were analyzed for year 3 compared with year 1 of the initiative. Multiple programs were implemented after the first year to improve performance metrics: a surgeon-directed preoperative risk-factor optimization program, enhanced care coordination and home services, a change in venous thromboembolic disease (VTED) prophylaxis to a risk-stratified protocol, infection-prevention measures, a continued emphasis on discharge to home rather than to an inpatient facility, and a quality-dependent gain-sharing program among surgeons. There were 721 Medicare primary total joint arthroplasty patients in year 1 and 785 in year 3; their data were compared. The average hospital LOS decreased from 3.58 to 2.96 days. The rate of discharge to an inpatient facility decreased from 44% to 28%. The 30-day all-cause readmission rate decreased from 7% to 5%; the 60-day all-cause readmission rate decreased from 11% to 6%; and the 90-day all-cause readmission rate decreased from 13% to 8%. The average 90-day cost per episode decreased by 20%. Mid-term results from the implementation of Medicare BPCI Model 2 for primary total joint arthroplasty demonstrated decreased LOS, decreased discharges to inpatient facilities, decreased readmissions, and decreased cost of the episode of care in year 3 compared with year 1, resulting in increased value to all stakeholders involved in this initiative and suggesting that continued improvement over initial gains is possible.

Exercise Interventions for Preventing Falls Among Older People in Care Facilities: A Meta-Analysis.

PubMed

Lee, Seon Heui; Kim, Hee Sun

2017-02-01

Falls in older people are a common problem, often leading to considerable morbidity. However, the overall effect of exercise interventions on fall prevention in care facilities remains controversial. To evaluate the effectiveness of exercise interventions on the rate of falls and number of fallers in care facilities. A meta-analysis was conducted of randomized controlled trials published up to December 2014. Eight databases were searched including Ovid-Medline, Embase, CINAHL, Cochrane Library, KoreaMed, KMbase, KISS, and KisTi. Two investigators independently extracted data and assessed study quality. Twenty-one studies were selected, that included 5,540 participants. Fifteen studies included exercise as a single intervention, whereas the remaining six included exercise combined with two or more fall interventions tailored to each resident's fall risk (i.e., medication review, environmental modification or staff education). Meta-analysis showed that exercise had a preventive effect on the rate of falls (risk ratio [RR] 0.81, 95% CI 0.68-0.97). This effect was stronger when exercise combined with other fall interventions on the rate of falls (RR 0.61, 95% CI 0.52-0.72) and on the number of fallers (RR 0.85, 95% CI 0.77-0.95). Exercise interventions including balance training (i.e., gait, balance, and functional training; or balance and strength) resulted in reduced the rate of falls. Sensitivity analyses indicated that exercise interventions resulted in reduced numbers of recurrent fallers (RR 0.71, 95% CI 0.53-0.97). This review provides an important basis for developing evidence-based exercise intervention protocols for older people living in care facilities. Exercise programs, which are combined with tailored other fall interventions and challenge balance training to improve balance skills, should be applied to frail older people with functional limitations in institutional settings. © 2016 Sigma Theta Tau International.

Driving through: postpartum care during World War II.

PubMed Central

Temkin, E

1999-01-01

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

A randomized trial of protocol-based care for early septic shock.

PubMed

Yealy, Donald M; Kellum, John A; Huang, David T; Barnato, Amber E; Weissfeld, Lisa A; Pike, Francis; Terndrup, Thomas; Wang, Henry E; Hou, Peter C; LoVecchio, Frank; Filbin, Michael R; Shapiro, Nathan I; Angus, Derek C

2014-05-01

In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock, mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal-directed therapy (EGDT), in which intravenous fluids, vasopressors, inotropes, and blood transfusions were adjusted to reach central hemodynamic targets, than among those receiving usual care. We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary. In 31 emergency departments in the United States, we randomly assigned patients with septic shock to one of three groups for 6 hours of resuscitation: protocol-based EGDT; protocol-based standard therapy that did not require the placement of a central venous catheter, administration of inotropes, or blood transfusions; or usual care. The primary end point was 60-day in-hospital mortality. We tested sequentially whether protocol-based care (EGDT and standard-therapy groups combined) was superior to usual care and whether protocol-based EGDT was superior to protocol-based standard therapy. Secondary outcomes included longer-term mortality and the need for organ support. We enrolled 1341 patients, of whom 439 were randomly assigned to protocol-based EGDT, 446 to protocol-based standard therapy, and 456 to usual care. Resuscitation strategies differed significantly with respect to the monitoring of central venous pressure and oxygen and the use of intravenous fluids, vasopressors, inotropes, and blood transfusions. By 60 days, there were 92 deaths in the protocol-based EGDT group (21.0%), 81 in the protocol-based standard-therapy group (18.2%), and 86 in the usual-care group (18.9%) (relative risk with protocol-based therapy vs. usual care, 1.04; 95% confidence interval [CI], 0.82 to 1.31; P=0.83; relative risk with protocol-based EGDT vs. protocol-based standard therapy, 1.15; 95% CI, 0.88 to 1.51; P=0.31). There were no significant differences in 90-day mortality, 1-year mortality, or the need for organ support. In a multicenter trial conducted in the tertiary care setting, protocol-based resuscitation of patients in whom septic shock was diagnosed in the emergency department did not improve outcomes. (Funded by the National Institute of General Medical Sciences; ProCESS ClinicalTrials.gov number, NCT00510835.).

Reliable communication in the presence of failures

NASA Technical Reports Server (NTRS)

Birman, Kenneth P.; Joseph, Thomas A.

1987-01-01

The design and correctness of a communication facility for a distributed computer system are reported on. The facility provides support for fault-tolerant process groups in the form of a family of reliable multicast protocols that can be used in both local- and wide-area networks. These protocols attain high levels of concurrency, while respecting application-specific delivery ordering constraints, and have varying cost and performance that depend on the degree of ordering desired. In particular, a protocol that enforces causal delivery orderings is introduced and shown to be a valuable alternative to conventional asynchronous communication protocols. The facility also ensures that the processes belonging to a fault-tolerant process group will observe consistant orderings of events affecting the group as a whole, including process failures, recoveries, migration, and dynamic changes to group properties like member rankings. A review of several uses for the protocols is the ISIS system, which supports fault-tolerant resilient objects and bulletin boards, illustrates the significant simplification of higher level algorithms made possible by our approach.

The cumulative effect of multiple critical care protocols on length of stay in a geriatric trauma population.

PubMed

Frederickson, Tiffany A; Renner, Catherine Hackett; Swegle, James R; Sahr, Sheryl M

2013-01-01

The elderly individuals are the most rapidly growing cohort within the US population, and a corresponding increase is being seen in elderly trauma patients. Elderly patients are more likely to have a hospital length of stay (LOS) in excess of 10 days. They account for 60% of total ICU days. Length of stay is frequently used as a proxy measure for improvement in injury outcomes, changes in quality of care, and hospital outcomes. Patient care protocols are typically created from evidence-based guidelines that serve to reduce variation in care from patient to patient. Patient care protocols have been found to positively impact patient care with reduced duration of mechanical ventilation, shorter LOS in the ICU and shorter overall hospitalization time, reduced mortality, and reduced health care costs. The following study was designed to assess the impact of the implementation of 4 patient care protocols within an elderly trauma population. We hypothesized that the implementation of these protocols would have a beneficial impact on patient care that could be measured by a decrease in hospital LOS. An archival, retrospective pretest/posttest study was performed on elderly trauma patients. The new protocols helped guide practical changes in care that resulted in a 32% decrease in LOS for our elderly trauma patients which exceeds the 25% decrease found in other studies. Additionally, the "Other" category for each variable was less frequently used in the post-protocol phase than in the pre-protocol phase, suggesting a spillover effect on the level of detail recorded in the patient chart. With less variation in practices in the post-protocol phase, Injury Severity score, and admission systolic blood pressure emerged as significant predictors of LOS.

Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions

PubMed Central

Shams, Tanzila; Zaidat, Osama; Yavagal, Dileep; Xavier, Andrew; Jovin, Tudor; Janardhan, Vallabh

2016-01-01

Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices. PMID:27610118

When there's a heartbeat: miscarriage management in Catholic-owned hospitals.

PubMed

Freedman, Lori R; Landy, Uta; Steinauer, Jody

2008-10-01

As Catholic-owned hospitals merge with or take over other facilities, they impose restrictions on reproductive health services, including abortion and contraceptive services. Our interviews with US obstetrician-gynecologists working in Catholic-owned hospitals revealed that they are also restricted in managing miscarriages. Catholic-owned hospital ethics committees denied approval of uterine evacuation while fetal heart tones were still present, forcing physicians to delay care or transport miscarrying patients to non-Catholic-owned facilities. Some physicians intentionally violated protocol because they felt patient safety was compromised. Although Catholic doctrine officially deems abortion permissible to preserve the life of the woman, Catholic-owned hospital ethics committees differ in their interpretation of how much health risk constitutes a threat to a woman's life and therefore how much risk must be present before they approve the intervention.

Facile and sustainable synthesis of shaped iron oxide nanoparticles: effect of iron precursor salts on the shapes of iron oxides.

PubMed

Sayed, Farheen N; Polshettiwar, Vivek

2015-05-05

A facile and sustainable protocol for synthesis of six different shaped iron oxides is developed. Notably, all the six shapes of iron oxides can be synthesised using exactly same synthetic protocol, by simply changing the precursor iron salts. Several of the synthesised shapes are not reported before. This novel protocol is relatively easy to implement and could contribute to overcome the challenge of obtaining various shaped iron oxides in economical and sustainable manner.

Facile and Sustainable Synthesis of Shaped Iron Oxide Nanoparticles: Effect of Iron Precursor Salts on the Shapes of Iron Oxides

PubMed Central

Sayed, Farheen N.; Polshettiwar, Vivek

2015-01-01

A facile and sustainable protocol for synthesis of six different shaped iron oxides is developed. Notably, all the six shapes of iron oxides can be synthesised using exactly same synthetic protocol, by simply changing the precursor iron salts. Several of the synthesised shapes are not reported before. This novel protocol is relatively easy to implement and could contribute to overcome the challenge of obtaining various shaped iron oxides in economical and sustainable manner. PMID:25939969

The importance of standardized observations to evaluate nutritional care quality in the survey process.

PubMed

Schnelle, John F; Bertrand, Rosanna; Hurd, Donna; White, Alan; Squires, David; Feuerberg, Marvin; Hickey, Kelly; Simmons, Sandra F

2009-10-01

Guidelines written for government surveyors who assess nursing home (NH) compliance with federal standards contain instructions to observe the quality of mealtime assistance. However, these instructions are vague and no protocol is provided for surveyors to record observational data. This study compared government survey staff observations of mealtime assistance quality to observations by research staff using a standardized protocol that met basic standards for accurate behavioral measurement. Survey staff used either the observation instructions in the standard survey process or those written for the revised Quality Improvement Survey (QIS). Trained research staff observed mealtime care in 20 NHs in 5 states during the same time period that survey staff evaluated care in the same facilities, although it could not be determined if survey and research staff observed the same residents during the same meals. Ten NHs were evaluated by government surveyors using the QIS survey instructions and 10 NHs were evaluated by surveyors using the standard survey instructions. Research staff observations using a standardized observation protocol identified a higher proportion of residents receiving inadequate feeding assistance during meals relative to survey staff using either the standard or QIS survey instructions. For example, more than 50% of the residents who ate less than half of their meals based on research staff observation were not offered an alternative to the served meal, and the lack of alternatives, or meal substitutions, was common in all 20 NHs. In comparison, the QIS survey teams documented only 2 instances when meal substitutes were not offered in 10 NHs and the standard survey teams documented no instances in 10 NHs. Standardized mealtime observations by research staff revealed feeding assistance care quality issues in all 20 study NHs. Surveyors following the instructions in either the standard or revised QIS surveys did not detect most of these care quality issues. Survey staff instructions for observation of nutritional care are not clearly written; thus, these instructions do not permit accurate behavioral measurement. These instructions should be revised in consideration of basic principles that guide accurate behavioral measurement and shared with NH providers to enable them to effectively implement quality improvement programs.

Data communication network at the ASRM facility

NASA Technical Reports Server (NTRS)

Moorhead, Robert J., III; Smith, Wayne D.; Nirgudkar, Ravi; Dement, James

1994-01-01

This three-year project (February 1991 to February 1994) has involved analyzing and helping to design the communication network for the Advanced Solid Rocket Motor (ASRM) facility at Yellow Creek, near Iuka, MS. The principal concerns in the analysis were the bandwidth (both on average and in the worst case) and the expandability of the network. As the communication network was designed and modified, a careful evaluation of the bandwidth of the network, the capabilities of the protocol, and the requirements of the controllers and computers on the network was required. The overall network, which was heterogeneous in protocol and bandwidth, needed to be modeled, analyzed, and simulated to obtain some degree of confidence in its performance capabilities and in its performance under nominal and heavy loads. The results of our analysis did have an impact on the design and operation of the ASRM facility. During 1993 we analyzed many configurations of this basic network structure. The analyses are described in detail in Section 2 and 3 herein. Section 2 reports on an analysis of the whole network. The preliminary results of that research indicated that the most likely bottleneck as the network traffic increased would be the hubs. Thus a study of Cabletron hubs was initiated. The results of that study are in Section 3. Section 4 herein reports on the final network configuration analyzed. When the ASRM facility was mothballed in December of 1993, this was basically the planned and partially installed network. A briefing was held at NASA/MSFC on December 7, 1993, at which time our final analysis and conclusions were disseminated. This report contains a written record of most of the information disseminated at that briefing.

Current approaches for assessment and treatment of women with early miscarriage or ectopic pregnancy in Nigeria: a case for dedicated early pregnancy services.

PubMed

Iyoke, C A; Ugwu, O G; Ezugwu, F O; Onah, H E; Agbata, A T; Ajah, L C

2014-01-01

It has been suggested that women with early miscarriage or ectopic pregnancy are best cared for in dedicated units which offer rapid and definitive ultrasonographic and biochemical assessment at the initial review of the patient. To describe the current protocols for the assessment and treatment of women with early miscarriage or ectopic pregnancy as reported by Nigerian Gynecologists, and determine if dedicated early pregnancy services such as Early Pregnancy Assessment Units could be introduced to improve care. A cross-sectional survey of Nigerian Gynecologists attending the 46 th Annual Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria. This was a questionnaire-based study. Data analysis was by descriptive statistics using Statistical Package for the Social Sciences software, version 17.0 for Windows (IBM Corporation, Armonk, NY, USA). A total of 232 gynecologists working in 52 different secondary and tertiary health facilities participated in the survey. The mean age of the respondents was 42.6 ± 9.1 years (range 28-70 years). The proportion of gynecologists reporting that women with early miscarriage or ectopic pregnancy were first managed within the hospital general emergency room was 92%. The mean reported interval between arrival in hospital and first ultrasound scan was 4.9 ± 1.4 hours (range ½-8 hours). Transvaginal scan was stated as the routine initial imaging investigation by only 17.2% of respondents. Approximately 94.8% of respondents felt that dedicated early pregnancy services were feasible and should be introduced to improve the care of women with early miscarriage and ectopic pregnancy. Reported protocols for managing early miscarriage or ectopic pregnancy in many health facilities in Nigeria appear to engender unnecessary delays and avoidable costs, and dedicated early pregnancy services could be both useful and feasible in addressing these shortcomings in the way women with such conditions are currently managed.

Protocol for the evaluation of a quality-based pay for performance scheme in Liberia.

PubMed

Bawo, Luke; Leonard, Kenneth L; Mohammed, Rianna

2015-01-13

Improving the quality of care at hospitals is a key next step in rebuilding Liberia's health system. In order to improve the efficiency, effectiveness, and quality of care at the secondary hospital level, the country is developing a system to upgrade health worker skills and competencies, and shifting towards improved provider accountability for results, including a Graduate Medical Residency Program (GMRP) and provider accountability for improvements in quality through performance-based financing (PBF) at the hospital level. This document outlines the protocol for the impact evaluation of the hospital improvement program. The evaluation will provide an estimate of the impact of the project and investigate the mechanism for success in a way that can provide general lessons about the quality of health care in low-income countries. The evaluation aims 1) to provide the best possible estimate of program impact and 2) to quantitatively describe the changes that took place within facilities as a result of the program. In particular, the impact evaluation focuses on the changes in human resources within the hospitals. As such, we use a three-period intensive evaluation of treated and matched comparison hospitals to see how services change in treated hospitals as well as a continuous data collection effort to track the activities of individual health workers within treated hospitals. We are particularly interested in understanding how facilities met quality targets. Did they bring in new health workers with higher qualifications? Did they improve the knowledge or competence of their existing staff? Did they improve the availability of medicines and equipment so that the capacities of existing health workers were improved? Did they address the motivation of health workers so that individuals with the same competence and capacity were able to provide higher quality? And, if they did improve quality, did patients notice?

Protocol for development and validation of a context-appropriate tool for assessing organisational readiness for change in primary health clinics in South Africa

PubMed Central

Sorsdahl, Katherine; Lombard, Carl; Petersen-Williams, Petal; Myers, Bronwyn

2018-01-01

Introduction A large treatment gap for common mental disorders (such as depression) exists in South Africa. Comorbidity with other chronic diseases, including HIV and diseases of lifestyle, is an increasing public health concern globally. Currently, primary health facilities as points of care for those with chronic disease provide limited services for common mental disorders. Assessing organisational readiness for change (ORC) towards adopting health innovations (such as mental health services) using contextually appropriate measures is needed to facilitate implementation of these services. This study aims to investigate the validity of the Texas Christian University Organisational Readiness for Change (TCU-ORC) scale in the South African context. Subsequently, we will develop a shortened version of this scale. This study is nested within Project MIND, a multiyear randomised controlled trial that is testing two different approaches for integrating counselling for common mental disorders into chronic disease care. Although the modified, contextually appropriate ORC measure resulting from the proposed study will be developed in the context of integrating mental health into primary healthcare services, the potential for the tool to be generalised to further understanding barriers to any change being implemented in primary care settings is high. Methods and analysis We will establish internal consistency (Cronbach’s alpha coefficients), test-retest reliability (intraclass correlation coefficient) and construct validity of the long-form TCU-ORC questionnaire. Survey data will be collected from 288 clinical, management and operational staff from 24 primary health facilities where the Project MIND trial is implemented. A modified Delphi approach will assess the content validity of the TCU-ORC items and identify areas for potential adaptation and item reduction. Ethics and dissemination Ethical approval has been granted by the South African Medical Research Council (Protocol ID EC004-2-2015, amendment of 20 August 2017). Results will be submitted to peer-reviewed journals relevant to implementation and health systems strengthening. PMID:29632084

Rapid assessment of Ebola infection prevention and control needs--six districts, Sierra Leone, October 2014.

PubMed

Pathmanathan, Ishani; O'Connor, Katherine A; Adams, Monica L; Rao, Carol Y; Kilmarx, Peter H; Park, Benjamin J; Mermin, Jonathan; Kargbo, Brima; Wurie, Alie H; Clarke, Kevin R

2014-12-12

As of October 31, 2014, the Sierra Leone Ministry of Health and Sanitation had reported 3,854 laboratory-confirmed cases of Ebola virus disease (Ebola) since the outbreak began in May 2014; 199 (5.2%) of these cases were among health care workers. Ebola infection prevention and control (IPC) measures are essential to interrupt Ebola virus transmission and protect the health workforce, a population that is disproportionately affected by Ebola because of its increased risk of exposure yet is essential to patient care required for outbreak control and maintenance of the country's health system at large. To rapidly identify existing IPC resources and high priority outbreak response needs, an assessment by CDC Ebola Response Team members was conducted in six of the 14 districts in Sierra Leone, consisting of health facility observations and structured interviews with key informants in facilities and government district health management offices. Health system gaps were identified in all six districts, including shortages or absence of trained health care staff, personal protective equipment (PPE), safe patient transport, and standardized IPC protocols. Based on rapid assessment findings and key stakeholder input, priority IPC actions were recommended. Progress has since been made in developing standard operating procedures, increasing laboratory and Ebola treatment capacity and training the health workforce. However, further system strengthening is needed. In particular, a successful Ebola outbreak response in Sierra Leone will require an increase in coordinated and comprehensive district-level IPC support to prevent ongoing Ebola virus transmission in household, patient transport, and health facility settings.

Does incorporation of a clinical support template in the electronic medical record improve capture of wound care data in a cohort of veterans with diabetic foot ulcers?

PubMed

Lowe, Jeanne R; Raugi, Gregory J; Reiber, Gayle E; Whitney, Joanne D

2013-01-01

The purpose of this cohort study was to evaluate the effect of a 1-year intervention of an electronic medical record wound care template on the completeness of wound care documentation and medical coding compared to a similar time interval for the fiscal year preceding the intervention. From October 1, 2006, to September 30, 2007, a "good wound care" intervention was implemented at a rural Veterans Affairs facility to prevent amputations in veterans with diabetes and foot ulcers. The study protocol included a template with foot ulcer variables embedded in the electronic medical record to facilitate data collection, support clinical decision making, and improve ordering and medical coding. The intervention group showed significant differences in complete documentation of good wound care compared to the historic control group (χ = 15.99, P < .001), complete documentation of coding for diagnoses and procedures (χ = 30.23, P < .001), and complete documentation of both good wound care and coding for diagnoses and procedures (χ = 14.96, P < .001). An electronic wound care template improved documentation of evidence-based interventions and facilitated coding for wound complexity and procedures.

The value of intervening for intimate partner violence in South African primary care: project evaluation

PubMed Central

Mash, Robert James

2011-01-01

Objectives Intimate partner violence (IPV) is an important contributor to the burden of disease in South Africa. Evidence-based approaches to IPV in primary care are lacking. This study evaluated a project that implemented a South African protocol for screening and managing IPV. This article reports primarily on the benefits of this intervention from the perspective of women IPV survivors. Design This was a project evaluation involving two urban and three rural primary care facilities. Over 4–8 weeks primary care providers screened adult women for a history of IPV within the previous 24 months and offered referral to the study nurse. The study nurse assessed and managed the women according to the protocol. Researchers interviewed the participants 1 month later to ascertain adherence to their care plan and their views on the intervention. Results In total, 168 women were assisted and 124 (73.8%) returned for follow-up. Emotional (139, 82.7%), physical (115, 68.5%), sexual (72, 42.9%) and financial abuse (72, 42.9%) was common and 114 (67.9%) were at high/severe risk of harm. Adherence to the management plan ranged from testing for syphilis 10/25 (40.0%) to consulting a psychiatric nurse 28/58 (48.3%) to obtaining a protection order 28/28 (100.0%). Over 75% perceived all aspects of their care as helpful, except for legal advice from a non-profit organisation. Women reported significant benefits to their mental health, reduced alcohol abuse, improved relationships, increased self-efficacy and reduced abusive behaviour. Two characteristics seemed particularly important: the style of interaction with the nurse and the comprehensive nature of the assessment. Conclusion Female IPV survivors in primary care experience benefit from an empathic, comprehensive approach to assessing and assisting with the clinical, mental, social and legal aspects. Primary care managers should find ways to integrate this into primary care services and evaluate it further. PMID:22146888

The global maternal sepsis study and awareness campaign (GLOSS): study protocol.

PubMed

Bonet, Mercedes; Souza, Joao Paulo; Abalos, Edgardo; Fawole, Bukola; Knight, Marian; Kouanda, Seni; Lumbiganon, Pisake; Nabhan, Ashraf; Nadisauskiene, Ruta; Brizuela, Vanessa; Metin Gülmezoglu, A

2018-01-30

Maternal sepsis is the underlying cause of 11% of all maternal deaths and a significant contributor to many deaths attributed to other underlying conditions. The effective prevention, early identification and adequate management of maternal and neonatal infections and sepsis can contribute to reducing the burden of infection as an underlying and contributing cause of morbidity and mortality. The objectives of the Global Maternal Sepsis Study (GLOSS) include: the development and validation of identification criteria for possible severe maternal infection and maternal sepsis; assessment of the frequency of use of a core set of practices recommended for prevention, early identification and management of maternal sepsis; further understanding of mother-to-child transmission of bacterial infection; assessment of the level of awareness about maternal and neonatal sepsis among health care providers; and establishment of a network of health care facilities to implement quality improvement strategies for better identification and management of maternal and early neonatal sepsis. This is a facility-based, prospective, one-week inception cohort study. This study will be implemented in health care facilities located in pre-specified geographical areas of participating countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific. During a seven-day period, all women admitted to or already hospitalised in participating facilities with suspected or confirmed infection during any stage of pregnancy through the 42nd day after abortion or childbirth will be included in the study. Included women will be followed during their stay in the facilities until hospital discharge, death or transfer to another health facility. The maximum intra-hospital follow-up period will be 42 days. GLOSS will provide a set of actionable criteria for identification of women with possible severe maternal infection and maternal sepsis. This study will provide data on the frequency of maternal sepsis and uptake of effective diagnostic and therapeutic interventions in obstetrics in different hospitals and countries. We will also be able to explore links between interventions and maternal and perinatal outcomes and identify priority areas for action.

Using a retention in care protocol to promote positive health and systems related outcomes.

PubMed

Larbi, Alfred A; Spielberg, Freya; Kamanu Elias, Nnemdi; Athey, Erin; Ogbuawa, Ngozi; Murphy, Nancy

2018-04-18

People living with HIV can experience the full benefits of retention when they are continuously engaged in care. Continuous engagement in care promotes improved adherence to ART and positive health outcomes. An infectious disease clinic has implemented a protocol to primarily improve patient retention. The retrospective, facility-based, costing study took place in an infectious disease clinic in Washington DC. Retention was defined in two ways and over a 12-month period. Micro-costing direct measurement methods were used to collect unit costs in time series. Return on investment accounted for the cost of treatment based on CD4 strata. ROI was expressed in 2016USD. The difference in CD4 and viral load levels between the two periods of analysis were determined for active patients, infected with HIV. The year before the intervention was compared to the year of the intervention. Total treatment expenditure decreased from $2,435,653.00 to $2,283,296.23, resulting in a $152,356.77 gain from investment for the healthcare system over a 12-month investment period. The viral load suppression rate increased from 81 to 95 (p = 0.04) over the investment period. The number of patients in need of HIV related opportunistic infection prophylaxis decreased from 21 to 13 (p = 0.06). Improved immunologic, virologic and healthcare expenditure outcomes can be linked to the quality of retention practice.

Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations.

PubMed

Lavery, Lawrence A; Wunderlich, Robert P; Tredwell, Jeffrey L

2005-10-01

To demonstrate the effectiveness of a diabetic foot disease management program in a managed care organization. We implemented a lower extremity disease management program consisting of screening and treatment protocols for diabetic members in a managed care organization. Screening consisted of evaluation of neuropathy, peripheral vascular disease, deformities, foot pressures, and history of lower extremity pathology. We stratified patients into low and high-risk groups, and implemented preventive or acute care protocols. Utilization was tracked for 28 months and compared to 12 months of historic data prior to implementation of the disease management program. After we implemented the disease management program, the incidence of amputations decreased 47.4% from 12.89 per 1000 diabetics per year to 6.18 (p<0.05). The number of foot-related hospital admissions decreased 37.8% from 22.86 per 1000 members per year to 14.23 (37.8%). The average inpatient length-of-stay (LOS) was reduced 21.7% from 4.75 to 3.72 days (p<0.05). In addition, there was a 69.8% reduction in the number of skilled nursing facility (SNF) admissions per 1000 members per year (Table 1) and a 38.2% reduction in the average SNF LOS from 8.72 to 6.52 days (p<0.05). A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.

How do nurses, midwives and health visitors contribute to protocol-based care? A synthesis of the UK literature.

PubMed

Ilott, Irene; Booth, Andrew; Rick, Jo; Patterson, Malcolm

2010-06-01

To explore how nurses, midwives and health visitors contribute to the development, implementation and audit of protocol-based care. Protocol-based care refers to the use of documents that set standards for clinical care processes with the intent of reducing unacceptable variations in practice. Documents such as protocols, clinical guidelines and care pathways underpin evidence-based practice throughout the world. An interpretative review using the five-stage systematic literature review process. The data sources were the British Nursing Index, CINAHL, EMBASE, MEDLINE and Web of Science from onset to 2005. The Journal of Integrated Care Pathways was hand searched (1997-June 2006). Thirty three studies about protocol-based care in the United Kingdom were appraised using the Qualitative Assessment and Review Instrument (QARI version 2). The literature was synthesized inductively and deductively, using an official 12-step guide for development as a framework for the deductive synthesis. Most papers were descriptive, offering practitioner knowledge and positive findings about a locally developed and owned protocol-based care. The majority were instigated in response to clinical need or service re-design. Development of protocol-based care was a non-linear, idiosyncratic process, with steps omitted, repeated or completed in a different order. The context and the multiple purposes of protocol-based care influenced the development process. Implementation and sustainability were rarely mentioned, or theorised as a change. The roles and activities of nurses were so understated as to be almost invisible. There were notable gaps in the literature about the resource use costs, the engagement of patients in the decision-making process, leadership and the impact of formalisation and new roles on inter-professional relations. Documents that standardise clinical care are part of the history of nursing as well as contemporary evidence-based care and expanded roles. Considering the proliferation and contested nature of protocol-based care, the dearth of literature about the contribution, experience and outcomes for nurses, midwives and health visitors is noteworthy and requires further investigation. (c) 2010 Elsevier Ltd. All rights reserved.

A literature review: polypharmacy protocol for primary care.

PubMed

Skinner, Mary

2015-01-01

The purpose of this literature review is to critically evaluate published protocols on polypharmacy in adults ages 65 and older that are currently used in primary care settings that may potentially lead to fewer adverse drug events. A review of OVID, CINAHL, EBSCO, Cochrane Library, Medline, and PubMed databases was completed using the following key words: protocol, guideline, geriatrics, elderly, older adult, polypharmacy, and primary care. Inclusion criteria were: articles in medical, nursing, and pharmacology journals with an intervention, protocol, or guideline addressing polypharmacy that lead to fewer adverse drug events. Qualitative and quantitative studies were included. Exclusion criteria were: publications prior to the year 1992. A gap exists in the literature. No standardized protocol for addressing polypharmacy in the primary care setting was found. Mnemonics, algorithms, clinical practice guidelines, and clinical strategies for addressing polypharmacy in a variety of health care settings were found throughout the literature. Several screening instruments for use in primary care to assess potentially inappropriate prescription of medications in the elderly, such as the Beers Criteria and the STOPP screening tool, were identified. However, these screening instruments were not included in a standardized protocol to manage polypharmacy in primary care. Polypharmacy in the elderly is a critical problem that may result in adverse drug events such as falls, hospitalizations, and increased expenditures for both the patient and the health care system. No standardized protocols to address polypharmacy specific to the primary care setting were identified in this review of the literature. Given the growing population of elderly in this country and the high number of medications they consume, it is critical to focus on the utilization of a standardized protocol to address the potential harm of polypharmacy in the primary care setting and evaluate its effects on patient outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Enhanced Recovery After Surgery: The Plastic Surgery Paradigm Shift.

PubMed

Bartlett, Erica L; Zavlin, Dmitry; Friedman, Jeffrey D; Abdollahi, Aariane; Rappaport, Norman H

2017-12-14

With a focus on providing high quality care and reducing facility based expenses there has been an evolution in perioperative care by way of enhanced recovery after surgery (ERAS). ERAS allows for a multidisciplinary and multimodal approach to perioperative care which not only expedites recovery but maximizes patient outcomes. This paradigm shift has been generally accepted by most surgical specialties, including plastic surgery. The goal of this study was to evaluate the impact of ERAS on outcomes in cosmetic plastic surgery. A prospective study consisting of phone call questionnaires was designed where patients from two senior plastic surgeons (N.H.R. and J.D.F.) were followed. The treatment group (n = 10) followed an ERAS protocol while the control group (n = 12) followed the traditional recovery after surgery which included narcotic usage. Patients were contacted on postoperative days (POD) 0 through 7+ and surveyed about a number of outcomes measures. The ERAS group demonstrated a significant reduction in postoperative pain on POD 0, 1, 2, and 3 (all P < 0.01). There was also statistically less nausea/vomiting, fatigue/drowsiness, constipation, and hindrance on ambulation compared to the control group (all P < 0.05). Significance was achieved for reduction in fatigue/drowsiness on POD 0 and 1 (P < 0.01), as well as ability to ambulate on POD 0 and 3 (P = 0.044). Lastly, opioid use (P < 0.001) and constipation (P = 0.003) were decreased. ERAS protocols have demonstrated their importance within multiple surgical fields, including cosmetic plastic surgery. The utility lies in the ability to expedite patient's recovery while still providing quality care. This study showed a reduction in postoperative complaints by avoiding narcotics without an increase in complications. Our findings signify the importance of ERAS protocols within cosmetic plastic surgery. 4. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study.

PubMed

Islam, Farzana; Rahman, Aminur; Halim, Abdul; Eriksson, Charli; Rahman, Fazlur; Dalal, Koustuv

2015-06-19

Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals. Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines. The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health conditions and treatments. The quality of healthcare is poor in district and sub-district hospitals in Bangladesh because of the lack of healthcare personnel and logistic support. An integrated quality improvement approach is needed to improve MNH care service in district and sub-district hospitals in Bangladesh.

Health Worker Compliance with a 'Test And Treat' Malaria Case Management Protocol in Papua New Guinea.

PubMed

Pulford, Justin; Smith, Iso; Mueller, Ivo; Siba, Peter M; Hetzel, Manuel W

2016-01-01

The Papua New Guinea (PNG) Department of Health introduced a 'test and treat' malaria case management protocol in 2011. This study assesses health worker compliance with the test and treat protocol on a wide range of measures, examines self-reported barriers to health worker compliance as well as health worker attitudes towards the test and treat protocol. Data were collected by cross-sectional survey conducted in randomly selected primary health care facilities in 2012 and repeated in 2014. The combined survey data included passive observation of current or recently febrile patients (N = 771) and interviewer administered questionnaires completed with health workers (N = 265). Across the two surveys, 77.6% of patients were tested for malaria infection by rapid diagnostic test (RDT) or microscopy, 65.6% of confirmed malaria cases were prescribed the correct antimalarials and 15.3% of febrile patients who tested negative for malaria infection were incorrectly prescribed an antimalarial. Overall compliance with a strictly defined test and treat protocol was 62.8%. A reluctance to test current/recently febrile patients for malaria infection by RDT or microscopy in the absence of acute malaria symptoms, reserving recommended antimalarials for confirmed malaria cases only and choosing to clinically diagnose a malaria infection, despite a negative RDT result were the most frequently reported barriers to protocol compliance. Attitudinal support for the test and treat protocol, as assessed by a nine-item measure, improved across time. In conclusion, health worker compliance with the full test and treat malaria protocol requires improvement in PNG and additional health worker support will likely be required to achieve this. The broader evidence base would suggest any such support should be delivered over a longer period of time, be multi-dimensional and multi-modal.

Health Worker Compliance with a ‘Test And Treat’ Malaria Case Management Protocol in Papua New Guinea

PubMed Central

Pulford, Justin; Smith, Iso; Mueller, Ivo; Siba, Peter M.; Hetzel, Manuel W.

2016-01-01

The Papua New Guinea (PNG) Department of Health introduced a ‘test and treat’ malaria case management protocol in 2011. This study assesses health worker compliance with the test and treat protocol on a wide range of measures, examines self-reported barriers to health worker compliance as well as health worker attitudes towards the test and treat protocol. Data were collected by cross-sectional survey conducted in randomly selected primary health care facilities in 2012 and repeated in 2014. The combined survey data included passive observation of current or recently febrile patients (N = 771) and interviewer administered questionnaires completed with health workers (N = 265). Across the two surveys, 77.6% of patients were tested for malaria infection by rapid diagnostic test (RDT) or microscopy, 65.6% of confirmed malaria cases were prescribed the correct antimalarials and 15.3% of febrile patients who tested negative for malaria infection were incorrectly prescribed an antimalarial. Overall compliance with a strictly defined test and treat protocol was 62.8%. A reluctance to test current/recently febrile patients for malaria infection by RDT or microscopy in the absence of acute malaria symptoms, reserving recommended antimalarials for confirmed malaria cases only and choosing to clinically diagnose a malaria infection, despite a negative RDT result were the most frequently reported barriers to protocol compliance. Attitudinal support for the test and treat protocol, as assessed by a nine-item measure, improved across time. In conclusion, health worker compliance with the full test and treat malaria protocol requires improvement in PNG and additional health worker support will likely be required to achieve this. The broader evidence base would suggest any such support should be delivered over a longer period of time, be multi-dimensional and multi-modal. PMID:27391594

Establishing a cGMP pancreatic islet processing facility: the first experience in Iran.

PubMed

Larijani, Bagher; Arjmand, Babak; Amoli, Mahsa M; Ao, Ziliang; Jafarian, Ali; Mahdavi-Mazdah, Mitra; Ghanaati, Hossein; Baradar-Jalili, Reza; Sharghi, Sasan; Norouzi-Javidan, Abbas; Aghayan, Hamid Reza

2012-12-01

It has been predicted that one of the greatest increase in prevalence of diabetes will happen in the Middle East bear in the next decades. The aim of standard therapeutic strategies for diabetes is better control of complications. In contrast, some new strategies like cell and gene therapy have aimed to cure the disease. In recent years, significant progress has occurred in beta-cell replacement therapies with a progressive improvement of short-term and long term outcomes. In year 2005, considering the impact of the disease in Iran and the promising results of the Edmonton protocol, the funding for establishing a current Good Manufacturing Practice (cGMP) islet processing facility by Endocrinology and Metabolism Research Center was approved by Tehran University of Medical Sciences. Several islet isolations were performed following establishment of cGMP facility and recruitment of all required equipments for process validation and experimental purpose. Finally the first successful clinical islet isolation and transplantation was performed in September 2010. In spite of a high cost of the procedure it is considered beneficial and may prevent long term complications and the costs associated with secondary cares. In this article we will briefly describe our experience in setting up a cGMP islet processing facility which can provide valuable information for regional countries interested to establish similar facilities.

The Effects of Alternative Resuscitation Strategies on Acute Kidney Injury in Patients with Septic Shock.

PubMed

Kellum, John A; Chawla, Lakhmir S; Keener, Christopher; Singbartl, Kai; Palevsky, Paul M; Pike, Francis L; Yealy, Donald M; Huang, David T; Angus, Derek C

2016-02-01

Septic shock is a common cause of acute kidney injury (AKI), and fluid resuscitation is a major part of therapy. To determine if structured resuscitation designed to alter fluid, blood, and vasopressor use affects the development or severity of AKI or outcomes. Ancillary study to the ProCESS (Protocolized Care for Early Septic Shock) trial of alternative resuscitation strategies (two protocols vs. usual care) for septic shock. We studied 1,243 patients and classified AKI using serum creatinine and urine output. We determined recovery status at hospital discharge, examined rates of renal replacement therapy and fluid overload, and measured biomarkers of kidney damage. Among patients without evidence of AKI at enrollment, 37.6% of protocolized care and 38.1% of usual care patients developed kidney injury (P = 0.90). AKI duration (P = 0.59) and rates of renal replacement therapy did not differ between study arms (6.9% for protocolized care and 4.3% for usual care; P = 0.08). Fluid overload occurred in 8.3% of protocolized care and 6.3% of usual care patients (P = 0.26). Among patients with severe AKI, complete and partial recovery was 50.7 and 13.2% for protocolized patients and 49.1 and 13.4% for usual care patients (P = 0.93). Sixty-day hospital mortality was 6.2% for patients without AKI, 16.8% for those with stage 1, and 27.7% for stages 2 to 3. In patients with septic shock, AKI is common and associated with adverse outcomes, but it is not influenced by protocolized resuscitation compared with usual care.

Outbreaks of infections associated with drug diversion by US health care personnel.

PubMed

Schaefer, Melissa K; Perz, Joseph F

2014-07-01

To summarize available information about outbreaks of infections stemming from drug diversion in US health care settings and describe recommended protocols and public health actions. We reviewed records at the Centers for Disease Control and Prevention related to outbreaks of infections from drug diversion by health care personnel in US health care settings from January 1, 2000, through December 31, 2013. Searches of the medical literature published during the same period were also conducted using PubMed. Information compiled included health care setting(s), infection type(s), specialty of the implicated health care professional, implicated medication(s), mechanism(s) of diversion, number of infected patients, number of patients with potential exposure to blood-borne pathogens, and resolution of the investigation. We identified 6 outbreaks over a 10-year period beginning in 2004; all occurred in hospital settings. Implicated health care professionals included 3 technicians and 3 nurses, one of whom was a nurse anesthetist. The mechanism by which infections were spread was tampering with injectable controlled substances. Two outbreaks involved tampering with opioids administered via patient-controlled analgesia pumps and resulted in gram-negative bacteremia in 34 patients. The remaining 4 outbreaks involved tampering with syringes or vials containing fentanyl; hepatitis C virus infection was transmitted to 84 patients. In each of these outbreaks, the implicated health care professional was infected with hepatitis C virus and served as the source; nearly 30,000 patients were potentially exposed to blood-borne pathogens and targeted for notification advising testing. These outbreaks revealed gaps in prevention, detection, and response to drug diversion in US health care facilities. Drug diversion is best prevented by health care facilities having strong narcotics security measures and active monitoring systems. Appropriate response includes assessment of harm to patients, consultation with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies. Published by Elsevier Inc.

42 CFR 456.601 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for mental diseases, or an intermediate care facility. Intermediate care facility includes... hospital, a psychiatric facility, and an intermediate care facility that primarily cares for mental...

Policies and Practices in the Delivery of HIV Services in Correctional Agencies and Facilities: Results from a Multi-Site Survey

PubMed Central

Belenko, Steven; Hiller, Matthew; Visher, Christy; Copenhaver, Michael; O’Connell, Daniel; Burdon, William; Pankow, Jennifer; Clarke, Jennifer; Oser, Carrie

2013-01-01

HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of among CJ-DATS correctional agency partners revealed that HIV policies and practices in prevention, detection and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery gaps in corrections. PMID:24078624

Project Hermes 'Use of Smartphones for Receiving Telemetry and Commanding a Satellite'

NASA Technical Reports Server (NTRS)

Maharaja, Rishabh (Principal Investigator)

2016-01-01

TCPIP protocols can be applied for satellite command, control, and data transfer. Project Hermes was an experiment set-up to test the use of the TCPIP protocol for communicating with a space bound payload. The idea was successfully demonstrated on high altitude balloon flights and on a sub-orbital sounding rocket launched from NASAs Wallops Flight Facility. TCPIP protocols can be applied for satellite command, control, and data transfer. Project Hermes was an experiment set-up to test the use of the TCPIP protocol for communicating with a space bound payload. The idea was successfully demonstrated on high altitude balloon flights and on a sub-orbital sounding rocket launched from NASAs Wallops Flight Facility.

Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain.

PubMed

Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

2015-01-01

The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), p<0.01], and acute coronary syndromes [1 (0.3%) vs. 9 (3.2%), p<0.01], during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14-0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.

Clinical Outcomes and Cost Effectiveness of Accelerated Diagnostic Protocol in a Chest Pain Center Compared with Routine Care of Patients with Chest Pain

PubMed Central

Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

2015-01-01

Aims The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Methods and Results Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), p<0.01], and acute coronary syndromes [1 (0.3%) vs. 9 (3.2%), p<0.01], during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14–0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. Conclusion An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources. PMID:25622029

[Alcohol and drug misuse of the elderly in health care facilities].

PubMed

Kuhn, S; Haasen, C

2012-05-01

A nationwide representative survey was conducted in residential care facilities and facilities offering care for the elderly in their homes (home care facilities) with the aim to estimate the rate of alcohol and drug misuse among this population and to evaluate the way in which nursing staff deal with the problem. A total of 5000 randomly selected facilities were contacted with a 2-page questionnaire. Reliable data were obtained from 550 residential care facilities and from 436 home care facilities. According to the investigated facilities, the mean rate of misuse among the elderly was 14%. Nearly all facilities acknowledge the necessity to react to these facts, but only a quarter of them considered their staff to be sufficiently trained. 38.4% of the residential care facilities and 26.9% of the home care facilities have a concept on how to react to misuse problems. Addiction services are rarely contacted. The prevalence of alcohol and drug misuse among the elderly in health care facilities is high compared to the same age cohort of the total population. The lack of networking between facilities for the elderly and addiction services is remarkable. © Georg Thieme Verlag KG Stuttgart · New York.

Evaluating the effectiveness of selected community-level interventions on key maternal, child health, and prevention of mother-to-child transmission of HIV outcomes in three countries (the ACCLAIM Project): a study protocol for a randomized controlled trial.

PubMed

Woelk, Godfrey B; Kieffer, Mary Pat; Walker, Damilola; Mpofu, Daphne; Machekano, Rhoderick

2016-02-16

Efforts to scale up and improve programs for prevention of mother-to-child transmission of HIV (PMTCT) have focused primarily at the health facility level, and limited attention has been paid to defining an effective set of community interventions to improve demand and uptake of services and retention. Many barriers to PMTCT are also barriers to pregnancy, childbirth, and postnatal care faced by mothers regardless of HIV status. Demand for maternal and child health (MCH) and PMTCT services can be limited by critical social, cultural, and structural barriers. Yet, rigorous evaluation has shown limited evidence of effectiveness of multilevel community-wide interventions aimed at improving MCH and HIV outcomes for pregnant women living with HIV. We propose to assess the effect of a package of multilevel community interventions: a social learning and action component, community dialogues, and peer-led discussion groups, on the demand for, uptake of, and retention of HIV positive pregnant/postpartum women in MCH/PMTCT services. This study will undertake a three-arm randomized trial in Swaziland, Uganda, and Zimbabwe. Districts/regions (n = 9) with 45 PMTCT-implementing health facilities and their catchment areas (populations 7,300-27,500) will be randomly allocated to three intervention arms: 1) community leader engagement, 2) community leader engagement with community days, or 3) community leader engagement with community days and male and female community peer groups. The primary study outcome is HIV exposed infants (HEIs) returning to the health facility within 2 months for early infant diagnosis (EID) of HIV. Secondary study outcomes include gestational age of women attending for first antenatal care, male partners tested for HIV, and HEIs receiving nevirapine prophylaxis at birth. Changes in community knowledge, attitudes, practices, and beliefs on MCH/PMTCT will be assessed through household surveys. Implementation of the protocol necessitated changes in the original study design. We purposively selected facilities in the districts/regions though originally the study clusters were to be randomly selected. Lifelong antiretroviral therapy for all HIV positive pregnant and lactating women, Option B+, was implemented in the three countries during the study period, with the potential for a differential impact by study arm. Implementation however, was rapidly done across the districts/regions, so that there is unlikely be this potential confounding. We developed a system of monitoring and documentation of potential confounding activities or actions, and these data will be incorporated into analyses at the conclusion of the project. Strengthens of the study are that it tests multilevel interventions, utilizes program as well as study specific and individual data, and it is conducted under "real conditions" leading to more robust findings. Limitations of the protocol include the lack of a true control arm and inadequate control for the potential effect of Option B+, such as the intensification of messages as the importance of early ANC and male partner testing. ClinicalTrials.gov (study ID: NCT01971710) Protocol version 5, 30 July 2013, registered 13 August 2013.

Do physical environmental changes make a difference? Supporting person-centered care at mealtimes in nursing homes.

PubMed

Chaudhury, Habib; Hung, Lillian; Rust, Tiana; Wu, Sarah

2017-10-01

Purpose Drawing on therapeutic physical environmental design principles and Kitwood's theoretical view of person-centered care, this study examined the impact of environmental renovations in dining spaces of a long-term care facility on residents' mealtime experience and staff practice in two care units. Method The research design involved pre- and post-renovation ethnographic observations in the dining spaces of the care units and a post-renovation staff survey. The objective physical environmental features pre- and post-renovations were assessed with a newly developed tool titled Dining Environment Audit Protocol. We collected observational data from 10 residents and survey responses from 17 care aides and nurses. Findings Based on a systematic analysis of observational data and staff survey responses, five themes were identified: (a) autonomy and personal control, (b) comfort of homelike environment, (c) conducive to social interaction, (d) increased personal support, and (e) effective teamwork. Implications Although the physical environment can play an influential role in enhancing the dining experience of residents, the variability in staff practices reveals the complexity of mealtime environment and points to the necessity of a systemic approach to foster meaningful culture change.

Examining Japanese women's preferences for a new style of postnatal care facility and its attributes.

PubMed

Shen, Junyi; Nakashima, Takako; Karasawa, Izumi; Furui, Tatsuro; Morishige, Kenichiro; Saijo, Tatsuyoshi

2018-05-21

Perinatal care in rural Japan is currently facing a crisis because of the lack of medical staff, especially obstetricians. In this study, a new style of postnatal care facility that combines both medical and nonmedical support is considered. Contrary to most postnatal care facilities in Japan, this new postnatal care facility accepts a puerperant from the cooperating maternity facility soon after birth (≤2 days). We conducted a hypothetical choice experiment to investigate whether this new postnatal care facility could be accepted by women in Gero City, Hida, Gifu Prefecture and how these women evaluate different kinds of postnatal care services. The results show that after a 2-day hospital stay, women from Gero City preferred to move to the new postnatal care facility over the other alternatives (continued hospitalization or discharge home). In addition, the estimated choice probabilities for selecting the postnatal care facility under different scenarios show a high level of acceptance for this new postnatal care facility. Copyright © 2018 John Wiley & Sons, Ltd.

Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys.

PubMed

Kruk, Margaret E; Leslie, Hannah H; Verguet, Stéphane; Mbaruku, Godfrey M; Adanu, Richard M K; Langer, Ana

2016-11-01

Global efforts to increase births at health-care facilities might not reduce maternal or newborn mortality if quality of care is insufficient. However, little systematic evidence exists for the quality at health facilities caring for women and newborn babies in low-income countries. We analysed the quality of basic maternal care functions and its association with volume of deliveries and surgical capacity in health-care facilities in five sub-Saharan African countries. In this analysis, we combined nationally representative health system surveys (Service Provision Assessments by the Demographic and Health Survery Programme) with data for volume of deliveries and quality of delivery care from Kenya, Namibia, Rwanda, Tanzania, and Uganda. We measured the quality of basic maternal care functions in delivery facilities using an index of 12 indicators of structure and processes of care, including infrastructure and use of evidence-based routine and emergency care interventions. We regressed the quality index on volume of births and confounders (public or privately managed, availability of antiretroviral therapy services, availability of skilled staffing, and country) stratified by facility type: primary (no caesarean capacity) or secondary (has caesarean capacity) care facilities. The Harvard University Human Research Protection Program approved this analysis as exempt from human subjects review. The national surveys were completed between April, 2006, and May, 2010. Our sample consisted of 1715 (93%) of 1842 health-care facilities that provided normal delivery service, after exclusion of facilities with missing (n=126) or invalid (n=1) data. 1511 (88%) study facilities (site of 276 965 [44%] of 622 864 facility births) did not have caesarean section capacity (primary care facilities). Quality of basic maternal care functions was substantially lower in primary (index score 0·38) than secondary care facilities (0·77). Low delivery volume was consistently associated with poor quality, with differences in quality between the lowest versus highest volume facilities of -0·22 (95% CI -0·26 to -0·19) in primary care facilities and -0·17 (-0·21 to -0·11) in secondary care facilities. More than 40% of facility deliveries in these five African countries occurred in primary care facilities, which scored poorly on basic measures of maternal care quality. Facilities with caesarean section capacity, particularly those with birth volumes higher than 500 per year, had higher scores for maternal care quality. Low-income and middle-income countries should systematically assess and improve the quality of delivery care in health facilities to accelerate reduction of maternal and newborn deaths. None. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND license. Published by Elsevier Ltd.. All rights reserved.

Challenges of Implementing a Communication-and-Resolution Program Where Multiple Organizations Must Cooperate.

PubMed

Mello, Michelle M; Armstrong, Sarah J; Greenberg, Yelena; McCotter, Patricia I; Gallagher, Thomas H

2016-12-01

To implement a communication-and-resolution program (CRP) in a setting in which liability insurers and health care facilities must collaborate to resolve incidents involving a facility and separately insured clinicians. Six hospitals and clinics and a liability insurer in Washington State. Sites designed and implemented CRPs and contributed information about cases and operational challenges over 20 months. Data were qualitatively analyzed. Data from interviews with personnel responsible for CRP implementation were triangulated with data on program cases collected by sites and notes recorded during meetings with sites and among project team members. Sites experienced small victories in resolving particular cases and streamlining some working relationships, but they were unable to successfully implement a collaborative CRP. Barriers included the insurer's distance from the point of care, passive rather than active support from top leaders, coordinating across departments and organizations, workload, nonparticipation by some physicians, and overcoming distrust. Operating CRPs where multiple organizations must collaborate can be highly challenging. Success likely requires several preconditions, including preexisting trust among organizations, active leadership engagement, physicians' commitment to participate, mechanisms for quickly transmitting information to insurers, tolerance for missteps, and clear protocols for joint investigations and resolutions. © Health Research and Educational Trust.

Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in Acute Care Hospitals: An Observational Cohort Study.

PubMed

Padula, William V

The purpose of this study was to examine the effectiveness and value of prophylactic 5-layer foam sacral dressings to prevent hospital-acquired pressure injury rates in acute care settings. Retrospective observational cohort. We reviewed records of adult patients 18 years or older who were hospitalized at least 5 days across 38 acute care hospitals of the University Health System Consortium (UHC) and had a pressure injury as identified by Patient Safety Indicator #3 (PSI-03). All facilities are located in the United States. We collected longitudinal data pertaining to prophylactic 5-layer foam sacral dressings purchased by hospital-quarter for 38 academic medical centers between 2010 and 2015. Longitudinal data on acute care, hospital-level patient outcomes (eg, admissions and PSI-03 and pressure injury rate) were queried through the UHC clinical database/resource manager from the Johns Hopkins Medicine portal. Data on volumes of dressings purchased per UHC hospital were merged with UHC data. Mixed-effects negative binomial regression was used to test the longitudinal association of prophylactic foam sacral dressings on pressure injury rates, adjusted for hospital case-mix and Medicare payments rules. Significant pressure injury rate reductions in US acute care hospitals between 2010 and 2015 were associated with the adoption of prophylactic 5-layer foam sacral dressings within a prevention protocol (-1.0 cases/quarter; P = .002) and changes to Medicare payment rules in 2014 (-1.13 cases/quarter; P = .035). Prophylactic 5-layer foam sacral dressings are an effective component of a pressure injury prevention protocol. Hospitals adopting these technologies should expect good value for use of these products.

Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in Acute Care Hospitals

PubMed Central

2017-01-01

PURPOSE: The purpose of this study was to examine the effectiveness and value of prophylactic 5-layer foam sacral dressings to prevent hospital-acquired pressure injury rates in acute care settings. DESIGN: Retrospective observational cohort. SAMPLE AND SETTING: We reviewed records of adult patients 18 years or older who were hospitalized at least 5 days across 38 acute care hospitals of the University Health System Consortium (UHC) and had a pressure injury as identified by Patient Safety Indicator #3 (PSI-03). All facilities are located in the United States. METHODS: We collected longitudinal data pertaining to prophylactic 5-layer foam sacral dressings purchased by hospital-quarter for 38 academic medical centers between 2010 and 2015. Longitudinal data on acute care, hospital-level patient outcomes (eg, admissions and PSI-03 and pressure injury rate) were queried through the UHC clinical database/resource manager from the Johns Hopkins Medicine portal. Data on volumes of dressings purchased per UHC hospital were merged with UHC data. Mixed-effects negative binomial regression was used to test the longitudinal association of prophylactic foam sacral dressings on pressure injury rates, adjusted for hospital case-mix and Medicare payments rules. RESULTS: Significant pressure injury rate reductions in US acute care hospitals between 2010 and 2015 were associated with the adoption of prophylactic 5-layer foam sacral dressings within a prevention protocol (−1.0 cases/quarter; P = .002) and changes to Medicare payment rules in 2014 (−1.13 cases/quarter; P = .035). CONCLUSIONS: Prophylactic 5-layer foam sacral dressings are an effective component of a pressure injury prevention protocol. Hospitals adopting these technologies should expect good value for use of these products. PMID:28816929

Differences in essential newborn care at birth between private and public health facilities in eastern Uganda.

PubMed

Waiswa, Peter; Akuze, Joseph; Peterson, Stefan; Kerber, Kate; Tetui, Moses; Forsberg, Birger C; Hanson, Claudia

2015-01-01

In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p<0.001). Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both private and public sector facilities, and a greater emphasis on tracking access to and quality of care in private sector facilities.

Increasing specialty care access through use of an innovative home telehealth-based spinal cord injury disease management protocol (SCI DMP)

PubMed Central

Seton, Jacinta M.; Washington, Monique; Tomlinson, Suk C.; Phrasavath, Douangmala; Farrell, Karen R.; Goldstein, Barry

2016-01-01

Background A spinal cord injury disease management protocol (SCI DMP) was developed to address the unique medical, physical, functional, and psychosocial needs of those living with spinal cord injuries and disorders (SCI/D). The SCI DMP was piloted to evaluate DMP clinical content and to identify issues for broader implementation across the Veterans Affairs (VA) SCI System of Care. Methods Thirty-three patients with SCI/D from four VA SCI centers participated in a 6-month pilot. Patients received customized SCI DMP questions through a data messaging device (DMD). Nurse home telehealth care coordinators (HTCC) monitored responses and addressed clinical alerts daily. One site administered the Duke Severity of Illness (DUSOI) Checklist and Short Form-8 (SF-8™) to evaluate the changes in comorbidity severity and health-related quality of life while on the SCI DMP. Results Patients remained enrolled an average of 116 days, with a mean response rate of 56%. The average distance between patient's home and their VA SCI center was 59 miles. Feedback on SCI DMP content and the DMD included requests for additional clinical topics, changes in administration frequency, and adapting the DMD for functional impairments. Improvement in clinical outcomes was seen in a subset of patients enrolled on the SCI DMP. Conclusion SCI HTCCs and patients reported that the program was most beneficial for newly injured patients recently discharged from acute rehabilitation that live far from specialty SCI care facilities. SCI DMP content changes and broader implementation strategies are currently being evaluated based on lessons learned from the pilot. PMID:24617497

Increasing specialty care access through use of an innovative home telehealth-based spinal cord injury disease management protocol (SCI DMP).

PubMed

Woo, Christine; Seton, Jacinta M; Washington, Monique; Tomlinson, Suk C; Phrasavath, Douangmala; Farrell, Karen R; Goldstein, Barry

2016-01-01

A spinal cord injury disease management protocol (SCI DMP) was developed to address the unique medical, physical, functional, and psychosocial needs of those living with spinal cord injuries and disorders (SCI/D). The SCI DMP was piloted to evaluate DMP clinical content and to identify issues for broader implementation across the Veterans Affairs (VA) SCI System of Care. Thirty-three patients with SCI/D from four VA SCI centers participated in a 6-month pilot. Patients received customized SCI DMP questions through a data messaging device (DMD). Nurse home telehealth care coordinators (HTCC) monitored responses and addressed clinical alerts daily. One site administered the Duke Severity of Illness (DUSOI) Checklist and Short Form-8 (SF-8™) to evaluate the changes in comorbidity severity and health-related quality of life while on the SCI DMP. Patients remained enrolled an average of 116 days, with a mean response rate of 56%. The average distance between patient's home and their VA SCI center was 59 miles. Feedback on SCI DMP content and the DMD included requests for additional clinical topics, changes in administration frequency, and adapting the DMD for functional impairments. Improvement in clinical outcomes was seen in a subset of patients enrolled on the SCI DMP. SCI HTCCs and patients reported that the program was most beneficial for newly injured patients recently discharged from acute rehabilitation that live far from specialty SCI care facilities. SCI DMP content changes and broader implementation strategies are currently being evaluated based on lessons learned from the pilot.

Gait Speed rather than Dynapenia Is a Simple Indicator for Complex Care Needs: A Cross-sectional Study Using Minimum Data Set.

PubMed

Huang, Tzu-Ya; Liang, Chih-Kuang; Shen, Hsiu-Chu; Chen, Hon-I; Liao, Mei-Chen; Chou, Ming-Yueh; Lin, Yu-Te; Chen, Liang-Kung

2017-08-21

The impact of dynapenia on the complexity of care for residents of long-term care facilities (LTCF) remains unclear. The present study evaluated associations between dynapenia, care problems and care complexity in 504 residents of Veterans Care Homes (VCHs) in Taiwan. Subjects with dynapenia, defined as low muscle strength (handgrip strength <26 kg), were older adults with lower body mass index (BMI), slow gait speed, and higher numbers of Resident Assessment Protocol (RAP) triggers. After adjusting for age, education, BMI, and Charlson's comorbidity index (CCI), only age, education, BMI and gait speed were independently associated with higher numbers of RAP triggers, but not dynapenia or handgrip strength (kg). Dividing subjects into groups based on quartiles of gait speed, those with gait speed ≤0.803 m/s were significantly associated with higher complexity of care needs (defined as ≥4 RAP triggers) compared to the reference group (gait speed >1 m/s). Significantly slow gait speed was associated with RAP triggers, including cognitive loss, poor communication ability, rehabilitation needs, urinary incontinence, depressed mood, falls, pressure ulcers, and use of psychotropic drugs. In conclusion, slow gait speed rather than dynapenia is a simple indicator for higher complexity of care needs of older male LTCF residents.

Protocol-based care: the standardisation of decision-making?

PubMed

Rycroft-Malone, Jo; Fontenla, Marina; Seers, Kate; Bick, Debra

2009-05-01

To explore how protocol-based care affects clinical decision-making. In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. The successful implementation and judicious use of tools such as protocols and guidelines will likely be dependant on approaches that facilitate the development of nurses' decision-making processes in parallel to paying attention to the influence of context.

Evaluation of the Effectiveness of Two Morphine Protocols to Treat Neonatal Abstinence Syndrome in a Level II Nursery in a Community Hospital.

PubMed

DeAtley, Heather N; Burton, Amanda; Fraley, Michelle DeLuca; Haltom, Joan

2017-07-01

The authors sought to evaluate the impact on length of hospital stay and treatment duration of morphine after implementation of a change in the institutional protocol for managing neonatal abstinence syndrome (NAS) in an effort to improve patient outcomes. A single-center, retrospective chart review was conducted at a Level II nursery in a community hospital in Kentucky. Fifty-nine neonates born between January 1, 2014, and December 31, 2015, who were diagnosed with NAS and received morphine for treatment were included. The protocol 1 group consisted of 33 neonates who received an initial dose of morphine 0.04 mg/kg/dose administered orally every 4 hours (January 1-December 31, 2014), and the protocol 2 group consisted of 26 neonates who received an initial dose of morphine 0.06 mg/kg/dose administered orally every 3 hours (January 1-November 30, 2015), after a change in the protocol for managing NAS was implemented on January 1, 2015. Data were reviewed and compared between the two protocol groups to determine the impact that the dosage change had on length of hospital stay and morphine treatment duration. The average length of stay decreased by 7 days in the protocol 2 group compared with the protocol 1 group (21 vs 28.65 days). The average duration of treatment decreased by 7 days in the protocol 2 group compared with the protocol 1 group (18.3 vs 25.4 days). These differences between groups were not statistically significant, however, because the population size was not large enough to achieve adequate power. These results indicate that protocol 2 displayed the potential to decrease length of stay and duration of treatment compared with protocol 1 at this facility; however, balancing higher starting doses with the risk of oversedation will continue to challenge the health care team. Concern for oversedation when using the higher starting dose in protocol 2 has prompted further research (e.g., protocol 3, initial morphine 0.05 mg/kg/dose every 3 hrs). Continued research is also necessary with larger patient populations to enable generalizability to other institutions. © 2017 Pharmacotherapy Publications, Inc.

Infection prevention and control practices related to Clostridium difficile infection in Canadian acute and long-term care institutions.

PubMed

Wilkinson, Krista; Gravel, Denise; Taylor, Geoffrey; McGeer, Allison; Simor, Andrew; Suh, Kathryn; Moore, Dorothy; Kelly, Sharon; Boyd, David; Mulvey, Michael; Mounchili, Aboubakar; Miller, Mark

2011-04-01

Clostridium difficile is an important pathogen in Canadian health care facilities, and infection prevention and control (IPC) practices are crucial to reducing C difficile infections (CDIs). We performed a cross-sectional study to identify CDI-related IPC practices in Canadian health care facilities. A survey assessing facility characteristics, CDI testing strategies, CDI contact precautions, and antimicrobial stewardship programs was sent to Canadian health care facilities in February 2005. Responses were received from 943 (33%) facilities. Acute care facilities were more likely than long-term care (P < .001) and mixed care facilities (P = .03) to submit liquid stools from all patients for CDI testing. Physician orders were required before testing for CDI in 394 long-term care facilities (66%)-significantly higher than the proportions in acute care (41%; P < .001) and mixed care sites (49%; P < .001). A total of 841 sites (93%) had an infection control manual, 639 (76%) of which contained CDI-specific guidelines. Antimicrobial stewardship programs were reported by 40 (29%) acute care facilities; 19 (54%) of these sites reported full enforcement of the program. Canadian health care facilities have widely varying C difficile IPC practices. Opportunities exist for facilities to take a more active role in IPC policy development and implementation, as well as antimicrobial stewardship. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

American Telemedicine Association: Telestroke Guidelines

PubMed Central

Berg, Jill; Chong, Brian W.; Gross, Hartmut; Nystrom, Karin; Adeoye, Opeolu; Schwamm, Lee; Wechsler, Lawrence; Whitchurch, Sallie

2017-01-01

Abstract The following telestroke guidelines were developed to assist practitioners in providing assessment, diagnosis, management, and/or remote consultative support to patients exhibiting symptoms and signs consistent with an acute stroke syndrome, using telemedicine communication technologies. Although telestroke practices may include the more broad utilization of telemedicine across the entire continuum of stroke care, with some even consulting on all neurologic emergencies, this document focuses on the acute phase of stroke, including both pre- and in-hospital encounters for cerebrovascular neurological emergencies. These guidelines describe a network of audiovisual communication and computer systems for delivery of telestroke clinical services and include operations, management, administration, and economic recommendations. These interactive encounters link patients with acute ischemic and hemorrhagic stroke syndromes with acute care facilities with remote and on-site healthcare practitioners providing access to expertise, enhancing clinical practice, and improving quality outcomes and metrics. These guidelines apply specifically to telestroke services and they do not prescribe or recommend overall clinical protocols for stroke patient care. Rather, the focus is on the unique aspects of delivering collaborative bedside and remote care through the telestroke model. PMID:28384077

An evaluation of pre-hospital emergency medical systems for suspected ST-elevation myocardial infarction in Colorado.

PubMed

Engelman, Glenn H; Carry, Patrick M; Kubes, Kyle M; Gleason, Michael J

2016-11-01

Patients presenting with ST-elevation myocardial infarction (STEMI) benefit from rapid cardiac reperfusion therapy. Emergency medical service (EMS) agencies can improve patient outcomes by calling STEMI alerts to the receiving facility. The aim of this study was to evaluate the use of pre-hospital activation systems for suspected ST-elevation myocardial infarctions (STEMI) throughout Colorado. A cross sectional, survey design was utilized to collect all data from EMS agencies in Colorado. A univariable logistic regression model was used to identify factors predictive of an agency reporting that they utilize a STEMI activation protocol. 84.5% [95% CI: 78.3 to 90.7%] of agencies included indicate that they utilize a STEMI activation protocol. Based on the logistic regression analysis, the number of EMT employees was significantly associated with whether or not an agency indicates that they utilize a STEMI activation protocol. For every 10% increase in the number of EMTs employed by an EMS agency, there was a 3.0 [95% CI: 1.5 to 6.0, p = 0.0012] fold increase in the odds of the agency indicating they utilize a STEMI activation protocol. Our study provides evidence that larger agencies are more likely to utilize a STEMI activation protocol. In areas without a STEMI system of care, improvements in smaller agencies that cover more ground (with longer transport times) should be the focus for protocol implementation. Based on the current prevalence of such training, competency based training in reading ST-elevations on ECG should be considered by EMS agencies.

Survey of 2014 behavioral management programs for laboratory primates in the United States.

PubMed

Baker, Kate C

2016-07-01

The behavioral management of laboratory nonhuman primates in the United States has not been thoroughly characterized since 2003. This article presents the results of a survey behavioral management programs at 27 facilities and covering a total of 59,636 primates, 27,916 housed in indoor cages and 31,720 in group enclosures. The survey included questions regarding program structure, implementation, and methodology associated with social housing, positive reinforcement training, positive human interaction, exercise enclosures, and several categories of inanimate enrichment. The vast majority of laboratory primates are housed socially (83%). Since 2003, the proportion of indoor-housed primates reported to be housed singly has fallen considerably, from 59% to 35% in the facilities surveyed. The use of social housing remains significantly constrained by: 1) research protocol requirements, highlighting the value of closely involved IACUCs for harmonizing research and behavioral management; and 2) the unavailability of compatible social partners, underscoring the necessity of objective analysis of the methods used to foster and maintain compatibility. Positive reinforcement training appears to have expanded and is now used at all facilities responding to the survey. The use of enrichment devices has also increased in the participating facilities. For most behavioral management techniques, concerns over the possibility of negative consequences to animals are expressed most frequently for social housing and destructible enrichment, while skepticism regarding efficacy is limited almost exclusively to sensory enrichment. Behavioral management program staffing has expanded over time in the facilities surveyed, due not only to increased numbers of dedicated behavioral management technicians but also to greater involvement of animal care technicians, suggesting an increase in the integration of behavioral care into animal husbandry. Broad awareness of common practice may assist facilities with program evaluation and assessment of progress in the field can generate recommendations for continuing the advancement of primate behavioral management programs. Am. J. Primatol. 78:780-796, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Survey of 2014 Behavioral Management Programs for Laboratory Primates in the United States

PubMed Central

BAKER, KATE C.

2016-01-01

The behavioral management of laboratory nonhuman primates in the United States has not been thoroughly characterized since 2003. This article presents the results of a survey behavioral management programs at 27 facilities and covering a total of 59,636 primates, 27,916 housed in indoor cages and 31,720 in group enclosures. The survey included questions regarding program structure, implementation, and methodology associated with social housing, positive reinforcement training, positive human interaction, exercise enclosures, and several categories of inanimate enrichment. The vast majority of laboratory primates are housed socially (83%). Since 2003, the proportion of indoor-housed primates reported to be housed singly has fallen considerably, from 59% to 35% in the facilities surveyed. The use of social housing remains significantly constrained by: 1) research protocol requirements, highlighting the value of closely involved IACUCs for harmonizing research and behavioral management; and 2) the unavailability of compatible social partners, underscoring the necessity of objective analysis of the methods used to foster and maintain compatibility. Positive reinforcement training appears to have expanded and is now used at all facilities responding to the survey. The use of enrichment devices has also increased in the participating facilities. For most behavioral management techniques, concerns over the possibility of negative consequences to animals are expressed most frequently for social housing and destructible enrichment, while skepticism regarding efficacy is limited almost exclusively to sensory enrichment. Behavioral management program staffing has expanded over time in the facilities surveyed, due not only to increased numbers of dedicated behavioral management technicians but also to greater involvement of animal care technicians, suggesting an increase in the integration of behavioral care into animal husbandry. Broad awareness of common practice may assist facilities with program evaluation and assessment of progress in the field can generate recommendations for continuing the advancement of primate behavioral management programs. PMID:26971575

Protocolized treatment is associated with decreased organ dysfunction in pediatric severe sepsis

PubMed Central

Balamuth, Fran; Weiss, Scott L.; Fitzgerald, Julie C.; Hayes, Katie; Centkowski, Sierra; Chilutti, Marianne; Grundmeier, Robert W.; Lavelle, Jane; Alpern, Elizabeth R.

2016-01-01

Objective To determine whether treatment with a protocolized sepsis guideline in the emergency department (ED) was associated with a lower burden of organ dysfunction (OD) by hospital day 2 compared to non-protocolized usual care in pediatric patients with severe sepsis. Design Retrospective cohort study Setting Tertiary care children’s hospital from January 1, 2012–March 31, 2014. Measurements and Main Results Subjects with international consensus defined severe sepsis and pediatric intensive care unit (PICU) admission within 24 hours of ED arrival were included. The exposure was the use of a protocolized ED sepsis guideline. The primary outcome was complete resolution of OD by hospital day 2. One hundred eighty nine subjects were identified during the study period. Of these, 121 (64%) were treated with the protocolized ED guideline and 68 were not. There were no significant differences between the groups in age, sex, race, number of comorbid conditions, ED triage level, or OD on arrival to the ED. Patients treated with protocolized ED care were more likely to be free of OD on hospital day 2 after controlling for sex, comorbid condition, indwelling central venous catheter, PIM-2 score, and timing of antibiotics and intravenous fluids (adjusted OR 4.2, 95% CI 1.7, 10.4). Conclusions Use of a protocolized ED sepsis guideline was independently associated with resolution of OD by hospital day 2 compared to non-protocolized usual care. These data indicate that morbidity outcomes in children can be improved with the use of protocolized care. PMID:27455114

Quarantine and protocol

NASA Technical Reports Server (NTRS)

1981-01-01

The purpose of the Orbiting Quarantine Facility is to provide maximum protection of the terrestrial biosphere by ensuring that the returned Martian samples are safe to bring to Earth. The protocol designed to detect the presence of biologically active agents in the Martian soil is described. The protocol determines one of two things about the sample: (1) that it is free from nonterrestrial life forms and can be sent to a terrestrial containment facility where extensive chemical, biochemical, geological, and physical investigations can be conducted; or (2) that it exhibits "biological effects" of the type that dictate second order testing. The quarantine protocol is designed to be conducted on a small portion of the returned sample, leaving the bulk of the sample undisturbed for study on Earth.

Envisioning Transformation in VA Mental Health Services Through Collaborative Site Visits.

PubMed

Kearney, Lisa K; Schaefer, Jeanne A; Dollar, Katherine M; Iwamasa, Gayle Y; Katz, Ira; Schmitz, Theresa; Schohn, Mary; Resnick, Sandra G

2018-04-16

This column reviews the unique contributions of multiple partners in establishing a standardized site visit process to promote quality improvement in mental health care at the Veterans Health Administration. Working as a team, leaders in policy and operations, staff of research centers, and regional- and facility-level mental health leaders developed a standardized protocol for evaluating mental health services at each site and using the data to help implement policy goals. The authors discuss the challenges experienced and lessons learned in this systemwide process and how this information can be part of a framework for improving mental health services on a national level.

Protocolized fluid therapy in brain-dead donors: The multi-center randomized MOnIToR trial

PubMed Central

Al-Khafaji, Ali; Elder, Michele; Lebovitz, Daniel J; Murugan, Raghavan; Souter, Michael; Stuart, Susan; Wahed, Abdus S.; Keebler, Ben; Dils, Dorrie; Mitchell, Stephanie; Shutterly, Kurt; Wilkerson, Dawn; Pearse, Rupert; Kellum, John A

2015-01-01

BACKGROUND Critical shortages of organs for transplantation jeopardize many lives. Observational data suggest that better fluid management for deceased organ donors could increase organ recovery. We conducted the first large multi-center randomized trial in brain-dead donors to determine whether protocolized fluid therapy increases organs transplanted. METHODS We randomly assigned donors to either protocolized or usual care in eight organ procurement organizations. A “protocol-guided fluid therapy” algorithm targeting cardiac index, mean arterial pressure and pulse pressure variation was used. Our primary outcome was the number of organs transplanted per donor and our primary analysis was intention-to-treat. Secondary analyses included: 1) modified intention-to-treat where only subjects able to receive the intervention were included, and 2) twelve-month survival in transplant recipients. The study was stopped early. RESULTS We enrolled 556 donors; 279 protocolized care, 277 usual care. Groups had similar characteristics at baseline. The study protocol could be implemented in 76% of subjects randomized to the intervention. There was no significant difference in mean number of organs transplanted per donor: 3.39 organs per donor, (95%CI: 3.14-3.63) with protocolized care, compared to usual care 3.29 (95%CI: 3.04-3.54) (mean difference, 0.1, 95%CI: -0.25 to 0.45; p=0.56). In modified intention-to-treat analysis the mean number of organs increased (3.52 organs per donor, 95%CI: 3.23-3.8) but was not statistically significant (mean difference, 0.23, 95%CI: -0.15-0.61; p=0.23). Among the 1430 recipients of organs from study subjects, with data available, 56 deaths (7.8%) occurred in the protocolized care arm and 56 (7.9%) in the usual care arm in the first year (Hazard Ratio: 0.97, p=0.86). CONCLUSIONS In brain-dead organ donors, protocol-guided fluid therapy compared to usual care may not increase the number of organs transplanted per donor. PMID:25583616

Does an oral care protocol reduce VAP in patients with a tracheostomy?

PubMed

Conley, Patricia; McKinsey, David; Graff, Jason; Ramsey, Anthony R

2013-07-01

Several studies have demonstrated that oral care with chlorhexidine gluconate (CHG) 0.12% solution reduces the incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients with endotracheal tubes in the ICU. Minimal evidence shows the effectiveness of any oral care protocols in preventing VAP in mechanically ventilated patients with tracheostomies in a step-down or progressive care unit (PCU). To determine the effectiveness of an oral care protocol in reducing the VAP rate in mechanically ventilated patients with tracheostomies in the PCU. A 12-month prospective study was conducted on 75 mechanically ventilated patients who had tracheostomies. The oral care protocol consisted of tooth brushing with toothpaste and applying CHG 0.12% solution every 12 hours. At the conclusion of the study, the VAP rate in the study population was compared with the National Health and Safety Network (NHSN) report for 2009 benchmark of 1.5 per 1,000 ventilator days. After the oral care protocol was implemented in the PCU, the VAP rate was 1.1 per 1,000 ventilator days over 12 months, compared with the NHSN report for 2009 of 1.5 per 1,000 ventilator days. Tooth brushing with toothpaste and applying CHG 0.12% solution may be an effective oral care protocol to reduce the VAP rate in patients in PCUs with tracheostomies who are being mechanically ventilated.

Quantitative Properties of the Macro Supply and Demand Structure for Care Facilities for Elderly in Japan.

PubMed

Nishino, Tatsuya

2017-12-01

As the Asian country with the most aged population, Japan, has been modifying its social welfare system. In 2000, the Japanese social care vision turned towards meeting the elderly's care needs in their own homes with proper formal care services. This study aims to understand the quantitative properties of the macro supply and demand structure for facilities for the elderly who require support or long-term care throughout Japan and present them as index values. Additionally, this study compares the targets for establishing long-term care facilities set by Japan's Ministry of Health, Labor and Welfare for 2025. In 2014, approximately 90% of all the people who were certified as requiring support and long-term care and those receiving preventive long-term care or long-term care services, were 75 years or older. The target increases in the number of established facilities by 2025 (for the 75-years-or-older population) were calculated to be 3.3% for nursing homes; 2.71% for long-term-care health facilities; 1.7% for group living facilities; and, 1.84% for community-based multi-care facilities. It was revealed that the establishment targets for 2025 also increase over current projections with the expected increase of the absolute number of users of group living facilities and community-based multi-care facilities. On the other hand, the establishment target for nursing homes remains almost the same as the current projection, whereas that for long-term-care health facilities decreases. These changes of facility ratios reveal that the Japanese social care system is shifting to realize 'Ageing in Place'. When considering households' tendencies, the target ratios for established facilities are expected to be applied to the other countries in Asia.

Quantitative Properties of the Macro Supply and Demand Structure for Care Facilities for Elderly in Japan

PubMed Central

Nishino, Tatsuya

2017-01-01

As the Asian country with the most aged population, Japan, has been modifying its social welfare system. In 2000, the Japanese social care vision turned towards meeting the elderly’s care needs in their own homes with proper formal care services. This study aims to understand the quantitative properties of the macro supply and demand structure for facilities for the elderly who require support or long-term care throughout Japan and present them as index values. Additionally, this study compares the targets for establishing long-term care facilities set by Japan’s Ministry of Health, Labor and Welfare for 2025. In 2014, approximately 90% of all the people who were certified as requiring support and long-term care and those receiving preventive long-term care or long-term care services, were 75 years or older. The target increases in the number of established facilities by 2025 (for the 75-years-or-older population) were calculated to be 3.3% for nursing homes; 2.71% for long-term-care health facilities; 1.7% for group living facilities; and, 1.84% for community-based multi-care facilities. It was revealed that the establishment targets for 2025 also increase over current projections with the expected increase of the absolute number of users of group living facilities and community-based multi-care facilities. On the other hand, the establishment target for nursing homes remains almost the same as the current projection, whereas that for long-term-care health facilities decreases. These changes of facility ratios reveal that the Japanese social care system is shifting to realize ‘Ageing in Place’. When considering households’ tendencies, the target ratios for established facilities are expected to be applied to the other countries in Asia. PMID:29194405

Zeitgeists and development trends in long-term care facility design.

PubMed

Wang, Chia-Hui; Kuo, Nai-Wen

2006-06-01

Through literature analysis, in-depth interviews, and the application of the Delphi survey, this study explored long-term care resident priorities with regard to long-term care facility design in terms of both physical and psychological needs. This study further clarified changing trends in long-term care concepts; illustrated the impact that such changes are having on long-term care facility design; and summarized zeitgeists related to the architectural design of long-term care facilities. Results of our Delphi survey indicated the following top five priorities in long-term care facility design: (1) creating a home-like feeling; (2) adhering to Universal Design concepts; (3) providing well-defined private sleeping areas; (4) providing adequate social space; and (5) decentralizing residents' rooms into clusters. The three major zeitgeists related to long-term care facility design include: (1) modern long-term care facilities should abandon their traditional "hospital" image and gradually reposition facilities into homelike settings; (2) institution-based care for the elderly should be de-institutionalized under the concept of aging-in-place; and (3) living clusters, rather than traditional hospital-like wards, should be designed into long-term care facilities.

Transitioning Adolescents and Young Adults With HIV Infection to Adult Care: Pilot Testing the "Movin' Out" Transitioning Protocol.

PubMed

Maturo, Donna; Powell, Alexis; Major-Wilson, Hannah; Sanchez, Kenia; De Santis, Joseph P; Friedman, Lawrence B

2015-01-01

Advances in care and treatment of adolescents/young adults with HIV infection have made survival into adulthood possible, requiring transition to adult care. Researchers have documented that the transition process is challenging for adolescents/young adults. To ensure successful transition, a formal transition protocol is needed. Despite existing research, little quantitative evaluation of the transition process has been conducted. The purpose of the study was to pilot test the "Movin' Out" Transitioning Protocol, a formalized protocol developed to assist transition to adult care. A retrospective medical/nursing record review was conducted with 38 clients enrolled in the "Movin' Out" Transitioning Protocol at a university-based adolescent medicine clinic providing care to adolescents/young adults with HIV infection. Almost half of the participants were able to successfully transition to adult care. Reasons for failure to transition included relocation, attrition, lost to follow-up, and transfer to another adult service. Failure to transition to adult care was not related to adherence issues, X(2) (1, N=38)=2.49, p=.288; substance use, X(2) (1, N=38)=1.71, p=.474; mental health issues, X(2) (1, N=38)=2.23, p=.322; or pregnancy/childrearing, X(2) (1, N=38)=0.00, p=.627). Despite the small sample size, the "Movin' Out" Transitioning Protocol appears to be useful in guiding the transition process of adolescents/young adults with HIV infection to adult care. More research is needed with a larger sample to fully evaluate the "Movin' Out" Transitioning Protocol. Copyright © 2015 Elsevier Inc. All rights reserved.

Legionnaires' Disease: a Problem for Health Care Facilities

MedlinePlus

... Clips Legionnaires’ Disease A problem for health care facilities Language: English (US) Español (Spanish) Recommend on Facebook ... drinking. Many people being treated at health care facilities, including long-term care facilities and hospitals, have ...

Advance care planning for residents in aged care facilities: what is best practice and how can evidence-based guidelines be implemented?

PubMed

Lyon, Cheryl

2007-12-01

Background  Advance care planning in a residential care setting aims to assist residents to make decisions about future healthcare and to improve end-of-life care through medical and care staff knowing and respecting the wishes of the resident. The process enables individuals and others who are important to them, to reflect on what is important to the resident including their beliefs/values and preferences about care when they are dying. This paper describes a project conducted as part of the Joanna Briggs Institute Clinical Aged Care Fellowship Program implemented at the Manningham Centre in metropolitan Melbourne in a unit providing services for 46 low and high care residents. Objectives  The objectives of the study were to document implementation of best practice in advance care planning in a residential aged care facility using a cycle of audit, feedback and re-audit cycle audit with a clinical audit software program, the Practical Application of Clinical Evidence System. The evidence-based guidelines found in 'Guidelines for a Palliative Approach in Residential Aged Care' were used to inform the process of clinical practice review and to develop a program to implement advance care planning. Results  The pre-implementation audit results showed that advance care planning practice was not based on high level evidence as initial compliance with five audit criteria was 0%. The barriers to implementation that became apparent during the feedback stage included the challenge of creating a culture where advance care planning policy, protocols and guidelines could be implemented, and advance care planning discussions held, by adequately prepared health professionals and carers. Opportunities were made to equip the resident to discuss their wishes with family, friends and healthcare staff. Some residents made the decision to take steps to formally document those wishes and/or appoint a Medical Enduring Power of Attorney to act on behalf of the resident when they are unable to communicate wishes. The post-implementation audit showed a clear improvement as compliance ranged from 15-100% for the five audit criteria. Strong leadership by the project team was effective in engaging staff in this quality improvement program. Conclusion  The outcomes of the project were extremely positive and demonstrate a genuine improvement in practice. All audit criteria indicate that the Manningham Centre is now positively working towards improved practice based on the best available evidence. It is hoped that as the expertise developed during this project is shared, other areas of gerontological practice will be similarly improved and more facilities caring for the older person will embrace evidence-based practice.

HIV patient retention: the implementation of a North Carolina clinic-based protocol.

PubMed

Keller, Jennifer; Heine, Amy; LeViere, Anna Finestone; Donovan, Jenna; Wilkin, Aimee; Sullivan, Kristen; Quinlivan, Evelyn Byrd

2017-05-01

Decreased visit attendance leads to poor health outcomes, decreased viral suppression, and higher mortality rates for persons living with HIV. Retention in care is an important factor in improving health status for people living with HIV but continues to be a challenge in clinical settings. This paper details the development and implementation of the NC-LINK Retention Protocol, a clinic-based protocol to locate and reengage out-of-care patients, as part of overall clinic retention efforts. The protocol was implemented as one of four interventions of the NC-LINK Systems and Linkages Project, a multi-site initiative funded by the HIV/AIDS Bureau and the Special Projects of National Significance. Lists of out-of-care patients who had not received HIV medical care in over nine months and did not have a future appointment were created each month. Patient navigators, case managers, and other staff then followed a standardized protocol to locate and reengage these patients in care. A total of 452 patients were identified for reengagement services. Of those, 194 (43%) returned to care, 108 (24%) had another definitive outcome (incarcerated, deceased, or relocated) and 150 (33%) were referred for additional follow-up to locate and reengage in care. In summary, 67% of patients were located through the efforts of the clinic staff. The results of this intervention indicate that it is possible to successfully integrate a protocol into the existing infrastructure of a clinic and reengage a majority of out-of-care patients into medical care.

Merging video coaching and an anthropologic approach to understand health care provider behavior toward hand hygiene protocols.

PubMed

Boudjema, Sophia; Tarantini, Clément; Peretti-Watel, Patrick; Brouqui, Philippe

2017-05-01

We used videorecordings of routine care to analyze health care providers' deviance from protocols and organized follow-up interviews that were conducted by an anthropologist and a nurse. After consent, health care workers were recorded during routine care by an automatic video remote control. Each participant was invited to watch her or his recorded behaviors on 2 different videos showing routine practices and her or his deviance from protocols, and to comment on them. After this step an in-depth interview based on preestablished guidelines was organized and explanations regarding the observed deviance was discussed. This design was intended to reveal the HCWs' subjectivity; that is, how they perceive hand hygiene issues in their daily routine, what concrete difficulties they face, and how they try to resolve them. We selected 43 of 250 videorecordings created during the study, which allowed us to study 15 out of 20 health care professionals. Twenty out of 43 videos showed 1 or more breaches in the hand hygiene protocol. The breaches were frequently linked to glove abuse. Deviance from protocols was explained by the health care workers as the result of an adaptive behavior; that is, facing work constraints that were disconnected from infection control protocols. Professional practices and protocols should be revisited to create simple messages that are adapted to the mandatory needs in a real life clinic environment. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

42 CFR 456.601 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... for mental diseases, or an intermediate care facility. Intermediate care facility includes... diseases includes a mental hospital, a psychiatric facility, and an intermediate care facility that...

42 CFR 456.601 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... for mental diseases, or an intermediate care facility. Intermediate care facility includes... diseases includes a mental hospital, a psychiatric facility, and an intermediate care facility that...

40 CFR 792.45 - Test system supply facilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... maintaining algae and aquatic plants. (2) Facilities, as specified in the protocol, for plant growth... supplies shall be preserved by appropriate means. (b) When appropriate, plant supply facilities shall be..., facilities for aquatic animal tests shall be provided. These include but are not limited to aquaria, holding...

The value of signs, symptoms and plasma heart-type fatty acid-binding protein (H-FABP) in evaluating patients presenting with symptoms possibly matching acute coronary syndrome: background and methods of a diagnostic study in primary care.

PubMed

Willemsen, Robert T A; Buntinx, Frank; Winkens, Bjorn; Glatz, Jan F; Dinant, Geert Jan

2014-12-12

Chest complaints presented to a general practitioner (GP) are frequently caused by diseases which have advantageous outcomes. However, in some cases, acute coronary syndrome (ACS) is present (1.5-22% of cases). The patient's signs, symptoms and electrocardiography results are insufficient diagnostic tools to distinguish mild disease from ACS. Therefore, most patients presenting chest complaints are referred to secondary care facilities where ACS is then ruled out in a majority of patients (78%). Recently, a point of care test for heart-type fatty acid-binding protein (H-FABP) using a low cut-off value between positive and negative of 4 ng/ml has become available. We aim to study the role of this point of care device in triage of patients presenting chest complaints possibly due to ACS, in primary care. Our research protocol is presented in this article. Results are expected in 2015. Participating GPs will register signs and symptoms in all patients presenting chest complaints possibly due to ACS. Point of care H-FABP testing will also be performed. Our study will be a derivation study to identify signs and symptoms that, combined with point of care H-FABP testing, can be part of an algorithm to either confirm or rule out ACS. The diagnostic value for ACS of this algorithm in general practice will be determined. A safe diagnostic elimination of ACS by application of the algorithm can be of significant clinical relevance. Improved triage and thus reduction of the number of patients with chest complaints without underlying ACS, that are referred to secondary care facilities, could lead to a substantial cost reduction. ClinicalTrials.gov, NCT01826994, accepted April 8th 2013.

Feasibility of Providing Safe Mouth Care and Collecting Oral and Fecal Microbiome Samples from Nursing Home Residents with Dysphagia: Proof of Concept Study.

PubMed

Jablonski, Rita A; Winstead, Vicki; Azuero, Andres; Ptacek, Travis; Jones-Townsend, Corteza; Byrd, Elizabeth; Geisinger, Maria L; Morrow, Casey

2017-09-01

Individuals with dysphagia who reside in nursing homes often receive inadequate mouth care and experience poor oral health. From a policy perspective, the combination of absent evidence-based mouth care protocols coupled with insufficient dental coverage create a pool of individuals at great risk for preventable infectious illnesses that contribute to high health care costs. The purpose of the current study was to determine (a) the safety of a mouth care protocol tailored for individuals with dysphagia residing in nursing homes without access to suction equipment, and (b) the feasibility of collecting oral and fecal samples for microbiota analyses. The mouth care protocol resulted in improved oral hygiene without aspiration, and oral and fecal samples were safely collected from participants. Policies supporting ongoing testing of evidence-based mouth care protocols for individuals with dysphagia are important to improve quality, demonstrate efficacy, and save health care costs. [Journal of Gerontological Nursing, 43(9), 9-15.]. Copyright 2017, SLACK Incorporated.

The study protocol of a cluster-randomised controlled trial of family-mediated personalised activities for nursing home residents with dementia.

PubMed

van der Ploeg, Eva S; Camp, Cameron J; Eppingstall, Barbara; Runci, Susannah J; O'Connor, Daniel W

2012-01-12

Following admission to a nursing home, the feelings of depression and burden that family carers may experience do not necessarily diminish. Additionally, they may experience feelings of guilt and grief for the loss of a previously close relationship. At the same time, individuals with dementia may develop symptoms of depression and agitation (BPSD) that may be related to changes in family relationships, social interaction and stimulation. Until now, interventions to alleviate carer stress and BPSD have treated carers and relatives separately rather than focusing on maintaining or enhancing their relationships. One-to-one structured activities have been shown to reduce BPSD and also improve the caring experience, but barriers such as a lack of resources impede the implementation of activities in aged care facilities. The current study will investigate the effect of individualised activities based on the Montessori methodology administered by family carers in residential care. We will conduct a cluster-randomised trial to train family carers in conducting personalised one-to-one activities based on the Montessori methodology with their relatives. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. Persons with dementia living in aged care facilities and frequently visiting family carers will be included in the study. Consented, willing participants will be randomly assigned by facility to a treatment condition using the Montessori approach or a control waiting list condition. We hypothesise that family carers conducting Montessori-based activities will experience improvements in quality of visits and overall relationship with the resident as well as higher self-rated mastery, fewer depressive symptoms, and a better quality of life than carers in the waiting list condition. We hypothesise that training family carers to deliver personalised activities to their relatives in a residential setting will make visits more satisfying and may consequently improve the quality of life for carers and their relatives. These beneficial effects might also reduce nursing staff burden and thus impact positively on residential facilities. Australian New Zealand Clinical Trials Registry - ACTRN12611000998943. © 2012 van der Ploeg et al; licensee BioMed Central Ltd.

The study protocol of a cluster-randomised controlled trial of family-mediated personalised activities for nursing home residents with dementia

PubMed Central

2012-01-01

Background Following admission to a nursing home, the feelings of depression and burden that family carers may experience do not necessarily diminish. Additionally, they may experience feelings of guilt and grief for the loss of a previously close relationship. At the same time, individuals with dementia may develop symptoms of depression and agitation (BPSD) that may be related to changes in family relationships, social interaction and stimulation. Until now, interventions to alleviate carer stress and BPSD have treated carers and relatives separately rather than focusing on maintaining or enhancing their relationships. One-to-one structured activities have been shown to reduce BPSD and also improve the caring experience, but barriers such as a lack of resources impede the implementation of activities in aged care facilities. The current study will investigate the effect of individualised activities based on the Montessori methodology administered by family carers in residential care. Methods/Design We will conduct a cluster-randomised trial to train family carers in conducting personalised one-to-one activities based on the Montessori methodology with their relatives. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. Persons with dementia living in aged care facilities and frequently visiting family carers will be included in the study. Consented, willing participants will be randomly assigned by facility to a treatment condition using the Montessori approach or a control waiting list condition. We hypothesise that family carers conducting Montessori-based activities will experience improvements in quality of visits and overall relationship with the resident as well as higher self-rated mastery, fewer depressive symptoms, and a better quality of life than carers in the waiting list condition. Discussion We hypothesise that training family carers to deliver personalised activities to their relatives in a residential setting will make visits more satisfying and may consequently improve the quality of life for carers and their relatives. These beneficial effects might also reduce nursing staff burden and thus impact positively on residential facilities. Trial Registration Australian New Zealand Clinical Trials Registry - ACTRN12611000998943 PMID:22236064

Supporting Tablet Configuration, Tracking, and Infection Control Practices in Digital Health Interventions: Study Protocol.

PubMed

Furberg, Robert D; Ortiz, Alexa M; Zulkiewicz, Brittany A; Hudson, Jordan P; Taylor, Olivia M; Lewis, Megan A

2016-06-27

Tablet-based health care interventions have the potential to encourage patient care in a timelier manner, allow physicians convenient access to patient records, and provide an improved method for patient education. However, along with the continued adoption of tablet technologies, there is a concomitant need to develop protocols focusing on the configuration, management, and maintenance of these devices within the health care setting to support the conduct of clinical research. Develop three protocols to support tablet configuration, tablet management, and tablet maintenance. The Configurator software, Tile technology, and current infection control recommendations were employed to develop three distinct protocols for tablet-based digital health interventions. Configurator is a mobile device management software specifically for iPhone operating system (iOS) devices. The capabilities and current applications of Configurator were reviewed and used to develop the protocol to support device configuration. Tile is a tracking tag associated with a free mobile app available for iOS and Android devices. The features associated with Tile were evaluated and used to develop the Tile protocol to support tablet management. Furthermore, current recommendations on preventing health care-related infections were reviewed to develop the infection control protocol to support tablet maintenance. This article provides three protocols: the Configurator protocol, the Tile protocol, and the infection control protocol. These protocols can help to ensure consistent implementation of tablet-based interventions, enhance fidelity when employing tablets for research purposes, and serve as a guide for tablet deployments within clinical settings.

Variability of DKA Management Among Pediatric Emergency Room and Critical Care Providers: A Call for More Evidence-Based and Cost-Effective Care?

PubMed

Clark, Matthew G; Dalabih, Abdallah

2014-09-01

Management protocols have been shown to be effective in the pediatric emergency medicine (PEM) and pediatric critical care (PCC) settings. Treatment protocols define clear goals which are achieved with consistency in implementation. Over the last decade, many new recommendations have been proposed on managing diabetic ketoacidosis (DKA). Although no perfect set of guidelines exist, many institutions are developing DKA treatment protocols. We sought to determine the variability between institutions in implementation of these protocols.

Interactive internet-based clinical education: an efficient and cost-savings approach to point-of-care test training.

PubMed

Knapp, Herschel; Chan, Kee; Anaya, Henry D; Goetz, Matthew B

2011-06-01

We successfully created and implemented an effective HIV rapid testing training and certification curriculum using traditional in-person training at multiple sites within the U.S. Department of Veterans Affairs (VA) Healthcare System. Considering the multitude of geographically remote facilities in the nationwide VA system, coupled with the expansion of HIV diagnostics, we developed an alternate training method that is affordable, efficient, and effective. Using materials initially developed for in-person HIV rapid test in-services, we used a distance learning model to offer this training via live audiovisual online technology to educate clinicians at a remote outpatient primary care VA facility. Participants' evaluation metrics showed that this form of remote education is equivalent to in-person training; additionally, HIV testing rates increased considerably in the months following this intervention. Although there is a one-time setup cost associated with this remote training protocol, there is potential cost savings associated with the point-of-care nurse manager's time productivity by using the Internet in-service learning module for teaching HIV rapid testing. If additional in-service training modules are developed into Internet-based format, there is the potential for additional cost savings. Our cost analysis demonstrates that the remote in-service method provides a more affordable and efficient alternative compared with in-person training. The online in-service provided training that was equivalent to in-person sessions based on first-hand supervisor observation, participant satisfaction surveys, and follow-up results. This method saves time and money, requires fewer personnel, and affords access to expert trainers regardless of geographic location. Further, it is generalizable to training beyond HIV rapid testing. Based on these consistent implementation successes, we plan to expand use of online training to include remote VA satellite facilities spanning several states for a variety of diagnostic devices. Ultimately, Internet-based training has the potential to provide "big city" quality of care to patients at remote (rural) clinics.

Reducing hospital-acquired heel ulcer rates in an acute care facility: an evaluation of a nurse-driven performance improvement project.

PubMed

McElhinny, Mary Louise; Hooper, Christine

2008-01-01

A nurse-driven performance improvement project designed to reduce the incidence of hospital-acquired ulcers of the heel in an acute care setting was evaluated. This was a descriptive evaluative study using secondary data analysis. Data were collected in 2004, prior to implementation of the prevention project and compared to results obtained in 2006, after the project was implemented. Data were collected in a 172-bed, not-for-profit inpatient acute care facility in North Central California. All medical-surgical inpatients aged 18 years and older were included in the samples. Data were collected on 113 inpatients prior to implementation of the project in 2004. Data were also collected on a sample of 124 inpatients in 2006. The prevalence and incidence of heel pressure ulcers were obtained through skin surveys prior to implementation of the prevention program and following its implementation. Results from 2004 were compared to data collected in 2006 after introduction of the Braden Scale for Predicting Pressure Sore Risk. Heel pressure ulcers were staged using the National Pressure Ulcer Advisory Panel (NPUAP) staging system and recommendations provided by the Agency for Health Care Quality Research (AHRQ) clinical practice guidelines. The incidence of hospital-acquired heel pressure ulcers in 2004 was 13.5% (4 of 37 patients). After implementation of the program in 2006, the incidence of hospital-acquired heel pressure ulcers was 13.8% (5 of 36 patients). The intervention did not appear to receive adequate staff nurse support needed to make the project successful. Factors that influenced the lack of support may have included: (1) educational method used, (2) lack of organization approved, evidenced-based standardized protocols for prevention and treatment of heel ulcers, and (3) failure of facility management to convey the importance as well as their support for the project.

Care coordination in epilepsy: Measuring neurologists' connectivity using social network analysis.

PubMed

Altalib, Hamada Hamid; Fenton, Brenda T; Cheung, Kei-Hoi; Pugh, Mary Jo V; Bates, Jonathan; Valente, Thomas W; Kerns, Robert D; Brandt, Cynthia A

2017-08-01

The study sought to quantify coordination of epilepsy care, over time, between neurologists and other health care providers using social network analysis (SNA). The Veterans Health Administration (VA) instituted an Epilepsy Center of Excellence (ECOE) model in 2008 to enhance care coordination between neurologists and other health care providers. Provider networks in the 16 VA ECOE facilities (hub sites) were compared to a subset of 33 VA facilities formally affiliated (consortium sites) and 14 unaffiliated VA facilities. The number of connections between neurologists and each provider (node degree) was measured by shared epilepsy patients and tallied to generate estimates at the facility level separately within and across facilities. Mixed models were used to compare change of facility-level node degree over time across the three facility types, adjusted for number of providers per facility. Over the time period 2000-2013, epilepsy care coordination both within and across facilities significantly increased. These increases were seen in all three types of facilities namely hub, consortium, and unaffiliated site, relatively equally. The increase in connectivity was more dramatic with providers across facilities compared to providers within the same facilities. Establishment of the ECOE hub and spoke model contributed to an increase in epilepsy care coordination both within and across facilities from 2000 to 2013, but there was substantial variation across different facilities. SNA is a tool that may help measure coordination of specialty care. Published by Elsevier Inc.

Living at the farm, innovative nursing home care for people with dementia - study protocol of an observational longitudinal study.

PubMed

de Boer, B; Hamers, J P H; Beerens, H C; Zwakhalen, S M G; Tan, F E S; Verbeek, H

2015-11-02

In nursing home care, new care environments directed towards small-scale and homelike environments are developing. The green care farm, which provides 24-h nursing home care for people with dementia, is one such new care environment. Knowledge is needed on the relation between environmental features of green care farms such as nature, domesticity and offering care in small groups and the influence on the daily lives of residents. The aim of this study is to explore (1) the daily lives of residents, (2) the quality of care and (3) the experiences of caregivers on green care farms compared with other nursing home care environments. An observational longitudinal study including a baseline and a six-month follow-up measurement is carried out. Four types of nursing home care environments are included: (1) large scale nursing home ward, (2) small scale living facility on the terrain of a larger nursing home (3) stand-alone small scale living facility and (4) green care farm. Quality of care is examined through structure, process and outcome indicators. The primary outcome measure is the daily life of residents, assessed by ecological momentary assessments. Aspects of daily life include (1) activity (activity performed by the resident, the engagement in this activity and the degree of physical effort); (2) physical environment (the location of the resident and the interaction with the physical environment); (3) social environment (the level and type of social interaction, and with whom this social interaction took place) and (4) psychological well-being (mood and agitation). In addition, social engagement, quality of life, behavioral symptoms and agitation are evaluated through questionnaires. Furthermore, demographics, cognitive impairment, functional dependence and the severity of dementia are assessed. Semi-structured interviews are performed with caregivers regarding their experiences with the different nursing home care environments. This is the first study investigating green care farms providing 24-h nursing home care for people with dementia. The study provides valuable insight into the daily lives of residents, the quality of care, and the experiences of caregivers at green care farms in comparison with other nursing home care environments including small-scale care environments and large scale nursing home wards.

An Impaled Potential Unexploded Device in the Civilian Trauma Setting: A Case Report and Review of the Literature.

PubMed

Thaut, Lane C; Murtha, Andrew S; Johnson, Anthony E; Roper, Jamie L

2018-05-01

The management of patients with impaled unexploded devices is rare in the civilian setting. However, as the lines of the traditional battlefield are blurred by modern warfare and terrorist activity, emergency providers should be familiar with facility protocols, plans, and contact information of their local resources for unexploded devices. A 44-year-old male sustained a close-proximity blast injury to his lower extremities while manipulating a mortar-type firework. He presented to the regional trauma center with an open, comminuted distal femur fracture and radiographic evidence of a potential explosive device in his thigh. His management was coordinated with the local Explosive Ordinance Disposal and the fire department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Explosive devices pose a grave threat when encountered. Familiarization with protocols to manage these patients can mitigate disaster. Emergency providers should expect and be prepared to coordinate care for these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Identifying elements of the health care environment that contribute to wayfinding.

PubMed

Pati, Debajyoti; Harvey, Thomas E; Willis, Douglas A; Pati, Sipra

2015-01-01

Identify aspects of the physical environment that inform wayfinding for visitors. Compare and contrast the identified elements in frequency of use. Gain an understanding of the role the different elements and attributes play in the wayfinding process. Wayfinding by patients and visitors is a documented problem in healthcare facilities. The few studies that have been conducted have identified some of the environmental elements that influence wayfinding. Moreover, literatures comparing different design strategies are absent. Currently there is limited knowledge to inform prioritization of strategies to optimize wayfinding within capital budget. A multi-method, non-experimental, qualitative, exploratory study design was adopted. The study was conducted in a large, acute care facility in Texas. Ten healthy adults in five age groups, representing both sexes, participated in the study as simulated visitors. Data collection included (a) verbal protocols during navigation; (b) questionnaire; and (c) verbal directions from hospital employees. Data were collected during Fall 2013. Physical design elements contributing to wayfinding include signs, architectural features, maps, interior elements (artwork, display boards, information counters, etc.), functional clusters, interior elements pairing, structural elements, and furniture. The information is used in different ways - some for primary navigational information, some for supporting navigational information, and some as familiarity markers. The physical environment has a critical role in aiding navigation in healthcare facilities. Architectural feature is the top contributor in the domain of architecture. Artwork (painting, sculpture, etc.) is the top contributor in the domain of interior design. © The Author(s) 2015.

Integrated Payment and Delivery Models Offer Opportunities and Challenges for Residential Care Facilities

PubMed Central

Grabowski, David C.; Caudry, Daryl J.; Dean, Katie M.; Stevenson, David G.

2016-01-01

Under health care reform, a series of new financing and delivery models are being piloted to integrate health and long-term care services for older adults. To date, these programs have not encompassed residential care facilities, with most programs focusing on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with similar populations in the community and nursing home. These results suggest the residential care facility population could benefit greatly from models that coordinate health and long-term care. However, few providers have invested in integrated delivery models. Several challenges exist toward greater integration including the private payment of residential care facility services and the fact that residential care facilities do not share in any Medicare savings due to improved coordination of care. PMID:26438740

Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams.

PubMed

Jones, Audrey L; Hausmann, Leslie R M; Kertesz, Stefan; Suo, Ying; Cashy, John P; Mor, Maria K; Schaefer, James H; Gundlapalli, Adi V; Gordon, Adam J

2018-05-12

Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients. To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities). We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities. Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941). Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support. In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0). VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.

Veterinary medical considerations for the use of nonhuman primates in space research

NASA Technical Reports Server (NTRS)

Simmonds, R. C.

1977-01-01

The validity of biomedical research using animal subjects is highly dependent on the use of 'normal' and healthy animals. The current costs of research programs dictate that a minimum number of animals and test replicates be used to obtain the desired data. The use of healthy and standardized animals increases the probability of obtaining valid data while also permitting greater economy by reducing the between-individual variation, thus allowing the use of fewer animals. Areas of concern when planning animal payloads include constraints of the flight on candidate species selection, screening for physiological and psychological normalcy, procedures for routine care and quarantine of new animals and those returning from space, ground-based studies to determine experimental protocol, selection of instrumentation, stress during transportation for flight operations, housing and care facilities at launch and recovery sites, and the overall veterinary program.

Major Incident Hospital: Development of a Permanent Facility for Management of Incident Casualties.

PubMed

Marres, Geertruid; Bemelman, Michael; van der Eijk, John; Leenen, Luke

2009-06-01

Preparation is essential to cope with the challenge of providing optimal care when there is a sudden, unexpected surge of casualties due to a disaster or major incident. By definition, the requirements of such cases exceed the standard care facilities of hospitals in qualitative or quantitative respects and interfere with the care of regular patients. To meet the growing demands to be prepared for disasters, a permanent facility to provide structured, prepared relief in such situations was developed. A permanent but reserved Major Incident Hospital (MIH) has been developed through cooperation between a large academic medical institution, a trauma center, a military hospital, and the National Poison Information Centre (NVIC). The infrastructure, organization, support systems, training and systematic working methods of the MIH are designed to create order in a chaotic, unexpected situation and to optimize care and logistics in any possible scenario. Focus points are: patient flow and triage, registration, communication, evaluation and training. Research and the literature are used to identify characteristic pitfalls due to the chaos associated with and the unexpected nature of disasters, and to adapt our organization. At the MIH, the exceptional has become the core business, and preparation for disaster and large-scale emergency care is a daily occupation. An Emergency Response Protocol enables admittance to the normally dormant hospital of up to 100 (in exceptional cases even 300) patients after a start-up time of only 15 min. The Patient Barcode Registration System (PBR) with EAN codes guarantees quick and adequate registration of patient data in order to facilitate good medical coordination and follow-up during a major incident. The fact that the hospital is strictly reserved for this type of care guarantees availability and minimizes impact on normal care. When it is not being used during a major incident, there is time to address training and research. Collaboration with the NVIC and infrastructural adjustments enable us to not only care for patients with physical trauma, but also to provide centralized care of patients under quarantine conditions for, say, MRSA, SARS, smallpox, chemical or biological hazards. Triage plays an important role in medical disaster management and is therefore key to organization and infrastructure. Caps facilitate role distribution and recognizibility. The PBR resulted in more accurate registration and real-time availability of patient and group information. Infrastructure and a plan is not enough; training, research and evaluation are necessary to continuously work on disaster preparedness. The MIH in Utrecht (Netherlands) is a globally unique facility that can provide immediate emergency care for multiple casualties under exceptional circumstances. Resulting from the cooperation between a large academic medical institution, a trauma center, a military hospital and the NVIC, the MIH offers not only a good and complete infrastructure but also the expertise required to provide large-scale emergency care during disasters and major incidents.

Performance of Stochastic Targeted Blood Glucose Control Protocol by virtual trials in the Malaysian intensive care unit.

PubMed

Jamaludin, Ummu K; M Suhaimi, Fatanah; Abdul Razak, Normy Norfiza; Md Ralib, Azrina; Mat Nor, Mohd Basri; Pretty, Christopher G; Humaidi, Luqman

2018-08-01

Blood glucose variability is common in healthcare and it is not related or influenced by diabetes mellitus. To minimise the risk of high blood glucose in critically ill patients, Stochastic Targeted Blood Glucose Control Protocol is used in intensive care unit at hospitals worldwide. Thus, this study focuses on the performance of stochastic modelling protocol in comparison to the current blood glucose management protocols in the Malaysian intensive care unit. Also, this study is to assess the effectiveness of Stochastic Targeted Blood Glucose Control Protocol when it is applied to a cohort of diabetic patients. Retrospective data from 210 patients were obtained from a general hospital in Malaysia from May 2014 until June 2015, where 123 patients were having comorbid diabetes mellitus. The comparison of blood glucose control protocol performance between both protocol simulations was conducted through blood glucose fitted with physiological modelling on top of virtual trial simulations, mean calculation of simulation error and several graphical comparisons using stochastic modelling. Stochastic Targeted Blood Glucose Control Protocol reduces hyperglycaemia by 16% in diabetic and 9% in nondiabetic cohorts. The protocol helps to control blood glucose level in the targeted range of 4.0-10.0 mmol/L for 71.8% in diabetic and 82.7% in nondiabetic cohorts, besides minimising the treatment hour up to 71 h for 123 diabetic patients and 39 h for 87 nondiabetic patients. It is concluded that Stochastic Targeted Blood Glucose Control Protocol is good in reducing hyperglycaemia as compared to the current blood glucose management protocol in the Malaysian intensive care unit. Hence, the current Malaysian intensive care unit protocols need to be modified to enhance their performance, especially in the integration of insulin and nutrition intervention in decreasing the hyperglycaemia incidences. Improvement in Stochastic Targeted Blood Glucose Control Protocol in terms of u en model is also a must to adapt with the diabetic cohort. Copyright © 2018 Elsevier B.V. All rights reserved.

Health care access for rural youth on equal terms? A mixed methods study protocol in northern Sweden.

PubMed

Goicolea, Isabel; Carson, Dean; San Sebastian, Miguel; Christianson, Monica; Wiklund, Maria; Hurtig, Anna-Karin

2018-01-11

The purpose of this paper is to propose a protocol for researching the impact of rural youth health service strategies on health care access. There has been no published comprehensive assessment of the effectiveness of youth health strategies in rural areas, and there is no clearly articulated model of how such assessments might be conducted. The protocol described here aims to gather information to; i) Assess rural youth access to health care according to their needs, ii) Identify and understand the strategies developed in rural areas to promote youth access to health care, and iii) Propose actions for further improvement. The protocol is described with particular reference to research being undertaken in the four northernmost counties of Sweden, which contain a widely dispersed and diverse youth population. The protocol proposes qualitative and quantitative methodologies sequentially in four phases. First, to map youth access to health care according to their health care needs, including assessing horizontal equity (equal use of health care for equivalent health needs,) and vertical equity (people with greater health needs should receive more health care than those with lesser needs). Second, a multiple case study design investigates strategies developed across the region (youth clinics, internet applications, public health programs) to improve youth access to health care. Third, qualitative comparative analysis of the 24 rural municipalities in the region identifies the best combination of conditions leading to high youth access to health care. Fourth, a concept mapping study involving rural stakeholders, care providers and youth provides recommended actions to improve rural youth access to health care. The implementation of this research protocol will contribute to 1) generating knowledge that could contribute to strengthening rural youth access to health care, as well as to 2) advancing the application of mixed methods to explore access to health care.

KatharoSeq Enables High-Throughput Microbiome Analysis from Low-Biomass Samples

PubMed Central

Minich, Jeremiah J.; Zhu, Qiyun; Janssen, Stefan; Hendrickson, Ryan; Amir, Amnon; Vetter, Russ; Hyde, John; Doty, Megan M.; Stillwell, Kristina; Benardini, James; Kim, Jae H.; Allen, Eric E.

2018-01-01

ABSTRACT Microbiome analyses of low-biomass samples are challenging because of contamination and inefficiencies, leading many investigators to employ low-throughput methods with minimal controls. We developed a new automated protocol, KatharoSeq (from the Greek katharos [clean]), that outperforms single-tube extractions while processing at least five times as fast. KatharoSeq incorporates positive and negative controls to reveal the whole bacterial community from inputs of as few as 50 cells and correctly identifies 90.6% (standard error, 0.013%) of the reads from 500 cells. To demonstrate the broad utility of KatharoSeq, we performed 16S rRNA amplicon and shotgun metagenome analyses of the Jet Propulsion Laboratory spacecraft assembly facility (SAF; n = 192, 96), 52 rooms of a neonatal intensive care unit (NICU; n = 388, 337), and an endangered-abalone-rearing facility (n = 192, 123), obtaining spatially resolved, unique microbiomes reproducible across hundreds of samples. The SAF, our primary focus, contains 32 sOTUs (sub-OTUs, defined as exact sequence matches) and their inferred variants identified by the deblur algorithm, with four (Acinetobacter lwoffii, Paracoccus marcusii, Mycobacterium sp., and Novosphingobium) being present in >75% of the samples. According to microbial spatial topography, the most abundant cleanroom contaminant, A. lwoffii, is related to human foot traffic exposure. In the NICU, we have been able to discriminate environmental exposure related to patient infectious disease, and in the abalone facility, we show that microbial communities reflect the marine environment rather than human input. Consequently, we demonstrate the feasibility and utility of large-scale, low-biomass metagenomic analyses using the KatharoSeq protocol. IMPORTANCE Various indoor, outdoor, and host-associated environments contain small quantities of microbial biomass and represent a niche that is often understudied because of technical constraints. Many studies that attempt to evaluate these low-biomass microbiome samples are riddled with erroneous results that are typically false positive signals obtained during the sampling process. We have investigated various low-biomass kits and methods to determine the limit of detection of these pipelines. Here we present KatharoSeq, a high-throughput protocol combining laboratory and bioinformatic methods that can differentiate a true positive signal in samples with as few as 50 to 500 cells. We demonstrate the application of this method in three unique low-biomass environments, including a SAF, a hospital NICU, and an abalone-rearing facility. PMID:29577086

Factors promoting resident deaths at aged care facilities in Japan: a review.

PubMed

Sugimoto, Kentaro; Ogata, Yasuko; Kashiwagi, Masayo

2018-03-01

Due to an increasingly ageing population, the Japanese government has promoted elderly deaths in aged care facilities. However, existing facilities were not designed to provide resident end-of-life care and the proportion of aged care facility deaths is currently less than 10%. Consequently, the present review evaluated the factors that promote aged care facility resident deaths in Japan from individual- and facility-level perspectives to exploring factors associated with increased resident deaths. To achieve this, MEDLINE, CINAHL, Web of Science and Ichushi databases were searched on 23 January 2016. Influential factors were reviewed for two healthcare services (insourcing and outsourcing facilities) as well as external healthcare agencies operating outside facilities. Of the original 2324 studies retrieved, 42 were included in analysis. Of these studies, five focused on insourcing, two on outsourcing, seven on external agencies and observed facility/agency-level factors. The other 28 studies identified individual-level factors related to death in aged care facilities. The present review found that at both facility and individual levels, in-facility resident deaths were associated with healthcare service provision, confirmation of resident/family end-of-life care preference and staff education. Additionally, while outsourcing facilities did not require employment of physicians/nursing staff to accommodate resident death, these facilities required visits by physicians and nursing staff from external healthcare agencies as well as residents' healthcare input. This review also found few studies examining outsourcing facilities. The number of healthcare outsourcing facilities is rapidly increasing as a result of the Japanese government's new tax incentives. Consequently, there may be an increase in elderly deaths in outsourcing healthcare facilities. Accordingly, it is necessary to identify the factors associated with residents' deaths at outsourcing facilities. © 2016 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

'We just do the dirty work': dealing with incontinence, courtesy stigma and the low occupational status of carework in long-term aged care facilities.

PubMed

Ostaszkiewicz, Joan; O'Connell, Beverly; Dunning, Trisha

2016-09-01

To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities. Incontinence is a highly stigmatising condition that affects a disproportionally large number of people living in long-term aged care facilities. Its day-to-day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long-term aged care facilities. This paper presents one finding, i.e. how careworkers in long-term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work. Grounded theory. Eighty-eight hours of field observations in two long-term aged care facilities in Australia. In addition, in-depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long-term aged care facility in Australia. Occupational exposure to incontinence contributes to the low occupational status of carework in long-term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers' affective and behavioural responses are characterised by: (1) accommodating the context; (2) dissociating oneself; (3) distancing oneself and (4) attempting to elevate one's role status. The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long-term aged care facilities. This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long-term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as 'dignity work'. © 2016 John Wiley & Sons Ltd.

Exploring Space Management Goals in Institutional Care Facilities in China

PubMed Central

Zhang, Jiankun

2017-01-01

Space management has been widely examined in commercial facilities, educational facilities, and hospitals but not in China's institutional care facilities. Poor spatial arrangements, such as wasted space, dysfunctionality, and environment mismanagement, are increasing; in turn, the occupancy rate is decreasing due to residential dissatisfaction. To address these problems, this paper's objective is to explore the space management goals (SMGs) in institutional care facilities in China. Systematic literature analysis was adopted to set SMGs' principles, to identify nine theoretical SMGs, and to develop the conceptual model of SMGs for institutional care facilities. A total of 19 intensive interviews were conducted with stakeholders in seven institutional care facilities to collect data for qualitative analysis. The qualitative evidence was analyzed through open coding, axial coding, and selective coding. As a result, six major categories as well as their interrelationships were put forward to visualize the path diagram for exploring SMGs in China's institutional care facilities. Furthermore, seven expected SMGs that were explored from qualitative evidence were confirmed as China's SMGs in institutional care facilities by a validation test. Finally, a gap analysis among theoretical SMGs and China's SMGs provided recommendations for implementing space management in China's institutional care facilities. PMID:29065629

Exploring Space Management Goals in Institutional Care Facilities in China.

PubMed

Li, Lingzhi; Yuan, Jingfeng; Ning, Yan; Shao, Qiuhu; Zhang, Jiankun

2017-01-01

Space management has been widely examined in commercial facilities, educational facilities, and hospitals but not in China's institutional care facilities. Poor spatial arrangements, such as wasted space, dysfunctionality, and environment mismanagement, are increasing; in turn, the occupancy rate is decreasing due to residential dissatisfaction. To address these problems, this paper's objective is to explore the space management goals (SMGs) in institutional care facilities in China. Systematic literature analysis was adopted to set SMGs' principles, to identify nine theoretical SMGs, and to develop the conceptual model of SMGs for institutional care facilities. A total of 19 intensive interviews were conducted with stakeholders in seven institutional care facilities to collect data for qualitative analysis. The qualitative evidence was analyzed through open coding, axial coding, and selective coding. As a result, six major categories as well as their interrelationships were put forward to visualize the path diagram for exploring SMGs in China's institutional care facilities. Furthermore, seven expected SMGs that were explored from qualitative evidence were confirmed as China's SMGs in institutional care facilities by a validation test. Finally, a gap analysis among theoretical SMGs and China's SMGs provided recommendations for implementing space management in China's institutional care facilities.

75 FR 54627 - Best Management Practices for Unused Pharmaceuticals at Health Care Facilities

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-08

... at Health Care Facilities AGENCY: Environmental Protection Agency (EPA). ACTION: Notice. SUMMARY: EPA... Unused Pharmaceuticals at Health Care Facilities. The guidance is targeted at hospitals, medical clinics... drafted a guidance document for health care facilities, which describes: Techniques for reducing or...

Study of the Relevance of the Quality of Care, Operating Efficiency and Inefficient Quality Competition of Senior Care Facilities.

PubMed

Lin, Jwu-Rong; Chen, Ching-Yu; Peng, Tso-Kwei

2017-09-11

The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities.

Study of the Relevance of the Quality of Care, Operating Efficiency and Inefficient Quality Competition of Senior Care Facilities

PubMed Central

Lin, Jwu-Rong; Chen, Ching-Yu; Peng, Tso-Kwei

2017-01-01

The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities. PMID:28892019

Protocol for a national prevalence study of advance care planning documentation and self-reported uptake in Australia

PubMed Central

Ruseckaite, Rasa; Detering, Karen M; Perera, Veronica; Walker, Lynne; Sinclair, Craig; Clayton, Josephine M; Nolte, Linda

2017-01-01

Introduction Advance care planning (ACP) is a process between a person, their family/carer(s) and healthcare providers that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care. The Australian government funds a number of national initiatives aimed at increasing ACP uptake; however, there is currently no standardised Australian data on formal ACP documentation or self-reported uptake. This makes it difficult to evaluate the impact of ACP initiatives. This study aims to determine the Australian national prevalence of ACP and completion of Advance Care Directives (ACDs) in hospitals, aged care facilities and general practices. It will also explore people’s self-reported use of ACP and views about the process. Methods and analysis Researchers will conduct a national multicentre cross-sectional prevalence study, consisting of a record audit and surveys of people aged 65 years or more in three sectors. From 49 participating Australian organisations, 50 records will be audited (total of 2450 records). People whose records were audited, who speak English and have a decision-making capacity will also be invited to complete a survey. The primary outcome measure will be the number of people who have formal or informal ACP documentation that can be located in records within 15 min. Other outcomes will include demographics, measure of illness and functional capacity, details of ACP documentation (including type of document), location of documentation in the person’s records and whether current clinical care plans are consistent with ACP documentation. People will be surveyed, to measure self-reported interest, uptake and use of ACP/ACDs, and self-reported quality of life. Ethics and dissemination This protocol has been approved by the Austin Health Human Research Ethics Committee (reference HREC/17/Austin/83). Results will be submitted to international peer-reviewed journals and presented at international conferences. Trial registration number ACTRN12617000743369 PMID:29101142

Partnered research in healthcare delivery redesign for high-need, high-cost patients: development and feasibility of an Intensive Management Patient-Aligned Care Team (ImPACT).

PubMed

Zulman, Donna M; Ezeji-Okoye, Stephen C; Shaw, Jonathan G; Hummel, Debra L; Holloway, Katie S; Smither, Sasha F; Breland, Jessica Y; Chardos, John F; Kirsh, Susan; Kahn, James S; Asch, Steven M

2014-12-01

We employed a partnered research healthcare delivery redesign process to improve care for high-need, high-cost (HNHC) patients within the Veterans Affairs (VA) healthcare system. Health services researchers partnered with VA national and Palo Alto facility leadership and clinicians to: 1) analyze characteristics and utilization patterns of HNHC patients, 2) synthesize evidence about intensive management programs for HNHC patients, 3) conduct needs-assessment interviews with HNHC patients (n = 17) across medical, access, social, and mental health domains, 4) survey providers (n = 8) about care challenges for HNHC patients, and 5) design, implement, and evaluate a pilot Intensive Management Patient-Aligned Care Team (ImPACT) for a random sample of 150 patients. HNHC patients accounted for over half (52 %) of VA facility patient costs. Most (94 %) had three or more chronic conditions, and 60 % had a mental health diagnosis. Formative data analyses and qualitative assessments revealed a need for intensive case management, care coordination, transitions navigation, and social support and services. The ImPACT multidisciplinary team developed care processes to meet these needs, including direct access to team members (including after-hours), chronic disease management protocols, case management, and rapid interventions in response to health changes or acute service use. Two-thirds of invited patients (n = 101) enrolled in ImPACT, 87 % of whom remained actively engaged at 9 months. ImPACT is now serving as a model for a national VA intensive management demonstration project. Partnered research that incorporated population data analysis, evidence synthesis, and stakeholder needs assessments led to the successful redesign and implementation of services for HNHC patients. The rigorous design process and evaluation facilitated dissemination of the intervention within the VA healthcare system. Employing partnered research to redesign care for high-need, high-cost patients may expedite development and dissemination of high-value, cost-saving interventions.

42 CFR 440.150 - Intermediate care facility (ICF/IIDICF/IID) services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Intermediate care facility (ICF/IIDICF/IID... Definitions § 440.150 Intermediate care facility (ICF/IIDICF/IID) services. (a) “ICF/IIDICF/IID services” means those items and services furnished in an intermediate care facility for Individuals with...

42 CFR 440.150 - Intermediate care facility (ICF/IIDICF/IID) services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Intermediate care facility (ICF/IIDICF/IID... Definitions § 440.150 Intermediate care facility (ICF/IIDICF/IID) services. (a) “ICF/IIDICF/IID services” means those items and services furnished in an intermediate care facility for Individuals with...

38 CFR 17.65 - Approvals and provisional approvals of community residential care facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... approvals of community residential care facilities. 17.65 Section 17.65 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Community Residential Care § 17.65 Approvals and provisional approvals of community residential care facilities. (a) An approval of a facility meeting all of...

Oral intradialytic nutritional supplement use and mortality in hemodialysis patients.

PubMed

Weiner, Daniel E; Tighiouart, Hocine; Ladik, Vladimir; Meyer, Klemens B; Zager, Philip G; Johnson, Douglas S

2014-02-01

Hemodialysis patients have high mortality rates, potentially reflecting underlying comorbid conditions and ongoing catabolism. Intradialytic oral nutritional supplements may reduce this risk. Retrospective propensity-matched cohort. Maintenance hemodialysis patients treated at Dialysis Clinic Inc facilities who were initiated on a nutritional supplement protocol in September to October 2010 were matched using a propensity score to patients at facilities at which the protocol was not used. Prescription of the protocol, whereby hemodialysis patients with serum albumin levels ≤3.5g/dL would initiate oral protein supplementation during the dialysis procedure. Sensitivity analyses matched on actual supplement intake during the first 3 study months. Covariates included patient and facility characteristics, which were used to develop the propensity scores and adjust multivariable models. All-cause mortality, ascertained though March 2012. Of 6,453 eligible patients in 101 eligible hemodialysis facilities, the protocol was prescribed to 2,700, and 1,278 of these were propensity matched to controls. Mean age was 61 ± 15 (SD) years and median dialysis vintage was 34 months. There were 258 deaths among protocol assignees versus 310 among matched controls during a mean follow-up of 14 months. In matched analyses, protocol prescription was associated with a 29% reduction in the hazard of all-cause mortality (HR, 0.71; 95% CI, 0.58-0.86); adjustment had minimal impact on models. In time-dependent models incorporating change in albumin level, protocol status remained significant but was attenuated in models incorporating a 30-day lag. Similar results were seen in sensitivity analyses of 439 patients receiving supplements who were propensity-matched to controls, with 116 deaths among supplement users versus 140 among controls (HR, 0.79; 95% CI, 0.60-1.05), achieving statistical significance in adjusted models. Observational design, potential residual confounding. Prescription of an oral nutritional supplement protocol and use of oral protein nutritional supplements during hemodialysis are associated with reduced mortality among in-center maintenance hemodialysis patients, an effect likely not mediated by change in serum albumin levels. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Protocolized fluid therapy in brain-dead donors: the multicenter randomized MOnIToR trial.

PubMed

Al-Khafaji, Ali; Elder, Michele; Lebovitz, Daniel J; Murugan, Raghavan; Souter, Michael; Stuart, Susan; Wahed, Abdus S; Keebler, Ben; Dils, Dorrie; Mitchell, Stephanie; Shutterly, Kurt; Wilkerson, Dawn; Pearse, Rupert; Kellum, John A

2015-03-01

Critical shortages of organs for transplantation jeopardize many lives. Observational data suggest that better fluid management for deceased organ donors could increase organ recovery. We conducted the first large multicenter randomized trial in brain-dead donors to determine whether protocolized fluid therapy increases the number of organs transplanted. We randomly assigned donors to either protocolized or usual care in eight organ procurement organizations. A "protocol-guided fluid therapy" algorithm targeting the cardiac index, mean arterial pressure and pulse pressure variation was used. Our primary outcome was the number of organs transplanted per donor, and our primary analysis was intention to treat. Secondary analyses included: (1) modified intention to treat where only subjects able to receive the intervention were included and (2) 12-month survival in transplant recipients. The study was stopped early. We enrolled 556 donors: 279 protocolized care and 277 usual care. Groups had similar characteristics at baseline. The study protocol could be implemented in 76 % of subjects randomized to the intervention. There was no significant difference in mean number of organs transplanted per donor: 3.39 organs per donor (95 % CI 3.14-3.63) with protocolized care compared to 3.29 usual care (95 % CI 3.04-3.54; mean difference, 0.1, 95 % CI -0.25 to 0.45; p = 0.56). In modified intention-to-treat analysis the mean number of organs increased (3.52 organs per donor, 95 % CI 3.23-3.8), but not statistically significantly (mean difference, 0.23, 95 % CI -0.15 to 0.61; p = 0.23). Among the 1,430 recipients of organs from study subjects with data available, 56 deaths (7.8 %) occurred in the protocolized care arm and 56 (7.9 %) in the usual care arm in the first year (hazard ratio: 0.97, p = 0.86). In brain-dead organ donors, protocol-guided fluid therapy compared to usual care may not increase the number of organs transplanted per donor.

A First Look at PCMH Implementation for Minority Veterans: Room for Improvement.

PubMed

Hernandez, Susan E; Taylor, Leslie; Grembowski, David; Reid, Robert J; Wong, Edwin; Nelson, Karin M; Liu, Chuan-Fen; Fihn, Stephan D; Hebert, Paul L

2016-03-01

Implementation of Patient Aligned Care Teams (PACT), a patient-centered medical home model, has been inconsistent among the >900 primary care facilities in the Veterans Health Administration. Estimate if the degree of PACT implementation at a facility varied with the percentage of minority veteran patients at the facility. Cross-sectional, facility-level analysis of PACT implementation measures in 2012. Veterans Health Administration hospital-based and community-based primary care facilities. We used a previously validated PACT Implementation Progress Index (Pi) and its 8 domains: access, continuity of care, care coordination, comprehensiveness, self-management support, and patient-centered care and communication, shared decision-making domains, and team functioning. Facilities were categorized as low (<5.2%, n=208), medium (5.2%-25.8%, n=413), and high (>25.8%, n=206) percent minority based on the percent of their own veteran population. Most minority veterans received care in high minority (69%) and medium minority facilities (29%). In adjusted analyses, medium and high minority facilities scored 0.773 (P=0.009) and 0.930 (P=0.008) points lower on the Pi score relative to low minority facilities. Relative to low minority facilities, both medium and high minority facilities were less likely of having high Pi scores (≥2) and more likely of having low Pi scores (≤-2). Both medium and high minority facilities had the same 3 domain scores lower than low minority facilities (care coordination, comprehensiveness, and self-management). Overall PACT implementation varied with respect to the racial/ethnic composition of a facility, with medium and high minority facilities having a lower implementation scores.

Health Facilities

MedlinePlus

Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialized care centers, ... psychiatric care centers. When you choose a health facility, you might want to consider How close it ...

Multi-disciplinary Care for the Elderly in Disasters: An Integrative Review.

PubMed

Johnson, Heather L; Ling, Catherine G; McBee, Elexis C

2015-02-01

Older adults are disproportionately affected by disaster. Frail elders, individuals with chronic diseases, conditions, or disabilities, and those who live in long-term care facilities are especially vulnerable. Purpose The purpose of this integrative review of the literature was to describe the system-wide knowledge and skills that multi-disciplinary health care providers need to provide appropriate care for the elderly during domestic-humanitarian and disaster-relief efforts. Data sources A systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed, CINAHL, and PsycINFO were conducted using terms such as Disaster, Geological Processes, Aged, Disaster Planning, and Vulnerable Populations. Forty-six articles met criteria for inclusion in the review. Policies and guidance regarding evacuating versus sheltering in place are lacking. Tenets of elderly-focused disaster planning/preparation and clarification of legal and ethical standards of care and liability issues are needed. Functional capacity, capabilities, or impairments, rather than age, should be considered in disaster preparation. Older adults should be included in disaster planning as population-specific experts. Implications for Practice A multifaceted approach to population-specific disaster planning and curriculum development should include consideration of the biophysical and psychosocial aspects of care, ethical and legal issues, logistics, and resources.

Measuring facility capability to provide routine and emergency childbirth care to mothers and newborns: An appeal to adjust for delivery caseload of facilities

PubMed Central

Allen, Stephanie M.; Opondo, Charles; Campbell, Oona M. R.

2017-01-01

Background Measurement of Emergency Obstetric Care capability is common, and measurement of newborn and overall routine childbirth care has begun in recent years. These assessments of facility capabilities can be used to identify geographic inequalities in access to functional health services and to monitor improvements over time. This paper develops an approach for monitoring the childbirth environment that accounts for the delivery caseload of the facility. Methods We used data from the Kenya Service Provision Assessment to examine facility capability to provide quality childbirth care, including infrastructure, routine maternal and newborn care, and emergency obstetric and newborn care. A facility was considered capable of providing a function if necessary tracer items were present and, for emergency functions, if the function had been performed in the previous three months. We weighted facility capability by delivery caseload, and compared results with those generated using traditional “survey weights”. Results Of the 403 facilities providing childbirth care, the proportion meeting criteria for capability were: 13% for general infrastructure, 6% for basic emergency obstetric care, 3% for basic emergency newborn care, 13% and 11% for routine maternal and newborn care, respectively. When the new caseload weights accounting for delivery volume were applied, capability improved and the proportions of deliveries occurring in a facility meeting capability criteria were: 51% for general infrastructure, 46% for basic emergency obstetric care, 12% for basic emergency newborn care, 36% and 18% for routine maternal and newborn care, respectively. This is because most of the caseload was in hospitals, which generally had better capability. Despite these findings, fewer than 2% of deliveries occurred in a facility capable of providing all functions. Conclusion Reporting on the percentage of facilities capable of providing certain functions misrepresents the capacity to provide care at the national level. Delivery caseload weights allow adjustment for patient volume, and shift the denominator of measurement from facilities to individual deliveries, leading to a better representation of the context in which facility births take place. These methods could lead to more standardized national datasets, enhancing their ability to inform policy at a national and international level. PMID:29049412

Health care and personal care needs among residents in nursing homes, group homes, and congregate housing in Japan: why does transition occur, and where can the frail elderly establish a permanent residence?

PubMed

Nakanishi, Miharu; Hattori, Keiko; Nakashima, Taeko; Sawamura, Kanae

2014-01-01

Japan has had high rates of transition to nursing homes from other long term care facilities. It has been hypothesized that care transitions occur because a resident's condition deteriorates. The aim of the present study was to compare the health care and personal care needs of residents in nursing homes, group homes, and congregate housing in Japan. The present study was conducted using a cross-sectional study design. The present study included 70,519 elderly individuals from 5 types of residential facilities: care medical facilities (heavy medical care; n = 17,358), geriatric intermediate care facilities (rehabilitation aimed toward a discharge to home; n = 26,136), special nursing homes (permanent residence; n = 20,564), group homes (group living, n = 1454), and fee-based homes for the elderly (congregate housing; n = 5007). The managing director at each facility provided information on the residents' health care and personal care needs, including activities of daily living (ADLs), level of required care, level of cognitive impairment, current disease treatment, and medical procedures. A multinomial logistic regression analysis demonstrated a significantly lower rate of medical procedures among the residents in special nursing homes compared with those in care medical facilities, geriatric intermediate care facilities, group homes, and fee-based homes for the elderly. The residents of special nursing homes also indicated a significantly lower level of required care than those in care medical facilities. The results of our study suggest that care transitions occur because of unavailable permanent residence option for people who suffer with medical deterioration. The national government should modify residential facilities by reorganizing several types of residential facilities into nursing homes that provide a place of permanent residence. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up

PubMed Central

2012-01-01

Background Malaysia has been at the forefront of the development and scale up of One-Stop Crisis Centres (OSCC) - an integrated health sector model that provides comprehensive care to women and children experiencing physical, emotional and sexual abuse. This study explored the strengths and challenges faced during the scaling up of the OSCC model to two States in Malaysia in order to identify lessons for supporting successful scale-up. Methods In-depth interviews were conducted with health care providers, policy makers and key informants in 7 hospital facilities. This was complemented by a document analysis of hospital records and protocols. Data were coded and analysed using NVivo 7. Results The implementation of the OSCC model differed between hospital settings, with practise being influenced by organisational systems and constraints. Health providers generally tried to offer care to abused women, but they are not fully supported within their facility due to lack of training, time constraints, limited allocated budget, or lack of referral system to external support services. Non-specialised hospitals in both States struggled with a scarcity of specialised staff and limited referral options for abused women. Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling. Conclusions The national implementation of OSCC provides a potentially important source of support for women experiencing violence. Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place – in other words a supportive health system. Furthermore, the successful replication of the OSCC model in other similar settings requires that the model – and the system supporting it – needs to be flexible enough to allow adaptation of the service model to different types of facilities and levels of care, and to available resources and thus better support providers committed to delivering care to abused women. PMID:22828240

An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up.

PubMed

Colombini, Manuela; Mayhew, Susannah H; Ali, Siti Hawa; Shuib, Rashidah; Watts, Charlotte

2012-07-24

Malaysia has been at the forefront of the development and scale up of One-Stop Crisis Centres (OSCC) - an integrated health sector model that provides comprehensive care to women and children experiencing physical, emotional and sexual abuse. This study explored the strengths and challenges faced during the scaling up of the OSCC model to two States in Malaysia in order to identify lessons for supporting successful scale-up. In-depth interviews were conducted with health care providers, policy makers and key informants in 7 hospital facilities. This was complemented by a document analysis of hospital records and protocols. Data were coded and analysed using NVivo 7. The implementation of the OSCC model differed between hospital settings, with practise being influenced by organisational systems and constraints. Health providers generally tried to offer care to abused women, but they are not fully supported within their facility due to lack of training, time constraints, limited allocated budget, or lack of referral system to external support services. Non-specialised hospitals in both States struggled with a scarcity of specialised staff and limited referral options for abused women. Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling. The national implementation of OSCC provides a potentially important source of support for women experiencing violence. Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place - in other words a supportive health system. Furthermore, the successful replication of the OSCC model in other similar settings requires that the model - and the system supporting it - needs to be flexible enough to allow adaptation of the service model to different types of facilities and levels of care, and to available resources and thus better support providers committed to delivering care to abused women.

Protocol for development and validation of a context-appropriate tool for assessing organisational readiness for change in primary health clinics in South Africa.

PubMed

Brooke-Sumner, Carrie; Sorsdahl, Katherine; Lombard, Carl; Petersen-Williams, Petal; Myers, Bronwyn

2018-04-09

A large treatment gap for common mental disorders (such as depression) exists in South Africa. Comorbidity with other chronic diseases, including HIV and diseases of lifestyle, is an increasing public health concern globally. Currently, primary health facilities as points of care for those with chronic disease provide limited services for common mental disorders. Assessing organisational readiness for change (ORC) towards adopting health innovations (such as mental health services) using contextually appropriate measures is needed to facilitate implementation of these services. This study aims to investigate the validity of the Texas Christian University Organisational Readiness for Change (TCU-ORC) scale in the South African context. Subsequently, we will develop a shortened version of this scale. This study is nested within Project MIND, a multiyear randomised controlled trial that is testing two different approaches for integrating counselling for common mental disorders into chronic disease care. Although the modified, contextually appropriate ORC measure resulting from the proposed study will be developed in the context of integrating mental health into primary healthcare services, the potential for the tool to be generalised to further understanding barriers to any change being implemented in primary care settings is high. We will establish internal consistency (Cronbach's alpha coefficients), test-retest reliability (intraclass correlation coefficient) and construct validity of the long-form TCU-ORC questionnaire. Survey data will be collected from 288 clinical, management and operational staff from 24 primary health facilities where the Project MIND trial is implemented. A modified Delphi approach will assess the content validity of the TCU-ORC items and identify areas for potential adaptation and item reduction. Ethical approval has been granted by the South African Medical Research Council (Protocol ID EC004-2-2015, amendment of 20 August 2017). Results will be submitted to peer-reviewed journals relevant to implementation and health systems strengthening. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Feasibility study for a numerical aerodynamic simulation facility. Volume 2: Hardware specifications/descriptions

NASA Technical Reports Server (NTRS)

Green, F. M.; Resnick, D. R.

1979-01-01

An FMP (Flow Model Processor) was designed for use in the Numerical Aerodynamic Simulation Facility (NASF). The NASF was developed to simulate fluid flow over three-dimensional bodies in wind tunnel environments and in free space. The facility is applicable to studying aerodynamic and aircraft body designs. The following general topics are discussed in this volume: (1) FMP functional computer specifications; (2) FMP instruction specification; (3) standard product system components; (4) loosely coupled network (LCN) specifications/description; and (5) three appendices: performance of trunk allocation contention elimination (trace) method, LCN channel protocol and proposed LCN unified second level protocol.

Issues in providing a reliable multicast facility

NASA Technical Reports Server (NTRS)

Dempsey, Bert J.; Strayer, W. Timothy; Weaver, Alfred C.

1990-01-01

Issues involved in point-to-multipoint communication are presented and the literature for proposed solutions and approaches surveyed. Particular attention is focused on the ideas and implementations that align with the requirements of the environment of interest. The attributes of multicast receiver groups that might lead to useful classifications, what the functionality of a management scheme should be, and how the group management module can be implemented are examined. The services that multicasting facilities can offer are presented, followed by mechanisms within the communications protocol that implements these services. The metrics of interest when evaluating a reliable multicast facility are identified and applied to four transport layer protocols that incorporate reliable multicast.

Considerations in establishing a post-mortem brain and tissue bank for the study of myalgic encephalomyelitis/chronic fatigue syndrome: a proposed protocol.

PubMed

Nacul, Luis; O'Donovan, Dominic G; Lacerda, Eliana M; Gveric, Djordje; Goldring, Kirstin; Hall, Alison; Bowman, Erinna; Pheby, Derek

2014-06-18

Our aim, having previously investigated through a qualitative study involving extensive discussions with experts and patients the issues involved in establishing and maintaining a disease specific brain and tissue bank for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), was to develop a protocol for a UK ME/CFS repository of high quality human tissue from well characterised subjects with ME/CFS and controls suitable for a broad range of research applications. This would involve a specific donor program coupled with rapid tissue collection and processing, supplemented by comprehensive prospectively collected clinical, laboratory and self-assessment data from cases and controls. We reviewed the operations of existing tissue banks from published literature and from their internal protocols and standard operating procedures (SOPs). On this basis, we developed the protocol presented here, which was designed to meet high technical and ethical standards and legal requirements and was based on recommendations of the MRC UK Brain Banks Network. The facility would be most efficient and cost-effective if incorporated into an existing tissue bank. Tissue collection would be rapid and follow robust protocols to ensure preservation sufficient for a wide range of research uses. A central tissue bank would have resources both for wide-scale donor recruitment and rapid response to donor death for prompt harvesting and processing of tissue. An ME/CFS brain and tissue bank could be established using this protocol. Success would depend on careful consideration of logistic, technical, legal and ethical issues, continuous consultation with patients and the donor population, and a sustainable model of funding ideally involving research councils, health services, and patient charities. This initiative could revolutionise the understanding of this still poorly-understood disease and enhance development of diagnostic biomarkers and treatments.

[The effects of multimedia-assisted instruction on the skin care learning of nurse aides in long-term care facilities].

PubMed

Wu, Yu-Ling; Kao, Yu-Hsiu

2014-08-01

Skin care is an important responsibility of nurse aides in long-term care facilities, and the nursing knowledge, attitudes, and skills of these aides significantly affects quality of care. However, the work schedule of nurse aides often limits their ability to obtain further education and training. Therefore, developing appropriate and effective training programs for nurse aides is critical to maintaining and improving quality of care in long-term care facilities. This study investigates the effects of multimedia assisted instruction on the skin care learning of nurse aides working in long-term care facilities. A quasi-experimental design and convenient sampling were adopted in this study. Participants included 96 nurse aides recruited from 5 long-term care facilities in Taoyuan County, Taiwan. The experimental group received 3 weeks of multimedia assisted instruction. The control group did not receive this instruction. The Skin Care Questionnaire for Nurse Aides in Long-term Care Facilities and the Skin Care Behavior Checklist were used for assessment before and after the intervention. (1) Posttest scores for skin care knowledge, attitudes, behavior, and the skin care checklist were significantly higher than pretest scores for the intervention group. There was no significant difference between pretest and posttest scores for the control group. (2) A covariance analysis of pretest scores for the two groups showed that the experimental group earned significantly higher average scores than their control group peers for skin care knowledge, attitudes, behavior, and the skin care checklist. The multimedia assisted instruction demonstrated significant and positive effects on the skin care leaning of nurse aides in long-term care facilities. This finding supports the use of multimedia assisted instruction in the education and training of nurse aides in long-term care facilities in the future.

Administrators' perspectives on end-of-life care for cancer patients in Japanese long-term care facilities.

PubMed

Fukahori, Hiroki; Miyashita, Mitsunori; Morita, Tatsuya; Ichikawa, Takayuki; Akizuki, Nobuya; Akiyama, Miki; Shirahige, Yutaka; Eguchi, Kenji

2009-10-01

The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

Resident and facility characteristics associated with care-need level deterioration in long-term care welfare facilities in Japan.

PubMed

Jin, Xueying; Tamiya, Nanako; Jeon, Boyoung; Kawamura, Akira; Takahashi, Hideto; Noguchi, Haruko

2018-05-01

To determine the resident and facility characteristics associated with residents' care-need level deterioration in long-term care welfare facilities in Japan. A nationally representative sample of 358 886 residents who lived in 3774 long-term care welfare facilities for at least 1 year from October 2012 was obtained from long-term care insurance claims data. Facility characteristics were linked with a survey of institutions and establishments for long-term care in 2012. We used a multilevel logistic regression according to the inclusion and exclusion of lost to follow-up to define the resident and facility characteristics associated with resident care-need level deteriorations (lost to follow-up: the majority were hospitalized residents or had died; were treated as deterioration in the including loss to follow-up model). Adjusting for the covariates, at the resident level, older age and lower care-need level at baseline were more likely to show deterioration in the care-need level. At the facility level, metropolitan facilities, unit model (all private room settings) and mixed-model facilities (partly private room settings) were less likely to experience care-need level deterioration. A higher proportion of registered nurses among all nurses was negatively related to care-need level deterioration only in the model including lost to follow-up. A higher proportion of registered dietitians among all dietitians and the facilities in business for fewer years were negatively associated with care-need level deterioration only in the model excluding lost to follow-up. The present study could help identify residents who are at risk of care-need level deterioration, and could contribute to improvements in provider quality performance and enhance competence in the market. Geriatr Gerontol Int 2018; 18: 758-766. © 2018 The Authors Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.

Gaps in the Substance Use Disorder Treatment Referral Process: Provider Perceptions.

PubMed

Blevins, Claire E; Rawat, Nishi; Stein, Michael D

2018-05-07

The demand for substance use disorder treatment is increasing, fueled by the opioid epidemic and the Affordable Care Act mandate to treat substance use disorders. The increased demand for treatment, however, is not being met by a corresponding increase in access to or availability of treatment. This report focuses specifically on the treatment referral process, which we have identified as 1 of the key barriers to timely and effective treatment. Difficulties in referral to substance use disorder treatment are examined through the lens of providers who make referrals (ie, referral source) and individuals who work in substance use disorder facilities (ie, referral recipient). Administrative officials, emergency department physicians, addiction physicians, government officials, providers, insurance officials, and mental health advocates (n = 59) were interviewed on the referral process protocol, challenges for providers and others making referrals, and issues with substance use treatment facility intake procedures. Several main themes were identified as barriers in the process: difficulties in determining patient eligibility, lack of transparency regarding treatment capacity, referral source knowledge/understanding of options, and issues with communication between referral source and recipient. We then proposed several solutions to address specific barriers. Current gaps in the referral process cause delays to care. Improving systems would involve addressing these themes and expanding the use of appropriate treatments for the many patients in need.

Identifying priority policy issues and health system research questions associated with recovery outcomes for burns survivors in India: a qualitative inquiry

PubMed Central

Chamania, Shobha; Potokar, Tom; Ivers, Rebecca

2018-01-01

Objectives This study aimed to identify priority policy issues and health system research questions associated with recovery outcomes for burns survivors in India. Design Qualitative inquiry; data were collected through semistructured in-depth interviews and focus group discussions. Setting Nine sites in urban and rural settings across India, through primary, secondary and tertiary health facilities. Participants Healthcare providers, key informants, burns survivors and/or their carers. Results Participants acknowledged the challenges of burns care and recovery, and identified the need for prolonged rehabilitation. Challenges identified included poor communication between healthcare providers and survivors, limited rehabilitation services, difficulties with transportation to health facility and high cost associated with burns care. Burns survivors and healthcare providers identified the stigma attached with burns as the biggest challenge within the healthcare system, as well as in the community. Systems barriers (eg, limited infrastructure and human resources), lack of economic and social support, and poor understanding of recovery and rehabilitation were identified as major barriers to recovery. Conclusions Though further research is needed for addressing gaps in data, strengthening of health systems can enable providers to address issues such as developing/providing, protocols, capacity building, effective coordination between key organisations and referral networks. PMID:29523568

42 CFR 440.150 - Intermediate care facility (ICF/MR) services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Intermediate care facility (ICF/MR) services. 440....150 Intermediate care facility (ICF/MR) services. (a) “ICF/MR services” means those items and services furnished in an intermediate care facility for the mentally retarded if the following conditions are met: (1...

45 CFR 234.130 - Assistance in the form of institutional services in intermediate care facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the intermediate care facility. (3) Provide methods of administration that include: (i) Placing of... intermediate care facility, whether the services actually rendered are adequate and responsive to the... intermediate care facility services under the medical assistance program, title XIX of the Act, but not later...

77 FR 21580 - Changes in Certain Multifamily Housing and Health Care Facility Mortgage Insurance Premiums for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-10

... Multifamily Housing and Health Care Facility Mortgage Insurance Premiums for Fiscal Year (FY) 2013 AGENCY... (MIPs) for certain Federal Housing Administration (FHA) Multifamily Housing, Health Care Facilities, and...; with a 15 basis point increase for all other market-rate multifamily housing, health care facility, and...

Marketing in the long-term care continuum.

PubMed

Laurence, J Nathan; Kash, Bita A

2010-04-01

Today, long-term care facilities are composed of independent, assisted living, and skilled nursing facilities along with many variations of those themes in between. The clientele for these various types of facilities differ because of the level of care the facility provides as well as the amenities long-term care consumers are looking for. However, there many similarities and common approaches to how reaching the target audience through effective marketing activities. Knowing who the target audience is, how to reach them, and how to communicate with them will serve any facility well in this competitive market. Developing marketing strategies for long-term care settings is as important as understanding what elements of care can be marketed individually as a niche market. Determining the market base for a facility is equally crucial since the target populations differ among the three types of facilities. By reviewing current marketing articles and applying marketing practices, we have crafted some general principles for which each facility type can learn from. Finally, we will discuss the types of marketing and how they related to the spectrum of long-term care facilities.

[Hip Fracture--Epidemiology, Management and Liaison Service. What do we need to close care gaps in treating hip fracture?--How to include the UK experience into the care in Japan].

PubMed

Takahashi, Hideaki E

2015-04-01

Various care gaps are noted in and between acute and rehabilitation hospitals, and after discharge from hospitals in Japan. In the most of acute care hospitals physicians take care of elderly fractured patients only by a request of orthopaedic team. This made a mean time until surgery was 4.5 days (2011). A critical pathway in treating hip fracture has certainly shortened days in the acute hospitals, care gaps may exist between hospitals. Although osteoporosis medication has started on discharge, it may be discontinued at home, in health or social care facilities under the care of primary care physicians. Even though it was estimated approximately 160,000 hip fractures per year in Japan, management of patients' address is not well established after discharge. In order to include the UK experience in Japan, two proposals were made for hospitals in treating hip fracture as follows. 1. Clinical auditing may be added to improve quality of care. An audit protocol is to be developed multidisciplinarily by orthopaedic surgeons and geriatricians, with interprofessional collaboration. 2. A fracture liaison service is to be established to make interprofessional care-mix possible, such as an increase of adherence of osteoporosis drugs and prevention of falls after discharge. A fracture liaison coordinator is to be assigned to the service in making a team approach possible to a patient and his/her family.

Interdisciplinary development and implementation of communication checklist for postoperative management of pediatric airway patients.

PubMed

Kim, Sang W; Maturo, Stephen; Dwyer, Danielle; Monash, Bradley; Yager, Phoebe H; Zanger, Kerstin; Hartnick, Christopher J

2012-01-01

The authors describe their multidisciplinary experience in applying the Institute of Health Improvement methodology to develop a protocol and checklist to reduce communication error during transfer of care for postoperative pediatric surgical airway patients. Preliminary outcome data following implementation of the protocol and checklist are also presented. Prospective study from July 1, 2009, to February 1, 2011. Tertiary care center. Subjects. One hundred twenty-six pediatric airway patients who required coordinated care between Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital. Two sentinel events involving airway emergencies demonstrated a critical need for a standardized, comprehensive instrument that would ensure safe transfer of care. After development and implementation of the protocol and checklist, an initial pilot period on the first set of 9 pediatric airway patients was reassessed. Subsequent prospective 11-month follow-up data of 93 pediatric airway patients were collected and analyzed. A multidisciplinary pediatric team developed and implemented a formalized, postoperative checklist and transfer protocol. After implementation of the checklist and transfer protocol, prospective analysis showed no adverse events from miscommunication during transfer of care over the subsequent 11-month period involving 93 pediatric airway patients. There has been very little written in the quality and safety patient literature about coordinating effective transfer of care between the pediatric surgical and medical subspecialty realms. After design and implementation of a simple, electronically based transfer-of-care checklist and protocol, the number of postsurgical pediatric airway information transfer and communication errors decreased significantly.

Issues in designing transport layer multicast facilities

NASA Technical Reports Server (NTRS)

Dempsey, Bert J.; Weaver, Alfred C.

1990-01-01

Multicasting denotes a facility in a communications system for providing efficient delivery from a message's source to some well-defined set of locations using a single logical address. While modem network hardware supports multidestination delivery, first generation Transport Layer protocols (e.g., the DoD Transmission Control Protocol (TCP) (15) and ISO TP-4 (41)) did not anticipate the changes over the past decade in underlying network hardware, transmission speeds, and communication patterns that have enabled and driven the interest in reliable multicast. Much recent research has focused on integrating the underlying hardware multicast capability with the reliable services of Transport Layer protocols. Here, we explore the communication issues surrounding the design of such a reliable multicast mechanism. Approaches and solutions from the literature are discussed, and four experimental Transport Layer protocols that incorporate reliable multicast are examined.

Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter?

PubMed Central

McGregor, Margaret J.; Cohen, Marcy; McGrail, Kimberlyn; Broemeling, Anne Marie; Adler, Reva N.; Schulzer, Michael; Ronald, Lisa; Cvitkovich, Yuri; Beck, Mary

2005-01-01

Background Currently there is a lot of debate about the advantages and disadvantages of for-profit health care delivery. We examined staffing ratios for direct-care and support staff in publicly funded not-for-profit and for-profit nursing homes in British Columbia. Methods We obtained staffing data for 167 long-term care facilities and linked these to the type of facility and ownership of the facility. All staff were members of the same bargaining association and received identical wages in both not-for-profit and for-profit facilities. Similar public funding is provided to both types of facilities, although the amounts vary by the level of functional dependence of the residents. We compared the mean number of hours per resident-day provided by direct-care staff (registered nurses, licensed practical nurses and resident care aides) and support staff (housekeeping, dietary and laundry staff) in not-for-profit versus for-profit facilities, after adjusting for facility size (number of beds) and level of care. Results The nursing homes included in our study comprised 76% of all such facilities in the province. Of the 167 nursing homes examined, 109 (65%) were not-for-profit and 58 (35%) were for-profit; 24% of the for-profit homes were part of a chain, and the remaining homes were owned by a single operator. The mean number of hours per resident-day was higher in the not-for-profit facilities than in the for-profit facilities for both direct-care and support staff and for all facility levels of care. Compared with for-profit ownership, not-for-profit status was associated with an estimated 0.34 more hours per resident-day (95% confidence interval [CI] 0.18–0.49, p < 0.001) provided by direct-care staff and 0.23 more hours per resident-day (95% CI 0.15–0.30, p < 0.001) provided by support staff. Interpretation Not-for-profit facility ownership is associated with higher staffing levels. This finding suggests that public money used to provide care to frail eldery people purchases significantly fewer direct-care and support staff hours per resident-day in for-profit long-term care facilities than in not-for-profit facilities. PMID:15738489

Adverse event reporting in Czech long-term care facilities.

PubMed

Hěib, Zdenřk; Vychytil, Pavel; Marx, David

2013-04-01

To describe adverse event reporting processes in long-term care facilities in the Czech Republic. Prospective cohort study involving a written questionnaire followed by in-person structured interviews with selected respondents. Long-term care facilities located in the Czech Republic. Staff of 111 long-term care facilities (87% of long-term care facilities in the Czech Republic). None. Sixty-three percent of long-term health-care facilities in the Czech Republic have adverse event-reporting processes already established, but these were frequently very immature programs sometimes consisting only of paper recording of incidents. Compared to questionnaire responses, in-person interview responses only partially tended to confirm the results of the written survey. Twenty-one facilities (33%) had at most 1 unconfirmed response, 31 facilities (49%) had 2 or 3 unconfirmed responses and the remaining 11 facilities (17%) had 4 or more unconfirmed responses. In-person interviews suggest that use of a written questionnaire to assess the adverse event-reporting process may have limited validity. Staff of the facilities we studied expressed an understanding of the importance of adverse event reporting and prevention, but interviews also suggested a lack of knowledge necessary for establishing a good institutional reporting system in long-term care.

It's Time to Develop a New "Draft Test Protocol" for a Mars Sample Return Mission (or Two…).

PubMed

Rummel, John D; Kminek, Gerhard

2018-04-01

The last time NASA envisioned a sample return mission from Mars, the development of a protocol to support the analysis of the samples in a containment facility resulted in a "Draft Test Protocol" that outlined required preparations "for the safe receiving, handling, testing, distributing, and archiving of martian materials here on Earth" (Rummel et al., 2002 ). This document comprised a specific protocol to be used to conduct a biohazard test for a returned martian sample, following the recommendations of the Space Studies Board of the US National Academy of Sciences. Given the planned launch of a sample-collecting and sample-caching rover (Mars 2020) in 2 years' time, and with a sample return planned for the end of the next decade, it is time to revisit the Draft Test Protocol to develop a sample analysis and biohazard test plan to meet the needs of these future missions. Key Words: Biohazard detection-Mars sample analysis-Sample receiving facility-Protocol-New analytical techniques-Robotic sample handling. Astrobiology 18, 377-380.

40 CFR 792.45 - Test system supply facilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... maintaining algae and aquatic plants. (2) Facilities, as specified in the protocol, for plant growth, including but not limited to, greenhouses, growth chambers, light banks, and fields. (c) When appropriate... supplies shall be preserved by appropriate means. (b) When appropriate, plant supply facilities shall be...

40 CFR 792.45 - Test system supply facilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... maintaining algae and aquatic plants. (2) Facilities, as specified in the protocol, for plant growth, including but not limited to, greenhouses, growth chambers, light banks, and fields. (c) When appropriate... supplies shall be preserved by appropriate means. (b) When appropriate, plant supply facilities shall be...

40 CFR 792.45 - Test system supply facilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... maintaining algae and aquatic plants. (2) Facilities, as specified in the protocol, for plant growth, including but not limited to, greenhouses, growth chambers, light banks, and fields. (c) When appropriate... supplies shall be preserved by appropriate means. (b) When appropriate, plant supply facilities shall be...

Understanding the Impact of Brain Disorders: Towards a ‘Horizontal Epidemiology’ of Psychosocial Difficulties and Their Determinants

PubMed Central

Cieza, Alarcos; Anczewska, Marta; Ayuso-Mateos, Jose Luis; Baker, Mary; Bickenbach, Jerome; Chatterji, Somnath; Hartley, Sally; Leonardi, Matilde; Pitkänen, Tuuli

2015-01-01

Objective To test the hypothesis of ‘horizontal epidemiology’, i.e. that psychosocial difficulties (PSDs), such as sleep disturbances, emotional instability and difficulties in personal interactions, and their environmental determinants are experienced in common across neurological and psychiatric disorders, together called brain disorders. Study Design A multi-method study involving systematic literature reviews, content analysis of patient-reported outcomes and outcome instruments, clinical input and a qualitative study was carried out to generate a pool of PSD and environmental determinants relevant for nine different brain disorders, namely epilepsy, migraine, multiple sclerosis, Parkinson’s disease, stroke, dementia, depression, schizophrenia and substance dependency. Information from these sources was harmonized and compiled, and after feedback from external experts, a data collection protocol including PSD and determinants common across these nine disorders was developed. This protocol was implemented as an interview in a cross-sectional study including a convenience sample of persons with one of the nine brain disorders. PSDs endorsed by at least 25% of patients with a brain disorder were considered associated with the disorder. PSD were considered common across disorders if associated to 5 out of the 9 brain disorders and if among the 5 both neurological and psychiatric conditions were represented. Setting The data collection protocol with 64 PSDs and 20 determinants was used to collect data from a convenience sample of 722 persons in four specialized health care facilities in Europe. Results 57 of the PSDs and 16 of the determinants included in the protocol were found to be experienced across brain disorders. Conclusion This is the first evidence that supports the hypothesis of horizontal epidemiology in brain disorders. This result challenges the brain disorder-specific or vertical approach in which clinical and epidemiological research about psychosocial difficulties experienced in daily life is commonly carried in neurology and psychiatry and the way in which the corresponding health care delivery is practiced in many countries of the world. PMID:26352911

HIV testing in correctional institutions: evaluating existing strategies, setting new standards.

PubMed

Basu, Sanjay; Smith-Rohrberg, Duncan; Hanck, Sarah; Altice, Frederick L

2005-01-01

Before introducing an HIV testing protocol into correctional facilities, the unique nature of these environments must be taken into account. We analyze three testing strategies that have been used in correctional settings--mandatory, voluntary, and routine "opt out" testing--and conclude that routine testing is most likely beneficial to inmates, the correctional system, and the outside community. The ethics of pre-release testing, and the issues surrounding segregation, confidentiality, and linking prisoners with community-based care, also play a role in determining how best to establish HIV testing strategies in correctional facilities. Testing must be performed in a manner that is not simply beneficial to public health, but also enhances the safety and health status of individual inmates. Longer-stay prison settings provide ample opportunities not just for testing but also for in-depth counseling, mental health and substance abuse treatment, and antiretroviral therapy. Jails present added complexities because of their shorter stay with respect to prisons, and testing, treatment, and counseling policies must be adapted to these settings.

A security/safety survey of long term care facilities.

PubMed

Acorn, Jonathan R

2010-01-01

What are the major security/safety problems of long term care facilities? What steps are being taken by some facilities to mitigate such problems? Answers to these questions can be found in a survey of IAHSS members involved in long term care security conducted for the IAHSS Long Term Care Security Task Force. The survey, the author points out, focuses primarily on long term care facilities operated by hospitals and health systems. However, he believes, it does accurately reflect the security problems most long term facilities face, and presents valuable information on security systems and practices which should be also considered by independent and chain operated facilities.

21 CFR 58.43 - Animal care facilities.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Animal care facilities. 58.43 Section 58.43 Food... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Facilities § 58.43 Animal care facilities. (a) A testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1...

21 CFR 58.43 - Animal care facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Animal care facilities. 58.43 Section 58.43 Food... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Facilities § 58.43 Animal care facilities. (a) A testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1...

21 CFR 58.43 - Animal care facilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Animal care facilities. 58.43 Section 58.43 Food... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Facilities § 58.43 Animal care facilities. (a) A testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1...

21 CFR 58.43 - Animal care facilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Animal care facilities. 58.43 Section 58.43 Food... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Facilities § 58.43 Animal care facilities. (a) A testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1...

21 CFR 58.43 - Animal care facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Animal care facilities. 58.43 Section 58.43 Food... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Facilities § 58.43 Animal care facilities. (a) A testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1...

Orbiting quarantine facility. The Antaeus report

NASA Technical Reports Server (NTRS)

Devincenzi, D. L. (Editor); Bagby, J. R. (Editor)

1981-01-01

A mission plan for the Orbiting Quarantine Facility (OQF) is presented. Coverage includes system overview, quarantine and protocol, the laboratory, support systems, cost analysis and possible additional uses of the OQF.

Fear and overprotection in Australian residential aged-care facilities: The inadvertent impact of regulation on quality continence care.

PubMed

Ostaszkiewicz, Joan; O'Connell, Beverly; Dunning, Trisha

2016-06-01

Most residents in residential aged-care facilities are incontinent. This study explored how continence care was provided in residential aged-care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care. Using grounded theory methodology, 18 residential aged-care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. There is a need to rethink the quality of continence care and its measurement in Australian residential aged-care facilities. © 2015 AJA Inc.

Accreditation Status and Geographic Location of Outpatient Echocardiographic Testing Facilities Among Medicare Beneficiaries: The VALUE-ECHO Study.

PubMed

Brown, Scott C; Wang, Kefeng; Dong, Chuanhui; Yi, Li; Marinovic Gutierrez, Carolina; Di Tullio, Marco R; Farrell, Mary Beth; Burgess, Pamela; Gornik, Heather L; Hamburg, Naomi M; Needleman, Laurence; Orsinelli, David; Robison, Susana; Rundek, Tatjana

2018-02-01

Accreditation of echocardiographic testing facilities by the Intersocietal Accreditation Commission (IAC) is supported by the American College of Cardiology and American Society of Echocardiography. However, limited information exists on the accreditation status and geographic distribution of echocardiographic facilities in the United States. Our study aimed to identify (1) the proportion of outpatient echocardiography facilities used by Medicare beneficiaries that are IAC accredited, (2) their geographic distribution, and (3) variations in procedure type and volume by accreditation status. As part of the VALUE-ECHO (Value of Accreditation, Location, and Utilization Evaluation-Echocardiography) study, we examined the proportion of IAC-accredited echocardiographic facilities performing outpatient echocardiography in the 2013 Centers for Medicare and Medicaid Services outpatient limited data set (100% sample) and their geographic distribution using geocoding in ArcGIS (ESRI, Redlands, CA). Among 4573 outpatient facilities billing Medicare for echocardiographic testing in 2013, 99.6% (n = 4554) were IAC accredited (99.7% in the 50 US states and 86.2% in Puerto Rico). The proportion IAC-accredited echocardiographic facilities varied by region, with 98.7%, 99.9%, 99.9%, 99.5%, and 86.2% of facilities accredited in the Northeast, South, Midwest, West, and Puerto Rico, respectively (P < .01, Fisher exact test). Of all echocardiographic outpatient procedures conducted (n = 1,890,156), 99.8% (n = 1,885,382) were performed in IAC-accredited echocardiographic facilities. Most procedures (90.9%) were transthoracic echocardiograms, of which 99.7% were conducted in IAC-accredited echocardiographic facilities. Almost all outpatient echocardiographic facilities billed by Medicare are IAC accredited. This accreditation rate is substantially higher than previously reported for US outpatient vascular testing facilities (13% IAC accredited). The uniformity of imaging and interpretation protocols from a single accrediting body is important to facilitate optimal cardiovascular care. © 2017 by the American Institute of Ultrasound in Medicine.

The Sepsis Early Recognition and Response Initiative (SERRI)

PubMed Central

Jones, Stephen L.; Ashton, Carol M.; Kiehne, Lisa; Gigliotti, Elizabeth; Bell-Gordon, Charyl; Pinn, Teresa T.; Tran, Shirley K.; Nicolas, Juan C.; Rose, Alexis L.; Shirkey, Beverly A.; Disbot, Maureen; Masud, Faisal; Wray, Nelda P.

2016-01-01

Duration of Initiative 48 months and currently ongoing. Setting The Houston Methodist Hospital System and affiliated hospitals (3 facilities with 2 hospital-run skilled nursing facilities in and around Houston), St. Joseph’s Regional Health Center (1 acute care hospital and 2 skilled nursing facilities in Bryan, Texas), Hospital Corporation of America (2 acute care facilities in Houston, 1 acute care facility in McAllen, Texas [Rio Grande Valley]), Kindred Healthcare (2 long term acute care facilities in Houston), Select Medical Specialty Hospitals (2 long term acute care facilities in Houston). Whom This Should Concern Hospital administrators, quality and safety officers, performance improvement and patient safety professionals, clinic managers, infection control and prevention staff, and other physicians, nurses, and clinical staff. PMID:26892701

Maternal-Fetal Monitoring of Opioid-Exposed Pregnancies: Analysis of a Pilot Community-Based Protocol and Review of the Literature.

PubMed

Ryan, Gareth; Dooley, Joe; Windrim, Rory; Bollinger, Megan; Gerber Finn, Lianne; Kelly, Len

2017-06-01

To describe/analyse a novel, community-based prenatal monitoring protocol for opioid-exposed pregnancies developed by our centre in 2014 to optimize prenatal care for this population. A literature review of published monitoring protocols for this population is also presented. Retrospective comparison of pre-protocol (n = 215) and post-protocol (n = 251) cohorts. Medline and Embase were searched between 2000-2016 using MeSH terms: [fetal monitoring OR prenatal care] AND [opioid-related disorders OR substance-related disorders] in Medline and [fetal monitoring OR prenatal care] AND [opiate addiction OR substance abuse] in Embase, producing 518 results. Thirteen studies included protocols for monitoring opioid-exposed pregnancies. No comprehensive monitoring protocols with high-quality supporting evidence were found. We evaluated 466 opioid-exposed pregnancies, 215 before and 251 after introduction of the protocol. Since implementation, there was a significant increase in the number of opioid-exposed patients who have underwent urine drug screening (72.6% to 89.2%, P < 0.0001); a significant reduction in the number of urine drug screenings positive for illicit opioids (50.2% to 29.1%, P < 0.0001); and a significant increase in the number of patients who discontinued illicit opioid use by the time of delivery (24.7% to 39.4%, P < 0.01). There was no difference in the CS rate (27.4% vs. 26.3%, P > 0.05). There were no observed differences in the rate of preterm birth, birth weight <2500 g, or Apgar score <7 (P > 0.05). Care of women with increased opioid use during pregnancy is an important but under-studied health issue. A novel protocol for focused antenatal care provision for women with opioid-exposed pregnancies improves standard of care and maternal/fetal outcomes. Copyright © 2017. Published by Elsevier Inc.

[Perceptions of primary health care among users and health professionals: a comparison of units with and without family health care in Central-West Brazil].

PubMed

van Stralen, Cornelis Johannes; Belisário, Soraya Almeida; van Stralen, Terezinha Berenice de Sousa; Lima, Angela Maria Dayrell de; Massote, Alice Werneck; Oliveira, Cláudia di Lorenzo

2008-01-01

This study analyzes perceptions of performance by primary health care facilities with and without the Family Health Program in municipalities with more than 100,000 inhabitants. Questionnaires from the Primary Care Assessment Tool developed by John Hopkins University and adapted to Brazil, contemplating eight dimensions of primary health care, were applied to users and professionals from a sample of 36 family health care facilities and 28 traditional primary care facilities. Thirty health professionals with university education, 207 with secondary education, 490 adult users, and 133 family members answered the questionnaires. The overall result did not show significant differences between perceptions of family health care facilities as compared to traditional primary health care facilities, but perceptions of health professionals were consistently more favorable than those of users. Comparing the scores for each dimension, family health care facilities always scored better (with the exception of level of access), but the difference in scores between facilities with and without the Family Health Strategy was only statistically significant for all three categories of respondents in relation to the items "family focus" and "community orientation".

Outcome after polytrauma in a certified trauma network: comparing standard vs. maximum care facilities concept of the study and study protocol (POLYQUALY).

PubMed

Koller, Michael; Ernstberger, Antonio; Zeman, Florian; Loss, Julika; Nerlich, Michael

2016-07-11

The aim of this study is to evaluate the performance of the first certified regional trauma network in Germany, the Trauma Network Eastern Bavaria (TNO) addressing the following specific research questions: Do standard and maximum care facilities produce comparable (risk-adjusted) levels of patient outcome? Does TNO outperform reference data provided by the German Trauma Register 2008? Does TNO comply with selected benchmarks derived from the S3 practice guideline? Which barriers and facilitators can be identified in the health care delivery processes for polytrauma patients? The design is based on a prospective multicenter cohort study comparing two cohorts of polytrauma patients: those treated in maximum care facilities and those treated in standard care facilities. Patient recruitment will take place in the 25 TNO clinics. It is estimated that n = 1.100 patients will be assessed for eligibility within a two-year period and n = 800 will be included into the study and analysed. Main outcome measures include the TraumaRegisterQM form, which has been implemented in the clinical routine since 2009 and is filled in via a web-based data management system in participating hospitals on a mandatory basis. Furthermore, patient-reported outcome is assessed using the EQ-5D at 6, 12 and 24 months after trauma. Comparisons will be drawn between the two cohorts. Further standards of comparisons are secondary data derived from German Trauma Registry as well as benchmarks from German S3 guideline on polytrauma. The qualitative part of the study will be based on semi-standardized interviews and focus group discussions with health care providers within TNO. The goal of the qualitative analysis is to elucidate which facilitating and inhibiting forces influence cooperation and performance within the network. This is the first study to evaluate a certified trauma network within the German health care system using a unique combination of a quantitative (prospective cohort study) and a qualitative (in-depth facilitator/barrier analysis) approach. The information generated by this project will be used in two ways. Firstly, within the region the results of the study will help to optimize the pre-hospital and clinical management of polytrauma patients. Secondly, on a nationwide scale, influential decision-making bodies, such as the Ministries of Health, the Hospital Associations, sickness funds, insurance companies and professional societies, will be addressed. The results will not only be applicable to the region of Eastern Bavaria, but also in most other parts of Germany with a comparable infrastructure. VfD_Polyqualy_12_001978 , 10.Jan.2013; German Clinical Trials Register DRKS00010039 , 18.02.2016.

Assisted living and nursing homes: apples and oranges?

PubMed

Zimmerman, Sheryl; Gruber-Baldini, Ann L; Sloane, Philip D; Eckert, J Kevin; Hebel, J Richard; Morgan, Leslie A; Stearns, Sally C; Wildfire, Judith; Magaziner, Jay; Chen, Cory; Konrad, Thomas R

2003-04-01

The goals of this study are to describe the current state of residential care/assisted living (RC/AL) care and residents in comparison with nursing home (NH) care and residents, identify different types of RC/AL care and residents, and consider how variation in RC/AL case-mix reflects differences in care provision and/or consumer preference. Data were derived from the Collaborative Studies of Long-Term Care, a four-state study of 193 RC/AL facilities and 40 NHs. Multivariate analyses examined differences in ten process of care measures between RC/AL facilities with less than 16 beds; traditional RC/AL with 16 or more beds; new-model RC/AL; and NHs. Generalized estimating equation models determined differences in resident case-mix across RC/AL facilities using data for 2,078 residents. NHs report provision of significantly more health services and have significantly more lenient admission policies than RC/AL facilities, but provide less privacy. They do not differ from larger RC/AL facilities in policy clarity or resident control. Differences within RC/AL types are evident, with smaller and for-profit facilities scoring lower than other facilities across multiple process measures, including those related to individual freedom and institutional order. Resident impairment is substantial in both NHs and RC/AL settings, but differs by RC/AL facility characteristics. Differences in process of care and resident characteristics by facility type highlight the importance of considering: (1) the adequacy of existing process measures for evaluating smaller facilities; (2) resident case-mix when comparing facility types and outcomes; and (3) the complexity of understanding the implication of the process of care, given the importance of person-environment fit. Work is continuing to clarify the role of RC/AL vis-à-vis NHs in our nation's system of residential long-term care.

Development of an alcohol withdrawal protocol: CNS collaborative exemplar.

PubMed

Phillips, Susan; Haycock, Camille; Boyle, Deborah

2006-01-01

The purpose of this process improvement project was to develop an Alcohol Withdrawal Syndrome (AWS) management protocol for acute care. The prevalence of alcohol abuse in our society presents challenges for health professionals, and few nurses have received formal education on the identification and treatment of AWS, which has frequently resulted in ineffective, nonstandardized care. However, nurses practicing in medical-surgical, emergency, trauma, and critical care settings must be astute in the assessment and management of AWS. DESIGN/BACKGROUND/RATIONALE: Following an analysis of existing management protocols, a behavioral health clinical nurse specialist was asked to lead a work team composed of physicians, pharmacists, and nurses to develop a new evidence-based alcohol withdrawal protocol for acute care. By implementing a standardized assessment tool and treatment protocol, clinical nurse specialists empowered nursing staff with strategies to prevent the serious medical complications associated with AWS. FINDINGS/OUTCOMES: The development and integration of a safe and effective treatment protocol to manage AWS was facilitated by collaborative, evidence-based decision making. Clinical experience and specialty expertise were integrated by clinical nurse specialists skilled in group dynamics, problem-solving, and the implementation of change. Improving care of patients in AWS is an exemplar for clinical nurse specialist roles as change agent and patient advocate.

Telepsychiatry in correctional facilities: using technology to improve access and decrease costs of mental health care in underserved populations.

PubMed

Deslich, Stacie Anne; Thistlethwaite, Timothy; Coustasse, Alberto

2013-01-01

It is unclear if telepsychiatry, a subset of telemedicine, increases access to mental health care for inmates in correctional facilities or decreases costs for clinicians or facility administrators. The purpose of this investigation was to determine how utilization of telepsychiatry affected access to care and costs of providing mental health care in correctional facilities. A literature review complemented by a semistructured interview with a telepsychiatry practitioner. Five electronic databases, the National Bureau of Justice, and the American Psychiatric Association Web sites were searched for this research, and 49 sources were referenced. The literature review examined implementation of telepsychiatry in correctional facilities in Arizona, California, Georgia, Kansas, Ohio, Texas, and West Virginia to determine the effect of telepsychiatry on inmate access to mental health services and the costs of providing mental health care in correctional facilities. Telepsychiatry provided improved access to mental health services for inmates, and this increase in access is through the continuum of mental health care, which has been instrumental in increasing quality of care for inmates. Use of telepsychiatry saved correctional facilities from $12,000 to more than $1 million. The semistructured interview with the telepsychiatry practitioner supported utilization of telepsychiatry to increase access and lower costs of providing mental health care in correctional facilities. Increasing access to mental health care for this underserved group through telepsychiatry may improve living conditions and safety inside correctional facilities. Providers, facilities, and state and federal governments can expect increased savings with utilization of telepsychiatry.

Pre-end-stage renal disease care not associated with dialysis facility neighborhood poverty in the United States.

PubMed

Plantinga, Laura C; Kim, Min; Goetz, Margarethe; Kleinbaum, David G; McClellan, William; Patzer, Rachel E

2014-01-01

Receipt of nephrology care prior to end-stage renal disease (ESRD) is a strong predictor of decreased mortality and morbidity, and neighborhood poverty may influence access to care. Our objective was to examine whether neighborhood poverty is associated with lack of pre-ESRD care at dialysis facilities. In a multi-level ecological study using geospatially linked 2007-2010 Dialysis Facility Report and 2006-2010 American Community Survey data, we examined whether high neighborhood poverty (≥20% of households in census tract living below poverty) was associated with dialysis facility-level lack of pre-ESRD care (percentage of patients with no nephrology care prior to dialysis start) in mixed-effects models, adjusting for facility and neighborhood confounders and allowing for neighborhood and regional random effects. Among the 5,184 facilities examined, 1,778 (34.3%) were located in a high-poverty area. Lack of pre-ESRD care was similar in poverty areas (30.8%) and other neighborhoods (29.6%). With adjustment, the absolute increase in percentage of patients at a facility with no pre-ESRD care associated with facility location in a poverty area versus other neighborhood was only 0.08% (95% CI -1.32, 1.47; p = 0.9). Potential effect modification by race and income inequality was detected. Despite previously reported detrimental effects of neighborhood poverty on health, facility neighborhood poverty was not associated with receipt of pre-ESRD care, suggesting no need to target interventions to increase access to pre-ESRD care at facilities in poorer geographic areas.

Pre-end-stage renal disease care not associated with dialysis facility neighborhood poverty in the United States

PubMed Central

Plantinga, Laura C.; Kim, Min; Goetz, Margarethe; Kleinbaum, David G.; McClellan, William; Patzer, Rachel E.

2014-01-01

Background Receipt of nephrology care prior to end-stage renal disease (ESRD) is a strong predictor of decreased mortality and morbidity, and neighborhood poverty may influence access to care. Our objective was to examine whether neighborhood poverty is associated with lack of pre-ESRD care at dialysis facilities. Methods In a multi-level ecological study using geospatially linked 2007-2010 Dialysis Facility Report and 2006-2010 American Community Survey data, we examined whether high neighborhood poverty (≥20% of households in census tract living below poverty) was associated with dialysis facility-level lack of pre-ESRD care (percentage of patients with no nephrology care prior to dialysis start) in mixed-effects models, adjusting for facility and neighborhood confounders and allowing for neighborhood and regional random effects. Results Among the 5184 facilities examined, 1778 (34.3%) were located in a high poverty area. Lack of pre-ESRD care was similar in poverty areas (30.8%) and other neighborhoods (29.6%). With adjustment, the absolute increase in percentage of patients at a facility with no pre-ESRD care associated with facility location in a poverty area vs. other neighborhood was only 0.08% (95% CI: -1.32%, 1.47%; P=0.9). Potential effect modification by race and income inequality was detected. Conclusion Despite previously reported detrimental effects of neighborhood poverty on health, facility neighborhood poverty was not associated with receipt of pre-ESRD care, suggesting no need to target interventions to increase access to pre-ESRD care at facilities in poorer geographic areas. PMID:24434854

Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya

PubMed Central

Burke, Thomas F; Hines, Rosemary; Ahn, Roy; Walters, Michelle; Young, David; Anderson, Rachel Eleanor; Tom, Sabrina M; Clark, Rachel; Obita, Walter; Nelson, Brett D

2014-01-01

Objective Injuries, trauma and non-communicable diseases are responsible for a rising proportion of death and disability in low-income and middle-income countries. Delivering effective emergency and urgent healthcare for these and other conditions in resource-limited settings is challenging. In this study, we sought to examine and characterise emergency and urgent care capacity in a resource-limited setting. Methods We conducted an assessment within all 30 primary and secondary hospitals and within a stratified random sampling of 30 dispensaries and health centres in western Kenya. The key informants were the most senior facility healthcare provider and manager available. Emergency physician researchers utilised a semistructured assessment tool, and data were analysed using descriptive statistics and thematic coding. Results No lower level facilities and 30% of higher level facilities reported having a defined, organised approach to trauma. 43% of higher level facilities had access to an anaesthetist. The majority of lower level facilities had suture and wound care supplies and gloves but typically lacked other basic trauma supplies. For cardiac care, 50% of higher level facilities had morphine, but a minority had functioning ECG, sublingual nitroglycerine or a defibrillator. Only 20% of lower level facilities had glucometers, and only 33% of higher level facilities could care for diabetic emergencies. No facilities had sepsis clinical guidelines. Conclusions Large gaps in essential emergency care capabilities were identified at all facility levels in western Kenya. There are great opportunities for a universally deployed basic emergency care package, an advanced emergency care package and facility designation scheme, and a reliable prehospital care transportation and communications system in resource-limited settings. PMID:25260371

Social workers' perceptions of barriers to interpersonal therapy implementation for treating postpartum depression in a primary care setting in Israel.

PubMed

Bina, Rena; Barak, Adi; Posmontier, Barbara; Glasser, Saralee; Cinamon, Tali

2018-01-01

Research on evidence-based practice (EBP) implementation in social work often neglects to include evaluation of application barriers. This qualitative study examined social workers' perspectives of provider- and organisational-related barriers to implementing a brief eight-session interpersonal therapy (IPT) intervention, a time-limited EBP that addresses reducing depressive symptoms and improving interpersonal functioning. Implementation took place in a primary care setting in Israel and was aimed at treating women who have postpartum depression (PPD) symptoms. Using purposeful sampling, 25 primary care licensed social workers were interviewed between IPT training and implementation regarding their perceived barriers to implementing IPT in practice. Data analysis was facilitated using a phenomenological approach, which entails identifying the shared themes and shared experiences of research participants regarding barriers to implementing IPT. Three themes emerged from the analysis of interviews: Perceived lack of flexibility of IPT intervention in comparison with more familiar methods social workers previously applied, specifically regarding the number of sessions and therapeutic topics included in the IPT protocol; insecurity and hesitance to gain experience with a new method of intervention; and organisational barriers, including difficulties with referrals, the perception of HMOs as health facilities not suitable for therapy, and time constraints. Addressing perceived barriers of social workers toward implementing EBPs, such as IPT for postpartum depression, during the training phase is crucial for enabling appropriate implementation. Future training should include examining practitioners' attitudes toward implementation of EBPs, as part of standardised training protocols. © 2017 John Wiley & Sons Ltd.

Using in situ simulation to evaluate operational readiness of a children's hospital-based obstetrics unit.

PubMed

Ventre, Kathleen M; Barry, James S; Davis, Deborah; Baiamonte, Veronica L; Wentworth, Allen C; Pietras, Michele; Coughlin, Liza; Barley, Gwyn

2014-04-01

Relocating obstetric (OB) services to a children's hospital imposes demands on facility operations, which must be met to ensure quality care and a satisfactory patient experience. We used in situ simulations to prospectively and iteratively evaluate operational readiness of a children's hospital-based OB unit before it opened for patient care. This project took place at a 314-bed, university-affiliated children's hospital. We developed 3 full-scale simulation scenarios depicting a concurrent maternal and neonatal emergency. One scenario began with a standardized patient experiencing admission; the mannequin portrayed a mother during delivery. We ran all 3 scenarios on 2 dates scheduled several weeks apart. We ran 2 of the scenarios on a third day to verify the reliability of key processes. During the simulations, content experts completed equipment checklists, and participants identified latent safety hazards. Each simulation involved a unique combination of scheduled participants who were supplemented by providers from responding ancillary services. The simulations involved 133 scheduled participants representing OB, neonatology, and anesthesiology. We exposed and addressed operational deficiencies involving equipment availability, staffing, interprofessional communication, and systems issues such as transfusion protocol failures and electronic order entry challenges. Process changes between simulation days 1 to 3 decreased the elapsed time between transfusion protocol activation and blood arrival to the operating room and labor/delivery/recovery/postpartum setting. In situ simulations identified multiple operational deficiencies on the OB unit, allowing us to take corrective action before its opening. This project may guide other children's hospitals regarding care processes likely to require significant focus and possible modification to accommodate an OB service.

Internet-based monitoring and benchmarking in ambulatory surgery centers.

PubMed

Bovbjerg, V E; Olchanski, V; Zimberg, S E; Green, J S; Rossiter, L F

2000-08-01

Each year the number of surgical procedures performed on an outpatient basis increases, yet relatively little is known about assessing and improving quality of care in ambulatory surgery. Conventional methods for evaluating outcomes, which are based on assessment of inpatient services, are inadequate in the rapidly changing, geographically dispersed field of ambulatory surgery. Internet-based systems for improving outcomes and establishing benchmarks may be feasible and timely. Eleven freestanding ambulatory surgery centers (ASCs) reported process and outcome data for 3,966 outpatient surgical procedures to an outcomes monitoring system (OMS), during a demonstration period from April 1997 to April 1999. ASCs downloaded software and protocol manuals from the OMS Web site. Centers securely submitted clinical information on perioperative process and outcome measures and postoperative patient telephone interviews. Feedback to centers ranged from current and historical rates of surgical and postsurgical complications to patient satisfaction and the adequacy of postsurgical pain relief. ASCs were able to successfully implement the data collection protocols and transmit data to the OMS. Data security efforts were successful in preventing the transmission of patient identifiers. Feedback reports to ASCs were used to institute changes in ASC staffing, patient care, and patient education, as well as for accreditation and marketing. The demonstration also pointed out shortcomings in the OMS, such as the need to simplify hardware and software installation as well as data collection and transfer methods, which have been addressed in subsequent OMS versions. Internet-based benchmarking for geographically dispersed outpatient health care facilities, such as ASCs, is feasible and likely to play a major role in this effort.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

PubMed Central

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

PubMed

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

A European study investigating patterns of transition from home care towards institutional dementia care: the protocol of a RightTimePlaceCare study

PubMed Central

2012-01-01

Background Health care policies in many countries aim to enable people with dementia to live in their own homes as long as possible. However, at some point during the disease the needs of a significant number of people with dementia cannot be appropriately met at home and institutional care is required. Evidence as to best practice strategies enabling people with dementia to live at home as long as possible and also identifying the right time to trigger admission to a long-term nursing care facility is therefore urgently required. The current paper presents the rationale and methods of a study generating primary data for best-practice development in the transition from home towards institutional nursing care for people with dementia and their informal caregivers. The study has two main objectives: 1) investigate country-specific factors influencing institutionalization and 2) investigate the circumstances of people with dementia and their informal caregivers in eight European countries. Additionally, data for economic evaluation purposes are being collected. Methods/design This paper describes a prospective study, conducted in eight European countries (Estonia, Finland, France, Germany, Netherlands, Sweden, Spain, United Kingdom). A baseline assessment and follow-up measurement after 3 months will be performed. Two groups of people with dementia and their informal caregivers will be included: 1) newly admitted to institutional long-term nursing care facilities; and 2) receiving professional long-term home care, and being at risk for institutionalization. Data will be collected on outcomes for people with dementia (e.g. quality of life, quality of care), informal caregivers (e.g. caregiver burden, quality of life) and costs (e.g. resource utilization). Statistical analyses consist of descriptive and multivariate regression techniques and cross-country comparisons. Discussion The current study, which is part of a large European project 'RightTimePlaceCare', generates primary data on outcomes and costs of long-term nursing care for people with dementia and their informal caregivers, specifically focusing on the transition from home towards institutional care. Together with data collected in three other work packages, knowledge gathered in this study will be used to inform and empower patients, professionals, policy and related decision makers to manage and improve health and social dementia care services. PMID:22269343

Improving detection and initial management of gestational diabetes through the primary level of care in Morocco: protocol for a cluster randomized controlled trial.

PubMed

Utz, Bettina; Assarag, Bouchra; Essolbi, Amina; Barkat, Amina; El Ansari, Nawal; Fakhir, Bouchra; Delamou, Alexandre; De Brouwere, Vincent

2017-06-19

Morocco is facing a growing prevalence of diabetes and according to latest figures of the World Health Organization, already 12.4% of the population are affected. A similar prevalence has been reported for gestational diabetes (GDM) and although it is not yet high on the national agenda, immediate and long-term complications threaten the health of mothers and future generations. A situational analysis on GDM conducted in 2015 revealed difficulties in access to screening and delays in receiving appropriate care. This implementation study has as objective to evaluate a decentralized GDM detection and management approach through the primary level of care and assess its potential for scaling up. We will conduct a hybrid effectiveness-implementation research using a cluster randomized controlled trial design in two districts of Morocco. Using the health center as unit of randomization we randomly selected 20 health centers with 10 serving as intervention and 10 as control facilities. In the intervention arm, providers will screen pregnant women attending antenatal care for GDM by capillary glucose testing during antenatal care. Women tested positive will receive nutritional counselling and will be followed up through the health center. In the control facilities, screening and initial management of GDM will follow standard practice. Primary outcome will be birthweight with weight gain during pregnancy, average glucose levels and pregnancy outcomes including mode of delivery, presence or absence of obstetric or newborn complications and the prevalence of GDM at health center level as secondary outcomes. Furthermore we will assess the quality of life /care experienced by the women in both arms. Qualitative methods will be applied to evaluate the feasibility of the intervention at primary level and its adoption by the health care providers. In Morocco, gestational diabetes screening and its initial management is fragmented and coupled with difficulties in access and treatment delays. Implementation of a strategy that enables detection, management and follow-up of affected women at primary health care level is expected to positively impact on access to care and medical outcomes. The trial has been registered on clininicaltrials.gov ; identifier NCT02979756 ; retrospectively registered 22 November 2016.

A cross sectional comparison of postnatal care quality in facilities participating in a maternal health voucher program versus non-voucher facilities in Kenya.

PubMed

Warren, Charlotte E; Abuya, Timothy; Kanya, Lucy; Obare, Francis; Njuki, Rebecca; Temmerman, Marleen; Bellows, Ben

2015-07-24

Health service fees constitute substantial barriers for women seeking childbirth and postnatal care. In an effort to reduce health inequities, the government of Kenya in 2006 introduced the output-based approach (OBA), or voucher programme, to increase poor women's access to quality Safe Motherhood services including postnatal care. To help improve service quality, OBA programmes purchase services on behalf of the poor and marginalised, with provider reimbursements for verified services. Kenya's programme accredited health facilities in three districts as well as in two informal Nairobi settlements. Postnatal care quality in voucher health facilities (n = 21) accredited in 2006 and in similar non-voucher health facilities (n = 20) are compared with cross sectional data collected in 2010. Summary scores for quality were calculated as additive sums of specific aspects of each attribute (structure, process, outcome). Measures of effect were assessed in a linear regression model accounting for clustering at facility level. Data were analysed using Stata 11.0. The overall quality of postnatal care is poor in voucher and non-voucher facilities, but many facilities demonstrated 'readiness' for postnatal care (structural attributes: infrastructure, equipment, supplies, staffing, training) indicated by high scores (83/111), with public voucher facilities scoring higher than public non-voucher facilities. The two groups of facilities evinced no significant differences in postnatal care mean process scores: 14.2/55 in voucher facilities versus 16.4/55 in non-voucher facilities; coefficient: -1.70 (-4.9, 1.5), p = 0.294. Significantly more newborns were seen within 48 hours (83.5% versus 72.1%: p = 0.001) and received Bacillus Calmette-Guerin (BCG) (82.5% versus 76.5%: p < 0.001) at voucher facilities than at non-voucher facilities. Four years after facility accreditation in Kenya, scores for postnatal care quality are low in all facilities, even those with Safe Motherhood vouchers. We recommend the Kenya OBA programme review its Safe Motherhood reimbursement package and draw lessons from supply side results-based financing initiatives, to improve postnatal care quality.

40 CFR 792.43 - Test system care facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 31 2010-07-01 2010-07-01 true Test system care facilities. 792.43 Section 792.43 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT (CONTINUED) GOOD LABORATORY PRACTICE STANDARDS Facilities § 792.43 Test system care facilities...

A comparison of sennosides-based bowel protocols with and without docusate in hospitalized patients with cancer.

PubMed

Hawley, Philippa Helen; Byeon, Jai Jun

2008-05-01

Constipation is a common and distressing condition in patients with cancer, especially those taking opioid analgesics. Many institutions prevent and treat constipation with titrated laxatives, which is known as a bowel protocol. An effective and well-tolerated bowel protocol is a very important component of cancer care, and there is little evidence on which to base selection of the most appropriate agents. This study compares a protocol of the stimulant laxative sennosides alone with a protocol of sennosides plus the stool softener docusate, in hospitalized patients at an oncology center. The docusate-containing protocol had an initial docusate-only step for patients not taking opioids, and four to six 100-mg capsules of docusate sodium in addition to the sennosides for the rest of the protocol. Thirty patients received the sennosides-only (S) protocol and 30 the sennosides plus docusate (DS) protocol. The efficacy and adverse effects of the protocols were monitored for 5-12 days. The two protocols were used sequentially, creating two cohorts, one on each protocol. Eighty percent of patients were taking oral opioids and 72% were admitted for symptom control/supportive care. Over a total of 488 days of observation it was found that the S protocol produced more bowel movements than the DS protocol, and in the symptom control/supportive care patients this difference was statistically significant (p < 0.05). In the S group admitted for symptom control/supportive care 62.5% had a bowel movement more than 50% of days, as compared with 32% in those receiving the DS protocol. Fifty-seven percent of the DS group required additional interventions (lactulose, suppositories or enemas) compared to 40% in the S group. Cramps were reported equally by 3 (10%) patients in each group. Eight patients (27%) experienced diarrhea in the S group compared to 4 (13%) in the DS group. The addition of the initial docusate-only step and adding docusate 400-600 mg/d to the sennosides did not reduce bowel cramps, and was less effective in inducing laxation than the sennosides-only protocol. Further research into the appropriate use of docusate and into the details of bowel protocol design are required.

Mn/ROAD testing protocols : vol. 1

DOT National Transportation Integrated Search

1997-12-01

This report presents a series of testing protocols used at the Minnesota Road Research Project (Mn/ROAD), the Minnesota Department of Transportation's (Mn/DOT) pavement testing facility. This report helps establish a history of the tests conducted an...

Medicare and Medicaid programs; fire safety requirements for certain health care facilities. Final rule.

PubMed

2003-01-10

This final rule amends the fire safety standards for hospitals, long-term care facilities, intermediate care facilities for the mentally retarded, ambulatory surgery centers, hospices that provide inpatient services, religious nonmedical health care institutions, critical access hospitals, and Programs of All-Inclusive Care for the Elderly facilities. Further, this final rule adopts the 2000 edition of the Life Safety Code and eliminates references in our regulations to all earlier editions.

[Prevention of adverse effects in latex allergic patients: organizing a latex safe operating theatre].

PubMed

Bonalumi, Sabrina; Barbonaglia, Patrizia; Bertocchi, Carmen

2006-01-01

In 2001 the General Health Direction of Region Lombardia approved (decree n. 22303) a guideline for the prevention of latex allergic reactions in patients and health care workers. This document provides general recommendations in order to standardize behaviors in regional health care facilities. The reason is due to a rise in the incident of reactions to latex products in the last 20 years. Nowadays the prevalence is higher in certain risk groups (subjected to frequent and repeated exposures) rather than the general population. The aim of the project was to organize a latex safe operating theatre in the Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena of Milan (Fondazione) and to standardize behaviors in order to prevent adverse effects in latex allergic patients. Thanks to the literature review and the creation of a multidisciplinar team, we produced a protocol. Therefore, we requested manufacturers the certification of the latex content of their products. Results and conclusion. When latex allergic patients need to undergone surgery in our hospital, a latex safe operating theatre is organized by personnel following a multidisciplinar protocol. No allergic reactions were experienced during surgical procedures after the creation of an environment as free as possible from latex contamination. The project will involve an emergency room, one room or more of a ward and of the outpatients department.

Does quality influence utilization of primary health care? Evidence from Haiti.

PubMed

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

A retrospective comparison of clinical outcomes and Medicare expenditures in skilled nursing facility residents with chronic wounds.

PubMed

DaVanzo, Joan E; El-Gamil, Audrey M; Dobson, Allen; Sen, Namrata

2010-09-01

Medicare skilled nursing facility (SNF) residents with chronic wounds require more resources and have relatively high healthcare expenditures compared to Medicare patients without wounds. A retrospective cohort study was conducted using 2006 Medicare Chronic Condition Warehouse claims data for SNF, inpatient, outpatient hospital, and physician supplier settings along with 2006 Long-Term Care Minimum Data Set (MDS) information to compare Medicare expenditures between two groups of SNF residents with a diagnosis of pressure, venous, ischemic, or diabetic ulcers whose wounds healed during the 10-month study period. The study group (n = 372) was managed using a structured, comprehensive wound management protocol provided by an external wound management team. The matched comparison group consisted of 311 SNF residents who did not receive care from the wound management team. Regression analyses indicate that after controlling for resident comorbidities and wound severity, study group residents experienced lower rates of wound-related hospitalization per day (0.08% versus 0.21%, P < 0.01) and shorter wound episodes (94 days versus 115 days, P < 0.01) than comparison group patients. Total Medicare costs were $21,449.64 for the study group and $40,678.83 for the comparison group (P < 0.01) or $229.07 versus $354.26 (P < 0.01) per resident episode day. Additional studies including wounds that do not heal are warranted. Increasing the number of SNF residents receiving the care described in this study could lead to significant Medicare cost savings. Incorporating wound clinical outcomes into a pay-for-performance measures for SNFs could increase broader SNF adoption of comprehensive wound care programs to treat chronic wounds.

Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American Sign Language users: A qualitative socio-ecological approach.

PubMed

Pendergrass, Kathy M; Nemeth, Lynne; Newman, Susan D; Jenkins, Carolyn M; Jones, Elaine G

2017-06-01

Nurse practitioners (NPs), as well as all healthcare clinicians, have a legal and ethical responsibility to provide health care for deaf American Sign Language (ASL) users equal to that of other patients, including effective communication, autonomy, and confidentiality. However, very little is known about the feasibility to provide equitable health care. The purpose of this study was to examine NP perceptions of barriers and facilitators in providing health care for deaf ASL users. Semistructured interviews in a qualitative design using a socio-ecological model (SEM). Barriers were identified at all levels of the SEM. NPs preferred interpreters to facilitate the visit, but were unaware of their role in assuring effective communication is achieved. A professional sign language interpreter was considered a last resort when all other means of communication failed. Gesturing, note-writing, lip-reading, and use of a familial interpreter were all considered facilitators. Interventions are needed at all levels of the SEM. Resources are needed to provide awareness of deaf communication issues and legal requirements for caring for deaf signers for practicing and student NPs. Protocols need to be developed and present in all healthcare facilities for hiring interpreters as well as quick access to contact information for these interpreters. ©2017 American Association of Nurse Practitioners.

24 CFR 232.500 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... is purchased, installed, and maintained in a nursing home, intermediate care facility, assisted... and intermediate care facility shall include those facilities designated as skilled nursing facilities...

42 CFR 442.2 - Terms.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR... a nursing facility, and an intermediate care facility for Individuals with Intellectual Disabilities...

Current prevention and control of health care-associated infections in long-term care facilities for the elderly in Japan.

PubMed

Kariya, Naoko; Sakon, Naomi; Komano, Jun; Tomono, Kazunori; Iso, Hiroyasu

2018-05-01

Residents of long-term care facilities for the elderly are vulnerable to health care-associated infections. However, compared to medical institutions, long-term care facilities for the elderly lag behind in health care-associated infection control and prevention. We conducted a epidemiologic study to clarify the current status of infection control in long-term care facilities for the elderly in Japan. A questionnaire survey on the aspects of infection prevention and control was developed according to SHEA/APIC guidelines and was distributed to 617 long-term care facilities for the elderly in the province of Osaka during November 2016 and January 2017. The response rate was 16.9%. The incidence rates of health care-associated infection outbreaks and residents with health care-associated infections were 23.4 per 100 facility-years and 0.18 per 1,000 resident-days, respectively. Influenza and acute gastroenteritis were reported most frequently. Active surveillance to identify the carrier of multiple drug-resistant organisms was not common. The overall compliance with 21 items selected from the SHEA/APIC guidelines was approximately 79.2%. All facilities had infection control manuals and an assigned infection control professional. The economic burdens of infection control were approximately US$ 182.6 per resident-year during fiscal year 2015. Importantly, these data implied that physicians and nurses were actively contributed to higher SHEA/APIC guideline compliance rates and the advancement of infection control measures in long-term care facilities for the elderly. Key factors are discussed to further improve the infection control in long-term care facilities for the elderly, particularly from economic and social structural standpoints. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

The effect of a nurse-led telephone-based care coordination program on the follow-up and control of cardiovascular risk factors in patients with coronary artery disease.

PubMed

Wong, Ningyan; Chua, Siang Jin Terrance; Gao, Fei; Sim, Sok Tiang Rosalind; Matchar, David; Wong, Sung Lung Aaron; Yeo, Khung Keong; Tan, Wei Chieh Jack; Chin, Chee Tang

2016-12-01

We sought to analyse the impact of a care coordination protocol on transiting patients with coronary artery disease who had undergone percutaneous coronary intervention (PCI) to primary care and its effect on cardiovascular risk factor control. A prospective observational study involving 492 patients who had undergone PCI either electively or after an acute coronary syndrome. A tertiary institution in Singapore. Patients who had undergone a PCI either electively or after an acute coronary syndrome. The SCORE (Standardized Care for Optimal Outcomes, Right-Siting and Rapid Re-evaluation) program was a nurse-led, telephone-based, care coordination protocol. Transition to primary care within 1 year of enrolment, the achievement of low-density lipoprotein (LDL) level of <2.6 mmol/l within 1 year and hospital admissions related to cardiovascular causes within 1 year were studied. Under the SCORE protocol, a significantly higher number of patients transited to primary care and achieved the LDL target within 1 year, as compared with non-SCORE patients. Discharge to primary care and achievement of target LDL continued to be higher among those under the SCORE protocol even after multivariate analysis. Rates of hospital admission due to cardiovascular causes were not significantly different. Care coordination improved the rate of transition of post-PCI patients to primary care and improved LDL control, with no difference in the rate of hospital admissions due to cardiovascular causes. These findings support the implementation of a standardized follow-up protocol in patients who have undergone PCI. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Realist evaluation of the antiretroviral treatment adherence club programme in selected primary healthcare facilities in the metropolitan area of Western Cape Province, South Africa: a study protocol

PubMed Central

Mukumbang, Ferdinand C; Van Belle, Sara; Marchal, Bruno; Van Wyk, Brian

2016-01-01

Introduction Suboptimal retention in care and poor treatment adherence are key challenges to antiretroviral therapy (ART) in sub-Saharan Africa. Community-based approaches to HIV service delivery are recommended to improve patient retention in care and ART adherence. The implementation of the adherence clubs in the Western Cape province of South Africa was with variable success in terms of implementation and outcomes. The need for operational guidelines for its implementation has been identified. Therefore, understanding the contexts and mechanisms for successful implementation of the adherence clubs is crucial to inform the roll-out to the rest of South Africa. The protocol outlines an evaluation of adherence club intervention in selected primary healthcare facilities in the metropolitan area of the Western Cape Province, using the realist approach. Methods and analysis In the first phase, an exploratory study design will be used. Document review and key informant interviews will be used to elicit the programme theory. In phase two, a multiple case study design will be used to describe the adherence clubs in five contrastive sites. Semistructured interviews will be conducted with purposively selected programme implementers and members of the clubs to assess the context and mechanisms of the adherence clubs. For the programme's primary outcomes, a longitudinal retrospective cohort analysis will be conducted using routine patient data. Data analysis will involve classifying emerging themes using the context-mechanism-outcome (CMO) configuration, and refining the primary CMO configurations to conjectured CMO configurations. Finally, we will compare the conjectured CMO configurations from the cases with the initial programme theory. The final CMOs obtained will be translated into middle range theories. Ethics and dissemination The study will be conducted according to the principles of the declaration of Helsinki (1964). Ethics clearance was obtained from the University of the Western Cape. Dissemination will be done through publications and curation. PMID:27044575

Perceptions of the characteristics of the Alberta Nutrition Guidelines for Children and Youth by child care providers may influence early adoption of nutrition guidelines in child care centres.

PubMed

Nikolopoulos, Hara; Farmer, Anna; Berry, Tanya R; McCargar, Linda J; Mager, Diana R

2015-04-01

In 2008, the Alberta government released the Alberta Nutrition Guidelines for Children and Youth (ANGCY) as a resource for child care facilities to translate nutrition recommendations into practical food choices. Using a multiple case study method, early adoption of the guidelines was examined in two child care centres in Alberta, Canada. Key constructs from the Diffusion of Innovations framework were used to develop an interview protocol based on the perceived characteristics of the guidelines (relative advantage, compatibility, complexity, trialability and observability) by child care providers. Analysis of the ANGCY was conducted by a trained qualitative researcher and validated by an external qualitative researcher. This entailed reviewing guideline content, layout, organisation, presentation, format, comprehensiveness and dissemination to understand whether characteristics of the guidelines affect the adoption process. Data were collected through direct observation, key informant interviews and documentation of field notes. Qualitative data were analysed using content analysis. Overall, the guidelines were perceived positively by child care providers. Child care providers found the guidelines to have a high relative advantage, be compatible with current practice, have a low level of complexity, easy to try and easy to observe changes. It is valuable to understand how child care providers perceive characteristics of guidelines as this is the first step in identifying the needs of child care providers with respect to early adoption and identifying potential educational strategies important for dissemination. © 2012 Blackwell Publishing Ltd.

Early malnutrition screening and low cost protein supplementation in elderly patients admitted to a skilled nursing facility.

PubMed

Harding, Krystal M; Dyo, Melissa; Goebel, Joy R; Gorman, Nik; Levine, Julia

2016-08-01

Malnutrition among skilled nursing facility (SNF) patients can lead to hospital readmissions and multiple complications. To evaluate the effect of an existing malnutrition screening and management program on prealbumin levels of patients in skilled nursing facilities. A retrospective design was used to evaluate baseline admission data including a prealbumin level. Patients with malnutrition received an oral protein supplement according to protocol. A comparison prealbumin level was obtained at 30days. Nearly half of the patients were severely malnourished on admission. Patients receiving the prescribed protocol had significantly increased prealbumin levels at 30days than those patients that did not receive the protocol as prescribed. A prealbumin level upon admission at a SNF could represent a reliable tool to evaluate malnutrition. Initiation of an early malnutrition screening and protein supplement program in this setting is essential to identifying and treating at-risk patients before complications occur. Copyright © 2015 Elsevier Inc. All rights reserved.

Optimizing radiologist e-prescribing of CT oral contrast agent using a protocoling portal.

PubMed

Wasser, Elliot J; Galante, Nicholas J; Andriole, Katherine P; Farkas, Cameron; Khorasani, Ramin

2013-12-01

The purpose of this study is to quantify the time expenditure associated with radiologist ordering of CT oral contrast media when using an integrated protocoling portal and to determine radiologists' perceptions of the ordering process. This prospective study was performed at a large academic tertiary care facility. Detailed timing information for CT inpatient oral contrast orders placed via the computerized physician order entry (CPOE) system was gathered over a 14-day period. Analyses evaluated the amount of physician time required for each component of the ordering process. Radiologists' perceptions of the ordering process were assessed by survey. Descriptive statistics and chi-square analysis were performed. A total of 96 oral contrast agent orders were placed by 13 radiologists during the study period. The average time necessary to create a protocol for each case was 40.4 seconds (average range by subject, 20.0-130.0 seconds; SD, 37.1 seconds), and the average total time to create and sign each contrast agent order was 27.2 seconds (range, 10.0-50.0 seconds; SD, 22.4 seconds). Overall, 52.5% (21/40) of survey respondents indicated that radiologist entry of oral contrast agent orders improved patient safety. A minority of respondents (15% [6/40]) indicated that contrast agent order entry was either very or extremely disruptive to workflow. Radiologist e-prescribing of CT oral contrast agents using CPOE can be embedded in a protocol workflow. Integration of health IT tools can help to optimize user acceptance and adoption.

Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities. Final rule.

PubMed

2016-05-04

This final rule will amend the fire safety standards for Medicare and Medicaid participating hospitals, critical access hospitals (CAHs), long-term care facilities, intermediate care facilities for individuals with intellectual disabilities (ICF-IID), ambulatory surgery centers (ASCs), hospices which provide inpatient services, religious non-medical health care institutions (RNHCIs), and programs of all-inclusive care for the elderly (PACE) facilities. Further, this final rule will adopt the 2012 edition of the Life Safety Code (LSC) and eliminate references in our regulations to all earlier editions of the Life Safety Code. It will also adopt the 2012 edition of the Health Care Facilities Code, with some exceptions.

A health maintenance facility for space station freedom

NASA Technical Reports Server (NTRS)

Billica, R. D.; Doarn, C. R.

1991-01-01

We describe a health care facility to be built and used on an orbiting space station in low Earth orbit. This facility, called the health maintenance facility, is based on and modeled after isolated terrestrial medical facilities. It will provide a phased approach to health care for the crews of Space Station Freedom. This paper presents the capabilities of the health maintenance facility. As Freedom is constructed over the next decade there will be an increase in activities, both construction and scientific. The health maintenance facility will evolve with this process until it is a mature, complete, stand-alone health care facility that establishes a foundation to support interplanetary travel. As our experience in space continues to grow so will the commitment to providing health care.

24 CFR 91.315 - Strategic plan.

Code of Federal Regulations, 2014 CFR

2014-04-01

... concise summary of the jurisdiction's activities to enhance coordination among Continuums of Care, public... care (such as health-care facilities, mental health facilities, foster care and other youth facilities...), which must be developed in accordance with the primary objective of the CDBG program to develop viable...

24 CFR 91.315 - Strategic plan.

Code of Federal Regulations, 2013 CFR

2013-04-01

... concise summary of the jurisdiction's activities to enhance coordination among Continuums of Care, public... care (such as health-care facilities, mental health facilities, foster care and other youth facilities...), which must be developed in accordance with the primary objective of the CDBG program to develop viable...

24 CFR 91.315 - Strategic plan.

Code of Federal Regulations, 2012 CFR

2012-04-01

... concise summary of the jurisdiction's activities to enhance coordination among Continuums of Care, public... care (such as health-care facilities, mental health facilities, foster care and other youth facilities...), which must be developed in accordance with the primary objective of the CDBG program to develop viable...

[Organization of workplace first aid in health care facilities].

PubMed

Ciavarella, M; Sacco, A; Bosco, Maria Giuseppina; Chinni, V; De Santis, A; Pagnanelli, A

2007-01-01

Laws D.Lgs. 626/94 and D.I. 388/03 attach particular importance to the organization of first aid in the workplace. Like every other enterprise, also hospitals and health care facilities have the obligation, as foreseen by the relevant legislation, to organize and manage first aid in the workplace. To discuss the topic in the light of the guidelines contained in the literature. We used the references contained in the relevant literature and in the regulations concerning organization of first aid in health care facilities. The regulations require the general manager of health care facilities to organize the primary intervention in case of emergencies in all health care facilities (health care or administrative, territorial and hospitals). In health care facilities the particular occupational risks, the general access of the public and the presence of patients who are already assumed to have altered states of health, should be the reason for particular care in guaranteeing the best possible management of a health emergency in the shortest time possible.

7 CFR 220.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... detention centers. A long-term care facility is a hospital, skilled nursing facility, intermediate care facility, or distinct part thereof, which is entended for the care of children confined for 30 days or more...

Consensus-based approach to develop a measurement framework and identify a core set of indicators to track implementation and progress towards effective coverage of facility-based Kangaroo Mother Care.

PubMed

Guenther, Tanya; Moxon, Sarah; Valsangkar, Bina; Wetzel, Greta; Ruiz, Juan; Kerber, Kate; Blencowe, Hannah; Dube, Queen; Vani, Shashi N; Vivio, Donna; Magge, Hema; De Leon-Mendoza, Socorro; Patterson, Janna; Mazia, Goldy

2017-12-01

As efforts to scale up the delivery of Kangaroo Mother Care (KMC) in facilities are increasing, a standardized approach to measure implementation and progress towards effective coverage is needed. Here, we describe a consensus-based approach to develop a measurement framework and identify a core set of indicators for monitoring facility-based KMC that would be feasible to measure within existing systems. The KMC measurement framework and core list of indicators were developed through: 1) scoping exercise to identify potential indicators through literature review and requests from researchers and program implementers; and 2) face-to-face consultations with KMC and measurement experts working at country and global levels to review candidate indicators and finalize selection and definitions. The KMC measurement framework includes two main components: 1) service readiness, based on the WHO building blocks framework; and 2) service delivery action sequence covering identification, service initiation, continuation to discharge, and follow-up to graduation. Consensus was reached on 10 core indicators for KMC, which were organized according to the measurement framework. We identified 4 service readiness indicators, capturing national level policy for KMC, availability of KMC indicators in HMIS, costed operational plans for KMC and availability of KMC services at health facilities with inpatient maternity services. Six indicators were defined for service delivery, including weighing of babies at birth, identification of those ≤2000 g, initiation of facility-based KMC, monitoring the quality of KMC, status of babies at discharge from the facility and levels of follow-up (according to country-specific protocol). These core KMC indicators, identified with input from a wide range of global and country-level KMC and measurement experts, can aid efforts to strengthen monitoring systems and facilitate global tracking of KMC implementation. As data collection systems advance, we encourage program managers and evaluators to document their experiences using this framework to measure progress and allow indicator refinement, with the overall aim of working towards sustainable, country-led data systems.

Medicaid claims history of Florida long-term care facility residents hospitalized for pressure ulcers.

PubMed

Baker, J

1996-01-01

The purpose of this study was to identify patterns of admission, discharge, and readmission between hospital and long-term care facility among a group of Florida long-term care facility residents with pressure ulcers whose care was paid for by Medicaid. A patient-specific, longitudinal claims history database was constructed from data provided by the Florida Department of Health and Rehabilitative Services. This database was used to determine and analyze hospital admissions for pressure ulcer care among Medicaid recipients cared for in a long-term care facility. Analysis of the data determined that more than half of the Medicaid-covered long-term care facility residents who formed the target study group (54.57%) had multiple hospital admissions associated with pressure ulcers. Pressure ulcer hospital admissions amounted to a program cost of $9.9 million.

Associations Among Health Care Workplace Safety, Resident Satisfaction, and Quality of Care in Long-Term Care Facilities.

PubMed

Boakye-Dankwa, Ernest; Teeple, Erin; Gore, Rebecca; Punnett, Laura

2017-11-01

We performed an integrated cross-sectional analysis of relationships between long-term care work environments, employee and resident satisfaction, and quality of patient care. Facility-level data came from a network of 203 skilled nursing facilities in 13 states in the eastern United States owned or managed by one company. K-means cluster analysis was applied to investigate clustered associations between safe resident handling program (SRHP) performance, resident care outcomes, employee satisfaction, rates of workers' compensation claims, and resident satisfaction. Facilities in the better-performing cluster were found to have better patient care outcomes and resident satisfaction; lower rates of workers compensation claims; better SRHP performance; higher employee retention; and greater worker job satisfaction and engagement. The observed clustered relationships support the utility of integrated performance assessment in long-term care facilities.

A Military Hospice Model

DTIC Science & Technology

1983-05-06

that apply) A. A hospice inpatient facility; B. An inpatient unit in a a. Hospital; b. Intermediate Care Facility ; c. Skilled Nursing facility; C. A...Care Hospital Intermediate Care Facility SNF Hospice Other No License Page 3 V. "WEIGHTED" STANDARDS Please feel free to indicate with a "W" in the

Assessing older drivers: a primary care protocol to evaluate driving safety risk.

PubMed

Murden, Robert A; Unroe, Kathleen

2005-08-01

Most articles on elder drivers offer either general advice, or review testing protocols that divide drivers into two distinct groups: safe or unsafe. We believe it is unreasonable to expect any testing to fully separate drivers into just these two mutually exclusive groups, so we offer a protocol for a more practical approach. This protocol can be applied by primary care physicians. We review the justification for the many steps of this protocol, which have branches that lead to identifying drivers as low risk, high risk (for accidents) or needing further evaluation. Options for further evaluation are provided.

Tiered protocol implementation improves treatment of hypoglycaemia in a neurosciences critical care and surgical intensive care unit.

PubMed

Van Berkel, Megan A; MacDermott, Jennifer; Dungan, Kathleen M; Cook, Charles H; Murphy, Claire V

2017-12-01

Although studies demonstrate techniques to limit hypoglycaemia in critically ill patients, there are limited data supporting methods to improve management of existing hypoglycaemia. Assess the impact and sustainability of a computerised, three tiered, nurse driven protocol for hypoglycaemia treatment. Retrospective pre and post protocol study. Neurosciences and surgical intensive care units at a tertiary academic medical centre. Patients with a hypoglycaemic episode were included during a pre-protocol or post-protocol implementation period. An additional six-month cohort was evaluated to assess sustainability. Fifty-four patients were included for evaluation (35 pre- and 19 post-protocol); 122 patients were included in the sustainability cohort. Hypoglycaemia treatment significantly improved in the post-protocol cohort (20% vs. 52.6%, p=0.014); with additional improvement to 79.5% in the sustainability cohort. Time to follow-up blood glucose was decreased after treatment from 122 [Q1-Q3: 46-242] minutes pre-protocol to 25 [Q1-Q3: 9-48] minutes post protocol (p<0.0001). This reduction was maintained in the sustainability cohort [median of 29min (Q1-Q3: 20-51)]. Implementation of a nurse-driven, three-tiered protocol for treatment of hypoglyacemia significantly improved treatment rates, as well as reduced time to recheck blood glucose measurement. These benefits were sustained during a six-month period after protocol implementation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain.

PubMed

van der Roer, Nicole; van Tulder, Maurits; van Mechelen, Willem; de Vet, Henrica

2008-02-15

Economic evaluation from a societal perspective conducted alongside a randomized controlled trial with a follow-up of 52 weeks. To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with nonspecific chronic low back pain. The intensive group training protocol combines exercise therapy, back school, and behavioral principles. Two studies found a significant reduction in absenteeism for a graded activity program in occupational health care. This program has not yet been evaluated in a primary care physiotherapy setting. Participating physical therapists in primary care recruited 114 patients with chronic nonspecific low back pain. Eligible patients were randomized to either the protocol group or the guideline group. Outcome measures included functional status (Roland Morris Disability Questionnaire), pain intensity (11-point numerical rating scale), general perceived effect and quality of life (EuroQol-5D). Cost data were measured with cost diaries and included direct and indirect costs related to low back pain. After 52 weeks, the direct health care costs were significantly higher for patients in the protocol group, largely due to the costs of the intervention. The mean difference in total costs amounted to [Euro sign] 233 (95% confidence interval: [Euro sign] -2.185; [Euro sign] 2.764). The cost-effectiveness planes indicated no significant differences in cost effectiveness between the 2 groups. The results of this economic evaluation showed no difference in total costs between the protocol group and the guideline group. The differences in effects were small and not statistically significant. At present, national implementation of the protocol is not recommended.

ABM Clinical Protocol #2: Guidelines for Hospital Discharge of the Breastfeeding Term Newborn and Mother: “The Going Home Protocol,” Revised 2014

PubMed Central

Evans, Amy; Taylor, Julie Scott

2014-01-01

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. PMID:24456024

A comparison of parent satisfaction in an open-bay and single-family room neonatal intensive care unit.

PubMed

Stevens, Dennis C; Helseth, Carol C; Khan, M Akram; Munson, David P; Reid, E J

2011-01-01

The purpose of this research was to test the hypothesis that parental satisfaction with neonatal intensive care is greater in a single-family room facility as compared with a conventional open-bay neonatal intensive care unit (NICU). This investigation was a prospective cohort study comparing satisfaction survey results for parents who responded to a commercially available parent NICU satisfaction survey following the provision of NICU care in open-bay and single-family room facilities. A subset of 16 items indicative of family-centered care was also computed and compared for these two NICU facilities. Parents whose babies received care in the single-family room facility expressed significantly improved survey responses in regard to the NICU environment, overall assessment of care, and total survey score than did parents of neonates in the open-bay facility. With the exception of the section on nursing in which scores in both facilities were high, nonsignificant improvement in median scores for the sections on delivery, physicians, discharge planning, and personal issues were noted. The total median item score for family-centered care was significantly greater in the single-family room than the open-bay facility. Parental satisfaction with care in the single-family room NICU was improved in comparison with the traditional open-bay NICU. The single-family room environment appears more conducive to the provision of family-centered care. Improved parental satisfaction with care and the potential for enhanced family-centered care need to be considered in decisions made regarding the configuration of NICU facilities in the future.

Integrated approach to oral health in aged care facilities using oral health practitioners and teledentistry in rural Queensland.

PubMed

Tynan, Anna; Deeth, Lisa; McKenzie, Debra; Bourke, Carolyn; Stenhouse, Shayne; Pitt, Jacinta; Linneman, Helen

2018-04-16

Residents of residential aged care facilities are at very high risk of developing complex oral diseases and dental problems. Key barriers exist in delivering oral health services to residential aged care facilities, particularly in regional and rural areas. A quality improvement study incorporating pre- and post chart audits and pre- and post consultation with key stakeholders, including staff and residents, expert opinion on cost estimates and field notes were used. One regional and three rural residential aged care facilities situated in a non-metropolitan hospital and health service in Queensland. Number of appointments avoided at an oral health facility Feedback on program experience by staff and residents Compliance with oral health care plan implementation Observations of costs involved to deliver new service. The model developed incorporated a visit by an oral health therapist for screening, education, simple intervention and referral for a teledentistry session if required. Results showed an improvement in implementation of oral health care plans and a minimisation of need for residents to attend an oral health care facility. Potential financial and social cost savings for residents and the facilities were also noted. Screening via the oral health therapist and teledentistry appointment minimises the need for a visit to an oral health facility and subsequent disruption to residents in residential aged care facilities. © 2018 National Rural Health Alliance Ltd.

Estimated cost of a health visitor-led protocol for perinatal mental health.

PubMed

Oluboyede, Yemi; Lewis, Anne; Ilott, Irene; Lekka, Chrysanthi

2010-06-01

Anecdotally, protocols, care pathways and clinical guidelines are time consuming to develop and sustain, but there is little research about the actual costs of their development, use and audit.This is a notable gap considering the pervasiveness of such documents that are intended to reduce unacceptable variations in practice by standardising care processes. A case study research design was used to calculate the resource use costs of a protocol for perinatal mental health, part of the core programme for health visitors in a primary care trust in the west of England. The methods were in-depth interviews with the operational lead for the protocol (a health visitor) and documentary analysis. The total estimated cost of staff time over a five-year period (2004 to 2008) was Euro 73,598, comprising Euro 36,162 (49%) for development and Euro 37,436 (51%) for implementation. Although these are best estimates dependent upon retrospective data, they indicate the opportunity cost of staff time for a single protocol in one trust over five years. When new protocols, care pathways or clinical guidelines are proposed, the costs need to be considered and weighed against the benefits of engaging frontline staff in service improvements.

Distribution of Trauma Care Facilities in Oman in Relation to High-Incidence Road Traffic Injury Sites: Pilot study.

PubMed

Al-Kindi, Sara M; Naiem, Ahmed A; Taqi, Kadhim M; Al-Gheiti, Najla M; Al-Toobi, Ikhtiyar S; Al-Busaidi, Nasra Q; Al-Harthy, Ahmed Z; Taqi, Alaa M; Ba-Alawi, Sharif A; Al-Qadhi, Hani A

2017-11-01

Road traffic injuries (RTIs) are considered a major public health problem worldwide. In Oman, high numbers of RTIs and RTI-related deaths are frequently registered. This study aimed to evaluate the distribution of trauma care facilities in Oman with regards to their proximity to RTI-prevalent areas. This descriptive pilot study analysed RTI data recorded in the national Royal Oman Police registry from January to December 2014. The distribution of trauma care facilities was analysed by calculating distances between areas of peak RTI incidence and the closest trauma centre using Google Earth and Google Maps software (Google Inc., Googleplex, Mountain View, California, USA). A total of 32 trauma care facilities were identified. Four facilities (12.5%) were categorised as class V trauma centres. Of the facilities in Muscat, 42.9% were ranked as class IV or V. There were no class IV or V facilities in Musandam, Al-Wusta or Al-Buraimi. General surgery, orthopaedic surgery and neurosurgery services were available in 68.8%, 59.3% and 12.5% of the centres, respectively. Emergency services were available in 75.0% of the facilities. Intensive care units were available in 11 facilities, with four located in Muscat. The mean distance between a RTI hotspot and the nearest trauma care facility was 34.7 km; however, the mean distance to the nearest class IV or V facility was 83.3 km. The distribution and quality of trauma care facilities in Oman needs modification. It is recommended that certain centres upgrade their levels of trauma care in order to reduce RTI-associated morbidity and mortality in Oman.

Minimizing the Risk of Disease Transmission in Emergency Settings: Novel In Situ Physico-Chemical Disinfection of Pathogen-Laden Hospital Wastewaters.

PubMed

Sozzi, Emanuele; Fabre, Kerline; Fesselet, Jean-François; Ebdon, James E; Taylor, Huw

2015-01-01

The operation of a health care facility, such as a cholera or Ebola treatment center in an emergency setting, results in the production of pathogen-laden wastewaters that may potentially lead to onward transmission of the disease. The research presented here evaluated the design and operation of a novel treatment system, successfully used by Médecins Sans Frontières in Haiti to disinfect CTC wastewaters in situ, eliminating the need for road haulage and disposal of the waste to a poorly-managed hazardous waste facility, thereby providing an effective barrier to disease transmission through a novel but simple sanitary intervention. The physico-chemical protocols eventually successfully treated over 600 m3 of wastewater, achieving coagulation/flocculation and disinfection by exposure to high pH (Protocol A) and low pH (Protocol B) environments, using thermotolerant coliforms as a disinfection efficacy index. In Protocol A, the addition of hydrated lime resulted in wastewater disinfection and coagulation/flocculation of suspended solids. In Protocol B, disinfection was achieved by the addition of hydrochloric acid, followed by pH neutralization and coagulation/flocculation of suspended solids using aluminum sulfate. Removal rates achieved were: COD >99%; suspended solids >90%; turbidity >90% and thermotolerant coliforms >99.9%. The proposed approach is the first known successful attempt to disinfect wastewater in a disease outbreak setting without resorting to the alternative, untested, approach of 'super chlorination' which, it has been suggested, may not consistently achieve adequate disinfection. A basic analysis of costs demonstrated a significant saving in reagent costs compared with the less reliable approach of super-chlorination. The proposed approach to in situ sanitation in cholera treatment centers and other disease outbreak settings represents a timely response to a UN call for onsite disinfection of wastewaters generated in such emergencies, and the 'Coalition for Cholera Prevention and Control' recently highlighted the research as meriting serious consideration and further study. Further applications of the method to other emergency settings are being actively explored by the authors through discussion with the World Health Organization with regards to the ongoing Ebola outbreak in West Africa, and with the UK-based NGO Oxfam with regards to excreta-borne disease management in the Philippines and Myanmar, as a component of post-disaster incremental improvements to local sanitation chains.

Minimizing the Risk of Disease Transmission in Emergency Settings: Novel In Situ Physico-Chemical Disinfection of Pathogen-Laden Hospital Wastewaters

PubMed Central

Sozzi, Emanuele; Fabre, Kerline; Fesselet, Jean-François; Ebdon, James E.; Taylor, Huw

2015-01-01

The operation of a health care facility, such as a cholera or Ebola treatment center in an emergency setting, results in the production of pathogen-laden wastewaters that may potentially lead to onward transmission of the disease. The research presented here evaluated the design and operation of a novel treatment system, successfully used by Médecins Sans Frontières in Haiti to disinfect CTC wastewaters in situ, eliminating the need for road haulage and disposal of the waste to a poorly-managed hazardous waste facility, thereby providing an effective barrier to disease transmission through a novel but simple sanitary intervention. The physico-chemical protocols eventually successfully treated over 600 m3 of wastewater, achieving coagulation/flocculation and disinfection by exposure to high pH (Protocol A) and low pH (Protocol B) environments, using thermotolerant coliforms as a disinfection efficacy index. In Protocol A, the addition of hydrated lime resulted in wastewater disinfection and coagulation/flocculation of suspended solids. In Protocol B, disinfection was achieved by the addition of hydrochloric acid, followed by pH neutralization and coagulation/flocculation of suspended solids using aluminum sulfate. Removal rates achieved were: COD >99%; suspended solids >90%; turbidity >90% and thermotolerant coliforms >99.9%. The proposed approach is the first known successful attempt to disinfect wastewater in a disease outbreak setting without resorting to the alternative, untested, approach of ‘super chlorination’ which, it has been suggested, may not consistently achieve adequate disinfection. A basic analysis of costs demonstrated a significant saving in reagent costs compared with the less reliable approach of super-chlorination. The proposed approach to in situ sanitation in cholera treatment centers and other disease outbreak settings represents a timely response to a UN call for onsite disinfection of wastewaters generated in such emergencies, and the ‘Coalition for Cholera Prevention and Control’ recently highlighted the research as meriting serious consideration and further study. Further applications of the method to other emergency settings are being actively explored by the authors through discussion with the World Health Organization with regards to the ongoing Ebola outbreak in West Africa, and with the UK-based NGO Oxfam with regards to excreta-borne disease management in the Philippines and Myanmar, as a component of post-disaster incremental improvements to local sanitation chains. PMID:26110821

Does size matter in aged care facilities? A literature review of the relationship between the number of facility beds and quality.

PubMed

Baldwin, Richard; Chenoweth, Lynnette; Dela Rama, Marie; Wang, Alex Y

Theory suggests that structural factors such as aged care facility size (bed numbers) will influence service quality. There have been no recent published studies in support of this theory, and consequently, the available literature has not been useful in assisting decision makers with investment decisions on facility size. The study aimed to address that deficit by reviewing the international literature on the relationships between the size of residential aged care facilities, measured by number of beds, and service quality. A systematic review identified 30 studies that reported a relationship between facility size and quality and provided sufficient details to enable comparison. There are three groups of studies based on measurement of quality-those measuring only resident outcomes, those measuring care and resident outcomes using composite tools, and those focused on regulatory compliance. The overall findings support the posited theory to a large extent, that size is a factor in quality and smaller facilities yield the most favorable results. Studies using multiple indicators of service quality produced more consistent results in favor of smaller facilities, as did most studies of regulatory compliance. The theory that aged care facility size (bed numbers) will influence service quality was supported by 26 of the 30 studies reviewed. The review findings indicate that aged care facility size (number of beds) may be one important factor related to service quality. Smaller facilities are more likely to result in higher quality and better outcomes for residents than larger facilities. This has implications for those who make investment decisions concerning aged care facilities. The findings also raise implications for funders and policy makers to ensure that regulations and policies do not encourage the building of facilities inconsistent with these findings.

A qualitative evaluation of the choice of traditional birth attendants for maternity care in 2008 Sierra Leone: implications for universal skilled attendance at delivery.

PubMed

Oyerinde, Koyejo; Harding, Yvonne; Amara, Philip; Garbrah-Aidoo, Nana; Kanu, Rugiatu; Oulare, Macoura; Shoo, Rumishael; Daoh, Kizito

2013-07-01

Maternal and newborn death is common in Sierra Leone; significant reductions in both maternal and newborn mortality require universal access to a skilled attendant during labor and delivery. When too few women use health facilities MDGs 4 and 5 targets will not be met. Our objectives were to identify why women use services provided by TBAs as compared to health facilities; and to suggest strategies to improve utilization of health facilities for maternity and newborn care services. Qualitative data from focus group discussions in communities adjacent to health facilities collected during the 2008 Emergency Obstetric and Newborn Care Needs Assessment were analyzed for themes relating to decision-making on the utilization of TBAs or health facilities. The prohibitive cost of services, and the geographic inaccessibility of health facilities discouraged women from using them while trust in the vast experience of TBAs as well as their compassionate care drew patients to them. Poor facility infrastructure, often absent staff, and the perception that facilities were poorly stocked and could not provide continuum of care services were barriers to facility utilization for maternity and newborn care. Improvements in infrastructure and the 24-hour provision of free, quality, comprehensive, and respectful care will minimize TBA preference in Sierra Leone.

Health Care Facilities Resilient to Climate Change Impacts

PubMed Central

Paterson, Jaclyn; Berry, Peter; Ebi, Kristie; Varangu, Linda

2014-01-01

Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator’s guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change. PMID:25522050

Fast-track surgery for uncomplicated appendicitis in children: a matched case-control study.

PubMed

Cundy, Thomas P; Sierakowski, Kyra; Manna, Alexandra; Cooper, Celia M; Burgoyne, Laura L; Khurana, Sanjeev

2017-04-01

Standardized post-operative protocols reduce variation and enhance efficiency in patient care. Patients may benefit from these initiatives by improved quality of care. This matched case-control study investigates the effect of a multidisciplinary criteria-led discharge protocol for uncomplicated appendicitis in children. Key protocol components included limiting post-operative antibiotics to two intravenous doses, avoidance of intravenous opioid analgesia, prompt resumption of diet, active encouragement of early ambulation and nursing staff autonomy to discharge patients that met assigned criteria. The study period was from August 2015 to February 2016. Outcomes were compared with a historical control group matched for operative approach. Outcomes for 83 patients enrolled to our protocol were compared with those of 83 controls. There was a 29.2% reduction in median post-operative length of stay in our protocol-based care group (19.6 versus 27.7 h; P < 0.001). The rate of discharges within 24 h improved from 12 to 42%. There was no significant difference in complication rate (4.8 versus 7.2%; P = 0.51). Mean oral morphine dose equivalent per kilogram requirement was less than half (46%) that of control group patients (P < 0.001). Mean number of ondansetron doses was also significantly lower. Projected annual direct cost savings following protocol implementation was AUD$77 057. Implementation of a criteria-led discharge protocol at our hospital decreased length of stay, reduced variation in care, preserved existing low morbidity, incurred substantial cost savings, and safely rationalized opioid and antiemetic medication. These protocols are inexpensive and offer tangible benefits that are accessible to all health care settings. © 2016 Royal Australasian College of Surgeons.

A survey of veterinary radiation facilities in 2010.

PubMed

Farrelly, John; McEntee, Margaret C

2014-01-01

A survey of veterinary radiation therapy facilities in the United States, Canada, and Europe was done in 2010, using an online survey tool, to determine the type of equipment available, radiation protocols used, caseload, tumor types irradiated, as well as other details of the practice of veterinary radiation oncology. The results of this survey were compared to a similar survey performed in 2001. A total of 76 facilities were identified including 24 (32%) academic institutions and 52 (68%) private practice external beam radiation therapy facilities. The overall response rate was 51% (39/76 responded). Based on this survey, there is substantial variation among facilities in all aspects ranging from equipment and personnel to radiation protocols and caseloads. American College of Veterinary Radiology boarded radiation oncologists direct 90% of the radiation facilities, which was increased slightly compared to 2001. All facilities surveyed in 2010 had a linear accelerator. More facilities reported having electron capability (79%) compared to the 2001 survey. Eight facilities had a radiation oncology resident, and academic facilities were more likely to have residents. Patient caseload information was available from 28 sites (37% of radiation facilities), and based on the responses 1376 dogs and 352 cats were irradiated in 2010. The most frequently irradiated tumors were soft tissue sarcomas in dogs, and oral squamous cell carcinoma in cats. © 2014 American College of Veterinary Radiology.

Standardized quality-assessment system to evaluate pressure ulcer care in the nursing home.

PubMed

Bates-Jensen, Barbara M; Cadogan, Mary; Jorge, Jennifer; Schnelle, John F

2003-09-01

To demonstrate reliability and feasibility of a standardized protocol to assess and score quality indicators relevant to pressure ulcer (PU) care processes in nursing homes (NHs). Descriptive. Eight NHs. One hundred ninety-one NH residents for whom the PU Resident Assessment Protocol of the Minimum Data Set was initiated. Nine quality indicators (two related to screening and prevention of PU, two focused on assessment, and five addressing management) were scored using medical record data, direct human observation, and wireless thigh monitor observation data. Feasibility and reliability of medical record, observation, and thigh monitor protocols were determined. The percentage of participants who passed each of the indicators, indicating care consistent with practice guidelines, ranged from 0% to 98% across all indicators. In general, participants in NHs passed fewer indicators and had more problems with medical record accuracy before a PU was detected (screening/prevention indicators) than they did once an ulcer was documented (assessment and management indicators). Reliability of the medical record protocol showed kappa statistics ranging from 0.689 to 1.00 and percentage agreement from 80% to 100%. Direct observation protocols yielded kappa statistics of 0.979 and 0.928. Thigh monitor protocols showed kappa statistics ranging from 0.609 to 0.842. Training was variable, with the observation protocol requiring 1 to 2 hours, medical records requiring joint review of 20 charts with average time to complete the review of 20 minutes, and the thigh monitor data requiring 1 week for training in data preparation and interpretation. The standardized quality assessment system generated scores for nine PU quality indicators with good reliability and provided explicit scoring rules that permit reproducible conclusions about PU care. The focus of the indicators on care processes that are under the control of NH staff made the protocol useful for external survey and internal quality improvement purposes, and the thigh monitor observational technology provided a method for monitoring repositioning care processes that were otherwise difficult to monitor and manage.

Characteristics of Owners of Residential Care Facilities.

ERIC Educational Resources Information Center

Horgan, Dianne D.; And Others

Although researchers have investigated quality and cost of residential care, little is known about the people who own and manage residential care facilities. In an attempt to find out more about these managers, members of the National Association of Residential Care Facilities (NARCF) were surveyed. Members (N=175) responded to questionnaires…

7 CFR 1956.143 - Debt restructuring-hospitals and health care facilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 103-354 will consider the following criteria for selection: past experience in health care facility... 7 Agriculture 14 2011-01-01 2011-01-01 false Debt restructuring-hospitals and health care... Settlement-Community and Business Programs § 1956.143 Debt restructuring—hospitals and health care facilities...

42 CFR 409.85 - Skilled nursing facility (SNF) care coinsurance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Skilled nursing facility (SNF) care coinsurance. 409.85 Section 409.85 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Coinsurance § 409.85 Skilled nursing facility (SNF) care coinsurance. (a) General provisions. (1) SNF care...

42 CFR 409.85 - Skilled nursing facility (SNF) care coinsurance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Skilled nursing facility (SNF) care coinsurance. 409.85 Section 409.85 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Coinsurance § 409.85 Skilled nursing facility (SNF) care coinsurance. (a) General provisions. (1) SNF care...

42 CFR 409.85 - Skilled nursing facility (SNF) care coinsurance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Skilled nursing facility (SNF) care coinsurance. 409.85 Section 409.85 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Coinsurance § 409.85 Skilled nursing facility (SNF) care coinsurance. (a) General provisions. (1) SNF care...

42 CFR 409.85 - Skilled nursing facility (SNF) care coinsurance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Skilled nursing facility (SNF) care coinsurance. 409.85 Section 409.85 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Coinsurance § 409.85 Skilled nursing facility (SNF) care coinsurance. (a) General provisions. (1) SNF care...

42 CFR 409.85 - Skilled nursing facility (SNF) care coinsurance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Skilled nursing facility (SNF) care coinsurance. 409.85 Section 409.85 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Coinsurance § 409.85 Skilled nursing facility (SNF) care coinsurance. (a) General provisions. (1) SNF care...

Early detection of health problems in potentially frail community-dwelling older people by general practices--project [G]OLD: design of a longitudinal, quasi-experimental study.

PubMed

Stijnen, Mandy M N; Duimel-Peeters, Inge G P; Jansen, Maria W J; Vrijhoef, Hubertus J M

2013-01-18

Due to the ageing of the population, the number of frail older people who suffer from multiple, complex health complaints increases and this ultimately threatens their ability to function independently. Many interventions for frail older people attempt to prevent or delay functional decline, but they show contradicting results. Recent studies emphasise the importance of embedding these interventions into existing primary care systems and tailoring care to older people's needs and wishes. This article presents the design of an evaluation study, aiming to investigate the effects and feasibility of the early detection of health problems among community-dwelling older people and their subsequent referral to appropriate care and/or well-being facilities by general practices. A longitudinal, quasi-experimental study is designed comparing 13 intervention practices with 11 control practices. General practices select eligible community-dwelling older people (≥ 75 years). Practice nurses from intervention practices (1) visit older people at home for a comprehensive assessment of their health and well-being; (2) discuss results with the GP; (3) formulate - if required - a care and treatment plan together with the patient; (4) refer patient to care and/or well-being facilities; and (5) monitor and coordinate care and follow-up. Control practices provide usual care and match the intervention practices on the presence of different primary care professionals within the practice. Primary outcome measures are health-related quality of life and disability. Additionally, attitude towards ageing, care satisfaction, health care utilisation, nursing home admission and mortality are measured. Some outcomes are assessed by means of a postal questionnaire (at baseline and after 6, 12, and 18 months follow-up), others through continuous registration over the 18-month period. A profound process evaluation will provide insight into barriers and facilitators for implementing the intervention protocol within general practices from both the patient and caregiver perspective. The proposed approach requires redesigning care delivery within general practices for accomplishing appropriate care for older people. A quasi-experimental design is chosen to closely resemble a real-life situation, which is desirable for future implementation after this innovation proves to be successful. Results of the effect and process evaluation will become available in 2013. The Netherlands National Trial Register NTR2737.

Advanced orbiting systems test-bedding and protocol verification

NASA Technical Reports Server (NTRS)

Noles, James; De Gree, Melvin

1989-01-01

The Consultative Committee for Space Data Systems (CCSDS) has begun the development of a set of protocol recommendations for Advanced Orbiting Systems (SOS). The AOS validation program and formal definition of AOS protocols are reviewed, and the configuration control of the AOS formal specifications is summarized. Independent implementations of the AOS protocols by NASA and ESA are discussed, and cross-support/interoperability tests which will allow the space agencies of various countries to share AOS communication facilities are addressed.

Low back pain among workers in care facilities for the elderly after introducing welfare equipment.

PubMed

Iwakiri, Kazuyuki; Takahashi, Masaya; Sotoyama, Midori; Liu, Xinxin; Koda, Shigeki

2016-07-29

The purpose of this study was to clarify the causes of low back pain among workers in care facilities for the elderly after the introduction of welfare equipment. We conducted anonymous questionnaire surveys among administrators and care workers in eight elderly care facilities. The questionnaires were designed to investigate the status of both the care workers and facility. In reference to the care facility, the questionnaires were comprised items for investigating basic information, occupational safety, and health activities. For care workers, in addition to basic information, occupational safety, and health activities, the questionnaires also comprised items for investigating resident transfer and bathing methods, low back pain, and occupational stress. Completed questionnaires were returned by eight care facility administrators (response rate: 100%) and 373 care workers (response rate: 92.3%), among which 367 were used for analyses. Many care workers participated in a variety of occupational safety and health activities that were conducted in the facilities. Various types of welfare equipment were introduced into the care facilities and subsequently used by many care workers during resident transfer and bathing. As a result, 89.9% of the care workers reported having only slight or no low back pain. The remaining 10.1% reported having serious low back pain that interfered with their work. On the basis of logistic regression analysis, low back pain was associated with the following variables: failure to provide the appropriate method of care to each resident, failure of colleagues to discuss methods for improving care, lack of instructions regarding the use of welfare equipment, and inappropriate job rotation. An association was also found between low back pain and poor posture, poor resident-lifting technique, insufficient time to complete work, and a shortage of workers to assist with resident transfer or bathing. Although care workers received instructions on the health and safety activities extracted from the surveys, an association was still found between these activities and low back pain. This was thought to result from some care workers not establishing the appropriate method of care for each resident, not discussing methods for improving care with other colleagues, not using the welfare equipment, and failing to practice appropriate job rotation. These results suggest that low back pain among care workers in the facilities for the elderly that have introduced welfare equipment is caused by a failure to sufficiently conduct appropriate care methods.

Oral healthcare access and adequacy in alternative long-term care facilities.

PubMed

Smith, Barbara J; Ghezzi, Elisa M; Manz, Michael C; Markova, Christiana P

2010-01-01

This study was undertaken to determine practices and perceived barriers to access related to oral health by surveying administrators in Michigan alternative long-term care facilities (ALTCF). A 24-item questionnaire was mailed to all 2,275 Michigan ALTCF serving residents aged 60+. Facility response rate was 22% (n = 508). Eleven percent of facilities had a written dental care plan; 18% stated a dentist examined new residents; and 19% of facilities had an agreement with a dentist to come to the facility, with 52% of those being for emergency care only. The greatest perceived barriers were willingness of general and specialty dentists to treat residents at the nursing facility and/or private offices as well as financial concerns. Substantial barriers to care were uniformly perceived. Oral health policies and practices within Michigan ALTCF vary, as measured by resources, attitudes, and the availability of professional care. There is limited involvement by dental professionals in creating policy and providing consultation and service.

An Australian Brain Bank: a critical investment with a high return!

PubMed Central

Garrick, T.; Dedova, I.; Hunt, C.; Miller, R.; Sundqvist, N.; Harper, C.

2012-01-01

Research into neuropsychiatric disorders, including alcohol-related problems, is limited in part by the lack of appropriate animal models. However, the development of new technologies in pathology and molecular biology means that many more questions can be addressed using appropriately stored human brain tissues. The New South Wales Tissue Resource Centre (TRC) in the University of Sydney (Australia) is a human brain bank that can provide tissues to the neuroscience research community studying alcohol-related brain disorders, schizophrenia, depression and bipolar disorders. Carefully standardised operational protocols and integrated information systems means that the TRC can provide high quality, accurately characterised, tissues for research. A recent initiative, the pre-mortem donor program called “Using our Brains”, encourages individuals without neuropsychiatric illness to register as control donors, a critical group for all research. Community support for this program is strong with over 2,000 people registering their interest. Discussed herein are the protocols pertaining to this multifaceted facility and the benefits of investment, both scientific and financial, to neuroscience researchers and the community at large. PMID:18543078

An Australian Brain Bank: a critical investment with a high return!

PubMed

Sheedy, D; Garrick, T; Dedova, I; Hunt, C; Miller, R; Sundqvist, N; Harper, C

2008-09-01

Research into neuropsychiatric disorders, including alcohol-related problems, is limited in part by the lack of appropriate animal models. However, the development of new technologies in pathology and molecular biology means that many more questions can be addressed using appropriately stored human brain tissues. The New South Wales Tissue Resource Centre (TRC) in the University of Sydney (Australia) is a human brain bank that can provide tissues to the neuroscience research community studying alcohol-related brain disorders, schizophrenia, depression and bipolar disorders. Carefully standardised operational protocols and integrated information systems means that the TRC can provide high quality, accurately characterised, tissues for research. A recent initiative, the pre-mortem donor program called "Using our Brains", encourages individuals without neuropsychiatric illness to register as control donors, a critical group for all research. Community support for this program is strong with over 2,000 people registering their interest. Discussed herein are the protocols pertaining to this multifaceted facility and the benefits of investment, both scientific and financial, to neuroscience researchers and the community at large.

Prevalence and incidence studies of pressure ulcers in two long-term care facilities in Canada.

PubMed

Davis, C M; Caseby, N G

2001-11-01

A study was initiated to determine the prevalence and incidence of pressure ulcers in two long-term care facilities in Canada, one with 95 residents and the other with 92 residents. The prevalence study was conducted at both facilities on a single day. The incidence study was completed after 41 and 42 days, respectively, at each facility. Data were collected on demographics, medical information, and possible contributing factors. Each resident was assessed for the presence of a pressure ulcer. Each ulcer was staged and anatomical location was noted. The prevalence of pressure ulcers in the two long-term care facilities was 36.8% and 53.2%, respectively. The incidence of pressure ulcers in the two long-term care facilities was 11.7% and 11.6%, respectively. In conclusion, the pressure ulcer prevalence is higher than published figures for the long-term care setting. However, a pressure ulcer incidence of less than 12% in each facility suggests an equal and acceptable level of nursing care in both facilities. The disparity of pressure ulcer prevalence between the two facilities may be explained by a difference of case mix.

Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia

PubMed Central

Lohela, Terhi J.; Campbell, Oona M. R.; Gabrysch, Sabine

2012-01-01

Background Globally, approximately 3 million babies die annually within their first month. Access to adequate care at birth is needed to reduce newborn as well as maternal deaths. We explore the influence of distance to delivery care and of level of care on early neonatal mortality in rural Zambia and Malawi, the influence of distance (and level of care) on facility delivery, and the influence of facility delivery on early neonatal mortality. Methods and Findings National Health Facility Censuses were used to classify the level of obstetric care for 1131 Zambian and 446 Malawian delivery facilities. Straight-line distances to facilities were calculated for 3771 newborns in the 2007 Zambia DHS and 8842 newborns in the 2004 Malawi DHS. There was no association between distance to care and early neonatal mortality in Malawi (OR 0.97, 95%CI 0.58–1.60), while in Zambia, further distance (per 10 km) was associated with lower mortality (OR 0.55, 95%CI 0.35–0.87). The level of care provided in the closest facility showed no association with early neonatal mortality in either Malawi (OR 1.02, 95%CI 0.90–1.16) or Zambia (OR 1.02, 95%CI 0.82–1.26). In both countries, distance to care was strongly associated with facility use for delivery (Malawi: OR 0.35 per 10km, 95%CI 0.26–0.46). All results are adjusted for available confounders. Early neonatal mortality did not differ by frequency of facility delivery in the community. Conclusions While better geographic access and higher level of care were associated with more frequent facility delivery, there was no association with lower early neonatal mortality. This could be due to low quality of care for newborns at health facilities, but differential underreporting of early neonatal deaths in the DHS is an alternative explanation. Improved data sources are needed to monitor progress in the provision of obstetric and newborn care and its impact on mortality. PMID:23300599

Implementing a tobacco-free hospital campus in Ireland: lessons learned.

PubMed

McArdle, D; Kabir, Z

2018-05-01

The Irish Health Service Executive (HSE) had set a target that all HSE facilities should implement the HSE Tobacco Free Campus (TFC) policy by 2015. The aims of this study are to examine hospital staff awareness and to assess the progress of selected HSE health care facilities towards a TFC policy. Three health care facilities that were conveniently located were self-selected in County Cork, namely, an acute hospital, a mental health service and an older person's facility. Three different types of quantitative data were collected between May and September 2016 drawn on Standards 3, 4 and 5 of the European Network for Tobacco Free Health Care Services (ENSH-Global) tools: (1) face-to-face consultation with health care facility managers on their progress towards the HSE TFC policy, (2) self-administered questionnaire to a purposive sample of 153 staff members across three health care facilities and (3) physical observation of signs of smoking and smoking-related information across each health care facility for objective verification of compliance. Of the 153 staff who completed the questionnaire, 64% were females, 39% were nurses, 20% were smokers and 76% agreed with the TFC policy. However, only 26% of the 153 staff had received training on motivational and tobacco cessation techniques. Seventy-seven percent of the 153 staff stated that the campus was not tobacco-free. Physical observation suggested signs of smoking within the campus across all three health care facilities surveyed. Staff awareness of the HSE TFC policy across selected health care facilities in Ireland is positive but is not sufficient. There are gaps in the implementation process of the HSE TFC policy in the health care facilities. Therefore, proper communication on the importance of the ENSH-Global standards and cessation training to all staff is necessary to help reduce smoking rates across the health care facilities and also to move towards a Tobacco Free Campus in Ireland.

Patient education and emotional support practices in abortion care facilities in the United States.

PubMed

Gould, Heather; Perrucci, Alissa; Barar, Rana; Sinkford, Danielle; Foster, Diana Greene

2012-01-01

Little is known about how patient education and emotional support is provided at abortion facilities. This pilot study documents 27 facilities' practices in this aspect of abortion care. We conducted confidential telephone interviews with staff from 27 abortion facilities about their practices. The majority of facilities reported they rely primarily on trained nonclinician staff to educate patients and provide emotional support. As part of their informed consent and counseling processes, facilities reported that staff always provide patients with information about the procedure (96%), assess the certainty of their abortion decisions (92%), assess their feelings and provide emotional support (74%), and provide contraceptive health education (92%). Time spent providing these components of care varied across facilities and patients. When describing their facility's care philosophy, many respondents expressed support for "patient-centered," "supportive," "nonjudgmental" care. Eighty-two percent agreed that it is the facility's role to provide counseling for emotional issues related to abortion. All facilities valued informed consent, patient education, and emotional support. Although the majority of facilities considered counseling for emotional issues to be a part of their role, some did not. Future research should examine patients' preferences regarding abortion care and counseling and how different approaches to care affect women's emotional well-being after having an abortion. This information is important in light of current, widespread legislative efforts that aim to regulate abortion counseling, which are being proposed without an understanding of patient needs or facility practices. Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation.

PubMed

Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C; Frederiksen, Christian A; Laursen, Christian B; Sloth, Erik; Mølgaard, Ole; Knudsen, Lars; Kirkegaard, Hans

2018-03-27

Trauma is a leading cause of death among adults aged < 44 years, and optimal care is a challenge. Evidence supports the centralization of trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone for structured interviews. A total of 22 facilities in Denmark were found to receive traumatized patients. All facilities used a trauma care manual and all had a multidisciplinary trauma team. The study found three different trauma team activation criteria and nine different compositions of teams who participate in trauma care. Training was heterogeneous and, beyond the major trauma centers, databases were only maintained in a few facilities. The study established an inventory of the existing Danish facilities that receive traumatized patients. The trauma team activation criteria and the trauma teams were heterogeneous in both size and composition. A national database for traumatized patients, research on nationwide trauma team activation criteria, and team composition guidelines are all called for.

A Redesign Approach for Improving Animal Care Services for Researchers

PubMed Central

Okpe, Orighomisan; Kovach, Jamison V

2017-01-01

Because a research institution's animal care and use program oversees the provision of services specified in approved protocols designed by researchers, the effective provision of services within these programs is paramount to ensuring the humane care and treatment of research animals in accordance with federal, state, and local regulations and institutional policies. To improve the services provided to researchers through animal care and use programs, we investigated the relationship between the researchers who conduct these types of studies and the veterinary operations that provide care and treatment for research animals. Through a case study conducted at a leading public research university, we used an action-research approach to redesign aspects of the process through which researchers and the veterinary operations interact by using the Design for Six Sigma methodology. Using this structured approach for building quality into the design of a process to better serve customers, we identified and prioritized researchers’ expectations regarding the role of veterinary operations in supporting their animal research activities. In addition, ideas for addressing researchers’ top-rated needs were generated through focus groups. By updating online resources, creating checklists and newsletters, and hiring additional veterinary staff, the services provided were amended to provide researchers with increased access to valuable information, improved clarity regarding the process for obtaining access to research facilities, and enhanced support for animal care services. PMID:28724497

A Redesign Approach for Improving Animal Care Services for Researchers.

PubMed

Okpe, Orighomisan; Kovach, Jamison V

2017-07-01

Because a research institution's animal care and use program oversees the provision of services specified in approved protocols designed by researchers, the effective provision of services within these programs is paramount to ensuring the humane care and treatment of research animals in accordance with federal, state, and local regulations and institutional policies. To improve the services provided to researchers through animal care and use programs, we investigated the relationship between the researchers who conduct these types of studies and the veterinary operations that provide care and treatment for research animals. Through a case study conducted at a leading public research university, we used an action-research approach to redesign aspects of the process through which researchers and the veterinary operations interact by using the Design for Six Sigma methodology. Using this structured approach for building quality into the design of a process to better serve customers, we identified and prioritized researchers' expectations regarding the role of veterinary operations in supporting their animal research activities. In addition, ideas for addressing researchers' top-rated needs were generated through focus groups. By updating online resources, creating checklists and newsletters, and hiring additional veterinary staff, the services provided were amended to provide researchers with increased access to valuable information, improved clarity regarding the process for obtaining access to research facilities, and enhanced support for animal care services.

The food and beverage vending environment in health care facilities participating in the healthy eating, active communities program.

PubMed

Lawrence, Sally; Boyle, Maria; Craypo, Lisa; Samuels, Sarah

2009-06-01

Little has been done to ensure that the foods sold within health care facilities promote healthy lifestyles. Policies to improve school nutrition environments can serve as models for health care organizations. This study was designed to assess the healthfulness of foods sold in health care facility vending machines as well as how health care organizations are using policies to create healthy food environments. Food and beverage assessments were conducted in 19 California health care facilities that serve children in the Healthy Eating, Active Communities sites. Items sold in vending machines were inventoried at each facility and interviews conducted for information on vending policies. Analyses examined the types of products sold and the healthfulness of these products. Ninety-six vending machines were observed in 15 (79%) of the facilities. Hospitals averaged 9.3 vending machines per facility compared with 3 vending machines per health department and 1.4 per clinic. Sodas comprised the greatest percentage of all beverages offered for sale: 30% in hospital vending machines and 38% in clinic vending machines. Water (20%) was the most prevalent in health departments. Candy comprised the greatest percentage of all foods offered in vending machines: 31% in clinics, 24% in hospitals, and 20% in health department facilities. Across all facilities, 75% of beverages and 81% of foods sold in vending machines did not adhere to the California school nutrition standards (Senate Bill 12). Nine (47%) of the health care facilities had adopted, or were in the process of adopting, policies that set nutrition standards for vending machines. According to the California school nutrition standards, the majority of items found in the vending machines in participating health care facilities were unhealthy. Consumption of sweetened beverages and high-energy-density foods has been linked to increased prevalence of obesity. Some health care facilities are developing policies that set nutrition standards for vending machines. These policies could be effective in increasing access to healthy foods and beverages in institutional settings.

Identifying health facilities outside the enterprise: challenges and strategies for supporting health reform and meaningful use.

PubMed

Dixon, Brian E; Colvard, Cyril; Tierney, William M

2014-06-24

Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records.

Dental implant status of patients receiving long-term nursing care in Japan.

PubMed

Kimura, Toru; Wada, Masahiro; Suganami, Toru; Miwa, Shunta; Hagiwara, Yoshiyuki; Maeda, Yoshiobu

2015-01-01

The increase in implant patients is expected to give rise to a new problem: the changing general health status of those who have had implants placed. The aim of this present study was to find out the needs of and proper measures for elderly implant patients in long-term care facilities. A questionnaire was sent by mail to 1,591 long-term care health facilities, daycare services for people with dementia, and private nursing homes for the elderly in the Osaka area, which is in the middle area of Japan, in order to extract patients with cerebrovascular disease or dementia who were possibly at risk of inadequate oral self-care, as well as patients with implants. Approximately half of all facilities responded that they cannot recognize implants, and many facilities did not know anything about oral care for implant patients. Residents with implants were reported at 19% of all facilities. Also, the facilities pointed out problems with implants relating to the difference in oral care between implants and natural teeth. There are people with implants in some 20% of caregiving facilities, and there is a low level of understanding regarding implants and their care among nurses and care providers who are providing daily oral care. © 2013 Wiley Periodicals, Inc.

Effectiveness of interventions to improve family-staff relationships in the care of people with dementia in residential aged care: a systematic review protocol.

PubMed

Nguyen, Mynhi; Pachana, Nancy A; Beattie, Elizabeth; Fielding, Elaine; Ramis, Mary-Anne

2015-11-01

The objective of this review is to identify and appraise existing evidence regarding the effectiveness of interventions designed to enhance staff-family relationships for people with dementia living in residential aged care facilities.More specifically, the objectives are to identify the effectiveness of constructive communication, cooperation programs, and practices or strategies to enhance family-staff relationships. The effectiveness of these interventions will be measured by comparing the intervention to no intervention, comparing one intervention with another, or comparing pre- and post-interventions.Specifically the review question is: What are the most effective interventions for improving communication and cooperation to enhance family-staff relationships in residential aged care facilities? In our aging world, dementia is prevalent and is a serious health concern affecting approximately 35.6 million people worldwide. This figure is expected to increase two-fold by 2030 and three-fold by 2050. Although younger-onset dementia is increasingly recognized, dementia is most commonly a disease that affects the elderly. Among those aged 65 to 85, the prevalence of dementia increases exponentially, and doubles with every five-year increase in age.Dementia is defined as a syndrome, commonly chronic or progressive in nature, and caused by a range of brain disorders that affect memory, thinking and the ability to perform activities of daily living. While the rate of progression and manifestation of decline differs, all cases of dementia share a similar trajectory of decline. The progressive decline in cognitive functions and ultimately physical function that these people face affects not only the person with the disease but also their family caregivers and health care staff.The manifestation of dementia presents unique and extreme challenges for the family caregiver. Generally it causes great physical, emotional and social strain because the caregiving process is long in duration, unfamiliar, unpredictable and ambiguous. In the later stages of dementia, many family caregivers relocate their relative to a residential aged care facility, most often when the burden of care outweighs the means of the caregiver. This is especially likely when the person with dementia ages, and has lower cognitive function increased limitations in activities in daily living and poorer self-related health. As a result, approximately 50% of all persons aged 65 years or over admitted into residential aged care facilities have dementia.The relocation of a relative into a residential aged care facility can be complex and distressing for family caregivers. While relocation alleviates many issues for the family caregiver, it does not consequently reduce their stress. The stress experienced by the family caregivers who remain involved post-relocation often continues and may even worsen. This is because family caregivers are uncertain about how to transition from a direct caregiving role to a more indirect, supportive interpersonal role, and may be provided with little support from care staff in this regard. Although family caregivers experience a new form of stress post-relocation, family involvement in residential aged care settings has been shown to be beneficial to residents with dementia, their families and care staff.Family involvement is widely acknowledged to provide the resident physical and emotional healing, optimal well-being, and the sustainment of quality of life. Family caregivers benefit from improved satisfaction with the facility and experiences of care, and greater well-being. Care staff benefit from enhanced job satisfaction and greater motivation to remain in their job. The key to these positive outcomes is effective communication and strong relationships between care staff and family caregivers.Effective communication between care staff and family caregivers is crucial for residents with dementia. This is because residents with cognitive impairment may have difficulties articulating their needs, concerns and preferences effectively. Family caregivers rely on staff for information about their relative's behavior in the residential aged care facility; however they themselves have in-depth information about the resident's physical, psychosocial and emotional histories that are necessary for developing individualized care support plans. Family involvement can support care staff in reducing residents' behavioral symptoms by assisting to identify social and emotional needs, or unmet medical needs. Ineffective communication from family caregivers in conveying information to care staff may be disruptive in the caregiving process, and may lead to disagreement regarding respective roles and approaches to caring for the resident. Consequently, family caregivers may withhold information that may support care staff and improve care. They may also be concerned about negative repercussions for the resident.Care staff and family caregivers generally have differing needs and expectations. Care staff are usually in the position where they have to manage a relationship with the family, which is based on multiple roles. Perceptions of family caregivers by care staff include seeing them as colleagues, subordinates, or people who themselves may be in need of nursing care. These different perceptions lead to role ambiguity and result in separate approaches to the caregiving process.Cohen et al. suggest in their study that family involvement can benefit people with dementia in residential aged care settings, their family carers and staff; however further research is required. The relationship between care staff and family caregivers is often challenging due to problems with communication, role ambiguity of both care staff and family carers, and differing approaches to caring for the resident. These problems highlight the need for interventions to constructively enhance the quality of family-staff relationships. For example, one intervention called Partners and Caregiving has been reported as being designed to increase cooperation and effective communication between staff and family. In this study, staff and family members were randomly subjected to treatment and control conditions. The treatment group received parallel training sessions on communication and conflict resolution techniques, followed by a joint meeting with the facility administrators. The results of the study demonstrated improved outcomes in the form of improved attitudes of staff and family members towards each other, less conflict between family and staff, and fewer intentions of staff to quit. Further research is vital in order to identify effective family-staff intervention studies that can provide directions for implementation in residential aged care facilities. Furthermore, it is equally important to identify interventions that are ineffective, so as to provide insights into potential pitfalls to avoid in order to improve staff and family members' relationships and the provision of care to people living with dementia in the future.Previous systematic reviews have focused on factors associated with constructive family-staff relationships in caring for older adults in the institutional setting and the family's involvement in decision making for people with dementia in residential aged care facilites. This review will however specifically investigate interventions for improving communication and cooperation that promote effective family-staff relationships when caring for people with dementia living in residential aged care facilities.

Treatment algorithms and protocolized care.

PubMed

Morris, Alan H

2003-06-01

Excess information in complex ICU environments exceeds human decision-making limits and likely contributes to unnecessary variation in clinical care, increasing the likelihood of clinical errors. I reviewed recent critical care clinical trials searching for information about the impact of protocol use on clinically pertinent outcomes. Several recently published clinical trials illustrate the importance of distinguishing efficacy and effectiveness trials. One of these trials illustrates the danger of conducting effectiveness trials before the efficacy of an intervention is established. The trials also illustrate the importance of distinguishing guidelines and inadequately explicit protocols from adequately explicit protocols. Only adequately explicit protocols contain enough detail to lead different clinicians to the same decision when faced with the same clinical scenario. Differences between guidelines and protocols are important. Guidelines lack detail and provide general guidance that requires clinicians to fill in many gaps. Computerized or paper-based protocols are detailed and, when used for complex clinical ICU problems, can generate patient-specific, evidence-based therapy instructions that can be carried out by different clinicians with almost no interclinician variability. Individualization of patient therapy can be preserved by these protocols when they are driven by individual patient data. Explicit decision-support tools (eg, guidelines and protocols) have favorable effects on clinician and patient outcomes and can reduce the variation in clinical practice. Guidelines and protocols that aid ICU decision makers should be more widely distributed.

Protocolized Treatment Is Associated With Decreased Organ Dysfunction in Pediatric Severe Sepsis.

PubMed

Balamuth, Fran; Weiss, Scott L; Fitzgerald, Julie C; Hayes, Katie; Centkowski, Sierra; Chilutti, Marianne; Grundmeier, Robert W; Lavelle, Jane; Alpern, Elizabeth R

2016-09-01

To determine whether treatment with a protocolized sepsis guideline in the emergency department was associated with a lower burden of organ dysfunction by hospital day 2 compared to nonprotocolized usual care in pediatric patients with severe sepsis. Retrospective cohort study. Tertiary care children's hospital from January 1, 2012, to March 31, 2014. Patients older than 56 days old and younger than 18 years old with international consensus defined severe sepsis and who required PICU admission within 24 hours of emergency department arrival were included. The exposure was the use of a protocolized emergency department sepsis guideline. The primary outcome was complete resolution of organ dysfunction by hospital day 2. One hundred eighty nine subjects were identified during the study period. Of these, 121 (64%) were treated with the protocolized emergency department guideline and 68 were not. There were no significant differences between the groups in age, sex, race, number of comorbid conditions, emergency department triage level, or organ dysfunction on arrival to the emergency department. Patients treated with protocolized emergency department care were more likely to be free of organ dysfunction on hospital day 2 after controlling for sex, comorbid condition, indwelling central venous catheter, Pediatric Index of Mortality-2 score, and timing of antibiotics and IV fluids (adjusted odds ratio, 4.2; 95% CI, 1.7-10.4). Use of a protocolized emergency department sepsis guideline was independently associated with resolution of organ dysfunction by hospital day 2 compared to nonprotocolized usual care. These data indicate that morbidity outcomes in children can be improved with the use of protocolized care.

42 CFR 442.1 - Basis and purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES... of services furnished by nursing facilities and intermediate care facilities for individuals with... agreements; Section 1902(a)(28), nursing facility standards; Section 1902(a)(33)(B), State survey agency...

Barriers to ethical nursing practice for older adults in long-term care facilities.

PubMed

Choe, Kwisoon; Kang, Hyunwook; Lee, Aekyung

2018-03-01

To explore barriers to ethical nursing practice for older adults in long-term care facilities from the perspectives of nurses in South Korea. The number of older adults admitted to long-term care facilities is increasing rapidly in South Korea. To provide this population with quality care, a solid moral foundation should be emphasised to ensure the provision of ethical nursing practices. Barriers to implementing an ethical nursing practice for older adults in long-term care facilities have not been fully explored in previous literature. A qualitative, descriptive design was used to explore barriers to ethical nursing practice as perceived by registered nurses in long-term care facilities in South Korea. Individual interviews were conducted with 17 registered nurses recruited using purposive (snowball) sampling who care for older adults in long-term care facilities in South Korea. Data were analysed using qualitative content analysis. Five main themes emerged from the data analysis concerning barriers to the ethical nursing practice of long-term care facilities: emotional distress, treatments restricting freedom of physical activities, difficulty coping with emergencies, difficulty communicating with the older adult patients and friction between nurses and nursing assistants. This study has identified methods that could be used to improve ethical nursing practices for older adults in long-term care facilities. Because it is difficult to improve the quality of care through education and staffing alone, other factors may also require attention. Support programmes and educational opportunities are needed for nurses who experience emotional distress and lack of competency to strengthen their resilience towards some of the negative aspects of care and being a nurse that were identified in this study. © 2017 John Wiley & Sons Ltd.

Trends in family ratings of experience with care and racial disparities among Maryland nursing homes.

PubMed

Li, Yue; Ye, Zhiqiu; Glance, Laurent G; Temkin-Greener, Helena

2014-07-01

Providing equitable and patient-centered care is critical to ensuring high quality of care. Although racial/ethnic disparities in quality are widely reported for nursing facilities, it is unknown whether disparities exist in consumer experiences with care and how public reporting of consumer experiences affects facility performance and potential racial disparities. We analyzed trends of consumer ratings publicly reported for Maryland nursing homes during 2007-2010, and determined whether racial/ethnic disparities in experiences with care changed during this period. Multivariate longitudinal regression models controlled for important facility and county characteristics and tested changes overall and by facility groups (defined based on concentrations of black residents). Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. Overall ratings on care experience remained relatively high (mean=8.3 on a 1-10 scale) during 2007-2010. Ninety percent of survey respondents each year would recommend the facility to someone who needs nursing home care. Ratings on individual domains of care improved among all nursing homes in Maryland (P<0.01), except for food and meals (P=0.827 for trend). However, site-of-care disparities existed in each year for overall ratings, recommendation rate, and ratings on all domains of care (P<0.01 in all cases), with facilities more predominated by black residents having lower scores; such disparities persisted over time (P>0.2 for trends in disparities). Although Maryland nursing homes showed maintained or improved consumer ratings during the first 4 years of public reporting, gaps persisted between facilities with high versus low concentrations of minority residents.

Evaluating the impact of the community-based health planning and services initiative on uptake of skilled birth care in Ghana.

PubMed

Johnson, Fiifi Amoako; Frempong-Ainguah, Faustina; Matthews, Zoe; Harfoot, Andrew J P; Nyarko, Philomena; Baschieri, Angela; Gething, Peter W; Falkingham, Jane; Atkinson, Peter M

2015-01-01

The Community-based Health Planning and Services (CHPS) initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas. Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km. Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.

Evaluating the Impact of the Community-Based Health Planning and Services Initiative on Uptake of Skilled Birth Care in Ghana

PubMed Central

Johnson, Fiifi Amoako; Frempong-Ainguah, Faustina; Matthews, Zoe; Harfoot, Andrew J. P.; Nyarko, Philomena; Baschieri, Angela; Gething, Peter W.; Falkingham, Jane; Atkinson, Peter M.

2015-01-01

Background The Community-based Health Planning and Services (CHPS) initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas. Methods and Findings Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km. Conclusion Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible. PMID:25789874

Evaluation of a discharge education protocol for pediatric patients with gastrostomy tubes.

PubMed

Schweitzer, Michelle; Aucoin, Julia; Docherty, Sharron L; Rice, Henry E; Thompson, Julie; Sullivan, Dori Taylor

2014-01-01

To evaluate the impact of a preprocedure education protocol for children who receive a gastrostomy tube (GT). A preintervention-postintervention design, using surveys and comparison between preprotocol and postprotocol cohorts, was used to evaluate the effect of implementation of a standardized GT education protocol with 26 subjects on caregiver, patient, and provider outcomes. The use of a preprocedure education protocol resulted in improved patient outcomes and increased caregiver knowledge and confidence and was considered a positive change by the providers. Often education is a forgotten part of a medical procedure, and the importance of education is typically only recognized after an adverse event occurs. Establishing a standardized evidence-based education protocol for GT care improves overall care and satisfaction. Use of a systematic and family-centered interdisciplinary approach markedly improves patient care. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Quality, efficiency, and cost of a physician-assistant-protocol system for managment of diabetes and hypertension.

PubMed

Komaroff, A L; Flatley, M; Browne, C; Sherman, H; Fineberg, S E; Knopp, R H

1976-04-01

Briefly trained physicians assistants using protocols (clinical algorithms) for diabetes, hypertension, and related chronic arteriosclerotic and hypertensive heart disease abstrated information from the medical record and obtained history and physical examination data on every patient-visit to a city hospital chronic disease clinic over a 18-month period. The care rendered by the protocol system was compared with care rendered by a "traditional" system in the same clinic in which physicians delegated few clinical tasks. Increased thoroughness in collecting clinical data in the protocol system led to an increase in the recognition of new pathology. Outcome criteria reflected equivalent quality of care in both groups. Efficiency time-motion studies demonstrated a 20 per cent saving in physician time with the protocol system. Coct estimates, based on the time spent with patients by various providers and on the laboratory-test-ordering patterns, demonstrated equivalent costs of the two systems, given optimal staffing patterns. Laboratory tests were a major element of the cost of patient care,and the clinical yield per unit cost of different tests varied widely.

Towards elimination of mother-to-child transmission of HIV: performance of different models of care for initiating lifelong antiretroviral therapy for pregnant women in Malawi (Option B+).

PubMed

van Lettow, Monique; Bedell, Richard; Mayuni, Isabell; Mateyu, Gabriel; Landes, Megan; Chan, Adrienne K; van Schoor, Vanessa; Beyene, Teferi; Harries, Anthony D; Chu, Stephen; Mganga, Andrew; van Oosterhout, Joep J

2014-01-01

Malawi introduced a new strategy to improve the effectiveness of prevention of mother-to-child HIV transmission (PMTCT), the Option B+ strategy. We aimed to (i) describe how Option B+ is provided in health facilities in the South East Zone in Malawi, identifying the diverse approaches to service organization (the "model of care") and (ii) explore associations between the "model of care" and health facility-level uptake and retention rates for pregnant women identified as HIV-positive at antenatal (ANC) clinics. A health facility survey was conducted in all facilities providing PMTCT/antiretroviral therapy (ART) services in six of Malawi's 28 districts to describe and compare Option B+ service delivery models. Associations of identified models with program performance were explored using facility cohort reports. Among 141 health facilities, four "models of care" were identified: A) facilities where newly identified HIV-positive women are initiated and followed on ART at the ANC clinic until delivery; B) facilities where newly identified HIV-positive women receive only the first dose of ART at the ANC clinic, and are referred to the ART clinic for follow-up; C) facilities where newly identified HIV-positive women are referred from ANC to the ART clinic for initiation and follow-up of ART; and D) facilities serving as ART referral sites (not providing ANC). The proportion of women tested for HIV during ANC was highest in facilities applying Model A and lowest in facilities applying Model B. The highest retention rates were reported in Model C and D facilities and lowest in Model B facilities. In multivariable analyses, health facility factors independently associated with uptake of HIV testing and counselling (HTC) in ANC were number of women per HTC counsellor, HIV test kit availability, and the "model of care" applied; factors independently associated with ART retention were district location, patient volume and the "model of care" applied. A large variety exists in the way health facilities have integrated PMTCT Option B+ care into routine service delivery. This study showed that the "model of care" chosen is associated with uptake of HIV testing in ANC and retention in care on ART. Further patient-level research is needed to guide policy recommendations.

Advanced yellow fever virus genome detection in point-of-care facilities and reference laboratories.

PubMed

Domingo, Cristina; Patel, Pranav; Yillah, Jasmin; Weidmann, Manfred; Méndez, Jairo A; Nakouné, Emmanuel Rivalyn; Niedrig, Matthias

2012-12-01

Reported methods for the detection of the yellow fever viral genome are beset by limitations in sensitivity, specificity, strain detection spectra, and suitability to laboratories with simple infrastructure in areas of endemicity. We describe the development of two different approaches affording sensitive and specific detection of the yellow fever genome: a real-time reverse transcription-quantitative PCR (RT-qPCR) and an isothermal protocol employing the same primer-probe set but based on helicase-dependent amplification technology (RT-tHDA). Both assays were evaluated using yellow fever cell culture supernatants as well as spiked and clinical samples. We demonstrate reliable detection by both assays of different strains of yellow fever virus with improved sensitivity and specificity. The RT-qPCR assay is a powerful tool for reference or diagnostic laboratories with real-time PCR capability, while the isothermal RT-tHDA assay represents a useful alternative to earlier amplification techniques for the molecular diagnosis of yellow fever by field or point-of-care laboratories.

The influences of Taiwan's National Health Insurance on women's choice of prenatal care facility: Investigation of differences between rural and non-rural areas.

PubMed

Chen, Likwang; Chen, Chi-Liang; Yang, Wei-Chih

2008-03-29

Taiwan's National Health Insurance (NHI), implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI) in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998-1999 was about 6.54 times of that in 1990-1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in rural areas. We concluded that women in rural areas were more likely to seek prenatal care in large hospitals, but were not more likely to perceive very convenient transportation to and from prenatal care facilities in the late 1990s than in the early 1990s. In contrast, women in non-rural areas did not have a stronger tendency to seek prenatal care in large hospitals in the late 1990s than in earlier periods. In addition, they did perceive an improvement in transportation for acquiring prenatal care in the late 1990s. More efforts should be made to reduce these disparities.

Resident challenges with daily life in Chinese long-term care facilities: A qualitative pilot study.

PubMed

Song, Yuting; Scales, Kezia; Anderson, Ruth A; Wu, Bei; Corazzini, Kirsten N

As traditional family-based care in China declines, the demand for residential care increases. Knowledge of residents' experiences with long-term care (LTC) facilities is essential to improving quality of care. This pilot study aimed to describe residents' experiences in LTC facilities, particularly as it related to physical function. Semi-structured open-ended interviews were conducted in two facilities with residents stratified by three functional levels (n = 5). Directed content analysis was guided by the Adaptive Leadership Framework. A two-cycle coding approach was used with a first-cycle descriptive coding and second-cycle dramaturgical coding. Interviews provided examples of challenges faced by residents in meeting their daily care needs. Five themes emerged: staff care, care from family members, physical environment, other residents in the facility, and personal strategies. Findings demonstrate the significance of organizational context for care quality and reveal foci for future research. Copyright © 2017 Elsevier Inc. All rights reserved.

Medication management policy, practice and research in Australian residential aged care: Current and future directions.

PubMed

Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon

2017-02-01

Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Nurse-driven protocols for febrile pediatric oncology patients.

PubMed

Dobrasz, Gina; Hatfield, Marianne; Jones, Laura Masak; Berdis, Jennifer Joan; Miller, Erin Elizabeth; Entrekin, Melanie Smith

2013-05-01

Infection is a frequent complication experienced by many children with cancer, with potentially life-threatening consequences that may result in hospitalization, prolonged length of stay, and increased mortality. The need for prompt assessment and early intervention for infection is widely recognized by ED staff as best practice; however, the average length of time to antibiotic administration varies widely in published studies. An interdisciplinary quality improvement initiative including physician, nursing, and pharmacy leaders was created to streamline the identification and treatment for this high-risk population. Based on published evidence for best practice and national recognition of the need for rapid treatment, the goal was set for administration of antibiotic therapy to less than 60 minutes after ED arrival. This project was conducted at 2 emergency departments in a pediatric health care system with 520 beds and a level I and level II trauma designation. Approximately 154,000 patients are seen annually. In the emergency departments, 271 staff members, including registered nurses, paramedics, and patient care technicians, required education about using the newly designed process. Records from all patients with fever and a known history of pediatric cancer who presented to the emergency departments were included in the retrospective review, including patients with solid tumors, acute lymphoblastic leukemia, acute myeloid leukemia, and chronic myelogenous leukemia. Exclusion criteria included patients in known remission, those with prior antibiotic therapy at another facility, congenital neutropenia, or parental concern or objection to treatment. A retrospective medical record review of febrile oncology patients treated from September 2008 until May 2012 was conducted to evaluate the impact of this evidence-based practice change to streamline the "door to drug" process. The average length of time until antibiotic administration, nurses' compliance initiating the protocol, and ED length of stay were determined. The review included 2758 medical records. During the study period from 2008 to 2012, one emergency department's average time for drug administration dropped from 103 to 44 minutes, and the second dropped from 141 to 61 minutes. Both campuses also improved their protocol compliance, with ED 1 increasing from 24% to 78% and ED 2 improving from 30% to 84%. This quality initiative has direct application for all ED leaders who treat children with cancer. High-risk patients can benefit from a streamlined nurse-initiated process that decreases negative consequences of fever. Collaboration by interdisciplinary leadership within the health care facility, as well as key stakeholder buy-in, is imperative to achieve a process that may lead to decreased hospital stay and reduced systemic infection or mortality for these vulnerable patients. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

The quality of family planning services and client satisfaction in the public and private sectors in Kenya.

PubMed

Agha, Sohail; Do, Mai

2009-04-01

To compare the quality of family planning services delivered at public and private facilities in Kenya. Data from the 2004 Kenya Service Provision Assessment were analysed. The Kenya Service Provision Assessment is a representative sample of health facilities in the public and private sectors, and comprises data obtained from a facility inventory, service provider interviews, observations of client-provider interactions and exit interviews. Quality-of-care indicators are compared between the public and private sectors along three dimensions: structure, process and outcome. Private facilities were superior to public sector facilities in terms of physical infrastructure and the availability of services. Public sector facilities were more likely to have management systems in place. There was no difference between public and private providers in the technical quality of care provided. Private providers were better at managing interpersonal aspects of care. The higher level of client satisfaction at private facilities could not be explained by differences between public and private facilities in structural and process aspects of care. Formal private sector facilities providing family planning services exhibit greater readiness to provide services and greater attention to client needs than public sector facilities in Kenya. Consistent with this, client satisfaction is much higher at private facilities. Technical quality of care provided is similar in public and private facilities.

Comparing the Costs of Military Treatment Facilities with Private Sector Care

DTIC Science & Technology

2016-02-01

Log: H 15-000527 Comparing the Costs of Military Treatment Facilities with Private Sector Care Philip M. Lurie INSTITUTE FOR DEFENSE ANALYSES 4850 Mark...other national challenges. Comparing the Costs of Military Treatment Facilities with Private Sector Care Philip M. Lurie I N S T I T U T E F O R D...members. The latter benefit, known as TRICARE, serves 9.5 million beneficiaries worldwide, and consists of care in Military Treatment Facilities (MTFs

Factors Affecting Discharge to Home of Geriatric Intermediate Care Facility Residents in Japan.

PubMed

Morita, Kojiro; Ono, Sachiko; Ishimaru, Miho; Matsui, Hiroki; Naruse, Takashi; Yasunaga, Hideo

2018-04-01

To investigate factors associated with lower likelihood of discharge to home from geriatric intermediate care facilities in Japan. Retrospective cohort study. We used data from the nationwide long-term care (LTC) insurance claims database (April 2012-March 2014). Study participants were 342,758 individuals newly admitted to 3,459 geriatric intermediate care facilities during the study period. The primary outcome was discharge to home. We performed a multivariable competing-risk Cox regression with adjustment for resident-, facility-, and region-level characteristics. Resident level of care needs and several medical conditions were included as time-varying covariates. Death, admission to a hospital, and admission to another LTC facility were treated as competing risks. During the 2-year follow-up period, 19% of participants were discharged to home. In the multivariable competing-risk Cox regression, the following factors were significantly associated with lower likelihood of discharge to home: older age, higher level of care need, having several medical conditions, private ownership of the facility, more beds in the facility, and more LTC facility beds per 1,000 adults aged 65 and older in the region. Only 19% of residents were discharged to home. Our results are useful for policy-makers to promote discharge to home of older adults in geriatric intermediate care facilities. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility.

PubMed

Newcomer, Robert J; Ko, Michelle; Kang, Taewoon; Harrington, Charlene; Hulett, Denis; Bindman, Andrew B

2016-03-01

Individuals who receive long-term services and supports (LTSS) are among the most costly participants in the Medicare and Medicaid programs. To compare health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care. Retrospective cohort analysis of California dually eligible adult Medicaid and Medicare beneficiaries who initiated Medicaid LTSS, identified as HCBS or extended nursing facility care, in 2006 or 2007. Propensity score matching for demographic, health, and functional characteristics resulted in a subsample of 34,660 users who initiated Medicaid HCBS versus extended nursing facility use. Those with developmental disabilities or in managed care plans were excluded. Average monthly adjusted acute, postacute, long-term, and total Medicare and Medicaid expenditures for the 12 months following initiation of either HCBS or extended nursing facility care. Those initiating extended nursing facility care had, on average, $2919 higher adjusted total health care expenditures per month compared with those who initiated HCBS. The difference was primarily attributable to spending on LTSS $2855. On average, the monthly LTSS expenditures were higher for Medicare $1501 and for Medicaid $1344 when LTSS was provided in a nursing facility rather than in the community. The higher cost of delivering LTSS in a nursing facility rather than in the community was not offset by lower acute and postacute spending. Medicare and Medicaid contribute similar amounts to the LTSS cost difference and both could benefit financially by redirecting care from institutions to the community.

Operating systems and network protocols for wireless sensor networks.

PubMed

Dutta, Prabal; Dunkels, Adam

2012-01-13

Sensor network protocols exist to satisfy the communication needs of diverse applications, including data collection, event detection, target tracking and control. Network protocols to enable these services are constrained by the extreme resource scarcity of sensor nodes-including energy, computing, communications and storage-which must be carefully managed and multiplexed by the operating system. These challenges have led to new protocols and operating systems that are efficient in their energy consumption, careful in their computational needs and miserly in their memory footprints, all while discovering neighbours, forming networks, delivering data and correcting failures.

A Quality Improvement System to Manage Feeding Assistance Care in Assisted-Living.

PubMed

Simmons, Sandra F; Coelho, Chris S; Sandler, Andrew; Schnelle, John F

2018-03-01

To describe a feasible quality improvement system to manage feeding assistance care processes in an assisted living facility (ALF) that provides dementia care and the use of these data to maintain the quality of daily care provision and prevent unintentional weight loss. Supervisory ALF staff used a standardized observational protocol to assess feeding assistance care quality during and between meals for 12 consecutive months for 53 residents receiving dementia care. Direct care staff received feedback about the quality of assistance and consistency of between-meal snack delivery for residents with low meal intake and/or weight loss. On average, 78.4% of the ALF residents consumed more than one-half of each served meal and/or received staff assistance during meals to promote consumption over the 12 months. An average of 79.7% of the residents were offered snacks between meals twice per day. The prevalence of unintentional weight loss averaged 1.3% across 12 months. A quality improvement system resulted in sustained levels of mealtime feeding assistance and between-meal snack delivery and a low prevalence of weight loss among ALF residents receiving dementia care. Given that many ALF residents receiving dementia care are likely to be at risk for low oral intake and unintentional weight loss, ALFs should implement a quality improvement system similar to that described in this project, despite the absence of regulations to do so. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Service readiness, health facility management practices, and delivery care utilization in five states of Nigeria: a cross-sectional analysis.

PubMed

Gage, Anastasia J; Ilombu, Onyebuchi; Akinyemi, Akanni Ibukun

2016-10-06

Existing studies of delivery care in Nigeria have identified socioeconomic and cultural factors as the primary determinants of health facility delivery. However, no study has investigated the association between supply-side factors and health facility delivery. Our study analyzed the role of supply-side factors, particularly health facility readiness and management practices for provision of quality maternal health services. Using linked data from the 2005 and 2009 health facility and household surveys in the five states in which the Community Participation for Action in the Social Sector (COMPASS) project was implemented, indices of health service readiness and management were developed based on World Health Organization guidelines. Multilevel logistic regression models were run to determine the association between these indices and health facility delivery among 2710 women aged 15-49 years whose last child was born within the five years preceding the surveys and who lived in 51 COMPASS LGAs. The health facility delivery rate increased from 25.4 % in 2005 to 44.1 % in 2009. Basic amenities for antenatal care provision, readiness to deliver basic emergency obstetric and newborn care, and management practices supportive of quality maternal health services were suboptimal in health facilities surveyed and did not change significantly between 2005 and 2009. The LGA mean index of basic amenities for antenatal care provision was more positively associated with the odds of health facility delivery in 2009 than in 2005, and in rural than in urban areas. The LGA mean index of management practices was associated with significantly lower odds of health facility delivery in rural than in urban areas. The LGA mean index of facility readiness to deliver basic emergency obstetric and neonatal care declined slightly from 5.16 in 2005 to 3.98 in 2009 and was unrelated to the odds of health facility delivery. Supply-side factors appeared to play a role in health facility delivery after controlling for socio-demographic factors. Improving uptake of delivery care would require greater attention to rural-urban inequities and health facility management practices, and to increasing the number of health facilities with fundamental elements for delivery of basic emergency obstetric and neonatal care.

Chapter 2: Commercial and Industrial Lighting Evaluation Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kurnik, Charles W; Gowans, Dakers; Telarico, Chad

The Commercial and Industrial Lighting Evaluation Protocol (the protocol) describes methods to account for gross energy savings resulting from the programmatic installation of efficient lighting equipment in large populations of commercial, industrial, and other nonresidential facilities. This protocol does not address savings resulting from changes in codes and standards, or from education and training activities. A separate Uniform Methods Project (UMP) protocol, Chapter 3: Commercial and Industrial Lighting Controls Evaluation Protocol, addresses methods for evaluating savings resulting from lighting control measures such as adding time clocks, tuning energy management system commands, and adding occupancy sensors.

Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

PubMed

Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

2015-05-01

Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa

PubMed Central

2014-01-01

Background Some countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda. Methods A cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress. Results Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care. Conclusion The integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems. PMID:25001366

The effects of a foot and toenail care protocol for older adults.

PubMed

Chan, Helen Y L; Lee, Diana T F; Leung, Edward M F; Man, Chui-Wah; Lai, Kwok-Man; Leung, Man-Wai; Wong, Irene K Y

2012-01-01

Foot and toenail problems are prevalent among older adults. The importance of foot care is often overlooked, however, because the associated problems are often considered to be minor. These "minor" problems often result in unnecessary distress and complications for older adults. This study aims to develop and examine the effects of a foot and toenail care protocol on promoting foot health in older adults. It includes a thorough assessment of foot health, footwear conditions, and specific self-care ability. On the basis of the assessment, an individualized nursing care plan was devised. It has been found that the implementation of the care protocol can help to increase the awareness of nurses and older adults with regard to foot health and that some foot and toenail problems can be identified earlier and better managed. Copyright © 2012 Mosby, Inc. All rights reserved.

Using action research to build mentor capacity to improve orientation and quality of nursing students' aged care placements: what to do when the phone rings.

PubMed

Lea, Emma J; Andrews, Sharon; Stronach, Megan; Marlow, Annette; Robinson, Andrew L

2017-07-01

To describe whether an action research approach can be used to build capacity of residential aged care facility staff to support undergraduate nursing students' clinical placements in residential aged care facilities, using development of an orientation programme as an exemplar. Aged care facilities are unpopular sites for nursing students' clinical placements. A contributing factor is the limited capacity of staff to provide students with a positive placement experience. Strategies to build mentor capability to shape student placements and support learning and teaching are critical if nursing students are to have positive placements that attract them to aged care after graduation, an imperative given the increasing care needs of the ageing population worldwide. Action research approach employing mixed-methods data collection (primarily qualitative with a quantitative component). Aged care facility staff (n = 32) formed a mentor group at each of two Tasmanian facilities and met regularly to support undergraduate nursing students (n = 40) during placements. Group members planned, enacted, reviewed and reflected on orientation procedures to welcome students, familiarise them with the facility and prepare them for their placement. Data comprised transcripts from these and parallel student meetings, and orientation data from student questionnaires from two successive placement periods (2011/2012). Problems were identified in the orientation processes for the initial student placements. Mentors implemented a revised orientation programme. Evaluation demonstrated improved programme outcomes for students regarding knowledge of facility operations, their responsibilities and emergency procedures. Action research provides an effective approach to engage aged care facility staff to build their capacity to support clinical placements. Building capacity in the aged care workforce is vital to provide appropriate care for residents with increasing care needs. © 2016 John Wiley & Sons Ltd.

Minimization of Hypoglycemia as an Adverse Event During Insulin Infusion: Further Refinement of the Yale Protocol.

PubMed

Marvin, Michael R; Inzucchi, Silvio E; Besterman, Brian J

2016-08-01

The management of hyperglycemia in the intensive care unit has been a controversial topic for more than a decade, with target ranges varying from 80-110 mg/dL to <200 mg/dL. Multiple insulin infusion protocols exist, including several computerized protocols, which have attempted to achieve these targets. Importantly, compliance with these protocols has not been a focus of clinical studies. GlucoCare™, a Food and Drug Administration (FDA)-cleared insulin-dosing calculator, was originally designed based on the Yale Insulin Infusion Protocol to target 100-140 mg/dL and has undergone several modifications to reduce hypoglycemia. The original Yale protocol was modified from 100-140 mg/dL to a range of 120-140 mg/dL (GlucoCare 120-140) and then to 140 mg/dL (GlucoCare 140, not a range but a single blood glucose [BG] level target) in an iterative and evidence-based manner to eliminate hypoglycemia <70 mg/dL. The final modification [GlucoCare 140(B)] includes the addition of bolus insulin "midprotocol" during an insulin infusion to reduce peak insulin rates for insulin-resistant patients. This study examined the results of these protocol modifications and evaluated the role of compliance with the protocol in the incidence of hypoglycemia <70 mg/dL. Protocol modifications resulted in mean BG levels of 133.4, 136.4, 143.8, and 146.4 mg/dL and hypoglycemic BG readings <70 mg/dL of 0.998%, 0.367%, 0.256%, and 0.04% for the 100-140, 120-140, 140, and 140(B) protocols, respectively (P < 0.001). Adherence to the glucose check interval significantly reduced the incidence of hypoglycemia (P < 0.001). Protocol modifications led to a reduction in peak insulin infusion rates (P < 0.001) and the need for dextrose-containing boluses (P < 0.001). This study demonstrates that refinements in protocol design can improve glucose control in critically ill patients and that the use of GlucoCare 140(B) can eliminate all significant hypoglycemia while achieving mean glucose levels between 140 and 150 mg/dL. In addition, attention to the timely performance of glucose levels can also reduce hypoglycemic events.

Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center.

PubMed

Manulik, Stanisław; Rosińczuk, Joanna; Karniej, Piotr

2016-01-01

Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services. The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services. The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected. All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel. Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility.

ABM clinical protocol #4: Mastitis, revised March 2014.

PubMed

Amir, Lisa H

2014-06-01

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Supporting Tablet Configuration, Tracking, and Infection Control Practices in Digital Health Interventions: Study Protocol

PubMed Central

Furberg, Robert D; Zulkiewicz, Brittany A; Hudson, Jordan P; Taylor, Olivia M; Lewis, Megan A

2016-01-01

Background Tablet-based health care interventions have the potential to encourage patient care in a timelier manner, allow physicians convenient access to patient records, and provide an improved method for patient education. However, along with the continued adoption of tablet technologies, there is a concomitant need to develop protocols focusing on the configuration, management, and maintenance of these devices within the health care setting to support the conduct of clinical research. Objective Develop three protocols to support tablet configuration, tablet management, and tablet maintenance. Methods The Configurator software, Tile technology, and current infection control recommendations were employed to develop three distinct protocols for tablet-based digital health interventions. Configurator is a mobile device management software specifically for iPhone operating system (iOS) devices. The capabilities and current applications of Configurator were reviewed and used to develop the protocol to support device configuration. Tile is a tracking tag associated with a free mobile app available for iOS and Android devices. The features associated with Tile were evaluated and used to develop the Tile protocol to support tablet management. Furthermore, current recommendations on preventing health care–related infections were reviewed to develop the infection control protocol to support tablet maintenance. Results This article provides three protocols: the Configurator protocol, the Tile protocol, and the infection control protocol. Conclusions These protocols can help to ensure consistent implementation of tablet-based interventions, enhance fidelity when employing tablets for research purposes, and serve as a guide for tablet deployments within clinical settings. PMID:27350013

Assessment of eHealth capabilities and utilization in residential care settings.

PubMed

Towne, Samuel D; Lee, Shinduk; Li, Yajuan; Smith, Matthew Lee

2016-12-01

The US National Survey of Residential Care Facilities was used to conduct cross-sectional analyses of residential care facilities (n = 2302). Most residential care facilities lacked computerized capabilities for one or more of these capabilities in 2010. Lacking computerized systems supporting electronic health information exchange with pharmacies was associated with non-chain affiliation (p < .05). Lacking electronic health information exchange with physicians was associated with being a small-sized facility (vs large) (p < .05). Lacking computerized capabilities for discharge/transfer summaries was associated with for-profit status (p < .05) and small-sized facilities (p < .05). Lacking computerized capabilities for medical provider information was associated with non-chain affiliation (p < .05), small- or medium-sized facilities (p < .05), and for-profit status (p < .05). Lack of electronic health record was associated with non-chain affiliation (p < .05), small- or medium-sized facilities (p < .05), for-profit status (p < .05), and location in urban areas (p < .05). eHealth disparities exist across residential care facilities. As the older adult population continues to grow, resources must be in place to provide an integrated system of care across multiple settings. © The Author(s) 2015.

Integrated Payment And Delivery Models Offer Opportunities And Challenges For Residential Care Facilities.

PubMed

Grabowski, David C; Caudry, Daryl J; Dean, Katie M; Stevenson, David G

2015-10-01

Under health care reform, new financing and delivery models are being piloted to integrate health and long-term care services for older adults. Programs using these models generally have not included residential care facilities. Instead, most of them have focused on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with matched individuals in the community and nursing home, and rates of functional dependency that fall between those of their counterparts in the other two settings. These results suggest that the residential care facility population could benefit greatly from models that coordinated health and long-term care services. However, few providers have invested in the infrastructure needed to support integrated delivery models. Challenges to greater care integration include the private-pay basis for residential care facility services, which precludes shared savings from reduced Medicare costs, and residents' preference for living in a home-like, noninstitutional environment. Project HOPE—The People-to-People Health Foundation, Inc.

24 CFR 91.220 - Action plan.

Code of Federal Regulations, 2012 CFR

2012-04-01

... in its strategic plan; (C) Surplus from urban renewal settlements; (D) Grant funds returned to the...) Being discharged from publicly funded institutions and systems of care, such as health-care facilities, mental health facilities, foster care and other youth facilities, and corrections programs and...

24 CFR 91.220 - Action plan.

Code of Federal Regulations, 2013 CFR

2013-04-01

... in its strategic plan; (C) Surplus from urban renewal settlements; (D) Grant funds returned to the...) Being discharged from publicly funded institutions and systems of care, such as health-care facilities, mental health facilities, foster care and other youth facilities, and corrections programs and...

Employee influenza vaccination in residential care facilities.

PubMed

Apenteng, Bettye A; Opoku, Samuel T

2014-03-01

The organizational literature on infection control in residential care facilities is limited. Using a nationally representative dataset, we examined the organizational factors associated with implementing at least 1 influenza-related employee vaccination policy/program, as well as the effect of vaccination policies on health care worker (HCW) influenza vaccine uptake in residential care facilities. The study was a cross-sectional study using data from the 2010 National Survey of Residential Care Facilities. Multivariate logistic regression analysis was used to address the study's objectives. Facility size, director's educational attainment, and having a written influenza pandemic preparedness plan were significantly associated with the implementation of at least 1 influenza-related employee vaccination policy/program, after controlling for other facility-level factors. Recommending vaccination to employees, providing vaccination on site, providing vaccinations to employees at no cost, and requiring vaccination as a condition of employment were associated with higher employee influenza vaccination rates. Residential care facilities can improve vaccination rates among employees by adopting effective employee vaccination policies. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Upgrading physical activity counselling in primary care in the Netherlands.

PubMed

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

2016-06-01

The systematic development of a counselling protocol in primary care combined with a monitoring and feedback tool to support chronically ill patients to achieve a more active lifestyle. An iterative user-centred design method was used to develop a counselling protocol: the Self-management Support Programme (SSP). The needs and preferences of future users of this protocol were identified by analysing the literature, through qualitative research, and by consulting an expert panel. The counselling protocol is based on the Five A's model. Practice nurses apply motivational interviewing, risk communication and goal setting to support self-management of patients in planning how to achieve a more active lifestyle. The protocol consists of a limited number of behaviour change consultations intertwined with interaction with and responses from the It's LiFe! monitoring and feedback tool. This tool provides feedback on patients' physical activity levels via an app on their smartphone. A summary of these levels is automatically sent to the general practice so that practice nurses can respond to this information. A SSP to stimulate physical activity was defined based on user requirements of care providers and patients, followed by a review by a panel of experts. By following this user-centred approach, the organization of care was carefully taken into account, which has led to a practical and affordable protocol for physical activity counselling combined with mobile technology. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Clinical and perceived quality of care for maternal, neonatal and antenatal care in Kenya and Namibia: the service provision assessment.

PubMed

Diamond-Smith, Nadia; Sudhinaraset, May; Montagu, Dominic

2016-08-11

The majority of women in sub-Saharan Africa now deliver in a facility, however, little is known about the quality of services for maternal and newborn basic and emergency care, nor how this is associated with patient's perception of their experiences. Using data from the Service Provision Assessment (SPA) survey from Kenya 2010 and Namibia 2009, we explore whether facilities have the necessary signal functions for providing emergency and basic maternal (EmOC) and newborn care (EmNC), and antenatal care (ANC) using descriptives and multivariate regression. We explore differences by type of facility (hospital, center or other) and by private and public facilities. Finally, we see if patient satisfaction (taken from exit surveys at antenatal care) is associated with the quality of services (specific services provided). We find that most facilities do not have all of the signal functions, with 46 and 27 % in Kenya and 18 and 5 % in Namibia of facilities have high/basic scores in routine and emergency obstetric care, respectively. We found that hospitals preform better than centers in general and few differences emerged between public and private facilities. Patient perceptions were not consistently associated with services provided; however, patients had fewer complaints in private compared to public facilities in Kenya (-0.46 fewer complaints in private) and smaller facilities compared to larger in Namibia (-0.26 fewer complaints in smaller facilities). Service quality itself (measured in scores), however, was only significantly better in Kenya for EmOC and EmNC. This analysis sheds light on the inadequate levels of care for saving maternal and newborn lives in most facilities in two countries of Africa. It also highlights the disconnect between patients' perceptions and clinical quality of services. More effort is needed to ensure that high quality supply of services is present to meet growing demand as an increasing number of women deliver in facilities.

Protocol for a national prevalence study of advance care planning documentation and self-reported uptake in Australia.

PubMed

Ruseckaite, Rasa; Detering, Karen M; Evans, Sue M; Perera, Veronica; Walker, Lynne; Sinclair, Craig; Clayton, Josephine M; Nolte, Linda

2017-11-03

Advance care planning (ACP) is a process between a person, their family/carer(s) and healthcare providers that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care. The Australian government funds a number of national initiatives aimed at increasing ACP uptake; however, there is currently no standardised Australian data on formal ACP documentation or self-reported uptake. This makes it difficult to evaluate the impact of ACP initiatives. This study aims to determine the Australian national prevalence of ACP and completion of Advance Care Directives (ACDs) in hospitals, aged care facilities and general practices. It will also explore people's self-reported use of ACP and views about the process. Researchers will conduct a national multicentre cross-sectional prevalence study, consisting of a record audit and surveys of people aged 65 years or more in three sectors. From 49 participating Australian organisations, 50 records will be audited (total of 2450 records). People whose records were audited, who speak English and have a decision-making capacity will also be invited to complete a survey. The primary outcome measure will be the number of people who have formal or informal ACP documentation that can be located in records within 15 min. Other outcomes will include demographics, measure of illness and functional capacity, details of ACP documentation (including type of document), location of documentation in the person's records and whether current clinical care plans are consistent with ACP documentation. People will be surveyed, to measure self-reported interest, uptake and use of ACP/ACDs, and self-reported quality of life. This protocol has been approved by the Austin Health Human Research Ethics Committee (reference HREC/17/Austin/83). Results will be submitted to international peer-reviewed journals and presented at international conferences. ACTRN12617000743369. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A cluster-randomised trial of staff education to improve the quality of life of people with dementia living in residential care: the DIRECT study.

PubMed

Beer, Christopher; Horner, Barbara; Flicker, Leon; Scherer, Samuel; Lautenschlager, Nicola T; Bretland, Nick; Flett, Penelope; Schaper, Frank; Almeida, Osvaldo P

2011-01-01

The Dementia In Residential care: EduCation intervention Trial (DIRECT) was conducted to determine if delivery of education designed to meet the perceived need of GPs and care staff improves the quality of life of participants with dementia living in residential care. This cluster-randomised controlled trial was conducted in 39 residential aged care facilities in the metropolitan area of Perth, Western Australia. 351 care facility residents aged 65 years and older with Mini-Mental State Examination ≤ 24, their GPs and facility staff participated. Flexible education designed to meet the perceived needs of learners was delivered to GPs and care facility staff in intervention groups. The primary outcome of the study was self-rated quality of life of participants with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD) at 4 weeks and 6 months after the conclusion of the intervention. Analysis accounted for the effect of clustering by using multi-level regression analysis. Education of GPs or care facility staff did not affect the primary outcome at either 4 weeks or 6 months. In a post hoc analysis excluding facilities in which fewer than 50% of staff attended an education session, self-rated QOL-AD scores were 6.14 points (adjusted 95%CI 1.14, 11.15) higher at four-week follow-up among residents in facilities randomly assigned to the education intervention. The education intervention directed at care facilities or GPs did not improve the quality of life ratings of participants with dementia as a group. This may be explained by the poor adherence to the intervention programme, as participants with dementia living in facilities where staff participated at least minimally seemed to benefit. ANZCTR.org.au ACTRN12607000417482.

77 FR 36281 - Solicitation of Information and Recommendations for Revising OIG's Provider Self-Disclosure Protocol

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-18

...] Solicitation of Information and Recommendations for Revising OIG's Provider Self-Disclosure Protocol AGENCY... Register notice informs the public that OIG: (1) Intends to update the Provider Self-Disclosure Protocol... Provider Self-Disclosure Protocol (the Protocol) to establish a process for health care providers to...

Institutional ethics committees as social justice advocates.

PubMed

Farley, M A

1984-10-01

The idea of involvement in social justice issues transcends the traditional responsibilities of most institutional ethics committees (IECs). Yet precedents for such an advocacy role exist in several areas: the development of regulations that protect handicapped newborns from discriminatory decisions of nontreatment and the institutional committees that review research protocols or formulate "do not resuscitate" policies. The need for IECs to take up social justice issues is based in the concepts of autonomy--the capacity for freedom of choice--and relationality--the capacity to known and to love. All the human ethical questions of freedom, well-being, and justice emerge in the health care setting, where the concepts of autonomy and relationality are intently focused on and sometimes threatened. If a health care institution is to address such questions as affirmative action policies in financing and purchasing, the just pricing of medical care, the ethics of treatment decisions, and the right to medical care, it needs a forum in which to deliberate, collaborate, and discern responsible corporate moral action. For example, an ethics committee can: Call for correction of problems of sexism, racism, and classism in health care institutions; Address government regulations in a way that enables a better understanding of professional commitments; and Lead facilities to discover ways to network with others to meet the needs of the populations they serve. Above all, IECs can help health care professionals find a new "hermeneutic" for interpreting the health care mission to allow them greater power to respond to the dignity and the needs of human persons.

Linking data sources for measurement of effective coverage in maternal and newborn health: what do we learn from individual- vs ecological-linking methods?

PubMed

Willey, Barbara; Waiswa, Peter; Kajjo, Darious; Munos, Melinda; Akuze, Joseph; Allen, Elizabeth; Marchant, Tanya

2018-06-01

Improving maternal and newborn health requires improvements in the quality of facility-based care. This is challenging to measure: routine data may be unreliable; respondents in population surveys may be unable to accurately report on quality indicators; and facility assessments lack population level denominators. We explored methods for linking access to skilled birth attendance (SBA) from household surveys to data on provision of care from facility surveys with the aim of estimating population level effective coverage reflecting access to quality care. We used data from Mayuge District, Uganda. Data from household surveys on access to SBA were linked to health facility assessment census data on readiness to provide basic emergency obstetric and newborn care (BEmONC) in the same district. One individual- and two ecological-linking methods were applied. All methods used household survey reports on where care at birth was accessed. The individual-linking method linked this to data about facility readiness from the specific facility where each woman delivered. The first ecological-linking approach used a district-wide mean estimate of facility readiness. The second used an estimate of facility readiness adjusted by level of health facility accessed. Absolute differences between estimates derived from the different linking methods were calculated, and agreement examined using Lin's concordance correlation coefficient. A total of 1177 women resident in Mayuge reported a birth during 2012-13. Of these, 664 took place in facilities within Mayuge, and were eligible for linking to the census of the district's 38 facilities. 55% were assisted by a SBA in a facility. Using the individual-linking method, effective coverage of births that took place with an SBA in a facility ready to provide BEmONC was just 10% (95% confidence interval CI 3-17). The absolute difference between the individual- and ecological-level linking method adjusting for facility level was one percentage point (11%), and tests suggested good agreement. The ecological method using the district-wide estimate demonstrated poor agreement. The proportion of women accessing appropriately equipped facilities for care at birth is far lower than the coverage of facility delivery. To realise the life-saving potential of health services, countries need evidence to inform actions that address gaps in the provision of quality care. Linking household and facility-based information provides a simple but innovative method for estimating quality of care at the population level. These encouraging findings suggest that linking data sets can result in meaningful evidence even when the exact location of care seeking is not known.

Prescribing behaviour after the introduction of decentralized drug budgets: Is there an association with employer and type of care facility?

PubMed Central

Andersson, Karolina; Carlsten, Anders; Hedenrud, Tove

2009-01-01

Objective To analyse whether prescribing patterns changed after introduction of drug budgets and whether there is an association between drug prescribing patterns and the type of employer and care facility. Methods Data analysed encompassed information on dispensed medicines, by workplaces, prescribed in the Region Västra Götaland, Sweden, for the years 2003 and 2006. Workplaces (n = 969) were categorized according to type of employer and type of care facility. Five prescribing indicators reflecting goals for cost-containing prescribing in Region Västra Götaland were assessed. Changes over time and differences between different types of employer and care facility were analysed by Mann–Whitney tests. Results In 2003, workplaces with a public employer had a significantly higher adherence to three of the prescribing indicators compared with private practitioners. Two of these differences remained in 2006. In 2003, none of the prescribing indicators differed between primary care and other care facilities. Three years later workplaces in primary care had a significantly higher adherence to three of the prescribing indicators than other care facilities. There was a statistically significant difference in change between 2003 and 2006 between primary care and other care facilities; there were no differences in change between workplaces with public and private employers. Conclusions Adherence to three of the prescribing indicators increased after the introduction of decentralized drug budgets. Workplaces with a public employer showed greater adherence to two of the prescribing indicators than private sector workplaces. PMID:19291589

Opportunities and limitations in using google glass to assist drug dispensing.

PubMed

Ehrler, Frederic; Diener, Raphael; Lovis, Christian

2015-01-01

The administration of intravenous drugs is a significant source of medical errors. Protocol based care are have been demonstrated to be an efficient way to favor best practices and to avoid simple errors such as those related to expiration date, hygiene regulation among other. The recent availability of the Google Glass, a hands free wearable device offers new opportunities to access care protocols at patients' bedside. In this article, we present a prototype application for displaying care protocols developed through a user centered design. The software enables the navigation through the different steps of care protocols and their validation using barcodes. Three interactions paradigms, tactile, vocal and by eye blink are proposed in order to provide hands free manipulation when necessary. The realization of a concrete project revealed some limitations that should be taken in account in order to ensure the proper behavior of the tool. If no formal evaluation has been performed, the first feedbacks are very positive and encourage us to go forward and test the tool in real care situations.

Care of pediatric tracheostomy in the immediate postoperative period and timing of first tube change.

PubMed

Lippert, Dylan; Hoffman, Matthew R; Dang, Phat; McMurray, J Scott; Heatley, Diane; Kille, Tony

2014-12-01

To analyze the safety of a standardized pediatric tracheostomy care protocol in the immediate postoperative period and its impact on tracheostomy related complications. Retrospective case series. Pediatric patients undergoing tracheotomy from February 2010-February 2014. In 2012, a standardized protocol was established regarding postoperative pediatric tracheostomy care. This protocol included securing newly placed tracheostomy tubes using a foam strap with hook and loop fastener rather than twill ties, placing a fresh drain sponge around the tracheostomy tube daily, and performing the first tracheostomy tube change on postoperative day 3 or 4. Outcome measures included rate of skin breakdown and presence of a mature stoma allowing for a safe first tracheostomy tube change. Two types of tracheotomy were performed based on patient age: standard pediatric tracheotomy and adult-style tracheotomy with a Bjork flap. Patients were analyzed separately based on age and the type of tracheotomy performed. Thirty-seven patients in the pre-protocol group and 35 in the post-protocol group were analyzed. The rate of skin breakdown was significantly lower in the post-protocol group (standard: p=0.0048; Bjork flap: p=0.0003). In the post-protocol group, all tube changes were safely accomplished on postoperative day three or four, and the stomas were deemed to be adequately matured to do so in all cases. A standardized postoperative pediatric tracheostomy care protocol resulted in decreased rates of skin breakdown and demonstrated that pediatric tracheostomy tubes can be safely changed as early as 3 days postoperatively. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Protocols for pressure ulcer prevention: are they evidence-based?

PubMed

Chaves, Lidice M; Grypdonck, Mieke H F; Defloor, Tom

2010-03-01

This study is a report of a study to determine the quality of protocols for pressure ulcer prevention in home care in the Netherlands. If pressure ulcer prevention protocols are evidence-based and practitioners use them correctly in practice, this will result a reduction in pressure ulcers. Very little is known about the evidence-based content and quality of the pressure ulcer prevention protocols. In 2008, current pressure ulcer prevention protocols from 24 home-care agencies in the Netherlands were evaluated. A checklist developed and validated by two pressure ulcer prevention experts was used to assess the quality of the protocols, and weighted and unweighted quality scores were computed and analysed using descriptive statistics. The 24 pressure ulcer prevention protocols had a mean weighted quality score of 63.38 points out of a maximum of 100 (sd 5). The importance of observing the skin at the pressure points at least once a day was emphasized in 75% of the protocols. Only 42% correctly warned against the use of materials that were 'less effective or that could potentially cause harm'. Pressure ulcer prevention commands a reasonable amount of attention in home care, but the incidence of pressure ulcers and lack of a consistent, standardized document for use in actual practice indicate a need for systematic implementation of national pressure ulcer prevention standards in the Netherlands to ensure adherence to the established protocols.

Critical factors for assembling a high volume of DNA barcodes

PubMed Central

Hajibabaei, Mehrdad; deWaard, Jeremy R; Ivanova, Natalia V; Ratnasingham, Sujeevan; Dooh, Robert T; Kirk, Stephanie L; Mackie, Paula M; Hebert, Paul D.N

2005-01-01

Large-scale DNA barcoding projects are now moving toward activation while the creation of a comprehensive barcode library for eukaryotes will ultimately require the acquisition of some 100 million barcodes. To satisfy this need, analytical facilities must adopt protocols that can support the rapid, cost-effective assembly of barcodes. In this paper we discuss the prospects for establishing high volume DNA barcoding facilities by evaluating key steps in the analytical chain from specimens to barcodes. Alliances with members of the taxonomic community represent the most effective strategy for provisioning the analytical chain with specimens. The optimal protocols for DNA extraction and subsequent PCR amplification of the barcode region depend strongly on their condition, but production targets of 100K barcode records per year are now feasible for facilities working with compliant specimens. The analysis of museum collections is currently challenging, but PCR cocktails that combine polymerases with repair enzyme(s) promise future success. Barcode analysis is already a cost-effective option for species identification in some situations and this will increasingly be the case as reference libraries are assembled and analytical protocols are simplified. PMID:16214753

The difficulties of conducting maternal death reviews in Malawi.

PubMed

Kongnyuy, Eugene J; van den Broek, Nynke

2008-09-11

Maternal death reviews is a tool widely recommended to improve the quality of obstetric care and reduce maternal mortality. Our aim was to explore the challenges encountered in the process of facility-based maternal death review in Malawi, and to suggest sustainable and logically sound solutions to these challenges. SWOT (strengths, weaknesses, opportunities and threats) analysis of the process of maternal death review during a workshop in Malawi. Strengths: Availability of data from case notes, support from hospital management, and having maternal death review forms. Weaknesses: fear of blame, lack of knowledge and skills to properly conduct death reviews, inadequate resources and missing documentation. Opportunities: technical assistance from expatriates, support from the Ministry of Health, national protocols and high maternal mortality which serves as motivation factor. Threats: Cultural practices, potential lawsuit, demotivation due to the high maternal mortality and poor planning at the district level. Solutions: proper documentation, conducting maternal death review in a blame-free manner, good leadership, motivation of staff, using guidelines, proper stock inventory and community involvement. Challenges encountered during facility-based maternal death review are provider-related, administrative, client related and community related. Countries with similar socioeconomic profiles to Malawi will have similar 'pull-and-push' factors on the process of facility-based maternal death reviews, and therefore we will expect these countries to have similar potential solutions.

Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities.

PubMed

Miller, Suellen; Fathalla, Mohamed M F; Ojengbede, Oladosu A; Camlin, Carol; Mourad-Youssif, Mohammed; Morhason-Bello, Imran O; Galadanci, Hadiza; Nsima, David; Butrick, Elizabeth; Al Hussaini, Tarek; Turan, Janet; Meyer, Carinne; Martin, Hilarie; Mohammed, Aminu I

2010-10-18

Obstetric hemorrhage is the leading cause of maternal mortality globally. The Non-pneumatic Anti-Shock Garment (NASG) is a low-technology, first-aid compression device which, when added to standard hypovolemic shock protocols, may improve outcomes for women with hypovolemic shock secondary to obstetric hemorrhage in tertiary facilities in low-resource settings. This study employed a pre-intervention/intervention design in four facilities in Nigeria and two in Egypt. Primary outcomes were measured mean and median blood loss, severe end-organ failure morbidity (renal failure, pulmonary failure, cardiac failure, or CNS dysfunctions), mortality, and emergency hysterectomy for 1442 women with ≥750 mL blood loss and at least one sign of hemodynamic instability. Comparisons of outcomes by study phase were assessed with rank sum tests, relative risks (RR), number needed to treat for benefit (NNTb), and multiple logistic regression. Women in the NASG phase (n = 835) were in worse condition on study entry, 38.5% with mean arterial pressure <60 mmHg vs. 29.9% in the pre-intervention phase (p = 0.001). Despite this, negative outcomes were significantly reduced in the NASG phase: mean measured blood loss decreased from 444 mL to 240 mL (p < 0.001), maternal mortality decreased from 6.3% to 3.5% (RR 0.56, 95% CI 0.35-0.89), severe morbidities from 3.7% to 0.7% (RR 0.20, 95% CI 0.08-0.50), and emergency hysterectomy from 8.9% to 4.0% (RR 0.44, 0.23-0.86). In multiple logistic regression, there was a 55% reduced odds of mortality during the NASG phase (aOR 0.45, 0.27-0.77). The NNTb to prevent either mortality or severe morbidity was 18 (12-36). Adding the NASG to standard shock and hemorrhage management may significantly improve maternal outcomes from hypovolemic shock secondary to obstetric hemorrhage at tertiary care facilities in low-resource settings.

Sexually transmitted disease syndromic case management through public sector facilities: development and assessment study in Punjab Pakistan.

PubMed

Khan, Muhammad Amir; Javed, Wajiha; Ahmed, Maqsood; Walley, John; Munir, Muhammad Arif

2014-01-01

Sexually transmitted infections (STIs) are a priority health problem. We proposed a prospective study in two districts of Punjab, using an intervention package, which included guidelines and protocols on syndrome-based management of STIs, adapted in light of technical guidelines from the National AIDS Control Program and the World Health Organization. The aim of this study was to assess the operational effectiveness of STI case management guidelines and to assess factors that determine the adherence to guidelines for management of STIs at public health facilities in Pakistan. A prospective study lasting 18 months (January 2008 to June 2009), which reviewed early implementation experiences of updated case management guidelines for delivery of syndrome-based STI/reproductive tract infection care, through public-sector health care facilities. The project was implemented in two districts of Punjab, Sargodha and Jhang. A Cox regression model with stratification was done. The prevalence of STI was 26 per 100,000 patients. In women, the reported symptoms were 80% vaginal discharge and 12% abdominal pain. Forty-four percent of men had a genital ulcer and 29% of men had genital discharge. Age of participants ranged from 13 to 60 years. The study comprised 28.6% men and 71.4% women. The majority of the population attending these clinics was from rural areas (70%). The variables independently associated with adherence to guidelines were availability of male paramedic, age of patient, and type of diagnosis made. There was an important interaction (effect modification) present between the area of health facility and patient sex. Screening, diagnosis, and treatment costs for many STIs are expensive and thus an easier, low-cost, syndrome-based public health strategy is the adoption of the proposed STI syndrome case management guidelines. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... under section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility services...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... under section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility services...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... under section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility...

Care outcomes in long-term care facilities in British Columbia, Canada. Does ownership matter?

PubMed

McGregor, Margaret J; Tate, Robert B; McGrail, Kimberlyn M; Ronald, Lisa A; Broemeling, Anne-Marie; Cohen, Marcy

2006-10-01

This study investigated whether for-profit (FP) versus not-for-profit (NP) ownership of long-term care facilities resulted in a difference in hospital admission and mortality rates among facility residents in British Columbia, Canada. This retrospective cohort study used administrative data on all residents of British Columbia long-term care facilities between April 1, 1996, and August 1, 1999 (n = 43,065). Hospitalizations were examined for 6 diagnoses (falls, pneumonia, anemia, dehydration, urinary tract infection, and decubitus ulcers and/or gangrene), which are considered to be reflective of facility quality of care. In addition to FP versus NP status, facilities were divided into ownership subgroups to investigate outcomes by differences in governance and operational structures. We found that, overall, FP facilities demonstrated higher adjusted hospitalization rates for pneumonia, anemia, and dehydration and no difference for falls, urinary tract infections, or DCU/gangrene. FP facilities demonstrated higher adjusted hospitalization rates compared with NP facilities attached to a hospital, amalgamated to a regional health authority, or that were multisite. This effect was not present when comparing FP facilities to NP single-site facilities. There was no difference in mortality rates in FP versus NP facilities. The higher adjusted hospitalization rates in FP versus NP facilities is consistent with previous research from U.S. authors. However, the superior performance by the NP sector is driven by NP-owned facilities connected to a hospital or health authority, or that had more than one site of operation.

In-shoe plantar pressure measurements for the evaluation and adaptation of foot orthoses in patients with rheumatoid arthritis: A proof of concept study.

PubMed

Tenten-Diepenmaat, Marloes; Dekker, Joost; Steenbergen, Menno; Huybrechts, Elleke; Roorda, Leo D; van Schaardenburg, Dirkjan; Bus, Sicco A; van der Leeden, Marike

2016-03-01

Improving foot orthoses (FOs) in patients with rheumatoid arthritis (RA) by using in-shoe plantar pressure measurements seems promising. The objectives of this study were to evaluate (1) the outcome on plantar pressure distribution of FOs that were adapted using in-shoe plantar pressure measurements according to a protocol and (2) the protocol feasibility. Forty-five RA patients with foot problems were included in this observational proof-of concept study. FOs were custom-made by a podiatrist according to usual care. Regions of Interest (ROIs) for plantar pressure reduction were selected. According to a protocol, usual care FOs were evaluated using in-shoe plantar pressure measurements and, if necessary, adapted. Plantar pressure-time integrals at the ROIs were compared between the following conditions: (1) no-FO versus usual care FO and (2) usual care FO versus adapted FO. Semi-structured interviews were held with patients and podiatrists to evaluate the feasibility of the protocol. Adapted FOs were developed in 70% of the patients. In these patients, usual care FOs showed a mean 9% reduction in pressure-time integral at forefoot ROIs compared to no-FOs (p=0.01). FO adaptation led to an additional mean 3% reduction in pressure-time integral (p=0.05). The protocol was considered feasible by patients. Podiatrists considered the protocol more useful to achieve individual rather than general treatment goals. A final protocol was proposed. Using in-shoe plantar pressure measurements for adapting foot orthoses for patients with RA leads to a small additional plantar pressure reduction in the forefoot. Further research on the clinical relevance of this outcome is required. Copyright © 2016. Published by Elsevier B.V.

Longitudinal variation in pressure injury incidence among long-term aged care facilities.

PubMed

Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Westbrook, Johanna I

2018-05-04

To examine variation in pressure injury (PI) incidence among long-term aged care facilities and identify resident- and facility-level factors that explain this variation. Longitudinal incidence study using routinely-collected electronic care management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. About 6556 people aged 65 years and older who were permanent residents in 60 long-term care facilities between December 2014 and November 2016. Risk-adjusted PI incidence rates over eight study quarters. Incidence density over the study period was 1.33 pressure injuries per 1000 resident days (95% confidence interval (CI) = 1.29-1.37). Funnel plots were used to identify variation among facilities. On average, 14% of facilities had risk-adjusted PI rates that were higher than expected in each quarter (above 95% funnel plot control limits). Ten percent of facilities had persistently high rates in any three or more consecutive quarters (n = 6). The variation between facilities was only partly explained by resident characteristics in multilevel regression models. Residents were more likely to have higher-pressure injury rates in facilities in regional areas compared with major city areas (adjusted incidence rate ratio = 1.25, 95% CI = 1.04-1.51), and facilities with persistently high rates were more likely to be located in areas with low socioeconomic status (P = 0.038). There is considerable variation among facilities in PI incidence. This study demonstrates the potential of routinely-collected care management data to monitor PI incidence and to identify facilities that may benefit from targeted intervention.

42 CFR 483.13 - Resident behavior and facility practices.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Resident behavior and facility practices. 483.13... SERVICES (CONTINUED) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.13 Resident behavior and facility practices. (a) Restraints...

40 CFR 160.43 - Test system care facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... testing facility shall have a number of animal rooms or other test system areas separate from those... GOOD LABORATORY PRACTICE STANDARDS Facilities § 160.43 Test system care facilities. (a) A testing facility shall have a sufficient number of animal rooms or other test system areas, as needed, to ensure...

40 CFR 160.43 - Test system care facilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... testing facility shall have a number of animal rooms or other test system areas separate from those... GOOD LABORATORY PRACTICE STANDARDS Facilities § 160.43 Test system care facilities. (a) A testing facility shall have a sufficient number of animal rooms or other test system areas, as needed, to ensure...

Exploring the transparency mechanism and evaluating the effect of public reporting on prescription: a protocol for a cluster randomized controlled trial.

PubMed

Du, Xin; Wang, Dan; Wang, Xuan; Yang, Shiru; Zhang, Xinping

2015-03-21

The public reporting of health outcomes has become one of the most popular topics and is accepted as a quality improvement method in the healthcare field. However, little research has been conducted on the transparency mechanism, and results are mixed with regard to the evaluation of the effect of public reporting on quality improvement. The objectives of this trial are to investigate the transparency mechanism and to evaluate the effect of public reporting on prescription at the level of individual participants. This study involves a cluster randomized controlled trial conducted in 20 primary-care facilities (clusters). Eligible clusters are those facilities with excellent hospital information systems and that have agreed to participate in the trial. The 20 clusters are matched into 10 pairs according to Technique for Order Preference by Similarity to Ideal Solution score. As the unit of randomization, each pair of facilities is assigned at random to a control or an intervention group through coin flipping. Prescribed ranking information is publicly reported in the intervention group. The public materials include the posters of individuals and of facilities, the ranking lists of general practitioners, and brochures of patients, which are updated monthly. The intervention began on 13th November 2013 and lasted for one year. Specifically, participants are surveyed at five points in time (baseline, quarterly following the intervention) through questionnaires, interviews, and observations. These participants include an average of 600 patients, 300 general practitioners, 15 directors, and 6 health bureau administrators. The primary outcomes are the transparency mechanism model and the changes in medicine-prescribe. Subsequently, the modifications in the transparency mechanism constructs are evaluated. The outcomes are measured at the individual participant level, and the professional who analyzes the data is blind to the randomization status. This study protocol outlines a design that aims to examine the transparency mechanism and to evaluate the effect of public reporting on prescription. The research design is significant in the field of public policy. Furthermore, this study intends to fill the gap of the investigation of the transparency mechanism and the evaluation of public reporting on prescription.

Framework for a National STEMI Program: consensus document developed by STEMI INDIA, Cardiological Society of India and Association Physicians of India.

PubMed

Alexander, Thomas; Mullasari, Ajit S; Kaifoszova, Zuzana; Khot, Umesh N; Nallamothu, Brahmajee; Ramana, Rao G V; Sharma, Meenakshi; Subramaniam, Kala; Veerasekar, Ganesh; Victor, Suma M; Chand, Kiran; Deb, P K; Venugopal, K; Chopra, H K; Guha, Santanu; Banerjee, Amal Kumar; Armugam, A Muruganathan; Panja, Manotosh; Wander, Gurpreet Singh

2015-01-01

The health care burden of ST elevation myocardial infarction (STEMI) in India is enormous. Yet, many patients with STEMI can seldom avail timely and evidence based reperfusion treatments. This gap in care is a result of financial barriers, limited healthcare infrastructure, poor knowledge and accessibility of acute medical services for a majority of the population. Addressing some of these issues, STEMI India, a not-for-profit organization, Cardiological Society of India (CSI) and Association Physicians of India (API) have developed a protocol of "systems of care" for efficient management of STEMI, with integrated networks of facilities. Leveraging newly-developed ambulance and emergency medical services, incorporating recent state insurance schemes for vulnerable populations to broaden access, and combining innovative, "state-of-the-art" information technology platforms with existing hospital infrastructure, are the crucial aspects of this system. A pilot program was successfully employed in the state of Tamilnadu. The purpose of this article is to describe the framework and methods associated with this programme with an aim to improve delivery of reperfusion therapy for STEMI in India. This programme can serve as model STEMI systems of care for other low-and-middle income countries. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Optimization of Ultrasonic Fabric Cleaning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hand, T.E.

The fundamental purpose of this project was to research and develop a process that would reduce the cost and improve the environmental efficiency of the present dry-cleaning industry. This second phase of research (see report KCP-94-1006 for information gathered during the first phase) was intended to allow the optimal integration of all factors of ultrasonic fabric cleaning. For this phase, Garment Care performed an extensive literature search and gathered data from other researchers worldwide. The Garment Care-AlliedSignal team developed the requirements for a prototype cleaning tank for studies and acquired that tank and the additional equipment required to use itmore » properly. Garment Care and AlliedSignal acquired the transducers and generators from Surftran Martin-Walter in Sterling Heights, Michigan. Amway's Kelly Haley developed the test protocol, supplied hundreds of test swatches, gathered the data on the swatches before and after the tests, assisted with the cleaning tests, and prepared the final analysis of the results. AlliedSignal personnel, in conjunction with Amway and Garment Care staff, performed all the tests. Additional planning is under way for future testing by outside research facilities. The final results indicated repeatable performance and good results for single layered fabric swatches. Swatches that were cleaned as a ''sandwich,'' that is, three or more layers.« less

Surgical Human Resources According to Types of Health Care Facility: An Assessment in Low- and Middle-Income Countries.

PubMed

Sheik Ali, Shirwa; Jaffry, Zahra; Cherian, Meena N; Kunjumen, Teena; Nkwowane, Annette M; Leather, Andrew J M; Von Muhlenbrock, Hernan Montenegro; Kelley, Edward; Campbell, James

2017-11-01

A robust health care system providing safe surgical care to a population can only be achieved in conjunction with access to competent surgical personnel. It has been reported that 5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. This study aims to fill the existing gap in evidence by quantifying shortfalls in trained personnel delivering safe surgical and anaesthetic care in low- and middle-income countries (LMICs) according to the type of health care facility. We conducted secondary analysis of 1323 health facilities, in 35 low- and middle-income countries using facility-based cross-sectional data from the World Health Organization Situational Analysis Tool to Assess Emergency and Essential Surgical Care. The majority of surgical and anaesthetic care in LMICs was provided by general doctors (range 13.8-41.1%; mean 27.1%). Non-physicians made up a significant proportion of the surgical workforce in LMICs. 26.76% of the surgical and anaesthetic workforce was provided by clinical medical officers and nurses. Private/NGO/mission hospitals, large, well-resourced institutions had the highest proportion of surgeons compared to any other type of health care facility at 27.92%. This compares to figures of 18.2 and 19.96% of surgeons at health centres and subdistrict/community hospitals, respectively, representing the lowest level of health facility. We highlight the significant proportion of non-physicians delivering surgical and anaesthetic care in LMICs and illustrate wide variations according to the type of health care facility.

Non-utilization of public health care facilities: examining the reasons through a national study of women in India.

PubMed

Dalal, Koustuv; Dawad, Suraya

2009-01-01

This article examines women's opinions about their reasons for the non-utilization of appropriate public health care facilities, according to categories of their healthcare seeking in India. This cross-sectional article uses nationally representative samples from the Indian National Family Health Surveys NFHS-3 (2005-2006), which were generated from randomly selected households. Women of reproductive age (15-49 years) from the 29 states of India participated (n = 124 385 women). The respondents were asked why they did not utilize public health care facilities when members of their households were ill, identifying their reasons with a yes/no choice. The following five reasons were of primary interest: (1) 'there is no nearby facility'; (2) 'facility timing is not convenient'; (3) 'health personnel are often absent'; (4) 'waiting time is too long'; and (5) 'poor quality of care'. Results from logistic regression analyses indicate that respondents' education, economic status and standard of living are significant predictors for non-utilization of public health care facilities. Women who sought the services of care delivery and health check-ups indicated that health personnel were absent. Service seekers for self and child's medical treatments indicated that there were no nearby health facilities, service times were inconvenient, there were long waiting times and poor quality health care. This study concludes that improving public health care facilities with user-friendly opening times, the regular presence of staff, reduced waiting times and improved quality of care are necessary steps to reducing maternal mortality and poverty.

Are healthcare aides underused in long-term care? A cross-sectional study on continuing care facilities in Canada.

PubMed

Arain, Mubashir A; Deutschlander, Siegrid; Charland, Paola

2017-05-17

Over the last 10 years, appropriate workforce utilisation has been an important discussion among healthcare practitioners and policy-makers. The role of healthcare aides (HCAs) has also expanded to improve their utilisation. This evolving role of HCAs in Canada has prompted calls for standardised training, education and scope of practice for HCAs. The purpose of this research was to examine the differences in HCAs training and utilisation in continuing care facilities. From June 2014 to July 2015, we conducted a mixed-method study on HCA utilisation in continuing care. This paper presents findings gathered solely from the prospective cross-sectional survey of continuing care facilities (long-term care (LTC) and supportive living (SL)) on HCA utilisation. We conducted this study in a Western Canadian province. The managers of the continuing care facilities (SL and LTC) were eligible to participate in the survey. The pattern of HCAs involvement in medication assistance and other care activities in SL and LTC facilities. We received 130 completed surveys (LTC=64 and SL=52). Our findings showed that approximately 81% of HCAs were fully certified. We found variations in how HCAs were used in SL and LTC facilities. Overall, HCAs in SL were more likely to be involved in medication management such as assisting with inhaled medication and oral medication delivery. A significantly larger proportion of survey respondents from SL facilities reported that medication assistance training was mandatory for their HCAs (86%) compared with the LTC facilities (50%) (p value <0.01). The utilisation of HCAs varies widely between SL and LTC facilities. HCAs in SL facilities may be considered better used according to their required educational training and competencies. Expanding the role of HCAs in LTC facilities may lead to a cost-effective and more efficient utilisation of workforce in continuing care facilities. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Case-mix and quality indicators in Chinese elder care homes: are there differences between government-owned and private-sector facilities?

PubMed

Liu, Chang; Feng, Zhanlian; Mor, Vincent

2014-02-01

To assess the association between ownership of Chinese elder care facilities and their performance quality and to compare the case-mix profile of residents and facility characteristics in government-owned and private-sector homes. Cross-sectional study. Census of elder care homes surveyed in Nanjing (2009) and Tianjin (2010). Elder care facilities located in urban Nanjing (n = 140, 95% of all) and urban Tianjin (n = 157, 97% of all). A summary case-mix index based on activity of daily living (ADL) limitations and cognitive impairment was created to measure levels of care needs of residents in each facility. Structure, process, and outcome measures were selected to assess facility-level quality of care. A structural quality measure, understaffing relative to resident levels of care needs, which indicates potentially inadequate staffing given resident case-mix, was also developed. Government-owned homes had significantly higher occupancy rates, presumably reflecting popular demand for publicly subsidized beds, but served residents who, on average, have fewer ADL and cognitive functioning limitations than those in private-sector facilities. Across a range of structure, process, and outcome measures of quality, there is no clear evidence suggesting advantages or disadvantages of either ownership type, although when staffing-to-resident ratio is gauged relative to resident case-mix, private-sector facilities were more likely to be understaffed than government-owned facilities. In Nanjing and Tianjin, private-sector homes were more likely to be understaffed, although their residents were sicker and frailer on average than those in government facilities. It is likely that the case-mix differences are the result of selective admission policies that favor healthier residents in government facilities than in private-sector homes. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

International Image Concordance Study to Compare a Point of Care Tampon Colposcope to a Standard-of-Care Colposcope

PubMed Central

Mueller, Jenna L.; Asma, Elizabeth; Lam, Christopher T.; Krieger, Marlee S.; Gallagher, Jennifer E.; Erkanli, Alaattin; Hariprasad, Roopa; Malliga, J.S.; Muasher, Lisa C.; Mchome, Bariki; Oneko, Olola; Taylor, Peyton; Venegas, Gino; Wanyoro, Anthony; Mehrotra, Ravi; Schmitt, John W.; Ramanujam, Nimmi

2017-01-01

Objective Barriers to cervical cancer screening in low resource settings include lack of accessible high quality services, high cost, and the need for multiple visits. To address these challenges, we developed a low cost intra-vaginal optical cervical imaging device, the Point of Care Tampon (POCkeT) colposcope, and evaluated whether its performance is comparable to a standard-of-care colposcope. Methods There were two protocols, which included 44 and 18 patients respectively. For the first protocol, white light cervical images were collected in vivo, blinded by device, and sent electronically to 8 physicians from high, middle and low income countries. For the second protocol, green light images were also collected and sent electronically to the highest performing physician from the first protocol who has experience in both a high and low income country. For each image, physicians completed a survey assessing cervix characteristics and severity of precancerous lesions. Corresponding pathology was obtained for all image pairs. Results For the first protocol, average percent agreement between devices was 70% across all physicians. POCkeT and standard-of-care colposcope images had 37% and 51% percent agreement respectively with pathology for high-grade squamous intraepithelial lesions (HSILs). Investigation of HSIL POCkeT images revealed decreased visibility of vascularization and lack of contrast in lesion margins. After changes were made for the second protocol, the two devices achieved similar agreement to pathology for HSIL lesions (55%). Conclusions Based on the exploratory study, physician interpretation of cervix images acquired using a portable, low cost, POCkeT colposcope was comparable to a standard-of-care colposcope. PMID:28263237

Improving cardiac operating room to intensive care unit handover using a standardised handover process.

PubMed

Gleicher, Yehoshua; Mosko, Jeffrey David; McGhee, Irene

2017-01-01

Handovers from the cardiovascular operating room (CVOR) to the cardiovascular intensive care unit (CVICU) are complex processes involving the transfer of information, equipment and responsibility, at a time when the patient is most vulnerable. This transfer is typically variable in structure, content and execution. This variability can lead to the omission and miscommunication of critical information leading to patient harm. We set out to improve the quality of patient handover from the CVOR to the CVICU by introducing a standardised handover protocol. This study is an interventional time-series study over a 4-month period at an adult cardiac surgery centre. A standardised handover protocol was developed using quality improvement methodologies. The protocol included a handover content checklist and introduction of a formal 'sterile cockpit' timeout. Implementation of the protocol was refined using monthly iterative Plan-Do-Study-Act. The primary outcome was the quality of handovers, measured by a Handover Score, comprising handover content, teamwork and patient care planning indicators. Secondary outcomes included handover duration, adherence to the standardised handover protocol and handover team satisfaction surveys. 37 handovers were observed (6 pre intervention and 31 post intervention). The mean handover score increased from 6.5 to 14.0 (maximum 18 points). Specific improvements included fewer handover interruptions and more frequent postoperative patient care planning. Average handover duration increased slightly from 2:40 to 2:57 min. Caregivers noted improvements in teamwork, content received and patient care planning. The majority (>95%) agreed that the intervention was a valuable addition to the CVOR to CVICU handover process. Implementation of a standardised handover protocol for postcardiac surgery patients was associated with fewer interruptions during handover, more reliable transfer of critical content and improved patient care planning.

WASH and gender in health care facilities: The uncharted territory.

PubMed

Kohler, Petra; Renggli, Samuel; Lüthi, Christoph

2017-11-08

Health care facilities in low- and middle-income countries are high-risk settings, and face special challenges to achieving sustainable water, sanitation, and hygiene (WASH) services. Our applied interdisciplinary research conducted in India and Uganda analyzed six dimensions of WASH services in selected health care facilities, including menstrual hygiene management. To be effective, WASH monitoring strategies in health care facilities must include gender sensitive measures. We present a novel strategy, showing that applied gender sensitive multitool assessments are highly productive in assessments of WASH services and facilities from user and provider perspectives. We discuss its potential for applications at scale and as an area of future research.

The Myth, the Truth, the NASA IRB

NASA Technical Reports Server (NTRS)

Covington, M. D.; Flores, M. P.; Neutzler, V. P.; Schlegel, T. T.; Platts, S. H.; Lioyd, C. W.

2017-01-01

The purpose of the NASA Institutional Review Board (IRB) is to review research activities involving human subjects to ensure that ethical standards for the care and protection of human subjects have been met and research activities are in compliance with all pertinent federal, state and local regulations as well as NASA policies. NASA IRB's primary role is the protection of human subjects in research studies. Protection of human subjects is the shared responsibility of NASA, the IRB, and the scientific investigators. Science investigators who plan to conduct NASA-funded human research involving NASA investigators, facilities, or funds must submit and coordinate their research studies for review and approval by the NASA IRB prior to initiation. The IRB has the authority to approve, require changes in, or disapprove research involving human subjects. Better knowledge of the NASA IRB policies, procedures and guidelines should help facilitate research protocol applications and approvals. In this presentation, the myths and truths of NASA IRB policies and procedures will be discussed. We will focus on the policies that guide a protocol through the NASA IRB and the procedures that principal investigators must take to obtain required IRB approvals for their research studies. In addition, tips to help ensure a more efficient IRB review will be provided. By understanding the requirements and processes, investigators will be able to more efficiently prepare their protocols and obtain the required NASA IRB approval in a timely manner.

Strategic planning and marketing research for older, inner-city health care facilities: a case study.

PubMed

Wood, V R; Robertson, K R

1992-01-01

Numerous health care facilities, located in downtown metropolitan areas, now find themselves surrounded by a decaying inner-city environment. Consumers may perceive these facilities as "old," and catering to an "urban poor" consumer. These same consumers may, therefore, prefer to patronize more modern facilities located in suburban areas. This paper presents a case study of such a health care facility and how strategic planning and marketing research were conducted in order to identify market opportunities and new strategic directions.

Patient Care Staffing Levels and Facility Characteristics in U.S. Hemodialysis Facilities

PubMed Central

Yoder, Laura A. G.; Xin, Wenjun; Norris, Keith C.; Yan, Guofen

2013-01-01

Background Higher numbers of registered nurses per patient have been associated with improved patient outcomes in acute care facilities. Variation and associations of patient-care staffing levels and hemodialysis facility characteristics have not been previously examined. Study Design Cross-sectional study using Poisson regression to examine associations betwee patient-care staffing levels and hemodialysis facility characteristics. Setting & Participants 4,800 U.S. hemodialysis facilities in the 2009 CMS ESRD Annual Facility Survey (CMS-2744), USRDS. Predictors Facility characteristics, including profit status, freestanding status, chain affiliatio and geographic region, adjusted for facility size, capacity, functional type, and urbanicity. Outcomes Patient care staffing levels, including ratios of Registered Nurses (RN), Licensed Practical Nurses (LPN), Patient Care Technicians (PCT), composite staff (RN+LPN+PCT), Social Workers, and Dietitians to in-center hemodialysis patients. Results After adjusting for background facility characteristics, the ratios of RNs and LPNs to patients were 35% (p<0.001) and 42% (p<0.001) lower, but the PCT-to-patient ratio was 16% (p<0.001) higher in for-profit facilities than those in nonprofit facilities (Rate ratio, 0.65, 95%CI, 0.63–0.68; 0.58, 0.51–0.65; 1.16, 1.12–1.19; respectively). Regionally, compared to the Northeast, the adjusted RN-to-patient ratio was 14% (p< 0.001) lower in the Midwest, 25% (p< 0.001) lower in the South, and 18% (p< 0.001) lower in the West. Even after additional adjustments, the large for-profit chains had significantly lower RN and LPN ratios than the largest nonprofit chain, but a significantly higher PCT-to-patient ratio. The overall composite staffing levels were also lower in for-profit and chain-affiliated facilities. The patterns hold when the hospital-based units were excluded. Limitations Nursing hours were not available. Conclusions The significant variation in patient-care staffing levels and its associations with facility characteristics warrants inclusion in future large-scale hemodialysis outcomes studies. ESRD networks and hemodialysis facilities should attend to quality assurance and performance improvement initiatives that maximize licensed nurse-staffing levels in hemodialysis facilities. PMID:23810689

The influences of Taiwan's National Health Insurance on women's choice of prenatal care facility: Investigation of differences between rural and non-rural areas

PubMed Central

Chen, Likwang; Chen, Chi-Liang; Yang, Wei-Chih

2008-01-01

Background Taiwan's National Health Insurance (NHI), implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Methods Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI) in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. Results After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998–1999 was about 6.54 times of that in 1990–1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in rural areas. Conclusion We concluded that women in rural areas were more likely to seek prenatal care in large hospitals, but were not more likely to perceive very convenient transportation to and from prenatal care facilities in the late 1990s than in the early 1990s. In contrast, women in non-rural areas did not have a stronger tendency to seek prenatal care in large hospitals in the late 1990s than in earlier periods. In addition, they did perceive an improvement in transportation for acquiring prenatal care in the late 1990s. More efforts should be made to reduce these disparities. PMID:18373869

ABM Clinical Protocol #21: Guidelines for Breastfeeding and the Drug-Dependent Woman

PubMed Central

2009-01-01

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. PMID:19835481

ABM Clinical Protocol #19: Breastfeeding Promotion in the Prenatal Setting, Revision 2015

PubMed Central

Rosen-Carole, Casey; Hartman, Scott

2015-01-01

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. PMID:26651541

Practice Management: The Game Changer

PubMed Central

Pessis, Paul

2016-01-01

The reimbursement landscape is undergoing significant changes. Practice management, which encompasses reimbursement, is becoming increasingly more important in securing business success. Each practitioner within a facility is responsible for fortifying the practice through thoughtful business protocols. Knowing legislation that impacts health care along with understanding the foundational components of reimbursement is key for keeping a practice financially healthy. Change is good, but making the changes is what counts! Legislation such as the Medicare Access and Chip Reauthorization Act defines the new payment models. Correcting current business practices might seem difficult on the surface, but implementing change is rewarding and an obligation of the practitioners within a facility to their patients. Financial stability for a practice occurs when sound business practices are routine. Today's audiologist must not only be proficient at performing his or her scope of practice, but must also accept that performing best business practices is part of the job. In the end, the patients seeking the services of the audiologist benefit most when a practice has the financial stability to be best in its class. PMID:28028326

78 FR 34386 - Agency Forms Undergoing Paperwork Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-07

...-to-date sampling frames of residential care facilities. Three year clearance is requested. Section... care facilities within each state that meet the NSLTCP definition and (2) for each relevant licensure... study definition of a residential care facility is one that is licensed, registered, listed, certified...

24 CFR 232.615 - Eligible borrowers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... intermediate care facility for which the Secretary of Health and Human Services has determined that the... intermediate care facility will meet not only the applicable fire safety requirements of HHS but will meet... application, a nursing home or intermediate care facility need not be providing such services if upon...

Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya.

PubMed

Sharma, Jigyasa; Leslie, Hannah H; Kundu, Francis; Kruk, Margaret E

2017-01-01

Quality of healthcare is an important determinant of future progress in global health. However, the distributional aspects of quality of care have received inadequate attention. We assessed whether high quality maternal care is equitably distributed by (1) mapping the quality of maternal care in facilities located in poorer versus wealthier areas of Kenya; and (2) comparing the quality of maternal care available to Kenyans in and not in poverty. We assessed three measures of maternal care quality: facility infrastructure and clinical quality of antenatal care and delivery care, using indicators from the 2010 Kenya Service Provision Assessment (SPA), a standardized facility survey with direct observation of maternal care provision. We calculated poverty of the area served by antenatal or delivery care facilities using the Multidimensional Poverty Index. We used regression analyses and non-parametric tests to assess differences in maternal care quality in facilities located in more and less impoverished areas. We estimated effective coverage with a minimum standard of care for the full population and those in poverty. A total of 564 facilities offering at least one maternal care service were included in this analysis. Quality of maternal care was low, particularly clinical quality of antenatal and delivery care, which averaged 0.52 and 0.58 out of 1 respectively, compared to 0.68 for structural inputs to care. Maternal healthcare quality varied by poverty level: at the facility level, all quality metrics were lowest for the most impoverished areas and increased significantly with greater wealth. Population access to a minimum standard (≥0.75 of 1.00) of quality maternal care was both low and inequitable: only 17% of all women and 8% of impoverished women had access to minimally adequate delivery care. The quality of maternal care is low in Kenya, and care available to the impoverished is significantly worse than that for the better off. To achieve the national targets of maternal and neonatal mortality reduction, policy initiatives need to tackle low quality of care, starting with high-poverty areas.

Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya

PubMed Central

Sharma, Jigyasa; Leslie, Hannah H.; Kundu, Francis; Kruk, Margaret E.

2017-01-01

Background Quality of healthcare is an important determinant of future progress in global health. However, the distributional aspects of quality of care have received inadequate attention. We assessed whether high quality maternal care is equitably distributed by (1) mapping the quality of maternal care in facilities located in poorer versus wealthier areas of Kenya; and (2) comparing the quality of maternal care available to Kenyans in and not in poverty. Methods We assessed three measures of maternal care quality: facility infrastructure and clinical quality of antenatal care and delivery care, using indicators from the 2010 Kenya Service Provision Assessment (SPA), a standardized facility survey with direct observation of maternal care provision. We calculated poverty of the area served by antenatal or delivery care facilities using the Multidimensional Poverty Index. We used regression analyses and non-parametric tests to assess differences in maternal care quality in facilities located in more and less impoverished areas. We estimated effective coverage with a minimum standard of care for the full population and those in poverty. Results A total of 564 facilities offering at least one maternal care service were included in this analysis. Quality of maternal care was low, particularly clinical quality of antenatal and delivery care, which averaged 0.52 and 0.58 out of 1 respectively, compared to 0.68 for structural inputs to care. Maternal healthcare quality varied by poverty level: at the facility level, all quality metrics were lowest for the most impoverished areas and increased significantly with greater wealth. Population access to a minimum standard (≥0.75 of 1.00) of quality maternal care was both low and inequitable: only 17% of all women and 8% of impoverished women had access to minimally adequate delivery care. Conclusion The quality of maternal care is low in Kenya, and care available to the impoverished is significantly worse than that for the better off. To achieve the national targets of maternal and neonatal mortality reduction, policy initiatives need to tackle low quality of care, starting with high-poverty areas. PMID:28141840

Considerations in establishing a post-mortem brain and tissue bank for the study of myalgic encephalomyelitis/chronic fatigue syndrome: a proposed protocol

PubMed Central

2014-01-01

Background Our aim, having previously investigated through a qualitative study involving extensive discussions with experts and patients the issues involved in establishing and maintaining a disease specific brain and tissue bank for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), was to develop a protocol for a UK ME/CFS repository of high quality human tissue from well characterised subjects with ME/CFS and controls suitable for a broad range of research applications. This would involve a specific donor program coupled with rapid tissue collection and processing, supplemented by comprehensive prospectively collected clinical, laboratory and self-assessment data from cases and controls. Findings We reviewed the operations of existing tissue banks from published literature and from their internal protocols and standard operating procedures (SOPs). On this basis, we developed the protocol presented here, which was designed to meet high technical and ethical standards and legal requirements and was based on recommendations of the MRC UK Brain Banks Network. The facility would be most efficient and cost-effective if incorporated into an existing tissue bank. Tissue collection would be rapid and follow robust protocols to ensure preservation sufficient for a wide range of research uses. A central tissue bank would have resources both for wide-scale donor recruitment and rapid response to donor death for prompt harvesting and processing of tissue. Conclusion An ME/CFS brain and tissue bank could be established using this protocol. Success would depend on careful consideration of logistic, technical, legal and ethical issues, continuous consultation with patients and the donor population, and a sustainable model of funding ideally involving research councils, health services, and patient charities. This initiative could revolutionise the understanding of this still poorly-understood disease and enhance development of diagnostic biomarkers and treatments. PMID:24938650

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey

PubMed Central

Oseni, Lolade; Mtimuni, Angella; Sethi, Reena; Rashidi, Tambudzai; Kachale, Fannie; Rawlins, Barbara; Gupta, Shivam

2017-01-01

This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi’s Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and staffed facilities in addition to ensuring the presence of skilled health workers. PMID:28301484

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

PubMed

Kozuki, Naoko; Oseni, Lolade; Mtimuni, Angella; Sethi, Reena; Rashidi, Tambudzai; Kachale, Fannie; Rawlins, Barbara; Gupta, Shivam

2017-01-01

This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and staffed facilities in addition to ensuring the presence of skilled health workers.

Quality: performance improvement, teamwork, information technology and protocols.

PubMed

Coleman, Nana E; Pon, Steven

2013-04-01

Using the Institute of Medicine framework that outlines the domains of quality, this article considers four key aspects of health care delivery which have the potential to significantly affect the quality of health care within the pediatric intensive care unit. The discussion covers: performance improvement and how existing methods for reporting, review, and analysis of medical error relate to patient care; team composition and workflow; and the impact of information technologies on clinical practice. Also considered is how protocol-driven and standardized practice affects both patients and the fiscal interests of the health care system.

Fast casual multicast

NASA Technical Reports Server (NTRS)

Birman, Kenneth; Schiper, Andre; Stephenson, Pat

1990-01-01

A new protocol is presented that efficiently implements a reliable, causally ordered multicast primitive and is easily extended into a totally ordered one. Intended for use in the ISIS toolkit, it offers a way to bypass the most costly aspects of ISIS while benefiting from virtual synchrony. The facility scales with bounded overhead. Measured speedups of more than an order of magnitude were obtained when the protocol was implemented within ISIS. One conclusion is that systems such as ISIS can achieve performance competitive with the best existing multicast facilities--a finding contradicting the widespread concern that fault-tolerance may be unacceptably costly.

The impact of protocol on nurses' role stress: a longitudinal perspective.

PubMed

Dodd-McCue, Diane; Tartaglia, Alexander; Veazey, Kenneth W; Streetman, Pamela S

2005-04-01

The study examined the impact of a protocol directed at increasing organ donation on the role stress and work attitudes of critical care nurses involved in potential organ donation cases. The research examined whether the protocol could positively affect nurses' perceptions of role stress, and if so, could the work environment improvements be sustained over time. The Family Communication Coordinator (FCC) protocol promotes effective communication during potential organ donation cases using a multidisciplinary team approach. Previous research found it associated with improved donation outcomes and with improved perceptions of role stress by critical care nurses. However, the previous study lacked methodological rigor necessary to determine causality and sustainability over time. The study used a quasi-experimental prospective longitudinal design. The sample included critical care nurses who had experience with potential organ donation cases with the protocol. Survey data were collected at 4 points over 2 years. Surveys used previously validated and reliable measures of role stress (role ambiguity, role conflict, role overload) and work attitudes (commitment, satisfaction). Interviews supplemented these data. The nurses' perceptions of role stress associated with potential organ donation cases dramatically dropped after the protocol was implemented. All measures of role stress, particularly role ambiguity and role conflict, showed statistically significant and sustained improvement. Nurses' professional, unit, and hospital commitment and satisfaction reflect an increasingly positive workplace. The results demonstrate that the FCC protocol positively influenced the workplace through its impact on role stress over the first 2 years following its implementation. The findings suggest that similar protocols may be appropriate in improving the critical care environment by reducing the stress and uncertainty of professionals involved in other end-of-life situations. However, the most striking implication relates to the reality of the workplace: meeting the goals of improved patient care outcomes and those of improving the healthcare work environment are not mutually exclusive and may be mutually essential.

Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability

PubMed Central

Adair-Rohani, Heather; Zukor, Karen; Bonjour, Sophie; Wilburn, Susan; Kuesel, Annette C; Hebert, Ryan; Fletcher, Elaine R

2013-01-01

ABSTRACT Background: Access to electricity is critical to health care delivery and to the overarching goal of universal health coverage. Data on electricity access in health care facilities are rarely collected and have never been reported systematically in a multi-country study. We conducted a systematic review of available national data on electricity access in health care facilities in sub-Saharan Africa. Methods: We identified publicly-available data from nationally representative facility surveys through a systematic review of articles in PubMed, as well as through websites of development agencies, ministries of health, and national statistics bureaus. To be included in our analysis, data sets had to be collected in or after 2000, be nationally representative of a sub-Saharan African country, cover both public and private health facilities, and include a clear definition of electricity access. Results: We identified 13 health facility surveys from 11 sub-Saharan African countries that met our inclusion criteria. On average, 26% of health facilities in the surveyed countries reported no access to electricity. Only 28% of health care facilities, on average, had reliable electricity among the 8 countries reporting data. Among 9 countries, an average of 7% of facilities relied solely on a generator. Electricity access in health care facilities increased by 1.5% annually in Kenya between 2004 and 2010, and by 4% annually in Rwanda between 2001 and 2007. Conclusions: Energy access for health care facilities in sub-Saharan African countries varies considerably. An urgent need exists to improve the geographic coverage, quality, and frequency of data collection on energy access in health care facilities. Standardized tools should be used to collect data on all sources of power and supply reliability. The United Nations Secretary-General's “Sustainable Energy for All” initiative provides an opportunity to comprehensively monitor energy access in health care facilities. Such evidence about electricity needs and gaps would optimize use of limited resources, which can help to strengthen health systems. PMID:25276537

Respiratory Therapist Job Perceptions: The Impact of Protocol Use.

PubMed

Metcalf, Ashley Y; Stoller, James K; Habermann, Marco; Fry, Timothy D

2015-11-01

Demand for respiratory care services and staffing levels of respiratory therapists (RTs) is expected to increase over the next several years. Hence, RT job satisfaction will be a critical factor in determining recruitment and retention of RTs. Determinants of RT job satisfaction measures have received little attention in the literature. This study examines the use of respiratory care protocols and associated levels of RT job satisfaction, turnover intentions, and job stress. Four-hundred eighty-one RTs at 44 hospitals responded to an online survey regarding job satisfaction, turnover intentions, and job stress. Random coefficient modeling was used for analysis and to account for the nested structure of the data. Higher levels of RT protocol use were associated with higher levels of job satisfaction, lower rates of turnover intentions, and lower levels of job stress. In addition, RTs with greater experience had higher levels of job satisfaction, and RTs working at teaching hospitals had lower rates of turnover intentions. The study extends prior research by examining how the use of respiratory care protocols favorably affects RTs' perceptions of job satisfaction, turnover intention, and job stress. In a time of increasing demand for respiratory care services, protocols may enhance retention of RTs. Copyright © 2015 by Daedalus Enterprises.

76 FR 9503 - Medicare and Medicaid Programs; Requirements for Long-Term Care (LTC) Facilities; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-18

... nursing facility (SNF) in the Medicare program, or a nursing facility (NF) in the Medicaid program. These..., as of April 2010, there are 15,713 long-term care (LTC) facilities (commonly referred to as nursing homes) in the U.S. LTC facilities are also referred to as skilled nursing facilities (SNFs) in the...

Abdominal trauma in infants and children: prompt identification and early management of serious and life-threatening injuries. Part II: Specific injuries and ED management.

PubMed

Rothrock, S G; Green, S M; Morgan, R

2000-06-01

Evaluation of children with suspected abdominal trauma could be a difficult task. Unique anatomic and physiologic features render vital sign assessment and the physical examination less useful than in the adult population. Awareness of injury patterns and associations will improve the early diagnosis of abdominal trauma. Clinicians must have a complete understanding of common and atypical presentations of children with significant abdominal injuries. Knowledge of the utility and limitations of available laboratory and radiologic adjuncts will assist in accurately identifying abdominal injury. While other obvious injuries (eg, facial, cranial, and extremity trauma) can distract physicians from less obvious abdominal trauma, an algorithmic approach to evaluating and managing children with multisystem trauma will improve overall care and help to identify and treat abdominal injuries in a timely fashion. Finally, physicians must be aware of the capabilities of their own facility to handle pediatric trauma. Protocols must be in place for expediting the transfer of children who require a higher level of care. Knowledge of each of these areas will help to improve the overall care and outcome of children with abdominal trauma.

[Evaluation auditing of the quality of health care in accreditation of health facilities].

PubMed

Paim, Chennyfer da Rosa Paino; Zucchi, Paola

2011-01-01

This article shows how many health insurance companies operating in the Greater São Paulo have been performing auditing of the quality of their health care services, professionals, and which criteria are being employed to do so. Because of the legislation decreeing that health insurance companies have legal co-responsibility for the health care services and National Health Agency control the health services National Health Agency, auditing evaluations have been implemented since then. The survey was based on electronic forms e-mailed to all health insurance companies operating in the Greater São Paulo. The sample consisted of 125 health insurance companies; 29 confirmed that had monitoring and evaluation processes; 26 performed auditing of their services regularly; from those, 20 used some type of form or protocol for technical visits; all evaluation physical and administrative structure and 22 included functional structure. Regarding the professionals audited 21 were nurses, 13 administrative assistants; 04 managers and 02 doctors. Regarding criteria for accreditation the following were highlighted: region analysis (96%), localization (88.88%) and cost (36%). We conclude that this type of auditing evaluation is rather innovative and is being gradually implemented by the health insurance companies, but is not a systematic process.

Limited Service Availability, Readiness, and Use of Facility-Based Delivery Care in Haiti: A Study Linking Health Facility Data and Population Data

PubMed Central

Wang, Wenjuan; Winner, Michelle; Burgert-Brucker, Clara R

2017-01-01

Background: Understanding the barriers that women in Haiti face to giving birth at a health facility is important for improving coverage of facility delivery and reducing persistently high maternal mortality. We linked health facility survey data and population survey data to assess the role of the obstetric service environment in affecting women's use of facility delivery care. Methods: Data came from the 2012 Haiti Demographic and Health Survey (DHS) and the 2013 Haiti Service Provision Assessment (SPA) survey. DHS clusters and SPA facilities were linked with their geographic coordinate information. The final analysis sample from the DHS comprised 4,921 women who had a live birth in the 5 years preceding the survey. Service availability was measured with the number of facilities providing delivery services within a specified distance from the cluster (within 5 kilometers for urban areas and 10 kilometers for rural areas). We measured facility readiness to provide obstetric care using 37 indicators defined by the World Health Organization. Random-intercept logistic regressions were used to model the variation in individual use of facility-based delivery care and cluster-level service availability and readiness, adjusting for other factors. Results: Overall, 39% of women delivered their most recent birth at a health facility and 61% delivered at home, with disparities by residence (about 60% delivered at a health facility in urban areas vs. 24% in rural areas). About one-fifth (18%) of women in rural areas and one-tenth (12%) of women in nonmetropolitan urban areas lived in clusters where no facility offered delivery care within the specified distances, while nearly all women (99%) in the metropolitan area lived in clusters that had at least 2 such facilities. Urban clusters had better service readiness compared with rural clusters, with a wide range of variation in both areas. Regression models indicated that in both rural and nonmetropolitan urban areas availability of delivery services was significantly associated with women's greater likelihood of using facility-based delivery care after controlling for other covariates, while facilities' readiness to provide delivery services was also important in nonmetropolitan urban areas. Conclusion: Increasing physical access to delivery care should become a high priority in rural Haiti. In urban areas, where delivery services are more available than in rural areas, improving quality of care at facilities could potentially lead to increased coverage of facility delivery. PMID:28539502

Together but apart: Caring for a spouse with dementia resident in a care facility.

PubMed

Hemingway, Dawn; MacCourt, Penny; Pierce, Joanna; Strudsholm, Tina

2016-07-01

This longitudinal, exploratory study was designed to better understand the lived experience of spousal caregivers age 60 and older providing care to partners with Alzheimer's disease and related dementias resident in a care facility. Twenty eight spousal caregivers were interviewed up to three times over a period of 2 years, and long-term care facility staff from four locations across British Columbia (BC), Canada participated in four focus groups. Thematic analysis of interview and focus group transcripts revealed a central, unifying theme 'together but apart'. The results identify key targets for policy makers and service providers to support positive health and well-being outcomes for spousal caregivers providing care to their partners diagnosed with Alzheimer's disease and related dementia and living in care facilities. © The Author(s) 2014.

[Reality of Inter-Professional Cooperation in Medical Day Care Facilities - What is Visible from the Level of Inter-Professional Cooperation].

PubMed

Ugai, Chizuru; Hata, Kiyomi

2015-12-01

In order to improve the quality of life of patients with moderate to severe symptoms who are highly dependent on medical care and to reduce the physical and psychological burden on family members, at medical day care facilities, care and services, such as functional training, is provided to improve daily life for patients in need of significant care who have intractable diseases under the Long-Term Care Insurance Act; home care patients, such as those in the final stages of cancer; and severely mentally and physically handicapped children under the Child Welfare Act. This study conducted semi-structured interviews with 15 nurses working in medical day care facilities with the objective of clarifying the reality of inter-professional cooperation of nurses working in these facilities and contributing to delivery of high-quality care. The results of the study revealed that the level of inter-professional cooperation of nurses at medical day care facilities was high and that professions that are involved in cooperation include visiting nurses, doctors, medical staff, such as physical therapists, caregivers, and welfare professions, such as care managers. The study also showed that the contents of cooperation include information exchange, information sharing, continuation of care, implementation of care that respects the intentions of the patient, care proposals, and guidance and control regarding care.

Indicators of Dysphagia in Aged Care Facilities

ERIC Educational Resources Information Center

Pu, Dai; Murry, Thomas; Wong, May C. M.; Yiu, Edwin M. L.; Chan, Karen M. K.

2017-01-01

Purpose: The current cross-sectional study aimed to investigate risk factors for dysphagia in elderly individuals in aged care facilities. Method: A total of 878 individuals from 42 aged care facilities were recruited for this study. The dependent outcome was speech therapist-determined swallowing function. Independent factors were Eating…

42 CFR 476.76 - Cooperation with health care facilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Cooperation with health care facilities. 476.76 Section 476.76 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... § 476.76 Cooperation with health care facilities. Before implementation of review, a QIO must make a...

Tribal Child Care Facilities: A Guide to Construction and Renovation.

ERIC Educational Resources Information Center

National Child Care Information Center, Vienna, VA.

This document provides technical assistance in addressing major areas of the child care facility construction and renovation process, including conducting a child care community needs assessment, identifying a site, financing costs, developing a business plan, conducting an environmental assessment, building and designing a facility, and hiring…

Special Education: Financing Health and Educational Services for Handicapped Children.

DTIC Science & Technology

1986-07-01

ABBREVIATIONS GAO General Accounting Office HCFA Health Care Financing Administration HHS Department of Health and Human Services lN ICF/MR intermediate care facility for...individuals discharged from a skilled nursing facility or intermediate care facility to the extent that the services are available through a local education

Non-health care facility anticonvulsant medication errors in the United States.

PubMed

DeDonato, Emily A; Spiller, Henry A; Casavant, Marcel J; Chounthirath, Thitphalak; Hodges, Nichole L; Smith, Gary A

2018-06-01

This study provides an epidemiological description of non-health care facility medication errors involving anticonvulsant drugs. A retrospective analysis of National Poison Data System data was conducted on non-health care facility medication errors involving anticonvulsant drugs reported to US Poison Control Centers from 2000 through 2012. During the study period, 108,446 non-health care facility medication errors involving anticonvulsant pharmaceuticals were reported to US Poison Control Centers, averaging 8342 exposures annually. The annual frequency and rate of errors increased significantly over the study period, by 96.6 and 76.7%, respectively. The rate of exposures resulting in health care facility use increased by 83.3% and the rate of exposures resulting in serious medical outcomes increased by 62.3%. In 2012, newer anticonvulsants, including felbamate, gabapentin, lamotrigine, levetiracetam, other anticonvulsants (excluding barbiturates), other types of gamma aminobutyric acid, oxcarbazepine, topiramate, and zonisamide, accounted for 67.1% of all exposures. The rate of non-health care facility anticonvulsant medication errors reported to Poison Control Centers increased during 2000-2012, resulting in more frequent health care facility use and serious medical outcomes. Newer anticonvulsants, although often considered safer and more easily tolerated, were responsible for much of this trend and should still be administered with caution.

Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

PubMed Central

Manulik, Stanisław; Rosińczuk, Joanna; Karniej, Piotr

2016-01-01

Introduction Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services. Objectives The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services. Materials and methods The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected. Results All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel. Conclusion Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility. PMID:27536075

Is There Extra Cost of Institutional Care for MS Patients?

PubMed Central

Noyes, Katia; Bajorska, Alina; Weinstock-Guttman, Bianca

2013-01-01

Throughout life, patients with multiple sclerosis (MS) require increasing levels of support, rehabilitative services, and eventual skilled nursing facility (SNF) care. There are concerns that access to SNF care for MS patients is limited because of perceived higher costs of their care. This study compares costs of caring for an MS patient versus those of a typical SNF patient. We merged SNF cost report data with the 2001–2006 Nursing Home Minimum Data Set (MDS) to calculate percentage of MS residents-days and facility case-mix indices (CMIs). We estimated the average facility daily cost using hybrid cost functions, adjusted for facility ownership, average facility wages, CMI-adjusted number of SNF days, and percentage of MS residents-days. We describe specific characteristics of SNF with high and low MS volumes and examine any sources of variation in cost. MS patients were no longer more costly than typical SNF patients. A greater proportion of MS patients had no significant effect on facility daily costs (P = 0.26). MS patients were more likely to receive care in government-owned facilities (OR = 1.904) located in the Western (OR = 2.133) and Midwestern (OR = 1.3) parts of the USA (P < 0.05). Cost of SNF care is not a likely explanation for the perceived access barriers that MS patients face. PMID:24163769

Quality of uncomplicated malaria case management in Ghana among insured and uninsured patients.

PubMed

Fenny, Ama P; Hansen, Kristian S; Enemark, Ulrika; Asante, Felix A

2014-07-24

The National Health Insurance Act, 2003 (Act 650) established the National Health Insurance Scheme (NHIS) in Ghana with the aim of increasing access to health care and improving the quality of basic health care services for all citizens. The main objective is to assess the effect of health insurance on the quality of case management for patients with uncomplicated malaria, ascertaining any significant differences in treatment between insured and non-insured patients. A structured questionnaire was used to collect data from 523 respondents diagnosed with malaria and prescribed malaria drugs from public and private health facilities in 3 districts across Ghana's three ecological zones. Collected information included initial examinations performed on patients (temperature, weight, age, blood pressure and pulse); observations of malaria symptoms by trained staff, laboratory tests conducted and type of drugs prescribed. Insurance status of patients, age, gender, education level and occupation were asked in the interviews. Of the 523 patients interviewed, only 40 (8%) were uninsured. Routine recording of the patients' age, weight, and temperature was high in all the facilities. In general, assessments needed to identify suspected malaria were low in all the facilities with hot body/fever and headache ranking the highest and convulsion ranking the lowest. Parasitological assessments in all the facilities were also very low. All patients interviewed were prescribed ACTs which is in adherence to the drug of choice for malaria treatment in Ghana. However, there were no significant differences in the quality of malaria treatment given to the uninsured and insured patients. Adherence to the standard protocol of malaria treatment is low. This is especially the case for parasitological confirmation of all suspected malaria patients before treatment with an antimalarial as currently recommended for the effective management of malaria in the country. The results show that about 16 percent of total sample were parasitologically tested. Effective management of the disease demands proper diagnosis and treatment and therefore facilities need to be adequately supplied with RDTs or be equipped with well functioning laboratories to provide adequate testing.

Quality of uncomplicated malaria case management in Ghana among insured and uninsured patients

PubMed Central

2014-01-01

Introduction The National Health Insurance Act, 2003 (Act 650) established the National Health Insurance Scheme (NHIS) in Ghana with the aim of increasing access to health care and improving the quality of basic health care services for all citizens. The main objective is to assess the effect of health insurance on the quality of case management for patients with uncomplicated malaria, ascertaining any significant differences in treatment between insured and non-insured patients. Method A structured questionnaire was used to collect data from 523 respondents diagnosed with malaria and prescribed malaria drugs from public and private health facilities in 3 districts across Ghana’s three ecological zones. Collected information included initial examinations performed on patients (temperature, weight, age, blood pressure and pulse); observations of malaria symptoms by trained staff, laboratory tests conducted and type of drugs prescribed. Insurance status of patients, age, gender, education level and occupation were asked in the interviews. Results Of the 523 patients interviewed, only 40 (8%) were uninsured. Routine recording of the patients’ age, weight, and temperature was high in all the facilities. In general, assessments needed to identify suspected malaria were low in all the facilities with hot body/fever and headache ranking the highest and convulsion ranking the lowest. Parasitological assessments in all the facilities were also very low. All patients interviewed were prescribed ACTs which is in adherence to the drug of choice for malaria treatment in Ghana. However, there were no significant differences in the quality of malaria treatment given to the uninsured and insured patients. Conclusion Adherence to the standard protocol of malaria treatment is low. This is especially the case for parasitological confirmation of all suspected malaria patients before treatment with an antimalarial as currently recommended for the effective management of malaria in the country. The results show that about 16 percent of total sample were parasitologically tested. Effective management of the disease demands proper diagnosis and treatment and therefore facilities need to be adequately supplied with RDTs or be equipped with well functioning laboratories to provide adequate testing. PMID:25056139

SOLVENT-FREE FACILE SYNTHESIS OF NOVEL α-TOSYLOXY β-KETO SULFONES USING [HYDROXY(TOSYLOXY)IODO]BENZENE

EPA Science Inventory

A facile, general and high yielding protocol for the synthesis of novel α-tosyloxy β-keto sulfones is described utilizing relatively non-toxic, [hydroxy(tosyloxy)iodo]benzene, under solvent-free conditions at room temperature.

Job role quality and intention to leave current facility and to leave profession of direct care workers in Japanese residential facilities for elderly.

PubMed

Nakanishi, Miharu; Imai, Hisato

2012-01-01

The aim of the present study is to examine job role quality relating to intention to leave current facility and to leave profession among direct care workers in residential facilities for elderly in Japan. Direct care workers completed a paper questionnaire on October 2009. From 746 facilities in three prefectures (Tokyo, Shizuoka, and Yamagata) 6428 direct care workers with complete data were included in the analyses. The Job Role Quality (JRQ) scale was translated into Japanese language to assess job role quality. Hierarchical multiple regression analysis showed that intention to leave current facility was primarily associated with job role quality: poor skill discretion, high job demand, and poor relationship with supervisor. Intention to leave profession was primarily associated with poor skill discretion. The results of the present study imply the strategies to direct care worker retention for each facility and policy efforts. Each facility can implement specific strategies such as enhanced variety of work and opportunity for use of skills, adequate job allocation, and improvement of supervisor-employee relationship in work place. Policy efforts should enhance broader career opportunities in care working such as advanced specialization and authorized medical practice. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Dentists' perceptions of providing care in long-term care facilities.

PubMed

Chowdhry, Nita; Aleksejūnienė, Jolanta; Wyatt, Chris; Bryant, Ross

2011-01-01

To compare the perceptions of dentists in British Columbia regarding their decisions to provide treatment in long-term care facilities and to explore changes since 1985 in Vancouver dentists' attitudes to treating elderly patients in such facilities. Dentists were randomly selected from all of British Columbia in 2008 and surveyed with a similar questionnaire to that used for a 1985 study of Vancouver dentists. The attitudes of current dentists, the patterns of their perceptions and trends over time were analyzed. Of the 800 BC dentists approached for the survey in 2008, 251 replied (31% response rate). Only 37 (15%) of these respondents were providing treatment in long-term care facilities, and another 48 (19%) had stopped providing services in this setting. Among those providing care, important considerations were continuing education in geriatrics, the presence of a dental team and fee-for-service payment. The most common reasons for deciding to provide services in long-term care facilities were to increase the number of patients being served and to broaden clinical practice. Dentists who had stopped treating patients in long-term care facilities reported their perception that treating elderly people is financially unrewarding and professionally unsatisfying. The perceptions of dentists shifted substantially from 1985 to 2008. In particular, dentists responding to the 2008 survey who had never provided services in long-term care facilities were more likely to perceive administrative difficulties and a lack of financial reward as barriers than those surveyed in 1985. In addition, the proportion of Vancouver dentists with advanced education in geriatrics declined over the period between the 2 studies (75 [22%] of 334 in 1985, 10 [11%] of 87 in 2008). Dentists who did not provide care for residents of long-term care facilities in 2008 seemed more likely to be deterred by administrative difficulties and financial costs than those not providing such care in 1985. In addition, fewer dentists had appropriate training in geriatrics. Continuing education, working with a dental team and payment on a fee-for-service basis were important factors for dentists who were providing care in such facilities.

Leveraging the trusted clinician: documenting disease management program enrollment.

PubMed

Frazee, Sharon Glave; Kirkpatrick, Patricia; Fabius, Raymond; Chimera, Joseph

2007-02-01

The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard TDM with a worksite-based primary care and pharmacy delivery protocol led by trusted clinicians. This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols, and compares them on contact and enrollment efficiency. The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Integrating a worksite-based primary care and pharmacy delivery system led by trusted clinicians with traditional TDM increases contact and enrollment rates, resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment in disease management programming.

Effectiveness of professional oral health care intervention on the oral health of residents with dementia in residential aged care facilities: a systematic review protocol.

PubMed

Yi Mohammadi, Joanna Jin; Franks, Kay; Hines, Sonia

2015-10-01

The objective of this review is to critically appraise and synthesize evidence on the effectiveness of professional oral health care intervention on the oral health of aged care residents with dementia.More specifically the objectives are to identify the efficacy of professional oral health care interventions on general oral health, the presence of plaque and the number of decayed or missing teeth. Dementia poses a significant challenge for health and social policy in Australia. The quality of life of individuals, their families and friends is impacted by dementia. Older people with dementia often have other health comorbidities resulting in the need for a higher level of care. From 2009 to 2010, 53% of permanent residents in Residential Aged Care Facilities (RACFs) had dementia on admission. Older Australians are retaining more of their natural teeth, therefore residents entering RACFs will have more of their natural teeth and require complex dental work than they did in previous generations. Data from the Australian Institute of Health and Welfare showed that more than half the residents in RACFs are now partially dentate with an average of 12 teeth each. Furthermore, coronal and root caries are significant problems, especially in older Australians who are cognitively impaired.Residents in aged care facilities frequently have poor oral health and hygiene with moderate to high levels of oral disease and overall dental neglect. This is reinforced by aged care staff who acknowledge that the demands of feeding, toileting and behavioral issues amongst residents often take precedence over oral health care regimens. Current literature shows that there is a general reluctance on the part of aged care staff to prioritize oral care due to limited knowledge as well as existing psychological barriers to working on another person's mouth. Although staff routinely deal with residents' urinary and faecal incontinence, deep psychological barriers exist when working on someone's mouth due to their own personal values of oral health or their views that residents should be looking after their own teeth or dentures. Furthermore, residents with behavioral issues associated with dementia frequently have their oral hygiene neglected as they may be resistant and violent towards receiving oral care from aged care staff. Studies have shown that residents with dementia will often refuse to open their mouth or partake in oral hygiene care by aged care staff. The aged care staff in return often do not pursue an oral care regimen for these "difficult" residents, perpetuating the cycle of oral neglect and resultant disease.Dental hygienists are qualified oral health professionals who are specifically trained to develop individualized oral health care plans and preventative programs to reduce oral health disease in the community. Residents with dementia in aged care facilities have the right to live their lives comfortably and free of oral discomfort or pain. A Victorian study conducted by Hopcraft et al. investigated the ability of a dental hygienist to undertake a dental examination/screening for residents in aged care facilities, to develop a preventative and periodontal treatment plan and to refer patients appropriately to a dentist. Results from this study demonstrated that there was an excellent agreement between the dentist and dental hygienist regarding the decision to refer residents to a dentist for treatment, demonstrating high sensitivity (99.6%) and high specificity (82.9%). Residents from 31 Victorian RACFs (n=510) were examined by a single experienced dental epidemiologist and one of four dental hygienists using a simple mouth mirror and probe. Hopcraft et al. concluded that hygienists should be utilized more widely in providing holistic oral health care to residents in aged care facilities.Recently, Lewis et al. discussed the need to develop models of care to improve access to dental care for frail and functionally dependent elderly people in aged care facilities, with the model of care involving dental hygienists/oral health therapists having merit.The concept of professional oral care involves an oral health professional such as a dental hygienist or oral health therapist supervising or assisting residents with their oral care. Oral care involves the mechanical removal of plaque and food debris using a toothbrush, interproximal brush and floss.In 2014, Morino et al. explored the efficacy of short term professional oral care from dental hygienists once a week after breakfast for one month. In this study, the dental hygienists did not perform dental scaling but brushed subjects' teeth using a toothbrush and interdental brush. Dental plaque scores decreased significantly (Fisher's two-tailed tests, p<0.05) in the professional oral health intervention group. Interestingly, the positive effects of this short term intervention were sustained for the following three months (Wilcoxon test, p<0.05).A pilot study in Arkansas was conducted by Amerine et al. and utilized the dental hygienist as the "oral health champion" in the residential aged care facility using the Oral Health Assessment Tool (OHAT) and Geriatric Oral Health Assessment Index (GOHAI) scores to measure oral health. The results from this study showed improvements in three measured areas (tongue health, denture status and oral cleanliness) in the dental hygiene champion group. These findings suggest that the presence of a dental hygiene champion in long term care facilities may positively impact the oral health of residents requiring assistance with their oral care. However, the authors noted further research in this concept is required.Van Der Putten GJ et al. explored the effectiveness of a supervised implementation of an oral health care guideline in care homes. In each ward of the care homes, a nurse who acted as the ward oral health care organiser (WOO) was appointed. The dental hygienist and an investigator would attend the RACFs every six weeks to support them. The dental hygienist would train the WOO, and the WOO would train the ward nurses and nurse assistants. Participants were allocated into an intervention or a control group. The intervention group received supervised oral care. Statistically significant differences in mean dental and denture plaque scores at six months in both groups occurred (student t-test, p < 0.0001). This research study implemented an intervention using the train-the-trainer approach and although improvements in dental and denture plaque scores were seen in the six-month period, the long-term effects of this intervention are unknown. Further studies exploring the long-term effects of staff training on oral health education are needed as well as ongoing staff training in aged care facilities.A systematic review on oral health and aspiration pneumonia conducted by Vander Maarel-Wierink et al. has suggested that, in the frail elderly, the best intervention to reduce the incidence of aspiration pneumonia is brushing of teeth after each meal, cleaning dentures once a day, and receiving professional oral health care once a week.The need to advocate for a new model of geriatric dentistry is critical. A holistic multi-disciplinary approach to health care for residents entering aged care homes is imperative to achieve better oral health and comfort for residents, especially with Australia's ageing dentate population. A dental examination and assessment on admission to a RACF should be conducted by a Registered Nurse (RN), followed by an oral health professional such as a dentist, dental hygienist or oral health therapist. Current practice in the majority of Australian government funded nursing homes is that the RN or the Assistant in Nursing (AIN) conduct the oral health assessment as part of the aged care funding instrument (ACFI). Ongoing oral health care supported by an oral health professional is important throughout the individual's residency and eventual palliation whilst in an aged care facility.No systematic reviews conducted on the impact of professional oral care on the oral health of elderly people living in residential aged care facilities could be located, despite extensive searching of Medline, CINAHL, EMBASE, Web of Science, Cochrane Central Register of Trials and Dentistry & Oral Sciences Source (DOSS) databases. A JBI systematic review was conducted in 2004, titled, "Oral hygiene care for adults with dementia in residential aged care facilities"; however, this review examined the prevalence, incidence and increments of oral diseases; the use of assessment tools to evaluate oral health; preventative oral hygiene care strategies; and the provision of dental treatment and so had a different clinical focus. Twenty studies were included for analysis in the review conducted by Weening-Verbree et al, The studies in this review addressed oral health knowledge of aged care staff and mostly were conducted as an educational session delivered by dental hygienists or dentists.Overall, the current evidence available on interventions to improve oral health for residents living in aged care facilities is inadequate and should be explored further.

Residents' self-reported quality of life in long-term care facilities in Canada.

PubMed

Kehyayan, Vahe; Hirdes, John P; Tyas, Suzanne L; Stolee, Paul

2015-06-01

Quality of life (QoL) of long-term care (LTC) facility residents is an important outcome of care. This cross-sectional, descriptive study examined the self-reported QoL of LTC facility residents in Canada using the interRAI Self-Report Nursing Home Quality of Life Survey instrument. A secondary purpose was to test the instrument's psychometric properties. Psychometric testing of the instrument supported its reliability and its convergent and content validity for assessing the residents' QoL. Findings showed that residents rated positively several aspects of their life, such as having privacy during visits (76.9%) and staff's being honest with them (73.6%). Residents gave lower ratings to other aspects such as autonomy, staff-resident bonding, and personal relationships. The findings point to gaps between facility philosophies of care and their translation into a care environment where care is truly resident-directed. Moreover, the findings have potential implications for resident care planning, facility programming, social policy development, and future research.

Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana and Tanzania: an intervention study.

PubMed

Duysburgh, Els; Temmerman, Marleen; Yé, Maurice; Williams, Afua; Massawe, Siriel; Williams, John; Mpembeni, Rose; Loukanova, Svetla; Haefeli, Walter E; Blank, Antje

2016-01-01

To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care. © 2015 John Wiley & Sons Ltd.

Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project.

PubMed

Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly; Dismuke, Clara; Janjua, Rabeea; Lynch, Mary G

2017-01-01

Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year. Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans. By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review.

PubMed

Das, Ashis; Gopalan, Saji S; Chandramohan, Daniel

2016-04-14

Pay for Performance (P4P) mechanisms to health facilities and providers are currently being tested in several low- and middle-income countries (LMIC) to improve maternal and child health (MCH). This paper reviews the existing evidence on the effect of P4P program on quality of MCH care in LMICs. A systematic review of literature was conducted according to a registered protocol. MEDLINE, Web of Science, and Embase were searched using the key words maternal care, quality of care, ante natal care, emergency obstetric and neonatal care (EmONC) and child care. Of 4535 records retrieved, only eight papers met the inclusion criteria. Primary outcome of interest was quality of MCH disaggregated into structural quality, process quality and outcomes. Risk of bias across studies was assessed through a customized quality checklist. There were four controlled before after intervention studies, three cluster randomized controlled trials and one case control with post-intervention comparison of P4P programs for MCH care in Burundi, Democratic Republic of Congo, Egypt, the Philippines, and Rwanda. There is some evidence of positive effect of P4P only on process quality of MCH. The effect of P4P on delivery, EmONC, post natal care and under-five child care were not evaluated in these studies. There is weak evidence for P4P's positive effect on maternal and neonatal health outcomes and out-of-pocket expenses. P4P program had a few negative effects on structural quality. P4P is effective to improve process quality of ante natal care. However, further research is needed to understand P4P's impact on MCH and their causal pathways in LMICs. PROSPERO registration number CRD42014013077 .

Chapter 23: Combined Heat and Power Evaluation Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kurnik, Charles W.; Simons, George; Barsun, Stephan

The main focus of most evaluations is to determine the energy-savings impacts of the installed measure. This protocol defines a combined heat and power (CHP) measure as a system that sequentially generates both electrical energy and useful thermal energy from one fuel source at a host customer's facility or residence. This protocol is aimed primarily at regulators and administrators of ratepayer-funded CHP programs; however, project developers may find the protocol useful to understand how CHP projects are evaluated.

Emergency and trauma care in Pakistan: a cross-sectional study of healthcare levels

PubMed Central

Razzak, Junaid A; Baqir, Syed M; Khan, Uzma Rahim; Heller, David; Bhatti, Junaid; Hyder, Adnan A

2015-01-01

Background The importance of emergency medical care for the successful functioning of health systems has been increasingly recognised. This study aimed to evaluate emergency and trauma care facilities in four districts of the province of Sindh, Pakistan. Method We conducted a cross-sectional health facility survey in four districts of the province of Sindh in Pakistan using a modified version of WHO’s Guidelines for essential trauma care. 93 public health facilities (81 primary care facilities, nine secondary care hospitals, three tertiary hospitals) and 12 large private hospitals were surveyed. Interviews of healthcare providers and visual inspections of essential equipment and supplies as per guidelines were performed. A total of 141 physicians providing various levels of care were tested for their knowledge of basic emergency care using a validated instrument. Results Only 4 (44%) public secondary, 3 (25%) private secondary hospitals and all three tertiary care hospitals had designated emergency rooms. The majority of primary care health facilities had less than 60% of all essential equipments overall. Most of the secondary level public hospitals (78%) had less than 60% of essential equipments, and none had 80% or more. A fourth of private secondary care facilities and all tertiary care hospitals (n=3; 100%) had 80% or more essential equipments. The average percentage score on the physician knowledge test was 30%. None of the physicians scored above 60% correct responses. Conclusions The study findings demonstrated a gap in both essential equipment and provider knowledge necessary for effective emergency and trauma care. PMID:24157684

The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia.

PubMed

Ahmad Sharoni, Siti Khuzaimah; Abdul Rahman, Hejar; Minhat, Halimatus Sakdiah; Shariff-Ghazali, Sazlina; Azman Ong, Mohd Hanafi

2018-01-01

Self-care behaviour is essential in preventing diabetes foot problems. This study aimed to evaluate the effectiveness of health education programs based on the self-efficacy theory on foot self-care behaviour for older adults with diabetes. A randomised controlled trial was conducted for 12 weeks among older adults with diabetes in elderly care facility in Peninsular Malaysia. Six elderly care facility were randomly allocated by an independent person into two groups (intervention and control). The intervention group (three elderly care facility) received a health education program on foot self-care behaviour while the control group (three elderly care facility) received standard care. Participants were assessed at baseline, and at week-4 and week-12 follow-ups. The primary outcome was foot-self-care behaviour. Foot care self-efficacy (efficacy expectation), foot care outcome expectation, knowledge of foot care and quality of life were the secondary outcomes. Data were analysed with Mixed Design Analysis of Variance using the Statistical Package for the Social Sciences version 22.0. 184 respondents were recruited but only 76 met the selection criteria and were included in the analysis. Foot self-care behaviour, foot care self-efficacy (efficacy expectation), foot care outcome expectation and knowledge of foot care improved in the intervention group compared to the control group (p < 0.05). However, some of these improvements did not significantly differ compared to the control group for QoL physical symptoms and QoL psychosocial functioning (p > 0.05). The self-efficacy enhancing program improved foot self-care behaviour with respect to the delivered program. It is expected that in the future, the self-efficacy theory can be incorporated into diabetes education to enhance foot self-care behaviour for elderly with diabetes living in other institutional care facilities. Australian New Zealand Clinical Trial Registry ACTRN12616000210471.

The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia

PubMed Central

Abdul Rahman, Hejar; Minhat, Halimatus Sakdiah; Shariff-Ghazali, Sazlina; Azman Ong, Mohd Hanafi

2018-01-01

Background Self-care behaviour is essential in preventing diabetes foot problems. This study aimed to evaluate the effectiveness of health education programs based on the self-efficacy theory on foot self-care behaviour for older adults with diabetes. Methods A randomised controlled trial was conducted for 12 weeks among older adults with diabetes in elderly care facility in Peninsular Malaysia. Six elderly care facility were randomly allocated by an independent person into two groups (intervention and control). The intervention group (three elderly care facility) received a health education program on foot self-care behaviour while the control group (three elderly care facility) received standard care. Participants were assessed at baseline, and at week-4 and week-12 follow-ups. The primary outcome was foot-self-care behaviour. Foot care self-efficacy (efficacy expectation), foot care outcome expectation, knowledge of foot care and quality of life were the secondary outcomes. Data were analysed with Mixed Design Analysis of Variance using the Statistical Package for the Social Sciences version 22.0. Results 184 respondents were recruited but only 76 met the selection criteria and were included in the analysis. Foot self-care behaviour, foot care self-efficacy (efficacy expectation), foot care outcome expectation and knowledge of foot care improved in the intervention group compared to the control group (p < 0.05). However, some of these improvements did not significantly differ compared to the control group for QoL physical symptoms and QoL psychosocial functioning (p > 0.05). Conclusion The self-efficacy enhancing program improved foot self-care behaviour with respect to the delivered program. It is expected that in the future, the self-efficacy theory can be incorporated into diabetes education to enhance foot self-care behaviour for elderly with diabetes living in other institutional care facilities. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12616000210471 PMID:29534070

ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015

PubMed Central

2015-01-01

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. PMID:25836677